Windows Into the Soul

Via a link on Scalpel or Sword, I read a post by Catholic blogger Dawn Eden which summarized a post by a medical student blogging under the name Pudu Overload who felt unnerved after observing abortions at a Planned Parenthood clinic.  Pudu Overload apparently identifies herself as a supporter of abortion rights, yet felt "incredibly freaked out about the whole thing and [I] don't know how to think about it.  It simultaneously seems like a small and an enormous thing."

I must qualify the statement about Pudu Overload's political leanings because, according to Dawn Eden, Pudu took her entire blog down after receiving hostile comments on the abortion post.  Ms. Eden then proceeds to quote the post in its entirety, along with screenshots of the blog before it was removed, presumably to verify that Pudu actually wrote it.  (You can read the  post cached here.)

Ms. Eden's comments upon Pudu conflict reveal an underlying opposition to abortion rights.  (I encourage you to read Ms. Eden's post yourself to see if you agree with this assessment.)  She then goes on to elicit support for Pudu Overload from her readers: "Please pray that this young medical student and others like her who witness legalized slaughter will receive the grace to see the truth of what is going on— and flee from it."  She also expresses regret that Pudu Overload should have received such hostile commentary from other abortion opponents and--rightly--encourages her readers to demonstrate more charity to those with whom they disagree.

I am troubled by the sequence of events described above for a number of reasons, the most trivial of which is my own support of abortion rights.  Even though my views are strong, I respect people who hold an opposing view, because I can sympathize with basis of these beliefs, and because I really do believe a civilized exchange of views is the foundation of a true democracy.

I am more troubled by the the hateful commentary Pudu Overload allegedly received in response to her post, and even more so that Ms. Eden has chosen to re-post Pudu's original writing to support her own anti-abortion stance.  This is misappropriation malappropriation^* of Pudu's words and views, and it seems especially egregious to me in this instance because it occurred when Pudu Overload presumably feels vulnerable and under threat.

The real issue here is easily lost in the anti-abortion jargon Ms. Eden uses to describe and sympathize with Pudu Overload's situation.  Yes, I agree abortion is an emotionally charged issue and witnessing the act itself is inevitably going to compel a young doctor to reassess her previously-held beliefs.  However, abortion is not the only such act to challenge doctors in training.  When I was a medical student I struggled with my beliefs and ethics when confronted with the following clinical situations:

1. Performing a pelvic exam on an anesthetized woman patient, without clearly obtaining consent from her beforehand.

2. Being offered an attempt at inserting a central line into a terminally-ill ICU patient because, I was told, "At this point, the only thing we can do for him is learn how to do procedures so we're ready for the next sick guy."

3. Witnessing the care of a micro-preemie infant who had been resuscitated just prior to the generally-agreed limit of viability (24 weeks gestation), and contemplating the great cost of his care against the likelihood he would only survive to live with significant chronic respiratory/neurological illness.

4. Contributing to the continuation of critical care (mechanical ventilation, pressors, artificial feedings) in a 80+ year-old patient beyond all reasonable expectation of meaningful recovery, because the patient's family could not agree to withdraw care and the medical team did not take on the difficult task of advising the family to do so.

Now, none of these clinical scenarios carries the social, religious or political weight of the decision to participate in abortion care, but each shares with abortion the problems of ethical ambiguity and physical invasion of the human body.  Numbers 2, 3, and 4 also deal specifically with the question of who decides when life should begin and when it should end, and what value we place upon humanity at different stages of the life cycle.  From my personal experience, they are as painful and agonizing to deal with as it is to counsel a woman with an unwanted pregnancy, and--for most doctors--far more common in practice.  All young doctors must confront these difficult clinical scenarios and decide for themselves which boundaries they will not cross and which beliefs will inform their care.  This process is intensely personal but benefits from open discussion with friends and peers, and an environment which acknowledges the possibility of ambiguity or conflict between belief and duty.

Pudu Overload's mistake might have been in sharing her experiences on a public forum such as a blog, but I don't blame her for that.  Instead, I applaud her for being so honest and exposing feelings which a lot of people share.  We need more personal, honest discussion such as Pudu's on difficult subjects such as abortion, and young doctors need a safe forum in which to express themselves.  They do not, however, need to become the victims of Internet abuse or have their words misappropriated malappropriated^* by others who want to promote an agenda.  Instead of passing her post around as an example of how poisonous the act of abortion is--and it so easily could have been the decision not to intubate a 23 4/7 week preemie, or to withdraw care from an 88 year-old grandmother--we should be encouraging her efforts to become a conscientious physician, no matter what procedures she ultimately chooses to include within her scope of practice.

Elizabeth the First of England is credited with saying, "I have no desire to open windows into men's souls" and I agree completely.  Let everyone examine their motives and fears and come to their own conclusions.  Doctors especially need to confront their feelings about difficult clinical scenarios, and they don't need the additional burden of having their words manipulated for the benefit of political agendas.  One lesson I've already learned in my career is the need to let go of partisanship and support people of conscience, no matter what their beliefs may be.

