Innocence or objectivity

There is an impossibility at the heart of the hpc. The impossibility is the assumption of innocence and the relation this has to the supposed position of objectivity. It is not a natural impossibility, like death, in the face of which one can labour heroically, but an unnatural impossibility which can render us at best foolish, at worse pernicious.

Ian Kennedy's Reith Lectures, delivered in 1980, led to a book which he gave the title: The Unmasking of Medicine (London George Allen & Unwin). In it he mounts a polemic against the profession of medicine, accusing medical practitioners of wielding the power over life and death. Kennedy ultimately wanted to know why it should be doctors who have that power, and why it couldn't be 'us' instead. He never elaborated what he meant be 'us', but Ian Kennedy was at that time an academic lawyer - a lecturer at the LSE. It never occurred to him that the profession of medicine ipso facto forced the practitioner into a position which ultimately must tangle itself up with death. In short, Kennedy's fallacy is that medics are inherently unsuitable to practise medicine, and 'we' would do it better, if only, like Austen's Lady Catherine, we had devoted ourselves to the practice. "If I had ever learnt I should have been a great proficient".

The assumption here, to spell it out, is that people fall into different categories. Them, and us: we are good, they are morally stained. It is the myth of the 'beautiful soul'. For surely, had Ian Kennedy chosen medicine, he would be confronted by the impossibilities of the practise himself.

When the Bristol Royal Infirmary row blew up in the national arena, the controversial labour peer Lord Levy phoned Ian Kennedy to invite him to chair the Inquiry. It is in the report of this inquiry that the explicit recommendations are made that the CHRE (see side panel for link) and the HPC be set up on the general principle that objectivity means knowing nothing about the practise. There is an assumption that objectivity can be achieved by obeying a set of rules, and limiting the subjective elements of life to the point of non-existence. It is a naive idea of objectivity, and open to abuse. It also flies in the face of recommendations by Dame Janet Smith, and written by the Right Hon Patricia Hewitt that the preservation of trust (that we have in people in general, including professionals in the medical field) has to be the starting point - that rules should not be written on the evidence of exceptions.

The recommendations of Kennedy's inquiry were taken up in the Health Professions Order 2001, and gave the basis upon which to create the CRHP (which now goes under the name CHRE) and the HPC. The HPO2001 was passed into law through Privy Council, thus making it one of very many pieces of legislation brought into existence without the usual full debate in the houses of parliament.

Laws, even well made laws, have to have careful attention when applying them in practice. And for this a whole other profession has grown up through the custom and practice of centuries: law. There is a common theme: how is the written rule brought to life in particular situations and applied to the life of a real human being. There are examples of bad application of law, with tragic consequences. There are examples of heroic bravery, sometimes also ending in tragedy. There is the letter of the law, and the spirit of the law. But the fact remains that some things, even tho written in books, still have to be carefully interpreted and weighed against the reality of the situation. Following the rules is not an adequate defense. No matter which way you look at it someone has to step in and bear the burden of reality. The rest of us can endeavour to create a society that won't scape-goat them, much less build an edifice upon that scape-goating, if hindsight gives a better solution.

We are back in the province of religion.