Ends and Means: Suicide Is Not a Medical Treatment

Jacob Sullum

6/8/2011 12:01:00 AM - Jacob Sullum

Jack Kevorkian's first suicide machine, which he called the Thanatron, delivered the same three chemicals commonly used to execute condemned prisoners: the barbiturate sodium thiopental to induce sleep, pancuronium bromide to paralyze the muscles and sodium chloride to stop the heart. After his medical license was suspended in 1991, Kevorkian had trouble obtaining the drugs, so he switched to the Mercitron, a mask attached to a tank of carbon monoxide.

In both cases, death was a favor that Kevorkian, who proudly eschewed payment for his services, dispensed to people who convinced him they had good reasons for wanting to die. By contrast, the suicide kits that Sharlotte Hydorn sold from her home in El Cajon, Calif., were available to anyone with $60 and a mailing address. Unfortunately, to the extent that the government recognizes a right to suicide, it takes its cues from Kevorkian, who died last Friday at the age of 83, rather than Hydorn, a 91-year-old entrepreneur whose business was shut down by the FBI the week before.

Kevorkian, a retired Michigan pathologist, helped about 130 people suffering from terminal or debilitating and incurable diseases kill themselves between 1990 and 1998, when he crossed the line between suicide assistance and euthanasia by directly administering lethal drugs to a man with amyotrophic lateral sclerosis. Convicted of second-degree murder, Kevorkian served eight years in prison.

Yet the man whom the American Medical Association called "a reckless instrument of death" pointed the way to physician-assisted suicide, which has been legalized in three states and recognized by the U.S. Supreme Court as a legitimate medical treatment. Oregon's Death With Dignity Act, approved by voters in 1994, allows a patient to kill himself with doctor-prescribed barbiturates if two physicians certify that he has six months or less to live, he is deemed free of any "psychiatric or psychological disorder" that might impair his judgment, and he makes two requests separated by at least 15 days.

In 2006, the U.S. Supreme Court ruled that Oregon physicians who prescribe drugs for suicide cannot be prosecuted under the federal Controlled Substances Act (which requires a doctor's permission slip to purchase the drugs that are most suitable for this purpose). A 2008 ballot initiative created a similar system in Washington state, and a 2009 ruling by the Montana Supreme Court likewise allows doctors to help patients with terminal illnesses hasten their deaths.

Suicide assistance is so well established as the province of state-licensed physicians that the FBI is investigating Sharlotte Hydorn for selling "adulterated and misbranded medical devices" -- i.e., elasticized plastic bags and plastic tubing that can be attached to a helium tank (sold separately) for a painless death by asphyxiation. The FBI, which raided Hydorn's home two weeks ago and carted away her merchandise, her sewing machine and her computers, is also considering charges of mail and wire fraud.

Contrary to the common-sense understanding of fraud, the problem with Hydorn's kits, from the government's perspective, is that they work as advertised. That might be OK for a properly vetted, legally approved suicide authorized by medical professionals, but not for the do-it-yourself variety that Hydorn facilitated.

If the government allowed that sort of thing, people might start to get the idea that they have a right to control their own lives.

Hydorn, who started her business after watching her husband suffer a painful, lingering death from colon cancer, says her aim is to help people escape unbearable suffering. Her critics object that what seems unbearable one day may not look so bad the next. "You have to make sure they don't want to end their life because they are depressed," a psychiatrist recently told ABC News, "because depression is treatable."

That stance may sound cautious and compassionate, but it effectively strips people of the autonomy to decide for themselves when their lives are worth living. Suicide is not a medical procedure, and doctors have no special expertise to determine when it is the right choice.