Getting to Know Dr.Death

The Camera is fascinated with the stump. It zooms in and out slowly, hovers around other parts of the body, then returns. The white cotton pants with little red flowers are crudely cut away so that we can see it: the stump, with a red spot on its tip. Blood? A scab?

Offscreen, a detached, almost kindly, voice speaks. "We're going to have the patient tell us exactly what her situation is. Can you go ahead, please?"

A small, gravelly voice responds. "Well, I've had rheumatoid arthritis for about 26 years now, and it's gotten progressively worse. The pain is not being controlled. Four years ago I lost my left leg, and two weeks ago I lost my right leg. And I lost an eye. I'm full of despair and I'd really like an out."

"You're contemplating taking your own life."

"I think that would be the best thing for me."

With that declaration, Dr. Jack Kevorkian is back in business. He'll offer to help the woman kill herself, and that will be enough to get on the evening news.

It's a Monday in March 1994, and more than a dozen reporters are crammed into the office of Dr. Kevorkian's lawyer, Geoffrey Fieger. After they watch the video, Fieger makes a statement. "She wants stronger medication to make the rest of her life more comfortable," he says. "If no medical doctor comes forward, Dr. Kevorkian will feel unbridled by his promise not to assist in any suicides."

The offer comes complete with a deadline: April 19, the day Kevorkian is scheduled to face trial--his first jury trial--for the assisted death of Thomas Hyde. It also comes about three months before another significant date in Kevorkian's crusade. By July 11, he and his followers must gather at least 256,000 signatures to put a constitutional amendment on the Michigan ballot this fall affirming the right to seek physician aid in dying.

This news conference, complete with visual aids, is what Kevorkian and Fieger do best: manipulate events and people in order to advance their agenda. But in this case it seems to backfire. A story in the next day's Detroit Free Press suggests that Fieger and Kevorkian rebuffed the efforts of a Houston pain specialist to treat Kevorkian's client. A Free Press op-ed piece hammers home the point: "Why couldn't Kevorkian just fix the poor woman up with the right doctor? Can't Kevorkian and company do anything without a camera rolling?"

These are not exactly raves. But Fieger accomplished his goal: He kept Kevorkian's name in the news and kept the agenda afloat.

What is the agenda? The casual observer would guess that Kevorkian's crusade has one overriding purpose: the reasonable conviction that people--particularly those who are chronically or terminally ill--should have the right to determine the circumstances of their own deaths, to choose death with dignity. But in Kevorkian's case, there's a bit more to it than that.

•

The moment Kevorkian, Fieger and a small entourage enter the lobby of the Second City comedy club in Detroit, the crowd parts, the television floodlights ignite and the reporters shout, "Jack! Jack, over here!"

But Fieger talks first. Tonight is the premiere of a new Second City revue, Kevorkian Unplugged, and two local DJs have invited Fieger and his client to help introduce the show. Trouble is, the show's producer was never consulted. Now, apparently fearing that Kevorkian would take over the evening's performance, she barred him and his lawyer from the stage. Fieger steps into the lights and spews his modulated anger.

"It's an outrage," he says in his nasal voice. "And I'm going to do something about it. I gave you permission to use Dr. Kevorkian's name so you could make money, and you do this to us? Uh-uh. With a show called Kevorkian Unplugged, they think his presence here is too political? Incredible! Isn't that true, Jack?"

The focus shifts, and Jack Kevorkian, thin and tiny next to Fieger's robust physique, is blindsided by the attention. "What do you think about all this?" one reporter asks.

Kevorkian, his deep voice made small, replies, "I have very little to do with it."

Kevorkian founders on a few more questions before Fieger snatches back the spotlight. "It will be over my dead body that they use his name!" he cries.

Suddenly, Kevorkian's eyes light and his lips curl into that famous open mouthed death's-head grin. "I wish he hadn't said over his dead body."

Fieger had earlier suggested I drop in on this event, that I might get a chance to collar the doctor for a few minutes. Kevorkian had declined requests for anything longer.

While Fieger milks his rage, Kevorkian sets about gathering signatures for his ballot initiative. He is an animated man, all jerky movements and manic grins, and he jumps around the lobby, thrusting his clipboard at people. Mostly, though, they come to him--asking for autographs, declaring him a hero. And everybody calls him Jack.

