Why the Doctor? Medical Ethics, Morality, and Equality of Care in Doctor Who

by Rachel Thomas

Doctor Who is the longest running and most successful sci-fi TV show in existence. That’s coming from a fan, of course, but it also happens to be true, at least as far as Guinness World Records and the BBC is concerned. What’s really funny is that it’s not about a daring starship captain or a war against robots; instead, it’s a cheaply made BBC series about a merry, mad old alien in a time machine that looks like a blue box, who flies around the universe saving planets and fixing problems (and dropping in on England pretty frequently), with the help of a sonic screwdriver and a human traveling companion or two. He’s called the Doctor, no matter what actor happens to be playing him at the moment (there have been eleven so far). He’s a Time Lord who, when he is near death can regenerate into a new person, although his name and general focus on ethics, saving people, and finding trouble remain the same. The box is called the Time And Relative Dimension In Space (TARDIS), and it’s bigger on the inside than it looks on the outside.

That’s the quick synopsis. The full story runs twenty-six seasons from 1963 to 1989, some of them terrible, some brilliant (and I don’t claim to have watched them all or even a quarter of them), plus a 1996 TV movie that’s best left unmentioned, and the current run from 2005 to the present date. That’s a lot of Doctor Who.

And yet over all that time, and across countless commentaries on how the show is culturally relevant, or anti-authoritarian, or, in recent years, atheist in creating a flawed god-like character people can get behind and still mistrust, one question seems to be rarely (if ever) asked. Fans of the show will know that Steven Moffat, the current executive producer, is spinning out an overarching plotline around the running joke “Doctor Who?”; we’ll all be interested to see how that turns out. But in the meantime I think it’s fair to ask the real unasked and unanswered question and to suggest a small, incomplete answer motivated by a love for the show that probably borders on mild obsession some days (yes, I can recite the dialogue from several episodes from memory, so what?). The question is this: Doctor why? Or, to spell it out completely, why out of all the names and titles in all the universe is this daft savior called the Doctor.

To answer “why the Doctor?” I have to start by introducing, as briefly and intelligently as I can, the particular ethics of being a doctor in Britain since the show is proudly and distinctively British. Any discussion of healthcare in the United Kingdom begins and ends with the National Health Service (NHS), started in 1948 in the ashes of the Blitz. The NHS runs hospitals, pays doctors (and surgeons and dentists), manages waiting lists, and prioritizes care needs for every citizen in the UK, and anyone living there for longer than six months each year. The whole system is funded by taxpayer dollars (or rather, pounds).

I think it’s safe to say that, on the whole, the British love their healthcare system. This admiration was probably made clear to most international viewers during the opening ceremony of the 2012 London Olympics, which celebrated the NHS along with other hallmarks of British-ness. This love for the NHS is often contrasted with a horror of the healthcare system in the United States. BBC America publishes a survival guide for Brits in the U.S. on their website called “Mind the Gap,” which delights in comparing the mercenary absurdity of the American system to the wonders of the NHS. One of their many posts on the subject warns that only millionaires can afford to set foot on American soil without health insurance.

This is the point that all these blog posts, and most defenses and praises of the NHS, tend to come back to: money. Within the National Health Service wealth does not, or at least should not, influence care, and poverty doesn’t limit it. The NHS is guided, ideally, by three principles. The first and most important is “that it meets the needs of everyone.” Care is based on need, only need, and everybody gets the best care the system can give them. At least, in theory. Here’s where it gets complicated, since, like anything, the Brits love to criticize the NHS almost as much as they like to brag about it.

One unfolding scandal focuses on whether the tax money the British government puts into the system is being efficiently used for the benefit of the patients (and taxpayers) at the other end. Dramatic examples of “bad” hospitals like Stafford Hospital, where patient mortality rates are far higher than they should be, have some people questioning whether the bureaucratic side of the NHS is spending too much on meeting quotas and requirements rather than on the patients themselves. This is a particularly important question now, since the UK, along with the rest of the world, is struggling with a recession. There have been cutbacks and austerity measures, and in the last few months, a move towards dramatically redesigning how the NHS is run. The new system will put a lot of power into the hands of panels made up of GPs, general practice physicians. The hope is that, with doctors managing things, the NHS will be more efficient and can offer a better quality of care to patients. On the other side of the aisle, there are concerns that changes to funding and to competitive restrictions on private hospitals will open up the whole NHS to the danger of privatization (compare this to the cries of socialized medicine during the healthcare debates in the U.S.). While the foundational intentions of the NHS, the ideal of equal care for everyone prioritized only on need, remain at the heart of these issues, everything becomes complicated when money, debt, bureaucracy, political divisions, human error and greed come into it, as they always will when we’re dealing with reality.

