Medical Humanities Blog

Medical Humanities Lexicon: Theodicy

Today's entry in the Medical Humanities Lexicon is "theodicy."

I believe in the sun even when it is not shining.

I believe in love even when feeling it not.

I believe in God even when he was silent.

This refrain was inscribed on the wall of a cellar in Cologne, Germany where Jews hid from the Nazis.  It was found by Allied troops in 1945.  Aside from its stark beauty, it neatly encapsulates the problem of theodicy, which is roughly defined as the question of how God can be perceived as good, right, or just, given the existence of suffering and evil in the world.

The problem arises as a dilemma in the technical sense.  Given the phenomena of evil, there are apparently two possibilities: either God is incapable of preventing the evil in question, or God is capable of preventing that evil but chooses not to do so.  The first option seems unsatisfying because it denies omnipotence to God, which is deeply problematic at least for many who ascribe Judeo-Christian beliefs.  The second option is arguably worse because it problematizes the notion of a just, benevolent God; how could such a God choose to permit such evil to occur? How could God be silent in the face of such suffering?

The problem of theodicy, which is sometimes referred to as the ontological problem of evil, is at least as old in Judeo-Christian traditions as the Book of Job itself, which is a marvelous albeit deeply troubling work.  To provide a basic narrative, Job is a righteous person who has generally enjoyed good health and prosperity.  Suddenly, and for no apparent reason, a number of horrific calamities befall him.  He loses all of his money, his children die one by one, he becomes afflicted with a number of gruesome illnesses, etc.  He naturally begins to wonder why his life has taken such a sharp turn, especially given that he has generally lived a life of piety.  This last point is important, for it is no answer to Job's problems to assert that his current misfortunes are his just desert, for there is no suggestion anywhere in the text that Job has perpetrated any works that would merit such punishment.

Job's problem, of course, is the problem of theodicy: the innocent suffer.  How can God justify it? How can God be both all-powerful and benevolent if the innocent suffer? The remainder of the text consists generally of a dialogue between Job and his peers, who assert the point I have already suggested is unpersuasive: Job's misfortunes must be linked to his own sins.  The idea that suffering is linked to personal sin is pervasive, especially in Judeo-Christian morality, and, in On the Geneology of Morals, Nietzsche provides the most eloquent explanation for why this idea maintains such currency: “[t]he meaninglessness of suffering, not suffering itself, was the curse that lay over mankind so far . . . .” (162) The sin-suffering narrative is so powerful precisely because it engenders meaning in the face of suffering, which may be more tolerable than the idea that suffering is entirely arbitrary:

suffering was interpreted; the tremendous void seemed to have been filled; the door was closed to any kind of suicidal nihilism . . . it placed all suffering in the perspective of guilt.  But all this notwithstanding -- man was saved thereby, he possessed a meaning; he was henceforth no longer like a leaf in the wind.

Ibid.

Job, however, rejects this narrative.  He insists that he is blameless, though his peers repeatedly return to the sin-suffering link both to explain Job's misfortunes and to preserve the notions of an omnipotent benevolent God.  In chapter 21 of the Book, Job moves to preseve the notion of a just God at the expense of the notion of an omnipotent God.  He argues not that God rules the world unjustly, but that he does not "rule" it all.  In a conception that presages the Deist ethos, the world just runs on without divine control.

God eventually appears, but one of the most fascinating puzzles of the entire Book is that God never answers the problem of theodicy.  Rather, God points out the immense chasm separating human and divine knowledge, and implies that he is uniquely concerned with the plight of humanity.  But he never provides a resolution to the dilemma.  Interestingly, Job is utterly satisfied with this response.  Some exegetes have interpreted this climax as signfying Job's relief at the presence of God.  God is no longer silent, to return to our original quotation.  His presence alone soothes Job, even if he supplies no answer to the problem that has been causing Job such anguish.

The paradox here is rather profound.  While Job may be soothed by being close to God, he could not be farther from divine understanding, as God himself reminds Job.  Many Jewish thinkers have attempted to resolve this paradox in one of two principal ways: (1) tracking Job's reaction, some commentators, most notably Maimonides have accepted the epistemic gap between human and divine comprehension, but have argued that suffering may be transcended through closer relation to the divine presence itself; or (2) some commentators, especially 20th century thinkers, have adopted Job's earlier tack, and begun to reject the notion of an omnipotent deity.

