Ethics Paper 1

My fascination with language and literature started in the womb, or so my father says. My pregnant mother would lay on the big couch in the living room, her protruding belly serving as a temporary desk in which she would correct the English essays of her high school students. In my youth, I laid in my dad's arms while he read the Minneapolis Star Tribune, not staring at the pictures, but rather at the shape of the letters, the collection of consonants and vowels. I learned at an early age that language serves as a connector between people and that literature serves as a means to understand human experiences outside of one's own.

In college, I pursued my love of language by majoring in English and Spanish. I took particular interest in the connections of different languages and literatures. After studying abroad in Spain, I knew the Spanish language well enough to delve into some of the complicated literature the language offered. What I found was a 1930's Spain confused by modernization and dictatorship, a Cuba at the turn of the twentieth century struggling with its identity as a post-emancipated nation, a modern-day Ecuador facing deforestation and loss of tribal autonomy. I connected these themes with those I had experienced in American and English writing, examined the way in which literature is multi-national, and explored the relationship between imperialism and literature. Miguel de Unamuno's Spain became my Spain, just as John Steinbeck's America became my America. I expanded my knowledge of American literature from the canonized works of Hawthorne and Melville to the lesser known but equally important novels of Harriet E. Wilson and Craig Womack. I learned about myself, my country, my place in this global society through literature.

Skilled writers detail a human event, propose an ethical dilemma or solution to an issue, and present the reader with the outcome in a manner that brings ethical theory "to life." Nearly every time I read our assignments for the course, I am reminded of a piece of literature that fleshed out a similar principle by using character studies and relevant societal situations. Our most recent lecture explored an important ethical issue negotiated between physicians and patients: autonomy and its limits. William Carlos Williams writes a fascinating essay on the limits of physician power in the context of patient care in his "The Use of Force." The short story details a physician's attempt to look in the sore throat of a young girl. The story is written in the first person perspective of the physician, and as the plot progresses, one can see the change in the physician's perspective as he struggles with the patient's continual resistance. When the doctor first arrives, he is amicable. His first attempt to look at her throat is gentle enough, "I smiled my best professional manner and asking for the child's first name I said…open your mouth…" (74). The child resists this attempt. The physician pushes child with a bit more forcefulness, but she continues to resist. As their encounter continues, the intensity builds: the doctor makes "orders" and insists "we're going through with this" despite the child's opposition. In the end, the physician loses any perspective on patient autonomy: "Perhaps I should have desisted and come back in an hour…but the worst of it was that I too had gone 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" (75). The speaker concludes, "The damned little brat must be protected against her own idiocy" (76). The child does not give up either, though. The last scene describes the child flying at the physician while "tears of defeat blinded her eyes" (76). This story depicts an important relationship often encountered in the physician/patient relationship, and while reading our assigned passages, I could not help but recall this piece of literature. It serves as a touch point for ethical examination of patient autonomy. Clearly Williams understood the essential boundaries of physician power. In the passage, the child gags upon the physician's thrust into her throat, is physically held down, and forced to open her mouth. The reader hears the physician trying to convince himself that it is for her sake, but he/she can not help but evaluate the physician's need for power in the setting of a poverty-stricken home in which he is called to cure the sick child. In his pursuit of clinical diagnosis, the physician ignored any sense of patient autonomy. The reader ends the story feeling conflicted and contemplative. Clearly the child's privacy has been invaded upon. As future physicians we will be forced to balance our fidelity to correct patient diagnosis, patient autonomy, and personal gratification. Williams's story provides a context in which to explore these concepts.

I am not alone in my observation of the intersection of literature and medical ethics. Wayne Booth explores the concept of literature as an ethical framework in his essay "Ethics in Medicine, as Revealed in Literature." He asserts that literature can serve as a reference from which health care leaders can gather ethical sentiments. He asserts that although writers "cannot demonstrate absolutely that certain medical practices are wrong, they can, if experienced genuinely in their emotional power, force every doctor or nurse to think…before embracing this or that form of medical practice." Booth maintains that scholars of medical ethics has neglected the evidence that poets, novelists, and dramatists have examined ethical dilemmas in medicine more overtly than great thinkers like Kant have done. It is important to note, that the doctor/patient encounter itself starts with a story-similar to that of a novelist or playwright. The novelist's detailed account of a situation is enough for a future physician like myself to question or reaffirm his/her own ethical outline. Ethics is about why and how we make moral decisions; it is the study of the principles, values, and theories that we use to guide our choices and actions. The basis of a good piece of literature examines the aforementioned principles, and indeed, I often use my bookshelf as resource for dealing with life's difficulties both professionally and personally.

My love of language and literature will always be with me. On the wall of my small apartment I have a screen print of the cover of The Grapes of Wrath. The last scene of the novel, where Rosalyn breast feeds a dieing man, is the quintessential example of science and humanity colliding: she has the innate ability to feed her child, but it is her sense of life that allows her to feed a starving man. Even though I am studying medicine, I appreciate that language and literature have exposed me to the complex interplay of the human spirit and the physical body. I plan to continue reading and studying languages and literatures, as I know that nurturing my fascination with these subjects will make me a more aware, sensitive physician. I appreciate that the story of Rosalyn, and that that Williams painted in his "Use of Force" force me to question my understanding patient care, including that of patient autonomy.

--Nicole Zanin, '10


Booth, Wayne. "Ethics in Medicine, as Revealed in Literature". from Stories Matter: The Role of Narrative in Medical Ethics. Ed. Rita Charon and Martha Montello. Routledge: New York, London, 2002.

Williams, Carlos Williams. "The Use of Force". From On Doctoring. Ed. Richchard Reynolds, MD and John Stone, MD. Simon & Shuster: New York, London, Toronto, Sydney, 2001.