One Flew over the Cuckoo Nest - the Ethics of Patient Treatment

“…She’s somethin’ of a cunt, ain’t she Doc?” Although Milos Foreman’s character, Randle McMurphy (Jack Nicholson), put his opinion of Nurse Ratched (Louise Fletcher) in the most vulgar of terms, he was not so far from the truth. In the movie One Flew Over the Cuckoo’s Nest (1975), Nurse Ratched’s treatment and care of the patients was unethical when compared to the standards one would expect of a health care administrator. She used control over her patients to ensure order, without regard to the feelings and concerns of the patients. This issue is presented by the director, Milos Foreman, through symbolism, characterization and scenes. This, in turn, determines how the director wants us, as viewers, to feel about the issue.

The ethical issue of patient treatment is portrayed in a serious but sometimes subtle manner throughout the film One Flew Over the Cuckoo’s Nest. One thing that the director uses in order to personify Nurse Ratched is symbolism. The first example of this is shown in her name. The name “Ratched” is not meant to be random, but thoughtfully chosen. It seems to be very close in sound to the word “wretched”. A person described as such would not bring about positive feelings, but rather is used to depict her as a miserable, mean and contemptible person. Another symbolic feature is in how Nurse Ratched’s hair is styled. The way in which it forms two points on either side of her head is reminiscent of horns, and more specifically, devil horns. It is quite obvious that this would evoke an adverse view of her since the devil is associated with evil. Her cap that she wears so proudly to identify herself as a nurse is also a symbol. It represents authority and sets herself apart from the patients. Although these examples may seem insignificant, it is the detail used which paints a whole picture of how the audience is supposed to feel about her.

Early in the film, Nurse Ratched is determined to win the battle of wills over Mac (Nicholson). She recommends to the staff that they commit Mac to the hospital instead of sending him back to jail, where the psychiatrists thought he belonged. The psychiatrists, with Ratched present, concluded: "He's not crazy, but he's dangerous." Ratched insists on committing Mac in spite of the danger, and her superiors defer. Thus we see Ratched's need to win trumps good judgment. She does win. Mac comes within seconds of crushing her windpipe. The ethical thing to do following the attack would have been to assign Mac to the disturbed ward or to have him released into the custody of the corrections dept. She doesn't. She arranges a lobotomy for Mac. That's how she wins. Ratched destroys Mac's ability to function at all; she neutralizes him; she takes away his humanity.

There are many situations in which Nurse Ratched exhibits control over her patients, by treating them as subordinates, humiliating them and de-masculinizing them without concern for their well-being. She uses control to withhold simple privileges, such as being able to watch a baseball game on the television, tub privileges and their right to have possession of cigarettes. It seems she actually derives satisfaction from this through hints of smiles, which are so seldom seen. This only brings about anger and hostility in the patients because of the way she treats them: like children instead of men. This is put best when one patient, Charlie Cheswick (Sydney Lassick) says, “Rules? Piss on your fucking rules, Miss Ratched! ... I ain’t no little kid! When you’re gonna have cigarettes kept from me like cookies, and I want something done!” This shows that the patients felt demeaned and held at the same respect as that of a child. A nurse has a responsibility to reduce the amount of stress on a patient in mental facilities, not cause it. Electroshock therapy and pre-frontal lobotomy procedures are also used as a form of control in the film. These should be used in extreme cases where it is necessary or beneficial to the patient or not used at all. In any circumstance though, it should definitely not be used as punishment or as a solution to subdue a problem patient in order to control them. This strays from the moral conduct expected of hospital personnel. One of the most disturbing scenes in the movie is when a patient, Billy Bibbit (Brad Dourif), is humiliated by the authoritarian, manipulative, patronizing, and mind games player Nurse Ratched in front all the other patients.

Ratched's treatment of Billy Bibbit demonstrates her lack of ethics and her spite. After Billy loses his virginity with the prostitute Mac sneaks into the hospital, Ratched's demeanor is not concerned but vengeful. She threatens to tell his mother of his sexual encounter he had in the hospital the previous night. In this way, he is treated like a child and not respected of his right as an adult to withhold personal information from others. He is made to feel so ashamed of what he had done:

“Billy: I-I can explain everything....

Nurse Ratched: Please do Billy, explain everything

(Billy glances back at the others and beams from their approval)

Nurse Ratched: Aren't you ashamed?

Billy: No, I'm not. (momentarily losing his stutter)

Nurse Ratched: You know Billy, what worries me is how your mother is going to take this.

Billy: Um, um, well, y-y-y-you d-d-d-don't have to t-t-t-tell her, Miss Ratched.

Nurse Ratched: I don't have to tell her? Your mother and I are old friends. You know that.

Billy: P-p-p-please