Thankfully, television shows are not bound by such tangled threads. While the best shows address human flaws—greed and error and ignorance—they don’t necessarily have to fix them with budget sheets and real world compromises that have to accept that the ideal of equal care for everyone can’t always be met in the middle of a possible triple-dip recession. You can fix almost any dilemma in the fictional England of Doctor Who by throwing a morally uncompromising, brainy alien in a blue box at it.

To try and show how and why the Doctor is the Doctor, as only the British creators can imagine him, I’d like to use a few explicitly medical episodes from the new series from 2005 on, the era I know best. Whovians who are better versed in the mountain of old episodes, radio shows, and novelizations, would probably be better qualified to try this. I hope I can keep from upsetting them too much.

“The Empty Child” and“The Doctor Dances” – Series 1 (2005)

While the Doctor’s name refers to his scientific knowledge as well as his medical expertise (he’s a “wise man” as well as a “healer”) he doesn’t usually sit around doing experiments or building machines. In fact, he deals with most situations using nothing more than his brain and his sonic screwdriver. When he encounters a mystery, he diagnoses it. He asks questions, looks for patterns, and examines the people or places involved. It’s a crime-solving exercise as well as a diagnostic one, but, of course, the original brainy investigator, Sherlock Holmes, was inspired by a doctor Conan Doyle knew. The connections between a diagnostic approach and a deductive one dates back to the first great deductive detective.

In “The Empty Child” and“The Doctor Dances,” the Doctor (in this series Christopher Eccleston) and his companion, Rose, land in London during the Blitz, chasing a mysterious alien craft. They discover that the craft was a medical pod that hit the center of London several months before their arrival and that it was sent by Captain Jack Harkness, an American-accented time traveler trying to pull a con on his former employers. Jack thinks the pod is empty, but it’s actually full of nanogenes or “subatomic robots,” which are programmed to heal whole planets in one go and are released when the medical pod crashes. These nanogenes find a dead boy wearing a gas mask and reanimate him. Thinking that this is what all humans are meant to look like, they transform the entire London populace into gas mask-wearing zombies, all under the command of the original zombie boy, Jamie, in search of his “mummy.”

Captain Jack proves helpful in the end, but for much of the two-episode arc he’s out for himself. He’s charming, ready to swoop in and save Rose when she ends up hanging from a barrage balloon over the city, but he only does so because he recognizes that she’s a time traveler too, and he’s looking to con time travelers . He tries to pass the medical pod off as a warship.

At first, Rose is charmed by his flashy technology (an invisible spaceship, transportation beams, and scanners galore) because she’s asked the Doctor to be more “Spock,” to use more gadgets and sci-fi lingo. This would be out of keeping with his character, though.

Back to London, the Blitz, and gas mask monsters. As things start to escalate, the Doctor is told to visit “the doctor” (a common running joke) to learn more about the child in the gas mask. The doctor is actually Dr. Constantine, who is treating people infected by the nanogenes at his hospital. The Doctor examines several of the infected, with full medical lingo, “head trauma, collapsed chest cavity” etc., and discovers they have the same wounds. Constantine himself is infected and after he becomes a gas mask monster it’s up to the Doctor (and his companions) to solve the mystery, get to the medical pod, and stop the nanogenes.

When Jack realizes that he has potentially doomed the entire planet, his defense is  a simple and repeated “I didn’t know!”

