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03/01/2015

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

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03/01/2015

Fools Rushing In?

Trevor Stammers is our guest blogger for today.  Dr. Stammers is the Programme Director for Bioethics and Medical Law at St. Mary’s University, Twickenham in London.  Prior to St. Mary’s, he practiced as a family physician for 27 years and was a senior tutor in General Practice at St George’s, University of London.  He is also the editor for the multidisciplinary journal The New Bioethics.  Thanks... // Read More »

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03/01/2015

Fools Rushing In?

Trevor Stammers is our guest blogger for today.  Dr. Stammers is the Programme Director for Bioethics and Medical Law at St. Mary’s University, Twickenham in London.  Prior to St. Mary’s, he practiced as a family physician for 27 years and was a senior tutor in General Practice at St George’s, University of London.  He is also the editor for the multidisciplinary journal The New Bioethics.  Thanks... // Read More »

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02/28/2015

11th Annual International Conference on Clinical Ethics Consultation

The 11th Annual International Conference on Clinical Ethics Consultation is being hosted by the Bioethics Program of Union Graduate College & Icahn School of Medicine at Mount Sinai, in New York City from May 20-22, 2015.   The schedule is fu...

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02/28/2015

Informed Consent for Egg Donation

This week in my small group/Bible study, one of my friends (who is a college professor at a major public university) was talking about her students. She mentioned that one of her students would be missing some class because she’s donating an egg. I could feel the tension mounting in my body as I thought about this student. I tried to briefly explain to my... // Read More »

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02/27/2015

When Are You Dead?

I am re-posting this press release from Southern Illinois University on some talks I am doing there next week.

CARBONDALE, Ill. -- A lecture next week at Southern Illinois University Carbondale will examine the question of when a person is legally dead.
Thaddeus M. Pope, director of the Health Law Institute at Hamline University School of Law, will present the 2015 John & Marsha Ryan Bioethicist-in-Residence lecture at the Southern Illinois University School of Law Center for Health Law and Policy.
Pope will address “When Are You Dead? Expanding Objections to Brain Death and Recommended Responses” at 5 p.m., Wednesday, March 4, in the courtroom in the Hiram H. Lesar Law Building.  The lecture is free and the public is encouraged to attend.
Media Advisory
Reporters, photographer and camera crews are welcome to cover the lecture. To make arrangements for interviews or for more information on the lecture, contact Alicia Ruiz, the law school’s director of communications and outreach, at 618/453-8700.  For the lecture in Springfield, contact Karen Carlson at 217/545-2155.
W. Eugene Basanta, the law school’s Southern Illinois Healthcare professor emeritus and health law and policy center director emeritus, said Pope will examine how the law defines death and the associated implications.

For several decades, neurological brain death has been legally established in the United States and throughout the world. Yet laws in California, New York and New Jersey require hospitals to continue physiological support, such as a ventilator, and there is an increasing push for similar accommodations in other states. Defining death is, at least in part, a cultural issue. Furthermore, it can have practical consequences for care providers and policymakers, Basanta said.

For example, a clinician and hospital can deem a patient is dead and move to take them off a ventilator, but then be threatened with a lawsuit by the family if that occurs. “There can be real practical challenges. The more we can do from a health care standpoint; the more technology we have, the more challenges we face,” Basanta said.

Pope will meet with the ethics committee from the Southern Illinois Healthcare hospitals on Thursday, March 5.  At 8:30 a.m., Friday, March 6, Pope will discuss futile care and the role that physicians play in a presentation entitled “Medical Futility-Policy Implications,” at the SIU School of Medicine’s South Auditorium, 801 N. Rutledge St., Springfield.

Pope, an associate professor of law, is chair of the Association of American Law Schools Section on Law, Medicine and Health Care. He speaks throughout the world and has a blog on futile care and end-of-life treatment.

This is the 11th bioethicist-in-residence lecture, and the ninth since John G. and Marsha C. Ryan endowed the visiting lecture series.

Founded in 2006, The John & Marsha Ryan Bioethicist-in-Residence supports an annual residence and lecture by a law or medicine ethics scholar for the SIU schools of law and medicine. The selected presenter visits classes at both schools and organizes interdisciplinary educational activities for students, residents and faculty. The presenter also interacts with students and offers a public lecture on the scholarship as it relates to law and medicine.

