November of the Soul

by George Howe Colt

  345 “grandeur”: A. Blum, “Suicide Watch,” New York Times, March 20, 2005.

  347 “Much could be gained”: Friedman, On Suicide, 52–53. The opposite prevention strategy was proposed in the seventeenth century by Richard Capel. He suggested that instead of avoiding bridges that might tempt one to jump, one should march firmly across with a constant heart, and the urge would be conquered. “A false meanes is for a man to yeeld to much to feares, so as to thinke to avoid tentation, by declining, and not by resisting, as some dare not carry a knife about them, or when their knife is out, cast it from them, this is to yeeld too much to Satan: neither doth it helpe the matter, but rather keepe the tentation in. . . . The way to drive away our tentation is to keepe our knives about us . . . to fight it out against Satan, by setting the Word and Christ against him.” Sprott, English Debate, 46.

  347 a landmark 1983 study: J. H. Boyd, “The Increasing Rate of Suicide by Firearms,” New England Journal of Medicine 308 (15) (1983): 872–74.

  347 the strictness of state gun-control laws: D. Lester and M. E. Murrell, “The Influence of Gun Control Laws on Suicidal Behavior,” American Journal of Psychiatry 137 (1) (1980): 121–22.

  348 “Where there are more guns”: A. Marcus, “Study: Handgun Ownership Raises Risk of Suicide,” Health on the Net News, www.hon.ch/News. See Hemenway and Miller, “Association of Rates.” See also Miller and Hemenway, “Relationship Between Firearms and Suicide.”

  348 eighty-two consecutive suicides: Seiden, “Suicide Prevention,” 271.

  348 King County, Washington, firearms study: A. L. Kellerman and D. T. Reay, “Protection or Peril? An Analysis of Firearm-Related Deaths in the Home,” New England Journal of Medicine 314 (24) (1986): 1557–60.

  348 “If some persons”: Seiden, “Suicide Prevention,” 271.

  348 “get the guns out of the house”: Apparently, few people heed such advice. In a study of depressed adolescents who entered psychotherapy, only 27 percent of parents who, at intake, reported having guns in their home removed them after being urged to do so by the therapist. (D. A. Brent et al., “Compliance with Recommendations to Remove Firearms in Families Participating in a Clinical Trial for Adolescent Depression,” Journal of the American Academy of Child and Adolescent Psychiatry 39 [10] [2000]: 1220–26.)

  348 study of 238,000 people: Wintemute et al., “Mortality Among Recent Purchasers.”

  349 “It is unlikely”: R. W. Hudgens, “Preventing Suicide,” New England Journal of Medicine 308 (15) (1983): 897–98.

  349 “The NRA is not for gearing”: A. Parachini, “Gun Deaths: Suicides Versus Murders,” Los Angeles Times, April 19, 1983, pt. V, p. 5.

  349 twenty-year-old manager: This and subsequent examples are taken from newspaper and magazine accounts.

  350 As a term project: L. Moss, “Help Wanted: A Limited Study of Responses to One Person’s Cry for Help,” Life-Threatening Behavior 1 (1) (1971): 55–66.

  Chapter V Life or Liberty

  352 “Suicide is a fundamental”: T. Szasz, The Second Sin (Garden City, N.Y.: Anchor/Doubleday, 1973), 67.

  352 “If the psychiatrist is to prevent”: T. Szasz, in a speech given at the conference “Suicide: What Is the Clinician’s Responsibility?” Boston, February 1, 1985.

  352 “In fact, I firmly believe”: T. Szasz, in a debate with Edwin Shneidman in 1972 at the University of California, Berkeley. Taped by Audio-Digest Foundation, Suite 700, 1930 Wilshire Blvd., Los Angeles, CA 90057.

  353 a lawsuit filed by the widow: The lawsuit against Szasz is described in Jamison, Night Falls Fast, 254.

  353 Abraham Lincoln: Psychiatrist Ronald Fieve has written that if Lincoln had been his patient today, he would insist on immediate “hospitalization, observation for suicidal intent, anti-depression drugs, and later, lithium as the treatment of choice.” Lincoln survived his depression without such help; gun control seems to have been the form of suicide prevention he could most have benefited from.

  353 “The ‘right’ to suicide”: Murphy, “Suicide and the Right to Die.”

  353 survived six-story jumps: Hendin, Suicide in America, 210.

  353 “The right to kill oneself”: Ibid., 225.

  353 “Suicide is not a ‘right’”: Shneidman, “Aphorisms of Suicide,” 322.

  354 “Although such cases”: S. E. Wallace, “The Survivor’s Rights,” in Wallace and Eser, Suicide and Euthanasia, 67.

  354 “Suicidal persons are succumbing”: M. Boldt, “The Right to Suicide,” Suicide Information and Education Centre Current Awareness Bulletin 1 (2) (1985): 1.

  354 “the act [of suicide] clearly represents an illness”: Szasz, Theology of Medicine, 68.

  354 “If a sociologist predicted”: A. Brandt, Reality Police: The Experience of Insanity in America (New York: William Morrow, 1975), 146.

  355 “If a middle-aged lady”: Debate between Szasz and Shneidman in 1972, University of California, Berkeley.

  355 “If everyone who evinces”: Friedman, On Suicide, 84–85. The difficulty of drawing the line between sickness and health was described by Melville: “Who in the rainbow can draw the line where the violet tint ends and the orange tint begins? Distinctly we see the difference of the colors, but where exactly does the one first blendingly enter into the other? So with sanity and insanity. In pronounced cases there is no question about them. But in some supposed cases, in various degrees supposedly less pronounced, to draw the exact line of demarcation few will undertake, though for a fee becoming considerate some professional experts will. There is nothing namable but that some men will, or undertake to, do it for pay.” (H. Melville, Billy Budd, Sailor and Other Stories [New York: Bantam, 1981], 52–53.)

  355 “The argument connecting”: Green and Irish, Death Education, 120.

  356 A Harvard University study: Hendin, Suicide in America, 189–90.

  356 “Suicide is pre-judged”: Quotes in this paragraph can be found in Hillman, Suicide and the Soul, 36, 37, 87, 93, 92.

  356 review of Hillman’s book: R. E. Litman, “Concern for Suicide: Before and After,” in Shneidman, Farberow, and Litman, Psychology of Suicide, 637–40.

  356 “In regarding the desire”: Szasz, Theology of Medicine, 81.

  357 “Some of the things”: Green and Irish, Death Education, 120.

  357 “If the person says”: Ibid., 121.

  PART 5 The Right to Die

  In updating this part, I relied heavily on two indispensable essay collections, The Case Against Assisted Suicide, edited by Kathleen Foley and Herbert Hendin, and Physician-Assisted Dying, edited by Timothy E. Quill and Margaret P. Battin, as well as on Marilyn Webb’s exploration of end-of-life issues, The Good Death.

  Chapter I A Fate Worse Than Death

  364 “Among the Karens”: Westermarck, Origin and Development of the Moral Ideas, 231.

  365 “Thus was he blessed”: Suetonius, The Lives of the Twelve Caesars, ed. J. Gavorse (New York: Modern Library, 1931), 115.

  365 “if any man labour”: Fedden, Suicide, 72.

  365 “Just as a landlord”: Lecky, History of European Morals, 1: 232–33.

  365 “I will not relinquish”: Ibid., 232.

  365 “do away with the sufferings”: Humphry and Wickett, Right to Die, 4.

  366 “the most excusable cause”: Moore, Full Inquiry, 270.

  366 “I esteem it the office”: F. Bacon, Selected Writings, ed. H. G. Dick (New York: Modern Library, 1955), 277. For pointing the way to this quote and to numerous other tidbits of helpful information, and for helping me clarify my thinking on right-to-die issues, I am indebted to Anne Fadiman and to her essay “The Liberation of Lolly and Gronky.”

  366 “We have very great pity”: Mannes, Last Rights, 64.

  366 “should not torment his patient”: Hendin, Death as a Fact of Life, 82–83.

  366 “in cases of incurable”: Russell, Freedom to Die, 57–58.

  366 “practices of savages”: Ibid., 62.

  366 “Vast numbers of human beings
”: R. G. Twycross, “Voluntary Euthanasia,” in Wallace and Eser, Suicide and Euthanasia, 88.

  367 “Some are proposing”: Y. Kamisar, “Euthanasia Legislation: Some Non-Religious Objections,” in Downing, Euthanasia, 115.

