Part I: Bioethics meets Hidden Figures at Mind the Gap “When you strike woman you strike rock”

Elizabeth Gabler (President, Fox 2000)

Mind the Gap HIDDEN FIGURES Panel

Hidden Figures is a fiction film adapted from Margo Lee Shetterly’s nonfiction book by the same  name. It is about a group of African American women who are mathematicians. As if that were not exceptional enough, they work for the National Aeronautics and Space Administration (NASA) at Langley, Virginia. But— wait for it— in the early 1960s. A true story— 

This movie is an homage to women taking their rightful place in the history of science, technology, engineering and maths (STEM). However, now understanding ‘art’ unleashes scientific capacity — this film about Sci-tech is also about STEAM. It is no accident most of the women depicted in the book and film were educated at Historically Black Colleges and Universities known then, and now, for pushing students to excellence in all fields. 

Hidden Figures focuses on a small pertinent aspect of the source book— how a cadre of Black women helped launch the Mercury 7 astronauts. Set in 1961, the back drop is a pivotal period in the United States civil rights struggle, the imbalances of the Cold War, and the peri-WWII legacy pushing women into the previously male dominated work force. The collaboration between the characters in the film mirrors that of the production team which developed the project. 

The California Film Institute, parent of the Mill Valley Film Festival (MVFF), has an ongoing initiative to improve the status of women behind the camera in the film industry. The initiative is called Mind the Gap. At MVFF39, October 8, 2016, Mind the Gap programing provided a sneak preview and panel dialog about Hidden Figures. Film professionals working on the project were present for a chat hosted by Variety’s Melina Saval. Participants included Elizabeth Gabler (president, Fox 2000), Mimi Valdez (Executive Producer), Mandy Walker (director of photography), and Marissa Paiva (Vice President, Fox 2000). These production partners and crew are deeply committed to providing a platform for the best films about and by women in a racially, culturally and gender expansive context. They are being the change they want to see.

The phrase that comes to mind about Hidden Figures is “When you Strike Woman you strike rock.” That’s a calculated intertextual reference to women’s struggle inserted by the filmmakers. The screenwriter, Allison Schroeder, and director of photography Mandy Walker along with Melfi, made fine compositional and emotional choices. Among those choosing a well informed visual aesthetic. DP Walker explained, during the Mind the Gap session, research included exploring the documentary series Eyes on the Prize; works of Concerned Photographer Gordon Parks; and those of Student Nonviolent Coordinating Committee photographer Danny Lyons

Hidden Figures. http://www.imdb.com/title/tt4846340/ accessed October 11, 2016

The Congressional STEAM Caucus. http://stemtosteam.org/events/congressional-steam-caucus/ accessed October 9, 2016.

Shetterly, Margo Lee.  https://www.harpercollins.com/9780062363596/hidden-figures accessed October 8, 2016

Eyes on the Prize. http://www.pbs.org/wgbh/amex/eyesontheprize/

Mind the Gap http://www.mvff.com/mind-the-gap/ accessed October 2, 2016

Part II: Bioethics meets HIDDEN FIGURES - A Peace Genre Film

Hidden Figures Panel Mind the Gap: (In no order)  Melina Saval (Variety), Elizabeth Gabler (president, Fox 2000), Mimi Valdez (Executive Producer), Mandy Walker (DP), Marissa Paiva (Vice President, Fox 2000), Zoë Elton (Director of Programming), Mark Fiskin ( CFI Executive Director)

HIDDEN FIGURES is a high concept film, but not unbearably weighted. Instead, writer Director Theodore Melfi’s exquisite ensemble animates this inspirational focused story with humor as well as purpose. These are after all the things daily helping people survive oppression. Among the actors are Taraji P. Henson, Octavia Spencer, Janelle Monáe, Kevin Costner, Kirsten Dunst, and Jim Parsons. For my money — it is a Peace Genre film.

HIDDEN FIGURES is important because it speaks to the lives of ordinary working people. In this case in a Black American community. They are not the most deprived, not the wealthiest. Depicting social and environmental justice only in the context of brutality desensitizes viewers to the subtle degradation which wears away at a persons potential. Violence brings in the box office, but where are the rest of the stories? Is the only drive for a better life defense of ones lowest level of the Maslow Scale — food and shelter? Evidence suggest otherwise and so does HIDDEN FIGURES. 

There is an on going dialog between film and social responsibility. Part of this dialog is stimulated by the technology of the art of film and the function of the brain. Our movie memory seems to go where our actual memory is stored. Over time our life understanding seems blurred with the stories and films we have seen mixed with those we have lived. That’s how film works at its best. We know what resonates consciously but we are less sure of the unconscious.

How is Hidden Figures good for understanding Bioethics? The tendency is to focus on the justice or injustice issues raised by the film and its times. The more bioethics relevant dialog occurs around beneficence — in the use of science and technology and film. Beneficence is, for simplicity sake — doing good with what we know, knowing what we do not know, and expanding knowledge through research. More concisely, beneficence is equivalent to scientific integrity. The film’s plot quickly ranks scientific beneficence concerns over autonomy or justice. 

The main character runs the risk of loosing her job and castigating other sisters in the workplace, by expressing her considerable mathematical capacity. The choices she makes are moral choices driven by good science. Just as in all applied bioethics, like clinical medicine, understanding the obligation to do good with science, including the science of film, yields decisions which also come closer to achieving autonomy and justice. 

Hidden Figures adds grist to US Congressional Caucus on STEAM ( Science, Technology, Engineering, Arts and Math.) The hop is this initiative will create the next generation of brilliance in pure and applied scientist — one with consciousness at the forefront, and improved representation across race, class, gender and culture. Most importantly, Hidden Figures supports scientific exploration in service of honesty. Enough well developed minds may eventually help us understand — the full potential of the art and science of film. 

Support Hidden Figures and other films in the peace genre by seeing it in the theater rated PG, Christmas Day 2016, in 13 cities. The full roll out will be in January 2017.

Hidden Figures. http://www.imdb.com/title/tt4846340/ accessed October 11, 2016

La Mission, Prototype for Peace Genre Film. http://www.bioethicsscreenreflections.com/2010/05/la-mission-prototype-for-peace-genre.html

The Congressional STEAM Caucus. http://stemtosteam.org/events/congressional-steam-caucus/ accessed October 9, 2016.

Shetterly, Margo Lee. https://www.harpercollins.com/9780062363596/hidden-figures accessed October 8, 2016

Eyes on the Prize. http://www.pbs.org/wgbh/amex/eyesontheprize/

Mind the Gap http://www.mvff.com/mind-the-gap/ accessed October 2, 2016

Williams, S. Justice, Autonomy, and Transhumanism: Yesterday. In: Colt H., Quadrilli S., Friedman L., Editors. The Picture of Health. New York: Oxford University Press. 2011. p. 84-89

Williams, September. “Bioethics at the Movies.” Review of Bioethics at the Movies. ed. Sandra Shapshay. The Journal of Bioethical Inquiry. vol 7 Issue 3, pp 329-331. 

CONCUSSION: Bioethics, Foot Ball and Post Traumatic Lies.

Concussion is a documentary biography about medical science’s triumph over a social and corporate conspiracy to suppress evidence of a serious preventable disease. Forensic pathologist, Bennett Omalu, MD, discovered a pathognomonic sign confirming chronic traumatic encephalopathy (CTE). He happened to find it in a cluster of professional football players during autopsies. Concussion was written and directed by Peter Landesman, who managed a riveting story pace, despite most of the visuals occurring in the inglorious world of microscopes and morgues —done to death on television. 

Will Smith’s Dr. Omalu in the lead role is a flawless interpretation of African born Omalu. The supporting cast includes Alec Baldwin, Gugu Mbatha-Raw, Luke Wilson, Albert Brooks, Adewale Akinnuoye-Agbaje and others. Ridley Scott is the principle producer. This is a heavy hitter production. Though several Black film awards recognized the work, few others have. Perhaps this is because the lead character is a Black man who is not blowing up anything, except the gladiator culture we like to call Football.

Concussion is a gentle story where a brilliant man driven by unflappable moral instinct does the right thing. Others join him, many kicking and screaming, eventually recognizing the effects of repetitive concussions in football and so elsewhere. The fact that this bold faced David and Goliath story, taking on the industry of Football, has had such a poor reception is a shocking, though not a surprising, eyebrow raising event. As the old word play goes, “Denial is more than a river in Africa.” 

Traumatic Brain Injuries from bomb blast during war, car crashes, playing football and other sports, share similar features.(See Going the Distance on this blog.) Exploring Concussion makes viewers understand the randomness of traumatic brain injury (TBI) especially with all those shots of players on the film colliding, pulled from game stock footage. It is similar to watching car accidents from a helicopter.

The effects of CTE develop progressively over a long latent period, often 1-1.5 decades into a football career. TBI goes to dementia more often than not if, a person lives long enough. Dementia is certainly the insidious boogyman many adults in the wealthiest nations most fear. 

If syphilis was considered the great masquerader during the first half of the twentieth century, and AIDS that of the latter half, TBI is vying for the role in this millennium. 

