SUICIDE MACHINE, PART 1: Kevorkian rushes to fulfill his clients' desire to die

Originally published March 3, 1997

Through almost seven years of helping people kill themselves, Dr. Jack Kevorkian has consistently violated most of the rules and standards he publicly claims to follow.

Engaged in a crusade to legalize physician-assisted suicide, the onetime pathologist and his lawyer, Geoffrey Fieger, have insisted Kevorkian follows strict guidelines.

But those claims do not hold up. Actually, Kevorkian appears most consistent at ignoring the rules he has written or endorsed, a Free Press investigation shows.

Kevorkian declined invitations to discuss the Free Press findings. But Fieger conceded in a recent interview that Kevorkian has found it hard to follow his "exacting guidelines" in an atmosphere of "persecution and prosecution."

"He's proposed these guidelines saying this is what ought to be done," Fieger said. "These are not to be done in times of war, and we're at war."

In reviewing the lives and deaths of 47 people whose suicides have been publicly linked to Kevorkian since June 1990, Free Press reporters interviewed hundreds of people and examined thousands of pages of documents, including medical records, autopsy reports, marriage and divorce records, police files, personal notes and letters.

The investigation also debunks perceptions that Kevorkian only helps people who are terminally ill -- likely to die within six months -- or are in agonizing pain.

In fact, at least 60 percent of Kevorkian's suicide patients were not terminal. At least 17 could have lived indefinitely and, in 13 cases, the people had no complaints of pain.

Many friends and relatives of the people who committed suicide with Kevorkian weren't even aware he had a written set of standards. But they believe he is willing to suspend almost any rule to accommodate people who really want to die.

"What comes across in the public as almost a fanaticism comes across in private as a wonderful eagerness to perform a service that he's convinced should be available to people," said Jan Evans-Tiller, widow of retired Unitarian minister John Evans, who died with Kevorkian's help.

Examining the Kevorkian suicides, the Free Press found that in clear violation of his own written standards:

KEVORKIAN HAS FAILED to consult psychiatrists, even when dealing with depressed people.

In a 1992 article setting out his rules for physician- assisted suicides, Kevorkian wrote it is always mandatory to bring in a psychiatrist because a person's "mental state is . . . of paramount importance." But the Free Press found at least 19 cases in which Kevorkian did not contact psychiatrists.

In at least five of those cases, the people who died had histories of depression.

KEVORKIAN HAS FAILED to observe minimum waiting periods before helping people to die.

He has stated that after signing a formal request, a person must always wait at least 24 hours before getting help to commit suicide. But the Free Press found at least 17 instances in which Kevorkian's first meeting with the person was also his last. In at least five of these, less than three hours passed from the signing of the request to the moment of death. In one case, the waiting period was one hour.

KEVORKIAN HAS FAILED to consult with pain specialists and other medical experts, even when the need was clearly indicated.

Kevorkian has endorsed a written rule requiring that a pain expert be consulted in any case where "pain is a major factor" in a suicidal patient's complaints. But out of 33 cases in which people came to Kevorkian complaining of chronic pain, he failed to consult a pain specialist in at least 17.

KEVORKIAN HAS FAILED to discover financial or family problems that may have contributed to a patient's wish to die.

He has written that skilled help is "necessary to detect personal or family disputes, to clarify financial problems" and help people with their wills and funeral arrangements. But his questioning in these areas is cursory at best. In one recent case, he failed to uncover multiple allegations of spousal abuse and debts of more than $320,000.

Kevorkian outlined these and other rules in a 1992 article he wrote for the American Journal of Forensic Psychiatry. Fieger has described the article as a codification of the guidelines Kevorkian lives by.

In an essay last August in USA Today, Fieger wrote that Kevorkian also "scrupulously follows" the 10 guidelines of Physicians for Mercy, a group of doctors who support physician- assisted suicide.

But in his recent interview with the Free Press, Fieger said it is often "not practical" for Kevorkian to follow the safeguards he has publicly embraced.

Psychiatrists and pain specialists are frequently reluctant to cooperate, Fieger said. In some cases, he added, a person's competency is so "obvious" that a psychiatric exam is unnecessary.

Fieger acknowledged the importance of the 24-hour cooling- off period Physicians for Mercy has prescribed for people seeking physician-assisted suicides. But he said the threat of police intervention has made Kevorkian reluctant to delay.

"Some patients don't want to wait," Fieger said.



A speedy death

Though Kevorkian and Fieger say the suicide doctor "counsels" all his clients extensively, the Free Press found numerous cases where contact was extremely brief, and focused mainly on scheduling and logistics for the suicide meeting.

Kevorkian has written that if a person seeks help committing suicide and then "manifests any degree of ambivalence, hesitancy, or outright doubt with regard to her original decision, the process is stopped" and the person can never again be considered for assisted suicide.

