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Dr.
Hofmann is a 5th year McGill resident in internal medicine. His
expertise and social activism range far and wide, he is known to be an
ardent defender of public medicine, an expert on immigrant rights in
Canada (esp. when it comes to medical care), and also the "clown
doctor".
I
met Dr. Hofmann
two years ago, and he deeply impressed me by pressing a toony into the
hand of a homeless that came up to us. This I have also often done, but
instead of walking away in embarassment as I often do, he shakes the
man's hand, asks his name, and chats him up. The hand extended to us
asks us not only for money and food, but for dignity and human contact
also. He's not known for his objective treatment of reality, but no one
can accuse him of having too small a heart. He gave us a bombastic
talk, a little one-sided perhaps, but simply the reaction to his
thoughts also greatly promotes reflection.
March 15th - Philosopher's Cafe: Dr. Derek Ruths: "Privacy: a right, a privilege, or both?"
Dr.
Somerville lived up to all expectations as she gave a bombastic debate
on how euthanasia is not only wrong in principle, but also carried
terrible practical consequences. After lampooning the great
social experiment in the Netherlands, Dr. Somerville proceeded to
launch a full-throttle attack on our utilitarian,
individualist-freedom world-views. Her argument is three pronged - (1)
Practical: euthanasia is impossible to control in pratice, because the
possibility of physicial-assisted death leads directly to pressure for
induced death on patients whose professed willingness to die did
not, in fact, original with him or herself; (2) Jurisprudence: although
there are very difficult cases where we certainly deeply sympathize
with the patient, "hard cases make for bad law" Dr. Somerville asserted
- these cases do not amount to an argument to legalize euthanasia, and
allowing euthanasia for these difficult cases makes a terrible
precedent for all the cases that will come after; (3) Complicity and
intention carries a different legal and moral responsibility than if we
let "nature take its course" - hence, withdrawing treatment (at the
patient's request, or by advance directive) should not be illegal, nor
should suicide - but assisted suicide is in a whole different legal/moral basket.
Her
last statement is worth remember: Dr. Somerville concluded that we are
all a bunch of utilitarians, but she told us that this is because we
are a product of our time, and the newer generation growing up today -
the young children and some teenagers - are much less individualistic
and utilitarian than us, putting much more emphasis on moral arguments
from principle - "they're driving their parents nuts", Dr. Somerville
says, and she will do everything she can to allow this new generation
grow up in that tradition.
The first Osler
Hour was held on January 6, 2010 in Thompson House. Over 50 students
attended the inaugural event, which raised money for the Montreal
Children’s Hospital. Participants expressed enthusiasm at the prospect
of meeting future colleagues. Joshua Gurberg, a first year medical
student explained, “We don’t have many opportunities to meet students
from the other [Health Sciences] faculties, let alone our peers from
the upper years. The Osler Hour is a refreshing way to solve this
problem…all while raising money for charity.”
Medical
students (and all healthcare students) are entering a professional
environment where patients and the public have access to large volumes
of health information of diverse quality, in which people are
(supposedly) "empowered" and able to assume greater responsibility for
their own health and treatment. As you are all well aware, this has
direct (and contradictory) clinical implications for physicians - what
do you think are some of the pro's and con's of this new dynamic?
Taking this question beyond the context of the clinic we see that the
same dynamic pertains across a number of social, cultural and political
contexts, where it is assumed that access to information can engage and
empower people, provide them with greater opportunities for
interactivity and a broader scope of choices, increase accountability
and transparency, and lead to better, more "democratic (i.e.
"healthier") outcomes. Is this really where 'more information' is
taking us, can we truly say this trend is a good thing?
This
was a small event, but it bred familiarity quickly. Dr. Barney spoke of
the "illusion of engagement", where the massive deluge of information
beguile its consumers in believing that the world changes by they
reading about it. It is difficult to argue against having access to
information, Dr. Barney notes, but the quality of the information is as
important as its quantity, and what is most important of all is how
consumers digest and act upon that information. To absorb passively is
not enough; we need to develope a culture where we realize that being
sponges aid no one. He struck at the heart of the habits of many of us,
I think, and me not least of all, and the message is very powerful.
N.B.
It was quite impossible to find a picture of Dr. Bereza online, which
doesn't happen these days unless it's by intention. What a great man.
Dr.