The emergency room is often where patients with traumatic injuries are first seen. How fast was the vehicle moving? What did it hit? These are among the first questions asked by ER clinicians. They are quickly estimating the amount of G-Force the person has been subjected to upon encountering an immovable object, like another car, or another players football helmet. 

When patients leave the ER, they often are relieved by the proclamation that a “brain scan” showed no bleeding. They do not understand the comment does not mean brain injury is absent. It only means one kind of brain injury has not been seen, bleeding. Bleeding is an acute brain injury which is treatable if recognized. CTE so far is not treatable, only preventable. 

When the injured ER patient is they told to come back if they vomit, have unequal pupils, and to have someone around to do “neuro checks,” they do not understand, these are signs of  brain swelling from edema or bleeding. The complications of repetitive, or single concussions do not usually manifest immediately and tend to be very subtle initially. People need to be told watch for those signs down the line and seek clinical assistance even if distant for the incident of injury. 

G-Forces of 50G or greater against a head causes a concussion. The outcome of that concussion only becomes clear overtime. Football players routinely suffer greater than 90G hits repetitively. The luke warm public response to the film Concussion reflects the reality that this “message film” convey’s at least one notion so terrifying that most parents and football fans, do not want to hear. The most poignant scene of the film is the final one, when you see it, you will understand why. 

http://www.cdc.gov/traumaticbraininjury/recovery.html

Recent science and trauma protocols suggest neurological logical rest following brain injury improves late outcomes. Rest is a more appropriate instruction than, ”you are fine.” In bioethics, beneficence or doing good with the knowledge of science, out ranks both autonomy 

References

See:

Concussion directed by Peter Landesman (2015) Star Capital

Village Roadshow Pictures,Scott Free Productions,The Shuman Company

Cara Films, The Cantillon, Company Star Capital (USA)122 min.

Read:

GOING THE DISTANCE meets SURFING FOR LIFE http://www.bioethicsscreenreflections.com/2014/12/going-distance-meets-surfing-for-life_15.html?spref=tw

League of Denial http://www.pbs.org/wgbh/pages/frontline/sports/league-of-denial/the-frontline-interview-dr-bennet-omalu/ Accessed 4/21/2016 

"Concussion by Jeanne Marie Laskas | PenguinRandomHouse.com". PenguinRandomhouse.com. Retrieved 2016-01-11.

The Concussion foundation http://concussionfoundation.org/

Boston University Brain Research Bank http://www.bu.edu/cte/our-research/brain-bank/

Center for Disease Control Brain Injury Recovery http://www.cdc.gov/traumaticbraininjury/recovery.html

Part I: SEMBENE X BLACK GIRL X CAMP THIAROYRE: Domestic Slavery and Bioethics

Image: http://www.sembenefilm.com/

The 2015 film, Sembene!, is a documentary about the late writer-director, Ousman Sembene, (1923-2007). His bioethics relevant filmography begins with his first film, Black Girl (1966) and finishes with his last work, Moolaadé (2004). The documentary, Sembene!, is directed by Samba Gadjigo and Jason Silverman. Samba was Sembene’s friend, colleague, and biographer. Sembene! was screened at the 38th Mill Valley Festival in October 2015. A stroke of programming genius also allowed patrons to view the recently restored Black Girl. Black Girl is one of the World Cinema projects preserved by Martin Scorsese’s Film Foundation, a testament to Ousman Sembene’s stature as African Cinema’s founder. 

The structure of the movie Sembene! is formed from clips of the visually sublime, narratively sleek dramas created by the legendary filmmaker. Circumstances resulting in the United Nations Declaration of Human Rights (UNDHR) parallel Sembene’s life and work. Conscripted into the French Colonial Army, the artist subsequently served in the Free French Forces during WWII.  In 1944, a massacre perpetrated by White Colonial French soldiers resulted in the deaths of somewhere between 70 and 300 Black French African troops who had been German prisoners of war, returned to their home continent. Sembene’s film about the massacre, Camp Thiaroyre (1988), is one of his most stinging indictments of colonialism, so much so it was banned in France until 2005. 

Forced by economics to migrate to France after the war, he eventually became a Marseille dockhand. He found a home among French trade unionists, communists, anti-colonial and intellectual progressives. His back actually broken from lifting cargo, he was confined to bed. During his long recovery he read voraciously — existentialism, rebellion and the works of the Harlem Renaissance. Emerging from that period a writer, he also grasped cinema’s potential, especially for those without alphanumeric literacy. 

Raised by his grandmother, Sembene found exquisite narrative focus in his films about women and their oppression. The documentary, Sembene!, pays special attention to the bookends of the director’s film career, Black Girl and Moolaadé. Black Girl is about a Senegalese woman who worked in Africa as a nanny for a wealthy ex-patriot French family. She agrees to join them in France when they leave Africa. On the nanny’s arrival in Europe, the previously more affable employers, now on their home turf, turn the tables. The Senegalese nanny’s chores are expanded. A domestic slave, she is stripped of all dignity and the capacity to return home.

Since 1966, when Black Girl was made, 64 Million women, 15% being children, work as domestics without contracts, guarantees of labor standards, or redress of injustices. These, and the rising documentation of physical and sexual abuse, resulted in action by the International Labor Organization (ILO). In 2013, the ILO entered into force an international convention, C19, which protects domestic workers from slavery. At this writing, twenty nations have ratified the convention. The United States, though disproportionately hiring foreign born domestics, has not ratified.  Sembene’s  politically sophisticated film pre-empted the need for the ILO convention by a half century. 

See/Read:

Sembene! directed by Samba Gadjigo and Jason Silverman (2015 ) Galle Ceddo Projects

Impact Partners, New Mexico Media Partners,SNE Partners (USA)1 hr. 22min. Available on line purchase.

Black Girl, directed by Ousman Sembene (1966) New Yorker Video (France) 65min. Available on line.

International Labor Organization Article 189: Domestic workers convention http://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_INSTRUMENT_ID:2551460  accessed February 4, 2016

Claiming Rights - Domestic Workers’ Movements and Global Advances for Labor Reform https://www.hrw.org/report/2013/10/27/claiming-rights/domestic-workers-movements-and-global-advances-labor-reform Accessed February 3, 2016

Bioethics & the Status of Women Filmmakers

There are currently less than 7% of films created by women making it to major film festivals —that is 7%, per year, worldwide. This percentage has remained low and static for 25 years. Film festival screenings constitute theatrical releases. Theatrical releases are required for film and/or television distribution.

Low access to film festivals limit women’s ability to earn livings behind the camera in their industry. The number of screen stories genuinely reflecting women’s experiences is also disproportionately diminished. Omission of the perspective of women in film complicates matters in the purview of bioethics: beneficence, autonomy and justice. 

23 percent of people surveyed consider entertainment television as the top three sources of their health information. That health information is being controlled through a male perspective as shots are usually called by male producers, directors and writers. It is a bioethical tenant that equality does not equal sameness. This was learned when in 1993, the US federal government mandated women and racial minorities be included in drug research. Clinical observation showed women and minorities were being harmed by lack of inclusion as women’s responses to pain and pain medications were significantly different from those of men. These new observations coincided with increasing the critical mass of women and peoples of color in the medical profession. Women in film seems to represent a parallel situation.

Women filmmakers are denied the opportunities to reflect functional abdominal pain, menopause, postpartum depression, caregiver burnout, forced sterilization. We are not seeing these stories; yet women struggle to comprehend their meanings in gyms, carpools and walks on dirt roads to schools around the world.

What is to be done? The 38th Mill Valley Film Festival (MVFF) in October 2015, piloted its “Mind the Gap” programming. This is a conscious efforts to seek and evaluate more films by women. The “Mind the Gap” goal is to change the disproportionately low numbers of films in major festivals, representing women working behind the camera, —directors, writers, cinematographers and producers. However, it is also an attempt to participate in a dialog about the origin of the problem. Mind the Gap includes a commitment to search for those films which do manage to be made by women, despite nearly insurmountable barriers. The hope is to help establish models which can be replicated to improve women filmmakers access to the industry. 

The MVFF is among the oldest and most respected USA film festivals. It is juried through the coveted Audience Awards, bestowed by a historically film savvy 60,000 MVFF patrons. In 2015, some 170 films were screened. Programmers of the MVFF are legendary for their curatorial capacity. Many of the independent, international, documentary, short and feature films seen at this festival are U.S, North American or World Premieres. MVFF’s influence derives from consistently programming and hosting major award winners well before the beginning of the award nomination season.

In the October 2015 MVFF, roughly thirty-three percent of films screened were developed by women behind the camera. That is a better female to male ratio than most top tier film festivals: compare Toronto, Cannes, Berlin, Sundance. However, the California Film Institute, the parent organization sponsoring the MVFF, has even higher aspirations. The CFI-MVFF goal is a fifty-fifty, female to male film director ratio, a far cry from the current international paltry 7% representation of women’s films in festivals. 

Among the 2015 MVFF premieres, with significant women’s content and as it happens also other forms of diversity, which you may not find in the Oscar lineup, were: Under the Same Sun (dir. Mitra Sen), A LIGHT BENEATH THEIR FEET (dir. Valerie Weiss), INTERWOVEN (dir.V.W. Scheich), and THE ASSASSIN (dir.You Hsiao-Hsien.)

