Focus On: Jack Kevorkian

September 2, 2010

Recent HBO films put “Dr. Death” back in the spotlight

Despite popular sympathies, critics say Kevorkian flouted the ethical duties of a doctor.


America once again found Jack Kevorkian in the spotlight, when Al Pacino took to the stage to accept best-actor honors at the Emmy Awards on Aug. 29 for his portrayal of the polarizing pathologist in the HBO biopic “You Don’t Know Jack.”


The 82-year-old Kevorkian, who assisted in the suicides of approximately 130 people in the 1990s, was saluted by both Pacino and the movie’s writer, who also won an Emmy last Sunday. Following the movie’s premiere last April, HBO aired a documentary following Kevorkian’s 2008 run for Congress, after his release from prison.


If Kevorkian receives an Oscar nod, as critics seem to be predicting, don’t be surprised if the controversial figure makes another cameo among Hollywood’s stars next year. Popular interest in Kevorkian seems almost to be cyclical, and this most recent wave of notoriety has once again drawn attention to the perennial issue of whether doctors ought to honor a patient’s requests to end his or her life.


Arguments about euthanasia often revolve around whether or not ending a patient’s life can be considered an act of “medical care.” But many physicians and ethicists do not think that Kevorkian’s brand of euthanasia was ever actually providing medical care to patients. Critics point to the assisted suicide that instigated his notoriety: Twenty years ago, in the back of a Volkswagen van parked in the woods outside Detroit, Kevorkian watched as 54-year-old Janet Adkins triggered his homemade suicide machine, releasing a lethal cocktail of drugs.


“I don’t think he ever, in a thoughtful way, stood for anything. He was not a clinician. He didn’t take care of the patients. Rather, he knew them very briefly, prior to killing them,” says Thomas Finucane, M.D., a core faculty member at the Johns Hopkins Berman Institute of Bioethics. “He didn’t confirm the diagnosis. He didn’t confirm that adequate palliation was impossible. He didn’t, and was not qualified, to know whether they suffered from the often lethal—and often treatable—disease of major depression.”


University of Pennsylvania’s Arthur Caplan came to the same conclusion. On, Caplan described how he once asked Kevorkian if he was aware that a woman he helped kill had a long history of severe depression and spent many years in a psychiatric hospital.


Kevorkian “snorted and replied, ‘How am I supposed to know all the details of her life?’” Caplan recalled, later writing that “his lack of knowledge of those he assisted in dying or killed outright made him such an easy target for critics that he wound up setting back the legalization of assisted suicide by many years.”


The state of Michigan revoked Kevorkian’s medical license in 1991, but this did not stop terminally ill people from turning to him. In 1998, the news program 60 Minutes aired a video where Kevorkian filmed himself administering a lethal injection to a 52-year-old man in Michigan with advanced Lou Gehrig’s Disease. Kevorkian was arrested soon after and charged with first-degree murder.


He was eventually convicted of murder in the second degree, and after serving eight years in prison, was released in 2007. Per the requirements of his parole, he cannot—and has not—assisted in the suicide of another person since. He has, however, continued to advocate for assisted suicide as a “medical service.”


At Take Part, Kevorkian repeatedly laments the timidity of the American public to question authority and rails against the American Medical Association. If the AMA would just declare assisted suicide a valid medical procedure, Kevorkian told the blog, no law would stop doctors from doing it.


“I’m sure there will be no doctor who will come forward and risk anything to help me,” the increasingly frail Kevorkian was quoted as saying. “If he does, it will be secretly, and I won’t have it done secretly.”


Euthanasia in America


The U.S. Supreme Court ruled against a constitutional right to assisted suicide (Washington v. Glucksberg) in 1997, which as a result, gave states the authority to prohibit the act.


Currently, the only ones that allow euthanasia are Oregon, Washington and Montana. Their laws include requirements establishing residency and mental soundness, concurring diagnoses of terminal illness by multiple doctors, and a prognosis that the patient has less than six months to live.


