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Reviews - Summer 2015

Wit — a film review, analysis and interview with playwright margaret edson.

By S.A. Larson, Doctoral Student

A Note on the Review

Although this review will focus on the 2001 HBO film adaptation, instructors have two mediums to choose from when considering how to incorporate Wit into the classroom: the 2001 adaptation of the play (available for free on Youtube) and Margaret Edson’s 1993 stage play of the same name (available at most libraries and for purchase through online book sellers).

Nichols, M. Wit [Movie]. Youtube. https://youtu.be/u0PPvYlGqL8. Published May 3, 2013. Accessed July 6, 2015.

Edson, M. Wit . New York: Faber and Faber, Inc.; 1993.

Film Summary

“You have cancer.” These are the words that open the 2001 HBO adaptation of Margaret Edson’s Pulitzer Prize-winning stage play, Wit . The adaptation, directed by Mike Nichols and starring Emma Thompson, tells the story of Dr. Vivian Bearing’s final weeks of life as she undergoes eight months of rigorous, and often painful, experimental treatment for Stage IV metastatic ovarian cancer.

In the film, Dr. Vivian Bearing is an accomplished professor and scholar of seventeenth century poetry. Despite her success, she has lived a life of isolation, seeking company among books rather than her peers. Her isolation leads her to seek solace in the viewer. Throughout the film she speaks directly to the camera (a stand-in for the viewer), confessing, reflecting, and even bantering to the viewer behind the lens.

Dr. Kelekian diagnosing Professor Bearing. Photo Credit: HBO Films, 2001

The film’s opening scene progresses at a rapid pace. In terse, sober dialogue Dr. Harvey Kelekian diagnoses Professor Bearing. Less than a beat later Dr. Kelekian begins explaining an experimental research protocol. Shocked from the sudden blow of her diagnosis, and not having had time to fully process the situation and assess her options, Dr. Bearing agrees to participate, hesitantly glancing down at the first page of the protocol before signing her name.

Because she is part of a clinical study, the film is set in a research hospital and focuses on Professor Bearing’s musings, reflections, and flashbacks as well as her interactions with her primary care providers. After the diagnosis scene, the viewer is introduced to Professor Bearing’s other contrasting primary care providers: the bumbling, awkward, research-minded resident, Dr. Jason Posner and the patient-focused nurse Susie Monahan.

The film also introduces a number of characters through a series of flashbacks. These scenes transport Professor Bearing through time and space. In a central flashback Professor Bearing returns to her time as a timid undergraduate being chastised by her professor, the prolific scholar of seventeenth century poetry, Dr. E.M. Ashford. It is in this scene that the semicolon, which provides a framework for the development of the major themes of the play and insights into each character, is first introduced. Through scenes portraying various aspects of clinical evaluations, medical tests and cancer treatment, the film artfully crafts the identity of the characters pulling the viewer toward a deeper understanding of each person’s struggles individually and with each other as the film progresses.

After a stepwise and measured decline, Professor Bearing’s life ends in a moment of chaos. This climatic final scene vividly portrays each characters’ reckoning with their own sense of self. Despite her “do not resuscitate orders (DNR)”, Dr. Posner calls a code when he discovers her heart has stopped. With a final emphasis on the disconnection between medical provider and patient, the viewer realizes that the resident’s resuscitation attempts are motivated by the desire to prolong his research rather than by any emotional connection to Professor Bearing. In contrast, the quietly confident Nurse Monahan (the only care provider who assumes the patient advocate role) rises up courageously against the medical team’s ill-fated efforts and forcefully cancels the code. The film ends with the camera zooming in on the heavily lighted face of Professor Bearing’s corpse, then slowly fades into a black and white photograph of Professor Bearing at a time prior to her cancer diagnosis, wearing a slight grin, her eyes open, leaving the viewer with an image of a woman finally unburdened by her bodily struggles with cancer, who has accepted her vulnerabilities and the care and comfort of others.

“Nothing but a breath”: The Significance of the Semicolon in  Wit

Wit is not a story of survival. Instead, the film deconstructs the typical tale of staying strong through cancer treatment, overcoming the odds, and surviving. The film skillfully constructs a story of repair and restoration of the individual not through treatment of the body ravaged by cancer, but by admitting one’s weaknesses, exposing oneself, and, perhaps most frightening of all, relinquishing control and, in the process, becoming vulnerable. In the end, one is left with the feeling that the main character of the play is being “healed, not cured” (M. Edson, Personal Communication, March 13, 2015).

On March 13, 2015 we sat down with Margaret Edson, the playwright whose 1993 stage play, Wit , served as the source material for the 2001 HBO film in her home to discuss her play and the subsequent HBO adaptation. Reflecting on her writing, Edson characterized Wit as a struggle between herself and her creation, Dr. Vivian Bearing. While Edson relinquished creative control over the film adaptation of her work, the film still retains this conflict between character and creator through the use of flashbacks that often interrupt the present hospital setting of the play. In these scenes, Professor Bearing seems to wrest control from Edson and become the director by staging the action and interjecting her own commentary. According to Edson, “We understand as much as our previous experience prepares us for.” Rather than admitting that she is feeling vulnerable, or does not understand what is happening in the hospital environment, Professor Bearing uses flashbacks to cope with the unfamiliar and regain her power by situating the unknowable present in the knowable past.

Professor E.M. Ashford dramatically explaining the importance of punctuation in John Donne. Photo Credit: HBO Films, 2001

One particularly striking flashback occurs shortly after Professor Bearing has been diagnosed with an advanced stage of cancer by Dr. Harvey Kelekian, her attending physician, and has consented to participate in an experimental treatment. This is the first step in Professor Vivian Bearing’s shift from a position of comfort in her identity as a “doctor of philosophy .  . . a scholar of seventeenth century poetry” who has “made an immeasurable contribution to the discipline,” to the unfamiliar and uncomfortable position of patient and specimen. Professor Bearing contextualizes this discomfort by remembering the early uncertainty she felt as an undergrad interacting with her professor, the renowned senior scholar of Metaphysical Poetry, Dr. E.M. Ashford. Using an “inauthentically punctuated” translation of John Donne’s “Holy Sonnet Six” she misinterprets Donne’s famous line: “ And death shall be no more, Death thou shalt die ” and is chastised for her unscholarly work. In the edition Professor Bearing’s version uses, the poem is punctuated by a semicolon while in the “authentic” and correct version used by Dr. Ashford, the poem simply uses a comma. This seemingly trivial difference in punctuation produces deep insight into the larger theme of the play and is beautifully articulated by Professor Ashford in the following lines:

Nothing but a breath–a comma–separates life from life everlasting. It is very simple really. With the original punctuation restored, death is no longer something to act out on the stage, with exclamation points. It is a comma, a pause.

This way, the uncompromising way, one learns something from this poem, wouldn’t you say? Life, death. Soul, God. Past, present. Not insuperable barriers, not semicolons, just a comma.

Professor Ashford’s proclamation describes Professor Bearing’s own struggle with her humanity and her mortality. She has worked so hard to conceal her vulnerabilities that passing into a state where she does admit her weakness and humanity seems like an insuperable barrier comparable to the semicolon Professor Ashford discusses. Thus, when Professor Bearing begins her treatment, she views death and weakness as adversaries that she must fight against. Even though she has had to leave her job as a professor, is in severe pain, and alone, she maintains a strong front by demonstrating her intelligence through wit. It is not until the end of the play, after she has been almost entirely broken that she finds a moment of clarity and realizes that “insuperable barrier,” the one she has been struggling with her entire life and throughout treatment is a simple comma, a simple acknowledgement of one’s humanity through raw vulnerability.

