Primum non nocere – first, do no harm. Such a simple medical principle in theory, such a complex one in practice. And made even more so with every medical advance that allows us to keep people alive for longer.
Best Interests is a four-part drama by award-winning screenwriter Jack Thorne about a parent’s fight to stop the withdrawal of treatment from her daughter, who is comatose and brain damaged by the consequences of a rare form of muscular dystrophy – or, as the mother puts it, “Letting her die”.
It is not based on any particular real-life case, though it of course brings to mind nearly one-year-old Charlie Gard and 12-year-old Archie Battersbee, whose fates had to be decided by the courts when doctors and their parents could not agree on a course of action – or inaction – for the children.
Sharon Horgan and Michael Sheen play Nicci and Andrew, the parents of young teenager Marnie (Niamh Moriarty, in her first screen role) and 17-year-old Katie (Alison Oliver, in only her second screen role after her debut in Conversations With Friends).
Marnie was diagnosed with her life-limiting condition as a baby. We see this and many other vignettes of Marnie and the family’s life in flashback. What begins with them trying to find the right room and wondering how to pronounce the doctors’ names will end with them knowing every hospital ward like the backs of their hands, administering complex drug regimes and knowing some of the doctors for longer than they do some of their friends.
Best Interests is bookended by scenes of Nicci speaking to the waiting press pack as she is about to enter the court hearing, watched from afar by Andrew. She says she is fighting for her daughter’s life and the stage seems set for a simple tale of a mother’s blazing, blinding love set against coldly correct science. But at the close of the episode we get her entire speech – delivered with magnificent ferocity by Horgan – showing the court case as only a continuation of the fight “for money, for wheelchairs, for breathing equipment, night-time support, educational support … while those in power tried to cheat us out of what our children need”.
The hour in between provides a masterly and profoundly moving examination of the many types of agony that arise when a child with a progressive illness reaches a point where palliative care becomes a consideration.
There are no heroes and no villains here. When Nicci rages at Dr Samantha (Noma Dumezweni) after the latter introduces the idea of changing Marnie’s care plan, the sense is not of battle-lines being drawn but of how quickly trust can break down and how devastating it can be for a doctor (and Samantha has cared for Marnie for seven years) to find themselves suddenly the face of evil in a parent’s eyes.
Thorne, a long-time supporter of disability rights who has explored the issue in his writing several times before, adds an often overlooked factor – the part that prejudice against disabled people, especially in straitened times and with a government that casts everyone not capable of maximum economic production as deadweight, plays in decisions that are made about their lives.
As a result of Thorne’s knowledge and experience, Best Interests is rich in the kind of detail that truly humanises and brings home the experience of a family with a chronically ill and increasingly disabled child as well as their current plight. It spends much time evoking Andrew and Nicci’s years of watching and waiting, of hoping for the best but trying, if you ever can, to prepare yourself for the worst that have gone before this crisis point.
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It doesn’t make her older, sidelined sister Katie into a rebel but shows the willing effacement that is so common and far more heartbreaking to watch in children with disabled siblings. Of course Katie yearns for more attention – and her parents yearn to give it to her – but she understands why it cannot be. It is a terrible truth that the child who is not dying has to give way to one that is. And that no parents, effectively grieving all their lives, can find the perfect way through. There is no perfect way through.
Best Interests captures smaller moments of truth, too. The flood of memories that come in quiet moments, as when Andrew gets crisps at the hospital vending machine (and the importance of crisps from hospital vending machines). The bathroom cabinet full of drugs and spare tubes as well as toothbrushes and toothpaste. But suffusing it all is Nicci and Andrew’s raging pain and sorrow. How does any parent bear it? Best Interests gets us closer than most dramas do to understanding all that “it” is. But its almost greater accomplishment is to show that the answer remains unfathomable.
