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

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

The character Norma Rae was a textiles factory worker in North Carolina. It was the 1970s,  when the textiles industry in the USA employed nearly 40% of the  nation’s workforce, and was largely not unionized. The same industry is now less than 2% of the work force but is experiencing a resurgence in the past few years, as work is returning from the instability of other nations. 

Norma, was poor, white, widowed and a mother of three. The factory town in North Carolina where she lived was rife with poverty, racism, sexism and classism.  She worked in the town company factory, as her parents had before her, and still did. The heft of this story and performances, taking this woman from unconscious to universal conscience remains impressive. Norma Rae stands on the shoulders of  Article 23 of the Universal Declaration of Human Rights which ascribes: 

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

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

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

Watch:

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

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

Read:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Watch:

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

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

Read:

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

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

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

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

A SEPARATE WIND: Bioethics Forced Migration, Violence and Grief

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

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

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

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

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

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

See:

A Separate Wind/Viento Aparte will be screened again 9/26/2015

tickets for this film and others at  http://www.sflatinofilmfestival.com/tickets/

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

 A Separate Wind/ Viento Aparte directed by Alejandro Gerber Bicecci (2014)

Mexico, Spanish/ English subtitles

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

Read:

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

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

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

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

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

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

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

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

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

Watch:

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

2007(108 min) 

Read:

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

For More Information see: 

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

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

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

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

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

BLACK AND WHITE, screened at the 2014 Toronto Film Festival and later at the Mill Valley Film Festival, in October 2014.  The same title was also used to discuss the film in various film trade publications. However, the film’s title changed by the time of its USA distribution date, January 30, 2015. The word ‘and’ was replaced with the word ‘or’. That is, the film title became BLACK or WHITE.   Use of the word ‘and’ better reflects the courage of writer-director Mike Bender in broaching contemporary issues around race and class. The film only superficially reflects two entities fighting one another. Much more prominent in the story is a struggle for Black and White to save each other. Bender dares to suggest, we might all be in this mess together, sinking or swimming.  Ignoring antebellum period themes,  it’s a new take. 

Rowena (Octavia Spencer) is the black grandmother of mixed race eight year old girl, Eloise (Jillian Estell).  Rowena is compelled to fight for custody against the child’s white, recently widowed, alcoholic, up scale lawyer grandfather, Elliott (Kevin Costner.) Rowena, and Elliot’s now dead wife, had a longtime truce regarding their grand-daughter’s best interest. The Black and White grandmothers together decided that the girl should live with the affluence Elliot’s family income could afford. The girl's residence was conditional on a grandmother being in the Brentwood house. Rowena, aware of Elliot’s flaws in parenthood, including alcoholism worsening under the pressure of grief, considers the previous custody arrangement void. 

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

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

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

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

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

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

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

Writer Director Mike Binder and September Williams

at Mill Valley Film Festival, October 8, 2014

COHOSTING SPECIAL SCREENING: GOING THE DISTANCE

SEE:

http://www.bioethicsscreenreflections.com/2014/12/going-distance-meets-surfing-for-life_15.html

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

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

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

Synopsis:

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

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

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

Watch the Trailer

Bay Area Screening Dates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Viewing: 

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

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

Additional Reading: 

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

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

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

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

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

Notes on the Mill Valley Film Festival, 2014

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

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

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

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

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

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

THE IMITATION GAME 

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

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

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

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

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

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

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

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

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

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

Further watching and reading: 

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

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

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

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

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

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

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

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

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

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.

References: 

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
Consultancy.

GOING THE DISTANCE SCREENING FUNDRAISER

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   



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