News Analysis: A Polarizing Figure in End-of-Life Debates

 

In reports of Dr. Jack Kevorkian’s death on Friday at the age of 83, the general rule of obituaries held: Do not speak ill of the dead.

Dr. Kevorkian was generally described as a difficult man who helped advance the cause of assisted suicide for those with terminal illness.

Within the movement known generally as death with dignity, however, the evaluation of his contribution might seem surprisingly qualified, and the praise decidedly muted.

“He raised the profile of the issue, but he put the wrong face on it,” said Eli D. Stutsman, a lawyer in Portland, Ore., who helped draft his state’s trailblazing Death With Dignity Act, which allows terminal patients to end their own lives with the help of a doctor.

The 1997 Oregon law was built with compromise and careful consideration of policy, Mr. Stutsman said. It includes requirements that the patient be at the end stage of terminal disease and not have psychiatric disorders like depression, and that the patient take the drugs used in the procedure without help, to ensure that the act is voluntary from start to finish.

It is a very different system from that of Dr. Kevorkian, who seemed to make up his methods as he went along. He did not appear to screen patients to determine whether they were actually close to death, and he seemed to make no efforts to get counseling for those who might have wanted to live longer.

He devised “suicide machines” that could deliver drugs or carbon monoxide gas and could be set off by the patients. He carted the equipment to patients in his battered Volkswagen van and left many of the resulting 130 or more bodies at emergency rooms or even in hotel rooms.

Death, certainly — but death with dignity, no.

“Under the Oregon Death with Dignity Act, we would have put him in jail,” Mr. Stutsman said. “We ended up using him as an example of how not to do it.”

Since the act was passed, 525 people have ended their lives under its auspices, according to the state’s 2010 annual report. In 2010, 96 prescriptions were written for the barbiturates used, and 65 people ended their lives.

Mr. Stutsman went on to be a founding board member of the Death With Dignity National Center, which promotes similar legislative efforts around the country. They face serious opposition by groups that reject physician-assisted suicide for reasons that include religious belief and concern that such laws would open the door to forced euthanasia.

Mr. Stutsman said successful campaigns in Oregon and Washington State showed the value of a strategy of compromise and coalition building.

“He was advocating from the margins of the political debate,” Mr. Stutsman said of Dr. Kevorkian. “I was working from the middle of the political continuum — it’s very hard to change public policy from the margins of the debate.”

The movement won a major victory in 2006 when the United States Supreme Court ruled that the federal government could not prosecute Oregon doctors who participated in the assisted-suicide law.

Peg Sandeen, the executive director of the Death With Dignity National Center, said the ruling helped convince states that their own efforts would be respected — and was, she said, a major factor in the 2008 passage of the Washington State bill.

The Montana Supreme Court held in 2009 that no state law restricts the right of its citizens to end their lives with the help of physicians, though the court did not go so far as to say that physician-assisted suicide is a right under the State Constitution.

Efforts so far in California, Hawaii, Maine and Vermont have not been successful, though a new bill is before the Vermont Legislature. Barbara Coombs Lee, the president of Compassion and Choices, a group that promotes what it refers to as “end-of-life choice” in legislatures and the courts and was a co-plaintiff in the Montana case, said Dr. Kevorkian “was quite scornful of any effort to change the law.”

She called his death “the end of an era.”

Noting that he was a polarizing figure — “people either thought he was a saint and martyred or the devil incarnate” — she explained, “To us, he was neither, but certainly pivotal to our movement.”

Even at the extremes, she said, he “raised everyone’s consciousness about the problem of end-of-life suffering” and spurred others to look for ways for those with terminal illness to end their lives on their own terms.

An “ignominious” death at the hands of Dr. Kevorkian “was a dramatic display of just how desperate people were who are seeking a peaceful end of their terminal disease,” she said.

The policy-oriented groups worked to distinguish themselves from the Kevorkian spectacle. One Washington briefing in 1999 was titled “Jack Kevorkian and Physician-Assisted Dying: Not One and the Same.”

Still, disagreement has its uses, said Scott Blaine Swenson, who was the executive director of the Death With Dignity National Center from 2001 to 2005. “He was the perfect foil” for the centrist movement that was promoting policy change, Mr. Swenson said. “You need somebody to play against,” he said.

Dr. Kevorkian — erratic, loud and playing by his own rules — helped the movement establish rules that voters could live with, Mr. Swenson said.

“The truth, I think, is that had a Kevorkian not existed, that folks in Oregon and other proponents of assisted dying would have needed to invent him,” he said.

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At War: Stanford Debates R.O.T.C.'s Return

April 29, 10:18 a.m. | Vote Results After two hours of debate, the Stanford faculty senate voted to bring ROTC back on campus: 28 members voted for its return, 9 voted against it and 3 abstained. During the faculty senate meeting, Former Secretary of Defense William Perry discussed how bringing ROTC back to Stanford could help the military by providing better trained and educated leaders. Much of the debate was centered on the military’s posture toward transgendered people and also on whether academic credit would be granted to ROTC courses. An amendment to the resolution of bringing ROTC back to campus was added that stated the faculty senate’s objection concerning the military’s treatment towards transgender people.

Since Congress voted to end the “don’t ask, don’t tell” law, several “elite” universities, including Harvard and Columbia, have decided to reinstate R.O.T.C. programs. Stanford might be next. Last week, an ad hoc R.O.T.C. committee at the university unanimously recommended that President John L. Hennessy invite the program back on campus. Today, the Stanford Faculty Senate is expected to support the idea as well.

