(Adapted from the stage play by Brian Clark)    (Video Clips included)

This film discusses the most important ethical issue- that of quality of life versus death.  This topic is presented with class, considerable angst, and comedic elements by a group of the most talented actors ever!  Richard Dreyfuss, Christine Lahti, John Cassavetes and Kenneth McMillan are the main characters in this life drama. They illustrate the dichotomy of a man’s dignity and intellect as being more important than the medical credo, ”Thou Shall Preserve Life at all Costs.” Indeed it defines what life truly is…  The viewer realizes that this film was ahead of its time, with many layers of relationships and touching scenes.  On the other hand, it is caught in the time warp of 1981.  I dare say, this would be a very different film if made in 2012.  But, that’s part of the emotional pull… not as many resources…just raw realities.

“Whose Life…” is like an unfinished quilt… It opens in Boston with a horrible car accident in which Dreyfuss’s character, Ken Harrison leaves his worksite, distracts his eyes from the road to tune the radio and collides… goes underneath a trailer truck- “Decapitated car.” You see retrospective glimpses of Ken’s life as a sculptor which totally defined his life…  and reason for existence.

He appears to have a C-4 complete injury, which translates to total paralysis – quadriplegia; (Not initially stated in the movie.) ***Below is a general guideline regarding what functions (2012 technologies) may be present/ absent with variability, based on weight, pre-existing medical conditions and age.

Reference: http://www.apparelyzed.com/quadriplegia-quadriplegic.html#quadriplegic-levels;

Mobility and Movement 

• Full head and neck movement depending on muscle strength. Limited shoulder movement.
• Complete paralysis of body and legs. No finger, wrist or elbow flexion or extension.
• Sympathetic nervous system will be compromised possibility of autonomic dysreflexia.          ( i.e. during  emergency situations, symptoms include hypertension, slower than normal heart rate,  headache, and sweating).
• Electric wheelchair may be controlled by either a chin or “sip and puff” controller, this will vary depending on dexterity.
• The person will require total assistance when transferring from a bed to a wheelchair and from a wheelchair into a car. A hoist will have to be used, possibly by two assistants for safety.
• Complete assistance required during mealtimes.

 

Respiratory System

• Able to breathe without a ventilator using diaphragm;
• Assistance required to clear secretions and assistance in coughing will be required.

Personal Care

• Complete personal assistance is required. The person will need assistance with washing, dressing, and assistance with bowel and bladder management.

Domestic Care

• Complete domestic care is required, such as household cleaning, washing of clothes and kitchen duties, preparation of meals and general household duties.

Communication

• A computer may be operated using iris recognition, mouth stick or voice recognition. Telephone can be used using voice recognition and headset.

The Sculptor…The Story Continues…

This artistic, intellectual man tries to convince “the audience” and every medical professional, that following the official diagnosis of quadriplegia, “the handwriting is on the wall”… (i.e. Life is no longer worth living …and he wants to die on his own terms). Dreyfuss’s character believes he has all of his faculties and remains steadfast in his belief… his right to do as he chooses. If there is no hope for recovery, nor any means to lead a productive life as he defines it, than he should have the right to control his destiny… and ultimately die without being sustained by “machines.”

As one can imagine, this story pushes all of the moral and ethical hot buttons.  In fact, there are no  “right answers.” Christine Lahti pays Dr. Claire Scott, while John Cassavetes  portrays the tough minded Rehabilitation physician.  Throughout, Dreyfuss uses his comedic talents –as his character using the only and most effective equipment he has at hand – his mind and his voice.  Ken Harrison tries to manipulate others  caught up in his hopeless situation…  He jokes, cajoles and flirts with every woman (from 12 years  old to 50+). Dr. Scott initially coveys the medically accepted practice to “keep him comfortable.”  And then, she becomes emotionally involved; she lets her guard down… which is a dangerous undertaking.  She goes to his studio, speaks to his former girlfriend… and becomes more conflicted. The patient obtains an attorney who “aids and abets” Ken Harrison’s cause.

A court hearing is held in the hospital. These scenes are among the most pivotal and moving. Dreyfuss, as Harrison delivers an articulate and heart wrenching narrative to the judge, who must decide if, given former legal precedents, he can agree to his request.  Psychiatrists play a role.  However, in the final analysis the judge must decide on Harrison’s competence – whether his thinking is influenced by a depressive state…. or not.

