"Children of Men" and Question 2 in Massachusetts

The question of physician-assisted suicide has come to the forefront in Massachusetts, where voters on November 6 will be confronted with a ballot initiative ("Question 2") to allow "a physician licensed in Massachusetts to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person's life." If the law is passed, Massachusetts would become just the fourth state in the nation - along with Oregon, Washington, and Montana - to legalize the practice. Obviously, the issue is contentious, and voices for and against the ballot initiative are busy making their cases to Massachusetts voters.

As I pondered the fate of this "death with dignity" ballot initiative in my home state, I stumbled on an interesting article that got me thinking about how this issue is tackled in film - in particular, in Alfonso Cuarón's 2005 dystopian film Children of Men.

In the 2005 article titled "On Physician‐Assisted Suicide: What We Learn From the Movies" in Neurology Today, James Gordon, MD explores the complexities of The Sea Inside and Million Dollar Baby, films which both revolve around the question of assisted suicide. (A more recent TV-film tackling the issue is You Don't Know Jack, which features Al Pacino as "Dr. Death" Jack Kevorkian.)

The Sea Inside (Mar Adentro), which stars Javier Bardem, tells the true story of Ramon Sampedro, who was left quadriplegic after a diving accident. Sampedro then underwent a 30-year fight for his own right to commit suicide - which, on account of his paralysis, he was unable to do without assistance.

Sampedro was ultimately successful, and died in January 1998 from potassium cyanide poisoning - the tasks being divided up among several people so that no one person would be held accountable.

Million Dollar Baby, Clint Eastwood's 2004 Oscar winner, follows a gruff boxing trainer named Frankie Dunn (Eastwood) who takes on struggling waitress Maggie Fitzgerald (Hillary Swank), and is torn apart with guilt after she breaks her neck in a match and is left a quadriplegic. Maggie's family shows up, but only to get a hold of her assets, and her physical and emotional state gradually worsens during hospitalization. Eventually, she asks Dunn for "one favor," pleading: "I can't be like this, Frankie. Not after what I've done. I've seen the world. People chanted my name...I got what I needed. I got it all. Don't let 'em keep taking it away from me. Don't let me lie here 'till I can't hear those people chanting no more."

Dunn, a Catholic, initially refuses. But after much deliberation, Dunn decides to honor her plea, secretly administering a fatal injection of adrenaline as he calls her "my darling, and my blood." This complex scene is every bit as moving as the climax of Of Mice and Men; and it's hard not to feel every bit of the concern, love, and mercy motivating Dunn to act. His intentions are those of a loving father, and the consequences of not acting appear to be nothing but needless pain and heartache leading to the same inevitable end.

It's worth noting, though - as Gordon does - that in the F.X. Toole story from which Eastwood's film was derived, Frankie's final exit from Mattie's room is described this way: 

"With his shoes in his hand but without his soul, he moved silently down the rear stairs and was gone, his eyes dry as a burning leaf."

Obviously, the original story was meant to convey an ambivalence - even a feeling of being "lost" or "soulless" - in the aftermath of the assisted suicide.

The bottom line, though, is that both of these films give rise to an ambiguity or ambivalence surrounding this moral question. They present the audience with noble characters with immense physical afflictions, and with loyal friends who wrestle deeply with their decision. I would bet that both movies tested - even if only slightly - the resolve and conviction of nearly every person in the audience who came into the theater thinking they stood firmly against assisted suicide, in all cases. (Gordon concludes that "these aren't medical stories, and they certainly aren't treatises on assisted death. Their beauty is their exploration of motive and conflict, of ambivalence and commitment, of the complexity of human experience under tragic circumstances.")

Unlike these two films, Alfonso Cuarón's Children of Men revolves around the hope of a birth instead of a death, and only obliquely deals with assisted suicide. But it seems to capture something at the heart of this action,which both of the above films miss - maybe because they're looking too closely at it.

This dystopian sci-fi film directed by Alfonso Cuarón thrusts us into a world in which two decades of universal human infertility have led humanity to the brink of total decimation. England is the exception, where an increasingly totalitarian government imposes aggressive immigration policies and inundates its citizens with Orwellian advertising campaigns. In the midst of the gray, dingy remnants of Western civilization, one man (Theo) discovers that a rebel group called "The Fishes" is concealing an inconceivable secret: one of their refugees, Kee, is miraculously pregnant.

Cuarón shows us a society plagued with utter hopelessness looks like - the bleak city streets are filled with wailing, drunkenness, depression, explosions, gunfire, indifference, theft, and hatred; and the ill effects of confronting this wasteland are only softened by the increased presence of stiff drinks and strong weed. When these don't suffice for escape, there is always "Quietus" - a heavily advertised government-administered "suicide kit" with sun-soaked images of peaceful beaches and sparkly water, and catch-phrases like "You Decide When" and "It's Your Life, It's Your Choice."

What strikes me about the landscape of Children of Men is that it can be seen as the landscape of the soul of the terminally ill and suffering person, writ large. It's not a person, but humanity itself, that is terminally ill - but the impulse toward self-destruction is the same. With a "yes" to Question 2 in Massachusetts, a person with a diagnosis of 6 months left to live can quietly commit suicide with a hundred pills of Secanol; in Children of Men, society itself (with its diagnosis of 60 years or so left to live) gradually commits suicide with thousands of kits of Quietus. The dire situation and desperate "mood" is basically the same, and we are seeing it from within.

