Stone Court has an amusing observation regarding Dick Cheney’s recent health scare:

What do you bet that the problem with Cheney’s foot that is being treated with anti-inflammatories is gout? I bet that they don’t want to call it that because of the associations with bloated aristocrats.

Press reports confirm that Cheney has previously been treated for gout, which makes this suggestion all the more likely.

There is an old game doctors play of attributing famous persons’ behavior and life stories to various presumptively-diagnosed illnesses: van Gogh was either depressive, migraine-prone, or suffered heavy-metal poisoning from eating paint; Goya may have suffered a progressive eye disease that explains the dark colors of his final paintings; George III of England’s “mad” fits were the result of porphyria, or possibly arsenic poisoning; Abe Lincoln may have had Marfan Syndrome; Byron may have been bipolar; and of course virtually everyone of note had syphilis. Cheney’s vaunted selfishness, and his habit of never denying his desires no matter how ill-advised, make gout a resonant diagnosis in his case - though he seems to lack the gourmandizing sensualism usually associated with that condition. Maybe money and oil have the same effect as pate’ and clotted cream - I wouldn’t know.

I’m as fascinated as anyone by this game, though usually suspicious of the conclusions. But I have ambivalent feelings about it: such speculations about historical figures seem to me somewhat irresponsible, since conclusive evidence is almost always lacking, and also disrespectful - an invasion of privacy in service of what is usually no more than prurient interest. Balanced against that is the questionable nature of harms to the dead: though it’s not flattering to the memory of Oscar Wilde to say he was syphilitic, it’s also true that he’s beyond complaining. In the case of still-living figures, the issue is more sharply drawn, and there is no question that the release of privileged information of this kind would be a grave breach.

That latter point seems to me relevant. It would certainly be wrong for Cheney’s doctor to announce he has gout, if Cheney has not authorized the release of that information. I think it is also wrong for knowledgeable professionals to use their training to infer facts about persons who are not their own patients, and then release that information. (For instance, when one Middle East ruler, years ago, was dying of pancreatic cancer, his handlers announced that he was resting comfortably. An American doctor was quoted in the same news story giving them the lie, saying pancreatic Ca is “the king of pain”. In that act the doctor took away that patient’s ability to control his public image, and possibly to comfort his followers - or scare off his enemies - as he chose to do. It was not literally a breach of confidentiality, but it was surely a breach of professional ethics read broadly.) And if these revelations are wrong regarding the living, then they would have been wrong had they been made in the past regarding the then-living, now-dead, famous people of history.

Certain counterpoints arise: As noted above, it is not as easy to say that it is obviously wrong to reveal the secrets of the dead after they have died. Also, there is the question of a possible duty of the famous to be forthcoming to the public with information that would be regarded as private for others - especially in the case of political figures. Arguably, we have a right to know about the Vice-President’s health, especially when the Veep has a known gamey ticker (whether we are entitled on the same grounds to know about his swollen toe is another matter). And finally, all this talk of professional confidentiality may not matter in an age when technical knowledge has become widespread, and any further desired knowledge is easily obtained over the Internet. It doesn’t take a doctor to speculate about a person’s health history now, so citing medical ethics as a barrier to doing so carries little weight. (Note that the speculative Cheney diagnosis cited above comes from a non-professional; consider the widespread discussion of the clinical facts of the Schiavo case - some of it on this blog - as another example.)

What is the point of this? That health information is powerful, and implicates central values in people’s lives. Traditionally it was vouchsafed only to obligated professionals, who were required to control and conceal it. Our culture of celebrity, the demise of the professional priesthood, and the widespread availability of both private and technical knowledge changes this dynamic, in ways we do not have an ethics to confront. (The dissemination of private medical information through legions of non-professional paper-pushers creates its own significant problem as well.) Unsympathetic as I am to Cheney and the burdens of his public position, I am not sure that quite everything about political, or just public, figures is open to comment. (And I realize I have contributed to the problem by naming him here in this post.)

And yet there is a public function served by all this loose talk. It is deliciously confirmatory of the public perception of Cheney as aloof, privileged, and self-indulgent to learn he suffers from the disease of Samuel Johnson, Edward Gibbon, and Henry VIII. Perhaps that is not the most significant political tidbit to come down the pike, especially just now, but it’s something, and perhaps something that we, his subjects and often enough victims, are entitled to consider. The political temblors that ran through the Soviet Bloc on the rumored ill health of various leaders were serious business indeed; correspondingly, the knowledge today that Cheney is hitting the high fats, or Bush is chomping pretzels again, are not without significance, and possibly, for some, hope. Are we to be denied in this matter?

As with more-traditional debates about medical privacy vs. a public right-to-know regarding the health status of political leaders, there is a question of balance to be faced in these non-professional speculations about health and behavior. It is asking a lot to ask the general public to refrain from invidious speculations of that kind. And if we are entitled to speculate freely, even to agitate with hostile intent against our leaders and their policies - and we are so entitled, I think - why are we not entitled to speculate about health matters also, especially when we, as public citizens, bear no special obligation of confidentiality?

As you see, I remain ambivalent. I want health information to be respected, which requires not just confidentiality on the part of those who receive privileged information, but - especially today with MedLine available to anyone and MDs and PhDs galore posting online - restraint among those with advanced knowledge and no such professional obligation. At the same time, I want the tradition of vigorous and broadbased political commentary - so much imperiled by Cheney and his ilk - respected and expanded. I find it distasteful to read informed speculation about what would ordinarily be private matters, even directed at those I think have an obligation to the public; I find it infuriating to see the public’s right to scrutinize and control their own government throttled by invasions of their own privacy by hostile governmental forces and by invocations of secrecy to cloak that same government’s incursions. In the end, I am tempted to conclude that Cheney’s big toe is of little moment in the battle to save our fast-dying Bill of Rights, but I don’t want to live in a world in which medical privacy has become a quaint and old-fashioned luxury.