Yet Kevorkian didn't respond when one of his early candidates made an ambivalent statement about her desire to die.

It was Oct. 21, 1991, and Kevorkian was on the phone with Marjorie Wantz, 58, who lived in Berrien County. She complained of constant vaginal pain and was scheduled to die in two days.

The main purpose of the phone call was for Kevorkian to discuss directions, schedules, and inexpensive motels with her husband, William, who would drive her to the Detroit area. But at one point, Bill Wantz put his wife on the line.

"Have you thought this over well?" Kevorkian asked.

"Yes, I thought it over well," she replied, according to a transcript of the conversation prepared for an Oakland County grand jury. "I got two choices. Either stay like this or go with the other way."

Kevorkian never asked Wantz what she meant. Instead, he replied, "You sound like you're in pain."

Marge Wantz replied, "I am in pain. I'm in pain and I'm getting nervous."

Kevorkian then asked one question about her doctors and pressed ahead with the logistics of her death.

Dr. Kalman Kaplan, a psychologist and expert in suicide prevention counseling, has read the transcript.

"It's not a genuine consultation," Kaplan said.

"When somebody says 'I could go two ways,' my first reaction is, 'It sounds like you're confused or ambivalent' . . . He doesn't explore those points . . . He doesn't draw her out."

Care or pressure?

Kaplan, who is studying Kevorkian's methods, has reviewed 14 videotapes made by Kevorkian of conversations with 12 people wishing to die.

"There are aspects of counseling in some of them," Kaplan said. "But in many of these tapes, it's difficult to see."

Kevorkian did ask Hugh Gale, a 70-year-old Roseville man suffering with emphysema, to make a list of things he enjoyed so he would have reasons for living. And there are numerous cases where Kevorkian has told people they are not ready to die and has put them off for days, weeks or even months.

But in many cases Kevorkian's conversations with his patients focused on negatives -- the things they couldn't do, rather than potential reasons to live.

Kaplan, head of the Suicide Research Center at Chicago's Columbia-Michael Reese Hospital and a psychology teacher at Wayne State University, cited a taped session with Janet Adkins, the 54-year-old Portland, Ore., woman who was Kevorkian's first suicide. Three days earlier, the Alzheimer's disease patient had beaten her son at tennis.

Rather than her tennis ability, the conversation focused on memory lapses that made it hard for Adkins to keep score on the court.



Wide range

The Free Press found that Kevorkian's patients and practices vary wildly.

* From terminal illness to no physical illness: He has assisted in the deaths of elderly, terminally ill and desperately suffering men and women, such as Merian Frederick, who died Oct. 22, 1993, at age 72, unable to speak, eat or swallow because of the fatal, paralyzing nerve disease ALS, also called Lou Gehrig's disease.

But Kevorkian also helped end the life of at least one woman, 39-year-old Rebecca Badger, who was a mentally troubled drug abuser and had no physical disease. An autopsy showed she was mistakenly diagnosed with multiple sclerosis.

* From years of counseling to minutes: Kevorkian has had at least three cases in which more than a year went by between his first contact with the suicide candidate and the moment of death.

He saw Margaret Garrish in her home in Royal Oak at least three times in two years before she died there in November 1994, legless, partially blind and crippled by arthritis.

But Kevorkian accepted Adkins as his first patient without ever speaking to her, only with her husband. Even when Kevorkian finally met Adkins, just two days before her death, he "made no real effort to discover whether Ms. Adkins wished to end her life," the Michigan Court of Appeals stated in a 1995 ruling upholding an order against Kevorkian's activity.

* From hundreds of pages of medical records to one or two are reviewed to make life and death decisions: Isabel Correa, a 60-year-old woman from Fresno, Calif., sent him a 216-page medical file before Kevorkian agreed to help her die.

Shirley Cline, 63, an Oceanside, Calif., woman with terminal colon cancer, sent only a one-page summary of her medical history.

Even when Kevorkian has voluminous medical records, it's not clear how he uses the information. For example, though Correa's main complaint was severe pain, her records make no mention of any consultation with a pain expert and Kevorkian never referred her to a pain specialist.

Very often, when Kevorkian has tried to consult with a patient's doctors, he has been turned down. But from the very beginning, he has shown a tendency to simply dismiss opinions different from his own.

One of the few cases in which Kevorkian did consult was Adkins'. He spoke with Dr. Murray Raskind, a psychiatrist who had been treating her at the University of Washington Hospital in Seattle, and a nationally recognized expert on aging and Alzheimer's.

Raskind told Kevorkian that Adkins was not competent to make a life-and-death decision. Kevorkian gave her a lethal injection anyway, writing later that his opinion was based solely on conversations with Adkins' husband.



