House, MD and Risk

My favourite show on network tv is House. It’s a popular enough show that I assume anyone reading this already knows the premise: Greg House is the head of a medical team that deals with the cases that baffle everyone else. He’s a medical Sherlock Holmes – almost literally; references to the Sherlock Holmes stories abound in the series.

The series is remarkable in a particular way – it illustrates one of the big debates in social theory today. The first side of this debate is represented by the German philosopher Jurgen Habermas. His position is basically in support of the standard liberal democratic attitude: 2 opposing sides in an argument sit down and have a rational discussion. Person A presents his case, and person B presents his. Either A or B is expected to present a more rational, fact based case, and so their position is selected to act upon.

The other side of this social theory debate is represented by folks like Zizek and Alain Badiou. In a nut shell, their position is that rational, fact based thought does not always lead to a clear course of action. Whether through insufficient data or through some constitutive limitation of the situation, there must come a point at which the rational discussion ends and a decision is made. A risk must be taken, perhaps in defiance of the standard democratic expectation of majority rule or individual choice.

House consistently finds himself between these two positions. In every episode, he and his team write down a list of the patient’s symptoms. Often, the team is split as to what the diagnosis should be. The doctors on his team are obviously intelligent, and at least one of them is every bit as excellent a doctor as House himself is. That’d be Foreman, for those who watch the show. The other two members of the team are Cameron (who just happens to be played by the hottest woman on tv) and Chase.

The patient is always, of course, in imminent peril. They’ll die in 24 hours if House’s team doesn’t come up with the answer. Often the symptoms conflict with one another; symptoms 1 & 2 suggest diagnoses X, but symptom 3 seems to rule out X and suggests diagnoses Y.

House stands by and occasionally interjects while Foreman, Cameron and Chase debate the possibilities. Foreman insists the diagnosis is X, while Cameron and Chase insist on Y. Eventually House stops the discussion and orders them to treat the patient for a wholly other diagnosis, Z. What follows is a replay of a famous anecdote from one of GWF Hegel’s lectures: Foreman (standing in for one of Hegel’s students) says the facts don’t fit Z, and House basically says “So much the worse for the facts.”

So they treat for Z. Sometimes House is right, and the patient is cured. Sometimes House is wrong, and the patient develops a whole new problem.

Sometimes the doctors find themselves in a situation where diagnosis X seems correct, but the lab test to confirm it will take 48 hours, whereas the patient only has 24 hours to live. If X is the wrong diagnosis, the treatment will kill the patient almost immediately. I think part of the reason House is such an admired character (despite his abrasive personality) is that he is capable of making a firm decision to treat. He says to forget the test and just administer the treatment; how many of the rest of us would hem and haw and fritter away the patient’s life trying to discover new and more reassuring facts?

So my suggestion is that decisions always come down to something like this. Take any ethical dilemma you please; you’ll often find yourself in a situation in which the facts don’t produce a clear answer. It is the same with politics; the situation rarely tells you what must be done. Sooner or later, an authoritative decision must be made. The rational, democratic discussion must end, and action must take place.