By Michael E. Miller
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Perper, Broward's medical examiner, agrees. So do the majority of Americans, according to Gallup, which announced last year that 61 percent of Americans support a terminal patient's right to die.
Perper notes, however, that the issue of assisted suicide is too dark a subject to be championed by most politicians. The opposition, while limited, is extremely vocal, led by the Catholic Church and conservative Christian political groups like the Christian Coalition and Fort Lauderdale's Center For Reclaiming America.
"It is a very deep religious problem at the very core," says Perper, who has studied the issue extensively. "Many religious faiths believe that God gives life and you cannot reject that gift. You got it and you can't discontinue it, or you are in violation of God's will."
The assisted-suicide controversy has a number of parallels to the abortion debate. In both cases a vocal minority has invoked the sanctity of life in an attempt to block acts they consider immoral. While women now have a right to abortion, most terminally or chronically ill patients who wish to end their lives in a dignified manner still must go it alone. And the parade of grisly self-inflicted deaths continues.
One of the most disturbing suicides of 1999 was that of Thomas Reynolds, age 74, who drank a half-bottle of Cygon 2E. The home-and-garden insecticide was still in his stomach and emitting a "strong, noxious odor" when he was autopsied. Reynolds, according to reports, helped the insecticide down with a bottle of vodka. He'd already arranged to be cremated before drinking this unfathomable cocktail.
Reynolds' death is a good example of how complicated the issue of elderly suicide can be. It's not all physical sickness. Reynolds suffered a heart condition, but records show that the cause of his suicide was heartbreak: His wife had died 23 days before his own death. His suicide goes to the heart of another scourge for senior citizens: untreated depression.
Consider the case of Osvaldo Suarez. Suarez had a heart condition that required bypass surgery in June 1998. His health problems forced him to quit his job at a grocery store -- the first time he hadn't worked for a living since he escaped from Cuba (and was rescued at sea) on a raft 30 years earlier. He became depressed. According to investigators, he mentioned suicide a week before he hung himself from his bird aviary in the back yard of his Hollywood home. One of his sons, who'd recently arrived in America from Cuba, found his body.
His wife, Beverly Suarez, a nurse who has worked with suffering older patients, says she believes the reason he killed himself was untreated depression caused by his bypass surgery. She says she frequently sees depression in veterans of bypass surgery at the hospital where she works. "For a man it is critical that they are functional," she says. "Some can cope and some can't. A lot of their problems seem to stem from a sense of hopelessness; they can't take care of themselves, they can't drive, monetary things. Maybe they can't have sex. They get more and more depressed. I really think a study needs to be done on the correlation between bypass surgery and depression and suicide."
Indeed depression is linked to almost all elderly suicides, often prompted by health problems or loneliness. McIntosh says research shows that most depression in the elderly goes untreated. Suarez is the rule, not the exception.
McIntosh stresses that the mental shock of finding out -- or even suspecting -- grave illness is often enough to prompt suicide, and Broward had several such cases in 1999, including George Julian's. Albert Lorenz, for instance. Lorenz, age 83, cared for his first wife until she died after a protracted battle with cancer. He often told his second wife, Virginia, that he'd never let an ambulance take him from his house. He'd kill himself first, he told her. On May 28, Lorenz, a retired salesman living in Coconut Creek, woke up and couldn't get out of bed. He told Virginia he thought he'd had a stroke. When she went to call 911, he forbid her to dial and told her to leave him alone. She heard a gunshot and found him facedown on the floor with a gunshot wound to the head. He died later at North Broward Medical Center.
McIntosh and Perper agree that cases like Lorenz's might be avoided if doctors and their staff work harder to identify depression and suicidal tendencies in those who receive devastating diagnoses. One Broward doctor, who spoke on condition of anonymity, says that trying to pick out potential suicides among those who receive grim medical news is next to impossible. "Bottom line: People respond differently," says the doctor, a general practitioner who also directs a nursing home. "And personally I don't blame them for choosing [suicide]. The suffering that goes on is unbelievable."
The doctor strongly encourages the use of living wills, which dictate that life-prolonging machines like respirators will be discontinued if the patient is terminally ill and in such poor shape that he can no longer communicate. Living wills, the doctor says, spare patients and their families the long and costly deaths that come courtesy of modern technology. He also is a strong believer in hospice programs -- which dispense large amounts of morphine to patients to ease their suffering as they die. But as Kantofsky's case shows, not everyone can get into hospice programs, and many suffering patients don't want to deteriorate to the point that a hospice will take them.