Assisted suicide and older people--a deadly combination: ethical problems in permitting assisted suicide.

On June 4, 1990, fifty-four-year-old Janet Adkins ended her life lying on a cot in the back of a Volkswagen van parked in a Michigan suburb. Aided by a retired pathologist, Dr. Jack Kevorkian, Adkins was hooked up to his homemade "suicide machine." She had a needle inserted in her arm, which first started saline flowing and, then, when she pressed the button on the macabre death machine, sent first a sedative and then deadly potassium chloride flowing into her veins. An active woman with loving children and grandchildren, Adkins had flown two thousand miles from her Oregon home to Michigan to seek Kevorkian's assistance in ending her life when she was diagnosed with Alzheimer's disease. Adkins was an active member of the Hemlock Society, an organization that supports legalizing assisted suicide in America. She made a deliberate decision to end her life rather than face the mental decline associated with senile dementia.(1) Kevorkian, a long-time proponent of physician-assisted suicide, took that opportunity to use his suicide machine as a way of making a public statement to the medical community and the larger society that suicide is acceptable and that doctors should be willing to assist those who choose to die. Kevorkian was not charged with any crime, although a temporary restraining order was issued, forbidding him to use his suicide machine again.(2) Ignoring the order, Kevorkian helped two other women to kill themselves in October 1991.(3) Since 1990 Kevorkian has helped twenty-one people to commit suicide.(4) These assisted suicides have brought dramatically to the nation's attention the debate over the right to die with dignity and the ethics of helping others to commit suicide. Suicide and assisted suicide are issues particularly relevant to older members of our society. Compared to other age groups, older persons are the group most at risk of committing suicide or double suicide, and they are one of the groups most likely to request assistance in ending their lives. Those under age twenty-five years make up 16% of the U.S. population and account for 16% of all suicides. Those aged sixty-five years and over make up 12% of the population but account for 21% of all suicides.(5) In 1990 the suicide rate for the United States population was 12.4 per 100,000. The suicide rate for individuals aged fifteen to twenty-four years was 13.2 per 100,000. The suicide rate for people sixty-five and older was 20.5 per 100,000. Figure 1 below graphically compares suicide rates by sex and age groups. The positive relationship between age and suicide, particularly in males, is striking. The old are also among those most likely to be suffering from a terminal illness or to be dying. Seventy percent of the two million people who died in 1985 were sixty-five or older. Not surprisingly, the majority of people involved in euthanasia cases are old. According to Humphry and Wickett, 64% were over sixty, while 51% were over seventy.(6) Dramatic medical advances have greatly increased life expectancy but also have increased the period of chronic illness and disability. There are currently many more older individuals in our population than at any previous time in history. Today there are approximately 31 million people sixty-five and older in the United States population. The number of those over the age of sixty-five exceeds the number of teenagers in the United States. It is projected that the number of older persons will double in twenty years to 60 million. However, the oldest-old cohort are the fastest-growing age group in the country and are expected to triple in number during that same time span. The rate of increase in the oldest-old population has been truly impressive. For example, there are now twenty times as many people over eighty-five as there were at the turn of this century. In 1960, there were 0.9 million people in that age category or above; this number increased to 2.3 million in 1980, a gain of 156% in twenty years. …