Bereza is the person who makes the final, difficult bioethics calls for
many hospitals in Montreal. Decisions to stop treatment in the face of
death and by wish of the patient is made by him. He romped over a
vast field of topics with us, starting from the legality of euthanasia
in Canada (it's not, but people are not really persecuted with that law
except when it is blatantly flaunted. Also, decisions to withdraw
treatment is perfectly legal, since the patient can refuse more or less
anything; treating without permission, in fact, would be considered
assault). From this, he went on to describing to us cases where the
death from withdrawal of treatment was cruel and terrible: a young man,
of olympic athletic ability, "survived" a car accident with his brain
squished in. His parents, of deep Catholic upbringing, nevertheless
decided that the young man himself, when he was alive, would never have
wished to continue living in that state and after hellish reflection
decided to remove treatment. However, the only way this young man could
die is by dehydration over a period of a week, and it is very, very
difficult to see your son die of dehydration - slowly husking out over
several days. The mother directly asked Dr. Bereza: how on earth is
that more humane than euthanasia?
Now Dr. Bereza did not pro or
con euthanasia as such in our Cafe, but he informed us well. He is for
outlawing euthanasia if such laws augment the people's confidence in
doctors and for promoting a general atmosphere of trust, but he is also
for enough leeway in the laws so doctors can act humanely, in
accordance with the patient's wishes. The only thing Dr. Bereza is
furious about is the too-gray areas, doctors who get no oversight and
get to play God - deciding to "kill" patients by upping their doses of
morphine in a non-palliative manner, but with palliative care being the
excuse. Dr. Bereza is a clearly a philosopher of great subtlety.
Palliative
care specialists, Dr. Bereza tells us, are a great bastion of defense
AGAINST euthanasia; in fact, a great palliative care service - the
option to die humanely and with diginity - palliatice care specialists
maintain, are the best, possibly the only defense against euthanasia,
because it severely reduces the market demand. This is is a fascinating
proposition and one that I will keep in mind.
Ms. Granfield is a historian, author, and an expert on John McCrae, the famed author of In Flander's Fields.
Dr. McCrae is probably the second most famous McGill doctor after Osler
- except most people don't know he was a McGill doctor! Heck, I
certainly didn't until last year, when I inquired about our stained glass window in our Stratacona building:
"In 1919, Percy Nobbs, who designed many buildings for McGill, was
commissioned to create a stained-glass window commemorating the members
of the Medical Faculty who fought or died in World War I. The deep
colours of this large work still illuminate the second floor hall of
the Strathcona Medical Building."
In any case, Ms. Granfield wrote a book about Dr. McCrae:
Where she acutely observed: "Despite John McCrae reaching Canadian icon status, his life has been largely unknown."
So
we had a real treat, learning how Dr. McCrae, despite his famous poem -
is not a pacifist at all. In fact, he is the child of a soldier, and he
always considered himself a soldier first, and a doctor second (!). He
enlisted in the Boer War at the tender age of 23, as an artillery man
(!). When World War I broke out, he was in Europe and immediately
checked himself into a baracks. When they told him he can't actually
fight any more, he became an army doctor, eventually heading the No. 3
Canadian General Hospital - where all the doctors are from McGill.
About this fact, he reportedly said: "ll the goddam doctors in the
world will not win this bloody war: what we need is more and more
fighting men". There was very little that was subtle (or, apparently,
humble) about Dr. McCrae.
We were told how Dr. McCrae is a
tremendous fan of Rudyard Kipling - how completely fitting, both poets
and willing fight and die for the British Empire. Indeed, McCrae fawned
over Kipling when they met at a hotel in England.
This was no ordinary lecture, it was replete with (working!) air raid noisemakers, pantyhoses,
WWI first aid kits (just some slings and bandages), the most primitive
"gas mask" which - amazingly - didn't cover the nose; it was just a
goggle for the eyes (because keeping chlorine gas out our eyes is going
to keep us alive significant longer than if we did not... yes...
hmm...). Said goggles even came with long instructions about proper
usage. Astonishing.
Anyway, an amazingly good time.
This wasn't the one shown to us, but yes, we got to see and play with a toy like this - amazing how much racket it could raise
Dr.