Dr. Ashford read to “Vivian.” Photo Credit: HBO Films, 2001

Professor Bearing’s moment of clarity is not grand or epic. Indeed, it is a simple moment painted with touches of childhood. In this scene, which takes place toward the end of the film, Professor Ashford pays Professor Bearing an unsolicited visit. A light, peaceful lullaby-like melody plays in the background. Shortly after the arrival of her old mentor, Professor Bearing quite literally takes a breath, pauses, and transitions from her guarded, isolated state to one where she is fully exposed. This moment occurs when Professor Bearing admits, after a pause and then a long exhalation, “I feel so bad” and lets roll a single tear. For the remainder of the scene she is completely exposed in her vulnerability. This scene is free of wit and displays of intelligence. Instead, Professor Bearing whimpers, and allows Professor Ashford to comfort her. Thinking she will find solace, as always, in the classics, Professor Ashford offers to recite one of Donne’s sonnets. However, now that Professor Bearing is vulnerable, without any pretenses or façade to maintain, she refuses the offer and instead welcomes Professor Ashford’s reading of the children’s book The Runaway Bunny .

Professor Bearing’s moment of vulnerability is directly related to her death. In the scene that follows, Dr. Posner discovers that Professor Bearing is dead. There is no transition between her scene with Dr. Ashford and the discovery of Professor Bearing’s corpse. In fact, much like Professor Ashford’s meditation on commas and death, Professor Bearing, after her moment of vulnerability, passes from life to death off screen (not acted out on stage), free of drama. It is only after she accepts her humanity and weakness that she can also accept her mortality.

Although Professor Ashford is discussing life and death, her words have a powerful tie to the world of rehabilitation medicine and would be useful for students to evaluate. While the end result of rehabilitation therapy is often a larger goal, the day-to-day clinician-patient interactions center on small achievements and using those small steps to progress to the larger goal. Patients and clients are not attempting to “overcome the seemingly insuperable barriers” in one step, but rather, are focusing on the daily small goal of passing beyond the point of the comma.

The Platinum Rule: Patient and Care Provider Interactions

Wit is more than a case study of an individual struggling with experimental cancer treatment and, in the process, her humanity. The play also depicts Professor Bearing’s interactions (or lack thereof) with her primary care providers Dr. Harvey Kelekian, Dr. Jason Posner, and Nurse Susie Monahan.

A still from the Grand Rounds scene in which Professor Bearing’s body is used as a text. Photo Credit: HBO Films 2001

With her characteristic dry wit, she reflects on the depersonalized nature of the hospital: “in Grand Rounds, they read me like a book. Once I did the teaching, now I am taught.” Despite Professor Bearing’s seemingly compulsive need to repeat her credentials to herself, in the hospital, and in the world of research she admits that “What we have come to think of as me is, in fact, just the specimen jar, just the dust jacket, just the white piece of paper that bears the little black marks.”

Through her series of flashbacks, Professor Bearing gradually becomes aware that she is guilty of the same inhumanity that readers are so apt to critique her primary care providers for exhibiting. In a sense of new self-awareness, she contextualizes Dr. Jason Posner’s view of patients as specimens with a scene in which she, herself, fails to appreciate or even recognize the humanity of her students. Ultimately, she realizes her behaviors as a professor were not that much different than those she is experiencing from her medical team.

In our interview for JHR , Edson described the essential nature of the human interaction between patient and clinician when she reflected on her own job as an aide in the physical therapy department of a community hospital, and as a physical therapy patient after separating her shoulder: “What makes me believe that I can try? It is my relationship with you . That really is all that I have. You make me feel that way – that I can try” Edson believes that Nurse Monahan successfully practices such a relationship ethic with Professor Bearing. While she may not have the academic intelligence of the research doctors or the scholarly and accomplished Professor Bearing, she is the backbone of the research hospital due to her combined skill and sensitivity.

While most are familiar with The Golden Rule (Treat others the way you want to be treated), Edson, in our interview, invoked The Platinum Rule (Treat others the way they want to be treated) and its importance in patient-clinician interactions. Nurse Monahan seems to best embody The Platinum Rule in the film adaptation of Wit . Rather than dehumanizing or patronizing Professor Bearing, Nurse Monahan seems to empathize with her patient. She seems to anticipate her patient’s needs, and the way Professor Bearing herself would wish those needs to be fulfilled.

Nurse Monahan and Professor Bearing sharing a deeply personal moment while discussing “Vivian’s” DNR. Photo Credit: HBO Films, 2001

Extracting this theme of human interaction from the play, Wit can be used to challenge students to examine the effects of their interactions with others in the classroom, clinic, and community. How do we address our patients? Can a simple choice of words actually influence our interactions to such an extent as to impact our therapeutic outcomes? For example, Students could examine the way Dr. Kelekian and Nurse Monahan each address Professor Bearing and how their respective addresses could influence patient-primary caregiver interactions. From one of the introductory scenes in the film, Dr. Kelekian addresses Professor Bearing as Dr. Bearing rather than using her first name. This act of professional respect is a silent acknowledgement of the rigor of their respective fields, their shared dedication to their scholarship and creates a collegial intimacy that drives their relationship throughout the play. In contrast, Nurse Monahan begins her relationship with Professor Bearing by using the respectful address of “Ms. Bearing.” It is not until Professor Bearing reaches the end of her life that she and Nurse Monahan shift their addresses to one another to the more significant and intimate “Vivian.”

Students could also trace the way Professor Bearing’s interactions with her three primary caregivers are depicted. They can critique each interaction, compare and contrast them, and perhaps even take the time to rewrite the way they would have handled the interaction had they been in the primary caregiver’s position.

“Pressing to the edge”

Interestingly, Edson shared that her first job was as a physical therapy aide. When reflecting on this early work, Edson observed, “The world of physical therapy, it seems to me, is incremental progress; is small steps, small improvements toward a distant goal.” Throughout the play Professor Bearing’s transformation into a human who has lived and is willing to admit her vulnerability is achieved through a similar series of small steps through a form of what Edson calls spiritual physical therapy. According to Edson, by the end of the play, Professor Bearing has been “pressed to the edge of what she feels safe doing and then has to do one more thing. And that’s where we grow, at the margin there, at the zone of discomfort. If there’s too much of that destabilization, then we retract, but if there’s the right amount that’s where our growth comes.” Nurse Monahan, who, with her gentle patience stands steadfastly by her side, becomes that clinician who pushes Professor Bearing just enough to help her grow. Their relationship allows for Professor Bearing to realize that truth that Edson describes: “the risk of your own weakness is the beginning of your own increase of strength.”

Practitioners, Patients, and Playwrights

“physical therapy is such a dialogue; it’s just the two of you and you’re talking about it and you’re doing it together.”.

According to Edson, “Studying theater is the best way to see what it’s like to be somebody else; to pretend to be somebody else.” By incorporating playwriting and acting into the PT curriculum, faculty can help students explore their growth as clinicians, grapple with their mistakes, and even gain a better sense of empathy and understanding for their patients.

Instructors can incorporate a multimedia approach to Wit by asking students to read a scene from the stage play and then watch the same scene from the film. In a simple compare-contrast exercise students can pair up and examine the differences and similarities between both mediums. Students can use this analysis to start a dialogue about the different insights they gained from the different mediums.

