Kenny is deliberately killed by heaven's occupants after becoming master of the PSP in order for him to save them. However, the town brings him back to life, leaving him in a persistent vegetative state.
Kenny is the first person in town to get a new PlayStation Portable (PSP) video game system and becomes inseparable from it (even ignoring two very large busty women walking by him). Meanwhile, Cartman, who couldn't get his own because he was late getting to the store, grows envious of Kenny's new toy. Kenny quickly works his way up to level 59 of the game Heaven vs. Hell, but because of his parents having an argument, he goes to complete the 60th level outside; there, he is run over by an ice-cream van while he celebrates (driven by someone playing the same game who just reached level 4) and dies.
In Heaven, Kenny learns that God created the PSP to search for the person who can command his legions against the forces of Hell in a manner like that of the video game. They need someone skilled enough to defeat an army of 10 billion damned souls with only 10 thousand troops. Basically, he is "Keanu Reeves". When Satan's spy returns to hell and warns him of Kenny, Satan decides to give up, seeing no point in trying to fight a "Keanu Reeves". His advisor urges him to still go through with the attack. Just as the armies of hell begin to attack, Kenny is revived. However, because he had been dead for that long, he cannot talk or communicate and has suffered permanent brain damage. He is kept alive through the use of a feeding tube. The reading of Kenny's will, in which Cartman is given the PSP (out of pity) and Stan and Kyle are given everything else, is interrupted by the announcement that Kenny is still alive. The lawyer mentions a passage about Kenny's wishes in the event of him being in a vegetative state, but the last page of the will is missing, making it impossible to tell what his wishes were.
As Satan's army begins to close in, the angels need Kenny dead so that they can win the battle of the Apocalypse. Meanwhile, Cartman, claiming his status as Kenny's "best friend forever" to the Colorado Supreme Court with the first half of the BFF medallion, gets an order to take out the feeding tube, and he removes the tube after tracking down and finding Kenny's other BFF medallion half (implied to have been planted there by Cartman). Stan and Kyle, along with Kenny's parents and other protesters, including Skeeter and Mrs. Garrison (who gets arrested for trying to bring food and water to Kenny), wage a mass media war to put the feeding tube back in and keep Kenny alive, while Cartman enlists supporters of the rights of "best friends forever" to leave Kenny's feeding tube removed.
After a long, intensive media campaign, (on live TV) the two sides are arguing in Kenny's hospital suite when Kenny's lawyer announces that the last page of the will has been found, and that Kenny's wishes were that if he were ever in a vegetative state, "please, for the love of God... don't ever show me in that condition on national television." In full twist of irony, the two sides immediately realize that they both have not only turned a very private, personal matter into a public spectacle but have been disrespectful of Kenny's wishes, and they leave him alone to die in peace.
Kenny returns to Heaven just in time to command the angels to victory; the battle is not seen, but is described ("Oh, how I wish I had a camcorder!", "Ooh, now they're calling in their demon dragons! Look at the size of them!", "Oh, this battle is bigger than the final battle of the Lord of the Rings movie! It's TEN times bigger than that battle!!!") The battle ends with a few surviving angels weakly cheering and dancing and Kenny receiving an awesome prize: a golden statue of Keanu Reeves.
Kenny is in a persistent vegetative state, and his parents cite things like blinking or smiling as signs of awareness, rather than categorizing them as the involuntary movements that are characteristic of those in a persistent vegetative state.
In making his case for the removal of the feeding tube, Cartman points to his rights as Kenny's "best friend forever" (or BFF for short) and he is given custody, instead of Kenny's parents and real friends. In the real-life case, custody of Terri Schiavo was initially given to her husband Michael Schiavo (who wanted the feeding tube removed), not to her parents, though he later gave up authority over the key decision to the court system and a state appointed guardian.
Cartman is seeking Kenny's removal from life support purely out of self-interest, as he will only get the PSP if Kenny dies. Some have argued that Michael Schiavo was also acting out of self-interest because of the $400,000 insurance money or for other selfish reasons (although he was offered over $1,000,000 to keep Terry Schiavo alive). Both Michael Schiavo and Cartman claimed they were only following the wishes of their loved ones. Some think this was done by Michael Schiavo because he was engaged during her vegetative state, initially with the blessing of Schiavo's parents.
Members of the Republican Party rally to the cause (in Kenny's case: they are unwittingly being controlled by a hooded minion of Satan (called Kevin), which uses the Republicans to achieve its goals).
Mrs. Garrison tries to bring food and water to Kenny but gets arrested, as many in favor of keeping Terri Schiavo alive did in a symbolic effort during her dying days.
The misplaced page of Kenny's will (as written above) implicates the media and both arguing sides of his friends and family as being disrespectful for displaying him on national television to try and gain supporters for their argument. As many South Park episodes end with a stated moral lesson, the implied lesson here is that both sides of the Terri Schiavo debate are wrong for making a private issue and family struggle a politicized media spectacle.
Terri Schiavo herself died the day after this episode aired, two weeks after having had her feeding tube removed.
This episode won a 2005 Emmy Award in the category of "Outstanding Animated Program (for programming less than one hour)". This is the first time the show has beaten other nominees, including The Simpsons and Family Guy. It also becomes the fourth prime time animated cartoon to win the award, behind The Simpsons, King of the Hill and Futurama.