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Compares ethical, medical, religious views of Dr. Jack Kevorkian, Judaism & Viktor Frankl (logotherapy).... More...
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Paper Abstract:
Compares ethical, medical, religious views of Dr. Jack Kevorkian, Judaism & Viktor Frankl (logotherapy).
Paper Introduction:
This paper is a comparative discussion of three very different perspectives on the voluntary decision to end one's life: Judaism; Viennese psychotherapist Viktor E. Frankl, whose position is similar to that of Judaism; and Jack Kevorkian, the pathologist whose very public assistance in the suicides of terminally ill patients has stimulated much open discussion about the right to die and what constitutes quality of life. At the extremes between good physical health and a body ravaged by terminal illness or unbearable, unending pain, Frankl (the "Doctor of the Soul") and Kevorkian ("Dr. Death") represent clear opposites in what appears to be a simple debate. When the discussion moves closer, however, when Frankl and Judaism are faced with devastating disease and Kevorkian deals with less imminent or obvious death, these two opposing arguments become
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She writes that this kind of decision "requires that we go deep within andunderstand ourselves clearly enough to choose wisely and to choose what isright in relationship to others from a point of stewardship."[xxi] Brown's father faced a prolonged wasting away of his body with littlehope of even a short-term recovery. When medical science is able to keep a bodyalive, yet unable to keep that body at the same time conscious and free ofpain, or when a vibrant mind is trapped where it cannot participate in theoutside world, then perhaps a dignified death is more sacred than lifesimply for its own sake. Man's Search for Meaning: An Introduction to Logotherapy. Lemonick observes whatthese decisions signal: "The laws against physician-assisted suicide nowon the books in the majority of states may be on their way out."[iv] Alongwith the highly publicized activities of Kevorkian, dubbed by the press"Dr. I. On one end is the contention that suicideis never an acceptable choice, for any reason or under any circumstances.On the other end is the argument supporting reasonable, rationalcircumstances for choosing to end one's life; here also lies the argumentthat, when such a choice is made, doctors have the right (and, perhaps,even the responsibility) to assist in making that death as dignified andpainless as possible. He is then committingnot only an act of violence; he is guilty of sacrilege."[xvii] Becausesuicide is so unacceptable to Jews, rabbis allow the widest possibleinterpretation of each suspicious death, many times clashing with secularrulings. Lemonick quotes Dr. William Wood,clinical director of the Winship Cancer Center at Emory University inAtlanta, who contends, "If we treat their depression and we treat theirpain, I've never had a patient who wanted to die."[vi] Frankl agrees thatthe will to live underlies and ultimately will overcome all other drives ifgiven the chance. Death," representtwo ends of a complex spectrum. Frankl argues that assisted suicide represents a failure by themedical community to preserve lives by helping to seek meaningful argumentsin favor of life. Robert E. Quill outlines the medical profession's five primaryconcerns about Kevorkian.[xxiv] First, the doctor is a pathologist, not aclinician, and therefore lacks the specialized training that would allowhim to analyze expertly the true roots of the patient's suicidal desires.Evaluating clinical depression, which causes many suicidal desires, can bea difficult diagnosis even for an expert psychiatrist. Those who dieleave behind many more who must deal with the resultant grief, loss, andchange. Judaism emphasizes the responsibility of eachindividual for the family and the community as a whole. defines suicide as "the taking of one's own lifebecause of an involuntary impulse to do so," but he differentiates thisfrom "self-sacrificing acts of heroism, the defiance of fugitives, or thedesires of those who wish to die with dignity."[i] Stephen Jamison alsomakes a clear distinction between suicide and assisted death, observingthat the latter "ends of the life of the patient . Judy Brown's father, suffering from pancreatic cancer, was the 1 thperson assisted to his death by Kevorkian. Whereverpossible, Judaic tradition gives the dead the benefit of the doubt. Brown's fathersucceeded in his attempt, with Kevorkian's expert help. Finally,doctors question Kevorkian's own motives for taking on these cases. Norton, 1993), 124-125.Ibid., 125.Ibid., 125.