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A Right to Die?

Should doctors be allowed to help suffering patients die? Twenty-five years ago, with his homemade suicide machine, Dr. Jack Kevorkian raised that question. It's an issue Americans still struggle with today.

A Right to Die?

Twenty-five years ago, Dr. Jack Kevorkian used a homemade suicide machine to help a 54-year-old Alzheimer's patient, Janet Adkins, end her life. Adkins was the first of many patients Kevorkian helped to die, but her case began a long debate over the ethics of assisted suicide.

Kevorkian and his machine were shocking. But in the 1990s the issue was also being raised by mainstream doctors, like Dr. Timothy Quill, of Rochester NY. He published an article about his experience prescribing life-ending medication to a long time patient. And, in 1994, Oregon voters passed a ballot initiative allowing doctors to prescribe lethal medication to terminal patients. Since then physician-assisted dying has become legal in four more states.

But for doctors and patients in the rest of the nation, it's a wrenching issue. The recent case of 29-year-old Brittany Maynard, who suffered from brain cancer, has once again brought the subject to the fore, and more than a dozen state legislatures are considering the issue.

Transcript

A RIGHT TO DIE?

March 23, 2015


TEASE:

DATE: June 6, 1990

ARCHIVAL (FRONTLINE, "THE KEVORKIAN FILE" 4-5-94):

JACK KEVORKIAN: I'm Dr. Jack Kevorkian, licensed doctor in Michigan. Do you want to go on?

JANET: No I don't want to go on.

JACK KEVORKIAN: You don't want to go on living?

JANET: I don't.

ARCHIVAL (NBC NIGHTLY NEWS, 6-6-90):

TOM BROKAW: A schoolteacher named Janet Adkins has triggered a national debate in the way she chose to die.

NARRATION: He was known as Dr. Death and for much of the 1990's the world was fascinated with Dr. Jack Kevorkian and his homemade suicide machine.

ARCHIVAL (PHIL DONAHUE SHOW, 4-26-90):

JACK KEVORKIAN: It's really the way executions are carried out by lethal injection, except this is self-execution.

ARCHIVAL (CBS, 10-24-91):

ART CAPLAN: To take someone and wire them up to a machine, to me that is very clearly an act of killing.

NARRATION: Although he created a public spectacle…

ARCHIVAL (ABC NEWS, 5-9-96):

JACK KEVORKIAN: There' no law here.

NARRATION: …Kevorkian focused attention on an important question -- one that Americans still struggle with today -- what should doctors do when suffering patients want to die?

DR. EZEKIEL EMANUEL (MEDICAL ETHICIST, UNIVERSITY OF PENNSYLVANIA): We should address what would give them purpose, not give them a handful of pills.

ARCHIVAL (CBS THIS MORNING, 10-14-14):

BRITTANY MAYNARD: I`m not ashamed to attach my name to what I think is a right that should belong to all terminally ill Americans.

ACT I:

ARCHIVAL (NBC NEWS, 6-5-90):

REPORTER: This is the suicide machine. All Janet Adkins had to do was push a button and lethal chemicals started flowing. Dr. Kevorkian said he took Mrs. Adkins to a park in a van with the machine inside.

NARRATION: The first time Kevorkian used his machine was on a 54-year-old Alzeimer's patient, Janet Adkins.

ARCHIVAL (NBC NEWS, 6-5-90):

JACK KEVORKIAN: She was conscious of what she wanted to do. She understood that she wanted to die, wanted to end her life.

GEOFFREY FIEGER (KEVORKIAN'S LAWYER): He was clever enough to develop the so-called suicide machine. The delivery mechanism was an artifice at that time to-to avoid the charge of murder.

ARCHIVAL (ABC, 20/20, 2-14-02):

BARBARA WALTERS: The patient starts the machine himself or herself?

GEOFFREY FIEGER: Yes. Through pushing the button on the side.

ARCHIVAL (ABC NEWS, 12-23-90):

PETER JENNINGS: The doctor who invented a suicide machine has been charged with first degree murder.

JACK LESSENBERRY (MICHIGAN JOURNALIST): His lawyer, Geoffrey Fieger, said to the District Judge, "Michigan has laws against murder. It's illegal to kill yourself, but it's not, there's nothing against assisted suicide." And the Judge scratched his head and said, "Oh, yeah. You're right." And that was that.

