House — Episode 3 (Season 6): “The Tyrant”
A good episode of House, with a nice turn by Thulsa Doom, full of many layers of moral dilemmas. Plus, if you ignore the scenes dealing with the heart, the medicine was pretty good.
Dibala, a brutal African dictator suspected of genocide, is in the United States to address the UN when he suddenly starts coughing up blood (or vomiting blood — it’s not entirely clear). He is admitted to House’s Foreman’s team at Princeton-Plainsboro for evaluation. The team’s initial differential diagnosis includes hemorrhagic ulcers of the lung, an assassination attempt using polonium (suggested by the dictator), and acid reflux. Foreman notices a bug bite on the patient’s hand and thinks he had has malaria. House, on the other hand, thinks the bump is not a bug bite but instead chloracne indicating dioxin poisoning (probably from an assassination attempt). Foreman goes with House’s idea and starts Dibala on Olestra (the same “fake fat” once used in no-fat potato chips. It is thought to increase fecal excretion of dioxin — i.e. it makes you poop more).
Dibala suffers a heart attack. He is started on oxygen, heparin (a blood thinner), and streptokinase (a “clot buster”). He survives, but since the heart is now involved and he has also developed a low grade fever, the team revisits their differential diagnosis. They now focus mostly on infectious causes including Lassa fever, Ebola, Marburg, and trypanosomiasis (African Sleeping Sickness). Once again, Foreman goes with House’s suggestion and starts the patient on ribavirin to treat Lassa fever. Dibala’s staff bring in an expatriate who has survived Lassa fever. They want to use her blood to help treat Dibala (they will presumably inject her antibodies — which would include antibodies against Lassa — into Dibala, providing him with passive immunity). Cuddy agrees over Cameron’s dissent.
Meanwhile, an opponent of Dibala has sneaked into the hospital and attempted to assassinate the dictator. The shots miss, but while evaluating Dibala, Chase notices a right eye hemorrhage. Further evaluation shows that an enlarged lymph node has blocked the retinal vein, leading to the bleeding into the eye. With lymph node involvement, the differential changes again and now consists of sarcoidosis, a Staph infection, and lymphoma. The lymphoma seems the most likely, so a biopsy is checked, but turns out to be completely normal. When Chase and Cameron tell Dibala the results of the test, it becomes clear that he is having problems with his short term memory. House suspects scleroderma is the cause, but Foreman suggests blastomycosis, a fungal infection (the argument here seems confusing to me: Chase says he agrees with Foreman, but then says he doesn’t think it is fungal). This time, Foreman sticks with his choice and starts Dibala on Amphotericin B, an antifungal medication. Cameron begins to have second thoughts that maybe it was scleroderma after all. Some blood tests are run which show that Dibala is positive for anticentromere antibodies (a test for scleroderma). As Foreman points out, it’s not a perfect test, but it does strongly suggest that scleroderma is the cause. Taking this into account, Foreman stops the Amphotericin and starts steroids to treat the scleroderma.
The next time we see Dibala, he is bleeding copiously from his mouth and nose. Chase is using a bronchoscope to look down into his lungs to find the source of the bleeding. He is able to cauterize one bleeding area, but another appears, and then another and another. It is too much for Dibala and his heart stops and he flatlines. Foreman calls for the paddles and the patient is shocked and shocked and shocked and shocked — all the while blood is pouring from his mouth and nose. It’s no use though, Dibala is dead.
After it’s all over, Foreman is mulling over the case and can’t decide what mistake he made. Was he too stubborn, or not stubborn enough? He wants to recheck some tests, but Dibala’s body is locked in the morgue. He discovers Chase visited the morgue earlier in the day and realizes that the blood tests for scleroderma did not come from Dibala at all, but from an elderly patient who died of the condition. Chase had purposefully misled Foreman so that Dibala would get the wrong treatment and die.
The medicine, for the most part (i.e. ignoring the cardiac scenes) was fairly sound. But, oh, those heart scenes dragged it down.As usual, major complaints are in red, minor in blue, nit-picking in green:
I’ve discussed shocking flat lines many times before — and I’m going to do it again — but with a twist: Dibali’s problem isn’t that his heart has stopped, it’s that’s he’s losing massive amounts of blood — which in turn is leading to the heart stopping. No amount of shocking (or anything) is going to restart the heart until the bleeding is stopped and blood replaced. It probably would not have been a bad idea to try some other maneuvers before declaring him dead (epinephrine or atropine, or CPR), but as I mentioned above, it wouldn’t have made a difference unless they stopped the hemorrhage first.
A recent bleeding problem (i.e. in the last six weeks) is a relative contraindication to the use of thrombolytic (clot busting) therapy. In another words, while not an absolute no-no, think twice before doing it. Dibala had some significant bleeding in his lungs just a day or two before — is using streptokinase really a good idea?
Regardless, you don’t give heparin with streptokinase (other thrombolytics, yes, just not streptokinase).
