Vital Topics: Social Work & Film
by SaraKay Smullens, MSW, LCSW, DCSW, CGP, CFLE, BCD
To say I found viewing the filmThe God Committeedisappointing in message and confusing in purpose is an understatement. After having limited available life-saving equipment and staff protection when hit by the 2020 pandemic, promotion of a film centering on an examination of how complex decisions are made in a hospital setting when there are not enough resources for those who need them seemed beyond timely. The God Committee, based on Mark St. Germain’s play by the same name (which premiered in July 2004), features members of an organ transplant committee in an urban hospital who in essence hold life or death in their hands. In this drama, they are the decision-makers who determine who among several candidates will receive an available heart.
But, to borrow from the nightmare reference in Hamlet, here’s the rub: The script of The God Committee, extremely hard to follow, shallow, and disjointed, disregards and misrepresents the process through which one receives an organ. Although this drama purports to examine complex ethical decisions and extremely difficult choices, as well as corporate input versus ethical and moral imperative to do what is right, it presents a biased and inaccurate depiction, highlighting the prevalence and domination of those who lack character, substance, and compassion. Insult is added to injury with a glaring missing component—no social worker is anywhere to be seen or heard in this film.
Had I not been expecting far more, I would have realized that the title itself offered warning of a work dominated by misinformation and faulty misperception. Social workers remember how the concept of the “God Committee” was used to foment opposition to the 2010 Patient Protection and Affordable Care Act (commonly referred to as ObamaCare), when opponents warned of “death panels” to decide if medical care for aging parents and grandparents would be withheld. Few are aware, however, that in 1961, a committee of seven citizens making these life or death decisions actually did exist. This group was a private sector creation known as the Admissions and Policies Committee of the Seattle Artificial Kidney Center at Swedish Hospital, later called the “God Committee.” In the early days of dialysis, its members decided who would receive life-saving treatment. Once technology led to more access to dialysis, government funding and guidelines protected far-reaching access.
The God Committeestars Kelsey Grammer as Dr. Andre Boxer, a detached but brilliant heart surgeon with the mantra, “The heart is just a muscle.” Julia Stiles plays Dr. Jordan Taylor, a compassionate and ethical surgeon trained by Boxer, who is also in a secret (they delude themselves) and troubled personal relationship with him.
The script focuses on members of a hospital organ transplant committee who must decide in an hour which of three patients will receive an available heart after the death of their first choice. However, as Jen Melanson, MSW, LCSW, a social work doctoral student at Sacred Heart University with more than 20 years of experience working in healthcare, explains, “Organ transplant wait lists are managed by the United Network for Organ Sharing (UNOS), who is contracted by the federal government.” She adds that “…in the case of The God Committee, once the original heart recipient expired, the hospital would need to contact UNOS for next steps. I do not believe the hospital could make a decision without taking that step.” (For more information, see Education - UNOS.).
As the plot progresses, Boxer, a highly pragmatic, key member of the committee, is unsettled when Taylor is appointed to membership, seeing her as far too emotionally involved with patients to make a rational decision. Other committee members are Dr. Valerie Gilroy (Janeane Garofalo), a world-weary administrator facing financial restraints and downward ratings; Father Dunbar (Coleman Domingo), a lawyer turned priest who brings with him a board message; and Dr. Allen Lau (Peter Kim), a psychiatrist with compelling emotional baggage.
Speaking of the omission of social work on this powerful committee, Ann Marie Marks, BSN, RN, MBA, CCM, a health executive and former transplant director, explains:
If one were to observe an actual transplant committee, in most cases the social worker would be a crucial and visible member of the team. In fact, a well-known job description in transplant centers or large payor organizations is that of transplant coordinator, often filled by a licensed social worker. I cannot imagine any aspect of the transplant decision process without a social worker at the table. This film serves as a reminder of how “silent” the recognition of social workers is, even in media.
The committee member who most accurately speaks to social work priorities is Nurse Wilkes (Patricia T. Floyd), who is invested in the well-being of each of the possible recipients, the most aware of their histories, and most articulate about their possible futures.
One of the recipients being considered is the indulged son (with a history of violence and cocaine overdose) of wealthy and powerful Emmett Granger (Dan Hedaya), whose carrot on a stick is a $25 million grant to the struggling hospital if his son receives the heart. The other possible recipients are a kind and clinically overweight doorman with a bipolar disorder diagnosis (who is scrupulously taking his meds and doing all possible to finance a college education for his three daughters) and a straight-shooting woman in her 70s who does not care what people think of her.