----------------------- 14 He facedthe prospect of losing his hard-won independence, as well as experiencingchronic, debilitating pain that would eventually become untreatable. W. Recent legal rulings have clarified the position of the courts,particularly regarding the physician's role in prescribing lethal doses ofmedicine to aid in a voluntary ending of a life. Against Suicide. These are rare exceptions, however, and Judaism remainsopposed to suicide in most circumstances. Judaic tradition also supports the injunction against suicide fromanother perspective. . Frankl, The Doctor and the Soul (New York: VintageBooks, 1986), 63-64.Lemonick, 82.Frankl, Man's Search for Meaning: An Introduction toLogotherapy (New York: Touchstone, 1984), 143.Frankl, The Doctor, 84.Frankl, Man's Search, 147.William Blair Gould, Viktor E. He does not spendhis time writing long treatises explaining his position and his works.Instead, he openly helps people who have asked for his assistance to endtheir lives. Berkeley, CA: Conari Press, 1995.Frankl, Viktor E. Pacific Grove, CA: Brooks/Cole, 1993.Jamison, Stephen. Jr. Frankl's view is shared by others, particularly those who deal withterminal patients on a regular basis. N. Forhim, the expected quality of his life seemed greatly diminished. This paper is a comparative discussion of three very differentperspectives on the voluntary decision to end one's life: Judaism;Viennese psychotherapist Viktor E. New York: Jonathan David, 1969.Lemonick, Michael D. Nelson Jr., W I. . . And since Hiroshima weknow what is at stake."[xiii] His implication is that the overwhelmingnumbers of human lives lost in the Holocaust and the dropping of the firstatomic bomb make each life still lived even more sacred and worthpreserving. . Frankl. Frankl writes, "Does death reallydecrease the meaningfulness of life? Charles Krauthammer contends,"In America the great moral barrier protecting us from . It reverberates among the living. . However, recent medical advances that allow doctorsto prolong life well beyond its "natural" end bring into question thedefinition of "harm" itself. N. It is the opposite of hope."[iii]However, the rational, carefully thought out decision to end one's lifebecause of a diminished quality of life, while tragic in its own way, is asubtly different situation. Suicide is never aseparate, single act. Where the debate becomes complicated, however, is when no immediatemedical emergency exists. Lamm outlines the kinds of circumstances that may cast doubt onwhether a death was actually a planned suicide, including evidence of achange of mind after the act was performed.[xviii] Consideration ofcircumstances allows Jews to find sacrificial suicides, such as Saul'simpalement on his own sword rather than falling into the hands of hisenemies, acceptable as examples of temporary states of extreme distress.Such states absolve the individual from sacrilegious intent. On the contrary . Michael D. He argues, "A human life marked from the beginning by theindividual's defiance of a biological handicap can be seen as one greatrecord-breaking race."[viii] Frankl believes, "Even the helpless victim ofa hopeless situation, facing a fate he cannot change, may rise abovehimself, may grow beyond himself, and by so doing change himself. Quill, Death and Dignity: Making Choices and TakingCharge (New York: W. "First and Last, Do No Harm." Time, 15 April 1996, 83.Lamm, Maurice. P. At Treblinka, mass suicide was a statement of freedom, self-control, and solidarity.[xix]For Jews, unlike Frankl, in some cases meaning can come through choosingdeath over life. Lemonick, "Defining the Right to Die," Time, 15 April1996, 82.Viktor E. In Dr. Jack Kevorkian, the opposing perspective has found an advocatewho argues his case primarily through very public acts. Saratoga, CA: R & E, 1993.Quill, Timothy E. Viktor E. Within rabbinical lore there is a place for suicide as a way to avoid slavery, sexual abuse, or idol worship. Nelson notes that Kevorkian is the only modern American physician tohave lost his license (which was revoked by the state of Michigan) becausehe assisted a patient's suicide, though he was certainly not the first everto have done so. we are under the imperative of utilizing our lifetimesto the utmost."[v] The logotherapist believes that the patient who decidesto kill himself, even facing a severely diminished quality of life fromwhich he has no chance of recovery, nevertheless can be helped to find areason to live. The heroes of Masada are heroes because of their willingness to commit mass suicide rather than surrender their lives and beliefs to the Romans. He writes, "Even if each and every case of suicide hadnot been undertaken out of a feeling of meaninglessness, it may well bethat an individual's impulse to take his life would have been overcome ifhe had been aware of some meaning and purpose worth living for."