In this portfolio, you are able to explore my growth through the FIQWS course through my essays and assignments which show my personal looks on my own life experience, healthcare narratives, and literary works.
My favorite assignment in this course was definitely the most tedious and difficult to write: the research project. In this paper, I took a deep look into the practice of physician assisted suicide and how society’s behavior and outlook towards older individuals can lead to serious dangers that play into it. This essay garnered a lot of comments from my classmates and professor, and definitely required a heavy amount of revising to come to the state that it is now; I hope you enjoy it – however imperfect it may be. This assignment (and its many parts), along with my outsider narrative, metaphor, and critical lens essays are visible on this website. I did find it easier than many of my classmates, however, to find sources that related to my topic, and I think that this can largely be attributed to how prevalent of an issue it is, how it is related to common psychology research, and how I tried to maintain a broad scope regarding which kinds of references I decided to include (research papers, perspective pieces, personal narratives, and websites defining certain phenomena).
In my outsider narrative essay, I discuss what it felt like to grapple with imposter syndrome and fear of inadequacy in an academic setting as I prepared to present a research project at a competition. This experience is one I am sure most people can relate to to some degree, and I found it very difficult to try to fully develop an image of my physical setting and thoughts during my experience. I hope that any space left to the imagination allows the readers to apply their own experience onto it and connect with me as they read.
If I were to offer any advice to anyone taking this course in the future, I would most certainly recommend to only write about things that interest you; sometimes, you may find yourself struggling to fully commit yourself to an assignment because you are uninterested, but looking deeply into the intricacies of a passage you are reading or a personal interest can always bring you that drive. Another tip I would recommend is to focus on individual paragraphs in works that you struggle to understand or conceptualize. This will allow you to think very critically on one, honed in, topic, and develop some strong ideas about it.
My metaphor essay was one of the most fun to write; I focused on the metaphor of Dracula and vampires when it comes to anatomical, economic, and political corruption. I refer to Kyle “Guante” Mhyre’s “To Throw a Wrench in the Blood Machine,” which I think is an impeccably written, fascinating, and impactful short story that I would definitely recommend to any readers. I also refer to Eula Biss’ On Immunity, which takes a really interesting and unique look on vaccination and associated social trends. If you’re into horror, this paper might be of the most interest to you, with lines such as “Dracula is depicted “arriv[ing] on a boat,” “summoning hoardes of rats,” and “particularly terrifying,” and “To start off, the “blood machine,” refers to a Dracula who is on a “reign of terror,” “tak[ing] control of the village’s resources, its watchmen and bureaucratic machinery, creating a system that will more efficiently identify victims and supply him with fresh blood,” being included.
My critical lens essay was particularly thought-provoking to write and demanded that I take on a different perspective (that of Arthur W. Frank’s “Chaos Narrative”) as I explored a film I first watched in middle school, Five Feet Apart.
I hope that my comments and writings are of interest to you and are thought-provoking. Thank you for reading and all the best,
Physician assisted suicide is a relatively new topic to come to the forefront of medical ethics, focusing on defining where the line must lie between man versus nature. It is allowed in some states and not others, and can be offered in pill form, gas administration, and other methods. A main concern to be brought up regarding this topic, however, is how ageism and existing implicit bias can play into our perspectives on its ethical status and how it can be governed.
There is a well-known story of a ~20 year old woman who had terminal cancer and was going to die eventually. She decided to not go through treatment, die with dignity, and take suidide pills prescribed by her doctor at home. She shared this journey online. Her story proved to be very controversial, despite it being her own life that she decided to take hold of. People heavily disagreed with her stance, saying that neither you nor a physician should have the right to control someone’s life – that is in G-d’s hands; may create a clash with secularism in healthcare.
This makes one wonder, would people have been more accepting of her decision and the physician’s prescription if she was an older woman? Ageism says yes; people consistently believe that younger people have more life to live, perhaps driven by evolutionary or subconscious biases, even if they are sicker. What is the driving force in how we view people’s decisions with their own body? Is one of the greater issues with physician assisted suicide the role of the physician rather than the concept of a sick individual ending their life? I believe that the greatest issue with physician assisted suicide is this concern. There has been a gross abuse of power and medical malpractice, especially when it comes to vulnerable populations such as the elderly or lower socioeconomic classes who don’t have access to second opinions or greater education on their illnesses.
Additionally, younger people are offered higher level seats on the organ transplant list: is this because they have “more life to live,” a higher chance of survival… etc. One is led to wonder, why? Prioritization of younger populations is most definitely a concern in healthcare, and this goes hand in hand with concerns about popularization of physician assisted suicide.
