Jack Kevorkian

Dr. Jack Kevorkian Dies at 83; A Doctor Who Helped End Lives


By KEITH SCHNEIDER

He died at William Beaumont Hospital, where he had been admitted recently with kidney and respiratory problems, said Geoffrey N. Fieger, the lawyer who represented Dr. Kevorkian in several of his trials in the 1990s.

Mayer Morganroth, a friend and lawyer, told The Associated Press that the official cause of death would most likely be pulmonary thrombosis, a blood clot.

In arguing for the right of the terminally ill to choose how they die, Dr. Kevorkian challenged social taboos about disease and dying while defying prosecutors and the courts. He spent eight years in prison after being convicted of second-degree murder in the death of the last of about 130 ailing patients whose lives he had helped end, beginning in 1990.
Originally sentenced in 1999 to 10 to 25 years in a maximum security prison, he was released after assuring the authorities that he would never conduct another assisted suicide.
His critics were as impassioned as his supporters, but all generally agreed that his stubborn and often intemperate advocacy of assisted suicide helped spur the growth of hospice care in the United States and made many doctors more sympathetic to those in severe pain and more willing to prescribe medication to relieve it.
In Oregon, where a schoolteacher had become Dr. Kevorkian’s first assisted suicide patient, state lawmakers in 1997 approved a statute making it legal for doctors to prescribe lethal medications to help terminally ill patients end their lives. In 2006 the United States Supreme Court upheld a lower court ruling that found that Oregon’s Death With Dignity Act protected assisted suicide as a legitimate medical practice.

During the period that Oregon was considering its law, Dr. Kevorkian’s confrontational strategy gained wide publicity, which he actively sought. National magazines put his picture on their covers, and he drew the attention of television programs like “60 Minutes.” His nickname, Dr. Death, and his self-made suicide machine, which he variously called the “Mercitron” or the “Thanatron,” became fodder for late-night television comedians.

In 2010 his story was dramatized in the HBO movie “You Don’t Know Jack,” starring Al Pacino as Dr. Kevorkian. Mr. Pacino received Emmy and Golden Globe awards for his performance. In his Emmy acceptance speech, he said he had been gratified to “try to portray someone as brilliant and interesting and unique” as Dr. Kevorkian. Dr. Kevorkian, who was in the audience, smiled in appreciation.

Given his obdurate public persona and his delight in flaying medical critics as “hypocritical oafs,” Dr. Kevorkian invited and reveled in the public’s attention, regardless of its sting.

The American Medical Association in 1995 called him “a reckless instrument of death” who “poses a great threat to the public.”

Diane Coleman, the founder of Not Dead Yet, which describes itself as a disability-rights advocacy group and that once picketed Dr. Kevorkian’s home in Royal Oak, a Detroit suburb, attacked his approach. “It’s the ultimate form of discrimination to offer people with disabilities help to die,” she said, “without having offered real options to live.”
But Jack Lessenberry, a prominent Michigan journalist who covered Dr. Kevorkian’s one-man campaign, wrote in The Detroit Metro Times: “Jack Kevorkian, faults and all, was a major force for good in this society. He forced us to pay attention to one of the biggest elephants in society’s living room: the fact that today vast numbers of people are alive who would rather be dead, who have lives not worth living.”

In the late 1980s, after an undistinguished career in medicine and an unsuccessful try at a career in the arts, Dr. Kevorkian rediscovered a fascination with death that he had developed during his early years in medicine, only now his interest in it was not as a private event but as a matter of public policy.

As a student at the University of Michigan Medical School, from which he graduated in 1952, and later as a resident at the University of Michigan Medical Center, Dr. Kevorkian proposed giving murderers condemned to die the option of being executed with anesthesia in order to subject their bodies to medical experimentation and allow the harvesting of their healthy organs. He delivered a paper on the subject to a meeting of the American Association for the Advancement of Science in 1958.

Gaining Attention

In the 1960s and ’70s, Dr. Kevorkian shelved his quixotic campaign to engage death for social purposes and pursued a largely itinerant career as a medical pathologist. Though his friends described him as funny, witty, personable and engaging in private, those he met in work and social situations portrayed him as awkward, grim, driven, quick to anger and unpredictable.
Fiercely principled and equally inflexible, he rarely dated and never married. He lived a penurious life, eating little, avoiding luxury and dressing in threadbare clothing that he often bought at the Salvation Army. In 1976, bored with medicine, he moved to Long Beach, Calif., where he spent 12 years painting and writing, producing an unsuccessful film about Handel’s “Messiah,” and supporting himself with part-time pathology positions at two hospitals.

