The message from Dr Death: Under arrest, Jack Kevorkian, an expert at ending lives. He has done it 19 times and he believes he is doing right. Last week he went on hunger strike to show America he meant it. Keith Botsford reports

Last Sunday, a self-styled 'obitiarist', the man known in the US as Doctor Death, 65-year-old Dr Jack Kevorkian, was released on dollars 2,000 bail from the Wayne County Jail in Detroit. He'd been dragged inside the previous Friday after three years of defying the Michigan authorities by continuing to assist the terminally ill - 19 in all - to take their own lives. Last August, when Kevorkian's tally stood at 17, the State of Michigan passed a law making 'suicide assistance' a felony; Kevorkian had assisted two further suicides since the law was passed, and his arrest, Kevorkian said, was 'Just what I want. It's my life or this immoral law.'

He'd had to be dragged to jail because his bail had been raised from dollars 10,000 to dollars 20,000, and Kevorkian had refused to pay his 10 per cent share of that bail. Once in jail, he had been on a hunger strike, and he was freed when a local attorney paid the dollars 2,000 for him, saying: 'They've reduced the issue of suicide and assisted suicide to a hysterical bunch of rhetoric. If I can get him out of jail and get those people to stop protesting in front of the jail and saying 'Free Jack', then I think my dollars 2,000 is well spent.'

From which you can gather that Doctor Death has divided America; and if you know the man, that he has done so quite deliberately. Unlicensed for the past two years, and therefore unable to obtain the drugs with which he operated his 'Mercitron', the patient-operated and Kevorkian-built machine (made of spare parts bought in garage sales) that delivered the death-dealing drugs; forced into medical retirement by the profession's refusal to hire him or publish his theories; unemployed since his last job in the early Eighties as a pathologist in California - Kevorkian has been at war with the medical authorities since he graduated from the University of Michigan medical school in 1952.

Death has always been his subject. After a brief stint as a doctor during the Korean War, Kevorkian says: 'I would take the death rounds. I would go around to all the people who were about to die and watch. The other doctors laughed at me.'

Perhaps because his mother suffered from a protracted and painful death from cancer, the idea grew on him that the medical profession, concerned with preserving life, had no answer to the problem of death, and, indeed, denied it. In 1989 he offered to assist in the death of a quadriplegic who had gone to court to win his right to die. When that case failed on the ballot, Kevorkian printed up business cards advertising himself as an 'obitiarist', a new speciality in medicine: one which doctors describe as 'medicide'.

At that point, Kevorkian had been unable to find a merciful way in which to make doctor-assisted suicide possible, and started work on his Mercitron. There was no shortage of newspaper stories on his 'mission', but it was an appearance on the Donahue television show that made it possible for him to make contact with his first volunteer, Janet Adkins, 54, a woman with Alzheimer's disease who wanted to die while she was still sound enough in mind to make her own decision.

His method then was simple. He had, and still has, a scruffy 1968 Volkswagen van. You go in head first, you come out feet first. You decide, you push the death-dealing button; Kevorkian supplies the means. When his licence to practise was taken away and he could no longer obtain the drugs, Kevorkian invented his 'Death Mask', and his last series of suicides have used this device in his own small apartment in a Detroit suburb: it fits over the face and delivers lethal carbon monoxide.

The question of an individual's right to die is no minor problem. In 1990, it reached the United States Supreme Court in the case of Nancy Cruzan, whose parents sued the State of New Jersey for the right to remove the feeding tube that kept their comatose daughter alive. They won, the court holding that there was no virtue in prolonging life against a patient's (in this case, the parents') wishes. Since then, the 'right-to-die' movement has gained momentum, and recently it has received backing from no less a personage than Hillary Clinton.

The Italian newspaper La Stampa reported on remarks made during one of the Clintons' many forays among the Hollywood elite, in which Hillary said that she herself had made a 'living will' - a statement, admissible in law, under which individuals may prescribe what is to happen to them should they be totally unable to decide for themselves. She said that the President agreed with her, and was about to make such a will himself. Then, in what she thought were off-the-record remarks, she continued to explain her views, entirely consistent with her known beliefs about abortion, that individuals effectively controlled their own bodies: they had a right to the death of their choice, as they did in reproductive matters.

However, these remarks, by one who is in charge of the President's health plan, were not widely quoted in the US. It is Kevorkian who is the catalyst for the debate about the right to death, and it is a role that Kevorkian plays to the hilt. He enlarges the argument about an individual's suicide to place the blame for the sufferings of many people directly on to the medical profession, which is already under heavy attack on many fronts. The doctors, according to Kevorkian, operate a 'cryptic totalitarian state'. They will not deal with death; they lie to their patients - they tell them the options for dealing with a fatal illness, but they do not say 'whatever we do, you're going to die anyway'; and it is widely perceived by dying patients and their families that they lie for a simple reason: the dying of an individual takes time, and it is lucrative.

Kevorkian has not made money out of his death-dealing; his patients have been in full possession of their faculties, and only one (who gave the state an opening to attack Doctor Death) has apparently hesitated on the brink. He sees his activity as a crusade. 'There is no rational argument against this,' he says, fully believing that history will vindicate him. (It could be said that the Netherlands already has, by permitting doctors to administer death to the terminally ill under some strict restrictions.)

He has his own rules: 'The patient must be mentally competent, the disease incurable.' And he is not without some support. The Michigan law was struck down by Judge Cynthia Stephens, who held that two terminally ill patients had the right to die: 'This court,' she said, 'cannot envisage a more fundamental right than the right to self-determination.' That ruling is being appealed, and a stay sought by the state allowed the current arrest.

Arthur Caplan, the director of Minnesota's Center for Biomedical Ethics, said: 'He (Kevorkian) tells us exactly where the health-care system stinks.' George Annas of Boston University's school of medicine has agreed that 'a significant part of the American public sees Kevorkian as a reasonable alternative to modern medicine' and, as he goes on to say, to its 'mistreatment (which) is a combination of deceit, insensitivity and neglect'.

Next week Kevorkian expects to be arrested again, this time in neighbouring Oakland County. 'I am not truly free with this hanging over me,' he says.

Doctors see death as the enemy. They are in the life business, not the death business. Kevorkian says, 'Some people want death, and I am going to give it to them.'

(Photographs omitted)

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