[vii] In Frankl's view, the doctor is responsible for encouraging patientswho face even the greatest physical and medical challenges to find ways totriumph over their difficulties. Patientsmay elect to have a "do not resuscitate" order placed on their charts,instructing hospital personnel not to perform heroic measures of revival inthe event of the failure of a major organ or other life-threatening medicalemergencies. Putnam's Sons, 1995), 246.Nelson, vi.Michael D. Frankl and Kevorkian, the "Doctor of Soul" and "Dr. suicide runs counter to the sixth commandment: "Thou shalt not kill." For this reason there are those in the Judeo- Christian world who reject the idea of "Living Wills" along with mercy killing as contrary to the commandments of God.[xvi] Maurice Lamm explains the Jewish opposition to self destruction:"The suicide, in effect, denies the lordship, the supreme mastery of God,when he decides that he is the lord of his own soul. Against Suicide (Saratoga, CA:R & E, 1993), 16.Stephen Jamison, Final Acts of Love: Families, Friends, andAssisted Dying (New York: G. "Defining the Right to Die." Time, 15 April 1996, 82.Nelson, Robert E. She believes that her father'schoice was arrived at after much soul-searching and was completely his own. Norton, 1993.-----------------------Robert E. She writes about her father'scarefully reasoned decision to contact the controversial pathologist andask for his help in committing suicide. The Choice: Seasons of Loss and Renewal After a Father's Decision to Die. . Some of Kevorkian'ssuicides might have survived for years before experiencing the diminishingquality of life they sought to avoid through an early death. At the extremes between good physical health and a body ravaged byterminal illness or unbearable, unending pain, Frankl (the "Doctor of theSoul") and Kevorkian ("Dr. Death," these legal trends have encouraged extensive public debate onwhen, if ever, ending one's life is acceptable. . Frankl: Life with Meaning(Pacific Grove, CA: Brooks/Cole, 1993), 148.Frankl, Man's Search, 139.Ibid., 151.Ibid., 154.Charles Krauthammer, "First and Last, Do No Harm," Time, 15April 1996, 83.Ibid., 83.Nelson, 62-63.Maurice Lamm, The Jewish Way in Death and Mourning (New York:Jonathan David, 1969), 215.Ibid., 217-218.Nelson, 63.Krauthammer, 83.Judy Brown, The Choice: Seasons of Loss and Renewal After aFather's Decision to Die (Berkeley, CA: Conari Press, 1995),99.Nelson, 276.Ibid., 276.Timothy E. Putnam's Sons, 1995.Krauthammer, Charles. AsQuill observes, Kevorkian "appears more interested in challenging societyand the medical profession than in engaging with individual dying patientsin their struggle to find their own path."[xxv] Quill suggests that the violent reactions of the medical community toKevorkian's work should cause doctors to evaluate the intensity of theirresponses: "If we are frightened by Dr. Kevorkian's methods, we shouldbegin to ask ourselves how the medical profession can be found so lackingthat a superficially bizarre approach to death can appeal strongly to thegeneral public."[xxvi] Many in the medical community argue that thefundamental precept of the Hippocratic Oath, "first and last, do no harm,"categorically makes impossible a physician's help in doing the ultimateharm of ending a life. . Nelson notes that this revocation "was probably theresult of the risk [Kevorkian] posed to the image of the medical professionby his numerous, highly-publicized actions, which were not rooted in thetypical physician/patient relationship."[xxii] Kevorkian's actions havebeen controversial in part because, as Nelson points out, the doctor "hasseemed more interested in developing and using innovative and sometimesbizarre technologies for death."[xxiii] Timothy E. N. Death and Dignity: Making Choices and Taking Charge. [for] in theface of death . P. . Final Acts of Love: Families, Friends, and Assisted Dying. Death") represent clear opposites in whatappears to be a simple debate. This removes him from the personal attachments that might otherwise havemotivated him to press for solutions other than death. Life is the gift of God who are we to take it away? N. Nelson Jr. He contends that triumph is alwayspossible. Neither viewpoint offers the absolute answer to whatis an extraordinarily complex question. whose hope forcontinued living and cure is gone, and who is faced with the alternative ofsuffering until inevitable death."