Maimonides, roughly contemporary of Aquinas, was arguably just as enamored with the concept of right reason as was the latter.  He suggested that through our intellect we could transcend our material existence and the suffering that accompanied it and move closer to God.  Though I admit to finding the transcendentalist response deeply unsatisfying, one arguably redeeming feature of the Maimonidean version is that it places the onus on humans to work out the problem of theodicy.  According to Maimonides, we cannot expect God to solve this problem for us.  It is humans who must grapple with it.  This response to me sounds remarkably familiar to one of my favorite essays ever, one which holds great personal significance for me, Camus' Myth of Sisyphus.  It is Sisyphus who choose his own fate by pushing the boulder up the hill.  Il faut imaginer Sisyphe heureux.

While transcendentalism maintained a powerful hold in Judeo-Christian thought for centuries following Maimonides, it became increasingly difficult to stomach after the Shoah.  Richard Rubenstein argues that "[t]he fact of Auschwitz rules out such ideas forever" (Leaman 187).  Moreover, the notion of a God who is utterly detached from the suffering of his children is deeply problematic for a tradition built upon the negation of that notion.  Harold Kushner, in his well-known account of his attempts to make meaning of the death of his son, escapes the theodic dilemma by rejecting God's omnipotence.  He observes that he can worship a benevolent but not all-powerful God, but that he cannot worship an omnipotent being who allows the innocent to suffer so.  Elie Wiesel adopts an entirely pragmatic approach: to abandon God would be to grant success to the hopes of the Nazis in seeking to exterminate a Jewish way of living and thinking.  Thus, belief in God is a pragmatic course, though he does not offer any resolution to the problem of theodicy itself.

Finally, Leibniz proposed that this world, even with its significant evils, is the best of all possible worlds.  Under this analysis, all actual evils are essential ingredients in the divine plan in which this world remains the best of all possible worlds.  To omit these evils would wreck the entire design itself.  Numerous commentators have criticized this proposal on many different grounds, the most obvious of which is that it seems to rely on a brazenly consequentialist ethic.

It should take no great exercise of moral imagination to see the connection of the problem of theodicy to the medical humanities.  The question of how an omnipotent, benevolent God can permit the innocent to suffer remains a profound problem for many, both for providers and health care professionals, and for patients and caregivers (each of whom may well take on both kinds of roles in their lives on multiple occasions).  Of course, the problem of theodicy is no problem at all for atheists, and there are certainly non-Western belief systems which are untroubled by the problem because the relevant deity or deities is not deemed omnipotent to begin with.

Nevertheless, I submit it is safe to suggest that there are many participants in medical practice for whom the problem of theodicy is profound and agonizing.  Even outside of a Western religious paradigm, Eric Cassell, one of the chief authorities on suffering, states that "[t]ranscendence is probably the most powerful way in which one is restored to wholeness after an injury to personhood" (45).

And even for those untroubled by the problem of theodicy, the sin-suffering narrative has demonstable clinical effects.  Some patients, for example, do not request adequate pain management because they feel that the pain is their just desert for the sins they have committed.  Through their suffering, they hope to expiate their sins.  Susan Sontag's Illness as Metaphor highlights some of the ways in which the suffering of cancer patients is linked to sin.  Saul Brody's seminal work on the history of leprosy shows an even closer link between illness, suffering, and sin.  Arguably, part of the impetus for such a narrative is that it resolves the problem of theodicy.  If suffering is linked to merit, or lack thereof, the notion of an omnipotent, benevolent God is left untroubled.

Thoughts?

____________________________________________________________

Bibliography

Mitchell, Stephen, trans. The Book of Job.  New York: HarperPerennial Press, 1987.

The Cambridge Dictionary of Philosophy, 2d ed., s.v., "Theodicy."

Leaman, Oliver.  Evil and Suffering in Jewish Philosophy.  Cambridge: Cambridge University Press, 1997.

Freeman, David L., Abrams, Judith Z., eds.  Illness and Health in the Jewish Tradition.  Philadelphia: The Jewish Publication Society, 1999.

