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, director for cancer servicei warned thatmar\y hospitals were failing to provideadequate care to the terminallv illbecause doctor were not "comfoflble"_ talking about death with theirpatients.f Last year, the director of public prose-I c.utigns' iss,.qed revised'ggidelines thati mak lesO.'likelythe prbs-ition of some-i one who helps a loved one die. Chiefi aqro.ng thery was if thesus-pect had actedl. solely out of compassion.An-inSuiry, orgnised by the think tankDemos, is being held inlo whether thelaw should be changed furtherto legalise"assisted dlot S".Mrs Smith said that the health author-ity, which serves a population of 5.4mil-lion wjth a budget of B.Sbillion, was"neither for nor against assisted suicide",But she told the inquiry; which is chairedby Lord Falconer, the formerLord Chan-cellor: "Our view is that the cur:reirt law

does not rnatch the requir_ ements of:the21st cehfury.' i*We reallv do need to look at a svstemthat allows public and patient choice inways that the law does not allow"At the moment, we have a situationwhere only some people can mqke thatgholcq. Ifyou can afford to go to Switzer-land that's fine but if you canl you arestuck within a system ihat doesn't reallyallow you to taik about i! never minhave access lo it"She s4d that protecting patientsagainst abuse was important but added:"Ihere is abuse in the current NHS svs-tem - some people are assisted - but wedon't articulale that very !ysll."Prof Tim Maughan, a-consultant oncol-ogis! rejeted'.Mls :smithts argurhents,sayin-g tht some patients who wanted tocomrnit stcide because they thoughtthey were terminally ill recoverd. Othr;may feel under pressure to chooseassisted suicide if it were an option thatdoctors were legally oblieed to ffer."I think the-cui:rent-law has got itright," he said. "There are prinplesbehind it which are very sounii. Doctorsshould not kill their pati"ents. The vulner-able should be protected."Sir Mike Richards, the Departnent ofHealth's cancer and end of lif care direc-to4'yesterday caled for a ncw debateabout the service doctors provide toptientb who are dyr1rg.Sir Mike told the inqutuV that morepatients should be able to choose to dieat home and called for better training fordoctors and nurses to help them.lel"comfrtable" discrissing -death wlttrthose in their cafeLabour introduced a f2O0million drivetwo years ago lo improve the way theNHS cares forpatients who are dvin butso far changes in the service had -been "in ipockets" he said. I- "We have noi yet made a huge step Ichange across the countrv. I"Ihe area where we ned to make the Ibiggest changes is probably in the hospi- Ital sector. It is where most patients die. Itis where we have the bilg,gesi ."ft"tJchallenge."

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THURSDAY FEBRUARY 24,201 1

GiVe patients$v,grBy lim Ross, Socl?lffairs,efitor ::l:l ird'1li:1t/,1iSH ;i9'#lwfi {ffi *}5WS4*J i4 g,

will be seenaS dboostforthe rightto diecampargn.It comes as the Government's clinical

The amount committ( by talrorrr in 2(Xlg inhopeit would mpiove care for tenninlly ill

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Jack KevorkianJack Kevorkian, champion of voluntary euthanasia, rried onJune 3rd, aged g3f,ORmostpeople, death starts to becomeI'interesting only with the first intima-tfons, 9f theii mortaliry As they'worftthrough the seven ages of m"", tnuiithoughts may increasinglv turn to the de-houghts may increasingly turn to the de-penflence, indignity and pain that afilict so

this time, hardlysurprisingly, he was work-ing as a pathologist.. {e j-ob, however, did:not.bring satisfac-tion. Perhaps this was because hii interestin death coexisted with two other pas_sions. One was artistic, an urge that tookhim from Michigan, the state t-o which hisArmenian parents had emigrated a fewyears before his birth, to Caliiomia. rhreDr Kevorkian painted, wrote, played theflute and made a lm aboui Fiandel,s"Messiah", while earning u rnugr.li"i"gas a jobbingpatholggist. ire ulso;pp;arebefore members of the state legisliure, attheir request, ro rell them uf * *"ritj"iletting prisoners on death row choosu er.elcution by anaesthetic.. 4u! experience, or rather the enzuingbrouhaha, seemb to have awakened anlotherpassion, this one for publicity. It wasthe relish with ivhich Dr Kevorkian courted controversy that provided the ootencvof the campaign for ssisted suicide whicoccupied thelast three decades ofhis life.The theory waslaid outin a series of ar-ticles en guthanasia for a German jounal,Mediane and Law. Ihe practice folo*.a,starting with advertisements in Detroiinewsppers for .rdeath with dignity" pro-vided by a "doctor consultant foittre teim:-nally ill". Soon came the Mercitron and theThanatron, ',suicide machines,' that en-

