Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

In this article we report relevant data that shed light on the topic of hope and patients’ expectations in the use of DBS, for standard, approved, and established indications, based on a broader qualitative study on the ethical and social challenges that healthcare providers face in the field of DBS.

Human cooperation is highly unusual. We live in large groups composed mostly of non-relatives. Evolutionists have proposed a number of explanations for this pattern, including cultural group selection and extensions of more general processes such as reciprocity, kin selection, and multi-level selection acting on genes. Evolutionary processes are consilient; they affect several different empirical domains, such as patterns of behavior and the proximal drivers of that behavior. In this target article, we sketch the evidence from five domains that bear on (...) the explanatory adequacy of cultural group selection and competing hypotheses to explain human cooperation. Does cultural transmission constitute an inheritance system that can evolve in a Darwinian fashion? Are the norms that underpin institutions among the cultural traits so transmitted? Do we observe sufficient variation at the level of groups of considerable size for group selection to be a plausible process? Do human groups compete, and do success and failure in competition depend upon cultural variation? Do we observe adaptations for cooperation in humans that most plausibly arose by cultural group selection? If the answer to one of these questions is “no,” then we must look to other hypotheses. We present evidence, including quantitative evidence, that the answer to all of the questions is “yes” and argue that we must take the cultural group selection hypothesis seriously. If culturally transmitted systems of rules that limit individual deviance organize cooperation in human societies, then it is not clear that any extant alternative to cultural group selection can be a complete explanation. (shrink)

In the article “Nudging and Informed Consent”, Cohen argues that the use of “nudging” by physicians in the clinical encounter may be ethically warranted because it results in an informed consent where obligations for beneficence and respect for autonomy are both met. However, the author's overenthusiastic support for nudging and his quick dismissal of shared decision-making leads him to assume that “soft” manipulation is un-problematic and that “wisdom” on the side of medical professionals will suffice to guard against abuse. Opposing (...) this view, we propose that: 1) patient preferences and values should not be boiled down to rational or irrational decisions based on cognitive reasoning alone, 2) potential threats to the physician-patient must be mitigated and could be minimized by employing alternative strategies that acknowledge the impact of cognitive heuristics in shaping decision-making but maintain transparency and trust, and 3) patient preferences and values can be legitimately influenced only under specific circumstances. The latter include: (1) exhaustion of other means; (2) evidence that nudging is effective in a specific context; (3) evidence of clear and active public misinformation (e.g., industry promoting smoking); (4) explicit pubic dialogue between various stakeholders including medical professional societies about nudging; (5) upholding shared decision-making as a preferred approach; and (6) a rich understanding of clinical reality beyond the simple dichotomy of beneficence-autonomy. (shrink)

Stigma can influence the prevention and identification of fetal alcohol spectrum disorder, a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies. We propose a descriptive model of stigma in FASD and note current knowledge gaps; discuss the ethical implications (...) of stigma based on two distinct criteria ; and describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD. (shrink)

Neuroscientists are increasingly put into situations which demand critical reflection about the ethical and appropriate use of research tools and scientific knowledge. Students or trainees also have to know how to navigate the ethical domains of this context. At a time when neuroscience is expected to advance policy and practice outcomes, in the face of academic pressures and complex environments, the importance of scientific integrity comes into focus and with it the need for training at the graduate level in the (...) responsible conduct of research . I describe my experience teaching RCR in a graduate neuroscience program and identify three personal reflections where further dialogue could be warranted: mobilizing a common set of competencies and virtues standing for professionalism in the neurosciences; tailoring RCR for the neurosciences and empowering students through the active engagement of mentors; soliciting shared responsibility for RCR training between disciplines, institutions and governmental or funding agencies. (shrink)

W. E. B. Du Bois was one of the most profound and influential African-American intellectuals of the twentieth century. This volume addresses the complexities of Du Bois' legacy, showing how his work gets to the heart of today's theorizing about the color line.

