In the House, MD season three episode “Son of Coma Guy,” House's patient, Gabe Wozniak, ask him what last words he’d like to hear from his own father. House hesitates, but answers honestly, “I’d like him to tell me that I was right; that I did the right thing.” What does it mean, to do the “right thing?” It sounds lofty and idealistic — and completely unlike what most people (think they) know of Dr. House.
Within the universe of House, MD, Dr. Gregory House (portrayed by Hugh Laurie in a consistently complex, and often brave, performance) is widely perceived by most of his colleagues (even those who respect him) to lack any sense of ethics. He’s bigoted, he doesn’t care about patients — often, he doesn’t even know their names! He’s blunt and overly harsh, refusing to suffer fools (or idiots or morons) gladly (or at all). On more than one occasion, both dean of medicine Lisa Cuddy (Lisa Edelstein) and House’s best friend James Wilson (Robert Sean Leonard) have wondered aloud if House has “even read an ethical guideline.” He’s been called many things, from “lucky” to “reckless,” “arrogant” and “preening” to “smug” and “needy.”
But House also has a reputation for integrity, according to one of his archest enemies, Edward Vogler (season one). He’s renowned as a physician and people come from far and wide (and even Cuba) to tap into his medical expertise.
Admittedly, House has done some things to warrant the less celebrated aspects of his reputation. His colleagues, hospital lawyers, and even some patients must sometimes wonder if House operates under any sort of ethical framework at all. After all, House has afflicted a coma patient with a migraine to test the efficacy of an anti-migraine drug; he has ventured into the morgue and shot a dead person in the head to perform an MRI (performing it on a live patient would have been quite deadly — and the dead guy had, explained House, donated his body to science). He has performed one physician-assisted suicide (but refused to do another, even though everyone from Wilson to his team were pushing him to do it). He has lied to the transplant committee to avoid condemning a patient to certain death, and he provoked any number of patients into physically attacking him (albeit all for a greater medical good).
“You are aware of the Hippocratic oath, right?” asks Dr. Eric Foreman in the first season episode “Damned if you Do.”
Article comments
1 - Joe
Excellent article. I completly agree, all of House's views on the ethics of medicine v the ethics of his actions are based on his own deadset desire to cure the patient, despite guidelines or off label use of drugs etc. He makes decisions that help the patient no matter what rule is broken because that's what he's there for. To cure patients.
2 - bliffle
IMO House is not primarily focused on curing but, rather, on learning. The search for cure leads him to study, think, research, consult, all to understand. Even after a patient death his job is incomplete: the question remains, why?
House is a searcher, not a curer.
The prototypical (TV) Dr. Ben Casey was a curer. He was rough and aggressive and heedless of the rules and the people around him as he fought for a cure.
House is more like Sherlock Holmes: a medical detective. Holmes wasn't a Crime Fighter. Crime was simply an interesting field to apply his intelligence and learning within. He found it amusing. As does House.
3 - Barbara Barnett
One of the cool things about the character is that you can read him either way and probably be right.House is such a complex character, and Hugh Laurie imbues him with layers and layers of nuance. But, Bliffle, there are just too many instances (and I'll get into that in part 2) of House going beyond the puzzle--after the puzzle is solved to make him simply a searcher. There's more to him than that.
House is also a very hidden character. His real self is quite deeply buried (as he wants it). This makes Wilson in particular, and Cuddy, to a lesser degree, very frustrated.
4 - blacktop
Excellent essay, Barbara. This really stimulates lots of thoughts. I think the best ethical question we have to ask of House the character and of "House" the show is the oldest one in the books: what would the world look like if we extrapolated House's behavior and choices on a wider scale? In other words, what would we face if every doctor behaved as House does?
I think the answer is obvious, we would have dangerous anarchy and chaos, resulting in unspeakable harm to untold numbers of patients. House does what he does only to save HIS patient, he truly does not care what the impact of his eccentric behaviors might be on the anonymous others he has not met or treated. If he can save his patient all is well in his world.
But House, who is neither stupid or cruel, relies on the curbing influence of Cuddy whose role is crucial in checking the full flood of the anarchy he would loose upon the hospital if other doctors or even House himself were given no limits. House knows how dangerous his choices are, he knows from experience that he is often right but not always. He also knows that he can be wrong on ocassion. Therefore he needs the push-back from Cuddy (and to a lesser extent Wilson, Foreman and the others) to curb his excesses and stimulate his imagination. Cuddy's delineation of the limits is what gives House the vital information he needs to push forward, to break past the accepted boundaries, to know where conventional medicine leaves off and his brand of genius begins.
