Pergamon 0277-9536(95)00141-7

Soe. Set lied. Vol 41. No 12. pp 161"-1619. 1995 Ell~-~ler 5~lence Ltd Printed m Great Britain

COMMENTS

PROFESSIONALS, INTELLECTUALS. VISIBLE PRACTITIONERS? THE CASE OF 'MEDICAL

HUMANITARIANISM'

CLAUDINE HERZLICH

Renee Fox's article raises several questions about medical humanitarianism, specifically about its actual impact, symbolic dimension, social mean- ing, organization and possible development. Although it is impossible to deal with all these aspects herein, I was. upon reading this article, led to think about how sociologists, especially in France. approach the study of the medical profession and its practices. Fox's analysis can help us glimpse the limitations in our own analyses and catch sight of problems that we may have long overlooked.

In much of the research conducted on the medical profession, doctors have been taken to be "pro- fcssionals'; and the aim has been to study their status and practices in relation to patients, colleagues and other care-givers in various contexts. As sociol- ogists, we have also dealt with other problems, such as the linkage between the evolving system of health care and changes in the medical profession. And some scholars have even inquired into the relations between the medical profession and the State, as doctors attempt to obtain recognition for their status or to consolidate it. But we have almost never been interested in doctors as 'citizens' who have to take positions on issues and in conflicts in the general society (and not just react to the problems related to their professional status and practices).

True. one basic orientation of this sociology has been to focus on the role of medicine in modern societies, a role reaching far beyond technical functions. During the 1960s and 1970s, 'medical power" constantly came under criticism. Its social and political effects were denounced as well as the abusive 'medicalization" of social problems. But studies of this sort have not led us to examine the specific role played by doctors, or some of them. in general social conflicts--in debates about values or in political problems as such. We have not asked whether--and how--doctors as citizens have taken part in public affairs.

As a consequence, when inquiring into the relations between doctors" professional status and public commitments, we have tended to focus only on the public actions of those physicians who have pressed professional demands. "Medical humanitari- anism" has shown us how the medical profession's status and qualifications can be invested in actions on behalf of a symbolically important cause. It thus brings to light the limits of a view that 'over- autonomizes" doctors as a social group that, defined uniquely in professional terms, remains apart from the issues and conflicts dividing society.

To undertake this type of analysis, sociologists would gain by paying closer attention to studies made by historians. Social historians have clearly shown that doctors in many countries have long been active in public affairs. They have thus shown how pro- fessional objectives and broader political goals can overlap. This holds especially for France. Several doctors played major parts in the French Revolution and during the events in 1848. In the late 19th century, there was a very tight alliance between the medical profession and politicians with regard to public health issues. Several doctors sat in Parliament, very often on the 'center left" [I]; they were the mainstays of the newly born Third Republic. In exchange, the government fully recognized their professional monopoly.

In the 20th century, doctors have played a less noticeable role in public affairs. Nonetheless, many of them--from the doctor who is major of a commune to the one who represents a district in the upper or lower house of parliament [2J---have perpetuated the tradition from the 19th century. Doctors have often actively taken sides in politics. During the 1930s, several doctors and medical students stood in the front ranks of the xenophobic far right, which would later support the Vichy government. This government would fulfill the wishes of the most reactionary factions in the medical profession by creating the Ordre des M~decins. On the side of the Resistance during WW II, a group of doctors led by Robert

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1618 Medical humanitarianism and human rights--Comments

Debre" supported plans for setting up national health insurance and drew up a reform for creating the modern hospital system in France.

As Fox has clearly shown in her analysis, medical humanitarianism takes its origins in its founders" political persuasions, even though their decision may have followed from disillusionment with their pre- vious political commitments. Some of the positions adopted by these founders were, indeed, political. For example, these doctors were often fascinated with Marxism, as many members of the intelligentsia had been after WW I!. Others made their decision out of moral convictions, and thus opposed the wars in Algeria and Vietnam. Above all, medical humanitar- ianism arose in the context of the May 1968 student movement. Medical students were quite involved in these events; and the School of Medicine in Paris was a high place of activism. In particular, these students drafted a "white book" containing a radical reform of medicine, medical education and the practice of medicine. This marked a break with 'capitalistic medicine'. For them. professional and political objec- tives seemed closely related.

