BOSTON -- On June 4 Janet Adkins, a woman in fear of losing her mind to Alzheimer's disease, traveled to Michigan for a back-alley suicide. The doctor who she found to expedite her wish was Jack Kevorkian, an M.D. and a maverick, that word we use to describe both crusaders and loose cannons.
Kevorkian drove his vehicle, his suicide-mobile, his welcome-to-death wagon, to a park in Oakland County, north of Detroit. There, in the back of a van, the doctor hooked up his patient to a machine. After saying thank you, we are told, Janet Adkins, 54, lover of music and mountain climbing, pushed a button that released a lethal drug into her body.
In the days since that fateful, fatal encounter, Mrs. Adkins has been eulogized by her minister as ''a pioneer in the battle for death with dignity.'' Kevorkian has been both lionized and vilified as he makes his way through the headlines and the talk shows, daring the authorities to turn the maverick into a martyr: ''If it's legal, let me do it. If it's illegal, stop me.''
And in these same days, questions of life and death -- what kind of life? what kind of death? -- have been raised in the public consciousness with a new scenario attached to them.
In some ways, Kevorkian is too easy a target for this discussion. With a ghoulish passion, the retired pathologist and self-described ''obitiatrist'' or death doctor, has advocated everything from experimentation on death-row inmates to a chain of nonprofit suicide clinics. ''My motto is,'' he says, ''A rational policy of planned death.''
From all accounts, Kevorkian was in no position to judge Mrs. Adkin's illness, the extent of her depression, or to offer counseling or alternatives. It is impossible to justify The terror of the life-support machine makes the suicide machine attractive.the role played by a stranger/physician -- one eager for a test case -- in providing the weapon for suicide. But in some ways, the attention to Kevorkian's personality begs the central questions about life and death and medicine.
I believe that there is such a thing as rational suicide. If a person is old enough or ill enough. The hard part is defining ''enough.'' When Bruno Bettelheim ended his life some weeks ago, it seemed to me that he deserved moral permission for his act. The stories about Janet Adkins are less clear.
Alzheimer's, diagnosed a year ago, had robbed her of her music and pockets of her memory. By some standards she wasn't far gone enough to give up on life. But it's fair to suggest that it wasn't just her sense of loss but her bleak vision of the future that caused this preemptive strike against the debilitating disease.
Kevorkian says that Mrs. Adkins had asked her doctor what he would recommend for her when she was finally in a vegetative state. The physician, according to Kevorkian, said, ''he would tell her husband to shoot her.'' If that is true, he offered nothing. She could exercise her will now or lose it.
The bleak future Janet Adkins faced is one that other elderly and ill recognize. Most of us have the desire to live as long as our minds are working. But at precisely the moment we might choose to die, we may have lost the capacity to make that choice. How many suicide pacts and acts are based on that fear?
The desire to control death may be a modern conceit, a kind of hubris against nature. But it is one based on modern technology. The terrifying specter of our age is a body attached interminably to a machine. The terrifying specter is a doctor who won't let us die, won't let us decide.
Janet Adkins' death landed in the news just as ethicists and doctors await the Supreme Court decision about Nancy Cruzan, the 32-year-old who has been in a permanent vegetative state for more than seven years. They are waiting to hear if the court will allow a family to remove a feeding tube.
There are some who believe that the slippery slope leads directly from Nancy Cruzan's hospital bed to Kevorkian's death-on-wheels. If we remove a feeding tube, soon we will have the chain of suicide clinics.
But I suspect that just the opposite is true. It is the fear of ending up ''a vegetable'' that drives many to extremes. It's the terror of the life-support machine that makes the suicide machine an attractive alternative.
There may always be rational suicides, always be cases in which a doctor's moral obligation to ease pain and suffering supersedes the demand to prolong life. But if we can be confident of humane treatment, if we can retain a measure of control over our lives even at their end, there will be few suicide-seekers in the back alleys of medicine. And Jack Kevorkian will be remembered as a maverick without a cause.