The passing of Dr Death: The Kevorkian legacy

The writer and Gaullist Minister André Malraux observed that, during his life, children were no longer taken to graves and taught the brevity of human life. Death, to put it simply, was being banished by citizens of western society. The longer one lived, the less inclined one was to consider the implications of mortality. Today, signs of aging are hidden cosmetically; the aged are banished to nursing homes at a moment's notice to be cared for in padded incarceration.

A man who did not fear talking about death, and the painful demise of a body in its twilight years, was Michigan-born pathologist Dr. Jack Kevorkian. Allowing competent, informed adults to make a choice about death was Kevorkian's platform from the start. But he raised the matter of human suffering to a public in a manner that often obscured his cause. He was no public relations genius, showing an astonishing degree of tactlessness. (In this, Australia's own Kevorkian variant Philip Nitschke suffers a similar problem, often confronting the law with a polemical barrel.)

He was infamous for driving around the United States in his Volkswagen van, assisting people to end their lives with a somewhat sinister death machine using carbon monoxide. In 1990, he reached notoriety when his machine was adapted to inject a lethal cocktail of drugs into an Alzheimer's patient. In 1998, Kevorkian took matters to yet another level, broadcasting the assisted suicide of Thomas Youk on CBS' 60 Minutes.

Another feature of his work that won him few friends was the way he disposed of his deceased clients, whom he often abandoned in the emergency rooms of hospitals or motels. As Portland attorney Eli Stutsman, the lead drafter of assisted suicide laws in Oregon and Washington recalled, 'We'd see his work, his name, his image associated with us, and it was something that we always had to work to explain and put in context' (Associated Press, Jun 5).

For all of Kevorkian's crude antics, the balance sheet in terms of recognizing and allowing patients a choice to end death turned out in his favour. What was curious was how Kevorkian himself was portrayed as a symptom of a troubled society. In the hot house of denial regarding problems posed by terminally ill patients, Kevorkian and his ilk would be allowed to flourish. 'He was on the other side of the spectrum,' argued executive director and attorney at the Patients Rights Council Rita Marker, pushing 'people suggesting legalizing (physician-assisted suicide) into the middle' (AP, Jun 5).

His legacy is not one that is treasured by some members of faith. Ned McGrath, spokesman for the Archdiocese of Detroit was unflinching in his condemnation. 'May god have mercy on his soul and on the scores of confused, conflicted, and at times, clinically depressed victims he killed' (Detroit Free Press, June 3). It was 'ironic' that Kevorkian himself had 'a dignified, natural death in a hospital', away from seedy locations in vans and motel rooms.

Kevorkian's actions persistently received rounded condemnation from major faiths, with a coalition of Protestant, Catholic and Muslim leaders speaking on one voice on his stance. The response from Kevorkian's attorney at the time, Geoffrey Fieger, suggested how polarized the debate had become. 'They should keep their religious noses out of secular business.'

Neither position was entirely satisfactory, and the campaign for assisted suicide gathered pace in the US through the 1990s, stalling at the ballots taken in Washington (1991) and California (1992). In 1992, Oregon became the first state to enact a statute – the Death with Dignity Act - allowing terminally ill individuals to end their lives through the taking of lethal medication supplied by a medical practitioner. Crucially, safeguards were introduced into the legislation requiring multiple medical consultations, a threshold of six months to live, and the presence of sound mind in the patient.

The issue of dying with dignity never ends. Rarely do people have the luxury of the quick death. The Kevorkian legacy shows that legislation, framed appropriately, can allow for instances of assisted suicide for terminally ill patients without instances of the slippery slope taking hold. Such legislation also eliminates the requirement of a Kevorkian to exist in the first place. The attempt to do so in Australia failed when the Northern Territory legislation on this subject was overturned by a Commonwealth act after it was in place for nine months.

The ethical matters about how a doctor violates the Hippocratic oath remain. The medical profession, at least in principle, is there to save life rather than end it. Nor are the spiritual matters of allowing a natural death, the domain of religion, irrelevant to the question. These are matters that no law can, by itself, ever satisfactorily frame.