MONEYBALL: Cultural Survival and Bioethics

This is a masculine story punctuated with love of a child, work, and sports. Adapted from the 2003 book by Michael Louis, Steven  Zaillian and Aaron Sorkin wrote a script which highlights Ben Miller's delicate directorial touch.  Talk about your mixed genres, this is sports movie that is also a chick flick date movie and it's a drama. Brad Pitt's performance in Moneyball is one of reflected inner conflict, much like the struggle of the city of Oakland where the story is set.

A bioethicist, notoriously without interest in professional sports, this story ”had me" at the point where less than stellar  players were intentionally recruited for the Oakland Athletics.   Some of us recall being in 5th grade; the last picked.  Who knew that a slow runner, lousy catcher and horrid pitcher could bat the daylights out of a ball?  The bioethical message of this film is that equality is not sameness. Diverse players can be treated as equally valuable despite their different skills. This is not really a story adverse to commodification of professional sport players.  Instead, it underscores how to interpret the value of a player within the game.

Moneyball reverses two classic paradigms; champions are champions and divorced people with children are doomed to battle.  Scientific principles, manifest in the computer nerd statistician, (Jonah Hill) alter the view of champion players.  Here, intelligent use of technology triumphs over stardom.  The statistician is the device of equality.  He shifts the team general manager's (Brad Pitt's) world view. The two inept losers, using their divergent realities become confident and capable, foreshadowing the same conversion for the team itself.   Scouts and other senior team staff are brilliantly portrayed as recalcitrant established old guard needing to be overthrown, as in any cultural or political evolution. They are all dragged kicking and screaming into the 21st century. 

In bioethics, culture can be either the greatest friend of beneficence (what we ought to do with knowledge) or its enemy supporting static influences.  For the purposes of this discussion culture is: how a group defines itself. Cultural evolution is imperative to cultural survival. Cultures, which do not change, die. Moneyball first defines baseball culture, sets up a device for change and demonstrates the evolution of the culture.

There are only two women in the film and one of them is a ten year old girl (Kerris Dorsey).  The general manager's ex-wife (Robin Wright) lives in a Los Angeles impeccably precious designed environment, a stark contrast to the grit of the baseball locker room.  She and her new husband are set up by their ice palace as dis-empathetic; just this side of sociopathy.  The "oh so wise for her years" daughter of the estranged parents is the device which shifts away from the culture of hostility between these adults.  Indifference to change, frequent in divorce, is demonstrated as untenable when caring for the love of one's life. The parent child relationship parallels the game of baseball in the shift to a more modern cooperation.  

The worldwide depressed economy has nearly murdered the independent film genre. Moneyball’s skillful crafting endures the poverty and resuscitates the art form with a jolt.

Moneyball (35 mm) Ben Miller. 2011.  USA. Columbia Pictures. 133 min.

Lewis, Michael. Moneyball:The Art of Winning an Unfair Game. W.W. Norton and Company. 2003.

For more ethics of professional sport also read:

Littman, John.  Crashing Augusta: Real life tales of sports, men and murder. Snowball Narrative. Mill Valley. 2010.

THE DESCENDANTS meets DARK VICTORY: Medical Ethics and Sudden Death

Bette Davis' character Judith Trahern, in the film Dark Victory (Goulding, 1939) was ahead of the times in her resistance to the medicalization of her death. She showed the autonomy only allowed a spoiled willful young heiress. The Descendants (Payne, 2011) is a film taking the dialog about the end of life to another level.  We now know that Kubler Ross' five stages of dying are also the stages of grief.  As with Citizen Ruth, a film about a glue sniffing pregnant woman, director Alexander Payne again demonstrates deft handling of complex bioethical issues in the Descendants.   The Descendants is a progressive sequel to Dark Victory. A Husband and Father (George Clooney) is heir to virgin Hawaiian land. He is obligated to do what is best for it and for his tragically terminally injured wife.  He takes his obligations seriously but with emotion not previously shown in men. Clooney's performance demonstrates, in contrast to Bette Davis', the profound inelegance of dealing with conflict within families at ethically charged transitions.  Dark Victory and The Descendants each provide a snap shot of knowledge about these transitions as understood in their eras.   

The Descendants is about a Father and his two children dealing with a tragic accident which rips the mother from the family. The film is unique because the star (the character who undergoes the most change) has no lines. She is pictured water skiing for a few seconds, establishing that she is vibrant, athletic and sensual. She spends the majority of the movie comatose in a hospital bed until finally removed from medical supports.  However, her arch controls the other members of the classic upper class American Family.  The first born child, in late adolescence, is not ready for the world and wallows in self-indulgences bordering rack and ruin.  

The second child, at ten, is a trooper and may be the only adult pictured in most of the film.   The father of the family is left to the task of enacting his wife's advance directive.  As instructed by the family physician, he gathers friends to say goodbye to his wife. He is detoured by figuring out with whom his wife was having an affair. The latter project brings him closer to his eldest daughter at a point where the issues of anger are shared between them. The affair becomes a transition object acceptable to direct their rage. Parent and child then proceed together down the path to acceptance of the mother's death.   

What else is different about the Descendants? Instead of being a maudlin hand wringer, The Descendants is a comedy - in the same vein that Citizen Ruth was a comedy.  It is also cross cultural (Hawaiian) and evokes a responsibility to conserve memories of families and the environment. Finally, the Descendants deals with sudden death. Deaths are sudden only because in current medicine, some people who appear fatally injured do occasionally survive. These occasions lead to an expectation of survival, and when it does not occur the death becomes "sudden."  Historically, all death was sudden except that from old age.   

Clinical medical ethics, an applied arm of bioethics, often deals with issues associated with the edges of life; birth, illnesses that leave people lingering between life and death, individualism vs. community, and end of life transitions.   Some deaths are known to increase the risk of complex grief; sudden, violent, mass death or those involving children or young people.  Complex grief looks clinically like a post traumatic syndrome because. The Descendants brings an understanding of complex grief in the setting of traumatic sudden death in the presence of the modern tool of autonomy, the advance directive.  The screen writers move Clooney's character through the process of grief, in the best ways to prevent prolonged grief - they demonstrate beneficence or what we know ought to be done in such situations.   

This process of grieving begins from the moment that a life threatening illness is apparent.  Family and friends of those dying from chronic illness or injuries have time to grieve.  In sudden death scenarios, the psyche of loved ones does not have advance warning which allows them to organize the task of their grief.  Complicated Grief manifest itself as emotional illness, substance abuse, increased stress resulting in cardiovascular disease, insomnia and so on. Many hospital settings provide services to improve end of life and palliative care (to make peace with death and pain). However, we know that complex grief is only apparent greater than six months out from the primary event. Frequently, the need to track complex grief symptoms is buried by the curative model of care instead of being exposed by the palliative model.  

