Spring, 2004
Written by Steven Knight
Directed by Stephen Frears Miramax Films, 2002 Available on DVD
Review by Lois LaCivita Nixon, PhD, MLitt, MPH
Director, Masters Program in Bioethics and Medical Humanities College of Medicine, University of South Florida, Tampa
Self-styled 'brokers' arrange the sale of organs to patients who can pay. Kidneys are the most commonly traded organs, and in most cases, poor persons in developing nations sell their kidney to a wealthy patient. The cost ... can run over $100,000 but the person actually selling an organ often sees very little of what amounts to a tremendous fortune.
- "The Black Market in Organs" Express News , University of Alberta
In our brave new world, national boundaries and borders have shifted, information flows freely and instantly across continents, and various cultures meet, clash, fuse and intertwine. Dazzling advancements in medical science and biotechnology surpass imagined expectations and, in doing so, demonstrate knowledge, skills and powers once thought beyond human capabilities. Numerous scientists around the world are engaged in active research with transplantation, cloning and stem cell research, and their reports are often accompanied by journal and news reports, reaction by the public and policy makers, and considerable commentary by bioethicists.
Just as writers and artists like Donne, Shakespeare, Brueghel and Milton became important record keepers for a society emerging from the stagnant Middle Ages to the blinding light of the Renaissance, contemporary writers, artists, and increasingly, film makers are intent on revealing changes wrought by our own shift from what had become familiar Industrial Age patterns to the Informational or Transformational Age we have currently come to know. Expansive times of discovery, innovation, migration, information and commerce are as challenging and stimulating to artists as they are to scientists. As John Donne observed in the 17th century, when another long-standing paradigm was giving way to change, "the new philosophy calls all in doubt."
In dark theaters many films force audiences to pay attention to ideas on the periphery, to examine ourselves and our society, and to be moved by potent moral issues. Swirling currents of change give rise to debates about new conditions, social movements, postcolonial studies, and speeded-up access of information and transportation. Not all images or outcomes are positive or hopeful but a good film story, such as the one described below, can function as a powerful tool for exposing problems affecting marginalized persons that ultimately affect all levels of society.
Dirty Pretty Things, a recent film directed by Stephen Frears, exemplifies some disturbing intersections of globalism, biotechnology and amoral behaviors brought about by abuse and greed. This story, like others including Death and the Maiden, Lone Star, Philadelphia, Whose Life is It Anyway, Requiem for a Dream, and Traffic, utilizes the postmodern genre of film to concretize social and ethical dilemmas also considered in tabloid headlines, textbooks and at professional conferences. The film's astonishing revelations about black market organ trafficking and views of gritty reality for society's poorest, most vulnerable, and barely visible populations, invite audiences to see, sort through details, formulate explanations, question motivations, and understand more fully political, social and ethical choices and consequences.
A very dark side of London is depicted in the film, a place where everything is for sale, at a price: prostitution, drugs, and most central to the story, black market sale of human organs. The compelling and suspenseful narrative focuses on five characters connected in one way or another to Hotel Baltic, a seemingly proper hotel by day, a site of depravity at night. Okwe, an illegal immigrant physician from Nigeria with no work papers, who has left home under harrowing circumstances, struggles with two menial jobs - driving a taxi during the day and working at night as the hotel's front desk clerk. At the hotel he befriends and assists one of the chambermaids, Senday, another immigrant from Turkey, also without papers and at risk of deportation, but also subject to sexual compromise and abuse.
Other figures include the hotel manager, the Russian doorman, and the Croatian prostitute. That they all have roots in places other than London underscores the overriding theme of alienation and loss of identity. In one way or another all are immigrants, alien figures in the substrata of London's vast underbelly, the people nobody sees. "Our guests," observes the sleazy manager, "are strangers - they leave dirty things, we make them pretty." Without the work performed by the constant churning groups of lower class workers cleaning toilets, washing dishes and sewing in sweatshops - in the hopes of gaining first-class citizenship - our own lives in London, New York, Paris or Miami would be quite different and less "pretty" than what we now experience.
For some time into the film the director uses his lens to focus audience attention on the nightmarish settings of lower class workers living at the edge, people living in a dirty, dark and frightening world just below the surface we occupy. After spending time exploring the subterranean abyss with characters whose lives seem hopelessly lost, the film story moves in another direction to show just how vulnerable - and valuable - these people are to those who seize on opportunities to profit.
During the night, while checking on an obstructed and overflowing toilet in one of the hotel rooms, Okwe's unclogging efforts produce a removed human organ. Shocked by this discovery but in no position to alert authorities, he and other staff engage in whispered conversations. Soon they learn about secret operations arranged by the hotel's manager, the procuring middleman in the deal, who has taken advantage of hotel rooms and his employee pool of illegal immigrants to establish a lucrative organ-for passport trade. Unqualified figures function as incompetent surgeons succeeding - or sometimes failing - in their closeted labors. All donors, of course, are undocumented, invisible, expendable, and beyond the knowledge and jurisdiction of the law. They, but particularly their desired "spare" part, are reduced to commodity status for those willing to pay large sums of money.
Frears' story, however horrible, is not science fiction. When we fail to ignore the poor, provide education and healthcare, and support human worth and dignity, we can expect the quality of our own lives to diminish. When we read about organ cannibalism or the sale of "body parts" in Iran, Tokyo and California, we should be grateful to Stephen Frears for providing ethicists with a grim but useful framework for discussions that must occur.
in collaboration with
Dartmouth-Hitchcock Medical Center
The opinions expressed in the journal, Lahey Clinic Medical Ethics,
belong to the individual contributors and do not represent the institutional position
of Lahey Clinic on any subject matters discussed.