Read: 

Smith, S., Pieper, K. et al, Gender & Short Films: Emerging Female Filmmakers and the Barriers Surrounding Their Careers examining short films and directors. http://annenberg.usc.edu/pages/~/media/MDSCI/MDSC%20LUNAFEST%20Report%2010515.ashx, accessed February 1, 2016.

Smith, Stacy L., Choueiti, M. et al. Inequality in 700 Popular Films: Examining Portrayals of Gender, Race,

 & LGBT Status from 2007 to 2014. http://annenberg.usc.edu/pages/~/media/MDSCI/Inequality%20in%20700%20Popular%20Films%2081415.ashx accessed February 1, 2016

MVFF Mind the Gap http://www.mvff.com/mind-the-gap/ accessed February 1, 2016.

How Healthy is Primetime Television…http://kff.org/other/report/how-healthy-is-prime-time-an-analysis-of-health-content-in-popular-prime-time-television-programs/ Accessed February 1, 2016.

NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research US Public Health Service http://archive.hhs.gov/ohrp/humansubjects/guidance/59fr14508.htm Accessed Feb 1, 2016

Cross Reference: 

http://www.bioethicsscreenreflections.com/2015/10/under-same-sun-peace-and-bioethics.html , accessed February 1, 2016

http://www.bioethicsscreenreflections.com/2015/10/a-light-beneath-their-feet-bridges.html

http://www.bioethicsscreenreflections.com/2015/10/interwoven-listening-hearing-and.html

http://www.bioethicsscreenreflections.com/2015/10/the-assassin-and-bioethics-death-and.html

UNDER THE SAME SUN: Peace and Bioethics

In the Indian state of Rajasthan, near the Pakistani border, three orphaned children take in an injured adolescent boy, securing his humanity. “It’s a little film,” said writer-director Mitra Sen about Under the Same Sun, waiting in the Filmmakers Lounge at the 2015 Mill Valley Film Festival. Her modesty is genuine but the characterization of the works significance is inaccurate.  

This ‘little film’ tackles enormous questions, using an equally large intelligence. Despite Sen’s earlier film, Peace Tree (2005), winning some 12 international awards, the director is oblivious to the power of Under the Same Sun. In this film, children are depicted exercising their moral capacity through their daily interactions with one another. 

Sen’s film craft honors the legacy of Mira Nair, with its complex screenplay, and converging political and emotional plot lines. Perhaps, the greatest surprise is Sen’s facility with suspense. It rivals Alfred Hitchcock’s on his best day.  Think of the corn field scene in North by Northwest, or racing through the Marrakesh market in The Man Who Knew Too Much. A ‘tell’ forewarns Sen’s mastery. Seeing her diligence when ordering a sandwich in a deli is to see the artist at work. When she sorts out what she wants, Mitra can teach others how to help create it.

The geography of the film is significant. The region has a cross cultural population, split between Hindu, Christian, Muslim and Sikh people, who interact with one another routinely. The balance between these religions derives from a long complicated past. Mitra Sen’s contemporary handling of the cross cultural issues is masterful. She pushes the viewer to see so many colors in motion at once that the differences between them blend into a white light. Through a single example of emerging conflict, we are forced to consider the universal human rights violations when using children as weapons of war. 

Bioethics pays special attention to the moral protection of innocent third parties. Justice requires an equal distribution of burdens and benefits. Children are disproportionately burdened and reap the least benefit in conflict zones. A middle school teacher, Mitra Sen’s primary aim is promoting childrens’ understanding of the mechanisms of peace.  

Under the Same Sun was not an easy film for which to find resources, as if any ever are. Beyond financial issues was the reality of the nation of principal production. Sen arrived from her Canadian home to commence casting and production within hours of the 2008 Mumbai terrorist bombings. Neither India nor Mitra Sen are unfamiliar with difficult chaotic circumstances. Yet, it is remarkable that amid unprecedented horror, Mitra traveled from across the country to the border between Pakistan and India and began to make her Peace Genre movie. 

One bioethical definition of peace is that it is a ‘good’.  Such ‘goods,’ in this context, cannot be held by the individual but only by humanity as a whole. However, we recognize peace when we catch glimpses. Otherwise, it eludes clarity.  In the same way that individuals may derail peace, a collective can keep it on track. Under the Same Sun turns the violence of war inside out, in search of the elusive peace. 

Watch

Under the Same Sun, directed by Mitra Sen ( 2015) Canada, Sandalwood Productions, 93 min.
http://www.underthesamesunthefilm.com/

Under the same Sun Trailer https://www.youtube.com/watch?v=vOHl7CKz4vs Accessed October 17, 2015

http://www.sandalwoodproductions.com/trailer.html. Accessed October 17, 2015

Read

Williams, S. LA MISSION : Prototype for the Peace Genre http://www.bioethicsscreenreflections.com/2010/05/la-mission-prototype-for-peace-genre.html?spref=tw Accessed October 17, 2015

Director Mitra Sen (Under the Same Sun), September Williams, MD (Bioethicsscreenreflections.com

A LIGHT BENEATH THEIR FEET Bridges Between Mental Health, Home Health Workers and Bioethics

A Light Beneath Their Feet is a coming of age story for both a daughter and a mother. Valerie Weiss’s directorial skill is remarkable. She uses a spotlight halo soft focus to keep the viewer tied to the amazing performances of Tayrn Manning (Gloria, the mother)  and Madison Davenport (Beth, the daughter). It is fortunate for the viewer that the director is able to keep up with the sophistication of the script and actors she has chosen to direct. Writer Moira McMahon Leeper has brilliantly clarified an inverted mother and daughter  relationship, occurring against the backdrop of mental illness. This film makes stressed family, clinicians, home care workers, and those with labile mental illness, feel less alone.

This film premiered at the 38th Mill Valley Film Festival, October 10, 2015. This is an intimate film about the continuum between mental illness and mental health. The bridge between these two entities is always in sway for everyone, the issue is extent.  Director Valerie Weiss came to her full film career after completing her doctorate in biophysics at Harvard. As such, she well understands the concept of elementary forced resonance, and that understanding has transferred to the subtleties of  her movie. It’s the subtleties that make this film great for  expanding bioethics consciousness. 

Every science student learns about the Tacoma Washington Narrows Bridge collapse in 1940. It is a bedrock tale in physics. Aeroelastic flutter, caused by high wind, unable to pass through the construction’s unbending side walls, caused the bridge to “catch the breeze.”  The arc of the bridges sway increased in magnitude,  eventually over taxing the elastic capacity of the materials used to build the structure. The initial signs of the rigid architecture’s collapse were barely perceptible. In A Light Beneath Their Feet Beth is able to recognize tiny shifts in the mental health of her mother, Gloria. Beth knows the bridge between her mother’s decompensated bipolar disease, and her functional capacity to be delicate, vulnerable to a cascade, gaining resonance, yielding ever widening arcs of suffering.

A Light Beneath Their Feet represents  the 38th MVFF programming as both Active Cinema and the theme Mind the Gap.  Mind the Gap  isabout disparity between talent of women, and availability of sustainable work for them in the film industry. The film brings honor to both these categories of the MVFF interest.

Through this film, we experience life with one of the 40 million (1:5)  people in the United States, with decompensated mental health. The mechanism of the film's narrative outlines that though  this is the story of a mother and a daughter, there are two caregivers. Family and professional caregiver’s narratives should star women. They are the people who usually do that work. Women do this work for less than a man would, poor acknowledgement, income and generally unacceptable working conditions. A Light Beneath Their Feet may be a work of fiction, but there is a whole lot of truth in it. 

Family caregivers and home health workers, like Beth, struggle to cobble together a life for themselves as well as that for their loved ones who may be ill. The movement for home health care workers to  unionize, and  be recognized, is well underway.  Beth is younger than most of the children caring for their mothers in the USA.  At college age, Beth is  forced to consider her educational options in the context of her mothers needs. The more accepted situation sees a middle aged child caring for an elderly parent. However, it is mental illness which usually prompts that inverted relationship as well. 

Dementia occurs disproportionately in the elderly, those with cardiovascular disease, traumatic brain injury and liver disease. Common fellow travelers of dementia are: depression, anxiety and psychosis. In the hands of an activated society, managing the abundant  dementia  diagnoses could be a back door to improving the home support for others with mental illness.

Those of any age or cause for decompensated mental health, share legal concerns regarding competency and bioethical assessment of capacity. Competency is an assumed legal construct  until proven absent. Capacity is innate. It allows individuals to establish and maintain a functional system of reasoning, protecting their own personhood. It is loss of capacity which results in judges declaring people ‘incompetent’ to manage their affairs. Incompetency is legally decided between matters of person and those of estate or finance. Fiscal conservators manage financial matters, writing checks, paying bills.  A guardian of person is assigned in circumstances where a person not voluntarily taking medications, or relinquishing weapons, may pose danger. All conservators are appointed by the court and serve as agents of that court. Being a danger to oneself or others is the sine qua non of incompetency. 