Furthermore, a concern is if PAS should be considered in elderly homes? There could definitely be an abuse of power in which physicians can unnecessarily cause patients to die even if they have more life ahead of them. Elderly people are also abused in nursing homes because they cannot advocate for themselves like some younger people can. Some nursing homes may support PAS in an abuse of power to “get rid of” the elderly that they dislike, especially as there has been a history of killing patients in nursing homes.
These are all concerns that I would like to explore in my paper and by looking at others’ perspectives and experiences.
Part II
Ageism presents a considerable threat to the ethics and applications of physician-assisted suicide (PAS) as a widespread practice. The greatest threat posed by PAS to humanity, particularly for older demographics, arises when social pressures combine with a physician’s ability to encourage and facilitate patients’ deaths, targeting marginalized groups disproportionately. This is embodied in senicide, in which elderly people are pressured to engage in the sacrificial act of dying to remove their strain on limited community resources. While the demographics at risk of PAS abuse include those who are severely intellectually and physically disabled, the focus of this paper is on the ties between age and associated acceptance of PAS. In this paper, I will first explore PAS as a standalone concept, followed by ageism’s implications, in which the greatest concerns regarding the ethics of PAS are rooted in how it can villainize and threaten older populations disproportionately.
Physician-assisted suicide is defined by the American Medical Association as when “a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act” (AMA 1), which can include prescribing life-ending medication, or even suggesting what a lethal dose of a type of medication so that the patient may consume it. This is different from euthanasia, in which a physician, themself, administers life-ending medication with a physician deliberately and directly causing the end of a patient’s life (Goligher et al. 1). Despite this difference, these phrases are often used interchangeably. In this paper, both terms will be utilized to discuss the physician-assisted administration of life-ending medications in the context where survival for a prolonged period is possible but not pursued, with euthanasia being a subclass of physician-assisted suicide.
The ethics of PAS, in itself, is a highly controversial topic. The greatest concern that arises from an inability to come to a national consensus on the ethics of the practice arises within its legality; only eleven US jurisdictions (California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington) and ten countries (Austria, Canada, New Zealand, Portugal, the Netherlands, Spain, Switzerland, Belgium, and Luxembourg) have effectively legalized the practice (CNN 1). Additionally, public support for legalizing PAS as a widespread practice has plateaued in the United States since the 1990s, ranging from ~47%-69% approval (Emanuel 1). However, this acceptance has proven to be conditional, which contributes to the difficulty in establishing effective and accepted legal guidelines on the practice. According to a study conducted in 2022, while the overall approval of assisted suicide as a general practice is only 18.1% , individuals who have a more liberal-leaning worldview (who typically come from younger or middle-aged, urban, and higher education backgrounds) are the most open to PAS (Borovecki et al., 21). This same study suggests, however, that despite disagreeing with the practice as a whole, 40.1% of surveyed individuals believed that PAS should be legalized because autonomy in end-of-life care is important (Borovecki et al. 23). These statistics suggest that while people may not support the practice, in itself, they do believe in the autonomy allowing for individuals to opt for physician-assisted suicide, if they so desire it.
The idea of supporting the principle rather than the practice is reflected in C. G. Prado’s outlook on PAS, believing in rationality of elective death while not supporting it as a practice in its own right. C.G. Prado is a professor emeritus in philosophy at the Queen’s College of Ontario, Canada, who places a large emphasis in his work on aging and suicide. In his writing discussing physician-assisted suicide, Prado argues that he does see the rationality in electing to subject oneself to life-ending medications when one is experiencing or anticipates “punishing… diminishing… and irremediable” suffering (Prado 1). All of these determinants can be applied to the state of being elderly and are difficult to quantify. Despite finding rationality in the practice, he finds that its acceptability is highly subjective. He also touches upon the most significant argument made by those in support of the rationality of PAS; he believes that one should have the autonomy to die without needing to endure the suffering and loss of control that illness can bring, taking upon a final act of control over one’s own life. He also discusses that “Life is not an unconditional good… What makes life worthwhile is what it offers, not its unconditional continuance” (Prado 1).
Arthur Frank’s The Wounded Storyteller encapsulates a number of outlooks of suffering and illness, including the chaos, quest, and restitution narratives, which describe how people approach and internalize their illness. He is a sociologist and scholar in illness and its associated psychological effects. Prado’s outlook on sickness and death is in alignment with Frank’s chaos narrative, which states that, oftentimes, in a condition of suffering and powerlessness, especially at the hands of irremediable illness, one’s destiny may be to come to acceptance with the inevitability of their condition. Frank describes chaos narratives to “reveal vulnerability, futility, and impotence [in the face of struggle and illness],” and that “[c]haos is the opposite of restitution; it imagines life never getting better,” (Frank 97). PAS may pose a contradiction to the chaos narrative, however, and align better with Frank’s quest narrative, suggesting that one may find power and some form of remediation in electing to end their own life, feeling enlightened and empowered in the process (despite the inevitability of falling to their illness). The quest narrative is arguably more satisfying to the human mind and its desire for control of oneself, making PAS understandably supported by many (Frank 115).
