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The Arts and Medicine
January 17, 2017

Extremis: A Documentary Look at End-of-Life Decisions in the ICU

Author Affiliations
  • 1Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill
JAMA. 2017;317(3):240-241. doi:10.1001/jama.2016.20009

Beep. Beep. Beep.

The scene opens with the rhythmic pulse of medical equipment. A physician gently rubs the hand of an intubated patient as she attempts to communicate with her. “How are you doing?” she asks, before immediately adding, “Oh, that’s a stupid question. I don’t think you’re doing very well right now.” The patient, her arms in restraints and her wrist bandaged from an arterial line, scrawls an illegible message on a sheet of paper. Resourcefully, the physician prints the alphabet on the reverse side and asks the patient to point to the first letter of what she is trying to say. Struggling to communicate, the physician asks the patient if she would like to be rid of the breathing tube, even if it meant she would die. We don’t hear the answer immediately, but minutes later the physician announces in a voiceover (against a vaguely menacing soundtrack): “Here’s the reality. We’re all gonna die. Everybody standing in this room is gonna die one day. And it’s good to have a little bit of a say in how.”