When Doctors Kill: Who, Why, and How
Page 26
“unbiased” review, the panel concluded that the mass infections were more likely due to deliberate actions because the viral load in the blood of the infected children was too high, an indication that the infection was intentional. Not a real surprising result coming from a group of puppets who probably couldn’t spell HIV. Dr.
Montagnier commented later that the report of the Libyan doctors “contained many mistakes showing that they didn’t understand much about HIV.” On May 6, 2004, the Criminal Court in Benghazi sentenced all of the Six to death by firing squad for intentionally infecting 426 Libyan children with AIDS. “The hospital,” Montagnier said, “needed a scapegoat.”
The convictions were appealed to the Libyan Supreme Court which heard the case in 2005. Eventually the Supreme Court revoked the death sentences and ordered a new trial. During the retrial some 50 relatives of the infected children demonstrated outside the court, holding poster-sized pictures of their children and wielding placards that read “Death for the children killers” and “HIV made in Bulgaria.” In December 2006, the court once again found all six defendants guilty and sentenced them to death in spite of scientific evidence that the youngsters likely had the virus before the medical workers had come to Libya.
156
15 Guilty Until Proven Innocent
The United States and Europe reacted with justifiable outrage to the unreasonable verdict issued against the six co-defendants who had already had served 7 years in jail. In contrast, the Libyan public celebrated as if their team had just won the Superbowl. After the sentence was pronounced, dozens of relatives outside the Tripoli court chanted “Execution! Execution!” Ibrahim Mohammed al-Aurabi, the father of an infected child, shouted, “God is great! Long live the Libyan judiciary!”
Surprisingly, several months later it was announced that the sentences would be commuted to life imprisonment. Coincidentally, earlier that same day the Libyan government had negotiated a $400 million settlement with the families of the 426
HIV “victims.” It also turns out, by sheer coincidence, that the European Commission committed $461 million to the Benghazi International Fund that morning. Coincidentally, earlier that same day the Libyan government had negotiated a $400 million settlement with the families of the 426 HIV “victims”. It also turns out, by sheer coincidence, that the European Commission committed $461
million to the Benghazi International Fund that morning.
On July 24, 2007 Nicolas Sarkozy, the President of France, officially announced that European negotiators had obtained the extradition of the prisoners, including the Palestinian doctor, who had been granted Bulgarian citizenship a month earlier.
The released prisoners left Libya on a French government plane accompanied by the European Union’s External Affairs Commissioner and the wife of the French President, Cécilia Sarkozy. Technically Libya did not free the Six but rather allowed them to serve their sentences in Bulgaria. Upon landing in Europe, however, they were immediately pardoned by the Bulgarian President, Georgi Parvanov, to the great dismay of the Libyan public. The Libyan episode dramatically emphasized the risks to life and limb encountered by foreign medical workers in non-democratic countries.
The American legal system is founded on the premise that a person is innocent until proven guilty. In fact, it has been said that it is better to let 99 guilty people go free than to convict one innocent person. Although our system doesn’t always work perfectly it is better than most other judicial options. The tribulations of Dr. Pou and the Benghazi Six have something in common; these doctors and nurses were likely trying their best to help their patients but ended up fighting for their lives and freedom. Both cases are similar in that they became national media events but at that point the paths diverged. In New Orleans, public sentiment was behind the accused and the protestors were anti-government. In Libya, the population rallied behind their dictator and completely bought the story sold by the political machine.
The former case ended up with an appropriate outcome based on the available facts and a victory for the judicial system; the latter almost ended up in the death of six innocent health care practitioners following a legal farce. While anyone can fall victim to unfair accusations, citizens in countries with an open legal system have a better chance of seeing justice served than those who are targeted by the very government responsible for conducting a fair trial.
Section 5
What Now?
Chapter 16
Euthanasia, and Assisted Suicide:
What Would Hippocrates Do?
The road to Hell is paved with good intentions.
– Unknown (originally attributed to Samuel Johnson)
Suicide, the killing of oneself, wastes countless lives and robs society of many gifted individuals. In addition to the average person beset with depression over a broken relationship, financial troubles, or the loss of a job, extremely creative people have also taken their own lives while in the throes of depression. Both Vincent van Gogh, the post-impressionist painter, and author Ernest Hemingway died by gunshot wounds; British novelist Virginia Woolf filled her pockets with stones and walked into a river near her home; and Kurt Cobain, lead singer of Nirvana, killed himself with a shotgun. There about one million suicides occur every year in addition to 20
million suicide attempts throughout the world. The National Institutes of Health (NIH) sees suicide as a major preventable health problem in America and for good reason. More than 32,000 successful suicides are registered every year in the United States with many of the victims being healthy, young adults. Teen suicide has also become an escalating tragedy and occasional pre-teen suicides are reported. There has been religious, ethical, and social opposition to suicide for millennia. It has been characterized as an affront to a life-giving God and a usurpation of the divine power over life and death. It has been widely perceived as the ultimate selfish act. In some locales, suicide has been considered a crime; botched attempts have led to the confiscation of the property of survivors in some cases and imprisonment or fines in others. It does not carry the death penalty.
