Dr. Death Strikes Again

By NANCY GIBBS

If you are dying, you may view Dr. Jack Kevorkian as a courageous crusader for your rights. If you are a doctor, he may seem more like a cheap purveyor of easy death. Either way, he has become the lightning rod of the right-to-die movement and a gifted promoter of a cause he desperately believes in -- and shockingly abets. Last week the doctor who has made his name by hastening death rather than forestalling it helped two more women kill themselves in Michigan. Lawmakers and doctors may debate the ethics of euthanasia endlessly; but while that argument unfolds, the activists have again decided to take life-and-death matters into their own hands.

In the vanguard is Kevorkian, a retired Michigan pathologist who appeared on every television talk show and news program in the country last year in the 24 hours after he helped Alzheimer's patient Janet Adkins commit suicide. He hooked her up to a homemade contraption that allowed her to push a button and send lethal potassium chloride into her veins. A Michigan judge chose not to prosecute Kevorkian for murder, since the state has no laws against assisted suicide, but forbade him to use the machine again. By last week, Dr. Death had found a way around that injunction.

The two most recent recipients of his care were likewise from Michigan: Sherry Miller, 43, had multiple sclerosis, and Marjorie Wantz, 58, suffered from a painful pelvic disease. While her husband watched, Wantz received a lethal injection from a device similar to the one Adkins used. Miller, attended by her best friend, suffocated on carbon monoxide breathed through a mask. Neither one was a patient of Kevorkian's, and neither was terminally ill. The doctor was present throughout, said his lawyer, Geoffrey Fieger. "He provided the expertise. He provided the equipment."

Public parks remain Kevorkian's preferred treatment centers. Adkins' suicide occurred in a rusting van parked in a campground; this time the two women were found dead in a cabin in the Bald Mountain recreation area, about 40 miles north of Detroit. Kevorkian himself called the police to report the fatalities. "The people were still hooked up to the machines when the sheriffs got there," said county sheriff sergeant Dale Romeo.

In the months since Kevorkian last detonated the euthanasia debate, the public's craving for information has grown. The strangest best seller in memory still hovers at the top of the charts: Final Exit, by Derek Humphry, founder of the Hemlock Society, instructs people on how to die, or to kill. Last summer, Wantz said, she tried to follow the directions in the book. When she failed, she turned to Kevorkian.

Humphry, like Kevorkian, has urged physicians to assist in patient suicides. But much of the medical community remains deeply divided over this issue. Doctors see firsthand the agony that confronts the terminally ill and the resources spent prolonging some lives that might be diverted to improving the lives of others. Many thus favor laws that make it easier for patients to reject aggressive medical care, and urge the stricken to make out living wills so that their wishes are met.

Some jurisdictions are prepared to go even further. Next month Washington state will vote on an initiative that would legalize physician-assisted suicide for patients with six months or less to live. If the proposal passes, Washington would become the first state to legalize active euthanasia. No Western country has yet done so. Earlier this year, Dr. Timothy Quill of Rochester, N.Y., wrote in the New England Journal of Medicine about helping a patient with acute leukemia kill herself with barbiturates. A state panel of physicians found his actions medically and legally appropriate, and a local grand jury cleared him of any criminal charges. Yet Quill, like many doctors, rejects Kevorkian's macabre approach. "He certainly doesn't stand for the mainstream," Quill says. "This will again muddy the water."

Defenders of the right to die point to the need for careful safeguards around the process: Kevorkian ignored them all. There were no second opinions, no consent forms, no examinations to make sure that Kevorkian's "patients" were of sound mind as they made their decision. As a pathologist more accustomed to dealing with people after they have died, Kevorkian was in no position to confirm the diagnosis of any of the women he helped kill themselves. And his defiant pursuit of publicity suggests a man more obsessed with the justice of his cause than with the interests of his patients.

Death in a rusting van or a remote cabin is hardly a death with dignity. But, as the numbers of people who came to Kevorkian's defense yet again last week indicates, many among the general public have a profound fear that one day they too might lose control of their life and be left at technology's mercy. Until the medical profession and state legislatures address the issue systematically, a retired doctor with a bagful of poisons and an obsession will be viewed as a savior by frightened people in search of final peace.

With reporting by Sophfronia Scott Gregory/New York