In general, ignorance is a recurrent theme in Doctor Who but in this two-episode arc in particular. Technology itself is neither good or bad, whether that’s the ignorance of Jack about the contents of the medical pod, of the child who uses the abilities the nanogenes gave him to look for his mummy, or even of the nanogenes themselves, ignorant of what a human being is “supposed to look like.” This ignorance is a negative and dangerous trait. Lack of knowledge is what has to be cured. The Doctor cures it by showing Jack what’s happened and not letting him off the ethical hook for his part in it. He cures it by finding out who Jamie’s mother is, too, and reprogramming the nanogenes to cure the gas mask monsters, turning them back into humans and fixing their original ailments and injuries. It’s in this final success that he delivers a line that just about any Doctor Who fan can recite off the top of his or her head, with all the right emphases: “Everybody lives, Rose! Just this once, everybody lives!”

Although there is rarely any direct mention of healthcare systems in the show, or of the ethics of high-quality, universal care behind the NHS in England, there are always several oblique references in the medical episodes. “Everybody lives” is one of these, since everybody includes all the victims, from all the strata of society, from the doctors in the hospital to the original, infected street child Jamie, and even the time-travelling rogue Captain Jack.

In reference to the NHS, there’s also a joke about “cutbacks” when Dr. Constantine wakes up and wonders why they’re all standing around in an empty lot. This joke is quickly reversed to more genuine pride when the Doctor announces to the newly fixed up crowd of Blitz-era Londoners, “Right, you lot! Lots to do! Beat the Germans, save the world, don’t forget the welfare state!”

“New Earth” – Series 2 (2006)

“Everybody lives!” could well be the tagline for the episode “New Earth,” the second episode to feature David Tennant as the new and even more manic Doctor (regenerated from Eccleston). He and Rose (who lasts through the changeover between Eccleston and Tennant) aren’t in London in this episode. They’re not even on Earth. They’re in the distant future on New Earth, which out of nostalgia, is a planet terraformed to look like old Earth. It’s populated by all sorts of evolved and hybridized humans, and one character, already familiar to fans, who serves as a pretty pointed commentary on human life. And cosmetic surgery.

She is the Lady Cassandra O’Brien, and she calls herself “the last human.” She is, in fact, a sheet of skin with a face and a brain in a vat, the result of hundreds of plastic surgeries to make her thin (yeah, it’s a pretty pointed joke). She’s on the run and living in the basement of a hospital on New Earth after the Doctor defeated her in a previous encounter. She discovers that the nuns, who run the hospital, the Sisterhood, are up to something suspicious. The Doctor and Rose, knowing nothing, come to the hospital to visit one of the patients. Cassandra kidnaps Rose and steals her body. With the Doctor’s reluctant help, she works out what the Sisterhood is up to. They’re growing human clones and giving them every disease in existence so they can develop cures.

What’s interesting about this episode is the unequivocal and, on the face of it, simplistic stance the Doctor takes on this behavior. It’s wrong, right from the start, and he works to put a stop to it. Although he meets and sees several patients who would have died without the cures developed by the Sisterhood, the nuns’ arguments that the suffering of these lesser creatures is the only way they can cure “those humans out there, healthy and happy” don’t sway him at all.

The Doctor’s reason for condemnation is simple, but it sums up the character and, to a certain degree, the philosophy behind medical care in the United Kingdom. The clones “are alive” and if people live because of the suffering of these others then “life is worthless.”

Here, once again, the distinct and guiding egalitarian philosophy of the NHS comes into play. The concept of a medical system that is supported by the suffering of sentient, rational creatures is anathema to that philosophy, and to the Doctor too.

The NHS is by no means a perfect system (as recent scandals, such as the Stafford Hospital inquiry, have shown), but the Doctor never stands for a system or a government. He stands for a certain set of ideals that reflect the culture that created and continues to create him as a character.

This stance becomes clear near the end of “New Earth,” after the Doctor uses his medical knowledge to “cure” the clones of their diseases. He tells Cassandra to leave Rose’s body and disperse into the air, that she’s “lived long enough.”

In the U.S., where conservative pundits relabeled the idea of end-of-life care in healthcare reform “death panels” during the Affordable Care Act debate, this might seem like a weird approach. But the NHS, while greatly increasing the life expectancy of British citizens, has always included some understanding of the limits of care, and in recent reforms has been working more and more towards inclusion and improvement of end-of-life care in the service. And Doctor Who, as a distinctly British program, doesn’t shy away from the idea that, while every life should be fought for and protected, every life does, eventually and necessarily, end. Even Cassandra, after entering another body that’s already dying, comes to this realization, saying, “You’re right Doctor, it’s time to die. And that’s good.”