A Short History of Suicide
Suicide is as old as humankind. In describing the tragic death of King Saul, the Bible mentions both attempted suicide and assisted suicide:
“The battle became fierce against Saul. The archers hit him and he was severely wounded by the archers. Then Saul said to his armor bearer, “Draw your sword, and thrust me through with it, lest these uncircumcised men come and thrust me through and abuse me.” However, his armor bearer would not, for he was greatly afraid.
J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 159
DOI 10.1007/978-1-4419-1369-2_16, © Springer Science+Business Media, LLC 2010
160
16 Euthanasia, and Assisted Suicide: What Would Hippocrates Do?
Therefore Saul took a sword and fell on it”, but he did not die. Saul then begged an Amalekite to take his life: “Stand beside me and slay me for anguish has seized me and yet my life still lingers.” The bible quotes the Amalekite as saying: “So I stood beside him and slew him because I was sure that he could not live after he had fallen” (II Samuel 1:1–10). When the Amalekite reported his actions to King David, perhaps expecting a reward, he was immediately executed.
In ancient Rome free citizens who wanted to commit suicide could do so legally if they formally applied for permission from the Senate. If their petition was approved they were given hemlock free of charge (the Roman version of a medical entitlement). However, Roman law specifically forbade the suicide of certain groups. Romans scheduled to stand trial for capital offenses could not legally kill themselves. If they did so prior to trial and conviction the state lost the right to seize their property. The suicide of a soldier was considered desertion from the army and was also illegal. If a slave committed suicide within 6 months of purchase, the master could claim a full refund from the former owner. Suicides committed for personal reasons were frowned upon, as in the cas
e of Mark Antony who committed suicide by stabbing himself with his sword when he mistakenly believed that his lover Cleopatra, Queen of Egypt, had killed herself. On the other hand, suicides committed for reasons of honor, such as after losing a decisive battle, were considered virtuous. This concept of virtuous suicide has lingered into modern times. The Japanese practice of “heroic” suicide continued until the end of the Second World War both in the form of the Kamikaze suicidal bombings by aviators and of harakiri, suicide committed by leaders who have failed in an assigned task. Sporadically, harakiri case reports are still published.
Ritualized suicides (sepukku) such as harakiri have been performed in Japan for centuries. Indeed it was an integral part of the code of the samurais. Dressed in a ceremonial kimono and often seated on sumptuous cushions, the warrior would place his sword in front of him and prepare for death by writing a stylized poem.
With his selected attendant standing by, he would then open his kimono, take up his wakizashi (short sword) or a tanto (knife), and plunge it into his abdomen, making first a left-to-right cut and then a second slightly upward stroke. On the second stroke, the assistant would perform the daki-kubi ritual by decapitating the noble victim with a single sword stroke that left the head still attached to the body by a thin strip of flesh. This tradition encompassed both honorable suicide and legal assisted suicide. In modern America, suicide is no longer considered noble and assisted suicide can land you in jail.
The Physician and Suicide
Most of us are afraid of death. Even those who are believers in a better world to come are not usually in a hurry to experience this inevitable encounter. Physicians generally function as brakes on the wheels of a train which is speeding down tracks inevitably leading to either nothingness or the afterlife depending on your beliefs.
The Physician and Suicide
161
When well-intentioned, merciful doctors hit the accelerator instead of the brakes and assist patients to their final resting place serious ethical, religious, and legal issues surface. Certainly doctors make mistakes of various magnitudes, as all humans do, and some of these errors can unintentionally lead to a patient’s death. In the vast majority of these instances, even if the mistakes were reckless and grave, the physician may well be subject to civil litigation but usually not criminal prosecution.
However, when a physician intentionally acts in a sporadic or systematic fashion to enable or assist suicide or hasten death through euthanasia there is substantial exposure to criminal charges including accusations of manslaughter or murder.
A distinction should be made between assisting in suicide and enabling suicide.
Enablement is a passive process whereas assisted suicide requires action. To assist someone who wishes to commit suicide, the doctor must do something which intentionally helps the patient to die. The physician’s actions may consist of providing information on how to end one’s life, giving depressed patients pills with dosage instructions that will lead to death, or designing equipment that can be used by a patient to take his or her own life. Physician-assisted suicide cases are the ones that make the headlines. Conversely, a physician may enable suicide by allowing a patient to forego life-saving treatment or by irresponsibly (or intentionally) prescribing powerful medications which can be misused by some patients. Physicians who run so-called “pills mills” may be unwitting enablers of suicide; at the least they significantly contribute to the current epidemic of accidental prescription drug overdoses. Upon request, even by telephone, their patients can receive narcotics and sedatives by fabricating the appropriate symptoms (which are easy to find on the internet) and answering a few quick questions.
