“One Flew Over the Cuckoo’s Nest” centers around a conflict between two figures. The first of these is nurse Ratchett, an experienced medical professional who runs a ward in a mental hospital, and the second is Randle McMurphy, an anarchistic figure who enters the ward as a patient and serves to continuously disrupt the order that Ratchett has established. Throughout the film, McMurphy is depicted as being intentionally disrespectful and as, importantly, being a borderline case about whose actual mental status several people are unclear. The film ends as Ratchett, having previously insisted that she can “help” McMurphy, has him lobotomized after her intrusion into the aftermath of a Christmas party results in one member of the ward killing themselves and McMurphy himself attempts to assault and to strangle her.
According to Ulrich, an ethical conflict may be primarily understood as a conflict between two agencies, both of whom are contained within the same broad structure and both of whom may seek to realize distinct outcomes within that structure (2003, p. 170). The narrative of “One Flew Over the Cuckoo’s Nest” can be seen to focus on key scenes of ethical conflict. The first of these occurs in a scene in which McMurphy attempts to change ward policy in order to enable several patients, including himself, to watch the opening game of the baseball world series. Ratchett announces that, according to convention and the written legislation of the ward, it is necessary that all members vote in favour of the change. When it seems as if McMurphy has secured enough votes in order to bring about the change, Rachett insists that he must receive the votes of a catatonic patients, and once he has seemingly achieved this, the nurse insists that the vote has closed. Such a situation presents a conflict as, on the one hand Ratchett is depicted being technically in the right, while at the same time it is clear that her primary interest is in the maintaining a conservative relation to order and not in the best interests of her patients. In this case, the actual agency and desire of those on the ward who are capable of expressing their wishes is subsumed under a general assumption that any disruption to the existing order is likely to have a negative effect on the well-being of patients.

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A second and complementary dilemma can be seen in the attitude that members of the hospital committee have towards McMurphy. One scene in the film involves these beurocratic professionals discussing whether or not McMurphy is in fact sufficiently ill to be treated at the hospital, or whether he should be returned to prison. While the majority of the hospital board insist that there is little reason for McMurphy to remain at the hospital, Ratchett insists that he should remain and that the institutional setting will serve to “help” him. This situation again presents a dilemma relating to language and to the capacity for conventional modes of describing and categorizing illness to cover over conflicts of interest. The film strongly suggests that Ratchett is primarily interested in behaving vindictively towards McMurphy and that she effectively wishes to “break” him as a result of the previous disruption which he has caused within her ward. Indeed, it is suggested that this desire, amplified by McMurphy’s increasing violence towards her authority, leads to Ratchett’s decision to lobotomize the protagonist.

In conclusion, while such a decision may have been technically justified based on contemporary beliefs regarding the benefits of lobotomy, it is important to note that the film does support any suggestion that Ratchett behaved in an ethically correct manner. Rather, the film manifests the danger inherent in the capacity for the language of categorization and diagnosis to facilitate abuses of power and authority.

  • Forman, Milos. One Flew Over the Cuckoo’s Nest. (1975). [Motion Picture.] United State: Fantasy Films.
  • Ulrich, Connie M., et al. “Ethical Conflict Associated With Managed Care: Views of Nurse Practitioners.” Nursing Research, vol. 52, no. 3, 2003, pp. 168–175.