Deciding To Die, With A Doctor's Help As Courts Consider Physician-assisted Suicide, Jack Kevorkian's Controversial Work Goes On. One Of His Allies Who Has A Terminal Illness Now Contemplates How To Manage Her Own Death.

Posted: November 20, 1996

FARMINGTON HILLS, Mich. — Janet Good itched and scratched until she was bloody. She went to her family doctor, then a dermatologist, and finally an internist.

The internist talked with her for a few minutes, looked in her eyes, ears and throat, and studied her yellowed skin. He had seen this before.

``I have bad news,'' he said. ``I don't want to tell you until I confirm it with tests.''

The following day, Janet Good, 72, a short woman with rose-rimmed glasses and a preference for pink sweat suits, returned to the doctor's office.

``Give it to me straight,'' she told him.

``You will die,'' he said.

A giant tumor in her pancreas had spread to her liver and was blocking the flow of bile. It was backing up into her skin, causing her to itch.

That was the day Janet Good knew she would die: Aug. 18, 1995.

She didn't panic or get depressed.

Her reaction was matter-of-fact. For 20 years this grandmother of six and great-grandmother of four had fought to legalize physician-assisted suicide.

She had always known she would end her life rather than suffer a lingering, horrible death. She had helped many others die. Now, her own time was approaching.

One question remained: Would she commit suicide peacefully at home, far from the media spotlight?

Or would she die with the help of her friend, ally and hero: Jack Kevorkian?

ALMOST NO ISSUE has hurled itself into front and center of American public debate faster than physician-assisted suicide.

And no one is more responsible for putting it there than Jack Kevorkian, the retired Michigan pathologist who has helped at least 45 people die since 1990, 17 since May.

Former surgeon general C. Everett Koop calls Kevorkian a ``serial killer.'' Other critics label him out of control, a madman.

Still, many Americans are becoming more accepting of physician-assisted suicide. They want more control over how and when they die. They want an alternative to a painful, protracted death.

In 1982, 46 percent of Americans in a Louis Harris survey supported the right of a terminally ill person to suicide with a physician's help. By last year, the percentage had climbed to 73 percent. And in 1994, Oregon became the only state to approve physician-assisted suicide.

Janet Good sees Kevorkian as a visionary. She has become his associate and advance team.

Need to reach Kevorkian? Call Janet. Need a date for a suicide? She'll help arrange it. A hotel for while you wait? She'll help find it.

She lives in a red-brick ranch house in the suburbs with white shutters and red maples out front. She's been married 54 years to a retired Detroit police inspector. She drives a Cadillac, goes to Mass, votes Republican.

Janet Good became an advocate for doctor-assisted suicide after the night in 1971 when her 83-year-old mother fell off the front porch at home in Detroit and crushed her skull.

``My mother ended up in a persistent vegetative state with a huge bed sore the size of a platter on her spine, eating her alive,'' Janet recalled. ``It took three and a half years of agony for my mother to die.''

She pleaded with doctors to help her mother die, she said, but they refused.

Janet's mother couldn't get out of bed, couldn't recognize anyone, couldn't speak. Countless times Janet went to the nursing home with mashed-up sleeping pills, determined to put them in her mother's milk shake.

``I would stand there and I would cry, . . . but I could not kill my mother,'' Janet said. ``I have never gotten over the guilt of not putting her out of her suffering.''

In 1980, Janet Good founded Michigan's chapter of the Hemlock Society, a national organization devoted to legalizing assisted suicide and euthanasia.

She saw this as an extension of her commitment to women's rights. For many years, she was a state equal opportunity officer and is in the Michigan Women's Hall of Fame.

When Kevorkian surfaced, Janet befriended him. He wanted his first assisted suicide to be at her home, but her husband objected.

Instead, Kevorkian helped his first patient, Janet Adkins, an Oregon woman with Alzheimer's, die in his rusty old van in 1990.

Gradually Janet and Jack became close. He'd bring her pineapple cake. Janet found him courageous and kind. Though his flamboyance sometimes frustrated her, she knew he was her ticket to political action.

``I can get what I want for this society by working with him,'' she explained.

She realized that she, too, might want his help to die.

