Elizabeth Coplan is an award-winning playwright and a writer for and the founder of Grief Dialogues Health Care Education. Her play “Honoring Choices” is being presented as part of Honoring Choices PNW’s celebration of National Healthcare Decisions Day; more information including registration can be found at https://www.celebratenhdd.online/the-play.

“Honoring Choices” – How We Use Plays to Help Families Make Better-Informed Advance Care Planning Decisions

 As a playwright, after I have determined the premise of my play, I focus on the audience.  Who will want to see this play and why?  What’s the purpose of the play?  When Bonnie Bizzell of Honoring Choices PNW approached me in late 2019 to write a play about advance care directives, her purpose was clear: to encourage families to engage in advance care planning and to help them start making better-informed decisions for themselves and their families.

 Using plays to start the conversation

 “Honoring Choices” was my first play about Advance Care Directives; however, it’s one of several plays I’ve written with the purpose of encouraging people to talk about death, theirs and their loved ones.

I’m often asked why, out of all possible approaches to discussing dying, death, and/or grief, I depend as much as I do on writing and producing plays.  To answer, I think of how audiences use plays to explore/understand other people’s situations– to see how the characters handle adversity and conflict and to ponder how they themselves would handle a similar situation. I think of the great tradition of the theater going back to how the Greeks used plays starting in the sixth century B.C. to open our eyes to new possibilities and to see ourselves and our loved ones in a new light. I think of the playwright Thornton Wilder, who explored the paths of our lives and our deaths so movingly in “Our Town.” Wilder wrote, “I regard the theatre as the greatest of all art forms, the most immediate way in which a human being can share with another the sense of what it is to be a human being.”

Building on Wilder’s insightful quote, I believe that theater is the greatest way to generate empathy, and after that, understanding. If people can see – and understand at a visceral level – how one family acts, they can internalize it and make whatever adjustments they need to apply it to their own situation. Theater draws people in. When an audience in a theater is engaged, you can hear a pin drop. You can see people literally leaning in. They’re participants in the drama as they become engulfed in it.

One outcome of the pandemic, maybe a surprising one, is how virtual theater can have an equally impactful effect. It’s a different kind of intimacy, with the audience looking at closeups of the actors, talking directly to them face to face.

Building so much content and drama into a short play

 I’ve always been a theatergoer. After high school, I moved to New York to act. Since then, I’ve read and seen many great plays. I especially appreciate great dialogue. Something magical happens when characters in a play speak to each other and react in ways that convey a heightened version of our lives. The subtext is also important, conveying what’s going on beneath the surface. What the characters aren’t saying can be at least as important as their words. A raised eyebrow or an “oh” can convey so much.

Tapping Zoom as inspiration

 As I mentioned, I was commissioned to write it by Bonnie for the Honoring Choices PNW conference, to be performed in person in February 2020. Covid had started to spread, but we didn’t know that then.  The performance went off without a hitch in Seattle, Washington on February 28, 2020.

We were scheduled for a series of live performances at a variety of  other conferences, and then they all were cancelled. I looked at the script and realized it would work on Zoom. Frankly, in some ways, it’s working even better on Zoom. When I adapted the play, I made the dialogue even tighter. Using the closeups we’ve all gotten used to seeing on Zoom allows faces to tell the story with fewer words and less explanation.

Balancing the various perspectives of each role: patient, family and medical professional

 I have been a patient as well as a family member of patients, so I have some familiarity with those roles. My former doctor, now retired from private practice, is my medical script consultant. She helps us with matters like accurately conveying what symptoms are likely to occur at various stages of illnesses. She also helps with how medical professionals say certain things and perform certain actions in a given situation. The drama and conflict that are inherent as the characters interact after a serious diagnosis create engagement for the audience and help to make each character’s perspective clear. How a doctor conveys a diagnosis can have an enormous bearing on how the information is received and how the patient and family members act and react.

Remembering personal experiences to inform the play

  “Honoring Choices” is the story of an older man who gets a terminal diagnosis of esophageal cancer from his doctor. His younger daughter is present during the call.  She hears a distinctly different version of what the doctor said than her father.  Then, the older daughter comes on the Zoom call. Generational and gender issues compound the fact that there is no advance care plan.  The core story, a father who receives a terminal diagnosis who hears one thing while his daughter hears another, is based on my own family and related scenario.

Directing the actors to add to the storytelling

We’ve performed the play a number of times with different casts and every cast brings something new and different – and they all work! Each cast brings its own history, and therefore delivers its own passion, empathy and tension to the play.

Our actors want to know their character’s backstory, and we work through those together.

Performances for Zoom are distanced and performed separately. This brings a different dynamic, one that is realistic for these days of the pandemic, when so many medical conversations are being held remotely on Zoom.

We have performed “Honoring Choices” with an all-Black cast and in a Spanish-language version. While the story of the play is universal, we made changes to the script to reflect cultural differences, including different dynamics among the characters. We asked the actors for their input, which they were happy to provide. Different casts also deliver differences in the performances, bringing added depth each time we tell the story.

We even ask our actors if they have an advanced care plan for themselves and their loved ones, and if they don’t, we recommend that they get one soon. By our evangelizing to them in this way, we bring an added degree of engagement and empathy that I think translates into their performances.

“Honoring Choices” persuades families to consider now, when there’s still time, to decide, share and understand each other’s wishes for the end of their lives. It’s a gift loved ones give to each other.

When it comes to timing, “it’s always too early. Until it’s too late.”

I believe it’s never too early, because, as Emily says in “Our Town,”  life “goes so fast.”