{"id":801,"date":"2015-01-20T11:34:51","date_gmt":"2015-01-20T10:34:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=801"},"modified":"2017-08-24T13:33:29","modified_gmt":"2017-08-24T12:33:29","slug":"physicians-and-magicians-a-magical-education-for-physicians-in-life-death-power-potions-and-defence-against-the-dark-arts-by-fiona-dogan-and-mark-harper","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2015\/01\/20\/physicians-and-magicians-a-magical-education-for-physicians-in-life-death-power-potions-and-defence-against-the-dark-arts-by-fiona-dogan-and-mark-harper\/","title":{"rendered":"Physicians and Magicians: A Magical Education in Life, Death, Power, Potions and Defence Against the Dark Arts by Fiona Dogan and Mark Harper"},"content":{"rendered":"

Abstract<\/strong><\/p>\n

The worlds of magic and medicine both involve the sudden initiation of an intimate relationship between two complete strangers \u2013 the magician and their subject, or the doctor and their patient. Magic requires the subject to have some degree of trust in the magician, to accept that props and setting may be required to aid the illusion, and to witness such a high degree of skill that belief in the magician\u2019s ability is sustained once the trick is complete. In the medical setting trust and confidentiality, the use of medical equipment, and the expertise and competence of the doctor are but a few essential components of a successful interaction. This is not to imply that the art of medicine is a trick, but rather a complex set of circumstances that can be engineered to promote the best possible outcome for both the doctor and the patient \u2013 or the magician and their audience.<\/p>\n

The concepts of magic in the Harry Potter series can be used as examples to study issues that medicine raises in our own society. By focusing particularly on The Order of the Phoenix<\/em>, The Half-Blood Prince<\/em> and The Deathly Hallows<\/em>, it is possible to compare the learning processes for both young magicians and medical students that are considered necessary to prepare them for life in their profession. Within the books there are interesting issues regarding perspectives of professional knowledge and power, with diverse examples of socio-economic status informing the treatment of certain groups by others. The psychology of the misuse of power by those in positions of authority and professionals acting under duress provide a measure of insight into the actions of doctors under a totalitarian regime. Finally the ethics of using science and magic are debated throughout the series, and provide valuable material for discussion of moral issues that can be translated directly to medicine.<\/p>\n

Physicians and Magicians: A Magical Education for Physicians in Life, Death, Power, Potions and Defence Against the Dark Arts\u00a0<\/strong><\/em><\/p>\n

Education<\/strong><\/p>\n

There is a clear comparison between magic and medicine in the structure of training which can be classified into three, occasionally overlapping, areas which broadly equate to the classic educational paradigm of knowledge, skills and attitudes.<\/p>\n

Right from the very beginning (we are excluding Owl Post although that may be equated to the acceptance letter) the similarities are striking. The young, aspirant magician\u2019s trip to Diagon Alley, to buy a pile of books they don\u2019t understand and a wand they don\u2019t know how to use, equates to the medical student\u2019s first visit to the University bookshop and purchase of stethoscope and other medical equipment. A cat, rat or owl would make a more interesting and interactive companion than a skeleton – if somewhat less relevant to medical studies. Here we see the first inklings of a professional attitude, in that both sets of students begin to take on the accoutrements that distinguish them from the non-medical or Muggle population.<\/p>\n

There are also many similarities in the education process. Hogwarts requires seven years compulsory teaching, with the witches and wizards \u201ccoming of age\u201d the year before they qualify. This provides a greater degree of freedom for them to practice their magic and hone their skills in the Muggle world, unprotected by the castle\u2019s enchantments and restrictions on underage magic. Similarly doctors in the UK qualify after five years but have a further two years as junior doctors, gaining more responsibility during their sixth and seventh years.<\/p>\n

Furthermore, both educations consist of a combination knowledge acquisition through book learning and skills through an apprenticeship. There is also a degree of crossover in the subjects studied: Potions and pharmacology, Arithmancy and chemistry, and Muggle Studies and communication skills.<\/p>\n

