Last Acts: Jack Kevorkian, Physician
|
||
| Hospice care for patients at the end of life dates
back hundreds of years, but took modern form in the late
1960's in London England. America established it's first
Hospice in 1974. Five years later, in 1979, Hospice
Northeast (Florida) was rudimental. It was formed in Jacksonville
by volunteer nurses in collaboration with physicians, and
it quickly gained support from the religious,
professional, and lay communities (Hurlbut, H.J., 1996). After
twenty-five years of the Hospice movement in the United States,
it is important to determine how successful we have been
in gaining physician and public support.
Although the number of Hospice services has exceeded 3,000 since 1974 (National Hospice and Palliative Care Organization, 2000), some disturbing events have developed in the last decade. On June 4, 1990, Janet Adkins, a 54 year old Portland, Oregon woman with Alzheimer's disease, pushed the button on a "suicide machine" developed by Dr. Jack Kevorkian, causing her death. The assisted suicide took place in the back of Dr. Kevorkian's 1968 Volkswagen van, in Groveland Oaks Park, Michigan. Dr. Kevorkian was present during this act. That was the beginning of more than one hundred assisted suicides over the next eight years by Kevorkian, utilizing his death machines. Jack Kevorkian had his medical license revoked in 1991. However, the Michigan legislature and justice systems were unsuccessful in preventing Kevorkian from terminating the lives of scores of people alleged to have terminal illnesses. Kevorkian brazenly produced a videotape, aired on CBS's "60 Minutes", that showed him giving a lethal injection to Thomas Youk, 52, who was diagnosed with Lou Gehrig's disease. Kevorkian was convicted of second-degree murder and sentenced to 10-25 years in prison with eligibility for parole in six years (Public Broadcasting System, 1999). This event alone might cause us to consider this an aberration of an insane individual; however, in the middle of the Kevorkian saga, the State of Oregon, on November 8, 1994, became the first state to legalize assisted suicide, when voters passed the Death with Dignity Act. Although legal appeals kept that law from taking effect, on November 5, 1997, Oregon residents again voted to uphold the state's assisted suicide law, allowing doctors to prescribe lethal doses of drugs to terminally ill patients (Public Broadcasting System, 1999). The imprisonment of Jack Kevorkian has raised him to the role of a martyr for a just cause among some groups. Others, however, such as Catherine Tucker of Compassion in Dying in Washington State said, "(Kevorkian's) contribution is providing the example of why we need reform because we do have back alley practitioners, and Kevorkian is most prominent" (McClear, James A., 1999). Analysis of 69 assisted suicides supervised by Dr. Jack Kevorkian concluded that 75 percent of his "patients" were not terminally ill at the time he helped them die. The autopsies were unable to confirm the presence of any physical disease in 5 out of 69 cases (Reuters, 2000). Further analysis of Kevorkian's "patient's" demographics indicate the assisted suicides were often performed on unmarried people coping with serious illnesses, particularly where clinical safeguards were lacking, which underscores the vulnerability of these individuals (Roscoe, Dragovic, Cohen, 2000). Hospice care is a stark contrast to physician
assisted suicide, whether administered by Kevorkian, or
performed according to the Death with Dignity Act of Oregon.
A comparison of the two models would resemble the
following equations:
Hospice patients are assisted and cared for by an interdisciplinary team of nurses, social workers, certified aides, trained volunteers, chaplains and physicians. Treatment may take place in the patient's home, assisted living facility, residential hospice center, or on a palliative care service in the hospital. Treatment is directed not only to pain management, but also psychosocial, emotional, and spiritual concerns are considered, with appropriate support provided. Pain is assessed and differentiated into visceral, somatic, or neuropathic types and medication prescribed according to the World Health Organization analgesic ladder. Family members are included in the care plan, and are encouraged to participate in their loved one's final days. When desired by the family, bereavement care and grief counseling is offered and provided. Surveys of families receiving the benefits of hospice care in Northeast Florida have consistently shown high praise for the care and comfort received during the terminal phase of their family member's end-of-life. An example of Hospice management may be illustrated by the following case: David S., a 67-year-old male, was diagnosed with adenocarcinoma of the lung with metastasis to the bone. He had undergone radiation therapy and chemotherapy, but refused further treatment because of severe nausea and vomiting. He was referred for hospice care. During the nurse's initial assessment visit, David complained of severe pain not responding to the prescribed medications. Thorough examination revealed a cachectic male with severe muscle wasting, and a sacral decubitus ulcer. He described pain in his hips and chest wall. Further discussion revealed David to be angry and depressed about losing his job after being diagnosed with cancer. He worried about financial pressures created by his illness, and was fearful that he would lose his home, and leave his wife with no place to live. Following the assessment, the physician determined which medication and dose was needed to adequately control David's pain and still allow him to remain as functional as possible. His wife was encouraged to call hospice any time, day or night, if she had concerns about David's condition. A schedule was established for nurse visitation to make certain David was comfortable and awake, and arrangements for a social worker's visit were made to explore the family's financial needs and help them obtain available community assistance. A few days later, David was at home in a hospital bed with wound care initiated for his decubitus. His wife had been taught to reposition him regularly. The social worker advised and assisted with financial concerns while medications were provided through the hospice pharmacy. The hospice chaplain arranged for regular visits from David's pastor at his request. Over the course of several weeks, David's pain began to increase, and medications were switched or increased to maintain good pain control. David eventually became weaker, more confused, and had difficulty swallowing. He was dying. The hospice team switched David to concentrated liquid morphine. Additional medications were also administered per rectum. This regimen kept David comfortable until he died, at which time the hospice program initiated bereavement care for his wife. The Hospice movement is progressively expanding both locally and internationally. However, there is still widespread ignorance about the nature and degree of services it provides. At the International level, the Dutch Senate recently enacted a law that made the Netherlands the first country to legalize mercy killings and assisted suicides for patients suffering unbearably with no hope of relief. "I hope that other governments will find the courage to follow suit," said Health Minister Els Borst. This legislation is "part of a global trend of the general public taking control of how they live and die", said the Voluntary Euthanasia Society in Britain. Belgium and Spain are also considering such laws (Deutsch, A., 2001). These actions are a clarion call for the medical community to vigorously proclaim its ability to provide superior end of life care with comfort and dignity. Public education through publications, specialty journals, legislative action, and simply word of mouth from grateful recipients, will remove the image of Hospice as a place of lost hope. With more knowledge, the public will realize that physician assisted suicide is an inferior solution to manage pain and suffering at the end of life. References
May, 2001/ Jacksonville Medicine[dcms-footer.htm]
|