ON A WARM, muggy evening in August 1993, Thomas Hyde, a 30-year-old construction worker, along with his wife and 2-year-old daughter, sat inside a battered and rusted 1968 Volkswagen bus parked behind an apartment complex in Royal Oak, a suburb of Detroit. Hyde suffered from amyotrophic lateral sclerosis, Lou Gehrig's disease. He had come to Royal Oak for one purpose: to end his life with the help of the VW's owner, Dr. Jack Kevorkian.
After fitting an oxygen mask over Hyde's head, Kevorkian connected the tubing leading from the mask to a small cylinder of carbon monoxide. Halfway down the tubing, Kevorkian had placed a paper clip that crimped the line, preventing the deadly flow of gas. To the paper clip, Kevorkian, a retired pathologist, had attached a string that he handed to Hyde. A moment later, after saying goodbye to his wife and daughter, Hyde pulled loose the paper clip, breathed the carbon monoxide and died.
Thomas Hyde was the 20th person to receive such assistance from Kevorkian.
Since the summer of 1993, the pathologist has helped another 110 people end their lives. The most recent of those deaths, was different. On Sept. 17, Kevorkian administered lethal drugs through an IV to Thomas Youk, a 52-year-old accountant who also was suffering from Lou Gehrig's disease. This was the first known case in which Kevorkian was the direct cause of death for one of his "patients." The death scene was videotaped by the pathologist and shown on "60 Minutes" during the important final week of November "sweeps," when viewer levels are measured to set advertising rates. Nielsen Media Research reported that an estimated 15.6 million households tuned in to the death, the highest numbers for the show this season.
It is undeniable that all of Kevorkian's approximately 130 "patients" have gone gently, but it is less clear if they, and Kevorkian, have done the morally right thing in these sorrowful cases.
It is even less clear if Kevorkian has had the motives he professes in helping others into what Henry James aptly called "The Great Perhaps."
Although he claims a staunch altruism with respect to the suffering of the terminally ill, as well as a reverence for the autonomy of the individual, one might well conclude that Kevorkian has had a bizarre and unhealthy interest in death and the newly dead.
Kevorkian's strange fascination with the dead stretches back to his early medical training in Michigan.
Kevorkian was first called "Dr. Death" while a resident at the Detroit Receiving Hospital. There, in 1956, he began photographing the retinas of patients at the moment of death. He set up his camera equipment and waited, calling the process his "death rounds." A few years earlier, in 1953, Kevorkian had been dismissed from the University of Michigan pathology residency because of his proposal that death-row inmates be used for medical experiments. Instead of executing inmates, Kevorkian called for rendering them unconscious while the experimentation took place. Death would come after the research was complete and the inmates' bodies were no longer useful.
In 1959, at a meeting of the American Association for the Advancement of Science, Kevorkian testified before a joint judiciary committee in Columbus, Ohio. The pathologist urged Ohio to revamp its capital punishment laws so "valuable medical experiments" might be performed on the condemned.
In the 1960s, Kevorkian developed an interest in oil painting. About three years ago, he displayed 13 of his works in a gala event in Royal Oak that drew hundreds of his supporters. His artworks included depictions of decaying bodies, swastikas, hollow-eyed skulls and Santa stomping on baby Jesus.
Kevorkian told Sun reporter Lisa Pollak, who attended the event, that he did not consider himself an artist. "I consider myself a cartoonist in oils," he explained, adding, "I call them pictorial philosophy, not art. Technically, it's not great art. But within limits, I'm proud of it."
In one of his works, titled "Genocide," Turkish and German soldiers hold a severed head by the hair. Kevorkian told Pollak that the painting depicted the horrors of war.
"For Kevorkian, whose family is Armenian, the painting represents both the persecution of Jews by Nazis and of Armenians by Turks. Kevorkian drew his own blood to stain the painting's barbed wire frame," Pollak wrote.
Geoffrey Feiger, the flamboyant lawyer who served as Kevorkian's spokesman, stage manager and confidant, described the artworks as "social commentary" meant for "the ages."
Kevorkian explained his gruesome handiwork this way:
"I pick subjects that are generally considered unpleasant because these are all parts of life that I think we should look at and think about. I only paint what is. I don't paint what I think should be."
Grisly mosaic
Kevorkian's supporters might argue that underscoring his bizarre characteristics constitutes an ad hominem argument against him -- an attack on the messenger, in essence. But what if the messenger has an overactive interest in killing?
