Medical Ethics: On April 13th, 1999, Dr Jack Kevorkian was sentenced to spend up to 25 years in jail. His crime? Killing an 83-year-old at his own request. Why? Because the man, suffering from a progressive and incurable neuromuscular disorder, was terrified of choking or suffocating to death.
Jack Kevorkian is eligible for parole in 2007 - which is why this book has been written. The authors have given us an apologia, but, mercifully, not quite a hagiography. They acknowledge their hero's impulsive and overweening self-confidence, which culminated in the folly of insisting that he defend himself in court. They also acknowledge his dismissive intolerance of opposition and his brazen dearth of political tact: getting yourself quoted in the press as opining that "the American people are sheep" is hardly the canniest way of winning friends and influencing people to lobby for your release.
Nevertheless, Between the Dying and the Dead tells the tale of a pioneering humanitarian - or at least of a humanitarian pioneer - fighting against a timid and conservative medical establishment to overturn irrational religious taboos.
Legalising euthanasia was not, in fact, the subject of his first crusade. His first cause - inspired by ancient Alexandrian practice - was to try and win for the inmates of death row the freedom to choose to die in the course of medical experimentation, rather than by more conventional means of capital punishment. If the convict volunteered, irreversible surgical-depth anaesthesia would be induced at the time set for execution. Once the experiments were completed, an executioner would administer a final dose of anaesthesia. The victim would feel no pain, and his death would at least be dignified by making possible research on living human bodies and so serving the advance of medicine. What could be more rational? If society insists on meting out the death penalty, then at least it should make it useful.
Kevorkian's second crusade involved campaigning to have the US follow the Soviet lead in alleviating the shortage of blood supplies by draining blood from cadavers - and in the case of military medicine, by transfusing blood directly from the dead to the battlefield wounded. It sounds macabre? So what? Why should mere squeamishness obstruct efficiency in saving lives?
But of course it is his campaign to legalise assisted suicide and voluntary euthanasia that has won Jack Kevorkian worldwide notoriety - as his nickname, "Dr Death", testifies. In 1988 he constructed his infamous suicide machine or "thanatron" to allow "adamant, incurable, suffering and terminal" patients to initiate a process of painless self-killing by drugs. Over the next decade more than 130 patients availed themselves of his help. As a consequence, Kevorkian's state licenses to practice medicine were suspended, and he found himself going in and out of court throughout the 1990s. After three acquittals and a mistrial, he was finally found guilty of second-degree murder in March 1999 - but only having thrown down the gauntlet to the judicial system by video-taping himself committing voluntary euthanasia and then having it broadcast on national television.
As told by Between the Dying and the Dead, Kevorkian's particular commitment to the legalisation of medical killing upon request illustrates both the strengths and weaknesses of the cause in general. Basic to his motivation is indignation at the horrendous states to which modern medicine can sometimes reduce patients. Take, for one example, the hydrocephalic boy strapped to a hospital bed and hooked to a ventilator, whose birth defect has left him with an oversized, boxlike head, the skull deformed by the pressure of the fluids filling the space where his brain should have been. Or take, for another example, the woman ravaged by cancer whose abdomen is stretched to five times its normal size by the fluids trapped within it, and whose face is frozen by pain.
Add, then, to the sorry plight of the patients, the timorous reaction of doctors - abandoning the dying, because death signifies professional failure, and refusing to administer sufficient drugs to relieve pain, lest the patient become addicted or comatose.
There is no doubt that there is a serious problem. But the fault of Kevorkian - and often of those who think like him - is to presume that changing the law to sanction assisted suicide or voluntary euthanasia is the best solution. Judging by the story told in this book, Kevorkian has given not a thought to the difficulties of restricting medical killing once it has been authorised, or to the damaging social ramifications of authorising it. As for the alternative solution of palliative medicine and care, he blithely dismisses it as incapable of adequate funding. But why accept this (rather American) limit, having railed against so many others? Why not devote one's natural crusading energies to fight for a vast expansion of palliative provision? The answer? Silence.
Between the Dying and the Dead will reward readers who want to know better what motivates one of the world's best-known (and crankiest) advocates of assisted suicide and voluntary euthanasia. But if you're looking for a balanced consideration of the complex ethical issues that these practices raise, then go elsewhere.
Nigel Biggar is Professor of Theology and Ethics at Trinity College Dublin, a member of the Ethics Committee of the Royal College of Physicians (London), and author of Aiming to Kill: The Ethics of Suicide and Euthanasia (London: Darton, Longman and Todd, 2004)
Between the Dying and the Dead: Dr Jack Kevorkian, the Assisted Suicide Machine, and the Battle to Legalise Euthanasia By Neal Nicol and Harry Whyte Vision, 273pp. £16.99