Bernard Kouchncr's idealism, as he created Mrdccins sans Frontirres. is representative of that of a generation for whom the will to 'practise [medicine] differently" replaced, after the failure of the May 1968 movement, the desire to fight against capitalist so- ciety. This new direction led to various commitments. Some leaders of medical students during May 1968 later played a major role in the movement for 'reval- uating general medicine'. Today, a few of them can be found in the front ranks of associations involved in the fight against AIDS. These doctors have, each in his own way, contributed to the emergence of a type of professional whose practice of medicine is closely linked to public campaigns and actions. But medical humanitarianism even more closely associ- ates the practice of medicine with a universal cause whose symbolic impact reaches far beyond the field of medicine.

By extending Fox's article, we might try to analyze how the political socialization of the founders of humanitarian medicine has interacted with their training and medical qualifications. By the time they decide to leave the arena of pure politics, these doctors acquired certain abilities: they know how to organize collective actions, speak in public, and be convincing: they are used to dealing with the media and have established personal relations with media people. These advantages turn out to be valuable for new undertakings, Their political socialization thus constitutes an original resource. In turn, the status of 'doctor ' has long served as a springboard for entering politics in France. Since the 19th century (at least), it bestows legitimacy on what doctors have to say about society: it authorizes them to diagnose crises and

*Debr~'s son would become de Oaulle's prime minister in 19_58.

propose remedies. In the case of 'humanitarian doctors', their involvement in actions 'in the field'-- an involvement based on their qualifications as medical practitioners--further reinforces their position.

The status and competence of doctors and the socialization of political activists are two mutually supportive factors that define the special traits of the group profile of humanitarian doctors. While analyz- ing the institutionalization of 'professional powers'. Eliot Freidson [3] has used the notion of "visible scientist' to refer to a type of prestigious professional (usually an academic or researcher) who, owing to his scientific prestige, can address a large public and become a spokesperson. Might we not use the phrase "visible practitioners" to account for this prestige and capacity for public intervention, which has to do with value choices as reflected in practices?

On the basis of such an analysis, we can raise questions about medical humanitarianism's current situation. How has it evolved since its early days? How to discern therein between value choices and professional motivations as such? In the early 1970s, French medicine underwent major change. During the previous two decades, the number of doctors had grown considerably, thus increasing competition within the profession. Furthermore, a cleavage was becoming clearly visible bctwccen the careers of general practitioners (or rank-and-file physicians) and hospital specialists. For young doctors who did not want to be caught up in the 'medical exams race' (the only way to have a prestigious career), the decision to take up an atypical form of practice, such as medical humanitarianism, could--apart from symbolic gratification--represent a way out of a professional dilemma.

Nowadays, doctors have an even harder time being integrated in the medical profession. Meanwhile, medical humanitarianism has been institutionalized. It has made technical innovations and is starting to be taught in medical schools. In these circumstances, what is the group profile of the doctors now making such a commitment? What are their political opinions? their religious affiliations? In which spe- cialties have they been trained? Do men outnumber women? How long will their commitment last? for a limited period after graduating from medical school and before permanently entering the profession? or will some of them make a career as humanitarian doctors? Moreover, in the various movements associ- ated with medical humanitarianism, does the classical distinction arise between rank-and-file practitioners who are turned toward action in everyday life and leaders who serve as spokespersons and can launch public actions?

In more general terms--in the terms of the soci- ology of professions--Fox's article broadens our perspectives for study and reflexion. The fact that medical humanitarianism first developed in France is to be set down to this country's recent political

Medical humanitarianism and human rights---Comments 1619

history. But it should also be related to the special role attributed to intellectuals in France. Since the Dreyfus AlTair in the late 19th century, intellectuals are expected to make value choices and defend them. Whenever they do not do so, the press often expresses its surprise about 'the silence of the intellectuals'. On the other hand, the notion of profession was not taken into account for a long time. In fact, its recent usage by sociologists and by the broader public is definitely an import from English. When inquiring into the relation between politics and values, we should not separate our analysis of medical professionals from the study of other social "elites' and of intellectuals. Significantly. Fox. whose research has constantly paid close attention to modern medicine's symbolic dimension and the

thus implied values, has shown us the approach to follow.

Centre de Recherche Sciences Mddecine

Maladie et Sciences Sociale C N R S - [ N S E R M , Paris, France

REFERENCES

I. Ellis J. The Physician-Legislators of France: Medicine and Politics in the Earl)' Third Republic. 1870-1914. Cambridge University Press, Cambridge, 1990.

2. Herzlich C., Bungener M.. Palcheler G. et al. Cinquante arts d'exercice de la mbdecine en France. Carri&es et pratiques des medecins franfais. 1930-1980. DoiB- INSERM, Paris, 1993.

3. Freidson E. Professional Powers: A Study of the ln.stitu- tionali:ation of Formal Knowledge, Chap. 9. University of Chicago Press. Chicago, 1986.