In 1984, prompted by the growing number of executions in the United States, Dr. Kevorkian revisited his idea of giving death row inmates a choice. He was invited to brief members of the California Legislature on a bill that would enable prisoners to donate their organs and die by anesthesia instead of poison gas or the electric chair.
The experience was a turning point. Energized by the attention of lawmakers and the news media, he became involved in the growing national debate on dying with dignity. In 1987 he visited the Netherlands, where he studied techniques that allowed Dutch physicians to assist in the suicides of terminally ill patients without interference from the legal authorities.
A year later, he returned to Michigan and began advertising in Detroit-area newspapers for a new medical practice in what he called “bioethics and obiatry,” which would offer patients and their families “death counseling.” He made reporters aware of his intentions, explaining that he did not charge for his services and bore all the expenses of euthanasia himself. He showed journalists the simple metal frame from which he suspended vials of drugs — thiopental, a sedative, and potassium chloride, which paralyzed the heart — that allowed patients to end their own lives.


First Patient

He also talked about the “doctrine” he had developed to achieve two goals: ensuring the patient’s comfort and protecting himself against criminal conviction. He required patients to express clearly a wish to die. Family physicians and mental health professionals were consulted. Patients were given at least a month to consider their decision and possibly change their minds. Dr. Kevorkian videotaped interviews with patients, their families and their friends, and he videotaped the suicides, which he called medicides.
On June 4, 1990, Janet Adkins, an Oregon teacher who suffered from Alzheimer’s disease, was the first patient to avail herself of Dr. Kevorkian’s assistance. Mrs. Adkins’s life ended on the bed inside Dr. Kevorkian’s rusting 1968 Volkswagen van, which was parked in a campground near his home.

Immediately afterward Dr. Kevorkian called the police, who arrested and briefly detained him. The next day Ron Adkins, her husband, and two of his sons held a news conference in Portland and read the suicide note Mrs. Adkins had prepared. In an interview with The New York Times that day, Dr. Kevorkian alerted the nation to his campaign.

“My ultimate aim is to make euthanasia a positive experience,” he said. “I’m trying to knock the medical profession into accepting its responsibilities, and those responsibilities include assisting their patients with death.”



By his account, he assisted in some 130 suicides over the next eight years. Patients from across the country traveled to the Detroit region to seek his help. Sometimes the procedure was done in homes, cars and campgrounds.

Prosecutors, jurists, the State Legislature, the Michigan health authorities and Gov. John Engler seemed helpless to stop him, though they spent years trying. In 1991 a state judge, Alice Gilbert, issued a permanent injunction barring Dr. Kevorkian from using his suicide machine. The same year, the state suspended his license to practice medicine. In 1993, Michigan approved a statute outlawing assisted suicide. The statute was declared unlawful by a state judge and the state Court of Appeals, but in 1994 the Michigan Supreme Court ruled that assisting in a suicide, while not specifically prohibited by statute, was a common-law felony and that there was no protected right to suicide assistance under the state Constitution.

None of the legal restrictions seemed to matter to Dr. Kevorkian. Several times he assisted in patient suicides just hours after being released from custody for helping in a previous one. After one arrest in 1993 he refused to post bond, and a day later he said he was on a hunger strike. During another arrest he fought with police officers and seemed to invite the opportunity to be jailed.


He liked the attention. At the start of his third trial, on April 1, 1996, he showed up in court wearing Colonial-era clothing to show how antiquated he thought the charges were.


From May 1994 to June 1997, Dr. Kevorkian stood trial four times in the deaths of six patients. With the help of his young and flamboyant defense lawyer, Mr. Fieger, three of those trials ended in acquittals, and the fourth was declared a mistrial.

Mr. Fieger based his winning defense on the compassion and mercy that he said Dr. Kevorkian had shown his patients. Prosecutors felt differently. “He’s basically thumbed his nose at law enforcement, in part because he feels he has public support,” Richard Thompson, the prosecutor in Oakland County, Mich., told Time magazine in 1993.

But on March 26, 1999, after a trial that lasted less than two days, a Michigan jury found Dr. Kevorkian guilty of second-degree murder. That trial came six months after Dr. Kevorkian had videotaped himself injecting Thomas Youk, a patient suffering from amyotrophic lateral sclerosis (Lou Gehrig’s disease), with the lethal drugs that caused Mr. Youk’s death on Sept. 17, 1998.


Dr. Kevorkian sent the videotape to “60 Minutes,” which broadcast it on Nov. 22. The tape showed Dr. Kevorkian going well beyond assisting a patient in causing his own death by performing the injection himself. The program portrayed him as a zealot with an agenda. “They must charge me; either they go or I go,” he told Mike Wallace. “If they go, that means they’ll never convict me in a court of law.” The broadcast, which prompted a national debate about medical ethics and media responsibility, also served as prime evidence for a first-degree murder charge brought by the Oakland County prosecutor’s office. In a departure from his previous trials, Dr. Kevorkian ignored Mr. Fieger’s advice and defended himself — and not at all well. It was an act of arrogance he regretted, he said later.


