Focus: The American way of death

When a Michigan court convicted Dr Jack Kevorkian two months ago of second-degree murder for injecting fatal drugs into the veins of a man with Lou Gehrig's Disease and a prison sentence of 10-25 years was passed on him, the former pathologist submitted to the jailer's cuffs and smiled. He had succeeded in his quest: to ignite public debate about doctor-assisted suicide and euthanasia.

Not that the issue was invisible in the United States before his conviction. The nickname "Dr Death" has been associated with Kevorkian since the early Nineties and his trial was far from his first tangle with the law. He has, by his own admission, helped 130 patients find peace through death.

Assisted suicide, moreover, has slowly been creeping up on abortion as the hottest question of medical ethics on the country's political stage. That too is thanks in part to Dr Kevorkian, but more particularly to Oregon, which, in 1992, became the first state in the US to attempt to legalise the practice.

If publicity was his goal, Dr Kevorkian surpassed himself with the Lou Gehrig's patient, whose name was Thomas Youk. Previously, Kevorkian had supervised patients as they delivered a fatal dose to themselves with a contraption he had invented, his so-called death machine. This time, he himself set the chemicals flowing. More than that, he videotaped the moment and gave the tape to the CBS news magazine, 60 Minutes, which, before rapt American viewers, aired it one Sunday night last autumn.

From behind bars, there is little more that Kevorkian can do to further his cause (although, he has threatened to continue his protest at the law by starving himself to death). Just last week, however, authorities in New Mexico announced they were investigating a former associate of Kevorkian in the death nine months ago of a terminally ill woman in the state.

Whether euthanasia becomes an accepted feature of medical practice in America will rest largely with individual states. The only federal guidance comes from a recent US Supreme Court ruling that said Americans have no constitutional right to choose an early death. The ruling did not, however, declare assisted suicide to be illegal. The Chief Justice, William Rehnquist, indeed urged an "earnest and profound debate" on the issue.

After a false start when its original 1992 law was overturned by the courts, Oregon finally passed in 1997 a bill allowing doctors to help direly ill patients speed their demise. The subjects must administer the final dose themselves, must be over 21 and mentally competent. They should also have statements from their doctors that they would anyway have only six months to live. A recent report by the New England Journal of Medicine said that in 1998 only 15 Oregonians took advantage of the new law, called the "Death with Dignity Measure". It also suggested that in every case, it was not unbearable pain itself that prompted their decisions. The main factors instead were a fear of dependency and a desire to escape the indignities that such dependency often brings.

Opponents of assisted suicide include disabled groups and the Catholic Church. Some warn that as costs of caring for the gravely ill soar, doctors and insurance companies will abuse laws like the one in Oregon, pressing for patients to be sent quickly on their way to save money and clear beds.

Even so, California, one of the largest states, may soon be following Oregon's lead. A draft bill, also called "Death with Dignity", has already passed important hurdles in the legislature and could be on the governor's desk for signature later this year. A recent poll of voters in California found overwhelming popular support for such a measure.