Dan Krauss’ Oscar-Nominated 'Extremis' Faces End-of-Life Decisions

Documentary filmmakers regularly venture into crisis zones to show us conditions in remote locations that we’ll never visit. But they also serve an important function when the situation they cover is closer to home and one we’re likely to experience, such as the impending death of an elderly parent in an intensive care unit.

Dan Krauss’s quietly powerful Academy Award-nominated documentary, Extremis (available to stream on Netflix), grants us respectful access to intimate scenes of family members grappling with end-of-life decisions at Oakland’s Highland Hospital. As gripping as these real-life dilemmas are, the viewer retains an emotional distance that allows for reflection and conversation.

“One of the goals of all my films is to put the audience in the shoes of the subjects and ask, ‘What would you do?’” Krauss says. “I think that’s a very powerful and provocative question to pose to an audience.”

Krauss, who grew up in Berkeley and now lives in Oakland, is a proponent of observational, rather than advocacy, filmmaking. He embraced that philosophy at UC Berkeley’s vaunted Graduate School of Journalism, where he earned his master’s degree.

“I would much rather have the audience have the opportunity to decide for themselves what their own belief system is than to have it spoon-fed to them,” Krauss declares. “I hesitate to associate my own work with the political activism of the Bay Area because I don’t consider myself a political filmmaker, and I go to great pains to present stories that neither cast a judgement nor present an absolute right or wrong.”

Those stories include Krauss’s unsettling portrait of a South African photojournalist, The Death of Kevin Carter: Casualty of the Bang-Bang Club. Released in 2004, the 27-minute film was an auspicious debut that garnered awards from the San Francisco and Tribeca film festivals, a pair of Emmy nominations, and Krauss’s first Oscar nomination in the Documentary Short category.

The Kill Team (2013) recounts the painful experience of U.S. Army Pvt. Adam Winfield, who blew the whistle on his platoon’s war crimes in Afghanistan. The feature-length doc likewise nabbed prizes at SFIFF and Tribeca, aired nationally on PBS’ Independent Lens and received Emmy and Directors Guild of America (DGA) nominations. (Krauss wrote a screenplay based on his doc, with plans to shoot it this year.)

All that recognition may have helped Krauss’s case when he approached Highland Hospital for permission to shoot in its ICU. It was irrelevant to prospective subjects, of course.

“You have to imagine you’re asking someone on what may be one of the worst days of their life if you can film them, and it’s a very difficult ask,” Krauss says. “I always approached people without my camera and discussed with them the goals of the project, and I always tried to be very open and honest about my own discomfort with the subject matter. I wanted to be as forthright as possible about my own fears and sense of vulnerability.”

So much for the myth that the filmmaker has the privilege of hiding behind the camera. That said, Krauss’s focus was always on the people making tough decisions in front of his lens.

“There were many, many people who were not willing to participate, understandably,” he says. “For those that did agree, I think they saw an opportunity to connect with other people and not feel so alone in their process, and to transform what otherwise could be a moment of pure loss into a way to help other people.”

One of the remarkable things about Extremis is the way in which it evokes deeper and broader issues while remaining grounded in personal dilemmas and private moments.

“One thing I learned is that the ICU is a place where faith and science collide in a fascinating way, which ushers in questions about what it means to be human,” Krauss says. “We are able to sustain life in ways once thought unimaginable. Because of that, we are now facing profound questions that are at the core of our humanness. The question is no longer can we sustain life but should we?”

Extremis is a model of documentary objectivity, but that doesn’t mean that its creator doesn’t have a point of view about the way that end-of-life conversations unfold in our society. Or, for that matter, that his POV didn’t shift in the course of making the film.

“Coming into the film, I didn’t have a sense of the urgency of that question,” Krauss admits. “The Supreme Court nominee is skeptical of death with dignity laws. The majority of Americans don’t wish to die in hospitals, and yet it’s something on the order of two-thirds of Americans die in the hospital or a skilled nursing facility. Our wishes and our reality of end-of-life care are not in sync.”

Extremis doesn’t advocate for a position or a policy, which we might trace to the filmmaker’s training and background in journalism. Throughout its understated 24 minutes, the film expresses a clear awareness that no two situations are the same, and it’s unfair to judge how people deal with their difficult circumstances.

“I did see moments of joy in the ICU; it isn’t all suffering and pain,” Krauss says. “When family members make a decision that is right for them — you see two families make very different decisions, but both choices are right — it teaches you that fundamentally the right decision comes from a place of love and compassion and not from interpretation of the Constitution or religious doctrine.”

Watch Extremis on Netflix. For more information visit netflix.com.