Shall we discuss this outside? A look at artistic and medical responses to ethical quandaries

'High quality, provocative, thought provoking art can ask ethical questions of its viewers in an engaging and public manner, something medicine, not infrequently, is unable to do, due to wisely-placed ethical constraints.'

Medical ethics is a system of moral principles that applies values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. Drawing, as ethics does, on these specialities one could speculate that in our age of cross fertilization and hybridity, contemporary art practice can contribute in a discursive manner to the many ethical dilemmas seen within medical practice. Indeed, I suggest, that the practice of medicine can benefit from contemporary art which has the freedom to raise questions in a useful manner within the public sphere which we as medics cannot.

As a practicing artist and GP, it seems to me that art has the freedom and perspicuity to go where angels fear to tread. On the other hand, medicine has, in my experience, the ability to inform and confront some of the thorny issues raised by art. Unsurprisingly for many artists ethical discussions form the meat and two veg of their practice. High quality, provocative, thought provoking art can ask ethical questions of its viewers in an engaging and public manner, something medicine, not infrequently, is unable to do, due to wisely-placed ethical constraints.  Metaphorically, art brings dilemmas kicking and screaming into the public sphere and thus demands that the wider society tackle these questions head on. While this process may not necessarily be a model of excellence for art work sited within a medical environment – which brings with it a specific set of requirements and demands – I think these forms of art practice do nonetheless raise interesting and pertinent questions for the meeting point between art and medicine.

One example of this is the contentious work by Polish artist Artur Zmijewski. Zmijewski recurrently returns in his practice to uncomfortable questions about the nature of power, decision making and informed consent. During the video artwork 80064 Zmijewski convinces an elderly Auschwitz survivor to have his fading camp number re-tattooed on camera. The work documents the discussion as the latter decides to go ahead with the ‘renewal’ of his tattoo. Zmijewski was and is aware of the ethically contentious nature of this work (1). However, he was clear that he did not force the subject, who acted out of his own free will. 80064 raises enormous questions regarding freedom, decision making and exploitation.  And what does all of this have to do with medicine? Leaving aside the right or wrong of the decision to make the work in the first place, I, am struck by how relevant the dynamic between artist and subject is to my practice as a doctor. How many of us doctors cannot recall a consultation where we used the inherent power of our position to convince a reluctant patient to undertake something which we, clinically, felt was of benefit for that patient? Yes, there is a world of a difference between the two scenarios. Nonetheless does 80064 not usefully question how power is used during consultations? However questionable Zmijewski’s actions are, does he not hold a mirror up to my actions as a power figure within society? By siting this discussion in the public sphere – rather than a purely medical sphere – the artwork forcibly opens the debate to a wider public, the constituency of the art of medicine cialis itself. Though I am not convinced that the means justifies the end, undoubtedly this work of art raises pertinent (medical) ethical questions. Watching this work both doctors and our patients must ask ourselves: ‘Do no harm’ –  to whom? And what exactly is meant by ‘harm’?

This brings me to a work by the artist Sophie Calle. I vividly recall my first death in medicine. The patient was elderly and, with a truthful simplicity, stopped breathing. It was a calm quiet occurrence and a deeply moving experience. I am enormously grateful to have been present at this person’s death. Death is witnessed by individuals and families all over the world, every instant of every day. We as medics are privileged to share such moments with them.

The experience returned to me when I came across Sophie Calle’s work Pas pu saisir la mort.  Calle reports that she was terrified she wouldn’t be present when her mother, Monique Sindler, died (2). She therefore videoed her mother’s last breath and subsequently exhibited the resulting work at the Venice Biennale. Despite installing Pas pu saisir la mort in a quiet, understated manner unsurprisingly the video installation was controversial. Undoubtedly the work raises interesting provocative questions about death, confidentiality, privacy, exploitation and decision making.

One hopes that the medics caring for Calle’s mother contributed some insight into the decision to record Monique’s death. This work firmly places a private experience of death within the public sphere (3). Medical ethics has much to contribute to such nuanced fraught discussions. As medics we cannot open up such private moments for public consumption. Confidentiality is absolute. Medical ethics precludes any possibility of discussing these moments publicly other than in an elusive, oblique manner. Nevertheless, surely it is useful to discuss publicly the impossibility of understanding the moment of death? It begs belief that any doctor who has witnessed the death of another human being has not struggled to understand the existential meaning of such an occurrence. Calle’s shocking recording of her mother’s death lifts this discussion from a private to the public sphere in a meaningful and, I suggest, sensitive manner. This shift can potentially influence how medicine, which rests predominantly within the private sphere, is practiced.

Interdisciplinary work is a hot topic within the art world. The concept infers that separate and seemingly unconnected specialities have much to gain from each other. As medics ethics is central to our work. We swim, drink and live in it moment by moment within our professional lives. We have a nose to sniff out and wrestle with ethical dilemmas. Likewise, artists are trained to home in on ethical quandaries which form the source for a multitude of diverse, thought provoking works. Thus can the speciality of medical ethics contribute to life and to art. Both parties have much to gain from fruitful, contentious and prolonged dialectically dialogue.