A narrative that is widely used as an example for this argument is that of Brittany Maynard, a 29-year-old Californian woman who was diagnosed with irremediable glioblastoma. Maynard ultimately ended her life via physician-assisted suicide in 2014, despite many unsuccessful treatments. Upon diagnosis, she came to find that her illness would leave her with repetitive seizures, cognitive decline, and severe personality changes, essentially meaning a complete loss of herself as a person, before it took her life. Knowing that she would inevitably die at the hands of her illness, she decided that she wanted to end her suffering, herself, before her illness could. She did so by travelling to Oregon, a state where PAS was already legalized, and obtaining a prescription for life-ending medication to electively consume in her home in California, surrounded by family when she decided to. Her decision, as she shared it very publicly online, was met with much contention, much of this arising from the fact that she was a young and conventionally attractive woman and that she should not have taken on the role of G-d.
This raises the question of whether people would have been more accepting of her decision and the physician’s prescription if she were an older woman. Ageism would argue in favor of this contention; the concept of ageism argues that humans have an inherent belief that younger people have more life to live, perhaps driven by evolutionary or subconscious biases, even if they are more ill. This is in alignment with the ideology of “New Ageism,” in which younger people group together all elderly individuals as a drain on society’s limited resources, being selfish and self-indulgent at the expense of younger, more deserving people, and therefore, they should engage in the altruistic act of ending their own lives, or engaging in senicide (or elderly killing) (Prosen 8). The term “New Ageism” was coined in 1991 by Robert H. Binstock, a professor in aging, health, and society at Case Western Reserve University and used by scholars against ageism to describe a serious, dangerous social norm that antagonizes the elderly. New Ageism is especially prevalent in social settings with economic recession and a lack of financial opportunity, as this would make conditions especially difficult for younger generations to find success in comparison to older, more well established generations, making it thrive during the COVID pandemic and beyond. New Ageism introduces the threatening concept, commonly labeled as “the slippery slope,” in which physician-assisted suicide can quickly become a socially-influenced practice in which those who are seen as a burden to society can be pressured, or even forced, into ending their lives, resembling eugenics (Prosen 10). This contradicts the common argument that PAS is a self-serving practice meant to find control and strength in one’s death, but rather paints it as a practice stripping people of their own self-determination/death. This was seen in the case of Diana Marsh, an elderly woman in the UK who died under a DNR order that she was physically and psychologically unfit to agree to and her family was unaware of (The Sun 1). Her story is similar to many others and suggests that physicians are in positions where they abuse their power in cases regarding the elderly and devalue their lives.
Life and death can soon begin to lose their meaning, especially if spirituality and compassion are lost with it. According to the arguments of Adrian Tomer, a researcher in psychology, those in support of physician-assisted suicide “masquerade as benevolent protectors who offer many new ‘rights…’ and are promulgating a dangerous new medical ethic that proposes to save money and other resources by letting nonproductive people die by sanctioning their suicide… older adults are at risk,” (Tomer 176). In this, Tomer pressures the significant issue that support of PAS inevitably places older adults, who are seen, especially in the context of senicide, as less valuable in society and would be altruistic in their decision to pursue PAS. Prosen suggests as a part of the “slippery slope” hypothesis, that the line separation of voluntary and involuntary euthanasia can quickly become eroded, especially at the hand of societal coercion and influence, especially in vulnerable populations in which a social obligation to die is formed (Prosen 10). This social obligation marks one of the greatest threats to a well-functioning legal and ethical policy regarding PAS, and marks the practice of PAS as overly risky.
Ultimately, the social concepts of “New Ageism” and a general inability to define which parameters should qualify one for PAS (and how to separate these from the general state of being elderly) make the legalization of PAS a great risk to older populations. The practice of PAS, in itself, if widespread, would devalue life to some degree and strengthen the influence of social factors on humanity and death. The popularization of this practice when tied in with a rapidly growing ideology of New Ageism would likely normalize these ideas that those with “less to live for” or offer society (elderly or severely disabled individuals) are in a position where they should end their own lives to relieve society of the burden of their own life. Not only does social pressure become an issue in encouraging older individuals into PAS, but some also suggest that physicians may begin to subject patients, via coercion or direct euthanasia, to death involuntarily, which may disproportionately affect disabled and elderly populations. PAS is incredibly dangerous and should not be only regarded in the context of offering end-of-life autonomy, as PAS is heavily influenced by external factors.
Part III
The implications of ageism on PAS can expand far beyond direct physician abuse of power and marginalization of older people. A major issue that may be overlooked is the possibility of a rising culture against older individuals which can contribute to senicide. The situation surrounding physician assisted suicide needs to be very heavily monitored; we need to be looking at changes in social trends and how people look at older people, how people view suicide as a socially tolerable and understandable act, and how physicians behave surrounding this. I also think that medical schools need to include this in their curriculum as it can very soon become a routine part of medicine and prescriptions.
