Notes on the Mill Valley Film Festival, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Further watching and reading: 

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

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

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

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

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

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

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

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

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

Part II: THE IMITATION GAME meets HOW I CAME TO HATE MATH/ Comment J'ai Détesté Les Maths Moral Relativism vs Beneficence and Justice: Maths and Economics

HOW I CAME TO HATE MATH/ Comment J'ai Détesté Les Maths is a film Directed by Olivier Peyon and written along with Amandine Escoffier. It  is a documentary whose initial purpose seems hijacked by historical events. Its parallel to the fictional historical biopic thriller, THE IMITATION GAME, screened at the Mill Valley Film Festival 2014, need be made. 
The MATH story, like in THE IMITATION GAME, begins lightly with young people who are awkward. Some of them, like Alan Turing,  grow into the lovely eccentricity that those who both love and understand maths often bear. Peyton’s film tours the world of elite global mathematics prize winners and its retreats. The viewer has the feeling of watching young Einsteins. The film is initially a celebration of Maths. 

After showing the rarefied air which the theoretical mathematicians breathe, MATHS eases viewers into the world of technical applications of maths. Finally, the story leads to the economic crisis of our current millennium and the misleading mathematical modeling which wrought it. 

Mathematicians, on camera, own the horrific results of their science.  It is reminiscent of Einstein after the the theory of relativity was weaponized. A nausea is shared by many clinicians and other applied scientists as they wade through memory of disasters sometimes mediated by applied theory, particularly when ethical parameters were absent. 

 “Is there any definable method for deciding whether any given mathematical assertion is true or not?”  The procedure for seeking this answer required stating a hypothesis, like any other science.  "If it were true," Toulman paraphrased  Alan Turing,  ”Any method of 'routinizing' mathematical proof can be thought of as a mechanical process.” Then the question was one of 'simple' technology “What sort of a “machine” would be needed to carry out such a proof?”   This was how the computer was theorized and developed.  It happened that the resources to build the machine arrived in the form of WWII.  However, the drive, well before the War, was Turing's theory needing proof. It happens that  the military remains one of a few venues where mathematics gets funded. The use of science and medicine in war is a bioethical issue.

“What happened with mathematical modeling?”  the last third of HOW I CAME TO HATE MATHS asks.
When Scientific theory jumps to technology, there is always a risk that those who best know the Science will loose or relinquish control of it. It is the fundamental basis of Bioethics that Scientist and Applied Scientist should resist the temptation to abandon their work to those less knowledgeable of their fields. Bioethics is not only a field for medical doctors, clinical medical ethics is only a subset. 

HOW I CAME TO HATE MATH asserts, mathematicians recognized errors in economic mathematical modeling earlier than has been admitted by financiers. In the blame game, the common person's behavioral finance is often pointed out while financiers and maths models are ignored.  As in other situations of bioethical conflict, the first step is recognizing a conflict and then exploring it. Taking responsibility is  requisite for the minds knowing the field to explore the  conflict, as happens in the film HOW I CAME TO HATE MATH.

Not too far away from the applications of the Turing Machine, or mathematical economic models we have seen similar loss of control of the fields of medicine and public health. Misuse of the technology ( knowledge) related to quarantine, perhaps for political capital, during epidemic scares,  come to mind. The murder of polio vaccine workers by extremist when the vaccine program was used as a shield for covert military activity also is an example. 

The logic of immorality is always flawed and bears consequences. However, detailed moral analysis may also bear negative results. The difference is made,  as in all science and ethics,not only by intention of but attention to details.  The people watching have to be able to recognize what they see. Biological Science receiving federal funding requires those learning to use it  have some training in Bioethics that is, graduate students. Apparently,  maths departments have no ethical educational obligation imposed by financiers. Maths and computer science have major bioethical  context in this and the last century.   Recognizing mathematical modeling’s role in a  devastating economic collapse of the world’s economy does not  excuse the greed of financiers, it only recognizes the bioethical issue.  

