On Wednesday, October 13, 2021, IU Center for Bioethics, Medical Humanities and Health Studies Program at IU, and The Charles Warren Fairbanks Center for Medical Ethics hosted a reading of Kurt Vonnegut’s 1968 play, Fortitude, for the American Society for Bioethics and Humanities 2021 Annual Conference. After the reading, there was a panel that included Jane Hartsock, JD as the moderator and Dr. Elizabeth Nelson, PhD, Dr. Peter Schwartz, MD, PhD, and Dr. Lucia Wocial, PhD.
Fortitude is a play about a scientist, Dr. Frankenstein, who has created a way to keep a person alive forever, by attaching their heads to machines that run the rest of their bodily functions. He has one patient to whom he has done this to, Sylvia, and in this play, she expresses her desire to die. However, Dr. Frankenstein is determined to keep her alive, despite the concerns of her beautician, Gloria, whom wants to discuss the potential for removing Sylvia from the machines. Dr. Frankenstein refuses and Gloria brings Sylvia a gun in order to die. However, Dr. Frankenstein planned for this and Sylvia’s arms do not allow her to shoot herself, and, out of desperation, she shoots Dr. Frankenstein. Dr. Frankenstein is then attached to the machines as well, allowing him to continue to live alongside Sylvia.
Following the reading, the panelists discussed the major issues. Dr. Nelson went first, talking about the idea of self, and how much of the body one can lose and still be considered themself. Since Sylvia had lost all of her body parts, being replaced by machines as each organ failed, all she had left was her head and mind. This play raises the question of where the self lives and if it is only in the mind, or in the body as a whole. She also notes that Sylvia’s mood had been carefully been controlled by drugs, which also raises the question of if controlled substances could alter the personality to the point where the self is no longer there.
Dr. Schwartz asked the question of what exactly Dr. Frankenstein is doing wrong? He argues that bioethics is to help medicine know its limits and to stop pursuing care after a certain point, but he notes that the points that medicine normally stops at is not here in this case. Sylvia is not suffering greatly, or perhaps she does but not often, expense is not a concern because Sylvia has a great wealth, Sylvia still has her consciousness, and end of life is not inevitable. Dr. Schwartz brings up that we may want to condemn Dr. Frankenstein because Sylvia has expressed a desire to die, however she also occasionally wants to live so which one is the authentic desire? There is no actual way of knowing.
Dr. Wocial spoke of the complete unwillingness of Dr. Frankenstein to dismiss any other path than the one that he has planned for Sylvia. She brings up that Dr. Frankenstein has chosen “life at all cost” and when Gloria expresses a thought that is contrary to that, he fires her. Dr. Wocial also notes the similarity in Sylvia and Gloria’s relationship to a nurse-patient relationship. She noted that the moral distress that was unaddressed in Gloria was probably the reason why she acted in a way that was inconsistent with her core values and was willing to give Sylvia the gun. Dr. Wocial stated that this was reflective of clinical practice in similar scenarios, where people may not be acting in the best interest of the patient but feel as though it is the only thing they can do.
Fortitude, while written in the 1960s and heavily influenced by the new technologies at the time, still raises a lot of issues that are relevant in today’s time. It is important to continue to ask these questions, especially with the current medical advancements that continue to extend life. Fortitude raises an important question that we all must ask: how far are we willing to go to keep someone alive?
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Emily is currently pursuing a Masters in Philosophy with a concentration in bioethics at IUPUI. She is also the graduate assistant in the IU Center for Bioethics.