The Wit film is a 2001 American Television Movie directed by Mike Nichols. It was based on the 1999 Pulitzer Prize winning play of the same title by Margaret Edson.
Upon watching the film
entitled “The Wit” by Margaret Edson, I have come to realize that this appears
to be a matter of life and death. The suffering of Vivian Bearing is shown in
the film as well as her relationship with her two doctors, her loss of dignity
and her death.
The Healthcare as it was presented in the story has set multiple
missions such as administration of medical treatment to patients, specialized
research conductions, training of interns and residents.
The film has shown
insensitivity of the professional healthcare workers toward the patient which
is evident with the hospital’s insensitive mechanistic approach to patients
having been asked repeatedly of “How are you feeling today?” It is also evident
in the scenario where Dr. Jason was about to do a physical examination and he
suddenly remembers that a woman must be present that he left Vivian in an
uncomfortable position on the stirrups and he even describes the necessity of
having another woman inside the room as a crazy clinical rule.
Moreover, his
insensitivity continues while doing the examination and has felt and large mass
and shouts “Jesus” which is certainly something that a patient doesn’t want to
hear. In this case, the principle of
nonmaleficence has already been neglected and his care towards Vivian was
never Patient-Centered but more of Research-centered.
And for me, the scene
where there is a grand round is also unethical because here, Vivian is being
touched, poked and discussed in the third person as if she is not present.
Moreover, Dr. Kelekian who
is the consultant of Vivian Bearing and at the same time lead researcher should
have clearly and specifically discussed and considered ethical considerations
such as Freedom from exploitation;
He should have reassured Vivian that the information or data that will be
gathered from her will not be used against her or in unjust manner.
The
research should cause no harm to
Vivian which it really did not happen in the film because Dr.Kelekian and Dr.
Posner are totally focused on their research blinding them from their
therapeutic obligations towards Vivian such as hospice care and they did not
even consider lowering the drug dose of Vivian even though she has severe fever
and is particularly unwell.
Both doctors even push Vivian to her limits giving
her 8 full doses of Hex-ametophospacil and Vinplatin which are both strong
chemotherapeutic drugs. Risks to the
research participant was not also considered knowing that full dosage of
the strongest chemotherapeutic that he offers has not been tested and used to
anybody before.
Moreover, research consideration of benefits to the research participant is not guaranteed and this had
even more put Vivian at risk. The experimental combination of chemotherapy did
not even benefit Vivian and this was not also discussed by Dr. Kelekian and Dr.
Jason. It is important to ask the question; ‘Who
benefits most from the continuation of the treatment regime, Vivian or the
research?’ Risk-Benefit Assessment was not even
done by Dr. Kelekian and Dr. Jason.
The risk was more than the benefit that
Vivian could possibly receive and such risk benefit ratio was not presented at
the initial discussion of the consultant/researcher to the client which is
Vivian. Right to Self-determination
was not even disclosed, this right was not discussed and the option of
withdrawing and refusing from the said experimental combined chemotherapy
treatment was not given to Vivian.
Vivian at that time was a highly vulnerable
patient because she has been diagnosed with Advanced Stage 4 Metastatic Ovarian
Cancer, as she herself notes that there is no Stage 5. In this case Vivian may
cling to any treatment which may offer a therapeutic benefit. At the same time, Right of the patient to full disclosure was not observed.
Dr.
Kelekian implied that there is no other treatment option through his lines
“this is the strongest thing that we have to offer you”; in such instance the principle of autonomy was also
neglected. Such circumstances did not even promote fully autonomous informed
consent without coercion and the boundaries were sufficiently blurred to tempt
patients to apparently helping themselves with the endeavor to help others.
The therapeutic intent proposed by the
experimental treatment in this scenario, is often called ‘therapeutic misconception’. It describes the tendency of patients
involved in high risk therapy trials to believe that such treatment was
designed for their personal health care, whereas such trials may, in fact, offer
them little or no direct benefit.
The
Doctor’s did not even become truthful about the treatment’s lack of success.
These doctors may have learned a lot for their research but they fail to
explain to Vivian that there isn’t a good treatment for Vivian’s condition.
This indicates that her consent was not informed and that they made her believe
that the treatment was more curative than it truly was.
Right to Privacy was not also observed by Dr. Jason, he just do his
diagnostic /physical examinations, his grand rounds explanation, his
interventions without even reassuring the privacy of Vivian and without even
explaining the course of action that he will do and at the same time without
even asking Vivian about her decision and insights regarding those
interventions and examinations. In such case, Freedom from harm, respect for autonomy and justice might as well
beneficence was neglected.
Conflicts
of Interest are very much obvious in the film wherein they are in
pursuit of patient-centred beneficence, seeking to maximize patient care and
welfare. On the other, they wish to push back the boundaries of scientific
knowledge. There is a divergence between patient care and the drive for
research and scientific knowledge. The first and most prominent is that of ‘professional integrity’.
The
relationship between the investigator and the patient must be ethically sound
and decisions must be made with the greatest moral scrutiny to ensure patient
nonmaleficence, however this in such manner was also neglected. Moreover, distinct lack of empathy was also
illustrated by Dr. Jason as he shows inability to see the fear and suffering
faced by Vivian. In addition, Respect for Autonomy and Justice was given by
Susie as she raises the question about the code status which involves two
options which Full Code (resuscitation) or DNR (Do Not Resuscitate). However,
Dr. Jason still continued to resuscitate Vivian at the end of the film because
he considers Vivian as research. The
film shows that special moral problems can arise when physicians recruit their
own patients as research subjects due to the fact that a possibility of coercion and exploitation seem especially great when using their own patients.
The film also shows that a hospital’s
provision of patient care can possibly be compromised by its commitment to
teaching and research, however, balance between these two should be observed
and there should be no conflicts of interest. Moreover, when it comes to human
subjects or patients, health care professionals should always be guided by the
four major bioethical principles and at the same time governed by the
Hippocratic oath which focuses on doing no harm.
At some point, I was also able
to realize that as a healthcare professional we must not only guide and provide
a quality and life full of dignity for our patients, we must only prepare them
to a quality and dignified death having no pain or distress as well as harm
done or being done to him/her.
Moreover, Nurse Susie has
become one of the ideal examples of being a nurse; she has shown support to
Vivian Bearing up to the patient’s last breath. Still, the essence of being a
nurse was portrayed in the film where these unbranded professionals nowadays
were shown of greater importance during those hard times of Vivian Bearing.
In terms of the psychosocial
aspect of Vivian Bearing, it must have been very hard on her part and if I were
her, I would really feel neglected and at the same time disrespected and those
things that were done to her were beyond being professional and will really
make you feel less of a person.
Life has been a constant cycle, you will never
know when and where are you going to need help and empathy from all sorts of
people. One of the few lessons that I’ve learned from the movie was that,
whether who and what position you are holding, one must learn to be
compassionate and people oriented and someone who is sensitive to feelings and
status of other people, in that way, it would be a great give and take
relationship in our society.
In every human relationship,
there are certain duties and rights that must be observed in order to maintain
a harmonious, just and orderly relationship.
