The Good Doctor has me thinking…
Recently I have begun watching ABC’s The Good Doctor, which is a medical drama based in the fictional, yet prestigious, San Jose St Bonaventure Hospital and follows the professional and personal journeys of a number of characters. The show is based on a South Korean tv medical drama called Good Doctor and is produced by Daniel Dae Kim and developed by David Shore (creator of House). The main character is Dr Shaun Murphy who has Autism. He is a surgical resident in the early seasons and the show focuses on how Dr Murphy navigates his professional and personal life, as well as how the hospital and other doctors, surgeons, nurses and patients navigate Dr Murphy’s style of communication and respond to him. As a medical drama, in my humble opinion, it is highly entertaining with the usual mix of interesting medical cases and personal drama required. The characters are also relatable in a number of different areas. As a springboard for a platform to talk about equality, equity and fairness, it is accessible and thought-provoking.
A key focus of the programme is the difficulty Dr Murphy has with communication. Well, I say difficulty in communicating, but in actuality I would say he communicates differently to what is recognised as an ‘accepted’ or ‘normal’ form of communication. Dr Murphy struggles to express emotions and becomes overwhelmed when things change and are not within his controlled environment. A number of his colleagues adapt their responses and ways of interacting with him in order to support and include him, whereas others do not and argue that despite his medical brilliance, and first-rate surgical skills, he should not be treated differently to the other surgical residents, as this is deemed unfair.
Whilst watching, the claims of treating all surgical residents equally, and ensuring the hospital higher-ups are being fair; notions of John Rawls’ writing scream out at me. Students who have studied Crime and Justice should be familiar with Rawls’ veil of ignorance, liberty principles and difference principle, in particular with its reference to ‘justice’. But the difference principle weighs heavily when looking at how Dr Murphy functions within the hospital institution with its rules, procedures and power dynamics which clearly benefit and align with some people more so than others. Under the veil of ignorance, maybe an empathetic doctor or surgeon is not required, but a competent and successful one is? Maybe being empathetic is a personal circumstance rather than an objective trait? For Rawls, it is important that the opportunity to prosper is equal for all: and this might mean the way this opportunity is presented is different for different individuals. Rawls asks us to consider a parallel universe and what could be (a popular stance to take within the philosophical realm): why can’t people with autism be given the chance to save lives and perform surgeries just because they cannot communicate in a way deemed ‘the norm’ when dealing with patients.
It is possible that I am over-thinking this. And when I ask my partner about it, they raise questions about why Dr Murphy should be given different opportunities to the other residents and the harm Dr Murphy’s communication barriers could and do cause within the series. But I feel they are missing the point: it is not about different opportunities, its about different methods to ensure they all have the same opportunity to succeed as surgeons. It is not about treating everyone the same, which might on the surface appear to be fair, it is about recognising that equal treatment involves taking account for the differences. Why should Dr Murphy be measured against norms and values from an institution which is historically white, non-disabled, male, and cis-gendered? This might appear to be a lot of thought for a fictional medical drama, but to reiterate it’s an excellent programme with plenty to think about…
Rawls, J. (1971) A Theory of Justice. Oxford: Oxford University Press.
Ryan, A. (1993) Justice. Oxford: Oxford University Press.
Stop strip searching children!
The Metropolitan Police are under constant criticism, more than any other police force, for at least as long as I have been a criminologist. Their latest scandal began with the case of Child Q, a 15 year old girl who was strip searched in school while she was menstruating after being suspected of carrying cannabis. No drugs were found and Child Q was extremely traumatised, resulting in self-harm and a suicide attempt. Tré Ventour recently wrote a blog about Child Q, race and policing in education here but following this week’s Children’s Commissioner report, there’s so much more to discuss.
The report focussed on the Metropolitan Police who strip searched 650 children in 2 years, many (23%) of whom were searched without the presence of an appropriate adult and as we criminologists would expect, the children were disproportionately Black boys. These findings were not surprising or shocking to me, and I also know that the Metropolitan Police force are not just one bad apple in this respect. The brutal search of Child Q occurred in 2020 but incidences such as these have been happening for years.
A teenage boy aged 17 was subject to an intimate search in 2019 where the police breached a number of clauses of PACE, ultimately resulting in the boy receiving an apology and £10,000 damages for the distress caused by the unlawful actions. These actions started with basic information being withheld such as the police officer failing to identify himself and informing the boy of his rights and ended with the strip search being undertaken without an appropriate adult present, in the presence of multiple officers, without authorisation from a senior officer and with no justification for the search recorded in the officer’s pocket book. Now I understand that things may be forgotten in the moment when a police officer is dealing with a suspect but the accumulation of breaches indicates a more serious problem and a disregard to the rights of suspects in general but children more specifically.
