The 'doctor' is out


Media attention aside, Jack Kevorkian's release from prison leaves unresolved the issue of end-of-life care

JACK Kevorkian, the man who made physician-assisted suicide a national issue and himself a household word, was paroled from prison Friday, a little more than eight years after he was convicted of second-degree murder in a case where he committed euthanasia, videotaped it, and sent the tape to Mike Wallace and 60 Minutes. Not surprisingly, his homecoming caused a media circus.

For the nine years that he was in practice as the nation's only self-proclaimed "obitiatrist," he was a major contributor to the circus atmosphere.

His jutting finger and frequent loud rants about corruption, his truly ghastly paintings, and the suicide machine itself were all stuff that tabloid TV longs for. When he showed up for one trial dressed in a Thomas Jefferson outfit he made himself, it was clear that he was something other than a medical pioneer.

Much of the speculation upon his release seemed devoted to a single issue: Will he break his promise to refrain from assisting in more suicides and do "it" again?

That is bound to cross the mind of everyone from beleaguered county prosecutors to Kevorkian's closest friends. He would certainly be unwise to do so for the next two years; the authorities could jail him immediately for violating his parole.

But that question, and most of the others being asked by the media this week, are not the important ones. What we should be thinking about is whether in the last eight years we have sufficiently improved end-of-life care.

Whatever you thought of Kevorkian, he didn't go out looking for patients. Rather, they beat a steady path to his door. They included people in chronic pain whose doctors wouldn't give them the time of day; people for whom life was merely a hellish existence, and people, like his last patient, a man with Lou Gehrig's disease, who was terrified that he would die helplessly choking on his own saliva.

The fundamental dilemma is that medicine today can keep people physically alive long past the point where that life has any quality. Since Kevorkian appeared on the scene, only one state, Oregon, has legalized a form of assisted suicide for the terminally ill. Hospice care has also been a booming industry. But there are thousands elsewhere who want to determine their own destiny - and believe they should have the right to do so.

Kevorkian himself may not be a good poster boy for the right-to-die movement, and in any event is unlikely to be around much longer. He is 79 and in poor health.

But with the first of the 75 million baby boomers now moving into their 60s, the uncomfortable questions Dr. Jack raised are not likely to go away. On the contrary, they are apt to be with us more than ever.