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07/23/2014

THE LEGEND OF KORRA: BIOETHICS meets ANIME

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

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This entry was posted in Health Care and tagged . Posted by September Williams, MD. Bookmark the permalink.

07/23/2014

Death & Medical Treatment – New Symposium

The August 2014 issue of the American Journal of Bioethics includes a symposium of over 20 articles on the intersection of medical treatment and death.  

I was unable to contribute to this issue because of competing manuscript deadlines this…

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

07/22/2014

Kim Teske – Compelling Story of VSED

The Globe & Mail has a very extensive story on Kim Teske and her use of VSED to die on her own terms.







































Teske had Huntington’s, an incurable genetic disease that combines aspects of Parkinson’s, Alzheimer’s and schizophrenia. She feared that, if she did not act now, she will end her days in an institution with strangers pushing mush into her mouth and hosing her down after she defecates.  


So, Teske stopped eating and drinking. Around noon on day 12 of her fast, Teske died peacefully, with none of the delirium or agitation that some watchers had anticipated.

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07/22/2014

What Is Ethics Doing?

<p class="MsoNormal" style="text-align: left;">I recall being a PhD candidate in philosophy in the 1970’s, I often pondered the subject matter of my graduate courses in ethics. I would ask myself, what does any of this have to do with ethics? What are we doing?</p>
<p class="MsoNormal" style="text-align: left;">As our courses went from Kant to Mill to G.E. Moore to the Emotivists and others, I couldn’t help but have a sense of unreality about the content of what I was learning.</p>
<p class="MsoNormal" style="text-align: left;">How can we use reason to find a basis for knowing right action? What are the ways we can define right action based on a normative moral theory?</p>
<p class="MsoNormal" style="text-align: left;">What is the meaning of good? Right? And obligation? Can these terms be defined within a theoretical, substantive moral framework or are they just expressions of feelings and emotions without any cognitive content? If they are more than the latter, what do they mean?</p>
<p class="MsoNormal" style="text-align: left;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in Clinical Ethics, Health Care and tagged , , , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

07/22/2014

Wake Up to Dying Project

The Wake Up to Dying Project is an awareness and action campaign that encourages people to think and to talk about dying.  The organizers do this by gathering and sharing stories about death, dying, and life. They also do this through art and hands-on opportunities to explore these important subjects.


The organizers believe that if we consider this difficult subject more purposefully we will be more prepared, practically and emotionally, to face this shared human experience. We might find ourselves more willing to participate in the dying process of a loved one or a neighbor. We might even be less afraid to think about our own deaths.


One cool aspect of the Project is a traveling exhibit which will offer people a safe and engaging place to listen to personal stories about death, dying, and life.



Exhibit visitors will hear audio stories from over fifty individuals, including: (a) people who are dying, and their family members; (b) experts such as doctors, nurses, chaplains and those who work regularly with the dying; people with particular insights about the process of grieving a lost loved one.  The audio stories will be complemented by abstract video and contemplative hands-on activities.


The exhibit will be housed in a mobile unit that travels from community to community and stays in each location for five to ten days. By parking on ‘Main Street,’ we hope to encourage participation from a large cross section of a community.


When visitors leave the listening trailer they enter a tent where engagement opportunities are offered, including local volunteer work and community art projects. They will also be invited to record and share their own stories. The tent is designed to act as a community space for the duration of the exhibit, and will be offered to local organizations to host related workshops, trainings, panels, and films. 

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

07/21/2014

Facebook’s Emotion Experiment: Implications for Research Ethics

Robert Klitzman and Paul S. Appelbaum

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07/20/2014

DALLAS BUYERS CLUB meets SCIENTIFIC INTEGRITY

DALLAS BUYERS CLUB  is a biopic about an unlikely hero, directed by Québécois Jean-Marc Valle and written by Craig Borten and Melisa Wallack. In case you get a call from your local AIDS-Walk coordinator, remember 50,000 cases of AIDS (Acquired Immune Deficiency Syndrome) still occur in the USA annually. Transmission is largely preventable with education, testing and early intervention. Ethnic peoples of color are disproportionately affected in new cases. Thirty-five years ago, I never imagined AIDS would be the defining disease of my career and then some.  After my AIDS-Walk call, I pulled out my notes on Dallas Buyers Club, which screened October, 2013 at the Mill Valley Film Festival. It has won three Oscars and too many to count other awards.

The year 2013, brought a number of film releases with main characters who had significantly degenerate moral fiber. You know them, good acting, sex, drugs, brutality prominent but few redeeming qualities.  Dallas Buyers Club (DBC) is not one of those films. Its lead character is definitely a degenerate, but develops moral fiber.  If “The Star” of a film is the person who undergoes the most change, Ron Woodroof (Matthew McConaughey) may be the star of the millennium. His character moves from self-serving reprobate to enlightened self-interest. In the process, he believably expands compassion for others. The compassion fall-out includes Jared Leto, (Rayon) who well plays a stereotype of a transgender woman whose script, in contrast to Woodroof’s, traverses only the narrow ground between dying and dying more.