5 - bliffle
I don't think House is interested in ethics at all, except insofar as it affects other people and how it may work with or against him. He's indifferent. As you would expect from an Aspbergers type.
6 - Barbara Barnett
Thanks Blacktop!
Clearly if House's medicine were the normative, we'd all be in a lot of trouble. You're right (and so is Foreman) there would be anarchy. and a lot of people would die. The unique things about House's medical practice are--first he is the court of last resort for the cases that finally reach his door. Lupe (in "House Training") had gone through other doctors and came up blank, which is when House came in. Because the other doctors who had previously seen her presumably looked for the horses hoofbeats (common infections among them)--House didn't--looking for zebras--which is why they missed the staph infection. So House rarely gets a normal medical case. Also, you are right. Cuddy and House's team act as filters to House's thought process, which can be wild and move extremely fast. And House does know it--which is why after Alone, when -- yes, he solved the case--but might have looked up other avenues had he worked with a team--agreed to hire a new team. House, himself, seems to like working with a team (and despite what he professes, knows the team's usefulness--and, as you say--push back).
And absolutely, House's focus is on his patient, and his alone--without regard at the moment for any anonymous "other." This has often good results, as he is focused on patient care and goes much farther (and sometimes gives more of himself) than other doctors might to ensure the best course for his patient, on the other hand, his single mindedness can be to the detriment of another patient who might lose out on a (for example) transplant organ (as in "Control")
Bliffle--I disagree that House has no ethical framework. He does. Too much of his behavior towards too many cases and patients suggest that it's way more than truth seeking or "the puzzle." Too often, long after the puzzle is solved and he knows the answer, he's still going. Cuddy made that mistake in "Fetal Position," when she said that House wouldn't mind that she'd taken over the case. She said the diagnosis had been made, so House wouldn't care if she stepped in. She was wrong.
7 - sue
There were two episodes that reflect what has happened in medicine that are in contrast to what House is willing to do. In the episode where Foreman is at odds with the hospital administrator at New York Mercy (97 seconds?), and in Living the Dream, both the administrator and the hospital inspector put down the line how doctors are supposed to treat patients. There are treatment guidelines, where 95% of patients will respond to the same treatment, and the hell with the patients who are in the other 5%. House doesn't think in those terms. He starts out that way, but in the end, damn the rules and cure the patient. Foreman believed that anyone who goes beyond the rules and cures the patients in the 5% is an anarchist, even if the patient died. House believed that you do what you have to do to save a life. House gave Stacy's husband the cocktail to diagnose him, even though he did not know what would happen when he gave it to him. House does not hang what he does on the means to the end; it is what happens in the end that matters. House could not live with losing that 5% to follow guidelines. In those 5% of cases, no one solved the case, and by not solving the case, a patient died. House solves cases because he can detach himself from any emotions that would interfere with the bravado he needs to do what needs to be done. If he was not emotionally detached, he might lose patients.
When Cameron quit, she told House that she thought he did what he did to cure the patient, but she said she was wrong. He did what he did because it was right. To her, there is a difference; to House, it is the same in the end.
House has said he cannot do anything different. The question is this-if you do everything moral and ethical and ordinary along the way but lose the patient, are you right in the end? Or, if you break moral and ethical rules along the way and save the patient, does that make you right?
Compare the patient in Informed Consent and Brennan with House. The doctor who experimented on many babies to cure hundreds or thousands more, and the fellow candidate that sacrificed one patient to help thousands or millions more-would House do what they did? I think not. House got rid of Brennan because he broke House's ethical rules. Yes, House has ethics. Patient's rights are important. You don't sacrifice even one to help another. But in Son of a Coma Guy, House helped Gabriel to kill himself to save his son. It was not House's decision, and House knew the father would not wake up again. If House thought Gabriel was wrong to sacrifice himself, if he thought Gabriel had a chance at a meaningful life, I don't think he would have helped him kill himself.
House is anything but indifferent when it comes to the benefit of his patients. He is indifferent when it comes to his own behalf. He doesn't care if people like him, because if he cared, he couldn't do what is necessary to cure the patient.
8 - sdemar
Excellent, Barbara. We have to remember that the only patients House treats are ones that noone else can cure. He is their last hope. House is a healer and he is not satisfied until he knows the answer. However, as Blacktop stated, he needs others to push back and question him because he knows he can go to far.
This was excellent to read and I find I usually agree with your understanding of House.
9 - Barbara Barnett
if you do everything moral and ethical and ordinary along the way but lose the patient, are you right in the end? Or, if you break moral and ethical rules along the way and save the patient, does that make you right?
