Friday, April 08, 2005


Strength and weakness

One of the things I've heard a lot in the last few weeks (most recently in President Bush's statement on the death of the Pope) is that a "culture of life" is one in which the "strong protect the weak." On the one hand, I'm all for the strong protecting the weak -- or, at least, I know I'm not in favor of the strong preying on the weak. But on the other hand, the way other people have been using this phrase in connection with cases like Terri Schiavo's troubles me. Maybe it's the constant repetition of the words that makes them start to sound strange in my ears, the way you sometimes realize that a perfectly ordinary word sounds weird. Like "that." That. That. That. Weird word.

When you see a relationship in which one party is strong and the other is weak, you could be looking at a healthy, protective relationship -- a father or mother caring for an infant child is perhaps the paradigmatic example of this good kind of strong-weak relationship, and I presume it's the one that "culture of life" spokespeople like President Bush have in mind. But asymmetrical power also happens to characterize violent relationships. It thus needs to be constantly kept in mind that relationships of violence and protection share a common feature: both occur in relationships where all the strength is on the side of one party. Indeed, there is often a razor thin line between the rhetoric of violence and the rhetoric of protection. Witness how the axiom that the "strong protect the weak" is sometimes used to rationalize going to war against the weak, for their protection of course.

It seems to me that even in the medical realm, the line between protection and abuse can be thin, although often we only recognize this in retrospect. The Hippocratic injunction to "do no harm" is important precisely because weakened patients are at the mercy of their doctors, and it's no coincidence that this latter phrase can have a menacing undertone. Sometimes in thinking that we are showing mercy, we can actually do harm.

So far, of course, I haven't said anything that "culture of life" proponents would disagree with. In the Schiavo case, for instance, the "culture of life" thing to do seemed clear to them: removing the feeding tube would be a clear instance of violence, of the strong failing the weak by using their power to withdraw nutrition. What troubles me, though, is that anyone can be absolutely sure that the opposite is not true: Schiavo's weakness, after all, is what enabled doctors to stab a tube into her stomach. Can we be absolutely sure that this exercise of power was not a violent one? (Stick with me for a moment.) Both leaving the tube in and taking the tube out are exercises of power, made possible by the doctors' strength and Schiavo's weakness. How do we know for sure that only one of these two exercises would have been protective, while the other was violent?

I imagine to many people it seems obvious that putting a feeding tube in a patient is clearly a case of the strong protecting the weak, since although it is an act made possible by the doctor's nearly absolute power over the body of the patient, it is done with the intention of preserving the patient's life. I don't want to overturn that idea completely, but I do think it should at least seem less obvious.

First, consider the history of medicine. There are many procedures, now thankfully obsolete, which seemed at the time like instances of the strong protecting the weak, but which turn out in retrospect to have been horrifying acts of violence. Take the once ubiquitous practice of "bleeding" patients, or using leeches. They seemed protective at the time, but now they would likely be ranked by most people as torture. (Tangential thought: keeping people on death's door alive is something that medical care shares in common with certain kinds of torture. That doesn't mean there are not clear and obvious ethical differences between medicine and torture. But the similarities should at least be kept in mind.) In sum, you don't have to be a devotee of Foucault to see that care for the body of another is closely related to the control of another body. Sometimes the passage of time makes what seemed like care start to seem like cruelty and control. The most civilized ways of treating diseases can later come to seem like madness.

I don't mean to sound like a medical Luddite. I have great faith in doctors and medical technology. But it seems reasonable, at least, to look at medicine -- and particularly end-of-life care -- with some skepticism. To many observers in the Schiavo case, it seemed clear, obvious, beyond doubt that we should deploy every technical method in our power (hint, hint) to keep Schiavo breathing. I guess I'm just saying that there may be hubris in this faith in our power. In his latest post, Timothy Burke reports about hearing Randall Terry on the radio, saying that (in Burke's paraphrase) "it was important to keep Schiavo alive because there might be medical technologies coming any day which would restore her consciousness or improve her condition." Shouldn't we at least also acknowledge that the day might also be coming when we look back in horror on the medical technologies we use now as a matter of course? Medicine does have an incredibly good track record of fixing its mistakes -- we don't bleed or leech people any more. But its progress is often dependent on identifying past conventions as mistakes. I wonder whether some future generations will be as aghast at our compulsion to keep people alive on machines as we are now aghast at the idea of letting blood to reduce fever. Again, I don't offer this as proof that feeding tubes are cruel or violent -- only that history warrants a certain amount of reasonable skepticism about the ways in which we use technological power over bodies that cannot resist our intrusions.

