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Amour: does old age have any honour left?
A harrowing film about a French couple’s struggle with dementia is a powerful but inadequate argument for legalized euthanasia.
It is a drastic understatement to observe that Austrian director Michael Haneke’s film Amour (Love) is harrowing and heartbreaking. I sat there just wanting it to be over. Yet I couldn’t leave. I felt like an animal caught in a hunter’s spotlight – unable to move, mesmerized.
Amour has been heaped with praise and is an Oscar nominee in five categories, including best film, best director and best foreign film. It is insightfully and accurately described by Francine Prose, of the New York Review of Books blog, as “a masterpiece you might not want to see”. This warning is merited: the film is intensely distressing. Paula Span, in the New York Times, under the banner of the “new old age”, calls Amour “the brutal truth”. Some people will see it as a clarion call for the legalization of euthanasia. I’d suggest, however, that it’s equally, if not more so, a clarion call for our responsibilities as families and a society to correct the circumstances in which many old and vulnerable people find themselves.
Anne (played by Emmanuelle Riva) and Georges (Jean-Louis Trintignant), the two main characters in the film, are such people and live in such circumstances. They are financially secure, upper middle-class, retired musicians, living in a classic, elegant apartment in Paris. They have one child, Eva (Isabelle Huppert), who is around 50 years old and visits them occasionally. She has two young-adult children who have left home, is in a troubled marriage, and preoccupied with her own problems. The acting is superb: it is difficult to believe these are not real life events, which adds to the serious emotional distress the film elicits.
It opens with firemen and a plain clothes detective breaking into an apartment and finding the decomposing body of a clothed, dead woman, with a crucifix on her chest. She is laid out on a bed, surrounded by wilted flowers which have been cut from their stems.
The story then shifts to a concert hall, where Anne and Georges are attending a performance of a Schubert piano concerto by Alexandre (the French pianist Alexandre Tharaud, who plays himself), who, as a 12-year-old, was Anne’s pupil. They are delighted by the performance, but come home to find an attempted break-in to their apartment. Anne suggests calling the police, but Georges refuses. This is the beginning of Haneke’s brilliant portrayal of what proves to be their increasingly vulnerable state and the unavailability of help, and of their, especially Georges’, refusal to accept it or lack of capacity to seek it.
Next morning, Anne and George are eating breakfast and Anne temporarily loses consciousness and is unresponsive to Georges’ questions about what is wrong. She regains consciousness but has no memory of losing it. She pours some tea, which spills because she cannot control her movements. The rest of the film documents in graphic detail both Anne’s physical and mental decline as a result of failed carotid artery surgery, strokes and dementia and Georges’ efforts to care for her, almost entirely without assistance.
We learn that Dr Bertier, Anne’s physician, and a hairdresser come once every two weeks. A nurse whom Georges hires comes three times a week. A second nurse is incompetent and abusive and is fired by Georges. The janitor helps Georges to carry in groceries and the janitor’s wife vacuums the rugs. Both offer whatever other help they can give, but Georges does not take up their offer. They are obviously curious about Anne’s condition and try to linger and talk, but Georges always promptly ushers them out.
Neuroscientist Dr Tiffany Chow, who has just written a book, The Memory Clinic: Stories of Hope and Healing for Alzheimer’s Patients and Their Families, told the Globe and Mail: “The number one mistake that caregivers make is thinking ‘I can do all this myself’. That’s a guaranteed recipe for burnout. Caregiving has to be done with some allies, whether it’s your personal friends, neighbours, other family members or professional care providers.”
Eva pays the occasional visit to her parents, once accompanied by her husband Howard, who suggests Anne be placed in a nursing home, a proposition Georges adamantly refuses. He has promised Anne, who is frightened of doctors and hates hospitals, to keep her at home. The only other visitors are Alexandre and a stray pigeon which flies in through an open window.
Meanwhile, we see in great detail Georges helping Anne in and out of her bed and her wheelchair, off the toilet, and, eventually, checking her diapers when she is bedridden; trying to get her to take water from a sipping cup and food from a spoon, both of which she refuses; reading to her; and trying to sooth her when she screams “mal” (hurt) over and over.
Finally, Georges tells Anne a story from his childhood – about being sent away to a summer holiday camp and letting his mother know through a prearranged signal of drawing stars on the weekly postcard he sent home, that he was desperately unhappy there, in part because, like Anne, he refused to eat, in his case, rice pudding. He completes the story, grabs the pillow from his side of their bed and suffocates Anne, whose struggles to escape slowly subside.
Georges goes out to buy flowers from which he cuts the stems and then chooses a dress from Anne’s closet. Our thoughts flash back to the opening scene of what we now realize was Anne’s body on the bed. We then see George using wide adhesive tape to seal the doorway into the bedroom.
In a following scene, the pigeon returns and one can’t be sure, at the time, whether Georges smothers it, as he did Anne, in the blanket in which he caught it, or cuddles and strokes and then releases it. In a letter which we subsequently see him writing, presumably a suicide note, we learn that it was released. This comes as a tiny affirmation of hope and respect for life. But in this unrelentingly depressing and joyless film, which resonates with a “culture of death" and makes death seem vastly preferable to life, it is a hugely welcome one.
So what can we learn from this film?
First, Amour shows us the impact, not only of the presence of love, but also of its absence.
