Sex, Money, and Bioethics Watching ER and Chicago Hope

There is a certain sadness that ER and Chicago Hope have captured the public's imagination in a way the Clinton Health Plan never did. As these TV serial dramas open their second season they have become so popular that bioethicists are at a district disadvantage in talking to the public if they do not know how medical practice is being portrayed in them. Embedded in both ER and Chicago Hope are issues regularly discussed on these pages. Although neither the medicine nor the bioethics of these TV dramas is real, both are often so compellingly portrayed as to provide us with extraordinary opportunities to use them to encourage more in-depth discussion, and to make bioethics itself more accessible and democratic. Yes, God help us, the contemporary bioethicist must watch TV to understand how Americans see bioethics issues and how they might usefully be explored in public forums. A TV serial drama must tell stories to entertain us; but stories also are, as narrative analysts rightly insist, the best way to convey values, and the reason Christ used parables to instruct. As Stephen Gillers, writing about LA Law six years ago put it, "In the end, every ethical rule must be tested against real stories."[1] Unless ethical rules can pass the test of leading to acceptable resolutions of the real problems of real people, they will not be taken seriously. How good are these stories, and how does bioethics fare in them. ER NBC's ER was the hottest new TV drama of the past season, nominated for a remarkable twenty Emmy awards. It often placed first in the weekly Nielsen ratings, attracting more than 24 million viewing households. What makes ER so popular? The easy answer is that its physician-creator, Michael Crichton (Jurassic Park), and its executive producer, John Wells (China Beach), have put together a fast-paced, MTV-formatted show that displays three of America's four favorite subjects: sex, violence, and youth. Most dramatic TV series tell two or three stories per hour; ER frequently has a dozen or more story lines going to keep the interest of those with very short attention spans. Violence is the focus of most high drama in all real life emergency departments. This one not only crams a week's worth into an hour, but its victims are also competently attended by young, good looking, ethnically diverse doctors and nurses who are all romantically involved with each other, or in a relationship strained by devotion to the ER itself. This says a lot, yet I don't think this formula alone moved the series so far so fast (although the success of Baywatch, the globe's most watched serial drama, may mean I'm wrong about this). The real star of this show is the fourth American standby, money; and it is money's remarkable absence that makes it the star. After all, as any health lawyer will tell you, the only place Americans (even those illegally in the U.S.) have a legal right to medical care, regardless of ability to pay, is in an emergency department. And in this TV-land ER everyone, regardless of race, class, age, or insurance status, gets immediate and compassionate care by dedicated professionals, no money questions asked. Given the show's popularity, a reasonable argument can be made that such amonetary attention is what Americans want from their health care system. But ignoring the context of American medical care in terms of money, power, and control by managers and insurers, ER continues the socially unhelpful TV tradition of pretending medical resources are unlimited, money is no object in medical care, and dedicated physicians can and should care only about the patient they are currently working on.[2] John Wells, of course, knows this and actually sees ER as reassuring an anxious public about their medical care, noting, "This is a place where you go and you sort of know who the people are, and you feel that they care about you."[3] This is in direct contrast to what is going on in the real world. …