At one point, Fieger asks the bartender for information about the producer who spurned him. "She'll lose her job over it!" he fumes.

Kevorkian pipes up. "Who owns Second City?" he says. "What religion are they? If they're Catholic, that would explain it. The archbishop would tell them to have nothing to do with me."

This is a familiar Kevorkian--Fieger gambit--characterizing anyone who crosses them as a religious fanatic. "Religion makes them crazy," Kevorkian says. I seize the opening and ask Kevorkian if he was ever religious.

"Not really," he says. "I went to Sunday school until I got tired of the myths. Walk on water! You can't fool a kid."

"Did you expect this kind of opposition when you started?"

"I didn't expect anything," he says. "I was always doing controversial things in the past, though. The cadaver-blood work we were doing, new kinds of transplants. Now they're thinking of computerizing the body's anatomy. I first proposed that 15 years ago--gridding an idealized human body." He says that he published his idea in a journal in Europe, where he has published most of his writings.

I ask why he publishes in Europe.

"Because Europeans are a lot more sensible," Kevorkian replies. "They have had a harder life. Americans are spoiled. Americans are goofy, and they're a little dumb."

•

To understand Jack Kevorkian, it helps to start with the Armenian holocaust, the mass killing of perhaps 1.5 million Armenians by Turks during World War One. His father was a survivor. "It was probably a pivotal event in shaping the emotional environment in which Jack was raised, and his outlook on life," says Dr. Harold Klawans, a prominent Chicago neurologist and writer who was once commissioned by Fieger to write a book on Kevorkian. (The book never found a publisher.) "Jack is the child of a holocaust survivor, but it was the wrong holocaust."

What Dr. Klawans means is that no special effort was ever made to understand the problems peculiar to Armenian holocaust survivors. Few people even remember the killings. Resentment seems to fester in Kevorkian, provoking some rather undiplomatic comments, such as the one he made in a 1991 magazine profile: "I wish my forefathers had gone through what the Jews did," he said. "The Jews were gassed. Armenians were killed in every conceivable way. Pregnant women were split open with bayonets and their babies were taken out. They were drowned, burned, heads were squeezed in vises. They were chopped in half. So, the Holocaust victims don't interest me. They've had a lot of publicity, but they didn't suffer as much."

"His normal stance is aggressive badgering," Klawans says. "That's his way of life. He is preoccupied with death, and it all comes from the Armenian holocaust."

The preoccupation with death manifested itself when Kevorkian was a resident at the Detroit Receiving Hospital in the mid-Fifties. It was there that Kevorkian instituted what he called his "death rounds." He would stalk the halls of the hospital at night, enter the rooms of those patients who were close to death and lift their eyelids to see how their eyes changed when they died. He hoped his data would help physicians to determine the exact moment a patient died. But nothing ever came of his observations.

While a resident at the University of Michigan Medical Center in 1958, Kevorkian became fascinated with an alternative to execution: Death row prisoners could be anesthetized and offer their bodies for scientific experimentation or organ harvesting. "It would be a unique privilege to be able to experiment on a doomed human being," he wrote. To that end, he dropped in on death rows around the country, soliciting the opinions of the potential guinea pigs (many were supportive). He corresponded with prisoners, wardens and state legislators, with only one concrete result: He was asked either to give up his death row solicitations or to leave his residency in Ann Arbor. He resigned.

His active mind continued to generate fresh ideas at his new post as a pathology resident at Pontiac General Hospital in Michigan, where he hit on another radical thought: Why not pump blood directly from a cadaver (continued on page 142)Dr. Death (continued from page 88) into a live volunteer? Think of the battlefield applications!

One night, when the corpse of a 14-year-old girl arrived in the emergency room, Kevorkian set up his experiment. He couldn't find the girl's jugular, so, thinking fast, he plunged his syringe directly into her heart and injected the blood into a vein of his 35-year-old volunteer. When he asked her how she felt, the volunteer spoke of a funny taste in her mouth. Kevorkian panicked. What am I doing? he thought. Poisoning her? Later he discovered that the girl had been drunk and guessed that his volunteer had tasted liquor.

There's a thread that runs through all of Kevorkian's obsessions. He's trying to rehabilitate death, to rescue something positive from its jaws: scientific knowledge, blood for the injured, new organs for those who need them. He's trying to seize life from death.

