KEVORKIAN, JACK

Jack Kevorkian has become the most well-known advocate in the United States for the cause of physician-assisted suicide. Having helped an estimated 130 terminally or chronically ill individuals kill themselves between 1990 and 1999, Kevorkian sparked a national debate on the ethical issues involved in euthanasia, or mercy killing. Although Kevorkian has argued that his actions have prevented needless suffering for patients in pain and that it has allowed them to die with dignity, others see his work as a violation of the medical profession's most cherished ethical principles affirming life over death. Working in an area of vexing ethical issues, Kevorkian was championed as a breaker of unnecessary taboos surrounding death. His crusade ended in 1999 when a Michigan state court convicted him of second-degree murder.

Kevorkian became a focus of national attention in 1990, after he assisted the suicide of Janet Adkins, a 45-year-old woman who was suffering from Alzheimer's disease, a degenerative disease of the brain that causes memory loss and intellectual impairment. Adkins had heard through the media about Kevorkian's invention of a "suicide machine" that allowed individuals who were ill to administer a lethal dose of poison to themselves. The machine, which Kevorkian assembled out of $45 worth of materials, consisted of three dripping bottles that delivered successive doses of three fluids: a harmless saline solution; a painkiller; and, finally, a poison, potassium chloride. When Adkins contacted Kevorkian about using the machine on her, Kevorkian agreed to assist her. Kevorkian diagnosed Adkins as suffering from Alzheimer's and arranged to perform the assisted suicide in a public park, in his rusting, 1968 Volkswagen van. After Kevorkian had inserted an intra-venous needle into her arm, Adkins pressed a red button that caused the machine to administer the painkiller and then the poison. Within five minutes, Adkins died of heart failure. Within days, Kevorkian had become a national media celebrity, appearing on such television shows as Nightline, Geraldo, and Good Morning, America.

This first of Kevorkian's assisted suicides illustrated the objections that many observers raise toward Kevorkian's methods. Although she had begun to show early signs of Alzheimer's, Adkins was otherwise in good health and was not terminally ill; she committed suicide more out of fear of future suffering than out of current suffering. She had joined the Hemlock Society—an organization that advocates voluntary euthanasia for terminally ill patients—even before she became ill. In addition, Adkins's Alzheimer's might have impaired her ability to make decisions. Some observers wondered

whether she was also suffering from depression, a treatable mental illness. Moreover, in cases in which a terminally ill patient has expressed a desire to die, established rules of medical ethics require that two independent doctors must confirm that the patient's condition is unbearable and irreversible; Kevorkian had ignored this requirement.

Kevorkian was charged with first-degree murder in the Adkins case, but a judge ruled that prosecutors failed to show that Kevorkian had planned and carried out Adkins's death. Attempts to prosecute Kevorkian were hampered by Michigan's lack of any law against physician-assisted suicide. Most other states have laws that make this act a felony.

In early 1991, a Michigan judge issued an injunction barring Kevorkian's use of the suicide machine, and in the same year, the state of Michigan suspended his medical license. Kevorkian defied such legal actions and continued to help ailing people to end their lives. Now that he no longer could prescribe drugs, Kevorkian assisted with suicides by providing a contraption that administered carbon monoxide through a gas mask. As he practiced assisted suicide and published on the subject—describing it in his own terms as "medicide" or "planned death"—he continued to be surrounded by controversy. For example, an autopsy that was performed on the body of the second person whom he had helped to commit suicide, a patient who had complained of a painful pelvic disease, found no evidence of any disease.

In 1992, the Michigan Legislature passed a bill outlawing assisted suicide, designed specifically to stop Kevorkian's activities (Mich. Comp. Laws § 752.1021). This law was used to charge Kevorkian with assisting in the death of Thomas W. Hyde, Jr., in August 1993. Kevorkian was jailed twice that year, in November and December. During his second jail stay, he embarked on an 18-day fast in which he protested his arrest by drinking only juice. His bail was reduced and was paid by Geoffrey Fieger, a flamboyant lawyer who has done a great deal for Kevorkian's cause as his friend and legal counsel. Kevorkian was found not guilty.

Kevorkian then attempted to place before Michigan voters a ballot initiative, Movement Ensuring the Right to Choose for Yourself (MERCY), which sought to amend the Michigan Constitution in order to guarantee competent adults the right to request and to receive medical assistance in taking their own lives. However, he failed to garner enough signatures to put the initiative on the 1994 ballot. In December 1994, the Michigan Supreme Court upheld the law that had made assisted suicide a crime, and in 1995 the U.S. Supreme Court refused to hear Kevorkian's appeal.