Blattberg's Cafe was as invigorating as it was challenging and
profound. There is no just war, he argues, because it is impossible to
conceptualize justice in a system characterized by a lack of rules. The
traditional philosophers of justice are trying to come up with a rule
book, saying that if a side in a war is behaving in a certain fashion
(no crimes against humanity, acting in self defense, etc.), then it is
fighting a just war. Dr. Blattberg argues that this is nonsense, war is
precisely characterized by the flaunting of rules. There are no way to
enforce such a rule book, since the greatest powers of enforcement -
the armies of the State - are precisely the agents committing the
offenses. Hence, he is not optimistic about the International Court of
Justice or the International Criminal Court - they'll always be
political toys with no real teeth.
Dr. Blattberg's own solution
to the conflict problem - and he is not a pacifist - is to have
real conversations with the other. If a war has already started, then
terrible mistakes have already been made and cannot be unmade.
Injustice has already occurred. We can be try to be the least injust we
can be in a war, but there is no such thing as a just war. Justice, to
Dr. Blattberg, is conflict resolution before the war - and not simple,
cheap conflict resolution either, not simple diplomatic negotiatings
and compromise - but deep resolutions in terms of conversations, with
each side making the utmost effort to understand the other.
I
have my (natural, cynical, undeserved) skepticism about such an
enterprise. Who will enforce the conversations? Dr. Blattberg's
answer: by their nature they will profit both sides. If enough
instances of it occur, people will realize that such conversations
brings about profit to everyone, and it become the norm for conflict
resolution. I hold him in high admiration for such robust
optimism, and reasoned, rational optimism at that. He is not
going for slight tweaks here and there, but a wholesale change of human
change of our attitude to conflict. For that cause, we can only support
him and wish him the best of luck.
Andre came in and threw down a handful of pick-up sticks. I didn't even know what pick-up sticks were until now, but it was Andre's archetype of a complex system, a system defined through the interactions of the constituents. Since complex systems usually exhibit chaotic behavior,
where what the system becomes has no relation to how the system began
(technically, a loss of correlation to initial conditions), Andre
claims that the effects of our actions are (quickly) completely
divorced from the intentions of our actions. Since our intentions cease
mattering and are overwhelmed by accidents, neither Free Will nor
Morality has any meaning. When humans believe we can predict
consequences, we are merely being arrogant and incompetent, but in fact
incompetence is precisely how humans are evolved. In a chancy,
accidental world, variation is a better solution than optimality, and
incompetence breeds variability - there are infinite ways to be
"wrong", but only one way to be "right" (or optimal).
Astonishingly,
we, as a group, wholly agreed with him that humans are arrogant,
incompetent creatures, and we responded very sympathetically to Andre's
thesis that we are actually evolved to be incompetent.
This is quite a curious situation, because if we accepted Andre's
arguments, we should stop all our activist activities - because we can
never be at all sure if we are doing good; in fact, statistically the
effects of our actions are not correlated with the intent of our
actions. We should even stop doing medicine - at least, it removes all
moral impetus and justification for medicine. Trying to remove poverty
can as easily result in more poverty as it might result in less
poverty; trying to be good leads to evil as easily as it leads to good
- this is the terrible thesis that no one challenged. Why is it?
Because there was no argument against it, or because we are, in fact,
fundamentally cynical and nihilistic? Neither Andre nor I tried to push
all these colloraries into the throats of the audiences, but I am left
with extraordinary questions.
Dr.
Mikkelson moderated over a fascinating session, hinged around an
utterly curious theory he has developed, on a formula for ranking the
value of a particular species. The formula increases the value of a
species based on the complexity (behavioral and physiological) of
individuals of that species, but the value of each member of that
species is subject to decreasing returns: the 10th member of that
species is less valuable than the 9th member of that species, for
example. According to this formula, due to our enormous advantage of us
over, say, cyanobacteria, humans can justifiably grow at the expense of
them, but our advantage over even bumblebees are small enough such that
we should contract our population size.
Needless to say, such a
heretical theory was attacked in the most joyful manner by our members,
and I did not exactly stay out of the foray. Dr. Mikkelson
defended the theory valiantly, although some of us were left with
an uncomfortable feeling that such a theory could be developed to fit
any conclusion, and the value of such a theory would be highly doubtful
in any policy decisions - especially one that might result in
manipulation of our population size. Even so, it takes tremendous
courage to originate and present such a counterintuitive theory, and
certainly the controversy it generated did not surprise Dr. Mikkelson
in the least. This courage, and the fact that Dr. Mikkelson came in the
day after he received a minor concussion means he deserves our
admiration and gratitude!