This is the $64,000 question, and the one asked by the show, and by the article. As I stated (and Sdemar as well)--House is the last chance these people has. He is a super-specialist, using a broad base of medical knowledge, his genius and intuitiveness and the push-back of his team to give people a last chance. This is a big reason why he's focused on the one patient. It's the nature of his unique and highly specialized practice (which by nature requires an unbelievable amount of general medical knowlege).
Compare the patient in Informed Consent and Brennan with House. The doctor who experimented on many babies to cure hundreds or thousands more, and the fellow candidate that sacrificed one patient to help thousands or millions more-would House do what they did? I think not. House got rid of Brennan because he broke House's ethical rules. Yes, House has ethics. Patient's rights are important. You don't sacrifice even one to help another. But in Son of a Coma Guy, House helped Gabriel to kill himself to save his son.
It's interesting. I don't think House approved of Powell's work (which is why he sent Cameron to research it, and why he wasn't reluctant to run all of those tests without Powell's consent). Just like he didn't approve of Brennan's tactics. It's not in the dialogue, but if you look at Hugh's expression when Brennan says: "That's why you hired us..." House has a slightly shocked look on his face. It's not why he hired them. With Gabe, he saw the purity of Gabe's unconditional sacrifice as something as well that House didn't believe existed. To House, Gabe was finally saving his son, something he couldn't do with his wife when the House burned down. House admired it for what it was, and becaUSE it was the patient's decision (and Gabe was terminal, in a sense), he went along with it (despite the fact that House was already in terrible legal trouble, and this could only make it worse for him.)
Hence, what you said, Sue, about House's indifference towards himself.
I agree, Sdemar, that House is a healer. And I do think House knows it, somewhere inside himself.
10 - sue
It is an interesting dichotomy that House needs the team to get him to a certain point in the ddx, but when he gets there, he is willing to put everything on the line and go forward based solely on his own methods and philosophy. Even when Cuddy, Wilson and his team tell him he is going too far and violating moral and ethical guidelines, House single-mindedly proceeds and does what he feels will save the patient. At that point, there is no one who can stop him.
None of the three original ducklings ever developed that bravado, preferring to remain on the safe side of the issue. None of them ever proposed anything so bold. None of them has the ability to sift through the extraneous information and key in on the real issue like House can. Foreman did it once when he was on his own at New York Mercy; since he has been back with House, he has reverted back to his original form. When a duckling makes a diagnosis, like Chase did in Finding Judas, he did not have to make that leap into unexplored territory.
Even with four years working with House, Chase never developed that bravado. The ducklings never developed the ability to read the patient like House can. When people say House has Aspergers, they miss this point. House is purposely antisocial, preferring not to make friends and follow social niceties. He has the ability to read people better than the people who follow the societal normalities that make them ordinary. He reads body language, and he can tell when people are lying. House has superabilities, the exact ones that people with Aspergers Syndrome (AS) are lacking. (I have a family member with Aspergers, so I am very familiar with the condition.) The difference is that people with AS don't know what they can't do; House does what he does with the full knowledge that other people wouldn't do the same thing.
House doesn't always make the right diagnosis, as in Finding Judas and House Training, but he is "cursed with the ability to do the math." By not attaching himself emotionally to the patient, he can live with the times when he is wrong. "Feeling bad" won't help future patients. When Lupe died, House felt bad, but he concentrated on the diagnosis. He has the confidence to tell himself that if he couldn't find the answer using his methods, no one could. They might if they followed "the rules," but their math is different from House's.
11 - Barbara Barnett
When Lupe died, House felt bad, but he concentrated on the diagnosis. He has the confidence to tell himself that if he couldn't find the answer using his methods, no one could. They might if they followed "the rules," but their math is different from House's.
Sue--I agree very much with what you're saying. Watching "House Training" again the other day, I was struck very much by just how bad House felt about it. I think he very much blamed himself, and while he told foreman he had nothing to forgive, so don't look to him for absolution--House, I don't think House let himself off the hook so easily. His pursuit of Lupe's disease even after they knew she was dying was less out of curiosity and much more out of needing to know so it wouldn't happen again. (I will be addressing that in the next part of this article, which I'll post up probably Tuesday.)
I think House also knows that he can let himself get too close--identify too closely, as well--to the patient. He's done it, and both Cuddy and Wilson have called him on it. But I think keeping his distance is an important part of his practice. If he stays far away, he doesn't have to consider the more dire consequences of the procedures he performs--it allows him to take chances. Remember, he refused to take those chances when Foreman was the patient.