International media have reported cases of pregnant women who have had their children apprehended by social services, or who were incarcerated or forced into treatment programs based on a history of substance use or lack of adherence to addiction treatment programs. Public discourse on the biology of addiction has been criticized for generating stigma and a diminished perception of self-control in individuals with an addiction, potentially contributing to coercive approaches and criminalization of women who misuse substances during pregnancy. We explored (...) whether this is the case based on literature from social psychology, ethics, addiction research, science communication, and philosophy. The literature shows that the relationship between public discourse on biological aspects of addiction and issues such as stigma and perceptions of diminished self-control are unclear, largely due to the complexity of these phenomena. However, concerns about the biological approach are nevertheless legitimate given the broader social and policy context of women’s health. (shrink)

Background: Fetal alcohol spectrum disorder (FASD), a complex diagnosis that includes a wide range of neurodevelopmental disabilities, results from exposure to alcohol in the womb. FASD remains poorly understood by Canadians, which could contribute to reported stigma faced by both people with FASD and women who drink alcohol while pregnant. Methods: To better understand how information about FASD is presented in the public sphere, we conducted content analysis of 286 articles from ten major English-language Canadian newspapers (2002-2015). We used inductive (...) coding to derive a coding guide from the data, and then iteratively applied identified codes back onto the sample, checking inter-coder reliability. Results: We identified six major themes related to clinical and scientific media content: 1) prevalence of FASD and of women’s alcohol consumption; 2) research related to FASD; 3) diagnosis of FASD; 4) treatment of FASD and maternal substance abuse; 5) primary disabilities associated with FASD; and 6) effects of alcohol exposure during pregnancy. Discussion: Across these six themes, we discuss three instances of ethically consequential exaggeration and misrepresentation: 1) exaggeration about FASD rates in Indigenous communities; 2) contradiction between articles about the effects of prenatal alcohol exposure; and 3) scientifically accurate information that neglects the social context of alcohol use and abuse by women. Respectively, these representations could lead to harmful stereotyped beliefs about Indigenous peoples, might generate confusion about healthy choices during pregnancy, and may unhelpfully inflame debates about sensitive issues surrounding women’s choices. (shrink)

“Everyday ethics” is a term that has been used in the clinical and ethics literature for decades to designate normatively important and pervasive issues in healthcare. In spite of its importance, the term has not been reviewed and analyzed carefully. We undertook a literature review to understand how the term has been employed and defined, finding that it is often contrasted to “dramatic ethics.” We identified the core attributes most commonly associated with everyday ethics. We then propose an integrative model (...) of everyday ethics that builds on the contribution of different ethical theories. This model proposes that the function of everyday ethics is to serve as an integrative concept that (1) helps to detect current blind spots in bioethics (that is, shifts the focus from dramatic ethics) and (2) mobilizes moral agents to address these shortcomings of ethical insight. This novel integrative model has theoretical, methodological, practical, and pedagogical implications, which we explore. Because of the pivotal role that moral experience plays in this integrative model, the model could help to bridge empirical ethics research with more conceptual and normative work. (shrink)

Discussion surrounding ethical and social issues in deep brain stimulation (DBS) has increased. This article introduces a special section on the ethics of DBS in The Journal of Clinical Ethics.

BackgroundResearch ethics and the measures deployed to ensure ethical oversight of research (e.g., informed consent forms, ethics review) are vested with extremely important ethical and practical goals. Accordingly, these measures need to function effectively in real-world research and to follow high level standards.MethodsWe examined approved consent forms for Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) studies approved by Canadian research ethics boards (REBs).ResultsWe found evidence of variability in consent forms in matters of physical and psychological risk reporting. (...) Approaches used to tackle the emerging issue of incidental findings exposed extensive variability between and within research sites.ConclusionThe causes of variability in approved consent forms and studies need to be better understood. However, mounting evidence of administrative and practical hurdles within current ethics governance systems combined with potential sub-optimal provision of information to and protection of research subjects support other calls for more scrutiny of research ethics practices and applicable revisions. (shrink)

In the last years, TV documentaries, articles in popular magazines, and Internet content have increased the public visibility of deep brain stimulation (DBS). The media may have also provoked significant clinical and public interest in potential future applications for treating psychiatric disorders beyond the current use of DBS in neurological disorders. In this article, we review and discuss the topic of patient and public understanding of DBS, focusing on both the clinical consequences of patient understanding as well as the broader (...) social consequences of public understanding. The literature and the experience of clinicians suggest that strongly optimistic media reports of DBS have had detrimental consequences for informed consent and the management of patient expectations before and after surgery. Likewise, this context has created complex issues for trust between clinicians, patients, and their families and may have hard-to-predict social impacts including on the relationships between public understanding of neuroscience, biological therapies, stigma, and mental illness. We propose an approach to tackle the clinical and social consequences of media messages on public understanding within a broad and interdisciplinary effort with concrete actions. This approach includes actions by all key players, including not only providers but also patients and their family members, as well as journalists. To further address issues at the intersection of informed consent and patient expectation, there should be more discussion on and actual testing and measurement of these recommendations or similarly minded practice changes. (shrink)