The chronic pain community teaches us that most intractable suffering, from pain, is either initiated or worsened by adverse emotion.  In the current century science has realized, when the mind is unsettled by anger, sadness or fear, the brain becomes a petri dish for neuro-psychologic and physiologic decompensation. This was beautifully shown in the drug store where Beth was lucent enough to recognize the psychosis another customer was similar to her own mania, which frightened her. It frightened her so much that she could not rationally respond by getting and taking her psychotropic medicines. The concept of emotional stress resulting in imbalanced health has recently been distilled, for children, in the animated film Inside Out. 

Gloria’s relationship with her psychiatrist has them both walking a clinical tight rope throughout the film. Her ability to maintain guardianship, not only of herself but her daughter is dependent on a consistent internal system of reasoning. True to reality, Gloria’s mental compensation is maintained through the love she shares with her daughter, but also by the essential use of appropriate psychotropic medications. Often with humor, A Light Beneath Their Feet captures the sense of wonder, and fear, for those sharing a life straddling the border of sanity. 

Photo Director Valerie Weiss PhD,  Actor Jena Malone, Writer September Williams, MD- After Give Us A Break!  Mind The Gap panel Mill Valley Film Festival 2015

Photo: Director Valerie Weiss PhD,  with Stacey L. Smith, PhD Director Media, Diversity and Social Change Initiative, USC Annenberg School for Communication and Journalism lunch after Mind The Gap panel Give Us A Break!

Watch 

A Light Between Their Feet (2015) directed by Valerie Weiss, USA PhD productions (90 min)

Inside Out (2015)directed by Pete Docter,Ronnie del Carmen USA Walt Disney Studios (94 Min) 

Read

National Alliance on Mental Illness https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

INTERWOVEN: Listening, Hearing and Bioethics

Director, Writer, Cinematographer and some Cast of INTERWOVEN

The film Interwoven had its world premiere at the 38th Mill Valley Film Festival,  October  9, 2015. It recalls the best of ensemble film traditions. There is a touch of John Cassavetes improvisational script development, a whisper of Pasolini’s version of Giovanni Boccaccio’s Decameron, and the texture of films like Grand Canyon and Traffic. This film is a part of the Peace Film genre (c.f. La Mission)

Unique to Interwoven, each character is initially stereotypical. Then, just as the viewer raises their palms to yawn, the inner-lives of the characters explode, or implode, on the screen in a web of inter-related complexity. Does the homeless sage deserve what he’s not got? Is a suicide prevention worker past giving a damn?  Can a violinist’s shrill racket be a prelude to virtuosity? This is not a preachy movie, though it does not shy away from message.  Everything doesn’t work out for this band of some sixteen Interwoven people, but everything does indeed work.

Directed by VW Scheich, and co-written with Uyen K (who is incidentally the director’s entertainment attorney-wife). Interwoven is an ambitious first feature for this team. Scheich breaks many novice rules.  A new director should use a small cast, few locations, and focus on dialog over geography. — These were not Scheich’s choices. Scheich confounds matters more by moving boldly across culture, race and class, over wide swaths of Los Angeles, creating a kaleidoscope of hope.  

The ensemble of Interwoven includes award winning star Mo’Nique (Precious). However, the majority of the players are solid ‘work a day actors.’ In casting, the writer-director team operated as though documentarians, searching for the story, not beginning with a theme but instead a process. When the casting call went out, some two hundred actors responded. “That was just the first day, ” Scheich says. Actors were asked to share poignant stories about their lives during their auditions. Some of the actors describe being confused at having neither lines to read nor monologs to recite.

Interwoven highlights the power of listening in both its production style and themes. In this way the film gains its bioethical influence. Listening is an acquired skill, requisite for ‘hearing’, but not sufficient.  Hearing it is key to bioethics. Informed consent is a process which requires listening and hearing, not just signing a piece of paper.  

The elements of informed consent require that a person is able to reflect back information delivered during disclosure of expectations if particular course of action is taken, it’s risks, benefits, and alternatives. Informed consent also demands that permissions are given for the course without coercion. The rules of informed consent  are are associated with  articles 6 and 12 of the Universal Declaration of Human Rights, which relate to personhood.  Matters of  family, spirituality, past struggles and personal cultural icons influence an individual’s capacity to give informed consent. Policy and procedures related to informed consent in medicine and human research are further operationalized in the Helsinki Declaration of the World Medical Association and its revisions. 

Without heavy handedness, the stories of Interwoven relate to death and loss. The film evolves, perching solidly, on what the late bioethicist Paul Ramsey described as “the edges of life.”  The team creating Interwoven has an intelligence which allowed them to find the truth they were meant to interpret from the narratives heard. Many of the characters were cast with actors from whom the original stories derived. Interwoven adds value to those watching from a clinical medical ethics vantage. How do you give bad news? Where does drinking alcohol cross the line into alcoholism? What is anticipatory versus prolonged grief, and how do we deal with it best?

Watch:

Interwoven (2015) directed by VW Scheich (USA) 87 mins

Interwoven Trailer https://vimeo.com/109253941

Read: 

Ramsey, P. Ethics at the Edges of Life: Medical and Legal Intersections (1980) http://www.amazon.com/Ethics-Edges-Life-Intersections-Lectures/dp/0300021410/ref=la_B001IYTN7S_1_9?s=books&ie=UTF8&qid=1444806624&sr=1-9

World Medical Association http://www.wma.net/en/30publications/10policies/b3/

Declaration of Human Rights  http://www.un.org/en/documents/udhr/index.shtml#a6

THE ASSASSIN AND BIOETHICS: Death and Destruction vs. Peonies and Silk

The Assassin was one of  the three opening night films at the 2015 Mill Valley Film Festival. Taiwanese filmmaker Hou Hsiao Hsien is no stranger to the Cannes festival awards. This film won him the Cannes 2015 Best Director. Attraction to the screen narratives of ‘assassins’ raises clear bioethical concern during pervasive aggression at home and abroad. The Assassin differs from others in its genre. It does not titillate with the brutality of cold blooded murder. Instead, The Assassin may demonstrate a filmic antidote for the desensitization of screen violence.

The original assassins are thought, by some, to have been mercenaries, in Persia, from the sect of Shia Islam, in the period between the 9th and 10th century. This sect worked against the Sunni Islam who controlled that empire. Assassins were tools of barons who held no independent army.

Though set in the Chinese context, and created by a man, The Assassin has a profoundly feminist sensibility. The assassin of this film’s interest is a woman born in a ninth century imperial court. It is a profoundly feminist approach to story telling. Her mother rejects imperial control and escapes, knowing the action will likely cost her life and that of her daughter. Before her death, the fleeing mother arranges her daughter’s care by an aunt and uncle. The imperial powers eventually wish to conquer the geographical region where the child has been fostered, again risking her death. For the child’s protection her surrogate parents place her in the care of a ‘nun.’ The Nun’s machinations train the child as an assassin. We meet the girl in young adulthood, were she is driven by her filial longings to break away from her heinous training.

The ‘Assassin Genre’ usually depicts an innocent, extracted from their family’s stability and values, being co-opted by an evil power. The plethora of large and small screen versions of this theme includes screen works ranging from The Borne Identity to more recent television shows like Complications and Blindspot. Malleability of unformed systematic reasoning, when faced with moral conflict, is often essential to training in the Assassin Genre, as in life. —Think child soldiers, street gang members, late adolescents in the military,  and fascists masquerading as religious extremist.

Bioethics is an applied ethics concerned with science and technology affecting the biosphere and it is inclusive of medical ethics. The underpinning principles of bioethics  are beneficence, autonomy and justice. Ethical sense generally comes from two separate mechanisms. The first is through principles, drilled into a person as in religion, academia and professions. The second approach to enhancing morality is ‘casuistry.’   Casuistry imparts moral understanding through cases or stories. However, it is not just the Aristotelian narrative plot curve that generates the organized portrayal of ethical dilemmas. Particularly in the case of film, the way in which stories are told influences meaning.

Greek drama analysis might argue that depicting an assassin's journey allows viewers to work through feelings of loss of connectedness. But screen science is a technology, incidentally facilitating art, and can be held to the standard bioethical scrutiny as are other technologies. Does the technology do good?  Does it interfere with the viewers autonomy or enlightened self interest? Are the burdens and benefits of this technology equitably distributed between the most and least vulnerable persons?

Clinically, film can be used to  intentionally manipulate emotion and physiology. Think Clock Work Orange. Other examples include use of film to desensitize persons with, say, arachnophobia. The retina can’t tell the difference between a real spider unless the mind clarifies the matter.  Our movie memory is stored  in the same places as our real experiences. ‘Suspension of disbelief’ is required to watch a film.

If the arachnophobe believes a film spider is real, then the clinical matter is training them to sublimate the emotional and physiologic response during repeated exposures. Eventually, the sublimation becomes automatic. If a viewer suspends believes the screen violence is real, there should be a mechanism to train them to abhor that violence.