There are even parallels in the same work hard, play hard ethic. Hours are long, learning goes on late into the night and copious quantities of beer are consumed – though there may be some suspicion that Butterbeer is not as potent as real ale.<\/p>\n

Right from the beginning, both sets of students are externally regulated by either the General Medical Council (GMC) or the Ministry of Magic (MoM). As well as overseeing competencies these bodies define and regulate the appropriate attitudes through the \u2018fitness to practice\u2019 committee and, as Harry discovers more than once in the series, the Improper Use of Magic Department. Furthermore they effectively create a closed-shop which cannot be breached by the non-professional. (1,2)<\/p>\n

However, whereas the GMC and the medical profession seem to be striving towards an ever more open and inclusive approach to the delivery of medicine, it could be argued that the MoM is rigidly sticking to a more archaic, paternalistic model. Muggles do not possess magic, and are generally not permitted to even know that wizards and witches exist. If mistakes are made and members of the Muggle population do become unintentionally aware of magic, it is acceptable to have memory charms performed on them without their knowledge or consent. This is demonstrated throughout the books, from the murders committed by Peter Pettigrew on the night of Voldemort\u2019s destruction to the treatment of the Roberts\u2019 family at the Quidditch World Cup in the Goblet of Fire. In The Deathly Hallows <\/em>Hermione decides that the best course of action for her parents is to modify their memories, in order to make them forget they have a daughter and feel a sudden desire to leave the country. As she possesses the knowledge and skill to perform such a spell, she does this herself without consulting her parents or any of her fellow magicians. (3\u20135)<\/p>\n

Much as one might, at times, wish to remove a patient\u2019s memory of an interaction -ethics aside – conventional (i.e. non-magical) medicine still only has the power to induce prospective amnesia, and even then on an imperfect basis. (6) Additionally, research has shown that better outcomes are associated with patients understanding their illness and being involved in decisions about their treatment so maybe a shift towards a more informative and holistic partnership between patients, doctors, magicians and Muggles can only be a good thing. (7,8)<\/p>\n

 <\/p>\n

Power in life\u2026<\/strong><\/p>\n

It\u2019s not only actions that have consequences but attitudes too, particularly when it comes to wielding the kind of power possessed by physicians and magicians. The \u201cuse-or-not\u201d of power is both a central theme of the Harry Potter books and an important consideration in terms of the doctor as magician.<\/p>\n

The magical world is hidden from Muggles, as Hagrid explains to Harry at the very beginning of The Philosopher<\/em>\u2019<\/em>s Stone<\/em>, because people would want magical solutions to all their problems if they knew it was available. (9) His point is reinforced in The Half-Blood Prince<\/em> during a conversation between the Muggle Prime Minister, the ex-Minister for Magic Cornelius Fudge and his replacement Rufus Scrimgeour:<\/p>\n

\u2018The Prime Minister gazed hopelessly at the pair of them for a moment, then the words he had fought to suppress all evening burst from him at last.
\n\u201cBut for heaven\u2019s sake \u2014 you\u2019re wizards! You can do magic! Surely you can sort out \u2014 well \u2014 anything!\u201d
\nScrimgeour turned slowly on the spot and exchanged an incredulous look with Fudge, who really did manage a smile this time as he said kindly, \u201cThe trouble is, the other side can do magic too, Prime Minister.\u201d\u2019 (10)<\/p>\n

This is useful in exploring the expectations some people – and some doctors – have about the power of medicine. In the past the physician was more like the magician, albeit one who used sleight of hand rather than real magic, creating power through obfuscation in a veneer of classicised language and instruments, such as the stethoscope, that put space between them and the patient. Interestingly, as their real powers have grown, the fa\u00e7ade has come down to a large extent and patients can have much greater knowledge of their conditions and of the \u2018spells\u2019 possessed by the doctor.<\/p>\n

