Medical Regret without Remorse: A Moral History of Harm, Responsibility, and Emotion in American Surgery since 1945

Abstract

This dissertation chronicles moments of reconsideration regarding what constitutes medical harm through the lens of “medical regret.” It mobilizes medical history to interrogate questions of ethics, policy, and clinical practice: How have certain medical practices come to be viewed as harmful? How has management of responsibility for such harm shifted? How is the past rationalized, remembered, and put into a moral order? Chapter 1 introduces medical harm as a historical and social problem. It outlines limitations in the existing literature on medical errors. Chapter 2 reviews recent work in the history of emotions and affect theory to develop the dissertation’s methodology. The chapter then traces the emergence of regret as an object in the human and economic sciences since the 1950s.

Three cases drawn from the history of surgery in the United States follow. Chapter 3 considers breast cancer surgery from the 1950s to 1980s to show how radical mastectomy’s psychological effects were made visible. Chapter 4 examines the development of sex-reassignment surgery for transgender patients in the 1960s and 1970s, tracing how some surgeons who participated in early efforts defined surgical success and managed their perceived shortfalls. Chapter 5 tracks the expansion of prostate cancer diagnosis and treatment from the 1980s to 2010s and describes how bureaucratic procedures managed anticipatory regret regarding the risk of over-diagnosis and over-treatment. Chapter 6 concludes by reviewing how, in the late twentieth century, the patient has emerged as the regretful agent for medical harm. Across the overlapping chronology of these episodes, the body is analyzed as a highly gendered source of affect and as the subject of biopolitical and bioethical governance. Practices including informed consent, experimentalism, and shared decision-making are shown to both provide patient safeguards and afford affective protections to medical practitioners.

The dissertation draws on the archival records of medical centers, surgeons’ personal papers, government regulatory bodies, and patient advocacy groups, as well as expert interviews with practitioners. Medical Regret without Remorse argues that the recognition of harm in modern biomedicine emerged alongside practices for managing medical regret and avoiding the professional and moral responsibility of remorse.