Albert Bonniers förlag, 2013.
Reviewed by Fiona Graham in SBR 2014:2
Review Section: Lost Treasure
Originally published 2003. New edition 2013.
Just three months after being uprooted from his care home in central Stockholm and dispatched to a stark concrete block in a distant suburb, Göran Rosenberg’s elderly father-in-law lies dying, accompanied by a young male nurse. For the private company running the home, its contract staff are interchangeable. They cannot provide the individual care that should be an integral part of their duties – a source of distress to the more conscientious among them. Why, then, Rosenberg ponders, does this young nurse overstep his professional brief to hold the hand of a dying man? What, in fact, moves him to behave like a decent human being?
This anecdote offers a way into an ambitious exploration of what it means to be human. At one level, Rosenberg critiques the excesses of neo-liberal doctrine and practice: the marketisation of the welfare state and the intrusion of the profit motive into healthcare, education, care of the elderly and even the criminal justice system. At a deeper level, he investigates a number of broader philosophical questions, ranging from duty and self-interest as the well-springs of human behaviour to the relationship between individual and society. An impressive cast of characters from the history of ideas make an appearance in Rosenberg’s examination of the nature of duty. Pure rationalism, exemplified by Kant’s categorical imperative, does not provide a firm enough basis for the phenomenon of dutiful conduct. Rather, as argued by Hume, a sense of duty is rooted in sympathy or fellow-feeling. Contrary to the views often ascribed to him by neo-liberals, Adam Smith held a sense of duty to be an essential precondition for a functioning society. Moving on from the Enlightenment to the present day, Rosenberg reviews the impact of Dawkins’ ‘selfish gene’ theory on contemporary ideas, ultimately rejecting evolutionary explanations such as Steven Pinker’s ‘reciprocal altruism’ as an adequate basis for the human sense of duty.
While duty has to be instilled in human beings, self-interest – ‘profit’ in Rosenberg’s terminology – is a universal motive with biological origins. Like Maslow, Rosenberg classes self-realisation (or ‘self-enrichment’, his preferred expression) as a basic need. It is hard for human beings to survive in the long run if they cannot realise their potential – as illustrated by the tragic story of Rosenberg’s father, who, on ‘a brief stop on the road from Auschwitz’, failed to find a place for himself in Swedish society and finally took his own life.
Bringing together self-interest and duty, Rosenberg cites Durckheim’s view of humankind as homo duplex; our dual nature as biological and social beings means that we sometimes put our own needs first, sometimes those of others. We need a measure of healthy selfinterest to survive as individuals, yet we are also sustained by a complex web of interdependency stretching back into the past and forward into the future; this is ubuntu – the art of being human – as practised in traditional African societies and described by Desmond Tutu.
The disease that Rosenberg diagnoses in contemporary Sweden, and indeed the West in general, is the belief that functions of a civilised society as basic as nurturing the next generation and caring for the old, the sick and those unable to provide for themselves can be performed more effectively and efficiently for financial gain. Education and healthcare are not products for sale on the market, but public goods that a decent society has a duty to provide for its citizens. A society that turns its schools and hospitals into profit-making concerns is a moral monstrosity. Rosenberg provides numerous well-documented illustrations, many gleaned from his years in the United States: proliferating financial scandals in healthcare, growing expenditure on policing accountability, and, most damning of all, the diversion of medical care to those who least need it but bring in the best profits.
Readers from the UK, where Margaret Thatcher once proclaimed that there was ‘no such thing as society’, will recognise this picture all too readily. At the time of writing, there are reports that even end-of-life care for terminal cancer patients is not safe from privatisation. Should this become a reality, will hardpressed, interchangeable nurses working for profit-making agencies be allowed to get to know their patients as individuals and hold their hands in their last few hours of life?