Improv is a low-stakes introduction to acting and playwriting for PT students. Students can take turns occupying certain roles such as: patient and practitioner, practitioner and a patient’s family member, and practice presenting unscripted interactions in front of the class. This short exercise would challenge the acting students to think from new perspectives while also giving the class the opportunity to give feedback on the scene.

The cover of Edson’s 1993 play

Edson suggests asking students to read various scenes from Wit, occupying different roles with each reading followed by a discussion of how their feelings and understanding of the situation changes with each character. There are two scenes in particular that lend themselves well to this exercise in empathy. The first, known as the “Popsicle Scene” occurs toward the end of the play when Nurse Monahan and Professor Bearing discuss code status. The second scene opens the play and depicts the interaction between Dr. Kelekian and Professor Bearing the moment she receives her initial diagnosis and makes the decision to sign on for an experimental research protocol.

Edson believes that actual playwriting can challenge students to become better listeners and more empathetic clinicians. “What playwrights do is imagine what other people say, imagine the thoughts and utterances of other people. And that’s what compassion is.” By asking students to write a scene in which they interacted with a patient, they will be forced to recall what their patient said and help to explore new strategies to improve listening skills. Further, by writing from the perspective of their patients, students are given practice empathizing with others. They must remove themselves from the authoritative position of clinician and truly feel what it is like to be the person on the receiving end of that knowledge.

Students can use playwriting to chart their progress as clinicians by composing a scene in which they consider how they would act in a certain patient situation before going on clinical rotations, then reconsider the scene after they have gained clinical experience, reflecting how they actually experienced that patient interaction. This style of writing can be an effective tool for students to grapple with challenging or disappointing situations during the clinical rotation. One of the most dreaded questions that one can ask is “Tell me about a time when you made a mistake.” Playwriting offers a creative approach to facilitate this reflection with students, asking them to compose a scene in which they reenact that mistake. To give students a clear perspective of the event, the scene should be composed using a stand-in character in place of the student herself. The instructor could then distribute the scenes to students who did not write the play and ask them to take turns performing the mistake as both the clinician and patient. During these performances the players, writer, and audience could work together remedy the situation thus making this a learning experience for the entire class.

In all, playwriting holds the potential to help students build a community in which they share and engage with one another’s work and in the process learn from the experiences of their peers.

Biography of Margaret Edson

Margaret Edson Photo Credit: Dave Smiley

Margaret Edson was born in Washington, DC in 1961. Between earning degrees in history and literature, she worked as a unit clerk on the cancer and AIDS in-patient unit of a research hospital.  Wit, written in 1991, is her only play. Edson has been a public schoolteacher since 1992.  She currently teaches sixth-grade social studies in the Atlanta Public Schools.

Timeline of  Wit Productions and Awards

Wit was written in 1991 and first premiered at South Coast Repertory, Costa Mesa, California in 1995.  It was produced in New York in 1998 and received the Pulitzer Prize for Drama in 1999.  The HBO production, featuring Emma Thompson, won the Emmy Award for best film in 2001; it is now available on You Tube. Wit was revived on Broadway in 2012, with Cynthia Nixon in the lead role.  The play has received hundreds of productions in dozens of languages.  The text is widely used in teaching, ranging from high- school English to graduate bioethics seminars .

About the Author(s)

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S.A. Larson

S.A. Larson graduated from Purdue University in West Lafayette, Indiana with a Bachelor of Science in Psychology and Bachelor of Arts in English Literature in May 2013. She is currently pursuing a doctoral degree in English Literature and a certificate in Bioethics at Emory. Stephanie is interested in interdisciplinary research and collaboration that explores the intersection between the humanities and medicine/healthcare. She is particularly interested in the ways medical and allied health students and professionals can use literature and film in the classroom and in clinical work. Her current research interests include literature of the American South, disability studies, film studies, and bioethics.

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The Anatomy Studies of Thomas Eakins

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By Angela Fritz, MA

Thomas Eakins, Self-Portrait, 1902, oil on canvas. National Academy Museum and School.

Since ancient times, art and science have shared common boundaries; many famous artists have used scientific experimentation to understand their surroundings more fully. Thomas Eakins (1844-1916) was one of these artists, who considered his interest in anatomy, perspective, dissection and motion in direct relationship to his artistic output. In fact, some of his most famous works are those depicting the surgical amphitheater classrooms of that time period.  Today he is considered one of the most significant American artists of the late 19 th century.

Thomas Eakins’ interest in draftsmanship began at an early age, and like most serious American artists of the Victorian era, he eventually travelled to Europe for more formal training.  Interestingly, he was not taken in by the loose brushwork and bright colors of the groundbreaking Impressionists.  He was a traditionalist at heart, and his artistic focus was a sense of realism primarily based in scientific observation.

Eakins became a drawing and painting instructor at the Pennsylvania Academy, where he encouraged his students to use the new medium of photography in order to aid their own understanding of anatomy and motion. He, himself, was fascinated by the lingering information a photograph could provide an artist. For a time, he worked alongside Eadweard Muybridge, famous for his sequential photos of bodies and animals, and an early developer of moving pictures. Eakins’ particular interest in the human form, however, led the artist to go on to develop his own technique for taking multiple images of a body in motion and layering them in one single image.  He felt seeing the images so close together gave a better understanding of actual movement.  In fact, his work, “Motion study: Male nude metallic markers attached to his body, running to left, 1885” is much like images produced today – over a 100 years later – in gait analysis labs.

Thomas Eakins, Motion study: male nude, metallic markers attached to his body, running to left, 1885. Courtesy of the Pennsylvania Academy of the Fine Arts.

It made sense for Eakins, who was an athlete himself, to marry his photographic techniques with his passion for sports in his oil paintings. The resulting images frequently show figures scantily clothed in a variety of physical poses.  He painted rowers, wrestlers, and swimmers and amassed an enormous collection of photographic studies. As an example of the integration of his photographic studies with his artistic work, the “Biglin Brothers Racing” painting is a thoughtful and accurate portrayal of the physicality of sport. The curators of the National Gallery of Art in Washington, D.C., where the painting is on exhibition, offer information on the painting’s composition and its social context:

In the decade following the Civil War, rowing became one of America’s most popular spectator sports. When its champions, the Biglin brothers of New York, visited Philadelphia in the early 1870s, Thomas Eakins made numerous paintings and drawings of them and other racers. Here, the bank of the Schuylkill River divides the composition in two. The boatmen and the entering prow of a competing craft fill the lower half with their immediate, large-scale presence. The upper and distant half contains a four-man rowing crew, crowds on the shore, and spectators following in flagdecked steamboats.

Himself an amateur oarsman and a friend of the Biglins, Eakins portrays John with his blade still feathered, almost at the end of his return motion. Barney, a split-second ahead in his stroke, watches for his younger brother’s oar to bite the water. Both ends of the Biglins’ pair-oared boat project beyond the picture’s edges, generating a sense of urgency, as does the other prow jutting suddenly into view.

Thomas Eakins, The Biglin Brothers Racing, 1872, oil on canvas, Courtesy National Gallery of Art, Washington

Ultimately, his honest and unorthodox approach to teaching about the nude figure (giving men and women equal access) lost him his job and damaged his reputation.  Time has healed that reputation and we now see the important advancements he made using our understanding of the human body in motion to inform the portrayal of the body in art .

