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Quirks and Quacks: Bernard Shaw and Medical Ethics

Reflecting on ethical considerations posed by the famous Irish-born satirist nearly a century after his play critiqued aspects of the medical profession.

Published April 19, 2004

By Jennifer Tang
Academy Contributor

Image via Wikimedia Commons.

You’ve invented a “miracle cure” for tuberculosis. Unfortunately, you have limited supplies of the drug and have room for only one more patient. You must choose between saving the life of a penniless doctor dedicated to helping the poor or a talented but dissipated artist whose neglected wife attracts your eye. Who would you save?

That’s the “dilemma” facing the protagonist of The Doctor’s Dilemma, George Bernard Shaw’s 1906 satire on the medical community and the conflict between the arts and sciences. To examine the play’s treatment of medical ethics and its relevance to today’s physicians, The New York Academy of Sciences (the Academy) co-sponsored a panel discussion and play at the Graduate Center of the City University of New York, on March 30, 2004. The event, The Doctor’s Dilemma: Quirks and Quacks, was co-sponsored by the Martin E. Segal Theater Center, the Bernard Shaw Society, and the City University’s Science and the Arts Program.

After actors from the Juilliard School of Drama read three scenes from Shaw’s play, a panel discussion was held with Mark Horn, MD, MPH, director of medical alliances at Pfizer’s Alliance Development; Howard Kissel, senior theatre critic for the New York Daily News, and John T. Truman, MD, MPH, Professor and Deputy Chairman of the department of pediatrics, Columbia University/Children’s Hospital of New York-Presbyterian. Rhonda Nathan served as moderator.

A Lifelong Skeptic

Kissel opened the discussion by stating that Shaw’s portrayal of doctors was too harsh. “Shaw was cantankerous and his plays were often designed to provoke controversy,” he said. The first scene, in which a group of doctors congratulate a colleague on his knighthood, rapidly turns into a debate over which medical procedure is superior. While the lead character believes that germs must be coated with a chemical in order for the body’s immune system to fight them, a surgeon believes that nearly all diseases are caused by blood poisoning, and yet a third says diseases can be avoided by cutting out everyone’s nuciform sac.

Shaw’s implication is that doctors promote their procedures to gratify their ego or their wallet rather than the needs of the patient. “Shaw counted doctors among his friends, but also remained a lifelong skeptic toward the medical profession,” Kissel said.

While Horn agreed that Shaw had “a contemptuous attitude toward doctors,” he thought the play was a parody that remains timely and contains some uncomfortable truths about medicine. For example, the play’s premise—how a doctor decides whom to treat when there is a limited supply of medicine—echoes the “health care rationing” of medical services offered by today’s HMOs.

The Poor Doctor versus the Brilliant Artist/Scoundrel

Truman noted that Shaw presented the conflict in terms of class and profession—the “poor doctor” versus the “brilliant artist/scoundrel.” But Shaw’s play harks back to an era when health care decision-making was influenced by the idea of ‘social utility.’

“In those days, if you wanted to get a kidney transplant, there was a ‘scorecard’ determining whether or not you would get it. You were rated according to what you had to offer to society, and that determined whether or not you got a kidney transplant,” he said. Such reasoning (based on Social Darwinism) is obsolete today, he felt, although the wealthy continue to have more options to receive better treatment than the poor.

In addition, the play’s satire on “medical fads” (the doctors each promoting their new procedures like salesmen), still holds up well today, according to Horn. He pointed out how “current styles of intervention” are a fact of health care and how medicine is constantly changing. For example, there has been a radical reassessment of coronary disease in recent years, and such once-heralded procedures as hormonal replacement therapy have been scrutinized.

Truman observed that the doctors in the play represent different schools of thought. “In the field of ethics, these doctors favor their own procedures because they may have an ‘unconscious bias’ toward their own specialty,” he said. He told an amusing anecdote about Rudy Giuliani, who reportedly visited several doctors during his treatment for prostate cancer. When he went to a radiation therapist, the doctor suggested radiation therapy; when he went to a surgeon, the doctor suggested surgery. “That does not mean doctors are bad; they do believe they have the correct solution,” he said.

What Does it Mean to be a Human Being?

Kissel cautioned, however, that we should remember when the play was written. “In the last 50 years, medicine has been miraculous,” he said. Shaw’s play was written at a time when many medical procedures were still unsafe, and it was not uncommon for people to die from them. Hence, the debate over vaccines in the play did not involve big companies like Pfizer, but vaccines that had been manufactured by farmers.

The panelists also questioned whether Shaw’s delineation of the line separating the arts and sciences remains true today. Are there irreconcilable differences between these two branches of human thought? Will they remain forever at odds?

Horn commented that artists and scientists are different in terms of temperament and this difference creates a barrier in communication. When human beings speak another language, he said, they might resort to “contempt, which would serve as a camouflage to hide feelings of fear over what they don’t understand,” he said.

“Nowadays, the arts have gone off in so many weird directions that the gap between art and science is much less than it was in Shaw’s time,” Kissel added. To him, the issue appeared to be more about humanity. “I think the more important question posed by the play is, what does it mean to be a human being?”

Also read: Avoiding Bias and Conflict of Interest in Science


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