Jack Tuller is in a black embroidered tuxedo jacket, decked out and ready to go in less than 30. While his loved ones wait outside the bathroom, he says a final thank you to his best friend, filmmaker, and director Bradley Berman. Jack Tuller was a 59-year-old musician, and in a new film, “Jack Has a Plan,” Bradley Berman details Tuller’s life—or rather, his death—and the ramifications of his decision to die by physician-assisted suicide.
Tuller and his wife are from San Francisco, where the California End of Life Option Act allows terminally ill patients to choose to end their lives using aid-in-dying medication, as prescribed by their physician and after carefully adhering to the steps outlined by the legislature. The criteria are as follows: the patient must be eighteen years or older residing in the state of California and diagnosed with a terminal illness that is expected to result in death within six months; the patient must have the capacity to make medical decisions and have the physical ability to take and ingest the drug. The decision is not legally considered suicide; rather, the cause of death is documented as the underlying terminal illness (in Tuller’s case, Major Neurocognitive Disorder).1 Patients who choose this have cited wanting some control over their life, to die with dignity, or to manage the incredible pain and suffering associated with their symptoms. Tuller says he wants to “[leave] in a blaze of glory” and that he wants his wife, Jennifer, “to be happy again.” While most of the moments shared with Berman’s audience are ones with Jack mobile, dancing, and astute, during the year before Tuller’s death, his motor function and speech are clearly in cognitive decline, and Tuller simply does not want the disease to progress any further.
Aid-in-dying, put bluntly, minimizes the guesswork of dying. While there is still variation in medications used, time until death, and more, knowing the date and time can help pivot patients away from their pain, help them focus on a life left living, and help loved ones prepare for their loss. Yet, the American Medical Association holds that physician-assisted suicide is “fundamentally incompatible” with the physician’s role due to its difficulty to control, and that interpretations of the legislature could pose serious societal risks.2 So far, there seems to be only anecdotal evidence that the aid-in-dying discussion could open up more candid conversations about other courses of care: hospice, palliative care, and the like.
Berman, extraordinarily, keeps the content light throughout the documentary, acknowledging its gravity while indulging in the humor of the decision, as only two best friends can do. Vignettes of Jack’s anecdotes around brain surgery are cut with old-school, black-and-white horror movie clips. When Jack ventures to reunite with his estranged mother, a voiceover from Berman outlines the choice to come bearing apple pie: not cherry, which is a total mess, and not pecan—because, well, that’s always a hit-or-miss. In one of the most endearing throughlines of the film, Jack finds his biological father (Jack Farrell, lovingly nicknamed “Jack Daddy”), and the two begin a close father-son relationship.
Just the friendship between Jack Tuller and Jack Daddy touches on one of the central difficulties in pursuing the aid-in-dying option: to choose an “arbitrary” end date would mean to close out all of the new, beautiful things that may have begun with the pursuit of living out one’s final days. Physicians often hesitate to give prognoses, as the course of disease is widely variable in each individual, and the predictions formed could greatly, irrevocably affect patients’ personal decisions, from apple pie to which course of treatment to pursue. We see Tuller’s mother-in-law sobbing in his arms, and Lemon, another friend, rebuking the sanity of Tuller’s decision. These reactions are derived from a confusing and devastating confluence of grief and acceptance, all prior to the actual moment of dying.
The relationship between Tuller and Berman is perhaps what is the most gripping factor of the film, as compared to other cases of patients who utilize their right to physician-assisted suicide. Berman clearly struggles with his responsibility to respect his friend’s wishes to document his health journey, while feeling like an accomplice to an act that he does not want Tuller to commit. Berman asks if Tuller considers this a suicide, and he says no—then retracts his statement. “I have the approval from Kaiser and the state of California to do it. It’s an allowed suicide.” Yet both documented and colloquial causes of death—by terminal illness or by “allowed suicide”—can be considered true. The interpretation may rest on what allows the patient to feel affirmed in his decision, and what may help alleviate some of the grief felt by his loved ones.
Tuller says that his decision was made largely to preserve the relationships that he has cherished so deeply throughout his life. “It would be a loss to the world for Jack to remove himself from the ranks of the living,” says Lemon, in a statement imbued with the irony of placing Jack in a cadre of the seemingly nameless, faceless, and homogenous. For the rest of healthcare providers and caretakers who rank among the living, “Jack Has a Plan” serves as a poignant and sweet reminder of what it means to honor a life.