The Descendants is a good example of how bioethics astute medical teams deal with the risk for complex grief. In the film, a doctor gently notifies the husband of his wife's brain dead state.  The Husband responds, "But, she is going to be okay, right?"  This is a frequent denial response in such situations. The doctor realizes that the husband can't hear what has been said.  With a grief counselor at his side, the physician simply repeats the facts and leaves the father to begin to absorb the reality. However, the grief counselor stays to support the father. The primary care doctor, with the long view of the family, is clear and decisive about the mother's condition and her advance directives. He charges the husband with tasks which will move the grief process along; gathering friends and family who need to say goodbye. Further, without clubbing the viewer over the head, a memorial is created through preservation of virgin lands commemorating the life force of the now broken family.   

The Descendants is one of a few movies about death and dying demonstrating doctors taking a back seat. It is accurate in its demonstration of best practice in end of life care. The health care team sets in motion circumstances that foster  the family dealing with their own grief. 

Dark Victory (35 mm) directed by Edmund Goulding. 1939. USA. Warner Bros. 104 min.   

Citizen Ruth (35 mm) directed by Alexander Payne. 1996. USA. Miramax. 103 min.   

The Descendants (35 mm) Alexander Payne. 2011. USA.  Fox Searchlight Pictures. 115 min.   

Also Read:   

Kauai, H. (2010) The Descendants. Random House. New York. 283 pp.  

Ramsey, P. (1980) Ethics at the edges of life.   Yale University Press. New Haven. 370 pp.   

Housley, J.  Beutler, L.  ( 2007) Treating Victims of Mass Disaster and Terrorism. Hogrefe & Huber Publishers. Cambridge. 72 pp.   

Pfeiffer M.  and Quadrelli, S. 2011)  Paternalism and beneficence: Dark Victory  in  The Picture of Health.  eds. Colt, H. , Quadrelli, S. and Friedman, L. Oxford University Press. New York.  p. 56- 60.   

Quill, E. et al (2010) .  Grief and Bereavement in  Primer of Palliative Care 5th edition.  American Academy of Hospice and Palliative Medicine. AAHPM. Glenview.   p. 160-163.

HUGO: Bioethics and Technology

Technology includes all applied knowledge, including science in the service of art. Film, has an impact on people and so other aspects of the biosphere. The first public screening of a film was in 1895, a century old it is a relatively new technology. Martin Scorsese's film, Hugo, eases the task of exploring historical relevance of screen grammar and technique. The story is adapted by screenwriter John Logan from Brian Selznick's fantasy novel. A children's film, it is all the better for this target audience. Adults are delicately guided to consider pitfalls of infatuation with applied science through a child’s innocent eyes. We are reminded that often scientists, physicians, engineers, film directors and others cursed with knowledge and creativity, are often found teetering between genius and ruin.

Hugo, also the name of the film’s main character, is trapped living between the walls of the Gare Montparnasse in Paris during the 1930s. He is surrounded by period appropriate icons of technology, clockworks and trains. The setting is not the Gare Montparnasse of today, rebuilt in the 1960s and where the TGV shoots off to Bordeaux. It is more the site of the 1895 spectacular train derailment, reported in all the world's newspapers and in Hugo's nightmares. The steam engine was the technological revolution of the 19th century, as the large screen and rocket were of the twentieth, and the small screen is of the twenty-first. A reclusive pre-teen orphan, Hugo maintains the train station's clock works, and studies mechanics. He spends his free time repairing an automaton; the broken mechanical robot left by his now dead father. In his pursuit of technological reward, Hugo is driven to immoral acts of lying, cheating and stealing.

People perceive the world first from real direct contact; primary socialization. Film works through depicted contact; secondary socialization. Film memory seems indistinguishable from dreams and primary memories in our brain’s catalog. The rub is, we are not sure what is learned primarily, secondarily or whether it matters. Audience capacity to host psyche altering screen depictions appears infinite. Predictable responses are invoked by repeated film viewings. 

Bioethics is branch of philosophy that explores what we ought to be doing with science and its applied technology. No longer is bioethics only applied to medical science but to all aspects of science and technology affecting the biological world. Scientist and technologist are increasingly charged with being moral custodians of beneficence. Beneficence is the bioethical principle supporting the obligation to rail against ignorance and simultaneously do good with what we know. Knowledge, like Eve's apple, causes conflicts particularly between beneficence, autonomy and justice. What new technology breeds down the time line is often difficult to anticipate. Who could have guessed the Lumiere Brothers home movies would yield Clockwork Orange or soldiers trained by video games? Uncertainty is rampant in the case of screen technology. Bioethics is a system of reasoning seeking to clarify ambiguity and facilitate action.

In a recent New Yorker cartoon, Dr. Frankenstein types on a computer while explaining to Igor, "I've given up trying to create life and instead create online personas." Frankenstein's Monster is an icon being replaced by screen technology. Distributive computing, reflected on beloved smart phone screens, singles out disease causing genes but also pinpoints a dissident for apprehension who is texting news of revolution. Hugo shows the challenges inherent in the evolution of screen technology while encouraging continued foray into the breech. Bioethics enhances moral reasoning regarding technology. Any technology created will be used; the bridle being considerate ethical analysis.

Hugo. (35mm) directed by Martin Scorcese. 2011. USA. Paramount Pictures. 128 mins.

Frankenstein. (35 mm) directed by James Whale. 1931. USA. Universal.

Clockwork Orange (35 mm) directed by Stanley Kubrick. 1971.  USA.Warner. 137 min.

Perils of Pauline (16mm) directed by Louis J. Gasnier Donald MacKenzie  1914.  USA. General Film Company & Eclectic Film Company. 

Le Voyage Dans La Lune (Trip To The Moon) (16mm) Georges Melies. 1902.  France. Gaston Melies Films.  14 min.

Metropolis. (16mm) directed by Fritz Lang. 1927.   Germany UFA. 153 mins (at 24 frames/min)

Safety at Last.  Fred C. Newmeyer and  Sam Taylor. 1923.  USA.  Hal Roach Studios.  73 min.

Williams, S.  Justice Autonomy and Transhumanism: YESTERDAY.  in The Picture of Health.:  eds. H. Colt, S. Quadrelli, L. Friedman   Oxford University Press . New York. 2010

see Inception: transhumanist dreams resolve grief ( 7/17/10 Bioethicsscreenreflections)

FREEDOM WRITERS, meet TO SIR WITH LOVE: Bioethics, Film and Understanding

FREEDOM WRITERS is another in the genre that started with the movie TO SIR WITH LOVE. It tells the story of a desperate inner city high school English teacher (Hilary Swank) forced to get creative. She discovers that every kid in her class, but one, knows first-hand what a Holocaust is. However, every kid in her class but the same one, does not actually know what "The Holocaust” was. 

