Jack Kevorkian, the enigmatic pathologist known as "Dr. Death" and "Jack the Dripper," who assisted in more than 130 suicides with his "mercy machine," leaves a legacy of activism and controversy.
The flamboyant doctor died last night at Beaumont Hospital in Royal Oak, Mich., of a pulmonary embolism at the age of 83, according to his lawyer Mayer Morganroth. Kevorkian had been hospitalized for about two weeks for kidney and heart problems. A clot broke free from his left leg and lodged in his heart.
Kevorkian, whose tactics included fasting, appearing at a trial in Puritan-era stocks and protesting in a ball and chain, was at once lambasted and praised for his passionate belief in the right to die.
Today, partially as a result of his efforts, Oregon, Washington and Montana allow terminally ill patients to ask a doctor for a lethal amount of medication after a medical and psychological evaluation, but they have rejected Kevorkian's call for "death on demand."
Those who have pushed for more liberal laws and legislation in other states say there is no single advocate with the same riveting rhetoric who could have the same impact as Kevorkian.
"His shoes will be extremely hard to fill," said Philip Nitschke, founder and director of Exit International, which leads the worldwide right-to-die movement. "He moved the debate forward in ways the rest of us can only imagine.
"He started at a time when it was hardly talked about and got people thinking about the issue," said Nitschke. "He paid one hell of a price, and that is one of the hallmarks of true heroism."
That price was a second-degree murder conviction in 1999. Kevorkian served eight years in prison, but was released early on parole on the condition he would not kill again.
Kevorkian never married and had no children, but his niece, Ava Janus, was with him when died.
"He brought to the fore the idea of personal autonomy," said longtime friend and biographer Neal Nicol, 71. "You have the right to choose how you did, regardless of the law."
Despite that, Kevorkian did not elect to end his own life, according to Nicol, who said doctors used no artificial attempts to keep him alive.
"All his affairs were in order," said Nicol, co-author of "Between the Dying and the Dead," who also assisted him as a technician in the suicides.
The doctor's mantra was "dying is not a crime," and he made national headlines with his invention -- the thanatron, Greek for suicide machine -- which gave patients a "dignified, humane and painless" death.
"The people we were helping, there was never any question in their minds," said Nicol. "None of the patients ever had a wavering moment in their decision."
A pull of the trigger released a drug to induce a deep coma. Once asleep, a timer would inject a lethal dose of potassium chloride to stop the heart.
Later, he used a "mercitron," or mercy machine, after his medical license was revoked after the first two deaths and he could no longer get the substances required for the thanatron.
"There were those in the movement who didn't agree with his methodology," Nicol said. "He was thwarted in that goal at every turn, but he did get the message out.
"He was determined and found it awfully hard to understand why people didn't see things as he did," he said. "Emotional basis and heart strings had no place in the movement."
Nicol said he was with Kevorkian just days before his death, visiting him at the hospital. Despite lung problems, "He was filled with hope," said Nicol. "He believed he was going to recover."
"The last comment I remember him making was that we can look back on our lives and believe we did something noteworthy," he said. "We did some good work."
Last year, Kevorkian was the subject of and HBO film, "You Don't Know Jack," starring Al Pacino, which inflamed critics and advocates alike.
For decades, those in the right-to-die movement have eyed Kevorkian with suspicion and disdain. They say the doctor was "death obsessed," and his bizarre antics set back the cause.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania., said at the time, he feared the film would turn Kevorkian into a "heroic martyr."
Caplan and others who support assisted dying with strict guidelines have said Kevorkian was "cavalier and insensitive" to the dying who turned to him.
Caplan said he once asked Kevorkian if he had been aware that one of his victims had a long history of depression. The doctor reputedly responded, "How am I supposed to know the details of her life?"
They also have said Kevorkian preyed on the mentally ill, who, with further evaluation, could have been helped.
Kevorkian became the face of the assisted suicide movement, which had its roots in the United States in the 1930s and gathered steam in the 1990s.