Extreme Measures (1996)

Last modified: May 22, 2017

A doctor working in the ER department of a busy downtown hospital stumbles upon a secret research program that is run by other doctors from his hospital. When he follows the trail, he discovers what is being done behind closed doors; this almost gets him fired and possibly killed…

Relevance

This film covers the subject of informed consent and voluntariness. It also discusses and important question that is not easily answered: “If you had to kill one person to cure cancer, wouldn’t you have to do that?”

This movie is included in the Fiction movies for RCR education.

Key words: Ethics / Decision making
Medium: This film is available on DVD
Fragments: 2

  • Fragment 1: [1:30:00-1:33:17]
  • Fragment 2: [1:38:00-1:43:10]

Internet Movie Database (IMDb) about this movie: IMDb
Crime/Drama/Mystery/ playing time: 118 min.

Context and Content

Two men break out of a building in an urban area; they seem rather distressed. They run off into the busy streets of New York City, where one of them is lost in the crowd and another is picked up by the healthcare services and is taken to a hospital. The doctor in charge of the ER; Guy Luthan (Hugh Grant) is not able to figure out what is wrong with this man and unfortunately the patient dies before he has a definitive diagnose. He does not know where this man came from nor what he had and this intrigues him; Guy starts a search for the man’s identity and the rest of his background and details.

Firstly, he calls the mortuary to obtain a cause of death of the man now identified as ‘Minkens’ and is told he died of a pulmonary embolism; a cause of death he finds highly unlikely given that the patient was scarred and looked like he took medication of some kind. When he pays the mortuary a visit, the medical examiner has no record of the patient and tells him that his hospital has a record of losing patients, thereafter he tells him to mind his own business. After this peculiar incident, Guy is triggered to start a search for the records of the missing body and is caught doing so by a staff member and surgeon dr. Manko (Paul Guilfoyle). A few days after getting caught looking through the hospital files, Guy finds his home searched and is thereafter charged with possession of medical cocaine, stolen from the hospital he works in.

After getting a tip from a homeless man he has treated several times, Guy is led to an underground movement called ‘the room’ where ‘moles’ live. He goes into ‘the room’ and finds one of the two men who escaped from the crowd earlier called ‘Minkens’. He is very sick. The ‘Moles’ tell Guy that some other men were taken besides Minkens; all healthy males; this makes Guy suspect that someone is doing medical tests on them. He remembers that a lot of costly blood tests where done on homeless people that had very little medical relevance.

He remembers ‘Minkens’ telling him something about ‘tri-phase’. He is hurt in his journey into the sewers in search of ‘the room’ and knocks on the door of his colleague and friend Jodie and asks her what she knows about ‘tri-phase’. He gets knocked down with a baseball bat by the boyfriend of Jodie (who is in a wheelchair) before he is able to get an answer to his question on ‘tri-phase’.

Guy wakes up in the hospital with a severe trauma to his neck, which left him paralysed from the neck downwards. An old friend and colleague dr. Lawrence Myrick (gene Hackman) enters his room and asks him a very difficult question: ‘what would you give to be healed and be able to return back to your everyday life as a doctor?’ Guy hesitates and answers: ‘anything’. Dr. Myrick replies: you should think about that…

Jodie (Sarah Jessica Parker) enters the room and tells him that he is not paralysed, but that he was tricked into thinking so by dr. Myrick, who is working on ‘tri-phase,’ a research program that researches paralysis and seeks for a cure. Dr. Myrick picks up the microphone and starts a speech that can be heard throughout the whole facility in order to reach Guy.

Fragments

The selected two fragments of the film should be viewed in sequence as they share an educational purpose.

