Saturday, 18 August 2018

Bioethics film analysis: In Vitro



In Vitro film link:
(spoilers follow, so consider watching this 18 minute film first before reading on)

Initial impressions:

“Guard your DNA, Protect and survive.”
The scientist did what she did out of desperation: Can’t get funding for her research. Rejection when she tried to get her works published.
Fertility treatment: if we can reprogram stem cells to fight cancer, then we can reprogram stem cells into egg or sperm cells.
The child produced by the scientist from fertilisation of her egg by her own stem cells died at age 35: her body was taken away for further human experimentation.
The scientist’s regret: You can’t undo what you’ve done. If you’re going to mess with the fundamentals, you’d better make sure you’re standing on solid grounds.

The first question that came up for me was, “Would the woman scientist be able to obtain ethics committee approval to do what she did?” There are some pretty clear guidelines out there and I don’t think she can get approval.

The second question was, “Is the technical method (turning embryonic stem cells into gametes) described in the film too sci-fi, or has there already been experimentation in this area?”
Which led me to this piece of research literature (and many other research articles if you google “stem cell change into gamete.”)
Several reports have shown that mouse embryonic stem (ES)-cells can differentiate into sperm (Toyooka et al., 2003; Geijsen et al., 2004) and ova (Hubner et al., 2003) and that human ES cells can also differentiate into germ cells in culture (Clark et al., 2004; Lacham-Kaplan et al., 2005). 
So, if this area is further researched, there is likely to be further development, and not that sci-fi at all!

Also, I noticed that in many bioethics film in popular culture, they attempt to make things look very futuristic, by having these transparent technological devices or voice command controlled things that seem different from the current technology. It seems quite stereotypical in those films. Technology is improving rapidly but there are still many things that are pretty similar to the way it was ten years ago, eg. laptops are still very common and look quite similar, even though it may be lighter now and run faster, TVs are still around, iPhone don’t look too different even though there have been new models every year, etc.

Pay attention to what you see, feel, hear.

How does the director use framing, lighting, music, pace, scene-setting and the like?

Opening:
In the opening, the first thing I heard was creepy music that sounded corrugated and insect-like. The colour was a gloomy dark blue to black. The sperms looked insect-like too, and seemed alive. The water drops resembled rain or tear-drops, and seemed to parallel with the shape of the sperms. The sperms jumped very suddenly, like the corrugated music. It was clear right from the beginning that this film has something to do with reproductive technology, because of the presence of the sperms.

Scene1:
The music changed to a higher pitch as the first human character appeared. This is a teenage or university aged girl who seemed to be running for her life, with the narrator saying “you can run, but you can’t hide” (The background music is very loud and the voice of the characters are soft in comparison. Is it meant to be that way, or is there something wrong with my computer?). We were given the precise date and time soon after the girl appears. Initially it was in a building, then the girl ran out to the streets of what looks like an urban area. I think the opening pace was slow even though the girl was running, because the action was very repetitive. It was easy for me to lose interest.

Scene2:
After the girl scene was a very long black screen, which made me even more bored. Then scenery changed significantly, to that of nature/wilderness, and we see a person from very far away walking slowly towards the camera. The music changed to a very slow sleepy classical type of music, which made me even more bored. There were the seagulls, then as the person walks closer, that’s when I worked out she’s a blonde middle aged woman.

Scene3:
Then the scene shifts indoors to a house with many glass windows and a sick looking woman in oxygen mask listening to music being playing by one of those very ancient machines (record players) from the mid-1900s? Amidst the music came a long beep which is the classical note people play to represent a cardiac arrest. Very soon after the beep, the blonde woman enters the house. The blonde woman didn’t realise what happened and kept talking to Sophia as usual, but there was no reply. I think it’s unusual she didn’t become immediately alarmed after there was no reply to so many of her sentences, but only realised there was something wrong when she saw Sophia (unless Sophia usually don’t answer her in their usual conversation because either she is already too weak from her illness, or there is something off with the relationship between these two people). The blonde woman clearly appeared very sad when she realised Sophia was dead, but she didn’t seem surprised, so I think she was expecting her to die. They filmed from various angles, both from the side of the blonde woman and Sophia.