For further information on the life and work of Thomas Eakins, please refer to the list below:

• Foster KA.  Thomas Eakins Rediscovered.  New Haven, CT: Yale University Press; 1997.
• Goodrich L.  Thomas Eakins.  Vol 1 and 2. Cambridge, MA: Harvard University Press; 1982.
• Sewell D.  Thomas Eakins.  Philadelphia, PA: Philadelphia Museum of Art; 2001.
• Rosenheim JL. Thomas Eakins, artist-photographer, in the Metropolitan Museum of Art.  Metropolitan Museum of Art Bulletin . 1994-1995; vol. 52, no.3:44-51 .

1. Thomas Eakins: Motion study: Male nude metallic markers attached to his body, running to left. Pennsylvania Academy of the Fine Arts Web site.  http://www.pafa.org/museum/The-Collection-Greenfield-American-Art-Resource/Tour-the-Collection/Category/Collection-Detail/985/coltype–Ephemera/mkey–433/pageindex–4/ . Accessed January 26, 2015.

2. Thomas Eakins: The Biglin Brothers Racing.  National Gallery of Art Web site.  https://www.nga.gov/collection/gallery/gg68/gg68-42848.html . Accessed January 25, 2015.

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Wit Film Reflection

The movie Wit is about an English Literature Professor, Dr.Vivian Bearing, a scholar of seventeenth century poetry. Vivian is diagnosed with stage IV Ovarian Cancer. Throughout the movie, she reflects on her life, and viewers witness her painful journey as she endures eight months of brutal/intense experimental chemotherapy treatment. The manner in which Vivian was treated by most of the healthcare providers in charge of her care was heartless, inhumane, insensitive, callous, and unprofessional to say the least.

Wit begins with Dr. Kelekian delivering the diagnosis of cancer to Vivian, he was condescending and assuming when Vivian asked him to go on, and Dr. Kelekian responded “you are a professor”. Such response was unprofessional, and suggestive that because she is educated and is a scholar, Vivian should automatically know the severity and details of such diagnosis. The doctor continued to use medical jargon as he communicated with his patient, and rambled about the experimental drug treatment that they are developing.  Dr. Kelekian did not allow Vivian to gather her thoughts or explore feelings. He then informs Vivian that as research, the treatment she’s to receive, will make a significant contribution to their knowledge. Therefore, the primary focus is not the patient, but the doctors/researchers. Vivian’s autonomy and right to choose was violated and taken away. She should have been afforded the opportunity to go home, think about what was discussed, and then decide what is best for her, not the researchers. She was denied the opportunity to grieve, be angry, and express her inner thoughts, and feelings.

Next, Vivian encounters Jason, Dr. Kelekian’s Fellow, and former student of Vivian. Jason’s behavior was awkward and subpar, not to mention unprofessional. After questioning Vivian about her medical history, he attempted to perform a vaginal exam without obtaining patient’s verbal consent, or explaining the procedure to her. He then realized the need for a female to be in the room during such examination. Jason ran out to get Nurse Susie, left the door open for several seconds, exposing Vivian with her legs up in the stirrups, before closing the door. Upon entering the examination room, the nurse immediately chastised Jason for leaving the patient in such an uncomfortable position. During the vaginal exam, Jason focused on himself, rather than the patient. He talked about how well he did in Vivian’s class and how great taking her class looked on his transcript. Once again, Jason failed to display compassion and professionalism that’s expected from one of such profession. He should have maintained eye contact with his patient, made her comfortable/put her at ease, asked if she was in pain, and explained in layman’s term what he was doing, as he  performed the procedure. To make matters worse, after completing the exam, he took off his gloves, stated he had to leave, and then exited the room without washing his hands. Additionally, Jason left without discussing his findings with Vivian, and did not afford her the opportunity to ask questions.

Anger, rage, and disappointment were the emotions evoked within me as I watched the movie. I thought about how many patients, to this day, are treated in the same manner as Vivian. Patients, especially the elderly, immigrants, and of low health literacy/low socioeconomic status, are treated this way. Such patients hesitate to question the doctor out of fear of being labeled difficult, or believe the doctor knows best, since he/she is the health care provider, allowing the doctor to make all the decisions. Patients lacking the support and presence of family members to speak up for them, like Vivian (despite literacy level), often remain silent as well. Our job as clinicians is to provide the patient with information as plain as possible, and involve them in the decision making process, every step of the way. We must empower the patient and promote autonomy, no matter what the outcome may be.

Throughout the movie, I witnessed the numerous occasions where Vivian was treated less like a human being, and more like a subject, a guinea pig whose sole purpose was to provide the researchers with more “knowledge”. Upon grand rounds, Jason pulled up Vivian’s gown, exposed her body, without asking permission. He then roughly palpated her abdomen and had the other residents, at the same time, touch her abdomen as well, again failing to obtain consent. The doctors also spoke over Vivian, using medical terminology, never once communicating with her. It was as if she wasn’t present in the room. The lack of communication and disregard for Vivian was deplorable. I wondered if the use of therapeutic communication and emotional intelligence is encouraged and taught in medical school.

Nurse Susie, on the other hand, displayed true professionalism. She treated Vivian as a human being, demonstrating compassion, honesty, and empathy. She represented Jean Watson’s theory of caring to the utmost. The nurse allowed Vivian to express her feelings. She listened intently, and provided comfort as her patient was alone and had no family members. Vivian trusted Susie, this was demonstrated when she cried, and told Susie that she was scared. Finally, she was allowed to show her true emotions. While eating popsicles, Susie informed Vivian of information that the doctors withheld from her, which was that she wasn’t going to get better. The nurse took the opportunity to also explain what DNR/DNI is, and allowed Vivian to truly make an informed decision regarding her health. Although it was clear to Vivian that death was imminent, she felt better, as Susie helped her regain her autonomy. Susie advocated for her patient on numerous occasions. She asked Jason to have the medication dosage lowered, as the patient experienced horrid side effects, but he failed to consider her input. Susie suggested to Dr. Kelekian to order PCA pump to ease Vivian’s pain and to keep her more alert, he too ignored her plea.

Down to the end of Vivian’s life, Jason continued to behave below the standard of a true professional. Upon learning that the patient was dead, Jason disregarded the DNR, performed CPR, and called a code. He went as far as to refer to Vivian as “research” when Susie pushed him out of the way, and yelled that the patient is DNR. This nurse truly advocated and cared for her patient. However, I would like to have seen Susie report the researchers’ deplorable actions to the higher powers that be from the very beginning. Although Vivian’s death would not have been prevented, she would have probably received better care, been informed about her prognosis, and included in the decision making process.  She deserved to be treated humanely and the doctors should have payed the price for treating her as “research”. It’s imperative for all healthcare workers to encourage one another to practice with honesty, kindness, gentleness, and compassion. Treating patients, and each other, the way one would like to be treated. Also, we must remember to live a balanced life. One must work, but must also live and enjoy life, as illness and death is no respecter of person or status.

