Monday, August 25, 2008

The burden of trust

In Fear and Trembling, Soren Kierkegaard advances a theory about the tension over whether or not to divulge information. In his view, disclosure is required by ethics but silence is favored for aesthetic reasons. His reasoning is as follows: an ethical person must seek to align their forces with those of greater society (the universal). Disclosure must be made to this body of fellow travelers in order for such an alignment to be possible. However, aesthetics prefers that the troubled soul maintain their independence from society at large, sharing their dilemma with at most a chosen few who may understand, and keeping their common associates free of the burden their knowledge imposes upon them. It would be a farce for the tragic hero to speak candidly to friends who would not and cannot understand the decision before him, but would nevertheless give (what seemed to them) good advice.

This tension has never been resolved, though our modern sensibilities turn less to Agamemnon and Abraham when trying to unravel the choices faced by an unclear conscience. "Unclear" is the most appropriate word I can conjure for the inner life of our society wracked by the moral ambivalence of professional obligation. "Innocent" is out of the question (who can be innocent who has made such choices as our doctors, soldiers, police force or social workers are called on to make?) while "Guilty" is not only too harsh but painfully inaccurate (guilty of what?). In the book "Just Culture", Sidney Dekker puts great emphasis on the importance of trust, and illustrates through many examples that trust can work on either side of Kierkegaard's dichotomy. The ideal, it seems, would be for trust to exist predominantly between society and those who make questionable (or flat-out wrong) decisions in the course of their professional callings. Such a trust would facilitate disclosure of these decisions, allowing others to learn from them.

However, the tension of the aesthetic cannot be dispelled so easily. Trust also exists, and may be much stronger, in the professional fraternities that exist for any occupation that involves very difficult and morally ambiguous choices. These organizations feel that they have a depth of understanding on their trials that the common man cannot share, and that to include the uninitiated in the dialogue of these trials will yield a naive, callow and counter-productive clamor that drowns out informed discourse and makes professional progression difficult or impossible. It is hard to ignore the logic of this, and recent popular sentiment has increasingly recognized that the soldier who has seen battle, the cop who has worked in the tough neighborhood, the doctor who has stood against death, and other demanding professions have, not the right, but the fact of an understanding unshared by the rest of society.

How can these men and women who have been through the fire trust those who have never been burned? How can the mass of humanity trust an elite with the privileged knowledge of experience? What is there to be gained by such trust?

What is to be lost is testified by the examples in the literature. A professional who voices their concerns to the populace at large must be prepared to be prosecuted and pilloried by people who understand that a mistake (or even a questionable choice) was made but cannot understand why. Expecting the public to understand the difference between technical and normative errors in a highly specialized profession may not be realistic. Expecting the public to accept technical errors with grave consequences almost certainly is not. At the same time, the professional may be ostracized by their erstwhile compatriots, who view them as a traitor to the order of those who both understand and bear such burdens. Even if the results are not so catastrophic, turning away from the aesthetic is inherently career limiting (the aesthetic has always been higher paid than the ethical), and confessions of professional culpability are unlikely to build confidence in prospective clients, even if it builds trust.

On the other hand, when the populace trusts the elite it doesn't ease the latter's burden but adds to it. In such a logical formulation, this additional burden then justifies increased trust, which further burdens the trustee. History is crammed with the despotisms of those who were given the trust of the populace for the burden that they held, and whether the rulers or the ruled are the more brutalized by such a relationship is difficult to divine. Such a cycle can only end in one way: rebellion. The honored dictator is brought low and despised as an inhuman monster rather than as a simple human of whom too much was asked.

Such has been the lot of the medical profession. Honored as pillars of the community, they saved lives and had the burden of life and death placed upon them. Accepting this burden, they assumed the mantle of the superhuman. Ever increasing demands of education, preparation and responsibility were matched with increasing rewards of salary and prestige. In the seventies, it was a commonplace in medical schools that people didn’t die in hospitals except through the failure of their physicians (for every symptom a cause, for every cause a diagnosis, for every diagnosis a treatment. Hence, no death). The trust placed in these saviors by their patients was enormous. Then came the rebellion. After all of the trust, the rewards and the honor paid to physicians, people still kept dying (even in hospitals). The failure of doctors to be more than human, to live up to the expectations they had accepted and propagated, led to their persecution and (frequently) ruin, which has continued on to this day. Perhaps Police and Social Workers should be glad that they are not well trusted.