Jack-In-The-TV-Box

Jared Keller at The Atlantic with the round-up. Keller:

HBO’s You Don’t Know Jack, the biopic of right-to-die activist Jack Kevorkian, hit the airwaves this weekend, stirring memories of the 1990s assisted-suicide debate that landed the Michigan physician in prison. With the venerable Al Pacino playing the eccentric doctor, critics expected a delicate take on a topic that–with the exception of “death panel” fears–has stayed low in the American subconscious since Kevorkian’s 1999 incarceration. Pacino’s portrayal of “Dr. Death” has indeed won praise, while the film’s portrayal of the embattled physician and right-to-die debate has evoked mixed reactions.

John Hanlon at Big Hollywood:

Al Pacino stars as Dr. Kevorkian and he gives a fine performance. I had expected the movie to paint Kevorkian in a positive light and I was pleasantly surprised that the movie does not portray him as a sensitive and flawless doctor trying to do the right thing for his patients. In this movie, Kevorkian is seen as a strange and self-centered individual who enjoys being in the spotlight and courting controversy. He is very unlikable and can be cruel to his patients (which can be seen in a dramatic scene of a suicide attempt that goes wrong).

On the other hand, Dr. Kevorkian’s legal opposition is not seen in a positive or appealing light either. Throughout the movie, one politician is seen as continuously attacking Kevorkian and bringing court cases against him. That politician is simply seen as a man with a vendetta trying to stop Kevorkian no matter what. We see him attacking Kevorkian without really understanding why he is so personally passionate about stopping the doctor.

In terms of the patients seen in the movie, it is hard not to empathize with them. They often speak about the pain and suffering they are facing and their deaths are often difficult to watch. Whereas Kevorkian is depicted in a harsh light, his practices of helping patients kill themselves are often seen more positively. Unfortunately, the movie does not feature much of a discussion or debate about the issues involving end of life care and the practices that Kevorkian became famous for supporting.

The biggest disappointment that I had with the film it that it does not provide insight into the main characters, including Kevorkian. The audience understands what Kevorkian actually did but there is little discussion about why he became so passionate about helping people end their lives. The audience does not get to understand who Dr. Jack Kevorkian really is and what he stands for, outside of his obvious belief that doctors should be able to help some patients kill themselves. Reading newspapers or books about Kevorkian could probably enlighten you as to what Kevorkian did that made him so controversial but I hoped that this movie would add more depth to the man and that it would contain more of a discussion and debate about the methods that Kevorkian used.

Rita Marker at First  Things:

I first met Jack via telephone in 1989 when we debated on a Cincinnati radio program. At that time he was searching for someone on whom he could test what he then called his “self-execution machine.” The ideal candidate, he explained, could be someone with multiple sclerosis, severe arthritis, or a terminal illness. It wasn’t until after his first victim died that he began to use more media-friendly labels for his gadget, like “mercitron” or “mercy machine.”

The media portrayed him as a retired pathologist. But Jack wasn’t retired, he was unemployed. With the exception of his residency and his military service in the 1950s, he had no clinical experience with live patients. He was even turned down for a job as a paramedic in 1989.

He did write many papers, though, trying to establish a new specialty called “obitiatry,” with his ultimate aim being an “auction market” using organs taken from “subjects” who were “hopelessly crippled by arthritis or malformations.” What a guy.

As for compassion, decide for yourself. In 1986, he described experimentation in which “subjects,” including infants, children and the mentally incompetent, would be used for experiments “of any kind or complexity.” Then, if the subject’s body was still alive after experimentation, “death may be induced” by such means as “removal of organs for transplantation” or “a lethal dose of a new or untested drug to be administered by an official executioner.” Four years later, he penned a statement explaining that the “voluntary self-elimination of individual and mortally diseased or crippled lives taken collectively can only enhance the preservation of public health and welfare.”

Yet, public perception of Kevorkian as a kindly doctor who eased the suffering of terminally ill patients remains. This, despite the fact that many among his 130 known victims were not “terminally ill.” In fact, autopsies found that some had no serious physical maladies at all.

