Second Opinion: Should legislators look to children’s movies when planning for our care?

High-quality films for children have a special place in our cultural landscape. To reach beyond children to adults requires a sure touch for tapping into the universal across the lifespan.

Many of the underlying fables convey deep and complex messages. As teased out in Bruno Bettelheim's remarkable Uses of Enchantment , the brooding themes of abandonment, death, witches and injuries allow children to come to terms with their fears and conflicts, particularly with parents and authority, in remote symbolic terms.

In the medical humanities literature http://iti.ms/1qe6TtJ, children's movies have illuminated a range of clinical subjects, including ageing in Up , traumatic brain injury in The Wizard of Oz , compliance with medications in Mary Poppins , sleep behaviour disorder in Cinderella, and headache in Harry Potter.

Contemporary fable

Yet, little did I suspect that one of the most successful movies of 2014 would provide a timely and contemporary fable. On the surface, The L ego Movie

is a riotous rollercoaster of entertainment, with a jaw-dropping and obsessive digital dedication to rendering all surfaces and materials as if made of Lego, from the water in the shower to the clouds in the sky.

Packed with cinematic and cultural references, from Metropolis, through westerns, Star Wars , superheroes, Terminator to Harry Potter, it tracks a deceptively anodyne everyman, Emmett, through an updated 1984 existence.

The jokes come fast and furious, with no brick of cultural or historical reference left unturned, from Michelangelo to Abraham Lincoln.

Emmett chances on the “Piece of Resistance” and is hailed as The Special who can stymie the plan of the evil villain, President/Lord Business, who intends to glue every brick and mini-figure in place definitively, denying individuality, unpredictability and spontaneity.

In a Bettelheimian touch, this parallels a late-breaking plot of a human child and father where the father wishes to preserve his huge Lego collection by gluing it together, against the wishes of the son to be creative and original.

Brokering uncertainty
As a key task of medicine is brokering uncertainty, http://iti.ms/1srqWac, with our patients and society, combatting undue rigidity in societal approaches to complexity is also a professional imperative.

We have been here before. At the heart of the great plays of Molière is the folly of humans trying to maintain artificially an ideal state that does not take account of future reality, whether through storing up spiritual credits ( Tartuffe ), money ( The Miser ) or medical advice ( Le Malade Imaginaire ).

As trends in theatre-going change, few of the public, or our students and trainees, will see or read Molière – the more's the pity – but his joyous sense of human finitude is captured by the central theme of The Lego Movie .

The rigidity of the father and Lord Business reflect the folly of trying to cast our future in stone (or bricks!).

This could be a neat metaphor for the impossibility of capturing the richness and complexity of events of later life in rigid, legally binding advance directives, http://iti.ms/1srqZCX, rather than the flexibility of clinically-guided advance care planning as currently practiced, http://iti.ms/1srqXLb.

A related concern in Ireland is an attempt to suppress the concept of “best interests” entirely from new legislation on assisted decision-making, in stark contrast to the nuanced but central role of “best interests” in the UK Mental Capacity Act 2005.

Principle of best interests
The original Law Reform Commission report on capacity in 2005, http://iti.ms/1srr0Xf, clearly outlined that although we must do all in our power to enable those with disability to make their wishes known, in many cases we need to work on the principle of "best interests" for those with a severe impairment of ability to decide.

The change in the Irish approach appears to arise from a rigid and doctrinaire interpretation of the Committee on the Rights of Persons with Disabilities, http://iti.ms/1srr2P0, (which ironically preserves “best interests” for children) which is disembodied from the practice of clinical medicine and the uncertainties of later life.

It is perhaps indicative of differing strength, advocacy and philosophical approaches of the constituencies for earlier onset disability and gerontology.

Most of us will die in later life, at a time when our care needs will have become more complex. Our challenge now is to shape a system that eschews simplification and rigidity in favour of complexity and flexibility.

It would be ironic if we get a better steer on this from children’s movies than from our legislators.

A version of this column originally appeared as a BMJ blog.

Prof Des O’Neill is a consultant in geriatric and stroke medicine