1 Boring Old Man

Kaler on Faculty Senate resolution: "It’s not a review of the Markingson case"

Fear and Loathing in Bioethics

by Carl Elliot

December 11, 2013

I think we’re getting a pretty good idea of where the University of Minnesota administration plans to take the "independent review" endorsed by the Faculty Senate last week. This interview with President Kaler appears in today’s Minnesota Daily:

The Faculty Senate just passed its resolution to create an independent, external panel to investigate how the institution conducts clinical research on human subjects. What do you think of the most recent developments in the Dan Markingson case?
I’m a big believer in shared governance, and so I’m willing to take the advice of the Senate and the panel… I think they will find that our review processes are robust and that we do, in fact, protect patients in clinical trials, but there’s been concern raised in how we do that, and so our goal is to air out clearly and very publicly what we do and have a panel of external experts validate that and be sure we are doing this absolutely as well as can be done. It’s certainly resulted as a consequence of a lot of repetitive publicity about the Markingson case, but it’s not a review of the Markingson case; it’s a review of what we are doing now and what we’re going to do moving forward.
This is something that began before you were president. What do you see as your role?
My role is to look forward, and as I said, that will be the charge of the panel.

And just to reinforce the point, the Daily editorial staff writes:

Though some, including University bioethicists and professors, may want more answers involving Markingson’s death, we should focus on avoiding potential tragedies and unethical behavior in the future.

The resolution passed by the Faculty Senate responded to an international call for an investigation into the death of Dan Markingson.  How would an investigation that avoids the Markingson case do anything to restore confidence in the university?

Outsiders see the persistence as the problem. "Holding on to your symptoms," "Stuck in the past," "Put it behind you," "Get over it," "Move on with your life," "Heal," "Let it go" – as if that’s good advice. But how do you do that when it’s the single most important determinate of your life? It’s the attempts at un·happening that cause so much of the problem. The traumatized person’s task is the opposite, how to live with an open wound that doesn’t, or can’t, heal. The afflicted often live their lives knowingly and unknowingly trying to prevent the past, un·happening in the future what they couldn’t un·happen in the past. And all that unhelpful advice entreats them to skip the vital step of knowing in detail what actually happened and recognizing its indelible impact.

President Kaler and the people at the University of Minnesota aren’t getting the point. They want to skip an essential step in the same way, to look at policies for the future without acknowledging the truth of what happened in the past. For that matter, the pharmaceutical companies have the same idea, some version of reform that skips the step of acknowledging what is being reformed. The Minnesota Daily editorial staff says, "we should focus on avoiding potential tragedies and unethical behavior in the future." And they might as well add "by skipping the tragedies and unethical behavior of the past." Traumatized people aren’t wallowing in the past, they are insistent [and persistent] in establishing its reality, knowing, sometimes without knowing why, that it’s their only salvation [and ours]. It’s why we have memorials – Ground Zero, Kennedy’s flame, the Holocaust, Viet Nam, Gettysburg, Civil Rights. We can’t change the past, but we can honor it and make sure we know it happened.

In a career of treating people with persistent traumatic illness, I never saw one successful case where there wasn’t some kind of memorial, public or private, some icon to assure that what happened was never forgotten. And in this last week, we saw footage of a dramatic version, a tribute to Nelson Mandela. One way he did the impossible in South Africa was his Truth and Reconciliation Commission. If the people who committed the atrocities of Apartheid came forward and admitted publicly what they had done, they were granted full amnesty. And if Mandela’s South Africa survives beyond him, that will likely have been an essential ingredient in why.