It can be extremely difficult to prosecute a doctor for enabling suicide or facilitating an accidental overdose secondary to the unethical or semi-ethical practice of medicine. Law enforcement agencies occasionally use officers to play the role of requesting patients in “sting” operations in order to document the excessive amounts of medications being prescribed by some doctors. The premise for the subsequent arrests is that these physicians have essentially become drug dealers and are partially responsible for the overdose deaths some of their patients.
They may also theoretically be held liable for other deaths outside of their patient pool if their overprescribed medications are sold on the street and used recreationally with fatal results. However, even when physicians have been brought to trial for these crimes, conviction proves to be very problematic and two or three retrials are not uncommon. The arguments made by the defense teams for the accused physicians consistently include one or more of the following valid points:
– Pain medications or sedatives are often requested by patients who can successfully fake their symptoms. You can create any virtual disease you want if you have an hour of Web access and a marginal ability to act. Studies have shown that doctors are not good at detecting deception even when forewarned. In fact, physicians were able to identify deception under experimental conditions only 10% of the time
– Large doses of medications are justified in some cases including medical conditions resulting in intractable pain. The savvy defense attorney may leave out the part that the oxycodone dosage that is appropriate for a person riddled with 162
16 Euthanasia, and Assisted Suicide: What Would Hippocrates Do?
metastatic cancer differs from the pain management needs of someone who calls their physician for drugs to relieve the excruciating pain of a hangnail, and
– Physicians simply can’t control their patients and force them to act responsibly There are likely thousands of physicians across the country and far more scattered throughout the world who have built thriving practices based on prescription drug peddling. It is highly unlikely that any of them will be sent to prison for enabling suicide though it is certain that some have done so on occasion.
Physician-Assisted Suicide
Physician-assisted suicide is a situation in which a physician provides information and/or the means of committing suicide to requesting patients so they can painlessly terminate their own lives. In these cases, the patient always initiates the final action leading to death. The doctor may actively participate by writing a prescription for a lethal dose of pills for his suffering patient or by suggesting that the patient consult a “how to do it” suicide guide such as “Final Exit” by Derek Humphry. A few physicians have gone beyond the call of duty and aggressively assisted their patients who wanted to die. In fact, in a few cases it seems that the patient may not have wanted to “end it all” after all.
The doctor who popularized assisted suicide in the twentieth century was Dr. Jack Kevorkian (a.k.a. “Dr. Death”). Kevorkian was born in 1928 in Pontiac, Michigan to Armenian immigrants. A very gifted student he taught himself German and Japanese during World War II while still in high school-it is unclear if he was hedging his bets pending the outcome of the war. Kevorkian graduated from the University of Michigan Medical School in 1952. Even in his student years, he expressed an unusual interest in death. His beliefs about death and euthanasia apparently crystallized when, as a medical intern, he witnessed the suffering of a woman dying from cancer. Kevorkian went on to specialize in pathology and in this capacity obtained a number of hospital positions including Chief of Pathology at Saratoga General Hospital in Detroit. He published more than 30 professional articles and booklets including one entitled “Prescription Medicine: The Goodness of Planned Death” in which he defended the patient’s right to suicide and euthanasia. He also advocated for the right of death row inmates to donate their organs for transplantation or experimentation. Kevorkian’s morbid interest in death also spilled over to his recreational activities. A gifted painter, he created several very depressing and scary paintings all with morbid themes. He also was a jazz musician and composer of a musical piece entitled “The Kevorkian Suite: A Very Still Life.”
After living in California for about a decade where he worked in a number of hospitals, he returned to Michigan w
here he earned a living, in part, by publishing articles on euthanasia in European journals. In 1989 after reading about a patient who had asked for euthanasia, he developed a highly publicized lethal-injection machine (the “Thanatron”) that delivered intravenous toxic medications at the push Physician-Assisted Suicide
163
of a button. Later, he developed a variant of this death machine, the “Mercitron,”
that delivered fatal concentrations of carbon monoxide through a facemask. Both of these devices were operated by the patients requesting Dr. Kevorkian’s “house call.”
On June 4, 1990 he performed his first physician-assisted suicide on a 54 year-old woman suffering from Alzheimer disease who had contacted him after reading his ad in the newspaper. The procedure was performed in the back of his Volkswagen van and consisted of an intravenous infusion of sodium pentothal (a short acting anesthetic) and potassium chloride (a chemical that stops the heart). Ostensibly, the patient injected her own medications into the intravenous catheter. After his third
“medicide” (as Kevorkian preferred to label his actions) in 1991, his medical license was revoked for violating Michigan state laws regarding euthanasia.