KEVORKIAN--- DOCTOR DEATH

Victor Bloom MD

So far, Dr. Kevorkian has been acquitted several times for charges of assisted suicide. Now he has pushed the envelope farther, and actually performed a lethal injection on a patient who, he was convinced' would suffer terribly and die an agonizing death. Kevorkian has much support in principle, the issue labeled, "death with dignity." Ironically, many of Kevorkian's victims have died under circumstances that were anything but dignified. Kevorkian has left bodies in motel rooms, emergency rooms and trailers. He seems to be a courageous and selfless man with a noble mission, but I suspect his motives.

First of all, Kevorkian chose to be a pathologist, which is the one medical specialty where the doctor does not work with live patients. He does autopsies and examines tissue specimens. There is no doctor-patient relationship or the development of clinical skills. Because of his inexperience in dealing with live patients, he would have great difficulty differentiating between a psychiatric depression and a depression secondary to chronic, debilitating physical illness. Both conditions can be successfully treated by physicians of appropriate clinical specialties. Several of Kevorkian's victims were plagued by chronic and severe depression, such that they were suicidal.

Patients with longstanding severe depression are prone to suicide, to end their mental torture, but of those many are fearful of actually taking their own life. They also hate the idea of dying alone. The stigma against committing suicide is very strong, and the depressive is weighed down with guilt. They are afraid of killing themselves and going to hell. When Kevorkian came along and said, in effect, "I will help you end your life, (since I am a physician and compassionate), many depressives felt they ÷had a guardian angel. Not only the patient, but family members were looking for an end to their suffering.

At first Kevorkian would set up a Rube Goldberg apparatus, where the patient could pull a string or press a button which would release a lethal gas (carbon monoxide), or injectible poison. This was called, 'assisted suicide' because it was the patient who actually precipitated the death. Even though Michigan made a law against assisted suicide with Kevorkian in mind, the brilliant polemics of his attorney, Feiger, influenced jury after jury to in effect nullify the law. The main argument was that Kevorkian was compassionate, and did not have evil intent. There was no psychiatric expert witness to propound the theory that Kevorkian is preoccupied with death and may derive some unconscious satisfaction from a seeming control over life and death. It may be a power trip that motivates the man, rather than really caring about a suffering, terminal patient.

We †all have our ways of dealing with the concept of death. Most commonly, the defense is 'denial'. Most people derive comfort and solace from religious beliefs of a life after death. It may be that Kevorkian's mechanism involves a fantasy of having a power over death. Admittedly, these are speculations and cannot be proven, but it may serve a useful purpose to have some basis to question Kevorkian's assertions that he is only interested in alleviating suffering.

According to his principle, many people are suffering with or without progressive physical deterioration. If the patient were you or a loved one, would you rather commit suicide or be treated for your physical ailment or your pain? If there is no alternative to physical pain and deterioration, doctors are not limited in providing pain relief, mostly by opiates, and ultimately, there is the hospice. The hospice is designed to care for the physical anÈd emotional needs of patient and family, and is the most civilized way of providing care for the dying, with the exception of dying at home, surrounded by a loving family.

People in desperate straits have little difficulty finding ways to commit suicide. There is ample literature provided by the Hemlock Society. Assistance can come from family and friends. It is not necessary for a medical doctor to perform the killing. Euthanasia is not a medical procedure. Kevorkian makes reference to doctors committing euthanasia throughout the ages, but actually, pain relief (short of death) is a time-honored and valid medical function. Toward the end of a terminal condition, the amount of drug to accomplish pain relief happens to be incompatible with life. With most doctors who are not preoccupied with death, the patient does not get a lethal dose to end the persons life, but to relieve the anguish of unrelieved pain.

If Dr. Kevorkian is not convicted of murder in the first degree (with intÍent, but without malice), it would open the door to other doctors being used and abused by family members who have animosity toward the patient, or waiting for their inheritance. Society has a proscription against murder for a very good reason, and that means that nobody can commit murder with impunity, not even doctors, not even pathologists.

Kevorkian insists that whether or not it is 'killing' or 'murder' depends on his state of mind, and nobody knows that but him. The question remains, does he know his own mind? Ironically, he has set himself up for his own death. He has committed a lethal injection which was televised and shown on "60 Minutes." He says if he is found guilty, he will starve himself to death. The die is cast.

Dr Bloom is Clinical Associate Professor of Psychiatry, Wayne State University and member of the American Academy of Psychoanalysis. He welcomes comments and questions at vbloom@comcast.net.