Even when those who know the science do their best at moral consideration, monitoring of consequences is paramount, in war and in peace. Having spent the last half of his life on Peace, Einstein would agree.  Hats if to the filmmakers of HOW  I CAME TO HATE MATHS, and the mathematicians they interviewed,  for the jerky C- turn made in the last third of this film. Don’t be fooled by the cute beginning. HOW I CAME TO HATE MATHS chronicles a whiplash in history that threatens to break a century’s neck.


How I Came to Hate Math / Comment j'ai détesté les ma (35mm) Directed by Olivier Peyon.(2013) Documentary. France (103 min)

How I came to  Hate Math  trailer www.youtube.com/embed/QVKtLkNF_PA" accessed October 16, 2014

The National Association of Retirement Plan Participants http://www.narpp.org/

Enstein, A., Nathan, O., Heinz, N. Einstein on Peace. Simon. 1960 

Punjwani, S. K. (2014). Understanding Underpinnings of
Act of Violence against Polio Workers: A Case Study of Pakistan. In I. Needham,
M. Kingma, K. McKenna, O. Frank, C. Tuttas, S. Kingma, et al., Fourth
International Conference on Violence in Health Sector; Towards Safety, Security
and Wellbeing of all (pp. 80-83). Amesterdam: Kavanah, Dewingeloo & Oud


Dear Readers,   

bioethicsscreenreflections has supported the development of the film GOING THE DISTANCE in an advisory capacity. It is a film about Traumatic Brain Injury recovery. I have the honor of co-hosting a fundraising screening for the film GOING THE DISTANCE, on February 15, 2014 - the day after Valentine's Day. The project now complete is in the push for final finishing funds. Please join us if possible, If not, a tax deductible donation may be made be made at http://www.goingthedistance.info/  Use the "donate now" button, also please share on your social media sites.  
*See  the GTD trailer at http://youtu.be/BZOI-qW4R3E 
*See entry on this site 12/2014  GOING THE DISTANCE  meets SURFING FOR LIFE: Bioethics and Traumatic Brain Injury   

Thank you for all your support over the years and the best for the holidays.


Bioethical issues in Traumatic Brain Injury 

GOING THE DISTANCE: JOURNEYS OF RECOVERY is a documentary film about the lives of survivors of Traumatic Brain Injury. Directed by multi-Emmy Award winning filmmaker David L. Brown, the project is seeking funding for its finishing phase. This film has had multiple previews in collaboration with brain injury advocates.  It has also been used in therapeutic TBI groups to gauge the communities' take on their depiction. An earlier film by the same director, SURFING FOR LIFE, reinforces that Brown, like any good film auteur, finds different ways of telling stories whose elements are significant to him. 

SURFING FOR LIFE deals with optimizing life from childhood through aging. It explores our relationship with water or what evolutionary biologists J. W. Nichols calls the ‘Blue Mind.’  GOING THE DISTANCE also deals with maximizing people's potential, after the have acquired brain injury. Not surprisingly, some of the films protagonists also have a restorative relationship with water. 

David L. Brown’s films have a solid optimism to them. That’s right, GOING THE DISTANCE is an optimistic film about TBI. The project follows four people through a narrative spanning roughly eight years. The work has the weight of longevity, diversity and the drama of living on the edges between life, death and rebirth. With four main characters, instead of one, the film is racial, gender, and age cohort inclusive. Permutations and combinations leave every viewer identifying with some part of the story. 

Why is Traumatic Brain Injury of particular bioethical concern?  There are tensions between beneficence, autonomy and justice manifest in issues around the epidemic incidence of TBI. The principle of beneficence, doing good with our science, services medical indications.  We now have plenty of neuroscience to support how these injuries occur at the cellular level and the best ways to prevent and deal with the sequelae. Yet, there are organizational and geopolitical barriers to clinicians and survivors accessing, or utilizing that information. Justice is facilitated by equipoise. Equipoise is the equitable distribution of burdens and benefits. Organizational and geopolitical factors often impede equipoise in the prevention and management of TBI. 

Among the important new science is a better understanding of ‘neuroplasticity,’ Dr. Albert Ray considers neuroplasticity the operating system for the nervous system.  It is the mechanism whereby the physical anatomy and physiological workings of our nervous system happen, both in normal and pathological conditions. It is what makes the brain programmable and re-programmable. 

