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Offline: History lessons
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Offline: History lessons
Corbis
Penguin Group
Doctors must not be complicit in torture. This principle is an important foundation of modern medical ethics. It draws one thick red line between absolutely unacceptable professional practice and a whole series of greyer moral predicaments. But is the question of how doctors ought to respond to a political regime displaying extreme violence quite so clearly answered? In Alone in Berlin, a novel about the resistance of ordinary individuals to fascism in 1940s Berlin, Hans Fallada presents two physicians for readers to examine. Both are collaborationists and both work in the brutal Nazi prison system. One doctor neglects his patients, leaving them to die in agony from perfectly treatable conditions. When challenged by the prison chaplain— himself guilty of collaboration, but someone who secretly tries to mitigate the worst excesses of the system—this doctor replies that since most prisoners will die by the executioner’s blade, “what do a couple of months matter?” The chaplain condemns him: “I call on you to renounce your profession!” A second prison doctor, Dr Brandt, is different. His task is to ensure that those about to be executed are fit and well. Yet he is the only person (after the short-lived chaplain) who shows any humanity towards the prisoners. He offers words of encouragement, he gives easing medications, and he provides the chance for a prisoner to pass a hidden note to a loved one. A prisoner, alone and close to death, judges Dr Brandt: “a good man”. By today’s standards, we may disagree. But if a physician is the only source of compassion in a regime utterly devoid of compassion, is a wholly critical verdict the right one? One might be left doubtful after reading Fallada’s recently translated 1947 masterpiece. *
Photolibrary
Public scepticism about climate change, and so the health effects of climate change, seems to be increasing. Public confidence in the scientific foundations of important public health and policy questions is surprisingly vulnerable to well-orchestrated and widely reported attacks from maverick or marginal groups. This fact justifiably dismays scientists. Our usual response is to assert the scientific evidence ever more forcibly. Or we plead fundamental public misunderstanding about the nature of science (which 710
thrives on robust scepticism). The answer, say some, is greater transparency. Or scrupulous honesty. Or better regulation. None of these proposals is likely to work. We need to accept that deference to science and scientists is diminishing. The institutional leadership of science is beginning to recognise this public push back. Instead, what might be needed is an independent forum where evidence and different interpretations of that evidence can be presented, assessed, and judged by expert and non-expert citizens in an organised open environment. An Institute of Public Reasoning—or, less prosaically, a National Agency for Science and Health—would be a democratic space to identify areas of agreement and disagreement about technical data, to define degrees of uncertainty around those data, and to set out a research agenda to reduce those uncertainties. Dissent from the scientific consensus should not be censored. Given the limitless reach of the internet, that approach will only foster mistrust. Dissent should be embraced and subjected to rigorous public investigation and crossexamination in a trusted independent public forum. If the public sees alternative views freely expressed but fairly scrutinised, the risk of unwarranted fears from extreme sources is likely to be lessened. * When the University of Sussex decided to erase English history before 1700 from its research and teaching programme, historians protested against “the arrogance of the present”. Even worse, they said, was the university’s decision to strike out all continental European history before 1900. The university defends itself by saying it is merely responding to savage government cuts. Sussex must refocus its work on more profitable causes. What counts in the curriculum at any moment says a great deal about the values of that particular period. So what does the medical curriculum of today say about the state of early 21st century medicine? That science has never been more important for understanding disease. That medicine has never been better poised to deliver health. And that the conscience of the profession has never been more riddled with moral uncertainty and self-doubt. Richard Horton, The Lancet, London NW1 7BY, UK www.thelancet.com Vol 375 February 27, 2010
Offline: History lessons
Corbis
Penguin Group
Doctors must not be complicit in torture. This principle is an important foundation of modern medical ethics. It draws one thick red line between absolutely unacceptable professional practice and a whole series of greyer moral predicaments. But is the question of how doctors ought to respond to a political regime displaying extreme violence quite so clearly answered? In Alone in Berlin, a novel about the resistance of ordinary individuals to fascism in 1940s Berlin, Hans Fallada presents two physicians for readers to examine. Both are collaborationists and both work in the brutal Nazi prison system. One doctor neglects his patients, leaving them to die in agony from perfectly treatable conditions. When challenged by the prison chaplain— himself guilty of collaboration, but someone who secretly tries to mitigate the worst excesses of the system—this doctor replies that since most prisoners will die by the executioner’s blade, “what do a couple of months matter?” The chaplain condemns him: “I call on you to renounce your profession!” A second prison doctor, Dr Brandt, is different. His task is to ensure that those about to be executed are fit and well. Yet he is the only person (after the short-lived chaplain) who shows any humanity towards the prisoners. He offers words of encouragement, he gives easing medications, and he provides the chance for a prisoner to pass a hidden note to a loved one. A prisoner, alone and close to death, judges Dr Brandt: “a good man”. By today’s standards, we may disagree. But if a physician is the only source of compassion in a regime utterly devoid of compassion, is a wholly critical verdict the right one? One might be left doubtful after reading Fallada’s recently translated 1947 masterpiece. *
Photolibrary
Public scepticism about climate change, and so the health effects of climate change, seems to be increasing. Public confidence in the scientific foundations of important public health and policy questions is surprisingly vulnerable to well-orchestrated and widely reported attacks from maverick or marginal groups. This fact justifiably dismays scientists. Our usual response is to assert the scientific evidence ever more forcibly. Or we plead fundamental public misunderstanding about the nature of science (which 710
thrives on robust scepticism). The answer, say some, is greater transparency. Or scrupulous honesty. Or better regulation. None of these proposals is likely to work. We need to accept that deference to science and scientists is diminishing. The institutional leadership of science is beginning to recognise this public push back. Instead, what might be needed is an independent forum where evidence and different interpretations of that evidence can be presented, assessed, and judged by expert and non-expert citizens in an organised open environment. An Institute of Public Reasoning—or, less prosaically, a National Agency for Science and Health—would be a democratic space to identify areas of agreement and disagreement about technical data, to define degrees of uncertainty around those data, and to set out a research agenda to reduce those uncertainties. Dissent from the scientific consensus should not be censored. Given the limitless reach of the internet, that approach will only foster mistrust. Dissent should be embraced and subjected to rigorous public investigation and crossexamination in a trusted independent public forum. If the public sees alternative views freely expressed but fairly scrutinised, the risk of unwarranted fears from extreme sources is likely to be lessened. * When the University of Sussex decided to erase English history before 1700 from its research and teaching programme, historians protested against “the arrogance of the present”. Even worse, they said, was the university’s decision to strike out all continental European history before 1900. The university defends itself by saying it is merely responding to savage government cuts. Sussex must refocus its work on more profitable causes. What counts in the curriculum at any moment says a great deal about the values of that particular period. So what does the medical curriculum of today say about the state of early 21st century medicine? That science has never been more important for understanding disease. That medicine has never been better poised to deliver health. And that the conscience of the profession has never been more riddled with moral uncertainty and self-doubt. Richard Horton, The Lancet, London NW1 7BY, UK www.thelancet.com Vol 375 February 27, 2010