04/10/2026
It is 30 years since the release of the film The English Patient, a grand epic with the vast, sweeping north African landscape as backdrop. To mark this anniversary, our chair Prof Willem Landman wrote an appropriately grand review in our latest September newsletter. After summarising key moments in the complex plot, he proposes an assessment of the closing scene of the film, an instance of medical assisted in dying (MAiD), that interestingly is seldom referenced.
"Would the English patient have been eligible for MAiD as envisioned for South Africa by DignitySA’s constitutional challenge?" he asks. Read on to find out and let us know your thoughts in the comments below.
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The English Patient is based on an eponymous novel by Michael Ondaatje, published in 1992. It was translated into 38 languages, shared the Booker prize in 1992, and won the Golden Man Booker 50 prize having competed against the best Booker winners of the preceding 50 years, with a finalist for each decade.
In 1997, the film won nine Academy Awards (Oscars), including best picture (Saul Zaentz), best director (Anthony Minghella), best supporting actress (Juliette Binoche) and best cinematography (John Seale).
The English Patient is indeed a milestone in the art of filmmaking.
Like the book, it is complex, with the Second World War as looming context, and five key characters. It is filled with intrigue, adventure and passion.
The film moves back and forth between two timeframes, the “present” and the “past”.
- The “Present” -
The “present” plays off in the bomb-damaged, abandoned Church of San Girolamo in Fiesole, a town on a hill overlooking Florence, in Italy, in October 1944, towards the end of the Italian campaign in which the Allied forces were driving the Nazi’s northward through Italy.
With her field hospital relocating, Hana, a Canadian Army nurse (Juliette Binoche), offered to remain behind in the abandoned monastery church to care for an unknown, severely burned man, named “the English patient” (Ralph Fiennes) on account of his accent (later to be identified a Hungarian, Count Ladislaus de Almásy). He was too badly injured to be relocated and not expected to survive much longer. He is bandaged and unrecognisably disfigured, suffers from amnesia, and does not remember his own name.
Almásy’s only possession is the ancient Greek historian Herodotos’s The Histories, with personal paper fragments and letters tucked inside. Hana reads Herodotus to him and administers morphine to ease his intense pain. Sedated, the English patient’s memory gradually returns and the “past” of the movie is revealed.
Also arriving at the monastery in the “present” are two characters who add to the complex tapestry of the film.
There is the enigmatic Caravaggio (Willem Dafoe), an Italian Canadian working for British intelligence, a friend of Hana’s father. He is at once colourful and somewhat menacing. His hands are bandaged because his thumbs were severed by the N***s and he shows an interest in Hana’s morphine. Sinisterly, he claims he knows who the English patient is and that he cooperated with the Nazi’s. He tells Hana that her patient in fact remembers everything.
Also arriving at the church-hospital is the handsome, cheerful Indian Sikh officer Kirpal (Kip) Singh (Naveen Andrews) who volunteered with the British military for sapper bomb disposal under Lord Suffolk. Hana and Kip develop feelings for each other and begin a relationship.
An iconic, truly magical, scene is when Skip hoists Hana up by means of a rope attached to a pulley so she could have a close-up look at the paintings high up on the walls of the church, by flickering light and with dancing shadows on the walls.
Kip withdraws emotionally when Lord Suffolk and his sapper team, with whom he experiences a sense of belonging, are killed while attempting to dismantle a new type of bomb set up under a bridge by the retreating N***s.
- The “Past” -
From the vantage point of the “present” – the abandoned church serving as a hospital – the English patient (Almásy), sedated by morphine, begins to reveal his past.
Before the war, Almásy was a cartographer who divided his time between a desert camp and Cairo. To draw his maps, he piloted his own plane over the majestic desert landscape.
An Englishwoman, Katharine Clifton (Kristen Scott Thomas), and her husband, Geoffry Clifton (Colin Firth), accompany Almásy’s desert exploration team. Almásy falls in love with Katharine, mesmerised by her voice as she reads Herodotos’s remarkable story of King Candaules of Lydia aloud by campfire.
When the war breaks out, the Cliftons abandon Almásy’s desert camp. In Cairo, Almásy and Katharine begin an intense affair. But Katharine cuts it short, saying that Geoffrey, whom she had recently married after their studies at the University of Oxford, would go mad if he were to find out.
Geoffrey discovers his wife’s affair with Almásy after she had already ended it. She is wracked with guilt. In an act of jealousy, Geoffrey pilots a plane, with Katharine on board, and deliberately crashes it into Almasy’s camp killing himself instantly, while Almásy survives and Katharine is seriously injured. She admits to Almásy that she always loved him.
Almásy carries Katharine to the nearby Cave of Swimmers for shelter. He promises to return with help and embarks on a long and arduous journey.
