Making Moral Distinctions

Gawande and Williams

Making Moral Distinctions

Gawande and Williams

Making Moral Distinctions
An email conversation about the news of the day.
March 16 1999 6:50 PM

Gawande and Williams

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But wait: I have to pause a moment to genuflect. You have children who are 3, 2, and 3 months, and you're in your residency, and you have time to ponder the day's headlines with the likes of me? You must be an iron man. Or have an iron woman as your partner. Probably both. (Under the circumstances, do you actually get away with observing, in a public forum, that sick spouses are crabby and bossy? My spouse took great exception to this characterization. I myself refuse to engage in the politics of personal destruction.) No one is throwing up, blood or anything else, thank God (and you wonder why normal people don't like to hang around with the parents of young children?), or writhing in pain. I packed the spouse off to bed and the children off to the pediatrician, who of course found that the very wilted one who I was sure had an ear infection only had a virus, but the one who was bouncing merrily off the walls and seemed on the mend had infections in both ears. I knew, with my unerring maternal instinct, that somebody did.

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I love your distinction between "judgment" errors and "normative" errors. This is exactly the distinction we've been needing for the past year. But I don't understand why you think it doesn't apply beyond such obviously life-and-death professions as surgery and aviation. The president's irredeemable offense was not the judgment error of having sex with an intern (the other kind of intern), but the normative error of lying about it and covering it up--as you put it, "a violation of essential norms of professional behavior, norms that allow people to be trusted and teams to work safely." I suspect we'll see, over time, that allowing ourselves to trust our political leaders is an essential norm, and also a matter of safety. I'm mystified by why you don't easily extend your distinction to Clinton's case.

I suppose I'm arguing that the commander-in-chief has a least as much power for ill as a surgeon or a pilot. But I also wonder whether, as a species, we can tolerate making this further distinction--between those for whom the consequences are weighty enough to demand moral rigor and those for whom they're not. Is this rigor really something we can recommend only as a situational necessity? Can we maintain it, when we need it, if it's not a value we embrace for its own sake? Clinton's example suggests to me that we can't.

Maybe tomorrow I can take you up on your thoughts of this morning about Gore. Today's WashingtonPost had a poll saying that only 41 percent of Americans think Gore is a strong leader, while 68 percent think George W. Bush is a strong leader. Surely this has something to do with Bush's amazingly sweet press of late (... and he's nice to his children! And he knows how to eat with a knife and a fork!). And a lot of it is the warm-bucket-of-spit problem that comes along with that nice mansion the vice president gets to live in. But some of this problem is his own ... What do you think it is? I incline to the view that it's pretty unfair, but it's also his fault. More anon.

In good health,

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Marjorie

Atul Gawande has written about medicine for The New Yorker and Slate, is a surgical resident in Boston, and is a fellow at the Harvard School of Public Health. Marjorie Williams is a contributing editor at Vanity Fair.