Kinzbrunner, Barry.  "Jewish Medical Ethics and End-of-Life Care."  Journal of Palliative Medicine 7, no. 4 (2004): 567.

Barilan, Y. Michael.  "Revisiting the Problem of Jewish Bioethics: The Case of Terminal Care." Journal of the Kennedy Institute of Ethics 13, no. 2 (2003): 147.

Cassell, Eric J.  The Nature of Suffering and the Goals of Medicine.  Oxford: Oxford University Press, 1991.

Kushner, Harold.  When Bad Things Happen to Good People.  New York: Avon Press, 1981.

Nietzsche, Friedrich.  On the Geneology of Morals.  Translated by Walter Kauffman & RJ Hollingdale.  New York: Random House, 1989.

Kapeli, Silvia.  "Between Suffering and Redemption: Religious Motives in Jewish and Christian Cancer Patients' Coping."  Scandinavian Journal of Caring Sciences 14, no. 2 (2000): 85.

Gunderman, Richard B.  "Medicine and the Question of Suffering."  Second Opinion 14, no. 1 (1990): 16.

Rahula, Walpola.  What the Buddha Taught.  New York: Grove Press, 1974.

Sontag, Susan.  Illness as Metaphor and AIDS and its Metaphors.  New York: Picador Press, 1989.

Brody, Saul.  The Disease of the Soul: Leprosy in Medieval Literature.  Ithaca, NY: Cornell University Press, 1974.   

Literature Review

Today's review will collate abstracts from:

Social Science & Medicine

Journal of the Kennedy Institute of Ethics

Disability & Society

Exhibit & Medical Humanities Lectures on Pain

Stacey Tovino over at Hamline University's Health Law Institute sent me a great link to an exhibit at the International Museum of Surgical Science (Chicago, IL):

The Universal Condition: Enduring and Alleviating Pain

Nearly every human being experiences pain at some point in life. “The Universal Condition” will examine issues in the perception of pain and chronicle medicine’s quest to relieve it, from the ancient use of psychoactive plants to contemporary laser therapy, focusing on milestones such as the discovery of anesthesia. Case studies will provide an in-depth look at some common pain syndromes, explaining their causes and available treatments.

Featured in the exhibit are historical artifacts from the Museum’s extensive collection, including prehistoric Peruvian trephined skulls, 19th-century anesthesia inhalers, and packaging for patent medicines containing opium, cannabis, and belladonna. The exhibit also showcases products and innovations in use today for the control of acute and chronic pain.

The exhibit is accompanied by a medical humanities lecture series on pain and pain management (related, but not the same, IMO), which includes talks from all manner of pain professionals and ethicists.  Looks fascinating; those of you in the area might enjoy it.  Those of us out of the area may be jealous.

Disability Blog Carnival # 7

Head on over to Disability Studies Blog for Disability Blog Carnival # 7.  All sorts of great stuff there.  Don't forget we have the honor of hosting Disability Blog Carnival # 8, so send us your links and stories.

ADDENDUM: The theme for Disability Blog Carnival # 8 is "contact."  I know that is somewhat mysterious, but I certainly hope it is interpreted expansively. 

Desiderius Erasmus

Today's installment in Who's Who in the Medical Humanities is Erasmus.  I'm somewhat surprised it's taken me this long to address Erasmus in context of medical humanities because Erasmus, like Montaigne, is something of a personal hero of mine.  It's those late humanists that particularly seem to move me (count Vesalius and da Vinci among them for sure, and Machiavelli's thought is often late humanist in content and style, though he lived earlier than all others mentioned here).  As usual, the Who's Who posts begin by surveying the thinker's life, briefly showing connections to humanist instruction and themes, and then moving on to suggest some possible relevance for the practicing medical humanist.

[Note: Biographical information is largely drawn from the online Catholic Encylopedia's entry]

Erasmus was born around 1466 in Rotterdam, an illegitimate child.  At the age of nine, Erasmus "was sent to the school of the celebrated humanist Hegius at Deventer, where his taste for humanism was awakened and his powers of mind received their bent for life."  Id.  Erasmus showed brilliance at an early age, but was derailed by the death of his parents in his early teens.  He entered a monastery school for two years, which he described as "lost years," and then he wandered for some time until his guardians forced him to enter the monastery of Emmaus.  While he did not care for the monk's life, he spent much of his time reading classical authorities, and studied Lorenzo Valla's work as well. 