Nonetheless, expectations have simultaneously risen and it often seems that patients think doctors should be able to do magic. Maybe it would help to show them how \u201cthe other side\u201d also has \u201cmagic\u201d; whether it is the ability of the virus to mutate to escape drugs and detection, or the cancer to hide in the patient\u2019s own cells (DNA even) to evade chemotherapeutic spells and radiation wands, only to re-emerge like Voldemort from his Horcruxes. There is still no \u201cMagic Bullet\u201d to specifically target every disease process. (11\u201314)<\/p>\n

The exchange above also illustrates how the patient can be affected by the amount of power they feel they have over their condition. As he feels he is losing control of the situation, the Muggle Prime Minister cannot contain himself any longer, and his words are redolent of patients and their relatives in the face of a poor prognosis. (15)<\/p>\n

The Dursleys are Harry\u2019s Muggle family from his mother\u2019s side. Despite being among the few Muggles who know about magic, they choose to ignore it for as long as is possible because they see magicians as troublemakers and a source of embarrassment. They pretend that Harry is mentally unstable rather than admit to him being a wizard. It is only in The Order Of The Phoenix<\/em> when\u2026<\/p>\n

\u201cThe arrival of Dementors in Little Whinging seemed to have breached the great, invisible wall that divided the relentlessly non-magical world of Privet Drive and the world beyond.\u201d<\/p>\n

\u2026they see the possible impact of magic on their own lives, and they begin to ask for Harry\u2019s advice and guidance.<\/p>\n

There are patients who have an analogous distrust of doctors, to the extent that they will leave conditions far longer than they should in order to avoid confronting the medical world. The Dursleys represent this group and demonstrate how people can have deep-seated and rationalised (though not necessarily rational) views. The Dursleys are, therefore, useful characters to consider when dealing with patients can be very afraid of a condition that they do not fully understand. (2)<\/p>\n

 <\/p>\n

\u2026 and power over death <\/strong><\/p>\n

The biggest ethical dilemma raised in Harry Potter books relates to the death of Albus Dumbledore in The Half-Blood Prince. After putting on a cursed ring by mistake Dumbledore asks Severus Snape for help. Snape uses a potion to trap the curse in Dumbledore\u2019s right arm temporarily, although they both know he will still be dead within the year. Dumbledore then asks Snape to kill him when the time comes, as this will prevent him suffering for longer than necessary whilst also solidifying Snape\u2019s position with Lord Voldemort in his double agent role.<\/p>\n

This situation is analogous to palliative treatment and physician-assisted death. As Snape delivers the final blow himself rather than provide the means for Dumbledore to take his own life, and Dumbledore is conscious up until the Avada Kedavra killing curse hits him, it would most likely fall under the category of voluntary active euthanasia. (5,10)<\/p>\n

The first issue this series of events raises is that of the ethical dilemma that surrounds the boundary between a duty of care and actively shortening a patient\u2019s life. Snape finally agrees to undertake this task \u2018for the greater good\u2019- to protect his double agent identity and therefore help assure the safety of the students at Hogwarts.<\/p>\n

In medicine the death of a terminally ill person in order to benefit the life of another is one of the core issues when discussing the legalisation of euthanasia. Setting aside the moral issues, benefit may be derived from both the individual, in terms of reduced suffering, and the collective, through the reduced drain of limited resources. However, this must be set against the need to protect elderly and vulnerable people, and provide optimum medical care. (16)<\/p>\n

The second issue this event raises is the emotional effect on the doctor or magician who delivers the final, fatal blow. We see Snape hesitate before killing Dumbledore and, even though at this stage he is portrayed as Voldemort\u2019s henchman, we can feel his reluctance. This is despite the fact that he is acting on a well thought-out and considered advance directive. As Dumbledore explains in The Deathly Hallows:<\/p>\n