Kevorkian continued to assist in suicides even as prosecutors in his home county unsuccessfully attempted to convict him on charges of murder or assisted suicide. On May 14, 1996, an Oakland County Circuit Court jury again acquitted Kevorkian of assisted suicide. In that case, the prosecution had argued that assisted suicide was a crime under Michigan common law. After the acquittal, county prosecutors suggested then that it was unlikely that they would take Kevorkian to trial again.

In his actions and his statements, Kevorkian flouted the ethical standards of the medical profession on the issue of assisted suicide. The american medical association, a national professional association of physicians, specifically forbids the practice of physician-assisted suicide. Many doctors deplore Kevorkian's techniques and see them as endangering the trust that must exist between physician and patient. Even the Hemlock Society opposes Kevorkian's actions, citing his lack of typical procedural precautions.

In 1998, Kevorkian allowed the CBS television program 60 Minutes to tape the lethal injection of Thomas Youk, a patient who was suffering from Lou Gehrig's disease. After the broadcast, county prosecutors again brought a second-degree murder charge against Kevorkian, who served as his own counsel in his trial. On March 26, 1999, a jury in Oakland County convicted him of second-degree murder and illegal delivery of a controlled substance. He was sentenced in April 1999 to 10 to 25 years in prison. During the next three years, he sought to appeal the conviction to appeals court in Michigan. However, the Michigan Court of Appeals affirmed the conviction, and the Michigan Supreme Court declined to review the appellate court's decision. Lawyers representing Kevorkian sought to appeal the case to the U.S. Supreme Court, but it declined to review the case.

Kevorkian's efforts in the cause of assisted suicide were only the latest in a series of his unconventional, even morbid, attempts to make a name for himself in the area of medical research. Kevorkian had earned the nickname Dr. Death in 1956, only three years after obtaining his medical degree, when he began making what he called death rounds at the Detroit-area hospital where he was employed. During those rounds, he examined dead bodies in order to collect evidence supporting his contention that the time of a person's death could be determined from the condition of the person's eyes. Kevorkian caused more controversy—and lost his job at the University of Michigan—in 1960, when he published the book Medical Research and the Death Penalty, in which he argued for the vivisection (i.e., the conduct of medical experiments on live subjects) of prisoners who had been sentenced to death. Claiming it would be "a unique privilege … to be able to experiment on a doomed human being," he outlined a plan in which the prisoner-subject would be anesthetized at the time of execution, then used for scientific experiments lasting hours or months, and finally executed using a lethal overdose. According to Kevorkian, this practice would create both a more painless execution and greater advances in medical research. The use of condemned prisoners for medical experimentation and organ donation has remained a consistent theme for Kevorkian. His 1991 book Prescription: Medicide: The Goodness of Planned Death rehashes these same arguments while also making a case for assisted suicide. In another unsuccessful venture, Kevorkian re-created experiments in which Soviet scientists had taken blood from recently deceased individuals and transfused it to live patients.

In a later article that set forth his plans for assisted suicide, Kevorkian suggested setting up suicide clinics: "The acceptance of planned death implies the establishment of well-staffed and well-organized medical clinics ('obitoria') where terminally ill patients can opt for death under controlled circumstances of compassion and decorum." As his use of the terms obitoria and medicide indicate, Kevorkian has a penchant for coining words. He dubbed his first suicide machine alternately a mercitron or a thanatron—the latter from the Greek word for death, thanatos—and has used the word obitiatry to indicate the medical specialization in death.

Kevorkian was born May 26, 1928, in Pontiac, Michigan. Named Murad Kevorkian at birth by his Armenian immigrant parents, he was the first of his family to attend college. He attended the University of Michigan Medical School and did his internship at Detroit-area hospitals. Acquaintances of Kevorkian testify to his prodigious intellect. The retired physician has demonstrated talent as a writer, painter, and composer. A series of 18 paintings that he made on such grisly topics as genocide, hanging, and cannibalism created a stir in Michigan during the 1960s. Kevorkian also has commented that his unconventional ideas have been influenced by the history of his Armenian ancestors, particularly the genocide in which 1.5 million Armenians were killed during world war i by the Turks. Kevorkian has never married.

