‘How Do You Want to Die?’

Netflix short film is important reminder of critical conversations we need to have

by Carleen Wild | Updated 04 Oct 2016 at 10:03 AM

Does your family know your wishes for your life — or death, should something happen to you and you can’t tell the doctor on your own?

If you’re brave enough to watch and open to the conversation, even the first three minutes of a new short film could change how you look at, and live, the rest of your life.

“By the time a patient may land in the ICU, the odds are high it may be too late for an easy, comfortable death,” said one end-of-life care specialist.

“Here’s the reality: We’re all going to die,” said Dr. Jessica Nutik Zitter, the palliative care physician featured in “Extremis.” “Everyone standing in this room is going to die one day. And it’s good to have a little bit of a say in how.”

“Extremis” is a recently released Netflix original documentary that takes viewers inside the intensive care unit (ICU) of an Oakland, California, public hospital. Throughout the 23-minute film, viewers follow Zitter and her colleagues as they work through the gut-wrenching decisions families are often forced to make in urgent end-of-life cases — specifically those relying on machine-based life support.

Among other honors, the film has been awarded Best Short Documentary from the Tribeca Film Festival. “This film’s cinematography is intimate yet unobtrusive; its point of view is empathetic and non-judgmental. And ultimately, it respects the conflicting perspectives at a morally wrenching crossroads,” the Tribeca jury wrote of “Extremis.”

Related:  ‘End of Life’ Care Needs a New Name

Oscar- and Emmy-winning filmmaker Dan Krauss (“The Kill Team”) wanted to “intimately examine ‘the intersection of science, faith, and humanity’ by observing personal, real-time accounts of how complicated and emotionally wrought the dying process becomes when there are opportunities for choice in death,” according to indiewire.com.

It’s a powerful and emotional film.

“‘Extremis’ invites us to consider whether each of us has a moral responsibility to prepare and plan for our death,” said Ruth Linden, Ph.D., founder and president of Tree of Life Health Advocates in San Francisco.

Advanced Directives in U.S.
  • Even among severely or terminally ill patients, fewer than 50 percent had an advance directive in their medical record.
  • Some 76 percent to 65 percent of physicians whose patients had an advance directive were not aware that it existed.
Source: http://www.cdc.gov

“As the film makes plain, by the time a patient may land in the ICU, the odds are high it may be too late for an easy, comfortable death; a death aligned with one’s values, goals, and wishes; or even a brief conversation or phrase on a white board that expresses one’s wishes,” she told LifeZette. “In its essence, ‘Extremis’ is a call for thinking ahead about how we want — and, importantly, do not want — to die. In its visceral depiction of the best and worst elements of the medicalization of death, we are warned of the dangers that can result from the failure to plan.”

The impact of decisions surrounding end-of-life care obviously impact more than just the individual. “These decisions and the paths taken impact many,” added Anna-Gene O’Neal, CEO and president of Alive Hospice in Nashville, Tennessee. “The film is real and raw.”

Out of the many conversations that could come of this film, Ann Norwich, an assistant professor of nursing and director of the adult gerontology nurse practitioner program at York College of Pennsylvania, agrees there is perhaps one more important than any other.

"Unfortunately, the documentary misses the opportunity to discuss the importance of patients making their wishes known through advance directives so that these end-of-life decisions can be based upon the patient's clearly documented wishes," Norwich said.

Related: At a Loss for the Right Words?

Advance directives guide care providers to offer care that is consistent with the patient's wishes and helps families to make decisions that align with the patient's values.

"'Extremis' [can] catalyze discussions among physicians and physicians-in-training about the challenges of communicating with and listening to patients and families. In so doing, the film will reduce the moral distress and inappropriate use of technology at the end of life," said Linden of Tree of Life Health Advocates.

  1. emergency room
  2. end-of-life care
  3. Extremis
  4. health care
  5. ICU
  6. palliative medicine
  7. Tribeca Film Festival
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