\u201cI ask this one, great favour of you, Severus, because death is coming for me… I confess I should prefer it to be a quick, painless exit to the protracted and messy affair it will be…\u201d<\/p>\n

Nonetheless, Snape fears for the consequences to himself:<\/p>\n

\u2018\u201cThat boy\u2019s soul is not yet so damaged,\u201d said Dumbledore. \u201cI would not have it ripped apart on my account.\u201d<\/p>\n

\u201cAnd my soul, Dumbledore? Mine?\u201d<\/p>\n

\u201cYou alone know whether it will harm your soul to help an old man avoid pain and humiliation,\u201d said Dumbledore.\u2019 (5)<\/p>\n

This illustrates a common argument against euthanasia, regarding the psychological burden that could be felt by the enabling physician. This has been a subject of specialist research for many years, involving doctors who work in clinics such as Dignitas in Switzerland and those who are required to administer lethal injections to criminals in the United States. (17)<\/p>\n

Part of the problem is that Snape is, necessarily, acting alone. It would be much easier if he had advice, support and objectivity from others. It therefore underlines the need in medicine for a multidisciplinary approach to these situations. (18)<\/p>\n

The description of the last moments before Snape kills Dumbledore bring up two further issues. The first is the effect on the peripheral characters: in the medical context, the relatives; in this context, Harry, who is shocked and frightened by the unfolding events.<\/p>\n

\u2018\u201cSeverus…\u201d<\/p>\n

The sound frightened Harry beyond anything he had experienced all evening. For the first time, Dumbledore was pleading.\u2019<\/p>\n

It is not until The Deathly Hallows that it becomes apparent Snape was acting on Dumbledore\u2019s wishes. At this point it seems that the old wizard is begging for his life to be spared.<\/p>\n

\u2018…Snape gazed for a moment at Dumbledore, and there was revulsion and hatred etched in the harsh lines of his face.<\/p>\n

\u201cSeverus… please…\u201d<\/p>\n

Snape raised his wand and pointed it directly at Dumbledore.<\/p>\n

\u201cAvada Kedavra!\u201d\u2019<\/p>\n

But furthermore, it is impossible to tell whether Dumbledore had actually changed his mind at the last minute and was, as it seemed to Harry, pleading for his life. And this is something that needs to be considered with medical euthanasia, particularly in patients with degenerative diseases that may compromise their ability to communicate or comprehend over time. These decisions are often made a long way in advance, and it can sometimes prove very difficult to be sure that their wishes have not changed. (10,19)<\/p>\n

 <\/p>\n

Defence against the Dark Arts<\/strong><\/p>\n

The steady implementation of the totalitarian state in the second half of the Harry Potter series closely mirrors the rise of Nazism in Germany prior to the Second World War. The persecution of the Jews and the Muggle-borns, Neville Chamberlain\u2019s appeasement policy and Cornelius Fudge\u2019s feverish denial, and the use of propaganda by Voldemort and the Death Eaters are but a few similarities. The actions performed by different magicians under this regime is an interesting study in psychological terms, and provides some insight into the behaviour of professionals such as doctors during wartime and under duress. (20)<\/p>\n

Under the rule of Hitler it was deemed necessary for doctors to experiment on classes of people who were considered \u2018lesser beings,\u2019 in order to further knowledge and discoveries in the field of medicine. This began with the psychological dehumanisation of the Jews and other \u2018undesirables\u2019 through smear campaigns, blaming them for the defeat of Germany in 1918 and the subsequent economic depression. Through the use of careful and steady propaganda it seemed like an almost natural progression for the Jews to eventually be segregated and placed on a registry system. Some doctors chose to accept the idea of the \u201cJewish plague\u201d and took pride in providing what they believed to be a valuable service to Germany and scientific advancement, whilst other doctors performed their duties under duress to avoid being killed themselves. It became commonplace for those within the medical profession to control, torture and kill Jews, homosexuals, the disabled and many others as part of their day\u2019s work, and to record the results of the various experiments performed. (21)<\/p>\n

