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Australian doctor reveals details of assisted suicides
POLICY AND PEOPLE
Kevorkian arrested on charge of first-degree murder fter he all but dared them to do it, authorities in Michigan charged retired pathologist and assisted-suicide advocate Jack Kevorkian with first-degree murder on Nov 25. The charges stemmed from a nationally televised broadcast in which Kevorkian was seen administering what he said was a lethal injection of potassium chloride to 52year-old Thomas Youk, of Waterford, Michigan. Youk was in the final stages of Lou Gehrig’s disease. The videotape, shown on the USA’s leading news documentary show 60 minutes, has reignited the debate in the USA over assisted suicide and euthanasia. 70-year-old Kevorkian, known in the media as “Dr Death”, has allegedly assisted in more than 130 suicides, and has been tried and acquitted three times in Michigan of assisting in the deaths of five terminally ill patients.
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Michigan voters overwhelmingly rejected a measure in November that would have legalised assisted suicide. Oregon is the only US state where the practice is legal.
Kevorkian acknowledged in interviews that the death of Youk was different from previous services he had provided. Before, Kevorkian provided the means by which patients could kill themselves, using a
machine to deliver a lethal dose of carbon monoxide. In this case, Kevorkian gave the injections himself, making the procedure euthanasia rather than assisted suicide. Oakland County Prosecutor David Gorcyca said that what Kevorkian did was not euthanasia at all, but premeditated murder. “In this case there is an obvious violation of the law”, Gorcyca said. The arrest was exactly what Kevorkian, whose medical licence has been revoked in both Michigan and California, said he wanted “to force the debate back into the public eye”. “I am going to prove that this is not a crime, ever, regardless of what words are written on paper”, he said in an interview with a Michigan newspaper. If convicted, Kevorkian could be sentenced to life in prison. However, he told 60 minutes he would starve himself to death rather than live incarcerated. Julie Rovner
Australian doctor reveals details of assisted suicides
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ustralia’s own “Dr Death”, Philip Nitschke, has revealed that he has helped 15 patients to die since the Northern Territory law permitting euthanasia was overturned by the Federal government. Before each patient’s death, Nitschke made a 10–15 minute videotape that might include the process of death if the patient requested it, but not the moment of death. Unlike Kevorkian, however,
Nitschke’s tapes have not been televised. The intent behind the making of the tapes was to protect Nitschke or the patient’s families if the need arose. According to Nitschke, the patients describe their life and suffering and explain that they are not under duress. The Australian Medical Association opposes euthanasia. Its Victorian President, Gerald Segal,
has stated that he will ask the Medical Practitioners Board to investigate Nitschke’s activities. Nitschke now lives in Victoria. The Board is already considering other matters related to Nitschke’s conduct. However, Victorian Police have said that they will act only in response to a complaint or to a referral from the Coroner. Bebe Loff, Stephen Cordner
Move to bring private medicine into Italian state hospitals taly’s Ministry of Health announced last month that doctors hired by the National Health System after Jan 1, 1999, will be able to practice private medicine only within public-hospital facilities. In addition, despite opposition by doctors’ unions—which have threatened to strike against this decision, the Ministry is determined to extend this restriction to all doctors already working in state hospitals. Until 1996, there was no private medicine in Italy’s public hospitals and doctors were free to see and treat patients in private surgeries and clinics after hospital working hours (allegedly for tax-free cash, hence the resentment at the impending ban). Although all grades of doctors may
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do private work, senior hospital specialists are expected to be most affected by the proposed restriction. The first step of the reform was enforced earlier this year. Doctors have had to choose whether they will see private patients officially in hospital or outside, not both. State hospitals are now obliged to create extra facilities for private practice. Critics have compared these measures to adding new first-class carriages to shabby second-class-only trains. However, supporters claim that the change will bring more resources to hospitals since private patients fees, which are set by the physician, will be shared by the doctor and the hospital. Incentives in the form of pay raises have been promised for those who
opt to do their private work inside hospitals. The unions, however, have said that the expected bonus is insufficient. Other decisions in the same package of newly approved legislation will also affect doctors. University physicians will no longer retire at age 70 years, but at 65 like their non-academic colleagues. Prison medical officers are to be transferred from the ranks of the Ministry of Justice to those of the Ministry of Health. And general practitioners will work more closely with local health districts and will be awarded more money if they help the health district achieve agreed goals. Bruno Simini
THE LANCET • Vol 352 • December 5, 1998
Kevorkian arrested on charge of first-degree murder fter he all but dared them to do it, authorities in Michigan charged retired pathologist and assisted-suicide advocate Jack Kevorkian with first-degree murder on Nov 25. The charges stemmed from a nationally televised broadcast in which Kevorkian was seen administering what he said was a lethal injection of potassium chloride to 52year-old Thomas Youk, of Waterford, Michigan. Youk was in the final stages of Lou Gehrig’s disease. The videotape, shown on the USA’s leading news documentary show 60 minutes, has reignited the debate in the USA over assisted suicide and euthanasia. 70-year-old Kevorkian, known in the media as “Dr Death”, has allegedly assisted in more than 130 suicides, and has been tried and acquitted three times in Michigan of assisting in the deaths of five terminally ill patients.