“The Lazarus Experiment” – Series 3 (2007)

“The Lazarus Experiment” sees the Doctor (still Tennant) and his new companion, medical student Martha Jones back on earth and in modern day London, attending the unveiling of a machine created by Professor Richard Lazarus. The machine makes Lazarus young again, much to everyone’s surprise and the Doctor’s suspicion. He investigates and discovers that the process has changed Lazarus’ DNA, and he’s morphing into a monster that drains human life. The Doctor has to stop him, but Lazarus doesn’t want to die.

The parallels with “New Earth” should be clear, but with one key difference. Lazarus doesn’t want to accept death, even at the very end. No matter what the cost. It’s in this episode that the idea that every human life must end, that that’s part of being human, is most fully explored.

This episode also complicates other episodes, ones where the Doctor defends change and evolution. In “New Earth” he saves a whole new species of cloned humans and introduces them into the world. In the “Lazarus Experiment” he criticizes Lazarus’ machine from the start, and Lazarus responds that he doesn’t want to see the human race progress. According to the Doctor, the difference with Lazarus is that his experiment isn’t about progress for humanity, it’s about him and “his customers living a little longer.”

“Not a little longer,” Lazarus replies, “a lot longer. Perhaps indefinitely.” While Rose mocks Cassandra for staying put while the human race evolves away from her, the Doctor and Martha are appalled that Lazarus is trying to rush change onto humanity before it can cope, a change that will be stratified based on wealth and power.

While this stratification, the fact that money talks, is a problem in every healthcare system, most familiarly and painfully at home in the U.S., the concept goes against the equality that is fundamental to the NHS. Of course, there are private hospitals in the UK that offer surgeries and beds faster than the NHS waiting list, but all for a price. Still, if a patient needs a surgery, the NHS will provide it. Eventually. The key word there is need, since elective surgeries and purely cosmetic procedures (of which Lazarus’ de-aging could be seen as a rather extreme example) aren’t covered by the NHS. You have to pay for your own nose jobs and tummy tucks, unless you can prove that you’ll die without them. You don’t have to pay for your open-heart surgery, but if you don’t or can’t pay for a private hospital you do have to wait, sometimes for years. Money talks everywhere, but it at least talks less when the government pays for everyone equally, and that equality, as is shown again and again, is one of the guiding moral principles of Doctor Who.

Another principle is progress. Between “The Lazarus Experiment” and “New Earth” we get a more complete picture of what progress in the Doctor Who universe is. It’s natural, universal, and viewed with wonder by the Doctor and his companions. It is, in short, evolution in the scientific sense, as viewed by truly passionate scientists, though with an added moral coda on the general sanctity of life (a natural life, beginning and ending). False stasis and engineered evolution are both condemned.

Because of this, the Doctor and Lazarus are in conflict even before he starts mutating into a man-eating monster. He and Lazarus talk about this even while Lazarus is in the process of transforming. The Doctor says Lazarus has defied “the laws of nature.” Lazarus replies that one lifetime wasn’t enough for him.

“It doesn’t work like that,” the Doctor says. “Some people live more in twenty years than other do in eighty. It’s not the time that matters, it’s the person.”

It’s a little bit cheesy, like any quotable, platitudinous line. The subtext of the Doctor’s lecture to Lazarus about lifespans is complicated. The Doctor is around a thousand years old and when he’s fatally wounded he regenerates. He isn’t immortal—he can be killed before regenerating—and while he only gets a certain number of regenerations, his lifespan is well beyond human. The basis of the Doctor’s explanation to Lazarus is that an extended life doesn’t necessarily mean a happier life. Life isn’t about length; it’s about the person living it. And it’s about how they deal with the end of it, too.

