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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.
If we could empathize with all life, we… [fill in the blank]￼
In Honour of my two teachers’ passing (seen together here). Rest In Power, bell hooks (d. 15/12/21) and Thich Nhat Hanh (d. 22/01/22).
If we could empathize with all life, we…
… wouldn’t treat all animals as either food or fodder.
… wouldn’t develop nuclear technology into bombs.
…would never show an interest in making so many guns and ways of destroying life.
…would more genuinely aim to achieve mutual understanding between individuals.
…wouldn’t have so much intergenerational trauma within families, communities, nations.
…would be more neighborly in all our affairs.
…wouldn’t treat trade like a sport, a winner-takes-all competition over natural resources.
…would harness the power of the sun for it shines on all life collectively.
…would cultivate care, and be kinder as a general rule.
… would teach kindness in school, a required class on every campus.
…would not build entire ideologies, systems of government, religions, arts, and culture around patriarchy.
… would not be reduced to binaries, not just in gender, but ‘black or white’ in our overall thinking, because that’s where it came from: A false yet powerful and enduring dichotomy.
Binary thinking produced gender binaries, not the other way around. Knowing this is key to its undoing. Please know that capitalism produced racism, and greed crafted classism. A2 + B2 = C2, still. Racism is exponentially untamed greed; and patriarchy an inferiority complex run rampant and amok. Such cultures of greed can’t be conquered by competition; greed can’t be beat! We need a new dimension.
If we could empathize with all life, we would aspire to be far more fair.
If we could empathize with all life, we would love more.
Fill in the blank.
Rule makers, rule breakers and the rest of us
There are plenty of theories about why rules are broken, arguments about who make the rules and about how we deal with rule breakers. We can discuss victimology and penology, navigating our way around these, decrying how victims and offenders are poorly treated within our criminal justice systems. We think about social justice, but it seems ignore the injustice perpetrated by some because we can somehow find an excuse for their rule breaking or point out some good deed somewhere along the line. And we lament at how some get away with rule breaking because of their status or power. But what is to be done about people that break the rules and in doing so cause or may cause considerable harm to others; to the rest of us?
Recently, Greece imposed a new penalty system upon those over 60 that are not vaccinated against Covid. Pensioners who have had real reductions in their pensions are now to be hit with a fine, a rolling fine at that, if they do not get vaccinated. This is against a backdrop of poor vaccination rates which seem to have improved significantly since the announcement of what many see as draconian measures by a right-wing government. There are those that argue that vaccination ought to be a choice, and this has been brought into focus by the requirements for health workers and those in the care profession to be vaccinated in this country. And we’ve heard arguments from industry against vaccination passports which would allow people to get into large venues and a consistent drip-drip effect of how damaging the covid rules are to the leisure industry and aviation, as well as the young people in society.
So, would it have been far more acceptable to have no rules at all around Covid? Should we have simply carried on and hoped that eventually herd immunity would kick in? Let’s not forget of course that the health service would have been so overwhelmed that many people will have died from illnesses other than Covid (they undoubtedly have to some extent anyway). The fittest will have survived and of course, the richest or most resourceful. Businesses will have been on their knees as workers failed to turn up for work, either because they were too ill or have moved on from this life and few customers will have thought about quaffing pints, clubbing, or venturing off to some faraway sunny place (not that they’d be particularly welcome there coming from plague island). It would have felt more like some Darwinian evolutionary experiment than civilised society.
It seems that making some rules for the good of society is necessary. Of course, there will be those that break the rules and as a society, we struggle to determine what is to be done with them. Fines are too harsh, inappropriate, draconian. Being caring, educating, works for some but let’s be honest, there are those that will break the rules regardless. Whilst we can argue about what should be done with those that break the rules, about the impact they have on society, about victims and crimes, perhaps the most pressing argument is about equality of justice. The rest of us, those that didn’t break the rules, might question how draconian the rules were (are) and we might question the punishments meted out to those that broke the rules. But what really hurts, where we really feel hard done by, let down, angry is to see that those that made the rules, broke the rules and for them we don’t get to consider whether the punishment is draconian or too soft. There are no consequences for the rule makers even when they are rule breakers. It seems a lamentable fact that we have a system of governance, be that situated in politics or business, that advocates a ‘do as I say’ rather than ‘do as I do’ mentality. The moral compass of those in power seems to be seriously misaligned. As the MP David Davis calls for the resignation of Boris Johnson and says that he has to go, he should look around and he might realise, they all need to go. This is not a case of one rotten apple, the whole crop is off, and it stinks to high heaven.