The discussion of the history and meaning of the "Hippocratic Oath"
with Dr Faith Wallis was quite stimulating, as we learned about the
ancient ideals of ritual purity, some of the strange medical promises
within the original Oath (including not performing certain surgeries!),
as well as the deeper common values, such as confidentiality, integrity
and awareness of doctor-patient boundaries, between modern and older
Oaths. The Library Tour gave us a glimpse into the life of Sir William
Osler, why he is so famous, and some fun explorations of various
ancient anatomy and medical manuscripts!
Dr.
Brookes gave a quiet, smooth, and thoroughly engrossing lecture on the
slowly growing role of women in medicine. From the traveling lecture
circuit of Dr. Potts (where she had women-only session to teach ladies
sensitive information on sex and gender), to Dr. Abbott's velvet bound
letter (an effusive complicment from Sir William Osler on her work in
congenital heart disease), Dr. Brookes gave us an intimate look at
these women - not as tools of history, not as rascally trouble-makers,
but as utter humans whose thorough humanity is both the cause and the
effect of their importance. Amid beautiful photos, historical artifacts
(the Osler library actually has Sir
Osler's letter to Dr. Abbott, which she carried in her purse), Dr.
Brookes gently ribbed McGill - which did not accept female medical
students until the 40's and the Osler Society- the illustrious ourselves - refused to admit women members for many years after that, even when Dr. Abbott tried to intervene.
A
wonderful evening when I sang eloquence on the virtue of anime. Not too
much discussion, the movie spoke for itself. I hope I made my point
that (1) anime isn't just for children and (2) anime rises above, far,
far above, the mainstream opiates of Dragonball Z or Sailormoon. Ugh.
*Is reduced to a quivering pile of lemon froth*.
I
sincerely believe that the greatest anime rivals and surpasses the
greatest movies and TV done by real people. But then why anime, you
say? Why not real people? Because anime is crystallized emotion. It is
purer than real people. Anime does not represent the real world,
indeed, like all great art, it represents what the real world ought to be. Anime is literally closer to art than films of real people.
We expected a bombastic, raw knuckle, no prisoners discussion, and
we got it. Dr. Somerville is widely known for her controversial views
on abortion, gay marriage, and many other issues beside; today she came
in to share with us her thoughts on how physicians (a little like
soldiers, I suppose) cannot claim freedom from ethical responsibility
by simply "following orders", but must practice their individual
conscience in their daily work. That is, if a physician sincerely
believes abortion is wrong, s/he should not be made to perform this
operation through coercion of law, and should not even be asked to
refer to another physician.
When many of us rose in intellectual
fervor, we found that her opinions are far more nuanced than they may
seem at first go. Dr. Somerville supports coercing physicians to do
abortions if said abortion is necessary to save the mother's life, and
she does not support freedom of conscience in other matters, such as
euthanasia. Her response to the question: "will you support a physician
who wants to exercise his or her freedom of conscience to do abortions in a society where the consense and legal status is that abortions is not allowed?" was a little dodgy and vague, but bordered on a "no".
But
Dr. Somerville is a world class thinker and debater, and today she
showed us why. She deftly handled every one of our objections without
pause, or, it seems, effort. Unfortunately, every such experience with
her leaves an uncomfortable (not necessarily bad,
in fact discomfort is often a good thing) taste in my mouth. It seems
to me that she is too convinced of her own righteousness, and that her
basis of being so convinced is fundamentally rooted in her own
emotions. She will defend her position using philosophical,
utilitarian, economic and political arguments, in fact she will defend
her position using any argument at all. But to analyze her defense, it
seems to me, misses the point; she does not defend her points because
she feels her defense is good (although it is invariably excellent), it
is her position itself that is fundamental, and, it sometimes feels,
fundamentally unchanging despite any and all argument.
Many
of us were stimulated to write and think about the challenges she
raised to us. Check back to see pieces of our work! Overall, an
extremely valuable session. Dr. Somerville said that she may disagree
with many things, but she will fight to the death for people's right to
say them. We should hold ourselves to the same standard.
Members
of Osler Society were granted quite a treat in this lecture, where Mr.
