It is a cruel fact about this world that being the victim of injustices sometimes makes the good seem intolerable.
Consider the case of Joseph Saikewicz, who died of leukemia in 1976 after the Massuchessetts Supreme Court concurred that he was not owed chemotherapy, which might have extended his life. Saikewicz was a sixty-seven-year-old man, who had been institutionalized because of his severe cognitive disabilities; he had an IQ of 10. Belchertown State School, where Saikewicz lived, had been exposed some six years prior for its horrendous conditions. (As one administrator described it, the ‘only difference between Belcherton and Auschwitz is the lack of gas chambers.’) All this matters for understanding the case, as Cathleen Kaveny has recently argued
. As she puts the problem, “given his background and history, Joseph Saikewicz would likely experience treatment as torture.” Because Saikewicz had been (in all probability) so badly ill-treated, the very remedy or effort that might have extended his life had become a means of eroding it.
The problem of how past injustices shape our present responsibilities is, to my mind, one of the hardest challenges we face as a people. In Saikewicz’s case, it’s reasonable to think that under other circumstances he would be owed treatment. Were he a similarly disabled individual with a history of being cared for and loved, we’d expect his caretakers and guardians to opt for the chance that his life would be extended through treatment. If that is right, the fact that Saikewicz was cognitively disabled is only a prior condition for why he would experience the treatment as abuse: as much of his history would be dominated by experiences of pain and suffering for no apparent point, it is doubtful he’d be able to discern that the new pain and suffering was really ordered toward his well-being. In this case, that past maltreatment does not exonerate the individuals from the responsibility to care for Sakewicz—it transforms the nature of the care that is owed, from treatment to comfort.
That, at least, is one way of framing how the Court might have reasoned about Saikewicz’s case. But there are others, which offer different accounts of how we might allow past injustices to inform our present action. For instance, suppose that Saikewicz really was owed treatments. If so, depriving him of them would simply heap one more injustice upon a long string of them. Even if Saikewicz experienced such treatment as torture, his caretakers might conclude that such a risk is simply the hazardous consequence of their past wrongs, and in no way should inhibit them from depriving Saikewicz of what he was owed.
I’m sympathetic to this account of the case, except that it seems clear that the past injustices entailed that Saikewicz is owed something more than mere treatment: he is owed treatment within a context which wholly reverses the past abuses, which leaves them behind utterly, which communicates and discloses and reveals only love, care, gentleness, and kindness. The problems in Saikewicz’s past had nothing to do with medical treatment—and the compensation or remedy for those problems ought have nothing to do with medical treatment, either. The alienation and abuse that Saikewicz suffered was social in nature, rather than medical, which means that medical care must now happen within a social environment that connotes hospitality and welcome.
I am tempted to say, in other words, that what justice demanded for Joseph Saikewicz was impossible without love. Absent love, the care that he in fact is due would itself be burdensome or damaging. What was missing from Saikewicz’s life in the institution where he lived was not simply adequate treatment, but the communication of value and concern which would make it clear even to an individual with the mental capabilities of a three year old that health care is not torture. In a sense, the past failures of justice make love an obligation: had he received even minimal care all along, there would be little reason to think he would experience treatment as torture.
How love and justice interact is, of course, one of the great questions of Christian ethics in the 21st century. While some thing that love is the kind of thing that exceeds what we owe to one another, it seems plausible that in a fallen world we are sometimes placed in situations where we can only give what we owe when we give more than that.