Viewers do not learn immediately which recipient is chosen. However, the premise that the hospital has full say over a transplant recipient and that one can actually purchase a heart through a sizable donation is beyond faulty. Melanson continues, “Certain aspects of this movie seem farcicalto me, such as judgments of a patient’s character and a large financial contribution playing a role in the hospital decision. I just don’t see either of those being a factor in real life.” She underscores her point with information from donoralliance.org: “While many factors are used to match organs with patients, only medical and logistical factors are taken into consideration for all organs. Personal or social characteristics such as celebrity status or income do not play a role in transplant priority.”
As former transplant director Ann Marks explains:
Yes, I have heard instances where wealthy and famous people are able to manipulate the system, usually because of relationships with decision makers. However, obtaining organs in this way is far more likely outside of this country. After witnessing transplant committees in health systems, payor organizations, our country’s government, and yes even at home, I have never observed an organ allocation based on financial influence.
She further offers:
[The film] fails to acknowledge the vast number of standards that exist to support clinicians and health systems in the decision process. Although, in a contentious hearing, the Senate Finance Committee recently criticized UNOS for tech and distribution problems, in my experience, the organization constantly strives to create a fair and equitable organ matching and allocation system for those in need.
The God Committee moves viewers back and forth from 2014 to 2021. With the passage of seven years, personal and professional decisions and their consequences are clarified, and lives and professional settings become more disheartening. Scenes are offered in hard-to-follow gulps, so here’s a hint I finally discovered—in scenes from the later time period, Boxer’s hair has thinned.
Chris McLaughlin, MSW, LCSW, former chair of his hospital’s ethics committee and present executive director of the Maine chapter of NASW, frames an important question centering on the film’s “misinformation, bias, and omissions.” In his words:
It’s a given—hospitals require system changes, including more recognition and use of the skills and talents of social work throughout the hospital, including the C Suite. Yet, I cannot help but wonder why a writer and director offers a story line encouraging a belief that callousness and greed dominate life and death decisions while hospitals are purposefully discriminating against those without power.
This question is especially important now, at such a dangerous and divided time when overworked and exhausted professionals are daunting in the pursuit of offering healing and support in a non-discriminatory setting, despite overwhelming obstacles.
The God Committee, with all of its flaws, brings attention to issues that are important in social work practice. For example:
- What would, or could, a social worker have contributed to the committee’s deliberations in The God Committee?
- Which areas of the NASW Code of Ethics are violated in The God Committee (recognizing that there is not a social worker on the committee, but consider what would have been unethical for a social worker in this situation)?
- What is the social worker’s role on a real-life transplant team?
- What is the solution when a service or resource is not available to all clients? Who is served, and who is not?
- How is the decision made, and how do we ensure that it is fair and equitable?
- In a medical setting, are social workers at the table when such decisions are made? If not, why?
- How can we advocate/educate for the need for social workers to be part of such decisions?
- Should a client’s lifestyle and other personal factors be considered in such decision-making?
- When given the responsibility/power to make decisions about allocation of services/resources, how can a social worker and agencies guard against temptation to use this power/responsibility inappropriately?
- Which areas of the NASW Code of Ethics relate to such decisions and to the lack of adequate resources for all who need them?
The God Committee might serve as a starting point for discussion of these and other questions by social workers and social work students.
Thinking more broadly, as the only democracy in the world where health insurance is not guaranteed, it isunconscionable that 26 million who live here are denied what is a right, not aprivilege. Wealth abounds for the privileged in the top one percent of ourpopulation.Appropriate taxation of this wealth would provide this insurance and, in addition, address the prevailing frustrations of limited supplies, resources, and services. The blueprint for addressing these and other looming societal problems is offered by the Social Determinants of Health (SDOH), a World Health Organization (WHO) initiative launched in the early 2000s. Together, through impassioned advocacy and activism, we can and we must turn this blueprint into necessary reality.
SaraKay Smullens, MSW, LCSW, DCSW, CGP, CFLE, BCD, whose private and pro bono clinical social work practice is in Philadelphia, is a certified group psychotherapist and family life educator. She is a recipient of the Lifetime Achievement Award (2004) and the Social Worker of the Year (2018) from the Pennsylvania chapter of NASW, and the 2013 NASW Media Award for Best Article. In 2018, she was one of five graduates of the University of Pennsylvania School of Social Policy and Practice selected for the school’s inaugural Hall of Fame. SaraKay is the author ofBurnout and Self-Care in Social Work (2nd Edition).