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• PRIVACY POLICY
• MOVIE WIT ANALYSIS IN NURSING

The action of the nurse while caring for his or her patient. Susie Monahan is a nurse who is taking care of Vivian Bearing who have metastatic Stage IV ovarian cancer. Susie is a kind of nurse that everyone will look up to because of the things that she have done in the movie. Throughout the entire treatment of Vivian, she assist her in everything that Vivian will do, like giving tissues to clean herself up and guiding her everytime she want to be in a sitting position. She frequently and sincerely asked her questions about her current status and what happened to her before she experienced the side effects of the treatments. She lift up the mood of Vivian to forget the harsh reality that is going on around her and when she really can’t take the pain she make sure to say that she is always there beside her,    one call away, and showed some empathy that can somehow help her emotionally. Conscious or not, she will asked a permission to Vivian before she will do something to her body for some procedures that she need to. She provides information about her current condition and explain it thoroughly to her in order for her to understand the different clauses and she also make sure that she give her an option because what matter most is her opinion. Whenever Susan think that the doctors medication is not good for Vivian, she make up to point to talk to them and discuss the matter because she knows that Vivian cannot take the pain that the full dosage will give to her. And lastly, which is more importantly is the way she respect and fight for Vivian’s decision not to resuscitate her if her heart stop beating. It is when Dr. Jason found out that Vivian is already dead, he called the doctors that handle code blue situation to resuscitate her and what Susan did is to fight them and yelled everyone saying that Vivian don’t want to be resuscitated but everyone is not listening to her but after sometime, Dr. Jason was able to stop them and told that them that he made a mistake for calling them because truly, Vivian make a form and that is not to resuscitate her. Major concepts seemed to be central in their practice of nursing. The major concept that central in the nursing practice in the movie are the person, environment, health, and nursing. Susan treat Vivian as a person who needs to be treated and she doesn’t ever showed that Vivian is like a guinea pig because she is being experimented to find cure for her illness. She cared for her as a person and not because of some experiment sample to acquire new knowledge in the field. A good environment also matters because it can make a big impact in the present condition of the client. That’s why Vivian is in a clean, well-ventilated, and quiet environment because it is essential for her recovery. Susan make sure that the quality and wellness of Vivian’s health is the priority. Like she intervened about the full dosage of dose that the doctor is planning to give her, saying that she cannot handle the inside pain even if she act tough on the outside. And lastly is the nursing in which it shows the discipline of science and arts. In here, Susan define what nursing is really is and it is all about the knowledge the she should interact and the skilled that she need to act in order build a mutual trust between the both of them. Person, environment, health, and nursing relate to each other in a way that they make up the general basis for nursing practice to achieve humanistic and holistic care that client wants to attain. Meaning, from these 4 concepts many nursing knowledge will start to rise because it serves as its guide or framework in the discipline. The nursing philosophies, conceptual models, middle-range theory, grand theory, practice theory, and metatheory develop with the help of the metaparadigm and key concepts it presented. From these 4 concepts, nurses are now knowledgeable enough and competent to address the needs of the every client that they will face in the future.

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• Bosanquet, S. (Producer), & Nichols, M. (Director). (2001). Wit [Motion picture on DVD]. United States: HBO Home Video.
• Edwards, A. (2019). Communication in the Context of the Nurse-Client Relationship [PowerPoint slides]. Retrieved from (http://sole.hsc.wvu.edu/Site/4121/File?InstanceID=779526).

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  PG-13 | Drama | 1 HR 39 MIN | 2001

Emma Thompson stars as a single-minded English professor who finds enlightenment through her struggle with cancer.

“Wit” by Margaret Edson: Ethical and Legal Issues Essay (Movie Review)

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Background Information

The movie “Wit” was written by Margaret Edson in 1998. The movie is basically about a fifty-year old woman who was a professor of English specializing in 17 th century poet, John Donne. The woman referred in the film as Dr. Vivian Blearing was diagnosed with stage 4 ovarian cancer. Following the diagnosis, Vivian was assigned to Dr. Kelekian and his fellow Jason, who happened to be Vivian’s student during his undergraduate. The movie revolves around Vivian, Dr. Kelekian, Jason, Susan (Vivian’s primary nurse) and several technicians. It is also intertwined by several scenes in which Vivian makes reference to her teaching career and her experiences with her students.

The movie is of significance to the medical and nursing worlds because it illustrates the relationship between a patient and healthcare practitioners. The central theme of the movie is the conflict of interest that most healthcare professionals encounter. In particular, the healthcare practitioners in this movie are charged with the responsibility of treating Vivian but instead Vivian becomes an object of experimentation for their research (Kent, 2001). A number of ethical and legal issues are evident in the movie and these issues are the subject of this paper. This paper examines in depth the ethical and legal issues that have been raised in the movie. It also discusses the effect of the unethical and illegal practices as well as the strategies that can be taken to avoid them.

Ethical Issues Identified in the Movie

Potter and Perry (2010) argue that “the principle of autonomy is based on the assertion that individuals have the right to determine their own actions and the freedom to make their own decisions” (p. 119). Respect for the individual is the keystone of this principle. Autonomous decisions are based on: individuals’ values, adequate information, freedom from coercion and reason and deliberation. Examples of autonomy in the healthcare include: refusing treatment, giving consent for treatment or procedures, and obtaining information regarding results of tests and treatment options (Potter & Perry, 2010).

Autonomy is highly disregarded in the movie “Wit.” The patient Vivian lacked the autonomy to make the right decisions. The doctors made all the decisions on her behalf. The decisions included the type of treatments to give her, the frequency of the treatments, and the decision to resuscitate or not to resuscitate. Vivian was not in a position to make the right decisions concerning her treatments because she lacked adequate information about her condition. The doctors knew that the doses of chemotherapy they were giving Vivian not only failed to cure her but also failed to remit the illness. Yet they continued with the treatments. They also failed to disclose this information to Vivian yet the information would have enabled her to decide whether or not to continue with the treatment.

Beneficence

Beneficence is commonly defined as the doing of good and is often thought to be the most critical ethical principle in health care (Potter & Perry, 2010). Fundamentally, the principle requires one to always consider his actions in the context of enhancing the welfare of the patient. This however becomes a challenge when what is generally considered to be good for the patient also brings harm to the patient or conflicts with the patient’s desire. Beneficence in the movie “Wit” is illustrated through Susan, the registered nurse who is in charge of Vivian. Susan is the only healthcare professional in the hospital who is concerned about the welfare of Vivian.

She is not only Vivian’s care giver but also her advocate. Many times, Susan disagreed with the doctors treating Vivian on the progress of Vivian’s condition and the treatments the doctors were giving her. She advocated for Vivian’s wellbeing by forcing the doctors to manage the side effects Vivian was experiencing from the chemotherapy. In addition, she advised Vivian’s physicians to reduce the dosage of chemotherapy they giving her due to the negative effects the chemotherapy was having on her.

The first instance of this type of advocacy occurs when Susan tells Jason, Dr. Kelekian’s fellow, to ask Dr. Kelekian to reduce the dosage after Vivian went back to the hospital due to fever and neutrophia (Edson, 2002, p. 44-45). Unfortunately Jason could hear none of it and argued that Vivian was strong enough to bear the full dosage. Susan also showed beneficence by informing Vivian on what was going on with the treatments she was getting and the prognosis given by the doctors.

Based on the information, Susan helped Vivian to make a decision that was beneficial to her. This is illustrated at the end of the film when Susan stopped the resuscitation efforts of the code team in honor of Vivian’s decision. Vivian had decided not to be resuscitated yet the doctors were insisting on the resuscitation for the sake of the research. The lack of beneficence on the other hand is portrayed by Vivian’s doctors who were more interested in their research efforts than on Vivian’s recovery and wellbeing.

