Jack Kevorkian has become a polarizing figure among health care providers and the public. He's a litmus test, in a sense, of our opinions about health care in general, and physicians in particular. When the discussion turns to Jack Kevorkian, it's difficult not to take sides.
And Barry Levinson's You Don't Know Jack certainly takes sides. Jack Kevorkian is a hero, we're told. He's a savior. He's the doctor we all wish we had.
You could argue some of these points, of course. For instance, do you really want a doctor whose only contribution to living patients is to kill them? I mean, isn't this taking medical specialization a little too far?
And there's Kevorkian's idea of a dignified death. What's so dignified about having your life ended in the back of a mobile suicide van? By a man you barely know?
And of course there's that whole legal thing. You know--murder. Homicide. Our society sort of frowns on that, doesn't it?
None of these issues gets the attention it deserves in Barry Levinson's treatment of Kevorkian, but that's OK. It's film. It's entertainment. Levinson doesn't have an obligation to teach us. Or even to make us think. And he's entitled to his point of view.
Actually, the problem with this film is not that Barry Levinson doesn't know Jack. He does. Or at least he has a clear vision of Kevorkian that he's able to articulate. And Al Pacino is brilliant in giving voice to that vision.
No, the real problem is that the debate around Kevorkian was never really about him. He became a lightning rod, of course. A willing and even eager one, seeking attention and confrontation the way a lightning rod draws electricity to it.
But the issues of assisted suicide and euthanasia actually have very little to do with Jack Kevorkian, or who he is, or what he did. What Kevorkian did was never about those issues, and was only indirectly about his 'patients.' The issues that drive the debate that crackled around him are much wider and much more complex. And these issues get shortchanged in Levinson's treatment.
Much of the attraction that assisted suicide holds for the general public, and for my patients, stems from fear. We're afraid of suffering, for instance. And we're afraid of losing our dignity and autonomy. More generally, we're afraid of losing control of our lives.
And most of us are left to face those fears in the setting of a health care system that doesn't really care about us. Too often, we die in hospitals that focus on preserving life at the expense of comfort and dignity. And many of us will die in nursing homes that are too understaffed and poorly reimbursed to provide quality care.
These realities don't find a place in Kevorkian's worldview. He seems to think that suffering is inevitable, and that a loss of dignity is simply a part of serious illness. Nor are these realities given room in Levinson's film. In fact, Levinson seems to buy into Kevorkian's worldview enthusiastically and unquestioningly, endorsing and promoting it as gospel.
But the suffering and loss of dignity that are so central to the Kevorkian/Levinson view of serious illness aren't inevitable. Although you'd never know it from this film, there are alternatives to Kevorkian's death machine. And many of those alternatives offer a very different view of what life with a serious illness could be like.
Since Kevorkian pushed his first lethal dose, hospitals have made great strides in integrating palliative care. Palliative care teams offer patients comfort and dignity under difficult circumstances. And, what is most important to many of my patients, these teams offer patients more control over their care, and more autonomy in the choices they make.
And for all of those patients--and that's most of us--who want to spend our last days at home, hospice has made enormous improvements in the care of people near the end of life. Hospice can promise exactly the sort of comfort and dignity and control that people used to seek in the back of Kevorkian's death van.
If you don't believe me, consider the numbers. In his career, it's estimated that Kevorkian helped about 130 people to die. Compare that with the 1.3 million people who use hospice every year. That's 1,299,870 people who chose a different path than the one that Kevorkian and Levinson embrace.
I'm not saying that one of those choices is the correct one. But can 1,299,870 people be wrong? Besides, a portrayal of an issue as complicated as assisted suicide that focuses on the choice of such a tiny minority doesn't do justice to the issues involved.
Still, that was Levinson's choice and those are his opinions. He's entitled to hold them, and to share them. Fair enough.
But maybe now Levinson will use his considerable talents to paint a more nuanced picture of the possibilities that are open to people with serious illnesses. I'll even loan him the title of my book: Last Acts. It would be a film about the choices that we have available to us, and all of the things that we can do even--or especially--when our time is limited. It would be a film about hope and opportunity rather than fear. That's a film I'd very much like to see.