FINAL FRAME

A New Lens Through Which to Consider End of Life Decisions

Nobody Gets Out of Here Alive

When death comes, we might hope that it will be quick and painless. If not, we might like to be able to choose where we pass, and what that looks like.

Increasingly, though, we don’t get that choice. In the UK, most of us would prefer to die at home. But well over half die in hospitals in England- 22,000 in intensive care units. In America, one in five people who die do so on, or shortly after admission to, intensive care.

But it doesn’t have to be that way. The ReSPECT Initiative (https://www.resus.org.uk/respect/) helps us say what we want if we suffer an unexpected medical event.

But death often follows a slow decline, and there is a sharp increase in hospital admissions in the last 3 months of life. There is time to make plans and to decide what we want at the end, and to make sure that we get it. But how do we do that?

We propose a new way to think about the issue: Final Frame.

Early in 2018, a photographer died of cancer. Let’s call her Ms Smith. As her cancer spread and treatments failed, she declined and ended up in hospital. She died on a poorly staffed open ward, surrounded by confused patients, without the dignity, privacy and humanity she’d wished for.

How did that happen? Where had communication failed?

At the celebration of her life, surrounded by photographs, the answer was clear. The conversations hadn’t been framed in a way that had allowed easy and open conversations with friends and family, and healthcare professionals. After all, conversations about dying can be tough.

The origins of Final Frame

Let’s think of you as a patient- it might be that you are young and with a cancer that has spread. It might be that you are an elderly person in a care home who might soon get another severe urine infection.

A doctor offers you a treatment, or asks ‘what you’d want in the future’. They might tell you the chance that the treatment will work, and side effects. But your conversation usually won’t cover your choices about how your life ends.

Now, let’s call you ‘Ms.Smith’, and think of a different conversation. You might have it with yourself, or with a loved one. It goes like this.

‘Let’s imagine the film ‘Ms Smiths Life’. It’s wonderful- full of comedy, thrills, adventure and romance. And its been long. But now, it is coming to its end. The screen is about to fade to grey. The credits are about to roll. What would you like the final frame of your film to look like?’  

In fact, this is a question nearly all can answer. Perhaps, ‘In bed at home, pain free and surrounded by my friends and family’, or ‘In our holiday home overlooking the sea in Cornwall, with my favourite music in the background and the fireplace on.’ The problem is that only you know this! Your doctor doesn’t. But they need to. Otherwise, you are both aiming for a different destination. So, what to do?

Firstly, decide what you want your Final Frame to be. Talk to friends and family if you want.

Next- make sure that everyone knows that this is what you want-including your doctors.

When a doctor offers a treatment, ask:

  • What are the chances of success?

  • What does success look like? (Cure? Extra years or weeks of life? With how much suffering or benefit to symptoms?)

  • At what cost? (What are the side effects of treatment? Will I end up weaker or stronger? Feeling sick? Tired?)

  • What will it do the chance of me getting my Final Frame?

What you hear might guide your decisions.

A 99% chance of complete cure, an extra 20 years of healthy life, without any side effects from treatment, and allowing you to get your Final Frame in the future, and you might take the treatment.

But a 50% chance of getting an extra 4 months, with lots of side effects? And if that might mean you end up declining and going to hospital? And when that might be too late to get your hospice bed, or the care package to keep you comfortable at home? You might decide to focus on comfort, dignity, trips to the seaside, seeing friends, and setting the scene for your Final Frame. Directing your own film.

Think about it. Chat to people. Friends.Work colleagues. Family. What is your Final Frame? What are theirs?

The Script

Upcoming event

  • BAFTA/ BFI Launch Event

    Q2 2026

    A press-invited event where a selected few film directors will discuss their favourite ‘final frame or sequence’ from a film- or that from one of their own cannon.