Pudu Overload, if you're reading this--I'm sorry for what happened, and I hope you put your blog back up.  Close your posts to comments if you must, but don't stop asking yourself how you feel.

*Addendum:  My friend and fellow blogger, Symtym, has drawn my attention to the improper use of the word "misappropriation" in the original version of this post.  After some discussion, I have changed this to the neologism "mal-appropriation" to express my intended meaning:  the deliberate use of an author's words to support ideas in opposition to her own.  Symtym suggested a more common term, "contrarian use," but I prefer my neologism for the purposes of the discussion above.

Comments

[Hilary]

Thank you for a wonderful post. I also think, although I have strong beliefs on the subject of reproductive rights, that civilized discourse is important.

I am happy you gave those examples of other ethically troubling situations that you found yourself in when training in medicine. I am so tired of people elevating issues of women's sexuality above other equally troubling ethical medical dilemmas, such as futile care and lack of informed consent.

[dragonfly]

I agree with DrCris.
It is so awful about the hateful commentary which Pudu recieved. To quote from a post I was reading today at http://mysadalterego.wordpress.com/

"be gentle, for everyone around you is engaged in a great struggle".

[DrCris]

I appreciate Symtym's assessment that this was legal behaviour.

However, I think it is a bit dodgy from an ethical point of view to republish an entire post and screenshots. It just seems a bit patronizing - "Obviously you can't hack in the world of abortion debate, so I will choose to republish your writings after the fact. And I recognise that you no longer want to be the centre of this discussion, but I don't care."

Athough the internet is eternal, and people can republish and quote, I think it is nice to respect that people sometimes make mistakes. And if people want to retire from the public face of dicsussion, then they should be allowed to and not be patronized.

[symtym]

You indeed can have opinions!!! That's what blogging is about, the more orthogonal the opinion the better ;)

In some respects this is similar to Flea's situation. He chose to make public content, best kept private (and preserve the personal nature of the content), with dire consequences to him legally and professionally. Once content is placed in the wild (web), its existence has been fundamentally changed — it becomes viral the moment you click. Message to those in the medical-blogosphere should be: you blog with the same risks that you create a medical record (life and application is limitless).

[Theresa]

I agree words should be used with specificity, that's why I appreciate the input. Should have looked up "misappropriation" before posting. I like "contrarian use" as a term--never considered using it--but I stand by my neologism for the purposes of communicating *my* opinion of Dawn Eden's post. I get to have opinions too.

I agree with the need to accept public discourse in all its nuances when we participate in Internet forums such as blogging. I agree that our words, once published, can be reused for purposes other than our own. This happens all the time and, in the name of free speech (of which I am an anguished supporter), I would never dare suggest these uses be limited. However, defending speech does not exclude critical evaluation of its uses. This goes on all the time, too. Freedom of speech without some kind of collective self-regulation is an intolerable scenario. Even if I will defend to the death your right to say something I disagree with, I'm still going to tell you I disagree, and if I think your actions are wrong, I'm going to say so. Some of the nuances of the crowd are my own.

I agree with your view on the negative effect of labeling, so I'm going to edit out my incorrect use of the word "misappropriation." Thanks again.

[symtym]

"Legal" definition of misappropriation is the codification, in our society, of our moral understanding of misappropriation — therein lies the thrust. The argument of only using misappropriation for its "moral weight" is to appropriate the connotation sans responsible use. We use words for purposes — to color our message. No purpose using the word, if not for the negative connotation it conjures.

Understand the neologism, but how about calling it what it is — contrarian use. Contrarian use goes hand-in-hand with public discourse. I think there is a step beyond the content when we label the content provider with a socially objectionable term (misappropriator). Once labeled, the next step is to dismiss the messenger based upon this labeling because they are now deemed sociably objectionable (conclusion sans factual basis creates a circular argument). The attack is on the argument, not the person.

The message of Pudu/Dawn is there may be contrarian views between the two and blog postings may be repurposed and retasked to accentuate this nature. And, there is no such thing as a personal discourse on the web, they are all public discourses and subject to the nuances of the crowd.

[symtym]

enrico

One's exploitation may be another's advocacy. I understand and agree on the concern, but differ on the characterization. On the web, we either believe in free speech or we don't. Free speech is a mutual activity and any attempt to control or curtail another's application of free speech cuts to one's defense of their free speech. There were no "legal corrections" (that's dismissive), but rather logical arguments about the post (not the positions in the post).

[Theresa]

I always appreciate symtym's take on matters, especially when he speaks from his legal expertise! I can't argue with his interpretation, including the perhaps improper use of the work "misappropriation" which I chose, not for its legal implication but for its moral weight. I could substitute the neologism "malappropriation" because my purpose in writing this post is not to challenge the legal implications of re-posting another blogger's work--and indeed, I agree with your interpretation--but to consider the moral implications of re-posting a blogger's words a) to support a position which is in opposition to her own, and b) when the blogger herself has removed herself from public debate after (reportedly) receiving hate/threat comments.

