Atlas Shrugged, part III, chapter I
Dagny’s first day in John Galt’s secret capitalist valley, and her whirlwind tour of its inhabitants, ends with a dinner party at Midas Mulligan’s house later that night:
Midas Mulligan met them at the door. She noticed that his grim, square face was not as harshly expressionless as she had thought: he had a look of satisfaction, but satisfaction could not soften his features, it merely struck them like flint and sent sparks of humor to glitter faintly in the corners of his eyes, a humor that was shrewder, more demanding, yet warmer than a smile.
He opened the door of his house, moving his arm a shade more slowly than normal, giving an imperceptibly solemn emphasis to his gesture.
Walking into the living room, she faced seven men who rose to their feet at her entrance.
“Gentlemen โ Taggart Transcontinental,” said Midas Mulligan.
…Her eyes moved slowly, in greeting, from face to face: Ellis Wyatt โ Ken Danagger โ Hugh Akston โ Dr. Hendricks โ Quentin Daniels โ Mulligan’s voice pronounced the names of the two others: “Richard Halley โ Judge Narragansett.”
Dagny, suitably impressed, compares the gathering to “that dream you imagine in childhood, when you think that some day, in heaven, you will see those great departed whom you had not seen on earth, and you choose, from all the past centuries, the great men you would like to meet”. Even as hedged as this is, it’s remarkable that Rand chose to have Dagny ever, even as a child, entertain the idea of an afterlife. It’s a departure from her usual template in which all Randian protagonists are good atheist, capitalist Objectivists from the moment of birth.
But as pleased as she is to meet them, she’s still troubled that they’ve chosen to give up their professions. To this, they say that her assumption is false, that they haven’t given up. Richard Halley says he’s still writing music, it’s just that it will never be heard outside the valley. Judge Narragansett is still writing treatises on law, which won’t be published outside the valley, and so on. And then there’s this:
“No, Miss Taggart, I have not given up medicine,” said Dr. Hendricks, in answer to her question. “I have spent the last six years on research. I have discovered a method to protect the blood vessels of the brain from that fatal rupture which is known as a brain stroke. It will remove from human existence the terrible threat of sudden paralysis… No, not a word of my method will be heard outside.”
Just so we’re clear on this, an Objectivist doctor has invented a new therapy that could save hundreds of thousands of lives each year. But he’s keeping it a secret, refusing to share this knowledge with anyone it might help because, he says, he isn’t getting paid enough.
In Rand’s fantasy world, the only moral standard that matters in any job is how much money you make. This is a willful denial of reality, since it’s impossible to overlook that ethical codes have been part of the profession of medicine since the beginning, going back to Hippocrates. The Declaration of Geneva, a modern physician’s oath, instructs doctors that their duty is to “consecrate [their] life to the service of humanity”, and to make the health of their patients their first consideration, overriding all other factors. As part of this vow, doctors have a moral duty to help people in need and to spread as widely as possible any knowledge or research that might assist them in doing so.
The idea of deliberately concealing or impeding access to information that could save lives is a flagrant contradiction of everything a doctor is supposed to stand for. That’s why the World Medical Assembly says that it’s unethical to patent new medical procedures, while the AMA states, “The intentional withholding of new medical knowledge, skills, and techniques from colleagues for reasons of personal gain is detrimental to the medical profession and to society and is to be condemned.”
Besides the abhorrent ethics of this, there’s a practical concern: what or whom did Dr. Hendricks do his research on? Even if he started with animal tests, he’d never be able to prove his method worked without human test subjects. Whatever his “method” is – a drug, a surgery, an implant – he must have needed volunteers at some point. Where did he get them from? And what rewards did he offer to induce them to participate and to accept all the risks and unpleasant side effects an experimental procedure like his must have had? (How much money would you want to be a guinea pig for experimental brain surgery?)
Drug discovery is an immensely laborious process, requiring all the resources of huge biomedical corporations. The cost of developing just a single new drug can be $350 million or more, potentially up to $5 billion when you take into account that many experimental drugs inevitably fail. In Galt’s Gulch, without that pesky “oversight” and “safety” stuff, it might be cheaper, but it can’t be that much cheaper – and the idea that a single doctor could do it in his spare time is a ludicrous absurdity.
“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.”
This recalls Ronald Reagan’s infamous 1961 anti-Medicare ad, which warned that if the program were passed, “we are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free”. Obviously, Medicare did pass into law, and despite Reagan’s fearmongering, it hasn’t turned the U.S. into a nation of slaves. (For one thing, no doctor is required to accept Medicare patients.)
Contrary to what Rand thinks, Medicare and other socialized medicine programs weren’t born out of a sinister desire to enslave doctors. They came about because we’ve seen what happens when health care is left completely up to the vagaries of the market. I’ve written about the horror stories of people enduring unimaginable suffering from treatable ailments, just because they couldn’t afford treatment. Imagine showing up at the hospital with a broken leg and being told they won’t help you because you’re too poor!
Programs like Medicare came about because people’s consciences revolted against allowing this to happen in a wealthy, advanced society. Since Rand doesn’t understand – indeed, outright rejects – the idea of empathy and compassion, she sees this as inexplicable behavior, and concludes that the only other explanation is pure evil, as implied by Dr. Hendricks’ sermon.
And since he regards state-paid health care as an outrageous infringement on his freedom, one can only conclude that he would turn away someone who was suffering or dying on his doorstep, if he didn’t think that person could pay him what he demanded. (That’s the only reasonable explanation for that line about “my choice of patients or the amount of my reward”). He’s already done exactly this, in effect, by inventing a life-saving medical treatment which he’s hoarding and won’t share. Even if you had the money, would you want to be treated by a doctor who was so callous? Would you trust a person like that to adequately manage your pain and suffering, to respond to your distress with sympathy, to respect your wishes in extremis? The very human emotions that Rand regards as weaknesses to be cast off are the emotions that make someone a truly great doctor. It’s she, in her blinkered arrogance, who’s blind to this.
Other posts in this series: