BEHAVIOR

Death defined

Controversy rages over how-to suicide books

D’ARCY JENISH August 26 1991
BEHAVIOR

Death defined

Controversy rages over how-to suicide books

D’ARCY JENISH August 26 1991

Death defined

BEHAVIOR

Controversy rages over how-to suicide books

During the past 2½ years, Marjorie Wantz, a former teacher’s aide, has been tormented by pelvic pain that never stops. From her bed in Detroit’s Sinai Hospital, the 58-year-old woman said last week that she has undergone 10 operations but doctors have still not determined the cause of the pain. Wantz, a mother of two, said that constant suffering has driven her to make two attempts to take her own life. She also said that she has tried to follow the advice contained in Final Exit, a detailed guide on how to commit suicide published in March by the Eugene,

Ore.-based Hemlock Society, which promotes legalized euthanasia. On Aug. 18, the book reached the top of The New York Times list of bestselling advice and how-to books. But Wantz described Final Exit as a disappointment. She added: “It tells you to use Seconal, but you can’t get it unless a doctor writes a prescription for you.”

According to many doctors and legal experts, the popularity of Final Exit reflects a growing public preoccupation with terminal illness. But some of the experts contend that the book’s author, Derek Humphry, founder of the 42,000-member Hemlock Society, represents the radical fringe of the debate in North America about euthanasia and the rights of the terminally ill. They say that a more accurate measure of public opinion will emerge from a Washington state plebiscite on Nov. 5. Voters will be asked to approve or reject a proposed law that would make Washington the first American state to let doctors help terminally ill patients end their lives. In Canada, meanwhile, two members of Parliament have introduced private members’ bills dealing with euthanasia. One would strengthen a patient’s right to refuse treatment, while the second would allow terminally ill patients to take their lives after appearing before a governmentappointed referee.

The success of Final Exit has injected new vigor into the debate over euthanasia. The 192-page book examines in clinical detail various ways of committing suicide. One chapter,

entitled “Death Hollywood Style,” describes an unreliable suicide method popularized by movies in which an individual injects air into his veins. Another chapter, called “Bizarre Ways to Die,” describes death by rattlesnake bite and by driving a car into a tree. The book recommends neither method. According to Humphry, the best method, because it is quick, clean and painless, is to take an overdose of

barbiturates on an empty stomach and accompanied by alcohol.

The $23.50 book is distributed and promoted by New York City-based Carol Publishing Group. Carol’s 34-year-old publisher, Steven Schragis, a co-founder, with Toronto-born Graydon Carter, of the New York-based satirical magazine Spy, said that he was eager to help promote Final Exit because he belongs to the Hemlock Society. Initially, Carol Publishing printed a total of 40,000 copies of the book, of which about one-half were sold by mail order through the Hemlock Society. Humphry said that Carol sent 300 review copies to media outlets across the United States, but no reviews appeared. Then, on July 12, The Wall Street Journal published an article about the book, and within 10 days bookstores had sold the entire first edition. Hemlock and Carol are

now printing another 125,000 copies, and Schragis said that bookstores have already placed orders for 227,000.

Two major Canadian bookstore chains, Cole’s The Book People and W. H. Smith Classics, were both awaiting delivery of their first copies last week. Cole’s president Thomas Bryden said that he expects to have the book in most of Cole’s 236 stores by early September. Said Charlotte Caplan, a book buyer with the 180-store Smith chain: “There has been an incredible demand for it.”

The second printing of Final Exit is likely to begin reaching bookstores just as another potentially controversial book on suicide is published. On Sept. 2, Buffalo, N.Y.-based Prometheus Books plans to publish Dr. Jack Kevorkian’s Prescription: Medicide, subtitled The Goodness of Planned Death. Kevorkian, who lives in a Detroit suburb, is the inventor of a so-called suicide machine. He gained international attention in June, 1990, when Janet

Adkins, a 54-year-old Portland, Ore., woman who had been diagnosed as having Alzheimer’s disease, killed herself in a community outside Detroit while attached to his machine. When she pressed a button, the device injected a lethal quantity of potassium chloride into one of her veins.