Heather Havrilesky in Salon:

Along with the pleasure of watching Pacino flesh out this strange, stubborn man, bickering amiably with his friends in a scratchy Midwestern accent at poker night or matter-of-factly interviewing patients about why they want to end their lives, HBO’s biopic demonstrates beautifully how the profile of a strange controversial figure like Kevorkian can be transformed into a moving, eye-opening story. Like Kevorkian himself, this film isn’t a splashy attention seeker, but its charms are apparent within the first few minutes, from Jack’s rambling, off-topic conversations with his friend Neal Nicol (John Goodman) to his humble little apartment, with its odd ambient light and framed photographs. Instead of glamorizing Kevorkian or making him appear more heroic or more suave than he is, the filmmakers embrace the down-to-earth nature of his life and his choices. Each scene, each shot reflects this perspective: the wide angle of Kevorkian crouched under his VW van, working on it, as activist Janet Good (Susan Sarandon) approaches to tell him she’s sorry she couldn’t help him with his first patient; the off-kilter banter with his sister Margo (Brenda Vaccaro) that always skitters around the darkness of what Kevorkian is taking on.

Most important, “You Don’t Know Jack” presents what many of us missed back when Kevorkian’s face was on all the magazine covers, navigating the kind of media storm that can make even the most unassuming idealist look like a grandstanding opportunist. Despite the grim nickname “Doctor Death,” despite the disturbing nature of what he did, rigging up tubes or gas masks to help terminally ill patients die, Kevorkian’s aims were anything but morbid. After watching helplessly as his mother died slowly in the hospital, lingering on, in pain, unable to speak, he decided to challenge the accepted approach to death in this country, an approach that he saw as inhumane at best, downright savage at worst.

Death doesn’t have to unfold the way we assume it does, Kevorkian argued. No one should necessarily have to accept years of suffering through whatever extended nightmare awaits them, in the hospital, in hospice, in the nursing home. Death isn’t some frightening, terrible thing. Just because we spend most of our lives trying to avoid its very existence, just because it’s depicted in books and movies and works of art as some shadowy, mysterious, dramatic presence, that doesn’t mean we’re utterly powerless in the face of it. As taboo as it is to look at it directly or to dictate its terms, death can simply be a choice to stop living.

Kevorkian himself didn’t always make the most rational choices. After helping 130 terminal patients end their own lives, Kevorkian had the audacity to show footage of himself administering a lethal injection to an ALS patient on “60 Minutes,” after which he openly dared authorities to do something about it. He then represented himself in his murder trial — stubborn idealists as passionate as Kevorkian aren’t always so open to advice in these matters — and subsequently spent eight years of his life in jail. Even as we witness Kevorkian skidding off the tracks, as his friends and former lawyer look on, cringing, it’s hard not to admire his tenacious adherence to his own principles. He didn’t want to help people behind closed doors, he wanted to change the laws of the land. He accepted his fate with an understated shrug. In his mind, he really had no choice. “When a law is deemed immoral by you,” he tells anyone who’ll listen, “you must disobey it.”

The film conjures a complicated picture of Kevorkian. But even with such witty, touching dialogue and such a moving performance by Pacino, what we remember most clearly at the end of this film are Kevorkian’s patients. These people didn’t see Kevorkian as “Doctor Death,” they saw him as an angel, one who might finally deliver them from their suffering.

Peter Hall at Cinematical:

There are a few moments where the tone of the film threatens to become a tad too overbearing. It’s difficult to watch what are essentially re-enactments of Kevorkian’s recorded sessions with his patients, but that’s to be expected. It would be disingenuous to shirk the real world implications of the troubling subject matter in favor of a less depressing film experience, so it’s hardly a complaint that a film about an inherently sad issue is, well, often quite sad. Levinson and company do their best, however, to inject appropriate levels of levity at regular intervals to shield You Don’t Know Jack from becoming the joyless film it may have been in less balanced hands; or, inversely, the dark comedy it could have been in another’s.

Instead You Don’t Know Jack does an admirable job of walking strictly in Kevorkian’s strange but fascinating shoes. Unsurprisingly, by film’s end the audience should, if nothing else, feel that they know far more about the mindset and motivations of the doctor than they’ve been given from superficial media reports that opt for cheap nicknames like “Dr. Death” over even attempting to paint a compelling portrait of the man behind the name.

