What Moral Narcissism Looks Like in the Medical World


All medical journals these days feel the compulsion to be high-minded, but none is as high-minded as the Lancet. It is as if the editors had taken lessons both in moral philosophy and rhetoric from Mr. Pecksniff himself.


Mr. Pecksniff, you may remember, was the preposterous hypocrite in Dickens’ Martin Chuzzlewit, who introduces his daughters, Charity and Mercy, by adding “Not unholy names, I hope?” As Know thyself was inscribed over the entrance to the temple to Apollo at Delphi, and Abandon hope, all ye who enter here over the entrance to Dante’s hell, so Mr Pecksniff’s words, Let us be moral, must be inscribed over the entrance to the offices of the Lancet, figuratively if not literally

In the week before a Malaysian Airlines plane, taking many AIDS doctors and activists from Amsterdam to Melbourne for an international conference on AIDS, was shot down over eastern Ukraine, the Lancet published a statement called the Declaration of Melbourne, a typically sickly and nauseatingly unctuous statement of ethical principles. It began by saying something that, if not a lie exactly, was certainly not a truth:

We gather in Melbourne, the traditional meeting place of the Wurundjeri, Boonerwrung, Taungurong, Djajawurrung and the Wathaurung people, the original and enduring custodians of the lands that make up the Kulin Nation, to assess progress on the global HIV response and its future direction, at the 20th International AIDS Conference, AIDS 2014.

This, of course, is the purest 21st century Pecksniffery; and unless the signers of the declaration (who look extremely self-congratulatory in photos accompanying the article) can each and severally explain in what sense the Djajawarrung are the custodians of the lands on which the city of Melbourne is built, I suggest that they be banished to the outback for five years to live as pre-contact Australian Aborigines lived.


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The declaration continues:

We, the signatories and endorsers of this Declaration, affirm that non-discrimination is fundamental to an evidence-based, rights-based and gender transformative response to HIV and effective public health programmes.

One could go mad trying to put this into plain English. It probably means that all patients with HIV, regardless of how they contracted it, should be treated as well as possible. Incidentally, this must be a matter of kindness and decency, or perhaps of expedience, not of rights, for otherwise the right would have been granted for everyone to behave as he wished and for others to pay for the consequences.


Let us continue our descent into oily Pecksniffery, incoherent because it’s so patently insincere:

To defeat HIV and achieve universal access to HIV prevention, treatment, care and support – nobody should be criminalized or discriminated against because of their gender, age, race, ethnicity, disability, religious or spiritual beliefs, country of origin, national status, sexual orientation, gender identity, status as a sex worker, prisoner or detainee, because they use or have used illicit drugs or because they are living with HIV.

Among other things, this statement appears to say that no one should be refused access to HIV prevention even if he already contracted it: in which case, however, prevention would be a little beside the point. Moreover, the declaration also seems to say that nobody should be criminalized because he is a criminal, that is to say a person who, one would hope, has been found guilty of a crime by a properly constituted court. What is meant, I presume, is that no one should be denied treatment because he is a criminal, a statement with which I would agree.


If it is true that the style is the man himself, I dread to think what kind of people the signatories of the Declaration of Melbourne are.


image illustrations via shutterstock. com and / Morphart Creation /

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