Model case

Kevorkian broke his rules even in an early case when he was making a point of trying to stick to them.

When Susan Williams wrote Kevorkian in late 1991, saying, "I'm asking you to help me commit suicide," he was on the brink of an important event -- the publication in a medical journal of his plan to create a new field of "obitiatry."

Kevorkian's lengthy article, "A Fail Safe Model for Justifiable Medically-Assisted Suicide," has consistently been cited by Fieger and Kevorkian as the definitive statement of Kevorkian's standards.

Kevorkian decided Williams would be his model case.

"In a way, you're making history here," he told her family during the first of three lengthy videotaped sessions he conducted in spring 1992.

But Kevorkian's new rules were quickly cast aside.

It is not known whether Williams, 52, of Clawson, crippled by multiple sclerosis and blind, was clinically depressed. Her grown son and only child, Dan, believes she was. Her physician at William Beaumont Hospital in Royal Oak had recommended she see a psychiatrist.

Williams even told Kevorkian, "What depresses me is when the sun shines" because she couldn't go outside.

At one point, Kevorkian said, "I'd like to have a social worker interview you." His article had said such consultations must be conducted.

He also said he'd like to have "another psychiatrist and neurologist here to make sure there's no morbid depression," again following the rules.

But at the next videotaped session, on May 3, Kevorkian announced he was dispensing with any psychiatric consultation because Beaumont Hospital had told him psychiatrists don't make house calls.

"I know she's sane," he declared. "Everybody does. This is just for the record."

There were no other consultations. At the third and final videotaped conference, the main topic was when Williams should die.

Several years later, in 1995, Kevorkian would endorse a rule requiring that "the time and site" of suicide are solely up to the patient.

That was not true for Williams.

Her sister Nancy Vervaras preferred Friday, May 15.

"I was thinking Wednesday," said Williams.

Kevorkian interrupted her: "I was thinking Sunday . . ."

In the end, Susan Williams, who wanted to die at night, on a Wednesday, died at 10:43 a.m. on a Friday, May 15, 1992.



A close observer

Carol Poenisch has a personal and political interest in assisted suicide.

She is the youngest daughter of Frederick, the 72-year-old Ann Arbor homemaker and social activist who died of carbon monoxide poisoning in an unoccupied apartment in Kevorkian's threadbare Royal Oak apartment building.

Poenisch is a leader of Merian's Friends, a group working to put a proposal legalizing assisted suicide on a Michigan ballot.

As one of her mother's primary caretakers, Poenisch became an insider in Kevorkian's world before her death, and a close supporter afterward through one of his trials. She is on the executive board of the Michigan Hemlock Society, a branch of the national right-to-die organization.

Poenisch, 42, with a graduate education in public health, has a unique perspective on Kevorkian.

She wants physician-assisted suicide legalized -- and regulated. But Poenisch believes the only regulation Kevorkian will ever adhere to is his own personal judgement.

Under Kevorkian's real rules, "you can't make a generalization about who would get this and who wouldn't," she said. Only Jack Kevorkian gets to decide.

"He believes that it's case by case," Poenisch said. "I think that's what he really believes."



CONSULTATION BY TELEPHONE

Jack Kevorkian: "Have you thought this over well?"

Marjorie Wantz: "Yes, I thought it over well. I got two choices. Either stay like this or go the other way."

Kevorkian: "You sound like you're in pain."

Wantz: "I am in pain. I'm in pain and I'm getting nervous."

Kevorkian then asked her one question about her doctors and pressed ahead with the logistics of her death.



STANDARDS SET ASIDE

"I've never met any doctor who lived by such exacting guidelines as Kevorkian,"Jack Kevorkian's attorney, Geoffrey Fieger, wrote in an essay for USA Today. "He published them in an article for the American Journal of Forensic Psychiatry in 1992. Last year he got a committee of doctors, the Physicians of Mercy, to lay down new guidelines, which he scrupulously follows."

But a Free Press investigation of Kevorkian-assisted deaths found that Kevorkian frequently ignoreshis own rules - and Fieger now contends Kevorkian can't be expected to observe them consistently until physician-assisted suicide is legalized.



WHAT KEVORKIAN SAYS

Every assisted-suicide candidate undergoes extensive counseling with Kevorkian.

Every candidate for assisted suicide must be examined by a psychiatrist.

Patients who complain of chronic pain should be examined by a doctor who specializes in pain control.

Before agreeing to assist a suicide Kevorkian makes a deatiled review of each patient's medical records.

Those who qualify for Kevorkian's help suffer from afflictions that are incurable or cannot be treated without intolerable side effects.

Death should not take place sooner than 24 hours after a patient has made a final request.