Scene4:
We see a very greyish and bluish scene of the MIT (UK) Library, a rectangular institution. The girl and a man comes out, separated paths, and the girl picks up the phone, which is a transparent device that looks different from the cell phone today. We soon find out her name is Lily. Lily’s face drooped a bit and slowed down the pace of her walking when the blonde woman told her that her mother passed away. The blonde woman also admits that she knew it was going to happen, but the girl stops walking and said she wasn’t expecting it to happen that quickly. The girl became very agitated and angry when the blonde woman revealed that her mother’s body had already been taken away so she couldn’t see her. She blamed the blonde woman for everything and hung up. The woman washed her face and tried calling again, couldn’t get her, tried to call Samsara clinic then changed her mind.

Scene5:
This is where all the answers start unravelling and the film picks up pace and became more interesting to watch. We see a photo of Sophia and Lily, so now we know how Sophia looked when she was alive and relatively healthy, which was very different from her sick dehumanised appearance. The blonde woman starts scrolling through her transparent computer device and that was when we got more clues to the background of this whole thing, and can deduct that this woman was a scientist of some sort. This scene keeps flicking back and forth between the blonde woman and Lily, with Lily going to the Samsara clinic possibly wanting to be with Sophia (interestingly, I noticed at this point that Samsara sounds like a male and female name combined into one, but when I looked it up, it is an Indian word for “wandering”, which reminds me of “the Fall”). In that institution, Lily received the message and as she started listening to the blonde woman narrating the background of all this, and she got out of the institution. The blonde woman described how in 2012 she faced the challenges many researchers face, which is getting funding for their research, so she used her own stem cells to create sperm cells (which looked like the scary sperm cells we saw in the opening, so the opening was a foreshadowing) and fertilise her own egg, which created Sophia. That step was irreversible: “nothing was ever the same again.” This is when see that her name is Rachel. Naïve, hot-headed and brightness added together led to a “reaction”, and they banned the procedure. Sophia was under constant monitoring and treated like a lab animal rather than a human. Then they lifted the ban when they thought she grew up healthily, and developed nations became a huge market for this procedure because there are many women wanting to conceive without a man. Then Sophia died at 35y.o., which instilled a great fear in the consumers so the researchers took her body to do more research. They will turn their attention to Lily, which is why she needed to escape. The whole tone was very nervous, and we are put into more suspense when we see Lily still being undecided, while Rachel, whom we now know is her grandmother, takes a ride in a vehicle (train?) in the tunnel that seem to last forever. Then we see Lily running, like the first scene, as Rachel waits anxiously for her, which is more relieving to see because at least she decided to escape. The news broadcast announces to the world about the news of Sophia dying from leukaemia. The film closes with the warning, “If you’re going to mess with the fundamentals, you’d better make sure you’re standing on solid grounds”.

What mood does that generate?

Suspense, fear, gloom, especially in the opening.

How does that impact what you see and head and how you process it?

Initially it was so gloomy and slow and repetitive that I lost interest. It was only when the scientist started explaining everything that I became interested.

Is there a character that carries the ‘voice' of the movie, or from whose perspective and experience (and moral point of view) events are told?

The scientist was the ‘voice’ of the movie.

Is there a specific dilemma explored in this movie? How would you describe it?

The ethics of human experimentation: experimenting on oneself as the scientist did, then treating the offspring of the scientist like a lab animal rather than a human. Also, we know that consanguineous marriages tend to have a higher rate of producing genetic defects due to closely related genes: has it occurred in the scientist’s mind that if she actually used her own cells to fertilise her egg, there may be an even greater chance of genetic defect?

A new technology that was prematurely made available when there was still lack of data about whether long-term complications can happen.