He's not satisfied with physician-assisted suicide alone: It's a dignified death, sure, and it saves some pain, but it's still just a death, a negative, a loss. Kevorkian's ultimate vision would combine all of his crusades into one. He would make each death a shining, productive event.

A year after he first assisted in a death, that of Janet Adkins, Kevorkian published his book Prescription: Medicide. In it he describes his mission: "It is not simply to help suffering or doomed persons kill themselves--that is merely the first step, an early, distasteful professional obligation (now called medicide) that nobody in his or her right mind could savor. I explained that what I find most satisfying is the prospect of performing invaluable experiments or other beneficial medical acts under conditions that this first unpleasant step can help establish--in a word, obitiatry."

"Obitiatry," in Kevorkian's lexicon, would be a medical specialty that dealt exclusively in positive planned death. Its practitioners would staff special suicide centers ("obitoriums"), where patients would have the option of volunteering for experimentation or organ harvesting before death. Planning ahead, he has dissected the state of Michigan into 14 obitiatry zones, each to be serviced by its own suicide center.

In a 1988 article, The Last Fearsome Taboo: Medical Aspects of Planned Death, published in the German journal Medicine and Law, Kevorkian speculates on practicing a new technique for removing a pancreas on a healthy but suicidal 22-year-old man who "certifies in writing his irrevocable intention of dying."

Until society is ready to accept such visions, however, Kevorkian will have to settle for his position as the man with his hand on the carbon monoxide valve.

•

Dr. Ljubisa Dragovic was bewildered when he arrived at the home of Sue Williams on May 15, 1992. Williams, who had suffered from multiple sclerosis, had died earlier in the day from carbon monoxide poisoning. She was Kevorkian's fourth assisted suicide. By the time Dr. Dragovic, the Oakland County, Michigan medical examiner, got there, the Kevorkian crew had turned the house into its field headquarters.

"When a death is being investigated, the police normally control the scene," Dragovic says. "Here, Fieger was orchestrating everything and the police were asking questions. When I showed up, he said, 'Hi, doctor. Want some coffee?' The dead woman was on the floor, and they were offering coffee and preparing pizza. Kevorkian was sitting in another room flipping the channels on the TV set to check on media coverage. It was a party atmosphere."

Dragovic was at this death scene only to advise another medical examiner. But you can be sure that if Sue Williams' death had been in his caseload, he would have classified it as a homicide, as he has with every Kevorkian case he's looked at. He regards anyone who would write "suicide" on the death certificate of a Kevorkian client as spineless and dishonest. "The fact that the patients want to die doesn't make these suicides," he says. "Someone else terminates their lives. That's why these are homicides." Dragovic argues that if you physically assist in a suicide, you've killed.

But it's not the act of homicide that arouses Dragovic's ire against Kevorkian; it's that the doctor is so bad at it. Dragovic, wearing a bow tie and khaki pants, has a teddy-bear look about him. But get him talking about Kevorkian's procedures, his scientific chops, and Dragovic becomes a grizzly.

"Kevorkian is a dilettante," he says. "He doesn't understand the basic principles of science. Your first and last example is Marjorie Wantz." Wantz was Kevorkian's second assisted death; she and Sherry Miller, his third assisted death, died on the same night in 1991. Wantz was a 58-year-old woman who claimed to suffer from severe pelvic pain that had grown increasingly worse despite ten operations to relieve it. In her videotaped consultation with Kevorkian, Wantz insisted on an autopsy after she died, to reveal the details of her suffering. "I want to be cut ten ways," she said.

Dragovic did the autopsy. "There was no evidence of a painful disease in her body," he says. "There is no controversy about that whatsoever."

Kevorkian helped her die despite the fact that her illness, even if real, was not terminal.

Even Derek Humphry, founder of the pro-euthanasia Hemlock Society, was appalled. "That woman was catatonic, she was out of it," he said after watching her videotaped consultation. "There should have been more examination. In four years he has helped 20 people to die. With legalized euthanasia, there would be 3000 or 4000 deaths a year. Say that even one of his 20 cases is questionable--that doesn't help us at all."