R.O.T.C., the Reserve Officers Training Corps, is a program for college students. R.O.T.C. cadets supplement their undergraduate academic curriculum with military and leadership training. Upon graduating and successfully completing the program, college seniors are commissioned as second lieutenants. Roughly 60 percent of newly commissioned officers in the Army come from R.O.T.C. programs, and more than 40 percent of general officers in the Army are R.O.T.C. graduates. The military pays for many cadets’ entire undergraduate education.

The attitude at Stanford toward reinstating R.O.T.C. has generally been positive. In this year’s student elections, 44 percent of voters supported a return of R.O.T.C. while 17 percent opposed it. Also, both of the school’s student-run newspapers supported bringing the program back.

Though R.O.T.C. has been away from Stanford for decades, the military is no stranger to the campus. Throughout this academic year, there have been military-themed lecture events. For example, a Military 101 seminar series was started by R.O.T.C. cadets and veterans to share with the greater Stanford community what military service entails. The speakers at these events have been senior active-duty officers from the Center for International Security and Cooperation and the Hoover Institution. Furthermore, Stanford is a veteran-friendly campus, with a vibrant veteran community at its graduate schools and a generous Post-9/11 G.I. Bill Yellow Ribbon Program. There are more student veterans on campus — upwards of 50 — than there are R.O.T.C. cadets. Perhaps as a result, the debate here has been civil and thought-provoking.

Now that “don’t ask, don’t tell” is ending, the military’s rules prohibiting transgender people from serving and granting academic credit for R.O.T.C. courses are the two main obstacles to inviting R.O.T.C. back on campus. A law school classmate of mine, Jon Margolick, penned an essay to one of the school’s newspapers, contending that although the concerns of transgender people were valid, the benefits associated with R.O.T.C. and public service outweighed the negatives.

The debate is not whether students can participate in R.O.T.C. but rather on whether the military can have R.O.T.C. cadres conducting training on Stanford’s campus. There are currently 14 Stanford students who are R.O.T.C. cadets. But because Stanford does not openly allow R.O.T.C. instructors and training on campus, these cadets have to travel off campus to complete their training. The travel can be onerous. One Marine cadet remarked that he had spent countless hours on the road driving to the University of California at Berkeley to fulfill his R.O.T.C. training. He found it odd that Berkeley never eliminated its program even though it is considered one of the most liberal schools in the nation.

One of the greatest challenges to bringing R.O.T.C. back to universities like Stanford and Harvard is the cost of education at these schools. Given that taxpayers finance R.O.T.C. training, the military could probably produce two to three R.O.T.C. graduates from a less expensive school for the cost of every Stanford cadet. Although some proponents say that quality is more important than quantity, my experience has been that there is little difference in quality among commissioning sources. I believe this stems from the success of the military’s officer basic training programs which establish a solid baseline for all R.O.T.C. graduates.

Both of my company commanders on active duty were R.O.T.C. graduates from small schools (Seattle University and Norwich). Both were considered among the best midlevel officers in the brigade, better than West Point graduates of the same year group or R.O.T.C. officers who had graduated from better-known schools. Moreover, unlike many of their peers, they are giving taxpayers a better return on their investment, because both officers plan on making the military a career.

With the federal government and military facing a constrained budget, the military will be looking to cut costs in all areas. Thus, the armed services may not immediately jump at an invitation to return to Stanford. And even if R.O.T.C. programs decide to return to elite campuses, there will be an issue of scale. Given the small number of R.O.T.C. cadets likely to be produced at a place like Stanford or Columbia, it might make little sense for the military to establish a large presence at those campuses.

Lacking sufficient instructors and resources on site, however, will only continue to dissuade prospective cadets from joining R.O.T.C. because the stresses associated with coordinating training and driving off campus for hours to attend mandatory training elsewhere. One Stanford cadet confided that he had contemplated transferring to West Point partly because of the stress associated with commuting to all of his military training requirements.

If the military really wants to grow its cadet population at elite schools, it will have to tailor its recruiting message. Some students will be interested in studying counterinsurgency, while others will be interested in the leadership training and still others in learning about weapons. Regardless, the military should develop a plan to single out talented college students who have options beyond the military, such as finance or consulting. The military should also focus on retaining these graduates once they become junior officers, where attrition rates have been high.

Despite any difficulties that might be associated with bringing R.O.T.C. back to campus, student veterans are optimistic that a move in this direction will help bridge a perceived civil-military divide between so-called elites and members of the military. Several Stanford cadets have told me that they deliberately conceal where they attend school during military training to avoid unnecessary attention. In an organization that emphasizes humility and teamwork, being a Stanford cadet could be difficult if fellow soldiers view him or her as pretentious.

In 1968, arsonists burned down Stanford’s Navy R.O.T.C. building. More than 40 years later, the pendulum of history has shifted, and the notion of having R.O.T.C. on campus no longer seems foreign. Thus far, the R.O.T.C. debate on campus has been framed through the narrow prism of faculty and student opinions about the military. The bigger takeaway that many Vietnam veterans point to, though, is how American society has come to embrace the military since the Vietnam War.

This Memorial Day, Stanford’s Graduate School of Business is hosting Paul Bucha at an event. Many students are looking forward to meeting Mr. Bucha, an alumnus of the Stanford business school and a Medal of Honor recipient for service in Vietnam. In a few years, a Stanford R.O.T.C. graduate, educated and trained on the Stanford campus, might be able to do the same for a new batch of young cadets.

Tim Hsia was the first soldier to contribute to the At War blog, after a chance meeting with the New York Times correspondent Stephen Farrell in 2008 in the Iraqi province of Diyala. A 2004 graduate of West Point and former Army infantry captain, he is now studying law at Stanford and is an R.O.T.C. instructor at Santa Clara University, which offers training for Stanford cadets.