ARCHIVAL:

JACK KEVORKIAN: We're here to discuss the wishes of Sherry Miller.

NARRATION: Kevorkian continued helping people die, and Michigan continued trying to stop him.

GEOFREY FIEGER: We were opposed by the prosecutor, the governor, the legislature, the police and the churches. They did everything they could to get him.

NARRATION: Eventually, the state outlawed assisted suicide.

ARCHIVAL:

MAN: Hit the Road Jack, and don't you come back no more.

ARCHIVAL (NBC, 8-17-93):

JUDGE: people versus Jack Kevorkian...

NARRATION: Kevorkian tested the new law almost immediately.

ARCHIVAL (NBC NEWS, 8- 27-93):

REPORTER: Prosecutors offered their evidence, Kevorkian admitting on video tape how he helped 30-year old Thomas Hyde commit suicide.

ARCHIVAL (FRONTLINE, "THE KEVORKIAN FILE" 4-5-94):

HYDE (Home video) I want…

JACK LESSENBURY: He videotaped his patients, and when you saw these videos you really had no doubt about how the outcome was going to be because these people were so compelling.

ARCHIVAL (FRONTLINE, "THE KEVORKIAN FILE," 4-5-94):

HYDE (Home video) I want to die.

WIFE: I want Tom to be free, he's suffered too long.

NARRATION: Watching the video, some jurors cried.

ARCVHIAL (NBC, 5-2-94):

We the jury find the defendant, Jack Kevorkian, not guilty.

NARRATION: In all, Jack Kevorkian faced four trials for assisted suicide, but was never convicted.

ARCHIVAL (ABC NEWS, 3-8-96):

Not Guilty.

GEOFFREY FIEGER: At that point, there was a tacit understanding to leave Dr. Kevorkian alone. We had won.

ARCHIVAL (ABC, 2-18-94):

JACK KEVORKIAN: I'm doing what a physician is supposed to do.

GEOFFREY FIEGER: There are many patients that nobody knows about. Hundreds of patients. But Jack wouldn't leave well enough alone.

JACK LESSENBERRY: Kevorkian wanted to ratchet the debate up a notch from assisted suicide to euthanasia.

ARCHIVAL (CBS NEWS, 60 MINUTES, 11-22-98):

JACK KEVORKIAN: Tom, do you want to go ahead with this?

TOM: Yes.

JACK LESSENBERRY: He said, "I've done euthanasia and I videotaped it. How do I get the widest possible audience?

NARRATION: Lessenberry called CBS' Mike Wallace, who interviewed Kevorkian and played the video on 60 Minutes.

ARCHIVAL (CBS NEWS, 60 MINUTES, 11-22-98):

MIKE WALLACE (Voiceover): Is he dead now?

JACK KEVORKIAN: I'm--he's dying now, because his oxygen's cut off. He can't breathe. So I'll--now I'll quickly inject the potassium chloride to stop the heart.

MIKE WALLACE: (Voiceover) He's dead.

JACK KEVORKIAN: (Voiceover) Yep. The heart has stopped.

GEOFFREY FIEGER: The suicide machine and injections are the same thing. Who cares if the patient pushed the button or Kevorkian? And Kevorkian was tired of that artifice.

EZEKIEL EMANUEL: I thought he was an evil character. It really wasn't about optimal care for the patient. It was about Jack Kevorkian making a big statement about what he wanted the country to do.

ARCHIVAL (CBS, 11-25-98):

DAN RATHER: Michigan prosecutors today charged Kevorkian with premeditated murder.

NARRATION: This time he was convicted and went to prison for eight years.

ARCHIVAL (CBS NEWS, 60 MINUTES, 6-1-07, USING VIDEO FROM 1998 TRIAL):

JUDGE: You have the audacity to go on national television, show the world what you did, and dare the legal system to stop you. Well, sir, consider yourself stopped.

JACK LESSENBERRY: He got a national debate going, which I think he then helped stifle by his own outrageous actions. To get America's attention, you've got to be in your face, and Kevorkian was very much in your face.