This is the story of how a single teacher can change lives.  In films about the transformative power of education, the children are at risks in most ways defined by the Declaration of Human Rights; food, housing, education, safety.  The learning gap between the rich and the poor screams for the principle of justice. However, conflict in the principle of beneficence is more accurate.  Ignorance is the disease to be fixed.  Beneficence is ethical use of knowledge. Beneficence directs what we ought to be doing with the knowledge we have. 

In principle based ethical decision making, we look for tensions between beneficence, autonomy and justice.  Clarifying the tensions supports the "hunch" that there is an ethical conflict.    In the medical context, beneficence is an obligation to transfer medical information. Information communication requires understanding. How do you make a person understand?

In FREEDOM WRITERS, the teacher physically walls her students off from the chaos of the contextual, geopolitical features which bear on justice.  She closes the door to her class room with the kids inside of it. A safe haven is created out of the storm. This is a smart approach when faced with a bioethical dilemma.  You can't control the geopolitical matters that create social injustice so you do what you can. Conflicts are best resolved resulting in suitable action if the order of considerations is weighted; starting with beneficence, then autonomy and finally justice. Our creative teacher takes her students out of the fray. She weights beneficence, or conveying knowledge, as the first priority. 

In FREEDOM WRITERS, the hook is introducing a group of adolescents to the Holocaust memoir, The Diary of Anne Frank.  Anne's story "de-alienates" the contemporary children. It makes them a part of a broader historical context. The students are freed from the narrow confines of a culture of underdevelopment by exposure to Anne Frank's life and death. 

It is not necessary to grasps every single aspect of a complex field but a clear conceptual understanding of the trends resultant from key information is important.  If knowledge is not relevant to groups of people themselves, it may not be absorbed.  How groups define themselves is called culture. Cultural relevance gaps frequently limit appropriate distribution of benefits and burdens (Justice) as regards information exchange.    

The basis of using film to enhance ethical analysis results from the interchangeable energies associated with narrative forms. Narrative forms include the Aristotelian six arts: dance, music, painting, literature, drama and poetry. Film is referred to as a synergy of all of the arts; becoming Andre Bazin's "seventh art".  What all the arts have in common is narrative.  Narrative forms have historically conveyed morality, through myths, jokes, fables, or religious books.  A specific case is outlined or seen.  The telling case has a theme which guides the observer to a planned engagement, a final conclusion and a resolution as the process finishes.  Using stories or cases to convey morality, is called Casuistry. It seems to work because it connects our common morality, leaving us to feel less alone.  This is how the teacher in FREEDOM WRITERS enhances understanding. 

The classic format of teacher "rescuing" the under developed children in films, is not always about white folks going to the black ghetto. The genre was initiated by the legendary Sydney Poitier, a black man, cast in TO SIR WITH LOVE.  This teacher changed the lives of working class white English teens.  Class, in the Euro-American context, has become synonymous with race. The most compelling films deal with those who return or stay in their communities to provide change. Examples of this version of the genre include STAND AND DELIVER (Menendez, 1988) and COACH CARTER (Carter, 2005).

Freedom Writers. dir. (35mm) directed by Richard LaGraveness.  USA. 2007. Paramount. 122 min. 

To Sir with Love (35 mm) directed by James Clavell. UK. 1967. Columbia. 105 min.
Also read:

Frank, Anneles Marie. The Diary of a Young Girl. (The Diary of Anne Frank) 1947. Bergen Belsen Concentration Camp 1947

For more information on bioethics film and understanding: see this blog site section on  Film/Bioethics Literacy - Lighten Up: Dying on Screen Slides  .030 and  .018 ( Narrative and Casuistry)  and slides 019 and 0.20 (Informed Consent)

WAITING FOR SUPERMAN, TO EDUCATE A GIRL: Education and Bioethics

During a recent California governor’s election race, ethical tensions surrounding "the American knowledge gaps" were voiced. Most party candidates endorsed the film, WAITING FOR SUPERMAN.  WAITING FOR SUPERMAN is a documentary about young American teachers striving to change the broken public education system. This, like other documentaries, tells the story by following individuals who are, in this case, striving for better education. The story also tracks the careers of a number of graduates, trained in Teach for America, as they struggle to build more equitable models of education for American Children. These teacher's gains are modest overall, but large in the communities where they have served. 

WAITING FOR SUPERMAN argues that communities have not let down the schools so much as schools have let down communities. Accompanying the analysis are truly shocking facts about the ways in which American public school districts are operated. Administrative rigidity appears to be to a detriment to education of the poorest students in the country. In contrast, educators are left to do one of the hardest jobs with limited resources. 

WAITING FOR SUPERMAN falls short in its analysis of the education gap because it never quite explains the value of education. Many of the kids depicted believe education will get them a good job. The film never corrects this misconception. Though better educated people are shown to have better jobs, all better educated people don't.  Getting a job through education is certainly a passé expectation in the current era.  FREEDOM WRITERS (LaGraveness, 2007), on the other hand, suggests that education enhances human consciousness.  Enhanced human consciousness changes the quality of individual lives; a more reliable outcome than guaranteed employment for most under-resourced communities. 

Looking at the educational gap more globally provides a better context than race alone. It also leads to more allied existences. TO EDUCATE A GIRL squarely anchors itself in expanding human consciousness. It, like WAITING FOR SUPERMAN, is a documentary. TO EDUCATE A GIRL best addresses all of the dimensions  of ethical  conflicts in education;  beneficence, autonomy and justice issues.  I screened this film at the Mill Valley Film Festival this past October. It is directed by Frederick Rendina and Oren Rudavsky.  It was made primarily with United Nations funds and was undistributed at the time of my viewing. It is, to my mind, the best of the type. TO EDUCATE A GIRL offers a thoroughly modern handling of how to fix significant aspects of the education gap between subsets of classes and universalizes the context. 

In a paradigm flip, TO EDUCATE A GIRL suggest that the true underclass of concern are the 110 million school aged children, not in school or under-schooled; two thirds of whom are girls. The narrative places the lower status of women squarely in the center of the major conflicts of human development. It weaves the geopolitical contextual features of the two nations of Nepal and Uganda. Both of these nations are fresh out of civil war.TO EDUCATE A GIRL gets high points for demonstrating how people can explore their own cultural attitudes, legacies of religion, colonialism and neocolonialism. It illustrates which attitudes cripple and underdevelop a generation's knowledge. It also highlights those practices which support beneficence, autonomy and justice.

Use of modern techniques of radio, television and the public health model of outreach are promoted in TO EDUCATE A GIRL. Equal weight is given to technical and more traditional models of singing and performing stories to guide better understanding. 

The fierce competition to get into "the best school" as in WAITING FOR SUPERMAN does not exist in TO EDUCATE A GIRL.  The goal instead is getting into school at all. Like the barefoot doctors movement, the film demonstrates a barefoot teacher’s movement. Teachers recruit children from villages by convincing their families to send their children to school. These teachers educate families first. The film also documents boys and men supporting themselves through supporting their sisters and wives aspirations.  It is the enlightened mother's, who wish to protect their girls from the perils of underdeveloped womanhood, who ultimately facilitate the most attitudinal change regarding education.  

