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Academy Award-nominated film ‘End Game’ examines end-of-life care

The Academy Award-nominated documentary "End Game" looks at different approaches in palliative care for people with terminal illness. The film follows medical practitioners, patients, and their families, as they tackle the difficult questions that arise during end-of-life care. NewsHour Weekend's Hari Sreenivasan sat down with the film's directors, Rob Epstein and Jeffrey Friedman, to learn more.

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  • Hari Sreenivasan:

    Directors Rob Epstein and Jeffrey Friedman are no strangers to Oscar nods. Winning Oscars three decades ago for the documentary films 'The Times of Harvey Milk' in 1985 and 'Common Threads' in 1990 — films widely known for positively influencing LGBT history. Their Netflix short film is an upfront and compassionate look at palliative care and hospice through terminally ill patients, their families and the medical practitioners who guide them through their end of life choices. It's called 'Endgame' and it's nominated for an Academy Award.

    Rob Epstein and Jeffrey Friedman recently stopped by the studio.

  • Rob Epstein:

    Dying is one of the two things that we all share in common. We're born, we die and it's the one thing we just you know, we push away the unimaginable. It's the ultimate existential dilemma, right? We're going to, we're here and that we're not here. So we do whatever we can to avoid thinking about it, talking about it, imagining it for ourselves.

    So here you know, we found these practitioners whose job it is, day in and day out, to help us with that. Help us through whatever suffering there might be involved in that experience for ourselves and our loved ones.

  • Hari Sreenivasan:

    Give me a sense of scale here. You chose two programs that are happening in San Francisco — a relatively progressive city in modern day America, right? What is the traditional form that most people end up dying in America today versus these options that seem pretty new and foreign to a lot of people that might be watching your documentary?

  • Rob Epstein:

    Well, I mean, what we wanted to present is the continuum of options — from being in a hospital and what a hospital is designed to do, if you're there at that point in your life, which is all about treatment and trying to keep you alive regardless of the circumstances.

    The other end of the continuum is hospice, where you're really there for that end of life experience and the quality of care that you're given in that situation. So what we each, what we do in the film, is to present that continuum of choice.

  • Hari Sreenivasan:

    There is also a challenge that people have with physically letting go of the body. There's all kinds of philosophical questions — is this the end? Is there a spirit is there a soul? What happens after I die? if I'm an organ donor what's going to happen to my body? or my daughter's body, right? There's a struggle here for so many different levels that you witness that the families are going through.

  • Jeffrey Friedman:

    Yeah. There are difficult problems, they could be the most difficult problems we will ever face. And what really inspired us, was watching these practitioners whose job it is really to help us work through these dilemmas and figure out what options we want that would align with what we believe in and that's different for each person.

  • Rob Epstein:

    I mean as you said because these practitioners are working, their job is within the context of terminal illness, all of these issues come into play — psychological, emotional, sociological those issues around end of life come into play in their work.

  • Hari Sreenivasan:

    How much of the challenge here is about the patient themselves versus all the people around the patient that have their own issues about the psychological, the sociological etc. right? I mean it seems that sometimes it's harder for everyone else around the sick person to let go?

  • Jeffrey Friedman:

    Well that's one system and it's one reason that the conversation is so important, that the people who are around you when you're facing the end understand and respect your wishes. But that can only happen if there's discussion about it.

  • Rob Epstein:

    Palliative care is a whole team so there is a physician, there's a social worker, there's a chaplain, there's an intern and all of the team of palliative care workers work with the family as well as the patient. So all of that is part of the conversation that's going on with the whole team.

  • Hari Sreenivasan:

    You also point out that different traditions deal with this differently. That it's you know, there's it's kind of the mainstream American you know, putting people into a casket and burying them. But in between there is a lot?

  • Jeffrey Friedman:

    Yeah, I mean letting go is a big part of the process. And you know, it's one of the aspects of the film that I think made it bearable was that there's so much caring and love involved in both –caring for patients and also letting go of loved ones. It's painful as it is, the pain is something that comes from love and feeling the love from families and also feeling that deep empathy and caring from the caregivers in these institutions that we were filming in, was really in the end very inspiring.

  • Rob Epstein:

    One of the doctors in the film says dying is not a medical issue, it's a human issue and that's something that we all share, that we all have in common. At the end, what we hope for is that it's about human kindness and compassion and patience and love. And that's what we all hope for.

  • Hari Sreenivasan:

    What did it do to you now that you've finished the film? Did you rethink? Do you have a list of wishes? Did you guys clarify this? I mean.

  • Jeffrey Friedman:

    I definitely wrote an advance directive, you know, I made sure that everyone around me knows what I want, what I don't want. But I think at a deeper level it really made me, it gave me more of a relationship with death, which is something that's a part of life not as something scary to be run away from but just something to look at with open eyes.

  • Hari Sreenivasan:

    The Oscar nod. You expecting that?

  • Jeffrey Friedman:

    I mean we were thinking about the Oscars until the nominations were announced.

  • Rob Epstein:

    But now it's all we're thinking about.

  • Hari Sreenivasan:

    Rob Epstein, Jeffrey Friedman, thank you both.

  • Rob Epstein:

    Thank you.

    Jeffrey Friedman" Thank you.

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