Now Is Good (2012): Choosing to Stop Treatment

Tessa Scott is seventeen and lives in Brighton. She has had leukemia since she was a child.

She decides to stop treatment. Instead she works through a list of things she wants to do before she dies, saying yes to everything: drugs, shoplifting, sex. She drags her best friend Zoey along with her.

Her father has given up work to care for her and cannot accept that she is dying. Her mother drifts in and out. Her younger brother absorbs himself in magic tricks while the household organizes itself entirely around his sister.

Tessa falls in love with Adam, the boy next door, who is grieving his own father. In the final stretch she deteriorates, and the film moves to her bedroom at home. Her family and Adam keep vigil, and her narration breaks into fragments as she dies.

Spoilers throughout. This page says how Now Is Good ends.

The film is good on texture. There is the boredom. There are flashes of cruelty toward the people doing the caring. There is the total loss of privacy that comes with being handled and watched.

It is unusually honest that stopping treatment can be a considered decision rather than a collapse of will. It is honest, too, that the people around a dying person will not all agree with it.

The family dynamics ring true. The father who hovers. The mother who flees. The sibling quietly pushed to the edge of his own household.

Tessa stays photogenic and articulate almost to the end. Reviewers picked up on the tendency to have her dying prettily.

The clinical record is less gentle. NCI's summary of the last days of life reports that among 203 people who died in acute palliative care units, the proportion able to communicate fell from 80% to 39% over the final 7 days. Anorexia, drowsiness, fatigue and breathlessness all rose in intensity closer to death. Difficulty swallowing and urinary incontinence became more common in the last few days.

Terminal delirium occurs before death in 50% to 90% of people. Most of it is hypoactive, meaning a reduced level of consciousness rather than agitation.

Predicting the timing is also harder than films suggest. One study of recognized dying signs found a median of 23 hours from the onset of death rattle to death, 2.5 hours from breathing with jaw movement, and about 1 hour from bluish discoloration of the hands and feet. Another found that many people had normal vital signs even in the last 12 hours.

The list itself, with its crimes and drugs and first sexual encounter, is a device for generating scenes. It is not a picture of how a seriously ill teenager's days pass.

Leukemia is not in dispute. The subtype is, and the reason is worth knowing: it comes from the book.

Jenny Downham's novel Before I Die names Tessa's subtype outright. Online reference entries about the film carry that name across. The reviews and distributor-facing synopses we checked, including the trade press, say only "leukaemia", with no subtype. We could not confirm that a subtype is spoken on screen or printed in the official synopsis.

That is a small distinction with a general lesson attached. Adaptations routinely drop clinical specifics that novels state plainly, and reference works then reunite them. If a precise diagnosis appears in writing about a film, it is worth asking where it came from. The film, or the thing the film was based on.

The decision at the center of this film is real, legitimate, and badly understood.

Ending treatment aimed at controlling a cancer is a different act from ending care. Sometimes further anti-cancer treatment will not help. Sometimes its cost outweighs what it can buy. The focus then shifts to symptoms, comfort and time, and that shift usually means more attention rather than less.

NCI's account of what that care covers is concrete. Physical symptoms including pain, fatigue, appetite loss, nausea, vomiting, breathlessness and insomnia. Emotional support for depression, anxiety and fear. Spiritual questions. Caregiver needs. And practical needs, including financial and legal worries, insurance questions and employment concerns.

The team is broad too. Palliative care specialists usually work alongside doctors, nurses, dietitians, pharmacists, occupational and physical therapists, chaplains, psychologists and social workers.

Palliative care and hospice care are used interchangeably in conversation, and NCI draws the line clearly.

Palliative care may be provided at any point during cancer care, from diagnosis to the end of life, and a person receiving it may continue cancer treatment at the same time. Hospice care begins when curative treatment is no longer the goal and the sole focus is quality of life.

The evidence for starting early is not vague. NCI notes that integrating palliative care into usual cancer care soon after a diagnosis of advanced cancer can improve quality of life and mood, and may even prolong survival, and that the American Society of Clinical Oncology recommends all patients with advanced cancer receive it.

Access starts with the oncology team, and coverage is broader than people assume. Private insurance usually covers palliative care services, and Medicare Part B pays for some symptom management.

The film touches on something families navigate badly and rarely name. Not everyone wants the same amount of information. Tessa has decided; her father has not caught up. That is ordinary rather than dysfunctional.

How much prognosis information a person actually wants is worth answering for oneself and telling the team. They cannot guess.

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Now Is Good is a well-made film about a decision that real people make and real families struggle with. The list is fiction. The decision is not. The thing worth carrying away is that stopping treatment and stopping care are two different things.

This page discusses Now Is Good for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.

• NCI — Palliative Care in Cancer
• NCI PDQ — Last Days of Life (Health Professional Version)