Jack Kevorkian neglected to factor faith into his approach to death.  And paid the price.

by Paul Creeden

Editor’s Note:  Yesterday Gallup released a new poll that shows assisted suicide — often conflated with “aid in dying” or “Death With Dignity,” as legal in Washington, Oregon, and Montana; or often called “euthanasia” by opponents — is the most divisive issue in the U.S., leading abortion, gay and lesbian “relations” and having a baby outside of marriage.  Our aging population and a medical system ill-equipped for an unprecedented influx of seniors will likely keep assisted suicide divisive for the next few decades as laws and medical ethics struggle to redefine death in a new age of medical advancements.

Dr. Jack Kevorkian is the subject of You Don’t Know Jack, an HBO film, which premiered on the cable network in April. Al Pacino plays “Dr. Death,” as Kevorkian was dubbed in 1956 after he performed, in his role as a pathologist, a photographic survey of the pupils of dying patients. Kevorkian has a documented fascination with death and with helping people accept their deaths as an opportunity for medical advancement and he was reportedly fired from a pathology job in 1958 for suggesting that prison inmates be encouraged to volunteer their organs for medical experimentation.

The HBO film, in my opinion, portrays Jack Kevorkian as a man who sees human beings in their animal simplicity: living creatures like any other who have limited life spans and mechanical failures. He is a medical pragmatist with no tact, but his notoriety demonstrates the ways in which our understanding of death has been distorted. For example, the greatest barrier to easing his first euthanasia clients was his stubborn insistence on lecturing them on the usefulness of their harvested organs. Medical staff who had agreed in the 1950s to a demonstration of his Thanatron, a lethal-dose-delivery device he constructed for use by patients who wished to end their own lives, got him fired from a hospital job. If Kevorkian had simply demonstrated his simple machine — patient activated to deliver a lethal dose of potassium chloride after sedation — and not actively pursued the use of assisted suicide, perhaps the course of his struggle within the medical community would have been easier.

As an AIDS hospice nurse in the 1980s and 1990s, I followed the career of Dr. Kevorkian with considerable professional and personal interest. His defense of the right to choose a time and method of painless death — for capable patients who had no hope of recovery and no relief from excruciating symptoms — resonated with me. And not only because he did so in the face of intense public scrutiny.  I was immersed in the care of terminal AIDS patients whom much of society had deemed expendable social outcasts, subject to suffering because of their sexual behavior. In my role as a hospice nurse, I was indeed providing the legal and conventionally acceptable service of easing the suffering of desperate, dying patients with narcotic medications which possibly hastened their deaths while easing their symptoms.

Jack Kevorkian’s process is irreligious, though his primary detractors are not; God does not enter into his consideration of what life and death are about. He is a man who has been trained to heal and understand illness in a society which places religious boundaries on methods of discovery and investigation.  He is driven by what is pragmatic, what makes sense for patients, in a medical establishment which does not always operate on that premise because it is often obstructed by religion, capitalism and/or litigation.

The abysmal ignorance of the realities of death in American culture fuels the frustration and headstrong attitudes of those few individuals, like Kevorkian, who work in the realm of death’s processes and its aftermath. Kevorkian’s anger is often portrayed as ego-maniacal rage, yet, as we see in You Don’t Know Jack, the emotional trigger for his crusade was the experience of helplessly watching his own mother die an excruciating and prolonged death. Personal motivation, based on my past experience, is common among those who deliver hospice or palliative care, the medically conventional mechanisms for aiding the terminally ill in their last months or hours.

This is why I say I know Jack. I know what drove Kevorkian to work to fix a system that seemed sadistically inhumane to him. Most Americans continue to die in pain and isolation in hospitals or nursing homes.  The difference between Kevorkian and me is that I chose to address that inhumanity in a more accepted way, inside the medical institutions where I’ve made my career; not necessarily a better or morally superior way, in my view. Kevorkian has paid a tremendous emotional and physical price for his advocacy, including ten years in prison.

