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06/13/2012

“The Descendants”: The Bioethics Movie That Wasn’t

Okay, I am probably one of the last people in the United States (no, probably the world) to watch the movie “The Descendants”. I had heard a lot about it, not only just from Clooney devotees or at Oscar time, but from scores of people who dubbed it a “bioethics movie.” So finally I decided to sit down for 2 hours with Mr. Clooney and give “The Descendants” a try.

At the end of the film (and actually throughout the entire film) all I kept asking myself was one simple question: “What would have happened if Matt King’s (played by G. Clooney) wife hadn’t had an advance directive?” Answer: then, the movie would have actually been interesting. Ironically, the film provides us with such rich, conflicted and messed up characters none of whom really get to shine because the only real ethical issue–whether to “pull the plug” on King’s cheating comatose wife–is obviated by her advance directive. The directive clearly states something to the effect that if I am in a state that I will never recover from don’t waste your time and money on me–pull the plug. So Mr. King, who learns on the same day that his wife is irreversibly in a coma and that she was having an affair, decides he will end her life. Does he agonize over it? No. Does anyone ever raise a concern perhaps in the next 3 days isn’t the time to turn off the ventilator because after all he just learned his wife was having an affair with a real estate agent? Nope. He’s just following orders–the orders in the crystal clear directive she thought to write out.

And even if we suspend disbelieve and ignore the fact that it would be pretty rare that a young, healthy woman would have an advance directive (only about 18-36% of all Americans do) and chalk it up to the fact that, as she was described by many in the film, she was an exceptional woman who thought of everything, it still seems like a big opportunity was missed in the film. This film could have been one of the greatest international teaching moments in cinema about advance directives ever–but it absolutely failed on every level. The film didn’t even engage with the fact that King’s wife, widely acknowledged to be into dangerous and risky exploits like racing boats (as well as cheating on George Clooney), might have had a directive for that reason alone. Or because she had two children and a husband. Nope, no discussion at all of whether the directive was an authentic reflection of the life she lived or anything else. The ethical issues in the movie were completely erased because an advance directive is just a not-to-do list. At least that is what this movie suggests.

So, I’m disappointed. Not in the acting or location of the film (both were great), but by the fact that this is one “bioethics movie” that could have been but never ever was.

Summer Johnson McGee, PhD

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  • http://www.facebook.com/gjsmithjd Gregory James Smith

    I haven’t seen this movie, but this is certainly an interesting ‘take’ on the bioethics aspects of the movie by Dr. McGee.  - Greg

  • http://profiles.google.com/kevintkeith Kevin T. Keith

    I’m not clear whether you object to the fact that, because she had an advance directive, the movie lacked real ethical tension, or that the movie presents advance directives as essentially “to do/not to do lists”.

    I can see that there would be many more opportunities for debate if she had not had an AD – thus raising the questions of the husband’s motivations and the validity of his interpretation of her wishes. But that’s just an objection that it should have been a different – possibly better – theatrical production, not an objection on grounds related to moral issues in the movie.

    I don’t understand the implication that the movie didn’t adequately depict challenges to an apparently valid AD that the character did in fact have. A valid AD *is*, in some respects, a “to do list” – at least to the extent that it details specific responses to specific situations, which responses are then expected to be enacted. An AD may not typically be challenged on grounds that it is not an “authentic reflection of the life the patient lived”. ADs express explicit wishes and directions; presumably those arise from the patient’s nature as a person, which itself presumably is reflected in the life they lived, but ADs are not held to a test of “the life the patient lived”, but rather are formal legal documents (executed by signature and witnessing, etc.) that impose specified obligations. If validly enacted, they are supposed to be carried out. If her husband is “following orders–the orders in the crystal clear
    directive she thought to write out”, he’s doing what he’s supposed to
    do. Given the distortions and over-dramatizations that so often infect medically-themed movies and TV shows, a movie in which someone has a valid AD *and it is actually followed*
    would be a welcome relief (even if perhaps slightly unrealistic)!

    I also don’t understand the issue of the reasons for the AD. What does it mean that she was “widely acknowledged to be into dangerous and risky exploits [and] might have had a directive for that reason alone. Or because she had two children and a husband”? Those seem like good reasons to have an AD – and certainly not reasons to invalidate one when it becomes relevant.

    There is an entire cottage industry devoted to invalidating not just advance directives as instruments of self-determination, but the concept of autonomy itself as a moral framework for healthcare. They constantly seek reasons to dismiss patients’ expressions of their desires and intentions in favor of someone else’s values or moral priorities, and to turn every clinical case into another Schiavo disaster. We hardly ought to complain about depictions of ADs being respected by caregivers and loved ones as valid and authoritative expressions of patients’ wills.