Bad-Guys, Buccaneers, and Bureaucrats

j^Bad-Guys, Buccaneers, and Bureaucrats: Images of Bioethics in Film* Edmund L. Erde My title might lead a reader to expect a lighthearted essay of simple design, but my subtitle suggests the opposite. The subtitle wins, at least for the opening pages. In my introduction I offer an account of the two broadest approaches to ethics and bioethics: quandary ethics and virtue ethics. After noting some of the risks and benefits of using film, ethics, and bioethics to illuminate one another, I consider some stylistic similarities and differences between typical pornographic films and medical feature films and note some cultural and symbolic aspects of films that bear on medicine (specifically how heroes are portrayed). Then I define the categories of bad-guys, buccaneers, and bureaucrats and apply them and the previous analyses to four films: The Hospital (1971), Medical Story (1975), Whose Life Is It Anyway? (1981), and Terms of Endearment (1983). Medical Story is a feature-length television production; the others are Hollywoodstyle feature films.1 Bioethics can be understood through two models of ethics, quandary ethics and virtue ethics.2 Quandary or problem-solving ethics tries to answer the question: What should one do in situations like this? Quandary bioethics is the conceptual and moral study of the prindples that should govern persons working in health care. A pervasive issue in quandary bioethics is whether doctors should do what is best for a patient (or sodety) or whether they should respect a patient's rational, free choice. This pits *An earlier draft of this article was presented on February 28, 1985, as part of a continuing public lecture series, "Images of Bioethics," in London, Ontario, Canada, cosponsored by the London Public Libraries and the Westminster Institute for Ethics and Human Values. I wish to thank Benjamin Freedman, formerly of the Westminster Institute, now of McGiIl University and the Sir Mortimer B. Davis Jewish General Hospital (Montreal), for help improving the essay. Thanks, also, to Anne Hudson Jones for her many helpful suggestions. Literature and Medidne 7 (1988) 148-69 © 1988 by The Johns Hopkins University Press Edmund L. Erde 149 paternalism against patients' rights. The most prominent right under contention is that of informed consent, the right of a mentally competent patient to all information about his or her condition, the treatment options (induding no treatment), their risks and benefits, and the opportunity to choose any of them. Quandaries are practical dilemmas: they arise over the application of given prindples (do what is best or respect choice) to spedfic situations. Philosophical controversy rages over how to understand the shape and limits of various prindples (e.g., whether they are rules of thumb or iron dad) and the systematic approaches proposed for resolving practical dilemmas.3 In the context of medicine, both quandaries and philosophical controversies have arisen, for example, about truth telling, abortion, euthanasia, killing and letting die, allocation of scarce medical resources, definitions of death, harvesting organs for transplantation, and using human beings in scientific research. Rivalling quandary ethics is virtue ethics. Virtue bioethics focuses on describing the cultural norms and charader traits presupposed by the practice of medicine. Virtue bioethics involves answering such questions as: What should I (to be a doctor) be? What character traits should I have? What metaphors should I apply to myself (e.g., warrior against disease, teacher to patients, or parent to the patient)?4 For a virtuous physidan, conduct in a highly charged context would either be dilemma-free because he or she acts from second nature, or dilemma-resolved because he or she thinks about what constitutes both the role of physician and the relationship that is the doctor-patient relationship. Because filmmakers are more likely to be interested in chararter and drama than in abstract dilemmas, film will seem more dosely affiliated to virtue ethics than to quandary ethics. Nevertheless, both kinds of bioethics are presented in film. Happily, our understanding of each form of ethics is advanced through sketches of situations and portraits both of physicians and nonphysicians—patients and nurses, for example—showing how aspects of their lives go well beyond what doctors see or know. Feature-length films can provide us with much detail

Bioethics · Health care · Medical ethics · Political science · Sociology · Subtitle · Virtue · Virtue ethics · Empathy and Medical Education · Law · Philosophy

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