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Letting people die

SIR: Jonathan Glover (LRB, 4 March) is certainly right that ‘it is not obvious’ that the verdict in the Arthur ‘Mongol Baby’ trial has ‘clarified the law at all’. It may have shown the difficulties of getting a jury to convict a doctor who has intentionally caused the death of a defective but otherwise healthy baby, if he was acting from humanitarian motives: but even that would be a dangerous conclusion to draw from the Arthur case, in which evidence was adduced of various pathological conditions from which the child might anyway have died. Admittedly, this was kept secret until the Home Office pathologist was confronted with it in the middle of the trial, by a paediatric pathologist who had originally agreed with him that there were no relevant abnormalities, but who had subsequently changed his mind for reasons which he had been forbidden to disclose beforehand. Professor Alan Usher, the Home Office pathologist concerned, has given an account of these transactions in the British Medical Journal of 5 December 1981. Whether further expert evidence would have confirmed the relevance of this new evidence cannot now be known, but the jury would no longer have seen this as the straightforward case of the death of an otherwise healthy Down’s syndrome child. Furthermore, it was never admitted that the intention had been to cause the baby’s death. It is true that various eminent medical defence witnesses said that such an intention might have been in accordance with good medical practice, but Dr Arthur chose not to give evidence and could therefore not be cross-examined on this point.

Mr Glover rather confuses the issue, however, when he writes, ‘Dr Arthur had written “Parents do not wish the baby to survive. Nursing care only,” and had prescribed a pain-killing drug. The baby contracted pneumonia and … died,’ without making it clear that ‘nursing care only’ excluded the provision of any sustenance, other than water with the drug, during the three days of the baby’s life. The question is not whether the rather high drug dosage was intended only to relieve pain (it isn’t clear, incidentally, what pain it was to relieve), but whether the treatment prescribed, which without food must eventually have led to death by starvation, could be justified by the parents’ declared wishes that the baby should not survive.

That being so, it is regrettable that the Attorney General should have said, in the House of Commons on 8 March (Hansard, Col. 348), that no points of law arose from the case which needed to be referred to the Court of Appeal. The point which did arise, of course, was whether, and if so in what circumstances, it was ever lawful to treat an infant in such a way that it is intended to die. This could have been resolved now, without in any way upsetting Dr Arthur’s acquittal. Obviously, any other outcome of this case would have been a tragedy: but that a doctor may sincerely believe that he is acting within the law doesn’t guarantee the correctness of that belief. Since some hospital workers do genuinely believe that they see things being done which are both wrong and illegal, they will continue to report them to LIFE, who certainly mean to go on pressing for prosecution in suitable cases. So we will now have to wait until some other unfortunate doctor faces a possibly less sympathetic court, without the doubts about the child’s real state of health being used as effectively as they were at the Arthur trial, before the law can be properly clarified. Either it is never lawful to withhold ordinary medical treatment, let alone normal feeding, from a baby whose parents do not wish it to survive, or there are some circumstances justifying doing so, with the intention that it should die. If so, these circumstances need to be carefully defined.

For example, what defects are so serious as to allow of this? What is to be done with a Down’s syndrome child which really is otherwise healthy? What about the various degrees of spina bifida? Is there to be some age limit, since serious abnormalities are not always diagnosed at birth: if so, will it be days, weeks or years? Wouldn’t it be more humane to give a lethal injection straight away, rather than wait for ‘natural’ death by starvation? Squeamishness is not a good guide for medical treatment! Do the parents always have to be consulted, when it is obvious to the doctors that the child is better dead? There are some slippery slopes here, which doctors ought not to be asked to negotiate without some guidance from the rest of us, through the law.