TO EDUCATE A GIRL provides an honest assessment of real obstacles in girl’s lives. Girls in most cultures, including the developed world, often do domestic work and toil in actual or metaphorical fields. Girls are sent out to work at an early age in under-resourced families. They are reliable as are usually their mothers.  If not working outside of the home, girls are often responsible for raising their siblings and caring for the elderly while the adults are working, dead or incarcerated. In many instances, forced or arranged marriages are required to support a girl’s family. Finally, female child genocide is a feature where agriculture and resources are limited. Girls create more mouths to feed. 

During war and the aftermath there is cultural destruction. Girls and women are often victimized by sexual assault. This occurs to a greater extent when women and girls are also political prisoners. Here victims of rape in the developed world meet their international sister in post-traumatic stress.  We find a similar circumstance in natural disasters and wherever people are refugeed or decimated en masse. Walking to school can mean losing a girl’s life in many contexts.  All of these are shown in TO EDUCATE A GIRL.  All of these frequently preclude the educational aspirations of girls. 

Fancy uncrowded classrooms may be ideal; however, they are not sufficient.  A good teacher, on the other hand, can transform even the worst classroom into a learning environment. The best and most creative teachers are needed in the most difficult circumstances.  A good teacher engages the learner. This is not to say they must be touchy feely. Teachers as shown in these films must have an organized program for engagement applicable to the community they teach.  Without engagement there can be no understanding and beneficence becomes a theoretical construct.  Without understanding there can be no autonomy and all the clinical medical ethical devices like informed consent and advance directives become useless.  Without autonomy there can be no transformation of individuals to form just societies. 

Waiting for Superman (DVD) directed by Davis Guggenheim. USA. 2010. Paramount Vantage. 112 min. 

 To Educate a Girl. (DVD) directed by Frederick Rendina and Oren Rudavsky. 2010 USA/Uganda/Nepal Talking Drum Pictures. 2010.  70 min.
For more information on understanding, education and bioethics: seethis blog site  section on  Film/Bioethics Literacy - Lighten Up: Dying on Screen Slide 25, ( Spiritual Assessment & Cultural Relevance)

THE KIDS ARE ALL RIGHT meets KRAMER VS KRAMER: Cell, Reproductive Science and Bioethics

I saw THE KIDS ARE ALL RIGHT in July of 2010.  Annette Bening was a highlighted guest at the Mill Valley Film Festival the following October. I suspected it would be an Oscar contender and so might not need the support of this blog to get into the teaching dialog in bioethics.  I couldn’t help noticing that as a bioethicist my take was different from the reviewers I read.
THE KIDS ARE ALL RIGHT is a movie beautifully acted by leads Annette Bening and Julianne Moore. They are two women married to each other who co-parent two children (Mia Wasikowska and Josh Hutcherson). The children seek out their biological father (Mark Ruffalo). The father is a womanizing habitually single man who gets his come uppings from the mothers, the children and his current bed partner and longtime friend (Yaya DaCosta).  THE KIDS ARE ALL RIGHT is about an average, upper middle class, American, nuclear family undergoing changes.  

There is no progressive politic in this film; neither feminist, racial, gender or even sexual, no call to action other than to hold onto your family tight and ride the roller coaster. It is a statement of facts of this family, presented as blithely as the reality that the sun rises in the east.  Writer-director Lisa Cholodenko shows craftsmanship in not cluttering the presentation with exposition. What buys our attention is the bioethical-cultural C change inherent in this narrative. 

Forty years ago, the characters and premise of the KIDS ARE ALL RIGHT would have given worldwide viewers whip lash.  Of the Mom’s in this film, one is a woman gynecologist.  Back in the day gynecology was considered a surgical subspecialty solidly dominated by men.  Informed consent only really hit real world medicine about thirty years ago. In THE KIDS ARE ALL RIGHT even the anonymous sperm donor has the opportunity to give informed consent before being contacted by his genetic daughter. Adopted children only recently have hope of routinely identifying their biological parents, it makes sense that this right should extend to genetic parents as well.  

Sperm banks differ in how they select donors.  One cryo-bank accepts only donors who attend or have graduated from a four year university, are tall, trim, heterosexual and between 19 and 34. Another bank only takes sperm from Nobel Prize winners. Newer sperm banks seek more eclectic gene pools. We like to think this diversity is an effort to avoid any appearance of supporting eugenics.  The genetic Papa in the KIDS ARE ALL RIGHT is a college drop-out and cook with a preference for meaningless sex. He is flawed like most people.  We gather from his comments that he may have fathered more than ten children by sperm donation for money.  Currently there are restrictions for number of children a sperm donor may parent. Fathering less than 10 children by sperm donation seems to statistically limit accidental marriage possibilities between siblings. Payment for sperm donation still occurs. You can’t buy babies but you can buy the stuff they are made of.   

Sperm donors and client parent rights are usually established via written informed consent that is signed by the client and surrogate. The informed consent is verified by the client's doctor. The principle of informed consent is a device of the medical ethical principle of autonomy.  It was the 1974 Belmont Report on the Protection of Human Research Subjects, the federal government's procedural response to the US Public Health Service Syphilis Study at Tuskegee, that established informed consent as a norm in both research and clinical patient interaction. 

Deep in the narrative of THE KIDS ARE ALL RIGHT lays the story of Baby M. In 1988, the New Jersey Superior Court awarded custody of “Baby M” to a couple named Stern under a “best interest of the child analysis”.  This analysis attempts to circumvent the commodification of children whilst recognizing the contractual relationship between clients who employ surrogates and their gene donors. This court’s analysis validated the surrogacy contract between Mary Beth Whitehead, the genetic mother of “Baby M,” and the Sterns, the client parents. However, buried in the best interest of the childdecision, there may be a bias against Ms. Whitehead’s potential of being disabled by Multiple Sclerosis and her circumstantial psychological unbalance.  Informed consent is used as evidence of a fiscal contract in surrogacy.  It is a twist in clinical ethics that a device to insure autonomy can inadvertently lead to human commodification.   Commodification of human beings is of particular concern to groups of people, and their offspring, who have historically or currently been bought and sold. 

In THE KIDS ARE ALL RIGHT, two children result from cell science. Cell Science has led to extraordinary technological advances including fertility surrogacy, vaccines, and most prominently the human genome project.   Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of Energy and the National Institutes of Health. Its goals were to identify the 20-25,000 genes in the human DNA, determine the sequence of billions of base pairs, store the information in databases, improve data analysis, transfer technologies to the private sector, and address the ethical, legal and social issues that arise from genetic  technologies.

