The Kevorkian Verdict

APPOINTMENT WITH DOCTOR DEATH

By: Michael Betzold
Momentum Books, 1993

Available in paperback ($14.95) and hardcover ($21.95) 1-800-758-1870


I.

DENIAL

"The so-called health professions have an indirect sickening power, a structurally health-denying effect. They transform pain, illness and death from a personal challenge into a technical problem and thereby expropriate the potential of people to deal with their human condition in an autonomous way."

-- Philosopher Ivan Illich (1974)



CHAPTER ONE

THE EYES OF DEATH

The hanged man's bloated bare feet dangle beneath the scaffold's trap door. The artist has us looking up, past the swinging man, at a powder blue sky mottled with white and pink clouds. The painting is by Jack Kevorkian.

Five times the young resident had gotten his ophthalmoscope to a patient's bedside minutes after death. This time, as he wheeled in the bulky mounted camera, he was elated to find the patient still alive. Finally, he could get shots of a cornea before, during and after death. He taped open the sick woman's eyelids and focused his lens.

He had asked to work nights at Detroit Receiving Hospital because more patients died then. His mission was to discover how eyes changed at the moment of death. Jokingly, he called his quest the Death Rounds. For added effect, he sometimes would wear a black arm band. Co-workers called him Doctor Death. He accepted the nickname.

"I was sort of the laughingstock of the hospital," the doctor admitted later in life.

This night, Doctor Death got what he wanted. As the woman went into convulsions and died, the blood vessels in her cornea quickly faded from view. Jack Kevorkian got it all on film.

For the American Journal of Pathology, Kevorkian wrote up his research in "The Fundus Oculi and the Determination of Death." It was a fine feather in the cap of a 28-year-old pathologist.

If eyes could pinpoint the moment of death, Kevorkian wrote, doctors would know when resuscitation was useless. They quickly could distinguish death from fainting, shock or coma. It was useful research.

"But really, my number one reason was because it was interesting," he told a reporter years later. "And my second reason was because it was a taboo subject."

Everyone who has known Jack Kevorkian first talks about his brain.

"He could tell you any major league baseball player's batting average," his boyhood chum Richard Dakesian told me, his voice tinged with awe. "He probably could have graduated from high school when he was 13 or 14.

"He's the smartest man I ever knew. I think he was born ahead of his time."

In fact, Jack Kevorkian was born May 28, 1928, in Pontiac, then a booming auto industry town north of Detroit. His parents were Armenian immigrants. He had an older sister, Flora, and a younger sister, Margo.

His mother and father had escaped the Turks' "final solution" -- the massacre of millions of Armenians in a holocaust the rest of the world mostly ignored.

"I wish my forefathers went through what the Jews did," Kevorkian said later. "The Jews were gassed. Armenians were killed in every conceivable way. Pregnant women were split open with bayonets and babies were taken out. They were drowned, burned, heads were smashed in vices. They were chopped in half.

"So the Holocaust doesn't interest me, see? They've had a lot of publicity, but they didn't suffer as much."

Jack grew up in a crowded neighborhood of Armenians, Greeks, and Bulgarians. His father, Levon, quit his auto factory job and ran a small excavating company.

"My parents sacrificed a great deal so that we children would be spared undue privation and misery," Kevorkian later wrote. "There was always enough to eat."

Jack played street games such as touch football, jump-rope, tag, and hopscotch and kick-the-can until dark. Then he'd go home and read voraciously. He loved to draw, too, especially fighter planes.

School bored him. One day in sixth grade, he was shooting paper wads. The teacher marched him off to the principal's office. The principal told Jack to pack his books-- and report the next day to junior high school. He had been promoted for throwing spitballs.

Jack was raised in the Armenian Orthodox faith, but he soon found it to be a fraud. "I realized I didn't believe in their miracles, walking on water, that sort of thing," he said. He quit Sunday school.

Baseball had more wondrous mysteries. His parents' radio could pull in Cleveland games, and Jack preferred Indians announcer Jack Graney's booming voice to the dull tones of Detroit Tigers broadcaster Ty Tyson.

Jack would draw crowds by bouncing a ball off steps and imitating Graney calling all nine innings of a pretend game.

Jack's dream was to go to Cleveland and train under Graney.

"I'd have been a great one-- better than Harwell," he once boasted. The Tigers' Ernie Harwell is in the broadcasters' wing of the baseball Hall of Fame. Graney is all but forgotten.

But Jack's parents wanted him to pursue a more serious career.

He had the tools. Dakesian remembered Jack as very studious and uninterested in the social whirl. In the 1945 yearbook at Pontiac High School, he does not appear on the roster of any sports teams or social clubs, but is listed as a National Honor Society special award recipient and a member of the Chemistry-Physics Club. While in high school, Kevorkian learned German and Japanese-- the languages of his nation's enemies.

In the fall of 1945, with World War II over, Jack enrolled at the University of Michigan. He quickly finished his undergraduate work and enrolled in U of M Medical School. He graduated in 1952 and decided to specialize in pathology-- the study of corpses and tissue to determine cause of death or disease.

