Über die Autorin bzw. den Autor

Timothy F. Murphy is Assistant Professor of Philosophy in the Biomedical Sciences at the University of Illinois College of Medicine. He is editor (with Marc Lappé) of Justice and the Human Genome Project (California, 1994) and (with Suzanne Poirier) of Writing AIDS: Gay Literature, Language, and Analysis (1993).

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Ethics in an Epidemic, a humane and graceful book by a philosopher of medicine, offers fresh insight into our attempts--popular and academic, American and non-American, scientific and political--to make moral sense of the pain engendered by AIDS.

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Ethics in an Epidemic: AIDS, Morality, and Culture

University of California Press

In And the Band Played On gay journalist Randy Shilts introduces one of the figures central to his history of the origins of the AIDS epidemicGaetan Dugasat the 1980 San Francisco gay pride parade: Dugas's diagnosis of Kaposi's sarcoma just a few weeks before had not dampened his spirits since he expected the blemishes to disappear.1 In the pages that follow, Shilts paints a picture of a self-absorbed profligate from whom AIDS radiated outward in an expanding circle, whose vainglorious sexuality enclosed others in the involuntary grip of AIDS. Mostly through And the Band Played On Dugas became known as "Patient Zero," the man whose erotic penchants and compulsions put him causally at ground zero of the American AIDS epidemic.2 Shilts's portrait of Dugas recalls the literary visions of "anointers" who in earlier times "spread" bubonic plague,3 and mass-media reports were quick to pick up the Dugas story in their headlines. Indeed, even the publisher's press release noted Dugas's story as one of the most salient features of the book.4

Others have also tried their hand at identifying the various forces that made the epidemic possible,5 but And the Band Played On remains the most ambitious account thus far about the origins of the epidemic, about what persons and circumstances were responsible for the emergence of the unprecedented syndrome. And if there have been discussions about the origins of the epidemic, there have also been discussions about its future. In often dire and foreboding language many of these discussions conjure a future despoiled not only of health by the epidemic. Public

health analyst Ronald Bayer's Private Acts, Social Consequences: AIDS and the Politics of Public Health, for example, summons a future beset by trials of immense consequence and gravity in matters of civil rights should progress against the epidemic not keep pace with public expectation.6 In law professor Monroe Price's Shattered Mirrors there is also augury of a future fatalistically vulnerable to moral desperation and political derangement.7 Part of Price's haruspicy here is achieved through word choice. The following words, for example, occur on a single page of Shattered Mirrors chosen at random: enemy, virus, bacteria, parasites, vulnerable, puzzle, change, pessimism, AIDS, unrelenting, mocking, resistant, microbes, quarantine, illness, incubated, infectious, poor, disgrace, unchecked, infection, problem, doubtful, competition, survival.8 The connotative force of page after page of dire language of this kind suggests a viral cataclysm whose outcome will determine the moral and medical perfectibility of man.9

The description of a figure who "spreads" AIDS is worth conjoining with considerations about the future of AIDS for what the conjunction reveals about the way responsibility is understood and assigned in the AIDS epidemic, about the way we think of the epidemic as a catastrophe, and about what remedies it requires. Its future turns out to be even more problematic than its present.

The "Spread" of AIDS

In describing the figure central to his account Shilts describes Dugas as "ideal for this community," the pretty-boy gay community, that is, by virtue of his sandy hair, inviting smile, trendy Paris and London clothes, and soft Quebec accent. By Shilts's account Dugas lived a life of parties, cocaine, Quaaludes, bars, baths, "poppers" (amyl nitrate), and travel. Once "the major sissy of his neighborhood in Quebec City," Dugas was an ugly duckling who became a swan, who could say with confidence: "I am the prettiest one."10 But his dangerous sexual liaisons, not his looks, earned Dugas prominence in Shilts's account. Dugas kept, for example, an address book that amounted to an archeological record of his sexual history, with strata so old that he sometimes did not recall the fossilized names he unearthed there. He was unapologetic about his wide circle of lovers, an erotic life all the more attractive to himaccording

to Shiltsas emotional compensation for an unhappy childhood. After years of taunting and torment by neighborhood bullies, he had carved "his own niche in the royalty of gay beauty, as a star of the homosexual jet set."11 Dugas's mortal sin in Shilts's account was his unwillingness to abdicate his eminence in gay erotic hierarchy when doctors wondered whether his disease might be communicable. He not only ignored doctors' counsel to abstain from sex but after sex he even showed partners his lesions: "'Gay cancer,' he said, almost as if talking to himself. 'I've got gay cancer,' he'd say. 'I'm going to die and so are you.'"12

That he had been epidemiologically linked to 40 of the first 248 men identified with what was then called "Gay-Related Infectious Disease" (GRID) and that he ignored counsels to refrain from sexual relations made Dugas a prime target for explanations requiring a villain behind the epidemic. And acceptance of the characterization of Dugas as a villain has carried over even to accounts otherwise critical of Shilts's work. English professor James Miller, for example, observes, "I still shudderwhether with voyeuristic pleasure or zero-at-the-bone fright I can't tellwhenever I recall the lurid bathhouse scene where Patient Zero exchanges bodily fluids with a Castro Street clone and then cackles vampirically as he reveals his fulminant lesions: 'I've got gay cancer. . . . I'm going to die and so are you.'"13 In describing Dugas's behavior in bathhouses, however, Shilts uses adverbs and adjectives sparingly. Only in describing Dugas's sexual willfulness does Shilts freely avail himself of a more expansive characterization, offering motives and attitudes.14 Thus the spare description of the bathhouse scenes permits and elicits varying reactions. Though some readers have found Dugas a vengeful, viral sadist, it is not clear whether Dugas's remark that his partner is going to die means that Dugas has successfully caused disease in this partner or whether, in the fullness of sexual time, the partner cannot hope to avoid the disease because gay life is the way it is, because the partner already has the disease, or because the disease is unavoidable in any case.15 Certainly, Shilts does not have Dugas cackling; on the contrary, he is talking almost to himself, whatever that might mean to a partner dressing hastily at his side, whatever that partner might have knownif anythingabout gay cancer and its meaning for his own fate.

Despite the caution Shilts exhibits about directly attributing malevolent motives to Dugas in bathhouse scenes, he nevertheless stacks the narrative cards against Dugas from the beginning. There is little in Shilts's presentation that might exculpate Dugas or mitigate the view that Dugas, either in his person or in the ideals he epitomized, bore significant

responsibility for the epidemic. It even appears that Shilts has characterized Dugas as the Aristotelian efficient cause of the epidemic, insofar as he appears as its mechanism of transmission in this country, and gay ideals were the formal cause of the epidemic insofar as they shaped the culture in which transmission could occur easily....