Dr. Death's Suicide

By NANCY GIBBS

In a rusting old van in a public campground 2,000 miles away from her home, Janet Adkins faced death last week. It took the form of an odd-looking contraption made mostly of three dripping bottles, the invention of a Detroit doctor named Jack Kevorkian. As Adkins settled down on a small cot, she was attended by Kevorkian. He hooked her up to a heart monitor, slid an intravenous needle into her arm and started a harmless saline solution flowing through the tube. Then he sat back and watched the monitor as she pushed a big red button at the base of the machine. Immediately, the saline was replaced by a pain killer; one minute later came the poison potassium chloride. Within five minutes Janet Adkins, an Alzheimer's disease sufferer who feared an excruciating future, was dead of heart stoppage.

The premiere performance of Kevorkian's suicide machine, which he invented for the terminally ill, blew open the debate over the boundaries of mercy killing. As the details of her life and death emerged, Adkins became a symbol of all those patients who confront a horrible disease and vow to maintain some dignity in death. And as Kevorkian carried his crusade for legal mercy killing to networks and newspapers around the country, he became a standard-bearer for all those who fail to see a moral difference between unplugging a respirator and plugging in a poison machine. He was quickly dubbed Dr. Death.

It was ironic that a retired doctor was promoting a homemade, low-tech device as a solution to the right-to-die dilemma. In recent years the agonizing debate over the issue has revolved around new technologies that can keep dying or comatose patients alive long after the quality of their lives is nil. Though most physicians will respect a patient's right to refuse treatment, they will not actively help bring about death. "This case seems to take the responsibility away from human beings and to put it in the hands of a machine," says George Annas, professor of health law at the Boston University School of Medicine. "If this doctor had given Mrs. Adkins a cyanide pill, he would probably be in jail today, rather than on the nightly news."

Yet in this case neither doctor nor patient works very well as a symbol for the euthanasia debate. Adkins, a 54-year-old Portland schoolteacher, was suffering from the early stages of Alzheimer's. A strong, lively woman who loved hang gliding and mountain climbing and playing her flute, she was not yet very sick; the week before her suicide she beat her 32-year-old son in a tennis match. It was more her dread than her disease that drove her to seek Kevorkian's help. Even before her illness she had joined the Hemlock Society, a group that supports terminally ill patients' right to die by means including assisted suicide. But in her home state of Oregon, such means are illegal, and doctors at her hospital say they never advise suicide as an option.

Kevorkian, though, is not like other doctors. A retired pathologist from Royal Oak, Mich., he has long been a pugnacious maverick, recommending, among other things, a scheme whereby doctors would render death-row patients unconscious so their living bodies could be used for medical experiments. In recent years Kevorkian has fought hard for a patient's right to commit suicide and a doctor's right to help. Last fall he invented the easily replicable suicide machine using $45 worth of hardware and tried to advertise it in a local medical journal. When the editors refused, he peddled the story to the local newspapers and soon found himself on the Donahue show.

Adkins read about Kevorkian and got in touch with him in Michigan, where the legality of assisted suicide is murky. Her three sons urged her to try experimental treatments for Alzheimer's. But when the therapy failed -- her memory continued to fade and her beloved flute playing became impossible -- she vowed to go through with her decision. Her husband Ronald, an investment broker, flew to Detroit with her, all the while hoping she would change her mind at the last minute. Just in case, he bought her a round-trip plane ticket.

Kevorkian, meanwhile, was searching for a place to accomplish the deed. The hotels, vacant office buildings and funeral parlors he approached all turned him down. So he resurrected his 1968 Volkswagen, bought the cot and some clean sheets. Without the aid of any hospital or lab, Kevorkian confirmed an Alzheimer's diagnosis and judged Adkins lucid. Two days later, they drove to a public park that had electrical outlets for campers. "There was no other place I could do it," he says. "My landlord would have thrown me out."

As soon as the line on the heart monitor went flat, Kevorkian called the police. Though he claims he never wanted publicity, he took center stage last week in a media barrage that ricocheted from Crossfire to Nightline, Good Morning America to Geraldo. Describing his device as "humane, dignified and painless" -- and his critics as "brainwashed ethicists" or "religious nuts" -- Kevorkian insisted that he wanted only to help patients in distress. "My biggest enemies," he says, "are the medical organizations because the independent doctors tell me they are behind me, but they can't speak out."

Though some right-to-die advocates called him "a brave pioneer," doctors , and ethicists challenged Kevorkian on both moral and procedural grounds. Even groups that sponsor "death with dignity" legislation are careful to include safeguards to prevent the laws from being abused. Most require that patients make a witnessed, legal request in writing, with two independent doctors confirming that the patient's condition is unbearable and irreversible. Says Susan M. Wolf of the Hastings Center: "Even the staunchest proponents of physician-assisted suicide should be horrified at this case because there were no procedural protections."

Doctors reflecting on the case note that Alzheimer's is difficult to diagnose. One symptom is sufficient mental deterioration to impair the ability to make decisions. "He has to claim she made her decision competently," observes Dr. Joanne Lynn, professor at George Washington University. "But the diagnosis of Alzheimer's is almost incompatible with that claim."

Even if the case were more clear-cut, much of the medical community would still reject Kevorkian's solution, fearing the damage that would be done if doctors routinely acted as executioners. "The doctor-patient relationship is based on mutual trust," notes Dr. Nancy Dickey, a trustee of the American Medical Association. "Our patients should not be concerned that we are going to make a value judgment that their lives are no longer worth living."

Kevorkian's fate rests with Michigan prosecutors, who must review state laws about assisted suicide. Seven years ago, the state's high court threw out a case against a man who gave a loaded gun to a friend who later shot himself. While suicide is not unlawful in many states, aiding and abetting suicide is. As yet no charges have been filed, but a Michigan judge has issued a temporary restraining order barring Kevorkian from assisting other suicides. The doctor admits to only one regret. Had the medical examiners come more quickly, Adkins' organs might have been harvested for transplant. "She had a good strong heart," he says. "I know, I watched it on the machine."

With reporting by Michael McBride/Detroit and Andrea Sachs/New York