Is gallows humor in medicine wrong?

Doctors and other medical professionals occasionally joke about their patients’ problems. Some of these jokes are clearly wrong, but some joking between medical professionals is not only ethical, it can actually be beneficial, concludes an article in the Hastings Center Report.

The author, Katie Watson, bridges the worlds of medical ethics and comedy: she is an assistant professor in the Medical Humanities and Bioethics Program at the Feinberg School of Medicine at Northwestern University and she teaches improvisation and writing at The Second City Training Center in Chicago. What prompted her to explore the ethics of gallows humor in medicine was the story a doctor friend told her in which, years earlier, he and other residents tried unsuccessfully to save a teenage pizza delivery boy who had been shot while delivering their dinner.

After finding the pizza box where the boy dropped it before running from his attackers, one of the residents made a joke: “How much you think we ought to tip him?” The residents laughed, and then ate the pizza.

“Was it wrong to make a joke?” the doctor asked.

This question intrigued Watson as a bioethicist, she says, “because it is about moral distress, power imbalances between doctors and patients, and good people making surprising choices.”

While there is a lot of literature on humor in medicine generally, particularly about clinician-patient interactions and the health benefits of laughter, she says there is relatively little that addresses gallows humor in medicine, which usually occurs between health care providers, and treats serious, frightening, or painful subject matter in a light or satirical way.

“The claim that being a physician is so difficult that ‘anything goes’ backstage misuses the concept of coping as cover for cruelty, or as an excuse for not addressing maladaptive responses to pain,” Watson writes. “However, blanket dismissals of gallows humor as unprofessional misunderstand or undervalue the psychological, social, cognitive, and linguistic ways that joking and laughing work. Physicians deserve a more nuanced analysis of intent and impact in discussions of when gallows humor should be discouraged or condemned in the medical workplace.”

Watson’s analysis draws on literature from the humanities and social sciences on why we joke and on various uses of humor, including “backstage” humor that serves as a bonding and coping mechanism among insiders and “bullying jokes.” She also observes changing standards in the backstage humor of doctors and medical students – whereas “cadaver antics,” in which medical students clowned around with body parts, were once a rite of passage, today they are “rarely tolerated, and the modern approach frames cadavers as former people.”

Deciding when gallows humor is okay, Watson says, turns on the ethical question, When is joking a form of abuse – of a patient, of trust, or of power? A joke about a patient’s condition told in front of the patient or the patient’s family is unethical because it has the potential to harm them. But she concludes that the tip joke was not wrong. “To me, the butt of the doctors’ tip joke is not the patient. It’s death,” she writes.

Not only did the joke not harm anyone, she adds, it may have helped the residents “integrate this terrible event and get through the shift.” In so doing, the joke may also have helped the next patient get the best possible care. After all, she writes, the residents “needed to laugh before they could eat, and they needed to eat to be at their

5 COMMENTS

  1. As cruel and unjust as it may sound, I don’t think the joke was off base. Think of it this way, doctors and nurses deal with sickness and death on a daily basis, if they cannont find a release, like the aforementioned joke, don’t you think they would burn out and have and/or have a nervous breakdown? The stress they go though would probably be enough to kill you or I, so any outlet can only be beneficial. Would you like a sad and depressed doctor not focusing on you to take care of you, or one who is in a clear frame of mind and has pushed a past tradegy to the side?

  2. Who benefits from inappropriate humor?

    There is a time and place for comedy, but a child’s death or death of some innocent soul is not the best time to poke malicious fun.

    How can you prove that the next patient benefitted from a stupid joke about a child getting murdered and dying? It just seems sadistic to laugh about someone else’s kid getting killed. I can’t find any humor because I have heard of kids getting cancer and dying horrible deaths. It is horribly tragic.

    Do these “residents”, who clearly lack class and creativity in the humor department,jokes about the people falling out of the Twin Towers or 9/11 jokes?

    Call me old fashioned, but there is a huge difference between humor and lack of class.

    • You miss the point. Unless you’re a professional who works in around the sick and dying, I doubt you can relate to the enormous amount of stress this places on them. The example articulated here is exactly the type of release from from this emotional and physical strain that they need to be able to deal with this daily trauma without any harm to the patient or family. Try listening in to conversations at a mortuary sometime between the employees preparing bodies for display or burial, or yes, listen to therapists and clergy talking between themselves and you’d be very surprised indeed. This sort of banter hurts none of those being talked about, but serves a larger purpose in providing a release via humor to those who need it most.

  3. I think the “joke” about the child’s death, (it is about death, correct?) is not creative and very insensitive. What if a relative, friend, or loved one happened to overhear that cruel remark?

    Was it a mature statement? I’m not trying to hold medical professionals and students to a higher standard, but it’s not junior high exactly.

    Would any of the laughing residents like a joke made about the demise of their child or immature kidding about their own deaths? It shows their blatant arrogance about everyone else except themselves.

    Do people training for clergy make morbid jokes, even occasional ones for their entertainment? I haven’t heard any.
    Enlighten me if you do.

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