After a period of intense neurological rest, recruitment and retraining of undamaged brain tissue improves functional capacity.  That recruitment process results from neuroplasticity, or reshaping parts of the brain, to assume tasks abandoned in the aftermath of the traumatic injury. Neuroplasticity fuels the work of occupational, physical and speech therapist and those acting in their stead. When forced to prognosticate, professionals do so within the parameters of the resource stressed systems in which they work. For instance they might cautiously say," A person with this initial assessment, receiving therapy weekly, can expect 'X' amount of functionality in one a year." GOING THE DISTANCE is a story about best chances to exceed those expectations.

Other manifestations of conflicts between beneficence and justice affect veterans returning from war zones with undiagnosed TBI as well as Post Traumatic Stress Disorder, car accidents, repetitive concussions from sports, violent assaults and motor vehicle accidents.  All of these disproportionately affect the young, very old,  poor, and people of color.  Adequate activities of known therapeutic benefit and prevention are often unattainable because of cost and lack of trained resources. Though brilliant acute trauma and neurosurgical care occurs in most urban centers in the USA, the follow up care is lacking. TBI, is a health and healthcare disparity issue. 

Traumatic Brain Injury also results in bioethical tensions between beneficence and the principal of autonomy, or the right to do what is in one’s own enlightened self-interest.  Most agree parents are appropriate surrogate decision makers for their children. Substituted judgment in adults, particularly young adults, with brain injury is wrought with uncertainty regarding extent of damage to a person’s decisional capacity. In this way TBI, like dementia, is a moving target. Dementia and TBI are related in other ways as well.

There is compelling data that negative cognitive effects are among the most disabling of post-concussion symptoms following moderate and severe TBI. These effects unfold slowly, sometimes over years and lead to high incidences of dementia. Deficits occur in attention, memory and "executive function," These deficits show up as impulsiveness, mental fatigue, frustration, depression, pain, self-medication, substance abuse and loss of employment. Justice suggest,” those with the most burden should have the most benefit.” In the most developed nations, minds which operate “like steel traps,” are adored. TBI survivors rarely have those kinds of minds and are often not well accommodated by legislative measures, including the application of the American Disability Act. 

The film CRASH REEL gives a good example of autonomy conflicting with beneficence. An extraordinary athlete, champion snow boarder, struggles with his late stage cognitive and physical limits. The recently completed film, STATES OF GRACE (reviewed elsewhere on this blog) like CRASH REEL, is about another person with uncommon capacity facing extraordinary adversity. There is much to learn from these films but it is not the story of GTD. 
GOING THE DISTANCE is about ordinary people riding waves of adversity, while attempting the boring things of daily life. They use “what they’ve got."  What they have is family, friends and advocates.  By example, GTD gently makes the point that those without support have rougher rides and may drown in the surf. GOING THE DISTANCE is a documentary about quiet heroes focused not on what they cannot do in TBI recovery, but what they can.  
GONG THE DISTANCE (Digital) directed by David L. Brown ( 2014) pending release USA.  62 mins  http://www.goingthedistance.info
SURFING FOR LIFE  (Video) directed by David L. Brown (1999) USA  68 min.  http://www.surfingforlife.com/ 
THE CRASH REEL (2013) directed by Lucy Walker http://thecrashreel.com/  HBO Films  USA 108 mins
STATES OF GRACE ( 2014) directed by Helen Cohen and Mark Lipman (USA) distribution pending 71 mins.
Nichols, W. J. Blue Mind. Little, Brown and Company, 2014.
Ray, A. Neuroplasticity, Sensitization, and Pain. in Comprehensive Treatment of Chronic Pain by Medical, Interventional and Behavioral Approaches. ed. Deer, T.R.;Leong,M.S; Ray, A.L. et. al. ; American Acad- emy of Pain Medicine. Springer Inc. 2013.p 759-768,
Shively S1, Scher AI, Perl DP, Diaz-Arrastia R. Arch Neurol. Dementia resulting from traumatic brain injury: what is the pathology? 2012 Oct;69(10):1245-51http://www.ncbi.nlm.nih.gov/pubmed/22776913 accessed December 12, 2014
Carmichael, S. (2010). Translating the frontiers of brain repair to treatments: Starting not to break the rules. Neurobiology of Disease, 37(2), pp. 1-10.



