The Use of Force - Case Study Example

THE USE OF FORCE” Bioethics is an important issue nowadays which is being widely discussed especially in the medical field where rights of the patients may sometimes collide with the powers of the medical personnel. Darryl Macer defines bioethics as “the study of moral choices arising from human involvement with life. Bioethics includes an assessment of benefits and risks related to human interventions, especially new technologies, and looks at balancing pursuit of individual autonomy with the duties of justice. Bioethics demands that technology assessment be thorough, and include assessment of the impact upon societies and individuals.” [1] Education in bioethics is seen as an answer to Socrates’ critical question: Can virtue be taught? It hopes to improve character and practice which is likely to help medical professionals understand where they should draw the line when it comes to exercising their power. William Carlos Williams’ story ‘The Use of Force’ can be used as a case study in bioethics since it effectively brings forth the issue and makes it possible to assess the enormity of the same. It compelling raises the issue of power of medical professionals as it collides with the values of bioethics. As Rudin et al. (1998) state: “Williamss Use of Force clearly demonstrates the ethical dilemma between respect for patient autonomy and the demands of paternalistic beneficence.” This is a highly thought-provoking piece of literature as we shall see in our discussion. The Use of Force is Williams’ classic piece on the ethics of medical profession where we see deeper conflicts involving patient rights, doctor’s discretion, paternalism and violence emerging in a compelling fashion. The story begins when the doctor is called by people he describes as new patients. Upon his arrival, he discovers a sick child who is as obstinate as anyone can possibly be for she refuses to open her mouth for examination. As the doctor works to try to get the child to open her mouth, the story becomes a battle of man over woman as the professional doctor gives way to the irritated man. At the mother’s attempts to coax her child to open her mouth for the doctor, the doctor grinds his teeth in disgust at her choice of words and becomes angered at the parents. At the child’s struggle to keep the doctor away, he becomes angered at her. “Don’t call me a nice man to her. I’m here to look at her throat on the chance that she might have diphtheria and possibly die of it. But that’s nothing to her.” As the child continues to struggle to keep from being examined, she begins to scream and fight, causing the mother to worry about her overexerting herself and the father to berate the woman. “But the worst of it was that I too had got beyond reason. I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her. My face was burning with it.” In this struggle, the child manages to fight off the first attempt to invade her mouth, but comes out of the altercation bleeding and with a cut on her tongue. The doctor in Williams’ story doesn’t try to mince words or downplay his fury and violent reaction in the face of great obstinacy but is highly aware of his use of force. Though he is a thorough professional as he declares "I would not insist on a throat examination so long as [the parents] would take the responsibility" still he feels he is left with no other options but to use force when parents are willing to have their child examined for diphtheria. The story is used as a means of self-exposure and revelation as the doctor is aware of what "one says to ones self at these times" and what one hides. When we see the doctor becoming as aggressive as the child was, we see how bioethics comes into play. Instead of instructing the child in moral education or leaving the house without examination, the doctor is overpowered by "feeling of adult shame, bred of a longing for muscular release" and forces himself to diagnose the life of a "savage brat" that he "had . . . fallen in love with," admiring the "magnificent heights of insane fury of effort bred of her terror of me." Williams shows his doctor and the girl in a power struggle where both parties are painfully aware of their defeat and victory at different moments. While the doctor eventually overpowers the girl, he was not too proud of the way he managed to achieve this victory. He was shamefully aware of the defeat suffered by his "unusually attractive little thing. . . . She had fought valiantly to keep me from knowing her secret" (131 & 135). The issue of bioethics surfaces when we notice doctor’s hidden pleasure over his use of force even though we may agree that it was a necessary step. In this battle, both the patient and the doctor are affected. This is a story with no explicitly wrong or right decisions. The field of bioethics has seen its share of such cases where both the doctor and patient are right in their own way and yet it appears that one has crossed his limits. For example the doctor in this case had no other option but to use force if he really wanted to examine the child. As a doctor it was his duty to make sure his patient was given utmost care and proper treatment. And since the patient herself was not an adult yet, it was her parents who had to make the decisions for her. However when seen from the child’s point of view, it appears that this highly stubborn and assertive girl did not want her mouth examined. She had made up her mind to hide her illness in her own way and for reasons only she understood best. If patients’ rights were invoked, she could easily have escaped this battle but as we know that in her case, these rights were not applicable but age doesn’t stop a person from being just that ‘a person’. As a person, she had a mind of her own and did not want to be swayed away. Williams’ treatment could then be seen as an attempt at "poetic realism" and as such it offers that "paradigmatic example of literature and bioethics in a close marriage" by highlighting the peculiarities of this case. The case can be considered "ironic" in that it presents the reader with a "dramatic, dialectical development." As Burke explains: Irony arises when one tries, by the interaction of terms upon one another, to produce a development which uses all the terms. Hence, from the standpoint of this total form (this "perspective of perspectives"), none of the participating "subperspectives" can be treated as either precisely right or precisely wrong. They are all voices, or