Some right-to-die advocates claim that passive euthanasia merely means allowing people to die the way they did a century ago, before the advent of what Barnard called “rampant technology.” They believe that in some cases more direct action is necessary—that it should be legal for physicians to provide a lethal dose of medication for terminally ill patients who request it. Others suggest that physicians should be permitted to give such patients a lethal injection—what is called voluntary euthanasia. “Can doctors who remove the feeding tubes from patients in a persistent vegetative state really believe that there is a huge gulf between this, and giving the same patients an injection that will stop their hearts beating?” wrote ethicist Peter Singer in his 1994 book, Rethinking Life and Death. “Doctors may be trained in such a way that it is psychologically easier for them to do the one and not the other, but both are equally certain ways of bringing about the death of the patient.” Wrote cardiologist Thomas Preston in the Wall Street Journal, “the morphine drip is undeniably euthanasia, hidden by the cosmetics of professional tradition and language.” Joseph Fletcher has asked, “What, morally, is the difference between doing nothing to keep the patient alive and giving a fatal dose of a painkilling or other lethal drug? The intention is the same, either way. A decision not to keep a patient alive is as morally deliberate as a decision to end a life.”
Legally, however, those decisions are vastly different. While in most states it is licit in most instances to withdraw life-support systems, thirty-nine states have statutes explicitly prohibiting assisted suicide, while in six other states the practice is implicitly prohibited by common law. With or without legal sanction, people have long been helping their suffering loved ones die. In 1920, thirty-six-year-old Michigan farmer Frank Roberts was convicted of murder and sentenced to life imprisonment in solitary confinement, and with hard labor, for supplying poison to his wife, who suffered from multiple sclerosis, had previously attempted suicide by swallowing carbolic acid, and had begged to die. (The governor later commuted Roberts’s sentence and he was released from prison after three years.) In 1983, Betty Rollin helped her seventy-six-year-old mother, terminally ill and often in agony from ovarian cancer, obtain a lethal dosage of barbiturates, then sat with her while she died. A television journalist and author, Rollin described her mother’s death in Last Wish, which became a best seller and generated thousands of letters, the vast majority of them praising her act.
Despite such a change in reception, assisted suicide remains risky, although judges and juries tend to be lenient. In one recent case, Huntington Williams, a seventy-four-year-old emergency medical technician in rural Connecticut, helped his longtime friend, sixty-six-year-old John Welles, who was dying of prostate cancer, complete suicide by cleaning his revolver, carrying it outside while Welles used a walker, and giving him advice about where to aim. (Williams walked to the end of his friend’s driveway before Welles pulled the trigger.) Charged with second-degree manslaughter under a state law prohibiting assisted suicide, which carries a maximum prison sentence of ten years, Williams was given a year’s probation. The courtroom, packed with friends of the two men, burst into applause when the decision was announced. One right-to-die advocacy group, studying newspaper clippings, has estimated that the incidence of double suicides and assisted suicides involving the terminally ill has increased forty times since Frank Roberts helped his wife to die. These admittedly unscientific findings probably represent only a small fraction of the actual cases, since few come to court or surface in newspapers or books. The vast majority are carried out in secret. Says a woman who obtained a lethal dose of barbiturates for her terminally ill mother, then sat with her while she swallowed it, “What makes me sad and a little angry is that because what I did is against the law, for the rest of my life I will have to keep secret something that I feel so good about.”
But even with the help of a friend or a family member, suicide can be difficult. Lethal medications aren’t easy to obtain, and without knowledge of what constitutes a lethal dose, people can easily find themselves worse off. Other methods, such as gunshot and hanging, may be more certain to end in death, but are extraordinarily traumatic for both the protagonist and the loved ones left behind. That is why an increasing number of people believe that it should be legal for physicians, who have the technical expertise, to assist terminally ill people to take their own life. Although no physician in America has ever successfully been prosecuted for assisting a suicide, every major national medical organization in this country opposes the practice, and over the years, only a few cases of physician-assisted suicide have come to public attention. That would change in June of 1990, when an unemployed sixty-two-year-old Michigan pathologist hooked up a fifty-four-year-old English teacher from Oregon to a homemade suicide machine in the back of his 1968 Volkswagen van.
