At Harvard Medical School someone is screaming, reports the Boston Globe. ‘Death!’, he shrieks, ‘Why after all these years have you not appeared?’ He begs for euthanasia, tormented by his pain. Medical students listen to him.
His lines were written by Sophocles, and the students are listening because they have to: it is part of their curriculum.
The remarkable thing is not that Harvard medical students are being marinated in Sophocles, but that the Globe thought it worth reporting. Most medical students in mainstream western universities will get some ethics teaching. Sophocles is just one tool in the teachers’ toolkit. It’s a very effective one, by all accounts, but no different in kind from the lectures and seminars more conventionally deployed. Ethics teaching aims to teach students some problem-solving strategies, and to help them to recognise, evaluate, criticise, cull or cultivate the values that they themselves bring to the wards.
The Globe seems to be bemused that this sort of exercise is deemed necessary. While acknowledging that old Greek light can usefully illuminate, it ascribes the need for that illumination to the march of medical technology: ‘As medical technologies extend the lives of the sickest, medical schools across the country have struggled to find a way to help doctors better navigate new moral quandaries around death and dying.’ While of course it is true that modern technologies do create new, acute and often painful ways of putting old questions, it is not true that there is a sudden modern need for emotionally literate doctors. People have been suffering and dying for quite a while, and they have rarely relished either the prospect or the experience. What might be true is that the proliferation of medical technology threatens to turn medicine into more of a merely technical business than it ever was – with the patient being regarded only as the bearer of an interesting set of challenges. If that’s true, then we need a strenuous counter-reaction – a reminder that medicine is about humans, not problems.
A corollary of the technologising of medicine is that nerds will be attracted to the profession, and will succeed in it. They need to be kept out. They’re disastrous. In fact they’re negligent.
Patients are humans. Humans are curious metaphysical cocktails: mind-body-spirit unities: amphibians who spend part of their lives in the physical, and quite a lot of their lives in the numinous. Some conditions are purely physical in their aetiology: road traffic accidents, for instance. But perhaps the aetiology of many or most has a mind or spirit element. And beyond any doubt at all, minds and spirits (whatever they are) have a profound effect on the efficacy of treatment and on rehabilitation. The iciest old reductionist acknowledges that placebos work.
Any doctor who closes his eyes to two thirds of the relevant evidence about his patient is dangerously negligent. That’s what a doctor who treats just bodies does. Any education that tells him that that’s OK, and any medical institution that endorses that Nelsonian blindness, needs radical reformation.
If there’s no room in the medical curriculum for both Sophocles and the insertion point of abductor pollicis longus, Sophocles should win. The insertion of abductor pollicis longus will be forgotten by all but the nerds by the morning after the anatomy exam, and learned again, and properly, by the surgeons who really need to know it.
Sophocles can help to mould students into the sort of three-dimensional entities who are capable of treating three-dimensional entities. But there are some incurable medical geeks who will sit unmoved through Sophocles, thinking about the Krebs’ Cycle. These people demonstrate that the medical school admissions procedure has failed. They should be filtered out by psychological profiling, probing interviewing or by whatever other means is necessary. Only those who weep at The Women of Trachis should be let loose on humans. The introduction of an admissions policy that enlightened really would be worth a column in the Globe.
While I generally agree with this, there are a few comments worth adding. First, the difference in medical education is fundamentally a difference in conceptions of what it means to be a doctor. As technology advances, it is not simply that we need doctors capable of handling the new medical and ethical dilemmas that arise, but also that we need to consider if doctors are agents exercising particular faculties and judgments or if they are really just instruments of medical practice. I am inclined to say the former, but how we answer this question will determine how we conceive of medical curricula.
Second, what, exactly, are we hoping to instill in medical students by teaching them Sophocles? There are two worries I have about a sort of lip-service ethics class, the first of which is that we may use Sophocles as merely a point of effervescence, as a test case over which students air their disagreements. They won’t be learning anything from the literature they are reading; they will simply be debating a contentious issue. We don’t need Sophocles for this; a common case-based ethics class would suffice. The other worry is that even if students do engage with the material, they will be doing so from a very modern perspective, viewing whatever is of value in the works in terms of their already-held stances — so Hamlet becomes a manic depressive, and the protagonists of Greek tragedies become embroiled in psychological battles. In this way, these sources just serve to reinforce the opinions that the students already have; they confirm, but they do not challenge.
While I generally agree with this, there are a few comments worth adding. First, the difference in medical education is fundamentally a difference in conceptions of what it means to be a doctor. As technology advances, it is not simply that we need doctors capable of handling the new medical and ethical dilemmas that arise, but also that we need to consider if doctors are agents exercising particular faculties and judgments or if they are really just instruments of medical practice. I am inclined to say the former, but how we answer this question will determine how we conceive of medical curricula.
Second, what, exactly, are we hoping to instill in medical students by teaching them Sophocles? There are two worries I have about a sort of lip-service ethics class, the first of which is that we may use Sophocles as merely a point of effervescence, as a test case over which students air their disagreements. They won’t be learning anything from the literature they are reading; they will simply be debating a contentious issue. We don’t need Sophocles for this; a common case-based ethics class would suffice. The other worry is that even if students do engage with the material, they will be doing so from a very modern perspective, viewing whatever is of value in the works in terms of their already-held stances — so Hamlet becomes a manic depressive, and the protagonists of Greek tragedies become embroiled in psychological battles. In this way, these sources just serve to reinforce the opinions that the students already have; they confirm, but they do not challenge.
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