[ii] Nelson contends, "Suicide istragic. Already, patients may create living wills, specifying the extent towhich they wish doctors to go in order to prolong their lives. For many physicians, the greatest objection to Kevorkian isnot his willingness to help people die but the almost missionary zeal withwhich he makes his actions known. He mayturn personal tragedy into triumph."[ix] Frankl's views have influenced many who have at some point consideredtaking their own lives, including adolescents who have read his books.William Blair Gould writes, "Some students who had thought of suicidequoted Frankl's statement that nobody has the right to throw away one'slife."[x] Frankl has an absolute belief in the sanctity of life whichpermeates all his writings. a subtle tradition of heroic suicide. New York: G. He has openly helped more than two dozenpatients, many (but not all) suffering from debilitating illnesses. monstrous God-doctoring is the one separating passive from active euthanasia."[xiv] Hewrites for those who see the recent rulings removing sanctions againstphysician-assisted suicide as giving doctors a "power heretofore reservedto God."[xv] This is also the Judaic argument. It is a waste of life. When the discussion moves closer, however,when Frankl and Judaism are faced with devastating disease and Kevorkiandeals with less imminent or obvious death, these two opposing argumentsbecome complicated. Frankl: Life with Meaning. . Krauthammer argues, "There is a great differencebetween, say, not resuscitating a stopped heart - allowing nature to takeits course - and actively killing someone."[xx] Where Kevorkian and hissupporters enter the picture is in situations where nature's course isslow, painful, and irreversible. Second, Kevorkianhas been willing to act without a long-standing relationship with patients. Frankl is the founder of logotherapy,healing through meaning, the third school of Viennese psychotherapy.Logotherapy seeks to help patients discover purpose in their lives as asolution to psychological trauma. He choseto end his life while he still had the capacity to do so and theappreciation of what his choice would mean for himself and his family. Many others would agree. This wasting would make himincreasingly dependent on his family, both for round-the-clock medical careand for financial assistance once his insurance was exhausted. The Jewish Way in Death and Mourning. As Nelson explains: For Jews, suicide is a sin. New York: Vintage Books, 1986.__________. Frankl, whose position is similar tothat of Judaism; and Jack Kevorkian, the pathologist whose very publicassistance in the suicides of terminally ill patients has stimulated muchopen discussion about the right to die and what constitutes quality oflife. Fourth, some of these casesinvolved patients with ambiguous diagnoses; experts disagreed on theseverity or immediacy of the illnesses involved. New York: W. Frankl argues the case for developing what he terms a "tragicoptimism," making the best of a situation even in the face of theinevitability of death.[xi] For him, "life remains potentially meaningfulunder any conditions, even those which are most miserable."[xii] Heconcludes the best-known of his books, Man's Search for Meaning, by noting,"Since Auschwitz we know what man is capable of. New York: Touchstone, 1984.Gould, William Blair. The Second Court ofAppeals struck down a New York state law which previously prohibiteddoctors from writing such prescriptions, following a similar ruling by theNinth Circuit Court in San Francisco. Third, he does notthoroughly review all the available information about a patient's case,including evaluating the extent to which the patient has explored allavailable options for treatment. W. The patient is himself unqualified tocomprehend all the nuances of his case and may in fact have misunderstoodhis conversations with his primary doctor. However, Nelson details one of the major exceptions to the Judaicproscription against suicide: There is . The Doctor and the Soul. Consideration of when or if such a decisioncan morally and ethically be made goes to the root of an individual'sbeliefs about the sanctity of life and freedom to choose one's own destiny. Living wills have become increasingly common, with the helpof mainstream public advocates such as columnists Abigail Van Buren and AnnLanders, who have more than once provided details of how to draw up such awill and where to write for more information or advice. Endnotes BibliographyBrown, Judy. One of the most eloquent voices against choosing to die for anyreason is Dr. Viktor E. W. Hecontacted Kevorkian precisely because the doctor was visible in hiswillingness to do what experts estimate many other physicians have beendoing quietly and individually throughout history.
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