The Wantz case isn't the only one to raise questions. According to a toxicologist who examined the body of Janet Adkins, the vaunted suicide machine actually didn't work as intended. Adkins died of an overdose of the barbiturate that was supposed to anesthetize her, not of the heart-stopping agent that was pumped in.

Even Kevorkian's term, "medicide," gnaws at Dragovic. "Medicide is nonsense," the medical examiner says. "Medicide means the killing of a physician. It is semantic, but it shows you the shallowness of the approach. Unless we seek advice from those who are better informed and have better understanding, we are going to be guided by those who understand and know less."

•

Geoff Fieger likes to claim a certain immunity from the material motivations of men. "I'm not interested in money," he says. "I don't even care about collecting the money in the lawsuits I win. All I care about is winning."

Winning, in the Kevorkian case, requires more of Fieger than mere courtroom agility. In fact, the courtroom has been a secondary forum for Fieger since he took over Kevorkian's defense almost four years ago. The primary forum is, of course, the media, and the primary tactic is the audacious sound bite.

"He'll say anything," says Michael Modelski, a former assistant prosecutor for Oakland County who tangled with Fieger in the early Kevorkian court appearances. "He would just make things up. If he thought it would make a headline, he would run with it, and he would laugh about it afterward." At one news conference, Fieger pinned a large red clown's nose on a blown-up photograph of Oakland County prosecutor Richard Thompson.

Fieger has said to me--repeatedly, as he says most things--that his outrageousness is designed to obscure the prickliness of his client. "I know I've won when they say, 'Kevorkian is OK, but I hate that Fieger.'"

When I stop by Fieger's house for a chat on a perfect Good Friday afternoon, the attorney is in rare form. We sit on his deck, which overlooks a golf course, and sip lemonade, then wine. It doesn't take much to set him off--maybe one mention of Dragovic.

"He's a Transylvanian vampire," Fieger cries. "He's a fucking lunatic if I've ever seen one. He made up his own definition of assisted suicide. Only in Oakland County is suicide murder. He made it up. We had him on the stand during the Sherry Miller and Marjorie Wantz thing. I said, 'Well, Dr. Dragovic, how was this homicide? I thought that you just described how they killed themselves. How did someone else murder them?'

"He said, 'They died twice.'

"I said, 'Very interesting. How did that happen?'

"He said, 'They died first by their own hands, then by Kevorkian's hand.' He's a fucking lunatic, in his fucking bow tie. You can quote me on that, because the fucking guy is a vampire."

This is clearly a performance, but it's a performance that, at times, seems to get away from the performer. At one point he conjures his own wacky theories of biological determinism. "It may be," he says, "that the ones who can accept assisted suicide are slowly evolving to a higher evolutionary plane, where they can see that this is an intellectual issue." Fieger and Kevorkian, in other words, are not just right, they're one rung up on the evolutionary ladder.

The Darwin shtick isn't the only demonstration Fieger attempts to make of the depth of his thought--and his soul--this afternoon. At one point I lob him the obvious hypothetical: If you were terminally ill, would you ask for Kevorkian's help?

"Fuck, who knows?" he says. "I can't even imagine it. I can't even comprehend it, and it scares the shit out of me. I asked Kevorkian. He's been with people when they die. I said, 'Tell me, teach me, Jack. Teach me. Are they afraid?' He says, 'They're 100 percent not afraid.' He says there's a point in the dying process when you want to die more than you want to live. We can't imagine it because we're not dying."

But Fieger says he has it figured out. In fact, he can imagine it. "I liken it to this," he says. "Before I ever had an orgasm I was scared to death that something bad was going to happen. Once you have one, you want to do it again and again. But before I'd ever done it, I didn't know. I was scared. So I guess no one can really understand until they're dying how they would want that."

Trying to swim back to solid ground, I ask about Kevorkian's April trial. A year ago, only hours after Wayne County prosecutor John O'Hair mentioned in a radio interview that he didn't have enough evidence to charge Kevorkian in an assisted suicide, Kevorkian called a news conference to clear up any ambiguity. "I assisted Thomas Hyde in a merciful suicide," he said. "There's no doubt about that. I state it emphatically."

I ask Fieger why they were so eager to get Kevorkian arrested on this one. "We needed a prosecution," he says. "You need to have a Scopes trial to reveal the ridiculousness of William Jennings Bryan, don't you? Otherwise, he might be considered in history as a great orator, but he's gone down as an utter fool."

