Mercy's Friend or Foe?

By NANCY GIBBS

Dr. Jack Kevorkian has spent much of his medical life searching for ways to make better use of human bodies, especially dead ones. Thirty years ago, as a young pathologist in Pontiac, Michigan, he became the first doctor to transfuse blood directly from a corpse into a live patient. He marveled at the possible uses -- on battlefields, for instance, or during a natural disaster -- and lamented the fact that public distaste for the procedure would probably preclude its clinical acceptance.

Over time he turned his attention to patients who were soon to be dead, looking to salvage whatever he could. The execution of condemned murderers seemed an extravagant waste, since controversial drugs and surgical techniques could be tested on criminal volunteers. The prisoner's brain provided a unique opportunity to study a criminal mind -- "an intact, living" brain, he emphasized. Further, from each prisoner might be harvested enough organs to save half a dozen lives. He has proposed an auction market in which rich people would bid for organs, and the money could be used to provide them to the poor for free.

Before long he found that his pathological interests precluded his being hired by any hospital. His ostracism, however, did leave him more time to rummage around flea markets, looking for old toys with small gears that he could use to build his inventions. His first "Mercitron," a precursor to the carbon-monoxide delivery contraption he provided to two more suicidal women last week, now sits in his lawyer's office. "He's very skilled in mechanical engineering," says Geoffrey Fieger. "He's very talented, in everything he builds."

Forced retirement also left him more time for painting, a hobby he has enjoyed for many years. His artistic tastes run to the surreal; one painting is called Nausea. Another, Coma. A third, an allegorical study of genocide, is set in a frame that, by various accounts, was either painted red to look like blood or painted in actual human blood that Kevorkian salvaged from outdated samples at the local blood bank, and from his own arm.

Kevorkian has become the kind of fanatic who could prompt people who share his views to change their minds. Two out of three Americans say they think doctors should be allowed to help desperately sick patients commit suicide, a cause for which Kevorkian has become the most celebrated champion. But as he appears on television after each new death, invoking a higher moral authority and ignoring court orders and judges' instructions, Kevorkian begins to embody all the warnings about how euthanasia, once unleashed, could get out of hand. "It's almost become obligatory for people who write or speak about the subject to distance themselves from Kevorkian," says Professor Yale Kamisar at the University of Michigan law school, who has followed the doctor's career for years. "They say, 'I'm not in favor of what Kevorkian is doing, but . . .' "

For one thing, Kevorkian has made clear his intention to work outside the law. When a Michigan judge dismissed murder charges against him but advised him against continuing his crusade, Kevorkian replied that he would never shirk his "medical duty. If my colleagues won't work with me, I will work alone." In 1988 Kevorkian suggested to founder Derek Humphry that the Hemlock Society, which supports euthanasia for the terminally ill, join forces with him and set up a suicide center. Humphry's response was "We're not lawbreakers, we're law reformers." But he recalls that Kevorkian insisted that such a center would get them publicity. "There are many people in the Hemlock Society who admire him," says Humphry. "My reservations are that he never talks about changing the law, and doctors won't follow him until the law is changed."

Even passionate supporters of euthanasia argue that there must always be safeguards -- second opinions from disinterested doctors, psychological evaluations, family consultations -- before any decision is made. Though Kevorkian is adamant about the precautions he takes, his enthusiasm for testing new techniques and promoting his cause has naturally raised concerns about his neutrality in counseling potential clients. A pathologist by training, he is not in the best position to make a judgment about patients when they are still alive.

The law rushed to Governor John Engler's desk last week, which would temporarily ban physician-assisted suicide until a commission can make a recommendation, is aimed directly at Kevorkian. But the doctor says it makes no difference to him if Michigan's elected representatives turn him into an outlaw. "He has told me that even if this does become a law, he would violate it," says Fieger. The problem is that once zealots claim the right to choose which laws they'll obey, all the underlying trust that permits professionals, and especially doctors, to function disappears.

Then there is the discomfiting pattern that, though men are three times as likely as women to commit suicide, so far all of Dr. Kevorkian's suicide patients have been female. It's not that he has any special fondness for watching women die, but rather, he has explained, because "women are just far more realistic about facing death and have got the guts to do it." Kevorkian considers his treatment a form of toughlove. He recalls his first client, ^ Janet Adkins, a vibrant 54-year-old just diagnosed with Alzheimer's who sought out Kevorkian because she was terrified of what the disease would do to her. "I loved that woman," he told the Washington Post. "And what I had to do was tough."

That doesn't satisfy his critics particularly. "He's more like a serial killer than a physician," says Professor George Annas of Boston University's school of medicine. There is already some evidence that Kevorkian's relentless grandstanding is raising alarms among euthanasia supporters. Last year the State of Washington debated Initiative 119, which would have allowed physician-assisted suicide. In early October the measure was heavily favored. Two weeks later, Kevorkian helped his second and third clients, both chronically but not terminally ill, to kill themselves. The ammunition he provided euthanasia opponents may well have helped defeat the measure in November.

It is unlikely that lawmakers in Michigan would have acted had Kevorkian not forced their hand. When his sixth client, a 45-year-old cancer patient, came to Michigan to consult with him and killed herself on Nov. 23, the bill that had stalled swiftly sailed through the legislature in less than 10 days, on overwhelming votes in both the upper and lower chambers. "It's just the outright assisting in a killing that this bill will prohibit," says representative Joseph Palamara, a Democratic state legislator from Wyandotte. "It doesn't affect whatsoever doctors who withhold or withdraw food."

In fact the law will indeed affect other doctors, because Kevorkian's crusade has in some way touched them all. In recent years the leaders of the hospice movement, specialists in pain management and depression, have been transforming the dying process, much as the natural-childbirth movement did to childbearing over the past generation. In a sense they are racing against the radicals. Once they can offer a more gentle and dignified alternative to either a life ground down by pain or a death in a high-tech hell, the demand for Dr. Kevorkian's service will disappear.

With reporting by Andrea Sachs/New York