Good Bedtime Reads – Fascism: A Warning

Fascism: A Warning

Author Madeleine Albright, Published by Harper Collins

I am not an avid reader of fiction. So, when recently asked to write a short piece for a section of the Society for Education in Anesthesia (SEA) newsletter entitled “Good Bedtime Reads,” I was excited by the opportunity, but also somewhat nervous that my choice of bedtime reads, that are mostly historical, might not appeal to the wider membership.

My anxiety was somewhat magnified by the realization that my present read, Madeleine Albright’s Fascism: A Warning, may prove to be a little controversial for some of our members. The author, as many will recognize, was the first female to serve as U.S. Secretary of State. However, what some may not know is that she speaks with some authority on this topic since her early life, in Czechoslovakia, was heavily impacted by the rise of fascism and because she has unique insights gleaned from her efforts fostering democracy as a diplomat.

By the time of our SEA Spring meeting I was half-way through the book. During the opening session we were privileged to hear Tom Nasca, CEO of the ACGME give a presentation entitled “The Foundation of Professionalism.” In his talk, he proposed that one anchor of the construct of professionalism was the mandate to be accountable to the higher ethical standards of a society. He postulated that this mandate was much easier to fulfill in a liberal democracy than under an authoritarian regime. These words truly resonated with me and any residual anxiety I had about writing the book review dissipated.

Ever since reading the brilliant analysis of the crucial role that German doctors played in the Nazi genocide in Robert Jay Lifton’s book The Nazi Doctors, I have been deeply interested in the impact of totalitarian regimes on ethical decisions of physicians and the possible abuse this could create.  I now felt very much energized to present my new read anchored in my belief that it would introduce a unique historical perspective to our members, a physician group that has an important mandate of ethical accountability.

Secretary Albright, as a professor, draws heavily on her life experiences as well as conversations with her students. She postulates that our history over the last 100 years has been characterized by a long-term struggle between democracy and fascism examining historical examples from Europe, Latin America, the USA, and Asia. In her analysis, she notes that certain patterns emerge and notes that fascist ideology thrives in conditions of economic, social and political chaos. Its genesis is frequently accompanied by the silence and passivity from certain elements of society. Fascism is ready to use any means required to achieve its goal, even violence.

She illustrates that, in its more modern and lethal form, fascism creates a very real threat to democratic freedoms. Much of the work of western governments, towards an ethos of supporting global democratic institutions, is threatened and could be reversed. Heads of state such as Recep Tayyip Erdogan and Vladimir Putin commonly use strategies similar to those used by Fascists of the 20th century that leave a legacy of fear and desperation.

One may ask, “What qualifies this book as a bedtime read?” It is not completely dour in its outlook. It offers optimism in its concluding chapters by describing leaders who were able to get past periods of significant discord; they did so, by incorporating the lessons of history and consequently preserved democracy.

My hope is that if you read this book, you also will appreciate the author’s perspective and the impact it may have on us as physicians when faced with societal demands that conflict with our core ethical principles.