If assisted suicide advocates had had a choice, they would not likely have chosen Jack Kevorkian as the standard-bearer for their cause. A short, skinny man whose hawkish face, close-cropped white hair, and porkpie hat made him look more like a racetrack tout than the television ideal of a physician, Kevorkian had evinced a fascination with the end of life that had earned him the nickname Dr. Death long before he hooked up Janet Adkins to his suicide machine. The only son of Armenian refugees who had come to this country to escape the Turkish genocide, Kevorkian had, over his career, become increasingly marginalized by the medical profession for his controversial proposals: that lives might be saved by performing battlefield transfusions directly from corpses to wounded soldiers; that doctors might calculate the optimal time for organ harvesting by photographing the retinal blood vessels of dying patients to determine the exact moment of death; that organs be harvested from consenting death-row inmates; that medical experiments be performed on consenting death-row inmates during executions to advance our understanding of the dying process—and thereby help to avoid killing innocent animals in the name of science.
As an intern, Kevorkian had been outraged by the plight of elderly patients allowed to suffer prolonged deaths; in his thirties, he had watched his mother die slowly and painfully of bone cancer. But the primary motivation that led him to assisted suicide was his interest in medical experimentation on the dying. When he heard that physician-assisted suicide and euthanasia were widely practiced in the Netherlands, it occurred to him that patients who opt for euthanasia might be ideal subjects. In 1987, he flew to Amsterdam and met with leaders of the Dutch euthanasia movement, who found his proposal so radical they feared it might damage their cause. Kevorkian returned home, determined to perform assisted suicides himself, though his goal of experimentation on the dying would eventually fall by the wayside. He passed out business cards that read:
Jack Kevorkian, M.D.
Bioethics and Obitiatry
Special Death Counseling by Appointment Only
(Obitiatry—from the Latin obitus, “death,” and the Greek iatros, “doctor”—was a word Kevorkian had invented to describe his specialty, the treatment of death and dying.) When the oncologists to whom he distributed his cards refused to refer patients to him, he inserted classified ads in local newspapers: “Is someone in your family terminally ill? Does he or she wish to die—and with dignity? Call Physician Consultant.” Only two people called, neither of whom Kevorkian felt would make an appropriate case: a man phoning from out of state on behalf of his comatose brother, and a young woman who was clearly mentally disturbed. Kevorkian published an article in which he described his plans for suicide clinics (“obitoria”) in which terminally ill patients might be assisted to their deaths “under controlled circumstances of compassion and decorum.” When his obitoria idea failed to catch on, he decided to act on his own. Working at his kitchen table, with an electric drill, a soldering iron, and $30 worth of parts scavenged from flea markets, garage sales, and hardware stores, he built his first suicide machine: a frame of scrap aluminum, a trio of intravenous lines connected to three inverted bottles—one containing a harmless saline s
olution, the second sodium pentothal, and the third a mixture of succinylcholine (a muscle relaxant) and potassium chloride (a poison)—and a simple on/off switch that triggered a small electric motor salvaged from a toy car. After an article about Kevorkian and what he dubbed his Mercitron appeared in a local Michigan newspaper, he started getting calls from around the country—from reporters wanting to interview him and from suffering people wanting to use his machine.
In the fall of 1989, Janet Adkins read about Kevorkian in Newsweek. Married thirty-three years, the mother of three, an English teacher at a community college in Portland, Oregon, and a member of the Unitarian Church and of the Hemlock Society, Adkins had been diagnosed with early-stage Alzheimer’s. As medical treatments failed and her mind continued to falter, she decided that, rather than risk waiting until she was unable to make any decisions at all, she would end her life. She considered taking pills or jumping from a tall building, but feared she might botch the job. Besides, she wanted a more dignified death. After reading about Kevorkian’s machine, she asked her husband to telephone Kevorkian, who encouraged her to take part in an experimental drug trial she was considering. But the drug didn’t work, her condition deteriorated, and the following April, her husband called Kevorkian again. After reviewing Janet Adkins’s medical records, Kevorkian decided he had found his first case.
