Boston. -- Put aside the subtle arguments about the right to die. Shelve the intricate ethical questions about doctor-assisted suicide. Jack Kevorkian is on the loose again.
The state of Michigan has a serial killer on its hands. Or a serial mercy killer. Or a serial aide and abettor to suicide. Choose one of the above. But the distinctions are becoming more blurred all the time.
Dr. Kevorkian, trained pathologist and self-proclaimed "obitiatrist," thinks of himself as a maverick and martyr in the spirit of Mahatma Gandhi. Dr. Death, the man with the motive -- "My motto is a rational policy of planned death" -- believes he's a crusader like Martin Luther King Jr. But as the count of the dead grows he looks more like Jack the Ripper, M.D.
First on the list of Dr. Kevorkian's patient-victims was Janet Adkins, a woman with Alzheimer's. In 1990 she pushed the button on the machine in his suicide-mobile in a park in Oakland County. Dr. Kevorkian was charged with and acquitted of first-degree homicide. It was ruled that she killed herself and there was no state law against physician-assisted suicide.
Then, last fall, came Sherry Miller and Marjorie Wantz, one with multiple sclerosis, the other with chronic vaginal pain. For his involvement with these deaths he was indicted again for murder and is awaiting trial.
Now there is Susan Williams. Last Friday, while out on bail, Dr. Kevorkian provided the gas canister and hands-off technical assistance to a 52-year-old woman crippled by multiple sclerosis. He was there -- on a suicide house call -- when she put on the mask, pulled the handle and breathed the carbon monoxide.
Each of these women wanted to die. Each of them was grateful, polite, replete with thank-yous to the man who provided them with the means. But that doesn't diminish the fact that Dr. Kevorkian has become an ethical outlaw, a free-lance death dealer providing paraphernalia and know-how to the users.
When Janet Adkins decided to take her life before she lost her mind, she saw suicide as a pre-emptive strike against a bleak Alzheimer's future. In the debate that followed, Dr. Kevorkian's bizarre personality seemed like a distraction from central questions about life and death and medicine.
The Adkins case ratcheted up the national discussion on everything from disconnecting life support to aiding suicide. Since then, Derek Humphry's how-to-kill-yourself book, "Final Exit" has become a surprise best-seller. The state of Washington proposed and defeated a referendum that would have allowed doctors to assist suicides in carefully defined cases of terminally ill patients.
In intimate conversations over living wills, families have discussed the conditions under which they want to live and die. In public forums doctors have been called to reconsider their role at the end of a life. There is appropriate debate about how and when a doctor might help us out of a lingering death.
Now Jack strikes again. This time, the sensitivity about life and death and medicine can only distract attention from the central question about Dr. Kevorkian.
Janet, Sherry, Marjorie and Susan were not terminal by accepted medical definitions. Janet, Sherry, Marjorie and Susan -- is it a coincidence that they are all women? -- were not Dr. Kevorkian's patients in any traditional sense. He has no more right to wander around Michigan offering death to ill women than he has to put loaded guns in the hands of depressed teen-agers.
As George Annas, an ethicist at Boston University, says sharply, "He doesn't have a doctor-patient relationship with these people. He's not there for treatment or diagnosis. He doesn't give them alternatives or reasons to live. He's there to help you die." The only question now says Mr. Annas, is "whether he should be in a mental institution or a prison."
The rebel and provocateur has so far frustrated the state's attempts to control him. He's been prosecuted as a criminal and had his license to practice medicine revoked. He's kept one step ahead of the legislature's attempts to write a bill outlawing physician-assisted suicide.
As long as Janet, Sherry, Marjorie and Susan pushed the button, he may not be guilty of first-degree murder. But he has provided the means and recklessly endangered lives. If nothing else, that's respectable grounds for a manslaughter charge or, in this case, womans laughter.
As Susan Wolf of the Hastings Center says, "The number one thing he's doing is killing people. You have to say it as it is."
In 1990 Dr. Kevorkian threw down a challenge. "If it's legal let me do it. If it's illegal, stop me." Now this renegade -- have carbon monoxide, will travel -- has issued a new challenge: Stop me before I kill again. That's exactly what Michigan must do.
Ellen Goodman is a syndicated columnist.