PC Among the Docs

by Theodore Dalrymple (July 2006)

A considerable proportion, if not an outright majority, of the medical profession is of conservative cast of mind: politically, that is, not technically. Perhaps a close and continuous acquaintance with human nature at its limits renders doctors, if not cynical exactly, at least circumspect about the prospects for human perfectibility.

It is surprising, then, that the major medical journals these days, edited entirely by doctors, are riddled with – I almost said rotted by – political correctness. It isn’t easy to define political correctness with precision, but it is easy to recognise when it is present. It acts on me as the sound, when I was a child, of a teacher’s nail scraping down a blackboard because his piece of chalk was too short: it sends shivers down my spine. It is the attempt to reform thought by making certain things unsayable; it is also the conspicuous, not to say intimidating, display of virtue (conceived of as the public espousal of the ‘correct,’ which is to say ‘progressive,’ views) by means of a purified vocabulary and abstract humane sentiment. To contradict such sentiment, or not to use such vocabulary, is to put yourself outside the pale of civilised men (or should I say persons?).

A recent edition of the New England Journal of Medicine, possibly the most august such journal in the world, exemplified the current grip of political correctness on the medical press. It was not by any means the most egregious example I could cite; it was interesting more for its subtlety than its blatancy. I should add, perhaps, that I do not object to the expression of certain views, which are themselves perfectly legitimate as opinions, as to the impossibility of publishing any other views.


In the NEJM of 15th June, there were two items that caught my eye. The first related to capital punishment, and the second to the epidemic of childhood obesity that afflicts America, and increasingly the rest of the world.


The article on capital punishment concerned an execution by fatal injection of a murderer in North Carolina. A special electroencephalograph was connected to him during his execution, and it suggested that he may have been more conscious during it than was previously supposed, and this in turn meant that death by fatal injection constituted the kind of cruel and unusual punishment forbidden by the Constitution. And since execution by lethal injection is about the most humane and painless that can be devised… well, you get the drift.


Let me say at once that, on the question of the death penalty, I face both directions at once. Viscerally, I am in favour of it – in my professional life I met quite a number of murderers for whom it seemed to me that death was the only just and indeed humane punishment – but I do recognise a very powerful argument against the penalty, namely the tendency of all jurisdictions, which after all rely on merely human institutions, to make mistakes and execute the wrong person. You might argue that only those of whom we can be sure that they committed a brutal murder should be executed: but in our system of law, all convicted prisoners are supposed to be guilty beyond reasonable doubt, and in that sense all should be equally eligible for any penalty that the law prescribes for their particular offence. I am, moreover, a little squeamish about the increasingly clinical nature of executions, as if they were medical procedures. I remember reading an account of an execution by fatal injection, though I now cannot recall where the account was published, in which the injection was preceded by a swabbing of the skin of the person to be killed. This seemed to me both ridiculous and sinister, as if we were trying to pretend that an execution was actually a surgical operation. This (if the account of the execution was accurate) is a terrible slippage.


On the other hand, I cannot share any sense of outrage against the idea of capital punishment, such as is now widespread in Europe. From the assumption of European moral superiority vis-à-vis the United States with regard to capital punishment, you would have thought that capital punishment had been outlawed in all of Europe in about 458 BC. In fact, the country in which the outrage is strongest, or at least most vocal, France, was the last country in western Europe to abandon it, in 1981 – hardly an aeon ago.


The suffering of the murderer from North Carolina – a possibility, incidentally, rather than a certainty – can hardly have lasted so long as to be counted an atrocity such as the Constitution was intended to outlaw. A person to be executed by fatal injection is first given a barbiturate to render him unconscious, then a muscle relaxant to render him immobile, and finally a drug to stop his heart beating. If this is cruel and unusual, then almost any punishment is cruel and unusual. If you measured the physiological response of an accused as a judge sentenced him to a ten-year prison sentence, you might just as well conclude that this was cruel and unusual punishment. It is a short step to saying that all punishment is cruel and unusual – which, of course, has long been the predominant view among criminologists.


It seems to me unlikely that, had the EEG conducted on the murderer in North Carolina demonstrated that he was fully unconscious at the time of the injection of the muscle relaxant, the NEJM would have reported it with the sub-text that we can now all accept capital punishment, it is all quite painless and humane, and therefore morally justified. In other words, we are dealing here more with politically-correct propaganda rather than true argumentation. It is not as if the NEJM is (or indeed should be) in disinterested search of a painless method of execution; nor is it likely that it would use the same data as an argument against euthanasia. It is establishing its membership of the great family of the right-thinking.