  367 only the beginning: “Of the five identifiable steps by which the Nazis carried out the principle of ‘life unworthy of life,’ coercive sterilization was the first,” writes Lifton. “There followed the killing of ‘impaired’ children in hospitals; and then the killing of ‘impaired’ adults, mostly collected from mental hospitals, in centers especially equipped with carbon monoxide gas. This project was extended (in the same killing centers) to ‘impaired’ inmates of concentration and extermination camps and, finally, to mass killings, mostly of Jews, in the extermination camps themselves.” (R. J. Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide [New York: Basic Books, 1986].) Lifton’s book offers a comprehensive description of the Nazi “euthanasia” program.

  368 “For every illness”: New York Times, January 18, 1985, B1.

  368 “The classical deathbed scene” and “Where can we draw the line”: J. Fletcher, “The Patient’s Right to Die,” in Downing, Euthanasia, 65–66.

  368 “I do not remember”: M. Angell, “The Quality of Mercy,” in Quill and Battin, Physician-Assisted Dying, 16

  368 dedication to life: It has been suggested that what one skeptical doctor calls “their crusade to slay the dragon of death” may be a function of doctors’ neuroses as much as of their concern for patients; on psychological tests, doctors score high on death anxiety.

  368 “The dignity starts with”: Clark, Whose Life Is It Anyway?, 143.

  369 “We are discovering”: Hendin, Death as a Fact of Life, 79.

  369 terminally ill seventy-eight-year-old: This story is told in Barnard, Good Life, 88.

  369 growing acceptance of passive euthanasia: In active and passive euthanasia, the patient has requested to die; in “mercy killing,” the “killer” takes matters into his or her own hands because the patient is no longer able to express his or her wishes, as in the case of a coma victim or someone suffering from Alzheimer’s disease.

  369 “Thou shalt not kill”: H. Gardner, ed., The New Oxford Book of English Verse (New York and Oxford: Oxford University Press, 1972), 682.

  370 “Basic to our considerations” and “It is morally justifiable”: Wanzer et al., “Physician’s Responsibility,” 955, 958.

  370 According to a study reported: USA Today, January 4, 1985, 1.

  370 “When inevitable death is imminent”: “The Vatican’s Declaration on Euthanasia, 1980,” in Larue, Euthanasia and Religion, 42.

  371 Doctors have been sued: In 1981, at the request of the patient’s family, two California doctors disconnected the respirator of a comatose patient named Clarence Herbert. (In the past he had told his wife he did not want to become “another Karen Ann Quinlan.”) When he did not die, they disconnected his feeding tube as well. When Herbert died six days later, the Los Angeles district attorney charged the doctors with murder. Although the case was eventually dismissed, it was the first time doctors had ever been charged for removing life-support equipment, and it sent shock waves through the medical community. But doctors can also be sued for not following a request to cease life-sustaining measures. William Bartling was a seventy-year-old retired dental-supply salesman suffering from emphysema, arteriosclerosis, chronic respiratory failure, an abdominal aneurysm, and a malignant lung tumor. In 1984, kept alive by a respirator, feeding and drainage tubes, and a device that vacuumed his throat every two hours, he requested to be disconnected from life-support systems and allowed to die. His doctors refused—and, for a time, tied his hands down so he could not pull out the tubes himself. After the state superior court ruled in favor of the doctors, a California appellate court overturned the decision, ruling that the hospital had violated Bartling’s right to “self-determination as to his own medical treatment.” Bartling, however, died twenty-three hours before the appellate court could hear his plea and two months before the courts affirmed his right to die.

  371 estimates that 70 percent: Webb, Good Death, 189. Ironically, in the last decade, physicians working with dying patients have noticed that in an increasing number of cases, it is the family members and not the doctors who are insisting on keeping suffering loved ones alive at any cost.

  372 66 percent of physicians: Humphry and Clement, Freedom to Die, 188.

  372 nine thousand terminally ill patients: W. A. Knaus et al., “A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients,” Journal of the American Medical Association 274 (1995): 1591–98.

  372 the case of Terri Schiavo: My account is drawn largely from articles in the New York Times published during March and April 2005, as well as from D. Eisenberg, “Lessons of the Schiavo Battle,” Time, April 4, 2005, 23–30.

  374 “I have learned from my life”: Barnard, Good Life, 15. Barnard would later stir controversy in the right-to-die movement by insisting that the decision of when to perform euthanasia was best made by the doctor—not by the the patient or the patient’s family.

  375 “Can doctors who remove”: P. Singer, Rethinking Life and Death (New York: St. Martin’s Press, 1994), 221.

  375 “the morphine drip is undeniably euthanasia”: T. A. Preston, “Killing Pain, Ending Life,” New York Times, November 1, 1994, A27.