"The voluntary self-elimination of individual and mortally diseased or crippled lives taken collectively can only enhance the preservation of public health and welfare."
—Jack Kevorkian

Although many deplore his actions, Kevorkian has increased public awareness of some of the most difficult ethical issues surrounding death and dying. With medical technology's increasing ability to prolong life have come more situations that bring great pain and suffering. Kevorkian's efforts to assist people in their deaths, although often falling short of accepted professional standards of diagnosis and care, have sparked a needed discussion on these issues. Nevertheless, even supporters of euthanasia sought to distance themselves from Kevorkian's practices after his convictions, drawing distinctions between his practices and their own beliefs in physician-assisted suicide

further readings

Betzold, Michael. 1993. Appointment with Dr. Death. Troy, Mich.: Momentum.

Goldsworthy, Joan. 1991. "Jack Kevorkian." In Newsmakers: 1991 Cumulation. Detroit: Gale.

Huber, Stephen W. 2002. "High Court Won't Hear Appeal by Kevorkian." The Oakland Press.

Murphy, Brian. 2000. "Jack Kevorkian Continues Crusade from Prison Cell." The Seattle Times.

Jack Kevorkian

Jack Kevorkian (born 1928) became known as "Dr.Death," in part, because he assisted many people in committing suicide. Kevorkian considered the right to die to be a basic personal right, having nothing to do with government laws. He felt there could be a time when a suffering person may choose death and that physicians should be allowed to assist.

Jack Kevorkian originally wanted to be a baseball radio broadcaster, but his Armenian immigrant parents felt that he should have a more promising career. So he became a doctor, specializing in pathology. Kevorkian worked primarily with deceased people, performing autopsies in order to study the essential nature of diseases. His parents never imagined that he would be the one to design the first modern Thanatron (Greek for "death machine") nor that he would be the first to help people use this machine.

Kevorkian was born on May 28, 1928, in Pontiac, Michigan. He was raised in an Armenian, Greek, and Bulgarian neighborhood. Kevorkian attended the University of Michigan medical school and graduated in 1952. Kevorkian initially received his macabre nickname, "Dr. Death," for his pioneering medical experiments in the 1950's. He photographed the eyes of dying patients in order to determine the exact time of death. He believed that this precise knowledge would yield valuable information about diseases. Kevorkian served as associate pathologist in three Michigan hospitals: St. Joseph's, Pontiac General, and Wyandotte General. He also worked as a pathologist in some Los Angeles hospitals. Kevorkian was the founder and director of the Checkup Multi-Phase Medical Diagnostic Center in Southfield, Michigan and Chief of Pathology at the Saratoga General Hospital in Detroit. He published more than 30 professional journal articles and booklets, including Prescription Medicine: The Goodness of Planned Death.

As Kevorkian witnessed the suffering of terminally ill patients, he became convinced that they had a moral right to end their lives when the pain became unbearable, and that doctors should assist in this process. To that end, he designed and constructed a machine that started a harmless saline intravenous drip into the arm of a person wishing to die. When the patient was ready, he or she would press a button that would stop the flow of the harmless solution and begin a new drip of thiopental. This chemical would put the patient into a deep sleep, then a coma. After one minute, the timer in the machine would send a lethal dose of potassium chloride into the patient's arm, stopping the heart in minutes. The patient would die of a heart attack while in a deep sleep. The death, according to Kevorkian, would be quick, painless and easy. For a person suffering from the pain of terminal cancer or some other disease, the machine would provide what Kevorkian called a painless "assisted suicide."

First Assisted Suicide

In June 1990, Kevorkian assisted in the first of many physician-assisted suicides. He used his machine to hasten the death of Janet Adkins, a 54-year-old woman from Portland, Oregon, who was suffering from Alzheimer's disease. The State of Michigan immediately charged him with murder, although the case was later dismissed, largely due to the unclear state of Michigan law on assisted suicide. By 1999, Kevorkian had been present at the death of nearly 130 people. In each case he made his assistance known to the public, as part of a determined campaign to change attitudes and laws on physician-assisted suicide.

Public Reaction

Many agreed with what Kevorkian was doing. On June 21, 1996, during an interview with a Detroit radio station, famed broadcast journalist Mike Wallace said, "I am an old man. I'd be the first, if necessary, to go to Kevorkian." Wallace said he could imagine seeking Kevorkian's services if he were suffering from a painful and lingering disease. "You have the right as a human being to do what you want to do with yourself," said Wallace.