It captures Georges’ and Anne’s love for each other, and Georges’ love as portrayed in his care for Anne. Flowers and music are often associated with love and appear frequently in the film, which is rich with symbolism, allusion and innuendo – for instance, in looking at the family photo album, Anne seems to look only at photos in which she is present.
It also merits noting that Haneke makes powerful use of silence, sometimes to express positive emotions and closeness; sometimes negative ones and alienation. And when Anne and Georges are listening to the CD Alexandre had given them of the concert they had attended, Anne abruptly says, “Stop the CD”, which Georges does. Music seems to represent the thread of life for this couple.
In contrast, the stark absence of love is seen in the almost total lack of any loving support from family, friends or community. Eva sums up her feelings in this regard, “I can’t believe that these days there's no way of handling this [Anne’s illness and Georges’ situation] efficiently.” Efficiency is a bureaucratic, emotionally detached value. From this perspective, the film can be viewed as a tragic commentary on the dissolution of families and the values of mutual support and responsibility for family members, especially when they are vulnerable, because they are old, sick and dying.
Likewise, it can be seen as an indictment of the community’s and society’s failure to provide palliative and hospice care and other support, including respite care, for those who try to look after their loved ones at home. Like Anne, most people want to die at home but can’t because of lack of support for their carers.
When Anne is bedridden and her dementia has become very advanced, she constantly cries out, repeating one word, “Mal” (hurt). It seems reasonable to interpret this as an indication of pain. Yet, we do not see her being given any pain relief treatment and, as noted already, the doctor visits only once every two weeks. Inadequate pain relief, or fear of being left in pain, is a reason people ask or advocate for euthanasia.
Another reason, and one of the main ones, is that they see themselves as a burden on others, especially their families. Other reasons are loss of control and the feeling that they are losing their dignity. They confuse being independent with having dignity and, therefore, perceive dependence as the loss of dignity. All of these are piercingly and powerfully communicated in Amour. But what can be done to address and eliminate those reasons is nowhere to be found.
In this latter respect, Intimate Death, a book by French psychologist Marie de Hennezel, who specializes in the care of dying people, could not be in starker contrast. In moving and poetic vignettes about dying people, and without denying suffering or romanticizing or glamourizing it, she tells us stories that allow us to see that dying can be the last great act of living.
Essential ingredients for that to be the case are the presence of hope; the sense that our life had meaning and can still have meaning, even when we are dying; the realization that we can still learn and even teach; that we have something to give others; and that we can leave a legacy. None of these features of a “good” death is present in Anne’s and Georges’ situation.
Early in the film, when Anne is wheelchair-bound, but not demented, Pierre, one of her and Georges’ friends, dies and Georges attends the funeral without her. When he returns she asks him about the service. Here’s what he says:
“It was rather bizarre. The priest was an idiot. Then one of Pierre’s co-workers made a speech that was embarrassingly emotional. His old secretary came with a radio cassette player and after the speech she put on “Yesterday” by the Beatles. You can’t imagine. Everybody turned round to look at her. Apparently, it wasn’t planned. His grandchildren were there. Of course they giggled as soon as the music began. Then the urn was put on a huge stretcher that was obviously designed for a coffin, and out we went into the rain. They placed the urn on a small electric cart that crawled along for what seemed like an eternity to the tiny hole they had dug. A lot of people had to stifle their laughter. It must have been terrible for Jeanne [Pierre’s widow].”
There’s a loss of solemnity and respect, a trivialization of the momentousness of death and the losses it involves, a failure to express grief and to mourn and, a lack of opportunity for healing. The secular music, the Beatles’ song “Yesterday”, represents the antithesis of hope. Hope requires a sense of connection to the future; this song implies that only a sad connection to the past is possible.
Having a sense of connection to the future when one is dying does not have to involve religion, although of course it can. One other way is to be aware of leaving a legacy. Canadian psychiatrist Dr Harvey Max Chochinov and his colleagues have been researching how to help dying people. They have developed what they call “dignity therapy”. Part of this is helping dying people to see what they can leave as a legacy to those they love and to other people.
Anne’s legacy was in her students, represented by Alexandre. But she refused to listen to the CD he gave her of his critically acclaimed concert. She refused to allow hope to creep in, to have a moment of joy. In fact, a dominant feature of Amour is that there are no moments of joy.
I began this review saying I sat through Amour just wanting it to be over. Both dying people and those who love them can also feel that way about death. But wanting it to be over is very different from wanting to be killed and the impact of each – that is, allowing to die, as compared with killing – is very different at institutional, societal and even global levels.
Some people will see Amour as an argument for legalizing euthanasia. The strongest case for this is the situation in Amour - an individual who is suffering and dying and wants to die.
But we must also consider the effect of legalizing euthanasia on other people, especially the possibility of elder abuse; on the medical profession and medicine’s millennia-old guiding principle, “curing where possible, caring always, never killing”; on the law as a primary institution upholding the societal value of respect for life; on other healthcare professionals and healthcare institutions; and on society’s most important values, especially that of respect for life.
Amour brings to mind lines from Alfred Lord Tennyson’s poem “Ulysses”:
The long day wanes: the slow moon climbs: the deep
It leaves us, however, with no sense that
Old age hath yet his honour and his toil;
Margaret Somerville is director of the McGill Centre for Medicine, Ethics and Law in Montreal.
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