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal (...) research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a cure of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction. (shrink)

Canada’s Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans mandates that all research involving human subjects be reviewed and approved by a research ethics board . We have little evidence on how researchers are dealing with this requirement in multisite studies, which involve more than one REB. We retrospectively examined 22 REB submissions for two minimal-risk, multisite studies in leading Canadian institutions. Most REBs granted expedited review to the studies, while one declared the application to be exempt from review. (...) Time between submission and approval ranged greatly, from four to 546 days. We received a total of 155 REB queries for changes and clarifications, most of which asked for further information, clarification, or additional documents. Less than a third of the REB queries were requests for specific changes, and a vast majority had a very limited impact on the research projects. Institutions also varied broadly in their description of what was required of local principal investigators. We conclude that the organizational and practical challenges these results imply could deter researchers from embarking on multisite research projects, and that recently proposed changes to the TCPS will not solve these problems. (shrink)

AbstractIntegrity is considered an important corporate value. Yet recent global events have highlighted the challenges firms face at living up to their stated values, especially when extended supply chain partners are involved. The concept of Supply Chain Integrity (SCI) can help firms shift focus beyond internal corporate integrity, toward supply chain integrity. Researchers and managers will benefit from an understanding of the SCI concept toward implementing SCI to better align supply chain partners with stated corporate values. This research fully develops (...) and empirically grounds the firm-level, inter-firm-oriented SCI concept. The thematic analysis of six firms’ archival and website content elaborated empirical descriptions of SCI themes and enabled the development of a process model for SCI, presenting a novel view of the underlying process by which firms can assess, develop, and maintain SCI across their supply chains. We propose the SCI model as an evolutionary process to improve a firm’s supply chain sustainability, rather than a dichotomous end state where firms either “have” integrity or they don’t. The SCI model could be used as a tool to help leaders create necessary change to better align values and supporting statements with culture, while influencing and affecting stakeholders across the supply chain. This is particularly important in today’s world, where business leaders must consider all stakeholders and address important stakeholder-driven issues such as supply chain sustainability, resilience, and security, which are now at the forefront in the ever-changing environment. (shrink)

Quantum mechanics is an extraordinarily successful scientific theory. But more than 100 years after it was first introduced, the interpretation of the theory remains controversial. This Element introduces some of the most puzzling questions at the foundations of quantum mechanics and provides an up-to-date and forward-looking survey of the most prominent ways in which physicists and philosophers of physics have attempted to resolve them. Topics covered include nonlocality, contextuality, the reality of the wavefunction and the measurement problem. The discussion is (...) supplemented with descriptions of some of the most important mathematical results from recent work in quantum foundations, including Bell's theorem, the Kochen-Specker theorem and the PBR theorem. (shrink)

In recent years the quantum foundations community has seen increasing interest in the possibility of using retrocausality as a route to rejecting the conclusions of Bell’s theorem and restoring locality to quantum physics. On the other hand, it has also been argued that accepting nonlocality leads to a form of retrocausality. In this article we seek to elucidate the relationship between retrocausality and locality. We begin by providing a brief schema of the various ways in which violations of (...) class='Hi'>Bell’s inequalities might lead us to consider some form of retrocausality. We then consider some possible motivations for using retrocausality to rescue locality, arguing that none of these motivations is sufficient to show that local retrocausal theories should always be preferred to nonlocal retrocausal theories, and therefore there is no clear reason to focus research efforts entirely on seeking local retrocausal models. Next, we examine several different conceptions of retrocausality, concluding that ‘all-at-once’ retrocausality is more coherent than the alternative dynamical picture. We then argue that since the ‘all-at-once’ approach requires probabilities to be assigned to entire histories, locality is not playing any crucial role within this picture. Thus we conclude that using retrocausality as a way to rescue locality may not be the right route to retrocausality. Finally, we demonstrate that accepting the existence of nonlocality and insisting on the nonexistence of preferred reference frames leads naturally to the acceptance of a form of retrocausality, albeit one which is not mediated by physical systems travelling backwards in time. We argue that this is the more natural way to motivate retrocausal models of quantum mechanics. (shrink)

