Dr. Jack Kevorkian-Serial Killer or Angel of Mercy?

DOCTOR JACK KEVORKIAN - SERIAL KILLER OR ANGEL OF MERCY?

From my research, it's clear that people often confuse the issue of physician assisted suicide with the individual, Jack Kevorkian who has brought this issue to the front pages of our newspapers. I wish to consider them separately.

Not much is known about Jack Kevorkian's childhood other than he was born of Armenian immigrants in 1928. It has not been mentioned what his father did for a living but it was presumably enough to finance his studies in college and med school. He has two siblings, both sisters, both living and involved with him and his work. According to both his sisters, Kevorkian was the favorite child at home.

Kevorkian is described by everyone who ever knew him, as very highly intelligent with a keen sense of humor.

He showed a preoccupation with death rather early in his medical career when he asked to work nights during his residency as a pathologist because more people died at night. He was successful in photographing a few people at the moment of death in order to study their eye movements. This behavior must have been considered a bit odd by his contemporaries who gave him the nickname of 'Dr Death'.

Then, still during his residency, he got what he felt was a brilliant idea. Why, he reasoned, waste convicts in execution when they could be put mercifully to sleep under general anesthetic, experiments done in vivisection and then, if they had not died from the experiments, a lethal dose of anesthetic could be administered.

This was before lethal injection had ever been discussed and hanging and the electric chair were the common means of execution of criminals.

Much to his dismay, his brilliant idea met with less than enthusiastic response from the medical community. He even went so far as to elicit approval from a convict or two on death row and yet, his ideas went largely unnoticed. And a growing opposition to the death penalty caused him to shelf his ideas for a while.

During the sixties, he had another brainstorm. He decided that newly dead corpses might provide a good harvest of blood and even talked a medical tech, Nicole Neal, into allowing him to transfuse Neal from a corpse. Kevorkian felt that this would really help things on the battlefields of Vietnam and pitched this idea to the Pentagon but was turned down. There was no interest in the medical community stateside because they felt that there was no shortage of blood and they didn't have to deal with corpses in that manner.

When the death penalty came back into vogue (Kevorkian mentioned in his book, "Prescription MEDICIDE" that he was confident it would come back as at no time in history did capital punishment totally disappear), the erstwhile pathologist began to push his idea of merciful death and vivisection on convicts with a new twist. One might, he pointed out, harvest organ donations from the convicts. He clearly stated, however, that organ donations was only a by product of the more important part of his plan i.e. the experiments. He wrote:

"My motive for pursuing this campaign is not to help alleviate the continuing shortage of organs. Rather it would be just a by-product of my aim to convince a self centered medical profession and an insouciant society to civilize the way the death penalty is inflicted." (PRESCRIPTION: MEDICIDE - Kevorkian)

However, there were those who felt his plans of vivisection were anything but civilized and bore some resemblance to the Nazi experiments in the death camps. Kevorkian felt his plans were different from what the Nazis did because the Nazis were indescriminate in chosing victims whereas all his subjects would be condemned convicts who were scheduled to die anyway, and also because the Nazis often did their experiments without anesthesia whereas his subjects would be totally anestisized from start to finish.

Undaunted by the lack of acceptance of his ideas, he continued to push them and in the late seventies, built the first machine for this purpose which he called a "Mercitron". This was a rube goldberg sort of contraption on which hung three bottles for I.V. drips. One, sodium pentathal to knock the patient out, another, potassium chloride, to cause death in the patient and a third, a saline solution to start the IV drip. He constructed this 'machine' out of household parts and hardware obtained from the local hardware store.

He sought a subject to try the Mercitron on, first seeking a dog from the pound. However, obtaining such an animal was difficult due to the protections against vivisection (the VERY thing Kevorkian advocated with condemned convicts!) and the good doctor realized that a suicidal human would be easier to find. Running ads netted him no takers but from an article published about him in a newspaper, he received a call from what was to be his first 'patient'.

She was a 54 year old woman who had been diagnosed Alheimers a year previously and was quite depressed about the prospect of losing her mental faculties. She and her husband were members of the Hemlock Society, a group which advocates the free choice of 'rational suicide'.