Shuffling Off This Mortal Coil

Emily Nash in the Mirror:

The musician, who had been blind for 15 years and was becoming increasingly deaf, realised his existence would be unbearable without his steadfast partner of over 50 years.

So Sir Edward, 85, and wife Joan, 74, decided to go to a Swiss assisted-suicide clinic where they could die “peacefully” together.

Son Caractacus, 41, and daughter Boudicca, 39, were with them. He said: “They drank a small quantity of clear liquid and then lay down on the beds next to each other. They wanted to be next to each other when they died. They held hands across the beds. Within a couple of minutes, they were asleep and they died within 10 minutes.”

In a statement, the brother and sister added: “After 54 happy years they decided to end their lives rather than continue to struggle with serious health problems.

Tom Sutcliffe in the Independent

Alexander Chancellor in the Guardian

Rod Dreher:

What true thing can possibly be said about a culture that exalts ordered, ritualized and hygienic self-murder — especially of the non-diseased — as an act of valorous liberty, except that such a culture is in terminal decline? We recoil in horror from Islamic suicide bombers, as we certainly ought, but at least those malicious ghouls are killing themselves, and, in the case of their Islamist death-cult societies, honoring self-murder, in the service of some higher ideal. What’s our excuse? What’s our higher ideal justifying this obscene defilement of humanity, of the human person, of human solidarity, and ultimately of the image of God within us all? Autonomy? Comfort? We begin by murdering God, we end by murdering ourselves.

John Derbyshire at Secular Right:

I have never been very clear about the religious objections to suicide and assisted suicide.   The only time I tackled a religious colleague about it he launched into a “slippery slope” argument.   Well, I suppose some slopes are slippery, and some aren’t. I can’t see this one as being particularly slippery.   In any case, slippery-slope is not a religious argument.   What is the religious argument?  Are there any secular ones, other than the slippery slope?

Erin Manning:

And if you are not a believer, if you see man as nothing more than an accumulation of carbon who is every moment gathering pain as he heads inexorably toward oblivion, then the lack of outcry at the news of someone’s act of euthanasia probably pleases you. I can understand that–but what I can’t understand are those who wish to reconcile euthanasia with faith, particularly Christian faith. So far, Christians who openly support physician assisted suicide or other forms of euthanasia remain in the minority, but there are some who advance the argument that euthanasia is compatible with Christianity–and there are others who have adopted a “personally opposed, but…” line of argument which promises to do as much to prevent euthanasia as that argument did to reduce abortion.

Andrew Stuttaford, here and here:

John, when it comes to something that is quite literally a matter of life and death, I think that the slippery slope argument has rather more force than is usually the case – any changes to the existing legislation would need to be drawn up very carefully indeed. The concern that people might be bullied into ‘choosing’ death is legitimate, as is the fear that medical staff might be compelled to assist in a procedure that they believe to be akin to murder.

That said, if we disregard the religious objections (and we should), the argument for change in at least one instance-that of the physically incapacitated individual who wishes to end it all but is unable to do so-appears to me to be irresistible. I’m not so worried about the able-bodied: they can almost always make their own arrangements, but the plight of, say, the paralyzed man who is desperate to die but has no realistic way of achieving that objective for himself, is truly hideous – and so are the laws that stand in his way. They should be changed.

UPDATE: A series of blog posts at Double X, including Nina Shen Rastogi, Kerry Howley, Hanna Rosin, Bonnie Goldstein and Amy Bloom

Samantha Henig at Slate

UPDATE #2: Chris Dierkes at The League

Will Wilson at PomoCon

First We Kill The Boomers, Then We Take Berlin

Health care and the end of life issues… thorny topic. Julian Sanchez rounded up most of this already. Let’s start off with Mickey Kaus talking about Ezra Klein, the young wanting health reform and how that relates to the Baby Boom:

As a Boomer, I must say I find it hard to believe we will stand for it–aren’t we the vainest generation in history that wants to live forever, etc.? Don’t we want the full might of the American medical-industrial complex dedicated to devising expensive breakthrough treatments that will prolong the lives of our friends and us? I know I do. It’s easy for Klein to want “rational” budgetary cost controls imposed to limit end-of-life care. He’s 17.

