TIME: Almanac 1993/TIME Almanac 1993.iso/time/061890/0618621.000

Text File | 1992-08-28 | 7.7 KB | 165 lines

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                                                          ETHICS, Page 69

Dr. Death's Suicide Machine


An ailing teacher's last decision inflames the euthanasia debate

By NANCY GIBBS -- Reported by Michael McBride/Detroit and Andrea
Sachs/New York


    In a rusting old van in a public campground 2,000 miles away
from her home, Janet Adkins faced death last week. It took the
form of an odd-looking contraption made mostly of three
dripping bottles, the invention of a Detroit doctor named Jack
Kevorkian. As Adkins settled down on a small cot, she was
attended by Kevorkian. He hooked her up to a heart monitor,
slid an intravenous needle into her arm and started a harmless
saline solution flowing through the tube. Then he sat back and
watched the monitor as she pushed a big red button at the base
of the machine. Immediately, the saline was replaced by a pain
killer; one minute later came the poison potassium chloride.
Within five minutes Janet Adkins, an Alzheimer's disease
sufferer who feared an excruciating future, was dead of heart
stoppage.

    The premiere performance of Kevorkian's suicide machine,
which he invented for the terminally ill, blew open the debate
over the boundaries of mercy killing. As the details of her
life and death emerged, Adkins became a symbol of all those
patients who confront a horrible disease and vow to maintain
some dignity in death. And as Kevorkian carried his crusade for
legal mercy killing to networks and newspapers around the
country, he became a standard-bearer for all those who fail to
see a moral difference between unplugging a respirator and
plugging in a poison machine. He was quickly dubbed Dr. Death.

    It was ironic that a retired doctor was promoting a
homemade, low-tech device as a solution to the right-to-die
dilemma. In recent years the agonizing debate over the issue
has revolved around new technologies that can keep dying or
comatose patients alive long after the quality of their lives
is nil. Though most physicians will respect a patient's right
to refuse treatment, they will not actively help bring about
death. "This case seems to take the responsibility away from
human beings and to put it in the hands of a machine," says
George Annas, professor of health law at the Boston University
School of Medicine. "If this doctor had given Mrs. Adkins a
cyanide pill, he would probably be in jail today, rather than
on the nightly news."

    Yet in this case neither doctor nor patient works very well
as a symbol for the euthanasia debate. Adkins, a 54-year-old
Portland schoolteacher, was suffering from the early stages of
Alzheimer's. A strong, lively woman who loved hang gliding and
mountain climbing and playing her flute, she was not yet very
sick; the week before her suicide she beat her 32-year-old son
in a tennis match. It was more her dread than her disease that
drove her to seek Kevorkian's help. Even before her illness she
had joined the Hemlock Society, a group that supports
terminally ill patients' right to die by means including
assisted suicide. But in her home state of Oregon, such means
are illegal, and doctors at her hospital say they never advise
suicide as an option.

    Kevorkian, though, is not like other doctors. A retired
pathologist from Royal Oak, Mich., he has long been a
pugnacious maverick, recommending, among other things, a scheme
whereby doctors would render death-row patients unconscious so
their living bodies could be used for medical experiments. In
recent years Kevorkian has fought hard for a patient's right
to commit suicide and a doctor's right to help. Last fall he
invented the easily replicable suicide machine using $45 worth
of hardware and tried to advertise it in a local medical
journal. When the editors refused, he peddled the story to the
local newspapers and soon found himself on the Donahue show.

    Adkins read about Kevorkian and got in touch with him in
Michigan, where the legality of assisted suicide is murky. Her
three sons urged her to try experimental treatments for
Alzheimer's. But when the therapy failed -- her memory
continued to fade and her beloved flute playing became
impossible -- she vowed to go through with her decision. Her
husband Ronald, an investment broker, flew to Detroit with her,
all the while hoping she would change her mind at the last
minute. Just in case, he bought her a round-trip plane ticket.

    Kevorkian, meanwhile, was searching for a place to
accomplish the deed. The hotels, vacant office buildings and
funeral parlors he approached all turned him down. So he
resurrected his 1968 Volkswagen, bought the cot and some clean
sheets. Without the aid of any hospital or lab, Kevorkian
confirmed an Alzheimer's diagnosis and judged Adkins lucid. Two
days later, they drove to a public park that had electrical
outlets for campers. "There was no other place I could do it,"
he says. "My landlord would have thrown me out."

    As soon as the line on the heart monitor went flat,
Kevorkian called the police. Though he claims he never wanted
publicity, he took center stage last week in a media barrage
that ricocheted from Crossfire to Nightline, Good Morning
America to Geraldo. Describing his device as "humane, dignified
and painless" -- and his critics as "brainwashed ethicists" or
"religious nuts" -- Kevorkian insisted that he wanted only to
help patients in distress. "My biggest enemies," he says, "are
the medical organizations because the independent doctors tell
me they are behind me, but they can't speak out."

    Though some right-to-die advocates called him "a brave
pioneer," doctors and ethicists challenged Kevorkian on both
moral and procedural grounds. Even groups that sponsor "death
with dignity" legislation are careful to include safeguards to
prevent the laws from being abused. Most require that patients
make a witnessed, legal request in writing, with two
independent doctors confirming that the patient's condition is
unbearable and irreversible. Says Susan M. Wolf of the Hastings
Center: "Even the staunchest proponents of physician-assisted
suicide should be horrified at this case because there were
no procedural protections."

    Doctors reflecting on the case note that Alzheimer's is
difficult to diagnose. One symptom is sufficient mental
deterioration to impair the ability to make decisions. "He has
to claim she made her decision competently," observes Dr.
Joanne Lynn, professor at George Washington University. "But
the diagnosis of Alzheimer's is almost incompatible with that
claim."

    Even if the case were more clear-cut, much of the medical
community would still reject Kevorkian's solution, fearing the
damage that would be done if doctors routinely acted as
executioners. "The doctor-patient relationship is based on
mutual trust," notes Dr. Nancy Dickey, a trustee of the
American Medical Association. "Our patients should not be
concerned that we are going to make a value judgment that their
lives are no longer worth living."

    Kevorkian's fate rests with Michigan prosecutors, who must
review state laws about assisted suicide. Seven years ago, the
state's high court threw out a case against a man who gave a
loaded gun to a friend who later shot himself. While suicide
is not unlawful in many states, aiding and abetting suicide is.
As yet no charges have been filed, but a Michigan judge has
issued a temporary restraining order barring Kevorkian from
assisting other suicides. The doctor admits to only one regret.
Had the medical examiners come more quickly, Adkins' organs
might have been harvested for transplant. "She had a good
strong heart," he says. "I know, I watched it on the machine."