The first of Kevorkian's 130 "patients," Janet Adkins, a 54-year-old Oregon woman with Alzheimer's disease, died June 4, 1990. The afternoon before her death in the back of Kevorkian's van, Adkins had played several sets of tennis.
The body of Kevorkian's second patient, Marjorie Wantz, a 58-year-old woman who complained of unremitting pelvic pain, was found in an autopsy by Dr. Ljubisa Dragovic, the Oakland County, Michigan, medical examiner, to have no signs of disease.
Hugh Gale, a 70-year-old sufferer of congestive heart disease and emphysema -- and the 13th of Kevorkian's cases -- died by carbon monoxide poisoning Feb. 15, 1993.
Gale was attended at his death by his wife, Cheryl, as well as by Kevorkian and two of his assistants, Margo Janus and Neal Nichol.
A short time after Gale's death, members of the anti-abortion group Operation Rescue claimed to have found a document in Nichol's trash allegedly saying that Gale had twice asked to have his mask removed during the procedure.
In a search of Kevorkian's Royal Oak apartment, police found a similar document with a line of type that had been whited out and typed over. In a subsequent trial, Kevorkian dismissed the obscured line as a typographical error, though Cheryl Gale and Nichol, after being offered immunity, indicated that Gale's protests twice were ignored by Kevorkian.
In August 1997, Kevorkian assisted in the death of 73-year-old Janet Good, a longtime activist in local and state politics in Michigan. For several years before her death, Good had assisted Kevorkian in his crusade. Good was charged with Kevorkian in the 1996 death of Loretta Peabody, a 54-year-old woman who suffered from multiple sclerosis.
At an initial hearing in May 1997, charges were dropped against Good when she said that she was suffering from pancreatic cancer and most likely would die before the start of the trial. Three months later, Good died in a suicide assisted by Kevorkian. An autopsy by Dr. Kanu Virani at the Oakland Medical Examiner's Office found no signs of disease in Good's organs, including her pancreas.
On March 2, 1998, Roosevelt Dawson, a 21-year-old Smithfield College student who was paralyzed from the neck down, died with the assistance of Kevorkian.
Dawson, who died with his mother at his side, was not terminally ill. In a subsequent interview, Dawson's mother spoke of Kevorkian's methods as a logical alternative to living with disabilities.
This death and others form a grisly mosaic. Until Kevorkian's recent conviction for second-degree murder, Michigan prosecutors had charged him in connection with three other deaths -- and three times he went free.
The difficulty of winning a conviction seems to underscore the ambivalence our society shares about end-of-life issues. These issues cut to the very heart of the nature and meaning of life and its relationship to suffering.
Thomas A Kempis in his 15th-century essay "Imitatio Christi" suggests that if one could be still in suffering and let it abide for a while, then no doubt that person would see the help of God come.
It is clear that some see Kevorkian as an angel of mercy, an agnostic sent by God to relieve intractable suffering. But I wonder about the pathologist's motives.
And I wonder if a rational and clearheaded discussion of these sensitive issues has not been pushed back significantly by this frail and volatile man, a man with an overactive interest in dying and the dead.
'My first euthanasia'
On May 2, 1994, a Michigan jury found Kevorkian not guilty in connection with the death of Thomas Hyde, Dr. Death's 20th "patient."
After the trial, a juror commented: "He convinced us he was not a murderer, that he was really trying to help people out."
A second juror said, "Dr. Kevorkian had acted principally to relieve Mr. Hyde's pain, not to kill him, and that is an action within the law."
A juror in another of the trials in which Kevorkian was not convicted said, "I don't feel it is our obligation to choose for someone else how much pain and suffering they can go through. That is between them and their God."
Recently, in Oakland County, Mich., Kevorkian, 70, acting as his own lawyer, went on trial for a fifth time and was convicted of second-degree murder and delivery of a controlled substance.
The indictment in the case, handed down in early December, came as the result of a videotape that appeared on CBS' "60 Minutes" on Nov. 22.
Being interviewed by Mike Wallace, Kevorkian admitted ending the life of Thomas Youk, a 52-year-old Michigan accountant suffering from Lou Gehrig's disease. Kevorkian called Youk's death "my first euthanasia," distinguishing it from other cases in which the pathologist simply provided the means for people to end their lives.
Kevorkian's latest trial again raised questions about this strange crusader for the rights of the dying and society's attitude toward euthanasia and assisted suicide.
How are we to come to grips with the issues raised by Kevorkian, a man whom even his supporters describe as an amalgam of P.T. Barnum and the Grim Reaper?
