PBS Frontline - Facing Death

Facing Death is an impressive documentary report on end-of-life at the hospital. It is the visual version of Dr. Gawande’s New Yorker article, Letting Go. Only this time the message is directed at us, not the doctors. We are told that almost half of all deaths take place in hospitals and then we are shown just how awful that looks.

The film should be called “fighting death” rather than “facing death” because that is what the people do who are featured in this film. Patients do not want to die and their families do not want to decide for them. They fight death like heroic soldiers in a desperate war. It is wrenching to watch as fragile and failing bodies submit to yet another painful intervention on the wisp of a hope that this time they’ll beat the odds. For most, the end is death, for some it is unconsciousness on a ventilator for unknown years to come.

The medical system is absolved. Although there is always uncertainty, the doctors know the odds and do their best to convey that to their patients. But what can they do in the face of people who don't want to die and families that won't let go? And of course there is always one more thing to be done. And you never know, sometimes patients surprise you.

Throughout the film we are continually reminded of the financial costs of various procedures. Is this why medical insurance is so high? We are informed that the United States is the only country that allows this vast expenditure of resources at the end-of-life. Do you remember the palliative care conferences that were to be paid by medicare until Fox News started calling them "death panels?" They were removed from our new health bill.

The film's vision is true one. Our current approach to death is painful, scary and expensive. See Sharon R. Kaufman's book . . . And a Time to Die -- How American Hospitals Shape the End of Life. Yet I feel manipulated -- by all the images of suffering, the monetary statistics, the compassionate doctors talking to distraught families who resist their advice. The film is intended, I believe, to prepare us for things to come. Big changes in health care are inevitable. The first of the baby-boomer will turn 65 this year. They are the first flakes in the coming storm of aging medical consumers. Our hospital approach to end-of-life will buckle under those numbers. And what will our brave new world look like? I cannot tell you. But I believe that people in this country will need more than fear-provoking film images to change their response to death. They need a palatable alternative, and that the film does not provided.