Not the least of ethical concerns related to cell science and its offsprings, reproductive technology and the Human Genome Project,  is the origins of the cells used to develop them.  Much of what we know of cell science derives from cells taken from an African American woman named Henrietta Lacks. In the 1950s, Mrs. Lacks resided in Baltimore. She was born from tobacco sharecropper slave roots in Clover, Virginia.  Her cells were taken from her during a biopsy for cancer. They were used for research purposes without her permission.   Her cells were named HeLa. HeLa became the first human cell line to grow in-vitro. HeLa is the origin of billions of dollars reaped by  private technology companies.  Neither Mrs. Lacks and her family, nor anyone else who has their tissue taken in medical procedures, has the legal right to consent or veto how their tissue is used once extracted.  

Generally there is no legal support for extending personal or family autonomy to the tissue of a person, unless it is to be implanted in a living recipient. Tissue routinely excised in medical procedures provides its source no legal assurance to partake in revenue that is generated by the use of their body part.  If there is no informed consent, there is no contract to be legally upheld. Like Mrs. Lacks, anyone's human body parts can be scattered across the world. This lack of wholeness, particularly at the point of death, is more than fiscally important in many cultures.  

THE KIDS ARE ALL RIGHT signifies an advance in human consciousness as regards same sex relationships and marriages.  KRAMER VS KRAMER premiered in 1979, creating a shock wave in its conclusion.  Mrs. Kramer (Meryl Streep) is a Lesbian.  Mr. Kramer (Dustin Hoffman) is inconsolable. The two enter a bitter divorce and custody battle underpinned by the emergence of their gender preferences.  The battle outed the gay parent on screen for the first time in history. However, Kramer vs. Kramer also highlighted the capacity for parents to show love for their children despite personal issues between themselves. They do the right thing; Mr. Kramer, Mrs. Kramer and her lesbian partner find a way to raise the child.  In THE KIDS ARE ALL RIGHT, the gender preferences of the moms are hardly a question in contrast to KRAMER VS KRAMER.  Ethical conflicts of reproductive technology and challenges of honesty between family members are correctly more important in THE KIDS ARE ALL RIGHT.

The Kids Are All Right.  35 mm. Directed by Lisa Cholodenko. USA. 2010. Focus Films. (106 min)

Kramer vs. Kramer.  35 mm. Directed by Robert Benton. USA. 1979. Columbia Pictures. (105 min) 

FOREST OF SWORDS: Patient Shows Up as Doctor

Forest of Swords is a documentary in progress by Filmmakers Helen S. Cohen and Mark Lipman.  The film is an intimate portrait of the recovery of Dr. Grace Dammann and family from catastrophic injury. The filmmakers have followed Grace and her family on camera from the day of her first discharge from the hospital. One wouldn't think of this material as rejuvenating or humorous but in the hands of this subject and these filmmakers both are true. Through this handling emerges a picture of what resilience is and how it nurtures healing.

In May of 2008, just before Memorial Day, Grace was in a violent motor vehicle collision on the Golden Gate Bridge.  This resulted in a coma for 6 weeks and the shattering of nearly every bone in her body as well as other injuries. Her 14 year old daughter and family dog were present in the vehicle and were physically remarkably unharmed.  

To date, Grace has endured over two years of surgery, and rehabilitation medicine.  Hers is a story of support through concentric circles of interlocking family and friends. These circles range from myriad individuals (see caringbridge.org) to the global reach of the San Francisco Zen Center, creative luminaries and medical professionals. Grace has lived to tell the story from the edge of life and from both sides of the doctor patient relationship. Both the edges of life and the doctor patient relationship are daily part of the applied bioethics known as clinical medical ethics. 

In the fiction "medical film genre" many works turn on physician's needing to heal themselves (FRANKENSTEIN, Whale 1931), becoming better doctors in the process (THE DOCTOR, Roberts 1992), and communities healing physicians (CITY OF JOY, Jaffe 1992).  FOREST OF SWORDS brings to the party an important conceptual shift.  In Grace's story we see a patient, who happens to be a physician, become her own agent for healing.  This is important because deep inside of every seasoned medical doctor is a recognition that every patient is the key to their own recovery or tolerance of illness. The question that FOREST OF SWORDS begins to answer is how patients, clinician's and families might best tap that vital energy. 

To be honest Grace's life and persona before the accident was remarkable. His Holiness the Dalai Lama presented Grace the “Unsung Heroes of Compassion" award in 2005 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 2008 memoir sequel, The Sum of Our Days.  Grace's unique spirit and genius inform the power of FOREST OF SWORDS.  

Be warned, this is not looking like a film for wimps or the faint of heart.  It makes the strong argument that the best hope for resilient recovery from injury is a foundation of a connected and intentional life.  If you can swing it you ought to be working on that foundation both before and after injury.  As Grace would say "showing up” every day is key.  The film, whose working title is Forest of Swords, is about life and recovery.  

FOREST OF SWORDS (DVD) (working title) Directed by Helen S. Cohen and Mark Lipman. Open Studio Productions. USA. In production (2010) To learn more about this film, previews and to support its development see http:www.openstudioproductions.com/independent.html

See Film/Bioethics Literacy section on this blog for more on "doctors as patients" and the Medical Film Genre. (Lighten Up Slides: slides 61 and 62 define the medical film genre, slide 70 medical film genre filmography and slide 71 medical film genre videography)

CHILD OF GIANTS: Lange & Dixon's Legacy

CHILD OF GIANTS is a documentary about being the child of two creative masters of the last century; photographer Dorothea Lange and painter Maynard Dixon. It is an honestly crafted work. It brings depth to the artist, honoring their work, without idolizing them. Tom Ropelewski, a screenwriter known for romantic comedies, recognized in Daniel Dixon's handling of his life with extraordinary parents a really good story. Daniel, an advertising copy writer, had a way of telling stories that translated tragedy into "matter of fact" and sometimes humor. Daniel's is the main narrative voice in the story. His perspectives are augmented by his brother's, other family members' and his parent's art. The oldest child often has more understanding of their parents, in hind sight, than others. It is not easy to be the offspring of people whose destiny is to change the way we see the world. Often the parents don't know what their destiny is; they just do what they do with passion, while walking a tight rope over an ocean of uncharted waters.

Dorothea Lange was some twenty years younger than her husband Dixon. Her early experience with her own parents’ marriage hadn't left her a big fan of convention. She was a feminist before the word was coined. Like her contemporary visual artist women colleagues, Freda Kahlo and Georgia O'Keefe she was a force to be reckoned with. Also, like them, her partners of necessity had to revel in the uniqueness of her creative character and be unintimidated by it. Maynard Dixon was not the hand maiden husband to the great genius of Dorothea Lange. She was his equal. Neither sacrificed much for the other's career; the children suffered for both.