Kevorkian is a man with a mission. He told Maclean’s last week that he is determined to create a new medical specialty called obitiatry. It would be dedicated to assisting the suicides of terminally ill people and harvesting their organs for use in transplants. He said that he has already conferred with six potential patients. One of them is Marjorie Wantz. Last week, Wantz and Kevorkian, along with two other doctors who have treated Wantz, appeared on a midmoming talk show on Detroit television station WJBK. Together, they discussed her problems, her eagerness to die and the pros and cons of physician-aided suicide. Before appearing on the show, a tearful Wantz told Maclean ’s that her chronic pelvic pain has made it almost impossible for her to walk. She said that she is unable to sleep for more than two hours at a time, and declared that she is determined to die using Kevorkian’s machine. Said Wantz: “I have pleaded with him many times to do it, but he says not until the doctors say there’s no hope.”

Kevorkian told Maclean ’s that he is determined to help Wantz end her life, even though a Michigan circuit court judge issued a permanent injunction in February prohibiting him or anyone else from using his suicide device.

Michael Modelski, an assistant prosecutor for Oakland County, which is near Detroit, said that the county obtained a temporary injunction immediately after Adkins’s death. Last December, a district court judge dismissed a charge of murder against Kevorkian for his part in Adkins’s suicide.

Meanwhile, a similar case involving Dr. Timothy Quill, a physician in Rochester, N.Y., suggested that U.S. law enforcement officials may have an increasingly difficult time prosecuting doctors who assist in suicides. Quill wrote an article, which was published

in The New England Journal of Medicine on March 7, admitting that he had prescribed barbiturates to a terminally ill cancer patient so that the woman could commit suicide. Monroe County district attorney Howard Relin said that his office launched an investigation and found the woman’s body in a local medical

school. He said that she had bequeathed her body to the school for use by anatomy students. Relin added that an autopsy revealed the presence of barbiturates and that his office referred the case to a 23-member grand jury. On July 26, the jury ruled that Quill should not be tried for manslaughter.

In Canada, the debate over euthanasia and the rights of patients has unfolded less dramatically. William Molloy, an assistant professor of medicine at McMaster University in Hamilton, said that he has developed a 43-page booklet entitled Let Me Decide, which allows healthy and competent individuals to prepare detailed advance instructions on what type of treatment they want to receive if they become seriously ill. Molloy said that since December, 1989, he has distributed 15,000 copies of the booklet to individuals and medical professionals in Canada and several other countries. He added: “This booklet allows people to choose anything from the most aggressive to the least aggressive treatment.”

Meanwhile, several provinces are considering legislation that would protect terminally ill patients from being kept on life-support systems against their will. Stephen Fram, a lawyer with the policy development division of the Ontario attorney general’s office, said that a proposed Substitute Decisions Act would allow individuals to decide what type of treatment they want—or do not want—if they become mentally incompetent. The bill also would assign decision-making authority to anyone designated by the individual.

While a broad consensus may be emerging in favor of a patient’s right to accept or refuse treatment, there is no such agreement on the role that doctors should play in assisting suicide. Many medical professionals point out that health-conscious North Americans, who eagerly pursue fitness and longevity, may also be more prone to degenerative diseases that result in slow, painful deaths. But many experts remain opposed to the concept of legalized suicide under any circumstances. Said Dr. Douglas Kinsella, a professor of medical ethics at the University of Calgary: “I believe it would be harmful to the medical profession. It transgresses one of our basic moral principles: Don’t kill.” With the influence of the medical establishment on one side and the anguish of the terminally ill on the other, the growing debate over euthanasia clearly will become more painful and emotional.

D’ARCY JENISH