TWO WEEKS AFTER she learned she was dying, Janet underwent a 10-hour operation to remove the cancerous portion of her pancreas.

She had rejected chemotherapy or radiation, but agreed to surgery, mainly to halt the itching. Doctors told her this would give her six months to live - a year at best.

The surgery wiped her out. So did the painkillers she received afterward. She was delusional. She ripped out the tubes in her nose and throat so doctors had to restrain her arms.

As she lay in her hospital bed, Jack Kevorkian came to see her. This created quite a stir. Only the week before, he had left the body of a suicide client in the hospital's parking lot.

He politely stopped at the front desk, and a guard followed him through the hospital.

His visit was social. Janet wasn't ready to die.

``It's not as if I'm eager to end my life,'' she said later. ``But I don't want to die the way I've seen so many people die. . . . Pain management is not the big issue. It's the indignity of having to be diapered and sedated. People can endure pain. But once their children have to wipe their butts, that's the end. When that dignity is gone, no one wants to live.''

As she slowly regained her strength that fall, Janet decided that when the time came, she would die with Kevorkian's help.

She had never asked him, but knew she could count on him. Death with Kevorkian would be the ultimate political statement, an activist's dream, a death for the cause.

She later reconsidered.

On Dec. 19, her husband, Ray Good, had a heart attack and required triple-bypass heart surgery. Janet was sure the heart attack came from worrying about her.

Ray returned home Christmas Eve. That was the worst night of their lives. Donna Unger, the middle of their three children, had planned a party at her home. Believing this would be the family's last Christmas together, she had spent months making a video of Ray and Janet's life together. They had been together since Ray was 15, Janet 12, when they rode bikes on Detroit's east side. Christmas Day would be their 54th wedding anniversary.

As she was wrapping presents that night, Donna Unger keeled over dead from a heart attack at age 51. Janet believed the stress of her own illness contributed to her daughter's death.

Janet began to question the idea of killing herself with Kevorkian. How could she put her family through more upheaval? Wouldn't it be better to die privately at home?

But fighting for assisted suicide had become the most important issue in her life.

SINCE THE 1976 New Jersey Supreme Court allowed Karen Ann Quinlan's family to remove her ventilator, refusing and withdrawing medical treatment have become routine.

Turning off a machine is considered a passive action - without it the patient would die anyway. But going the next step to active intervention - having a doctor prescribe a lethal dose or help with an injection - is a crime in 44 states.

This year, however, two federal appeals courts - the Ninth Circuit in California, and the Second Circuit in New York - ruled that terminally ill Americans have a constitutional right to end their lives with a doctor's help.

The California court said that Americans have a constitutional right to make sound medical decisions, which include removal of a feeding tube. A dying person's decision to have a doctor hasten his death is just an extension of that right.

``We see no ethical or constitutionally cognizable difference between a doctor's pulling the plug on a respirator and his prescribing drugs which will permit a terminally ill patient to end his own life,'' the court wrote.

The New York court cited a different reason: You can't give people on life support the option to end their lives, by removing machines, and not give the same option to terminally ill people who are not on machines.

Supporters rejoiced. Critics attacked.

``No court decision can deny what is fundamentally and naturally true: that assisting in suicide is nothing less than taking another person's life,'' Cardinal Anthony J. Bevilacqua said. ``I ask all people of good will to join me in praying that our society will soon return to support for life and turn away from the culture of death.''

The Supreme Court last month agreed to hear appeals of those two cases, and its ruling by June could generate as much controversy as the 1973 Roe v. Wade decision on abortion.

ON MAY 6, A GORGEOUS Michigan morning, Janet Good got dressed up in her pink sweat suit - the one with little bunnies pushing a baby carriage on the front - and sat in the front row of a Pontiac courtroom.

She attended every one of Kevorkian's trials, always sitting in the front row.

This was Kevorkian's third trial, this time for helping Marjorie Wantz and Sherry Miller kill themselves in 1991. He was particularly brazen, buoyant, indignant that day in court.

Referring to Wantz, Kevorkian's lawyer, Geoffrey Fieger asked:

``Doesn't society have a right to make her suffer?''

In practice, yes, Kevorkian replied. In theory, no.

``Do we control our bodies?''

