"The Kevorkian Epidemic" by Paul R. McHugh, in The American Scholar (Winter 1997), 1811 Q St. N.W., Washington, D.C. 20009.

By helping more than 40 depressed sick people to kill themselves, Dr. Jack Kevorkian has helped give life to the controversy over assisted suicide—and won scattered acclaim as a humanitarian crusader. McHugh, director of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine, says Michigan’s "Dr. Death" is outrageously, even insanely, mistreating those who put themselves in his care.

"Most suicidally depressed patients are not rational individuals who have weighed the balance sheet of their lives and discovered more red than black ink," McHugh writes. "They are victims of altered attitudes about themselves and their situation, which cause powerful feelings of hopelessness to abound." Their depression is treatable—and it should be treated. Modern medicine no longer regards even terminal illnesses as "signposts to the grave," he notes, but views diseases rather as "processes in life for which the body has ways of compensating and resisting, even if only temporarily."

Depression among the seriously ill comes in two forms, McHugh says. Patients with certain illnesses—including Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, AIDS dementia, and Huntington’s disease— are often afflicted by depression as a symptom of their ailments. "They are overcome with a sense of hopelessness and despair, often with the delusional belief that they are in some way useless, burdensome, or even corrupt perpetrators of evil . . . ," he writes. "These patients lose their capacity to concentrate and reason, they have a pervasive and unremitting feeling of gloom, and a constant, even eager willingness to accept death."

Though that may seem a reasonable assessment of the patients’ situation to family members and physicians, it is actually part of the illness, as much a symptom of it as fevers, pain, or loss of energy. Modern antidepressant drugs, McHugh says, are "usually effective at... restoring the patient’s emotional equilibrium."

Of course, some seriously ill patients are suicidally depressed for other, "perfectly understandable reasons, given the grueling circumstances of their progressive and intractable disease." But their demoralization—unlike symptomatic depression— tends to wax and wane, to come in waves, and to be worse at certain times, such as during the night. "All patients afflicted with disease—curable or incurable—are susceptible to bleak assumptions about their future and their value," he says. "These susceptibilities can be magnified or diminished by the behavior of their physicians." In short, demoralization, too, is treatable.

Most pain-ridden patients suffering from terminal or progressive diseases do not in fact go in search of death, McHugh points out.Those who do are not the norm; they are people who need the help and protection of their physicians. The death-dealing Dr. Kevorkian instead "trades upon the vulnerabilities and mental disorders of these patients and in so doing makes a mockery of medicine as a discipline of informed concern for patients."