The Quietus kits are not the central focus of the film, but just one more expression of a will to destroy before being destroyed, to kill before being killed. In other words, in the infertile world of Children of Men, "death with dignity" and "it's your choice" aligns neatly with the violence, terrorism, and murder permeating society - what's noticeable is not where the destruction is aimed (at oneself or at others), but that destruction is the prevailing wind.

By normalizing suicide and embedding it in this wider situation, Children of Men divorces the act from the raw emotions, nuanced contexts, and "complexity of human experience" that make for our ambivalence in Million Dollar Baby and The Sea Inside. The Quietus suicide kit and its commercials do not look noble or compassionate, an example of the Enlightenment self taking control of its own destiny - instead, the government looks callous, its commercials look tawdry, and its users look afraid and sad, the innocent victims of this doomed landscape.

The appearance of a woman pregnant with new life, however, transforms that landscape, and breathes hope into the world. In one scene, Kee recalls how she thought about ending her life, and the life inside her, with Quietus, until she felt and understood the beauty of both of their lives:

"I never seen a pregnant woman before. But I knew. I felt like a freak. I didn't tell nobody. I thought about the Quietus thing. Supposed to be suave. Pretty music and all that. Then the baby kicked. I feel it. Little bastard was alive, and I feel it, and me too. I am alive."

We see in these lines a choice for life and against death, prompted by hope. If all of humanity in Children of Men is seen as a metaphor for the terminally ill, Kee and her baby represent a glimmer of hope within that person, and the resulting will to live, to fight for life.

The rest of the film plays off of this stunning dichotomy, an "either/or" between the machine of death and the delicate flowering of new life - a contrast which makes for some of the most powerful moments in the film. Theo's first encounter with Kee in a barn, set to the stirring soundtrack of John Tavener, evokes a Nativity-like sense of awe; and we watch as Theo, who had previously spent his days coping with the death around him by getting good and drunk, is suddenly transfigured into a creature of hope.

How does all of this "hope" translate back to the individual person, and from dystopian England to assisted suicide in Massachusetts?

Supporters of Question 2 will argue that it doesn't. The hope that Kee represents, they might say, is so often nowhere to be found in an individual who knows they're dying; who does not want to be a burden to their children or loved ones; who has lived a full, rich life and wants to prevent needless suffering. Such a situation is the world of Children of Men without Kee's pregnancy - and without Kee's pregnancy, her only alternative, as for so many others, was a Quietus kit.

Terminally ill patient
in hospice care
But one organization has shown that this argument is flawed, for several reasons. First, there is the very real possibility of outliving a prognosis: "Under this ballot question, anyone who has been given six months to live would be eligible to obtain a life-ending prescription. But many doctors know that kind of prognosis is just an educated guess. Individuals sometimes live much longer than doctors predict...patients could end their lives months or even years before their time." In Children of Men, Kee's child might not survive; and even if she has children of her own, humanity will eventually die out. But Theo and Kee still press on, with the hope of extending "the human project" beyond its expiration date. Similarly, the life-affirming hope in the possibility of added years may give the terminally ill a renewed will to live.

Also, the choice for suicide sometimes stems from an impermanent, resolvable mental health issue - and the new law doesn't make space for that possibility. "All patients requesting a life-ending prescription would not be required to meet with a psychologist or psychiatrist, professionals who are trained to detect and diagnose mental health concerns." In Children of Men, Theo and Kee both dabble with the thought of Quietus. But the appearance of Kee's child is a sort of "clearing" of the entire landscape of doom surrounding them to reveal a deeper reality of hope. Similarly, in the terminally ill, a life-affirming attitude may be a buried, dormant reality, obscured by an acute depression on the surface.

But the greatest hope for the terminally ill is the possibility of the afterlife. A Harvard neurologist wrote recently about what he experienced while in a week-long, brain-dead coma. Given that the engine for thought and emotion in his brain was completely shut down, the former skeptic says that his ongoing consciousness - filled with vivid, coherent experiences - is totally inexplicable scientifically. This testimony adds to the already massive stack of serious literature laying out the evidence for life after death. If we are mere animals, then the deep suffering and pain of the terminally ill is arguably pointless. (This is why animals are "put down" every day, and naturalistic philosophers like Peter Singer unflinchingly support euthanasia.) But human beings, for thousands of years, have noted the apparent immateriality of consciousness, and considered the very real possibility of eternal communion with the divine after death (many, by linking their suffering to "the suffering God" of Dietrich Bonhoeffer). And diverse philosophical and religious traditions - from Platonism to Hinduism to Catholicism - have seen a final act of violence against the gift of life as dangerous for the soul, potentially blotting out hope for that communion.

Considering these three points, the tragedy of a "yes" for Question 2 is the tragedy of Theo or Kee choosing Quietus before having a chance to know, love, and protect Kee's child. In the heart of the terminally ill, impulses of fear, despair, and destruction run wild like the panicked citizens of the new England. But a very real hope is there, waiting to cry out like Kee's child as she and Theo make their way through the gunfire. That cry makes all of the agents of fear, despair, and destruction still and submissive; it says: "Here is a life. And where there's life, there's hope."