By
msnbc.com contributor
updated 6/1/2007 10:19:04 AM ET 2007-06-01T14:19:04
COMMENTARY

The last time I saw Jack Kevorkian was April 23, 1994, in a courtroom in Pontiac, Mich.

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Oakland County prosecutors had charged him in the death of 54-year-old Janet Adkins of Portland, Ore. The charges were assisting in a suicide, murder and delivering a controlled substance for administering drugs without a license.  I was there to testify that what he had done to Adkins — providing her with his "suicide machine," which she used in the back of his 1968 VW van parked in a dark campsite to end her life — was both immoral and a gross violation of medical ethics.

Kevorkian, who became known in the press as "Dr. Death," was found not guilty. A few years later he was asked by Thomas Youk, a 52-year-old who had trouble breathing and swallowing due to advancing Lou Gehrig's disease, for help in dying. Kevorkian injected him with a lethal dose of potassium chloride while videotaping the ghastly proceedings. He sent the tape to "60 Minutes," which aired it. This gave prosecutors incontrovertible evidence that Jack had gone from assisting in suicides to personally killing people. He was sentenced to 10 to 25 years for murder. After serving just over eight years, Jack is back.

I believed Kevorkian was a very dangerous killer then, and I still believe it now. He helped dozens of depressed and disabled people die without trying very hard to convince them to live. 

That day in the Pontiac courtroom, he stared and scowled as I said that it was unethical for a doctor to help kill someone they barely knew, who was not terminally ill and who was still enjoying a good quality of life. Adkins had been told she had Alzheimer’s but it was not clear how many months or years of quality life she had left when she used Jack’s jury-rigged death machine to infuse a lethal dose of drugs into her bloodstream.

All this matters because now that Kevorkian is out of jail, he has said he plans to reinsert himself as a vocal participant in the ongoing debate in America over assisted suicide. 

No doubt he will get an audience. There are plenty of Americans who still, incredibly, view him as a hero. And the media loves him, too, knowing the audience-grabbing power of an unrepentant killer.

To be fair, there are those who admire Kevorkian as the lightning rod who changed how Americans view both the care of the dying and assisted suicide. After all, didn’t he bring these issues center stage in courtrooms, state legislatures and the media? No one else did more than he did to promote assisted suicide.

Fanatic, not leader
But I do not see him this way. He was more of a fanatic than the founder of a movement. A zealot who could rally public opinion but could not shape it.

You see, Kevorkian believes in suicide on demand.  He thinks that doctors have an obligation to help anyone who decides that their life is not worth living, whatever their reason. Some of the 130 people he helped die had no terminal illnesses. Some were clearly depressed. Others had histories of mental illness. Only a few got any counseling. Kevorkian helped them all to die.

Kevorkian’s problem was and is that he likes death way too much. The enthusiasm he brought to his cause was always deeply troubling.  No doubts, no ambivalence, ever seemed to cross his mind as he dispatched his victims. The fact that he helped some to die within hours of meeting them, the fact that he would turn a disabled man’s death into a national spectacle by giving a tape of his murder to "60 Minutes" — never mind that they used it! — and the fact that he never seemed to try particularly hard to talk those who came to him out of their decision to die made him morally suspect then and hardly worth hearing from now.

There are other reasons besides his fanaticism and moral obtuseness that we don’t we need to hear anymore from Jack Kevorkian.  

When Kevorkian went to jail, polls showed Americans were not sure what to think about legalizing assisted suicide.  They still are not.  According to an Associated Press poll out this week, 48 percent of people said assisted suicide should be legal; 44 percent said it should be illegal. 

Debate has passed him by
But the debate has grown more sophisticated than it was when Kevorkian was offing people on TV.

The citizens of Oregon legalized a form of physician-assisted suicide in 1997.  Proponents said the biggest obstacle they faced was Kevorkian and what he had done.  They convinced people to vote for legalization despite Kevorkian, not because of him.

Critics who knew of Kevorkian's seeming disinterest in those he helped to die worried about abuse of the vulnerable and dying in Oregon.  However, the passage of the carefully crafted Oregon law seems to have accomplished the goal of giving the terminally ill the option of controlling their death without encouraging them to die. 

What is so interesting is that almost no one who asks for a lethal dose of medication actually does end their life. The Oregon law requires a determination of terminal illness by two doctors, counseling and a waiting period before a doctor can assist in dying.

It was the Oregon law, not the actions of Jack Kevorkian, that shook the complacency of the medical and nursing professions in that state and across the country. And it was the rise of palliative care and hospice as an alternative to rather than as a result of Kevorkian that has made dying a less horrifying prospect all over the United States. 

We are far from ensuring a dignified and pain-free death for every American. The Terri Schiavo case was a stark reminder that your right to control how and where you die is not beyond the meddlesome grasp of pandering politicians and religious harpies. But we know now what we did not know when Kevorkian went on his assisted-suicide rampage — that we have a duty to make dying bearable and to ensure that each person gets the support, technology and pain control they wish.

The fact that Jack is back is no cause for celebration. The world of death and dying has, thankfully, passed him by. There is still more to talk about but not much useful that Jack Kevorkian can possibly say.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.

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