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her with the means to end her life swiftly and without pain.
They had seen the situation coming and discussed it beforehand.
Derek obtained some tablets and gave them to Jean, who took
them and died soon afterwards.
Dr Jack Kevorkian, a Michigan pathologist, went one step
further when he built a 'suicide machine' to help terminally ill
people commit suicide. His machine consisted of a metal pole
with three different bottles attached to a tube of the kind used
to provide an intravenous drip. The doctor inserts the tube in
the patient's vein, but at this stage only a harmless saline solution
can pass through it. The patient may then flip a switch,
which will allow a coma-inducing drug to come through the
176
Taking Life: Humans
tube; this is automatically followed by a lethal drug contained
in the third bottle. Dr Kevorkian announced that he was prepared
to make the machine available to any terminally ill patient
who wished to use it. (Assisting suicide is not against the law
in Michigan.) In June 1990, Janet Adkins, who was suffering
from Alzheimer's disease, but still competent to make the decision
to end her life, contacted Dr Kevorkian and told him of
her wish to die, rather than go through the slow and progressive
deterioration that the disease involves. Dr Kevorkian was in
attendance while she made use of his machine, and then reported
Janet Adkins's death to the police. He was subsequently
charged with murder, but the judge refused to allow the charge
to proceed to trial, on the grounds that Janet Adkins had caused
her own death. The following year Dr Kevorkian made his
device available to two other people, who used it in order to
end their lives. 1
In other cases, people wanting to die may be unable to kill
themselves. In 1973 George Zygmaniak was injured in a motorcycle
accident near his home in New Jersey. He was taken
to hospital, where he was found to be totally paralysed from
the neck down. He was also in considerable pain. He told his
doctor and his brother, Lester, that he did not want to live in
this condition. He begged them both to kill him. Lester questioned
the doctor and hospital staff about George's prospects of
recovery: he was told that they were nil. He then smuggled a
gun into the hospital, and said to his brother: 'I am here to end
your pain, George. Is it all right with you?' George, who was
now unable to speak because of an operation to assist his breathing'
nodded affirmatively. Lester shot him through the temple.
The Zygmaniak case appears to be a clear instance of voluntary
euthanasia, although without some of the procedural
Dr Kevorkian was again charged with murder, and with providing a prohibited
substance, in connection with the latter two cases, but was once more
discharged.
177
Practical Ethics
safeguards that advocates of the legalisation of voluntary euthanasia
propose. For instance, medical opinions about the patient's
prospects of recovery were obtained only in an informal
manner. Nor was there a careful attempt to establish, before
independent witnesses, that George's desire for death was of a
fixed and rational kind, based on the best available information
about his situation. The killing was not carried out by a doctor.
An injection would have been less distressing to others than
shooting. But these choices were not open to Lester Zygmaniak,
for the law in New Jersey, as in most other places, regards mercy
killing as murder, and if he had made his plans known, he
would not have been able to carry them out.
Euthanasia can be voluntary even if a person is not able, as
Jean Humphry, Janet Adkins, and George Zygmaniak were able,
to indicate the wish to die right up to the moment the tablets
are swallowed, the switch thrown, or the trigger pulled. A person
may, while in good health, make a written request for
euthanasia if, through accident or illness, she should come to
be incapable of making or expressing a decision to die, in pain,
or without the use of her mental faculties, and there is no
reasonable hope of recovery. In killing a person who has made
such a request, who has re-affirmed it from time to time, and
who is now in one of the states described, one could truly claim
to be acting with her consent.
There is now one country in which doctors can openly help
their patients to die in a peaceful and dignified way. In the
Netherlands, a series of court cases during the 1980s upheld a
doctor's right to assist a patient to die, even if that assistance
amounted to giving the patient a lethal injection. Doctors in the
Netherlands who comply with certain guidelines (which will
be described later in this chapter) can now quite openly carry
out euthanasia and can report this on the death certificate without
fear of prosecution. It has been estimated that about 2,300
deaths each year result from euthanasia carried out in this way.
178
Taking Life: Humans
Involuntary Euthanasia
I shall regard euthanasia as involuntary when the person killed
is capable of consenting to her own death, but does not do so,
either because she is not asked, or because she is asked and
chooses to go on living. Admittedly this definition lumps two
different cases under one heading. There is a significant difference
between killing someone who chooses to go on living and
killing someone who has not consented to being killed, but if
asked, would have consented. In practice, though, it is hard to
imagine cases in which a person is capable of consenting and
would have consented if asked, but was not asked. For why
not ask? Only in the most bizarre situations could one conceive
of a reason for not obtaining the consent of a person both able
and willing to consent.