Neher, a teacher of art history and philosophy at Dawson College, came
in to talk about how art representation of anatomy developed and
matured through the 15th to 19th centuries. Beginning with Byzantine
and Middle Age art, where representation was more symbolic than
realistic, he then traces the development of perspective from Brunelleschi
to modern times, and also follows the improvement of techniques for
tracing reality: from grids to the camera obscura. From these technical
improvements came deeper understanding of human proportion and anatomy.
Albert Durer
is a favorite of Neher, Durer's obsessive work in defining the standard
human seems to be the quintessential fusion of anatomy and art.
We
finally reach the great anatomy atlases of the 18th and 19th centuries,
and the Osler Librarians brought out truly extraordinary pieces of
their collection. One of the atlases was at least a meter and a half
tall, the height of a small person. Some were hand painted in dream
like colors, all positioned their bodies in poetic and disturbing
postures. One in particular, "The Angel", of a lady whose back was
exposed - as in anatomically exposed - with two large flaps of skin
spread to the side like wings - has a peculiar way of burning its way
into one's eye and mind. All in all, a visual and mental feast into
art, history and anatomy.
Dr. Davis is Chair of the Canadian NGO AHED-UPSED
(Academics for Higher
Education and Development - Universitaires pour l'education superieure
et le developpement). He spoke about the desperate need many countries
have for doctors, such as Rwanda and Ethiopia - but the great dilemma
is that these are the same countries least equipped to provide doctors
for themselves. What is the solution, then? A great programme of
barefoot doctors, people trained with minimal but essential medical
skills? Certainly, but at the same time, should we seek to provide for
them a system of experts, full-fledged doctors trained to our own
standards?
Bringing
doctors from these countries here to study necessarily results in a
great brain drain. Training these doctors in their own countries, in situ,
as it were, is a better recourse. Dr. Davis sponsors academics to go to
developing countries to further educate existing personnel, in the
hopes of creating high level experts within those countries. It is
perhaps a difficult tactic - high level experts presume a high level of
social infrastructure before their potential is maximized - but this is
the chicken and egg problem; it also takes experts to create that
infrastructure. My recent trip to Belize, working with its lone
psychiatrist trained at McGill, convinces me of this fact. We therefore
all greatly hope the success of Dr. Davis, who sorrow'd over the fact
that "I must sleep, sometimes...", and hope that you will check out
their website: AHED-UPSED, and support this great cause!
Dr. Roland del Maestro is a world renowed neurosurgeon with, peculiarly
but enviably, a passion for Leonardo da Vinci. It began in a course on
the psychology of Genius, where the professor's task is for students
to favorably compare a character to Mozart - no mean task. Dr.
Del Maestro chose Da Vinci, and it lauched him on a lifelong adventure,
as well as having one of the largest private collections of Da Vinci
materials in the world. This formidable presentation was enhanced by
the other large da Vinci collection - that of the Osler Library.
The presentation focused on Da Vinci's fascination with grotesque
figures and faces, which Da Vinci usually drew in complimentary pairs -
usually a man and a woman facing each other, with protruding noses and
wicked chins, complete with warts, gnarly teeth, straggling hair and
other accessories. Later collectors found them disturbing (not to
mention the Church), and these pairs were cut in two. Happily, inkings
of the paired faced often survived.
Dr. Del Maestro gave the uplifting message that Da Vinci was able to
look beyond beauty, finding humanity even within the mutilatingly
disfigured members of our race. I cynically wonder to what extent was
it
simply Da Vinci's boredom, since Tolstoy has already hinted that all
beautiful people are alike, but all grotesque people are grotesque in
their own way. But even if that were the truth, Dr. Del Maestro's
belief is by the far more productive.
This was a bombastic discussion, beginning with a Christian Right's
advocacy video of how developed countries (here, synonymous with
Christian countries) have declined in population while other
nations, particularly African and Islamic, have increased.
Through the simple mathematics of demographics, the video intoned,
Western Civilization will simply become extinct. A curious turn came at
the end of the video, where gays and non-married couples were lampooned
as being among the causes of the decline.
Dr. Clark then spoke a dark phrase: "Demographics is destiny". For all
the ideological gulf between the video and our liberal beliefs, the
video was not misquoting numbers; indeed one day Great Britain can
become dominatingly Indian or even Arabic, and France be seen as an
extension of Morocco. Beyond a change in population composition, simple
growth is also a problem. The Green Revolution has slowed, the energy
sources we rely on are proving to be limited, criticism of Malthusian
pessimism must cast their nets ever wider for solutions.
