Why Jack Kevorkian had a profoundly correct message

Although Jack Kevorkian was only a few years older than I was, and we both practiced pathology in southern California for many of the same years, I never met Dr. Kevorkian.

I found him from a distance to be a deeply odd character, and a profoundly flawed messenger but with a profoundly correct message.

I can’t improve on the quick summary of Jack Kevorkian by an unnamed author that the New York Times issued on his date of reported death, June 3, 2011:

“Dr. Jack Kevorkian, the central figure in a tumultuous national drama surrounding assisted suicide, died Friday in Royal Oak, Mich., his lawyer told the Associated Press. He was 83 and had been hospitalized with pneumonia and a recurring kidney condition. Dr. Kevorkian, a medical pathologist who challenged social taboos about disease and dying, defied prosecutors and the courts to help terminally ill patients end their lives at times of their own choosing. He spent eight years in prison after being convicted of second-degree murder in the death of the last of the more than 100 patients whose suicides he assisted starting in 1990. His stubborn and often intemperate advocacy for the right of the terminally ill to choose how they die is widely credited with sparking a boom in hospice care in the United States, and with making physicians more sympathetic to their pain and more willing to prescribe medication to relieve it.”

Kevorkian’s work in assisted suicide closely followed the uproar that greeted my JAMA publication of the essay “It’s over Debbie” authored by “name withheld by request” on January 8, 1988.

This was a time when the American medical enterprise was very afraid to use opiates to treat pain in cancer and other terminally ill patients, concerned that they would addict, or would be accused of addicting, their desperate patients. And doctors and nurses practiced the notion that human life should be preserved and extended at any cost in suffering or money.

It took the Debbie case, the Kevorkian extreme actions, and yet other trailblazers who saw life and death through a different prism to move our society, ever so slowly, towards realizing that death is not the enemy; the enemies are premature death, disease, disability, pain, human suffering.

Death is normal. Every American deserves to have a death with dignity and as free from pain as possible, as can now happen with much hospice care.

Strange though he was, Jack Kevorkian helped us as a society to move a little closer to that ideal.

Let’s keep that trend line.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • ninguem

    Except many of the patients in question were not terminally ill. Many were not even seriously ill.

    And yes, I remember the “It’s over Debbie” essay. Readers can find it here:

    http://web.missouri.edu/~bondesonw/Debbie.HTM

    Housestaff initiating an act of euthanasia? A physician in training. On a patient barely known to the resident. In the middle of the night. No consultation with the faculty who know the patient. That’s what happened in the essay. Fictional or factual, I don’t know if that was ever revealed. I sure hope it was fictional.

    You call that”heroic”?

    That’s irresponsible, and I’ll say that about Kevorkian, and the GYN resident described in “It’s Over, Debbie”.

  • Marc Gorayeb, MD

    A profoundly correct message? Euthanasia, assisted suicide, whatever you want to call it, is relieving pain by ending life. It blurs the distinction between human and animal. If that’s where you are philosophically and morally, then I guess you won’t find this author’s comments shocking. Maybe veterinary medicine would have been a better fit.

    • BobBapaso

      I believe in no difference between humans and other animal their right to life and humane care.

  • Andrea

    I think Dr’s do not realize the difference between how hospice is supposed to be and the way it really is. Knowing of their behavior in three different states, they do little except to drop off the pills. Parasites at the public trough.

    • BobBapaso

      All Medicare providers could be described as, “Parasites at the public trough.” But I would blame the builders of the trough for this behavior. And I have heard stories of wonderful care provided by Hospice here in California.

  • http://www.womeninpainawareness.ning.com carol

    As a person who was in chronic intractable pain: from trigeminal neuralgia, atypical facial pain, and anaesthesia dolorosa, after numerous brain surgeries which left me with numerous side effects, dozens of medications in various combinations, procedures and therapies, none of which helped, I was advised by a pain management specialist ( a psychiatrist who ran his own pain clinic), 2 psychologists, a social worker, and neuroopthalmologist that ‘rational suicide’ was okay in my case. Had something not occurred a short time later that made me doubt my rationality (a neurosurgeon told me he was going to do a mesenphalic tractotomy that changed when I got to the hospital to a leukotomy (mini frontal lobotomy). “You’ll still have the pain; you just will not care that you do.” he told me., I would have committed suicide. Since then, many, many years later, the pain resolved, (except for eye usage and movement pain that still keeps me disabled but is not as horrendous as the constant, spontaneous and triggered pain – so bad I used to get my face washed under general anaesthesia.)
    I have been asked wouldn’t it have been horrible had you killed yourself then? No, At that point it was very appropriate; and I wish there had been somewhere there who would have been able to help me with it.
    Suicide is not the worst thing that can happen. Unremitting pain, unendurable suffering, that is the worst. There is nothing wrong with someone being able to help you, even if it is thru suicide. (and yes, you need confirmation and maybe a board of folks verifying nothing else can be done.)
    Carol Jay Levy, B.A., CH.t

  • William Nuesslein

    Doctor Jack Kevorkian is a hero to me. Thank you, Doctor Lundberg, for your wise words.

  • http://www.MedicalManiacs.com PatricParamedic

    Medicine is a garden of some truly ugly ironies and none is stranger than this:

    Since 1990 3,410 U.S. MDs (that I know of) have been either convicted or sanctioned for causing unnecessary deaths. Most folks died of unwarranted surgeries; thousands were killed by adverse drug reactions that ought never have been prescribed. 400 were murdered outright; 5,000 patients were sexually assaulted. Almost exactly 2,500 physicians are convicted of felony-level crimes each year.

    Criminal surgeons cut open countless thousands of human chests, for no better reason than to amass wealth. Are their numbers a large percentage of the total? Of course not. But they do enormous damage, and they are almost never reported by their peers.

    And yet Jack Kevorkian – a man not driven by wealth – who actually sat with his patients; cried with them; felt their pain & carried out begged-for deaths with dignity, is treated more shoddily than any of his lab coat criminal peers, including those who murdered spouses, bombed their enemies; shot down coworkers and sexually assaulted children.

    I happen to investigate bad doctoring for a living. Few are more critical of errant physicians than I am.

    But bad medicine kills 400+ citizens per day, and the only thing Jack Kevorkian was convicted of – in my humble opinion – was uncommon humanity.

  • http://twitter.com/DoctorFisher David Fisher MD

    Please 

  • http://twitter.com/DoctorFisher David Fisher MD

    Please stop equating adequate pain relief and good hospice care with physician-assisted suicide.  There is a vast difference.  As a hospice and palliative care physician, I have no qualms about prescribing high doses of narcotics and other medications in order to relieve the suffering of my dying patients.  My intent is never to kill them.  Doctor Kevorkian willfully and purposely ended his patients’ lives with lethal injection.  A request for relief from pain is normal.  A request for death is not, and should not be celebrated or accepted by the medical community as a normal part of suffering and dying.  Yet more and more physicians are celebrating those who declare that they want a “death with dignity” as they get in line to write them a prescription for  lethal drug.  Legalizing physician assisted suicide will add pressure to those who already feel they are a burden to society.  David Brooks’ recent article in the NYT that blames our budget crisis on those who do not choose “death with dignity” is proof of the undue pressure that will mount on the disabled and chronically ill, if assisted suicide continues to be framed as a noble and dignified gesture.  Let’s focus our efforts on research into better palliative care and pain relief so that no one would ever feel the need to ask for their doctor to intentionally end their life.

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