On June 1, a few days after playing tennis with one of her sons (she could still beat him but she could no longer keep score), Adkins and her husband flew to Detroit and met with Kevorkian in their room at the Red Roof Inn. Later, they went out to dinner. (In the preceding weeks, Kevorkian had frantically contacted doctors’ and dentists’ offices, funeral homes, hotels, churches, and friends, in an effort to find a site for the assisted suicide. Everyone refused him. Adkins told him that his van would be fine.) On June 4, 1990, three days after Adkins and Kevorkian had met, Kevorkian’s two sisters drove Adkins to a wooded public campground outside Detroit, where Kevorkian, who had rented a campsite, was waiting in his van. Adkins lay down on the built-in bed next to the suicide machine. The windows were draped with yellow curtains Kevorkian had sewn to give them some privacy. Kevorkian hooked up Adkins intravenously to the saline solution. At Adkins’s request, Kevorkian’s older sister, Flora, read the Twenty-third Psalm. When she was ready, Adkins pushed the switch, shutting off the saline solution and opening the adjoining line of sodium pentothal, which would put her to sleep. Adkins said, “Thank you, thank you.” Kevorkian replied, “Have a nice trip.” After one minute, a timing device triggered the flow of potassium chloride. Within six minutes Adkins was dead.
At the time, Michigan had no laws that specifically addressed assisted suicide; the act was covered under statutes prohibiting murder and manslaughter. Kevorkian was arrested and charged with first-degree murder. The charge was eventually dismissed. Over the following eight years, Kevorkian would assist in at least 130 more “medicides” (Kevorkian shorthand for “medically assisted suicides”). Some took place in parks and motels, some in the homes of friends, some in the back of Kevorkian’s rusted white VW bus. (Afterward, Kevorkian always notified the authorities and let them know where the body could be found. For convenience—and so his vehicle wouldn’t be impounded when the police arrived—he often left the corpse in a wheelchair, an explanatory note pinned to the clothing, outside a hospital door.) Some used the Mercitron, or a variation incorporating the minor improvements Kevorkian made, Rube Goldberg–fashion, over time. After Kevorkian’s medical license was suspended, and he could no longer easily obtain potassium chloride, some used a second Kevorkian creation, in which the patient released a clip on a tube to deliver carbon monoxide through a plastic mask. Over the years Kevorkian was helped in his work by a Dickensian cast of characters: his younger sister, Margo Janus, who was often behind the camera, videotaping the proceedings, until her death in 1994; Neil Nicol, a salesman of medical supplies, who had been the experimental subject when Kevorkian had first transfused blood from a corpse (a stroke victim) to a live human being (Nicol) in the sixties, and who now assisted with logistics and transportation, furnishing the carbon monoxide as well as providing his living room’s foldout sofa for the site of several Kevorkian-assisted suicides; and Geoffrey Fieger, a flamboyant local lawyer and former rock band roadie, known for winning huge settlements in medical malpractice suits, who kept his client from being convicted during an eight-year game of cat and mouse with local prosecutors determined to prevent Kevorkian from turning Michigan into what they called “the suicide capital of the world.”
The defacto manager for Kevorkian’s jury-rigged operation was an energetic older woman named Janet Good, former district manager for a company selling home permanents, active feminist, and founder of the Michigan chapter of the Hemlock Society. Good met Kevorkian in 1989 after she saw his ads, offering to help the terminally ill, in her local newspaper. “I was getting calls from all these poor, suffering people who were saying, ‘Please send me a Hemlock pill,’ “ Good recalled when I met her in 1997. “I thought Dr. Kevorkian could give me narcotics to help them out of their misery.” He couldn’t, but he told Good about his suicide machine.