In Harry\u2019s world there are certain witches and wizards who can be used to represent the actions of different medical professionals under the oppressive regime in Nazi Germany. Firstly interesting parallels can be drawn between Hitler\u2019s \u201cAngel of Death\u201d Dr. Josef Mengele, and the Head of the Muggle-Born Registration Committee Dolores Umbridge. Mengele had a background in genetics and twin studies in particular, and revelled in the fact that Hitler\u2019s regime allowed him to further his studies through experimentation in a way that would not have been possible previously. Similarly Umbridge is vociferous regarding the offensive nature of half-breeds and later Muggle-borns, and seems unperturbed who is in charge as long as she is able to increase her power and her freedom to use it. It later comes to light that she abused her position or power as early as the beginning of The Order of the Phoenix, when she illegally sent Dementors after Harry to try and silence him regarding Lord Voldemort\u2019s return. She was initially appointed by the Ministry as the Defence Against the Dark Arts teacher at Hogwarts in order to keep a closer eye on Harry and Dumbledore, but rapidly progressed up the ranks due to her dedication and ruthless personality. Whilst not in league with Voldemort himself, she certainly upheld his ideals and, similar to Mengele in Germany, seemed to delight in using the political situation to her advantage to achieve her aims. (2,21)<\/p>\n

Alecto and Amycus Carrow represent the Nazi doctors who truly believed in their leader\u2019s vision and would do everything in their power to assist in its\u2019 realisation. They differ slightly from the type of doctor portrayed by Umbridge, as they believed in Voldemort\u2019s particular ideals rather than his general approach. The Carrows excelled under Voldemort\u2019s rule during the Second Wizarding War, and revelled at the chance to freely use the previously illegal Unforgiveable Curses: Imperio (control), Cruciatus (torture) and Avada Kedavra (death) \u2013 the same methods used on the \u201cundesirables\u201d by the Nazis during the Second World War. Harry is depicted on posters and referred to by the Ministry as \u2018Undesirable No.1\u2019.<\/p>\n

Professor Snape\u2019s true loyalties are in question up until his dying moments at the end of The Deathly Hallows, where it is revealed that he had indeed been trying to protect Harry all along. Working as a double agent for Dumbledore, he made the difficult decision to continue to work for Voldemort in the hope that he could exert some control over the Carrows\u2019 punishments inflicted upon the students they were in charge of. This has previously been the case with doctors who speak out after working under duress, in an attempt to limit suffering as much as they can in a difficult situation. (5)<\/p>\n

The character of Voldemort himself raises important issues regarding the psychology of a dictator. Voldemort used great acts of evil to split his soul into 7 pieces (Horcruxes) to attempt to gain immortality and power. The concept of \u2018doubling\u2019 describes how a person is able to commit acts previously abhorrent to them, as they simply \u2018switch off\u2019 their other side. This has been offered as an explanation why people, such as Nazi doctors, were able to torture and kill \u2018undesirables\u2019 on a regular basis. (10,21)<\/p>\n

Conclusion<\/strong><\/p>\n

Throughout the Harry Potter books there are many comparisons that can be drawn between the magical and the medical world. The similarities and differences that have been highlighted give us an original way of looking into important issues concerning the medical profession, and the magician-Muggle relationship raises interesting points regarding the doctor-patient interaction. Ultimately it leaves one wondering whether we as physicians try too hard to be magicians? Or is it that patients actually want us to be magicians? As always, the reality probably lies somewhere between the two extremes.<\/p>\n