Others disagreed with this opinion. The National Spinal Cord Injury Association opposed assisted suicide because there were better ways around the problem. "Refusing medical treatment is your choice to die how you wish-in your own home with your family or in your hospital bed. Assisted suicide is you giving somebody the power to take your life away. A person is given the power to kill."

Legal Issues

Despite constant legal problems, Kevorkian continued to assist with suicides. In 1994, he faced murder charges in the death of Thomas Hyde, who suffered from a terminal nerve illness known as Lou Gehrig's disease. Jurors agreed with the argument that there was no statute against assisted suicide in the state of Michigan, and thus Kevorkian could not be found guilty.

The Kevorkian team of defense lawyers won yet another acquittal. They successfully argued that a person may not be found guilty of criminally assisting a suicide if that person had administered medication with the "intent to relieve pain and suffering," even it if did hasten the risk of dying. Kevorkian was prosecuted four times in Michigan for assisted suicides, and he was acquitted in three of those cases; a mistrial was declared in the fourth.

In 1998, the Michigan legislature enacted a law making assisted suicide a felony punishable by a maximum five year prison sentence or a $10,000 fine. This law went into effect months before a ballot proposition legalizing assisted suicide was defeated by Michigan voters. It closed the loophole on relief of pain and suffering, which Kevorkian's lawyer's relied upon to obtain acquittals. The statute provides that a person who knows another intends to kill himself and provides the means, participates in the suicide, or helps to plan the suicide, is guilty of a felony.

Kevorkian proceeded with what he thought was right, and challenged authorities to arrest and prosecute him. On September 17, 1998 he took the ultimate step in the assisted suicide of Thomas Youk. Instead of asking the patient to press the button to inject the fatal dose of drugs, Kevorkian, after speaking gently to the man suffering from Lou Gehrig's disease, administered the drug himself. Furthermore, he videotaped the entire event so there would be no doubt of what he had done. He then gave the tape to the television show 60 Minutes. The episode was aired for the whole world to see.

Shortly thereafter, Kevorkian was arrested in Michigan for first-degree murder. In this case, when he injected Thomas Youk with the lethal drugs, he committed euthansia, or mercy killing, not assisted suicide. Kevorkian was also charged under the felony law that bans assisted suicide, which went into effect approximately two weeks before Youk's death. Kevorkian decided to represent himself in the Youk murder trial. On March 26, 1999, he was convicted of the lesser offense of second degree murder by a Michigan jury.

In the maelstrom of opinion created by his beliefs, Kevorkian continued his campaign for legalized physician-assisted suicides. He expected to be arrested, and he often was. He felt he was doing his best for people who were terminally ill and suffering great discomfort. In so doing, Kevorkian raised national awareness of assisted suicide and forced the courts and legislatures to make decisions on this controversial issue.

Further Reading

Detroit Free Press, March 7, 1997; December 10, 1998; November 21, 1998; March 23-28, 1999; April 12, 1999.

Euthanasia Research and Guidance Organization, www.FinalExit.org

Newsweek.com, Jack Kevorkian, Death Wish, http://newsweek.com/nw-srv/issue/14_99a/printed/us/na/na0714_1.htm □

Kevorkian, Jack

The pathologist Jack Kevorkian became the central figure in the physician-assisted death controversy in the United States, a controversy that has had ripple effects throughout the world. Born in 1928, Kevorkian was the son of refugees who escaped the Turkish massacre of Armenians in 1915. Many of the members of his mother's family and all of the members of his father's family were among the victims. The Kevorkians settled in Pontiac, Michigan, where his father worked in an automobile factory and his mother looked after Jack and his sisters Margo and Flora, who would assist him throughout the activism career he launched in his later adult years.

"Intelligent," "resourceful," and "independent" are adjectives often applied to the young Kevorkian by those who knew him. He went his own way and questioned authority long before it became commonplace to do so. An honor student in high school, Kevorkian obtained his medical degree from the University of Michigan in 1952.

Early Career

The specialty with the most appeal to him was pathology, the study of diseases and their effects. He soon devoted himself to studying the physical changes wrought by death. As early as his residency at Detroit Receiving Hospital in 1956, colleagues gave him the nickname "Doctor Death." Kevorkian was especially curious about the status of the eye at death, and arranged to be notified when a patient was on the verge of death. After death, the cornea becomes hazy and the retina segmented and pale as blood circulation ceases. Kevorkian recommended that his fellow physicians examine the eyes whenever there is a need to look for signs of life. His findings were published in medical science literature.

