My mother has been living with stage IV lung cancer for over five years now, and for me, Lulu Wang’s film The Farewell, partially based on the director’s own experiences, touched something that felt undeniably true. I have been trying to reckon with my own inability of saving her and the constant state of unknowing that shrouds our every day. These last five years have been a tug-of-war between the reality I want and the reality I get, and one of the hardest parts is the little power I have in framing my own narrative. There are many essays, books, films and songs that try to capture the unpredictabilities of illness—of life—and The Farewell was one that successfully rendered those tensions for me. I believe there are different stories that are effective for each of us; that strike a cord and raise a flurry of ethical quandaries we wouldn’t have otherwise entertained.
The Farewell begins as Wang’s grandmother, who lives in China, is diagnosed with stage IV lung cancer. Her family has been told by doctors that she has three months to live, and the family decides not to tell the grandmother—the holder of the illness and diagnosis—saying no good could come of disclosing the cancer or prognosis. Instead, Wang’s family arranges an elaborate wedding banquet to reunite family members back in their hometown of Changchun, with the covert intention of gathering everyone for their dying matriarch—a marital procession turned fake funeral. The film, which premiered at the Sundance Festival in January 2019, remains a rich source of discussion, particularly in the realm of medicine.
The Farewell is a comedic drama, which deftly handles the heartbreak and humor that arise from experiences of illness. The tangible proximity of wedding celebration and funeral suspend the film in a delicate space between absurdity and deep suffering. Despite the artificiality of the arrangement itself, the film exudes familial tenderness. The protagonist, Billi, played by Awkwafina, asks her parents repeatedly whether secrecy is ethical in the face of a terminal disease. We follow Billi as she struggles to manage the mixed fear, anxiety and warmth she feels towards her grandmother, parents and extended family in China.
Throughout the film, Billi is caught between the responsibilities of caring for her grandmother, the frustration of her own futility in saving her grandmother from imminent death, and the cultural differences in Chinese and American morals she stands between. The film successfully carries the thematic elements one would ask from a movie about cancer—the vexed and unexpected realities of illness; the realization of human insufficiency; the redundancy of that realization; and the convoluted path towards acceptance.
Striated in rich layers of pain and love, the film asks its viewers to question what it means to have responsibility over information, and the ethics of disclosing that information—or not doing so, as becomes important in the case of The Farewell. The film is, in many ways, inextricable from medicine because the questions it poses have and will always be important for empathic doctoring. The issues that emerge in the plotline around the delivery of medical information are present in today’s caregiving culture.
For instance, the balance of autonomy and beneficence in treating terminally ill patients remains fraught and unresolved in China. Cross-cultural case studies show that truth-telling is similarly opaque in other countries, including Taiwan, Japan, Turkey, Iran and more. But even in the United States, where truth-telling rings with virtue and moral clarity, sociocultural and individual differences make conversations between physician and patient, physician and family, complicated. While truth is a fundamental pillar for establishing trust in the clinical encounter, there is limited empirical information on the constituents of patient perspectives that physicians need to embrace for effective communication.
The film reaffirms the need for empirical research on how physicians can better accommodate the diversity of patient perspectives in regard to diagnosis, prognosis and family dynamics. Especially in a country like the U.S., where individual expression is valued, physicians must continue to rigorously investigate what their role is in truth-telling, and how those conversational nuances shift with each patient and family.
But beyond rekindling the urgency for such empirical knowledge, The Farewell allows us to grapple with a deeper, visceral and phenomenological understanding of truth. The film is successful on the surface because it is a meticulous reproduction of realities that persist between cancer and patient, patient and family, family and doctor, country to country. But it is perhaps even more successful when it acts as a moral exercise for its viewers.
The Farewell is emotionally challenging because it exists in morally gray terrain, and asks its characters, and audience, to linger in that discomfort. We become sympathetic to Billi because the insufficiency she feels about telling her grandmother the truth about her illness and, thus, saving her, is an active wrestling with control in her own coming of age story. If Billi could tell her grandmother, maybe she could save her. We, as viewers, hold onto this hope, even when we know the reality is unlikely. The film speaks as a larger metaphor: the desire of knowledge, and the fantasy of control; if the dissemination of information could be controlled, then maybe the disease could be too. Maybe death would be preventable.
But then, we are confronted with the consequences of control and deception—not just the thematic “deception” of withholding information from Billi’s grandmother, but the abstract idea of deception, which is that knowledge and control act in congruence with each other; they do not. The film ruptures these illusions of controlling knowledge as a way of controlling life, and by doing so, urges us to suspend our own desire for narrative control, and control more generally.
Stories like The Farewell are necessary in medicine because they provide us with safe spaces for exercising moral dilemmas that are essential for recognizing our own biases, and honoring the stories of others. Medicine, undoubtedly, requires precision for effective care. But medicine, undoubtedly, requires imagination too. And that’s what this film offers. It gives us the opportunity to take a step back and really ask ourselves: What is the patient’s narrative? What does the traditional narrative arc of recovery say about our own desires for narrative simplicity? And what are the consequences of such complacency? What are the areas of opacity, of unknowing, of discomfort in the stories we hear, and how do we respond with appropriate care? These questions will never be answered, not to completion at least, but perhaps we can get closer to their truths by seeking out stories that make us pause, ask, and listen.