DEATH AND THE MAIDEN

Who would use the services of the right-to-die movement’s death assisters? If suicide were “medicalized,” if there were a death dispenser in every neighborhood staffed with a knowledgeable, certified facilitator, what kind of person would partake? What, in psychologists’ jargon, would be his “presenting problem?” And just what kind of assistance would the physician in the physician-assisted suicide really supply?

For a preview of that brave new landscape, there is no better place to look than at the record being so industriously compiled by Dr. Jack Kevorkian, Royal Oak, Michigan’s notorious “Dr. Death.” The enterprising pathologist has been at it for six years and has, at this writing, assisted twenty-eight suicides–though only his ever-present lawyer knows when and where he will surface next, schlepping the bottles and tubes of the Rube Goldbergian death equipment he calls the “Thanatron” or, more recently, the “Mercitron.”

In the absence of competitors, Kevorkian has attracted a broad spectrum of people seeking a physician-assisted way out. They have come from the proverbial all walks of life, from the trailer park and the manicured suburb. In many respects, the doctor’s clients represent a pretty good sample of the general population. Except for the fact that most of them are women.

Like the men, they are younger than you might expect–ranging from age 40 to early 80s–with a surprising number (or perhaps not so surprising, given mid-life crises, menopause, empty nests) in their 50s. The most striking fact about the field, though, is how much what one might call the “objective despair index” differs by sex. Most of Kevorkian’s men were declared terminally ill by their own doctors; they were in constant, severe pain from medically diagnosed causes and were often physically incapacitated. Whatever you think about suicide or physician-assisted suicide, these were easier calls.

Many of the women, on the other hand, had more ambiguous complaints: in a chart like the one compiled by Kalman Kaplan, director of the Suicide Research Center at Columbia-Michael Reese Hospital in Chicago, we see that most of the Kevorkian women were not diagnosed terminal and had not been complaining of severe or constant pain. We see conditions like breast cancer (for which there is now great hope), emphysema, rheumatoid arthritis and Alzheimer’s (a condition that usually burdens relatives more than the people who have it). Reading the case histories it is clear that many of these women’s lives were messy and unattractive. But in all-too-typical female fashion, the patient often seems to have been most worried about the disease’s impact on others. Is it possible that a certain type of woman–depressive, self-effacing, near the end of a life largely spent serving others–is particularly vulnerable to the “rational,” “heroic” solution so forcefully proposed by Dr. Death?

Kevorkian is far too media-savvy to have been sanguine for long about his disproportionate number of female patients. As the deaths of his first eight women clients were registered and charges of misogyny started ringing from the editorial pages, he began, in his fashion, to make his oeuvre look more like America. The number of men grew as the work progressed, finally bringing the total to eleven. But even with the added effort to diversify, one problem remains: Kevorkian seems to like to feint and bobble, to flirt and play coy with his clients. Some of this tendency stems from his problems finding appropriate venues for medicides and from his responsible attempts to make sure patients have explored the range of treatments. But much of it seems to have come out of Dr. K’s pleasure in the process, in playing God. The upshot is that many of Kevorkian’s male prospective clients had already killed themselves by the time Kevorkian got around to “setting the date.”

Kevorkian’s experience with men is mirrored in suicide records from the National Center for Health Statistics. Women attempt suicide three times more often than men, according to the center. The reason we end up with far more completed male suicides–24,000 men to 6,000 women in 1992–is that men generally seem determined to succeed. They blow their heads off and throw themselves off buildings. Women tend to take overdoses of pills. Sexist as it may sound, women’s suicide attempts are more like the classic “cry for help”–a perverse way of reaching out, of bringing people to the bedside and hands to the body.

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