ACT II:

TIMOTHY QUILL (DOCTOR AT UNIVERSITY OF ROCHESTER MEDICAL CENTER): There was a lot of discussion about, if Kevorkian's crazy does this mean that these kinds of acts are all crazy -- or might there be a place for this in medicine?

ARCHIVAL (CBS NEWS, 12-15-93):

REPORTER: Rochester NY internist Timothy Quill knows first hand the wrenching decisions doctors make in the face of death.

ARCHIVAL (NBC NIGHTLY NEWS, 7-26-91):

TIMOTHY QUILL: I think it goes on much more commonly than anyone would openly acknowledge.

NARRATION: Just months after Kevorkian's first case, in an effort to broaden the debate, Dr. Timothy Quill published an article in the New England Journal of Medicine.

ARCHIVAL (CBS NEWS, 60 MINUTES, 1-5-97):

ED BRADLEY: It was the first time a mainstream physician had publicly confessed to helping a patient take her own life.

TIMOTHY QUILL: I had had this remarkable experience with a patient named Diane, who I had helped to die after a long medical adventure. I did finally agree, that I would provide the medication.

NARRATION: But Quill took a risk because in NY State, assisted suicide was against the law.

TIMOTHY QUILL: I waived my Fifth Amendment rights, and testified before the grand jury because I really felt if they heard the story and met me, I'd be so different from most everything else they were seeing that it would be hard to believe that they would prosecute.

ARCHIVAL (NBC, 7-26-91):

DA: There is no basis for criminal liability against Dr. Quill.

EZEKIEL EMANUEL: It provoked a discussion. There was, as you might expect, a divide in the medical community about whether this was the right thing to do, this was the wrong thing to do.

NARRATION: Those opposed to legalization worried that patients would be pressured to prematurely take their lives.

EZEKIEL EMANUEL: I think the people who get, who potentially get abused by legalization are people who might be, seem to be a burden on their family, who might have less good situations, less stable situations.

ARCHIVAL (NBC, 1-8- 97):

PROTESTERS: We're not dead yet! We want to live!

NARRATION: In 1997, Dr. Quill took the debate to the U.S. Supreme Court.

ARCHIVAL (C-SPAN, 1-8-97):

TIMOTHY QUILL: We all agree with the need for good pain relief. But we also have to address the question of what to do when that care fails.

ARCHIVAL (C-SPAN, 1-8-97):

CARDINAL LAW: We would create a societally imposed duty to die. So that the terminally ill and the elderly and the disabled, would begin to feel guilty if they did not get out of the way.

TIMOTHY QUILL: We lost nine to nothing, but there was a lot of stuff that came out of that Supreme Court decision that moved the practice of palliative care forward a lot.

NARRATION: In its ruling, the court made clear that even though doctors could not intentionally end patients' lives, they could prescribe as much pain medication as needed.

ARCHIVAL (ABC, 6-27-97):

REPORTER: Doctors can give patients drugs to relieve their pain, knowing those drugs could hasten death.

NARRATION: While the issue was moving through the courts attention turned to states that were attempting to put aid in dying bills on the ballot. Barbara Coombs Lee helped write the measure that went to Oregon voters in 1994.

BARBARA COOMBS LEE (PRESIDENT, COMPASSION & CHOICES): The argument that we made was people who are dying, who are mentally competent, who have unbearable suffering, should be able to ask their doctor for life ending medication.

NARRATION: Their bill would allow doctors to prescribe lethal medication to terminally ill patients, but not administer it themselves. It also required waiting periods, second opinions and that patients have less than 6 months to live.

ARCHIVAL (CBS NEWS, 10-12-94):

MAN: Are we going to have people moving here so they can kill themselves?

EZEKIEL EMANUEL: If you have this as an exit, a solution, then you might not attend to adequate care for people who are dying.

NARRATION: Some worried that legalizing aid in dying could lead to worse treatment for patients at the end of life.

EZEKIEL EMANUEL: I just don't think that when a patient says my life isn't worth it, that the right response is here's a packet of pills. I think the right response is to explore to them what can give their life meaning in this crucial part of the end of their life

ARCHIVAL (CBS, 10-12-94):

BOB SCHIEFFER: A first in the nation measure that legalizes doctor assisted suicide..

BARBARA COOMBS LEE: I think everyone was pretty surprised on election night, 1994, when we won.