These two cases are the cases of children who were suspected of carrying cannabis, an offence likely to be dealt with via a warning or on the spot fine. Hardly the crime of the century warranting the traumatising strip searching of children. And besides, we criminologists know that the war on drugs is a failed project. Is it about time we submit and decriminalise cannabis, save police time and suspect trauma?
What happens next is a slightly different story. Strip searching in custody is different because as well as searching for contraband, it can also be justified as a protective measure where there is a risk of self-harm or suicide. Strip searching of children by the police has risen in a climate of fear surrounding deaths in custody, and it has been reported that there could be an overuse of the practice as a result of this. When I read the report, I recalled the many conversations I have had over the years with my friend Rosie Flatman who is a practitioner who specialises in working with victims of Child Sexual Exploitation (CSE) and other forms of abuse. Rosie has worked with many girls who have been subject to strip searches when in custody. She told me how girls would often perceive the search as punishment for being what the police believed was disruptive. That is not to say that the police were using strip searches as punishment, but that is how girls would experience it.
Girls in custody are often particularly vulnerable. Like Rosie’s clients, many are victims and have a number of compounding vulnerabilities such as mental ill health or they may be looked after children. Perhaps then, we need to look at alternatives to strip searching but also custody for children, particularly for those who have suffered trauma. Rosie, who has delivered training to various agencies, suggests only undertaking strip searches where absolutely necessary and even then, using a trauma informed approach. She argues that even the way the procedure and justification is explained can make a big difference to the amount of harm caused to vulnerable children in police custody.
Just some more meaningless populism…
As we follow the recent American-style media circus posing as the Conservative Party leadership contest set to determine the interim Prime Minister until the next General Election, we are reminded that both ‘finalists’, Rishi Sunak and Liz Truss are pretty much showing us their real faces fairly early in the show, while they pander to their own, in a frenzy to be seen as the modern-day version of Thatcher. Truss’ emulation of the ‘Iron Lady’ through evident vocal coaching to sound more ‘masculine’ and ‘assertive’ has helped her come across even more awkward and inept than before; perhaps the ‘Wooden Spoon’ may be a more appropriate title. Nevertheless, with promises to cut taxes…despite having announced 15 tax rises in just over 2 years…‘restore trust’ in politics…despite having been directly complicit in keeping the outgoing clown Prime Minister (Boris Johnson) in power for so long given his track record for lying…and continue with an illegal migration policy that will see refugees and asylum seekers deported to Rwanda, we are reminded that it is not the British public that will get a say in who will represent our country on the global stage, but a comparatively handful of Conservative Party members.
Lest we forget that the Conservative Party membership is dominated by middle-aged white men, many with nationalist and strongly-held religious views, seeking to preserve traditions that go back (sometimes) centuries. It seems inevitable then that the next leader will not be a racially minoritised candidate, despite being the elite private-school multi-millionaire type that Conservative voters have grown to love since the 2010’s, paving the way for Liz Truss to put her very important ideas surrounding growing British apples and setting up pork markets in Bejing to the forefront of the current populist political model we have unfortunately allowed to flourish in the UK. Truss may find meeting the Queen during her term as quite awkward given her openly anti-monarchist history. She also seems, despite having voted to remain in the European Union in the 2016 Referendum, to have jumped on the bigoted Brexit bandwagon that is slowly eroding the last remaining remnants of democracy in this country. We know that every crumb of functioning public sector life has been crushed over the past 12 years:
- Students have seen their EMA’s and grants scrapped, and their university tuition fees trebled;
- Teachers across most education institutions are in both a pay and retention crisis;
- The National Health Service is in much the same critical position with a massive shortage of GP’s, doctors and nurses and record-level waits for hospital treatments;
- The social care sector has been decimated leaving the elderly and vulnerable both financially and physically worse off;
- Those with disabilities are disproportionately disadvantaged by so-called ‘welfare reforms’ which introduced a Universal Credit benefit merger;
- Cuts to legal sectors and legal aid has left the poorest in society unable to afford high-quality legal advice and representation in court;
- Children have seen their benefits cut and, with a sharply rising inflation rate and a looming recession by the end of this year, the use of food banks among the poorest families has been higher than ever recorded…
…and there are many other examples. Without getting into yet another Brexit debate, there is no doubt that the very act of voting to leave the EU in 2016, and its subsequent consequences, has had a long-lasting impact in these services, one which we cannot hope to treat for many years. Let us not be in any illusion that either of these candidates will swoop in and majestically heal the UK from the deep wounds this Party has inflicted for 12 years, nor that there will be some miraculous light at the end of the tunnel of tyranny. Perhaps this is a rather pessimistic outlook on the years leading up to the next General Election, but unless in the unlikely event the soon-to-be PM decides to call a snap election to allow the public to finally boot out the last of this government and pave the way to some change, the situation seems rather hopeless…at least for the time being.