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July 28, 2014

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 andBarriers 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.  
references:

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

July 28, 2014

The End of End-of-Life Law

Check out this new article by UVA professor Lois Shepherd "The End of End-of-Life Law."

As the title suggests, Shepherd's article argues that questions about medical care at the end of life should be approached like other important questions about medical care—with consideration to patients’ wishes, values, interests, and relationships, and without special laws, special burdens of proof, or unique requirements for documentation. She contends that reducing legal distinctions between end-of-life decisions and other health care decisions can bring efficacious changes to both sorts of decision making processes.

The heart of the article is a "blueprint for reform" through the following eight general principles that should guide the law relating to all health care decisions, including those we now think of as end-of-life decisions.

  • Principle 1: Respect and Care for the Patient Require Balancing Rather Than Rigidly Prioritizing Among Patient Instructions, Wishes, Values, and Interests
  • Principle 2: All Patients Should Have a Surrogate Decision Maker, and the Same Standards of Decision Making Should Apply to All Surrogate Decision Makers
  • Principle 3: Requirements for Advance Documentation by Patients Should Be Minimal
  • Principle 4: Binding Pre-Commitments Should Be Allowed Only Sparingly and for Compelling Reasons; They Should Not Be Required or Encouraged
  • Principle 5: Rushed Decisions That People Do Not or Should Not Want to “Live Like That” Should Be Avoided
  • Principle 6: Communication About Health Care Decisions Should Be Encouraged but Not Scripted by Law
  • Principle 7: Appropriate Safeguards to Protect Patients with Diminished Capacity Are Needed
  • Principle 8: Relief of Pain and Suffering Should Always Be Permitted and Considered an Important Goal of Care


July 27, 2014

New NINR Video Focuses on Preparing for the End of Life

A new video, co-produced by the National Institute of Nursing Research seeks to help people by answering one of life’s most sensitive questions: how can a person best prepare for the end of life? 



Developed to highlight content from NINR’s recently released End of Life module, the video stresses the importance of learning about end of life care options, which focus on comfort and quality of life.

NINR Director Dr. Patricia A. Grady, the featured speaker in the video, explains “A person can best prepare for the end of life by becoming informed. So many of us have questions about death and dying but hesitate to ask them. Our module provides comprehensive information about the many issues that can arise at the end, from the physical, emotional, and mental symptoms associated with dying to more practical concerns, such as where to find end-of-life care.”   

July 26, 2014

Following in the Errant Footsteps of the VA

The recent revelation of the crisis—and failure–of caregiving in the VA health system raises grave concerns for American health care in general and should motivate physician leaders to re-evaluate their approach to ethical health care. Until recently, the VA health system was a recognized leader in health care quality, patient safety and ethics, outperforming most American hospitals in these areas. It had also established an... // Read More »
July 25, 2014

Even after Tracey Decision, Unilateral & Covert DNR Orders Continue

Last month, the UK Court of Appeal confirmed that while clinicians do not need family consent to write a DNR order, they must at least consult with families before writing a DNR order on an incapacitated patient.   But a court decision does not c...
July 24, 2014

The upcoming debate over “CIRM 2”–CORRECTION

(I made an error about a past video involving the late actor Christopher Reeve in my post yetsterday. I strongly implied, at least, that such a video was used in the 2004 campaign for passage of California Prop. 71.  That would not be correct.  The video in question, easily found on YouTube, was aired [it indicates there] by Nuveen Investments during the 2000 Super Bowl.... // Read More »
July 24, 2014

Presidential Bioethics Commission 101

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was formed by Congress and charged with identifying fundamental principles for research involving human volunteers. It completed its work and was ended in 1979. That commission is recognized as the first contemporary U.S. bioethics commission and since its formation, bioethics has […]
July 24, 2014

The Facebook Emotions Study

Over at my Business Ethics Blog, I just posted my thoughts on the recent controversy over the Facebook / Cornell study. I look at the question not of the ethics of the Cornell researchers, but of Facebook as a corporation I basically argue that: a) the risks involved were trivial; b) the commercial context matters, […]
July 24, 2014

Care or Kickbacks?

In the complicated world of HMOs and referrals, some health care systems have started enforcing “continuity of care” policies that keep patients within that hospital system.  The stated goal of this policy is to facilitate care through one group of physicians and one medical record system.  However, it seems that systems like this do more […]
July 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