To what extent are we comfortable with government interference in
family planning? Singapore offers hard cash to those with high
education to produce children, while imposing stiff penalties on those
with lower education - soft eugenics. But if governments are seen to
have a responsibility for future generations, such interference may not
simply be permissible, might they be necessary?
Personally, I am untroubled by a change in population composition, so
long as the great cultures of the world thrive. The vigor of such
cultures reassure me that this ought to be the case; as long as wine is
being sipped and Voltaire quoted, the French are doing quite well -
regardless of the genetic composition of the sipper and the quoter.
Similar, someone of African origins, if s/he recites Confucian and
ponders the Dao De Jing, that is Chinese enough. The worthy
endeavor here, in my opinion, is not the restriction on immigration,
promotion of birthrates / marriage (and conversely introducing birth
control in "less benign" countries), and banishing homosexuality; the
task is to simply bring out the worthiest portions of every culture, so
they are propagated without regard to national and racial lines.
As for overall growth, demographics may well be destiny - but I do not
see that destiny any more clearly than the destiny marked out
by economics, science, and historical inertia. The
seventeenth century would never have foreseen the decine in birthrates
now held as standard in developed nations. A Malthusian
disaster may come to pass, but we should not be too certain. We still
blindly navigate a path as if in a storm or dense cloud, our increased
ability to foresee is made naught by our vastly increased acceleration.
The bends and falls of the road soon to come are hidden from us.
Now, I feel, more than ever, we must cultivate diversity and
variability of solutions: any economist will tell you to hedge and
diversify in risky times. When the bends and falls come, we
can simply hope that some segment of existing society proves capable of
handling the new challenge. Biological success is achieved by deepening
the gene pool, I feel we must deepen our cultural pool.
Some
of us decided that black humour was good, others decided it was bad -
but certainly none were indifferent. Our group was varied and deep:
from the full spectrum of medical
students to a law student who is also a stand up comic to a doctoral
student in neuroscience, together we circled the topic warily.
What is black humour? Is it simply humour that is dependent on the
suffering of others? Is I slipped on a banana peel and my
girlfriend laughs at my stupidity, is that black humour? A
surgeon in the OR making macabre comments on the fat of an obese
patient or an ER doctor ridiculing a drug addict for his or her
weakness is certainly black humour, but what if the patient makes those
same comments about him or herself?
We
quickly realized humor is context-dependent: if I had
seen close
family seriously harmed through a similar accident as the banana peel,
I may well interpret my girlfriend's actions as black humour of the
worst type. Is that a misinterpretation,
and is it a negative indicator of my girlfriend's character? Cafe
attendees pointed out many instances where physicians seem to
comment humorously on their patients without suffering, it seems, a
degradation of their ethics. Other participants witness jokes and other
humour that they found truly offensive. Certainly the medical
literature's consensus is that such humour should be limited .
If
we cannot agree if black humour is good and bad, then I feel clearly
"blackness" is not the proper divider or category of that type of
humour which we feel to be bad. I was enormously enlightened when I
challenged the group: are
there any humour not dependent on the suffering of others?
Someone immediately answered: of
course!The
example was puns, and other pure ridiculousness. A group of us debated
that for a while, and it dawned that we laugh not at suffering, but at
absurdity. Humour, it seems, is our reaction to irremovable cognitive
dissonance, to the raw madness, absurdity and ridiculousness of an
usually mysterious world. Yet in this world it is suffering that we
most often find to be absurd. A person works hard, helps others, is a
model human being and yet suffers ten years of horrid cancer at the
end. There is an incongruence there which our intellect can grasp, but
our emotion cannot swallow. In these cases, when the sorrow has finally
passed, a tragic humour will remain - much as some of us can laugh - a
bitter laugh, true - at Nazi concentration camps or the Cultural
Revolution; it is a laugh at their madness.
What we find to
be unacceptable in humour, then, is not a focus on
suffering
(self or other). Rather, it is a malevolence, real or interpreted, an
ill-intent that may transform into action. This malevolence is
injurious and offensive in all expressions; that it is often combined
with humour does not mean it is
humour, either humour's cause or effect. It is this
malevolence we ought to limit, even ban outright, not humour.
