“The end of life is still life”

The last breath is the adaptation of Dr. Claude Grange’s work. How was your film born?

Costa-Gavras: I arrive at an age when you think about your own end (Smile). The idea of ​​a film on the theme of the end of life had already gone through my head, but reading the book The last breath caused a click.

The book fascinated me from the first page, making me discover the world of palliative care. Dr. Grange recounts the end of life of patients welcomed in the service he created and directed, in Houdan (Yvelines).

Before writing the script, I needed to meet you, dear Claude, so that you confirm me, orally, that these fascinating stories were very true.

And for you, Dr. Grange, what does this first meeting represented?

Dr Claude Grange: I am only a country doctor and I am not used to frequenting intellectual circles. Without the intermediary of the philosopher Régis Debray who had prefaced my work and offered it to Costa, I would probably never have known this one.

I had been very marked by your films Z And Admission. During our first meeting, you gave me your DVD filmography and I was therefore able to dive into the whole of your work …

C.-G. :: You were therefore forced to look at everything (He smiles)!

How did you develop the adaptation of this book to philosophical accents?

C.-G. :: This feature film should not be a speech on the end of life. Because a film is above all a narrative line, action, characters and emotions. In short, a show!

I scripted the story of each of the people, remaining as faithful as possible to the work. The end should be neither a happy ending nor a burial. I had to find something that gives hope to the spectator.

I also watched Living, The documentary produced by Victor, Claude’s son, in order to observe the doctor in action and inspire it.

Finally, I wanted to bring a striking element to the screen: often terrorized by death, the relatives of a person at the end of their life have trouble accepting the prospect of their departure. The film evokes the power that our entourage can try to exercise on the conditions of our own death, whereas, it seems to me, this passage should belong only to us alone.

Dr. G.: Faced with such a risk, palliative medicine is a counter-power! More humble than curative medicine, it is not in the omnipotence of healing. In palliative care, caregivers face their own limits and build a care project to ensure the best comfort in the patient. We see him in the film, the doctor is attentive to the patients, devotes them time and is not in a vertical position of authority.

How do you find your cinema double, embodied by Kad Merad?

Dr. G.: Sensational! His interpretation corresponds to my experience. Before filming, I advised Kad Merad not to stand in a position of overhang towards the patients. In my practice, I am a fairly tactile someone and he took this back in his gestures: taking the hand of a patient, sitting at his bedside, tightening bereaved in his arms …

C.-G. :: I wanted to film this skills and I wanted all the nurses and doctors of the film to be real caregivers working in palliative care. This can be seen through their gestures when they administer treatment for example. On the set, the nurses became my advisers at the staging (He smiles).

On the screen, the doctor speaks of giving birth people from their death …

C.-G. :: “If we need a midwife to give birth to us, we need an even wise man to get out of it,” writes Montaigne. The two ends of life, birth and death should be able to live as little painfully as possible. But we have so formatted doctors to heal that many of them envisage death as a failure. Some sometimes want to do a little more, even when you can no longer cure, even if it means giving false hopes to patients and continuing unnecessary treatments.

The political debate around the end of life law is intensifying this month. Your film is released at that time. Is it a coincidence?

C.-G. :: Absolutely. And this competition of circumstances does not delight me. I especially would not want my film to be instrumentalized, because it is neither supporter nor activist. In addition, it comes out on my birthday! It will be a terrible gift if it does not work (He laughs) …

Is it necessary to create more palliative care units in France?

Dr. G.: 5,500 beds and 168 palliative care units (figures from the national center end of life palliative care 2023, editor’s note), It’s far too little! This type of unit must develop in each department for the most complex situations and the palliative approach everywhere else, at the hospital and at home.

This will involve the compulsory training of caregivers in palliative practice. Listening, presence, the announcement of serious illness, it can be learned. At the start of my career, I was fleeing the dying. It was the nurses who humanized me, for example teaching me to say hello in the rooms where I did not want to go …

Are you for a change in the existing legal framework?

Dr. G.: For a quarter of a century, I accompanied nearly 4,000 people at the end of their life. On this number, only three patients, despite the care provided, wanted to go to Switzerland for assisted suicide …

Palliative care meets the three essential needs of a person at the end of life: do not suffer, not be abandoned and consider a care project that makes sense. Develop palliative care. This is the solution, I am convinced.

What is your point of view on euthanasia and assisted suicide?

Dr. G.: The hand that can not be the one who kills death. It would be the caregivers in a position to betray the oath of Hippocrates to ask them to be the armed arm of an act that others do not want to perform.

Assisted suicide is not a medical issue. It would be a real disaster to bring it into the hospital. The answer is the legislator called to find the solution for people who ask to die.

In the film, the character of Estrelia, who wanted to die at the start, agrees to benefit from a “” deep and continuous sedation until death »». How is it different?

Dr G: Sleeping is not killing. This end-of-life sedation is completely compatible with the 2016 Claeys- leonetti law. In the film, no gesture or any attitude of caregivers go in the direction of assisted suicide or euthanasia. I am also very grateful to Costa-Gavras for having respected the philosophy of palliative care.

C.-G. :: I wanted to let the spectator think for himself. My film is a tribute to life and caregivers. We have experienced eras in France where the solidarities were very strong and we must find this spirit within an increasingly fragmented society. Take care of the most vulnerable.

Dr. G.: Yes, taking care of the most fragile, the poorest, the most sick, is an act of fraternity. Bringing the streets of the street to these end -of -life spaces, thanks to the presence of volunteers, a philosopher or a filmmaker is very important, because it helps us to think about the subject collectively.

Costa-Gavras, you always chair the Cinémathèque française, you travel in festivals and schools to speak cinema. Where does such a transmission momentum come from?

C.-G. :: If I fled Greece, my native country, at the age of 22, it is precisely because access to transmission was forbidden to me. As I said in my memories, I was excluded from the university system due to my father’s political commitments*.

France welcomed me and gave me everything. I was able to study the letters at the Sorbonne, the cinema at Idhec, the Institute of Advanced Cinematographic Studies, and I started alongside René Clair, René Clément, Yves Allegret, Jacques Demy, Yves Montand, Simone Signoret …

French cinema welcomed me in such a beautiful way that I do everything I can to give it back, especially through the presidency of the Cinémathèque française. My pleasure to discover films is always as lively as when I was a young man. A work cannot change the world on its own, but cinema has done so! It has the power to bring the spectators of all continents around universal emotions and feelings.

*Resistant during the German occupation, he was antimonarchist after war.