Faking it for real – A Paper Mask (Collee, 1987)

April 22, 2008


  Paul McGann plays Martin Harris/Dr Simon Hennessey in Paper Mask (1990, [VHS], High Fliers Video Distribution)

(Warning: contains plot spoilers!) In his novel A Paper Mask John Collee explores the issue of bogus doctors – that is, people who fraudulently gain employment as doctors and practice medicine within conventional hospital settings or as general practitioners without formal qualifications. Through the actions of his character Matthew Harris, a hospital porter who adopts the identity of Dr Simon Hennessey following the latter’s death, he offers an account of the basis of medical expertise which jarrs sharply with a conventional view of the importance of formal medical education.

Author John Collee is both a doctor and writer of TV medical scripts (see Henry III, W.A. “Going Beyond Brand Names”, Time, Monday 3rd April 1989, pg. 2), including the screenplay for the 1990 film Paper Mask. While both book and film may be considered quite ‘lightweight’ they nevertheless succinctly highlight some of the less frequently discussed bioethical issues implicit in medical practice, though also provide an interesting set of observations on the true nature of medical skill and its acquisition. Read the rest of this entry »

Choosing our children? – GATTACA

August 29, 2007

(Warning: contains plot spoliers!)  Produced more that a decade ago, GATTACA remains one of the most thought-provoking cinematic visions of a world where current breakthroughs in genetics have been taken to one possible extreme.  The premise of the film is neatly summarised in the trailer (which is included as an extra feature on the DVD):
Genetics – what can it mean?  The ability to perfect the physical and mental characteristics of every unborn child.  In the not too distant future, our DNA will determine everything about us.  A minute drop of blood, saliva or a single hair determines where you can work, who you should marry, what you are capable of achieving.  In a society where success is determined by science, divided by the standards of perfection, one man’s only chance is to hide his own identity by borrowing someone else’s.”

From a young age, Vincent, the central character of the story (played by Ethan Hawke), has longed to be an astronaut.  Unfortunately for Vincent, however, he was conceived by his parents in the traditional manner and has inherited with their genes significant risk factors for a number of diseases, notably a 99% risk of heart disease.  In a society where most children are conceived in vitro and screened for inheritable diseases, physical characteristics and other ‘potentially prejudicial conditions’, Vincent has no chance of passing the selection process to enter the GATTACA academy and fulfil his dream to go into space; he is ‘a utero, a faith-birth, an In-valid’.  As he bemoans in the voiceover “I’ll never understand what possessed my mother to put her faith in God’s hands rather than those of her local geneticist” (9:04), adding later “It didn’t matter how much I lied on my resume, my real resume was in my cells.  Why should anybody invest all that money to train me, when there are a thousand applicants with a far cleaner profile?” (15:12).

Unwilling to accept the fate determined by his genes, Vincent resorts to extreme measures.  Via a secretive middle-man he is put in touch with Jerome (Jude Law), who was genetically selected by his parents and, as such, is  ‘a Valid, a vitro, a made-man’. Jerome may have the genetic credentials to succeed, but he has been involved on a car accident and is now confined to a wheelchair. He is willing to sell his genetic identity to Vincent; “You could go anywhere with this guy’s helix tucked under your arm” enthuses the agent (23:35).  So it is that Vincent becomes ‘a borrowed ladder, a de-gene-rate’ – somebody who pays for blood and urine, skin cells and hair from a Valid in order to cheat the ID tests and routine screening at the workplace and masquerade as a different genetic persona. 

GATTACA offers huge potential for teaching.  The whole film could be shown to students, but most of the interesting science and bioethics really occurs in the first half hour.  The best single clip for conveying the main issues involves Vincent’s parents going to the genetic service to order their second child (10:35 to 12:37, starting “Like most parents…”), although you may elect to start viewing from 9:04 and include Vincent’s discussion of his own birth.