As an intern at Henry Ford Hospital in Detroit, Kevorkian one day came upon a middle-aged woman suffering from cancer. In his 1991 book, Prescription: Medicide, Kevorkian, in typically purple prose, described the encounter as an awakening for him:

"The patient was a helplessly immobile woman of middle age, her entire body jaundiced to an intense yellow-brown, skin stretched paper-thin over a fluid-filled abdomen swollen to four or five times normal size. The rest of her was an emaciated skeleton: sagging, discolored skin covered her bones like a cheap, wrinkled frock.

"The poor wretch stared up at me with yellow eyeballs sunken in their atrophic sockets. Her yellow teeth were ringed by chapping and parched lips to form an involuntary, almost sardonic 'smile' of death. It seemed as though she was pleading for help and death at the same time. Out of sheer empathy alone I could have helped her die with satisfaction. From that moment on, I was sure that doctor-assisted euthanasia and suicide are and always were ethical, no matter what anyone says or thinks."

In 1953, the Korean War interrupted Kevorkian's career. He served 15 months as an Army medical officer in Korea, then finished his service on a Colorado mountaintop

encampment, where he taught himself to read music and scanned baroque scores by lantern in a tent. He got a little wooden recorder, a primitive wind instrument, and then a flute. Both were good for playing Bach.

Discharged, Kevorkian did residencies at Pontiac General Hospital, in his hometown; at Detroit Receiving, where he pioneered his Death Rounds, and at the University of Michigan Medical Center. It was there, during a seminar in 1958, that an offhand question prompted Kevorkian to research the history of autopsies. Reading journals in German, he found an account describing how the ancient Greeks did medical experiments on condemned criminals in Alexandria, Egypt. The article "shackled me with responsibility to promulgate a profound idea," he wrote later. "Possibilities churned in my youthful and impractically idealistic mind. How simple a solution to so many perplexing problems."

Doing further research, Kevorkian found that 13th-Century Armenians-- his ancestors-- also had done experiments on condemned men. Doctors gave wine to prisoners to anesthetize them, then cut them up to study blood circulation.

In October, on a day off, Kevorkian drove his 1956 Ford to Columbus, Ohio, the nearest state with the death penalty, on "a righteous crusade" to "challenge profound philosophical viewpoints and clash head-on with enduring and powerful taboos."

Unannounced, he walked in on the warden at the Ohio State Penitentiary and asked to meet with death-row convicts. Kevorkian wanted their reaction to his idea of doing medical experiments at their executions. Amazingly, the warden agreed "without manifesting a trace of the selfish and Machiavellian hypocrisy that fuels much of civilized society."

Kevorkian interviewed two young murderers. One later sent him a letter: "I would gladly give you what you requested of me and in doing so it might help others."

Kevorkian never heard from the other convict, but the one consent was enough: "I knew beyond doubt that the proposal was practical... the crusade was unstoppable."

Elated, Kevorkian wrote an essay outlining his proposal: At the time of execution, put the condemned to sleep with drugs, then do experiments and finally inject lethal drugs to carry out the sentence. The benefits: Millions saved in research costs. New cures discovered. And, not least of all, a chance to find what makes the criminal mind tick.

He argued that "any human being condemned to unavoidable death for any conventional reason...whether justly or not, anywhere in the world should be allowed this choice." He proposed a new specialty of doctors to do the experiments, saying it would be "a unique privilege...to be able to experiment on a doomed human being."

Anticipating objections, Kevorkian insisted his proposal was unlike Nazi concentration camp experiments.

"Those medical crimes apparently were such a horrendous discovery for the civilized world that, regrettably, they seem to have blunted reason and common sense with regard to the rational assessment of the use of condemned human subjects for research," Kevorkian wrote. "Medical experimentation on consenting humans was, is and most likely always will be the laudable and correct thing to do."

Professional journals and popular magazines rejected Kevorkian's article outlining his proposal. Kevorkian later admitted his essay "reeked with sophomoric idealism and was highly impractical." But he was able to present it at the December 1958 meeting of the American Association for the Advancement of Science in Washington. D.C.-- only because the group's chairman figured the outlandish scheme would turn more people against capital punishment. Kevorkian's speech caused a minor stir in the press, but drew no official support save for a stirring endorsement from an animals rights group, which pointed out that cutting up humans would save the lives of rats and guinea pigs.

The publicity embarrassed the University of Michigan. The chairman of the pathology department asked Kevorkian to drop his campaign or leave. There was a doctor shortage, so Kevorkian confidently quit and found a job back at Pontiac General.

As opposition to the death penalty grew, Kevorkian put his campaign on the shelf. He had experienced for the first time "the enormous force of social, political and historical inertia which makes it almost impossible to implement seemingly radical change, to bridge the wide gap between rational theory and actual practice."

Pontiac General was a busy and loosely run city hospital. Kevorkian had free rein in the pathology department. A colleague told him that Russian doctors were experimentally transfusing blood from corpses. Kevorkian decided to give it a try. He enlisted help from a young medical technologist named Neal Nicol and others.

When a victim of a heart attack or auto accident was brought in, Kevorkian's team would do a quick autopsy, put the body on a tilt table, stick a syringe in the jugular, let the blood drain into a bottle, then give the blood to live patients. It worked.

