The Persistent 'Dr. Death'

SARA ENGRAM

August 22, 1993|By SARA ENGRAM

Like a bad penny, Dr. Jack Kevorkian keeps popping up. Most recently, he made news when he was charged in Michigan this past week for violating the state's new law against assisting in a suicide. The law is facing a constitutional challenge in Michigan's Court of Appeals, but Dr. Kevorkian's insistence on violating it anyway raised the ire of a county prosecutor.

A loner and a zealot, "Dr. Death" has been roundly spanked and told to go away by all the authorities -- legal, medical and moral. Even people working to legalize physician-assisted suicide see him as a liability to their cause, the man who "puts a face on the fears" of euthanasia, as one supporter of the movement put it.

And yet people keep seeking him out for help in ending their lives. Since June 1990, Dr. Kevorkian has helped 17 people to die, most recently on Aug. 4.

But law enforcement officials have been frustrated in their efforts to prosecute him; until last year Michigan did not have a law they could use against him.

Dr. Kevorkian's press conference Aug. 5, at which he described in detail how he helped a 30-year-old man to commit suicide the day before, was an open challenge to the law, prompting Wayne County prosecutor John O'Hair to file charges against him.

Mr. O'Hair said he hoped the charges would help to force the state to come to grips with the issue of physician-assisted suicide.

Despite the prosecutor's good intentions, it's not likely that a criminal case can resolve such a volatile issue. Neither criminal charges nor public criticism seems to deter desperate people from turning to Dr. Kevorkian's macabre brand of services.

And nobody has yet proven that he has done anything more than help people fulfill their own death wishes.

Dr. Kevorkian has become a symbol of a larger issue, but he is not the real problem. The deeper challenge lies in addressing the reasons people turn to him in the first place.

That challenge takes us beyond the laws and moral dilemmas surrounding assisted suicide to our approach to health care itself.

If the medical system paid as much attention to caring for people -- helping them cope with their conditions -- as it does to curing them, the people who turned to Dr. Kevorkian might not have considered death their best alternative.

People in this country are more afraid of the process of dying than of death itself -- not a surprising thing, given the technological wizardry that can prolong a semblance of life indefinitely. But the ability to preserve vital signs doesn't seem to guarantee much attention to making life livable.

In all kinds of ways -- from lack of attention to pain management to their ignorance of the range of hospice services available for HTC terminally ill patients -- too many physicians overlook the crucial details that can make life bearable for suffering people.

Until that changes, Dr. Kevorkian will always have customers.

Earlier this month, Dr. M. H. Merson, head of the global AIDS program for the World Health Organization, provided some insights into these problems in a speech to the World Conference on Medical Education, meeting in Edinburgh, Scotland.

His topic was the challenge AIDS poses to medical education, but the lessons gleaned from more than a decade of experience with AIDS and HIV infection apply to many other areas of medicine as well -- particularly the chronic conditions that can prompt people to seek assistance in ending their lives.

Dr. Merson faulted medical schools for paying too little attention to the context in which physicians practice, for concentrating too much on curing symptoms and not enough on providing the long-term care and support patients need.

Physicians of the future, he said, would need more than an arsenal of treatments. They also need vastly improved communication skills and the ability to deal with patients and their families as allies and active participants in decisions about medical care.

Especially with AIDS and with long-term, chronic conditions such as arthritis, diabetes and some forms of cancer, they need to worry as much about providing comfort and support as about treating symptoms.

Dr. Merson also challenged medical schools to give their students a better understanding of public health, of how social factors affect the spread of diseases and of the importance of preventive medicine.

Medical schools can't solve all the problems of the health care system -- access to services and paying for them are still major problems in this country. But Dr. Merson's remarks illustrate the kind of changes in medical care that can help to make Dr. Kevorkian irrelevant.

Sara Engram is editorial page director of The Evening Sun.

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