According to the Oregon Department of Human Services, 59 patients died in 2009 by taking lethal medication prescribed under the state’s assisted-suicide law. The department reported that a total of 95 prescriptions were written last year, and that 12 of the patients who received them were still alive by the end of 2009.


Just days before HBO debuted the documentary “Kevorkian,” Oregon’s medical board suspended the license of a psychiatrist who was set to open a private facility where the terminally ill could end their lives amidst purchased flower arrangements and catering for friends and loved ones in attendance.


The board stated that Stuart Weisberg, a 37-year-old addiction-treatment specialist in Portland, had wrongly authorized a medical marijuana card for a drug addict, and had issued an improper prescription to another patient, while under a five-year reprimand by the board.


Weisberg had recently sent an invitation to local physicians and politicians for a dinner where he planned to discuss his so-called “Dignity House.” In his invitation, Weisberg said he was inspired by Kevorkian.


International perspective


In other countries, the stances on assisted suicide range from well established laws to recent legislative failures to outright uncertainty. Belgium, for example, has the Belgian Act of Euthanasia, which was passed in 2002. Meanwhile, in Canada, where euthanasia remains a much-debated topic, a bill that would have protected physicians from prosecution for assisting in a suicide was voted down just three months ago.


Euthanasia is legal in the Netherlands, as long as doctors perform the procedure under specific circumstances. The patient must be in unbearable pain that has no prospect of improving, and the request for euthanasia must be voluntary and persistent over time. Also, a regional review committee assesses whether a case of assisted suicide meets all the criteria, and if not, the case is brought to a prosecutor as a criminal offense.


And yet, one physician interviewed by the Ohio-based International Task Force on Euthanasia and Assisted Suicide (ITFEAS), recounted a case wherein a Dutch doctor euthanized a 26-year-old ballerina who had arthritis in her toes and said she didn’t want to live anymore.


In the video “Euthanasia: False Light,” which aims to make people question whether the procedure should really be legalized, Robin Bernhoft, M.D., said the comment from the doctor who performed the procedure was: “One doesn’t enjoy this sort of thing, but it’s her choice.”


“Have we reached a point as a society that we’re like gum wrappers?” Bernhoft says. “Are we that disposable?”


In England, where euthanasia is illegal, the Royal Society of Medicine hosted a conference on June 30 on the ethics of assisted suicide. The meeting, open to doctors and the lay public, was meant to provide “a safe and reflective environment,” as well as “make a genuine contribution to the current debate.”


Last thoughts


In his practice, teaching and research, the Berman Institute’s Finucane focuses on avoiding the overtreatment and under-treatment of the frail elderly, as well as encouraging the use of advance directives. So he intimately understands how difficult it is for a physician to discern the best possible way to respond to patients in terrible pain and who see death approaching.


An interesting fact is that more than half of the people who died with Kevorkian’s assistance showed no evidence of terminal illness, according to autopsies ordered by the state of Michigan. So while some literally didn’t have much to live for, the hopelessness that others felt might have been worth exploring and questioning in more depth.


But often, Kevorkian didn’t do that. “He met them, and in a day or two, he went out to the Volkswagen with them,” says Finucane, a professor in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine.


Looking ahead to the fall election season, Finucane points out that those who remain unsure how they feel about the issue should at least be wary of the rhetoric of politicians—and their supporters—who smear together the concepts of palliative care with fear-mongering imagery of Kevorkian and euthanasia.


“In my opinion,” Finucane says, “the cornerstone rule of all medical ethics is: Everybody has the right to say, ‘Keep your hands off me.’ And if you say that anybody who does that is committing suicide, or asking for ‘passive euthanasia,’ that’s a very unfortunate way to use those words.”


In an Aug. 31 column in the Detroit Free Press, Kevorkian’s attorney told the writer that Kevorkian plans to capitalize on this most recent wave of notoriety by renewing his effort this fall for recognition of a right to die.


~ Michael Pena

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Michael Pena
Thomas Finucane

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