In 1961, in a paper in The Journal of Clinical Pathology, Kevorkian acknowledged the cadaver blood research "has an ostensible undercurrent of repugnance which makes it difficult to view objectively." But corpses were a free, ready-made source of blood, he wrote. He added that "permission of next of kin is not necessary if corpse blood is to be taken... Routine consent from the recipient is no more necessary than in instances of conventional blood bank transfusions."

Dr. Murray Levin, then an internist at Pontiac General, said Kevorkian's frequent talk about his research unnerved his colleagues.

"Most of us just sort of changed the subject when he got on it," Levin said. "We thought it was inappropriate. We had plenty of blood. We didn't need to deal with cadavers."

After Time magazine gave his work a mention, Kevorkian thought of a new twist: To save lives in wartime, why not transfuse blood directly from a corpse to an injured soldier on a battlefield? Not even the Russians had tried to do that.

One day, a stroke victim came in. Kevorkian put the corpse on the tilt table. Neal Nicol, whose blood type was compatible, lay on the floor next to the dead man. Through a transfer device Kevorkian had rigged up, the dead man's blood flowed into Nicol's veins. Nicol felt no ill effects.

Soon after, Kevorkian hooked up a female staffer to an 18-year-old girl who had died in a car crash. Kevorkian went for the corpse's jugular, but her neck was mashed and he couldn't get the needle in. Thinking fast, he plunged the syringe into the dead girl's heart and drew out the blood. The recipient reported a funny taste in her mouth . Kevorkian panicked, wondering if he was poisoning her. After an autopsy, he discovered the dead girl was drunk. He surmised that the recipient had been tasting the liquor.

Kevorkian published his new research in a 1964 article in Military Medicine, complete with posed "battlefield" pictures of a corpsman transferring blood from a "dead" soldier to a wounded man. The man playing the corpse looks like Kevorkian.

Kevorkian pitched his idea to the Pentagon, figuring it could be used in Vietnam, but the Defense Department turned a cold shoulder and Kevorkian was denied a federal grant to continue his research. He reacted to the rejection with a more sweeping rejection of his own: "I resolved never again to waste time and effort in futile appeals for support from government agencies."

Kevorkian called his years at Pontiac General "the best days of our lives." But the research added to his oddball reputation. "It got me into trouble. Jobs closed down because of that." His resume-- full of articles on death-row experiments, cornea photography at death, and cadaver blood transfusions-- "scared the hell out of people."

Even his hobbies produced frightening things.

In the early 1960's, Kevorkian took a Pontiac adult education class in oil painting. His classmates were mostly conventional housewives who were painting clowns and kittens and trees.

"Ugh!" he recalled 30 years later. "I just do not like anything banal.

"I says: I'll show them. I'll paint something that will turn their stomachs, and then I'll quit this course."

To his surprise, his staid classmates love what he drew. To his childhood talent for drawing, Kevorkian had added his extensive knowledge of anatomy and deep interest in deathly matters. The art class painting became the first of 18 striking, gruesome, surrealistic visions full of skulls and body parts and cannibalism and harsh religious parody. Kevorkian executed his canvases with brash directness. The paintings, exhibited sporadically around Michigan for nearly two decades, usually caused a sensation.

"I tire easily of beautiful scenes and portraits, and abstract art has no tangible or intelligible significance for me," he told a newspaper in 1964. "People may wince at some of my paintings, but nobody has yet denied their forceful accuracy."

His art, he said, portrayed "distasteful but widespread aspects of human existence...that show how hypocritical we are."

In the painting Genocide, a yellowish male torso is seated at a dinner table. Its large arms are holding a huge knife and fork. On a table are two gray nuclear warhead-shaped salt-and-pepper shakers, a soldier's upturned helmet filled with bronze bullets and a large dish full of golden crucifixes.

To paint the frame for Genocide, Kevorkian mixed outdated blood from blood banks with a little of his own.

"That gets people," he chuckled.



CHAPTER THREE

THE DOCTOR DEATH DIET

"A well-balanced sense of humor is a great defense against hopelessness and reckless panic which can lead to undue expense, danger, and psychic turmoil. A well-tickled 'funny bone' is a prerequisite for keeping things in clear perspective."

-- Jack Kevorkian, Slimmeriks and Demi-Diet

Like the quills of a porcupine, Jack Kevorkian's principles kept getting in the way of things like a career and a family.

When Pontiac General brought in a new chief pathologist who was enamored with technology, Kevorkian battled the new order, lost and quit. For 18 months, he worked at Wyandotte General Hospital in the downriver suburbs of Detroit. Then he launched another ambitious project. In Southfield, he opened Checkup Diagnostic Center, "a multiphasic diagnostic clinic for preventive medicine examinations." Technicians took histories and did X-rays and lab tests on walk-in clients and provided them with computer print-outs of their medical status. The business lasted only a year and a half because "other doctors felt competition and were frightened," according to Kevorkian.

In 1970, Kevorkian became chief pathologist at Saratoga General Hospital on the east side of Detroit. The job would be the apex of his orthodox medical career.