After leaving the monastery, he entered the Bishop of Cambrai's diplomatic service, and was sent to complete his studies in Paris, but quickly found nothing but contempt for Scholastic pedagogy.  (Already we can see two significant elements of the Renaissance humanist: the immersion in the classical canon, and a distaste for the logic and disputation of Scholastic method).  Id.  His English friend Colet urged him to abandon Scholasticism and devote himself to Scriptual studies, after which Erasmus set about gaining facility with Greek and Latin at Paris and Louvain.  Id.  He began to publish (in the first decade of the sixteenth century), and thereafter sojourned through Italy, receiving an honorary Doctor of Divinity at Turin, and meeting distinguished humanists in Bologna, Padua, and Venice.  He was received well by the cardinals in Rome, but earned both fame and controversy in 1509, when he published In Praise of Folly, which heavily satirized the Catholic Church.

He became a professor of divinity and of Greek at Cambridge, and spent time living in Basel, England, and Louvain between 1514 and 1521.  The Colloquia was published in 1519.  Erasmus' perspectives on the Church must be located in some of the obvious religious tensions of the time, and Martin Luther's activities dialectically interacted with traditional Catholic authority.  Erasmus found himself in a most awkward position, according to HistoryGuide.  He was reviled by traditionalists for igniting the Protestant "heresies," and villified by Luther and his adherents for refusing to give up on the Catholic church and join the protestants. 

And this tough spot is where I want to pick up the question of Erasmus's relevance for the modern medical humanist.  Much of this discussion raises points suggested by Gary Remer in his outstanding book, Humanism and the Rhetoric of Toleration.

Erasmus exchanged many letters with Luther.  Each saw the other as important and worth engaging for a variety of reasons.  Erasmus's undying hope was that through dialogue and cultural exchange, Luther's relatively uncompromosing positions could be accommodated with Catholic authority such that violence could be avoided.  The use of discourse as a pressure release, as a way of preventing war is as humanist an idea as exists (if we recall the studia humanitatis as being characterized in part by a reference to classical sources in the service of virtue).  Erasmus adopted numerous means for facilitating such a dialogue, one of which was his constant focus on the notion of adiaphora.

Adiaphora in Greek means "indifferent things."  Erasmus argued that the number of tenets any Christian must believe in order to "be" a Christian were few in number.  On these core precepts, dissension was not possible without departing from the Christian domain.  On all other matters, which comprised the vast majority of subjects for theological debate, Christian persons of reasonable mind could disagree in good conscience (and all remain Christian, or catholic, in the literal meaning of the word).  These adiaphora were not determinants of Christian identity.  In this way Erasmus sought to accommodate divergent views on faith, salvation, doctrine, and practice.

It should not take too much to see some basic implications for the modern medical humanist.  First, there is the ardor with which Erasmus sought to use dialogue as a way of mediating conflict: this is arguably a paramount role for ethics consultants.  Second, Erasmus's method is ingenious as a way of promoting accommodation of plural views: identify core points upon which some kind of accord seems possible, and suggest that reasonable persons in good conscience can meaningfully debate adiaphora (and these core points need not be universal principles; they may simply be what I like to think of as contingent commonalities, shared perspectives that simply happen to be shared in the particular context at issue).  And note that the notion of adiaphora and Erasmus's political objectives animate a conception of dialogue in the service of a practical, virtuous aim (the prevention of bloodshed).

Perhaps it is not too strong to suggest that the quality of the discourse itself in both medical humanities and bioethics practice could be enhanced if discussion proceeded along Erasmian lines of attempting to disentangle adiaphora from core precepts and working to build assent in the latter.  Of course, it must be noted that Erasmus's objectives were not realized, and wars rooted in religious, among other, disagreements, raged across Europe for the next century and beyond.  Thus, to invoke Erasmus in the service of enhancing conversation and discourse is not to trumpet a utopian ideal, but to suggest there is much to learn from Erasmus' efforts.