There also needs to be heavy regulation on the legality of prescription of PAS pills/medications because things can get out of hand very quickly. Social dynamics are constantly changing and are inherently tied with what is considered normal, acceptable, and allowed in medicine, expanding even into the reproductive medicine era. We need to be able to control these dynamics and prevent them from becoming discriminatory before significant, unchangeable issues arise.
Source Report
Name: Nicole Yeroushalmi
Research Question(s): How does ageism tie into concerns with physician assisted suicide and its interplay with social factors?
How does this text extend/support/contradict the theme you’re exploring from the NM course texts)?
What is the function of this text in your research?Is it an example of what you are asserting, does it support your argument (provide evidence), is it an opposing viewpoint, etc.
Connect this text to at least one other text on your chart. (There will be synthesis of texts needed in the formal writeup of your topic. Connecting sources here should help with that.)
Shows the legality of PASPhysician-Assisted Suicide is legal* in eleven jurisdictions: California, Colorado, District of Columbia, Hawaii, Montana* Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. June 1997 Washington v. Glucksberg: PAS is not protected universally by the due process clause. Left it up to the states to decide
gives real data and understanding provides a viewpoint that suggests that end of life euthanasia as a humane measure differs from PAS
tie to AMA article: both suggest that physicians and states should have the autonomy to not have to administer PAS and that it may not be the best option in all cases
Full Citation: Frileux, S , et al. “When Is Physician Assisted Suicide or Euthanasia Acceptable?” When Is Physician Assisted Suicide or Euthanasia Acceptable?, Journal of Medical Ethics, 5 May 2002, jme.bmj.com/content/29/6/330.short?casa_token=DYqoCSWaEbcAAAAA:225JLO02WH5DFeLmT8BgTIN3m-eDUuDYErdimqXEa-IP84NzTsCHV_1v7REaJC__y0kNxcXyAAo. Accessed 18 Nov. 2024.
shows that age ties into people’s perspective on the acceptability of individual cases of PASsupports my theme that there is a tie between ageism
Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability.Conclusions: People’s judgments concur with legislation to require a repetition of patients’ requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient’s age itself than do older people
offers a new understanding of human psychology and how it may affect social influences on PAS supports principle of ageism affected PAS ethics produces nuance because older groups of people are more likely to have their perspectives changed based on age
tie to Ezekiel article: they counter each other. this suggests that potential abuses may arise from PAS and its legalization, while ezekiel argues that abuse is not a serious concern at the current moment.
Full Citation: American Medical Association. “Physician-Assisted Suicide.” AMA Code of Medical Ethics, American Medical Association, 2016, code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide.
legalizing PAS opens the door to power abuses by physicians as well as forcing physicians to act against their own ethics/religion/belief identities physicians nevertheless must always maintain a pledge to honoring patients’ wishes to no longer seek care, pain management, etc.
offers a confirming viewpoint comes from a reputable source; the american medical association is the ethical governing body of medicine
tie to CNN article: both suggest that physicians and states should have the autonomy to not have to administer PAS and that it may not be the best option in all cases
Full Citation: Emanuel, Ezekiel, et al. “Website Filtered.” Jamanetwork.com, 2024, jamanetwork.com/journals/jama/article-abstract/2532018?casa_token=EXAPo19FWPsAAAAA:J80reHpp0HcUEVx8nOqyV0Hm8O1F4cFy6tWiMaTFxXrGTxSlJdGbM0aAY9P4VDlo8gmqBwtCZw&casa_token=8R4cwKf2cC0AAAAA:kF8y8kVpID6me1kSDOZudmwfvrhxGl8rKkJyURzprANl4cFZCtTh9gagGijLBJvSwIkvn-gpRg. Accessed 18 Nov. 2024.
support for PAS has plateaued since the 1990’s (47-69%) most cases of PAS have to do with cancer there is not widespread abuse of PAS in practice
counters my argument: says that widespread abuse of PAS is not an issue, however, does not confirm that it may not become one in the future
tie to Frileux article: they counter each other. Frileux suggests that potential abuses may arise from PAS and its legalization, while this argues that abuse is not a serious concern at the current moment.
Full Citation: Kheriaty, Author. UC Irvine UC Irvine Previously Published Works Title Social Contagion Effects of Physician-Assisted Suicide: Commentary on “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?”. Journal. 2015.
shows the story of brittany maynard and how it encouraged others to seek PAS (Werther Effect) Shows the story of a young 14 year old girl who was no longer suicidal from CF after being encouraged (papageno effect) PAS increases nonassisted suicide rates by 6.1%
suggests other issues tied with PAS and its effects
tie with Chhikara: younger people are being more and more drawn to the idea of PAS; does its popularization pose a risk to existing social structures surrounding life and death?