About that time, Kevorkian was engaged to a young store clerk. But he broke it off. Kevorkian thought his fiancee was not self-disciplined. Marriage wasn't worth it, he decided, if he couldn't find a perfectly compatible partner who shared his values and goals and interests.

He later called his rejection of marriage the biggest mistake of his life.

"That's shirking responsibility as a human being," he said of his refusal to procreate. "From nature's standpoint I'm immoral."

As a bachelor and a loner, Jack Kevorkian had plenty of time for his passions -- painting, music and writing. He learned keyboard instruments. He got a concert organ and a harpsichord so he could play his beloved Bach.

For a New York publisher, Philosophical Library, Kevorkian wrote a medical history, The Story of Dissection, and a philosophical treatise, Beyond Any Kind of God. The jacket of the latter book describes it as an "effort aimed at trying to peer into the Great Unknown" and "to divine a philosophic view as timeless, as totally unchangeable, as the universe with which it deals."

Going from the sublime to the ridiculous, Kevorkian wrote, illustrated and self-published a limerick-laden diet book, Slimmeriks and the Demi-Diet.

By way of a biography, Kevorkian offered:

The author's official position/ Is not in the field of nutrition/It wasn't his "dish"/ When at Ann Arbor, Mich.,/ He became a postmortem physician.

Kevorkian's diet book humor was gentle and silly, not caustic. He opined that "fat people are not jolly" because "deep down they don't like being fat." But he insisted that "I am not on a 'body-beautiful' crusade. It makes little difference to me how you want to look to yourself."

Though a Jack Kevorkian diet eventually would sound like the creation of a David Letterman joke writer, the skin-and-bones pathologist was serious in explaining his personal battle with obesity. That took place in his freshman year at college, when a sedentary life-style and overeating ballooned him to "an unbelievable 162 pounds." In desperation, he started leaving half of all portions on his plate uneaten. That became the basis for his diet philosophy of "controlled nibbling." He also started lifting weights, seeking refuge from the "intimidating cacophony of voices, bouncing balls and thumping feet" in the university gym.

"I just wasn't going to compound my embarrassment and sagging self-esteem by exposing my effete, blubbery body to a gymful of physical fitness buffs," he wrote, explaining his decision to pursue a solitary form of exercise.

The gist of Doctor Death's advice, without the limericks: Don't smoke, avoid milk, get moderate exercise and eat whatever you want - just leave half of it on your plate.

Even in a diet book, Kevorkian couldn't resist a dig at death. He sketched a grave digger wiping his brow, resting on his shovel and staring at an enormous bulge in a fresh grave. The accompanying limerick explains:

A life of profane deglutition/ Can end in a real grave condition:/ How the masses consumed/ Can be fitly entombed/ Will weigh heavy upon the mortician.

Many people have wild dreams. Few act on them. But Jack Kevorkian had no family or promising career to hold him back.

As he approached age 40, Jack's big dream was to go to Hollywood and make a movie about Handel's Messiah.

Jack wasn't exactly a movie buff. He said he stopped going to movies after seeing M*A*S*H, because he found that film full of gory scenes and vile language. His own kind of movie would be more cerebral.

On June 23, 1976, Kevorkian filed incorporation papers with the State of Michigan for a new company called Penumbra, Inc., to produce his movie. He quit his job at Saratoga General, packed all his belongings in his beige 1968 Volkswagen van and drove to Los Angeles. He couldn't find an affordable apartment, so he slept in the van for a while.

Kevorkian talked his way into film studios and worked on his movie late at night. Somehow the lone wolf pathologist managed to complete a full-length, 90 minute film - something that doesn't happen without collaboration and considerable expense. But the film apparently never was exhibited, and it was the only subject in his life that Kevorkian steadfastly refused to talk about when he later became famous.

In 1979, he returned to Michigan and worked briefly at a hospital in Owosso. Soon he was back in California. To make ends meet, he took part-time jobs at the Beverly Hills Medical Center, where he resumed his "Death Rounds" of photographing the eyes of patients, and at Pacific Hospital in Long Beach. In 1981, he took a full-time job at Pacific. His boss, Dr. Fred Hodell, said Kevorkian's work was brilliant.

In 1982, Kevorkian rented a tiny apartment above a garage on Termino Avenue in the Belmont Heights area of Long Beach, an upscale oceanside neighborhood. He lived just above a garage.

"Termino" is Spanish for "the end."

The neighbors didn't care much for the headstrong doctor and his rickety van. One resident on Termino, Jeanne Craven, said Kevorkian always was coming in very late at night and complaining about barking dogs.

"Jack kept weird hours and he creeped up in this dilapidated old van," Craven said. "Naturally dogs are gonna bark."

Down the street lived an architect, Robert Murrin, and his family. Kevorkian tried to get their dog, Doric, impounded for barking at the mail carrier.

After one year at Pacific Hospital, Kevorkian quit in another dispute with a chief pathologist. He "retired" to devote his time to his movie, his research and writing and his reinvigorated death-row campaign.

