It was always my intention to follow up my previous post — the latest installment in my Howard’s Divine Comedy series — with this addendum, because that installment, on the topic of Death With Dignity, worked best with its narrow linguistic focus. But, I also felt strongly that I had to comment on a film I’d recently seen, released this past September, titled Blackbird, and starring Susan Sarandon as…

…a woman with ALS who wishes to die with dignity.

Crazy timing, I know!

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First, a refresher…

• Death With Dignity is an end-of-life option that allows the terminally ill to legally request and obtain medications from a physician to end their life in a peaceful, humane, and dignified manner.
• Death With Dignity is only legal in 8 U.S. states, the District of Columbia, and a handful of other countries: parts of Australia, Belgium, Canada, Colombia, Luxembourg, The Netherlands, and Switzerland.
• Imagine the Cruelty: A terminally ill person tells you that their illness is causing so much pain and misery that they’ve lost the will to live, there are no drugs or other medical interventions that can provide relief, and you say to them, “Too bad, you must continue suffering, and if you do try to end your life, you and anyone who might assist you will have broken the law and shall be punished.”

Crazy, right?!

And yet, that is the law for the overwhelming majority of humans on this planet.

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An Opportunity To Persuade

Blackbird, an English language remake of the 2014 Danish film Stille Hjerte (English: Silent Heart), is a deeply mixed bag.

As I’ve mentioned, Death With Dignity, aka Physician-Assisted Dying, is still highly controversial and mostly illegal. Therefore, it is a safe bet, in my opinion, that if Blackbird hadn’t arrived during the Covid pandemic, it would have been viewed much more widely and caused much more of a stir. (It actually premiered in September 2019 at the Toronto Film Festival, in Canada where Death With Dignity is legal, a whole year before it was released to mostly closed theaters and streaming services.) 

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The Good

To be fair to the filmmakers, I’d like to first applaud what I liked about the movie, and there really was a lot to like. As this is not a formal movie review, a simple list should suffice:

• The cast, across the board, was excellent, and each performance was grounded and heartfelt.
• While some might find it too slow and cerebral, I LOVE slow and cerebral, and I can’t imagine approaching this particular subject in any other way.
• The writing and directing gave the film the feeling of a stage play: long scenes, often with the whole cast or all the characters in a given scene in view, rather than the camera moving around constantly for closeups of each character. This is another aspect that some may dislike, but that I, a lover of theater, enjoyed very much.
• The setting — a lovely house and the sand-duned seashore where it’s located — is captured in all its soothing, picturesque beauty by the cinematography.

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The Sin Of Omission

From reading a bunch of reviews and articles of/on Blackbird, and watching some interviews with the director and cast, I did get the impression that the filmmakers do believe that people should have a legal right to choose Death With Dignity (e.g. The Hollywood Reporter, and an interview with actor Sam Neill), but I’m pretty sure that the film was NOT primarily intended as a persuasive statement in favor of it.

Nor did it need to be. 

However, with so much at stake, when so many millions of people still live under laws that make it a crime to end one’s own life in order to end one’s suffering from a terminal illness, it is extremely unfortunate that, due to a simple act of omission, the film does do some degree of harm to the Death With Dignity cause by not offering a more representative depiction of the realities of ALS.

ALS is an Iceberg Disease: The part that is seen sticking out of the water is just a relatively tiny portion of the whole experience. Many ALS patients, like Susan Sarandon’s character Lily, seem on the surface to have very little wrong with them. Whether they have a slowly-progressing variety of ALS, or they were only recently diagnosed with the earliest symptoms, they may be walking and using their arms and hands well enough to appear relatively active and able. Even the wheelchair-bound are less conspicuous and pitied than ever thanks to efforts to destigmatize disabilities.

Those whose disease began with difficulty breathing, swallowing and talking, might seem worse off, because their speech is slurred, and/or they use a very visible assisted-breathing apparatus. But even in these cases, unless you are a caregiver for an ALS patient, you only see the afflicted for relatively brief portions of their days and nights, they put on their best brave face for you, and they are comforted by your visit.

The iceberg, beneath the surface of the water, is enormous, and an ALS patient’s day-to-day struggle with the most basic activities of daily living, as well as the cumulative grief and anguish from living in a body that is wasting away and becoming paralyzed, and from slowly losing one ability after another, is similarly enormous and not immediately noticeable. (I write about this at length in my memoir, and in numerous posts here on my blog, The Owl Journal.)

Off the top of my head, I can only recall four very brief moments in Blackbird‘s 98 minutes that hinted at Lily’s physical challenges, hereby presented compared to my own current functioning:

Lily	Howard
Struggles but succeeds at putting on her robe because her left arm is paralyzed	My arms and hands aren’t paralyzed, but I no longer have the dexterity to put on or take off a robe
Climbs and descends the stairs in her home VERY slowly, highly dependent on the handrail.	I can only climb 3-4 stairs, and only with the aid of another person
Drops a glass of wine from her right hand, suggesting it is getting weaker	I must use both of my hands to pick up and drink from a glass, cup, or mug of any kind
While out on a beachwalk with the family, she has to stop and rest	Beachwalk?! The walk from my armchair in the living room to the bathroom and back is near my limit

In stark contrast, one of the most memorable moments in the film is a scene where Susan Sarandon enters a room, stunning in a gorgeous, flattering red dress, glowing and smiling, ready for the evening’s family Christmas dinner party.

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The Simple Solution Missed

I’m not a filmmaker, but I’ve been a student of film, and I know that a guiding principle of this visual artform is “show, don’t tell.”

Why not, then, simply show more instances of Lily’s struggles, perhaps a montage about halfway through, with music and no dialogue, just little glimpses of her:

• dropping more things
• straining to stand up from the toilet
• being unable to get up from a seated position on the floor, and as a result being stranded there, in need of her husband’s help
• trying and failing to fold laundry with one hand
• fumbling to wash her hair, also with just one hand, etc.

Then, when she explains her decision to end her life, briefly late in the film, the viewer has these visuals as a frame of reference and is much closer to a real understanding of what Lily’s life has been reduced to, and the suffering that she finds unbearable.

I’m talking about maybe 2-3 more minutes of film!

Again, it’s fine with me that Blackbird is not an overt political statement. But, I do find the sin of omission to be maddening, especially given that the solution would have been so simple.

😢