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Rousseau’s social contract, vulnerable children, toothless tigers ... and us
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A quarter millennium ago, Jean-Jacques Rousseau published his major work of social existentialist philosophy, On the Social Contract.
This classic — which impacted the constructs of modern sociopolitical thought and clearly influenced the framing of the U.S. Constitution — essentially enunciated the concept that to gain the rights and benefits of a modern society, strengthened by rules, social order and mores, the members of that society must support their government in defining and enforcing rules of play and social constructs.
Further, Rousseau proposed that the obverse also should apply, entitling citizens to withdraw their obligation to obey, or to change leadership through elections or other appropriate means, when government no longer secures their natural rights.
In subsequent eons, this concept has served us well, and our government has generally fostered a stable social environment predicated on beneficence and natural order, maintaining the rights of the citizens as enshrined in the Constitution.
The events surrounding and including the Civil War tested this nation greatly, but fundamental principles supervened, and the nation emerged as a strengthened entity, more certain of its moral compass, notwithstanding some remaining social issues that are still vexed today.
Invective over altruism
Holding our environment as a beacon of democracy, the citizenry of the U.S. has sometimes been accused of exhibiting a sense of moral superiority.
For example, sitting safely thousands of miles across an ocean, most of our nation expressed concern and then horror at the excesses of Nazi Germany in the 1930s and 1940s, particularly focused on the pogroms within Germany and other European nations that had been invaded.
Rumors emerged of the egregious crimes surrounding the concentration camps and gas chambers, and the extinction of complete populations of socially and physically vulnerable citizens.
Our national anger became more extreme at the end of World War II, when it became clear that these rumors had a devastating and horrific factual basis, and this culminated in the call for the war crimes trials of Nuremberg.
What has always been astonishing is that the majority populations involved allowed this to happen. This was not associated with an established, powerful and dangerous monarchy with a vice-like grip on the nation. It was the product of a harsh political movement, spearheaded by an unhinged and bigoted nationalist zealot, and it occurred stepwise as the movement gained momentum.
I have often wondered why the physicians and other community leaders in Germany did not try harder to combat the rise of Nazism. It is clear that there were individual physicians of courage who protected their minority neighbors, either by speaking up, standing forth for their rights, or sometimes by just hiding them.
When one of the greatest violations of the Hippocratic Oath in more than 2 millennia took place — the active participation of Nazi and other physicians in dangerous and painful human experimentation on vulnerable minority populations — the absence of action by the German medical community was obvious and has been well-documented.
Sadly, we now have a clear modern parallel in the United States, which has gained ground in recent months.
We have observed the gradual rise of neofascism, endorsed to some extent by members of the dominant political party either by their silence or sometimes by overt support. There has been a rising climate of xenophobic bombast and rhetoric directed against a range of minority and immigrant populations, with a concomitant rise in violence directed against them.
We have now seen obvious documentation of the new U.S. phenomenon of separating more than 15,000 children from their parents as a cumulative cookie-cutter response to a mixture of attempted legal and illegal immigration. Those who are less thoughtful are captured by the extremist rhetoric, claiming that our national identity is at stake and that our borders are under assault by imaginary columns of invading hoards.
Just a couple of weeks ago, one of my friends — a brilliant and talented surgeon from another institution — responded to the day’s headlines by growling, “This isn’t our problem. It’s their fault. ... If those people had stayed where they belonged, we wouldn’t have to take their kids away from them and send them all back where they came from!”
How can a smart man be so narrow and so dumb, and allow invective to replace altruism?
Take meaningful action
Fortunately, our learned colleges and medical societies have taken a position, and several have issued statements condemning the separation of children from their parents at our national entry portals, as well as the lack of organization and planning for how to deal with them.
Much like the current government’s view of Obamacare — “We’ll shut it down and then figure out an alternative strategy” — these bozos have not thought this through, and now we are starting to see deaths of children in custody.
Once again, government minions (and acting minions) have risen to their platforms in the extremist press, blaming everyone within a 360-degree vista for the problem rather than taking a moment to gaze into a mirror.
Back to our medical organizations, there simply cannot be anyone at any of the learned colleges or societies who seriously believes that a bland position paper, hidden on the back page of the local (or national) newspaper, can actually have any meaningful impact. Toothless tigers! This is likely to have the same effect as the private citizen physician in Nazi Germany whispering to his wife in 1935, “They should be ashamed of themselves and somebody should really do something about all this!”
However, the medical profession does have weapons: collective average IQs that are very high, substantial incomes and resources, and influence on the community, and our colleges and societies have political action committees that mostly focus on protecting our incomes and resources.
History will judge us harshly for our actions today. I can already imagine the paragraphs in the history books of 2050 that describe how the nation that viewed itself as having spawned modern democracy allowed more than 15,000 children to be taken from their parents — in many cases lost in an irretrievable political and social morass — without an apparent chance to regain their family environment!
But folks, it is worse.
We are now seeing visual evidence — from traditionally reliable sources — that shows abuse of these kids, and we are beginning to record deaths of children in custody. What democratic nation has children in custody when they have committed no crime?
It seems it is time for the medical societies and colleges to hold a colloquium, perhaps under the auspices of the medical ethics police — the Institute of Medicine — to set a well-orchestrated plan, pool some political action committee resources and launch a public campaign to stop this.
If the “Need to Impeach” movement can gain so much traction under the helm of a single, perhaps somewhat eccentric individual, what could the collective impact of the physicians of this nation achieve? Surely on a simple matter of conscience, we must try to do something meaningful!
For more information:
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO, is HemOnc Today’s Chief Medical Editor for Oncology. He also is president of Levine Cancer Institute at Atrium Health. He can be reached at derek.raghavan@atriumhealth.org.
Disclosure: Raghavan reports no relevant financial disclosures.