75 years after the publication of the Beveridge report, LSE Festival Beveridge 2.0 (Mon 19 Feb – Sat 24 Feb 2018) offers a week of public engagement activities exploring the ‘Five Giants’ identified by Beveridge in a global 21st-century context. Tickets to all the events, which are free and open to all, can be booked here.
On Thursday 22 February 2018, ‘The Doctor’s Dilemma’ presents an evening of analysis and discussion of health service resource allocation and medical ethics, culminating in a staging of George Bernard Shaw’s 1906 play, The Doctor’s Dilemma. Ahead of this collaboration between LSE Language Centre, LSE Department of Philosophy and Scientific Method and the LSE Students’ Union’s Drama Society, participants reflect on the enduring significance of Shaw’s play and the relevance of presenting it here at LSE as part of the Festival programme.
LSE Festival Beveridge 2.0 Preview: The Doctor’s Dilemma
This evening of drama and debate features a close creative collaboration between students studying literature at LSE, academic staff and a representative of the medical profession, who put their thoughts together to respond to the modern-day implications of the ‘doctor’s dilemma’. On Thursday 22 February 2018 as part of LSE Festival Beveridge 2.0, the expert discussion will assess the extent to which current medical practices and policy embody principles relating to ‘Disease’, the fifth of the ‘Five Giants’ addressed in Beveridge’s 1942 Report, widely looked upon as the blueprint for modern-day NHS healthcare provision. It will also act as a prelude to a staged production of George Bernard Shaw’s 1906 play, The Doctor’s Dilemma, put on by the Literature section of the LSE Language Centre and the LSE Students’ Union Drama Society.
Shaw held strong and controversial views in many areas, including pacifism, evolution (he opposed Darwinism) and reform of the English alphabet (the large bequest he left in his will for this project posed a legal conundrum). Medicine was no exception, and besides espousing eugenics, Shaw was also an opponent of vaccination, which he dismissed as ‘a peculiarly filthy piece of witchcraft’; in 1944, just before the establishment of the NHS, Shaw declared ‘more people are now killed by vaccination than by smallpox’. Shaw and William Beveridge were close friends, united by their commitment to the Fabian Society, and in his correspondence Beveridge refers to giving one of his speeches, for a 1907 parliamentary committee, a ‘dress rehearsal’ under Shaw’s guidance.
The action of Shaw’s play, The Doctor’s Dilemma, focuses on the question of competing claims for a just-discovered cure for tuberculosis, which was still, at the time of writing, an incurable and normally fatal disease. Philosophy students will find that the play’s plot resembles uncannily the so-called ‘Trolley Problem’ scenario in its attempt to establish the most deserving recipient for a scarce supply of the newly-developed cure. The consultant at the centre of Shaw’s The Doctor’s Dilemma, the freshly knighted Sir Colenso Ridgeon, is labelled at one point in the play ‘Mr saviour of lives’. Is there an ethical risk of doctors in the perhaps less melodramatic, day-to-day world of contemporary medical practice too readily succumbing to the lure of ‘playing at God’? And if so, is this risk growing in the current climate of fiscal austerity?
Speaking at the event, Professor Alex Voorhoeve (LSE Department of Philosophy) is a leading expert in the field of medical ethics, who has written extensively on the theory and practice of distributive justice, especially in health. He has worked with organisations that connect purely academic study to medical policy and practice, such as the US National Institutes of Health, and was co-author of a 2014 report for the World Health Organisation, Making Fair Choices on the Road to Universal Health Coverage. He sees Shaw’s The Doctor’s Dilemma as a gripping, vivid examination of the central problems faced by medical staff in all countries:
- When one cannot meet everyone’s medical needs in full, whose needs should one prioritise?
- On what grounds should individual doctors make decisions which will lead some to live and others to die?
- And how can one balance people’s interests impartially, when one is inevitably personally affected by and involved with them?
Dr Anna Smielewska joins Alex in conversation on Thursday 22 February on this series of compelling questions. Anna is a medical practitioner from Addenbrooke’s Hospital Cambridge, who offers her insights into the theme of the evening through her own introduction to the notion of medical ethics:
As a student, I remember ‘Medical Ethics and Law’ as almost an afterthought, swallowed by the looming giant composed of patients, wards, imposing consultants and my clumsy attempts to take blood from my unfortunate partner during the first round of practical work. At that stage we were all buoyed by the sudden new responsibility and collectively we were going to make the world a better place. Issues of budgets, rationing and crises were seen as something abstract and hotly debated in our seminars with ‘the patient always comes first’ conclusively delivered as the final crowning argument. This morning I woke up to yet another headline on the crisis that the NHS is facing. Have I simply grown up, or have things become worse over the years? How does one put the interests of each and every patient first? I believe that as a profession we still hold on to the ideal of making the world a better place, but the ethical debates involved have become far more pertinent. I do not think that throwing money at a problem will make it go away. I am afraid that the seeds of the current issues have been there far longer than the various political parties would have us believe and in order to address the problem, we need to build from the bottom up.
This revival of The Doctor’s Dilemma, the only drama to be presented in this year’s LSE Festival, is fittingly given in the Shaw Library, named in honour of Shaw’s wife, Charlotte, a leading Fabian. Interestingly, she had first been involved with the London School of Medicine for Women, and attended this institution with a view to giving it a substantial endowment. In the event she chose to give funds instead to the fledgling LSE, and was to remain a generous and crucial benefactor in the early decades of the School’s history.
Jason Spevack, a student of Management with a professional background in film and television, directs The Doctor’s Dilemma, his third production during his time as an LSE undergraduate. Jason comments that the experience has proved for him a unique and stimulating endeavour:
Personally, having the opportunity to direct a play with the LSE Language Centre for the past three years has been a rewarding part of my extracurricular education; and sharing it with the wider London community is the most exciting venture for its relevance to the present is apparent throughout.
This feature was authored by Dr Olga Sobolev and Dr Angus Wrenn, LSE Language Centre.
Note: This feature post gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics.