The recent loss of Nelson Mandela’s physical life pushed me to write the first essay in the three topic series I have planned for a while. The topics are 1) Heroes and Super Heroes, 2) Aging and 3) Dying on film.  As it happens, his life made significant contributions in each of these areas.   My hope is to juxtapose the different ways these ethical tensions are made accessible on the screen across generations, genres and platforms; adults x children, drama x comedy, live action x animation, film x television, large screen x small screen. The goal is that various age cohorts and clinicians will consider moving out of their comfort zones and view new formats and genres.  Hopefully better screen literacy will help cross cultures and generations and provide better bioethics and clinical medical ethics. Away we go into Bioethics Screen Reflections for 2014!


I saw the United States premiere of MANDELA: LONG WALK TO FREEDOM at the Mill Valley Film Festival on October 9, 2013. I have been thinking about the film for two months, having read the autobiography, from which it was adapted nearly twenty years before. LONG WALK TO FREEDOM, directed by Justin Chadwick and screenplay written by William Nicholson, had an enormous task; to follow the lead of an eminently literate, political humanist in a film genre which contradicts the main character’s essence.   Actor Edris Alba plays Mr. Mandela wielding the full scope of self-reflection, commitment and fallibility. 

If a hero has to be perfect, then no one can aspire to the job. If a film must be flawless, all would be unwatchable.  Super Heroes save others and are endowed with powers making them godlike. The ability for individuals to identify with Mandiba’s fallible human character in the film will likely be of more value, in inspiring others to leadership, than simply heaping accolades in memorial to his considerable uniqueness. His fallibility does not detract from his human hero status, nor did it prevent him from freeing himself and in so doing enabling others to do so as well. This is the true mark of the human hero story. They are usually recruited to struggles reluctantly; forced to overcome apparent insurmountable obstacles with a group of confidants (or at very least one.) Think Don Quixote.

There are at least two bioethical conflicts illustrated by this film; One being a beneficence concern and the other a justice concern. The need to depict a significant leader without portraying him as a god is a beneficence issue. Unfortunately it is anathema for a film about a hero. It may be difficult for audiences to get their heads around.  This even though, our science and humanities knowledge tells us when men are deemed greater than human, the outcome for human development is poor. Mr. Mandela walked that line cautiously and so tried the film.

The issue of equitable distribution of benefits and burdens, or justice, is raised in key relationships between Mandiba and his family; in side of prison; ultimately those who were exiled and those who stayed on the home front. It is a fundamental issue in those who commit themselves to humanitarian struggle that they are public beyond the apparent immediate needs of their families, though in service of both.  Sorting out whether you are to provide for the care of your family or be the agent of their care is an issue in many careers sharing borders with struggle.

It is an important part of film literacy for viewers and teachers of bioethics to understand the role of genre. Audiences defined genre. The ways in which they respond to how films "present" stories, creates the marketed. The strength of the allegiance of the filmmakers to genre defines the works monetary potential and so production potential. Projected monetary success determines the probability of a film seeing the light of projection. The often noted hypocrisy of the major film industry products is in fact determined by what viewers support and do not support. The standard changes only when viewers demand it.

The 'Biopic' or biography-picture genre focuses on the ‘star.’  The star of a film is the character who undergoes the most change. By this standard one could argue actor Naomie Harris’ Winnie Mandela portrayal would make her the star of this film. Mandiba is shown confident, pensive and rational throughout the first two-thirds of the film. It is through her suffering that he begins to struggle with the details of the ethical conflicts associated with the effects of the demands of choosing a life of struggle, on family.  However, she is more than family, she is a comrade in arms so shares the same conflict. 

LONG WALK TO FREEDOM works against its genre, because the nation of South Africa is the true primary character, not Mr. Mandela.  The films difficulty deepens because the filmmaker and screenwriter had to make a star movie out of the story of a man whose historical record shows he did not cast himself as a star, but as a drafted leader in a cadre of equally strong heroes.
I suspect there was enormous hand wringing over the film’s diminished depiction of the cadre to which Mr. Mandela historically belonged; giving only a passing nod to the extraordinary likes of Oliver Tambo, Brahm Fischer and Walter Sisulu. The movement for one person one vote in South Africa was not dependent on Mr. Mandela alone. Would that it and struggles to come be so simple. The longing of the average person for simplicity sends patrons to the theater. It is our job to use film as a device helping people understand more deeply and finding resonance of the work within themselves. This has been the purpose of all storytelling throughout human history. When we see these issues in clinics with overwhelmed parents, in colleagues and so on, suggest films that may help.

It is hard to make a film whose main character seeks to defy the adoration of the chosen genre, but I am glad Chadwick struggled to do so with MANDELA: LONG WALK TO FREEDOM. 

Mandela Long Walk to Freedom (35mm) directed by Justin Chadwick. UK. The Weinstein Company. 2013.