Full Citation: Chhikara, Neelam. “Extending the Practice of Physician-Assisted Suicide to Competent Minors.” Family Court Review, vol. 55, no. 3, July 2017, pp. 430–443, https://doi.org/10.1111/fcre.12285.
tells the story of a young girl who was not able to receive PAS despite her excruciating pain and suffering from a brain cancer because she was under 18
poses a different perspective that ageism can go both ways – younger people can suffer from it as well
tie with UC Irvine: younger people are being more and more drawn to the idea of PAS; does its popularization pose a risk to existing social structures surrounding life and death?
Works Cited
American Medical Association. “Physician-Assisted Suicide.” AMA Code of Medical Ethics, American Medical Association, 2016, code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide.
Borovecki, Ana, et al. “Attitudes about Withholding or Withdrawing Life-Prolonging Treatment, Euthanasia, Assisted Suicide, and Physician Assisted Suicide: A Cross-Sectional Survey among the General Public in Croatia.” BMC Medical Ethics, vol. 23, no. 1, 17 Feb. 2022, https://doi.org/10.1186/s12910-022-00751-6.
Chhikara, Neelam. “Extending the Practice of Physician-Assisted Suicide to Competent Minors.” Family Court Review, vol. 55, no. 3, July 2017, pp. 430–443, https://doi.org/10.1111/fcre.12285.
CNN Editorial Research. “Physician-Assisted Suicide Fast Facts.” CNN, CNN, 29 May 2023, www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html.
Frank, Arthur W. The Wounded Storyteller : Body, Illness, and Ethics. University of Chicago
Press, 1995.
Frileux, S , et al. “When Is Physician Assisted Suicide or Euthanasia Acceptable?” When Is Physician Assisted Suicide or Euthanasia Acceptable?, Journal of Medical Ethics, 5 May 2002, jme.bmj.com/content/29/6/330.short?casa_token=DYqoCSWaEbcAAAAA:225JLO02WH5DFeLmT8BgTIN3m-eDUuDYErdimqXEa-IP84NzTsCHV_1v7REaJC__y0kNxcXyAAo. Accessed 18 Nov. 2024.
Kamble, Shanmukh V., et al. “Young Indians’ Views of the Acceptability of Physician-Assisted Suicide.” International Perspectives in Psychology: Research, Practice, Consultation, vol. 1, no. 3, 2012, pp. 165–176, https://doi.org/10.1037/a0029380. Accessed 17 Mar. 2020.
Kheriaty, Author. UC Irvine UC Irvine Previously Published Works Title Social Contagion Effects of Physician-Assisted Suicide: Commentary on “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?”. Journal. 2015.
Prado, C.G. “Ageism and Elective Death.” Ethics, Medicine and Public Health, vol. 1, no. 4, Oct. 2015, pp. 442–449, https://doi.org/10.1016/j.jemep.2015.10.016. Accessed 18 Nov. 2019.
Prosen, Patricia. “Public Opinions of Physician-Assisted Suicide: The Role of Ageism in Acceptance.” Department of Sociology, University of Manatoba, Aug. 2005, mspace.lib.umanitoba.ca/server/api/core/bitstreams/d224271c-05e0-4e3b-b96a-396aed109967/content. Accessed 18 Nov. 2024.
Tomer, Adrian. “Death Attitudes and the Older Adult.” Google Books, 2018, books.google.com/books?hl=en&lr=&id=knp0DwAAQBAJ&oi=fnd&pg=PT309&dq=physician+assisted+suicide+ageism&ots=bXPynmdQM3&sig=UTgIlQfH–3tPsIskrD04t1tseQ#v=onepage&q=physician%20assisted%20suicide%20ageism&f=false. Accessed 18 Nov. 2024.
The concept of a vampire is a common metaphor for force of evil or political corruption in western culture, and its applications on powerful social norms and collectivism are evident in the two writings explored in this essay: On Immunity by Eula Biss and “To Throw a Wrench in the Blood Machine,” by Kyle “Guante” Tran Mhyre. The concept of the collective mindset and social influence is particularly explored in the context of vaccination in the face of epidemics in Eula Biss’ On Immunity. This book investigates Biss’ own experience with facing contradicting opinions on what is best for her family and community as a whole, and how she had to make decisions on the basis of what society and the media was telling her. A particular metaphor used in Biss’ writing is one that compares the likeness of Dracula to illness and immunization. This metaphor can be connected to a poem by Kyle “Guante” Tran Mhyre, titled, “To Throw a Wrench in the Blood Machine,” which also employs the symbol of a vampire. In this poem, Guante utilizes the likeness of Dracula in a different context, using it as a metaphor for greedy and powerful politicians. In both writings, the metaphor of Dracula highlights the power of social unification in overcoming corrupt threats to the well-being of a society or community as a whole. These metaphors can be positively influential as they empower individuals who may feel under the control of those greater than themselves. While the metaphorical vampire is able to act as a threat by taking advantage of society’s collective mindset, it can also be overcome with a collective resistance, developing a nuanced perspective on the two-faced impact of a like-minded population; it can both make it vulnerable to threats when the community is ill informed and resistant to them when the community is properly informed. In this essay, I will first review each writing independently, and then explore their connections with one another on the basis of their purpose in utilizing the metaphor of a vampire and how it plays a role in these texts.
