Abstract
In the future, death may be only a launching pad to a digital eternity. Would you choose to “pass over” into the Internet cloud-based San Junipero, a simulacrum of a beautiful seaside town where everyone is eternally young, with the slight drawback that most of the residents are already physically dead? This is the question posed in season 3, episode 4 of the hit series Black Mirror on Netflix. Many episodes of the series start with a demonstration of a seemingly innocuous technology in the not-too-distant future. Yet, by the end, the viewer is often nudged toward the terror of unchecked innovation. Although we highly recommend the series to both technophiles and anyone attracted to dystopian stories, this particular episode is a welcome respite from the show's usual dark outlook and a compassionate exploration of the potential advanced care planning challenges of the future.
We open in the year 1987 on the glistening coast of San Junipero where we meet our protagonists Yorkie and Kelly. Yorkie, portrayed by Mackenzie Davis, is shy, mild mannered and nervously exploring the magical reality of San Junipero for the first time whereas Kelly, played by Gugu Mbatha-Raw, is fierce, stylish, and seasoned to the world. We learn that both Kelly and Yorkie are “tourists” in San Junipero who are only able to visit for five hours each week. The concept of limited time is quickly introduced as Kelly states “we only have a few hours, let's enjoy it.” Although most of San Junipero is depicted as a joy-filled, guilt-free existence, there is a darker side. The “Quagmire” nightclub offers a nefarious alternative to the almost innocent culture of San Junipero with leather-clad denizens in one room and an ongoing cage fight in the other. The brief but haunting scene suggests that eternal life for some might feel purposeless, an endless existential crisis leading to more and more extreme behaviors to feel something.
The storyline centers around the burgeoning love of Yorkie and Kelly as they time-hop through decades of the 20th century, always remaining young, beautiful, and healthy. In reality, Yorkie is a 61-year-old gay woman paralyzed after a tragic accident in her 20s. She lives in a long-term care facility in a persistent vegetative state dependent on mechanical ventilation but is able to voice her wishes through a “comm box” to her doctors and nurses. Yorkie visits San Junipero on a “trial” yearning to live out a life that she never had access to, to finally feel something, to dance, and, most importantly, to love. Her family has stopped visiting and shunned her after she came out to them. After a few nights in San Junipero, she has chosen to “pass over” and spend eternity there where she can become a “full-timer.”
Alternatively, Kelly is a 75-year-old woman with metastatic cancer who has been given a prognosis of 3–6 months. She is cognitively intact and lives alone in a nursing home, dependent on her nurse for activities of daily living. Her husband, Richard, recently died after 49 years of marriage. Kelly chooses to spend her last months of life visiting San Junipero and re-living her wild youth through “immersive nostalgia therapy.” Unlike Yorkie, who has embraced everything about her new life in San Junipero, Kelly is wary of what toll virtual immortality will take on her. When her husband, Richard, died, he decided not to pass over to San Junipero as a matter of principle. Their daughter had died before them, never having had the option of immortality in the cloud. Kelly herself is planning to die without “passing over” stating “when I die, I'm done.” Kelly states this out of respect for her daughter and her husband, yet struggles with her own belief that there is no afterlife, leaving her with the decision of death alone or death with an open-ended future in San Junipero with Yorkie. The emotional landscape of Kelly's decision-making dilemma feels very true to the work of making meaning from what might be perceived as senseless suffering and the desire to seek growth and renewal near death.
Although the focus of the episode is the love story and Kelly's ultimate decision, other relevant palliative care themes abound. Autonomy, preservation of self, and the meaningful embrace of time are key motifs. The episode is clearly biased in favor of the right-to-die movement. Both women choose the time and place they will die as well as how they will spend their afterlife. This is portrayed as a dignified, pain-free, and logical choice. Yorkie and her nurse Greg even plan to get married to bypass state law so that Yorkie's “conservative” parents cannot prevent her from choosing how and when she will die.
Another theme that runs throughout is the concept of naming death as a reality and an inevitability. When Yorkie's nurse Greg explains that Yorkie is “scheduled to pass over tomorrow” Kelly immediately quips, “let's just call it what it is; dying.” Kelly originally plans to die and not spend eternity in San Junipero but as she falls in love with Yorkie, her goals and plans change. Kelly ultimately chooses a life of virtual eternal youth with Yorkie in San Junipero. In palliative care language: As her death approaches, what matters most to Kelly comes into focus, her goals shift and this affects her decisions and her previous advanced care plan. Ultimately, we highly recommend this episode of Black Mirror for its thoughtful and nuanced exploration of common palliative care themes that are relevant both today and in the not-too-distant future.