THE DEATH of a woman through the use of a "suicide machine" last June stirred both controversy and deep feelings of sympathy for the woman, who had Alzheimer's disease. Basic issues of the "right to die" are involved in the case, especially now that Dr. Jack Kevorkian, who devised the machine, has been charged with first-degree murder.
The first-degree murder charge can hardly stand, since the woman, Janet Adkins, wanted to die, fearing that the ravages of Alzheimer's disease would make her a hopeless vegetable and a burden to her loved ones. She flew all the way from Oregon to Michigan to make use of the suicide machine, which injected chemicals into her arm when she pushed a button.
Unlike most states, including New York State, Michigan does not have a law explicitly making it a crime to assist in a suicide. The prosecutor said, however, that the doctor "cannot avoid his criminal culpability by the clever use of a switch."
There is a growing public acceptance of the right to die. In a recent poll, 49 percent said the incurably ill should have the right to commit suicide, an increase from 40 percent in a 1975 poll. A much greater percentage favored the right to die through the withdrawal of hospital life-support systems.
Last year, a panel of doctors wrote in the New England Journal of Medicine that it would not be immoral for a doctor to supply sleeping pills to a patient and indicate how many would be needed for a fatal dose.
There are many problems surrounding the right-to-die issue. The most obvious one is whether a person wishing to commit suicide is mentally competent to make such a decision. The question is pertinent in the case of Alzheimer's, which presents almost a Catch-22 type of situation.
In the case of Mrs. Adkins, the disease was in its early stages, and she appeared quite competent to make the decision. And yet it is still troubling that her medical adviser, Dr. Kevorkian, was a zealous advocate of euthanasia who was possibly more interested in advancing his cause than in the interests of the patient.
"Right to die" usually refers to the cases of terminally ill or comatose patients who are being kept alive in hospitals by extraordinary means. The U.S. Supreme Court last June upheld the right to avoid unwanted medical treatment in such cases.
There is a broad range of right-to-die situations -- the use of extraordinary life-support systems to keep people alive; the withdrawal of such systems, after which patients die "natural" deaths; and assistance with voluntary suicide, as in the case of Mrs. Adkins.
The "right to die" sounds like a simple principle, but the application of it is far from simple.
The Adkins case raises ethical questions for the medical profession, religious questions for the public and legal questions for legislators. The debate should result in better procedures for handling such heart-rending cases than now exist.