Doctor Kevorkian dead, but not by suicide

Recently it was announced that Dr. Jack Kevorkian (also known as Dr. Death) died — ironically, not by suicide.

As a psychiatrist, one of the things I consider part of my job description is suicide prevention.  Although many consider Dr. Kevorkian a civil rights activist for assisted suicide, I believe that there was a severe lack of ethics in his medical practice.

From everything I’ve read in the media (and I do acknowledge that this information is not as complete as the information presented at his three criminal trials), there is a lot of controversy about how he proceeded to do his work.  There are reports that he did not perform full psychiatric screenings to assess for depression or other treatable mental illnesses; that a significant number of patients did not in fact have terminal illnesses; that a few patients did not present with any physical problems whatsoever at autopsy; and that death for some patients came within 24 hours of meeting with with Dr. Kevorkian for a consultation.

There are also reports that Dr. Kevorkian was interested in the very scientific process of vivisection.  Finally, Dr. Kevorkian was not an internist, or oncologist, or psychiatrist.  He was a pathologist, practicing in the one area in medicine that requires the least amount of patient care, in fact functioning more as a scientist in a lab rather than a clinical physician.  It’s all a little frightening, what he claimed he did, which was assist over 130 patients in suicide with a machine that he created to inject the medications.

The area of assisted suicide is certainly controversial, and the culture of health care has trended to one of “do whatever it takes” to keep someone alive.  A significant amount of health care dollars are spent on the last year, and the last month of a patient’s life, and most of that money is spent in an effort to keep the patient alive.  For some, by the time it comes to make a decision about CPR and other end-of-life saving measures, the decision must be made by the family because the patient is no longer able to do so.  This is the other extreme of how to manage terminal issues, and this end of the spectrum is just as unfortunate.

Patients should not have to suffer through the last months of their lives, but assisted suicide, as it stands now, may not be the best option either.  While it is difficult for physicians to bring these issues up with patients prematurely, this is often the one saving grace in difficult situations and this also helps families and patients manage these difficult issues with some guidance, whatever their decisions may be.

Christina Girgis is a psychiatrist who blogs at
getaheadwithdrg.

 

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  • ninguem

    Glad to see someone bringing up this aspect of Kevorkian.

    A substantial number of his “patients” had minimal disease, and SOME HAD NO DISEASE on autopsy.

    They were suicidal. They had psych issues.

    The doctor’s job is to make the diagnosis, and Kevorkian failed miserably.

    I have no idea why people make him out to be some sort of hero. He was a disgrace to the profession.

    • Bobbo

      He was instrumental to bringing the topic of physician assisted suicide out in the open, for which he should be applauded. However, he may end up doing more harm then good to the PAS movement through his unethical practices.

    • jeffmchpn

      Please, Dr. Kevorkian was an MD. His post graduate specialization was in Pathology. One of my most respected colleagues is an internist with specialty certifications in Geriatrics and … Pathology. He is a full professor at a NE medical school and received the AGS Clinician of the Year award in 2005. My point is, Dr. Kevorkian was a physician, and in my opinion he acted as a sensitive, emphatic one in addressed the suffering of patients and family members who sought his care.

      I must also categorically dispute your rather arrogant contention that, “They were suicidal. They had psych issues.” Really? You have probably never suffered to any great or lengthy degree, or watched and cared for a loved one who has; nor have you long dealt with any uncertainties in your life on this Earth. Most of us live in the gloriously painful and rewarding gray areas of life. I would guess you do not consider chronic moderate to severe pain a major disease, so a patient with severe, intractable pain might have “had minimal disease.” Even
      one of those “SOME [who] HAD NO DISEASE on autopsy.” Gee, it’s all in the definitions!

      I much prefer a life well-lived, filled with the surprises in responding to open questions, and active listening to people, birds, the wind, and the waters. I have cared for many patients who’ve suffered progressively debilitating diseases, from ALS to MS to Parkinson’s, Alzheimer’s, and other dementing diseases. I can tell you that the human spirit is alive, vigorous, and remains defiantly independent around personal choices re. the time and manner of their impending ends. The same is true for stroke victims, and those suffering progressive dementias as result of a series of smaller strokes. The one overarching constant is a deep desire for dignity and spiritual peace. The ALS patients and families who accepted impending death with a sense of peace did not suffer when they could no longer breathe. Really.
      They chose to die “a natural death”, without a period of intubation which necessitates a heart-wrenching MD-
      mediated extubation when all are finally OK with a death that had been inevitable for years.

      And so it goes in that “wifty” space on the boundaries between life and death, signposts on a journey. Our pain and fear lies in our separation from those we love.

  • Molly Ciliberti, RN

    I for one and glad that my state, Washington, has legal assisted suicide for those suffering and terminally ill. It has been working well as has the law in Oregon. Funny there hasn’t been a run on it by depressed people; it has safe guards to protect everyone involved. Reassuring to know that the option is available should I need it.

  • jeffmchpn

    Nursing is my third major career, after education and work in business as a systems analyst and consultant. As virtually all my nursing career has been in oncology and hospice, I have experienced life, death, and humanity in its extremity — often. And I, too, am grateful for the wisdom and courage of the citizens in Oregon and Washington for the rational, compassionate laws they’ve passed, and in Oregon, confirmed! Elizabeth Kubler-Ross defined death with dignity as “dying according to ones character.” Dying with integrity and whenever possible, a sense of validation of who we are, and who and what we care about.

    Remember that Dr. Kevorkian was quite literally an outlaw, and he received utterly no referrals or medical records from other providers. In my experience suffering of the depth which provokes suicidal despair occurs when meaning and hope are remote, seemingly impossible to ever regain in the face of chronic, let alone terminal, pain and loss. In my hospital oncology experiences I witnessed fine, compassionate physicians prescribe rapid increases in opioid medications (morphine, Dilaudid, fentanyl) for a few patients at the end of lengthy battles with cancer, and the wicked treatments involved leading to terrible suffering.
    Yet the relief afforded by death stubbornly eluded them; the irony was and is that even very high doses of opioids rarely kill patients who have been taking high doses over a period of time. It’s called physical tolerance to the side effects, such as respiratory depression, which can and do kill others.

    Until our society demonstrates the the courage, common sense, and humanity to provide universal health care as a basic right let no one have the arrogance to pretend there is no right to die — with dignity. And certainly, whenever possible, doing so responsibly.