personalities, or positions, integrally affecting one another. When the dialectic is properly formed, they are the number of characters needed to produce the total development. (512) The diagnostic procedure in this story- right from the highly professional manner in which inquiry is made to the final use of force to confirm the doctor’s suspicions- is an artistic exploration of power struggle as it ensues when rights and duty collide. The entire situation is created with the help of true exploration of sounds, expressions and actions that we see. It is not reduced to a typical story where symptoms are discussed in some medical jargon that most people do not understand. Instead, the author has made it a point to bring out the entire struggle, the violence, the friction and collision that arose from the situation in which a girl exhibits false though fierce price in "keeping her secret" and the doctor resorts to irrational fury and then extract some unintelligible pleasure from his "attack". All the voices are clearly accentuated to make bioethical aspect of the case even more important. We hear the parents as they show their concern enveloped in embarrassment and the girl’s absolute refusal to give up that makes her hysterical. Two important aspects of this diagnostic act are worth paying closer attention to. Firstly, it all begins in very professional manner as the doctor adheres to accepted rules and procedure. He receives the information that he requires as a medical professional such as "fever for three days . . . a lot of sickness around"--the doctor takes "a trial shot at it as a point of departure" and asks "Has she had a sore throat?" The doctor knows that "we had been having a number of cases of diphtheria in the school to which this child went" and so despite her parents’ response that "No . . . No, she says her throat dont hurt her," the doctor demands visual verification--"Have you looked?" (131-2) Here we see the doctor doing what he is expected to do as a medical professional. He is relying on knowledge that is obtained by what is called “close contact” and his surroundings in order to build "prior probabilities." K. Danner Clauser further explains that a medical practitioner could often "best the specialists" because "[h]e knew the incidence of . . . disease in his population; and he knew the incidence of symptoms that existed independently of that disease." (p. 42) The most interesting aspect of the situation is doctor’s empathetic understanding of the pride of the child, embarrassment and concern of the parents and his own use of force. He is a sensitive observer who seems to be able to read the situation quite well. Though he chastises the over-indulgent mother and pays more attention to father’s sympathetic behavior, he does recognize that "both the mother and the father almost turned themselves inside out in embarrassment and apology." However he seems to connect on a different level with the father whose dilemma he can read well as he was shown torn between "the fact that she was his daughter, his shame at her behavior, and his dread of hurting her," along with "his dread also that she might have diphtheria" ( FD 1 33)). The doctor understands that the child is scared of getting hurt and flinches at the use of the word hurt. Doctor has deep empathic knowledge of the situation which when combined with sound medical know-how give the story its ethical touch. In fact the very reason bioethics comes into play is because here we meet a doctor who is not devoid of feelings but is almost poetic about the entire situation. The very first thing the reader understands about the narrator of the story is that he is a kind and compassionate country doctor: “They were new patients to me, all I had was the name, Olson. Please come down as soon as you can, my daughter is very sick. When I arrived …” Since he didn’t have anything more than a name and had never seen them before, yet still rushed out to the house demonstrates his compassion. As the mother leads him into the kitchen where they’re keeping the sick child, it becomes obvious that this family lives in poverty and a call for the doctor is a last resort. His professional attitude comes out immediately as he observes “her face was flushed, she was breathing rapidly, and I realized that she had a high fever.” His immediate suspicion is to look for signs of diphtheria, which had been affecting several children at the child’s school, but his professional manner doesn’t happen to work to get the child to relent to his inspection and the interference of the parents only serves to bring out his human reactions. Empathy plays an important role and is oddly as consistent as the use of force itself. The doctor understands fully well the financial condition of the house. It is hinted at when the mother sheepishly apologizes for her daughter working in the kitchen despite her poor health: "It is very damp here sometimes." Financial instability often results in pride which doesn’t allow people to volunteer more information than necessary as the doctor knows why the parents "werent telling me more than they had to . . . thats why they were spending three dollars on me" (FD 131). After closer analysis, we conclude that bioethics is a controversial issue which may never be able to develop a set of right and wrongs since in the field of life sciences, there are several times when the boundaries of right and wrong blur so much that ethical distinction becomes impossible. We understand that every person has a right to make medical decisions for himself but in the case of invalids, young children and mentally instable elderly, it is not always possible. Leaving their medical decisions to them is not only impossible, it is also downright criminal. This is where we must forgo of patients rights to making health choices and act in the true spirit of beneficence. References [1] “Are equality rights arguments essential within the debate of bioethic issues?” Retrieved online on 2nd April 2005 from: http://www.bioethicsanddisability.org/is.htm [2] K. Danner Clausner, "Approaching the Logic of Diagnosis," in Logic of Discovery and Diagnosis in Medicine, ed. Kenneth F. Schaffner, (Berkeley: University of California Press, 1985), p. 42. [3] Edward Rudin, M.D., Rachel Edelson, M.S., M.A. and Mark Servis, M.D. Literature as an Introduction to Psychiatric Ethics. Academic Psychiatry 22:41-46, March 1998 [4] Burke Kenneth. A Grammar of Motives. Berkeley: University of California Press, 1945. Read More