Other even trickier problems will arise with the parents, who owe a child the same duty, so far as normal care is concerned, as do doctors – neither less, nor more. Where a paediatrician is justified in bringing about the death of a baby by depriving it of food, it would be difficult to argue that the same did not apply to its parents. So what if some conservatively-minded doctor were to refuse the parents’ request to stop feeding a child which, rightly or wrongly, they believed to be defective, whereupon they asked for it back to do this for themselves? Up to now, that would be manslaughter by neglect, at the very least. But they could claim to have been forced into this position by the unjustified refusal of their doctor to comply with a reasonable request, and they could quote in support some distinguished doctors who said at the Arthur trial that it was acceptable medical practice so to dispose of a mongol baby, at the parents’ request. Of course, it wasn’t so much the parents’ right to take matters into their own hands which was emphasised here, as the impropriety of the law concerning itself with doctors’ decisions in these difficult questions: but as the law now stands, the one would seem to follow from the other, or not as the case may be.

The dangers of allowing parents or other lay persons to decide on what medical conditions may justify euthanasia are obvious. And it is most undesirable that this should be left to arbitrary decisions taken by lay juries under what is often a great deal of emotional pressure. If positive euthanasia is to be permitted at all, the circumstances need to be closely defined, perhaps making it clear that decisions on life or death are to be taken by medically and/or legally-qualified persons alone, and not to be shared with the parents or with anyone else. For that, nothing less than an Act of Parliament will suffice.

C.B. Goodhart
Gonville and Caius College, Cambridge


Reprosuctive

SIR: Stephen Bann is right in placing Jacques Derrida’s Dissemination and Glas in the context of the Tel Quel group (LRB, 4 March). Derrida is a highly original but also intensely assimilative writer – his own term is ‘reprosuctive’. But the Tel Quel group should not be overvalued – even in their divergence from Derrida – as they acknowledge the Return of the Sacred. In this regard the important presence for Derrida is Georges Bataille, one of the group’s precursors; and it is with Bataille that Glas is explicitly concerned. It is also important to remember Roger Caillois and others of the Collège de Sociologie of the 1930s whom Denis Hollier is bringing back to our attention.

I should add that while one cannot avoid the religious connotation of ‘saving’ in Saving the Text, I do state on the first page of the book that what is involved is not ‘a religious effort in the ordinary sense: the allusion is to the well-known concept of “saving the appearances” … and my title suggests that we are still endeavouring to convert thinking to the fact that texts exist.’

Derrida’s mode of reading is a signal event in the history of commentary rather than a dissolution of commentary. He takes French explication de texte to a higher power. In that sense he conserves or reworks what he reads and the deconstructive activity becomes part of the structure of texts he deals with. No cargo cult is in view. Derrida’s case reminds one of Nietzsche’s statement in Ecce Homo: ‘The psychological problem with the Zarathustra type is how a person who keeps saying “no” to an extraordinary extent and to everything to which one had previously said “yes” can be despite this the spiritual antithesis of a no-sayer.’

Geoffrey Hartman
Yale University


America and Israel

SIR: Mr Ian Gilmour flatters Israel (LRB, 18 February). What a powerful little state it is! It ‘effectively controls American policy in the Middle East’, and it controls the President, the parliament and the media of the United States, too. This it does because it has in its service something that Mr Gilmour calls ‘Zionism’, which is not, according to Mr Gilmour, the movement of national liberation of the Jews. It is more like their multinational corporation. And it is the mightiest multinational of all; the influence of Exxon and Bechtel upon the fate of the Arab peoples deserves not a mention alongside what is being prepared for them by the America-Israel Public Affairs Committee, 444 North Capitol Street NW, Washington, DC 20001.

The Middle East badly requires an explanation. The region is so eventful, and so elaborate. Mr Gilmour has an explanation, and it is attractively simple. Like the bewildered girl in Randall Jarrell’s novel, he looked under his bed and discovered a horse. The Palestinians are ‘in exile’, Lebanon has been ‘wrecked’, pro-Western Arab states are ‘undermined’, the Soviet Union ‘gains in prestige’ – and all because of Israel. There is much that Mr Gilmour prefers not to know. To wit: the Palestinians are in exile because they refused to recognise that Jews are their neighbours because they have a right; Lebanon was wrecked by a civil war between Palestinian terrorists and Christian fascists, a war which Israel did not start but which it put to some use; the charged constellation of religious and social forces known as Islam is a greater threat to pro-Western Arab regimes than Israel, and a threat that would be only inflamed if these regimes sued Israel for peace; and the Soviet Union’s position in the region is bettered because the Saudis, as they candidly admit, fear Zionism more than Communism.

