Abstract
You Don’t Know Jack is a documentary on the life and career of Dr. Jack Kevorkian, a pathologist from Pontiac, Michigan. A staunch proponent and practitioner of physician assisted suicide, he facilitated the deaths of 130 people between 1990 and 1998 before being imprisoned on a charge of second-degree murder in 1999.
The movie begins with a TV broadcast on the story of David Rivlin, a man who suffered a body surfing accident that left him quadriplegic with a paralyzed diaphragm, restricting him to a ventilator for life. We meet him in the process of suing the state of Michigan for his right to commit suicide. The next shot is a quick cut to Dr. Kevorkian and his sister sitting in front of their TV watching this broadcast, appalled by the state’s treatment of this man, exclaiming “He’s suffering not living, just like Ma!” The film doesn’t delve much further into the specifics of their mother’s death, but it certainly alludes to her suffering as the source of his interest in physician assisted suicide. Inspired by Mr. Rivlin’s situation, Kevorkian and his former laboratory assistant set out to build a “mercitron,” which would allow Rivlin to self-administer a combination of sodium thiopental and potassium chloride to end his life. The final product looks like something from a middle school science fair. Kevorkian then reaches out to offer the use of this device to Rivlin, but shortly after beginning his presentation, Mr. Rivlin becomes agitated, and his medical team removes Kevorkian from the room.
Mr. Rivlin is ultimately granted his wish to end his life, and he is sedated before being removed from his ventilator. Kevorkian sees this on the news and exclaims that this is “cruel and unusual” and that his method of lethal injection is far more humane. This stokes Kevorkian’s enthusiasm and propels him to travel far and wide, offering his services to as many patients as he can in a series of emotional conversations with patients and their families. Stories of extended suffering and a “will for it to end quickly” abound, and Kevorkian was all too happy to oblige these patients.
In some rare instances, he shows restraint. He declines service to a young man with severe untreated depression and a woman who recently received a diagnosis of Parkinson’s disease. To them he says, “it’s not your time.” During an interview, he remarks that he turns away 98% of people who call him for help and that his “procedure” should only be offered after a “second, third, and fourth” opinion from other physicians. However, at no point in the movie does Kevorkian speak with any other doctor. In fact, the only doctors in the movie display silent disdain and nothing more. Most opposition comes in the form of murder charges and lawsuits from the Oakland County Prosecutor Richard Thompson and protests at his home from an unnamed but enthusiastic religious group.
Despite the media circus and being sued on three separate occasions, he manages to remain a free man until, like Icarus flying too close to the sun, he pushes the limits of the law, sharing a video on 60 minutes in which he administers lethal medications to a young man with ALS. For this, he is charged with second degree murde r. In previous trials, Kevorkian won with the argument that the lethal medication was self-administered; however, this defense would no longer stand in this case. As a further display of hubris, he decides to abandon his legal counsel and represent himself in court for a second-degree murder charge. Despite emotional testimony from the brother and widow of his patient, Kevorkian loses a lopsided legal battle and is sentenced to 10–25 years in prison.
Over the course of the film, Kevorkian’s image shifts from that of a doctor with a personal history of loss—and an axe to grind with current medical practice—to a man whose ego knows no bounds. This is best encapsulated when, in response to questioning on his authority to assist with suicide, Kevorkian responds that, “All physicians act like God,” because our interventions change the natural course of events. Kevorkian did this alone and outside of legal and medical systems. However, this statement caused me to reflect on how medicine has changed my perspective on “the natural course of events” and death.
Over the course of medical school, my ideas about death have changed significantly. Before, my concept was very black and white. You are either dead or alive. Then, I had my first experience in the trauma slot. As a second-year student, I stood to the side of the room as a stretcher burst through the doors, and a man received round after round of CPR as a flurry of movement surrounded him. Eventually, the resident running the operation announced “Stop, time of death xx:xx.” Before my eyes, death had transformed from a singular end point to a process that could seemingly be concluded at anytime.
During my month-long rotation on palliative care, the process of dying has become more familiar than I had thought possible. DNR orders, stopping the escalation of treatment, and, in some cases, withdrawing life-sustaining treatments were all different ways we collectively determined how that process should play out. I had never thought death could be subject to so much choice. It’s struck me how much variability there has been in my patients regarding this choice. Some want every procedure possible done, while others prioritize time outside of the hospital and at home. Regardless of the actual decision, reaching a choice that aligns with the values of the patient was the hallmark of a successful consult.
You Don’t Know Jack portrayed the distress caused by a lack of choice in people facing critical illness incredibly well. The desperation caused by this distress led many people to enlist Dr. Kevorkian, who offered a choice when no other could be found. His methods and ego put him well outside of the law, but the movie highlights the importance of autonomy and choice in the process of dying.