Not in our society.

Why do you help the patients?

I empathize with patients. I want a physician who says, ``I'll help you.'' That's the kind of doctor I want. That's the kind of doctor I want to be. A physician should do all he can to preserve the health and life of a patient, within bounds of patient autonomy. That's one duty. The other part is to arrest and alleviate suffering.

Why should a physician help people leave this world?

That is part of the duty of reducing suffering.

Isn't it the job of the medical profession to keep her alive even though it's against her will?

No.

Doesn't she have a right to say enough?

That is autonomy, Kevorkian said.

During the lunch break, in the courtroom cafeteria, a class of eighth graders mobbed him, asking for his autograph.

``If you had stomach cancer,'' said one girl, ``you'd think he was a hero, too.''

AFTER SPENDING THE DAY at Kevorkian's trial, Janet Good held a special event at her house that evening.

A suicide.

Austin Bastable, 53, who lived across the Detroit River in Windsor, Ontario, had suffered from multiple sclerosis for 26 years. His wife and children washed him, dressed him, fed him. He tried to kill himself in 1994, but his wife found him and called for an ambulance.

For years he pushed unsuccessfully for legal suicide in Canada. Bastable's Web page on the Internet - part of a site known as DeathNET - featured video pictures of himself and music from John Lennon's 1971 song ``Imagine.''

Bastable communicated via e-mail - pecking out letters with his left hand. His last entry was dated May 1, the eve of a television interview. ``If they don't know how tedious my days are,'' he wrote, ``they soon will. I guess they'll cut out the graphic bits - like my getting an enema while bent over the bathtub.''

A day later, a man named Paul Flynn e-mailed a response: ``I have MS. I do not want to die. For God's sake, stand up like a man, and stop pretending that quitting is brave. I think you are either a coward or a dramatist, probably the latter.''

Through e-mail, Bastable contacted Janet Good and made a date with Kevorkian. Janet had agreed with Kevorkian's request to have the suicide at her home. Ray Good had changed his mind.

After six years of his wife's working with Kevorkian, after six years of hearing her talk with those suffering people on the phone, after getting to know Austin Bastable and his wife personally, after realizing his own wife might soon be in similar agony, Ray Good not only agreed to let Bastable die in his family room, but also built a wheelchair ramp so Bastable could get from the driveway into the house.

When Janet returned from court that evening, Bastable and his wife, Nina, were there. Kevorkian arrived around 8.

Bastable was having trouble swallowing and knew that a feeding tube was next. He had left instructions with the funeral director: ``Put a big smile on my face.''

As Janet described the scene, everybody assembled in the family room. Bastable sat in his wheelchair, beneath a print of Shakespeare's home, Stratford-upon-Avon, and near a shelf of Reader's Digest condensed novels.

As Kevorkian and other doctors he had invited repeatedly asked if he understood what he was about to do, Bastable blurted: ``Let's get the show on the road.''

Ray Good shook his hand and said a cop's farewell: ``Good-bye. Nice knowing ya.'' Then he left the room. Janet and her daughter, Marjorie, stayed, with everyone else.

Someone slipped a mask over Bastable's mouth and nose, and Bastable turned a metal knob releasing deadly carbon monoxide gas. He also pulled a string, allowing an injection of barbiturates and deadly drugs to flow into his veins, Marjorie recalled.

Janet watched as his eyes closed, his breathing slowed, and he died.

Even though this fate could soon be her own, she thought only of the death she had witnessed.

``It was so peaceful, so beautiful,'' Janet said. ``I felt so relieved for him. His suffering was over.''

JANET GOOD WAS HAVING a conversation in her living room one June afternoon when the phone rang.

She wasn't going to answer it, but the caller identification box flashed her doctor's number.

``Oh, hi,'' she said sweetly. ``. . . Oh yes! OK. OK. Great. Wonderful. I'll probably come by today or tomorrow.'' She smiled and hung up.

``He prescribed me the pills I want - with refills!''

She could now get enough pills to kill herself and avoid embarrassment. How would it look if Kevorkian's chief lieutenant couldn't get enough drugs to end her own life? She had given too many pills away, helped too many others, and hadn't saved enough for herself.