Nonmaleficence

Nonmaleficence is defined as “the duty to do no harm,” (Potter & Perry, 2010, p. 314). This principal is ingrained in the Code of Ethics for Nurses. It asserts that the nurse “must not knowingly act in a manner that would intentionally harm the patient,” (Marshall, 2001, p. 12). Some treatments have high risks of causing harm to the patient, but they also have great good for the patient, for instance, chemotherapy and bone marrow transplant which can make the patient weaker and vulnerable to opportunistic infections but which may cure the illness. The lack of nonmaleficence is evident in the movie “Wit” in various ways.

First and foremost, Vivian, the patient was diagnosed with ovarian cancer at the latest stage, that is, stage 4. This thus implies that it was almost impossible for her cancer to be cured. Nevertheless, the doctors at the hospital admitted her and began giving her doses of chemotherapy. To the doctors, Vivian was not just a patient but an object of research, a guinea pig on which the doctors could carry out their research studies and advance their knowledge and prestige in the medical field. The doctors knew that the doses of chemotherapy they were giving Vivian were not helping her in any way but were instead making her body weaker and weaker. Yet, they continued with the treatment and expected her to persevere it.

At the beginning of the play, Dr. Kelekian informed Vivian that they expected full cooperation from her when he stated that: ‘We will of course be relying on your resolve to withstand some of the more pernicious side effects,” (Edson, 2002, p. 9).

Moreover, Vivian had the option of receiving a lesser dose of the chemotherapy. However, the doctors insisted on the full dosage for the sole purpose of the research. Dr. Kelekian argued that: there may be times when you’ll wish for a lesser dose, due to the side effects. But we’ve got to go full-force. The experimental phase has got to have the maximum dose to be of any use,” (Edson, 2002, p. 11). A significant harm was inflicted on Vivian and included not only physical harm through weakening of her body, but also emotional and psychology harm.

Veracity is defined as “telling the truth,” (Chitty & Black, 2007, p. 120). Telling the truth has usually been regarded as a basic necessity in human relations. Ingrained in the nurse-patient relationships is the assumption that nurses will be honest with their patients. However, in some cases nurses are limited by an organizational system that limits the nurse on what she can tell the patient. In such cases, the nurse engages in involuntary withholding of the truth. Voluntary deception is however considered to be immoral. Persons in need of healthcare may also not be totally honest when giving their health information.

Likewise, healthcare professionals may not be honest when responding to patients’ inquiries for information related to their treatment or prognosis. Reasons for such dishonesty include the notion that patients would be better off not knowing certain information or that they are not capable of understanding the information (Erichsen, Danielsson & Friedrichsen, 2010).

Veracity is evident in the movie “Wit” when Susan, the registered nurse taking care of Vivian decided to tell Vivian the truth about her condition. Vivian was getting large doses of cancer chemotherapy without any success of remission. In fact, the cancer was progressing at an alarming rate. She was near death, but the research physicians wanted to challenge her body with chemotherapy for as long as possible to observe the outcome.

Everyone on the medical staff had been cold, technically-minded, and no one had shown any concern for her except for Susie. Vivian had not been informed about the chemotherapy failure or the prognosis that she was dying. One night, Susan found Vivian crying and in a state of panic. She first helped to calm her, then shared a popsicle with her at the bedside while she disclosed the full truth to Vivian about her chemotherapy, her prognosis, her choices about her code status in case her heart stopped, that is, whether Code Blue or DNR, as well as her imminent death.

Susie affectionately explained: “You can be “full code” which means that if your heart stops, they’ll cal a Code Blue and the code team will come and resuscitate you and take you to Intensive Care until you stabilize again. Or you can be “Do Not Resuscitate,” so if your heart stops we’ll … well we’ll just let it. You’ll be “DNR.” You can think about it, but I wanted to present both choices …” (Edson, 2002, p. 67). Susie therefore felt an urge to be truthful an honest. By giving human respect to Vivian, Susie was showing her capacity to be human.

Fidelity refers to faithfulness or honoring one’s commitments or promises to patients (Chitty & Black, 2007). The nurse is supposed to be faithful to her role by seriously taking into consideration all ethical responsibilities related to the practice. When nurses accept patients, they are bound to offer the best care to them. Failure to do so is unethical. Commitment to promises, commitments and agreements builds the trust that is crucial for the nurse-patient relationship.

In the movie “Wit,” fidelity is illustrated well by Nurse Susan who goes out of her way to take care of Vivian and comfort her. She responds to her every need whether physical, emotional or psychological. She feeds her, keeps her company, talks with her, clams her when she is distressed and informs her of the progress of her condition. She also advocates for her healthcare by intervening when the doctors fail to take the proper action. Through all these, Susan shows her commitment to her profession. This creates a trustful relationship between her and Vivian (Dahlin, 2004).

On the other hand, the lack of fidelity is also illustrated in several occasions. First and foremost, any healthcare professional is bound by his practicing license to provide utmost care to their patients. By taking on Vivian as his patient, Dr. Kelekian was committed to provide the best care that would help alleviate her suffering and improve her quality of life if the illness would not be cured. This commitment was however not upheld.

This is because Dr. Kelekian and his fellow, Jason, were more interested in research that would increase their knowledge and enhance their medical careers. As a result, Vivian became a guinea pig for testing the effects of the new treatments. Although the treatments had adverse effects on her, the physicians did not stop or reduce the dosage in spite of the advice given to them by Nurse Susan. In the end, Vivian not only died from the cancer but the quality of her last days was deteriorated by the treatments.

Legal Issues Identified in the Movie

Malpractice.

Malpractice is considered to be “the greatest legal concern of healthcare practitioners,” (Chitty & Black, 2007, p. 92). It refers to negligence applied to the acts of a professional. It occurs when a professional fails to act as a reasonably prudent professional would have acted under the circumstances. It is not a necessity to prove that a healthcare professional had the intention of being negligent. The legal action may be based on the wrong done either through commission or omission. The precondition of a malpractice action is based on two factors including the nurse’s specialized knowledge and skills and the patient’s harm inflicted by the nurse in the execution of her duties.

Malpractice is a key ethical issue raised in the movie “Wit.” Malpractice in the movie is reflected by the physicians’ refusal to act reasonably given the condition of Vivian. When Vivian was diagnosed with the ovarian cancer, the doctors knew that chances for her survival were minimal, if not non-existent. Despite this knowledge, they proceeded with the full dose treatment of chemotherapy thus inflicting great physical, emotional and psychological harm on Vivian.

For eight months, Vivian endured the painful treatment and its more painful and distressing side effects. To make the situation worse, the doctors did not provide Vivian with medications for the side effects until Susan the primary nurse intervened. All these constitute malpractice on the part of Dr. Kelekian and his fellow, Jason.

Informed Consent

This principle requires all patients to be granted the chance to give informed consent before any treatment except when there is a life-threatening emergency (Chitty & Black, 2007). The consent must be voluntary, must be given by an individual with the capacity and competence to understand, and based on adequate information. In the movie “Wit,” Dr. Kelekian gave Vivian the informed consent form to sign after briefly giving her the details about her condition and the treatments they would give her. However, the information given to Vivian about her condition and treatment was inadequate and full of medical jargons thus making it hard for Vivian to comprehend the full meaning of what the doctor said. Thus, the consent given was not an informed consent (Layman, 2009).