Kevorkian made a somewhat macrabre video tape of her and all his 'patients' probably in case any questions should arise as to their free will choice of his services. Her doctor disagreed with her choice of suicide saying that she had many good years ahead of her. But this is what she wanted.

On the day they chose, Kevorkian had some problems with the 'mercitron' and she waited 5 hours until she got a chance to use it but use it she did and Kevorkian made headlines though not in the medical journal he wished but rather in the news as he was a suspect in a murder case. There was no law against 'physician assisted suicide' at the time and he was released and knew he found his niche. Without abandoning his goal (making death meaningful through experimentation and organ harvest), he ended up helping out 19 other people to die.

Some were terminally ill but most were disabled (several had Multiple Sclerosis) and one had no physical ailments but suffered from Major Depression. She complained of pelvic pain but on the autopsy, it was discovered that there was no physical cause of that pain. Kevorkian does not do much checking up on the patients relying on their word that they wish death, to be sufficient reason for an assisted suicide.

A law was passed by the Michigan legislature prohibiting physician assisted suicide but Kevorkian has defied the law and only is facing charges on one case where the patient's intent is not real clear. He lost his medical license a few years ago and now cannot obtain the chemicals for the mercitron so most of his assisted suicides were done with plain old carbon monoxide, which takes about five minutes to render a person unconscious - not as merciful as Sodium Pentathal which renders a person unconscious in seconds.

Kevorkian considers himself a humanitarian of the first order despite the opposition he's received - he attributes that opposition to stupidity or narrow sightedness or religious fanaticism. Considering his attitudes towards others together with the fact that he has always been a loner suggests he might be suffering from some sort of pathological narcisism. Indeed, he was engaged once but broke off the engagement because the lady did not meet up to his requirements of discipline. Later he lamented his decision because he did not procreate and thus felt he was immoral in denying the world, his progeny.

Masterson writes:

"In this narcissistic intrapsychic structure, the object representation was omnipotent, controlling, all-powerful, the self representation being grandiose and special, the affect being that of feelings of superiority, uniqueness and well-being..." (THE NARCISSISTIC AND BORDERLINE DISORDERS by James Masterson, MD)

Geoff Fieger, his attorney who has gained quite a bit of fame and fortune by representing his illustrious client simply says:

"Kevorkian's qualities were probably not the best qualities to have in intrapersonal relationships but they are qualities which allow people to rise about the rest of us." (APPOINTMENT WITH DR DEATH by Michael Betzold, from a personal interview with Fieger, April 22, 1993)

Unlike his attorney, Kevorkian has not received much in the way of material gain from his business and he lives very simply in a one bedroom apartment, sparcely furnished. He drives an old Volkswagon Van which he's had for years. His last good job was in 1970 when he was chief pathologist at Saratoga Hospital on the East side of Detroit.

He left that job in 1976, to fulfill a dream to make a film in Hollywood which he somehow, as a lone wolf successfully achieved. But the film was never exhibited and Kevorkian will not talk about it at all. He hopped from job to job in the next few years, in California and back in Michigan. He resumed his macabre research on the dead and even wrote an article which went into detail about vivisection in history on condemned criminals. In a 1986 article in MEDICINE AND LAW, Kevorkian praised the Nazi doctors for trying to get some good out of concentration camp deaths through medical experimentation.

Kevorkian seems a man of many talents and after an oil painting class, he painted several rather good paintings which he exhibited at an art fair. His paintings appeared to not have much appeal to the art lovers though as they all concerned death in one way or another. Dr Kevorkian, a slight man, claims that in his freshman year in college, he fought a great battle with obesity, his weight rising to 162. He wrote a book on his success in keeping his weight off. The book, spiced with his brand of clever humor, advises people to eat whatever they want but leave half of all portions on the plate.

Some of Kevorkian's critics say that he seems to 'get his jollies' out of assisting a suicide. Indeed, in watching his demeanor in the video tapes, he is a bit too casual for a person about to witness the death of another, indeed to CAUSE that death. He smiles and jokes and describes his methods in detail. There is some support for saying that he enjoys helping folks to die and has just found a legal way to do it, unlike others like Jeffrey Dalmer. There are some similarities in the young Dalmer to the young Kevorkian.

