The Legacy of Jack Kevorkian

June 7, 2011

Dr. Jack Kevorkian died Friday. To say that Kevorkian was a controversial figure would be an understatement. Controversy was what he sought, and he was not disappointed.

Kevorkian, a medical pathologist, achieved notoriety in the 1990s by assisting over 100 persons to bring about their own deaths through his suicide machine. The machine was designed to allow persons to inject themselves with a lethal drug. In at least one case—the case that resulted in his 1999 conviction for murder—Kevorkian himself injected an individual with a lethal dose.

To some, Kevorkian was a hero; others considered him a publicity hound and killer. Almost all physicians considered his actions unethical, if not illegal.

I’m a strong advocate for legalization of assistance in dying. Indeed, it was the subject of my doctoral dissertation. However, I have mixed feelings about Kevorkian. One problem is that he became the poster boy for those opposed to legalizing assisted dying. Kevorkian typically spent very little time with the people that he helped to die: he made no serious assessment of their competency; he did not confirm their diagnosis with other physicians; he made no detailed review of their medical history; and he rarely discussed with them alternatives to assisted dying. (Some have also claimed that at least a few of the people he assisted did not make a voluntary choice for death, but there’s no firm evidence of that.) To call these individuals “patients” of Kevorkian, as some have, would be a mistake. Kevorkian was not their treating physician. In fact, as a pathologist he was not qualified to treat them. What Kevorkian did was to verify they wanted to die and then make a quick assessment that they were terminally ill or seriously disabled. After a brief waiting period, usually a day or two, he then proceeded to help them carry out their desire to die. His hurry-up-and-get-it-over-with approach is what opponents of assisted dying predicted would happen in tens of thousands of cases in those states that decided to legalize assisted dying.

Fortunately, this has not turned out to be the case. Both in Oregon and Washington, the two states that have legalized assisted dying, patients are required to seek assistance from their treating physician and rigorous safeguards ensure the patients are competent, have a durable desire to hasten their deaths, and have carefully considered alternatives to assisted dying, such as hospice care and aggressive pain management. As a result, there has been no evidence of any abuses—such as subtle pressure from relatives, incompetent patients, or hasty decisions— in Oregon or Washington.

But one can’t judge Kevorkian too harshly. First, even the most conscientious physician is apt to act hurriedly in a situation where he risks prosecution for murder. (After his first trials, which resulted in acquittal, Kevorkian started to take more time with some of those who sought his assistance.)

Moreover, Kevorkian drew attention to a problem that was all but ignored by the medical establishment, namely the suffering of patients in terminal or severely disabled conditions. In doing so, he raised public awareness of the need for social and legal change. It’s safe to say the movement to legalize assisted dying would not have acquired sufficient momentum to achieve success in any state had it not been for Kevorkian. One can only hope that more states will come to recognize the right of patients to exercise some control over the manner of their deaths. Legalizing assisted dying so that desperate, seriously ill persons do not have to travel across the country to seek surreptitious, hurried assistance from a pathologist would be the most fitting tribute to Kevorkian.