THE DOCTOR Very Freely Adapted from Arthur Schnitzler’S Professor Bernhardi by Robert Icke 10 August – 28 September 2019
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Registered Charity Number 282167 THE DOCTOR very freely adapted from Arthur Schnitzler’s Professor Bernhardi by Robert Icke 10 August – 28 September 2019 CAST CREATIVE TEAM PRODUCTION TEAM Automation Operator Oliver Alvin-Wilson Direction Production Manager James Barbour Robert Icke Daniel Palmer Production Electrician Nathalie Armin Set and Costume Design Production Assistant Philip Burke Paul Higgins Hildegard Bechtler Lauren Young Production Carpenters Mariah Louca Light Company Stage Manager Gruff Carro Nat Lunn Pamela Nomvete Natasha Chivers Claire Sibley Set built by Daniel Rabin Sound and Composition Deputy Stage Manager Tom Gibbons Bethan McKnight Cardiff Theatrical Joy Richardson Services Casting Assistant Stage Manager Kirsty Rider Julia Horan CDG Beth Cotton Automation supplied by Weld-Fab Stage Juliet Stevenson Associate Costume Head of Costume Engineering Ltd Designer Claire Wardroper Naomi Wirthner Deborah Andrews Practical Lighting Wardrobe Deputy Howard Eaton Ria Zmitrowicz Additional Composition Rebecca Goldstone Lighting Ltd Hannah Ledwidge Wardrobe Assistant Tech Week Runner Drums Resident Director Cáit Canavan Flora van Trotsenburg TD Moyo Hannah Ledwidge Costume Maker Technical Department Costume Supervision Maureen Cordwell Student Placement Megan Doyle Costume Placement Layla Bradbeer Costume Assistant Alys Young Bioethics Consultant Maybelle Laye Chief Technician Daniel Sokol Design Assistant Jason Wescombe Programme Design Michael Hankin Lighting Technician and Print Robin Fisher Cantate Communications Sound Technican Production and Rehearsal George Lumkin photos by Manuel Harlan Sound No.1 Johnny Edwards Sound No.2 Dylan de Buitléar Cover: Juliet Stevenson photographed by Nadav Kander 1 CLARIFYING BEST INTERESTS An extract from Tough Choices: Stories from the Front Line of Medical Ethics by Daniel Sokol, published by The Book Guild. If from the lamp emerged a bioethics genie who granted Overall best interests me only one wish, I would ask for the ability to determine may legitimately differ what is in the best interests of a particular individual. With such insight I would resolve many of the thorniest from medical best dilemmas in clinical ethics, discerning immediately what is best for the patient. Should we withhold treatment interests, and the two from this severely disabled neonate? Should we repeatedly inform this woman with Alzheimer’s disease that her should not be confused. husband died 10 years ago? Should we respect the confidentiality of this sexually active 14 year old girl? Nowadays it is almost trite to say that “best interests” is a broader term than “medical best interests.” While important, health is one value among others that may, on occasion, be offset by those others. Hence a bon vivant might accept the life shortening effects of eating full fat brie daily in exchange for the pleasure he derives from it. Overall best interests may legitimately differ from medical best interests, and the two should not be confused. The philosopher Ronald Dworkin makes another useful distinction: between experiential interests and critical interests. Experiential interests concern our sensations of pain and pleasure. I have experiential interests in playing squash, performing magic, and writing this book. Under this conception, it makes no sense to talk of the experiential interests of patients in a persistent vegetative state. They have no such interests. They do, however, have critical interests. These concern the sort of things that give meaning to our lives, that © Abobe Stock/freshidea ultimately determine whether our lives are going well or badly. Friendship, the wellbeing of loved ones, and the respect of others are examples of critical interests. These can be frustrated or satisfied even in the absence of consciousness. Spreading malicious rumours behind someone’s back can harm their critical interests even if that person never finds out; so too can failing to discharge a promise to hand over a dead person’s savings to her children. Why? Because most people have critical interests in maintaining a good reputation and helping their family to flourish. 2 3 The philosopher Ronald Dworkin makes another useful distinction: between experiential interests and critical interests. The existence of critical However, even when ground, a compromise her judgment clouded by The anencephalic baby interests explains why patients are autonomous solution; give the patient indifferent relatives and with no prospects of a clinicians should attempt most doctors strive to do more time or information the short lived experiential meaningful life has neither to uncover patients’ their best for their patients. to decide; and invite them interests of illicit drugs. experiential nor critical past and present wishes, In his book Resolving to speak to another doctor Her refusal to be treated interests in continued either by consulting the Ethical Dilemmas Bernard or other patients with signals a premature life. Where lies that patients themselves (or Lo offers a strategy to similar experiences. If death. Such is the price indeterminate threshold their relatives) or from promote a competent this strategy fails, accept of our liberal emphasis below which attempting written documents such patient’s best interests. This the patient’s refusal. This on respecting autonomy, to prolong survival is as advanced statements. strategy could also be used approach aims to protect whatever its undeniable no longer in a person’s What things are important by relatives and loved ones. patients from seemingly benefits. Although it is interests? This is where to this person? How can Firstly, try to understand unwise decisions, while legally obligatory in Britain the genie’s gift would be we respect his or her the patient’s perspective respecting their autonomy. and the United States, most helpful. Respecting critical values in our (“What worries you As we have privileged respecting a competent a competent refusal of clinical management? most about this illness/ access to our own interests, refusal of treatment is not treatment is not always in To paraphrase Professor treatment/ operation?”). respecting a person’s always in the patient’s best the patient’s best interests. Gillon, the trick is not Secondly, address autonomy tends to benefit interests. to put ourselves in the any concerns and them. One of the greatest When there is no Dr Daniel Sokol is the Bioethics patient’s shoes, but to misunderstandings. This tragedies in medicine is indication of a patient’s Consultant on The Doctor. He is a imagine what it is like for bioethicist and barrister at 12 King's may be enough to resolve when respecting a patient’s values, how should we Bench Walk in London, where he the patient to be in his or any initial disagreement autonomy has the opposite determine what is best? practises mainly in the areas of her shoes. This requires medical negligence and catastrophic about treatment. Thirdly, effect: when it goes against Clearly we should consider personal injury. He is an award- an appreciation of that if appropriate, try to their critical interests. experiential interests. winning columnist and has sat on person’s experiential and committees for the Ministry of Justice persuade the patient to Although formally having Yet critical interests also and the Ministry of Defence. In critical interests. When accept medically indicated capacity, we can sometimes play a part, as all human October 2018, he published Tough patients are unable to Choices: Stories from the Front Line interventions. If persuasion be blind to our own good; beings share a common of Medical Ethics, his first book for make their own decisions, is unsuccessful, negotiate thus the seropositive 25 core of critical interests, members of the public. doctors should, on legal a plan that is mutually year old declines our such as the freedom from and ethical grounds, act in acceptable to both parties. outstretched hand at the indignity. their best interests. Try to find common edge of life’s precipice, To paraphrase Professor Gillon, the trick is not to put ourselves in the patient’s shoes, but to imagine what it is like for the patient to be in his or her shoes. 4 5 ARTHUR SCHNITZLER AND HIS MEDICAL DRAMA PROFESSOR BERNHARDI by Judith Beniston Arthur Schnitzler was in every sense a Viennese writer. Like the hyphenated He was born in the city in 1862 and it remained his compound “doctor-writer”, home until his death in 1931. The topography of Vienna and its distinctive landmarks feature prominently in his these juxtapositions speak writings, together with a broad cross-section of its late nineteenth- and early twentieth-century inhabitants. of complex and perhaps Other labels that one might attach to Schnitzler are less neat. He was a doctor-writer, ultimately choosing a literary conflicted private and over a medical career but unmistakably influenced by his medical training. And, as he put it in December 1914, he public identities. was “a Jew, an Austrian, a German”. Like the hyphenated compound “doctor-writer”, these juxtapositions speak of complex and perhaps conflicted private and public identities. The Schnitzlers were a medical family. Arthur’s maternal grandfather had been a doctor; his father, Johann Schnitzler, was an eminent laryngologist; his brother, Julius, became a surgeon; and his sister, Gisela, married her father’s successor, Markus Hajek, whose patients were to include Sigmund Freud and Franz Kafka. It was taken for granted that Arthur would study medicine, and he duly qualified in 1885, subsequently becoming his father’s assistant. However, hospital medicine exacerbated his tendency to hypochondria and he was never entirely committed to it or to medical research. Having started to publish poems and short prose in the 1880s, he wanted to be a professional writer, and after his father’s death in 1893 he resigned his post. As a doctor-writer Schnitzler brought a distinctive skill set to his literary work. Training in rational, evidence- based diagnosis can be applied to both literary characters and broader social ills, and writing medical case histories encourages clarity of expression and scrupulous attention to detail.