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. 

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 


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.


 "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. 


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


PART II: SEMBENE! X MOOLAADÉ X DESERT FLOWER: Female Genital Mutilation and Bioethics

Sembene! Theatrical Trailer https://vimeo.com/139538743

Sembene! is a documentary co-directed by Samba Gadjigo and Jason Silverman. The filmmaking duo uses Sembene’s screen works to bracket the life events of African cinema’s founder. The ultimate illustration of capacity for complex socially relevant, visually compelling cinema lay in Sembene’s 2004 final film, Moolaadé (Magical Protection). This is a heart wrenching story of a woman named Collé living in a fictional, locked in time, Burkina Faso village.

Collé’s is a polygamous family. She resists her daughter having female genital mutilation (FGM), colloquially called “cutting.”  She is horrified that a relative secretly ‘cut’ her youngest daughter. The mother has been steadfast in her refusal of cutting since her children were born. Now, under the pressure of impending marriage, even the bride to be elder daughter wants her mother to capitulate. The mother still refuses though, causing the bride to social ridicule. Collé’s ostracism and beatings are her reward for redefining the cultural moral high ground.

Gradually winning a few other village women over, they often gather at the radio where new thoughts are introduced by journalism and music. The men in the village are not oblivious to the radio's support of women’s rebellious acts. The glory of Moolaadé is that the fight against female genital mutilation arises from the same culture from which the horror comes. Collé fights to change the archaism within her own community. Medicine has been served well when recognizing “The people with the problem very often hold within them the solution.”

Desert Flower is a film adapted from the book of the same name by Somali born writer and human rights worker, Waris Dari. It shows the evolution of the author’s own understanding and isolation because of her FGM. Her courage is catalyzed by her European immigration and moral shifts. 

If we believe that principles in ethical decision making are weighted; and that which is not medically indicated cannot be beneficent; real life protagonists like Collé are not well served when medical practitioners consider providing ‘female circumcision.' One could argue that male circumcision is equally archaic and medically not indicated. However, incidences of known and common negative sequela are not well documented in male circumcision.

FGM is like the Nazi Sea Water experiments. The Nuremberg Code, drawn from the Nuremberg Trials is, along with the United Nations Declaration of Human Rights, the historical underpinning of modern bioethics. The former established two major violations of human research and medical care. One was research without a scientific hypothesis. The other is doing things that don’t need to be done. The classic example is the sea water experiments. There was no need to only give people sea water to drink, not for research or for their care. Centuries of ship's logs document the effects of drinking seawater.  Another example is a 40 year observational study of the natural history of syphilis on 300 Black men in Alabama when it had long been studied in Oslo years before. 

Emerging from stigma, the documentation of the negative effects of FGM, provided by those who have had it, establishes a clear pattern. Gynecologist Dr Rosemary Mburu from the World AIDS Campaign in Kenya, reports “female genital cutting” in her work. She estimates that while 15% of cut girls die of the excessive loss of blood or wound infection, survivors have lifelong pain, including: while having sex, urinating or working. 

Mary Nyangweso Wangila's 2014 book, Female Genital Cutting in Industrialized Countries: Mutilation or Cultural Tradition?, provides an excellent analysis.   Mary makes a strong case for not pitting culture against the human consciousness movement of the last 200 years. Slavery was once an acceptable norm too, but you can’t begin to stop it if no one agrees to try.  There we are, full circle back at Sembene’s first film, Black Girl and the issue of domestic slavery. 

Both of Sembene’s bookend films, like the story directors Samba Gadjigo and Jason Silverman portray, deal with personhood as included in each aspect of the UN Declaration of Human Rights. Sembene is both honored and dishonored by being called the father of  African Cinema… he is so much more than that. 


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.

Moolaadé directed by Ousman Sembene (2004)  New Yorker Video  (France) 2hr. 4min. Available on Line available on line.

Desert Flower (directed by) Sherry Hormann (2009)  Desert Flower Film Productions (Germany)  120 mins

Wangila, Mary N. Female Genital Cutting in Industrialized Countries: Mutilation or Cultural Tradition? Prager 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.)

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,
accessed February 1, 2016

MVFF Mind the Gap http://www.mvff.com/mind-the-gap/ 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: 




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. 

Under the Same Sun, directed by Mitra Sen ( 2015) Canada, Sandalwood Productions, 93 min.

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


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  is about 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!


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) 


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?


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

Interwoven Trailer https://vimeo.com/109253941



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

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 
A Light Beneath Their Feet
Son of Saul (Saul Fia)
Here Is Harold (Her er Harold)
Love Between the Covers
Beasts of No Nation
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. 

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.


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)


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.