Atlantic Monthly

Head Case

Henry Marsh, the sawbones in question, has traveled to the Ukraine serially for fifteen years, always with the goal of helping Ukrainian colleagues make do with poor equipment, or none. Cutting open patients’ heads and using screws and drills bought at a hardware store would be grounds for license-suspension and possibly imprisonment in England. Here, it appears to be an act of compassion — and one that reveals a pernicious double-standard in medical ethics.

Eugene Volokh has argued that when patients are imminently endangered, they should be allowed to exercise a medical equivalent of a right to self-defense. When an ax-murderer is trying to kill you, you can take extreme measures, for example by shooting him dead. When tumor or air-bubble has invaded your head and squished your brain in potentially lethal way, you can’t use extreme measures to fight it unless the FDA says they’re safe. If no FDA-approved measures exist, then the tumor wins, and you die.

This film, not yet aired in North America, is the second documentary in ten years about primitive neurosurgery, and suggests a revision along the lines Volokh proposes. To most, Marsh’s actions seem reasonable, even laudable — but why? Because he operated on Ukrainians instead of Londoners? Unlike Ukrainians, Londoners tend to have proper medical drills handy (and if they used Bosch drills, they probably wouldn’t run out of batteries, as Marsh’s did). But extreme cases do arise even in Belgravia. And when they do, inflexibility at the margins of bioethics seems just as harmful there as in Kiev.


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