“You had the audacity to go on national television, show the world what you did and dare the legal system to stop you,” said Judge Jessica R. Cooper, who presided over the trial in Oakland County Circuit Court. “Well, sir, consider yourself stopped.”


On June 1, 2007, Dr. Kevorkian was released from prison after he promised not to conduct another assisted suicide.


He was born Murad Kevorkian in Pontiac, Mich., on May 26, 1928, the second of three children and the only son born to Levon and Satenig Kevorkian, Armenian refugees. His father founded and owned a small excavation company.

The young Jack Kevorkian was described by his friends as an able student interested in art and music. He graduated from the University of Michigan, where he pursued a degree in engineering before switching to medicine.

He was the author of four books, including “Prescription: Medicide, the Goodness of Planned Death” (Prometheus, 1991). He is survived by his sister, Flora Holzheimer. Another sister, Margo Janus, died in 1994.

Mr. Fieger said that Dr. Kevorkian, weakened as he lay in the hospital, could not take advantage of the option that he had offered others and that he had wished for himself. “This is something I would want,” Dr. Kevorkian once said.

“If he had enough strength to do something about it, he would have,” Mr. Fieger said at a news conference Friday in Southfield, Mich. “Had he been able to go home, Jack Kevorkian probably would not have allowed himself to go back to the hospital.”

Dr. Kevorkian was a lover of classical music, and before he died, his friend Mr. Morganroth said, nurses played recordings of Bach for him in his room.

NY Times http://www.nytimes.com/2011/06/04/us/04kevorkian.html?pagewanted=all

The Libby Zion Case or A Case That Shook Medicine

Many people have vowed to avenge the untimely death of a relative. Lawyer and journalist Sidney Zion actually did so -- to the benefit of patients and doctors-in-training nationwide.


After his 18-year-old daughter Libby died within 24 hours of an emergency hospital admission in 1984, Zion learned that her chief doctors had been medical residents covering dozens of patients and receiving relatively little supervision. His anger set in motion a series of reforms, most notably a series of work hour limitations instituted by the Accreditation Council on Graduate Medical Education (ACGME), that have revolutionized modern medical education.


Just about everyone involved in the Libby Zion case -- her father, her doctors and the people who testified at the trial that eventually resulted -- has a different account of what happened. But there are some undisputed facts.

Libby was a college freshman with an ongoing history of depression who came to New York Hospital in Manhattan on the evening of Oct. 4, 1984, with a fever, agitation and strange jerking motions of her body. She also seemed disoriented at times.

Unable to diagnose her condition definitively, the emergency room physicians admitted her for hydration and observation. As the physician of record, Raymond Sherman, a senior clinician who had treated several members of the Zion family, approved the decision by phone.

On the hospital ward where she was sent, Libby was evaluated by two residents: Luise Weinstein, an intern eight months out of medical school, and Gregg Stone, who had one additional year of training. They, too, were not quite certain of Libby's diagnosis. Stone termed it a "viral syndrome with hysterical symptoms," suggesting that Libby was overreacting to a relatively mild illness. The doctors prescribed a shot of meperidine, a painkiller and sedative, to control her shaking. Sherman approved the plan by phone.

The events of the next several hours will always remain controversial. At about 3 in the morning, Weinstein went off to care for some of the 40 other patients she was covering. Stone went to sleep in an adjacent building, where he would be available, if necessary, by beeper.

After the doctors left, Libby became more agitated. The nurses contacted Weinstein at least twice. Weinstein ordered physical restraints to hold the patient down and prevent her from hurting herself. She also prescribed an injection of haloperidol, another medication aimed at calming her down. Busy with other patients, Weinstein did not reevaluate Libby.

Libby finally fell asleep, according to the nurses, but when a nurse's aide took her temperature at 6:30 a.m., it was 107, dangerously high. Weinstein was called and emergency measures were tried to lower the temperature. But Libby Zion suffered a cardiac arrest and died. Weinstein called her parents, telling them doctors had done everything they could.

To the doctors at the hospital, the case was an inexplicable "bad outcome" in which a healthy young woman had died of a mysterious infection.

But the more Sidney Zion learned of the circumstances of Libby's death, the more he rejected this assertion. He became convinced his daughter's death was due to inadequate staffing at the teaching hospital. And he grew determined to ensure that others not fall victim to the same gaps in the teaching hospital system that he blamed for his daughter's death.

A System Under Scrutiny

First, there was a question as to whether the meperidine, known to cause fatal interactions with phenelzine -- Libby Zion's antidepressant -- had produced the high fever. Second, Sidney Zion questioned the use of restraints and shots for an increasingly agitated patient.