The consultation at the clinic hints at the science that has been employed, but also raises nicely some of the issues concerning whether or not this would be a good development.  The parents seem willing to have diseases screened out, even to specify the gender, eye colour, hair and skin tone of their new child but wonder aloud whether it might be good to leave a few things to chance.  At this point they are put firmly in their place by the genetic counsellor, “you want to give your child the best possible start. Believe me, we have enough imperfections built in already, yout child doesn’t need any additional burdens” (11:55).

A second clip that may be worth including runs from 15:12 to 16:01, the section where Vincent discusses his genetic ‘resume’ and then goes on to highlight how, despite genetic discrimination being illegal, all sorts of secret testing could be undertaken if you refused to take an official screening.

What are some of the issues raised by the film?  One important one, of course, is whether the science might ever deliver a society of this kind.  This question has become increasingly important in the time since the film was made as a succession of real-life cases of pre-implantation genetic diagnosis (PGD) have moved the boundary concerning legally-permitted uses of PGD.

In reality, the particular technology used in the film could provide genetic selection, but not genetic enhancement. With conception still involving fertilisation of the mother’s eggs using the father’s sperm you can only choose from the range of genetic options that are represented within the genomes of the two parents.  To its credit, the film does actually make this point when the genetic counsellor explains “Keep in mind this child is still you, simply the best of you.  You could conceive naturally a thousand times and never get such a result” (11:58).

The technological limitations of the methods used in the film in no way invalidates discussion of the possible ethical consequences of this kind of screening, not least because other genetic breakthroughs may allow broader and more overt selection than is currently possible. 

The issue of discrimination based upon the results of genetic testing is already a genuine concern. In the UK, there is currently a voluntary moratorium on the use of gene test information by insurance companies, but this is due to be reviewed in 2011 and worries have been expressed by, for example, the cancer charity Breakthrough Breast Cancer and by the GeneWatch organisation that the current ban will not be secured. The depicition in the film of a kindergarten unwilling to take young Vincent as a pupil because the insurance won’t cover him is not necessarily far-fetched.

Being able to eradicate certain inherited diseases is clearly an appealing proposition; the key question, however, concerns the cost to individuals and to society that may be required to achieve such a goal.  It is also illuminating to consider the case of Jerome who, of course, had the right genes but his interaction with the environment (in this case, collision with a car) has rendered him unacceptable to a perfection-orientated society.   It reminds us that despite even the most strident models of genetic determinism,  our genes alone will never be enough to entirely define who we are as people.

GATTACA is repeated regularly on satellite movie channels.  It was shown on Channel 4 on September 4th 2005 (TRILT identifier: 001B88FE), and is available as an off-air recording from the BUFVC.

If you like BioethicsBytes…

June 5, 2007

If you have been using the BioethicsBytes website to find out information about multimedia resources for teaching about bioethics, you may also like to take a look at the Literature, Film and Genetics site. Although their “about us” section is not currently very informative, it is fair to say that the site does exactly what it says on the tin. There are reviews and ratings of a variety of books and films where genetic themes are raised.  The material in their database can be browsed by Author/Director, Fiction (i.e. book), Film, Topic (Adaptation, Biological Determinism,… [through to]…, Vivisection and Young Adult).  There is also an interesting section on Criticisms, listing publications by their team. 

Gene therapy – Die Another Day

February 8, 2007

(Warning: contains plot spoilers!)  This is one of those occasions when a blockbuster film gets the science wildly wrong.  Central to the plot of the 2002 James Bond film Die Another Day is the ability of one of Bond’s foes, the North Korean Colonel Moon, to radically alter his appearance and resurface as upper crust caucasian Gustav Graves.  The change is achieved, as Bond (Pierce Brosnan) tells M (Judi Dench), by “Gene therapy – new identities courtesy of DNA transplants”. 