Among the greatest challenges in raising children with an understanding of oppression is insuring they do not become victims of it. There are critical points in children's lives were they need to be secure, that they are the center of the universe. But when your mother is busy advancing a new art form which has the power to document a call for justice in a turbulent time of history, it's pretty clear you are not the center of the universe. When your father disappears for months at a time to paint the vanishing indigenous peoples and lands of the south west, it's rather like telling children there is no Santa Claus at the wrong point in their development.

Dorothea watched the great depression unfold from the window of her studio in San Francisco. When given the opportunity to use her skill to express something of meaning about the depression she did so with singular elegance, creating icons which changed policy and arguably ushered in the error of the concerned photographer. During the internment of Japanese Americans she used the camera again as an organ of human consciousness, creating enduring images of strength and shame.

In medicine we know how you describe a problem affects how you handle the problem. As in the HIV/AIDS epidemic, what you call a thing determines how you respond to it. If it is seen as a narrow outbreak or an isolated economic depression in rural areas -- government has little need to intervene. A whiny baby gets Tylenol and is sent home; an inconsolable febrile child gets a lumbar puncture and admitted. When evidence of wide scale suffering and despair is undeniably documented as in Dorothea's photographs of the depression, the narrative cannot be ignored.

Modern medical ethics is usually taught by the principle based method. In this method one learns to analyze the tension between major ethical principles, particularly beneficence, autonomy, and justice. An alternative to principal based moral reasoning is casuistry. Casuistry uses cases or stories to enhance moral reasoning. The density of visual works of Lange and M. Dixon in the film demonstrate how their visual narrative was able to bring otherwise distant stories to the eye line of masses of Americans. This proximity of visual narrative affected moral reasoning around social policy. Dorothea found greater meaning in her work than in her marriage. The marriage broke up at a time when people were rarely divorced. The Dixon boys were destabilized once again.

In general, all children have a problem forgiving parents for destroying the family romance; children of giants or not. Forgiveness begins to happen when you are a parent yourself. Child of Giants is a story of how Daniel and John were both damaged and nourished by the eccentricities and strengths of their parents, and then forgave them their humanity. It is said that the developmental tasks of life's end include communicating to those whom you love some specifics. Daniel Dixon died before seeing the final cut of CHILD OF GIANTS. However, it seems that in the process of making the film, Daniel's final developmental tasks were achieved. It is our good fortune that filmmaker Tom Ropeleski had the good sense and skill to create this documentary. After all, the legacy of a great artist should be that they inspire more great artists.

CHILD OF GIANTS. DVD. Directed by Tom Ropeleski. USA. 2010.

MIRAL: Roots of Peace

MIRAL is a cross cultural, inter-generational film about preparing people for Peace; particularly those who have been oppressed by war. Peace in the world of bioethics is a “good,” which can only be held by humanity as a whole -- not the individual. It is important to understand that Peace is likely to be found in a collective unconscious which transcends our divisions. Peace exist in the territory that connects us, not that which separates us.  

Miral, a seventeen year old girl derives from the characters of three other women in the film. These women are reminiscent of universal stories from the era before God was considered male. Universal stories resonate within the human core and contain archetypes. Archetypes are imprints that exist in our psyches. Those of us who work with dying people encourage personal narratives; how many times we hear King Lear and his daughters! Archetypes are a way in which human beings make sense of complex experiences. Artists tend to express these core experiences in ways that translate across culture. The term archetypes comes from the Greek word archetypos, meaning "first of its kind."  Archetypes derive from icons. Icons are Gods and their doppelganger Monsters.   

When God was a woman, she had three parts: Creation, Love, and Destruction.  Nadia is Miral's mother. Nadia was a victim of sexual violence, which resulted in the creation of Miral. Nadia's indomitable spirit of resistance was manifested by her gnawing off parts of herself to escape the trap in which she was caught; until predictably there was nothing left.  Hind el Husseni  as a young Palestinian woman, turned a corner in the blue dawn light of Jerusalem to find 55  children hungry and displaced by the Deir Yassin massacre. This massacre destroyed an Arab- Palestinian village during the civil war that just preceded the end of British rule of Palestine & Israel in 1948.  Hind's first statement to the children in the school she founded is always, "I love you." Not unlike Maria Montessori Hind sets about the task of educating children for Peace. Fatima, a nurse is fired for freeing patients who would be taken as prisoners of war.  This injustice radicalizes Fatima to extremism. Fatima meets Nadia in prison while serving 3 life sentences for a bomb that did not go off. Fatima's brother, who works at the home for children with Hind, cares for Nadia at his sister’s request. He then marries Nadia, raising her baby, Miral, as his own and educating her at Hind's school.  Nadia, Hind, and Fatima contribute parts of Miral, "a common red flower that grows by the side of the road.”   Hence creation, love and destruction bring the roots of Peace.     

MIRAL is a good film for those interested in bioethical issues because it deals with ethical conflict at global, historical and personal levels.  In Fatima, it has a direct reference to ethical conflict in a health care provider. It demands a review of the Declaration of Human Rights which is an important part of the origin of the field of modern bioethics. Miral's ethical conflict is truly tripartite between, beneficence (what knowledge brings and she has been impeccably educated); autonomy (respect for the right to act in her own self-interest) manifested by her love for Hani who at the time is embracing acts of sabotage which risk life; and justice (equipoise in distribution of risk and burdens) for a people displaced for centuries (Jewish people) and a people being refugeed to accommodate them (Palestinians).   

Julian Schnabel is a Jewish American painter and clearly consummate film director. He is the son of a 1948 Hadassah president and so is hardwired to attempt to do good against the odds. He and Palestinian writer, Rula Jebreal, bring her semi-autobiographical novel to the screen. The film's collaborative process reflects the struggle and goals about which it speaks. In this film steeped in war, Schnabel's apt creative capacity shows no graphic violence. A bulldozer wrecking a Palestinian home rips tears from us as we add our reactions to the shots of the impotent members of the refugee camp. Our emotional temperature is changed with the use of film craft: shifting color, saturation, grain and focus. The films words are spare, visuals are modern, and the music decisive.  An homage to EXODUS (Preminger, 1960) in handling of geography and innovation of storytelling,   Mr. Schnabel and film family have created a film both epic and specifically intimate.  We identify with Miral's adolescent evolution to Peace agency and more importantly, we want to be her.     

MIRAL.  35 mm. Directed by Julian Schnabel. Venice/France/USA.  2010. The Weinstein Company.  (112 min)  

For more Film / Bioethics Literacy on this site see: "Lighten Up" slides, 0.045, 0.046 (How film changes culture), .053 (Read All Tracts), 0.057 (lighting what is it saying). 

also cf. LA MISSION: Prototype for the Peace Genre  on this site May 2010 

NOWHERE BOY: Open Adoption and Autonomy

NOWHERE BOY is a coming of age story about triumph over destructive losses to find wholeness and direction for a young man.  His is the story not of an icon so much as a typical example of changes of thinking that hallmark a generation. This is an ordinary story, of an ordinarily confused adolescent, seeking to clarify those things which constitute acting in his own best self-interest.  In bioethics, such self-interest is serviced by respect for the principle of autonomy.  The fact that the young man is John Lennon, is in a way incidental. Skilled documentary filmmaker cum fiction director, Sam Taylor-Wood, convincingly argues it is the boy’s tough process that made the creative "John Lennon.”

