Bioethics Forum Essay

On Naming Names

No names will be named in this essay. Which I guess makes it philosophy.

Technically I am trained to do philosophy. I got my masters and my Ph.D. in a department of History and Philosophy of Science – a very fine program located in a marvelous state university situated in one of those Midwestern towns that counts as a blue college dot in a sea of voter red.

So I could have become a philosopher. But I remember distinctly the day I decided I was really an historian at heart. I went to go fetch my mail in our common room, and I came upon three fellow graduate students – all men, all majoring in philosophy. The three were discussing a problem: If you were suddenly, instantaneously transported into outer space without a spacesuit or a spacecraft, what would you die of?

The first claimed you’d explode. The second insisted you’d freeze to death. The third was sure you’d suffocate.

“Wait a minute,” I asked them. “Under what circumstances would you suddenly, instantaneously be transported into outer space without a spacesuit or spacecraft?”

It was as if I were a ghost. They could not even hear my question. I could still hear them, though, and their crazily consumptive argument was making my head do that kind of thing your head does when you’re trying to find a tissue with which to capture a bug, while still keeping one eye on the bug, but then you see another bug. (What?)

It is true that if a group of historians gathers over as much alcohol as philosophers are famous for consuming, we may find ourselves imagining counterfactuals. We may, for example, talk about which dead person we’d most like to interview, which non-extant document we’d most like to find, what might have happened to world history had SARS been spread just a little bit farther to just a little bit more vulnerable of a population.

But when sober, we generally don’t bother. We’re just not that into it. What we crave are the strange but true facts of human existence – the weirdness of individual stories, the beauty of contingency. The philosopher quests for the generalizable where we historians seek the exquisitely unique. (You can tell that is true because I’m generalizing, and I said at the outset this would be philosophy.)

So a few (nameless) people have lately asked me – some directly over lunch, some quite indirectly in (nameless) journals – why it is I’ve named names in (nameless) bioethical critiques of late. Why not, they wonder, just criticize practice, and not individuals?

I actually started thinking a lot about the issue of naming names before I started doing it. I was thinking a lot about it because in the past I worked with a very fine activist born with a nameless condition on trying to change the social and medical treatment of her condition. That person insisted to me that, no matter what we did, we had to criticize practice and not individuals. In her philosophy of activism, she was a pragmatist. Her attitude, sensibly, was that if we criticized individuals, we might bring that person down, but we would not change practice. We would also get into a “he said, she said” kind of tussle that would distract from our purpose and make the media focus on us instead of the issues.

That older case was different from what I’ve been dealing with more lately, though. In that older case, although one clinician-theorist had been very visibly associated with the problematic practices we were trying to change, the practices had become endemic. Everybody was doing it, so we couldn’t really change things for the better by going after that one clinician-theorist (although a very excellent journalist eventually did just that, in a terrific and widely read book I’m not specifying).

In the cases I’ve been dealing with lately, only a couple of individuals have in fact been engaging in what I’ve seen as really ethically problematic behavior. So to write about their practices generally without naming names seemed really wrong, because it seemed to suggest a much more widespread ethical lapse than in fact exists – thus potentially tarnishing a clinical field in which most of the clinicians are not at fault (or are not only not at fault, but in some cases have been struggling hopelessly to stop the unethical behaviors).

Now, I know that there’s a way philosophers sometimes write where they are taking someone specific to task without openly naming that person, even though everybody in the know knows about whom they’re talking. And don’t get me wrong; I find that kind of rhetoric adorable.

But real accountability requires real names. A colleague of mine writes about this in his most recent book, where he discusses why we historians cannot promise our IRBs that we will not harm our subjects. He points out that sometimes we go into a project pretty much knowing that we’re likely to harm some of our oral history subjects, because we’re tracking an uncomfortable history where – almost by definition – somebody did some dumb or bad stuff.

It’s also really hard to appropriately laud those who did the right thing without naming the names of those who didn’t along with those who did. For much needed inspiration and perspective, lately I’ve been reading the definitive biography of a particular founding father by an historian whose name you would surely know. Through it, I have been reminded how the stirring lessons we take from the history of our brave and wise founders is made possible by knowing who exactly said and did what to whom. We need to know the names of the cowards and traitors to really appreciate the heroes and martyrs. (By the way, I learned from this biography how a certain author of the Declaration of Independence tried to hold a certain king accountable for various specific transgressions, but that certain co-signers found it distasteful or perhaps scary to name the king’s name.)

Years ago, I developed a little bit of fame at a certain Big Ten university for banning the word “society” from my course. I was teaching a course on something and something else, and I had grown weary of my students constantly saying, “Society thinks . . .” or, “Society says . . .” This was my students’ way of seeing the world as hopeless in its oppression: Society was to blame for gender discrimination, for oppression of the poor, etc.

As long as Society was to blame, no one was to blame. And no one had to change the status quo, because no one could change Society. Once I forced my students to start naming who exactly thinks or says this or that, their whole view of the world changed. Suddenly they realized who was responsible for promoting this (mis)representation or that ugly norm. And they realized you just had to change the behaviors of those people. Suddenly my students had power. The giant named Society had magically shrunk; the short guy with the slingshot had magically grown.

Perhaps it is that sudden resolution of the vision of power that scares us in the naming of names. So long as we do not name names, we can just take our paychecks and fade into the big picture with the rest of Society. We are not obligated to see who is doing what, and so we are not obligated to see who we are. We are not obligated to try to be big.

But we historians can’t seem to not name names. It isn’t that we are essentially better; we are just constitutionally incapable of not pointing to the particulars,

We cannot suddenly, instantaneously be transported into outer space.

I used to think myself a fake historian, because I didn’t feel I knew enough history to be real. And I still think of myself as unworthy of the profession, especially when I read something like that amazing biography of that amazing founder. But I know at least I have the vocation of history. Because it seems to me that I no longer understand why one would even try to think about morality outside of the context of the real, outside of the evidence, outside of the naming of names.

But don’t quote me.

Alice Dreger is Professor of Clinical Medical Humanities and Bioethics at Northwestern University Feinberg School of Medicine.

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