This is, of course, nonsense.  Although gene therapy has the potential to correct diseases resulting from a faulty copy of one gene there is never the scope to carry out such radical alterations as portrayed in this film.  Indeed, even the more limited aspiration to use gene therapy to cure relatively simple diseases has had a chequered history (see, for example, the BioethicsBytes notes on the Horizon programme Trial and Error, and news stories about leukaemia risks from one gene therapy method).

Are there any clips worth using in teaching about gene therapy?  Despite the fact that the content is way off beam, I use clips from the film as an engaging introduction to a lecture on the science and ethics of gene therapy.  The quote from Bond to M actually comes quite late in the film, long after the clinic where the work was supposedly being carried out has been destroyed.  If you have the technical capability it is worth trying to show the section 59.33 to 59.46 where M and Bond are talking (from “now tell me about this cuban clinic…” to “… didn’t know it really existed) directly before the earlier footage, 40.49 to 41.45, where Bond visits the clinic at about the same time Jinx (Halle Berry) sees off the surgeon with the words “… famous after they’re dead”.

Euthanasia – Million Dollar Baby

September 13, 2006

(Warning: contains plot spoilers!)  I was really caught out by this film when I first saw it, so I hope I’m not ruining it for you with this entry.  Maggie, the female boxer played by Hilary Swank, suffers a serious accident and ends up in hospital.  She tries to persuade her coach Frankie (Clint Eastwood) to kill her and end her suffering.  To feel the full impact you really need to watch the whole, but that’s not really feasible in a teaching setting both because of the length of the movie and the violent content.  Try watching just the section where Maggie asks her coach to end her life.  This is about 1hr 45 into the film; a 3 minute clip could from that point be used as a discussion starter.  There is one verbal cross-reference in this section to “do[ing] what my daddy did for Axl” (her father put down the family dog, mentioned 1 min 14 into film) but this section still stand alone reasonably well.  Other potentially useful clips come with Frankie’s visit to his priest to discuss the situation and then a 2 minute clip starting at 1:58 where he administers a large dose of adrenalin to end Maggie’s life. 

Therapeutic cloning – The Island

July 24, 2006

(Warning: contains story spoilers!)  The Island looks into a near future (the year 2019 is specified) where it has become possible for the rich and famous, including top sportsmen and the US President, to have a clone of themselves made as an ‘insurance policy’.  The clients are led to believe that the clones (aka Agnates) are kept in a permanent vegetative state, but this is not true.  The clones, which are made using an accelerated development system, are, in fact, awake and carry out certain jobs.  They are told that they are survivors after a catastrophic accident and have to live indoors, unless they win the lottery and with it the chance to move to the contamination-free Island.  This is a cover story to explain their sudden disappearance when their organs need to be harvested for the sponsor.  The film focusses on an escape by two clones, Lincoln 6 Echo (Ewan McGregor) and Jordan 2 Delta (Scarlett Johansson), who go in search of their sponsors after Lincoln discovers the truth about what it means to win a move to “The Island”.

The film can be a useful vehicle for discussing human cloning.  For example, you could get the students to compare and contrast the cloning depicted in the film with the science and current legislation of both therapeutic and reproductive cloning.

The film is a certificate 12, so there are few problems content-wise in showing the whole thing to any secondary or university group.  However, some scenes in isolation (supported by a little background from the teacher) are sufficient to serve as a case study.  In particular Chapter 17 “Why do they lie to us?” (0:59:02 to 1:02:43) is very good – nb includes one use of ‘shitty’.  Also Chapter 7 (0:23:00 to 0:26:00) depicts an adult ‘birth’; Chapter 14 (0:48:30 to 0:51:50) the sales pitch to potential customers about the limitations of human life and a statement that the Agnates are “products, not human”; Chapter 15 (0:52:50 to 0:54:05) where we are told that Jordan 2 Delta’s sponsor is dying; Chapter 30 (1:43:45 to 1:45:50) “How many are affected?” and Chapter 33 (1:54:40 to 1:55:33) “When did killing become a business for you?”