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On Our Own Terms: Moyers on Dying. Living With Dying (Part 1; A Different Kind of Care (Part 2); A Death of One's Own (Part 3; A Time to Change (Part 4)

Distributed by Films for the Humanities and Sciences, P.O. Box 2053, Princeton, NJ 08543-2053; 800-257-5126
Produced by Public Affairs Television
Directed by Elena Mannes
VHS, color, 4 part series - each tape 90 min.
College - Adult
Health Sciences, Death and Dying, Psychology

Reviewed by Oksana Dykyj, Head, Visual Media Resources, Concordia University, Montreal

Highly Recommended  Highly Recommended    ALA

On Our Own Terms is one of those rare documents which go beyond mere information about a part of life experience for which few people are prepared. This series is a first step to effect change in the way the dying are treated, and an important step in building a culture of caring by making the viewers think about the process of death. Although many ethical issues are broached, the driving force for both the producers of the series and the subjects they follow is a kind of humanistic philosophy that simply transcends positions for or against technological aid to prolong life.

Since the broadcast of this series on PBS in early Fall 2000, numerous publications have devoted space to discussing issues on how to improve dying and examining different points of view on the role technology should play in death. This series has had a profound effect on the media and thus on viewers who watch television and are faced with having to think about their own mortality. It has brought the topic of dying, not the Hollywood fantasy death represented by film icons such as Greta Garbo in Camille, or Ali McGraw in Love Story, but the real and often agonizingly painful and horrible experience that most Americans endure. More than 80% die in hospitals or nursing homes away from their friends and family, unable to get the appropriate pain relief they need. In each part of the series we enter the last chapter in the lives of people who, through their generosity and willingness to be the subjects of this documentary, enrich our lives by sharing with us the end of theirs. Watching the series is not an easy task. It is impossible not to shed a tear at the strength, determination, and courage of the subjects and their families and friends. But, we come away with a clearer understanding of dying and its ramifications, as well as a strong appreciation of humanity.

In Living With Dying a pediatrician with terminal cancer becomes the patient and interprets the reality of his own situation from grief to embracing the death process. The cultural aspects of the death process are also discussed as being joyful and uplifting in some cultures, a kind of spiritual call to freedom. But cultural differences may also cause a certain level of frustration for health care providers who try to respect people's desires. Some communities do not want their loved one to know the extent of their sickness thus making it difficult for the health care providers to get at their wishes in the event that they can no longer speak for themselves. Documents like Advanced Treatment Directives, which are interpretations of wishes, can give power of attorney to a family member to continue when the patient is no longer able to make decisions. Health care providers and their patients form close relationships as pain is relieved by morphine but suffering is relieved by human intervention. This episode clearly speaks to what is human and what is humane.

A Different Kind of Care presents the research and practice of New York's Mt. Sinai Hospital and Memorial Sloan-Kettering Cancer Center. Palliative medicine deals with issues of control over how we die while easing the suffering. It has often been thought of as giving up, but when the patient is dying and no one is willing to talk about it, the patient dies alone with no connection since everyone is afraid to speak. This silence is in itself a source of suffering for the patient. There still appears to be a lack of awareness by medical professionals of the presence of pain and how to deal with it. The idea of addiction to morphine is not necessarily true in those patients who need it since they do not abuse it. Art therapy in many instances is very useful, as their self-expression is one of the things under the patients' control. Hospice care evolves out of the agreement that health restoration will not be pursued, only comfort measures. But most insurance doesn't cover home health care and pain medication (patches) can amount to between $3,000 and $4,000 a month. It is clearly evident that providing compassionate care is still a constant challenge.

A Death of One's Own examines the issues surrounding assisted suicide. Doctors' moral dilemmas in administering the hastening of death are juxtaposed to the patient's desire to wait until the last possible moment of control. A Louisiana veterinarian with Lou Gehrig's Disease finds himself in the position of feeling that he cannot wait until he is unable to swallow and, because of his doctor's moral framework he must do it alone while he still can. In Portland, a woman is able to control her death under Oregon's Death with Dignity Act which allows her physician to help her die, yet deciding when is the right time is difficult. More often than not, it is the doctor and the family who control the process. A doctor can make dying better for the patient as well as for the family. It ends up not being about prolonging life but making dying better. Arguments are put forth by a group of medical students who are thinking about pro-life advocacy and its repercussions.

The last program, A Time to Change deals with the changing culture of dying by examining the work performed by the Balm of Gilead project in Birmingham, Alabama. They advocate that all suffering: physical, emotional, spiritual, and social, needs to be met, and that we must add pain as the fifth vital sign that medical personnel examine, on the same par as respiration, temperature, blood pressure and pulse. They emphasize the importance of listening to patients and paying attention. Although difficult for them, hospice caregivers get a sense of peace from doing their job well. The challenges are many, including covering the cost for uninsured patients and searching out places for people to live out their last days. It is clear that the current medical system does not provide for continuity and change is necessary to overcome the obstacle of relying on the old ways of doing things. The change that is proposed as necessary is three-tiered: the way in which doctors and nurses relate to patients and their families, the amelioration of the local care system, and finally to change policy to reflect the leaps forward in caregiving.

The importance of this 6-hour series cannot be over-emphasized. It conveys the immediacy of people's lives, their interaction with healthcare providers, and their inevitable passing with dignity and caring while at the same time providing viewers with the factual information they need to think about in relation to their own lives. It is most highly recommended for public libraries, hospital libraries, and academic libraries supporting medical schools, sociology departments and cultural studies departments. It is a seminal series that affects everyone.