In “When Breath Becomes Air”, there are two interesting theme that support each other in a precise way, the role of humanity in care and the physician’s ethical responsibility. The first theme that emerges is that the presence of humane inside the treatments is really important. After a significant improvement of the medical skill, the author realized that the advanced skill is not enough for the patients and this will lead to a frustration of people. The true thing that a doctor need to have is the responsibility of emotional support of them. From the sentence “Cadaver dissection is a medical rite of passage and a trespass on the sacrosanct, engendering a legion of feeling: from revulsion, exhilaration, nausea, frustration, and awe to, as time passes, the mere tedium of academic exercise.” (pp. 44) we can see that the author is grappling not with “first-operation risk” but with the ethical and emotional conflict produced by early anatomical training, which already signals the limits of a purely technical stance. He suggested that the skill is insufficient without humane, because this experience shows how technical routines can drift toward objectifying the person if not counterbalanced by empathy and moral attention. This can be analyzed with another sentence “In anatomy lab, we objectified the dead, literally reducing them to organs, tissues, nerves, muscles… ” (pp. 49) as well. During the early clinical encounters he firstly approached the body as divisible parts, a theoretical orientation that clarifies anatomy but risks eclipsing personhood, and subsequently he recognizes this is insufficient for patient care. As well as he mentioned that he made a long, quick cut through his donor’s diaphragm, his protector was both livid and horrified because he had seemed to cavalier about it (pp. 50). He was only thinking in a doctor perspective at that time and he couldn’t get the feelings of the patients. From the three sources we know that at the beginning of his doctor life he didn’t know the importance of emotional support. This recognition prepares the transition to the second theme, showing that compassion is not an “extra,” but the condition for responsible medical judgment.
The second theme is that, the responsibility of a doctor is a major thing that a doctor should have, especially under uncertainty where choices carry moral weight. The decision of the doctor is really huge and it is really hard to have an moral choice. For example it is hard tell if a person is better to be alive or dead if he is disabled in someway, or more precisely, clinicians must weigh survival against the quality and burdens of life, and “doing more” is not automatically “doing right.” This changed the author a lot and let him to think deeper. There is a section perfectly demonstrate this idea - he was treating a patient that had a tumor abutting his hypothalamus which largely destroyed his basic drives such as sleep, hunger, thirst, etc. (pp. 74). This is the most severe patient that the author ever met at that time. Finally the patient died and this was one of the first times he directly confronted a patient’s death in a role that made him morally accountable for preceding choices. But before it, this case led him think of the ethics of a treatment. The dilemma was whether aggressive intervention might deepen suffering or whether allowing a natural death would better honor the patient’s good. All the time before it he thought that death is the worst option during the treatment but this case forced him to reconsider the assumption that death always equals failure. This is also mentioned the same idea directly at first in a certain dialogue “But sometimes you know, I think it’s better if they die” (pp. 38). In front of the “momento mori” he was thinking at a higher level of a patient and that death may not be that scary.
After directly confronting death in practice, and returning to the first theme, back to the first theme, he was starting to thinking about the apology and witness to patients. After that person died, he attend her autopsy (pp. 76) and watched the pathologists. Although she was dead, the act of attending the autopsy functions as accountability and respect—witnessing the person, not just the case, and acknowledging obligations to the family. After that he also changed his method from largely focus on technical skills to emotional supports. Also, as he said “Learning to judge whose lives could be saved, whose couldn’t be, and whose shouldn’t be requires an unattainable prognostic ability.” (pp. 80) He integrated this concept into the life and death of the patients. Recognizing that prognostic certainty is unattainable pushes him toward humility; therefore compassion and responsibility must guide action where prediction cannot. He does not literally “control” life and death but controls the “right” to decide the life of a person, in this case he should treat as humane as he can, otherwise this is a abuse of his power and he is not showing respect to the patient if he don’t do that. From the paragraph “The pain of failure had led me to understand the technical excellence was a moral requirement.” (pp. 105) He directly mentioned the responsibility of a doctor and the moral way of treatment through out the whole Part 1, which basically suggested that this was actually one of his primary thoughts. After that this responsibility was also showed off in a following scene, he treated a rude person in calm just because he was a doctor. (pp. 106 - 111).
Last but not lease, he learnt a lot during the development of his doctor life, from school to job, and this also led him to learn the moral cases. As he wrote “It felt to me as if the individual strands of biology, morality, life, and death were finally beginning to weave themselves into, if not a perfect moral system…” (pp. 112 -113) He finally developed the view of the responsible of a moral sight to be a doctor. Thus the two themes—humanity in care and ethical responsibility—do not run in parallel but converge: empathy disciplines judgment, and responsibility gives empathy practical shape in life-and-death decisions. This is another precise and interesting view outside of the main theme of the book (identity contrast or remembrance of death) but it actually reflect back to what happened on himself. The development of these thoughts also contributes to a calm response of the death himself.