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02/27/2015

Lessons from Ebola: Presidential Bioethics Commission Releases Recommendations on Preparedness for Public Health Emergencies

Elizabeth Fenton

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02/27/2015

Collating Some Resources about 3-Parent IVF

With the recent news that Great Britain will indeed forge ahead with the use of nuclear transfer techniques to create “3-parent babies,” in an effort to interdict maternally-inherited mitochondrial disease, and in light of Courtney Thiele’s February 9 post on this blog (with the associated discussion), I thought it might be useful to take a moment and pull together some links to past discussions on... // Read More »

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02/26/2015

The Center for Practical Bioethics Weighs In on Proposed “Right to Try” Legislation in Kansas

A perspective from John G. Carney’s (President, Center for Practical Bioethics) based on testimony before the House Committee on Health and Human Services (HB 2004, Right to Try)


Most of us would agree that the “Right to Try” legislation proposed in the State of Kansas is appealing in the world of ideas and the realm of rhetoric where personal freedom and the pursuit of limitless aspirations are admirable ideals. But the world of reality bends its merits to questionable decisions that may disrupt the safe delivery of care to the most vulnerable population that healthcare professionals are called to serve.

In bioethics we recognize the deep-seated human impulse to rescue the imperiled, which is what this legislation seeks to do. However, we also grudgingly acknowledge that we could not run our businesses, public and private services or health care systems while indulging this impulse without limits. Furthermore, it is also widely accepted that “spectacle ethics” that turn individual cases into cause célèbre should not dictate public policy – no matter how heart-breaking they are. In the real world, there are good reasons to think that the “Right to Try” legislation should not be pursued despite our natural impulse to rescue.

While the popular framing of this issue characterizes interventions as miraculous and life-saving, there is little to no evidence that the interventions actually result in a good or “hoped for” outcome. We are not bound to provide a treatment that offers no benefit. In fact, it is a violation of our moral duty to do so.

Proponents may argue, if there is some evidence in the first phase of the clinical trial process that the patient may benefit from this treatment, then we should allow them access in the face of their impending death. Urgency is a given in these instances and experts argue that impending death is a criterion that allows for special consideration in these cases. But we are also obliged to consider the facts before arguing for new legislation to provide that consideration. 

Recent efforts within the FDA clearly demonstrate the agency’s attention to this issue. The FDA has updated and expanded its expedited processes for accommodating requests for access to drugs under development called Investigational New Drug (IND) Application. FDA Commissioner Dr. Margaret Hamburg has reported that in FY 2013, the most recent year for which data are available, nearly 100% of all applications submitted were approved (974/977) and many of those requests processed within hours of submission.

FDA has further pledged to continue to streamline its efforts despite its mandate to ensure safety and efficacy. For individual states to adopt legislation that circumvents the process of safety and efficacy places undue burdens on private business and manufacturers. Drug and medical device companies have repeatedly expressed concerns about their ability to handle and process the applications diverted from the FDA.

Furthermore, drug manufacturers are under no obligation to provide access to their products. The effects of unlimited access to drugs that have only been through Phase One clinical trials cannot be known and subverts the scientific process. In turn, accommodating appeals by individual patients ultimately diverts private business interests on the basis of questionable practices.

The substantive ethical and practical problems associated with this bill, coupled with the fact that these instances are exceedingly rare (estimated to be about 5 cases a year in Kansas), raise serious doubts about its merits. Significant and promising collaborative efforts are underway, such as the ALS Emergency Treatment Fund, that offer far more hope to patients than “Right to Try.”

The agencies that provide for our safety and ensure the efficacy of treatments operate in the real world, as does the legislature. Despite our natural need to rescue the imperiled, this committee and this body retain the responsibility to legislate with prudence and wisdom.

John G. Carney, President and CEO
Center for Practical Bioethics

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02/26/2015

Bioethics Commission Releases Brief on Ebola and Ethics Preparedness for Public Health Emergencies

Today, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released a brief, Ethics and Ebola: Public Health Planning and Response, to the administration and the public on ethical preparedness for public health emergency response, with a focus on the U.S. response to the current Ebola epidemic in western Africa. The brief considers […]

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