In the story, John has been adopted by an aunt and uncle. He has grown up without knowing his birth mother or father. The death of his uncle, whom he adored, catalyzes waves of desire to connect the dots between sketchy early childhood memories and his current reality.  He needs to know his birth parents. Denial of this need causes rebellious actions, expulsion from school and other attempts at individuation. This film is an infinitely more subtle handling of ethical issues around adoption than the strong but comedic film THE KIDS ARE ALL RIGHT (Cholodenko, 2010).

Most of the last century, the norm in adoption was to protect the unenlightened self-interest of involved adults through closed adoption. In closed adoption children have no contact with birth parents once adopted. The unadoptable were institutionalized or placed in foster care, as illustrated in CIDER HOUSE RULES. (Hailstrom, 2000).  Modern physician’s ethical consultation around pregnancy is supposed to explore all medically indicated options; birth with rearing, birth with adoption, and abortion.  Through Matt Greenhalg's script craft and deftly delivered performances by Kristin Scott Thomas, David Threlfall, Josh Bolt, and Ophelia Lovibond, ethical conflicts between these options are expressed through characters.  For instance, John's Aunt Mimi initially is the embodiment of the approach of closed adoption.

In the past 25 years, coinciding with the bioethics of protection of the rights of vulnerable persons, the rights of adopted children and birth mothers relinquishing children under duress are more fully being considered. In NOWHERE BOY, both adolescent John and his mother, a manic depressive scarred from the burdens of relinquishing her son, are both vulnerable persons In the case of adopted and foster children, the rearing parents are the guardians of those children's autonomous rights. Mimi acts as proxy for John. There has been an inherent ethical conflict for the rearing parents in the face of little scientific information about the developmental outcomes of children in closed adoption.  The demands of adopted children led to legal remedies which allowed for adoptions to be opened and outcomes to be evaluated. Along with his creative talent, John Lennon’s genius may have included his demanding open adoption for himself forty years before those legal challenges occurred.

With the expanded knowledge of outcomes in different forms of adoption come opportunities for individual and societal moral growth. The bioethical principle of beneficence is the obligation to do good with knowledge.  What we have learned from open adoption is related to acceptance or rejection of differences between biological and adoptive parenthood. Virtually all researchers currently agree: insistence that biological and adoptive parenthood are the same leaves adoptive children with no venue to express grief, anger, or fears about abandonment and rejection from either parent.  If parents are unreceptive to the needs of their children to express how they feel, then loss of self-esteem has been observed. John lost self-esteem when his aunt was unable to allow him to express grief around his uncle's death or his mother's rejection.

John’s relationship with his aunt is in contrast to the one with his mother. John's access to his birth mother, who loves music and teaches him in turn to play an instrument, provides him with a tool for self-expression.  John's passion for expression eventually enables his birth mother and his rearing mother, who are sisters, to complete developmental tasks in their own relationship.  It bears stating that the lyrical, visual and narrative demonstration of John's passion for music, and his process of creativity are as well done as any artist biographic film. The scenes of John learning to play the banjo and write music are layered and reminiscent of Citizen Kane’s wife’s opera debut.

Dedicated to Anthony Minghella, this film has three hallmarks of a Minghella collaboration: A love triangle - uniquely between the birth mother, adoptive mother and John; all parties are eligible for redemption, and finally the work is visually breathtaking.

Nowhere Boy. 35 mm. Directed by Sam Taylor-Wood. USA The Weinstein Company. October 8, 2010. (97 min)

INCEPTION: Transhumanist Dreams Resolve Grief

INCEPTION is a science fiction thriller, about a transhumanistic capacity to access and influence the mind by tapping the subconscious through dreams. It's billed as a film about corporate espionage. I say it's a film about resolving universal human issues around grief and sudden death through highly developed dream therapy.

The Hettle Rule is operant in this blog. Paul Hettle is a filmmaker and an important film educator.  I went to film school after I was a physician.  Hettle's style of teaching is the opposite of the medical education model. The Hettle Rule is: "Only acknowledge the positive while screening footage". This is his way of encouraging more of what he wants to see. He totally ignores horrendous errors, not wanting to inadvertently reward them.   Though it was the 1990s, this was a twenty-first century way of teaching.   The Minghella Corollary to the Hettle Rule is: "Never assume that anyone doesn't need to know when they are hitting on all cylinders, be they Oscar winning directors, cinematographers, actors or producers." There is so much good in the film INCEPTION, applicable to bioethics screen reflection, that I am compelled to think about it and to encourage others to do so as well.

INCEPTION is embroidered with references to the combined applied science technologies of medicine, psychiatry, psychology, architecture, chemistry, physics and sculpture.  With training in all of these, those of my household took an hour post-screening to be sure we had the plot straight and that it was consistent. We did and it was. This film is very likely going to be a major cultural phenomenon. Missing it will be like having missed M*A*S*H (Altman 1970).  INCEPTION is a good film for teaching clinical ethical issues. Its story turns on tension between key plot points: 1) lack of full understanding about the science underlying dream probing technology and 2) applying the science of dream probing technology without full informed consent of those at risks. There is also more than a passing nod to issues around world energy supply, depression, suicide, and intergenerational prolonged grief.

INCEPTION's application of film art and science is strong.  It is reminiscent of the first viewing of THE SIXTH SENSE (Shyamalan, 1999). These films build a world and a language which the viewer has to learn and follow.  You need to be awake and stay awake, start to finish. The rapid rate of cuts and images on the screen speak loudest to a post internet generation. However, the directorial and script structures honor classic film styles. The recurrent visual of "the maze" is homage to NORTH BY NORTHWEST (Hitchcock, 1959) protagonist, Roger O. Thornton, trapped like a mouse in a maze, in the extreme long shot on the grounds of the United Nations.

Classic film grammar is also used in INCEPTION but with a twist. The twist is that the script kaleidoscopes classic techniques.  An example would be the classic film technique known as the Griffith Escape. A simple version of the Griffith Escape: the camera cuts between the damsel in distress tied to the railroad track, the speeding train, and the cavalry in route to her rescue. The closer the train gets the shorter the interval between the cuts, heightening suspense approaching the climax. The plot of INCEPTION raises each shot to the power of four in the escape, demanding the viewer to function not in three dimensions but sixteen. The Kaleidoscope geometry expands likewise to heighten the sense of resolution. Bookending of themes, at the beginning and end of the story, are similarly mathematically assembled.  Further, each actor is moving in 4 story lines, simultaneously and together as an ensemble.  Albert Einstein would have loved this film for its ability to bend time and space. INCEPTION is a platform not only for exploration of a fictional technology, but also of film technology's influence on individuals and cultures.

