1. Did you have preconceived notions of mentally retarded people before you watched this film? How were those stereotypes affected?
   
   
2. Reflect on the concept of “intelligence”. Do you think IQ is a fair measure of Larry’s “intelligence”?
   
   
3. Larry has mixed feelings about the results of his IQ test. Why?
   
   
4. Did any parts of the video make you uncomfortable? Why?
   
   
5. Discuss the concept of community. How is yours like or unlike Larry’s?
   
   
6. How do we balance a person’s right to autonomy versus our need to protect them?
   
   

1. What are the most significant points each “expert” makes. How does it reflect their professional practice or personal bias?
   
   What are some of the ramifications of each position on our society?
   
   
2. Reflect on Dr. Portenov’s reply when asked what Ms. Schiavo will die from.
   
   
3. What role should politics, law and ethics play in end-of-life decision making? How are they reflected in the video?
   
   
4. Should financial concerns be part of end-of-life decision making?
   
   
5. Are there any commonalities upon which a compromise could be built?
   
   
6. Terri Schiavo’s plight is compared to Karen Ann Quinlan’s situation in the 1970’s. Is it a reasonable comparison? What might be considered significant variables?
   
   
7. What responsibility do medical professionals have to evaluate and weigh new knowledge and technology against old paradigms of care?
   
   

1. Compare and contrast each main character. What makes them similar? What makes them dynamically different?
   
   
2. How would you characterize each woman’s motivation to “get better”?
   
   
3. Reflect on the concept of “trust”. How does it play out among the clients? How does it play out between the clients and the staff?
   
   
4. What part do family dynamics play in each woman’s situation? Parent/Child? Twin sisters?
   
   
5. What do you think of the group therapy sessions? The individual sessions with staff?
   
   

1. What exactly do we mean by "playing God?"  What does such a title suggest about our notion of God
   
2. Jim Steen, the man who died waiting for a new lung, said that he could not ask his family to decide whether he was “worth” all of the time and massive medical expenses in order to prolong his life. Who has the right to decide which patients will get life-saving treatments? Should committees and society at large be responsible for deciding, for example, who will be placed on the organ transplant list, or is it a family/personal decision?
   
   
3. In the West, the struggle to be healthy in the midst of illness is often seen as the “battle between good and evil.” Death is typically seen as defeat or failure. Is our Western philosophy of “good vs. evil” helpful? Harmful? Would a change in philosophy/mindset affect our approach to medicine/healthcare?
   
   
4. In general, do doctors in America structure a patient’s potential treatment plan with resources (such as limited money) in mind? Should Uwe Reinhart have been more upset with his father’s physician in Germany for not offering him aggressive treatments?
   
   
5. Why is it that we spend so much money at the end of life and so little for preventative care earlier in life? Have we become “trapped by technology?”
   
   
6. Christopher’s mother must decide whether or not to take her newborn baby off of life support. She states: “No one ever wants to make that decision, particularly about their own child, more so an infant who is only six days old.” Is every parent/newborn entitled to such drastic treatment when the prognosis is so futile? Does it make a difference that Christopher’s mother is on Medicaid?
   
   

Worlds Apart: A Four-Part Series on Cross-Cultural Healthcare
By Maren Grainger-Monsen, MD, and Julia Haslett, Stanford University Center for Biomedical Ethics
Produced by Fanlight Productions, 2003
Mohammad Kochi's Story - 14 min
Justine Chitsena's Story - 11 min
Robert Phillips' Story - 10 min
Alicia Mercado's Story - 13 min

Worlds Apart tells the stories of four individuals and their families: Mohammad Kochi, Justine Chitsena, Robert Phillips, and Alicia Mercado. Mr. Kochi is a 63-year-old man from Afghanistan who is diagnosed with stomach cancer. He agrees to have surgery, but later refuses his oncologist’s recommendation for chemotherapy due to religious beliefs, language barriers, and family conflict. Justine Chitsena, a 4-year-old from Laos, has an atrial septal defect (a hole in the muscle wall of her heart) which her doctors’ feel should be repaired by surgery. Her mother is considering the operation but her grandmother is opposed. They are part of an ethnic minority in Southeast Asia called the Khmu, and have strong cultural beliefs and traditional healing practices as well as mistrust of Western medicine that give rise to this conflict. Robert Phillips is an African American man in his mid-thirties who has been on hemodialysis for end-stage renal disease and is hoping for a renal transplant, which will greatly improve his life. He speaks very eloquently and candidly about his experiences with medicine as a bureaucracy and about the racial disparities that he has witnessed and experienced. Alicia Mercado is a 60-year-old Puerto Rican woman living in New York’s “Hell’s Kitchen” neighborhood, who has struggled with diabetes, hypertension, and asthma for years. The many social problems she faces as a Spanish-speaking woman living alone, and he fears about reliance on medication, put her chronic illness management into a different perspective. Filmed in patients’ homes, neighborhoods, and places of worship, as well as in hospital wards and community clinics, these unique trigger films follow patients and families from a variety of backgrounds as they face critical medical decisions. The Worlds Apart series offers an invaluable tool for raising awareness about sociocultural barriers to patient-provider communication, and the way they affect the healthcare of culturally and ethnically diverse patients.
 
Facilitator’s Guide by Drs. Alexander Green, Joseph Betancourt, and Emilio Carrillo is available providing patient background information, suggestions and information for the facilitator plus questions to use in small group settings.