Dr. Eve Saks (Jennifer Gardner) spoke particularly to me. She had that deer in the headlights feel to her — as she decided to which side of the road she would jump — with her patients, or with her retrograde moving profession. Her subtle portrayal of an overwhelmed newbie was reminiscent of my internship at Cook County Hospital, Chicago in 1985.  I saw 17 hospitalized patients with AIDS, within my first 35 days. Fortunately, I had good role modeling by Drs. Ron Sable, Renslow Sherer and Dr. Jonathan Mann. 


Among those 17 patients was an 8 year old girl with Leukemia, AIDS and tuberculosis – the later was diagnosed on autopsy, which brings me to the bioethical point. Four years before that autopsy, I was told in medical school that miliary or disseminated tuberculosis no longer existed — that was then, this was now.  Diseases change and so should the manner of treating and studying them and their cures.  In medicine it’s not “location, location,” but “observation, observation.”


DBC is about how AIDS, science, research and Federal Drug Administration regulations were forced to change. The change was pushed by the autonomy of people who ran the most risk of dying from AIDS and their allies.  The principle of justice requires equipoise or the equitable distribution of burdens and benefits.  The job of clinicians is to understand and communicate the burdens and benefits so that individuals, who can, are able to exercise their autonomy. When there is no proven cure, those with life threatening illnesses and intact decisional capacity, now, can choose through the informed consent process, to run the risks of clinical research protocols, whose outcomes are as yet unproven.  Access to such trials is currently a health disparity. Navigating the clauses in the three proceeding sentences is the job of bioethics in new diseases, therapies and research.  This is how we learned that oral anti-virals could reduce HIV/AIDS vertical transmission from mother to child. 


Data safety monitors (DSM), augment institutional review boards and were given teeth during the rise of the AIDS epidemic.  DSM allowed tracking of acceptable burdens associated with research, on vulnerable persons while the studies are in progress.  DSM also can stop studies where the burdens outweigh the benefits, or the benefit is so clear that lifesaving therapies should not be with-held to complete the research.  This acceptability should be consistent with the 2013 World Medical Association amended Declaration of Helsinki on Medical research. Significantly this amendment references identifiable human material or data. This would recognize the privacy of genomic material correcting ethical violations associated with HeLa cells and other genetic technologies. Consider, non-small-cell lung cancer, the most ubiquitous cancer in the world.  In that case, we look at the value of Palliative Care, genomic-bio-marker driven therapy and clinical trials, all three at once. The criteria for treatment look like a menu at an over stocked diner, but bioethics helps to navigate them.   Such protocols would not be possible without changes in policy and procedure reflected by the struggles of those affected by HIV/AIDS and the bioethical analysis accompanying them.


Set in 1985, the story is sandwiched between the year before AZT was found effective (the first of the anti-viral drugs used in HIV/AIDS) and the year after, Robert Gallo and Luc Montagnier both discovered HIV-1 as the agent causing AIDS.  The footprints of the Dallas Buyers Club are everywhere.


references:


Dallas Buyers Club (35mm) directed by Jean-Marc-Vallee (2013) Focus Features (USA) 116 min


Some other films about the HIV/AIDS epidemic:


How to Survive A Plague (35mm) David France (2012) Sundance theatrical/IFC (USA) 109min


Philadelphia(35mm) directed by Jonathan Demme (1993) Tri Star (USA) 125 min


Yesterday (35mm) directed by Darrell Roodt(2004)HBO USA ( South Africa) 96 min ( Zulu, English  subtitled)


The Declaration of Helsinki http://www.wma.net/en/30publications/10policies/b3/  accessed July 16, 2014 2013


HIV/AIDS statistics USA http://www.cdc.gov/hiv/statistics/basics/ataglance.html accessed July 16, 2014.


World Association of Bronchoscopy and Interventional Pulmonology Academy : Small Sample Tissue Acquisition and Processing for Diagnosis and Biomarker-driven Therapy of NSCLC. Bioethical issues video commentary. http://www.wabipacademy.com/site/webcast/clinicalstem1/step40

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This entry was posted in Health Care and tagged . Posted by September Williams, MD. Bookmark the permalink.

07/19/2014

Do Oregon and North Dakota Healthcare Surrogates Perform Better?

In most states an individual can appoint a healthcare agent not only without the consent of the agent but also without even discussing the appointment with the agent.  In fact, many healthcare surrogates fulfill the role of substitute decision mak…

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07/18/2014

Is complicity important in Hobby Lobby decision?

ontinued litigation will not unite the country but compromise can. Forcing individuals and their companies to act against deeply held religious belief should not be done and will only inflame partisan rancor.

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This entry was posted in Health Care and tagged , , , . Posted by Chris Donato. Bookmark the permalink.

07/18/2014

Safeguarding Children in Emergencies through Ethical Pediatric Research

Tomorrow, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) will present its recommendations on pediatric medical countermeasure (MCM) research at the 10th Annual Pediatric Bioethics Conference in Seattle. The conference, hosted by the Treuman Katz Center for Pediatric Bioethics at the Seattle Children’s Hospital, takes place July 18 and 19, 2014; its […]

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