Along similar lines, Erasmus spent much time differentiating the roles the orator could take.  Embodying the profoundly humanist notion (traced back to Cicero and Quintillian) that speaking could only be effective (in promoting virtue, of course) if it was strictly tailored and shaped to the particular audience being addressed, Erasmus noted the different patterns of discourse in the contentio and the sermo.  The former exists where the speaker and the audience have different levels of knowledge, perhaps asymmetrical information.  The setting of a contentio is advocative in nature; the speaker aims to exhort, to persuade, to convince.  The objective is persuasion, not necessarily enhancing conceptual knowledge or even collective understanding.

By contrast, in a sermo, the participants are all knowledgeable on the subject of the discussion, which operates more like a dialogue between respected colleagues.  Obviously, if one seeks to enter into a sermo and begins using rhetoric and methods more suited for the contentio, learning may be frustrated and discourse diminished.  This idea of tailoring oration to suit the audience and the aims of speech is the classic rhetorical principle of decorum, suggesting an etymological link for the conceptual point addressed earlier:  the suggestions Erasmus makes for enhancing discourse and communication on matters of public debate are tied to understanding rhetoric and audience.  To the extent the latter is correlated with better communication, this literally is a a core tenet of the humanist project: to use rhetoric in the cultivation of virtue (or virtuous acts, like communicating better).

There is a small but growing bioethics literature on the importance of communication, highlighting the notion that the quality of the communication itself is of ethical content.  Erasmus would probably have agreed.

I Promise Not to Steal the Microwave

I have the most amazing case of stage fright. I can mouth off without thinking in front of the people I respect the most (from colleagues to faux news pundits), but put up one post on someone else's blog, and I freeze faster than a deer in headlights. Of course, I realize that the key here is that I've the time to think, and worry about reaction, whereas when I'm actually talking to someone, I simply act and react (and flip out later). Still, it is mind-boggling in an amusing sort of way.

Anyhow, Daniel approached me several months ago about guest blogging, and I was quite flattered. However, as he noted, I do already blog for another site, the Women's Bioethics Blog, as well as my own blog , and one of my main concerns was how would I decide what belonged where, blog-wise. Thinking about where to blog what rather closely mirrors the major decision I had to make about graduate school. In sort of a funny train of thought twist, the choice was between my current department of Philosophy at the University at Albany, and amusingly, Daniel's - the University of Texas Medical Branch's Institute for Medical Humanities. Bioethics or the medical humanities?

Of course, we have definitions for both subject areas, but to be honest, as an outsider to both fields, I (to this day) find the distinctions to be blurry lines at best. From my perspective on the outside (as Daniel noted, I have an obscure degree that focuses on interdisciplinary work and "parallel thinking") both fields borrow heavily from others. Philosophy, psychology, sociology, political science - even, to my dismay, scary mathematical things like statistics.

However, my studying-for-her-MCATs, works-in-medical-research sister offers the following quickie differentiation: there is a potential breadth to bioethics that the medical humanities, through its very title, is limited in. But on the flip side, the medical humanities offers a depth that bioethics often lacks, due to its broad nature.

My own definition tends to mirror this, with the following explanations. I find that the medical humanities is narrower than bioethics; there is, for example, no environmental ethics in the medical humanities, nor is there media ethics and responsibility, or many other fields that you can pull out of the very (almost too) broad name of bioethics. The medical humanities has a very specific and narrow depth of focus, but in that some areas that I, at least, am very interested in are left to the side.

The second thing is actually a very strong negative for the field of bioethics, at least for me. There is no narrative in bioethics. Certainly, narrative matters (in both the literal sense and as reference to the excellent, thought-provoking, and sometimes controversial column of the same name), but I can't seem to find it in bioethics. Unlike the medical humanities, which seems rich with history, literature - even poetry! - and storytelling, bioethics tells no stories. And if you discover anything about me, you will discover that I tell stories.

This, then, would seem problematic, as I opted for the non-narrative degree. I suppose this is my one concession to ego - I happen to be fairly confident in both my skill as a writer and my utterly stubborn personality. Any professor thinking that they will knock my particular writing style out of me is in for a rather rude awakening. Oh sure, I'll modify tone as necessary; I can be as dry as the next journal author. But that doesn't mean I'm dropping what makes my writing quirky, referential, and well, mine. Just because I'm playing the game doesn't mean I can't wear pigtails. (That worked as a metaphor when I first wrote it out...)