"They gave her a drug that was destined to kill her," Zion later stated, "then ignored her except to tie her down like a dog." To the distress of his daughter's doctors, Zion began to refer to her death as a "murder."

Zion's anger was exacerbated by what he learned about the hospital's staffing on the night Libby died. "You don't need kindergarten," he wrote in a New York Times op-ed piece, "to know that a resident working a 36-hour shift is in no condition to make any kind of judgment call -- forget about life-and-death." In addition, Weinstein, the intern assigned to Libby, was covering a large number of patients; Stone, the other resident, was never awakened; and the supervising physician, Sherman, wasn't called when Libby deteriorated.
As a columnist for the New York Daily News and a friend and confidante of many journalists and power brokers in the city, Zion vented his outrage about the state of medical education widely and loudly.

Over time, the image of the bedraggled, unsupervised intern wreaking damage in hospitals would be featured in the pages of The Washington Post, the New York Times and Newsweek. One overtired intern, interviewed on TV's "60 Minutes," obligingly forgot one of Mike Wallace's questions.

In May 1986 Manhattan District Attorney Robert Morgenthau agreed to let a grand jury consider murder charges. Although it declined to indict, the jury issued a report strongly criticizing "the supervision of interns and junior residents at a hospital in New York County."

In response, New York State Health Commissioner David Axelrod established a blue-ribbon panel of experts headed by Bertrand M. Bell, an outspoken primary care physician at the Albert Einstein College of Medicine in the Bronx, to evaluate the training and supervision of doctors in the state. Bell had long criticized the lack of supervision of physicians-in-training.

In 1989, New York state adopted the Bell Commission's recommendations that residents could not work more than 80 hours a week or more than 24 consecutive hours and that senior physicians needed to be physically present in the hospital at all times. Hospitals instituted so-called night floats, doctors who worked overnight to spell their colleagues, allowing them to adhere to the new rules.

Still, some physicians resisted reform efforts. One simply could not become a qualified doctor, they argued, without experiencing firsthand what happened during the often unpredictable first 36 hours of a patient's illness. Critics attacked the night-float system, arguing that the constant trading off of patients among physicians would impede care. Many institutions essentially disregarded the new regulations.

Until 2003. In that year, the ACGME made reduced work hours mandatory for the accreditation of residency training programs across the country. The new ACGME standards look remarkably similar to those of the Bell Commission.

Now it is commonplace to see chief residents at medical centers charting the numbers of hours worked by their staffs. Residents who wish to stay longer at work are at times sent home to sleep, a development that would have been inconceivable in the past.

As might be expected, the new requirements are a work in progress. A study published in the Sept. 6, 2006, issue of the Journal of the American Medical Association found that 80 percent of interns nationwide still sometimes work excessive hours.


Data measuring whether work hour limits have improved patient care are just coming in. One study published in the New England Journal of Medicine in 2004 did find that eliminating extended work shifts improved the attention span of interns.

Historical Legacy

Historians these days tend to distrust the idea that the actions of specific people truly cause large-scale change. Rather, many argue, change more commonly results from a complex interplay of cultural and political factors.

In the case of Libby Zion, however, it is possible to trace a straight line from her death to Sidney Zion's campaign to the Bell Commission to the ACGME regulations. To be sure, it took the social changes of the 1960s and 1970s to make graduate medical education susceptible to reform from the outside. But Sidney Zion sped things up considerably, ensuring that Libby had not died in vain.

In the winter of 1994, Zion v. New York Hospital finally went to trial. Court TV avidly covered the proceedings, which were full of vitriol on both sides. In presenting its case, the hospital introduced a claim, unsupported by toxicology testing and vigorously disputed by the plaintiffs, that Libby Zion had died as a result of cocaine ingestion that she had concealed from her doctors. The jury hedged, attributing responsibility to both the doctors and the patient. Sidney Zion still calls the $375,000 jury award to him a travesty of justice.

There is one other legacy of Zion's crusade. By championing the cause of patients and families who believed they had been harmed by the medical profession, Zion helped set the stage for the medical-errors movement that began in the 1990s. To aggrieved patients and their families, Zion became a sort of folk hero.

"There is a conspiracy of silence among doctors," declared a woman from Queens in a letter to Zion. "They lie to dead patients' families." Likewise, a man who had undergone unsuccessful surgery urged Zion, "Do not give up your fight."

Throughout his crusade, Sidney Zion's anger was paramount. Indeed, it is quite possible that without this rage, he might not have accomplished what he did. Zion was "aggressive, narcissistic, self-indulgent, pushy, persistent and paranoid," psychiatrist Willard Gaylin memorably wrote in the Nation, "but that is precisely the stuff successful reformers are made of." ·

Read more at http://www.washingtonpost.com/wp-dyn/content/article/2006/11/24/AR2006112400985.html