Carl Elliot suggests that whistleblowers are motivated by honor, rather than by concepts like human rights or professional ethics. He disdains the idea that whistle blowers might be motivated by monetary rewards (“the morality of the bazaar.”) He sneers at any system of research oversight that relies on “petty rules and arcane regulations.”
Virtue ethics also motivated another famous whistleblower, Henry Beecher, whose 1966 article in the NEJM shocked the nation. Beecher, like Eliott, was skeptical about the value of regulation or of ethics committee review of research studies. Instead, he felt that research subjects could only be protected by a “the presence of an intelligent, informed, conscientious, compassionate, responsible investigator."
Elliott’s sense of honor may explain why he feels so unsatisfied with the results of his efforts in the Markingson case. By most metrics, his whistleblowing efforts were successful. They led to national press coverage and highly critical reports by outside experts and the State’s own internal auditor, including mandated advocates for research participants, transparent conflict-of-interest policies, and timely reporting and review of adverse events in research studies.
But these were changes in the rules. What Eliottt wanted and never got was for institutional leaders to acknowledge their heinous behavior and apologize to Markingson’s mother, Mary Weiss.
Years ago, Carl and I collaborated to organize a conference about Walker Percy. Percy was a physician who never practiced, a philosopher, and a novelist. His books often featured seriously impaired physicians who had lost interest in the more mundane aspects of medicine or who, instead, sought to diagnose and perhaps the spiritual ailments of late-twentieth century America. At the conference, Elliott noted that Percy’s novels “often portray medicine in decline, sold out to greedy capitalists and narrow scientists.” The most appealing doctors in his novels are “burned out and dispirited, quacks or crooks.”
Elliott’s own writing picks up on Percy’s themes of decline and cynical profit-seeking. He speaks of the soul-destroying effects of medical education. He lambasts ethicists who take money from drug companies. Like Percy, he worries that doctors have lost their souls and that, even worse, they don’t even know what they’ve lost.
While Elliott’s book reflects ideas from Percy, it also evokes a different tortured Southern writer – William Faulkner. Like Faulkner, Elliott looks to his past – his Southern Presbyterian upbringing, his medical training – to make sense of both his own life choices and the choices of others like him, the medical whistleblowers who took on the corrupt medical establishment at great personal cost, fighting battles that, on some level, they knew they could not win.
Carl’s meditations on biomedical research scandals constantly return to the lessons he learned watching his father stand against racism and segregation in the South and the lessons that he learned in medical school in South Carolina. The book ends with a description of his father’s funeral.
Echoes of Faulkner are everywhere in Elliott’s new book. “This book,” Elliott writes, “Is a conversation with ghosts.” And again, “Had I ever really understood the story? Even now, I struggle to make sense of it.” And, “Whistleblowers need a story that explains what has happened in a way that does not leave them felling broken and meaningless. The problem is finding that story.”
Faulkner was always trying to find the story, to understand his own past by understanding the past of his people in Mississippi, by understanding America’s past. Elliott’s attempt to find meaning in stories of medical whistleblowers have the same urgency and frustration as Quentin Compson’s conversations in his cold Harvard dorm room.
Ideas of honor and the whole notion of an ethics based on virtues rather than rules are both deeply out of fashion. Explaining why those ideas are relevant is a frustrating task. As Elliott tries to understand his own determination to expose medical corruption, I sense the same frustration that Faulkner’s young protagonist, Quentin Compson, felt as he tried to explain the history and traditions of the American South to his wry Canadian college roommate. After a long night of delving, and deep confusions, the roommate finishes the conversation by saying that he only has one more question – why, he asks Quentin, do you hate the South?
And the famous last line of the book is: “I don’t hate it,” Quentin said, quickly, at once, immediately. “I don’t hate it,” he said. I don’t hate it he thought, panting in the cold air, the iron New England dark; I don’t! I don’t! I don’t hate it! I don’t hate it.”
For Elliott, the question might be about why he hates medicine and bioethics or what the contours might be of a hatred that is so interwoven with the anger-driven hope that whistleblowing or writing about whistleblowing might awaken the benumbed consciences of the so-called healers or the ethicists who claim to be the awakeners.
Faulkner, like Elliott or like Quentin Compson, both loved and hated the South. Elliott’s relationship to the South and its tradition of honor is similarly ambivalence. He describes, with both horror and fascination, the way that South Carolina Representative Preston Brooks nearly beat Massachusetts Senator Charles Sumner to death in May of 1856 because Sumner had insulted the honor of Brooks’ family. The beating shocked the Senate but made Brooks a folk hero in South Carolina. The honor ethic persists. “Few whistleblowers resort to violence,” Elliott writes, “although I suspect some of the have fantasized about it.” He then describes with delight the pleasures of vengeance as portrayed in American movies like True Grit.
Elliott is advocating for a living, breathing, robust, and muscular ethics of virtue such as Faulkner describes in The Bear. “Courage, and honor, and pride and pity, and love of justice and of liberty. They all touch the heart, and what the heart holds to becomes truth, as far as we know the truth.” In such an ethics, rules and regulations are beside the point. A virtuous person becomes virtuous because they were raised right, raised to be discerning, raised to be able to see right and wrong and to be compelled to side with the right. In his Nobel acceptance speech, Faulkner suggested that the virtuous person does not seek “defeats in which nobody loses anything of value, of victories without hope and, worst of all, without pity or compassion.”
There are no victories in such ongoing struggles. The victory is in the fight, even if it inevitably ends in defeat.
Literary scholar Houston A. Baker Jr., saw Faulkner as daring readers “to enter with him into furious contest with and dreadful excavation of the past and of the Americas.” Elliott is doing the same, demanding that we confront the past not by imagining that rules and regulations made by the sinners will lead to salvation but by at least recognizing that manifold ways that we, all of us, have sinned.
Will it work?
Perhaps the best summary of an ethic of honor is Houston Baker’s summary, “Who else could have declared a war against a power with ten times the area and a hundred times the men and a thousand times the resources, except men who could believe that all necessary to conduct a successful war was not acumen nor shrewdness nor politics nor diplomacy nor money nor even integrity and simple arithmetic but just love of land and courage.” Such might be the philosophy of many whistleblowers.
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