Kevorkian wrote a comprehensive history of experiments on executed humans. It was published in 1985 in the obscure Journal of the National Medical Association after more prestigious journals rejected it. In the article, Kevorkian described in gruesome detail how the 16th-Century Mayans sliced open the chests and pulled out the beating hearts of human sacrifice victims and ate their peeled bodies, how Italians conducted electrical experiments on fresh corpses, and how French experimenters shouted victims' names into the ears of heads severed by the guillotine. Those lurid descriptions later filled many pages in Prescription: Medicide.

Kevorkian's research convinced him that modern methods of execution were inferior to the way it was done in the French Revolution or medieval India.

"Lethal injection is probably the most tolerable method on a subjective level," Kevorkian wrote in Prescription: Medicide. "But when it comes to technicalities of performance, the guillotine doubtlessly is easier to use, more uniformly consistent, and absolutely certain. And having an elephant squash the victim's head is the quickest of all..."

Kevorkian renewed his death penalty crusade. Capital punishment was making a comeback. The Supreme Court reapproved the death penalty in 1976, and the next year mass murderer Gary Gilmore became the first American executed since 1968. At the same time, new strides in transplanting organs provided Kevorkian with a new rationale. Surely no one could object to harvesting organs at execution from consenting convicts, thereby saving several lives in the bargain!

Kevorkian searched newspapers for the names of condemned criminals appealing their sentences. He wrote them letters. Some wrote back. He besieged prison authorities with requests for consent to his proposal. All refused to cooperate.

Kevorkian believed the rationality of death-row organ harvesting and experimentation should be self-evident.

"We wontonly squander priceless opportunities to study ourselves and our living brains, as well as new ways to make us wiser, healthier and happier," he wrote. "We snuff out lives of criminals eager to make amends by donating their organs and helping science unlock some of nature's deepest secrets."

Kevorkian's logic didn't prevail. Legislators in Kansas, Oklahoma, Texas and California toyed briefly with allowing organ donation by death-row prisoners, but the proposals were squashed under the elephantine weight of official disdain.

In 1986, Kevorkian learned the doctors in the Netherlands were helping people die, mostly by lethal injection.

"Then I conceived the idea of expanding my death row proposal to include experimentation on willing patients who opt for euthanasia," he wrote. His new crusade for assisted suicide would be an outgrowth of his lifelong campaign for medical experiments on the dying.

Kevorkian churned out articles about the usefulness of planned death and the benefits of euthanasia. More rejection notes followed. "Are you serious?" editors would scrawl across his manuscripts. The only journal that would print his articles was Medicine and Law, published only in Germany.

In a 1968 article in Medicine and Law, Kevorkian praised Nazi doctors for trying to get some good out of concentration camp deaths by conducting medical experiments. He proposed euthanasia with few restrictions. He questioned whether psychiatrists should have the right to choose suicide. He outlined a system of centers for death-on-demand, calling them "obitoria."

"It's time for a society obsessed with planned birth to consider diverting some of its attention and energy from an overriding concern with longevity of life at all costs to the snowballing need for a rational stance on planned death," he wrote.

At obitoria, research could be carried out on any consenting adult. Patients who did not wish to be anesthetized could remain conscious during some experiments. What kind of research would Kevorkian permit?

"No aim could be too remote, too silly, too simple, too absurd; and no experiment to outlandish. Any magnitude of gain would be better than vacuous death."



CHAPTER FOUR

BY APPOINTMENT ONLY

"Just try it once - that's all we ask."

-- David Letterman's "Top Ten Promotional Slogans for the Suicide Machine" (#10)

One day in 1986, Jack Kevorkian's dingy van was gone from Termino Avenue. He had moved back to Michigan and rented a walk-up apartment on Main Street in Royal Oak. Here he seemed even more out of place than he had been in Belmont Heights.

Royal Oak was an older, family-oriented suburb whose downtown was transmuting into a trendy post-punk landscape. Strolling the sidewalks were ladies and gentlemen with multicolored spiked hair, nose-rings and tattoos. Beneath Kevorkian's windows were singles bars, sidewalk cafes, nouvelle cuisine restaurants, stylish resale shops and metro Detroit's foremost purveyor of exotic leather lingerie and bondage apparel.

Kevorkian's flat was bare and utilitarian. Living off his savings, he slept on a mattress and worked at a plywood desk surrounded by cardboard file boxes scavenged from alleys. He bought a manual typewriter for $2 at a garage sale. He still had his VW van, but sometimes rode his sister Margo's black one-speed bike to seminars. He was a regular at the local library and the Salvation Army store. He played Bach and sometimes watched cartoons on TV. Sylvester the Cat was his favorite.

Kevorkian tried many local hospitals and even the Oakland County Medical Examiner's office, but he couldn't get a job.

"I'm too controversial for most positions," he explained in 1990. "All they have to do is see my publications on cadaver blood and on the condemned prisoner work. That alone settles the issue."

Kevorkian continued his provocative writing. In a 1986 article in the Journal of the National Medical Association, Kevorkian argued that only doctors should decide bioethical questions. He called for the medical profession "to reestablish biological order and reassert leadership" by creating a new medical specialty that would combine clinical training with the study of philosophy and religion.

"In the final analysis it is medical theory or action that is the crux of any biomedical problem with regard to any patient individually (and collectively through them with regard to society). From this, it follows that the skill and knowledge of a competent physician are more basic and would reign supreme."