But if Mr Gilmour understands little about the Middle East, he understands even less about America. His coarse comments about ‘the corruption of American politics by Zionism’ betray a really breathtaking ignorance and incomprehension of the political system of the United States. The Jews of the United States, when they seek ‘clout out of all proportion to their numbers’, are playing by its rules, as are the American Hellenic Institute, the National Rifle Association and Mr Ralph Nader. They have formed a lobby in a country in which, for complex historical and cultural reasons, a group is not embarrassed by the prosecution of its own interests. The pro-Israel lobby is no more than the expression in the area of foreign affairs of the Jewish part in democracy. Mr Gilmour, on the other hand, evidently believes that power in a society should be distributed among its groups strictly ‘in proportion to their numbers’. Not very Tory.

The Israeli lobby has sometimes succeeded and sometimes failed. It owes its successes not to bribes, as the Korean lobby did, nor to the slick techniques of public relations, as the Saudi lobby did, but to the merit of its argument. Mr Gilmour does not see this, because he does not believe that its argument has merit. Instead, he warns ominously of ‘the full weight of Zionist pressure and propaganda’ upon American candidates and voters. Propaganda is Mr Gilmour’s term for a view with which he disagrees; pressure, his term for its popularity. What all this means, however, is that Americans tend to vote for people who seem to be in sympathy with their position, and the position of a large number of Americans has so far been pro-Israel. Bad for Mr Gilmour, but not exactly sinister.

The ‘vast Zionist rotten borough’ that is the US Senate, moreover, did not prevent the Saudis from being awarded either F-I5s or AWACS; and that body appears to be in accord with the new tilt of American policy toward Riyadh, as it is championed by Secretary Weinberger. Of such inconvenient facts Mr Gilmour takes no note. (Of other inconvenient facts – the summary Arab rejection of Fahd’s rather maximalist plan, for example – he takes note, but no lesson.) Perhaps Mr Gilmour suspects that it was all along the secret plan of ‘Zionism’ to provide the Saudis with their planes, because then it could take the Gulf too, in accordance with its well-known ‘territorial ambitions’.

Mr Gilmour does not merely differ with American policy-makers, and with the majority of the American public: he defames them. He has ideas, but they have motives. He has principles, but they have pressures. Those who advance the Arab argument, like John Connally, are ‘fair’ and ‘sensible’ and ‘brave’, but all the others are tools. Presumably Mr Gilmour numbers himself among the brave, as he rehearses the clichés of a ‘comprehensive settlement’ and the canards of anti-Zionism. I say anti-Zionism, not anti-semitism. Mr Gilmour is, of course, not an anti-semite. Imagine what he might have written then.

Leon Wieseltier
Harvard University


Marxismo

SIR: With friends as faint-hearted as Jon Elster, what need has Marxism of enemies? So much of what he writes (LRB, 18 March) is contestable. For example, can the political writings of Trotsky and Gramsci really be regarded as displaying the ‘boringly predictable’, ‘conspiratorial-cum-functionalist attitude’ that we are told is characteristic of Marxian social analysis?

I wish, however, to concentrate on the assertion (quoted approvingly from A. J. Ayer) that ‘there is no such thing’ as ‘Marxist philosophy’. Elster does make an exception of ‘analytically-trained philosophers’ such as G. A. Cohen, but since he goes on to criticise, in my view correctly, Cohen’s penchant for functional explanations, this concession would seem to have little focus. Ayer’s remark might be pardoned as coming from one evidently ignorant of the work of Georg Lukacs, Theodor Adorno and Louis Althusser – to name only the most outstanding Marxist philosophers of the century. But Elster should know better. It is true that these thinkers write in an idiom unfamiliar to those reared in the analytical tradition. But to dismiss them therefore, as Elster seems to, at a time when some Anglo-Saxon philosophers are shrugging off their parochial disdain for other intellectual traditions (I am thinking, for example, of Richard Rorty’s Philosophy and the Mirror of Nature) is surely to take a highly retrograde step.