12 - ann uk
Hooray you're back ( I was suffering withdrawal symptoms ) and discussing the very subject that was exercising me - House's ethics.
I was watching 3/4 "Informed Consent" and was puzzled by an unexplained flashback to 3/1 where House ( wearing different clothes ) is brooding on Wilson's accusation that his desire to cure Richard is just selfish curiosity.Since very little happens in " House " by accident , it seemed to me that the writers were drawing a deliberate comparison between House and Ezra Powell.House's attitude to patients' rights and informed consent is just as dismissive as Powell's, so is Wilson right in accusing him of the same cold-blooded curiosity ?
The difference is that House's curiosity is always directed at the patient's survival, for him the overriding right is the right to live.
But House himself is capable of the same harsh realism as when in 1/4 " Maternity" he sacifices the life of one baby to save the rest.
- but after the baby's death ,when we see House alone at night carrying out the autopsy it is clear that this ulta-rational decision had a heavy emotional cost.
House as a doctor operates on the moral frontier and this means he has to be his own censor.He can't rely on protocol or convention to protect him from the cost or consequences of his decisions.
In " Informed Consent " House forces his team to face up to the fact that there are situations which don't allow for neat choices between right and wrong and where it isn't enough to play by the rules. As doctors they will have to make choices that are hard to live with and that is why he tells Cameron that he is proud of her when she accepts this hard truth.
House the vulnerable private man ,is also the hard- edged ,uncompromising,dangerous, outsider- that's what makes him so compelling.
13 - ann uk
PS. I do so agree with Blacktop about Cuddy's crucial role in representing the wider social obligations that have at least an equal validity with House's individual ethics.She is no more your average administrator than House is your average doctor and the writers have been careful not to cast her as the rule-bound villain and House as the lone crusader so that the conflicts between them are never simple.
Incidentally, she understands House much better than Wilson and where is that significant hand holding in Wilson's Heart going to lead ?!
14 - Buds
Great article, BB. Looking forward to the second part.
With regard to the searcher/curer philosophies, IMO House is primarily a searcher and secondly a curer. Once the learner in House has been satiated, the curer takes over. The curer is the part he hides from everyone. He hides it by keeping his distance and hence tries to maintain his objectivity. It is because of the curer in him, that we see him put himself at risk even after the puzzle has been solved, as in "Control".
House doesn't break the rules just to be different, or a maverick, or for the sake of breaking them, he does it because that is what works for him. He has found that the patients he receives are mainly from the 5% category, meaning that regular treatment can't/won't help them. This forces him to bend or break the rules for the sake of his patients.
15 - Jane
It's interesting that House allowed Brennan to resign rather than turning him in to law enforcement (or Cuddy). He poisoned a patient, after all! I think House could see that Brennan's motives were, in a twisted way, noble and allowed him to salvage his life and career.
BTW, I think it's clear that House fired ROF for thinking too much like House himself, which meant he wasn't useful as a team member. Had they not thought that much alike, maybe House would have found him some kind of position. I hope ROF comes back at some point.
16 - Anna
It's a pity that I have read this article so late.Four brilliant young Italian philosophers have written a very interesting book about Dr House's philosophy and the first part is about House's ethics. I don't think the book has been translated into English. It's called: "Dr House's philosophy", by Blitris (the name of the group of four philosophers).
17 - Barbara Barnett
Anna--sounds like a great read. I'd be curious how they're theory about House's ethics compares to my own thoughts (obviously I'm no philosopher, but... I think I know House pretty well as a character)
18 - Anna
I borrowed the book from the local library a few months ago and I enjoyed it a lot, especially the part about ethics (the study of House's logic was definitely difficult for someone who is not excellent at maths, but extremely intriguing).
Very, very schematically, these students make references to the character of Kierkegaard's Single (hope this is the correct philosophical term!)to point out how House's hyper-ethics only answers one single duty, that is to say the duty to save his only patient in that very moment and he sacrifices any other ethical duty and therefore any other subject or person , whereas conventional and universal ethics would require House to behave in the same way towards him/her.
House's hyper-ethics is always the ethics of the single, unique situation and its corresponding unique answer.Therefore, when House has to decide, his decision is not conditioned by fixed rules, but originates from a pure act of folly.
Please forgive me if what I have just written makes no sense, but it is difficult enough to fully understand it in my original tongue, let alone to translate it into a foreign language!
19 - Barbara Barnett
Anna--thanks. Very interesting. And it makes some sense, although I'm not sure about some of it. thanks for sharing it!