And what has Dr. Death taught us about our positions on end-of-life issues?
In a March 1996 Washington Post poll, 51 percent of the respondents favored physician-assisted suicide (54 percent of men and 47 percent of women). The following statistics from that poll received far less attention:
* Although 55 percent of white Americans favored physician-assisted suicide, only 20 percent of African-American respondents favored Kevorkian's methods and morals.
* While 57 percent of the respondents between the ages of 40 and 49 approved of physician-assisted suicide, only 35 percent over the age of 70 did.
* Assisted suicide was favored by only 37 percent of people under the poverty line.
The statistics indicate that age, race and class have a lot to do with our views of assisted suicide. Blacks, the poor and the elderly overwhelmingly disapprove of it. Perhaps their opposition is driven by mistrust of physicians and the health industry's efforts to hold down costs.
Kevorkian has shown us that the medical profession is geared to preserve life even when death is a more desirable outcome. Rather than aggressively treating terminal illnesses, we need to concentrate on making some people with these illnesses pain-free. In a recent study of 4,000 patients who died after hospital intervention, 40 percent were reported to have been in pain "most of the time" during treatment. Although significant medical advances are being made in the treatment of pain, they do not always translate into more effective pain management for the dying.
"Taken together, modern pain-relief techniques can alleviate pain in all but extremely rare cases," according to a 1994 report by the New York State Task Force on Life and Law. Yet the public holds the view that intractable pain is inevitable in terminal illness.
Loss of values
If Kevorkian has taught us a great deal about how we live and die, he also has misled us. He frequently points to The Netherland's enlightened policies on end-of-life issues, but they deserve closer scrutiny.
In 1993, the Netherlands passed legislation establishing specific rules by which physicians could assist terminal patients in their deaths. But the Dutch experience might be far more mixed than Kevorkian would have us believe. In a recent report by the Royal Dutch Medical Society, the Dutch government acknowledged that the original guidelines are no longer being adhered to. Annually, nearly 4,000 people die in The Netherland's by physician-assisted suicide. Of those cases, an estimated 1,000 involve involuntary euthanasia, acts expressly forbidden by the Dutch policy but not prosecuted.
A 1994 Dutch medical commission also recommended the inclusion of psychiatric patients in the guidelines for those covered by the physician-assisted suicide law. The subsequent increase in the number of suicides in The Netherland's recently has led two noted Dutch attorneys to observe: "The creep toward involuntary euthanasia and mercy killing in the Netherlands has gone unchecked, despite legal conditions designed to guarantee voluntariness."
The Dutch experience leads us to another way that Kevorkian has misled us. He presents his typical patient as a rational, thoughtful person who has made an independent decision to end his life, a kind of modern-day Socrates willing to drink the hemlock.
In most of his recent interviews, Kevorkian has stressed pain relief as the most important part of assisting these people. He argues frequently that the people he helps can no longer stand the pain and thus make a choice of quality over quantity of life. But a study in Washington state, which along with Oregon has the strongest physician-assisted suicide constituencies in the country, showed that only 31 percent of terminally ill patients listed pain relief as a motivation in their desire for death.
Seventy-five percent of the patients in the Washington study listed "not wishing to be a burden" as a reason for seeking physician-assisted suicide.
A profile of a more typical candidate for physician-assisted suicide is an elderly, depressive female who thinks of herself as a burden.
Of Kevorkian's first 43 patients, 28 were women, many of whom were not suffering from terminal illnesses. None of these patients received a competent psychiatric evaluation before turning to Dr. Death.
The most disturbing aspect of the Kevorkian affair is neither the self-promoting atmosphere he brings to these tragic cases nor his obvious lack of empathy for his "patients" in their dying moments. What's most distressing is the loss of the values we once cherished.
Before the advent of modern medicine, we died younger and more frequently. Death was something that clung to the lives of those left behind. When we died, our souls went somewhere, and that destination had a kind of metaphysical and moral sense to it. In that age, our anxiety about death stemmed from our fear of eternal condemnation.
In the modern world, anxiety about death has eased, and, consequently, guilt has all but disappeared.
In "Death Comes for the Archbishop," novelist Willa Cather suggests, "Men travel faster now, but I do not know if they go to better things." If Kevorkian has his way, we all might be traveling faster to death, but it is not clear that our age is one that believes we go on to better things.
Stephen Vicchio, professor of philosophy at the College of Notre Dame, also teaches medical ethics in the Robert Wood Johnson Fellows program at the Johns Hopkins Medical School.
Pub Date: 04/04/99