The Michigan Supreme Court has overruled the state's Court of Appeals, holding that a law (now expired anyway) outlawing assisted suicide was constitutional and clearing the way for indictment of Dr. Kevorkian for common law felony murder (New York Times, December 18, 1994).

Suicide should not be illegal. A rational decision to kill oneself may be the right decision. At the end of his life, Sigmund Freud, in terrible pain from cancer, murmured to his physician, "This makes no more sense," and the doctor injected him with a lethal dose of morphine. Freud's decision that his life was over, and desire to end his own suffering, probably made sense.

On the other hand, it should not be too easy to commit suicide. People who marry in haste may repent at leisure, but people who kill themselves hastily never have a chance to rethink. Many suicides--by gunshot, leaping from heights, and other means--certainly result from hasty decisions by people in depressed or angry mental states. If these individuals had waited, many would have reconciled to life. Even some mortally ill individuals have concluded that they found better closure to life by spending more time with their loved ones than if they had killed themselves when first diagnosed.

It is rumored that many physicians are willing to help terminally ill patients end their lives even though it is against the law and may involve some risk for the physician. The physician may actually do no more than to answer a question such as, "How many of these would it be dangerous for me to take?" In such cases, though the doctor has provided the needed information, all responsibility for the decision--and the ensuing action--rests on the patient.

Since death is the consequence, the decision to kill oneself should be difficult to make and to carry out, as a way of ensuring that those who do it have really thought about it and really want to die. By legalizing assisted suicide, we make it more likely that this will not be the case-- people will reach the decision too lightly. Certain legislative schemes try to solve this problem by creating a bureaucracy of death--to die, you must get the permission of two doctors certifying you are terminally ill, etc. This does not really guarantee that the ultimate decision will be correct; like the old concept of the firing squad (someone fires a blank, no-one really knows if they hit the victim or not, etc.) it merely lessens the responsibility of the individual by spreading it across more people.

A common theme in many ethical dilemmas is: Who gets to make the decision? Every human being should have the right to decide his own death, but once we allow any human being to decide another's death, we are getting into extremely tricky territory (don't infer a death penalty opinion from this; I'll deal with this in another issue.) The guiding principle of the Hippocratic oath is "Do no harm." Doctor Kevorkian's enthusiasm for assisted suicide seems to create a gross conflict of interest which violates the rule. There is an old saying, "When you have a hammer, everything looks like a nail." A tort case, taught in all law schools, involves a physician who did an early skin transplant not because it was really called for, but because he wanted to do one. He was held liable for medical malpractice. Similarly, Dr. Kevorkian is the last person I would ask for an opinion on whether it was time for me to die.

Has Dr. Kevorkian ever talked a patient out of killing himself? If he has never tried, think about the implications. He is then not functioning as a doctor at all, but merely as a killer, in the same sense that a doctor who prescribes Valium to every patient who asks is functioning as a drug dealer. If there is a significant chance that decisions to grant death will be made in disregard of the best interests of the patient, then the Hippocratic oath, which embodies everyday, common-sense ethics, is violated.

Consider also the possibility that Dr. Kevorkian is an unsually clever serial killer, a man who takes pleasure in assisting or causing death but has cloaked himself in constitutional and ethical issues to disguise his actions. Virtually no other branch of ethical decision-making presents us with such a perverse possibility. The worst thing that might be true about Mother Teresa is that she is egotistical or proud of her fame and her actions; but the worst thing that might be true about Dr. Kevorkian is that he is a sadist who enjoys killing.

This gives us another reason not to structure our laws so as to accomodate such people or validate their actions. In fact, assisted suicide is a solution without a problem. The means of killing oneself, even painlessly, are within every one's reach; and communication of the information on how to do so is clearly protected by the First Amendment. Any humane purpose served by allowing assisted suicide is outweighed by the dangers of creating a class of killer doctors and encouraging people to end their lives prematurely.