Science fiction and horror films are often used to teach bioethics.  The prototypical film example is the monster built by Frankenstein (Whale, 1931). In Frankenstein, we see both scientist and society taught the lesson not to play God. The same lesson about new technology has been continuously taught over seventy years.  INCEPTION differs from much of horror and science fiction. This film explores the conflicts and dangers of a new technology without demonization of the technology itself. Instead, it shows how such access to the mind might serve humanity and enhance individual growth; as a dream therapist may do.

Transhumanism is a philosophical movement linked to bioethics, largely through the principle of beneficence; the obligation to do good with scientific knowledge. Transhumanism is known for exploring ethical issues around science beyond last century's negative portrayals. Though operant in much medical and other life-enhancing applied sciences, futurist films serve as the philosophy’s most frequent venue for re-examination of cultural attitudes around science and technology.  The film, INCEPTION, is an example of a complex exploration of cultural concerns around thought manipulation through dream technology and offers an atypical resolution. The resolution is the dissolution of the wall that separates the idea from the application; the concept from the reality. INCEPTION is about the expansion of human potential beyond its known physical and psychological limitations, complete with the inherent risks and benefits of the tasks.

INCEPTION. 35 mm. Directed by Christopher Nolan. USA. Warner Brothers. July 16, 2010 (148 mm)

For more Film/Bioethics on this site see: "Lighten Up" slides, 0.019, 0.020 (Informed Consent), .032 (Aristotelian Plot Curve), 0.059 (Camera Angle), 0.060 (Meaning of Shot Size to the Viewer).

ARMY WIVES: Aristotle Would Have Watched TV

Those who are looking at this blog for only reference to art house films, and heavy documentaries will be disappointed. Television is what is closest to the average person. The average person is where morality and ethics derive.

I have been tracking the development of ARMY WIVES since its first episode. Inherent in its story line related to war, knew it would of necessity deal with ethical themes. ARMY WIVES is an ensemble cast. It is the story of four women, and a man who are spouses of active duty army personnel. They are raising their families on an army base in the USA. They are of different socioeconomic backgrounds and they become friends. Last night’s episode deals with loss, grief and redemption on the domestic front.

Season 4, Episode 7, May 23, 2010 10 PM PDT Lifetime:

In this episode in the ‘A’ story line a pregnancy is lost by a couple who dearly wanted another child. The husband, who has seen active duty, has the strength to explore his own grief and feelings of inadequacy to support his and his wife’s pain. The second army wife, the closest friend of the woman who has lost her pregnancy, is struggling with issues around her husband’s absence in family life. He is often altered in his character, related to his secret missions. She is choosing between divorce and living through it and moves to a compromise -- an acceptable action for her moral tension. The third army wife, a nurse cum paramedic, struggles to reconcile the loss of her son to a reenlistment and fears that he will not finish college, ( loss of a dream for her progeny), and may have worsened post traumatic stress disorder or die in combat. The fourth Army wife, who has lost her eldest daughter to a bombing on domestic soil some episodes ago, now sends her daughter off to college. She chooses to regain something she lost, when she became an army wife, her own education. She dropped out of Harvard Law School and now wants to return to study law at the university near the army base where she lives.

Information flow and changes in technology, medicine, and ecology shift at warp speed. It is important to see how artist and media synthesize and influence morality in this shifting milieu. In particular, the genre melodrama is closest to the hearts of the majority of the people. In many ways, television is the equivalent to the Greek Poetics of Aristotle - yes the Greek plays. At the end of the day, many look at television and deal with aspects of their own lives that would be too painful to access without the distance of the screen. This is one of the ways that film and television work. It is also the reason that bioethicist and clinical medical ethicist especially need to understand how film and television communicate.

Season 4, Episode 7, May 23, 2010 10 PM PDT Lifetime

(For more on Film/Bioethics on this site see "Lighten Up" - slides 29 - 36, and in the reference slides at the end for Aristotle, On Man in the Universe, Walter J. Black. New York, 1943.)

LA MISSION : Prototype for the Peace Genre

I am not sure how much power a film has to have to not be slotted into the “Ethnic Film” genre, which restricts the market of its distribution. I am sure that the Bratt Brother’s LA MISSION (2009) has more than enough power to properly title its theme and genre. Written and directed by Peter Bratt, LA MISSION is about transitions from violence to an agent of Peace. Starring Ben Bratt, (co-producer) the main character embodies the film’s subtitle quote of a Spanish expression, “from the thorn emerges the flower.”

Peace in the world of bioethics is a universal “good,” and as such can only be held by the humanity as a whole -- not the individual. LA MISSION is about corralling passionate spirit and channeling it toward Peace. This film is not only about a Latino family, a black woman, low riders, gay teenagers, gentrification, gang bangers, medicine men, indigenous peoples, parents struggling to do what is best for their children, women who are victims of violence, city bus drivers, healthcare systems or healthier lifestyles; though it stars all of these.

The Bratt brothers are part of some exceptional company in the Latino Ethnic film genre - LA FAMILIA, LA MISMA LUNA, PAN’S LABYRINTH and THE SEA INSIDE, to name a few. But they have also created a cross cultural-cross genre film. Like other brilliant Latino, and black film productions. LA MISSION is not yet marketed broadly, so its universality is stealth. It’s hard to get a film like LA MISSION made, harder to get it promoted. Its audience is limited by an R rating; a bias against content tamer than the DVD’s being watched on most high-schoolers hand held devices at lunchtime

LA MISSION’s script is seamless down to the meaning of the posters on the walls of the lead character’s garage. It makes a strong argument for the writer-director hyphenate. The visuals are stunning, as would be expected from Japanese-American cinematographer Hiro Narita, set in the hues of San Francisco’s Mission neighborhood. The acting is gripping at every level also not unexpected from Benjamin Bratt but the rest of the cast pushes even his bar. Finally, this film is hot! It has all of the essentials of the best Hollywood drama. However, La Mission also goes to the head of the line for films important in clinical ethics. It looks at cross-cultural concerns in health promotion, violence prevention, and grief mediation.

In the case of LA MISSION I suggest we take a page from other parts of the struggle for Peace; we create a movement to pass the word. Assign it if you teach. Demand it in your local theater. If it is playing near you and you have 10 bucks to spare, see this movie. Defy the attempt of last century film marketing and critics to dice and slice our humanity. Pass the word -- the Peace film genre has arrived and its prototype is LA MISSION.

LA MISSION. 35 mm. Directed by Peter Bratt. USA. Screen Media Ventures. 2010 (117 min)