Among the tenants of bioethics, and especially clinical medical ethics, is that those who know a field best have increased ethical obligation within that field. Film master Hou Hsiao Hsien’s gives a new twist to reversing the desensitization to violence.That’s a good thing since drilling principles into young minds doesn’t seem to be working.  He uses the juxtaposition of heinous acts with extraordinary beauty. He directs  viewers’ minds to be afraid of violence, initially because it waste time better used for more intimacy with the pleasing aesthetic of this filmmakers’ world. We beg, “Let her walk through that field just one more time!”

Though presaged by the elegance portrayed in many martial arts films, Hou Hsiao Hsien's film Assassin has left the ‘kick’ genre in the dust. The Assassin is not about killing, but demonstrates escape from horrid depictions by pushing prayers for peonies and silk.

Reference for Assassin
Watch:

The Assassin (2015) directed by Hou Hsiao Hsien (China, Hong Kong, Tiawan) Well Go (2015) 105 mins

The Assassin Trailer https://www.youtube.com/watch?v=YSoXoOAY1zU

2015 Mill Valley Film Festival

Bioethics and the Mill Valley Film Festival

Bioethics Screen Reflections Supports the California Film Institute 38th Mill Valley Film Festival (www.cafilm.org) From October 8, 2015 to October 18, 2015 we will screen/review the following films:

The Assassin 

Interwoven

Brooklyn

A Light Beneath Their Feet

Remember

Carol

Son of Saul (Saul Fia)

Sembene!

Here Is Harold (Her er Harold)

Love Between the Covers

Beasts of No Nation

Body

Dheepan

Creative Control

A Perfect Day

Paper Tigers

In Defense of Food

A special focus will follow bioethical issues reflected in the 38th Mill Valley Film Festival category of “Mind the Gap,” which considers the relatively small number of women able to earn a living in the film industry, despite the large percentage of talent and skill women represent in the field.  

Follow along with us over the month of October. Mill Valley Film Festival programmers have proven to be among the most savvy in the field. Their online film notes can guide direct viewing for the year even, if you are not able to attend. But, do try to join us. Often the world, continental and USA premieres offered become the most highly awarded films of their release years. 

See:  https://tickets.cafilm.org/websales/pages/list.aspx?epguid=3e8cf7a7-5095-4a32-8cb4-f42862162ee0&alpha=b& 

We will keep you posted @Bioethicsscreen  and @MVFilmfest

Part I: NORMA RAE x EUROPA '51: Bioethics & Workers Unions

Norma Rae is a 1979 film, based on the life of the late, legendary, textile workers’ union organizer, Crystal Lee Sutton. In the title role, Sally Field honors the formidable works of the film’s director Martin Ritt, and the screenwriting spouses Harriet Frank and Irving Ravetch. The re-viewing of  Norma Rae, in a bioethical context, is prompted by the worker health confounding plethora of  anti-union legislation plaguing several of the poorest states of the USA. An eighteen year old, entering the work force this year, has probably never seen the film Norma Rae. That is a travesty. 

The character Norma Rae was a textiles factory worker in North Carolina. It was the 1970s,  when the textiles industry in the USA employed nearly 40% of the  nation’s workforce, and was largely not unionized. The same industry is now less than 2% of the work force but is experiencing a resurgence in the past few years, as work is returning from the instability of other nations. Norma, was poor, white, widowed and a mother of three. The factory town in North Carolina where she lived was rife with poverty, racism, sexism and classism.  She worked in the town company factory, as her parents had before her, and still did. The heft of this story and performances, taking this woman from unconscious to universal conscience remains impressive. Norma Rae stands on the shoulders of  Article 23 of the Universal Declaration of Human Rights which ascribes: 

Everyone has the right to work, to free choice of employment, just and favorable work conditions,  protection against unemployment (and among other things), the right to form and to join trade unions for the protection of their own interests. Like much of the UDHR, Article 23, sprang from unprecedented violations of humanity wrought by the expansion of technology associated with the atrocities of both WWI and WWII. This is how Norma Rae meets bioethics. 

The science of public health shows, from 2012-2013, alarming trends of disparity in states where the bargaining capacity of unions, and union organizing, has been diminished by recent legislation. In those states, workers wages are lower; there are lower amounts of health insurance coverage needed for individuals age and life stage; non-union workers pay a larger share of their health insurance premiums; poverty rates are higher in both adults and children; infant mortality is higher and; workplace fatalities are a startling 54% higher. 

Norma Rae’s transcendence to consciousness, prompting her union organizing, visually parallels the ascension of the main character in Roberto Rossellini’s Europa ’51, Irene Knox.  Irene (Ingrid Bergman) is the wife of a wealthy American industrialist residing in post WWII  Rome. After her child dies, she searches for and attains a sensibility close to that of St. Francis of Asissi. Oddly, St. Francis is considered the earliest documented source of Bioethics. Imagery of St. Francis is iconic for  empathy in Europa ’51 — flocks of children and families like birds, frequently surround Irene, as she shifts her world perspective to embrace them.

Watch:

Norma Rae (35 mm) directed by Martin Ritt, USA 20th Century Fox. 1979 (110 min)

Europa ’51 (35 mm) directed by Roberto Rossellini, Italy, I.F.E. Releasing Corporation 1952 (113 mins)

Read:

Clifford, S. http://www.nytimes.com/2013/09/20/business/us-textile-factories-return.html?pagewanted=all&_r=0  Accessed September 9, 2015

Crystal Sutton Collection http://www.crystalleesutton.com/about.html Accessed September 9, 2015

Death on the Job: The Toll of Neglect. http://www.aflcio.org/content/download/126621/3464561/DOTJ2014.pdf  Accessed September 14, 2015

Ricardo Andrés Roa-Castellanos, Bioethical common factors amidst Krause masonry and Saint Francis of Assisi systems of thought appeal to respectful dialogue, nature and understanding: the Jahr’s dialogue beyond the age of "enlightment" and the metadisciplinary "dark" ages. http://hrcak.srce.hr/74189 Accessed September 14, 2015.

The Universal Declaration of Human Rights http://www.un.org/en/documents/udhr/ accessed August 31, 2015.

Part II: NORMA RAE x EUROPA '51: Bioethics, Dual Loyalties & Crystal Lee Sutton

In Norma Rae, and Europa 51 the leading women are seen in factories which are loud, mechanical, inhuman. Focus on the grinding gears seems to imitate the work of their minds. Workers visually blend with the machines. Both the lead characters interact with the roughness of the lives around them. The camera captures faces and expressions of  the destitute and poor of spirit. Director Ritt’s homage to Rossellini’s neorealism is complete. There is sickness and death; stroke, deafness, infection, suicide, murder, broken limbs. Only the women leads and their compadres, male non-lover partners, find these occurrences anathema.  

Irene Knox is an outsider looking in on a world to which she is compelled to extend compassion. Norma Rae is born from the roughest circumstances, which she struggles to change. It is through the wonders of human consciousness that Norma Rae, jumps from pure survival to a desire for enlightenment. The leap is portrayed with the delicacy of a metaphysical love affair and a Dylan Thomas poem. Remarkably, these two women with beginnings so different end up in the same place. 

Bioethical conflict arises in circumstances where there are competing goods. When good and bad are clear, that is not a conflict. The system of health care as portrayed in both films illustrate this tension. In the textile factory the doctor is paid by the factory owners, implicitly required to maintain the status quo despite repeated instances of occupational disease and health stresses. Arguably, the doctor tries to maintain individual factory workers incomes, for as long as those individuals can stand to work.  

In the run of the day, there is a duality of obligation to both employer and patient in the tasks of public health. When you ask a tired, starving man if he would rather eat or sleep, you see the bioethical conflict occupational health, workman’s compensation, social security, and corporation doctors deal with, or ignore, daily.

Europa 51’s doctors obscure facts repeatedly. The cause of death of Irene’s son is withheld from her. When a prostitute is ill, and despised by neighbors in a slum, Irene summons a doctor. Without explanation  the doctor declares “there is nothing to be done.” Then, he abandons Irene to the task of doing that ‘nothing.’

Irene’s desire to make change for individuals around her abounds.  She stands in, as a worker on a factory shift, for a woman with several children and a date. Irene is told her behavior is dangerous to her own well being, proven by her being locked into an asylum. Norma Rae was also locked away, but in jail.  Both women did plenty of good before the jailers threw away the keys. These films make us ask,”For whom do these doctors work?”  

Medicine failed not only  the character Irene Knox but, the real Norma Rae, Crystal Lee Sutton.  Crystal matriculated at  Alamance Community College in 1988.  She finished her working career as a certified nursing assistant.  Being among the medical profession did not save her.  Crystal died on September 11, 2009, from a usually slow growing tumor of connective tissue surrounding the brain, a meningioma. The mass escaped appropriate followup because of insurance company protocols. She died in hospice at 68 years old. When asked by a reporter, how she would like to be remembered she said, 

“It is not necessary I be remembered as anything… but I would like to be remembered as a woman who deeply cared for the working poor and the poor people of the USA and the world … (So) that my family and children, and children like mine, will have a fair share and equality."

