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  • Field Notes
  • Alex Capron

Jay Katz, 1922–2008.

The obituaries reporting Jay Katz's death on November 17 typically described him as an authority on medical ethics and an advocate for the rights of patients and research subjects. This characterization by the New York Times, Los Angeles Times, Boston Globe, Yale Daily News, and other newspapers is right, as far as it goes, but it misses the unique contribution he made to our field, which The Hastings Center recognized in presenting him the Henry Knowles Beecher Award in 1993.

Katz—who spent half a century on the Yale faculty, most of it at the law school—was certainly an expert on the ethical aspects of medicine and science. And he was a defender of all persons exposed to exploitation or neglect at the hands of powerful professionals and the state. As he said in an address in Nuremberg in 1996 to commemorate the fiftieth anniversary of the war crimes trial of the Nazi doctors—the only time he returned to his native Germany, whence he had fled in 1938—his professional life had been dedicated to such people: "In all my work, the disadvantaged in our midst, those stripped of their rights and dignity—the mentally ill, women, children, patients, research subjects—have always been my people."

This devotion, born from identification with the vulnerable, led to many articles in law, medicine, and ethics journals and to the pioneering 1974 casebook, Experimentation with Human Beings. Katz also presented influential testimony at congressional hearings and served on official panels that examined and criticized research abuses such as the Tuskegee Syphilis Study and post–World War II radiation experiments.

But the distinctive feature of Jay's scholarship lay not in his commitment to the rights of the vulnerable but in his insistent probing into medicine's stance of objective benevolence toward patients and the law's commitment to rational decision-making. This not only made him question the meaning of the ethical principle of "autonomy"—a skepticism more widespread now than it was in the early days of bioethics, when patient self-determination was advanced rather ferociously as a counterweight to physicians' prevailing paternalism. Rather, drawing on his training as a psychoanalyst (work that he continued throughout his academic career), Jay demonstrated that the prevailing conception of the physician-patient relationship as two people united in a quest to improve the patient's situation was not simply false but an invention (created not just by physicians but by patients as well) that aimed to obscure inherent vulnerabilities, uncertainties, and tensions. Going beyond this diagnosis, Jay prescribed penetrating conversation as the best—albeit not a simple, painless, or failsafe—means for physicians and patients (as well as investigators and subjects) to form a mutually respectful and self-aware relationship that acknowledges their conflicts.

This insistence on an "obligation for conversation" lies at the heart of his masterwork, The Silent World of Doctor and Patient. Long after we have all been exhausted by the debates over codes, guidelines, and principles, the insights of this book will be there to inspire all who seek a richer and more humane bioethics. [End Page c2]

Alex Capron
University of Southern California Gould School of Law
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