Thank you Dr. Manion for becoming a physician after college graduation as aphilosopher. Your analysis of responses to anti-vaxxers who fail ill and require care at opportunity cost to others demonstrates why we need moral philosophers in medicine.
Thanks Jean Maria. It's been quite the journey. I hope that the field of medicine can accommodate the restoration of pondering, not just clinically but in a grander sort of renaissance spirit. The production-line mentality that's gripped America's for-profit economic model for the longest time has dehumanized the profession and turned the practice of medicine into a transactional, almost robotic exchange. It's no surprise that docs are in distress. I suspect a significant part of it is the underlying existential despair that accompanies such a dehumanization of human caring.
Funny, I had a dream about the word "comeuppance" as a young girl before I had knowingly ever heard it. (it was being threatened me by the Wicked Witch of the West---don't recall my dream "crime"). I rather think the clinicians' sentiment is "you'll get yours! (comeuppance, that is)" when anyone threatens the orthodox message about vaccination. And while I agree that no physician should every rejoice in the misery of others, apparently it is quite a SM trend for others to post deathbed stories of the repentant unvaccinated.... Oh, what depths the quest for that viral post can plumb.
A very interesting discussion is taking place at Rebel-Wisdom here on substack, entitled "Religious Wars of the Pandemic Endgame". With respect to vaccination specifically, another substacker Mary Harrington of Unherd, convincingly opines that "The growing tendency for ‘the vaccinated’ to treat ‘the unvaccinated’ as other or impure recalls the willingness of an earlier age to deny others simple forms of inclusion [such as burial on consecrated ground] on the basis of baptism. Never mind what studies say about the efficacy of Covid vaccination in protecting us from severe illness (which evidence strongly suggests it does) or mitigating further infection (perhaps more debatable)[especially now during Omicron]. Increasingly, vaccination carries a social meaning as well as a medical one. It’s a ritual infusion — albeit via injection, not anointment — of sacred liquid, whose application confers freedom from spiritual taint."
This purity-sanctity distinction from impurity-heathenism also brings to mind the idea of a behavioral immune system... I learned from Norman Doidge in a piece "Needlepoints" https://bit.ly/Needlepoints on understanding Vaccine Hesitancy. During the plagues, he reminds us that a common practice was to nail fast the doors and windows of any house where an infected person was known to reside....no matter who else might be inside....
This is not that far a stretch from Caplan's disputed clinician "Schadenfreude"... a little farther from your softer "getting one's comeuppance".
As always, a thoughtful reply. And you're so right about extnding that "comeuppance" concept to the vaxxed HC person toward the non-vaxxed HC provider, as in "you'll get your just desserts for taking such an oppositional stance."
That said, it's too easy for us to adopt holier-than-thou stances, whether vaxxed or not. I think a challenge we face (and this pertains to anyone who challenges paradigms) is not only being clear about our own reasoning for the stance we take, but striving to understand the reasoning of the other.
I'm "shot_x_3" and I know why I decided to get my 2 shots plus booster. (Or at least I think I know :) And I think I know my concerns about those who are not vaxxed.
It would be a fascinating podcast to explore the conceptualizations and perceptions we have of the various stances we and differing others take.
This is a truly brilliant articulation of a profoundly complex dynamic; the article systematically breaks down each component of the diagnosis with precision, analytical rigor, and heart. Sharing widely!
Many thanks Allison. Not many have patience for complex dynamics. But … it’s where we’ve got to go. Simplistic reductionalism is going to lead us to radical stupidity. (As if, we aren’t already there.)
Thankyou Kernan - I agree with you - it has to be normal to have feelings even transiently which are not what many would term 'positive' under such circumstances. I have been involved in this very scenario and without a doubt, I felt irritated, sad and actually transiently hopeless. My patient very much regretted their anti-vaxx stance and told me how they lied to their relatives to stop them nagging them to get vaccinated. As they told me this, my compassion was back and I felt so, so sad for this person. It was ghastly and by the next day, they were dead. I found myself really upset by it all. YET, I do not believe that vaccination should be mandatory. I think that in so doing, we shut down dialogue with those who are opposed. I think we should be very clear about what we know are the benefits and the risks of vaccination (particularly for the young). I have also seen some severe, life threatening thrombotic events related to vaccination in a young person. The anti-vaxxer patient did have obesity as a risk factor. And that brings me on to your other comments........I do get frustrated that there are certain behaviours which are 'judged' more by some physicians than others - none of us are perfect and different things will trigger each of us. We do not possess absolute truth and it will be years before we know the outcomes of what is the real effectiveness of our preventive measures or treatment strategies.
thanks for your thorough thoughts especially detailing the emotional cascade. They're all going on concurrently, and we've got to find a way to articulate them.
I guess that’s true, Kernan, and generally I’d agree. But can a human truly dissociate their feelings—and their subconscious—from their conscious and purposeful actions? 🤔
Maybe in general practice this isn’t important. But what about an ER or Trauma surgeon making a split second decision—and yes, that’s a stretch—would they subject to a split second lapse or hesitation based on adverse feelings?
Those are great reflections. And I agree with where (I think) you're going with this. Harbor angry thoughts > vengeance-behaviors occur. But we all have angry thoughts; they don't HAVE to lead to angry actions. I think the important thing is - having the thought and associated feeling is entirely fine. It's what you then do with it.
Thank you Dr. Manion for becoming a physician after college graduation as aphilosopher. Your analysis of responses to anti-vaxxers who fail ill and require care at opportunity cost to others demonstrates why we need moral philosophers in medicine.
