Warning: spoilers ahead.
The penultimate episode of AMC’s Mad Men provided an all-too-familiar portrayal of the paternalistic nature of medicine via the handling of Betty Draper-Francis’s diagnosis of lung cancer. While the episode takes place in 1970 and there has since been a gradual shift to a more patient-centered approach in medicine, it offers a glimpse into power imbalances in medical care that still can occur today.
When Betty’s new classmates bring her to the emergency room, the first words out of the doctor’s mouth are “Mrs. Francis, is it possible to get your husband down here?” Betty assumes it is for the purpose of driving her home, but the doctor assures her that it is, in fact, for the purpose of explaining her condition to her husband, Henry, either prior to or at the same time he discloses the diagnosis to Betty.
When the doctor indicates that it is more serious than a broken rib, and Betty questions the extent of her condition, the doctor simply states that there is a telephone in the waiting room. In other words, he removes any ownership Betty has over knowledge of her own health and body, and insists on disclosing this information through her husband – man to man.
The next time we see Betty and Henry, they are in a different doctor’s office; Betty, perfectly coiffed but uncomfortably perched on an examining table, while Henry and the doctor discuss her condition in the background as if she was not in the room. The doctor describes his prescribed treatment, informs Henry that at this stage, these treatments are largely palliative, and extends his condolences — all to Henry.
Betty explicitly states that she would like to inform her children of her illness on her own terms. At her stage of advanced cancer, Betty has limited opportunities for active decision-making left, and determining how and when to disclose her illness to her children is one such instance. Henry takes possession of Betty’s remaining sense of agency, telling her daughter Sally about her mother’s cancer, blatantly ignoring the one request Betty made of him.
The only informed consent involved in this scene is Henry’s: the doctor describes the potential treatment options and the diagnosis to Henry alone, ensuring that he is the only party with sufficient knowledge to make any informed decisions. Allowing Betty to have any say in her own medical treatment was not presented as an option.
Throughout the series, Betty has struggled to retain her already-limited autonomy in terms of her career, finances, and treatment of her mental health. It should, therefore, not be as jarring as it is to see this total disregard of Betty’s autonomy regarding her health care and handling of her illness. Betty isn’t just on the weaker end of a power imbalance – she is nonexistent in the equation.
Dr. Elizabeth Yuko is a bioethicist at the Center for Ethics Education at Fordham University, editor of Ethics & Society, and coordinates the HIV and Drug Abuse Prevention Research Ethics Training Institute. You can follow her on Twitter at @elizabethics.