I also hope that opening up the discussion to the other ethically-challenging clinical scenarios would raise a larger point about how we can encourage doctors to become more reflective about these issues. Dawn Eden would like young doctors to refuse to participate in abortion care--fine. But her appeals to conscience fall flat in light of the "malappropriation" of Pudu Overload's words to support her own views. Is this how you persuade people of the correctness of your opinion?

Thanks for the analysis of the legal issues, these are important for all of us to understand and it certainly helps me grasp the situation better.

[Gary Levin]

Pudu's original post was clear and I thought quite neutral...i am not at all sure why she took it down...

[enrico]

T,
Excellent post! Though I have to wonder: what was so controversial about what YOU wrote? On Twitter you were obviously conflicted about how much of a crapstorm this might create, but I don't see anything that generates controversy.

@symtym: your legal corrections aside, what I gathered from T's view is that Dawn seems to profess a genuine concern and almost maternal interest in Pudu's "spiritual formation" vis a vis this experience. However, by not only posting her words in their enitrety (totally OK with me so far) but at the same time offering screenshots (now I have a problem) which provide nothing more to further Dawn's argument or core information, leaves the reader with a feeling as though Pudu has been nothing short of exploited for Dawn's purposes. If Dawn cared for Pudu's feelings, what would be the point of resurrecting, like an unwilling blog zombie, not just the content, but the look and feel of the site taken down?

You can go on about whether or not it was in Dawn's right to do so, whether there was an "expectation" of privacy once taken down (not), etc,. but you're missing the forest for the trees. Even if T misused a few words or stretched the definition of some concepts, I think we all got the bigger meaning.

[symtym]

There is much here I agree with; however, I'm concerned about the notions of "personal," "misappropriation" and the implied notion of copyright.

First, "personal, honest discussion...on difficult subjects" may be impossible in the venue chosen by Pudu Overload ("Pudu"), because of the inherent nature of blogs and the ability, without moderation, to post comments. Because of the ability to post comments anonymously. Because of the ability of RSS/Atom to repurpose and retask content. We are left with not "personal, honest discussion," but with public discussions with varying degrees of "honesty" and anonymity. The venue chosen does not conform to the traditional notion of "personal."

Second (out of order), there is laced throughout your post the implied argument that there is some right of Pudu violated. The obvious right is that of copyright. There is no citation to the facts regarding whether Pudu reserved all or some rights. From your citation to the Google cache, of the now offline Pudu website, would indicate that content rights were not addressed. Even if we adopt the position that all Pudu's rights were reserved, the use by The Dawn Patrol ("Dawn") website is well within the doctrine of Fair Use. It may be argued that the whole post was quoted. The counter is that it represents a singular thought entry in a web journal made public. It will be argued that it was removed from the web. Well, no one in 2008 should have the false belief that you solely control content placed on the web. Your own citation to the Google cache of Pudu is illustrative. What remains is a matter of style, do you post Pudu's content in toto in your blog or do you cite to the post in a known quasi-permanent cache on the web? Dawn chose the former, a style I think we both agree is not desirable; but nevertheless allowable under Fair Use.

Continuing on the notion of Fair Use, it is well within the nature of the doctrine and in the very nature of blogs and other forms of social communication facilitated by the web to offer other's content for commentary. Implicit in the offerring of content for commentary is the positioning of one's views with respects to another. The criticism that to do so creates "victims of...others who want to promote an agenda" is inconsistent with the history and practice of blogging and other social communications on the web.

Lastly, "misappropriation" means the intentional, negligent or illegal use of the property or funds of another person for one's own use or other unauthorized purpose. If your two uses of the term "misappropriation" is hyperbolic, then it would seem overwhelming inconsistent with the social communications on the web as we know them. If your two uses of the term "misappropriation" is intentional, then you are simply wrong (supra point 2).

In concluding, both Pudu and Dawn are intentionally participating in a public discussion. Both are presenting content in media forms that allow commentary, repurposing and retasking of content. Fair Use allows for the commentary, repurposing and retasking of content — and this absolutely includes contrarian views (or "agenda[s]"). Misappropriation is a very harsh term without a factual basis in Dawn's post.

Should Pudu be encourged to post — sure, but with the admonition that your posts are public and subject to Fair Use and may be used to support contrarian positions. The ability to freely express on the web may be deemed a "right," but no right exists without some conceptualization of constraints, and therein lies my concern with your post. Elizabeth the First of England may have had "no desire to open windows into men's souls," but the web is about the proposition of bearing one's soul to force windows open. Caveat scriptor trumps caveat lector.

[DrMidlife]

Very happy to see my own thoughts represented here. I start med school next summer.

[rlbates]

I applaud you and your clear writing! Very nice post, Theresa. Very nice indeed.

[Liz D]

Thanks for the well-written, thoughtful post.

In my opinion, it is always ethically questionable to re-publish another's work without permission, no matter what the platform.

In this instance, I find Ms. Eden's behavior even more questionable, because she was using the author's work to advance a view other than the author's.

[mark's tails]

Very well written post.