He reaches the British-controlled town of El Tag. The British do not believe his story and refuse to mount a rescue mission. Tragically, had he identified the injured Katharine by her real name, and not as his wife, which he did in the hope of receiving urgent help for her, she might have been saved because her name was well known to the British through her husband’s work for them making detailed aerial maps of North Africa.
In the years that follow, Almásy cooperates with German forces in North Africa. This enables him to return to the desert. He retrieves a colleague’s plane buried in the sand, flies back to the Cave of Swimmers, where Katharine’s body has been lying for several years. He wraps her remains in a cloth and attempts to fly her out of the desert. The plane suffers a mechanical failure and catches fire. Almásy is on fire but escapes the flaming inferno by parachute. He suffers from severe burns, leaving him unrecognisable, and is found and rescued by Bedouin tribesmen.
- A Merciful End -
Back to the “present”. The critically burned Almásy, the English patient, suffering from failing organs, distraught and in severe pain, decides that he is ready to die. He signals this to his devoted nurse, Hana, by deliberately pushing several vials of morphine toward her. He says that he has “had enough”. Hana is deeply emotional but understands his desire for a merciful death. She grants his wish by administering a lethal dose of morphine into his IV drip.
As Almásy drifts into permanent sleep, Hana reads aloud the final, heartbreaking letter written by his late lover, Katharine, which she wrote while dying alone in the Cave of Swimmers.
Says AI: “This scene serves as one of the emotional peaks of the film, framing the act not as a crime, but as a final, compassionate gesture of mercy and love between the caregiver and her patient.”
- Legalising Merciful Death -
Interestingly, reviews of the film tend not to pick up on this theme of medical assistance in dying (MAiD). Considering contemporary debates about the ethics of both MAiD itself and of legalising MAiD, the following aspects of the final scene of the movie are worth noting:
* The English patient was injured, not suffering from an illness, although his organs were beginning to fail because of his injuries;
* It is hard to tell whether he was in a terminal state, often defined as likely to die within six months; burn patients now have a better recovery rate than in the 1940s, so he could have been in a terminal state;
* It is hard to tell whether he was in a terminal state, often defined as likely to die within six months; burn patients now have a better recovery rate than in the 1940s, so he could have been in a terminal state;
* His suffering was because of physical pain as well as resultant mental distress;
We do not have any reason to believe that he was not mentally competent to decide about his continued life and to request MAiD;
* His request was voluntary, with no-one coercing or pressuring him into his decision, although the war and limited medical care obviously narrowed his options;
* Hana was in the employ of a field hospital with medication provided by the hospital, so it was a case of medical assistance in dying; and
* MAiD was administered by the caregiver, not self-administered; the English patient was likely incapable of self-administering due to his injuries.
Would the English patient have been eligible for MAiD as envisioned for South Africa by DignitySA’s constitutional challenge? I believe so.
The English patient was likely mentally competent, had severe injuries making any semblance of a normal life impossible, without ever higher dosages of morphine his suffering was unbearable and intractable, and his request was the outcome of a free choice.'=
With responsible institutional safeguards in place and observed, assistance like Hana’s would not only be ethically justified (as a matter of right and compassion) but also legal in a South Africa shaped by the normative standards – values, principles and rights – of its Constitution.
Palliative care is always non-negotiable in a MAiD setting. And with the extreme suffering caused by burn wounds palliative care and its limits require increased scrutiny.
Instances of nurses identifying with the suffering of their patients, even to the point of causing their death to end their suffering, are regularly reported worldwide in the media and lead to criminal prosecutions, like our own Smorenburg (1992) High Court case.
These instances involve non-voluntary MAiD where nurses act on what they believe is in patients’ best interest and without patients’ consent. This was not the case with Hana’s deed of compassion since Almácy himself judged his own life no longer worth living and consented to receiving a lethal dosage of morphine.
DignitySA’s court challenge involves voluntary MAiD only.
- In Conclusion -
The English Patient is one of those timeless films that do not show their age despite radical developments in acting style and photographic technology. Hence it can be revisited, like works of classical literature, or groundbreaking movies, such as Ben Hur, The Shawshank Redemption, 2001: A Space Odyssey, or Shindler’s List. It is a story of love, betrayal and perhaps even redemption. Its stunning cinematography beautifully captures the majestic north African desert landscape.
Above all, it is a story of identification and solidarity with another, of caring and compassion for the sufferer, to the point of heeding the ultimate request despite the personal emotional cost involved for the helper.
- Script by Michael Ondaatje and Anthony Minghella
- Based on Michael Ondaatje’s novel The English Patient
- Directed by Anthony Minghella
- With Ralph Fiennes as Count Ladislaus de Almásy; Juliette Binoche as Hana; Willem Dafoe as Caravaggio; Naveen Andrews as Kirpal (Kip) Singh; Kristen Scott Thomas as Katharine Clifton; and Colin Firth as Geoffrey Clifton
1996
- 162 minutes
- Awarded nine Oscars
- Film review by Prof Willem Landman, Co-founder and Chairperson of DignitySA