abled "clients" to inject themselves withdrugs or to release a dose of lethal carbonmo.noq-de, turning the blood cherry redand sufi.lsing the cheeks in death with amisleadingly healthy glow.Over r3o people died painlesslv withthe help of these machinei and the doctorwlio invented them,The rstwsJarietAd-kins, aformer college instructor on disabit-ity, who resolved to kill herself the dav shewas.liagnosed with Alzheimer's, an didso, tvith Er Kevorkian in attendance, in hisrusty van in a Michigan campsite. Those *who followed her seemed unremarkable:a bus drive4 a doctor, " rup.*ir"i "t " "ii:ow factory and so on, all ierminallv ill orso they believed. Studies of thos whosought out DrKevorkian, however, suggestthat thoughmanyhad a worsening ilss,cancer perhaps or a neurological disease, ityag n9! usually rerminal. Auropsies

showed five people had no disease ail.Ihose who came to him were more likelyto,be;wornen than men, often,uamanieand typically ill-at-ease when talkine todoctors. Little over a third were in piin.Some presumably suffered ftom no morethan-hypodrondria or depression.Though- censured by^lawyers, clergy-men and the American Medical Associa_tion, Dr Kevorkian proved atm."fii" ,t"p.Frequently arrested, he would,argue per-suaSivellz that he was rnerely,heliingn-happy people to carry out thir orn,rish-es. Juiors'irr three trials acquitted him,perhaps making him think h would foieverrernayl beyond the reach ofthe prose-cutors ahd legislators he so loved toiaunt.From the first, he made no effort to concealhis role in helping people die, sometimesnotifuing the police after the event andeven having it filmed, Indeed, it was thetelevising of a tape of him actually admin-istering a lethal injection that eventuallyput him in prison. But even then he pubh_ly regretted not his actions but only'his de-cisionto conducthis own defence. '

Hardcases,badlaws?The judge who sentenced him said the trialwas not about the political,or rrioral cor-rectness of euthanasia, it was about break-ing the law "You had the audacity to go onnatrnnal television," she. said,,."-a"rr.the legal system to stop you. Well, sir, con-sider yourself stopped." He was, thoushhe was-released on parole after only eig-htyears of a ro-25-year sentence- Dr Kevorkian was hardly lovabler3om-bastic and arrognt, ne wutd liken him-self to Galileo, Ganiihi and,Martin LutherKing. He revelled in opprobrium. He ex-ploited the wlnerable. yet he also helpedpeople who surely wantedto die,and threason. He is also credited with promotinghogpices and the wider use of strong pai

killers for th dyrng. Even good.or, "]ourse, mayhave creepy champions. I

Asofmany atthe end of theirlives.Butin youth,at least in rich countries, thev are likelv tobe shielded from the actual-giving ui ofthe ghost, quotidian event rouitr ii is.Many indeed reach adulthood irithoutseeing a corpse, or even the recoedsablvanimal carcass fromwhich theiinxt steali'gbop will be,ct Death, fsr thern, isyucky, best not thought about. But not orJack Kevorkian. He ws fascinated bv it.It is not clear when *tis fr.itin't.-gari.butthe' uld.be.Dr,Kevorkililr.lyli-a{,it by thg tirne he was,attending thUhiversiry of Mihigan Medlcat,ScfrJt.iirivas there that he first proposed that con-demned prisoners should, with theif per-rnission, be executed under anaesthesiii toenable doctors to experiment on their bo-dies, before going on to harvest their or-gans and use them for research. A fewyears later, after serving as a military doc-tof in Korea, he would arry out,studies of9. !g-"1eye j_usr as life laves the body(the blood vessels in the cornea become in-visible). He alss advocated drawing bloodfrom corpses for use in transfusins. By

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