In Eula Biss’ On Immunity, the concept of social interference in community health is emphasized, and the symbol of the vampire is introduced later to embody the mass hysteria that arose from it, villainizing the government and vaccination. Additionally, Biss later describes the image of vampires as a symbol for illness, rather than vaccination. Biss explores the intricacies between social norms, propaganda, and codependence when it comes to immunization and how epidemics and wide-scale illnesses can be overcome. Biss begins by describing a mother’s innate and natural desire to protect her child, keeping them pure, clean, and invincible against all illness or dangers that may come their way. She describes how as soon as her son was born, she “was no longer fearless,” (Biss 6) but, rather, afraid, constantly concerned, and inadequate. Much of this was caused by the rising flu epidemic in which mothers, media outlets, and even politicians argued whether or not it was safe to get vaccinated. It is with that the vampire metaphor is introduced in Biss’ writing.
Rather than this being a new metaphor, this one is from “an 1881 handbill titled The Vaccination Vampire” (Biss 14). Biss describes that, “[k]nown to feed on the blood of babies, vampires of that time became a ready metaphor for the vaccinators who inflicted wounds on infants,” (Biss 14). This clearly demonizes the vaccinator, painting it as someone meant to inflict nothing but harm on young, “pure babes” (Biss 14) for their own personal satisfaction. This, being an old metaphor proving applicable to a new era, suggests that this demonization and fear of vaccination is nothing new, and, potentially, this fear is ingrained in our existing social structures. Much of this fear may arise from society’s desire for control and fear of those in a stronger, more influential position than them. Biss explores this by stating, “Victorian vampires, like Victorian doctors, were associated not just with corruption of the blood, but also with economic corruption… [B]eing almost exclusively available to the rich, doctors were suspect to the working class” (Biss 15). The power dynamics between the wealthy class and working class, tied in with a history of corruption and economic turmoil in the hands of large magnates, presents itself as a repeating cycle – happening both in the victorian era, as well as in the 2008 real estate market crash that Biss references, causing distrust of the government and the vaccines that they produced (Biss 9). It is clear here that society’s fear can paint vaccines in the face of these vampires – bloodthirsty, powerful, violating, and self-serving.
Along the lines of how Biss describes much of her fear of vaccines arising from social interaction and rumors, this same distrust of powerful figures such as Dracula, has similarly spread. However, Biss further explores the vampire metaphor in a different context, suggesting that Dracula can be seen as a symbol for the illness, itself, that the vaccine is meant to prevent. Dracula is depicted “arriv[ing] on a boat,” “summoning hoardes of rats,” and “particularly terrifying,” (Biss 15). Many illnesses traveled these same ways, and, thus, another connection can be made. Biss refers to the concept of “herd immunity,” (Biss 19), in which, if all individuals are willing to face the evil of the vampire, or the disease/vaccine in this context, the overall social welfare of the country can be saved, however, this requires everyone to change their way of thinking. Overall, the socially produced fear of vaccination and illness is embodied in the image of Dracula through Biss’ writing.
In Kyle “Guante” Tran Mhyre’s “To Throw a Wrench in the Blood Machine,” this author similarly utilizes the symbol of a vampire, or Dracula, as a metaphor for corruption in the hands of powerful individuals in government, while relating this to the context of social well-being. To start off, the “blood machine,” refers to a Dracula who is on a “reign of terror,” “tak[ing] control of the village’s resources, its watchmen and bureaucratic machinery, creating a system that will more efficiently identify victims and supply him with fresh blood,” (Mhyre 1). In this, Mhyre uses Dracula as a metaphor for corrupt politicians who seek to utilize their power for their own personal gain, exploiting the political system and those it controls. While Mhyre begins by explaining the evil that these politicians have over society, he is quick to describe that there are real solutions, lying in collective activism through voting. Dracula is an eternal figure who does not die; however, Mhyre describes that while he may always be there, there are ways to strip him from his power and control. While society may not be able to eradicate corruption, there are certainly ways to combat it. By referring to Dracula as a “Blood Machine” as well, Mhyre dehumanizes these corrupt individuals and suggests that there are physical mechanisms, such as voting, which is placed in a metaphor as a “wrench,” to overcome them.
