RADIO / A bad dose of bedside manners: Robert Hanks on the case for letting life run its course

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The Independent Culture
GIVEN THAT death is supposed to be the last great taboo, a surprising amount of it gets on to the radio. Last week's edition of Medicine Now (Radio 4, Wednesday), reporting on the BMA's annual conference, ended with a discussion of the medicalisation of death - an area that you'd have thought was by definition pretty solidly medicalised. According to David Field of the University of Leicester, though, doctors now intervene far too much in death, even when their intervention can't actually save a life. More and more people are dying in hospital, where bureaucracy can keep an eye on them: the choice of how you die and where you die is being whittled away.

Field's argument, in effect a plea for privacy and dignity, was rather moving. But what was most noticeable was the supposition behind it: not that people are afraid of death, but that they are afraid of hospitals. The natural assumption is that if people are afraid of medical things, it's because they associate them with morbid things. But the truth is that many people see doctors as morbid things in themselves.

There was something of this attitude on display in Truth to Tell (Radio 4, Tuesday), the second of a series of 'little-known true stories' recounted by Anthony Smith (formerly of A Sideways Look . . . ). This week, following on from the extinction of the great auk, he told us about Alexis St Martin. Following an accident with a musket in 1822, he was left with a hole in his side a little less than an inch in diameter. He refused to have it stitched, and the wound never closed up. So for the next 10 years, a Dr Beaumont peered, poked, and dangled bits of food through St Martin's perforation, finding out most of what we know about how the digestive system works. St Martin, meanwhile, devised a bung to make eating a slightly tidier and more nourishing process.

The problem with Smith is that, after years of looking sideways, he has trouble seeing things straight on; there always has to be a twist, a quirk. Perhaps the idiosyncrasy is uncontrived, but you can't escape the suspicion of contrivance. Somewhere, not necessarily at a conscious level, he's scratching his head and saying: 'Oh dear, what uniquely personal kink can I give to this one?'

Here, the kink was anti-medical: St Martin, we were told, steadfastly refused the medicalisation of his body. Beaumont's efforts to further the cause of science were represented as harassment - when St Martin moved jobs, Dr Beaumont would pursue him, still prodding and dangling. Why St Martin allowed this to carry on wasn't clear - bribery, you assume.

Unfortunately, Smith's freewheeling, anecdotal style and wry delivery made it hard to tell how much of what he said was conjecture, how much plain fact - the only piece of direct evidence presented that St Martin was unhappy about the situation was a quotation from Beaumont's notes on the case, in which he said that the subject was often 'difficult and uncooperative'. And Smith also deliberately slanted things his way - while St Martin was chummily referred to as 'Alexis', the doctor remained a distant, slightly chilly 'Beaumont'. If there was a moral here, it came from the story-teller, not the story.

On the other hand, the morals of the enticingly named Baby Farming and Baby Murder (Radio 4, Wednesday) leapt out of the material. This was a plain, old-fashioned feature on Victorian methods for disposing of unwanted children, given a pleasantly downbeat narration by Stanley Williamson.

At a time when illegitimacy was socially unacceptable, and abortion and adoption of unwanted children illegal, a thriving secret economy developed to fill the gap: there was a number of institutions where young women could go into retreat for a few months, and a number of other institutions existed to take care of the products (these were largely for the middle and upper classes: infanticide was only rarely practised by the working classes).

The economics of the baby-farms was also natural enough: if you were being paid to keep the baby by the week, you kept it alive as cheaply as possible; if you were given a lump sum, the profit was in getting rid of the child as soon as you could. Whichever, the child would end up being fed either a little more or a little less than it needed to keep from starving.

In this case, doctors came out smelling of roses: they exposed the business, forcing the introduction of the Act for the Preservation of Infant Life of 1872 and the compulsory registration of all births and deaths. In other words, more bureaucracy and more medicalisation: this seems to be where we came in.