There are few hotter topics today than feminism. No other so thoroughly
counter-intuitive idea - that there really is
no man and woman, at the most there is male and female - have made such
an inroad in our society. The race debate had settled on race as being
culturally constructed; is gender also completely culturally
constructed, with no basis in biology? If it is culturally constructed,
then is it completely arbitrary, and can we literally wish it away?
Will it be replaced by something else, or can we, in fact, do without
any notion of gender?
I almost feared stepping into the
debate, so explosive it was during the session. No other topic brought
such extremes of opinions - from gender being nearly completely
biologically based, through anatomy and genetics - to the
other
extreme, whereby each person ought to have his or her own gender, being
forced into no category simply due to anatomical or genetic accidents,
which do not in all cases determine self-recognition anyway.
With
the certain doom of being called a male chauvinist and
then burnt
at stake, I feel unmoved in my certainty that of all the
categorizations in this world, while gender may have done as much harm
as any - race, class, caste, profession, age - it is probably among the
least socially constructed. Undoubtedly, race is historically
constructed (see Brace 2005 - there are only clines and gradients in
"race", no clearly demarctions), class and caste and profession are
entirely constructed, sex and age seem to be have more biological
reality than the others. Thus, just because gender is socially
constructed does not mean it is arbitrary. The few cases we brought up
(the child who was born a male then lost his penis, was brought up as a
woman but decided he was a man) proves no laws about gender, but does
disprove certain laws about gender. Just that it can be reimagined does
not mean, in my view, it can be abolished competely.
Although I
deeply sympathize with the feminist motivation that enormous harm have
been committed in the past, many of which ought to be addressed and
readdressed, our goals ought, in my view, be social improvement, not
radical deconstruction. Do even the extreme feminist construct nothing
about the world? Do they classify no one? Am I me, or am I a male
chauvinist? If I see you not as a woman, will you not see me as human
being, until I prove to you I am neither a dog nor a chimp,
nor
anything in between? (I will burn in hell for the last statement).
We
tend to think of Canada as having a universal health care system. The
cracks in this system are many, however, and people fall through it
daily - sometimes with catastrophic consequences. Whether you are a new
immigrant on a three month wait or you're bouncing between statuses
waiting for our bureacracy to process you, Medicare will not
cover you. If you're sick under one of these
conditions, hospitals
are reluctant to take you in and may scare you away with threats of
calling immigration or giant bills, and collection agencies will run
after you - with the said gigantic bills.
Rachel, from Project Genesis
give us a chilling account of doctors withholding birth certificates
from mothers who cannot pay their hospital fees. This is against the UN
Charter of Human Rights, which declares everyone has a right to
identity. An even scarier Gazette article was pulled to light, where
such practice was condoned, and fearmongering against new immigrants -
who form a truly miniscule part of our health budget costs - accusing
them of "maternal tourism", whereby they enter Canada, give birth and
leave - an accusation without any grounding in facts or ethics.
Two
pediatric residents also joined us from this session, and they cut to
the heart of the problem when they said it was a matter of good faith.
Will Canada, as a country of immigrants early and late, be willing to
trust its new immigrants that they will, like the current residents,
become strong contributers to Canadian society? Or will Canadians breed
a mistrusting culture of self-righteousness - they have not contributed to our
society, why should we care for them? The only answer to
that is by caring for them, they will have a chance to contribute.
Some
reductionists are calling for the merging of psychiatry into neurology,
trumpeting that since all thoughts are in the brain, it is through
treatment and research of the brain that all mental illnesses will be
cured. To the enlightened psychiatrists, of course, this sounds nothing
more like another form of cultural induced madness - culturally induced
from a few centuries of heady rationalism and reductionism, and mad
because it bears no resemblance to reality.
My own philosophical
axe is that yes, with no doubt, all thoughts ARE in the brain, and the
brain IS made up of chemicals, and chemicals ARE, ultimately, made up
of quarks and leptons. This weak reductionism is patently true on
inspection. But to confuse this weak reductionism with the strong
reductionism where we also believe the most useful research direction
in mental health is through the dissection of thoughts into brain
matter, brain matter into chemicals, well, that is a mad confusion
indeed. A unsuccessful caveman is the one who had to
know quarks to make fire.
