The narrative follows a similar pattern to that of Silence, in that the story is told via way of multiple narrators, and the reality Dr. Suguro must discover is that many of his colleagues are driven to enhance their own careers, rather than actually helping the sick. Yet despite the subject matter, The Sea and Poison is not an overly gory or grisly novel when it comes to description, but rather focuses instead on the characters involved as well as the ethical, philosophical, and moral decisions they must make. The Sea and Poison remains primarily a philosophical and existential work, rather than historical, since one could argue, that given the time it was published (1958), not a lot of information about the atrocities performed by the Imperial Japanese Army upon prisoners of war was that well known.
Likewise, Suguro must face his own ethical dilemma when he is instructed to perform a live vivisection on an American prisoner who dies as result. Later, when discussing the procedure with one of his colleagues, Suguro insists that someday they will “have to answer for it.” What makes this statement all the more ironic (as well as saddening) is that many scientists who participated in these crimes in fact not only went unpunished, but died wealthy men. Endo ends the book brilliantly by showing both the lack of concern as well as any resolution gained by way of Suguro’s colleague who responds with, “Answer for it? To society? If it’s only to society, it’s nothing to get worked up about…If those who are going to judge us had been put in the same situation, would they have done anything different? So much for the punishments of society.”
Perhaps the only resolution, then, is the indifference felt by Suguro’s colleague, Toda, as well as the other doctors. Or since one’s conscience can be dictated, there is no resolution, in other words. The fact that Suguro is the one pondering his conscience makes him the odd man out in this situation.