07 November 2024

The Hippocratic Oath

I have weirdly strong feelings about the Hippocratic Oath as an ethical frame around the medical profession. I think it is the most noble commitment which any professional community makes.

Over on Twitter I have accumulated a little thread of commentaries on the friction between physicians’ obligations versus our politics & society. In it I repeatedly reference “the shade of Hippocrates”, not just because I am pagan in that sense, but because referencing him underlines that the commitment is sacred in every sense of the word, the material equivalent of bodhicitta.

Two of my favorite evocations of the profundity of the commitment come from pop culture.


The first is a little scene from the TV series The West Wing in which President Jed Bartlet talks to his wife Abbey, who is a physician.


Jed
Eisenmenger’s Syndrome.

Abbey
It’s a cyanotic heart condition. There’s something called ventricular-septal defect …

Jed
The Ayatollah’s son has it.
[⋯]

Abbey
What’s the problem, Jed? Don’t tell me there’s a problem with State …

Jed
The only doctor available won’t do it.

Abbey
He’s Jewish?

Jed
Persian.

Abbey
He doesn’t have a choice.

Jed
Abbey …

Abbey
He doesn’t. Doctors aren’t instruments of the state, and they’re not allowed to choose patients on spec.

Jed
I can’t order him to do it.

Abbey
Yes, you can.

Jed
Through the power vested in me by you?

Abbey
Samuel Mudd set Booth’s leg after he shot Lincoln. Doctors are liable in this country if they don’t treat the patient in front of them.

Jed
Just for the record, this is why we don’t talk about foreign policy — which we do, but you don’t think we do enough.

Abbey
Why?

Jed
Because Samuel Mudd was tried and convicted of treason for setting that leg.

Abbey
So?

Jed
What “so”?

Abbey
So that’s the way it goes. You set the leg.

The second is from the TV series Firefly. Jayne wakes up in the dispensary after having betrayed not just their doctor, but their doctor’s sister, whom we have seen him sacrifice a great deal to protect. The doctor says to him:


You’re in a dangerous line of work, Jayne. Odds are you’ll be under my knife again. Often.

I want you to understand one thing very clearly.

No matter what you do, or say, or plot — no matter how you come down on us — I will never, ever harm you. When you’re on this table, you’re safe, because I’m your medic.

And however little we may like or trust each other, we’re on the same crew. Got the same troubles, same enemies, and more than enough of both.

Now, we could circle each other and growl. Sleep with one eye open. But that thought wearies me. I don’t care what you’ve done. I don’t know what you’re planning on doing. But I’m trusting you. I think you should do the same.

Because I don’t see this working any other way.

This is on my mind because we are entering a time of profound conflict.

I am bitter. I am scared. I am angry.

And I am determined to remember that my object is and will remain to save everybody. Including my enemies. Especially my enemies.

06 November 2024

Ignorance, and different kinds of Trump voters

Waking up to Trump’s victory in the 2024 election, I shared to social media the comment:

Most of Trump’s voters weren’t asking for what’s coming.

But they will embrace it when it arrives.

A wise friend challenged me for acting as an apologist for Trump voters. But this is an indictment of them.


My wise friend mistook me as suggesting that Trump voters are not really mean-spirited bigots. I recognize that Americans — not just Trump voters — broadly are mean-spirited bigots. I recognize that bigotry is integral to support for Trump.


But. Anyone reading this is likely to have a hard time understanding how bogglingly ignorant & misinformed most ordinary Americans are about politics.

As I learned from Chris Hayes before he was famous:

The undecideds I spoke to didn’t seem to have any intuitive grasp of what kinds of grievances qualify as political grievances. Often, once I would engage undecided voters, they would list concerns, such as the rising cost of health care; but when I would tell them that Kerry had a plan to lower health-care premiums, they would respond in disbelief — not in disbelief that he had a plan, but that the cost of health care was a political issue. It was as if you were telling them that Kerry was promising to extend summer into December.

I have done a little bit of political attitudes research for my day job. I can report from the field that it is not just “undecideds” who are that confused. Many people with strong party affiliation are in the dark. Left and right. College-educated and not.

I have had people ask who the Presidential candidates were. I have had people attributing Biden policies to Trump and vice versa. I have heard Democrats who hated Trump say that his first term proved that if he won it would not be that bad. They. Don’t. Know.

That ignorance is not a blessing. It does not make Trump voters less culpable. It does not protect us from what I see ahead. The same tendencies which produced that ignorance will make them rationalize every horror that comes. I have heard people say things that make my blood run cold.


It helps to break down Trump voters into three types, including two kinds of MAGAs.

Though with precious few exceptions MAGAs refuse to recognize themselves as fascists, that is what both types are. Fascists are driven by bigotry, drawn to the absurdities of fascist rhetoric which free them not just from moral responsibility but from having to think rationally at all.

Hard MAGAs have bloodlust. They do in fact dream of gunning down millions of people they hate et cetera. They know Haitian immigrants are not eating pet cats, but since Those People are inhuman monsters, they love the lie for getting at the “essential truth” that the suffering & death of Those People is a positive good in itself.