Fragment: Myrick’s Speech part 1: In search of Guy [±1:30:00-1:33:17]

Dr. Myrick recruited human subjects from the street. They were mostly addicted and homeless men without a future. They were recruited because he needed human subjects for his research on neural tissue regeneration. He is already able to regrow nerve tissue in persons who had their spine surgically severed, but still needs to control the overgrowth of tissue, as this poses problems like epileptic insults. He puts Guy through the experience of being paralysed himself in order to make him understand what it is like to be hopeless due to a handicap. He ends his speech with the question if Guy would be willing to join his staff, as he is understaffed and believes Guy is a doctor who is prepared to do the right thing.

Fragment: Myrick’s Speech part 2: In conversation with Guy [1:38:00-1:43:10]

Dr. Myrick: “I’m 68 years old Guy, so I cannot waste time. 3 years to get from a rat to a dog and after 5 years maybe if I am lucky I can work on a chimp. We have to move faster than that.” – “If you had to kill one person to cure cancer, wouldn’t you have to do that?”

Ethics

There are two main themes that run through Dr Myrick’s medical experiment: the involuntariness of the research subjects versus the benefit or gain that is acquired through the research.

The first point is deemed unethical by our current standards of research ethics: no subject should be included in a medical experiment against his/her will, especially if he/she is not aware to be included. It does not matter that the subject is a junkie or a homeless person, all are seen as equal and they should be given a choice whether or not they are willing to participate in research.

The second point is that of benefit or gain; the question dr. Myrick asks Guy is interesting in this context: “If you had to kill one person to cure cancer, wouldn’t you have to do that?” this is a stance that is open for debate as it has many different sides to it.
From a Utilitarian point of view one could argue that killing a limited number of people in order to save a greater number of people (later) could possibly be the right thing to do. This would work as a kind of moral equation, which would in theory have a certain tipping point. The scales could tip in favour of killing a limited number in order to save the greater number; this would be in line with what dr. Myrick would say.

Deontologists would respond to this line of argumentation with the argument that one is not allowed to intentionally kill people in order to save others, as it is by principle not allowed to kill another human being. The not foreseen end of a patient’s life may however be an unintentional side effect of doing medical research. This is what deontologists call the doctrine of double effect. The doctrine of double-effect leaves room for medical experimentation with people, who could possibly die from those experiments without it being unethical due to fact that the act does not have the intention of ending the patient’s life. The intention of the experiment is not to kill in order to advance medical science or save other people’s life. Death would in these cases be an unintentional side effect of the act of performing medical experiments.

Realism

I believe this fragment and the rest of the movie provides us with a realistic sketch of possible grey areas a researcher could move into in order to save people or advance medical science. The intentions of dr. Myrick are good, but his methods are unethical.

A good aspect of the movie is the fact that Guy experienced being paralysed himself. You can see Guy doubting for a second after having had this experience.

Dr. Myrick wants to bypass the scientific community altogether by performing his experiments in secrecy and ignoring all guidelines set out by the scientific community on research ethics. He wants to bypass all stages of early research like lab rats, animal research etc. Instead he wants to move directly to first-in-man-studies without approval of an IRB or another institute or individual that could adequately assess his research plans.

Suggested use for education

Even though the case presented in this film is quite extreme I believe these fragments may be used to illustrate the importance of the consent procedure in medical research, the need for open science and the overall importance of research ethics in general.

Firstly, these fragments may be used to highlight the importance of research ethics for medical research. Without research ethics and codes of conduct, research may be executed that harms the participants in order to ‘help numerous others’. A discussion may be started on the role of utilitarianism in medical ethics and the difficulty of finding the right balance between harm and benefit.

Another topic that may be discussed based on these fragments is open science. In order to maintain scientific integrity and responsible research it is important to maintain an open scientific culture; trials should be registered and data should be shared when research is concluded.

The last topic that is illustrated by the fragments above is that of consent in medical ethics. A well-performed consent procedure is essential in guarding the freely chosen participation in medical research. A lack of a consent procedure enables researchers to use patients without their consent in order to advance medical science.

Ending

Dr. Myrick’s speech does not persuade Guy to participate in the research program and the police come in to take dr. Myrick in. This is the end of the research program.

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