LOS ANGELES TIMES INTERVIEW : Jack Kevorkian : Defending Assisted Suicide Right Up to the End

“This is what I want,” Dr. Jack Kevorkian said on Nov. 5, when he realized that he was going to end up in jail as a result of assisting a suicide, one of 19 he had witnessed since connecting Janet Adkins to his suicide machine--the “Mercitron”--on June 4, 1990.

He was wrong. Three days later, an opponent who said he was sick of Kevorkian’s antics paid the bail the physician had refused to surrender. Days later, Kevorkian, 65, stood by while a fellow doctor inhaled carbon monoxide, his 20th assisted suicide.

Now, he’s back in jail, again refusing to post bail and on a hunger strike. Last week, he could barely whisper, according to his lawyer. “We are now beginning the death watch for Dr. Kevorkian.” he said.

Had the retired pathologist died four years ago, he probably would not have merited a mention in the local papers, let alone in Los Angeles, where he lived off and on from 1976 to 1988, mainly in Long Beach, working at Pacific Hospital by day and on a movie about Handel’s Messiah by night (never shown).

A lifelong bachelor, Kevorkian is the son of survivors of the Armenian holocaust. His sister, Margo Janus, serves as his assistant but is not present at the suicides. This week, Wayne County Circuit Judge Richard Kaufman is to rule on the constitutionality of Michigan’s assisted-suicide statute, a law so hastily written that it is considered defective by some Kevorkian opponents. If he upholds the law, Kevorkian is scheduled to go on trial Jan. 5--if he is alive.

In his first interview in more than six months, and six days into his hunger strike, Kevorkian was visibly weak, often speaking in whispers. “I hope this is not my last interview,” he said at its close, “but I’m afraid it might be.”

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Question: You haven’t had anything to eat for almost a week. How do you feel?

Answer: I’m getting steadily weaker. They cut down my juices . . . limiting me to one or two four-ounce portions . . . and now I have decided to just limit myself to water. I am taking a One-a-Day multiple vitamin.

Q: How much do you weigh?

A: I think they weighed me in at 128 (he now weighs 117). . . . But I haven’t really started to drop flesh. You know when you do this, the first two days or so are really hard, but now the hunger pangs have nearly stopped.

Q: Why a hunger strike?

A: My liberty has been unjustly stolen. . . . Liberty means more to me than life itself. I don’t want to die, no more than anybody else. I have the same qualms about death as anybody.

Q: What should people understand about physician-assisted suicide?

A: First of all, the issue is not about physician-assisted suicide but about suffering and the right not to have to suffer.

Q: But it is about ending life . . .

A: No, not really. It’s about the quality of life, according to an individual’s personal opinion. It’s all about personal autonomy, and the right of a competent adult to decide, with medical guidance, when that quality (of life) has medically diminished beyond what they think is the point of no return.

Q: So you are saying that any rational, competent individual should have the right to determine when their physical life should be at an end?

A: Any adult. Yes--provided the medical data support it, as far as the physical condition goes. Eventually, I guess, we could get into the psychological realm. There are mental patients who suffer from depression, for example, who may be able to make rational decisions about their future, but that would be far too controversial to take on now. This is far too uncivilized a society yet.

Q: Some people say you may have stepped over the line with your second patient, Marjorie Wantz (she died on Oct. 23, 1991), who said she suffered from terrible vaginal pain that nothing could relieve.

A: She had real physical pain. . . . There was one doctor who opposed me, opposed what I am doing, who said it was real pain. . . . Clinically, she had enough measurable physical damage (from an operation in which nerves were severed) to account for her pain.

Q: Some of your critics say you are on the far-out fringe of American culture, that you are obsessed with death and have been for decades.

A: I am obsessed with life! And death is a part of life, as much as we may try to deny that in this country, in this society. Some psychologists say that we ought to think about death for five minutes every day. I may be “obsessed,” if that is the term, with trying to learn about what it is. First of all, I’d like to know what it means--what the meaning of death is on the scientific plane. You look at a dead body on a slab, that doesn’t tell you anything about death. We really don’t know what death is. I’d like to get more scientific research into it.

Q: You did some experiments, I believe, in trying to determine the exact moment of death by filming changes in the eyeball.

A: The retina, yes. I did film the changes in an effort to pinpoint the exact time the heart stops, to try and determine at what point it just doesn’t pay to try and resuscitate a person, to figure out how without severe brain damage . . .

Q: Did your work help establish that?

A: No, it was a beginning, but nobody carried it on, and I didn’t either.

Q: When did you first think of assisting patients to commit suicide? Your mother, I believe, died a lingering and painful death from cancer when you were a young doctor. Did that have an influence?

A: I don’t know that it did. I already knew it was right. From the time I first saw horribly suffering patients in the hospital where I was being trained as a young doctor, I was absolutely convinced that this was right.

What finally happened was there was this fellow in Michigan, David Rivlin, who was a quadriplegic, on a respirator, and he went on television and said he wanted to die. I went to see him and realized that I should invent something to help him.