A
Michigan voters overwhelmingly rejected a measure in November that would have legalised assisted suicide. Oregon is the only US state where the practice is legal.
Kevorkian acknowledged in interviews that the death of Youk was different from previous services he had provided. Before, Kevorkian provided the means by which patients could kill themselves, using a
machine to deliver a lethal dose of carbon monoxide. In this case, Kevorkian gave the injections himself, making the procedure euthanasia rather than assisted suicide. Oakland County Prosecutor David Gorcyca said that what Kevorkian did was not euthanasia at all, but premeditated murder. “In this case there is an obvious violation of the law”, Gorcyca said. The arrest was exactly what Kevorkian, whose medical licence has been revoked in both Michigan and California, said he wanted “to force the debate back into the public eye”. “I am going to prove that this is not a crime, ever, regardless of what words are written on paper”, he said in an interview with a Michigan newspaper. If convicted, Kevorkian could be sentenced to life in prison. However, he told 60 minutes he would starve himself to death rather than live incarcerated. Julie Rovner
Australian doctor reveals details of assisted suicides
A
ustralia’s own “Dr Death”, Philip Nitschke, has revealed that he has helped 15 patients to die since the Northern Territory law permitting euthanasia was overturned by the Federal government. Before each patient’s death, Nitschke made a 10–15 minute videotape that might include the process of death if the patient requested it, but not the moment of death. Unlike Kevorkian, however,
Nitschke’s tapes have not been televised. The intent behind the making of the tapes was to protect Nitschke or the patient’s families if the need arose. According to Nitschke, the patients describe their life and suffering and explain that they are not under duress. The Australian Medical Association opposes euthanasia. Its Victorian President, Gerald Segal,
has stated that he will ask the Medical Practitioners Board to investigate Nitschke’s activities. Nitschke now lives in Victoria. The Board is already considering other matters related to Nitschke’s conduct. However, Victorian Police have said that they will act only in response to a complaint or to a referral from the Coroner. Bebe Loff, Stephen Cordner
Move to bring private medicine into Italian state hospitals taly’s Ministry of Health announced last month that doctors hired by the National Health System after Jan 1, 1999, will be able to practice private medicine only within public-hospital facilities. In addition, despite opposition by doctors’ unions—which have threatened to strike against this decision, the Ministry is determined to extend this restriction to all doctors already working in state hospitals. Until 1996, there was no private medicine in Italy’s public hospitals and doctors were free to see and treat patients in private surgeries and clinics after hospital working hours (allegedly for tax-free cash, hence the resentment at the impending ban). Although all grades of doctors may
I
1838
do private work, senior hospital specialists are expected to be most affected by the proposed restriction. The first step of the reform was enforced earlier this year. Doctors have had to choose whether they will see private patients officially in hospital or outside, not both. State hospitals are now obliged to create extra facilities for private practice. Critics have compared these measures to adding new first-class carriages to shabby second-class-only trains. However, supporters claim that the change will bring more resources to hospitals since private patients fees, which are set by the physician, will be shared by the doctor and the hospital. Incentives in the form of pay raises have been promised for those who
opt to do their private work inside hospitals. The unions, however, have said that the expected bonus is insufficient. Other decisions in the same package of newly approved legislation will also affect doctors. University physicians will no longer retire at age 70 years, but at 65 like their non-academic colleagues. Prison medical officers are to be transferred from the ranks of the Ministry of Justice to those of the Ministry of Health. And general practitioners will work more closely with local health districts and will be awarded more money if they help the health district achieve agreed goals. Bruno Simini
THE LANCET • Vol 352 • December 5, 1998