Impact of Legal/Ethical Issues on the Healthcare Delivered

The major impact the ethical and legal issues raised in the movie had on Vivian’s care was the deterioration of her health. The treatment given to her was too strong for her weakening body and as a result her health deteriorated with each cycle of treatment she received. In addition, illegal and unethical practices deteriorate the quality of life of patients. In Vivian’s case, the treatment she received prolonged her life but her life was full of misery and agonizing pain.

In the end, the agonizing treatment did not cure her illness and instead she died. If Vivian had had the opportunity to make informed consent to the treatments she received and if the physicians had been honest with her from the beginning, she would not have suffered the way she did. Second, the lack of humanity on the part of the doctors when dealing with Vivian had negative effects on her emotional health. Vivian cried out of frustration and distress on many occasions. She felt helpless and as an object to be used, abused and poked at the discretion of her physicians. This is illustrated when she laments that: “I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home,” (Edson, 2002, p. 41).

Factors that Contributed to the Lapses in the Standards of Care

In this particular movie, the standards of care were not upheld because of a number of factors. The first factor is the interest of the medical professionals. Dr. Kelekian and his fellow Jason were carrying out a research study that would help them come up with a more effective treatment for ovarian cancer. However, the treatment they were working on needed experimentation. When Vivian came to the hospital with stage 4 ovarian cancer, the doctors saw it as a good opportunity to carry out the experimentation. Vivian was put through the full dose of chemotherapy irrespective of the negative consequences it had on her. As a result, standards of care were compromised for the sake of advancing knowledge (Ulrich Zhou & Grady, 2009).

The second factor that contributed to the compromise of standards of care at the organization is the organizational climate. An organizational climate that upholds standards of care should be created by the managers or senior professionals of the organization. In Vivian’s case, the senior medical professionals (Dr. Kelekian and his fellow, Jason) were at the forefront in compromising standards of care. Although the nurse could identify the unethical and illegal practices, she lacked the power to bring them to an end. The only thing she could was to advocate for better care for Vivian but the ultimate decision lay with Dr. Kelekian. Commitment from the management and senior professionals is thus important in upholding standards of care.

Strategies and Resources that could be used in Coping with the Identified Issues Immediate Strategies

Any healthcare organization interested in ending unethical practices in the short-term can undertake several strategies. The first strategy requires nurses to recognize situations in which healthcare professionals such as physicians compromise the ethical values or situations in which the ethical values conflict. Nurses may experience a troublesome sense in cases when something does not feel right, thus showing that certain duty or task may not have been carried out in the best or most appropriate manner (Kelly, 1998). Nurses need to admit to such feelings not only to themselves but also to their peers and should thus start discussions about the situations, which will in turn help in validating the encounters and clarifying feelings of uncertainty or distress.

Once nurses recognize moral distress or an ethical dilemma and become motivated to take action, they can undertake a six-step process described by Purtillo (2005) to analyze and resolve ethical problems in clinical situations. Ideally, nurses will not be working in isolation to resolve dilemmas but will be engaged in collaborative inquiry and dialogue with other members of the healthcare team. The familiar problem-solving process involves the steps of assessing, identifying the ethical problem, analyzing the problem, exploring the options, implementing the action, and evaluating the process outcome (Cohen & Erickson, 2007).

Long-term Strategies

In the long-term, healthcare organizations should set up ethics committees and ethics consultation services to provide assistance to staff, patients, and families. The multidisciplinary committees can provide unique views to every situation that includes ethical questions. Senior clinicians who serve on the committees are excellent resources for new and seasoned nurses. Ethics consultation services include individuals with expertise in bioethics and clinical decision making who help facilitate communication, mediate conflicts, and alleviate distress in nurse caregivers (Clark & Taxis, 2003).

Ethics rounds and nursing ethics committees also are avenues for healthcare providers to discuss morally distressing situations and to identify strategies for coping. During ethics rounds, nurses and other members of the healthcare team have an opportunity to focus on specific cases with ethical dilemmas that cross all disciplines (American Nurses Association, 2001).

Nursing ethics groups, composed only of nurses, also can be formed to develop nursing competencies and skills necessary for ethical problem solving (Andrews, 2004). In such a forum, nurses can discuss difficult cases and identify issues that may require policy changes. Such groups also can provide opportunities for nurses to learn, apply, and practice the process behind analyzing and solving ethical dilemmas. Many schools of nursing have clinical faculty who specialize in nursing ethics and who are excellent resources for consultation. Clinicians also can seek individual guidance from ethicists in their organizations or communities who are skilled and knowledgeable in ethical theory (Hamric, 2002).

Nurses are encouraged to complete formal education in ethics through electives or continuing education courses. Courses are available through schools of nursing, healthcare institutions, and professional organizations.

Distance-learning classes may be offered to accommodate broad audiences (Ellenchild-Pinch & Graves, 2000; Jameton, 1993). Journal clubs or brown bag lunch discussions are opportunities for staff to develop the communication and critical-thinking skills needed for ethical analysis (Turner, 2003). Educational offerings may focus on the role of nurses in supporting ethical practice, increasing awareness of the impact of ethical dilemmas in the healthcare setting, and enhancing nurses’ abilities to form ethical arguments and justify decisions (Matzo, Sherman, Nelson-Marten, Rhome, & Grant, 2004).

Reference List

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association.

Andrews, D. R. (2004). Fostering ethical competency: An ongoing staff development process that encourages professional growth and staff satisfaction. Journal of Continuing Education in Nursing, 35, 27–33.

Chitty, K., & Black, B. (2007). Professional nursing: concepts & challenges . Philadelphia: Elsevier.

Clark, A. P., & Taxis, J. C. (2003). Developing ethical competence in nursing personnel. Clinical Nurse Specialist, 17 , 236–237.

Cohen, J., & Erickson, J. (2007). Ethical dilemmas and moral distress in Oncology Nursing Practice, 10 (6), 775-780.

Dahlin, C. (2004). Ethics in end-of-life care. Journal of Hospice and Palliative Nursing, 6 (1), 1-2.

Eddie, F. (1994). Moral and ethical dilemmas in relation to research projects. British Journal of Nursing, 3 (4), 182-184.

Edson, E. (2002). Wit. New York: Demco Media.

Ellenchild-Pinch, W. J., & Graves, J. K. (2000). Using Web-based discussion as a teaching strategy: Bioethics as an exemplar. Journal of Advanced Nursing, 32, 704–712.

Erichsen, E., Danielsson, E., & Friedrichsen, M. (2010). A phenomenological study of nurses’ understanding of honesty in palliative care. Nursing Ethics, 17 (1), 39-50.

Hamric, A.B. (2002). Bridging the gap between ethics and clinical practice. Nursing Outlook, 50, 176–178.

Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. Clinical Issues in Perinatal and Women’s Health Nursing, 4 , 542–551.

Kelly, B. (1998). Preserving moral integrity: A follow-up study with new graduate nurses. Journal of Advanced Nursing, 28 , 1134–1145.

Kent, H. (2001). At Wit’s end. CMAJ, 164 (6), 841.

Layman, E. (2009). Human experimentation: Historical perspective of breaches of ethics in US health care. The Health Care Manager, 28 (4), 354-374.

Marshall, P. (2001). End of life care: ethical issues. Kansas Nurse, 7 (4–7), 11–12.

Matzo, M. L., Sherman, D. W., Nelson-Marten, P., Rhome, A., & Grant, M. (2004). Ethical and legal issues in end-of-life care: Content of the End-of-Life Nursing Education Consortium curriculum and teaching strategies. Journal for Nurses in Staff Development, 20, 59–66.