Personal interest overriding the good of the society: The scientist’s personal ambition made her tamper with the fundamentals. Money-making: technology released prematurely, because it had a market.

Are there social values explored or evident in it?

Yes.

What are they?

Human rights: The rights of Sophia were clearly infringed as she was monitored not allowed to live a normal life. After she passes away, the rights of Lily to see Sophia for one last time was infringed and Lily will likely get monitored the way Sophia did.

Autonomy and informed consent: Informed consent is required before an autonomous decision can be made. The consumers of this technology cannot make informed consent because there isn’t enough known about this technology yet.

Knowledge: The scientist’s desire for knowledge led her to do something which might have been illegal (as I don’t think what the scientist did can get past the ethics committee). The desire for knowledge seems to override human rights as Sophia was being studied like animals.

Competition: The scientist had to compete with other researchers for funding, and she did this “irreversible step” in an attempt to beat her competitors.

Equality: The developed nations are the people who accessed the technology in the film. So it seems like the more affluent people are the ones that can access this.

How prevalent are they in your social context?

They are very prevalent issues in our society. Furthermore, I wonder whether people can ever truly receive informed consent.

How do they relate to the general values of your community?

People are constantly trying to stand up for their rights, especially in developed nations. There are 12 years of compulsory education so people have some knowledge, which helps the society function better. People are always competing, and the motivating factor for that varies widely.  Equality doesn’t seem to happen: the more affluent get access to better things, which makes people even more competitive because they realise this point.

What virtues or vices are exemplified in it?

Love.

How would you describe them?

Love between mothers and daughters.

How are they portrayed?

The scientist’s sadness when she realised Sophia passed away. The scientist’s immediate concern for Lily’s wellbeing. Lily’s desire to see Sophia. Sophia conceiving Lily naturally might mean she had a romantic relationship with a man? Photo of Sophia and Lily together smiling. The scientist hugging Lily when Lily arrives.

How are they evaluated?

The love is obviously great because when the scientist narrates the whole background, it is obvious she changed from a person who was all about knowledge and competition to one that became concerned for the wellbeing of her genetic offspring, and this love overrode the priorities of her younger days as she became increasingly regretful about what she did.

Is there an overarching approach to ethics (theory and/or practice) evident in the movie?

Don’t mess with the fundamentals, ie. human genetic make-up?

How would you describe it?

There’s repeated warnings in this film, like “guard your DNA, protect and survive.” And how the scientist’s mistake cannot be reversed, and “nothing was ever the same again.”

How prevalent is it in your social context?

ART/IVF is already heading towards that direction. The world’s first IVF baby is only 40 years old now, so we don’t really know the long term consequences yet. Yet there are already so many people being born by IVF in developed nations.

To what extent does it line up and/or conflict with your understanding of Christian ethics?

Humans should not play God. I think manipulating the human genome excessively is playing God. It might even lead to consequences like significantly reduced human lifespan etc.

The biblical command for a man and a woman to come together in one flesh to procreate and multiply all over the earth is not being followed in IVF.

In what ways, if any, have social values influenced the development and/or use of technology in this movie?

Knowledge and competition: In developed nations, many people are delaying their childbearing because they may view their education and career as a more important priority than parenthood. It becomes increasingly difficult to conceive naturally as one grows older. So there is a strong market out there for ART/IVF.

In what ways, if any, has the development and/or use of technology influenced social values in this movie?

The technology impacts on human rights, autonomy and informed consent. The “experimental” offspring have no choice over the fact that she was born by unnatural methods. She became an experimental subject with no human dignity as potential consumers fear that she may have some genetic defect. As soon as she was “cleared”, a huge market utilised this technology. However, this market was unable to make an informed consent because there wasn’t enough known about the consequences yet.

Does the movie raise new questions for you? What are they?

If somebody accesses IVF technology, will their genetic materials be retained by some research facility and get experimented on?

Did it generate new insights? What are they?

It can take several generations to realise the full impact of the decisions made by previous generations, yet the world constantly has to make these types of decisions.


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