Their relationship got off to a difficult start when Good’s husband, a retired police captain, refused to let their home be the scene of the Janet Adkins “medicide.” But Good soon made herself indispensible: screening applicants (“I think of them as patients, but we call them clients, so we’re not thought of as practicing medicine without a license”); getting release forms signed; scheduling assisted suicides; suggesting hotels and plane flights for out-of-town clients; and taking notes at Kevorkian’s hearings and trials. Indeed, if the Kevorkian operation could be said to have an office, it was the family room of Good’s suburban redbrick ranch house, which sat on a half-acre plot of carefully clipped lawn bordered by purple impatiens. In the shadow of a large television and a glass-fronted bookcase filled with Reader’s Digest condensed books, Kevorkian met Good almost every other day, occasionally playing hooky on the local golf course. Sitting in two well-worn pink recliners, with a jar of chocolate-covered graham crackers (Kevorkian’s favorite cookies) between them and the Goods’ spaniel at their feet on the lavender wall-to-wall carpeting, they sorted the mail Kevorkian had lugged there in a large shopping bag. (Good’s husband, who tolerated but did not smile on these proceedings, usually retreated outside to weed the garden.) The letters were divided into three piles: those thanking Kevorkian for his work (“I call them ‘the love letters’ “); those from people Kevorkian couldn’t help either because they were insufficiently sick or serious or because they were depressed; and those from potential “candidates.” Good or Kevorkian called every candidate, interviewed them, and requested their medical records. Good was also, occasionally, present at the end, when, she says, Kevorkian often wept. She explained to me, “People say, ‘It’s so macabre—you’re there when people die.’ But it’s so personal, so private, so gentle, so nonsuffering, so easy, that all you feel is calmness for the family. I admire the doctor for putting his life in jeopardy, but I admire him even more for the caring and concern he gives people in the final hours and minutes of their lives.” (Several months after I met her, Good, suffering from pancreatic cancer, was herself helped to her death in her home by the man she called “the doctor” or “Doc” or, occasionally, “my Doctor Kevorkian.”)
Even today, it would be difficult to overestimate the grip that Kevorkian had on the national imagination. His name recognition in the nineties was second only to Bill and Hillary Clinton’s. He was called a devil, a monster, a loose cannon, a lunatic, a madman, a psychopath, a sicko, a kook, a publicity hound, a vigilante, a serial killer, Jack the Ripper, the Antichrist, Doctor Arrogance, and Doctor Death. He was also called a hero, a saint, a savior, a visionary, a crusader, a prophet, a pioneer, an angel of mercy, and Doctor God. Right-to-life protesters and disability rights advocates picketed his court appearances; strangers approached him on the street to bless him or encourage him to �
��keep up the good work.” His critics called him callous and controlling; his “patients” said he was far more caring than the other doctors they’d encountered during their suffering. In court, family members of people Kevorkian had assisted to their deaths wore buttons that read I BACK JACK.
Kevorkian’s notoriety was doubtless reinforced by his personal eccentricity. A lifelong bachelor who lived on his pension and Social Security benefits—he never accepted payment for his services—Kevorkian subsisted largely on a diet of Velveeta-on-white-toast sandwiches, bought his threadbare clothes at the Salvation Army (he favored cardigan sweaters and clip-on ties), worked at a plywood desk on a manual typewriter purchased for $2 at a garage sale, and slept on a single mattress on the floor of his rented second-floor apartment in Royal Oak, a suburb of Detroit. He loved puns, wrote risqué limericks, was a passionate golfer, and played cards every other week with a small circle of acquaintances. (He was said to have a good poker face.) He played the flute, organ, and piano. He composed music. (In 1976, after quitting his job as a pathologist, he drove his van to Los Angeles, where he spent his meager savings on making a film—never released—based on Handel’s Messiah.) He was an amateur painter whose canvases depicted severed heads, maimed bodies, internal organs, skulls, cannibalism, and genocide. By all accounts, he was a shy, cocky, witty, vulgar, opinionated man with a profound disdain for authority. His few friends and associates admitted he could be prickly and abrasive, but said these qualities were more than compensated for by his brilliance and his courage. Kevorkian likened himself to Margaret Sanger, Sigmund Freud, Rosa Parks, Dr. Martin Luther King Jr., and the fictional Dr. Frankenstein. He showed up for a television interview dressed up in cardboard stocks, with a ball and chain on one leg, to dramatize his persecution; for a court appearance, he wore a colonial costume—tights, powdered wig, shoes with oversize buckles—to protest being tried under a centuries-old common law. He gave the family members of his early medicides gold chains engraved with a number indicating their loved one’s chronological place in the order of those he had assisted.
November of the Soul Page 56