Soft MAGAs have doublethink. Horseshit to rationalize horrors — as good, as necessary, or as not actually horrible — works better the more preposterous it is because it distracts from facing the centrality of their bigotry. They “believe” that Haitian immigrants eating pet cats must be “true”: it “makes sense”, it justifies the fantasy they have of Getting Rid Of Those People. They don’t think about what that will require, and when the bloodshed does appear before them, these kinds of “beliefs” will justify their schadenfreude at the suffering & death.

Non-MAGA Trump voters do not think like fascists. They are bigots but it is not their central motivation in the same way. They prefer to look away from their own bigotry; the shame they feel about it compels them to deny they have it rather than to correct it as they should. They dislike the absurdities of MAGA, but see aligning with MAGA as “necessary” in the face of the Greater Evil of the nightmarish “radical left” Democratic Party. They have selected an information bubble which protects them from hearing the story about Haitian immigrants eating cats; Trump’s nonsense is irrelevant, they just have a thirdhand impression that he cares about the Important Problems facing Real Americans. If MAGA fascism guns down millions of people, they will deny that they knew and it will be half-true because they go out of their way to not know.


Both the bigotry and the support for horrors is equally monstrous in all three cases. Practically everyone in all three categories will help fascism build murder factories. I respect refusing to care about the machinery of their thinking and the degree to which they actively want what they will build, because the bottom line is the same.

But. If one wants to understand them — and there are instrumental reasons why one would — one has to see how only the hard MAGAs want murder factories as a positive good, while the dynamics are different for the others. My hand-wave-y guess is that about half of Trump voters are soft MAGAs, with non-MAGAs outnumbering hard MAGAs by a small margin.


From Milton Meyer’s book with the brilliant title They Thought They Were Free: The Germans 1933-45:

Outside, in the streets, in the general community, “everyone” is happy. One hears no protest, and certainly sees none. You know, in France or Italy there would be slogans against the government painted on walls and fences; in Germany, outside the great cities, perhaps, there is not even this. In the university community, in your own community, you speak privately to your colleagues, some of whom certainly feel as you do; but what do they say? They say, “It’s not so bad” or “You’re seeing things” or “You’re an alarmist.”

And you are an alarmist. You are saying that this must lead to this, and you can’t prove it. These are the beginnings, yes; but how do you know for sure when you don’t know the end, and how do you know, or even surmise, the end?

[⋯]

But the one great shocking occasion, when tens or hundreds or thousands will join with you, never comes. That’s the difficulty. If the last and worst act of the whole regime had come immediately after the first and smallest, thousands, yes, millions would have been sufficiently shocked — if, let us say, the gassing of the Jews in ’43 had come immediately after the “German Firm” stickers on the windows of non-Jewish shops in ’33. But of course this isn’t the way it happens. In between come all the hundreds of little steps, some of them imperceptible, each of them preparing you not to be shocked by the next. Step C is not so much worse than Step B, and, if you did not make a stand at Step B, why should you at Step C? And so on to Step D.

And one day, too late, your principles, if you were ever sensible of them, all rush in upon you. The burden of self-deception has grown too heavy, and some minor incident, in my case my little boy, hardly more than a baby, saying “Jewish swine,” collapses it all at once, and you see that everything, everything, has changed and changed completely under your nose. The world you live in — your nation, your people — is not the world you were born in at all. The forms are all there, all untouched, all reassuring, the houses, the shops, the jobs, the mealtimes, the visits, the concerts, the cinema, the holidays. But the spirit, which you never noticed because you made the lifelong mistake of identifying it with the forms, is changed. Now you live in a world of hate and fear, and the people who hate and fear do not even know it themselves; when everyone is transformed, no one is transformed. Now you live in a system which rules without responsibility even to God. The system itself could not have intended this in the beginning, but in order to sustain itself it was compelled to go all the way.

You have gone almost all the way yourself.

04 November 2024

The far right pitch

I just succumbed to subscribing to John Ganz’ Unpopular Front, and was rewarded with a post offering a sharp critique of left anti-antifascism which named some things which have been bothering me. (In short, a certain school of left antifascism which sees sees “liberalism” as nothing other than a defense of capitalism, sees fascism as the instrument which capitalism creates to suppress the left, and therefore regards liberals as at least as great a threat as actual fascists, if not an even greater threat. Someday I need to write about this perverse misunderstanding of fascism at length.)

The post contains long quotes from Prophets of Deceit: A Study of the Techniques of the American Agitator, a 1949 book by “two nearly forgotten Frankfurt School sociologists, Leo Löwenthal and Norbert Guterman” which already have me glad I subscribed. It would be dishonorable to share the subscriber-only post, but I think it is fair to share a key bit of his quotation from the book which summarizes of the far right appeal:

My friends, we live in a world of inequality and injustice. But whoever believes that this state of affairs will ever be or can ever be changed is a fool or a liar.

[⋯]

Not utopia but a realistic struggle to grab the bone from the other dog — that is our program. Not peace but incessant struggle for survival; not abundance but the lion’s share of scarcity. Can you realistically expect more? To win this much you will have to follow me. We will form an iron-bound movement of terror. We will ally ourselves with the powerful in order to gain part of their privilege. We will be the policemen rather than the prisoners. And I will be the leader. I will think for you, I will tell you what to do and when to do it. I will act out your lives for you in my public role as leader. But I will also protect you. In the shadow of my venom you will find a home.