Book Review

Between the Dying and the Dead: Dr. Jack Kevorkian's Life and the Battle to Legalize Euthanasia

N Engl J Med 2007; 356:1281March 22, 2007

Article

Between the Dying and the Dead: Dr. Jack Kevorkian's Life and the Battle to Legalize Euthanasia
By Neal Nicol and Harry Wylie. 273 pp., illustrated. Madison, WI, Terrace Books, 2006. $27.95. ISBN: 978-0-299-21710-5

For decades, end-of-life decision making, and euthanasia in particular, has been a highly contested topic — not only in the fields of bioethics and medicine, but also in society in general. The debate involves various actors. It has its icons and symbols, like Nancy Cruzan and Terry Schiavo, who were maintained in a persistent vegetative state; Ramón Sampedro, who was paralyzed from the neck down in a diving accident and fought for almost 30 years for his right to die; and several well-known doctors. Perhaps the most disputed figure in this debate is Jack Kevorkian, the subject of Between the Dying and the Dead.

The authors of this book, longtime collaborators and friends of Kevorkian, try to show what kind of person he is and what has motivated him. The son of Armenian immigrants who sought refuge from genocide, he learned to mistrust governments and politicians. At school, he was a rebel and a joker — never a diplomat. In medical school, he was fascinated by science and death, astonishing his fellow residents with bizarre experiments. As a pathologist, he argued that prisoners on death row should be given the option of dying by surgical anesthesia rather than by other means of execution so their bodies could be used for organ donation and medical experimentation. He also made a case for the transfusion of blood from cadavers to patients. He had difficulty understanding why other people did not appreciate his ideas and research, and even found them macabre and eccentric. In 1987, during a trip to the Netherlands, he learned of euthanasia and started to make his so-called suicide machines. Through his involvement in assisted-suicide cases, he became an internationally known figure and went through several trials until he was finally convicted of second-degree murder in 1999.

After reading this book, I still find it unclear why Kevorkian did what he did. Was it the search for a cause that could make him famous, a compassion for the dying, or a predominantly technical and utilitarian view? The authors make exaggerated claims that the requirements for assisted suicide in the Oregon Act and similar bills in the United Kingdom are taken directly from Kevorkian's publications, and that because of Kevorkian the medical community has begun to pay attention to palliative care. But the impression I have of Kevorkian is that of a tragic figure, often isolated, out of touch with reality, and without common sense. He is tragic because he charged himself with an impossible mission: questioning medical ethics, sometimes with the right arguments but often with the wrong solutions. Kevorkian was right in identifying such problems as physicians' lack of attention to suffering and the shortage of organs for transplantation. But the authors also show that as long as medicine is considered a primarily technical profession, ethical arguments opposing assisted suicide and euthanasia are merely religious. The authors empathically describe a man who has devoted his life to challenges and lost battles, but this is also a history of bioethics.

Henk A.M.J. ten Have, M.D., Ph.D.
University Medical Center, 6500 HB Nijmegen, the Netherlands
h.tenhave@unesco.org