Dying and death were neglected topics of research and education in medicine when the young physician was conducting his studies. He was therefore almost as much an outsider as an insider. Difficulties in working against the mainstream were also being experienced by other pioneers in their various clinical and academic environments. Kevorkian showed little or no interest in these parallel developments. Years later he still held himself apart from the hospice/palliative care movement, death education and counseling, peer support groups, and the rapidly expanding base of research knowledge. Kevorkian therefore made himself vulnerable to criticism that he had failed to inform himself of significant developments in pain control, social support, and other areas in the field of death and dying.

Meanwhile, he considered marriage but broke off his engagement because he judged that his fiancée did not possess "sufficient self-discipline" (Betzold 1996, p.38). Many years later he expressed regrets for missing out on the satisfactions of family life, but the absence of these obligations and distractions offered more opportunity for his other pursuits. In addition to his primary agenda, Kevorkian learned to play several musical instruments, and created some intense, death-haunted oil paintings.

The Activist

Kevorkian had an activist agenda in mind long before he became a public figure. He proposed that the bodies of executed criminals be used for scientific experiments. The convicts would be anesthetized in order to keep their bodies somewhat alive and therefore available for experiments that could not be conducted on people who were entirely alive. He also transfused blood to living patients from the corpses of people who had experienced a sudden death. Both the death-row proposal and the cadaver donor procedure were ill-received by the medical establishment. Kevorkian's views made him increasingly unpopular and therefore limited his employment opportunities. As his mainstream medical career faded, however, Kevorkian had more time available to advance his mission.

Kevorkian set forth his agenda in his book Prescription: Medicide (1991). He took the position that the Hippocratic oath is not and never has been binding on physicians. Kevorkian contended that a new medical specialty, "obitiariry," should be established to offer "moribund people" a dignified and easy death and to provide the opportunity for experimental research on their remains. This specialty would be practiced at centers for medically assisted suicide and research, which were to be known as "obituaria." Kevorkian thought that medically assisted suicide—or what he termed "medicide"—should be made available to all people who wish to end their suffering, whether or not they are terminally ill.

Kevorkian's Crusade

The first step in applying his program was his construction of a "suicide machine" that he called first the Thanatron, then the Mercitron. The physician prepares the machine, but it is the patient who presses a button to release a deadly drug. A middle-aged woman by the name of Janet Adkins was the first person to make use of Kevorkian's invention on June 4, 1990. Kevorkian was charged with murder but was then released when the court ruled that Michigan had no law against assisted suicide. His license to practice medicine in Michigan was suspended, however, and later authorities in California did likewise.

During the 1990s Kevorkian was "present" at the deaths of at least 120 people. His participation in these deaths was labeled as "murder" or "homicide" by Michigan authorities who, nevertheless, failed in repeated attempts to convict him. He was charged repeatedly with assisted suicide as well as murder, each time defying and defeating the courts with the help of a high-profile attorney. Kevorkian argued that he had not and would not kill anybody—the patients had made the last move on their own volition.

It was Kevorkian who put himself into a position in which a guilty verdict was almost inescapable. He invited CBS's 60 Minutes program to show a videotape he had made of his participation in the death of Thomas Youk. The result was conviction for second-degree murder and delivery of a controlled substance. He received a sentence of ten to twenty-five years in prison, which he began serving in 1999. Despite Kevorkian's conviction and jailing, the assisted suicide controversy stimulated by his beliefs and actions continues to influence health care, legislation, and the field of bioethics.

See also: Bioethics; Euthanasia; Hippocratic Oath; Suicide Types: Physician-Assisted Suicide

Bibliography

Betzold, Michael. Appointment with Doctor Death. Troy, MI: Momentum Books, 1996.

Kaplan, Kalman J., ed. Right to Die versus Sacredness of Life. Amityville, NY: Baywood, 2000.

Kastenbaum, Robert. "Looking Death in the Eye: Another Challenge from Doctor Kevorkian." In Kalman J. Kaplan ed., Right to Die versus Sacredness of Life. Amityville, NY: Baywood, 2000.

Kevorkian, Jack. Prescription: Medicide. Buffalo, NY: Prometheus, 1991.

ROBERT KASTENBAUM