Dr. Ali Khalili was a 61-year-old man so racked by bone cancer that he needed a cane to walk and a full-time morphine pump to cut the pain.
He was also among Chicago’s most respected physicians, a leader in establishing rehabilitative medicine here, with an international reputation as a researcher and local renown as a doctor dedicated to relieving the worst of human suffering.
So, his decision to commit suicide Monday by inhaling carbon monoxide in the presence of Michigan right-to-die activist Dr. Jack Kevorkian has added a new and troublesome dimension to the debate over physician-assisted suicides.
Khalili is the first doctor to seek Kevorkian’s help, and he did so in what Kevorkian’s attorney says was a deliberate attempt to force the medical profession to address this issue. Why Khalili, who apparently had the knowledge and means to end his life quietly, chose this extraordinarily public act isn’t known. No note or other record of his motives has been released, and friends and colleagues said he never confided such thoughts in them.
But Khalili turned to a man whose methods and motives have been questioned even by those who support the right of terminally ill patients to end their lives. And some medical ethicists wonder how, and if, one can sort out whether Khalili was a doctor making a rational decision to die or an agony-riddled patient just seeking some sort of peace.
“His death points to a fundamental ambiguity on the part of the physician community,” said Laurence O’Connell, president and chief executive officer of the Chicago-based Park Ridge Center for the Study of Health, Faith and Ethics. “By implication, this physician has endorsed this form of physician-assisted suicide. It’s a comment, a substantive comment.”
Khalili, who lived in a large, modern home in Oak Brook, died about 8:30 a.m. in a red brick apartment building behind the police station in the Detroit suburb of Royal Oak. The apartment is leased by Kevorkian, who lives in an apartment next door.
Kevorkian, who is believed to have helped 19 other people die since 1990, was with Khalili when he inhaled carbon monoxide, according to Kevorkian’s attorney Michael Schwartz.
Schwartz declined to say if Kevorkian, 65, assisted Khalili in his suicide. Under a Michigan law that went into effect earlier this year, it is a felony for a doctor to knowingly provide a patient with the means to commit suicide or to physically help him do it. Being present at a suicide is not illegal.
Kevorkian was released on bond from jail just two weeks ago on charges of violating the assisted suicide law in connection with two deaths in neighboring Wayne County. Officials in Oakland County are investigating a third possible charge in the death of a 72-year-old widow who died Oct. 22 after inhaling carbon monoxide in the same apartment as Khalili.
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Police took Kevorkian into custody Monday morning but released him after he refused to answer any questions, said Royal Oak Lt. Don Novak. The case has been turned over to the Oakland County prosecutor’s office.
According to Schwartz, Khalili had been diagnosed with bone cancer in 1990 and had considered suicide then. By the time he contacted Kevorkian several months ago, his condition had worsened to the point that he walked with difficulty and suffered extreme pain from lesions in his bones, the attorney said. He had recently visited a Chicago oncologist, according to Schwartz, and had been taking Nembutal, a tranquilizer.
The two doctors spoke by phone several times before Khalili traveled to Royal Oak on Sunday. He spent the night at a motel before going to Kevorkian’s apartment Monday morning. The attorney refused to say if any of the doctor’s family members were present at the suicide.
This final journey seemed an odd one for a highly respected doctor whom friends described as eternally optimistic despite the debilitating effects of his illness.
A native of Iran with a medical degree from Tehran University, Khalili was an intern at Columbus Hospital on Chicago’s North Side and spent several years working in New York City before moving back to Chicago in 1965.
He joined the staff of the Rehabilitation Institute of Chicago, a nationally prominent 20-story medical facility, which at the time was just a handful of doctors working in a former warehouse at Ohio Street and McClurg Court. “At times, there were just the two of us, and he and I had to see all the patients,” recalled Dr. Henry Betts, the institute’s medical director and chief executive officer.
“He was very, very bright, very creative and very caring. He was very important in the development of the Rehab Institute,” Betts said.
Khalili went to Grant Hospital in Chicago in 1969 as a founding member of its rehabilitation department and guided its expansion from a single room to a floor and a half.
He continued on the faculty of Northwestern University Medical School, which is affiliated with the Rehabilitation Institute, as an associate clinical professor of physical medicine and rehabilitation. He was considered an expert in the field of muscle spasticity and spent much time working with the victims of strokes and cerebral palsy.
“He had a reputation in the medical community as someone who was very, very concerned with suffering and the devastation of disease,” said Ken Vaux, a professor of ethics at the University of Illinois Medical School in Chicago, who did not know Khalili personally.
Khalili’s own suffering forced him to retire from Grant Hospital last year, and he had also given up teaching. Still, in a recent visit to friends at Grant, he was jovial, said Grant cardiologist Sukhjit Gill, a longtime colleague.
“All I can tell you is that Dr. Khalili knew exactly what was going on, he was in complete control up to the end,” Gill said.
Khalili’s decision to take his own life under Kevorkian’s supervision-and what it means to the medical community and the public-has raised concern among medical ethicists.
“Physicians have the same problems dealing with death as everyone else,” said Yeates Conwell, director of the Laboratory of Suicide Studies at the University of Rochester School of Medicine in New York. “The notion that a physician can approach the end of their own lives with a dispassionate view is somewhat romantic.”
Dr. Nancy Dickey, a trustee of the American Medical Association-which has condemned Kevorkian’s philosophy that doctors should assist in suicides-agreed.
“When doctors become ill, they become patients,” said Dickey, a former chair of the AMA’s council on ethical and judicial affairs. “Sometimes, we forget that.”
Still, some feel Khalili’s death is bound to make a thorny issue even thornier.
“This person may have been struggling, not only as a person, but also as a doctor,” O’Connell said. “Can we separate this person in agony from the professional? It is still important to recognize that this person is a physician. Something is being said.”