Concussion is a form of traumatic brain injury that has been defined as a “trauma-induced alteration in mental status that may or may not involve loss of consciousness.” Terms such as getting a “ding” or getting your “bell rung” are sometimes used as colloquialisms for concussion, but inappropriately downplay the seriousness of the injury. It is estimated that between 1.6 and 3.8 million concussions occur annually in the United States as a result of participation in sports or recreational activities. (...) To date, there are no objective, biological markers for concussion; rather, the current diagnosis of concussion is dependent upon symptom reporting by the athlete. In the acute phase, concussions can result in a broad spectrum of symptoms that can be transient or last for days, weeks, or even months. Symptom prolongation is generally referred to as post-concussion syndrome. (shrink)

This paper examines the bond between humans and dogs as demonstrated in the life and work of Emily Brontë . The nineteenth century author, publishing under the pseudonym, Ellis Bell, evinced, both in her personal and professional life, the complex range of emotions explicit in the human-dog bond: attachment and companionship to domination and abuse. In Wuthering Heights, Brontë portrays the dog as scapegoat, illustrating the dark side of the bond found in many cultures. Moreover, she writes with (...) awareness of connections - unknown in the nineteenth century - between animal abuse and domestic violence. In her personal life, Brontë's early power struggles with her companion animal mastiff, Keeper, evolve into a caring relationship. In a human-dog bond transformation that survives Brontë's death, Keeper, becomes both bridge and barrier to other human relationships. A dog may, and in this case Keeper does, take on a comprehensive role in which he both mourns his own loss and comforts others in their collective grief. (shrink)

Emily Brady provides a systematic account of aesthetics in relation to the natural environment, offering a critical understanding of what aesthetic appreciation ...

For early modern metaphysician Anne Conway, the world comprises creatures. In some sense, Conway is a monist about creatures: all creatures are one. Yet, as Jessica Gordon-Roth has astutely pointed out, that monism can be understood in very different ways. One might read Conway as an ‘existence pluralist’: creatures are all composed of the same type of substance, but many substances exist. Alternatively, one might read Conway as an ‘existence monist’: there is only one created substance. Gordon-Roth has done the (...) scholarship a great favor by illuminating these issues in Conway. However, this article takes issue with Gordon-Roth's further view that Conway ‘oscillates’ between the extremes of existence pluralism and monism. In its place, I argue we should read Conway as a priority monist: the whole of creation is ontologically prior to its parts. (shrink)

This book comprises all of John Bell's published and unpublished papers in the field of quantum mechanics, including two papers that appeared after the first edition was published. It also contains a preface written for the first edition, and an introduction by Alain Aspect that puts into context Bell's great contribution to the quantum philosophy debate. One of the leading expositors and interpreters of modern quantum theory, John Bell played a major role in the development of our (...) current understanding of the profound nature of quantum concepts. First edition Hb (1987): 0-521-33495-0 First edition Pb (1988): 0-521-36869-3. (shrink)

Viewed this way, the texts yield striking examples of language and notation that are irreducibly ambiguous and productive because they are ambiguous.

Trans and gender-nonconforming people sometimes say that certain gender norms are authentic for them. For example, a trans man might say that abiding by norms of masculinity tracks who he really is. Authenticity is sometimes taken to appeal to an essential, pre-social “inner self.” It is also sometimes understood as a moral notion. Authenticity claims about gender norms therefore appear inimical to two key commitments in feminist philosophy: that all gender norms are socially constructed, and that many domains of gender (...) norms are both morally and prudentially bad. I argue that that this apparent tension is illusory. Concordant with existing trans narratives of authenticity, I articulate an existentialist view that understands authenticity as a socially embedded, constructive project undertaken in a non-ideal social world, rather than a reflective uncovering of a pre-given, essential self. I then show that authenticity and morality can come apart; what is authentic for someone need not be either morally good or good for them. I conclude that the authenticity of gender norms does not cut against the feminist commitments that I identify. This conclusion enables a theoretical space that is both respectful of trans experience and critical of dominant gender norms, an important liberatory goal. (shrink)

The laws of nature have come a long way since the time of Newton: quantum mechanics and relativity have given us good reasons to take seriously the possibility of laws which may be non-local, atemporal, ‘all-at-once,’ retrocausal, or in some other way not well-suited to the standard dynamical time evolution paradigm. Laws of this kind can be accommodated within a Humean approach to lawhood, but many extant non-Humean approaches face significant challenges when we try to apply them to laws outside (...) the time evolution picture. Thus for proponents of non-Humean approaches to lawhood there is a clear need for a novel non-Humean account which is capable of accommodating these sorts of laws. In this paper we propose such an account, characterizing lawhood in terms of constraints, which are understood as a form of modal structure. We demonstrate that our proposed realist account can indeed accommodate a large variety of laws outside the time evolution paradigm, and describe some possible applications to important philosophical problems. (shrink)