The clips we are considering: 

RANGE OF MOTION   http://www.imdb.com/title/tt0258078/
LIVING PROOF  http://www.imdb.com/title/tt1229367/?ref_=nv_sr_1
CONTAGION  http://www.imdb.com/title/tt1598778/

The questions we are asking: 

T1 What medical tv shows / films have you seen? How are the healthcare providers portrayed?

T2a What do you think of this doctor portrayal? (RANGE OF MOTION)

T2b Compare the doctor in RANGE OF MOTION with the one in LIVING PROOF. What do you think? 

T3 How do you think this doctor and patient's husband are affected by the deadly epidemic? (CONTAGION)

T4 What do you think medical film/TV can show or teach us? 

These entry is for the educational use of medical students and professionals participating in #BioethxChat today. The use of movies and scenes from movies for teaching purposes appear to be protected under the Fair Use Doctrine, as codified in the Title 17 , Section of 107 of the U.S. Copyright Code. this allows for copy written material to be used for non-profit educational purposes. Views are encouraged to view the entire films  by DVD or other screen means. Special thanks to Dr. Henri Colt for assistance with  these clips and presentations. Dr. Colt is the chief editor of the book picture The Picture of Health, which I highly recommend.  

September Williams, MD





EVERYTHING COMES FROM THE STREETS: Chicano Low Riders and Bioethics.

Last fall at the San Francisco Latino Film Festival there was a preview of the spectacular documentary, Everything Comes from the Streets. This film is an example of excellent programming on the part of that festival. This year the SF Latino Film Festival runs from September 12 - 22, 2014.

Everything Comes from the Streets is a documentary directed by Alberto Lopez Pulido and co-produced by Mr. Pulido, Kelly Whalen and Rigo Reyes.  It is a story about the significance of Low Riders in Chicano culture. A beautifully shot film, it carefully handles the struggle for identity and civil rights, particularly in the Chicano community. My interest in Low Rider Culture was re-ignited when it was used in the San Francisco based film La Mission (Bratt, 2009), which was the first film blogged on this website.

A Low Rider is both a car and the person who drives it. Low Riders, the cars, are rigged by the expertise of community developed mechanical physicists, operating under the cloak of local driveways and garages. Materials for the work historically come from salvage yards, not only deriving from cars, but the hydraulics of discarded airplanes. The rigging results in the rear of the car riding lower to the ground than the original factory specifications.  This aesthetic preference is also the restructuring that makes the car float, slowly down the roads, cruising on parade. This film illustrates why these vehicles need to be on parade. They are extraordinary pieces of artwork, expressing creative, cultural and engineering pride. There is more to this particular cultural icon than the cars themselves. 

Everything Comes from the Streets traces Low Riders from their roots in East Los Angeles and Espanola, New Mexico. The visual home of the film is San Diego County.  After the first Low Riders hit the streets in the 1950's, organizations began to spring up in support of them; the cars, the people who drove and their admirers.  These social "Car Clubs" developed structures that were also able to support community based social change. Additionally, the Low Rider movement had a specific contribution to Chicana feminism. By the 1970s, women, as well as men, were frequently involved in the same mechanics, redesign of their own vehicles for display, expression of creativity, pride, and organized community responsibilities. 

In the late 1970's, Chicano pride became a threat to the USA status quo. The film illustrated this reality in the San Diego area.  There, city ordinances were selectively enforced to prohibit Low Riders from Cruising and gathering audiences. This abuse of law violated the constitutional right of the Chicano community to peacefully assemble.  Collateral congestion and random legal offenses were inaccurately attributed to organized Car Club cruising. Low Rider Culture was misrepresented as synonymous with gang culture, particularly in the 1979 film, Boulevard Nights.  This representation fueled an even more skewed perception of Low Riders.