Following this scenario, Fieger would be attorney Clarence Darrow, but he bridles when I suggest that.

"No!" he says. "Clarence Darrow was an old, cigar-smoking, frumpy-looking guy. In style I think we're different. But I'm just as good a lawyer as he ever was."

•

Last November, Kevorkian and Fieger began building toward their day in court. First, Kevorkian was jailed when he refused to post $2000 of a $20,000 bond in the assisted suicide of Thomas Hyde. Immediately, he began a long-threatened juice fast, and just as quickly, Fieger began tolling his client's death knell. Kevorkian entered jail on a Friday, and on Sunday, Fieger was quoted as saying, "We don't have much time. I don't think that Jack has long to live. He's not doing well. He's very haggard, very cold."

A couple of days later, John DeMoss, a lawyer who opposes assisted suicide, posted Kevorkian's bail just to get him off the TV screen.

Then, in December, Kevorkian was back in jail in connection with the assisted suicide of Merian Frederick, and again he began to fast. This time nobody stepped in, and the nation was treated to regular televised images of the hunger striker huddled under a blanket in a wheelchair, his wan face obscured by gray stubble.

"He was really angry that I got him out," says Fieger, who had the bond lowered to $100. "He heard Gandhi had fasted for three weeks, and he got to do it for only 18 days."

This blindered belief in their own place in history is what drives Kevorkian and Fieger in their crusade. "He's not infallible, he's not God," Fieger says. "He just happens to be absolutely right."

It's a powerful certitude, particularly when coupled with the team's emotionally appealing message, as stated by Fieger: "If you're sick and dying and suffering, and you say 'Enough's enough,' you have the right to get out. I mean, that's pretty logical."

The subject becomes complicated, though, when you add the twist that we not only have the right to bring about our own deaths but also to have professionals help us.

"If you really believe in self-determination, it has no limits," says Yale Kamisar, the Clarence Darrow Distinguished Professor at the University of Michigan Law School. Kamisar believes that the legal distinction should be maintained between removing life supports and actively helping someone die. "Once you establish the right to actively choose to die, then any time a person says, 'I'm suffering enough,' you can't say, 'Well, that doesn't meet my standard of suffering.' There really is no stopping point."

Other people have more practical concerns about legalizing assisted suicide. "Let's get universal access to health care, and train doctors in pain management. Let's train the public that they have a right to refuse treatment and to participate in decision making," says Dr. John Finn, the medical director of the Hospice of Southeastern Michigan, which works with terminally ill patients to provide a "soft" death through pain mediation, counseling and other services. "To legalize physician-assisted suicide and not do all those other things is a nonsolution. We have to start by dealing with the real problems."

Earlier this year, Verna Spayth, a polio survivor, led a group of 15 disabled-rights activists in a protest before Michigan's Commission on Death and Dying, which was established in 1993--at the same time a law prohibiting assisted suicide was enacted. The activists objected to a proposal by the commission to legalize assisted suicide not only for the terminally ill but also for those with incurable or irreversible conditions that cause suffering. "That's not terminal illness anymore," says Spayth. "That's me and my friends." Spayth's main concern is the subtle societal coercion of people who are already vulnerable. "If you told your doctor that you wanted to commit suicide, he'd send you to a psychiatrist," she says. "If I said the same thing, he might congratulate me on making such a selfless decision."

•

Throughout his trial in April, Kevorkian seemed to know something no one else did. While Fieger and assistant prosecutor Tim Kenny sparred, while a procession of witnesses testified to the psychological agony of dying with Lou Gehrig's disease (a common cause of death is strangulation on saliva) and while the Court TV commentators speculated on what the jury might decide, Kevorkian sat placidly at the defense table, studying Japanese.

By the time the jury returned with its verdict--after five days of testimony and nine hours of deliberation--Kevorkian had put aside his exercise in self-improvement. But he looked pretern aturally confident as he sat waiting, dressed casually in the same white windbreaker he had worn throughout the trial, over a maroon cardigan and no tie. In fact, he looked almost smug.

His loose smile didn't change when the verdict was announced: not guilty.