  375 “What, morally, is the difference”: Fletcher, “Patient’s Right to Die,” 68.

  375 described her mother’s death: Rollin, Last Wish.

  375 In one recent case: The story of Huntington Williams and John Welles is from W. Yardley, “For Role in Suicide, a Friend to the End is Now Facing Jail,” New York Times, March 4, 2005, A1, and W. Yardley, “Probation for Connecticut Man, 74, Who Aided Suicide,” New York Times, April 8, 2005, A24.

  376 have come to public attention: In a particularly poignant example, in 1985, John Kraai, a seventy-six-year-old general practitioner in a small town near Rochester, New York, injected a lethal dose of insulin into his patient and friend of more than forty years, an eighty-one-year-old nursing-home resident suffering from Alzheimer’s disease and gangrene of the feet. Shortly after he was charged with second-degree murder, Kraai killed himself by lethal injection.

  376 Michigan pathologist: My account of Dr. Kevorkian’s activities is taken largely from Michael Betzold’s Appointment with Doctor Death and Jack Kevorkian’s Prescription: Medicide, as well as from numerous newspaper accounts, and from my interviews with Geoffrey Fieger and Janet Good. See also J. Lessenberry, “Death Becomes Him,” Vanity Fair, July 1994. Information about Kevorkian in prison is from T. Ward, “Dr. K: I Expect to Die in Prison,” Daily Oakland Press, April 11, 2004.

  380 the man she called “the doctor”: Kevorkian called Janet Good his “associate” and to show his appreciation gave her a signed print of one of his paintings, The Gourmet (War). In it, a Roman centurion stands behind a decapitated man who, his neck dripping with blood, holds a plate on which his severed head reposes, an apple in its mouth. Good was proud of the gift but kept it behind her computer desk, and showed it only to a few friends. “I don’t think any sane person would hang that on the wall,” she told me.

  383 Gallup poll in 1947: E. D. Stutsman, “Political Strategy and Legal Change,” in Quill and Battin, Physician-Assisted Dying, 247.

  383 1995 study: Doukas et al., “Attitudes and Behaviors on Physician-Assisted Death: A Study of Michigan Oncologists,” Journal of Clinical Oncologists 13 (5) (1995): 1055–61.

  383 1996 study of physicians: A. L. Back et al., “Physician-Assisted Suicide and Euthanasia in Washington State: Patient Requests and Physician Responses,” Journal of the American Medical Association 275 (1996): 919–25.

  384 1997 New England Journal of Medicine report: L. R. Slome et al., “Physician-Assisted Suicide and Patients with Human Immunodeficiency Virus Disease,” New England Journal of Medicine 336 (6) (1997): 417–21.

  384
the same journal reported: D. E. Meier et al., “A National Survey of Physician-Assisted Suicide and Euthanasia in the United States,” New England Journal of Medicine 338 (17) (1998): 1193–1201.

  384 1996 survey of 852: D. A. Asch, “The Role of Critical Care Nurses in Euthanasia and Assisted Suicide,” New England Journal of Medicine 334 (1996): 1374–79.

  384 “I feared the effects”: T. Quill, “Death and Dignity: A Case of Individualized Decision Making,” New England Journal of Medicine 324 (10) (1991): 691–94. For a discussion of “nonabandonment,” see T. E. Quill and C. K. Cassel, “Nonabandonment,” in Quill and Battin, Physician-Assisted Dying, 24–38.

  384 seemed quite civilized: Comparing Quill and Kevorkian, bioethicist Arthur Caplan wrote, “I am convinced that what Kevorkian did in helping Janet Adkins die is completely immoral. Yet I do not believe that Quill acted unethically. . . .

  “Kevorkian did not know Adkins prior to attaching her to his homemade suicide device; Quill had known Diane as a patient and as a friend for many years before her death. Kevorkian scoured the country looking for someone upon whom he could use his machine. Quill did all that he could to get his patient to choose life, not death.

  “Kevorkian helped to her death a woman who was questionably competent, was in no pain and who was not terminally ill; Quill wrote a prescription for sleeping pills for a terminally ill, competent woman who was in a great deal of pain. Kevorkian personally hitched Janet Adkins to a machine that he himself had built, promoted and fervently hoped someone would use; Quill fervently hoped he could help manage Diane’s suffering so that she never would choose to end her life.” (Betzold, Appointment with Doctor Death, 146.)