Awakenings is a 1990 American drama film adapted from Oliver Sacks’

memoir of the same titlle. The film was directed by Penny Marshal and was
produced by Walter Parkes and Lawrence Lasker. The director and the
producers of the film first encountered the memoir when they were
undergraduates at Yale University in New Haven, Connecticut. Oliver Sacks
was a clinical neurologist who decided to work in a chronic hospital in New
York. Backed in 1969, he used an experimental drug L- dopa to “awaken” a
group of catatonic post-encephalitic patients.

The plot of the movie starts when Dr. Malcolm Sayer comes to work in
Bainbridge hospital. Dr. Malcolm Sayer is an antisocial,awkward and a stiff
person. He has no experience in working with patients rather he likes to work
in a laboratory. We can even see at the beginning of the film that he
passionately discussed his experiments about earthworms. Since he worked
as a medical doctor, he interacted with most of his patients. Through this, he
was able to discover that several stimuli can trigger responses from his
patients. This thrilled Dr. Sayer so he proceeded on performing more
experiments. He theorize that his patients were not frozen at all but at a stage
of Parkinson’s disease. In the same year,he also discovered a new
experimental drug L-dopa which he first used to his patient Leonard Lowe
without knowing the side effects. As he started to see the good results
particularly the awakening of Leonard, he also let the other patients to take
the drug. They also got the same results like Leonard. However, as the time
passed the side effects started to arise. Leonard was the first one to
experienced this. He becomes paranoid and agitated. And experienced
dyskinesia which is found in several studies today that can be induced by
synthetic dopamine. The other patients also felt the same effects. Given this,
Dr. Sayer realized that the good effects of the drug were just temporary.
Leonard and the other patients never had the same remarkable awakening
just like what they have experienced in the summer of 1969.

The movie stressed the importance of following research protocols as

well as medical and research ethics. It also stressed the importance of
enjoying life,work, and company of family and friends.

There are bioethical issues involved in the film adaptation of Oliver

Sacks’ memoir. It involves violating 4 bioethical principles and ethical
guidelines derived from influential codes and regulations such as the
Nuremberg Code (1947), Declaration of Helsinki (2000), Belmont Report 
(1979), CIOMS (2002) , and U.S. Common Rule (1991).

Respect for Autonomy.

Although Dr. Malcolm Sayer asked for permission from
Leonard’s mother, the same thing didn’t happen from the other
patients. Dr. Malcolm Sayer made them take part in his experiment
without the consent of their family or next of kin. As these patients don’t
have the capacity to make an informed and voluntary decision, the
researcher should have obtained advice from any surrogate decision-
maker such as a relative, friend or authority that is authorized to decide
on the patient's behalf and in the patient's best interest. Also, parents
or guardians, if any, are to give consent for minors as defined by the
Principle of Self Determination of the Mental Health Law (WHO,1996)
Another scenario that was identified to have violated this
principle was when the patients were not informed of their rights after
they reawakened from their catatonic state. They have lost their
autonomy because of their blind trust to Dr. Sayer whom they think to
be their savior or someone who can treat them from their condition.
This action is called paternalism. It involves assuming the interest of a
patient without his/her informed consent (Murgic et al., 2015).

Nonmaleficence.
The Principle of nonmalifence obligates Dr. Malcolm Sayer to
not cause harm towards his patients or participants of his experiments.
However, given that he adminstered the drug to them without even
knowing the side effects this have shown that he did not follow the
research protocol which should have involve the collection of
adequate data about the experimental drug, establishment of an
animal model and acqusition of toxicity data of the experiemental drug.
He deliberately jeopardize the physical and mental health of his
patients. As stated in an ethical guideline of clinical research published
in National Institutes of Health, research methods should be valid and
feasible, designed with a clear scientific objective, uses accepted
principles, methods, and reliable practices. In addition to this,
statistical plans must be of sufficient power to definitively test the
objective and for data analysis. Invalid research or experiment like this
is unethical because it is a waste of resources and exposes people to
risk. Furthermore, when he already knew the side effects of the drug
as they were exhibited by Leonard, he continued to manipulate or
increase the dosage to 1000 mg to the other patients. He caused
more anxiety or sense of uncertainty towards the prognosis of their
disease.

Beneficence
Although uncertainity and risks are inherent in clinical research,
this principle should have obligated Dr. Malcolm Sayer to minimize the
risk of his actions. But since he was not able to balance both the risks
and benefits of the drug therapy and continued to increase the
dosage, he caused more harm than being an assistance or source of
welfare to his patients. The ethical guidelines in clinical research
published in National Institutes of Health require that everything must
be done to minimize the risks and inconvenience to the research
subjects and the benefits should always outweigh the risks.

Justice
 He violated this when he decided to choose the catatonic
patients as participants of his study. He knew that they are easily
accesible, vulnerable, and less able to decline. The principle of justice
obligates the researcher to not intentionally compromise other people
for the benefit of another. Belmont report in 1979 has stated that the
selection of research participants should not be based on their
vulnerability or ease of access. Their right to fair treatment should be
uphold.
Medical research has the tendency to exploit the participants of the
study. For this reason, ethical guidelines were established to protect the
patients, participants, as well as the integrity of science. Clinical trials should
never commence if the researchers didn’t have enough information about the
drug. Important information such as toxicity data should be gathered from a
well established animal model to know whether the experimental drug has
harmful side effects. If the researcher did not follow the research protocols, it
could cause harm, injury, and psychological stress to the participants of the
study which the researcher should avoid as it violates the principle of
bioethics.
As what have observed in the movie, the clinical trial was initiated
without having adequate information about the L-dopa. Although it permitted
the patients to have a short awakening period, the psychological stress that
they have felt when they reentered into a world after decades of being trapped
in their catatonic state will never compensate their “awakening”. They also
experienced great anxiety or great sense of uncertainity towards the
prognosis of their disease as they have observed that Leonard Lowe, the first
patient to be adminstered with the drug has already fallen to side effects of L-
dopa. Dyskinesia and fcatatonia caused fear to all of the patients and their
loved ones.

I. Conclusion
To draw the inference, the movie requisites the researchers and
medical professionals to always adhere to the research protocols, research
ethics and principle of bioethics. Before commencing a clinical trial, important
information about the drug should be gathered and animal models should be
established to gather adequate information like toxicity data that can help
determine whether the drug has harmful side effects.
The movie did also focused on the idea of patient’s health versus
benefits which can be helpful when making a decision whether to initiate or
continue a drug therapy. The movie reflects the need to appreciate and live
life with work, play, friendship and family as these are the things that people
always take granted for.

II. References

Cassell, E. J. (2000). The principles of the belmont report revisited. how have
respect for persons, beneficence, and justice been applied to clinical
medicine? The Hastings Center report. Retrieved September 18, 2021, from
https://pubmed.ncbi.nlm.nih.gov/10971887/.
Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015, September 29).
Paternalism and autonomy: Views of patients and providers in a transitional
(post-communist) country. BMC Medical Ethics. Retrieved September 18,
2021, from https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-
015-0059-z.

U.S. Department of Health and Human Services. (n.d.). Ethics in clinical

research. NIH Clinical Center. Retrieved September 18, 2021, from
https://clinicalcenter.nih.gov/recruit/ethics.html.

World Health Organization. (1996, January 1). Mental health care law : Ten
basic principles : With annotations suggesting selected actions to promote
their implementation. World Health Organization. Retrieved September 18,
2021, from https://apps.who.int/iris/handle/10665/63624.