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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.
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.
The crime of war
Recently after yet another military campaign coming to an end, social media lit all over with opinions about what should and should not have been done as military and civilians are moving out. Who was at fault, and where lies the responsibility with. There are those who see the problem as a matter of logistics something here and now and those who explore the history of conflict and try to explain it. Either side however does not note perhaps the most significant issue; that the continuation of wars and the maintenance of conflict around the world is not a failure of politics, but an international crime that is largely neglected. For context, lets explore this conflict’s origin; 20 years ago one of the wealthiest countries on the planet declared war to one of the poorest; the military operations carried the code name “Enduring Freedom”! perhaps irony is lost on those in positions of power. The war was declared as part of a wider foreign policy by the wealthy country (and its allies) on what was called the “war on terror”. It ostensibly aimed to curtail, and eventually defeat, extremist groups around the world from using violence and oppressing people. Yes, that is right, they used war in order to stop others from using violence.
In criminology, when we talk about violence we have a number of different ways of exploring it; institutional vs interpersonal or from instrumental to reactive. In all situations we anticipate that violence facilitates more violence, and in that way, those experiencing it become trapped in a loop, that when repeated becomes an inescapable reality. War is the king of violence. It uses both proactive and emotional responses that keep combatants locked in a continuous struggle until one of them surrenders. The victory attached to war and the incumbent heroism that it breeds make the violence more destructive. After all through a millennia of warfare humans have perfected the art of war. Who would have thought that Sun Tzu’s principles on using chariots and secret agents would be replaced with stealth bombers and satellites? Clearly war has evolved but not its destructive nature. The aftermath of a war carries numerous challenges. The most significant is the recognition that in all disputes violence has the last word. As we have seen from endless conflicts around the world the transition from war to peace is not as simple as the signing of a treaty. People take longer to adjust, and they carry the effects of war with them even in peace time.
In a war the causes and the motives of a war are different and anyone who studied history at school can attest to these differences. It is a useful tool in the study of war because it breaks down what has been claimed, what was expected, and what was the real reason people engaged in bloody conflict. The violence of war is different kind of violence one that takes individual disputes out and turns people into tribes. When a country prepares for war the patriotic rhetoric is promoted, the army becomes heroic and their engagement with the war an act of duty. This will keep the soldiers engaged and willing to use their weapons even on people that they do not know or have any personal disputes with. Among wealthy countries that can declare wars thousands of miles away this patriotic fervour becomes even more significant because you have to justify to your troops why they have to go so far away to fight. In the service of the war effort, language becomes an accomplice. For example they refrain from using words like murder (which is the unlawful killing of a person) to casualties; instead of talking about people it is replaced with combatants and non-combatants, excessive violence (or even torture) is renamed as an escalation of the situation. Maybe the worst of all is the way the aftermath of the war is reflected. In the US after the war in Vietnam there was a general opposition to war. Even some of the media claimed “never again” but 10 year after its end Hollywood was making movies glorifying the war and retelling a different rendition of events.
Of course the obvious criminological question to be asked is “why is war still permitted to happen”? The end of the second world war saw the formation of the United Nations and principles on Human Rights that should block any attempt for individual countries to go to war. This however has not happened. There are several reasons for that; the industry of war. Almost all developed countries in the world have a military industry that produces weapons. As an industry it is one of the highest grossing; Selling and buying arms is definitely big business. The UK for example spends more for its defence than it spends for the environment or for education. War is binary there is a victor and the defeated. If a politician banks their political fortunes on being victorious, engaging with wars will ensure their name to be carved in statues around cities and towns. During the war people do not question the social issues; during the first world war for example the suffragettes movement went on a pause and even (partly) threw itself behind the war effort.
What about the people who fight or live under war? There lies the biggest crime of all. The victimisation of thousands or even millions of people. The civilian population becomes accustomed to one of the most extreme forms of violence. I remember my grandmother’s tales from the Nazi occupation; seeing dead people floating in the nearby river on her way to collect coal in the morning. The absorption of this kind of violence can increase people’s tolerance for other forms of violence. In fact, in some parts of the world where young people were born and raised in war find it difficult to accept any peaceful resolution. Simply put they have not got the skills for peace. For societies inflicted with war, violence becomes currency and an instrument ready to be used. Seeing drawings of refugee children about their home, family and travel, it is very clear the imprint war leaves behind. A torched house in a child’s painting is what is etched in their mind, a trauma that will be with them for ever. Unfortunately no child’s painting will become a marble statue or receive the honours, the politicians and field marshals will. In 9/11 we witnessed people jumping from buildings because a place crashed into them; in the airport in Kabul we saw people falling from the planes because they were afraid to stay in the country. Seems this crime has come full circle.