Difficult Doctors and Rational Fears

Should the doing of bioethics require the reading of novels? No, unless we believe that fiction trumps nonfiction as a means of exploring complex issues in medicine and the life sciences, and also that writers of novels have a lock on the arts-and-humanities department of the moral imagination. And it’s hard to get science right—convincing, not distracting—in a literary novel, even as plot-driven genre fiction may rely on biotechnological twists.

So, let’s narrow our scope to the care of the sick, and to medical ethics. Should the development of our personal capacity for empathy with those who suffer—with those who are sick, dying, frightened, threatened, weary, or in need of care and compassion for some other reason—include the reading of novels (and other fiction) in addition to reading nonfiction, discussing difficult cases, or writing personal narratives about our own experiences? If so, does it matter which novels?

Yes, and yes, if only to make sure The Death of Ivan Ilyich makes it onto the syllabus. Tolstoy’s novella about a judge who is blindsided by mortality—we just redecorated, how can I be dying?—meets Martha Nussbaum’s test for the sort of reading experience that is most likely to stir the emotions and in so doing, encourage the reader “to imagine what it is like to live the life of another person who might, given changes in circumstance, be oneself or one of one’s loved ones.”¹ While reading nonfiction can engage the emotions, it may prompt sympathy rather than empathy: the factual details may remind us that this is not our story, however much we are moved by it. Discussing and writing about our own experiences can deepen our understanding of what we have experienced, but may not suffice to help us imagine a different experience, a different future, or a different self. Realist novels—and, as long as we’re making moral judgments, let’s make aesthetic judgments, too, and clarify that Nussbaum is talking about classic novels—aid the moral imagination because they invite us into a complete world, force us to “see and to respond to things that may be difficult to confront,” and also allow us to experience not just admiration, but pleasure. The reader of The Death of Ivan Ilyich is allowed to enjoy the experience of reading Tolstoy while simultaneously having her emotions wrung out by the experience of empathizing with Tolstoy’s dying protagonist. Even if this reader enjoys the experience of reading an outstandingly well-crafted personal essay or other nonfiction narrative about the experience of life-threatening illness—think of Marjorie Williams’s “Hit by Lightning” or Anne Fadiman’s The Spirit Catches You and You Fall Down—admitting to aesthetic pleasure when confronted by the documented pain of real others seems callous. Their pain is not there for our pleasure.

The special virtue of Ivan Ilyich is that it’s short. This matters if we are exhorting physicians and nurses to read fiction as a means of reflecting on the work they do, and that we may not do ourselves. But this essay is not about Ivan Ilyich. This essay is about a classic novel about a good doctor. It’s a long novel—perhaps too long for the medical ethics syllabus, but worth seeking out by readers interested in what the origins of contemporary medical practice looked like to a Victorian novelist writing about his contemporary scene. When medicine was organizing itself as a profession, how did physicians make choices about which members of society got to see a real doctor? What did patients expect from real doctors? Did nineteenth-century physicians have conflicting ideas about how, and how much, they ought to be paid? (Yes.) Is boutique medicine a new idea? (No.)

Anthony Trollope’s Doctor Thorne is not a portrait of an ideal Victorian-era physician. Dr. Thomas Thorne is gruff, prickly, idiosyncratic. He is also an adoptive parent of exceptional virtue, a good citizen, someone who is trusted even by those who don’t like him much. Trollope calls him “my hero” (p...