In The Sublime in Modern Philosophy: Aesthetics, Ethics, and Nature, Emily Brady takes a fresh look at the sublime and shows why it endures as a meaningful concept in contemporary philosophy. In a reassessment of historical approaches, the first part of the book identifies the scope and value of the sublime in eighteenth-century philosophy, nineteenth-century philosophy and Romanticism, and early wilderness aesthetics. The second part examines the sublime's contemporary significance through its relationship to the arts; its position with respect (...) to other aesthetic categories involving mixed or negative emotions, such as tragedy; and its place in environmental aesthetics and ethics. Far from being an outmoded concept, Brady argues that the sublime is a distinctive aesthetic category which reveals an important, if sometimes challenging, aesthetic-moral relationship with the natural world. (shrink)

Standpoint theorists have long been clear that marginalization does not make better understanding a given. They have been less clear, though, that social dominance does not make ignorance a given. Indeed, many standpoint theorists have implicitly committed themselves to what I call the strong epistemic disadvantage thesis. According to this thesis, there are strong, substantive limits on what the socially dominant can know about oppression that they do not personally experience. I argue that this thesis is not just implausible but (...) politically pernicious; it is an excuse for ignorance and silence that stifles our ability to address many injustices. Moreover, I argue that if we are to avoid lending support to the SEDT while working within a standpoint theory framework, we must hold that the socially dominant can achieve marginalized standpoints. So, we must hold that men can achieve feminist standpoints, that white women (and men) can achieve black feminist standpoints, and so on. (shrink)

There is a long tradition, in the history and philosophy of science, of studying Kant’s philosophy of mathematics, but recently philosophers have begun to examine the way in which Kant’s reflections on mathematics play a role in his philosophy more generally, and in its development. For example, in the Critique of Pure Reason , Kant outlines the method of philosophy in general by contrasting it with the method of mathematics; in the Critique of Practical Reason , Kant compares the Formula (...) of Universal Law, central to his theory of moral judgement, to a mathematical postulate; in the Critique of Judgement , where he considers aesthetic judgment, Kant distinguishes the mathematical sublime from the dynamical sublime. This last point rests on the distinction that shapes the Transcendental Analytic of Concepts at the heart of Kant’s Critical philosophy, that between the mathematical and the dynamical categories. These examples make it clear that Kant's transcendental philosophy is strongly influenced by the importance and special status of mathematics. The contributions to this book explore this theme of the centrality of mathematics to Kant’s philosophy as a whole. This book was originally published as a special issue of the Canadian Journal of Philosophy. (shrink)

Relational quantum mechanics (RQM) is an interpretation of quantum mechanics based on the idea that quantum states do not describe an absolute property of a system but rather a relationship between systems. There have recently been some criticisms of RQM pertaining to issues around intersubjectivity. In this article, we show how RQM can address these criticisms by adding a new postulate which requires that all of the information possessed by a certain observer is stored in physical variables of that observer (...) and thus is accessible by measurement to other observers. This makes it possible for observers to reach intersubjective agreement about quantum events that have occurred in the past. We suggest a possible ontology for a version of RQM employing this postulate; this ontology upholds the principle that quantum states are always relational, but it also postulates a set of quantum events that are not strictly relational. We show that the new postulate helps address the preferred basis problem in RQM. (shrink)

Both Stoic and Buddhist ethics are deeply concerned with the ethical dangers of attachments. Three dangers stand out: (1) the destructive consequences of overwhelming emotionality, brought on by attachment, both for oneself and others, (2) the dangers to one's agency posed by strongly held, but ultimately unstable, attachments, and (3) the threat to virtuous emotional engagement with others caused by one's own attachment to them. The first two kinds of moral dangers have informed Stoic models of detachment (see Wong (2006). (...) In this paper I draw on Buddhist texts to present a model of detachment that responds primarily to the third moral danger of attachment, the danger of not loving well. (shrink)

Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

This book establishes how Hanna Segal's approach provides a clear focus to this burgeoning yet troublesome area of thought. With contributions from internationally-renowned psychoanalysts and academics influenced by Hanna Segal-Wollheim, Feldman, Steiner, Sodre, Anserson and others-this book addresses a wide range of issues such as classic and contemporary literature, film, the problems of old age, emotions, modernism and emigration.