Prompted by the plight of David Rivlin, a quadriplegic who litigated to be removed from his respirator so he can die,, the sight of a dying woman in a hospital bed, and the memory of his mother Satenig's death over two decades earlier, Dr. Jack Kevorkian builds his first "death machine". out of parts bought at a flea market. He meets with Rivlin and presents his device. Kevorkian explains that through an intravenous line, Rivlin can self-administer first a harmless saline solution, followed by a barbiturate that will cause him to fall into a coma, and then potassium chloride that will stop his heart, thus causing death. Due to the expense and the difficulty of obtaining the drugs, Kevorkian later develops a less expensive method using tanks of carbon monoxide. Rivlin, however, becomes agitated and Kevorkian is forced to leave. Rivlin is later removed from his respirator and food and water are withheld. In an interview with reporter Jack Lessenberry, Kevorkian denounces what he sees as the cruelty of his unnecessarily protracted death, comparing it to the Holocaust. He believes that his "death machine" would've brought about a quicker and easier death. He begins offering his services as a "death counselor".
His first patient is Janet Adkins, a 54-year-old woman from Portland, Oregon who is suffering from Alzheimer's disease. The disease is in its early stages, but Adkins is increasingly suffering from memory loss and confusion. With Kevorkian's help, she dies on June 4, 1990. He begins aiding people in earnest. As Kevorkian's notoriety increases, he provokes polarizing public opinion. His supporters believe he is performing a public service and that the government has no right to interfere with the decisions of competent individuals who want to die. He insists that he gives his patients a means to end their suffering; they alone made the decision and initiated the process. He also claims to have turned down 97 or 98 percent of the people asking for his help. His critics, however, believe he is playing God. Conservative Oakland County prosecutor Richard Thompson believes Kevorkian is a murderer, but can't gain a conviction; he attributes his failures to Michigan's weak laws regarding assisted suicide and advocates stronger laws. In 1998, Thompson loses an election to a more liberal assistant prosecutor, David Gorcyca, who has no interest in wasting money (a major criticism of Thompson) prosecuting Jack Kevorkian as long as he only assists in suicides.
However, Thomas Youk's September 16, 1998 death is different. Youk, reputed to be Jack Kevorkian's final patient, is so crippled by amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) that he cannot self-administer the drugs. Kevorkian administers it personally. A video of Youk's death is presented as part of Kevorkian's interview with reporter Mike Wallace of the CBS news program 60 Minutes. It leads to him being indicted and, despite the intervention of Youk's widow Melody and his brother Terry, convicted of second degree murder. Kevorkian represents himself; in previous cases, he was represented by attorney Geoffrey Fieger. He is sentenced to 10 to 25 years in prison. He wants his case is heard by the United States Supreme Court so that the issue of assisted suicide can be decided. The Court declined to do so, however. Kevorkian is released in June 2007 after serving over eight years.