In Michel Foucault’s book Discipline and Punish there is a phrase that fascinates me: ‘a small penal mechanism’.
‘At the heart of all disciplinary systems functions a small penal mechanism’, he says.
The sentence came to mind recently when I heard that the Irish government was introducing a €75 charge for each round of chemotherapy. The charge is nicely judged: it will only apply to those cancer patients who are not poor enough to qualify for a medical card (free treatment) but are too poor to be able to afford private medical insurance. They have, perhaps, given up insurance in these times of austerity in order to feed their kids, and now faced with the terrifying prospect of cancer they must reassess the situation. It is a game of exquisite torture.
I’m reliably informed that chemotherapy can involve anything from a handful of rounds to dozens or even hundreds.
What does this particular form of ‘austerity’ tell us about the people imposing the charge?Minister Dr James Reilly – the man who closes down public nursing home beds while simultaneously being a shareholder in a private nursing home, the man who was listed in Stubbs Gazette recently as an undischarged debtor in relation to a €1.9 million debt on a nursing home – has cast around in his health budget of €1407,8000,000 (or €1.4 bn) and found a group of people who will try to pay up no matter what because the alternative is unthinkable.
What’s more, they’ll never be on the streets protesting. The big man (and Reilly is big) picked a fight with the sick child.
When the bully in the school yard picks the sick child he does so, not just to satisfy a sadistic pleasure or to allay some hurt in his own psyche, but to maintain discipline within his own gang and terror in the yard. The penal mechanism works to keep the sick child frightened and alone, but also as an example of how far things can go. ‘Look,’ the bully is saying, ‘we’re even prepared to beat the sick child. Imagine what we’d do to you.’ And of course, the schoolyard bully has all of the powers of surveillance at his disposal, which means that there’s nowhere to hide, that he and his gang can come and get you at any moment.
So this penal charge on life-saving treatment isn’t just about saving money, though that in itself is calculated and callous. This is about selecting special sacrificial ‘others’. In Ireland we don’t even like to talk about cancer and find it difficult to associate the word with ourselves so much so that the mere mention of cancer in relation to a healthy person used to provoke the traditional invocation: ‘God bless the mark’. In selecting poor cancer patients Reilly and his gang have picked on a particularly vulnerable and isolated group of victims.
Italian writer and Auschwitz survivor Primo Levi famously remarked in relation to Palestinians that ‘everybody is somebody’s Jew’. This carefully isolated category of sick person is Reilly’s Jew.
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