In the same issue, there were two articles about the epidemic of childhood obesity in America. This epidemic, now spreading worldwide, has been brought about by physical inactivity and the consumption of junk food. (I once saw a striking illustration of the connection between junk food and obesity on the streets of Bangkok. I once watched children emerge from an exclusive school there, and they grazed on huge quantities of junk food the moment they were free to do so. Not surprisingly, they were fat, startlingly so in a land where most people are elegantly slender.)


The articles in the NEJM discussed the responsibility of the government to forbid food companies from advertising, especially on television, directly to small children. Personally, I see nothing wrong with a proposal to censor such advertising. By definition, small children are not fully capable of making up their own minds about things, and it seems to me that advertisements directed at them to get them to do things which are likely to be permanently damaging to them, for the sake of making a profit, or rather an extra profit, are immoral.


What was very striking about the two articles in the NEJM, however, was the complete absence of reference in either of them to the responsibilities of parents towards their own children, or to the cultural context in which parents have largely abandoned such responsibilities. The articles mentioned that television advertisements had made it difficult for parents to control their offspring’s diet, and that they somehow transferred the onus for making a choice about diet from the parents to the children. A majority of children now claimed that it was they, not their parents, who decided what they ate.


I hesitate to mention my own childhood in this context, in case I should be thought to be implying that I have turned out perfect (I am, in fact, slightly overweight). But when I was a child, I ate what I was given, or else I went hungry. As a result, of this take-it-or-leave-it attitude, I increased my repertoire of what I would eat, learned to like many things that were good for me though they were not as immediately attractive to me as various unhealthy or nutritionally worthless foods, and learned moreover that my choice – or rather my whim – was not the beginning and end of the universe.


Of course, the question as to why so many parents have transferred authority from themselves to their children as young as three years old is a very interesting and important one, to which more than answer can be given, and at more than one level of analysis. This transfer of authority is a mass phenomenon, otherwise the epidemic would not have taken place. Parents no longer seem in control of how much television their children watch, what their children buy with their money or even what they eat at home.


The problem might be, for example, that people have come to believe that the satisfaction of choice, no matter how ill-informed, whimsical or deleterious, however childish or child-like, is the whole meaning of existence, at all the ages of man, from the very moment of birth onwards. Clearly, this has a connection with the notion of consumer choice: it is the wrongful extension of a principle that, in the right context, is obviously an excellent one. The epidemic of childhood obesity is a precise illustration of Edmund Burke’s famous dictum that men are qualified for liberty in exact proportion as they are (or have been in the past) prepared to place a limit on their own appetites.


We might ask what kind of society we have created in which so many parents do not control the diet of their own children, and what such a lack of control – surely not confined to diet – bodes for the future. Perhaps parents are just too busy nowadays to make the effort; or perhaps they subscribe to the sentimental (and lazy) idea that to give children what they want exactly when and how they want it is an expression of deep love.


But whatever the reason, the fact that two articles about the problem of childhood obesity in the NEJM could fail even to mention individual parental responsibility is indicative of what one can only call a totalitarian mindset. According to this mindset, it is for the government to solve every problem, either by prescribing behaviour, or forbidding it, or of course both. It is not that I think that the proposal that the government should ban the advertising of noxious products to small children is wrong; what bothers me is the failure to recognise that there is any other dimension to the problem, a dimension that is in fact much more serious.


No doubt the NEJM does not want to court unpopularity, or even notoriety, by suggesting that millions of American parents are, at least in this respect, failing their own children (I suspect that they are failing them in other respects too). It is always safer, from the point of view of gaining the esteem of the intelligentsia and of avoiding their censure, to blame those in authority or large corporations rather than ‘ordinary’ people, who are by definition blameless victims. But to absolve ordinary people of all blame for the obesity of their own children, by simply omitting to mention it altogether, is to deny them agency as full human beings. Far from being generous towards, or respectful of, ordinary people, it is extremely condescending towards them. Poor things, they are but putty in the hands of television companies and the food industry.


If the only publicly admissible or mentionable locus of responsibility for the diet of children is the government, we have accepted the premise of totalitarianism. The authors of the articles in the NEJM might answer in their own defence that their articles considered only those measures the government could take to affect the situation; nevertheless, the fact that they did not mention even in passing that parents had some active role to play in their children’s diet suggests to me that the thought did not even occur them. Here truly is the dog that did not bark in the night-time.


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