Death is a comma

by Michel Fariña, Juan Jorge, Mooney, Catherine, Solbakk, Jan Helge

This film tells the moving story of Vivian Bearing, a professor of English literature who is diagnosed with advanced ovarian cancer. The film’s aesthetics, combined with an outstanding performance by Emma Thompson, shake the spectator to the very core and highlight some of the major dilemmas in medical ethics. [1]

Avoiding any low blows, the film presents a cinematographic gallery of the main articles included within the UNESCO Universal Declaration of Bioethics and Human Rights related to palliative care, including such topics as Informed Consent, Privacy, Respect for Human Dignity, and Benefit and Harm within Clinical Research.

But the most interesting thing about this film is that it enhances the Declaration’s “state of the art” approach to medical ethics by confronting us with the existential horizon of life and death, a horizon beyond all norms. And it does so through an unexpected narrative.

When Vivian, our fictional patient, has to go through the immense suffering that terminal cancer patients endure, she resorts repeatedly to retrospective reflection to using her imagination over and over again. More specifically, she flashes back to a scene in which her doctoral thesis is reviewing an essay of Vivian’s that discussed John Donne’s Holy Poems, Sonnet X. The professor harshly critiques Vivian’s use of an edition that incorrectly punctuated the last verse of Donne’s sonnet, precisely the verse that dealt with life’s finitude and death’s ephemerality. In the text that Vivian used, the editor had placed a semicolon, a pronounced division, where John Donne had used a mere comma, a brief pause, before the sonnet’s resounding conclusion.

That comma, seemingly trivial and insignificant, returns nonetheless in the patient’s wakeful hours. It storms in over and over, in her morphine-induced dreams, tempering her relationship with the disease that is mining her body. For the spectator, who helplessly watches this attack – of the cancer, but also of the medicine that supposedly treats it – the comma ends up being a catharsis in front of all this devastation. Death, as Vivian is beginning to appreciate, is but a fleeting pause in a journey that continues.

And in the end, when the battle seems to be lost, the poem returns one last time. But this time, it returns whole and complete. It returns victorious through an off-screen monologue in Emma Thompson’s voice, suggesting a passage from pain to suffering and from suffering to unexpected clarity about death’s finitude and life’s immortality:

Death be not proud, though some have called thee
Mighty and dreadfull, for, thou art not soe,
For, those, whom thou think’st, thou dost overthrow,
Die not, poore Death, nor yet canst thou kill mee;
From rest and sleepe, which but thy pictures bee,
Much pleasure, then from thee, much more must flow,
And soonest our best men with thee doe goe,
Rest of their bones, and soules deliverie.
Thou art slave to Fate, chance, kings, and desperate men,
And dost with poyson, warre, and sicknesse dwell,
And poppie, or charmes can make us sleepe as well,
And better then thy stroake; why swell’st thou then?
One short sleepe past, we wake eternally,
And death shall be no more, Death thou shalt die.

Death, Be Not Proud
Sonnet X
John Donne (1572 - 1631)

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COMMENTS

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Message from Paula Paragis  » 15 March 2023 » paula.paragis@gmail.com 

Very interesting article. Thank you Dr. Demir for his valuable bibliographic recommendation. It is also important to include the importance of the advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision. As we know, it is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity. There is a very good book by Rui Nunes on the subject. Thanks to the authors for reminding us of the bioethical value of this film!

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Message from Muge Demir  » 9 March 2023 » mdemir@hacettepe.edu.tr 

Hi, I am lecturer in the departmant of Medical Ethics and History of Medicin in Turkiye. We use this movie for 10 years in our lectures, courses, training programmes. For example the first scene is used for the education about informed consent in research.
Further reading: Demir M, Akpınar A. Evaluation of Medical Ethics Education Based on a Film Wit: A Quantitative Content Analysis. World of Medical Education. 2022;21(64):119-132.
(doi: 10.25282/ted.1098440)

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