Kaus returns to the subject:

Reader D emails:

When I worked in the healthcare industry several years ago there was a study that found a large percentage of Medicare costs were incurred in the last six months of life.  This is not about whether you get your hip replaced or your cataracts removed.  It is more about heroic efforts to keep you alive.  I’m a baby boomer also.  So I want the healthcare available but I don’t want to languish in an ICU on a ventilator with IV drips with no hope!My answer:  Fair enough. But I want to make the decision to cut off treatment, not have it made by a cost-watching health board. Choice! The resonance with the abortion debate seems obvious. … Both are life/death decisions. Are they both best handled by individuals and their families in consultation with their doctors? You’d think the case for “choice” at the end of life might be stronger, since the life at stake is likely to be able to participate in making that choice. …

He also links to Michael Barone

Third, the segment of the electorate that did most to produce the Obama victory and give the Democrats large majorities in Congress is the least concerned and least informed about health care. That segment is the 18 percent of voters under 30. Young voters preferred Obama to John McCain by a 66 percent to 32 percent margin, according to the exit poll. Voters 30 and over preferred Obama by only a 50 percent to 49 percent margin. Some 63 percent of the young voted Democratic for the House of Representatives. Only 51 percent of the rest of Americans did so. Without the young, the votes would clearly not be there for what the Democrats are trying to force through.

But what do the young know or care about health insurance? They have the fewest medical problems of the whole population. Their image of health care, at least until they become pregnant and have babies, is university health services. You come in if you feel like it, someone else pays, you get some pills or some counseling, or whatever. As for the downside of government insurance, pollster Scott Rasmussen reports that the young favor capitalism over socialism by only a 37 percent to 33 percent margin. The rest of us prefer capitalism by a 57 percent to 17 percent margin.

But while young voters may be open to government health insurance, they surely don’t care very much about the issue. Voters with experience dealing with doctors and insurance companies care more. Democrats hope they can assemble the votes and finagle the financing before anyone much notices. Those who oppose them have some material to work with.

Ann Althouse responds to Kaus:

Now, as you may know, the Supreme Court denied the existence of a federal constitutional right to physician-assisted suicide, but the opinion (by Chief Justice Rehnquist) shows deep concern for the interests of the individual who might suffer from untreated depression or who might be vulnerable to “abuse, neglect, and mistakes.” The Court worried that family and medical personnel might subtly pressure someone to choose death to save money, and that, even uncoerced, some people might think it is the decent, honorable choice to spare their families the cost of medical care.

But all of that supports Kaus’s point. It’s one thing to deny the choice to die, quite another to deny the choice to live. The individual may not have a right to get killed, because the state’s interest in protecting people from coercion and abuse is a good one. But Kaus is concerned about a government that wants you dead — perhaps not by actively offing you, but by maintaining full control over the medical treatments you need in order to fend off death.

Julian Sanchez:

In the real world, the decision to do throw the kitchen sink at every ailment is either funded by the government, or by private insurance. A fair amount of the time, it will be made not by the actual patient, but by family members for whom “do whatever it takes” is a low-cost salve for the guilt of never actually visiting grandma at the home. The insurers are substantially constrained in the range of treatments they need to cover, which gives doctors little enough incentive to control costs or limit tests or treatments themselves. (My impression is that this is partly a function of an increase in the increasingly cozy relationships between referring doctors and testing facilities.) These “choices” are not free. They are not a noble reflection of the infinite preciousness of life. These socialized costs—and they’re effectively “socialized” whether it’s the government or private insurers picking up the tab—raise premium costs, make it more expensive to employ people, push some people out of coverage entirely, and otherwise divert scarce resources from things that might actually help somebody.  The notion that this perverse result is somehow required by “medical ethics” is simply grotesque.

This is pretty clearly unsustainable. The more medical technology advances, the greater the number of expensive longshots, the more hours and minutes we can lease back from oblivion at ever greater cost. Over the long term, we can decide that any probability of any added increment of lifespan for people in medical care trumps evey other possible private and public good, or we can ration. That rationing can be by individuals weighing the costs and benefits relative to their resources, or it can be by governments—whether directly or by regulation of insurers and providers. Between those options, I’ll leave it to the wonks.  But please, if you’re going to claim an unlimited right to make other people subsidize the understandable impulse for denial and wishful thinking, at least let’s not pretend that it’s somehow a matter of protecting “individual choice.”