Kevorkian acknowledged: "Critics will undoubtedly point out the great danger of concentrating so much power (over life-or-death decisions) in one person and the ever-present threat of abuse of that power." But he said critics exaggerated. Isolated cases of abuse were merely a sign of human imperfection, not any flaw in his proposal, he wrote.

At Michigan State University in East Lansing, Howard Brody, a family practice doctor and an expert in medical ethics, came across Kevorkian's article. Brody was forming a multi-disciplinary committee on ethics, so he wrote Kevorkian a letter of offering to put him on the group's mailing list.

Kevorkian shot back a bristling reply. The gist of his letter, Brody said, was: "How dare you put me on your mailing list? I think what you're doing is a terrible thing. Only doctors should do this. I'm not interested in anything you are doing."

Looking for comrades, Kevorkian in 1987 flew to Amsterdam. Again he found rejection. To his surprise, he discovered euthanasia was not legal but merely tolerated in the Netherlands. And the leaders of the Dutch euthanasia movement considered his proposals for organ harvesting and experimentation so radical they would hurt the cause.

Still, speaking to Dutch doctors who had actually aided in suicides spurred Kevorkian to action.

"I decided to take the risky step of assisting terminal patients in committing suicide," he wrote later. "I could not even consider performing active euthanasia and thereby being charged with murder."

Mulling over methods, Kevorkian recalled a medical school professor who once had remarked that breathing carbon monoxide was the best way to commit suicide. In Prescription: Medicide, Kevorkian wrote that the gas is "toxic enough to cause rapid unconsciousness in relatively low concentration. Furthermore, in light-complexioned people it often produces a rosy color that makes the victim look better as a corpse."

In a passage that eerily foreshadowed his most controversial case, Kevorkian also pointed out a drawback to carbon monoxide: "Some patients, especially those prone to claustrophobia, might suffer discomfort or stress in having to breathe through a plastic mask placed over the nose and mouth." He also speculated: "Popularization of the procedure and the general availability of canisters of the gas could lead to wholesale 'copycat' suicides by others who are in no way terminally or physically ill. That in turn could evoke such a powerful emotional reaction from various clerical and lay factions as to force the voluntary or legal curtailment of supplies of carbon monoxide for that purpose."

Eventually, Kevorkian decided on lethal injection as the best method. He was ready to launch a new career. "To add a touch of dignity and legitimacy to the new specialty, I coined the word 'obitiatry,'" he wrote. He printed up business cards that read: "Bioethics and obitiatry. Special death counseling, by appointment only." He went to hospitals and tried to pass them out to oncologists. Most doctors recoiled.

In June 1987, he placed classified ads in local papers:

DEATH COUNSELING

IS SOMEONE IN YOUR FAMILY TERMINALLY ILL?

Does he or she wish to die - and with dignity?

CALL PHYSICIAN CONSULTANT

According to Kevorkian, the ads brought only two responses: one from a man whose brother had been in a coma for six months, and therefore could not consent, and the second from a rambling young woman whom Kevorkian judged to be mentally ill.

"Maybe the ads were too unobtrusive," Kevorkian mused. "Maybe they were taken to be a charlatan's macabre get-rich-quick scheme or merely the prank of a 'kook.'"

In August 1987, the metro Detroit Health Care Weekly Review published an article about Kevorkian's ideas on euthanasia and death-row organ harvesting. George Adams, the story's author and the paper's publisher, had met Kevorkian the previous year. Adams was one of only five students who showed up for a class on medical ethics that Kevorkian was scheduled to teach at Oakland Community College. The class was canceled for lack of enrollment, but Adams and Kevorkian became friends.

Adam's article was the first widespread exposure for Kevorkian, and it generated a lot of angry response from the readers of the weekly, a paper aimed at the Detroit area's medical professionals and administrators.

A follow-up article in the American Medical Association's weekly tabloid, American Medical News, got Kevorkian national attention in the medical community -- most of it negative.

He was turned down for a lowly paramedic's job at William Beaumont Hospital in Royal Oak. He had crossed the line from being a medical outsider to an absolute pariah.

"I never really fit in," Kevorkian said in 1991. "But I did use to feel at least that I belong to a healing profession. They don't think so any more - and I don't either."

Casting about for an income, Kevorkian remained inventive.

One day, an eager salesman visited Tom Pendell, public relations assistant for the National Football League's Detroit Lions. The man showed Pendell a prototype of a sun visor cap made from high-grade construction paper.

"It had some pretty elaborate, well-done designs of lions' heads on the front," Pendell recalled. "He had a very high-quality product. It really was a nice item."

The man "had a distinct personality," Pendell said. "He was a pretty good salesman, personably persistent." But the entrepreneur had overlooked one basic fact: the Lions played in the Pontiac Silverdome. Pendell told him that sun visors didn't make much sense in an indoor stadium.

Later on, when the unusual name hit the news, Pendell recalled Jack Kevorkian as the sun visor salesman.

Kevorkian tried to sell his inventive visors to other sports teams. Again he struck out.

