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End of Life Issues in the Cinema. From Million Dollar Baby (2004) to The English Patient (1996)

Wilson Astudillo1 and Iñigo Marzábal2

1Centro de Salud de Bidebieta-La Paz .San Sebastián (Spain). 2Departamento de Comunicación Audiovisual y Publicidad de la Universidad del País Vasco (Spain)

Correspondence: Wilson Astudillo. Bera Bera 31-Iº Izqda. 20009, San Sebastián (Spain).

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Received 10 December 2006; accepted 20 December 2006

In art it is harder to deal with death than life

Chéri Samba, African painter

Now, what I want is, Facts. Teach these boys and girls nothing but Facts is what Charles Dickens puts into the mouth of Mr. Gradgrind at the beginning of the novel Hard times. Imbued with the positivism of the times and obsessed by preserving his household and the education of his children from the unhealthy influence of literature, this character considers that when fiction comes in the door, reason flees through the window. Undoubtedly, in our western tradition, it is Plato who posited the bases of this distrust. In his argument between philosophers and poets he banishes the latter from the Republic and poetry from the world of ideas, since both the epic and the tragic lead the spectator to experience feelings (piety and fear) outside rational volition.

We are all constantly impelled to make decisions. But this decision-making process is not merely rational; it is plagued by ghosts and grey areas. Hence the importance given by us to narrative; hence that human constant: there is no known civilisation that has not been known to endow itself with narrative through which to make itself known. The History of humankind is also the History of the stories that civilisations have told themselves to account for their existence. Firstly, because we tend to organise our lives narratively as a means to endowing them with meaning and unity; we tend to orchestrate the events of our lives, as the philosopher Alasdair MacIntyre would say, around “the narrative of seeking” that gives coherence to our biographies. Secondly, because when we see what others have done, we have a richer tapestry of what is happening to us. Thus, oral, written or audiovisual narrative is about showing men and women who to a certain extent resemble us, endowed with physical and moral attributes that differentiate them; susceptible to speaking, expressing themselves and acting, to initiate actions; immersed in conflicts that each of us has to deal with in our own way, in the given situation and on thre basis of the resources deriving from out own biographies.

This is why the Basque Society for Palliative Care devoted its 15th Meeting, held in San Sebastian in November 2006, to The Cinema and Medicine at the End-of-Life. This is because the cinema is the main source generating narrative in today’s world of visual images, and because through those particular resources available it reproduces more vividly than any other medium situations that are susceptible to fostering a richer dialogue about the medical and ethical problems that arise due to the struggle to survive illness and death; the different ways of coping with these; how those affected react and what effects those involved are subjected to. And all this from the perspective of palliative care. This is because it is commonly accepted that the aim of today’s’ medicine is not merely to cure. Death is no longer seen as a medical failure. When it is not longer possible to cure with bioethics and the palliative movement we are beginning to glimpse the possibility of caring for, accompanying and –mainly- offering an answer to the grief of patients with tumour-due or degenerative illnesses, so debilitating and progressive. In sum, our aim is to attempt to alleviate the suffering of terminal patients and allow them to die in peace.

Accordingly, the Basque Society for Palliative Care warmly thanks the Journal of Medicine and Movies for publishing these pages addressing some of the topics dealt with at that meeting with a clearly multidisciplinary vocation. This is because people from areas so apparently distant as medicine, philosophy or cinematographic analysis have offered their experience and knowledge to the service of a single aim. Here we include four contributions: Million Dollar Baby (2004) and Palliative Care; I think Plato was ill: The cinema and philosophy at the end-of-life; The cinema, ethics and medicine at the end-of-life: the power of metaphor, and The cinema and the teaching of medicine: palliative care and bioethics.

José Elias García Sánchez, Enrique García Sánchez and María Lucila Merino Marcos analyse Clint Eastwood’s Million Dollar Baby (2004). The narrative not being a strictly medical issue, they divide their work into two parts: a first section in which they analyse the relationship between Frankie Dunn and Maggie Fitzgerald, marked by6 the weight of a traumatic past, father-offspring relationships, and the struggle for a better future, oriented in the world of boxing. The second part addresses medico-ethical considerations, derived from the quadriplegia to which Maggie has been reduced after a treacherous hit by an opponent. Here, issues such as the desires and life project of the patient, pain and suffering, blame and responsibility, suicide and euthanasia are explored.

The work by Antonio Lastra I think Plato was ill: The cinema and philosophy at the end-of-life is a reflection on the end of human life; about that “strong time” in which the last exchanges and last words are made, from philosophy. The author admits his profaneness in both medicine and in the cinema. That is, he appears as someone “who does not show the due respect for the sacred”. From this stance, he proposes to the reader a suggestive and original tour through philosophical thought about that sacred and inapprehensible experience that is death. And he does this through the cinema, through the medium that in his own words “has improved our condition as spectators, of beings who are in front of the sacred”.

The article by Iñigo Marzabal entitled The cinema, ethics and medicine at the end-of-life: The power of metaphor starts out from the fact that death continues to be a mystery. We know little or nothing about it except that, one day, it will happen to all of us. This is why it is a fertile territory for addressing issues of emotions and reasons, of moral problems and existential dilemmas, of fulfilled desires and unfinished projects. He offers us two scenarios en which we might consider death to have some meaning: medicine and its empirical-technical expertise, on one hand, and narrative and its metaphorical power, on the other. It is this latter metaphorical knowledge that he tackles in the article - the capacity of narrative in general and of an audiovisual narrative in particular- to speak of those entities who await death, human beings, and to do so obliquely through metaphor. The narrative reviewed in The English Patient. From the interlinked histories that course through the tale and from the metaphors it is based on, Marzabal shows how the narrative experience can become a true moral experience.

In The Cinema in the teaching of Medicine: Palliative care and bioethics, Wilson Astudillo and Carmen Mendinueta review the teaching potential of the cinema in Palliative Care and Bioethics, because cinema reflects the particularity, circumstances, and the individual and social context of daily life. According to the authors, the cinema is a powerful tool for students to gain experience in the solving of bioethical conflicts my means of the evaluation of certain situations reflected on the wide screen, as well as stimulating their sensitivity and allowing them to see beyond the purely visual (images). In their article, the authors also refer to a series of movies susceptible to being used in “medical teaching”, “palliative care” and “bioethics”.

Finally, the issue is completed with the usual feature of Medicine through stills, in this case offering information about people with terminal cancer who have appeared on movie posters.


The Editors would like to thank the translation team of the Languages Service of the University of Salamanca for their collaboration in the English version of this Journal.