Janet was so excited she asked her daughter to videotape her picking the drugs up at the pharmacy.

Now she had control. She could take her life when she wanted.

She had chronic pain, like a dripping faucet. Her abdomen was bloated. She popped an occasional pain pill, but tried to limit them. They made her foggy, and there was so much to do.

After being acquitted for the third time in May, a week after Bastable's death, Kevorkian and Janet had become busier than ever. In one 10-day stretch, they helped three people die.

ON DAYS WHEN SHE WASN'T helping Kevorkian, Janet and Ray often went gambling. She loved the slots.

On the drive over to Windsor one day in July, Janet revealed something quite surprising. She was embarrassed to still be alive.

People had made so much fuss. They'd waited so long - it had been nearly a year since her surgery. Yet here she was, not only gambling, but winning!

``People think I'm a fraud,'' she said. ``Sometimes I feel I should get on with it already.''

Inside the casino, Janet relaxed, laughed. She dropped three coins at a time into the slot machines and hit the button. Cherries. Cherries. Come on, cherries! She was playing with the casino's money. She'd won $900 in the last few weeks.

Suddenly, whistles and sirens. Ka-ching, ka-ching, ka-ching! A bar and two wild cherries - 480 quarters fell into her happy hands.

Time for lunch.

In the cafeteria, she talked openly about how she might die. She put down her slice of pizza and picked up a spoon. She started mashing imaginary pills in an imaginary bowl.

``This is how you do it,'' she said. ``You mash up a whole bunch - I don't want to tell you, but it would depend on your size - you mash them into a powder.

``First you have to eat a late meal, about an hour before. Then you take some seasickness medicine, Dramamine, about half an hour before. This will help you keep it all down. Then you mix the pills with some pudding or applesauce, you need something the right consistency. Then you gulp it down real fast. You want to get it all in before you start to get drowsy or fall asleep.

``Then that's it. You've done it.''

She said her husband wanted her to die in bed next to him. Her daughter, Marjorie, also wanted to be with her when she died, but Janet worried that it could be traumatic for her.

After revealing all that, Janet returned to the slots.

Ka-ching. Ka-ching. Ka-ching.

Around 3 p.m., she cashed out, down $31.

Back home an hour later, Janet checked her phone messages and mail.

``Hello, Janet, my name is Diane . . . I'm calling for help with an assisted suicide. Please call me back.''

The voice was tragic, pathetic, desperate.

On the table was an overnight-delivery package. Janet ripped it open. Inside were medical records and a handwritten note:

``Dear Janet Good, My mother suffers horribly from ALS. She fears going into a nursing home worse than death itself. She is in such misery. Please help us contact Dr. Kevorkian.''

``Oh, God, we're so busy,'' Janet said. ``I don't know where we could even fit her in. . . . Why can't there be a Dr. Kevorkian in every state?''

ON SEPT. 6, JANET MET Kevorkian at the Quality Inn in the Detroit suburb of Bloomfield Township. Janet described what happened next.

Isabel Correa, 60, and her husband, Trino Soto, had flown in from Fresno, Calif., and were waiting in a first-floor room.

Correa suffered from debilitating nerve disease and spinal-cord tumors. Three months earlier, unable to lift her head, she had undergone surgery to fuse a piece of hip bone into her neck. After that, she decided, no more suffering.

Janet parked her Cadillac on the wrong side of the motel. She walked around and checked on Correa. Janet was the advance team. Her job was to say hello and see that everything was fine.

As she approached the room, Janet noticed several people standing around. She saw a man climb down from the cab of an 18-wheeler. Dressed in a suit, he didn't look like a truck driver.

Were these cops? she wondered. Or crazies? She had read about abortion doctors being shot and killed. How did they know she and Jack would be there? Were her phones tapped?

She went into Correa's room and told her they might not be able to help her die today. The woman, sitting in her wheelchair, sobbed.

``Please don't abandon me,'' she pleaded. ``Please don't. Is the doctor here?''

Janet told her Kevorkian was waiting in his car.

He arrived a few minutes later with his suicide machine and his video camera. He decided to postpone the suicide, but videotaped her plea. He always records his patients on tape before he helps them die, to avoid doubt about his role and their desire.