Watch:

Norma Rae (35 mm) directed by Martin Ritt, USA 20th Century Fox. 1979 (110 min)

Europa ’51 (35 mm) directed by Roberto Rossellini, Italy, I.F.E. Releasing Corporation 1952 (113 mins)

Read:

Clifford,S. http://www.nytimes.com/2013/09/20/business/us-textile-factories-return.html?pagewanted=all&_r=0  Accessed September 9, 2015

Crystal Sutton Collection http://www.crystalleesutton.com/about.html Accessed September 9, 2015

Shultz, C. http://truth-out.org/archive/component/k2/item/86086:you-probably-knew-crystal-lee-sutton Accessed September 15, 2015.

London, L. Dual loyalties and the ethical and human rights obligations of occupational health professionals. Am J Ind Med. 2005 Apr;47(4):322-32. http://www.ncbi.nlm.nih.gov/pubmed/15776476  Accessed September 18, 2015.

A SEPARATE WIND: Bioethics Forced Migration, Violence and Grief

A Separate Wind/ Viento Aparte opened the 7th annual Cine+Mas San Francisco Latino Film Festival. Director Alejandro Gerber Bicecci’s film though billed as a coming of age story, is also a miraculous buddy movie. The buddies? ... a brother and sister, fifteen and twelve. Together they traverse 7 of Mexico’s 31 states, by truck, car, bus and foot. Other than receiving the kindness of strangers, sometimes paying for it, the children are on their own. In this process, they stare down anticipatory grief for a sick family member, and immediate grief for their country.

In writer-director Bicecci's hands, states are not just geography, but also “states of being.” This film is “the other side” of many stories. The children are relatively affluent and sheltered, having grown up in Mexico City. Their mother’s Indio-like spirit is counterbalanced by their father's chilly pragmatic style. Weaving between these parental opposites the waifs manage to wade through life’s muck, approximating a straight line to their destination. 

This is a story as much about truth and reconciliation as it is about violence and terror. Bicecci frames most shots from the viewpoint of one or the other of the children, or of their memories. Once you learn this distinctive film language you feel comfort in the directors hands. Settings and characters feature Indio, Spanish, African and ancient Mesoamerican influences in a thoroughly modern context, of language and music.The vast diversity of Mexican identities depicted defies the notion of one linear history of its people. 

For all its beauty, A Separate Wind is not a fairytale. But it does recognize that even in hideously violent circumstances gentleness can  still be found. Much of this film turns on the threat of violence insidiously invading the young travelers, though it never does. If the children were caught in that depravity, then the story would be about those incidences. Bicecci says, "Then the story would no longer be about siblings emerging understanding of their own relationship, to one another, and their country.

The situational violence, the director tells his audience, parallels what he witnessed scouting the film's locations, leading  him to make rewrites. With those rewrites violence itself becomes a character.  However, the perpetrators of the violence are never shown on screen so denied that power. Instead the film craft directs the siblings, and the viewers to identify with the victims, the most vulnerable-- a journalist witness, peasants with a brutal masters, a prostitute whose lively hood depends on her John.

A Separate Wind explains why its protagonists and thousands of other children walk across continents seeking not paradise, but at least a less brutal world.

See:

A Separate Wind/Viento Aparte will be screened again 9/26/2015. Tickets for this film and others at  http://www.sflatinofilmfestival.com/tickets/

Runs annually and this year 9/18/2015 -10/3/2015

A Separate Wind/ Viento Aparte directed by Alejandro Gerber Bicecci (2014) Mexico, Spanish/ English subtitles

Trailer: https://www.youtube.com/watch?v=3RZsoVHEmAk

Read:

Why are so many children trying to cross the US border http://www.bbc.com/news/world-us-canada-28203923

A MIGHTY HEART: Bioethics and Article 19 of the Universal Declaration of Human Rights

The power of the first viewing of A Mighty Heart is a plot which rips Daniel Perlman from his pregnant wife and soon to be born son. This is set amid the chaos of Pakistan, a country simultaneously ancient and at 55 years post colonial rule, younger than wines in a good cellar. The second viewing, through excellent film craft, shows A Mighty Heart tells a very different and peaceful story. It is the story of a multiracial, multicultural, feminist, who loses her husband, yet her spirit refuses to capitulate to the tactics of terror. 

A Mighty Heart is directed by Michael Winterbottom. The screenplay is written by John Orloff. The film is an adaptation of the memoir written by  journalist Mariane Pearl who is played by Angelina Jolie.  Mariane is the widow of Wall Street Journal reporter Daniel Pearl, who in 2002, was assassinated in Pakistan. Dan Futterman portrays Daniel Pearl.

Since 1992, over 1000 journalists have been documented to be  killed in the line of their duty, The conviction for these crimes around the world is around ten percent. Those responsible for the killings have enjoyed relative impunity for their actions. It is journalist James Foley, murdered in August 2015 in Syria, along with others, which prompts this second look at A  Mighty Heart. Jim, like Pearl was beheaded by fascists. The word fascist is chosen intentionally, avoiding the various euphemisms often applied to such murderers. 

The visuals of A Mighty Heart, beat a rhythm of an environment wrought with the oppression of masses of people, crammed into tight spaces. Medical researchers working with rats know that if you put too many in a cage, they will turn on one another.  As Marianne Pearl points out, she lost her journalist expatriate husband, but ten Pakistanis were also killed by extremist that same year. The visuals of poverty, the streets of Islamabad and Karachi, juxtaposed with privilege, the homes and servants of journalists, expatriates and wealthier Pakistani citizens, delicately illustrate fascist fundamentalism coming to have such a foothold. It’s an old story. Destitute people cling to ideologies which replace the void left by  their dignity. 

Why is this a bioethical issue? Maslow's hierarchy of needs is a theory in psychology proposed by Abraham Maslow in his 1943 paper "A Theory of Human Motivation.” The hierarchy says that  the essentials of physiology, safety, and love and belonging are prerequisite to esteem and self actualization. Health and welfare of individuals through the beneficent use of health sciences may be requisite in exercising ones enlightened self interest. However beneficence and autonomy are not sufficient to provide equal distribution of burdens and benefits, that is, justice in extraordinary circumstances of injustice. Building requires blueprints. In 1948, five years after Maslow’s ‘A theory of Human Motivation,’ the Universal Declaration of Human Rights (UDHR)  was ratified by the newly minted United Nations.The UDHR operationalized Maslow’s hierarchy in service of building more just societies. Freedom of the press,and more, is addressed in Article 19 of the UDHR:

“Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.”

In combination with a campaign to stop impunity for those murdering journalists there are calls for the international courts to consider the murder of journalist as crimes against humanity, A Mighty Heart  is worth second look as it struggles to speak truth to article 19 of the declaration of human rights.

Watch:

A Mighty Heart (35mm) directed by Michael Winterbottom USA Paramount Vantage. 2007(108 min) 

Read:

Pearl, Mariane (2003). A Mighty Heart. with Sarah Crichton. New York City: Charles Scribner's Sons. ISBN 978-0-7432-4442-8.

For More Information see: 

The International Federation of Journalists http://www.ifj.org/campaigns/end-impunity/ accessed August 31, 2015

United Nations Press Freedom Day 2015 http://webtv.un.org/search/world-press-freedom-day-side-event/4224398140001?term=world+press+freedom+day  accessed August 31, 2015 accessed

National Writers Union Co-Sponsors Press Freedom Day at the United Nations https://nwu.org/nwu-co-sponsors-world-press-freedom-event-at-the-united-nations/

The Universal Declaration of Human Rights http://www.un.org/en/documents/udhr/ accessed August 31, 2015.

BLACK AND WHITE VS BLACK OR WHITE: Bioethics and Mixed Race Families

BLACK AND WHITE, screened at the 2014 Toronto Film Festival and later at the Mill Valley Film Festival, in October 2014.  The same title was also used to discuss the film in various film trade publications. However, the film’s title changed by the time of its USA distribution date, January 30, 2015. The word ‘and’ was replaced with the word ‘or’. That is, the film title became BLACK or WHITE.   Use of the word ‘and’ better reflects the courage of writer-director Mike Bender in broaching contemporary issues around race and class. The film only superficially reflects two entities fighting one another. Much more prominent in the story is a struggle for Black and White to save each other. Bender dares to suggest, we might all be in this mess together, sinking or swimming.  Ignoring antebellum period themes,  it’s a new take. Rowena (Octavia Spencer) is the black grandmother of mixed raceeight year old girl, Eloise (Jillian Estell).  Rowena is compelled to fight for custody against the child’s white, recently widowed, alcoholic, up scale lawyer grandfather, Elliott (Kevin Costner.) Rowena, and Elliot’s now dead wife, had a longtime truce regarding their grand-daughter’s best interest. The Black and White grandmothers together decided that the girl should live with the affluence Elliot’s family income could afford. The girl's residence was conditional on a grandmother being in the Brentwood house. Rowena, aware of Elliot’s flaws in parenthood, including alcoholism worsening under the pressure of grief, considers the previous custody arrangement void. 

