Williams' "The Use of Force" and first principles in medical ethics

Williams' "The Use of Force" and first principles in medical ethics Barbara Currier Bell Suppose you could discuss only a single work during a course in medical ethics—what would you choose? A case study? A discursive text? A new contribution to thought? My choice would be a reading that is unique in combining the value of all three. My choice would be "The Use of Force," the short story by William Carlos Williams.1 Williams' stories are no strangers on medical ethics syllabi, of course. As a doctor, Williams speaks with special authority; and when that authority doubles with Williams' greatness as a writer, it becomes all the more compelling. Few can miss that greatness because Williams was not a "literary" writer; his fiction appears immediately true to life. Never mind that this seemingly effortless or anecdotal style resulted from years of practice and even a theory or two about art: such reminders are the stuff of literary criticism and need not be expanded upon here.2 What matters for a medical ethics course is that "The Use of Force" has a simple plot, involves no more than two main characters, and is only four to five pages long. It is an especially realistic and readable case study. Still, much the same could be said of other stories by Williams (including a couple he liked better) or, for that matter, of other doctorwriters ' fiction—Anton Chekhov's, for instance. What makes "The Use of Force" unique beside comparable texts is the instruction in ethics that it provides. One familiar way of characterizing this instruction is to say that "The Use of Force" makes its characters into individuals. Since, the argument goes, nobody can reach ethical insight without appreciating the 244 THE USE OF FORCE individuality of their fellow humans, a stimulus to such appreciation is ethically instructive. Williams himself enunciated this argument and started the emphasis on individuality in his fiction. In one famous proclamation he wrote, for instance, "The finest short stories are those that raise . . . one particular man or woman to the distinction of being an individual." 3 He strove to create that distinction for characters in his works and succeeded . Yet again a point might be made against the uniqueness of this story, for most good fiction makes characters into individuals: on the basis of this feature alone, a huge number of readings are equally instructive. Or, to flip the coin, making characters seem universal is just as helpful to ethical insight—and just as ubiquitous in good fiction—as making them seem individual. For greater insight, then, the point about instruction must shift away from character and over to plot. What happens in "The Use of Force" is simple. The doctor-narrator answers a call to help a sick child named Mathilda, discovers she does not want to be helped, and forces help upon her. Most commentators start by pointing out that Williams is concerned with dramatizing the doctor-patient relationship: the plot is elaborated by the doctor's clear and critical thoughts about what he is doing. Two interpretive lines follow, both of which illuminate ethical dimensions of the story.4 Although my own reading of the story differs from both of these interpretive lines, they are worth discussing as an introduction because they demonstrate, at one level, the complexity in the story, and, at another, the complexity of ethics itself. The first line of interpretation sees the doctor as wrong, or bad. In using force against a child, he violates duties of kindness owed by all human beings to each other, but particularly by doctors to their patients. He could and should have done otherwise. He recognizes his wrongdoing himself, and scorns himself. As readers, we should reject the doctor's behavior: one version of this reading even sees Mathilda as victorious at the end, not physically, but morally. The second line of interpretation sees the doctor as "human." In using force against a child, he does what he must to cure her. He can choose no other way. He knows all the time what he is doing is wrong, by some standards; but he also knows that his savagery is justifiable, by...