"There’s nothing inherently medical about dying. It’s much more than medicine. It’s purely human" – Dr B.J. Miller

End game, nominated for best documentary (short subject), is a Netflix film that follows terminally ill patients as they make choices regarding their end of life care. All the stories covered take place in California, where physician assisted suicide is not yet legal. It is a beautiful, tragic film about facing death and being treated with the utmost care and dignity until your dying breath.

"If I have to clean her, it would be my honour."

The film opens on the bedside of Mitra, a former midwife from Iran with terminal cancer. It is left up to her husband and mother to decide whether she will go through another round of treatment. There are obvious disagreements between the two of them. Mitra’s husband sees her as a fighter and is holding out hope for her recovery. He says, when discussing caring for her at home: "If I have to clean her, it would be my honour." Her mother cannot bear to see her suffer. Mitra’s doctor patiently bears with them through these troubles, saying: ‘We’ve been dealt a hand of cards. We can wish we had different cards; we can try and play a different game, but this is where we are now’. We follow this family through the turmoil of coming to terms with Mitra’s diagnosis – holding back tears until they are outside her room, so as to hide their sadness from her. End Game makes clear the suffering of this family, but also highlights their joy – spending what time they can with a woman they love so dearly. The documentary does not clinicalise or sterilise death, instead it faces death head on with all the joy and suffering that comes with it.

Dying is human

An interesting figure present throughout the documentary is Dr B.J. Miller. At 19, Dr Miller lost an arm and both of his legs in an accident. He went on to finish his medical degree and now he works in palliative care – running the Zen Hospice Project. Viewers of End Game get to hear much of Dr Miller’s perspective on death and suffering, as well as having an intimate perspective into his conversations with dying patients. He says of suffering and death: "You don’t run away from suffering" and "there’s nothing inherently medical about dying. It’s much more than medicine. It’s purely human."

"Every moment is a gift"

One of the patients at the Zen Hospice Guest House, Pat, has uterine cancer. Despite her poor prognosis, she radiates hope, saying: "Every moment is a gift; you’re still here – and that’s a gift."

Another of Dr Miller’s patients, Thekla, has decided she wants to die at home and her care team is doing their best to facilitate that. Viewers follow Thekla at her appointments with Dr Miller. She is a woman who clearly has a fighting spirit, saying to Dr Miller: "You gave me an assignment; you told me to make friends with death. I have failed the assignment – I love to live." What follows is a candid and beautiful discussion about death and fear. Speaking about her death, she says: "It could be terrible, it could be wonderful. This part of my life [terminal illness] is wonderful – and who would’ve thought?"

Importance of palliative care

I was struck by the passion of the palliative care specialists featured in this film. Their priority is always to help people "live as long as possible, as well as possible", focusing on "emotional, psychological and spiritual support". Never once is there a discussion of cost; never once is one of the patients made to feel burdensome.

How different would this documentary be if there was another option – physician assisted suicide – presented to the patients? The tone would change entirely. This additional "choice"would undermine any other discussion about end of life care and devalue the lives of those dying people.

If you plan on watching one Oscar nominated film this, make it End Game. It will leave you with an honest depiction of what good, loving palliative care looks like – and it does not involve physician assisted suicide.