Can Dr Death be a true hero?

The American doctor's plan to harvest the organs of euthanasia volunteers will provoke outrage. Has he gone too far?

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He has been dubbed America's Dr Death, the Grim Reaper Incarnate, and his home visits are a prelude to the grave. He is the inventor of a "suicide machine" and his recommended route to eternal oblivion is a lethal dose of carbon monoxide.

He is Dr Jack Kevorkian, the founder of a Mercy Clinic in Michigan where people are helped to die. In six years he has helped 28 to escape their suffering, in the clinic, in their own homes and in appartments rented for the purpose. He has had his doctor's licence revoked, has spent time in jail and been threatened with long sentences six times. His peers have branded him a "reckless agent of death."

But today Dr Kevorkian, 68, the world's leading proponent of doctor-assisted suicide, is hailed as a hero by the British Medical Journal; as a man of action, a clinical Copernicus or Che Guevara, who took on the legal, medical and religious establishments, and said, "I dare you to stop me."

They tried and they failed. Instead, Dr Kevorkian's actions ignited an international debate about the right of a patient who has endured great suffering to seek a doctor's help in ending their life at a time of their choosing. He has never charged for his services nor has he once been condemned by the family of those he helped to die.

His campaign has achieved growing popular support for that right here and in America, where a federal appeals court has now recognised a "constitutional right to die" effective in nine states, and the state of Oregon has legalised state doctor assisted-suicide.

"He is a maverick, but he is a hero to many British people who see the need to recognise and regulate medically assisted suicide," says Merideth MacArdle of the Voluntary Euthanasia Society. "We owe him a great debt."

Two-thirds of Americans support doctor-assisted suicide, and an NOP poll in 1993 put British support even higher, at 79 per cent. A survey of doctors published last month by Glasgow University found that more than half supported rational suicide, and more than a quarter had been asked for help to die by desperate patients. Another survey, in 1994, found that 10 per cent of doctors admit to helping someone to die.

The British Medical Association remains implacably opposed to the idea, and hence the significance of the glowing tribute for Dr Kevorkian in today's issue of the BMJ which is co-authored by the the journal's North American editor. The editorial castigates the conservatism that is rife in medicine which inhibits frank discussion of some of the fundamental issues of civil liberty and medical practice: "... only a few doctors have stood up and said `Enough!' to their profession and society. Kevorkian seems to be one," the journal reads.

However, it now seems that someone should be saying "Enough" to Dr Kevorkian.

Last month, a Michigan court failed to convict the doctor over his involvement in the deaths of two women It was the sixth case to have been brought and to have failed and it is unlikely that any fresh lawsuit will be attempted. It was the case deemed most likely to succeed because neither of the women was terminally ill - one had multiple sclerosis and the other severe pelvic pain - although both wanted to die. As in every other suicide Dr Kevorkian has supervised, their wishes were meticulously documented and he had video-tape recordings in which they expressed their desire for death.

But not content with the success of his combative efforts to legalise doctor-assisted suicide - it is predicted that many more states will follow the lead of Oregon in the next few years - Dr Kevorkian immediately began pushing at the barriers of what is ethically acceptable yet again.

For his next trick, Dr Kevorkian will assist at a suicide and then, with the prior consent of the deceased and the appropriate medical tests, his or her organs will be removed soon after death for use in transplant surgery.

Geoffrey Fieger, Dr Kevorkian's lawyer and agent in Detroit, Michigan, says that Dr Kevorkian has the support of "several surgeons" who would be willing to carry out organ removal. "It hasn't happened yet but it will. Soon. Even if I knew when I wouldn't tell you," Mr Fieger said yesterday.

The harvesting of organs adds a new, commercial dimension to the right to die issue. Critics warn that the terminally ill may feel pressurised into assisted suicide so their relatives can benefit from the sale of their organs. For those supporters of Dr Death, it may be one step too far on the journey he began in 1990.

It was in that year that Dr Kevorkian, the son of Armenian refugees from Turkey and an obscure former pathologist in a suburb of Detroit, helped Janet Adkins, 54, who was suffering from Alzheimer's disease, to die using his specially devised suicide machine.

His interest in death was long established. He chose pathology because it is "studying the dead to help the living," but he dismisses claims that he is obsessed with it. He courted controversy early in his career with his suggestion that death-row prisoners could be used for medical experimentation just prior to death and that organs be harvested from executed criminals.

As a young doctor, Dr Kevorkian experimented as an artist and in one painting, called "Genocide," he used his own blood and exhibited it with dark red fluid dripping into a trough underneath the canvas. "I never called them art but philosophy in paint," Dr Kevorkian says. "The purpose was to provoke thought."

To date, Dr Kevorkian has provoked millions to think about death, about their right to determine their own time and circumstances of departure from life. He has helped doctors face up to the dilemma of modern medical practice that enables more people to survive for longer but with a questionable quality of life. But perhaps now is the time for him to step aside, and allow a calmer discussion of the issues. The hero has made us uncomfortable for long enough.

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