By Ben Achtenberg
Ben Achtenberg's provocative documentary, Caring at the End of Life (45 minutes), raises a number of key issues faced by patients and those who care for them, including the role of technology, deciding when to use or withdraw life-sustaining treatments, the importance of effective pain management, and the impact of patients' culture, religion, and community on care decisions. Focusing on the key roles of nursing staff in patient care and communication, it profiles the cases of six severely ill hospitalized patients. The video offers no easy answers, but challenges viewers to think about and discuss their own hopes, fears, and beliefs. Achtenberg was nominated for an Academy Award for his earlier film Code Gray.
The two brief, related study films listed below are designed to help audiences focus their discussion on particular areas of concern.
Stanley (15 minutes): This disturbing case study presents a comatose patient whose family and healthcare team are in conflict over how long to continue with the treatments that are keeping him alive. In making decisions about his care, they confront difficult ethical questions about patient autonomy vs. the needs of the family, about who is in a position to judge what another person would want, about the role and impact of religious faith, and about the certainty or fallibility of medical judgement. Stanley combines several sequences from Caring at the End of Life, for groups who wish to discuss the implications of this particular case.
Discussing Advance Directives (15 minutes): Two nurses and a physician, part of a foundation study on patient communication, meet to discuss the difficulties they encounter in working with other staff and patients on advance directives. Among these are misunderstandings, among both patients and staff, about the differing roles of living wills, durable powers of attorney, and "do not resuscitate" orders; confusion about how to interpret these documents in the light of changing medical circumstances; and the ambivalence of some patients about having to make such decisions at all. This thoughtful and sometimes amusing discussion expands a sequence seen in the longer film.
These films were partially supported by the Robert Wood Johnson Foundation.
Reviews
~ "Demonstrates the importance of collaborative practice in advance care planning and superbly highlights the critical role nurses can play in achieving better end-of-life outcomes." - Carol Taylor, CSFN, RN, PhD, Georgetown University Center for Clinical Bioethics
~ "Ben Achtenberg and Christine Mitchell have captured the complexity of end-of-life decision making. Health care professionals may see themselves and their colleagues in new ways that will hopefully encourage self-scrutiny and behavior change." - Mildred Z. Solomon, EdD, Center for Applied Ethics & Professional Practice
~ "These situations will ring true to practicing clinicians and offer an opportunity for stimulating discussions among students, clinicians, and all involved in health care." - Elizabeth F. Hiltunen, MS, RN, CS
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