He had just unzipped the camcorder case, when someone knocked.

``Room service.''

``I don't want room service,'' Correa's husband said.

``You want this room service,'' the voice repeated.

``Oh, no, I don't.''

Then another voice: ``Jack, we saw you go in there. Open up.''

Kevorkian let in the police.

No one was arrested, but the police confiscated Kevorkian's video camera and tapes he had made of earlier suicides - including one the authorities didn't know about. Janet got home around midnight.

The next day, in another suburban motel room, Kevorkian and Janet Good helped Isabel Correa die.

MANY OF THE NATION'S leading advocates for improving the care of dying people oppose suicide.

They say suicide is a misguided reaction to a medical system that has abandoned dying patients.

``It's a well-documented fact that those asking for assisted suicide almost always change their mind once we have their pain under control,'' said Kathleen Foley, a pain specialist at Memorial Sloan Kettering Cancer Center in New York and director of the Project on Death in America, an effort to improve care for the dying.

``It is not people in pain but those anticipating pain who most often request physician-assisted suicide,'' she told an interviewer last summer. ``A patient with the support of family and friends, a sense of the transcendent - however defined - and a doctor who makes it clear the patient will not be abandoned is not going to ask to have life ended.''

Janet Good contends that suicide must be legalized and medical standards established, precisely to protect people.

``Physician-assisted suicide happens every single day in homes and hospitals across America,'' she said. ``And it is not regulated. There is so much room for abuse. People are begging for laws, begging for regulation. The public wants it. Dr. Kevorkian wants it. If we could get this regulated, he would stop.''

Critics say doctors have never had the right to take a life, and that giving them such power is dangerous.

``If it came to pass that it was legalized, fine,'' said Carlos Gomez, a University of Virginia physician who opposes suicide and has testified against Kevorkian. ``Find your willing executioners. It's not hard. You can kill in a variety of fashions. We know what drugs to use. Train a group of people, and do it. If it comes to pass, the medical profession should stay as far away from it as possible.''

The Clinton administration, through the Justice Department, filed a brief last week with the Supreme Court opposing assisted suicide.

University of Michigan law professor Yale Kamisar, who has known Janet Good for 20 years and studied suicide laws nearly twice that long, strongly opposes the Supreme Court's legalizing assisted suicide.

``We have to take a stand now,'' Kamisar said. Once the court establishes that terminally ill people have the right, he said, there will no longer be a legal distinction between withdrawing life support and actively causing death.

Then, he predicts, ``there will be 100 lawsuits with people saying, `I have bad burns,' `I have a stroke,' and the courts will decide disease by disease, illness by illness, when suicide is permissible and when it isn't. The court will have to balance your interest in ending your life against society's interest in preventing free suicide.''

``Pain is subjective, suffering is subjective,'' he said. ``Where is the thing going to end?''

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, says the issue should be left to state legislatures.

``If we see courts trying to carve this out, then we're just lining ourselves up for a reenactment of the abortion debate,'' he said, ``a horrible way to go.'' Caplan is convinced that several states will eventually legalize suicide.

``We're headed inevitably toward legalization,'' he said. ``I've never doubted it for an instant. A society as obsessed with autonomy and self-determination as we are, as cuckoo over liberty, as fearful as we are of being dependent when we die, as worried as we are about the high cost of dying, and . . . [with] the low status assigned to the elderly in the culture, it doesn't take a sociological genius to predict a movement toward legalization.''

And if America legalizes assisted suicide before providing affordable long-term care, Capplan said, old people will feel a responsibility to die, ``to end their lives rather than tax the system.''

EPILOGUE: Last week, police fingerprinted Janet and took her mug shot. She was indicted on four felony counts for helping with an Aug. 30 suicide - the suicide police learned about when they seized Kevorkian's videotapes at the Quality Inn.

The judge said he would dismiss the charges against Janet if she proved to him she was terminally ill. Janet has no such intention. She wants no special treatment.

Though she is in constant pain and knocks herself out with narcotics each night, she also doesn't expect to die anytime soon.

Janet still has not decided how she will die - with Kevorkian or without him.

Maybe she will just die in her sleep. She says she wouldn't mind that at all.

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