Looking death in the eye: enhancing public understanding of palliative care through film
Fictionalised death is commonplace in film – cinemagoers are used to seeing it dramatised on screen. Documentary depictions are another matter: it’s extremely rare to see direct images of terminal illness and the moment of death in non-fiction films, with death ultimately remaining a taboo subject.
In his feature-length documentary film, ISLAND, and the interrelated gallery video installation, The Interval and the Instant, Professor Steven Eastwood has taken an unflinching look at terminal illness and the dying process.
Following the commercial release of ISLAND and an international tour of the installation, the film and artwork have been widely disseminated – with an accompanying educational toolkit – in the fields of palliative care and medicine, partnering with hospices and trusts around the UK.
Centring palliative care patients
The project began when Fabrica, Brighton’s centre for contemporary art, invited artists to respond to the theme of end of life. In his successful proposal, Professor Eastwood said that he wanted to be witness to the moment of death – with the intention of learning both more about the process of dying, and about how the public would respond to such controversial subject matter.
In 2017, Eastwood made ISLAND, a documentary film following the stories of four people – all of whom inpatients or outpatients of Mountbatten Hospice on the Isle of Wight – during the last year of their lives. One of the patients, Alan, invited Eastwood to be present when he died, and his final moments appear in the film. By engaging with palliative patients as willing co-participants, Eastwood centres a group who are rarely heard from due to our society’s collective discomfort with terminal illness and death.
The Interval and the Instant, a multi-screen gallery video installation, takes the form of a long-form triptych loop that invites the viewer to witness intimate moments of illness, including the moment of death. The visual language, non-narratorial structure and prolonged duration allow the viewer to reflect on the passage of time, relationships, illness and mortality.
A person with a terminal diagnosis is denied presence and participation in our culture ... Their image can be guarded, protected, and often without consulting the person going through the illness. Denying that person an image only further contributes to how they are repressed.— Professor Steven Eastwood
Challenging our perceptions of death
Enhancing public understanding
Through its 2018 release in cinemas and on streaming services (MUBI, Amazon and iTunes) in 2019, ISLAND has reached thousands of people worldwide; the film’s trailer has been shared more than 36,000 times online, and its website attracted 50% international site visitors.
The Interval and the Instant was first exhibited at Fabrica, Brighton in autumn 2017 before touring to the Blackwood Gallery, Toronto and La Ferme du Buisson Art Centre, Paris, reaching a total international audience of approximately 10,000. Together, the works have greatly increased public awareness of palliative care, death and dying by drawing back the curtain on what these processes really look like.
Further, ISLAND has provoked debate in the UK and beyond about the visibility of hospice care and those with terminal illness, as well as the ethics of filming death. The film was covered by media outlets including BBC Breakfast, Sight and Sound, the Sunday Times and the Guardian.
There is no doubt in my mind that this extraordinary film is a gift to anybody who wants to expand their horizon and explore death and dying in a non-threatening and accessible way.— Dr Andreas Hiersche, Lead Clinician in Palliative Care, Brighton & Sussex University Hospitals
Influencing professional practices
A 2018 report from the Royal College of Physicians (Bailey and Cogle 2018) found that doctors and medical staff struggled with difficult conversations with dying patients, and called for better education in all aspects of palliative care.
Following the release of ISLAND and The Interval and the Instant, Professor Eastwood was invited by Dr Andreas Hiersche, Lead Clinician Palliative Care, Brighton & Sussex University Hospitals, to run a session for third-year medical students.
This session, now run annually, provided the foundation for an educational toolkit based on ISLAND, and informed by Eastwood’s additional research for The Interval and the Instant, to help prepare doctors, nurses and medical students for their encounters with palliative patients.
In collaboration with production company Hakawati, Eastwood set up a working group with established partners Mountbatten and Martlets hospices, and new partners St. Oswald’s Hospice and Barts & The Royal London Hospital, to run pilot training sessions using ISLAND as a tool for reflective learning.
Findings from the pilot sessions were used to construct the final toolkit for ISLAND, which was launched in November 2019. The project has been widely praised within palliative care: in a foreword to the toolkit, consultant Kathryn Mannix describes ISLAND as "a film to set the record straight" after decades of "inaccurate, misleading and over-dramatised screen portrayals of dying".
Since the release of the film and its toolkit, more than 65 universities and hospices across the UK have requested them. Plans are underway to broadcast ISLAND internationally and to make the film available to international universities and hospital libraries.
It has given me the courage to respect everyone’s choice on how they want to be treated when dying.— Student nurse, Royal London Hospital
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