This is a sentiment that the show expresses on more than one occasion. Funnily enough, it’s something I’ve heard my dad, who’s a doctor, say more than once, too. He appreciates seeing patients at both extremes of human nature, the ones that accept death with an astonishing level of peace and the ones who want to be intubated again and again and put on more and more machines to avoid it. Both situations are awe-inspiring because of the strength of their acceptance or desperation, but it’s the ones who have managed to live and accept death that are positively awe-inspiring. These are the patients that leave my dad happy and relaxed when he comes back from rounds. The others are the ones that he takes tense calls about during dinner and rushes off to save (for the third or fourth time). He’ll always go because he’s a doctor and it’s his duty to always try to save everyone under his care. But the atmosphere is always different when he comes back after a death that was always inevitable but that ended in struggle and desperation versus a death that was just as inevitable but that ended peacefully and surrounded by friends.

Of course, the ethics get a lot more complicated in Doctor Who, where everyone the Doctor meets is under his care, and it’s up to him to save all of them (again, the sort of ethic that can be pretty simply linked to a country with a national healthcare system that covers all citizens, immigrants, and foreign students as well). This responsibility to the masses sometimes requires him to give up on saving an individual, although he never gives up without giving them a chance.

Unfortunately, Lazarus doesn’t take his chance. He isn’t swayed by this argument about life for the living, but he wouldn’t be a very good villain if he were. He thinks he deserves immortality and that he can do great things with his added life. It’s at that point that he turns into a ravening scorpion-like monster that sucks the life out of people.

After some chases and derring-do, he Doctor and Lazarus again confront each other in Southwark Cathedral. Lazarus explains that after facing death defenseless during the Blitz he decided to “arm [him]self against it.” That’s why he built the machine. The Doctor cuts through this grand speech about “changing the course of history” with a simple question, “What about the other people who died?” meaning those Lazarus has already killed. Lazarus replies, “They were nothing.”

He breaks the cardinal rule, the goal the Doctor fights for. “Everybody lives.” He uses up his last chance. The Doctor defeats him (while saving the lives of two others) and Lazarus dies, an old man again.

The ethics always get a bit sticky when the Doctor has to kill a bad guy to stop them, but here the situation is handled with classic Doctor Who simplicity. He had to do it in order to save everyone else. And even though he had to do it, he extended lifelines to Lazarus left and right because the Doctor will first offer to save his worst enemy (he does, on more than one occasion) rather than leaving them to die. Conveniently for the narrative and the ethical implications of the show, they always choose to die, so we don’t get episodes where the Doctor and his nemeses have to cohabitate in the TARDIS. Although I’m sure there’s fan fiction about it.

How This All Answers the Question (Sort of)

Doctor Who, like any well-made narrative, can be interpreted through many different lenses. People tend to default to a religious angle. I’ve read articles that suggest he’s a new version of God for an atheistic society and that he’s an immortal being we can be friends with. For some reason, the medical angle is usually skipped.

But behind all his near immortal alien-ness, he’s still called “The Doctor,” and not just in the sense of a scientific or philosophical Ph.D. (although he is that as well). He’s the Doctor in every sense that word carries, and particularly the medical one. He fixes things and heals people and planets. He puts the sanctity of life before everything else but with a focus on natural life, life with an end, so that he isn’t above offering end-of-life care, too, when the situation requires it.

He’s not a doctor in the NHS, because he’s always been anti-authoritarian from the moment the first Doctor, played by William Hartnell, stole his TARDIS from the Time Lords and set off to interfere with history, against all his people’s rules. As a doctor conceived of by British writers, producers, and actors, he follows the governing principle of the NHS without getting bogged down in the bureaucracy and scandals of a real-world system. He tries to meet the needs of everyone, even, in some cases, his enemies.

Most medical dramas are bound to hospitals, patients that have been admitted and, in American dramas, either have insurance or spend a hefty part of the episode dealing with the drama of not having it. In Doctor Who, the Doctor makes house calls, he goes where he’s needed and deals with what he finds there because it’s his duty to help in any situation. Although most fans scoff at the executive producer Steven Moffat’s suggestion in the dialogue of “A Good Man Goes to War” that the universe gets the word “doctor” from the Doctor’s name, it still goes to show how intimately his behavior is linked, in the minds of the creators and viewers of the show, to the archetype of the selfless healer beyond and outside the tangles of modern healthcare politics.