A Mean Act of Revenge Upon Lifeless Clay

Jack Kevorkian died today, and many are commenting about his role in the “right to die” movement.  While I am a supporter of the movement generally, I did not find Kevorkian to be a courageous man.  His actions had a significant detrimental impact on the efforts of others to provide ways for physicians to aid the terminally ill to end their lives on their own terms and with dignity. 

Consider for a moment the case of Diane, and imagine the circumstances she found herself in.  She had been raised by an alcoholic family when she was a child and had suffered a great number of torments in her life, including vaginal cancer as a young woman, clinical depression, and her own alcoholism.  When her physician diagnosed her with myelomonocytic leukemia, she was presented with the options:  She could proceed without treatment and survive for a few weeks or perhaps even a few months if she was lucky, but the last days of her life would surely be spent in pain and without dignity; it was not how she wanted her friends and family to remember her.  If she accepted the treatment her doctor had discussed, there was a 25% change of long-term survival, but the treatment itself — chemotherapy, bone marrow transplantation, irradiation — would also rob her of much of what she valued about life, and would likely result in as much pain as doing nothing.  For her, the 25% chance that such treatment would succeed was not worth it.  Others might have differed in their assessment, but this was hers. 

Neither option presented to her — let the disease run its course or accept a treatment she had rejected — was acceptable, and so she considered the unspoken alternative.  Diane’s physician told her of the Hemlock Society, even knowing that he could be subject to criminal prosecution and professional review, potentially losing his license to practice medicine.  But by having a physician who knew her involved in her decision, her mental state could be assessed to ensure that it was well-considered and not a result of overwhelming despair.  Her physician could explain how to use the drugs he prescribed — ostensibly to help her sleep — so that until the time came, she could live her life with confidence that she had control over when to end it.  She could enjoy the short time she had remaining without being haunted by fears that it would be ineffective or result in any number of consequences she did not want.  In the end, Diane died alone, without her husband or her son at her side, and without her physician there.  She did it alone so that she could protect all of them, but died in the way that she herself chose. 

The story of Diane is one that her physician, Dr. Timothy Quill, published in the New England Journal of Medicine in 1991.  A copy of it can be found here.  It was one of the first public accounts of a physician acknowledging that he had aided a patient in taking her own life.  It was to prompt a debate about the role of physicians at the end of life, and a subsequent study published by the same journal in 1996 found that about 20% of physicians in the United States had knowingly and intentionally prescribed medication to hasten their patients’ deaths. 

But the quiet, thoughtful, and sober approach adopted by Quill and many other physicians to the issue of physician-assisted suicide was very much derailed by the grandstanding antics of Kevorkian.  His theatrical flouting of the law, prompting law-enforcement agencies to act in making an example of him rather than seriously considering the merits of his views, were counterproductive to the medical debate. 

Kevorkian’s fascination with death was long part of his life.  He was not, as many believe, christened with the nickname “Dr. Death” because of his efforts promoting physician-assisted suicide.  That happened long before, during the 1950’s shortly after receiving his medical degree.  While a resident at the University of Michigan hospital, he photographed the eyes of terminally ill patients, ostensibly to identify the actual moment of death as a diagnostic method, but more truly “because it was interesting [and] a taboo subject.”  Later, he presented a paper to the American Association for the Advancement of Science advocating “terminal human experimentation” on condemned convicts before they were executed.  Another of his proposals was to euthanize death-row inmates so that their organs could be harvested for transplantation. 

His views have politely been described as “controversial,” but are perhaps more accurately considered gruesome and bizarre, such as his experiments aimed at transfusing blood from corpses into injured soldiers when other sources of blood were unavailable.  The result of his various investigations was considerable professional damage, causing him to resign or be dismissed from a number of medical centers and hospitals.  His own clinic failed as a business.  For all his current notoriety, Kevorkian was throughout his career considered very much an outsider to the mainstream medical-science community. 

In considering the legacy of Kevorkian, it is important to recognize the long history of the debate over physician-assisted suicide, which dates at least from the days of ancient Greece and Rome.  The modern debate in the United States has its origins in the development of modern anaesthesia.  The first surgeon to use ether as an anaesthetic, J.C. Warren, suggested it could be used “in mitigating the agonies of death.”  In 1870, the nonphysician Samuel D. Williams suggested the use of chloroform and other medications not just to relieve the pain of dying, but to spare a patient that pain completely by ending his life.  Although the proposal was made by a relatively obscure person, it attracted attention, being quoted and discussed in prominent journals and prompting significant discussion within the medical profession.  The various discussions culminated in a formal attempt to legalize physician-assisted suicide in Ohio in 1906, although the act was rejected by the legislature in a vote of 79 to 23. 

Today, there are three states that have legalized the practice of physician-assisted suicide — Oregon, Washington, and Montana.  The history of how that legislation came to pass, and the various court challenges that have been raised, is fascinating in its own right.  For now, suffice it to say that my own view is that those states legalized the practice because of the courageous efforts of physicians who are largely unknown, not because of the actions of Kevorkian.  Indeed their courage is all the greater that they achieved as much as they did despite his activities.