In 1990, Kevorkian told People magazine that his life had been "a failure":

"If I had married, I'd have had kids - kids and family are everything. Looking back, I would do almost everything differently."

George Adams told me that Kevorkian suddenly dropped out of sight in 1988. For a while Doctor Death was back in California.

One night, Kevorkian called Adams at home after midnight. He reported he was back in Michigan and told Adams he had given up on the idea of working through the system to win support for his ideas.

"I'm just going to have to take the first step to force the issue," Adams recalled Kevorkian saying.

That year, Kevorkian's article, "The Last Fearsome Taboo: Medical Aspects of Planned death," appeared in Medicine and Law. He argued that modern society, facing the longstanding prohibition against planned death, was "subjected to unrelenting paternalistic control based on moral codes that are rapidly becoming obsolete." He called the medical profession "physically (philosophically) retarded, drifting aimlessly without a coherent or even workable ethical code."

Kevorkian outlined his vision thus: "The acceptance of the planned death implies the establishment of well-staffed and well-organized medical clinics ('obitoria') where terminally ill patients can opt for death under controlled circumstances of compassion and decorum....Physician involvement should extend far beyond mere termination of life to permit exploitation of the enormous potential benefit that could accrue from the acquisition of organs for transplantation and the performance of daring and otherwise impossible human experiments under irreversible general anesthesia."

What kind of experiments? Kevorkian provided some hypothetical examples:

*The removal of kidneys, liver and heart from a convict at execution.

*Four days of drug research on another death-row prisoner.

*Implantation of a chimpanzee liver in another prisoner.

*Drug research on a woman with breast cancer who chooses suicide in an obitorium.

*The removal of organs from a "mentally competent 30-year-old man, badly deformed, in great pain, and essentially helpless due to worsening cerebral palsy" who "is granted his wish to die in an obitorium."

*An experimental test of a new technique for removing a pancreas, performed on "a 22-year-old man in robust physical condition" who "certifies in writing and beyond doubt his irrevocable intention of dying" after two years of professional counseling fails to stem his suicidal intentions.

*Four days of drug research on the brain of "a hopelessly incompetent 65-year-old woman crippled by Alzheimer's disease" who enters an obitorium with "proper consent and endorsement from all family members and from designated authorities."

*Drug tests and the removal of the stomach, liver and small intestine from a "full-term infant born with severe spina bifida, paraplegia, and hydrocephalus." The tests formerly were conducted only on rats.

Kevorkian wrote that "obitiatry would make it possible to conduct daring and highly imaginative research beyond the constraints of traditional but outmoded, hopelessly inadequate, and essentially irrelevant ethical codes now sustained for the most part by vacuous sentimental reverence." Such experiments would curtail the use of animals for research, save money and accelerate medical progress, he claimed, but added: "Perhaps the greatest advantage would be the further unshackling of the primal human right of what should be absolute personal autonomy within the bounds of reasonable law."

Critics, Kevorkian conceded, would resort to "unjustified, irrelevant, and occasionally deceitful scare tactics" such as "an emotional resurrection of the Nazi tragedy." But what the Nazis did, Kevorkian wrote, was "merciless killing," not mercy killing.

"Such horrendous infringement of a concept does not necessarily invalidate it," he said.

Kevorkian concluded by saying that "euthanasia" - a "good death" - did not go far enough.

"Such a death still entails complete negativity, no matter how serene. It serves no constructive or positive purpose beyond the bleak aim of extinguishing life. An immense amount of inherent good is thereby senselessly squandered. The aim should extend far beyond a mere 'good' death toward a superlative ideal, which technically might be called 'eutatosthanasia' or best death."

On Aril 4, 1988, Kevorkian called the Oakland County Prosecutor's Office to get a legal opinion on whether obitiatry would be legal in Michigan.

"None was given and there is no statute addressing this issue," wrote Michael Izzo, an assistant prosecutor, in a report. Kevorkian's call prompted an inquiry by the state department of licensing.

State investigator Cathy Svoboda interviewed Kevorkian on August 29, 1988, at a Denny's restaurant in Royal Oak. Kevorkian showed Svoboda a California driver's license and said his residence in Royal Oak was temporary. He gave Svoboda his journal articles and explained his views. Svoboda wrote in a report:

"Dr. Kevorkian indicated he is an ethical researcher and is not permanently employed as an independent physician....Dr. Kevorkian is not pursuing participating in active euthanasia...because it is not legal and he does not want to get into trouble. He also said that no oncologists would refer patients to him at this time."

Kevorkian told Svoboda he had planned to assist in a suicide when he was living in California but "there was an attempt to get euthanasia on the ballot and he was asked to refrain from performing the illegal act."

To qualify for his help in dying, Kevorkian said, according to Svoboda, a patient "would have to be terminally ill and would have to be met by the attending physician four or five times" and that "an attempt should be made to dissuade the person." Later in the interview, Svoboda noted "he said it should take only one meeting by a bioethiatrist. The second meeting could last five seconds but at least it would be in the records."

Svoboda noted that Kevorkian "fashions much of his thinking on the way these deaths are prepared for and done in Holland."

