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219 Judy Z. Segal sufferinG And the rhetoric of cAre 12 Writing in the 1950s, biologist Jean Rostand (1894–1977) imagined an experimentally produced homo biologicus who might say of himself the following: i am the product of carefully selected semen irradiated with neutrons; my sex was predetermined and i was incubated by a mother who was not mine; i was given injections of hormones and DnA during gestation, and subjected to activation of the cortex; after i was born my intellectual development was stimulated by several grafts; at the present time i am having annual treatments to keep my mind at its best and my instincts in full vigour. i cannot complain of my body, my sex or my life. But what am i, in fact?1 Writing in 1969, historian of medicine Pedro Lain Entralgo took it upon himself to “complete Jean Rostand’s joke, and reply to homo biologicus”: you are a being capable of falling ill, and who will fall ill one of these days. And then, in the very depths of your being, you will feel a need to be cared for and helped by a man with special technical knowledge, who is prepared to treat you as a friend. in short, a good doctor.2 The joke, of course, was that there would someday be such a homo biologicus; i think we can agree there is, except in certain details, such a being. The joke’s completion—that such a being will fall ill and need the care of a good doctor—is offered by Entralgo with a tinge of irony. yet we can agree on this too: that even with technological advances, and in some cases because of 220 g After the Genome them (who, for example, can interpret the images that imaging technologies produce?),3 human beings will continue to need something we may be happy to call, the care of a good doctor. i am interested in “care,” the term itself—and the figure (sans gendering ) of the “good doctor.” Scholars have forwarded an ethics of care and a logic of care.4 My project is to suggest some of the details of a rhetoric of care. if we are going to talk about care, we need to be clear what we are talking about. Care—with its collocations and its functions as “inducement to action”5 —circulates in health discourse promiscuously; it is eulogistic, even what Kenneth Burke might call a “God-term.”6 Care has persuasive force, but its meaning is underspecified: it is polysemous, but more. Health care is, in certain quarters, itself a contested phrase, with some scholars arguing that health care policy is an already invasive take on something that might better be called health policy.7 Caregiver and care receiver have constituted care as a commodity and invoke a personal economics of care.8 Care is distributed inequitably, which seems paradoxical: hardly caring. Care is often contrasted with cure—sometimes in an idiom in which nurses care and doctors cure, and sometimes in another idiom: for some commentators, cure ends when the battle against disease has been lost and care (meaning palliation) takes over, the emblem of defeat.9 Practices subsumed under care, such as diagnostic and treatment procedures performed by physicians and technicians , are sometimes carried out without behaviors we would associate with care at all: coldly, perhaps from behind barriers, with human contact at a minimum. Care preceded by the adjective pastoral has a particular (and particularly Christian) meaning in clinical settings, and suggests that care can be spiritual in nature, and that when it is, it is a specialized kind of care.10 Prefixed by Medi- or Obama-, care denotes something having to do with insurance coverage rather than caring for, caring about, or even caring that. To invoke care is not always to persuade us that what we will get, when we become sick, is to be conscientiously, and even tenderly (for that is suggested by care too), looked after. in this chapter, i consider some ways in which care is materialized, especially in north American hospitals, and later i will consider the good doctor, in that context as well. i make two primary interventions: i argue that care requires a recognition of patients as human agents, and i suggest a novel curriculum for training doctors. While there are significant differences between Canada and the United States on matters of health policy, health insurance, and access to health services, literature across...

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