Disruption of under-resourced ethnic communities of color, under the guise of "urban renewal," was the norm in the 1960's and 1970's. Being organized, Car Clubs were logically part of community leadership that struggled, and still do struggle, against attempts to dilute Chicano identity and deny the community a geographic venue. With surprising good humor, Everything Comes from the Streets speaks to resisting oppression based on race and class. 

Why should Bioethicist care about Everything Comes from the Streets? The empirical Two Tiered Assessment of Shared Decisional Capacity reviews, Disclosure and Barriers to Disclosure during the process of informed consent, in medicine and clinical research. Clinicians should be aware of common barriers to shared decisional capacity. Examples of those barriers are: physical states including pain; psychological distress like grief, post-traumatic stress syndrome, depression/anxiety; educational differences (language and literacy) and patients’ perception of institutional chauvinisms. Institutional chauvinisms include the major "-isms."  Examples are ageism, sexism, genderism, classism, colonialism, professionalism and racism.  People tend to shut down communication and understanding when they recognize chauvinisms are being applied to them, with or without intention. 

Barriers to shared decisional capacity are barriers to good clinical medical ethical care of patients -- That's why Everything Comes from the Streets is important to Bioethicists. Once barriers are identified, clinicians can work to counter the negative effects.  In the case of institutional chauvinisms, clinicians demonstrating a commitment to learn about a person's family, spiritual needs, struggles and icons of culture, (FaSSI), may help to remove barriers to shared decisional capacity.   Born from the Chicano community, the film Everything Comes from the Streets is about family, spirit, struggle and cultural icons and can help improve goals of more ethical medical care.  

Everything Comes from the Street directed by Alberto Lopez Pulido (2014) http://everythingcomesfromthestreets.vhx.tv/watch (USA) 56min  

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

September Williams'  Bioethics Screen Reflections: LA MISSION : Prototype for the Peace Genre http://www.bioethicsscreenreflections.com/2010/05/la-mission-prototype-for-peace-genre.html?spref=tw

Regarding Shared Decisional Capacity, FaSSI and institutional chauvanisms see online: Williams, September.  Pain Disparity: Assessment and Traditional Medicine in THE AMERICAN ACADEMY OF PAIN MEDICINE Textbook on Patient Management. 2012 Deer, T.R.; Leong, M.S.; Buvanendran, A.; Gordin, V.; Kim, P.S.; Panchal, S.J.; Ray, A.L. (Eds.) Springer SBN 978-1-4614-1559-6



The Legend of Korra is an anime, action, fantasy, steam punk comic drama series. Unlike live action film, it is difficult to understand who is the author of an animation. In live action film, the author is considered the director. Animation is a more collaborative process with a long list of creatives which tends to diversify the form. The Legend of Korra series is created by Bryan Konietzko and Michael Dante DiMartino who are also writers along with Bryan Konietzko and Tim Hedrick. The credits routinely list 4 directors and too many to count artist and voices. Blending of themes and form of production is an attribute reflected within this particular series. 

Avatar: The Legend of Ang (The Last Air Bender) which aired 2005-2008 was the forerunner of the Korra series. Many who started watching Avatar Ang are now in their twenties and remain devotees of the realm. The resurgence of a complex fantasy genre, expanded beyond the play of young children, may speak more about reality than the make believe worlds in constructs.

Korra appeals to people who are, or want to be, cross cultural. Fantasy is the activity of imagining things, especially things that are impossible or improbable. Fantasy is also closely linked to play. There seems to be a need for the play in creativity both in art and science. In order for the human mind to develop properly we know that children require play. In the past, children were less exposed to the harsh details of the “real world,” making it easier to figure out. The importance of play in the past may have been confined to developmental ages 2 to 10 years. However, the inundation of more complex exposures, ending childhood earlier, seem to have required more complex and prolonged play... I’m just sayin’. There is a resurgence of detailed fantasy story-lines in animation and in literature over the past twenty years. 