 <\/p>\n

References<\/strong><\/p>\n

    \n
  1. General Medical Council L. Tomorrow\u2019s doctors: Recommendations on undergraduate medical education. 2009.<\/li>\n
  2. Rowling J. Harry Potter and the Order of the Phoenix. 1st ed. Bloomsbury; 2003.<\/li>\n
  3. Rowling J. Harry Potter and the Prisoner of Azkaban. 1st ed. Bloomsbury; 1999.<\/li>\n
  4. Rowling J. Harry Potter and the Goblet of Fire. 1st ed. Bloomsbury; 2000.<\/li>\n
  5. Rowling J. Harry Potter and the Deathly Hallows. 1st ed. Bloomsbury; 2007.<\/li>\n
  6. Twersky RS, Hartung J, Berger BJ, McClain J, Beaton C. Midazolam enhances anterograde but not retrograde amnesia in pediatric patients. Anesthesiology. 1993 Jan;78(1):51\u20135.<\/li>\n
  7. Coulter A. Paternalism or partnership? BMJ. 1999 Sep 18;319(7212):719\u201320.<\/li>\n
  8. Bond C, Blenkinsopp A, Raynor DK. Prescribing and partnership with patients. Br J Clin Pharmacol. 2012;74(4):581\u20138.<\/li>\n
  9. Rowling J. Harry Potter and the Philosopher\u2019s Stone. 1st ed. Bloomsbury; 1997.<\/li>\n
  10. Rowling J. Harry Potter and the Half-Blood Prince. 1st ed. Bloomsbury; 2005.<\/li>\n
  11. Williams S, Weinman J, Dale J, Newman S. Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction? Fam Pract. 1995 Jan 6;12(2):193\u2013201.<\/li>\n
  12. Kenten C, Bowling A, Lambert N, Howe A, Rowe G. A study of patient expectations in a Norfolk general practice. Health Expect. 2010;13(3):273\u201384.<\/li>\n
  13. Illich I. Limits to Medicine: Medical Nemesis – The Expropriation of Health. Marian Boyars; 1976.<\/li>\n
  14. Strebhardt K, Ullrich A. Paul Ehrlich\u2019s magic bullet concept: 100 years of progress. Nat Rev Cancer. 2008 Jun;8(6):473\u201380.<\/li>\n
  15. Lupton D. Medicine as Culture: Illness, Disease and the Body. SAGE; 2012. 79-136 p.<\/li>\n
  16. Harris D, Richard B, Khanna P. Assisted dying: the ongoing debate. Postgrad Med J. 2006 Aug;82(970):479\u201382.<\/li>\n
  17. Stevens KR Jr. Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians. Issues Law Med. 2006;21(3):187\u2013200.<\/li>\n
  18. Seale C. Legalisation of euthanasia or physician-assisted suicide: survey of doctors\u2019 attitudes. Palliat Med. 2009 Jan 4;23(3):205\u201312.<\/li>\n
  19. Hotopf M, Lee W, Price A. Assisted suicide: why psychiatrists should engage in the debate. Br J Psychiatry. 2011 Jan 2;198(2):83\u20134.<\/li>\n
  20. Curthoys A. Harry Potter and historical consciousness: Reflections on history and fiction. Hist Aust. 2011 Apr 13;8(1):7\u201322.<\/li>\n
  21. Lifton RJ. The Nazi Doctors: Medical Killing and the Psychology of Genocide. Basic Books; 2000.<\/li>\n<\/ol>\n

    Author contact details:<\/p>\n

    1. Fiona N Dogan,\u00a05th<\/sup> year BM BS student, Brighton and Sussex Medical School<\/p>\n

    f.dogan1@uni.bsms.ac.uk<\/p>\n

    2. Dr C Mark Harper BSc MBBS FRCA,\u00a0Consultant Anaesthetist,\u00a0Brighton and Sussex University Hospitals
    \nmark.harper@doctors.org.uk<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    Abstract The worlds of magic and medicine both involve the sudden initiation of an intimate relationship between two complete strangers \u2013 the magician and their subject, or the doctor and their patient. Magic requires the subject to have some degree of trust in the magician, to accept that props and setting may be required to […]<\/p>\n

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