musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

This above all: to thine own self be true


It was my first year in University after what seemed like an eternity in high school. Glenn and I decided to room together, although I only knew him through friends. He seemed friendly enough, but I suppose I should have known better than to share accommodations with someone who preferred partying to studying; someone who freely admitted he had only enrolled because of his parents.

Along with about 10 other students we had rented rooms in a largely unsupervised house on a quiet well-treed street near the campus. On weekdays it was peaceful, and the idyllic walk to our classes was just how I’d imagined university life would be. Glen did not have those kind of expectations, though. He couldn’t wait until the weekends to let loose…

I mean it just started with a little thing… Stuff usually begins this way though, doesn’t it?  Glenn was going out with a student nurse at the time, and she’d managed to steal (no, borrow) a pair of OR scrubs from the hospital for him. He thought they would make great clothes he could wear around the flat -and to the parties he insisted on holding most weekends. What I really objected to, however, was him trying to convince her to get some low-level drugs from the hospital for his parties. I was so naïve, I had no idea what constituted ‘low-level’ -drugs were drugs…

Glenn lived in a make-believe world: he wore the scrubs to the parties he held at the house, and pretended he had been accepted into medical school for the coming year. Everybody enjoyed the parties, but I suspected it was because his girlfriend managed to steal a few drugs for them. I could tell she wasn’t happy about it, but on weekends, I took to studying at the library until it closed so I wouldn’t have to weather the storm. I didn’t think we’d last as roommates if I complained; it felt wrong to remain silent, though: it wasn’t how I was raised.

I began to wonder about obligations: those that I owe to others, obviously, but also whether the same rules applied to myself. And if so, were they moral arguments, or just, well, preferences? Like whether I should tell his friends about where Glenn got the drugs -or whether it would be appropriate for me to just smile each time I was asked what it was like to live with a future medical student. I mean, how important is self-respect? Is it simply an awareness of how others see me, or something more profound: how I see me? In other words, do I have a moral obligation to care about me?

Is morality simply an awareness of the norms that govern my interactions with other people -that I owe to others? Or do those norms extend to what I owe to myself? I began to feel guilty about living with Glenn…

The real implications of those long ago questions surfaced again recently in an essay I happened upon.[i]  I discovered that some philosophers question whether there are any valid obligations to the self: for example, does morality only apply if there’s a need to coordinate the competing interests of different people that might compromise essential values of their personal liberty or autonomy? ‘With many interpersonal obligations, the person who is owed something can release the one who owes them. But what if the person who’s owed something and the person who owes it are the same person?’ Could I just release myself from any obligation I don’t want to fulfil? And if so, would this render any other commitments to myself either impossible or trivial?

Of course there are other ways of looking at the problem: Immanuel Kant thought that the duty of self-respect was fundamental to moral life. He thought that it was wrong to treat oneself (or anyone else) as a mere means to an end rather than an end in itself. And long before Kant, Confucius thought that self-cultivation was a valuable moral end…

Contemporary philosophers, too, have accepted many self-obligations: ‘pursuing self-knowledge, avoiding self-harm, cultivating one’s talents, resisting oppression, and keeping promises to oneself.’ 

But even in those early days of my university education, I began to realize that most of my friends sensed that there was a moral obligation driving many of our choices and behaviours: living up to commitments seemed important. Doing drugs at parties was simply unacceptable.

An obligation has at least two essential features: once accepted, it is non-optional; and, as an obligation, it is directed at a specific target. Of course there is also a crucial distinction between obligations that are genuinely owed to the self, and those that are in some sense about the self but are ultimately owed to other people as well: not to criticize or embarrass Glenn at one of his parties, for example. Still, are acts that are harmful to the self, matters of moral obligation, and yet acts that are not obviously self-harmful simply a matter of preference? I wondered about those parties…

And what if  the tendency to moralise self-care might risk making us more judgmental, and less empathetic, towards other people who might be dealing with the same challenges? Should a commitment to a self-image have conflicted with a moral obligation to criticize a roommate?

I have to admit that I quickly began to dislike Glenn and made plans to find another place to live near the campus. He’d already broken up with the nursing student, and even if I realized she’d been manipulated, I’d never criticized either of their behaviours; I’d been complicit in his conduct, and although I had nothing in common with the friends he always invited to the parties, I think they already suspected he wasn’t planning to enter Medical school…

Although I had no safe way of proving to authorities that there were drugs at his parties, was there still an obligation to inform our landlord what I knew about them? Or, as I rationalized at the time, was it simply none of my business? Would telling the owner have mattered anyway?

What did seem to be important, though, was Glenn himself. By being silent about his deceptions, was I setting him up for a lifetime of pretence? Would he continue to reap what he insisted on sowing -or would he eventually realize what was happening? I don’t know.

I found another place to live a few weeks later and eventually heard from one of his friends that he dropped out of university after the first semester. Nobody seemed overly curious about where he ended up, though. And at the time, not even me.

But after all the intervening years, I now feel guilty; I suppose it’s too late to matter, though…

[i] https://psyche.co/ideas/is-it-morally-wrong-to-not-take-care-of-yourself

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