hospice workers how many of their
pain and suffering are part and parcel
patients would commit suicide if they
of the human condition."
were receiving adequate support and
As the point man for medical ethics
treatment for pain, they could name
at Boston University, Dr. Michael
few.
Grodin has spent the last decade think-
Rabbi E.B. (Bunny) Freedman con-
ing about assisted suicide and its role in
curs. As director of Jewish Hospice
modern medicine. And as a Jew,
Services for Hospice of Michigan, the
Grodin has studied what the scholars
rabbi has interviewed hundreds of
have to say about the issue. Both veins,
patients who, once their physical pain
he believes, lead to the same conclu-
was relieved, absolutely wanted to live.
sion.
"You relieve pain, you make sure
"The bottom line is that physician-
they don't feel alone, you make sure
assisted suicide is not acceptable within
they don't feel like a burden, and
Jewish law," said Grodin, who directs
nobody will ever want to die. It's
BU's Law, Medicine and Ethics
against human nature to want to die.
Program. "Judaism deals with the liv-
We've dealt with 1,200 Jewish patients
ing. You are a living person in all
in the last five years and I found this
respects until you die. We don't make
dictum to be completely true," Rabbi
judgments that one person is more
Freedman said.
valuable than another because they are
He acknowledged that many people
dying. We treat people as God's cre-
entering hospice care consider assisted
ation."
suicide, but abandon the idea after they
Western medicine, he said, takes a
find relief from their physical symp-
similar approach, only from the oppo-
toms.
site direction. "Medicine has tradition-
"But rarely when hospice care is
ally never been involved in killing peo-
instituted do they ask to die," he said.
ple," Grodin said. The American
"Most people requesting to die have
Medical Association is staunchly
opposed to physician
aid in dying, although
dissenting members
have taken the debate
to the public.
0
0
Embedded in
0.
Grodin's assault on
euthanasia is the fun-
damental irony of the
assisted suicide move-
ment: Kevorkian,
whose contact with
patients usually con-
sists of a brief meeting
hours before their
death, has been largely
responsible for bring-
ing to light the failings
of our health care sys-
tem in the way it treats
the dying.
Above: Ron Seigel fears
Indeed, to Grodin,
that legalizing assisted
Kevorkian's success as a suicide will lead to the
movement maker
"euthanasia" of less
comes precisely because able-bodied members of
he is "a symptom of a
society.
problem, not a solu-
tion."
Above right: Rabbi
"If you do all the
E.B. Freedman believes
things that we should
hospice care can elimi-
do [to treat the dying],
nate the desire to end
the number of people
one's life with the help
of a doctor.
who would want to kill
themselves would be
Right: Rabbi Shmuel
miniscule," suggested
Irons of the Kollel
Grodin.
Institute equates assist-
When he recently
ed suicide with murder.
asked a gathering of

x

O

2/20
1998

88

such pain that they'd rather be dead
than have the pain they're experiencing.
The first job of the hospice is to remove
the pain. Then there are [psychological
and spiritual] issues."
In their book on assisted suicide,
The Suicide Machine, reporters for the
Detroit Free Press write that 34 of 47
people who sought Dr. Kevorkian's ser-
vices were in "chronic or cancer pain"
and more than a dozen had already
rejected further medical care.
"We live in a culture and a society
that has not dealt with death and
dying. [Americans] see physician-assist-
ed suicide as a simple solution to a very,
very complicated problem," Grodin
said.
The complexity of the issue makes it
even more difficult to grapple with than
abortion, which has been reduced to a
series of smaller debates about the point
of conception and the circumstances in
which abortion is morally acceptable.
As Grodin puts it, the issue of physi-
cian-assisted suicide forces a serious,
and ultimately Herculean, reexamina- •
tion of this country's health care system.

Giving people the care they need to
face death comfortably won't be easy.
For starters, it's not clear what care they
need. One facet, however, of compre-
hensive end-stage treatment is the abili-
ty to die at home. Hospice services,
which are now sought by a small but
expanding percentage of patients, will
have to become far more commonly
used.
Hospice care is available and accessi-
ble, Rabbi Freedman said, but there is
"resistance" on the part of a medical
establishment that is geared to curing
disease rather than controlling pain.
"In Europe, palliative care is very
popular, it's a very developed discipline.
In America, the medical system is a
macho system. It's rich, it's focused on
cure, but it's not good at accepting ter-
minality and pulling back from curative
measures and getting pain and symp-
toms under control. There's a time
when palliation is what a family needs.
"The focus should be on the quality
of the person's life. What's missing is a
recognition by the general population
of [hospice care's] ready accessibility,"
Freedman said.
If Kevorkian has inadvertently
exposed the deficiencies in our medical
system, he also has helped popularize
hospice care as an alternative to physi-
cian-assisted suicide, the rabbi said.
Eighteen percent of Americans die in
hospice care and the number is rising,
he said.
Some encouraging signs suggest that
the landscape is changing.
Last October, Physician's Weekly
reported that, in the year after Oregon's
1994 referendum endorsing physician-
assisted suicide, referrals to hospices
rose 20 percent. By 1996, about a quar-
ter of Oregonians died in hospice pro-
grams — instead of hospitals, for exam-
ple — and fully half of the state's can-
cer patients — those most likely to be
in severe pain — ended their lives in
hospice care.
Of course, the expansion of hospice
care and further research into pain
management cannot come to pass with-
out one thing: money.
And in today's climate of HMO cost
increases and Medicare reform, the like-
lihood of expanding hospice coverage
seems slim. Witness the trials of a bill
before Congress that would effectively
widen benefits for HMO enrollees by,
among other things, requiring their
insurers to eliminate pre-authorization
requirements for emergency room visits
and pay for specialists when a patient is
referred by a primary care doctor.
Although the legislation has the