Potter, P. A., & Perry, A. G. (2010). Fundamentals of Nursing. Philadelphia: Elsevier.

Purtillo, R. B. (2005). Ethical dimensions in the health professions (4th ed.). Philadelphia: Elsevier Saunders.

Turner, M. H. (2003). A toolbox for healthcare ethics program development. Journal for Nurses in Staff Development, 19, 9–15.

Ulrich, C., Zhou, Q., & Grady, C. (2009). Recommending research participation to patients: an ethical imperative? Clinical Scholars Review, 2 (2), 41-44.

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IvyPanda. (2022, March 20). “Wit” by Margaret Edson: Ethical and Legal Issues. https://ivypanda.com/essays/ethical-and-legal-issues-related-to-the-movie-wit-by-edson/

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1. IvyPanda . "“Wit” by Margaret Edson: Ethical and Legal Issues." March 20, 2022. https://ivypanda.com/essays/ethical-and-legal-issues-related-to-the-movie-wit-by-edson/.

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Wit in Movies

This week I watched a video essay titled “Shane Black’s The Nice Guys (2016) : Wit, Done Right.” This video discusses wit in Hollywood movies and brings up the clever use of wit in the movie The Nice Guys, a movie that underperformed according to this video essayist. I think the topic of wit, especially in relation to the movie The Nice Guys is an important topic, because wit is often done poorly in movies, and movies with well crafted wit tend to be overlooked. As this video essay brings up, The Nice Guys nicely balances between using typical tropes and jokes in new and interesting ways, as well as directly criticizing typical jokes in order to be witty. Another important aspect of The Nice Guys is that throughout the whole movie, as the story changes and adapts, so do the characters, style, and jokes of the movie. There is a fairly consistent style throughout, but the jokes evolve as the characters develop and get to know each other. Unlike other movies that might just keep using the same type of witty banter for most scenarios, The Nice Guys builds on its old jokes, even making fun of them. This meant that as a viewer I appreciated the later jokes in the movies just as much as the earlier jokes because I felt like I had grown alongside the main characters.

In terms of this video essay’s form, the video mostly uses video clips, background music, and voiceover. One interesting choice made was that every time the video cuts to a scene with important dialogue, the background music of the video essay cuts out completely. On the one hand I found this technique effective because it caught my attention every time and drew me to pay close attention to the audio of the scene, but I’d almost rather that the video essay have the music fade down but keep playing quietly in the background. I think that changing the volume drastically would still draw viewer’s attention, but keep more of a consistent feel throughout the whole video. Besides these audio interruptions, I think the rest of the video is very effective in keeping a consistent tone with the movie. The author’s voiceover performance is witty and causal enough that it totally fits with the clips from the movie. Also when the video featured text, the font and color of the text felt consistent with the style of the movie as well, meaning that I wasn’t distracted from the argument of the video.

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Movies | ‘Blink Twice’ review: This nervy, off-center…

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Movies | ‘blink twice’ review: this nervy, off-center thriller is a breakthrough for channing tatum.

“Blink Twice” is many things: a bracing debut feature, already a source of debate fodder —and, undebatably, the career assignment that Channing Tatum really, really needed.

He’s a funny kind of kind-of star. Tatum has learned to command the screen in the right role, working around his technical limitations, mostly to do with his voice. But coming off the strained, overblown romantic comedy “Fly Me to the Moon,” where he could barely get through his rapid-fire banter without gasping for air before the punchline, his performance in “Blink Twice” is pretty astonishing.

Is it because he’s playing a bad guy? No spoiler there; it’s in the movie’s trailers. Antagonists can free an actor, or at least vary an actor’s diet of solemn or sardonic good guys. Often, though, actors see villainy, even complicated villainy, as a license to overkill.

Not here. Tatum’s turn in “Blink Twice” is like the movie itself: crafty, rich, strange and, even when it wobbles a bit, destabilizing in ways guaranteed to lead to a less-than-stellar audience exit poll CinemaScore on opening weekend. More interestingly, it’s a bracing directorial debut for co-writer Zoë Kravitz. It’s also one of the few recent American thrillers with something on its mind, and the wiles to tap into something inside an organically realized nightmare scenario.

Tatum’s character is clouded by a recent, vaguely specified scandal, and “Blink Twice” begins with this man in apology and image-repair mode, having redirected some of his wealth to philanthropic galas and good causes. He has also bought a small private island somewhere, apparently in the Caribbean. There he spends time with close friends, eating stunningly photogenic meals, drinking wines costly enough to tilt the stock market this way or that. Also, he still does some drugs, as he did more carelessly, we hear, in the old days. Now, as Slater King tells one of his guests, it’s “with intention.”

The guest is a newbie, a knockout and agog at her good fortune. She’s the real star of “Blink Twice”: Naomi Ackie, the excellent English actress, playing Frida, a somewhat directionless Los Angeles cocktail waitress who works for a catering firm with her roommate, played by the invaluable supporting ringer Alia Shawkat. At a gala honoring King, the ladies decide the crash the party they’re supposed to be working and it works. King invites them to join his posse for a jaunt down to the island.

The screenplay by Kravitz and E.T. Feigenbaum pretends to be a straight-line narrative, but there’s something afoot, and it’s messing with Frida’s senses and sense of time. Something in the food? In the flowers picked from the nearby jungle, by the perpetually nearby local “help”? The louche male guests, played by Christian Slater and Haley Joel Osment, to name two, dart between conviviality and connivance, while the women — led by Adria Arjona, terrific as the longtime veteran of a babes-in-“Survivor”-land reality series — get high, get drunk, and run around as if being pursued by wolves.

Where this scenario goes next has its payoffs, and a drawback or two. “Blink Twice” lands on a gratifyingly bloody note, and with near-miraculous skill, director Kravitz manages some tonal change-ups beautifully, thanks to the razor-sharp editing of Kathryn J. Schubert and an ever-surprising sound design from Jon Flores, folding nicely in with Chanda Dancy’s score. The visual design of the picture, very big on blood reds and geometric carve-ups of this corner of paradise, feels like a single idea, fully expressed. If the resolution to “Blink Twice” won’t satisfy everyone, well, there it is.

Watching the film, certain probable influences come to mind, including Jordan Peele’s work, especially the great scene in “Get Out” with Betty Gabriel as the smiling, freaked-out housekeeper. The private-island premise recalls the late Jeffrey Epstein’s real estate holdings along with his crimes. The mind games and aggressively art-directed evocations of untrustworthy paradise, meanwhile, may link back for some viewers to lesser works such as “Don’t Worry Darling.”

Even if you get ahead of the story here, or resist the daring lurches in tone, “Blink Twice” marks a formidable directorial debut. As an actor (not onscreen here), Kravitz is so effortless, you rarely detect any overt planning or determination in her performances. Her movie’s a different case: a precise visual telling of a tale heading somewhere awful, but also cathartic. There is wit here, and expert supporting turns (Geena Davis is on the money as the billionaire’s assistant who has seen too much). Ackie is exceptional. And as dead-eyed schemer hiding behind a veneer of gentle contrition, Tatum has rarely seemed more alive and engaged on screen.

“Blink Twice” — 3.5 stars (out of 4)

MPA rating: R (for strong violent content, sexual assault, drug use and language throughout, and some sexual references)

Running time: 1:42

How to watch: Premieres in theaters Aug. 22

Michael Phillips is a Tribune critic.

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