"Dr. Kevorkian does not believe laws should rule or guide morality," Svoboda concluded. "Dr. Kevorkian maintains he is law-abiding but cannot agree or condone how law does not represent the consensus of society. He is making every effort to change laws and at the same time fulfill the demands of society. Dr. Kevorkian writes about his opinions -- he has not acted on them."

Sometime in 1988, Kevorkian contacted Derek Humphry, the British-born journalist who in 1980 had founded the Hemlock Society with his second wife, Ann Wickett. Hemlock advocated legal physician-assisted suicide for the terminally ill. Kevorkian suggested to Humphry that they join forces and set up an experimental suicide center.

Humphry rejected the proposal. He later told a reporter that the idea of "getting a taxi to a suicide clinic appalled us."

In the summer of 1989, David Rivlin, a 38-year-old quadriplegic who lived in a nursing home in the Detroit suburb of Farmington Hills, publicly asked to be disconnected from life support. Rivlin's spine had been severed in a surfing accident when he was 19, and a failed spinal operation had left him breathing with a respirator. He faced decades of that kind of life. The Oakland County Prosecutor's Office tried to intervene to stop his death.

Kevorkian decided it was time to act. Rivlin --and others to follow-- needed help in dying, he believed. But to make the matter as ethically clean as possible and to minimize abuse and coercion, the patient should "pull the trigger."

It took Kevorkian only a few days to work out the design, sketching on the Formica table in his kitchen: Start an intravenous drip of a harmless saline solution. Have the patient press a button to activate a device to stop the saline solution, start a new drip of thiopental and set off a 60-second timer. The thiopental would put the patient into a deep coma. After a minute, the timer's click would send a lethal dose of potassium chloride through the IV, stopping the heart in minutes. The patient would die of a heart attack while asleep.

Quick, painless and easy.

As the summer drew to a close, Kevorkian rummaged around hardware stores, garage sales, flea markets and his own junk piles. Using household tools, toy parts, magnets and electrical switches, he fashioned the death machine. It had an electric-clock motor with a pulley axle, a fine chain and two coils acting as electric bar magnets. He covered it with scrap aluminum siding and fashioned a handle and a stand for the drug bottles. The total cost of materials was $30.

He called the machine the Thanatron - Greek for "death machine."

He then added a device that would allow Rivlin to pull the string with his clenched teeth. But Rivlin rejected Kevorkian's help. A judge refused to intervene. Rivlin went to a friend's home and Dr. Jack Finn, director of the Hospice of Southeastern Michigan, supervised the removal of life support.

Undeterred, Kevorkian decided to test his new machine on a stray dog scheduled to be euthanized. Veterinarians in a local dog pound asked him to get permission from the head of the county health department, who referred Kevorkian to the humane society, who told him the request would have to be put in writing and handled at the next board meeting, four weeks away.

Frustrated, Kevorkian said it looked like he would have to use the machine first on a human being to prove it was safe for killing an animal that was going to die anyway.

He submitted an ad to the Oakland County Medical Society Bulletin:

Doctor Seeking patients for new practice of obitiatry.

The submission was passed on to the board of the medical society. One of the board members was Dr. Murray Levin, Kevorkian's old colleague from Pontiac General. The board rejected the ad. But when a TV station found out about the matter, Dr. Jack Kevorkian and his suicide machine flashed into the living rooms of Detroiters for the first time.

Watching were a young woman and her father. She called Kevorkian and arranged a meeting. The man, 47, had inoperable cancer. He said he would rather die while alert than slip into a drug-induced stupor. But he lapsed into unconsciousness before he could try the suicide machine.

Again, Kevorkian tried to place a display ad announcing his services. This time, all the local papers refused it. But he got the kind of publicity you can't buy when first the Oakland Press, then the Detroit News ran stories about his search for patients.

"I have no fear about what I'm doing," Kevorkian told the News. "I'm here to help anybody who's in distress, or thinks he is." He said the machine was "dignified, humane and painless, and the patient can do it in the comfort of their own home at any time they want."

After national wire services picked up the story, Kevorkian, at age 61, finally got the recognition he had sought all his life. Via phone hookups from the apartment, he went on radio call-in shows nationwide. Soon, patients were calling him asking for help. But most were from out of state, and Kevorkian said he would not travel to states where assisting a suicide was a crime.

A local woman with multiple sclerosis called. Kevorkian met with the woman, her daughter and her neurologist. He urged her to try another course of therapy but agreed he would help her die later. After two months, the woman called to say the new therapy had failed and she had more pain than ever and wanted to die. But Kevorkian told her the first patient must be terminally ill. He promised she could be his second patient.

"In order to minimize the passionate (if irrational) storm of criticism certain to be evoked by such a procedure, I realized that ideally it should be in connection with a suffering and indisputable terminal patient - for example, someone dying of incurable and widespread cancer," he later wrote. "I explained how that should blunt condemnation of my assisting her as the second case."

A few weeks later, the woman with MS agreed to hold a press conference at her home to announce her wish to use the Thanatron. But before she could go on the air, a relative whisked her away to a hospital. Kevorkian never heard from her again.

In Portland, Oregon, Ronald Adkins picked up a copy of Newsweek and read an article about Jack Kevorkian. On November 13, 1989, he called Royal Oak.



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