When doctors go wrong | thearticle

Jack the Ripper “operated”, so to speak, in the Whitechapel area of London in the later part of 1888. Because of the nature of the injuries he inflicted, some of which were fatal, it was

suggested at the inquest of one victim that he must have had “anatomical knowledge” (who hasn’t?) and the hypothesis was floated that he might have been a doctor. This is fanciful, as

whoever the Ripper was (see below), he clearly was not constrained by the normal medical practice hours. He did most of his work at night. Try getting a GP at that time. Jack the Ripper was

_not _a doctor, but the idea that he might have been has exaggerated, in the public mind, the seriousness of his transgressions. We trust our doctors to, at the very least, offer as little

violence as possible. And when they “go wrong” it seems gratuitously shocking. We are surprised, but _why _are we surprised? They have form. An inquiry into the activities of the “rogue

breast surgeon” Ian Paterson (pictured) concluded that he might have mutilated more than 1,000 women during his tenure at the privately-run Little Aston and Parkway hospitals in the West

Midlands. This would have involved the compliance, even if only by incompetence, of support staff, fellow surgeons and the wider cultural context in which the medical profession is assumed

to be at one with virtue. And that connivance includes most of us. Mr Paterson exploited a culture of trust, but that doesn’t exonerate those who contributed to that culture. If you trust

someone, and they turn out to be sinister, that’s a failure on your part as well. John Bodkin Adams probably initiated a shuffling off of the mortal coil of quite a few of his patients and,

it has to be said, did quite well out of it. The most famous murderer of the Victorian age was Dr Crippen who, to be fair, was a bit more of an aromatherapist-snake oil type than your

genuine consultant (and might well have been innocent anyway). And step forward Harold Shipman, a man whose inclination in the direction of non-voluntary euthanasia is astounding. He didn’t

muck about. (Shipman was, incidentally, a particular favourite of my late grandmother who, having moved at the age of 80 into sheltered housing, decided that elderly people are intolerable:

“We could do with him in here”, she said.) Despite these glaring anti-Hippocratic examples, we tend to believe that the red-faced and bloated GP sat opposite us who is telling us to take our

shirt off must actually be obeyed. Why? Michel Foucault didn’t get many things right but one claim that was central to his work applies in this case: that sometimes the best way to

understand relationships is to look at them in terms of the underlying structures of power. What more imbalanced power-relationship can there be than that between doctor and patient? When a

patient walks into a GP surgery, they are vulnerable by definition; when they willingly submit themselves to the verdict of the GP their vulnerability is amplified. Authoritarians, bullies

and people who enjoy being at the apex of the power structure will seek out those opportunities. The Foucault analysis captures a broad point, but it doesn’t explain everything. Because

within the pertinent power structures are encapsulated the vagaries of human intention. It might well be that Shipman and Paterson exploited their power, but they might have done so for

different reasons. In fact, they probably did: in the case of Shipman there was a financial motivation; for Paterson it’s difficult to avoid the conclusion that part of his motive was

sexual. I’ll put this conjecture out there as well: that to be a doctor is necessarily to see the patient primarily as object rather than subject (in the Kantian sense). If I’m going to

treat you effectively, that necessitates that I regard you as a physical object in the world, and that at the point of diagnosis I might lose focus on you as something more than your mere

physical body. That’s a morally dangerous situation to place yourself in when it comes to the everyday transactions that we have with each other. These, as Roger Scruton argued, cannot be

conducted on the basis that we are objects in the world, but that we are irreducible perspectives on it as well. I salute the work of doctors. I’m surprised that not more of them “go wrong”.