In both Biss’ On Immunity and Mhyre’s “To Throw a Wrench in the Blood Machine,” there is a clear negative metaphorical representation of a vampire, or Dracula, and a connection with community welfare against corruption. While in Biss’ writing, the vampire can represent two types of threats to society, a vaccine and illness, the clear goal of going against it is to protect the well being of the community in which it is threatening. If one views Biss’ main representation of the vampire as the vaccine, it is clear that the strongest threat it poses is corruption by the wealthy and powerful, just as Mhyre utilizes the vampire metaphor. Mhyre writes, “defeating dracula.. will… deprive him of one specific set of tools that he will otherwise use to hurt people,” (Mhyre 1). This aligns with Biss’ writing, as it suggests that while society collectively deciding against using the government’s corrupt weapon of a vaccine will not eradicate the threat of the illness or further corruption, it does hinder the control and overall mission of the corrupt individuals in power. Overall, both Biss and Mhyre are able to utilize the symbol of a vampire in their metaphors to convey the message that when a society comes together as a collective against a corrupt government or common threat, resolution is possible.
Chronic illness can be a complex and debilitating element in our lives. Therefore, people throughout history have attempted to develop methods of approaching chronic illness psychologically to cope with it better and find emotional recovery as well as physical. The Chaos Narrative is a perspective introduced by Arthur W. Frank in his analytical book, The Wounded Storyteller. Frank describes this narrative as a particular, pessimistic way that individuals describe illness, consisting of a general storyline that includes illness, struggle, and a lack of hope for eventual recovery or complete restitution. This narrative is particularly unique in that it does not place a large emphasis on the socially desirable concepts of healing or hope. Instead, it offers an understanding of those who find their resistance against chronic illness to be futile and devastating. This point of view is illuminated in the film, Five Feet Apart, directed by Justin Baldoni and released in 2019. This film follows the lives of cystic fibrosis (CF) patients who struggle in isolation from birth as contact with other people, especially other CF patients, could kill them. It ends in the tragic death of a main character, Poe, and the eventual separation of two romantically linked characters, Will and Stella. Despite the protagonists’ attempts to connect and find happiness, their illness eventually drives them apart and the film ends in death and tragedy. This film supports the idea posed by Frank that a lack of acceptance of the chaos narrative can lead to unfounded hope, which can only result in further devastation. In this essay, I will first explore Arthur Frank’s conceptualization of the chaos narrative, then the film Five Feet Apart, and, finally, their applications to one another.
The chaos narrative is the least hopeful and most devastating narrative in considering and coping with illness. Frank describes chaos narratives to “reveal vulnerability, futility, and impotence [in the face of struggle and illness],” and that “[c]haos is the opposite of restitution; it imagines life never getting better,” (Frank 97). In his lens text, Arthur makes the point that it becomes incredibly difficult to imagine a resolution at the end of a deep, tiring struggle in stories that align with this narrative. These narratives apply the most to cases in which there is a life-long struggle in grappling with the side effects of an illness or event. Frank makes direct reference to the Holocaust to describe the struggle to verbalize the pain that can come along with trauma. He writes, “What cannot be evaded in stories told by Holocaust witnesses is the hole in the narrative that cannot be filled in, or… cannot be sutured. The story traces the edges of a wound that is so much of the body, its insults, agonies, and losses, that words necessarily fail,” (Frank 98). He describes that chaos narratives are inherently difficult to reflect on verbally, in that they are so emotional, tragic, and raw that it is almost impossible to understand the pain they cause without having lived them (Frank 115).
Furthermore, Frank places a large emphasis on how unsatisfying the chaos narrative can be. People aspire to find hope and inspiration in the stories of those who have undergone the greatest struggles; however, these narratives do not offer that relief. Rather, Frank argues: “Chaos feeds on the sense that no one is in control. People living these stories regularly accuse medicine of seeking to maintain its pretense of control – its restitution narrative – at the expense of denying the suffering of what it cannot treat,” (Frank 100). In this quote, Frank is reflecting on the social undesirability of the chaos narrative. It strips us of our desire for and façade of constantly being in control of our own lives and able to recover from whatever physical or emotional sickness is plaguing us. This lack of control can be inherently painful and make the inflicted feel as if they are being denied their truth, and as if their narrative cannot be satisfying to those hearing it. This social desire to satisfy others with a restitution-centered story makes it far more difficult for the afflicted to accept the futility of their struggle and further endangers them to be let down, disappointed, and destroyed.
