Hate the Sin, Operate on the Sinner

There’s a story in the BMJ about a German surgeon who refused to operate on an anaesthetised patient because he – the patient – had a swastika tattoo.  The surgeon, it’s reported, was a Jew who couldn’t find it in his conscience to operate on anyone with Nazi sympathies.  The head of the German Medical association has said that the surgeon should not be reprimanded.

While I have a fairly visceral dislike of the far right, which extends to anyone with far-right sympathies, I think that this opinion is flawed.  There’s several reasons for this, and they refer to all the players in the scenario.

First, and weakest, is that we don’t know that the guy was a Nazi.  He could have been an ex-Nazi who doesn’t have the cash for a tattoo removal; or maybe he was satisfied that it’d never be seen publicly.  It may be that the probability of this being the case is low; but the surgeon can’t have known it not to be.  But this reason is, as I said, very weak.

There are stronger reasons, though.  Let’s allow that the patient actually does currently have neo-Nazi beliefs.  Learning that his operation was interrupted for no medical reason, but because his surgeon was a Jew, is – I’d have thought – not likely to weaken his adherence to Nazism.  He could just as well take it as evidence that Jews really don’t like gentiles, and Germanic gentiles in particular.  Yes, the reasoning is fallacious – but a Nazi who doesn’t fall prey to fallacious reasoning at least once in a while is unlikely to stay a Nazi for very long.

Along similar lines, one could mount a kind of Arendtian argument along the lines that central to Nazism was the idea that you could draw a bright line – moral, political, social – between Jew and non-Jew; from this reasoning, to say that one has the right not to operate because one is Jewish is unwittingly to play into that false antagonism.  This kind of point is picked up in the BMJ article by Claudia Wiesemann, who notes that

World Medical Association’s 1948 Declaration of Geneva states: “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.”

But, the article continues:

She believes that the “doctor in Paderborn should have operated on the patient. He should have been prepared for situations of this kind,” she said. “However, I think the doctor should not be reprimanded for refusing to do the operation. Firstly, he took care to arrange for somebody else to step in and did not endanger the patient.”

The second reason, she added, is that the Declaration of Geneva was originally drafted “to preclude the horrible racial politics of medicine during German national socialism. It is a sadly ironic twist of history that exactly this paragraph now should serve to judge as morally unethical what the Paderborn physician has done—or not done—to a neo-Nazi. I feel it would be morally dubious for a German law court to pursue him for that.”

Well, except that he could have endangered the patient.  It’s not clear whether another surgeon was available at that time; if not, the patient would have been exposed to anaesthetic risk one more time than necessary.  But endangerment aside, I think that there’s also something a bit twisty about the way that a clear violation of the Geneva Declaration is being defended on the grounds that the Declaration was made in the wake of Nazism.  So what?  The Declaration says that race, religion, politics and all the rest of it have nothing to do with medical practice.  That means that Nazi medical practice would be condemned.  It doesn’t mean that Nazis would be excluded from treatment, even temporarily; there’s an ocean of difference (and not just moral: it’s ontological, too) between Nazi practices and Nazis.  The Geneva Declaration’s moral power comes from the fact that it extends moral protection even to the repugnant, while still condemning what they do.

I think, too, that there’s something morally dodgy about medics taking on a quasi-judicial – or simply judgmental – role.   At least as far as the surgeon qua surgeon is concerned, the moral or legal status of the patient is neither here nor there.  (I’ve written on a related theme in the American Journal of Bioethics in response to a paper by Gesundheit et al; the focus is slightly different, but there’re clear points of contact.)  A medic’s job is – at least plausibly – primarily to cure, and thereafter to give comfort.  To refuse this is to misunderstand what being a medic is about.  Nor can appeals to conscientious objection carry much weight here – even if you think that there should be scope for such objections, it’s one thing to refuse to participate in a procedure you think wrong (as in the abortion conscience clause), and quite another to refuse to carry out a procedure you admit to be permissible on a person you don’t like.

So, somewhat against my instincts, I think that a reprimand would be in order.  Just because someone is an arse, it doesn’t mean that they can’t be wronged.  And it looks like the patient here, arse though he may have been, has been wronged.

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