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Study: Kevorkian patients weren't dying
By WES ALLISON © St. Petersburg Times, published December 8, 2000 TAMPA -- Just 17 were terminally ill. Only one was under hospice care. Five had no discernable illness at all. Only one-fourth of the 69 patients whom Dr. Jack Kevorkian helped kill in his hometown of Pontiac, Mich., actually were close to dying, according to an analysis by researchers at the University of South Florida. Their findings, which they say illustrate potential pitfalls of unregulated euthanasia and doctor-assisted suicide, are published in a short but sharply written letter in Thursday's New England Journal of Medicine. They are based on an examination of the autopsy reports of people Kevorkian helped commit suicide from 1990 to 1998. "Altogether, our findings underscore the vulnerability of women and groups of men . . . to physician-assisted suicide and euthanasia, particularly when clinical safeguards are lacking," the letter said. The authors also said their findings may erode some of Kevorkian's standing as a folk hero of the right-to-die movement and suggested his patients may have had other options they didn't understand or explore. "Many Americans have talked about, "I want a Kevorkian when I'm ready to die,' but my suspicion is much of the American public doesn't understand that these were not terminally ill people," said Donna Cohen, a professor of aging and mental health at USF who helped write the study. Only Oregon permits doctor-assisted suicide, but other states, including Florida, have considered it, and many likely will do so again. Lori Roscoe, a visiting assistant professor at the USF Ethics Center and the lead author of the Journal piece, said she hopes her research will "illuminate the need for giving people choices for managing serious chronic illnesses way before they get to the point of looking for options for how to die. "Because it's illegal, there isn't a lot of data on which to base clinical evaluations or to base safeguards," Roscoe said. Kevorkian, a pathologist, has acknowledged helping more than 100 sick people end their lives. He was acquitted of homicide five times until last year, when he was convicted of second-degree murder in the death of a man with Lou Gehrig's disease. He is serving a 10- to 25-year prison sentence. Roscoe, whose field of study is aging, health and ethics, analyzed the autopsy files for her doctoral dissertation, a project she began three years ago. With Cohen's help, she and a fellow USF student, Julie E. Malphurs, submitted a proposal to the Oakland County, Mich., chief medical examiner, Dr. L.J. Dragovic, then flew to Michigan to study the files. They spent two years on the project. In their study, "terminally ill" was defined as having less than six months to live. Most of the 69 patients did suffer chronic and often painful, life-threatening illnesses, including cancer, heart disease and neurological disorders such as multiple sclerosis and amyotrophic lateral sclerosis, or Lou Gehrig's disease, which is fatal. But in five patients, the autopsies revealed no significant physical disease. The analysis also showed that 72 percent of them were widowed, divorced or never married. And 71 percent were women, which is significant because men commit suicide more frequently than women, and other studies have shown that most patients who receive a doctor's help in dying are men older than 65. The authors said Thursday that patients' reasons for choosing suicide could go beyond their illnesses. They could include patients' isolation, how well their pain is managed, their feelings of autonomy, and whether they're familiar with alternatives to hastening their death, such as hospice care. On Thursday, Kevorkian's supporters questioned the USF findings because Dragovic, who also is listed as a co-author, is a longtime Kevorkian critic who testified against him. Faye Girsh, president of Hemlock USA, a right-to-die group and Kevorkian supporter, also took issue with the notion that Kevorkian's patients were vulnerable. "These people sought Kevorkian out," she said. But Diane Coleman, president and founder of Not Dead Yet, which opposes euthanasia and assisted suicide, said the USF study illustrates problems with the practice and exposes Kevorkian as an opportunist who preyed on the disabled. Thirty-eight of the 69 suffered neurologic conditions, and most of them were wheelchair-bound. "He's been touted as a hero by so many, and yet he did this," Coleman said. "He robbed many disabled women and others of their lives by responding to their despair in a way society would never respond if they were not disabled women." Aside from being impassioned, the debate over assisted suicide also is mired in secrecy and fear. Studies in several national medical journals have shown doctors do help patients die, yet tell no one, and other surveys have shown Americans like the idea of controlling how they succumb to terminal illness. But putting those beliefs into practice, as the USF analysis suggests, can be tricky. Who really wants to die, and who is simply depressed, or feeling desperate? What alternatives are available that the patient may know nothing about? Part of the problem is that established medicine admittedly does a poor job of controlling pain and providing palliative care. Experts agree suicide is less inviting when patients are more comfortable. "Our whole country got into trouble with this when we learned how to extend death, not just extend life," Cohen said. "So many people don't understand their illness. So many people don't have doctors who understand their pain." The Netherlands legalized physician-assisted suicide last month. Oregon's Death with Dignity Act, which took effect in 1998, permits doctor-assisted suicide when two doctors agree a patient is expected to die within six months and is not depressed. During the first year, 16 people employed the law, and 27 did last year. In stark contrast to Kevorkian's patients, 21 of those 27 were receiving hospice care. Girsh of the Hemlock Society said the USF's findings about Kevorkian's patients make a good argument for more laws like Oregon's. "It would be something people could discuss openly," Girsh said. "Hemlock is popular in Florida because we teach people ways to do it themselves, and then you don't have to worry about whether you pass muster or not. You just do it. "If that's what the public wants, that's what the public is going to get. And there's certainly downsides to that."
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