Rowena is no slouch. She is a more typical black woman than the average film portrayal of a woman of her race, middle-working class and age.  Industrious, she operates several small diversified businesses out of her home in the intact black community of South Central Los Angeles, a community rarely reflected on screen. Through her toil,  a decent though not opulent lifestyle has been afforded to her large extended family, most of whom live nearby and are doing well. Among her children, a lawyer son is forced into the custody battle. However, there is one  exception to Rowena’s pride, another son, a reprobate dope-fiend. Any American family, of any race,  with enough living children is bound to have one of the type. Rowena’s fallen son is the father of Eloise. The child’s mother, attracted to the degenerate, died in childbirth. 

Obvious bioethical concerns in BLACK AND WHITE include concerns for the best surrogate for a child whose parents are no longer able  to parent; the age of autonomous decision making for children and historical injustices inherent in racism and classicism. The role of grief, acute and prolonged, in the context of substance abuse stands out. In the end it is the lagging of social construction,  far behind the science of the human genome, that keeps viewers watching. 

Stephen Riley wrote an analysis of stresses, those identifying as Mixed Race, felt in filling out Box 9 on the 2010 United States census. He describes people agonizing about accurately portraying their racial identity. Riley states “For those who desire to portray their ‘accurate racial’ identity, I have news for you —  ‘racial accuracy’ is an oxymoron.  ‘Race’ as a biological, or anthropological construct is an utter fallacy.”  

Support for leaving behind personal struggles with ‘identity’ is in the census instructions for Box 9, “Race is key to implementing many federal laws and is needed to monitor compliance with the Voting Rights Act and the Civil Rights Acts and are also used to assess fairness of employment practices, to monitor racial disparities in characteristics such as health and education and to plan and obtain funds for public services.” Riley proposes Mixed Race people should check the box which best defines, “How others identify you.”

BLACK AND WHITE offers brilliant honest images, dialog and acting in this sometimes humorous, other times painful,  self-reflective story. Mike Binder’s approach is not as facile as people might find comfortable. The film BLACK AND WHITE suggest that race is a diversionary tool preventing people from getting to the real work of survival in this millennium. 

Black and White/Black or White (35mm) directed by Mike Binder. USA. Relativity Media. 2015 121 min)

Riley, S.  2010 Census- Some thoughts. mixed race studies: http://www.mixedracestudies.org/wordpress/?page_id=6079 accessed January 31, 2015.

Writer Director Mike Binder and September Williams at Mill Valley Film Festival, October 8, 2014

Bioethicsscreenreflections.com is happy to announce the film STATES OF GRACE Hits Bay Area Theaters THIS MONTH OF JANUARY 2015!

States of Grace hits Bay Area theaters to coincide with the installation of a movable median barrier on the Golden Gate Bridge in early January. Dr. Grace Dammann’s life was forever changed when a driver crashed head on into her car during a routine commute across the bridge in 2008.  

Join us for one or more screenings. Expanded Distribution of Films is dependent on initial viewership in limited release theaters - TO HELP and for ticket information go to: http://openstudioproductions.com/states-of-grace/

Synopsis:

After spending more than a year in rehabilitation hospitals, the film follows Grace as she returns home to Green Gulch Farm Zen Center in Marin, where she lives with her partner Fu Schroeder and their adopted teenage daughter Sabrina. Family dynamics are turned upside down as each of them must negotiate new roles and responsibilities. Through intimate verité footage and interviews with Grace’s doctors, family, and friends, States of Grace paints an inspiring portrait of trust and devotion as it delicately documents the pain and power of one woman’s fight to reinvent herself.

Honored with audience awards at the Mill Valley, Seattle Lesbian & Gay, and Napa Valley film festivals this fall, viewers have cheered States of Grace as “a moving, complex, and powerful journey” and “a knockout filled with beauty, wit, and compassion.”

Join filmmakers Helen S. Cohen and Mark Lipman in person at all six Bay Area screenings. Grace and Fu will also be in attendance at the Rafael Film Center on January 8. Get your tickets now and spread the word to family and friends! Don’t miss this chance to see States of Grace on the big screen!

Watch the Trailer

Bay Area Screening Dates

January 5 & 6, 7:30 pm | Balboa Theatre, San Francisco

January 6, 7 pm | The New Parkway Theater, Oakland

January 7, 7:30 pm | Vogue Theatre, San Francisco

January 8, 7 pm | Rafael Film Center, San Rafael

January 12, 7:30 pm | Shattuck Cinemas, Berkeley

STATES OF GRACE: Disability and Chronic Pain as a Bioethical Issue

STATES OF GRACE is a “must watch” film for health care providers. It deals with the health of caregivers, professionals and families, as well as that of persons who have become disabled. In STATES OF GRACE, Dr. Grace Dammann, is a revered physician who signed more than one thousand death certificates during the height of the HIV/AIDS epidemic. In 2008, just before memorial day, while commuting from work, another driver crashed head-on into her car as she crossed the Golden Gate Bridge. 

After seven weeks in a coma and twelve surgeries, Grace regains consciousness, her cognitive abilities surprisingly intact though her body left shattered. That’s the easy part of the story. When Grace returns home, following a year in rehabilitation hospitals, consummate Filmmakers Helen S. Cohen and Marc Lippmann shadow her and her family. Four years later, Grace remarkably returns to work, in her wheelchair, to serve in an innovative pain clinic that cares for San Francisco’s most resource stressed communities. The film’s eloquence is underscored by the work of acclaimed editor Kenji Yamamoto. 

To be honest, as stated on this site in 2010, “Grace's life and persona before the accident was remarkable.” His Holiness the Dalai Lama presented Grace the Unsung Heroes of Compassion Award for her care of thousands of AIDS patients, during the era when HIV/AIDS was always a death sentence. How Grace and her family became a part of Isabel Allende's extended family is reflected in the author's memoir sequel, The Sum of Our Days. A Buddhist, the extraordinary relative sparing of Grace’s cognitive function seems a gift of her mindfulness practice. 

This January, through Grace’s efforts and those of other Peace loving people, a median is being placed on the Golden Gate Bridge. Grace explored the incidence of disability and deaths which had occurred on the iconic span. She set about diminishing the risks of such incidents reoccurring, by legal remedy. Figuratively, with both hands and legs bound behind her back, Grace has made more change than can reasonably be expected in any single lifetime. She is the Steven Hawking of the activist spirit. 

Why is chronic disability and pain a Bioethical issue? The World Health Organization estimates over 37 percent of adults in the most developed nations, including 100 million Americans, have persistent pain conditions. Acute pain is increasingly associated with treatment with only opiates or adjunct medications, however chronic pain requires a more integrative approach, which is rarely available in the fast paced, computer documentation driven allopathic office visit. 

Though film and television abound with story-lines about torture, traumatic accidents, sports injury, war or criminal assaults, these acute pain scenarios have well documented persistent pain sequelae which are not often addressed or anticipated. The hallmark of good palliative medicine is anticipation. Hospice care, or care of those dying eminently, is the latter part of palliative medicine. Palliative medicine is aggressive distressing symptom management. It is an approach which should begin, in accordance with our science, at the onset of serious disease and in all chronic pain. This palliative approach is frequently omitted, even when people have conditions known to bear heavy persistent pain like post traumatic stress disorder, traumatic brain injury, dysfunctional uterine pain or depression. 

The Institute of Medicine proposed a blueprint for transforming pain in America designed to heightened awareness of chronic pain and its consequences, emphasizing prevention, improved management and self-management. Poor chronic pain management contributes to epidemic rates of prescription drug abuse. 

Chronic Pain and Disability are beneficence issues. We now have new neurological science which is rarely applied in routine pain management. There is also a maleficence concern: inappropriate use and insufficient titration of prescription pain medications by prescribers, healthcare organization’s limits on providers time and rising commodification of health care. 

Chronic pain, and the things that cause it, are justice issues. Pain disparity is the disproportionate incidence of chronic pain and worse pain management. That is, those who more pain afflicted do not often receive the benefit of new pain science and integrative care. In the United States, pain disparity is reflected by those who are people of color, very old, very young, gay, lesbian, bisexual, transgender, whose first language is other than the dominant speach, housed in the inner city and rural areas or are veterans of the United States military. The solution to diversion of prescription drugs can not be left in the hands of the U.S. Drug enforcement Agency. The doctor-patient relationship, expanded to include practitioners of known effective integrative medical modalities, is the better bet. 

Bioethics Screen Reflections began supporting the film by blogging on it here in 2010, when its working title was FOREST OF SWORDS. That title has many references, among them being to a Buddhist koan, or a riddle to be released from solving in ones life. Here, the most relevant reference comes from Sanskrit: A forest perceived from a distance by a traveler seems filled with mango trees. The traveler hopes to gain sustenance from the mangoes for the rest of the trip. As the traveler approaches the forest, the leaves of the trees manifest themselves as blades. To survive, the traveler must move through the blades and somehow access the nutrition of the fruit. The evolution of this film’s working title from “ FOREST OF SWORDS” belies the journey toward “STATES OF GRACE.” It is a journey we a wish all survivors of serious trauma and chronic pain to make. 