Q: So you were stimulated to invent your suicide machine for him?

A: Yes, but before I made it, he got a court ruling and his doctors sedated him and removed him from the respirator.

Q: Janet Adkins used it first, on June 4, 1990--three and a half years. By this time, did you expect other doctors to have come forward and supported you or presided over publicly announced assisted suicides?

A: Well, I thought they might. It was more a hope, I guess. Many support what I am doing. . . . But they are afraid.

Q: The same law that outlaws physician-assisted suicide in Michigan set up a state Commission on Death and Dying to study the problem and recommend a new law within 15 months. Are you hopeful about that?

A: Absolutely not! This commission will never do anything. It was set up in a way to prevent it from doing anything. (Michigan Gov. John) Engler has said that himself. I told one man on it who claims to support me that if he had any integrity, he would resign from it.

Q: Polls show that support for what you are doing is as high as 75%. Would you be in favor of a statewide referendum on physician-assisted suicide?

A: . . . I’d be for anything to show that the public supports this.

Q: Organized medicine has not been very supportive of you. The Michigan state board of medicine stripped you of your license; few doctors have spoken out to back you. Do you blame their opposition on pressure from what you call religious fanaticism?

A: Not the medical profession so much --the legislature, yes, but the pressures on the medical community are different. A few doctors are religious, but the pressures, in large part, are financial.

Q: Please explain?

A: Well, some of it might come from the pharmaceutical industry; fewer drugs would be used. Same with anyone who has a financial interest in keeping people alive, no matter what their condition. Nursing homes might stand to lose jobs and income, too. . . . but I don’t think that justifies continuing the suffering of people who don’t want to suffer.

Q: How do you respond to critics who contend that legalizing assisted suicide will open the door for granny to be pressured into bowing out early by her family so they can get her money or just get rid of the burden?

A: That’s the equivalent of saying: (Richard) Nixon was a felon. He dishonored the presidency. Other people could dishonor the presidency--so should we abolish the office?

Q: Should anyone ever attempt to persuade anyone to commit suicide?

A: Absolutely not, not under any circumstances. And if people are afraid . . . why not put in the death penalty for any doctors who should abuse it? . . . That means the few of them who are left who will dare to do it will do a damned good job!

But you know what? I’d still do it--and I think I’d be pretty damn safe, because no patient, no family member ever has complained. I have outlined a pretty fail-safe system of checks and procedures for deciding who is a candidate and who isn’t. . . .

I had one patient who was all ready to go. We had had three consulting sessions, and we were having a fourth session the day before she was scheduled. I had required her to have one psychiatric evaluation and then had to ask her to have another. Her daughter had flown in from out of state for the procedure . . . and, at the last minute, I had to say no.

Why? Because I saw something during the interview that convinced me that she just wasn’t ready, and though it hurt me to say I’m sorry, I just can’t help you. . . . She . . . overdosed herself and died.

The main point is . . . that this is a medical procedure--medical. And that only medical men should decide.

We don’t really need any laws, except for one making it a felony for anyone other than a doctor to do this.

Q: How many people have you seriously consulted with who finally decided not to end their lives?

A: Most of them. More than double (the 20 suicides witnessed); maybe triple that.

Q: Critics wonder how you can presume to counsel these people. You are not a psychologist.

A: Well, I wish (they) could have seen how the faces of the people I have counseled light up . . . to see the great relief they get just from talking to someone, a doctor, who is willing to talk to them and help them. . . .

Remember, they seek me out. And the first thing I always try to do is to help them find something to live for.

Q: Would you like to see euthanasia legalized?

A: Yes, we need euthanasia, for certain cases where people are in comas or too immobile to even press a button.

Q: What is the ultimate responsibility and charge of a physician?

A: It is to preserve health and encourage the maintenance of health and to combat disease, to comfort and prevent suffering and relieve suffering. Note that word, disease . It means literally . . . an absence of ease, of well-being. What I think a doctor should do is prevent disease, by any means necessary.

Q: Do you consider yourself more scientist than doctor?

A: I am probably a mixture, although in recent years I have been more interested in clinical rather than laboratory work.

Q: What would you do if the state and the medical authorities huddled and said tomorrow “OK”--but only if you agree not to do it anymore?

A: Nothing would make me happier. . . . They could have all my consultation notes and tapes, if they wanted; I’d be happy to advise them, if they wanted . . . and then get out of the way. I’ve got plenty of other things I want to do. I want to say that I don’t enjoy this. This is terribly wrenching, terribly draining. . . . I do not enjoy watching people die. But nobody else is coming forward to help these patients.

Q: Do you think the day will come when assisted suicide is fully legal and accepted in the United States?

A: I think eventually, but it will be for the wrong reasons. It will be because health-care costs are climbing too high, and because the elderly population is going to expand.

Q: How could we sum up Jack Kevorkian’s philosophy of life?

A: Live and let live, and don’t hurt.