Jean Maria Arrigo
Thanks Jean Maria. It's been quite the journey. I hope that the field of medicine can accommodate the restoration of pondering, not just clinically but in a grander sort of renaissance spirit. The production-line mentality that's gripped America's for-profit economic model for the longest time has dehumanized the profession and turned the practice of medicine into a transactional, almost robotic exchange. It's no surprise that docs are in distress. I suspect a significant part of it is the underlying existential despair that accompanies such a dehumanization of human caring.
Funny, I had a dream about the word "comeuppance" as a young girl before I had knowingly ever heard it. (it was being threatened me by the Wicked Witch of the West---don't recall my dream "crime"). I rather think the clinicians' sentiment is "you'll get yours! (comeuppance, that is)" when anyone threatens the orthodox message about vaccination. And while I agree that no physician should every rejoice in the misery of others, apparently it is quite a SM trend for others to post deathbed stories of the repentant unvaccinated.... Oh, what depths the quest for that viral post can plumb.
A very interesting discussion is taking place at Rebel-Wisdom here on substack, entitled "Religious Wars of the Pandemic Endgame". With respect to vaccination specifically, another substacker Mary Harrington of Unherd, convincingly opines that "The growing tendency for ‘the vaccinated’ to treat ‘the unvaccinated’ as other or impure recalls the willingness of an earlier age to deny others simple forms of inclusion [such as burial on consecrated ground] on the basis of baptism. Never mind what studies say about the efficacy of Covid vaccination in protecting us from severe illness (which evidence strongly suggests it does) or mitigating further infection (perhaps more debatable)[especially now during Omicron]. Increasingly, vaccination carries a social meaning as well as a medical one. It’s a ritual infusion — albeit via injection, not anointment — of sacred liquid, whose application confers freedom from spiritual taint."
This purity-sanctity distinction from impurity-heathenism also brings to mind the idea of a behavioral immune system... I learned from Norman Doidge in a piece "Needlepoints" https://bit.ly/Needlepoints on understanding Vaccine Hesitancy. During the plagues, he reminds us that a common practice was to nail fast the doors and windows of any house where an infected person was known to reside....no matter who else might be inside....
This is not that far a stretch from Caplan's disputed clinician "Schadenfreude"... a little farther from your softer "getting one's comeuppance".
As always, a thoughtful reply. And you're so right about extnding that "comeuppance" concept to the vaxxed HC person toward the non-vaxxed HC provider, as in "you'll get your just desserts for taking such an oppositional stance."
That said, it's too easy for us to adopt holier-than-thou stances, whether vaxxed or not. I think a challenge we face (and this pertains to anyone who challenges paradigms) is not only being clear about our own reasoning for the stance we take, but striving to understand the reasoning of the other.
I'm "shot_x_3" and I know why I decided to get my 2 shots plus booster. (Or at least I think I know :) And I think I know my concerns about those who are not vaxxed.
It would be a fascinating podcast to explore the conceptualizations and perceptions we have of the various stances we and differing others take.
This is a truly brilliant articulation of a profoundly complex dynamic; the article systematically breaks down each component of the diagnosis with precision, analytical rigor, and heart. Sharing widely!
Many thanks Allison. Not many have patience for complex dynamics. But … it’s where we’ve got to go. Simplistic reductionalism is going to lead us to radical stupidity. (As if, we aren’t already there.)
Thankyou Kernan - I agree with you - it has to be normal to have feelings even transiently which are not what many would term 'positive' under such circumstances. I have been involved in this very scenario and without a doubt, I felt irritated, sad and actually transiently hopeless. My patient very much regretted their anti-vaxx stance and told me how they lied to their relatives to stop them nagging them to get vaccinated. As they told me this, my compassion was back and I felt so, so sad for this person. It was ghastly and by the next day, they were dead. I found myself really upset by it all. YET, I do not believe that vaccination should be mandatory. I think that in so doing, we shut down dialogue with those who are opposed. I think we should be very clear about what we know are the benefits and the risks of vaccination (particularly for the young). I have also seen some severe, life threatening thrombotic events related to vaccination in a young person. The anti-vaxxer patient did have obesity as a risk factor. And that brings me on to your other comments........I do get frustrated that there are certain behaviours which are 'judged' more by some physicians than others - none of us are perfect and different things will trigger each of us. We do not possess absolute truth and it will be years before we know the outcomes of what is the real effectiveness of our preventive measures or treatment strategies.
thanks for your thorough thoughts especially detailing the emotional cascade. They're all going on concurrently, and we've got to find a way to articulate them.
I like the use of comeuppance in this scenario. I guess “appreciation of karma” might be a similar concept.
I guess the positive enjoyment aspect commonly attributed to schadenfreude is what makes it less appropriate, especially for a physician.
👍
Thanks Joe. But even if one did gloat privately, it's still okay to harbor those feelings as long as they don't interfere with the provision of care.
I guess that’s true, Kernan, and generally I’d agree. But can a human truly dissociate their feelings—and their subconscious—from their conscious and purposeful actions? 🤔
Maybe in general practice this isn’t important. But what about an ER or Trauma surgeon making a split second decision—and yes, that’s a stretch—would they subject to a split second lapse or hesitation based on adverse feelings?
Maybe I’m making too much of nothing. 😉
Those are great reflections. And I agree with where (I think) you're going with this. Harbor angry thoughts > vengeance-behaviors occur. But we all have angry thoughts; they don't HAVE to lead to angry actions. I think the important thing is - having the thought and associated feeling is entirely fine. It's what you then do with it.
I agree. In the end, it’s the action that counts. 👌