‘You Don’t Know Jack’ on HBO

“You Don’t Know Jack”

HBO Films (based on a true story)

Premiered 9 p.m. April 24

The premise: Michigan pathologist Jack Kevorkian ( Al Pacino) doesn’t believe that patients with debilitating diseases should be kept alive against their wishes. Calling “self-determination a basic human right,” Kevorkian in 1989 invents a machine that administers salt solution followed by the barbiturate sodium thiopental, then the drug potassium chloride — first putting the patient to sleep, then stopping his or her heart. The machine, triggered by the patient, creates a painless death that is far more humane than the care provided by palliative care doctors to patients at the end of life, Kevorkian believes. He contends such doctors use “Nazi methods” in which they take patients off life support and starve them by withholding nutrition or fluids.

Working with his sister Margo Kevorkian (Brenda Vaccaro) and his friend and laboratory technician Neal Nicol ( John Goodman), Kevorkian assists in the death of more than 130 patients, videotaping each procedure to show that the patient wanted to die. (The film reports that he routinely turned down more traditional suicide requests.) Kevorkian’s patients include a man with a severe spinal cord injury and a woman with debilitating multiple sclerosis.

When Kevorkian loses his medical license, he relies on Nicol to get the nonprescription supplies he needs. He resorts to carbon monoxide gas rather than intravenous medications (which he can no longer legally obtain); with a mask over the head, the patient pulls a string to self-administer the gas. When this method is used on a 70-year-old man (Hugh Gale) who, at one point, hesitates, Kevorkian is investigated by a prosecutor. Although not charged in that case, Kevorkian faces criminal charges three other times for assisting in a suicide, assistance that is then illegal in all 50 states. Each time, he is acquitted.

But when Kevorkian administers a lethal injection of the sedative Seconal, the muscle relaxer Pavulon and the drug potassium chloride to a patient with amyotrophic lateral sclerosis in 1998 — and shows the video footage on CBS’ “60 Minutes” — he is charged with murder and convicted.

The medical questions: Is Kevorkian’s machine a realistic method for causing a painless death? Is there a medical difference between the intravenous and gas methods for inducing death? Can a non- psychiatrist determine that a suffering patient who wants to die isn’t simply depressed?

The reality: Neither the intravenous device nor the later device that administered gas caught on, even in Oregon and Washington, where the self-administration of lethal medication is now allowed (Oregon since 1997, Washington since 2009). Instead, patients receive a prescription for a lethal dose of a barbiturate. Voluntary euthanasia (the process of directly helping a terminally ill patient die by delivering a lethal medicine at the patient’s request) is still illegal in all but those two states, says Dr. Timothy E. Quill, professor of medicine and psychiatry at the Center for Ethics, Humanities and Palliative Care at the University of Rochester School of Medicine in New York.

In states where physician-assisted suicide is illegal, the doctor can be criminally charged, as Kevorkian was, for providing a lethal medication to the patient and assisting suicide, says Lynn Lowy, associate general counsel at New York University Langone Medical Center.

Intravenous medication to cause death is much easier to administer reliably than gas, as the movie shows. But there are few instances in which a doctor aiding a suicide in order to relieve suffering is medically necessary, since suffering can be relieved by sedation, says Dr. Joseph Lowy, director of the Palliative Care Service at Langone.

Further, Joseph Lowy says, no competent or humane physician would ever use a muscle-paralyzing agent such as Pavulon (pancuronium bromide) even after administering a sedating barbiturate and potassium chloride. The level of sedation can vary, he points out, and “there is no greater terror than being awake and unable to move or breathe from muscular paralysis.”

Lowy objects strongly to Kevorkian’s notion (as the film portrays it) that doctors routinely “starve patients,” rather than helping them end their lives directly, pointing out that patients are generally anorexic at the end of life and don’t feel like eating.

As for depression, it can certainly cause those suffering with medical conditions to believe that their cases are hopeless, says psychiatrist Keith Ablow, author of “Living the Truth,” adding that when the depression is treated, their outlook may improve.

Ablow says that any patient whom Kevorkian considered for euthanasia should have been assessed first by a psychiatrist, though ethically, he points out, psychiatrists could not have participated in such an evaluation, knowing that the end result was to be an illegal suicide.

Siegel is an associate professor at New York University’s School of Medicine.

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