For further information read:
Mandela, Nelson. Long Walk to Freedom. Little Brown & Co. 1994.
A brief history of the African national Congress.  http://www.anc.org.za/show.php?id=206     accessed December 12, 2013

Zoe Elton. Mandela: Long Walk to Freedom /http://www.mvff.com/ ; accessed December 13, 2013

Museum of the African Diaspora was the sponsor of the MVFF screen of MANDELA LONG WALK TO FREEDOM see: http://www.moadsf.org/


The 5th annual San Francisco Latino Film Festival, Cine+Mas was held September 12-27, 2013. It was a marvel of the best international and national films I’ve seen in a long while.  I was moved by many of the works but the sensibility of the documentary film LA GENTE DEL RIO was profound as my first watching the birth of neo-realism.

An Argentinean film, LA GENT DEL RIO’s directors are Martin Benchimol and Pablo Aparo. It is the story of the people from an aging declining town as told through the voices of its people who are similarly described.  Situated a hundred kilometers from Buenos Aires, the town’s life was seasonal in the past. People came during the summers to swim in and cross the river.  Over the years these transients, dare say rag-tagged visitors, were accused of bringing vandalism to the town. Much of the towns peoples focus became talking about and understanding of what the river people have to do with the fading of the town’s opulence. Eventually, a private policeman is hired who sets up a sentry booth on the town square and patrols to prevent and monitor the river people. In the process the town’s people, through their own presentations lay bare the plight of aging in small, no longer prosperous, rural communities.

On the heels of being so taken by LA GENT DEL RIO, I saw NEBRASKA, Alexander Payne’s most recent film. Remarkably it is filmed similarly, in the neo-realist homage black and white sensibility.   The bioethical themes match the beneficence and autonomy issues associated with caring for the aging, dying and cognitively impaired people in declining small towns.  Both films are life reviews of individuals and the place where they live. Life review is a way of working through end of life tasks.

NEBRASKA is shot on location in a small town in the state for which it is named, and over the highways of four Midwestern USA regions.  The extras, even those with spoken lines are mostly drawn from the streets and bars of this one small town.  Beside the extras, the stars were also brilliant too; Bruce Dern, Bay Area Local Will Forte, Bob Odenkirk, June Squibb and Stacy Keach.  They share the feeling of The River People depicted at the tip of South America, accentuating the universal process of aging in this century.

In the tradition of the Mill Valley Festival there were two separate opening films for this the 36th Festival. NEBRASKA was opening across from the remake of the 1947 film the SECRET LIFE OF WALTER MITTY.  I chose to see NEBRASKA, instead of MITTY because I studied medicine in that state at Creighton University and cared for people in the region. Further, Alexander Payne previously has made bioethics relevant films, particularly CITIZEN RUTH and THE DESCENDANTS. NEBRASKA did not disappoint; raising concerns about the ecology of aging, relevant to Baby Boomers, their elders and children.

LA GENT DEL RIO. (35mm) directed by Martin Benchimol and Pablo Aparo,  Argentina.  Independent. 2012.

NEBRASKA (35mm) directed by Alexander Payne. USA. Paramount. 2012. 


BEASTS OF THE SOUTHERN WILD: Bioethics and Neorealism

Beasts of the Southern Wild is nothing short of a miracle in that it ever made it to the screen. It is an act of cultural, film industry and moral defiance. As a fantasy documentary, it crosses every genre expectation. The plot describes a culture where the humans run toward the neighborhood of the Bathtub, on a fictional Island in the Louisiana bayou, where the waters rise and engulf them over and over again.  The hero of the story is a six year old girl named Hush Puppy (Quvenzhane Wallis),  who has only a memory of a mother and whose father ( Dwight Henry) is a rough man who is nearing the end of his life.  With no sentiment, the culture of the Bathtub is simply survival not change. The story is unique in many ways, not the least of which is its film grammar.  Director-writer, Benh Zeitlin and writer Lucy Alibar have in their "oh so this century" take dared to cross cultures in every way.  Though mysticism is usually a cop-out for those who do not understand the culture being portrayed, this team defies that norm.
Beasts of the Southern Wild raises questions about beneficence, autonomy and justice. Is it ethical for people to live in a place we know will flood over and over again? Does a parent have the right to raise a child in a place which is so harsh in the name of maintenance of the child's culture when there are other options?  Where is the equipoise or justice in having the youngest members of a culture continually suffer the most burden and loss? Somehow we as viewers find ourselves cheering for the unconventional resolutions the film offers.

Created with non-professional actors, using location and historical stock footage, finally finding the visual story in the editing, Beasts of the Southern Wild is truly a new Neorealist film.  Like the Italian Neorealist films, its themes are the lives of poor and working, rural people, struggling to withstand massive oppression. In this case, the relentless environment of the Bathtub is the oppressor with a cameo by modern medicine as its cousin.   There are scenes reminiscent of Rossellini's Open City.  Tragic frailty, like in some Italian Neorealist work, is met with courage, strength and the hope inherent in children.  Enormous credit goes to Beasts of the Southern Wild for the nod to the relationship between social and ecological justice; a universal tale using only tools that could be mustered in the 21st century. 

Beasts of the Southern Wild. ( 35 mm)  directed by Benh Zeitlin. USA. Fox Searchlight. 2012.
Open City. (35 mm)  directed by Roberto Rossellini. Italy. Minerva Film Spa. 1945