New Sovereignties and the Translation of Clinical Authority

On February 14, 2018, 17 people were killed at Marjory Stoneman Douglas High School in Parkland, Florida. News of the massacre quickly began trending on social media. For the first time since the preceding October after a mass shooting in Las Vegas, the now sadly familiar discourse about gun violence in the United States raised its head to front-page prominence. At the same time, many media outlets reported that the Parkland incident was the eighteenth school shooting in the United States this year, and as of May that number had grown to 23 shootings at American schools, such that we are averaging more than one shooting a week in 2018. The specter of gun violence as something that needs control is unlikely to fade within the foreseeable future.

Attempting to translate their authority as clinicians so that it is legible and efficacious in broader domains, they take up the rhetoric of sovereign responsibility. They attempt to repurpose claims made in other instances on the state as claims to be made instead on the beneficent hospital.
Debate continues to rage over how American society might prevent the recurrence of this culture-bound terror. In its current iteration, public responses on the left tend to locate the etiology of mass shootings with lack of gun control, and on the right, public discourse responds with concerns over mental health (and the occasionally resurrected diatribe against simulated violence in video games and film). Both positions push a government-backed “solution” as self-evident and more or less the only option with any teeth. However, there is another discursive formulation of the issue, one that is not necessarily inimical to either and that has been treated with an equal lack of skepticism.

Just one day after the shooting at Marjory Stoneman Douglas High School, the president of the American Medical Association—the oldest and largest association of physicians in the country—published his opinion on the Parkland tragedy. In it, he calls gun violence a “public health crisis,” identifying it as “epidemiological” in nature. The medical establishment has attempted to claim authority over the issue of gun violence for decades, but the law has placed numerous barriers in its way. The so-called Dickey Amendment has greatly hindered research into the topic, and pediatricians are barred from discussing gun safety with patients in several states.

Attempts to translate this policy concern into an issue of public health are nothing new. And it is not only from official or professional spheres that these claims are being made, either. While I was a graduate student at the University of Chicago, an enduring concern was the conspicuous absence of a Level 1 adult trauma center in the city’s South Side, infamous for its high incidence of gun violence. Activists pressured the University to open such a center, and discourse was constituted in the mode of the private institution’s responsibilities to its public catchment. Despite the significant costs—in terms of both labor and capital—the University acceded to these demands, and it is scheduled to open the trauma center in 2018.

Bird's eye view of medical students in white jackets marching down the street in protest.
Medical student protest. Indi Samarajiva/Flickr (CC BY 2.0)

Also while at Chicago, I witnessed dozens of medical students from the Pritzker School of Medicine stage what they called a “die-in” protest after the police shooting of the teenager Laquan McDonald. Wearing the ritual garb that marks them as medical professionals and authorizes their individual voices as simultaneously the voice of the institution of biomedicine, the students lay down on the plaza in front of City Hall. They demanded that such violence be recognized as a “public health crisis.” “Our white coats give us authority to speak out on behalf of our patients,” the student organizer of the event told the news media.

This final statement in particular highlights an aspirant sovereignty—represented here by the medical students in their white coats as iconic instantiations of the medical establishment itself—making biopolitical claims to the life and death of individuals within the University of Chicago’s catchment area. Attempting to translate their authority as clinicians so that it is legible and efficacious in broader domains, they take up the rhetoric of sovereign responsibility. They attempt to repurpose claims made in other instances on the state as claims to be made instead on the beneficent hospital.

This embodies just one instance of widespread ambitions to translate issues otherwise framed as concerns of public policy into those of clinical authority. The apparatuses of biomedicine reach far beyond the walls of the clinic. In the field of medical ethics, we regularly see cases in which clinicians send social workers and police to patients’ homes for suspected child or elder abuse; quarantines are enacted and enforced on threat of penalty; and treatments are compelled against a patient’s expressed desires. Clinicians have led many protests—similar to the gun violence case described above—against social conditions as diverse as climate change, food deserts, and immigration policy. In each instance, the physicians involved translate public policy into clinical policy and claim at least some authority over the given issue for the beneficent purpose of promoting the biological well-being of their subjects. Just a few months prior to the Parkland shooting, the Journal of the American Medical Association (JAMA) published an article advocating the creation of “sanctuary hospitals,” seizing the political opportunity opened by the actions of the federal government and explicitly calling for clinical territorial sovereignty in opposition to the sovereign rule of the federal government.

As the state continues to retract support for the financially destitute, the chronically mentally and physically ill, and the victims of gun violence, the institution of biomedicine has begun to pick up the slack, expanding and entrenching its authority under the banner of beneficence. Yet, in the shadow of beneficence emerge the darker concomitants of sovereignty. The internet (like the bioethics case conference) is littered with stories about medical kidnapping, monopolistic market practices, and the quasi-imperialism of public health volunteerism abroad. Typified as beneficent, these otherwise troubling actions receive less moral scrutiny from the general public than they might deserve, avoiding serious criticism as, at worst, “justified paternalism.” But as the last several decades of anthropological research have made increasingly clear, just because something appears as common sense, it does not mean that it is indisputably good and true. In fact, beneficence is not necessarily compatible with a number of other ethical ideals, like autonomy, justice, and respect for persons. Thus we are left with the question: As clinical authority is translated into domains abandoned by that of the classical state, what checks and balances and what democratic processes can we imagine to discipline the new sovereignty of biomedicine?

Colin Halverson is a postdoctoral fellow in the Center for Biomedical Ethics and Society at Vanderbilt University.

Cite as: Halverson, Colin. 2018. “New Sovereignties and the Translation of Clinical Authority.”  Anthropology News website, June 7, 2018. DOI: 10.1111/AN.883

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