This idea is heavily supported by the film, Five Feet Apart, in which the two protagonists, Will and Stella, suffer from Cystic Fibrosis (CF) and are left in tragedy as they have to come to terms with the chaos narrative that encompasses their lives. CF is a life-threatening illness that forces them to stay at least 6 feet apart at all times, as a transfer of pathogens between the two of them could kill them both. A major plotline in the film describes their attempts to find fulfillment in their lives which, until the moment that they met, were incredibly unhopeful and lonely. As they get to know each other, they make an agreement to only remain five feet apart instead of 6, as it makes them feel as if they are more in control of their destiny than their illness is. This idea is highlighted in the scene where the characters first meet, and Stella says to Will, “Let me guess, you’re the kind of guy that ignores the rules because it makes you feel in control,” and Will agrees. Throughout the film, their attempts to escape from their illness and the restrictions that it places upon them and their happiness prove catastrophic, as they begin to get each other sicker and into dangerous, life-threatening situations. They also see one of their best friends, Poe, die from CF. Eventually, it becomes apparent that they can never escape from the pain and control with which their sickness afflicts them. Their tragedy is inevitable and is not until the end of the film, when Will is forced to leave Stella and go to another hospital, that they both recognize this. By coming to terms with the chaos storyline that encompasses their lives, they are both, once again, left devastated and alone. Rather than this experience becoming a “quest” in which one seeks to take advantage of their situation as a learning experience, it is rather a form of surrender to the illness that has consumed their lives. They undergo the suffering that is an element of both narratives, but gain nothing positive from the pain, which is unique to the chaos narrative. This is manifested in the final scene of the movie, where Will is forced to say goodbye to Stella forever to say her life. He says, “They say if you love something let it go… I don’t wanna go, but I have to.” In this, Will surrenders to CF and gives up on the hope of them ever being together, sacrificing any relationship he could ever have with her for the hope that she will survive.
Frank, in his writing, is able to describe the struggle that comes with unfounded hope in the face of inevitable pain caused by chronic illness or catastrophe. He states that “[a]ll of us on the inside of some chaos want assurances that if we fell in, we could get out. But the chaos narrative is beyond such bargaining; there is no way out,” (Frank 102). This perfectly describes Will and Stella’s situation; they both had the unwavering desire to believe that, even though they were plagued with their illness, they would find a way to still find happiness and comfort in one another. What they hadn’t come to terms with until the end of the film, however, was that there may never be that restitution in their story – they are fated to the failure and suffering that their illness has inflicted upon them, no matter how much they desire to escape from it. Their initial hope that they could escape, or outrun, their illness was unfounded and only left them worse off than when they started; they were left with the pain of a memory of what could have been and what they have lost, even if they know that their image of being together, truly, could never have been. This further suggests that the quest narrative is unbefitting to this film; there was no benefit or learning gained from their struggles with illness and lost.
In summary, by refusing to accept the inevitable tragedy and lack of resolution that comes with stories that align with the chaos narrative, both Will and Stella in the film, Five Feet Apart, are left in tragedy and pain as they lose each other. Their hope to escape from the inevitable was unfounded and only worsened the pain of the loss of their idealistic dreams. This highlights the importance of accepting the chaos narrative, especially in others’ storytelling, preventing the formulation of false, unfounded, hope, which can only result in more devastation. It highlights a need to shift away from the idealistic Restitution Narrative, which can often be unattainable and misleading.
The multifaceted concept of medicine was initially difficult for me to grasp as a child. I would watch shows on television about doctors trying to cure ailments and make my own visits to urgent cares, the ER, and pediatrician, but these experiences seemed to consistently remain focused on surface-level care limited to physical treatments of symptoms.
There seemed to be a repetitive algorithm that defined the practice: walk in, check in, wait your turn, explain your symptoms, get examined, get prescribed, and leave.
I liked the idea of becoming a doctor and helping others. What could be better than using textbook knowledge to end someone’s illness-induced pain?
It wasn’t until I got older that I began becoming exposed to individuals’ personal narratives of their experiences with health struggles and with medicine. Once again, a lot of this came from the media – social media posts, documentaries, and television – but my own family, as well.
These challenged my previous notions of the field and I began to understand that the practice reached far further than just helping people overcome physical ailments.
It seemed that every word a physician uttered echoed in the minds of the patients and their families who heard them. No matter how insignificant a short interaction felt to the doctor, its impact would always be evident. Dismissive, or simply uneducated physicians who weren’t able to understand the cultural, psychological, and social nuances that healthcare entails, left patients feeling alone, abandoned, or relapsing into the same sicknesses that they were being treated for.
In the last few years, I got to volunteer in healthcare facilities and in pharmaceutical/healthcare research laboratories with people who have truly committed themselves to bettering the field of healthcare and making it more inclusive and effective. I also wanted to see medicine begin to prioritize treating the root cause of illnesses rather than just symptoms. Everyone deserves the chance to be seen by a physician who can offer this to them, and while this requires significant reforms to the healthcare system as a whole, I believe that, as a physician, I can begin to do this for my patients, at the very least.
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