Most UK doctors are not doctors, at least not proper doctors. The primary medical qualifications available in the UK are bachelor degrees, not doctorates. The public, as a courtesy, call us Doctor, but even that goes when the provenance of the practice is from the barber-shop – and so we call our surgeons Mr or Miss.
Ethicists and academic lawyers, on the other hand, are almost invariably proper doctors. They follow a narrow career path – bachelor degree, maybe a masters, and then a doctorate. And so we come to the strange state of affairs where the doctoring work is done by non-doctors, while the proper doctors sit back and pontificate about the doctoring work of the non-doctors.
And pontificate it most assuredly is. Even the most casual observer of the current debate about suicide and euthanasia cannot fail to be struck by the high deontological tone of the proper doctors contributing to the debate. Just as the same observer cannot fail to be struck by the practical, pragmatic tone struck by the non-doctors contributing to the debate.
Now, for those who have left their dictionaries at home, deontology and pontificate are natural bed fellows. Deontology is an ethical doctrine that holds that right actions are determined by rules (as opposed to consequences), whilst to pontificate is, according to the OED, to speak in a dogmatic or pompous manner. Both are about dogma and rules.
It is deontology that gives us “we should do the right thing, even if it has bad consequences”. Dogmatism trumps pragmatism.
Non-doctors, on the other hand, are by nature consequentalists (right actions are determined by the consequences of those actions). In treating our patients, we weigh our options on the basis of the likely outcomes of the treatment, and so it is the consequence of the treatment that determines what we do.
It is consequentalism that allows us to say: “we can – note can, not should – do something wrong, because the outcome will be right”. Pragmatism trumps dogmatism.
Now, our deontological proper doctors may remain harmless enough, as long as they remain in their ivory towers. But should they escape into the real world of practical medicine, it is another matter altogether. For Dr Dogma has a cousin, a most unpleasant cousin, whose name is – you guessed it – Dr Death.
Dr Grumble is a doctor with a real doctorate who escaped from his ivory tower where he used to pontificate in a deontological way to become a consequentialist jobbing doctor.
Just occasionally Dr G sits on a committee alongside two lawyers and this post has highlighted what Dr G has already noticed which is that practising doctors are very much more pragmatic than lawyers. There are many sensible decisions that the committee might have made in order to achieve a pragmatic outcome which the lawyers have prevented because of concerns about the route rather than the desired end.
There is something about being at the coalface in medicine which focuses the mind on how to get to the right outcome despite all the impediments en route.
To paraphrase Thomas More, the world construes according to its wits but a court construes according to the law. That’s the difference.
Dr G – I think this is about legal risk aversion (which the lawyers call risk management) and real world risk management at the coal face, which doctors have always done, but don’t call it so.
Julie – absolutely – lawyers deal with man made problems at their own slow pace; doctors have to manage all comers in real time.