Over the course of finishing my undergraduate thesis, I realized that although my passion fell into medicine, it's not just medicine; it spills out to science (fact and fiction), politics, policy, the media, food and more. I am, in many ways, simply a glorified academic magpie. And I realized that my particular magpie tendencies were almost perfectly matched with the dual degree program being offered at the University at Albany and the Alden March Bioethics Institute.

If you're looking for a formal discussion of the differences between the fields, well. This obviously is not it. Thankfully, it wasn't meant to be! In fact, all this was meant to be is an explanation of why my first post for Daniel hasn't appeared as quickly as I thought it would. What started off as a few sentences at the beginning of another essay morphed into what you're reading now.

And what did I decide, about what will go where? Well, I'd like to be able to tell you that I discovered some rational format, that my posts here will be more thoughtful and researched and references, while my Women's Bioethics Blog posts will be faster, more off-the-cuff commentary pieces, and my own blog will continue to be a hodgepodge of everything including the sink - all of which, come to think, is true. It will likely be arbitrary, relying on gut and feeling, sometimes sloppy, often shy, and hopefully always boggled and amused.

(For now, I can at least feel better about having gotten something posted, before I fly back across the country, if not the thing I originally intended!)

Guest Blogger: Kelly Hills

As I've mentioned since the outset, getting different voices contributing at this blog is a top priority.  Thus, I am happy to introduce MH Blog's first guest blogger, Kelly Hills.

Kelly is a Ph.D student in bioethics and philosophy at the University of Albany and the Alden March Bioethics Institute (which runs the virtual clearinghouse for academic bioethics, www.bioethics.net).  After completing her undergraduate degree in the Comparative History of Ideas and Medical History and Ethics at the University of Washington, she headed for the balmy environs of upstate New York to do her graduate work.  She maintains her own blog (where you can find a marvelous example of a caregiver narrative as she describes her thoughts and feelings on caring for a parent with cancer) and regularly contributes to the Women's Bioethics Blog under the handle "Buddhist Valkyrie."  She has just completed a paper on Rawls, so she deserves your acclaim and your understanding, though not necessarily your pity.  Welcome!   

Conference on Disability in Early Medieval Europe

Okay, so I've been seriously remiss in posting notifications for different conferences.  The blog is just over five months old, and this is certainly one of the kinks I need to work out.  But Penny Richards over at Disability Studies Blog alerts us to a conference the content of which is particularly interesting to me:

DISEASE, DISABILITY AND MEDICINE IN EARLY MEDIEVAL EUROPE, AD 400-1200
Concepts of Health and the Healthy Body

School of English Studies
University of Nottingham
6-7 July 2007
Call for papers

The second conference on Disease, Disability and Medicine in Early Medieval Europe, AD 400-1200 will focus on questions of what constitutes a healthy body in the medieval world, health care, cure and the language of care. The meeting aims to be a forum for scholars working on the topic in a variety of disciplines and regions of Northern Europe, including all aspects of disease, disability and medicine. The conference aims foster interdisciplinary approaches and we invite contributions from archaeology, palaeopathology, history of medicine, as well as history of religion, philosophy, linguistic and historical sciences.

Abstracts should be submitted to Christina Lee (300 words or less) by February 28, 2007.

A few points: first, I am absolutely fascinated by the Middle Ages -- Early, Middle, and Late (I'm particularly interested in the Twelfth Century Renaissance and Eleanor of Aquitaine, but I also find the Plantagenet kings ceaselessly fascinating, and I also have more than a passing interest in the Vikings and William the Conqueror).  I'm something of an amateur medievalist, with strong emphasis on the "amateur" aspect.  I've probably read about sixty books -- both academic and popular history -- on medieval history, but alas, given that I lack primary languages, I remain nothing but a motivated amateur.  (However, I do have to say that having even some basic grasp of social and political conditions at various points in the Middle Ages, as well as a rudimentary comprehension of some elements of a peculiarly medieval world view has proved to be tremendously useful for me in trying to trace both the rise of modernity and the inception of the studia humanitatis).

