Emergency response is not portrayed, in fact the film shows the importance of understanding when not to respond. While it is the instinct of responders to always try something else if treatment is ineffective the patient’s wishes always come first, for a medical professional this can feel like giving up but in cases like these it is the right thing to do.
The film was educational in its own way, without using data or an excess of science to attempts to prove its point. I believe its educational value is in the simplicity of the message being presented and that adding explanations or scientific background for the grief process would detract from the films emotional impact.
The film shows the challenging decisions that have to be made by doctors, patients, and family members. Although in the end the decision to continue fighting a terminal illness rests with the patient, their doctors have the enormous responsibility of providing honest medical opinions in a way that allows patients to understand their illness and make educated decisions. The film showed how challenging that is for doctors when their instincts are to keep fighting until the end, to give their patients hope even when a treatment has a slim chance of working and could make the patient sicker.
The film includes perspectives from the doctors, both the oncologists involved in primary care for their patients as well as specialists, both nurses and palliative doctors, to deal with the final months of treatment. The patients and their families provides the other viewpoints, with several families dealing differently with the situations they found themselves in.
The film sustains its narrative by following the stories of several patients suffering from terminal cancers and the doctors treating them. While medical information concerning the type and severity of each case as well as the treatments considered was used to show the severity of each case, the film used emotion to deal with the difficult subject of mortality.
The film addresses a general audience, although the subject matter requires a more mature outlook in order to fully understand the film. Although there is some medical aspects to the film, the meaning is based in the emotional aspect of mortality which can be conveyed without previous medical expertise.
The film focuses on differing outlooks on death from terminal illness, to accept certain inevitabilities and place importance on the quality of life rather than the time remaining as opposed to the traditional medicine approach of fighting until the last moment to extend life.
Although the film was touching, I could not avoid feeling that this was not an entirely true representation of the acceptance process for the patients and families portrayed. The bravery shown by terminal patients is humbling, and watching them make the most difficult decisions possible shows only the strength of human spirit. The fact that there was a camera present would however have changed the outcome, and I am not convinced that the patients and family members would have been willing to show their anger and grief to the same extent. This is seen in one scene where the wife of a terminal patient began to cry and turned away from the camera until she was able to compose herself again.
The most persuasive part of the film was when the palliative care doctor discussed the importance of understanding a patients goals. Everyone has different priorities and will make decisions on their treatment based on those priorities. The ideas presented in the film that deal with the point where treatment is no longer the best course of action are more widely accepted now but still challenge doctors whose entire professions focus on saving lives.
The film suggests a change in the treatment of terminal patients nearing the end of their lives. Several doctors in the film expressed that they were unprepared to deal with that part of medicine. Experience is the most effective means of education in the medical field, however the film seems to suggest that more training in medical school would be a good first step in preparing doctors not to see the loss of terminal patients as a failure, but in many cases as an inevitability.