Dr. Arthur Caplan is Director
for the Center of Bioethics,
Philadelphia.
Q: Where are you on this issue ?
Caplan: Well, I'm certainly more in the camp of critics, worry warts,
nay-sayers. I find myself looking at the kind of people that have come to Dr.
Kevorkian and recoiling at the idea that a Janet Adkins or a Sherry Miller or a
Marjorie Wantz could have been helped to die as the best option that the system
could give them. I find myself thinking ocassionally, there's a Tom Hyde out
there and that's someone who I think in good conscious did deserve some help,
he was at the end of his rope and had no other options. But until America gets
to a point where I can be assured it's not going to put rationing before
assisted suicide, it's not going to stop worrying about what to do with 40
million uninsured people, it's going to do something about making a decent
longterm healthcare system, until I'm convinceed that assisted suicide is the
absolute option of last resort in the way that I think many of its proponents
hope and wish it to be, until I see that societal commitment, I'm going to
stand against it and I'm going to try and argue against it.
It's not that I think I can't be given cases individually where I would
say yes. And in fact in my own life I've been present -- I haven't done it,
but I've been present at some assisted suicides, so I can hardly say that my
ethics lead me to absolute opposition in believing that it is immoral. But I
think that the duty of medicine is to try and talk people out of it -- that's
one of the reasons I've been present at some assisted suicides -- even though out
of respect for the person's choice, I've been there and out of a fear of where
we're headed as a society with respect to health care -- an aging population
that's going to be drawing down resources. People think now, they're facing a
system that's trying to ration. That is mere hint of what is to come. As the
baby boomers begin to move into their older years and begin to really stress
the system, they put resource demands on it.
I worry that assisted suicide is not going to be the option of last resort
-- it's going to be the attractive solution of first resort. Not that we're
going to have a government dictating, you must die, that suddenly within the
society, the notion will come that the older and disabled who are expensive
should do the responsible thing and leave. I don't want to be in that place
and I'm not persuaded that this culture or this society, isn't going to get us
to that place.
Q: And that isn't happening anyway?
Caplan: I think it happens a lot in our society that people feel "I don't
want the meter running, I don't want to spend my final days on care that I
prefer not to have..."But it's very different when someone is saying, look,
we're going to hasten your death and we can allow you to escape into the here
and after based on quality of life grounds."
Now what you get is people who are saying -- God they won't stop giving me
this technology, can't you disconnect it and let me go? We tried to respond to
that and I think we've done pretty well about neutralizing the financial issue
there, but when you move further, out into the traditionally prohibited areas,
doctors helping people to die, -- using their skills that way, I think the
incentive and the number of people potentially affected gets to be so large
that it becomes tempting as a policy solution.
Q: They say this is the last trial...what should happen to
Kevorkian?
Caplan: Well, I think Kevorkian is in some ways going to wind up in one of
the states that legalize, maybe that will be Michigan, maybe it will be another
one. He may find himself involved in certain types of right to die movements,
but I think he'll continue to push where he's shown us he wants to go.
I think Dr. Kevorkian believes that the line that medicine should draw
around assisted suicide is neither around pain, nor around terminal
illness...it must go further and that's where I expect him to be going, I
expect him to be leading the charge to expand the right to die to those who say
by their own free will or their own choice, 'that's it for me.' So I don't
think he's going to disappear, but I think he's going to move out to a
different area of the right to die debate. But the more dangerous and
potentially disasterous part of that debate as far as I'm concerned, for our
society. That's where I would expect him to be residing in Oregon or
Washington or some other state with a liberalized law on the books and then
pushing those state legislatures to say why stop with the terminally ill, why
stop with the cancer patient in a lot of pain, shouldn't we go further when
that's what patients are asking us to do?
Q: What do you see when you watch this trial?
Caplan: Well it's interesting. I've spent a lot of time following
Kevorkian and I think I know the cases, the people he's been involved with as
well as anybody and I tried to read Jack Kevorkian's writings and his books and
I've been in a courtroom once to oppose him in the Adkins trial. I gave
testimony against him because I thought it was important, I just went and
testified about that and I can't watch the trials now and I don't watch them as
they appear because they scare me. Everything I see about Kevorkian puts in
mind a person obsessed with death, a person who can't accept it and is trying
to gain personal control and victory over it by saying, I'll control the timing
of it. I'll beat death by becoming its master and it frightens me because I
think that's strong in American culture -- It's that notion that rather than
give in and be compliant, we will master it. It's the same thing that led us
to find it very difficult to disconnect the machines. It's the same thing that
makes it so hard for us to deal with dying in our homes -- we have to put them
into institutional settings. It's the same things that leave us speechless
when we try and talk about dying either in theological terms or medical terms.
So when I see the trial come on, I turn it off because in some sense the
language, the format, the histrionics, the style of battle is exactly what I
don't like about what America is doing with death and dying.
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