The Legend of Korra unfolds in a mythical world, at once futuristic and merging of ancient Asia, Inuit, and steam punk visuals. Characters are heterogeneous, including animals, spirits and human beings. The series deals with war and conflict. The strength to change conflict is dependent on diversity, the ability to be or do more than one thing. This is contrary to reality, which often focuses on singularity as a major attributes. In The Legend of Korra, Bison’s fly, people cross between worlds of spirit, human and the elements. Humans of this universe have psychokinetic capacity to merge with and animate the major elements, fire, water, earth and air.

Avatar Korra is a 17 year old girl, not male as is often more common in the fantasy genre. Girls and women have significant representation during critical points in the series. In Hindu, ‘Avatar’ loosely translates as an “incarnation of a higher being.”  There is only one Avatar on the earth at a time. Avatars are reincarnations of other Avatars. The power to psychokinetically bend (or move) all 4 major elements, Air, Fire, Water and Earth is the defining characteristic of an Avatar. They differ from other “benders” in the universe who generally only can move one of the elements, the one from the similarly named kingdom from which the person derives.  It is this synergistic bending of all elements, which empowers Avatar Korra to potential resolve universal conflicts and promote harmony. 

These Avatars differ from standard Super Heroes, say, of the Marvel or DC universe in other ways. Avatars are born children, not converted by science or tragedy. Avatars are well cared for by their families and communities, who are obligated to help them grow into their identities. Unlike Superman or Batman, they generally are not orphans, loners or hidden behind alternate identities. To learn to bend all 4 elements, Avatars must be trained by mentors. The most complex and cerebrally taxing bending is that of Air. In a real world, were children and adults are essentially latch key kids, the appeal of this fantasy is understandable. Korra is in training to bend air as the series opens. Villains are those who manipulate the elements for purposes other than peaceful. 

Persons born after 1985, are often referred to as the millennial generation, generation Y, or the fantasy generation. They watch screens for entertainment, information and socialization on a variety of devices. Screen narratives are currently watched at will and repetitively during much of their conscious lives. Television broadcast times are not retro but made archaic by technological access transcending confines of time and geography. Eighty-three percent of adults in the USA have cell phones, 35% of which are smart phones. Those who are Black and Latino reflect trends of higher usage and using their phones as their major source of Internet access and “watching.” This watching places people in realms other than realism continuously and simultaneous with the dwelling in the “real world.” That is to say technology allows parallel universes in the mind. 

There was a time in history where real dead people were not shown on screens amidst real wars. It may be that, reality is overrated in the minds development.” We still do not fully understand the positive power of immediate escape into fantasy on screen, but we do understand that it is important in early childhood.  In this time, when the evolution of brain capacity is being vastly accelerated, in ways which most schools are not designed to accommodate, one could argue that the current digital leap parallels speaking, counting and writing in its importance. It may be protective from the barrage of non-fantasy life dependent on the narrative line.

The task of Bioethicists is to seek the knowledge to understand the ‘good’ of screen fantasy because it is delivered by a ubiquitous technology. Its appeal well into generations of adulthood parallels unprecedented pressure to make sense painful realities. The question is how does screen fantasy improve coping for this generation? There must be a reason why so many are driven to “watch,” and particularly watch animation, and create it. 

The Legend of Korra blends humans with natural elements in the way that the born from Manga anime Ghost in a Shell creates cyborgs. The series minimalist sophistication indicates the need for more thought about the meanings of repetitive viewing and stimulation by animation. To do that, Bioethicist should consider watching viewing trends in The Legend of Korra. 

The Legend of Korra (television series) created by Bryan Konietzko and Michael Dante DiMartino ( 2012 - current) Nickelodeon Animation (33 episode: 24 minutes.) 

Williams, S. book review. Bioethics at the Movies by Sandra Shapshay. Journal of Bioethical Inquiry September 2010, Volume 7, Issue 3, pp 329-331

Ford, Paul J. in Bioethics at the Movie’s Existential Enhancement in Ghost in the Shell in Bioethics at the Movies by Sandra Shapshay. Baltimore : Johns Hopkins University Press, 2009.

Special thanks to Curd Williams-Hertz for flagging the Legend of Korra and Avatar: The Legend of Ang and the quote,” reality is over rated,” see curdwilliams-hertz.com