Managerialism, students and the language of failure
Imagine that every professional or semi-professional footballer in the country had the same ability and the same fitness levels. How would it be possible to distinguish between them, how would league tables be established, who would play for the top teams? Nonsense of course because we know that not every football player can have the same ability or fitness levels for that matter. And there is a myriad of reasons why this may be the case. However, there is probably little doubt that those that have been professionally coached, even at the lowest level in the professional game can run rings round most part time amateur players.
Not everyone can be at the top, in the Premier League. If we took a sample of players across the leagues and were to somehow measure ability then the likelihood would be that we would find a normal distribution, a bell curve, with most players having average ability and a few with amazing ability and a few with some but perhaps inconsistent ability. It is probably likely that we would find those with the most ability in the Premier League and those with the least in lower or non-league clubs and these are probably semi-professional or amateurs. Perhaps it would be prudent to reiterate that those with the least ability are still way ahead of those that do not play football or just dabble in it occasionally. This then is not to say that those at the lower end of the skills distribution curve are rubbish at playing football, just that they, for whatever reason, are not as skilled as those on the opposite side of the curve. And those that have average skill i.e., the greatest number of footballers, are very good but not quite as good as the most skilled. Make sense so far, I hope so?
If we apply the logic to the skill of footballers can we not apply the logic elsewhere, in particular to university students. Surely, in terms of academic ability, we would find that there were those at the one end of the curve achieving A and B grades or 1st degrees and then the majority in the middle perhaps achieving C and D grades of course tailing off to those that are achieving perhaps low D and F grades. We would probably hope to find a normal distribution curve of sorts. We could probably say that those with lower grades have far greater academic ability than anyone that hasn’t attended university. We could certainly say that the majority i.e. those getting C and higher D grades are good or very good academically when compared to someone that hasn’t attended university but not quite as good as those achieving A and B grades. The assessment grading criteria seems to confirm this, a D grade is labelled as ‘satisfactory’, a C grade ‘commended’ a B grade ‘of merit’ and an A grade ‘distinguished’. Just to reiterate, achieving a D grade suggests a student has displayed ‘satisfactory’ academic ability and met the requisite ‘learning outcomes’.
Why is it then that degrees at institutional level are measured in terms of ‘good degrees’? These are a ‘1st and 2.1. At programme level we talk of ‘good grades’, ‘A’ grades and ‘B’ grades. The antithesis of ‘good’ is ‘bad’. This logic then, this managerialist measurement, suggests that anything that is not a 1st or a 2.1 or an ‘A’ or ‘B’ grade is in fact a ‘bad’ grade. Extending the logic further and drawing on more managerial madness, targets are set that suggest 80% of students should achieve a ‘good grade’. A skewing of a distribution curve that would defeat even the best statistician and would have Einstein baffled.
Let me revisit the football analogy, using the above language and measurements, a comparison would suggest that any player outside of the Premier League is in fact a ‘bad’ player. Not only that but a target should be set where 80% of players should be in the Premier League. The other leagues then appear to be irrelevant despite the fact that they make up probably 90% of the national game and prop up the Premier League in one form or another.
With such a use of language and a desire to simplify the academic world so that it can be reduced to some form of managerial measurement, it is little wonder that perfectly capable students consider their work to be a failure when they earn anything less than an A or B grade or do not achieve a 1st or 2.1 degree.
It is not the students that are failing but higher education and academic institutions in their inability to devise more sophisticated and meaningful measurements. In the meantime, students become more and more stressed and disheartened because their significant academic achievements fail to be recognised as achievements but are instead seen at an institutional level as failures.