Narration: In 1997, after numerous legal challenges, the law—called the Oregon Death with Dignity Act-- went into effect.

ACT III

NARRATION: Dr. Quill still specializes in palliative care…

TIMOTHY QUILL: Hello

NARRATION: relieving suffering, often at the end of life.

TIMOTHY QUILL: So how are you doing right now?

MICHAEL MARASCO: I'm doing very well. Fine. Pain seems to be managed quite well.

NARRATION: He says care for patients who are in pain has improved dramatically as a result of the assisted suicide debates of the 1990s.

TIMOTHY QUILL: Things like heavy sedation came out of that discussion. You know, that was not available 20 years ago.

TIMOTHY QUILL: If pain gets really bad or things are really bad that we can be very aggressive with managing your pain.

MICHAEL MARASCO: Yes.

TIMOTHY QUILL: Now we have options that were not there, that are legally accepted.

NARRATION: But some patients still suffer, like 54 year old Michael Marasco, whose cancer has spread to his bones.

MICHAEL MARASCO: It's very intolerable.You're doing this, just making me comfortable, prolonging the inevitable, and it's not the way I want to go.

NARRATION: Marasco wants Dr. Quill to help him die.

MICHAEL MARASCO: Just say goodbye to your loved ones, take a shot, go to sleep, and not wake up. And that should be my right.

NARRATION: In New York, as in most states, it is not.

ARCHIVAL (DIANE REHM SHOW):

DIANE REHM: You're listening to the Diane Rehm show.

NARRATION: Last spring, in Maryland, John Rehm-- husband of radio

personality Diane Rehm—was several years into a long decline from

Parkinson's disease.

DIANE REHM: He announced to the doctor, "I am ready to die. I can no longer use my hands. I can no longer feed myself. I can no longer stand or walk without assistance.

The doctor said, I cannot help you die. The only way that you can do this is to stop taking medication, stop drinking water, and stop eating." John said, "Well, I don't want to starve myself.

NARRATION: But, like many other patients facing the same dilemma, he did.

DIANE REHM: It took 10 days. He should have been able to choose how he died.

ARCHIVAL (ABC NEWS, 9 21-07):

WOMAN: This is the prescription

NARRATION: Only five states allow doctors to help patients die.

ARCHIVAL (HBO, "HOW TO DIE IN OREGON," 2011):

PHARMACIST: There's your merchandise. There's your card back. Thank you.

PATIENT: Thank you.

PATIENT (on the phone): I picked up the medication today at Buy Mart, so we have it here in the house...Good bye.

NARRATION: In Oregon, where it's been legal for 17 years, more than a third of patients who obtain the drugs never take them.

But more than 850 people have taken their lives, including 29-year old Brittany Maynard, who had brain cancer.

ARCHIVAL (CBS, 1-21-15):

REPORTER: Brittany wanted to choose when she died, so she was forced to leave California and move to Oregon where a doctor could legally prescribe medication that would end her life.

Narration: Before she died last November, Brittany reached out to Barbara Coombs Lee, who now runs an advocacy organization, Compassion and Choices. They made a video that was seen by millions.

ARCHIVAL (CBS, 1-21-15):

BRITTANY MAYNARD: I will die upstairs in my bedroom that I share with my husband, with my mother and my husband by my side and pass peacefully with some music that I like in the background.

BARBARA COOMBS LEE: She wanted to be an advocate and she wanted to do whatever she could with her remaining time, to help campaign to make this available to other people in every state.

ARCHIVAL (CBS 1-21-15):

REPORTER: Brittany Maynard's story reignited debate as California becomes the 14th state, along with Washington, DC to take steps toward right to die legislation

BARBARA COOMBS LEE: People just are calling us every day saying I want to introduce a Brittany Bill.

NARRATION:Dr. Quill is also still pushing for change.

TIMOTHY QUILL: We don't have answers for every kind of suffering. There have always been hard cases. There will always be hard cases.

NARRATION:He recently joined a new lawsuit, asking New York State not to prosecute doctors who help suffering patients end their lives.

TIMOTHY QUILL: We believe that terminally ill patients should have the right to request this kind of assistance.

NARRATION: As for Michael Marasco, he made the decision to stop eating and drinking. Dr. Quill kept him comfortable in the hospital as he passed away.

(END)