June 15, 2011

Rites

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Kevorkian saw himself as King or Mandela. I saw him as more creepy than courageous. I didn’t understand that he was intentionally provocative. In the HBO documentary Kevorkian, he says, “Someone has to go to jail for change to happen.” And he did, and change happened.

He died as he intended, quietly and without pain. Just the way he intended for all of us to die, as we choose, and with dignity. But his was not a quiet life. His New York Times obituary confirms the controversial paradigm shift he initiated in the 1990s:

“His critics were as impassioned as his supporters, but all generally agreed that his stubborn and often intemperate advocacy of assisted suicide helped spur the growth of hospice care in the United States and made many doctors more sympathetic to those in severe pain and more willing to prescribe medication to relieve it.”

It is illegal in the US for a physician to directly administer life ending drugs with our without their patients’ consent. Kevorkian administered a lethal injection and was jailed for second-degree murder. While in prison, he educated himself on the constitutional amendments. After eight years, he left prison (for good behavior and because of illness) and made a run at Congress. In 2008 he ran on the platform that the Ninth Amendment guaranteed our right to control how and when we die. His death, like his life, has provoked important debate over this right. He was fearless about death. After leaving prison he commented, “They know now I don’t fear anything.”

This energy has advanced end of life care practices and has reawakened our culture to how we die. Kevorkian’s mission is not fulfilled by the current advancement of hospice and palliative Care. These services minimize suffering, but do not completely address the issues of choice and dignity. PBS’s Frontline television program “Facing Death” explores the harsh realties and complexities of end of life care and decision-making. Modern medical intervention is capable of extending life in ways we may not understand, not be aware of, and not choose. One of the New York Mount Sinai Hospital doctors in the program likens the technology to “science fiction.”

But it’s reality. Lewis M. Cohen’s 2010 best selling, No Good Deed: A Story of Medicine, Murder Accusations, and the Debate over How We Die explores the issue from legal, medical and religious perspectives. Awareness and legislation are building around the issue of our right to choose how and when we die. The right to die vs. the sanctity of life will soon be at the forefront of national debate. Already the political, legal, religious, ethical and medical issues around dying reflect the pro-life/pro-choice controversy.

Kevorkian initiated the debate, and took it beyond the scope of cultural acceptability. Unlike King and Mandela he was more polarizing than magnetic. No single leader has come to the fore on the issue of right to die. Though there is evidence that we are moving from a culture of denial around death, to one that seeks death with dignity, choice, and control.

Like many revolutions emerging worldwide, the advancement of death rights are likely to come from a groundswell, following in the footsteps of civil rights, feminism, and gay rights. As the Baby Boomer generation ages into the “Golden Boomer” era, our exposure to the medical and legal realties of dying will become vivid. Ours is not a generation comfortable with institutional control of our life.

A revolution is in its nascence. Oregon, Washington and Montana have legalized physician-assisted suicide. This emerging reform is reflected in HBO programming: following up Kevorkian and the Barry Levinson/Al Pacino film You Don’t Know Jack, (both currently on HBO On Demand), with The Sundance grand jury prize winning documentary, How to Die in Oregon. Once again, HBO reflects the interests, passions and zeitgeist of our culture. It is a difficult but important piece to view (It runs through June 19). Oregon’s Death with Dignity Act allows for voluntary euthanasia (from the Greek “good/well death”). Physicians are now able to prescribe medication which terminally ill patients self-administer to end their life. Both mental and physical capacity is required to obtain the prescription. Control over how one dies alleviates but does not necessarily eradicate fear. The documentary takes a long, raw look at the process and the courage of those who choose to die with dignity at their own hand. In a recent interview with the Hollywood Reporter, about her new ABC Talk show Katie Couric commented on How to Die in Oregon:

“Gee, if I had a show, I would invite her [Cody Curtis’] husband and children, the documentarian and then someone who felt uncomfortable with the Oregon law, and have an intelligent conversation about something that people probably find difficult to talk about but probably need to talk about.”

Even dead, Kevorkian still frightens me. Watching his documentary has brought me closer to my own fear of dying and suffering. He has provoked me to take steps to try to ensure that my death will be as I choose. This fear is likely to move many of us to a place of activism.

“I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.”
-Nelson Mandela

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