Excerpt from Ken Harrison’s Appeal 

“I do not want to die because as far as I’m concerned, I’m dead already. I’m only asking to be discharged and left alone. I’ll never have the chance to direct a good God damned thing. The most important part of my work was my mind, my imagination – my best asset. I used to love women and how they thought, how they looked, how they smelled. Now my mind tortures me with what might have been… I want to be set free.”

Ladyjustice has a permanent disability that is technically considered paraplegia with distinct physical limitations. However, does her medical diagnosis truly limit her? No… mind over matter.  This writer “finds a way” in each and every instance…gives up or asks for assistance if the situation potentially presents a danger to her.  Regarding the legal, moral and ethical faced by quadriplegic patients (4 limbs), each individual must decide individually as they struggle with  their own moral compass. .

[Ladyjustice happens to know one family who is currently facing this excruciating situation now  with a young son.]   This writer truly does not know how she would feel if this situation was thrust upon her. Having a pre-existing disability provides experience, insight and some perspective…  BUT, it does not mean that as disabled persons, we are something akin to the “great and powerful OZ who knows all… “  As a former clinical speech-language pathologist, Ladyjustice has seen many  “good minds trapped in bodies” that either would not move or were unable to accomplish controlled movements.  ‘Talk about prison!

Keep in mind that this film was made well before the age of technology.  In real life, depending upon the specific location of the spinal cord injury, there may be some hope of recovery of partial function… to the very rare occurrence of full recovery of such injuries.   Electrical stimulation of muscles and the use of stem cell research appear to be among the methods commonly exhibiting promise with current research.

Reasons for Hope

The following are a few examples of hope for the future. Be advised, one should resist the temptation to “put all your eggs into any one basket,” as research is just beginning and success is often with rodents or on a very limited human basis.

1)       (October 2011) FLAMES- Floating light activated micro-electrical stimulation.  This new wireless technology,, first of a kind,is now in its third year of development under a four year NIH grant.  Such tiny micro-stimulators can activate nerves in the spinal cord below the site of injury.  They are energized by a beam of  infrared light through an optic fiber located adjacent to the spinal cord.  After the device is implanted, they can “float in the muscle tissue.”  The patient pushes a button on an external unit, which triggers the laser beam which activates the FLAME device.  They are very small (sub-millimeter). The devices will not deteriorate, as they are wireless and cause minimal tissue irritation.  As this equipment advances to the clinical stage, spinal cord injury patients will be able to regain critical functional skills.  Link: http://www.sciencedaily.com/releases/2011/10/111017133804.htm

 

2)       (May 2012) A single case reported in the Journal of Neurosurgery by Dr. Susan McKinnon of St. Louis related the groundbreaking news that helped to restore some limited hand function by “detouring nerves” so-to-speak.   When someone is injured, if nerves remain connected to the spinal cord, to provide support and nourishment, they can remain healthy, even years after the injury.

 

Two years after intensive physical therapy and the initial injury, Dr. McKinnon re-routed nerves running parallel to nerves at the C-7 site of injury and connected nerves from the upper arm above the injury, thus enabling them to “communicate with the brain.”  This is a revolutionary technique previously not attempted.  By removing the communication barrier at the site of injury, the patient was able to move/bend the thumb and index finger.  The pincer grasp aids people in using utensils, eating and writing, as some examples. Link: http://www.sciencedaily.com/releases/2012/05/120515104500.htm

 

3)      Stem cell implantation is underway in Zurich, Switzerland with 12 spinal cord injury patients in a multi-year clinical trial.

 

4)      Another area of endeavor involves suppressing tissue inflammation by blocking proteins in the immune system, allowing for improvement in those recovering from catastrophic injuries.  Preliminary work with rats/mice demonstrated significant gains in walking when a different protein was suppressed following exercise.  Hopefully, such examples can translate to humans in the future.

 

Back to the Movie…

The judge makes his decision… Ladyjustice will not reveal the outcome.  If you are reading this account, you really should rent the movie.  The aftermath… and how it is dealt with by the hospital staff and “the viewing audience” may or may not be predictable… or the ending one wants to see.  However, it is well worth the time… if not for the many lessons taught and the “but for the grace of God go I.”

 

 

Links to the Movie 

http://www.youtube.com/watch?v=LOJLi6_aBUo;