I am strongly in favour of a genuine interchange between analytical philosophy, which has given such striking proof of its continued vitality over the past decade or so, and the various schools of Western and classical Marxism. But this would be a very different enterprise from the absurd project which Elster espouses of grafting onto the little he leaves of Marxism some of the more dubious elements of mainstream social thought – for example, methodological individualism and games theory. Whatever emerged from this search for ‘microfoundations’ would bear no resemblance to any brand of Marxism.

Alex Callinicos
Department of Politics, University of York


Roads to Rome

SIR: I have just read my colleague Gabriel Josipovici’s interesting review of The Penguin Book of Hebrew Verse (LRB, 4 February), in which he complains of ‘our [my italics] Rome-centred, Classics-centred view of the past’. Evidently he is living in a different world from myself: many of the literature students that I teach have not even heard of Horace or Ovid, let alone have any sense of their place in European letters, so that a complaint which might have had tactical validity a hundred years ago seems peculiarly untimely today (when, furthermore, Classics departments throughout the country are faced with contraction or closure). From a different angle, Dante or Shakespeare, little of whose energies, for better or worse, were devoted to the study of post-Biblical Hebrew literature, might have been surprised by his opinion. Nor does he give a single concrete instance of the supposed sovereign cultural importance of non-Biblical Hebrew verse. The true reason for reading these poems is surely likely to be their intrinsic merit, or even the challenge that they constitute to our customary sensibilities, rather than their important place in the literary history of Western Europe. Pace Mr Josipovici, Rome is, and, as long as we care for the truth (which may not now be long), will remain, central.

Charles Martindale
Classical and Medieval Studies, University of Sussex

Gabriel Josipovici writes: As a Classicist, Charles Martindale ought to be familiar with the uses of rhetoric. When I spoke of ‘our Rome-centred, Classics-centred view of the past’, I did not do so after taking an opinion poll. I was generalising from my own impressions of that vague and fluid thing, the ‘cultural Establishment’ as it exists in England even today, enshrined in universities, the ‘quality’ papers, literary journals, the British Council etc. I think it is easier for someone coming to this country from elsewhere to recognise how far English culture is still dominated by attitudes and assumptions that are a century old, even if only by the terms in which it chooses to react to them and deny them. I am sorry about Charles Martindale’s students (and presume he, too, is being rhetorical when he says he has Classics students who have not heard of Horace and Ovid), but the point I was making was not one about the reading of 18-year-olds but rather the kind of point that Edward Said made so eloquently in Orientalism. As to his last criticism, I did indeed stress that one of the pleasures of the anthology lay in its introducing us to many new and excellent poems. But I myself will not be able to read Medieval poetry, especially the songs of the Crusaders, in the same way after reading the moving poems in this anthology commemmorating the Jewish martyrs of Mainz or Blois. One knew of the pogroms unleashed by the Crusades, of course, but poems like those of Ephraim of Bonn or Barukh of Mainz bring home the pain and suffering involved as history books can never do. Our reading of Christian poetry, from ‘The Dream of the Rood’ to Herbert’s ‘The Sacrifice’, must be affected by a stanza like the following, from an anonymous poem about the massacres: ‘O everlasting God, we seek refuge in the shadow of your Wings. We have been abandoned, alone and suffering, because we refused to bow our heads before the crucified one … Let all who put their trust in him be put to shame!’


No Smoking

SIR: Michelangelo’s acorns on the Sistine ceiling remind Nicholas Penny of women’s breasts (LRB, 18 March). Professor Frederick Hartt, who had an iconographical axe to grind, has seen them as eucharistic grapes. It is notoriously easier to see things if you want to see them and it is therefore with some trepidation that I report that I have always felt these acorns (particularly those on which the ignudo to the left above Jeremiah leans) to be, rather, a magnificent illustration of why the Romans used he same word (glans) to denote both an acorn and a penis. My trepidation is increased when I recall something I am told Freud said about the symbolism of cigars – that there are times when a cigar is just a cigar.

Roger Jones
London WC1