Viewing: 
STATES OF GRACE ( Digital) directed by Helen S. Cohen and Marc Lippmann (2014) distribution pending. USA. States of Grace http://openstudioproductions.com/states-of-grace/ accessed January 1, 2015States of Grace.Trailer, http://vimeo.com/26124168 #Vimeo 

GONG THE DISTANCE: Journeys of Recovery (Digital) directed by David L. Brown ( 2014) pending release USA. 62 mins http://www.goingthedistance.info 

Additional Reading: 
Williams, S. Forest of Swords:When Doctor Shows Up As Patient, http://www.bioethicsscreenreflections.com/2010/12/forest-of-swords-patient-shows-up-as.html 

Tsang A, Von Korff S. Lee J. et al. Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. Journal of Pain 2008; 9:883-89. 

Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. Summary. Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: The National Academies Press, 2011. http://books.nap.edu/ openbook.php?record_id=13172&page=1 Accessed October 1, 2014. 

Williams, S. Pain On Screen in The Pain Practitioner: Integrative Management for Optimal Patient Care. American Academy of Pain Management. In Press Winter 2015. 

Williams S. Pain Disparity: Assessment and Traditional Medicine, in The American Academy of Pain Medicine Textbook on Patient Management. Deer TR, Leong MS, Buvanendran A, Gordin V, Kim PS, Panchal SJ, Ray AL (Eds). 2013, pp 935-946.

Notes on the Mill Valley Film Festival, 2014

I saw 19 films at the 2014, 36th Annual Mill Valley Film Festival (MVFF36) this October. After the first five films on my list I realized a pattern which the festival's programmers had not intentionally planned. There were at two major groups that stood out with some that crossed both.

One group of films dealt with people with Enormous Skill, or Promise, Meeting Extraordinary Adversity. They all in some way reflected the relationship between the brain and the mind or how the mind deals with the stress the brain transmits.  The dissolution of the Brain-Mind paradox also reflects ways in which new science, particularly neuroscience, is creating broader social inclusion of individuals with circumstances which previously, historically, would have stigmatized them; autism spectrum traits, physical disabilities, gender differences.

Beneficence - or doing "good" with knowledge, including technology, is Beneficence. I consider these films to illustrate “doing good” with knowledge. I call this set of films 'Promise meets Adversity,' They include: THE IMITATION GAME,  STATES OF GRACE, THE THEORY OF EVERYTHING, IMPERIAL DREAMS and MOMMY.  None of these were comedies but they are all very good.

A second large group of movies at MVFF36 thematically dealt with issues of Proxy Parenting. Who best raises a child? Ethically, we consider that parents represent the best interest of their children, unless proven otherwise.  These films pondered more questions than they answered but Then if not the parent - who? Sometimes the best a parent can do is to select others to act in their stead. Working parents do it all the time, if it can be afforded.  Overwhelmed parents do it also. When parents relinquish parental involvement, temporary or permanently how do we define their right to do so. At what age is a child able to decide on their own about who should parent them?

Medically and legally we have made a value judgment to emancipate children for sexual issues but not for other matters. Should the parameters of emancipation be psychological, cultural, religious or intellectual? Regarding autonomy, do we as bioethicists or clinicians,  “know it when we see it?”  I call this group of films 'Parents and Proxies.'  The MVFF2014 relevant films are: MARIE'S STORY, NATURAL SCIENCES/Ciencias Naturales,  LIKE SUNDAY LIKE RAIN. Li  THE TALE OF PRINCESS KAGUAY/Kaguya-Hime No Monogatari, BLACK AND WHITE and SOLEILS. Many of these films have significant comedic or lighthearted elements though the deal with serious issues.

Part I: THE IMITATION GAME meets HOW I CAME TO HATE MATH/Comment j'ai détesté les Maths, Moral Relativism vs Beneficence and Justice: Moral Injury, War and Computer Science

THE IMITATION GAME 

Alan Turing was a Cambridge trained mathematician, wonderfully portrayed by Benedict Cumberbatch (Sherlock) in the WWII bio-historical thriller, THE IMITATION GAME. The film directed by Morten Tyldum and written by Graham Moore was screened at the 36th annual Mill Valley Film Festival 2014. It is an adaptation of a book by Andrew Hodges, Alan Turing: The Enigma 

While a fellow at the MacLean Center for Clinical Medical Ethics in 1990, it was this writer's profound good luck to meet and spend time with the late Dr. Stephen Toulman, a British born physicist, mathematician, philosopher and communications expert. Also Cambridge educated, Stephen knew Alan Touring and his work. Dr. Toulman shared his 1984 New York Review of Books article 'The Fall of Genius,' a critique of the Hodges book, with a digestible explanation of the way that mathematicians minds work. 

Moral relativism is used in arguments about defense of safety and security in times of war. War being defined as “a state of armed conflict between different nations or states or different groups within a nation or state”. In the loosie-goosie world of the noncombatant, war is often used as a metaphor. Dr. Toulman wanted to be sure of what we spoke. Most importantly he looked at the arguments which drive scientific exploration during war and their consequences. 

The plot of THE IMITATION GAME supplies a protagonist who is focused on the work of his mind, to the exclusion of most social contact nearly on the Asperger's Syndrome spectrum. During this period, that work is construction of a machine ultimately able to decode Nazi strategic plans for attacks on allied forces during WWII. The machine historically is known as the Turing Machine and it’s inventor the father of distributed computing.

At its simplest, distributed computing allows the extraction of any single item from a group, for whatever purposes; defining the human genome or spying on citizens. The popular television show, PERSON OF INTEREST provides many fictional examples. THE IMITATION GAME raises important ethical conflicts which plague each of us in science and medicine and become more tense in the circumstance of war. Applied Science, as was the case of the Turing Machine, can be used for good, but in the process harm can also be done, the traditional “double effect” or duplicity of all things. Navigating such conflicts are the life’s blood of practical Bioethics. 

 In the case of THE IMITATION GAME, members of the British Intelligence Service who were endowed with mathematical sensibility, had to make a moral choices which cost the lives of Allied Soldiers. The choice was necessitated because the technology they built worked so well, they “had to,” let their comrades die. 

“Had to,” is a phrase which always risks moral relativism. All moral frameworks are relative, except the one conveniently determine to be absolute at the moment. There is a plethora of popular television which justifies torture despite article 5 of the Universal Declaration of Human Rights. Immoral actions may be taken, but one shouldn’t fool one’s self with the idea they are the results of absolute moral choices. 

Often in the case in War and triage, “the greater good” doctrine wins as the absolute morality model of the day. In the IMITATION GAME, each mathematician involved believes ending the war sooner, rather than later, is justifiable at the cost of many Allied lives. If they could not choose, they simply could follow the commander’s orders, sounding strikingly like the struck down morality of the Nuremberg defense. Justice, by weighing burdens and benefits is an intellectual as well as an emotional norm. Yet, in the film, though at least considered, the decision is portrayed primarily as emotional. 

Hodges book was written thirty years after Turing died of cyanide poisoning and vicious immoral hormonal castration of his person, his homosexuality being odds with then vile British law and anti-gay bias. One cannot discount the role of “having to “let people die, playing in the psyche of depression and suicide. Those who care for Veterans of active combat dying in hospice, are aware of soldiers' attempts to reconcile moral injury from military obligations with their own humanity. 

Mathematicians generally know the difference between correct and incorrect answers, valid and fallacious arguments. Math and philosophy are intrinsically linked by logic, among other things. It could be argued that the burden of the Turing Decoders inaction to protect Allied soldiers, in THE IMITATION GAME was higher than would be for others, because as mathematicians they could calculate the risks as they were creating them. 

Further watching and reading: 

The Imitation Game (35mm) directed by Morten Tyldum ( 2014) Black Bear Pictures ( UK) 114 mins 

The Imitation Game trailer http://www.imdb.com/video/imdb/vi3398414105/imdb/embed?autoplay=false&width=480 

The Universal Declaration of Human Rights http://www.un.org/en/documents/udhr/ accessed December 11, 2014 

Toulman, S. The Fall of a Giant, Andrew Hodges, Alan Touring: The Enigma. http://www.nybooks.com/articles/archives/1984/apr/26/turing-the-system/accessed October 15, 2010 

National Center for PTSD, Moral Injury in the context of War. http://www.ptsd.va.gov/professional/co-occurring/moral_injury_at_war.asp accessed November 11, 2014. 

Miles, S.H. Oath Betrayed: Americ's Torture Doctors. University of California Press. 2009. 312p. 

Beneath the Blind Fold (Digital Political Documentary) Directed by Ines Sommer and Kathy Berger Somers ( 2012) Sommer Film Works seehttp://beneaththeblindfold.com/about-the-film/ 

Person of Interest (2011-) TV Series. imdb.com/title/tt1839578/?ref_=ext_shr_tw_tt 

H.T. King, Jr., The Legacy of Nuremberg, Case Western Journal of International Law, Vol. 34. (Fall 2002) https://litigation-essentials.lexisnexis.com/webcd/app?action=DocumentDisplay&crawlid=1&doctype=cite&docid=34+Case+W.+Res.+J.+Int%27l+L.+335&srctype=smi&srcid=3B15&key=db0b2e01ff75ee68ea576eec125e7c37 accessed December 11, 2014.