The Thanatron

So, if religion played no part in Kevorkian’s judgement or actions regarding death, what part does religion play in Kevorkian’s story?  Over the course of decades he was publicly persecuted, though not successfully prosecuted, by Michigan lawyer Dick Thompson, who later co-foundered the Ave Maria School of Law in Ann Arbor, an ultra-conservative Roman Catholic law school. Thompson was primarily responsible for making Kevorkian’s mission a matter of public and political debate by taking the issue to “pro-life” groups, evangelical and Catholic churches and the media. Once “exposed” in the media, Kevorkian was condemned from pulpits of many denominations, and yet, being irreligious himself, seemed inured to the criticism of the religious. His focus remained riveted on what he saw as a right of practical and pragmatic self-determination as aided by a qualified medical professional and bound by a primary, ethical commitment to ease needless suffering.

This is where the divide exists between those who see themselves as the guardians of public morality through organized religion and those who see themselves as scientific practitioners, I believe: those who implement society’s religious prohibitions and conventions have not been able to keep up with scientific and medical advancements. The custodians of various spiritual traditions, largely men of little science or medical experience, are divorced from the realities of death and dying in modern society, as are most of the general population. While these religious actors may be intimately versed in speculations about afterlife, their knowledge of the realities of life and death from a practical, scientific, or medical perspective are limited.  Critics of assisted suicide and end of life planning have seldom had to face the technical and ethical challenges medical practitioners must consider.

Monolithic prescriptions, as offered by dogma and tradition, as to how people must die or what choices they must make in a scientific and secular age, such as home hospice care or clinically assisted suicide, are inevitably out of sync with individual and unique realities in hospitals, nursing homes and intensive care units. Kevorkian made this painfully clear to us all.

Modern health care professionals continue to become more irreligious or secular, in keeping with an overall trend in U.S. society . Many, while they may privately subscribe to a religious, philosophical or habitual belief system, are divorcing their professional lives and ethics from those systems out of pure necessity; in order to work in modern medicine and to meet the needs of a diverse patient group. As government-funded medicine becomes more widespread, prohibitions against insertion of religion into clinical choices also becomes more common.

From my own clinical experience, I am reminded of a day in a job I held in a Manhattan hospital in 1988, when I was assigned as a nurse to a married, female Hasidic Jewish patient. I attended to her with my best clinical knowledge and sensibilities.  She seemed pleased and comfortable until her husband and several of her male relatives came to visit. They threatened me with violence for having taken care of her against their religious standards of decency, since I had to touch her without another woman present in order to deliver my care. In the end, because there was no other nurse available to tend to the woman, they relented. Their religious objection was simply irrelevant because their priority and mine was the patient’s medical needs.

Hospice care is agreed upon by the patient and the provider as a contract for a clearly defined service, willingly consumed by the informed, terminal patient who abandons access to technical, life-maintaining (or death-prolonging) measures. During my hospice career, I encountered representatives of religious beliefs who actively encouraged my patients to leave hospice care by condemning it as sinful or inappropriate to their religious tradition.  I also encountered religious people who judged my role in hospice care as immoral and unethical. None of this had any relevance to the performance of my duty as a hospice nurse, so long as my patients maintained their consent and contract for hospice care. I have found over the years that the relationship between the provider of medical services and the patient is more and more devoid of religious considerations in our increasingly technical, scientific society.

I see Jack Kevorkian is an avatar of the growing  secular spirit of the medical community and of the times. Clinically assisted suicide is a hot-button issue, one intimately related to how we address end of life care, though it has been distorted by politicians and religious groups for their purposes.  The debate is far removed from the reality of one person’s unbearable, untreatable pain and one provider’s expert ability to help.  To Kevorkian, religion and politics have no place at all in the personal decisions of providers and patients who must together, in good conscience, alleviate intense end-of-life suffering. In civilized societies, as Kevorkian sees it, where religion and government are constitutionally divorced, there is no reason why qualified medical providers of clinically assisted suicide, who break no laws, should be demonized, prosecuted and imprisoned. Government and society have simply failed to recognize the irrelevance of monolithic religious attitudes toward the suffering of those for whom life no longer holds hope, comfort or meaning. Jack Kevorkian has led the way to this realization and has paid dearly for it.

Paul Creeden is an independent writer in Boston, Massachusetts. He holds a B.S. degree in Cellular Biology from Boston College and is a retired registered nurse with decades of experience in psychiatric and hospice nursing. His blog is called Buddha’s Pillow. As a guest member of the Harvard Humanist Association, he co-facilitates The Humanist Contemplative Group and writes for The New Humanism, the journal of the H.H.A.. He is also working on an upcoming anthology with other writers in concert with AIDS Action Committee of Massachusetts.