Dr.
Gold put his fingers (or rather, a philosophical sledgehammer) on the
pulse of the problem when he said that the lung is not understood when
we have taken it apart to its tissues and cells, it is understood when
we manifestly see those tissues and cells working together to perform
the function of
the lung. How
the brain "secretes" thought is very far from being understood, and
taking it apart to its cellular level will not construct that
understanding. That understanding will come from disciplines such as
psychiatry or anthropology, if anywhere.
As a group of future
doctors, our concern with the problem is clearly not theoretical but
practical: members are much less interested in issues of fundamentals,
but in practical issues of how
does this translate to better treatment? This concern
gives us a powerful shield against any reductionism.
Dr. Giovanni spoke of the Homo
Sacer
- that peculiar breed of human beings lying between life and death,
who are, in a sense, left-over flesh stripped of personhood. Example of
abound: Jews in Nazi concentration camps, our criminals who are
condemned to death, humans immediately after they are pronounced brain
dead. These people, or more properly, these mounds of flesh, cannot be
legally killed, as they have been stripped of "someoneness". Scientists
and doctors have utilized these Sacer
creatures as test subjects and organ donors without the moral
difficulty of using subjects who have full personhood. What is the
line, then, between life and death? Must this line be only arbitrary?
Can we look to something for higher authority? Can nature, in some
sense, make a particular decision more "natural?"
A muddled but
fantastic conversation followed, as we clawed and tangled with
ghostly subjects who seemed to disappear every time we confront them -
only to strangle us from behind. By the end we still have not agreed on
a definition for "nature" (is it simple "everything"? Is it the
"default" position? Is it "non-humanness"?) or for morality. However,
some deep points emerged: our morality is a function of our knowledge
and power. As we increase in knowledge and power, the things we take to
have moral status increases. Heart stopping is no longer a criterion of
death because we have knowledge of brainwaves and we have the power to
manually beat the heart, if we must, ad infinitum.
Again, over
30 people came. As we neared the end, we heard angry yelling
by overly enthusiastic participants who decided to take their
differences outside. Then we knew all was good.
Dr.
Hutchinson began by describing the pharmaceutical industry as
"psychopathic". There's no moral connotation in that, merely the
objective description that the first duty of Big Pharma is to
their stockholders and profit making. Hence, they are psychopathic in
the sense that they're purely committed to looking after themselves.
Dr. Hutchinson then asked: is it possible to work with a psychopath? If
so, how? If not, how can we change the current situation?
The
conversation romped all over: comparisons of the anti-Pharma movement
to the Green movement in the 60's, the nature of altruism and could all
altruism simply be psychopathy in disguise, possible evolution and
revolution of society, and an excellent illumination of the subtle ways
Big Pharm
can change perspectives and forge research beneficial to itself. The
last is not done through bad
research, but through excellent research pursued in directions that
will profit it - hence the current focus on pills and molecules, as
opposed to holistic and preventative healing.
As a
participant, I certainly have my own philosophical axe to grind.
Shamelessly, I'll write my own take: the problem is not
whether
phamaceutical companies are psychopathic, I think it is a problem of
balance of power. Members of a complex system, each with their own
roles, are allowed to be psychopathic - our liver cells doubtlessly
seem psychopathic to free-living amoeba, obsessed as our liver cells
are with its peculiar functions. Problems arise when any
particular psychopath has so much power that it can pull all of society
in its wake. There is no need to change the nature of the Pharm
industry, I feel, merely to put them in balance with the other
interests of society. How to do that, I leave for speculation on
another
day.
Just under 50 people participated, a wonderful time.
Dr. Thomas Schlich discussed how the Austrian physician Lorenz Böhler
revolutionized fracture care within the context of a field hospital
during the First World War. We learned that based on the philosophies
of rationalization and the increased importance given to efficiency
during this time, Böhler developed a new system of techniques and
technologies, including various machines for immobilization, impeccable
record-keeping and a new use of photography, that standardized fracture
care.
Dr. Schlich elaborated his insights into the nuances of the enabling
conditions of war, why Böhler was particularly successful in promoting
his method post-WWI in Austria, while others were less successful in
spreading and institutionalizing a standardized method -a very
interesting talk indeed, with lots of questions and sharing of new
perspectives!
Over 30 people attended - the new year is kicking off great.
