'Defining Hope': Film Review

A clear-eyed and compassionate conversation starter.

End-of-life questions are front and center in a documentary exploring the experiences of healthcare professionals and their patients.

Carolyn Jones, who previously profiled frontline healthcare workers in The American Nurse, turns her attention to a crucial but seldom-discussed aspect of medicine — namely, death and dying — in her new film. Shining a light on hospice and palliative care, approaches that are still considered alternative, Defining Hope builds a persuasive case for the ways they empower patients and their loved ones.

The documentary follows two nurses: Diane Ryan, who's on staff at Calvary Hospital, a Bronx facility devoted to hospice and palliative care, and Gilbert Oakley, of Visiting Nurse Service of New York. Their commitment to their work and the sense of fulfillment it gives them come through powerfully in their interviews for the film and in their intimately tracked interactions with patients.

Having worked in a conventional hospital's ER, Ryan says she was struck by the emphasis on invasive procedures at any cost and the loss of dignity that often went with it. She understands what many of her cancer patients have been through — crucially, not only as a caregiver but as a former patient herself. "They've gotten so much treatment," Ryan notes, "that their bodies can't take it anymore."

In contrast, patients' time at Calvary allows them to focus on whatever matters to them, rather than being subjected to grueling procedures and medicines. "You learn to live," one patient says, her adult daughter beside her in the hospital bed. But it's more than a matter of philosophy and attitude; the film highlights the very real effects of self-determination. A charming, grizzled World War II vet, having watched his late wife go through eight years of cancer treatment, opts for "do not resuscitate" when it comes to his own ailments, and it's more than evident that the choice is liberating for him. For a good-humored 95-year-old patient of Oakley's, still living in his apartment with his wife, each visit from the nurse is more than a medical rundown; the man is fully involved in decisions about his day-to-day care.

Jones' subjects are not all elderly patients, and some of the dilemmas facing them are not so much end-of-life as life-or-death: how far to go with risky surgeries and debilitating treatments. At Children’s National Medical Center in Washington, a teen and her family weigh whether she should undergo surgery to remove the last of her brain tumor, and possible her memory with it. A recuperating 12-year-old heart-transplant patient, who said yes to the operation "because I still want to be alive," now wants to be a nurse or doctor.

Through these patients' stories, Defining Hope provides a vision of healthcare reform that often gets lost amid the ongoing debate over insurance and the economics of medicine. "Quality of life" may be a tossed-around phrase, but Jones' clear-eyed film shows how it can be a guiding principle.

Production company: Carolyn Jones Productions
Distributor: Screenvision Media
Director: Carolyn Jones
Producer: Lisa Frank
Executive producers: Carolyn Jones, Donald & Barbara Jonas, Kate Judge, Jeannie Patz Blaustein
Director of photography: Jaka Vinsek
Editors: Laura Israel, Chelsea Smith, Candace Thompson
Composer: Marc Ribot

87 minutes