The Authority of the Captain: Reflections on a Nautical Theme

Abstract

In many respects, as Areen notes, medicine has never done as well as today. Physicians can intervene with success undreamt of before. With all going so well from a technological and scientific point of view, why all the fuss? Why at times does there seem to be a mutiny brewing? To answer the last question one must recall the various senses in which the physician has been regarded as Captain of the ship. These senses turn on the various ways in which physicians have been seen to be in authority or to be authorities.¹ I have in mind here a distinction illustrated by one of the differences between sheriffs and lawyers. Sheriffs are in authority; they can arrest individuals. Lawyers can be authorities regarding circumstances under which officers of the peace should proceed to arrest individuals. However, lawyers are not as such in authority to arrest individuals. There are numerous ways in which physicians come into authority both within the health care team and with respect to patients. Here it is worth underscoring that even if physicians may be captains of the health care hierarchy or team, it does not follow that they are masters of their patients. One must recall, after all, that the metaphor of physicians as captains of the ship has its strongest originary use in the operating room where the chief surgeon is responsible for his or her assistants as well as the nurses and others aiding in the operation.