September 27, 1996 | During the opening minutes of  Extreme Measures,  we find Hugh Grant cast as Dr. Guy Luthan, a British-born doctor hard at work in the emergency room of a Manhattan hospital. And even though the movie has been advertised as a medical thriller, it's hard to shake the suspicion -- for a while, at least -- that what we're really going to see is something more along the lines of Four Patients and an Autopsy.
 
There is Grant, ineffably debonair in a lab coat, T-shirt and faded jeans, cracking wise and beaming boyishly as he tends to the wounded. One patient, a drug-addled crazy, complains loudly about another patient, a wounded police officer. "That fucker shot me!" the crazy wails. "Um, yes," Grant replies, somehow managing a witticism while stanching a geyser of blood. "But you did shoot him first."
 
At first, you have every right to fear the worst: Grant will lean heavily on his familiar repertoire -- the tousled hair, the shy stammer, the self-deprecating smile -- while gliding through the plot and going through the motions. Another one-trick movie star does his shtick, whether it's appropriate or not,  in a by-the-numbers thriller. Ho-hum.
 
Very soon, however, a curious thing starts to happen: As Extreme Measures  gets progressively darker and chillier, and Dr. Luthan becomes increasingly paranoid about inexplicable events at his hospital, Grant grows less facile and more substantial. Slowly, the offbeat casting begins to make sense, to the point of seeming positively inspired. Grant is an exceptionally engaging comic actor, but he is nobody's idea of a conventional action-movie hero --  which is one of the reasons why he is so perfect for this particular role. He is unafraid to appear utterly terrified when it makes good sense for Dr. Luthan to be frightened. And he looks more than vulnerable enough to make the audience fear the worst when his character must literally fight for his life.
 
Think of how scruffily scared and hopelessly outclassed Bruce Willis seemed during the first  Die Hard,  particularly in those scenes where, simply because he wasn't yet a full-blown movie star, there was at least a glimmer of a chance that he might not live happily ever after. (A classic movie moment: Willis, trapped on a rooftop, wails: "Oh, God! Please don't let me die!") Grant may already have Nine Months and Four Weddings and a Funeral to his credit, but he, too, is at a point in his career where you can't be entirely sure how things will turn out for any character he portrays.
 
It isn't giving away anything important to say that Dr. Luthan uncovers a conspiracy to use homeless people as human guinea pigs. Nor is it telling too much to reveal that a brilliant Nobel Prize-winner, played by Gene Hackman, is the man behind the grisly enterprise. (If the filmmakers wanted any of this to come as a surprise, too bad: All this and more is revealed in  TV ads and coming-attractions trailers.) The movie builds to a grippingly suspenseful sequence in which Grant's character may or may not catch the attention of an unexpected visitor. But the real climax is a compelling debate over medical ethics and other moral issues. And this is where the casting of Grant really pays off.  Hackman's character, Dr. Lawrence Myrick, speaks with passionate eloquence about his desire to help all of humanity by sacrificing a few disposable wretches. Myrick's arguments are so lucid, so forceful, they might even be convincing enough to win over the profoundly dubious Dr. Luthan. At least, that's what we're supposed to think if the familiar scene is to have any dramatic tension at all. And it does, because Grant appears thoughtful enough, and behaves un-macho enough, to make his character's last-minute conversion seem a very real possibility.
 
Working in tandem with Elizabeth Hurley, his long-time significant other, Grant produced Extreme Measures, and tailored Tony Gilroy's screenplay (based on a novel by Michael Palmer) to suit his particular talents. (Originally, the lead character was -- big surprise! -- an American.) But there is little on screen to indicate that this is some kind of ego-fueled star vehicle. Instead, Extreme Measures is a textbook example of what first-rate professionals can do when they are working at the top of their form on a frankly commercial project. Within the confines of this particular universe, the movie offers the best of all possible worlds: a smashingly exciting thriller that also is a provocative drama of uncommon depth, intelligence and moral complexity.
 
Considerable credit must go to Michael Apted, a filmmaker who is equally adept at documentaries (35 Up, Moving the Mountain) and dramatic features (Gorky Park, Coal Miner's Daughter). Partially as a result of his experiences in nonfiction cinema, Apted has developed a sharp eye for believable ambiance and revealing detail. That comes in very handy here, particularly when he must stage scenes that, if guided by a lesser director, might look like E.R. reruns.
 
Throughout Extreme Measures, Apted subtly emphasizes one of the screenplay's grimmer ironies: Because the hospital is so understaffed and overcrowded, and because even the most well-meaning employees are frequently stymied by sloppy filing and unreliable computers, it's very easy for conspirators to conduct unauthorized experiments -- and even easier to whisk away both living patients and inconvenient corpses. Remember how bleak things seemed way back when George C. Scott raged against the health-care system in The Hospital (1971)? Well, Apted wants you know that, 25 years later, things are much, much worse, even without bad guys trying to exploit the situation.
 
And speaking of the bad guys: For once, we have a thriller in which the henchmen have dramatically sound and emotionally compelling reasons to be henchmen. It wouldn't be fair to reveal just what those reasons are -- somehow, the advertising guys managed to avoid spilling these beans. Suffice it to say that, when David Morse and Bill Nunn go about the nasty business of making life miserable for our hero, they don't exactly whistle while they work. This is a small touch, but it demonstrates just how much thought has gone into the details here.
 
Just as Hugh Grant makes the protagonist more recognizably human than this kind of character usually appears in this sort of thriller, Gene Hackman gives the antagonist a much more formidable gravitas than you will find in most standard-issue movie heavies. Hackman is smart enough to play against the character's hubris, so that Lawrence Myrick comes across as a genuinely selfless innovator who actually makes a great deal of sense as he rationalizes his use of street people as test subjects. In Myrick's view -- a view he very much wants Luthan to share --  the deaths of a few can benefit millions. He is not a mad scientist or a twisted megalomaniac. And that, of course, makes him all the more effective and unsettling as a modern-day Mephistopheles.
 
Extreme Measures is fairly conventional in the broad outlines of its plotting. But it does have some ingenious surprises to spring. At least two involve a strikingly attractive nurse played by Sarah Jessica Parker. Another involves a gruff-talking cop, played by Peter Appel, whose providential arrival during a key confrontation may not really change matters one way or the other. In the area of stunt casting, there is a cameo appearance by director David Cronenberg (Dead Ringers, The Dead Zone) that will be very amusing for those who recognize him. At the time Cronenberg enters the picture, a moment of comic relief is quite welcome. Because, by that point, Hugh Grant has stopped joking and started sweating.