Second, given my interest in the medical humanities, I am particularly interested in understandings of and cultural responses to health, illness, and disease in the Middle Ages.  One of my favorite classes I took in law school was a course on English Legal History, in part because the final third of the semester was spent studying how the Pestilence forced such dramatic changes in the legal culture.  Anglo-American law looks the way it does today because of the Pestilence.  So the subject of this conference is particularly interesting to me.

Third, and this is a point I have been meaning to blog about for some time, I am finding that more and more of my academic interests are implicating questions of disability and disability studies.  I was thinking about this, and I have read some disability scholars suggest that disability studies is in some sense an all-encompassing field.  One can quibble with this suggestion for a variety of reasons, of course, but the more I think about it, the more I believe that it is probably unwise to pursue inquiry in bioethics and the medical humanities with no understanding of or ability to be conversant with disability studies.  How, after all, could one separate the study of health care from the study of disability? As disability scholars are fond of remarking, everyone is either disabled or a moment away from becoming disabled.

Of course, lots of disciplines and fields of inquiry are worthwhile; I suppose one has to make choices about what fields and models are meaningful enough to one to try to learn something about them.  I suppose I am expressing here a commitment to engaging disability studies and disability scholars in general in context of bioethics and the medical humanities, because I think the cross-talk would be both meaningful and vitally important (anyone who thinks the disability perspective is tangential to bioethics has not spent much time examining the futility controversy).  As such, look for a Disability Studies blogroll coming soon (in addition to the Health Law and Policy blogroll added recently).   

Writing & Error

Apropos the recent discussion on apology laws and medical error comes this lead from TIME Magazine:

Doctors' sloppy handwriting kills more than 7,000 people annually. It's a shocking statistic, and, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM), preventable medication mistakes also injure more than 1.5 million Americans annually. Many such errors result from unclear abbreviations and dosage indications and illegible writing on some of the 3.2 billion prescriptions written in the U.S. every year.

To address the problem—and give the push for electronic medical records a shove—a coalition of health care companies and technology firms will launch a program Tuesday to enable all doctors in the U.S. to write electronic prescriptions for free.

This raises a number of interesting points regarding language and medicine.  First is the seemingly self-evident notion that language matters in medicine.  Though this will seem obvious to any clinician who has ever bothered to take a patient history, it does not follow that all manifestations of the proposition (that language matters in medicine) are equally obvious. Thus, the second, and related point, that even the form of that language may contribute meaningfully to a given measured outcome, even a measured clinical outcome.  In part, the ethical model of literature and medicine posits that writing about illness can be therapeutic .  If this is so, and it seems plausible if not confirmed by randomized controlled trials,* then language, in both form and content, matters in clinical practice. 

For the physician, this TIME report neatly captures the notion that both the form the language takes (even "form" writ small, as in penmanship) and the meaning of the language (i.e., the wrong medication written down by the provider) as written measurably contribute to medical error.  Thus, though measurement is needed to assess the various ways in which language affects outcomes, it seems safe to suggest that this proposition has some merit without such evidence. 

Of course, as the article goes on to make plain, such a basic means of reducing error seems long overdue.  The article does draw one eyebrow-raising inference:

Thousands of people are dying, and we've been talking about this problem for ages," says Glen Tullman, CEO of Allscripts, a Chicago-based health care technology company, that initiated the project. "This is crazy. We have the technology today to prevent these errors, so why aren't we doing it?"

One of the reasons is that doctors haven't invested in the needed technology, so it's being provided to them.

(emphases added)

Thoughts?

*This is said with some irony.  I am well aware of the criticisms tendered against a somewhat uncritical acceptance of RCTs as the gold standard, superior in any potential epistemic investigation it could be deployed in.  RCTs obviously rest on an important evidentiary methodology, but there are some kinds of questions for which other kinds of methods -- especially qualitative methods -- would be superior.  See Jason Grossman & Fiona J. McKenzie, "The Randomized Controlled Trial: gold standard, or merely standard?" Perspectives in Biology and Medicine Vol. 48, no. 4 (2005): 516-534.

Disability Blog Carnival # 6

Disability Blog Carnival # 6 is up over at Emma the Wheelchair Princess's blog.  The theme of the blog carnival is relationships: "family, friends, community stories."

Check it out!