BioethicsTV: The Farewell Welcomes Us to Talk About Truth Telling at the End of Life


Craig Klugman

Publish date

Tag(s): Legacy post
Topic(s): Art BioethicsTV Cultural Decision making End of Life Care Ethics

by Craig Klugman, Ph.D.

The film, “The Farewell” claims to be a movie “based on an actual lie”. Billi is a first generation Chinese-American twenty-something artist living in New York near her parents. After not being awarded a Guggenheim fellowship (a fact she hides from her family), she learns that her parents are heading back to China to visit her grandmother (Nai nai) who has been diagnosed with stage 4 lung cancer and has a three-month life expectancy. The catch is that Nai nai does not know about her health situation and the family has decided not to tell her. Instead, she believes the family is gathering for the wedding of Billi’s cousin (who has been dating his girlfriend for three months and no, she is not pregnant). Billi is not invited because her parents fear that she won’t be able to maintain the lie.

Although broke, Billi maxes out her credit card and makes the trip to China, surprising her entire family with her presence. The film then follows preparations for the wedding (we never learn if it is a real wedding, a faux wedding, or is later annulled). Billi’s aunt (Nai nai’s younger sister) explains that they do not want to burden Nai nai with knowledge of her death and the wedding provides a convenient excuse for everyone to gather and say goodbye. One of the questions of the film is how do you say goodbye when the person leaving does not know it is their final goodbye?

Film poster linked to from A24 productions website

The film explores the cross-cultural issue of informing a person about their death. In the U.S., our standard ethical stance is that patients should be told the truth of their diagnosis so that they can participate in decision-making about their medical care and well-being. And as Billi says, she can say goodbye to people and finish what she may want to get done. Billi is the character representing a mainstream U.S. audience, raised in a culture that values the individual who make their own decisions. Her parents, aunties, and uncles represent a more communitarian tradition where decisions are made by the family. In this case, the family believes knowledge would be a burden and would only cause Nai nai unhappiness. Besides, there is nothing medically that can be done.

In clinical ethics, this conundrum reminded me of cases where a family asked us not to tell the patient if her diagnosis was of a fatal disease. The family’s request created a challenge because we wanted to honor their cultural beliefs, but we also had to follow medical ethics and law which says a person should be involved with their decision making and give context. The key here is “should”. As Benjamin Freedman suggests, we could set up a situation where the patient can decide not to know. With these cases, I advised asking the patient “what do you know about your situation”, “What do you want to know about your situation”, and “Who do you want to make decisions”. The result was an honoring of autonomy and cultural practice since a patient is free to say they do not want to know anything and their children (usually they chose the eldest male child) should know their information and make the decisions. I always have this conversation with the patient away from their family because any present family may nudge the patient toward a particular decision. In all cases, the patient knew more than anyone credited them with knowing. In some cases, they wanted to know and participate in decisions and in others they were happy to not know. In a few cases, knowing they were dying would have caused emotional and psychological suffering, especially in patients also struggling with dementia.

Some thinkers distinguish between passive lies, such as withholding information, and active lies, telling an untruth. In this case, the story begins with the aunt being told the true diagnosis and keeping that away from Nai nai. But we also see the cost of active lying. The aunt first tells Nai nai that she has “benign shadows” from her pneumonia and will be fine. That moves down the slippery slope to creating an entire wedding (that Nai nai plans and pays for) as an excuse to bring the family together. And goes so far as to fake medical records—A CT scan is photoshopped to say “benign shadows” instead of cancer. The problem is that every Nai nai encounters has to be part of the coverup. Billi has to agree to lie to make the trip—something she initially resists but then comes to accept (after all, she has kept her failed Guggenheim bid a secret). In the U.S., one cannot obligate a person to lie. Thus, even if there was an agreement to hide the truth, it is not possible to ask every staff, family, and visitor to abide. In China, though, the function of the family overrides this Western prohibition.

SPOILERS AHEAD – Skip this section if you want to avoid spoilers

Billi raises the question of what would Nai nai want? Would Nai nai want to know? Surprisingly, we are given an answer. The Aunt tells that when Billi’s grandfather was dying, Nai nai chose not to tell him until he was on his deathbed. She did tell, but only when he was actively dying. The Aunt and Billi lead us to think that this is the decision Nai nai would make for herself because it is the one she made for her husband. The Aunt says when the time is right, close to death, she will share the diagnosis with Nai nai. This brief conversation is a turning point in the film, when Billi accepts her family’s decision to tell the lie, and she moves from being conflicted over how to handle the situation to spending as much time as possible with her Nai nai (including opening up about her own secret).

The journey of this film’s creationis almost as interesting as the movie itself. Writer-director Lulu Wang was unable to get any studio to pick up her script. She then crafted a personal essay for This American Life(the podcast is found here) which led to studios expressing interest in the piece. Much of the filming took place in China and many of the actors wanted to meet the real people they were portraying in the film. That meant the actor playing Nai nai wanted to meet the real Nai nai who met all of the actors and came to the set. Even though the movie was made six years after the events it portrays, the real Nai nai still does not know she has cancer (yes, she has so far lived 6 years past her diagnosis). They had to film the movie about not telling a woman her cancer diagnosis without the real woman finding out about her cancer diagnosis. Even more challenging: In Chinese, the name of the film is “Don’t Tell Her” which might be a giveaway.

THE FILM in BIOETHICS and HEALTH HUMANITIES – It’s safe to come back now

One of the main characters of this story is food. Food is everywhere. We see the family preparing and eating food at home or dining out at restaurants. In films about China and Chinese families, food is often a symbol of what is not said. The act of feeding others is a substitute for saying “I love you” and demonstrated affection. In the beginning scenes in the U.S., Billi eats dinner with her parents at their square table—all angles with clear delineations between top and bottom, symbolizing a clear notion of right and wrong. But in the scenes in China, the family is always at a round table (usually with a lazy susan in the center) where the distinctions between people and morality are more nuanced.

For teaching purposes, I plan to show this film in my Death & Dying class to show cross-cultural perspectives of dying. The film explores the ethics of truth-telling, both the honoring of individual autonomy and the burden of self-knowledge. It is also a film about privilege—the Chinese relatives are well-off, their family can afford to come together with short notice, Nai nai has access to medical care and people who are willing to take care of her. The film also suggests that we need to take time to listen to our elders and hear their stories. For example, Nai nai was shot as a child soldier who fought for the new China. Her children leaving China may symbolize their rejection of a country for which she was willing to lay down her life. Another point for teaching discussion is that much of the movie’s lines are in Chinese with English subtitles and all of the cast is Chinese. I took that positively, that the film was offering a more realistic portrayal of this family (rather than dubbing into English which rarely works well), but in a period of U.S. history where “the foreign” is not so embraced, this storytelling technique could also be an opportunity to discuss representation, domination of language, and minorities in U.S. cinema. At its core, this is a story about a family that has dispersed across the world to pursue their individual dreams but comes back together to support and love.

The Farewell
Written and directed by Lulu Wang
1:38 run time

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