Kevorkian may have the support of some religious people but he makes no bones about the fact that he has no use for religion. He considered the church of his birth a fraud (Armenian Catholic) and Yahweh, a manmade god. He wrote:

"Technically committed by oath, a doctor has no business invoking any other principle or creed. Judeo-Christian ideas become not only irrelevant but anathema." (PRESCRIPTION MEDICIDE - Kevorkian)

The news services showed films of Kevorkian saying:

"Medical tyrants, religious tyrants... it's the tyrants who rule the world" (seen on the PBS special FRONTLINE)

Although Kevorkian doesn't seem to be getting any material benefit from his business (which he calls OBIATRY), he is getting the fame he has sought all his life. And he feels that it is long overdue as he wrote:

"I alone represent the feckless intellectuals whom Einstein addressed... Yet I am not really alone for I have the rare honor of representing a host of truly intellectual giants - indeed geniuses - now dead, who spoke out courageously." (GREAT MINDS RULE FROM THE GRAVE by Jack Kevorkian)

WHAT IS WRONG WITH PHYSICIAN ASSISTED SUICIDE?

We will not deal with any of the religious reasons here except to say that a deist feels that only God can create and destroy. Additionally, a deist who believes in the hereafter might think twice about taking a chance of destroying his/her future for a few moments of relief from the pain.

It's actually relief from the pain we all seek and not death. Trouble is at times we feel death IS the only relief from pain. However, studies have shown this is not true at all.

Good pain management which includes counseling and medication as well as autogenics can be a better relief from the pain. A relief without hurting the relatives or going through what must be a harrowing experience of committing suicide.

Here are some reasons that physician assisted suicide may not be the look, even from a secular point of view (disregarding religious reasons)

1. People have the right to commit suicide and can do so anytime. But when you allow another person to assist, are you not giving up your total autonomy to that person? You plan a date and then, while that person is there, you might be a bit redicent to back down because perhaps that person will not come back. In a couple of cases, Kevorkian let his patients know that he had to 'do it' soon because the law or something else might stop him. That's pressure which might not be good as death is such a final step.

Dr Howard Brody compared Kevorkian's methods to a Dr Timothy Quill who prescribed a lethal dose of pain medication to one of his patients dying from cancer - "Diane" eventually used the pills to commit suicide. Brody, chairman of Michigan's bioethics committee, pointed out that:

"Quill's patient can take a bottle of barbituates and look at it and say 'I'm just going to die tonight - I'm just too bad' and then say 'Maybe I should sleep on this, I'll see how I feel in the morning'...she can decide whether to die or not die without Quill standing there looking at her, saying 'when are you ready?'...she has the freedom to think about it a bit." (APPOINTMENT WITH DR DEATH - Michael Betzold)

2. Suicide of any type is still too difficult on the surviving relatives. Suicide involves a free will decision to leave whereas a natural death leaves the decision beyond human range. In a natural death, there can be a better preparation for it. The relatives of a suicide victim have much to get used to. For one thing, there is the feeling of guilt that you somehow failed the person. For another thing, the feeling that this person didn't love you. I speak from experience as my mother committed suicide and it took me two years to get over it. Relatives of suicide victims do not grieve normally, with a serenity that this person is now at rest. This can be seen in the relatives of the twenty people whom Kevorkian assisted. They meet and have a sort of support group. Several seem to be unable to mention the incident without breaking down and weeping, even years later. Most express ambivilence at their relative or friend's decision but wished to allow the person the free will to decide. Many families of persons who committed suicide say they would never do that because of the terrible adjustments the family must make. Psychologists say that 75 percent of of those committing suicide are angry at their families and seeking a way to 'get even' whether consciously or unconsciously.