A second general rule that's been bouncing around in my mind: What the strong see as protection, the weak often see as domination. That should at least be borne in mind here too. Imagine a pathologically protective father, who in the interest of keeping his son safe, keeps the child under lock and key for years. Interview the parent, and you'll hear someone saying that the strong should protect the weak. Look at all the dangers the child would face outdoors, and look at how physically secure he is indoors. But interview the child after the passage of years, and you'll hear a different story: about a parent who has crushed the autonomous life of the child. It wouldn't take many imaginary juries to rule that this relationship was abusive, perhaps even violent -- even though the father never laid a hand on his son to harm him, and even though his intentions were protective. We would still be able to see that the father used his power to dominate his weaker son and deny him the measure of autonomy that all human beings have been given. Violence against another person does not just involve the infliction of physical pain; it also involves the curtailment of personal freedom. (Incidentally, make sure you find time to read this post by Michael Bérubé.)

In raising these points, again, my point is to introduce some reasonable doubt into the idea that all medical interventions are examples of the strong protecting the weak. Relationships between the strong and the weak are often prone to violence -- either against the body or the will of the weak. And although we often hear from people like Randall Terry that we don't know what medicine might be able to accomplish, we seldom hear people tempering our faith in medical technology. Whenever we become confident that we know how to use our power for the betterment and protection of the weak, it's time to rein in our confidence by reminders about how power can be abused even by the good-intentioned. Violence is not less violent when the strong think they know what is best for the weak.

In the last few weeks, with all of the invocations of God's will for a "culture of life" and all the references to the strong and the weak, I've sometimes thought of Paul's "thorn in the flesh," an unidentified physical ailment mentioned in 2 Corinthians 12:
Three times I appealed to the Lord about this, that it would leave me, [9] but he said to me, ‘My grace is sufficient for you, for power is made perfect in weakness.’ So, I will boast all the more gladly of my weaknesses, so that the power of Christ may dwell in me. [10] Therefore I am content with weaknesses, insults, hardships, persecutions, and calamities for the sake of Christ; for whenever I am weak, then I am strong.
I can't put my finger on why, but the idea that weakness is strength seems worlds apart from the idea, trumpeted loudly by many Christians today, that the strong must protect the weak from every thorn of the flesh. Don't get me wrong: I'm not saying that we should not care for the sick and dying by alleviating their suffering. But there is a point at which describing ourselves as strong becomes a refusal to recognize our weakness, and a point at which that refusal becomes an idolatrous faith in our own sufficiency instead of the sufficiency of grace. Maybe that's the final reason why statements like President Bush's -- the "strong protect the weak" -- trouble me, for when repeated incessantly, that mantra starts to sound like a boast. How different would the "culture of life" look if its mantra was: Power is made perfect in weakness.

Collective Improvisation:
I don't think Paul's statement could justify an unwillingness to treat the sick, which seems to be the implication of your last point. He's saying that when weakness presents itself that's when Christ is shown to be strong because nothing else can show such strength. He's not saying we should try to make or keep people weak. I'm sure he'd be horrified at that notion. 

Posted by Jeremy Pierce

Posted by Anonymous Anonymous on 4/10/2005 08:32:00 PM : Permalink  

I'm not saying that we shouldn't treat the sick, and I tried to say that explicitly. Nor was I suggesting that Paul would support any such notion, since you're right that he would be horrified by it, as am I.

But he would also be horrified by the idea that human strength is sufficient to annihilate weakness. I think the point of this passage is to give a description of physical weakness that makes it valuable as a source of humility, and to emphasize that grace is sufficient even when attempts to cure the flesh are not. So I quoted the passage because I think sometimes in "culture of life" arguments, humility and the sufficiency of grace become overshadowed by boasts about medical capabilities and the sufficiency of the strong in protecting the weak. The strong should protect the weak, but while always keeping in mind that perfect strength is in weakness. The two ideas should keep each other from either excessive trust in our strength or excessive indifference to the weakness of the sick.

As you can see, this is probably one of the many cases where poetic license has gotten me in trouble. I'm aware that I may be putting this passage from Paul into a context where it was not intended, and I'm sorry if my clumsy invocation of the passage left the impression that I am a medical Luddite or that I think we should not care for the sick. 

Posted by Caleb

Posted by Anonymous Anonymous on 4/11/2005 07:47:00 AM : Permalink  

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