"Dr. Death" terminal; will end-of-life research thrive?

Jack Kevorkian, M.D., sideman to the suicides of more than 130 people by his own estimate, may finally have been sidelined from his role as Angel of Death by a Michigan jury's guilty verdict in March. Now the question on the minds of many working in end-of-life research is whether Kevorkian's conviction for second-degree murder will finally spell the end to his uncanny ability to dominate the media and drown out rational discussion of how our society grapples with the inevitability of death. No one will probably know for sure until his promised appeal is resolved, but that hasn't extinguished the hope, widely held among end-of-life researchers and caregivers, that Kevorkian's run is finally over.

Kevorkian, a retired pathologist, pushed the legal point last September by videotaping himself administering a lethal injection of potassium chloride to Thomas Youk, a 52-year-old suffering from amyotrophic lateral sclerosis. The troubling video was broadcast during a segment on "60 Minutes" in November. Kevorkian used the national television stage to challenge prosecutors to charge him with murder, a rap he had beaten four times before. They quickly complied.

"The more extreme Kevorkian has gotten, including this last go-round on '60 Minutes,' the more energy and time . . . we have to spend disassociating ourselves from this crazy lunatic," says psychiatrist Samuel Klagsbrun, M.D., a lecturer at Columbia's College of Physicians & Surgeons, who teaches medical students how to deal with end-of-life care. "By far most of us, I think, work incredibly hard to respond to all of the reasons that people want to die, such as pain and discomfort and loneliness, and dissuade people from wanting that kind of an exit."

Kevorkian's video stunt struck many as more tiresome than flamboyant. Nonetheless, his antics sparked a firestorm of media coverage: nearly 1,300 articles and television reports during the two weeks before and after the "60 Minutes" episode aired. Once again he proved that he could ruthlessly exploit the press, reducing any reasoned debate on what to do about end-of-life care to a black-or-white referendum on euthanasia.

Klagsbrun, for one, has fought for decriminalization of physician-assisted suicide when necessary. More than ever, Klagsbrun says, the media and society need to explore such important issues as the morality of a doctor's participation, safeguards on assisted suicide, and ways to improve and increase palliative and hospice care. With Kevorkian firmly in control of the media stage, however, these crucial issues have been largely exiled to the darkened wings.

At a seminar for the press convened by the Columbia Graduate School of Journalism in January, Professor Joseph Turow from the University of Pennsylvania's Annenberg School of Communication presented an analysis of the media's coverage of Dr. Kevorkian during the two weeks before and after the "60 Minutes" episode. The conclusion: Kevorkian had hijacked the media with his own agenda. By and large, Turow said, the press had framed the "60 Minutes" episode as a legal story; of 100 stories randomly selected from the nearly 1,300 that appeared, more than 70 percent treated the program principally as a crime piece. Meanwhile, such important issues as hospice care, the role of euthanasia vs. the withdrawal of care, and even strategies to accommodate patients who have last-minute changes of heart appeared in fewer than 10 percent of the stories analyzed. For professionals grappling with end-of-life care decisions and policy, the Kevorkian din has been frustrating.

But a report on the results of Oregon's first-year experience with legalized physician suicide provided a brief respite and some hope for a more reasoned debate in the future. Published in the New England Journal of Medicine (Feb. 18, 1999), the article by the State of Oregon health department showed that in 1998 only 23 people were reported to have received prescriptions for lethal drug doses from their doctors. Among the group of 23, 15 patients died after taking the medication, six died from their underlying illnesses, and two were still alive on Jan. 1, 1999. Physician-assisted suicide accounted for about 5 of every 10,000 deaths in Oregon in 1998, an encouraging sign of restraint to supporters of the law. For the first time, the Oregon results, appearing in such a widely read and respected peer-reviewed medical journal, documented the real-world experience of physician-assisted suicide in the United States.

If Kevorkian's methods are the only end-of-life choice people have in mind, the conversation "gets polarized," says Timothy Quill, M.D., an internist in Rochester, N.Y., whose 1991 account in the New England Journal of Medicine of assisting a patient to die helped spark some of the first discussions about legalizing the practice.

The report on Oregon's experience, Quill says, "now provides a middle ground for discussion and a predictable way that this [physician-assisted suicide] might occur." With solid data finally on the table, Quill says, with a hint of relief, "it does change the debate a bit."--Scott Hensley

Related links...

  • "The Kevorkian Verdict: The Life and Legacy of the Suicide Doctor," PBS Frontline

  • Mike Britten, "Move over, Dr. Kevorkian," Salon

  • Timothy E. Quill, Christine K. Cassel, and Diane E. Meier, "Care for the Hopelessly Ill: Clinical Criteria for Physician-Assisted Suicide," reprinted with permission from New England Journal of Medicine, Nov. 5, 1992, by DeathNet

  • Debate on assisted suicide, Drs. Timothy Quill and Ira Byock, National Public Radio's "All Things Considered"

  • Howard Brody, "Kevorkian and Assisted Death in the United States," British Medical Journal 318:953-954 (April 10, 1999); author is director of the Center for Ethics and Humanities in the Life Sciences, Michigan State

  • The Kevorkian Papers, documentary archive maintained by Ted Gerk

  • Project on Death in America, Soros Foundation

  • Hemlock Society, right-to-die organization not affiliated with Kevorkian

  • FairCare, end-of-life care program organized by Dan Tobin, M.D.

  • International Anti-Euthanasia Task Force

  • Marilyn Webb, The Good Death: The New American Search to Reshape the End of Life (NY: Bantam, 1997)

  • American Medical Association's response to Kevorkian (letter from AMA general counsel Kirk Johnson to Michigan Attorney General Frank Kelley, October 10, 1995)

  • Top cartoonists look at Kevorkian, Daryl Cagle's Cartoonists Index

  • Kevorkian's jazz flute album A Very Still Life

  • SCOTT HENSLEY writes about medical technology from the New York bureau of Modern Healthcare. His free-lance work has appeared in the Chicago Tribune, the New York Times Syndicate, Diversion, and 21stC. His Modern Healthcare article about the competitive business of supplying blood to hospitals recently won a Health Care Journalism Award from the National Institute for Health Care Management.

    Photo Credits Kevorkian: AP / Wide World Photos