3. In any but the very terminal patients, the disease course might reverse and the person might become better. Several of Kevorkian's patients were people with Multiple Sclerosis and this disease typically shows a course of exacerbation and remission. Many patients, terribly disabled at the 3 year point, are again walking at the ten year point. In patients like the first, with Alsheimers, no one can predict the course. As her doctor said, she would have had many good years ahead of her. Just days before her suicide, she won a game of tennis with her son. Then, too, with Alsheimers, there is always a possibility that they will find a cure before the person is badly disabled from it. As has been said, it's not the uncertainty of the future which scares us but rather what we perceive as the _certainty_ of the future. However, the future often comes out differently from our perceptions of what it will be.

4. Only 3 or 4 percent of suicides are terminally ill persons. In the rest, there is probably a better way of handling the pain. Although 3 out of 4 suicide attempts are women, men are far more successful at completing the act. This may be because of the difficulty involved with committing suicide if one does not choose something violent like a gun. However, most all people who are talked out of suicide and receive help, are very glad to find a new life out there and very happy they did not go ahead with their plans of ending it all. Suicide is a poor treatment for depression, it turns out. And depression, not the physical illness is the problem. It's been shown by people such as Helen Keller and others that quality of life is in the person and not in how healthy or able they are.

Hugh Gale, the Kevorkian patient with COPD said he did not sleep at night but his wife said that after he talked with Kevorkian, he slept very well for the first time in years. This shows that his not sleeping was not entirely due to his illness and thus, things like this could have been managed with a less final solution like better pain management and counseling.

5. The American Medical Association is opposed to Physican Assisted suicide for two reasons, primarily.

A. A good relationship between physician and patient is based on trust. If this trust is not there, the patient may not take his/her doctor's advice and thus, might undermine a possible cure. Right now, people are more prone to trust folk medicine rather than empirical medicine. A good example of this would be one of Kevorkian's patients, Martie Ruwalt, who when told to obtain chemotherapy, chose instead, a folk treatment from Mexico. This decision may have well cost her, her life but she evidentally did not trust empirical medicine enough to follow her physician's advice. In the Netherlands, where physician assisted suicide and euthanesia (there's a fine line between the two) have been practiced for twenty years, patients express a mistrust of treatments suggested by their physicians. "We don't know whether that yellow stuff in the needle will cure us, or kill us".

B. The AMA does not know how it would be possible to safeguard against abuses of physician assisted suicide and euthanesia - it would be almost impossible to prevent abuse. No one but Dr Kevorkian and his patients were there at the time of suicide. Suppose one of them changed their mind but Kevorkian would still wanted to go ahead with the procedure. Who would know? Indeed, the one case for which Kevorkian is being tried, was a man with Lou Gehrig's disease (ALS). Thomas Hyde, 30 years old, was never really clear about whether he desired physician assisted suicide and on the day he was scheduled for it, he stood by his daughter's crib and cried like a baby. When Kevorkian asked him if he were sure, just before Kevorkian put on the mask to administer carbon monoxide, Hyde said something which Kevorkian admitted was 'unintelligible' however, Kevorkian said he saw a tiny smile on Thomas' lips which made Kevorkian feel he had the go-ahead. This is not much of a sign, however and even if Hyde clearly wanted suicide which is certainly possible, one can see how easy it would be to abuse this and administer death to those who don't want it or have changed their minds.

One of the doctors interviewed on Frontline said that Kevorkian was a criticism of all the doctors, for these people should have been able to have conversations about their pain with their own doctors. "Where were their doctors when they needed them?" he asked.

by Sue Widemark, sysop Cheese Whiz BBS Phoenix, AZ. 602-279-0793

The information above is presented to the public as a public service, free of charge by the author (Sue Widemark) but is copyright by Sue Widemark, 1994. It may be freely copied but must be presented unabridged, as above.

Resource materal used in the above:

APPOINTMENT WITH DR DEATH by Michael Betzold (Momentum, Troy, MI. 1993)

PRESCRIPTION: MEDICIDE by Jack Kevorkian (Prometheus; Buffalo, NY 1991)

THE NARCISSISTIC AND BORDERLINE DISORDERS by James F. Masterson, MD (Brunner/Mazel; New York, NY 1981)

Also, the TV program, FRONTLINE: "The Kevorkian Paper", aired in April 1993 on PBS.