It was a clear victory for Kevorkian and his team. But because of Fieger's defense tactics, it wasn't quite the resounding verdict on the issues of assisted suicide and personal freedom that Fieger had promised when he touted the case as "the Scopes trial of the Nineties" and "the trial of the century." Fieger forced the trial to go ahead when both the judge and the prosecutor would have preferred to wait for an appeals court ruling on the constitutionality of Michigan's law banning assisted suicide. In spite of all this buildup, Fieger went on to use loopholes and technicalities to defend Kevorkian, rather than ask the jury to acquit his client because he'd been charged under an immoral law, or because he represented civil rights in their purest form.

First, he dropped the bombshell that the suicide had actually occurred in Kevorkian's van while it was parked behind his apartment in Oakland County--not on an island in Wayne County where the body was found. The case, he said, was being tried in the wrong county and should therefore be dismissed.

Then he turned to semantics. One subsection of Michigan's law banning assisted suicide exempts anyone who is "administering medications or procedures, if the intent is to relieve pain or discomfort and not cause death, even if the medication or procedure may hasten the risk of death." Fieger, in a brilliant display of chutzpah and persuasion, convinced the jury that, in strapping Hyde to the canister of carbon monoxide, Kevorkian's intent was not to cause death but to relieve pain. (It may have convinced the jury, but it wouldn't convince the appeals court. Eight days after the verdict, the panel of judges declared the assisted-suicide ban unconstitutional on narrow, technical grounds. The high court then backhanded Kevorkian by reinstating murder charges against him in the deaths of Marjorie Wantz and Sherry Miller. Immediately, Fieger and the prosecutors were at it again.)

The strategic maneuvering ultimately overshadowed some of the quieter, more intriguing moments of the trial. One of the most interesting exchanges, for instance, was buried in the middle of Kevorkian's testimony, when Fieger asked him about the motivation behind his death-related research and experimentation. "Maybe it's the boy in me," Kevorkian responded. "In a way, I haven't grown up. I'm curious, and new things interest me. And like a young boy--taboos really challenge me."

•

My favorite of the paintings is the Christmas deconstruction. It shows an emaciated body, its hands and feet withered, standing dejected in a dark room, swathed in twisting vines of red and green garland. An ornament hangs from a fingertip. Two wrapped presents occupy the foreground. To the right of the "tree," the black-booted leg of Santa Claus descends through a fireplace and crushes a baby in a manger.

The painting, titled Fa-La-La-La-La, La-La, La, La, was a Jack Kevorkian original, and was quite adeptly rendered, at least in the snapshot I've seen of it. It apparendly no longer exists, though--lost, along with 17 other paintings, in transit from California to Michigan in 1990. But Kevorkian is working to re-create two of the lost paintings--not, unfortunately, the Christmas scene, nor another painting called Genocide, which was adorned with a frame daubed with Kevorkian's blood.

The re-creation that is sure to cause the greatest stir is of a lost painting that was called The Gourmet. It depicts a yellow, decapitated body seated with serving fork and carving knife before a feast--its own head, stuffed with an apple, on a silver platter. Side dishes decorate the table: a helmet filled with bullets, a bowl of crosses. The salt and pepper shakers are mortar shells.

Fieger plans to auction Kevorkian's artwork. He said he expects the pieces to fetch $100,000 each, which would fund the campaign to amend Michigan's constitution. The amendment, if it makes the ballot and passes, will read as follows: "The right of competent adults who are incapacitated by incurable medical conditions to voluntarily request and receive medical assistance with respect to whether or not their lives continue shall not be restrained or abridged."

Its stark language bothers Derek Humphry. "It is open-ended euthanasia, and it's full of risks," he says. "No conditions, no waiting periods. Any doctor can help any incurably sick person anytime at any place. The thinking people in our movement are appalled by it. If you have Kevorkian's type of euthanasia, it will be a slippery slope. Kevorkian's is a recipe for skiing down a glacier."

Ironically, though, the amendment would seem to put Kevorkian himself out of the suicide business; his Michigan medical license was revoked in late 1991, after his second and third assisted suicides. When I asked Fieger about it, he didn't seem too concerned. "How could the father of assisted suicide not be allowed to do it?" he said.

I asked him why he hadn't tried to get Kevorkian's license reinstated.

"I will," he said. "It's not my most important goal right now. I mean, it hasn't stopped him, has it?"