You’d think they’d use a newer thrombolytic at a cutting edge hospital like Princeton-Plainsboro.
You don’t give Amphotericin IV push — it’s too dangerous. Quoting the FDA: “rapid intravenous infusion has been associated with hypotension, hypokalemia, arrhythmias, and shock.”
The incubation period of malaria is at least seven days, usually longer. The mosquito bite mark should have gone away by then.
To be fair to Foreman, it’s quite a stretch for House to consider a single bump on the hand chloracne.
Anticentromere antibodies tend to occur in the more limited, milder forms of scleroderma. This should have given Foreman more reason for pause.
The mirror box is a relatively new technique for phantom limb pain, and while it does show promise, it doesn’t work that fast (it takes multiple treatments) or that completely.
The medical mystery was good this week — lots of unexplained bleeding usually is — though not terribly original. It earns a B+. The final solution generally fit the symptoms, and had a nice twist, so earns another B+. I have mixed feelings about the medicine overall. Most of it was quite good, but two scenes were particularly bad. I wish I could split the score, but I can’t (well, it is my site, so I guess I could — but I won’t), so I give the medicine a weak C. The soap opera was very good. There was House/Wilson, House/Neighbor, House/Foreman, Foreman/Thirteen, Chase/Cameron, Chase/Dibali, Cameron/Dibali, and of course, Foreman/Chase. It deserves an A.
Last week’s House review
A list of all prior House reviews
October 5th, 2009 at 10:34 pm
okay, DVR cut off right as Foreman was about to take the lighter to the sign in sheet….what did I miss?
October 5th, 2009 at 10:35 pm
My favorite episode in a LONG LONG time, only because of the moral and ethical dilemmas and whatnot.
October 5th, 2009 at 10:39 pm
Official Comment
Nick F:
A pensive look on Foreman’s face, and then the previews of next week’s episode (which looks, in part, to address some of these issues again)
October 5th, 2009 at 10:42 pm
Excellent episode. Very touching performances by the major parties and I loved how radically everyone’s views and level of calm changed throughout the episode but I thought the romantic relationships (especially those between Foreman and Thirteen) were getting way too overplayed.
October 5th, 2009 at 10:42 pm
An amazing episode (and good review) but I’m curious about House’s treatment for his neighbor’s phantom pain. Is that mirror-trick actually effective and would it work so suddenly after the neighbor having pain for more than 30 years?
October 5th, 2009 at 10:44 pm
so..not much. whew….
it was nice to have the old gang back, I’m curious where things go from here.
October 5th, 2009 at 10:44 pm
Nevermind – either it was just added to the review or I missed it earlier. Good to know. :)
October 5th, 2009 at 10:51 pm
I think if James Earl Jones was in a Twinkies commercial it would be a work of art. I think this was maybe the most dramatic House ever; but that could be because I’m a fan of Mr. Jones. The downstairs neighbor was even a good sub-plot.
October 5th, 2009 at 10:57 pm
Does anyone know why steroids would cause such profuse bleeding? I’m assuming they were talking about using something like prednisolone. Is it because it’d inhibit TxA2 thus compounding the problem associated with the heparin and streptokinase? In that case is this a contraindication in real life? No steroids if any anticoagulants are used?
October 5th, 2009 at 10:59 pm
What I’ve seen on the “mirror box” technique for relieving phantom pain is that it seems to work instantly but the pain will come back shortly after getting out of the box. The neighbor would have to use the mirror-box several times over the course of weeks for it to completely work.
Here’s: http://www.ted.com/talks/vilayanur_ramachandran_on_your_mind.html a video of -I believe- the man who “invented” this technique. For me that was the best part of the episode -mostly because it involved House.
October 5th, 2009 at 11:13 pm
i was with brian on this one scott: from all the stuff ive read by ramachandran previously, the patient usually receives an immediate release of their hand and their pain on the first usage of the mirror box.
let us know what you think.
October 5th, 2009 at 11:16 pm
Fantastic episode, but I was disappointed to see no interaction whatsoever between Hugh and James.
October 5th, 2009 at 11:24 pm
Nice to see Forman’s human side…. Just when you think he’s gonna be ‘Typical Arrogant Foreman’ he does something so totally out of character for him, it’s a welcome sight to see..
Who’d have thought that Chase had such a propensity and capacity for self-sacrifice?
“The needs of the many outweigh the needs of the few” – So Chase kills one to potentially save 100’s of thousands from racial genocide…
A bravo performance to James Earl Jones (a.k.a the voice of Darth Vader) for his portrayal of an African Dictator…. There were similarities to Idi Amin & Nikolai Ceausescu (from Romania) with a dash of Hitler for good measure. A VERY good performance and hopefully he’ll win a Daytime Emmy for it.
House being stir crazy at Wilson’s house? It was nice to see even thought Wilson’s neighbor was even MORE of an Ass then the newly subdued House is, he thought things through and faced the guys arrogance with kindness…. Took a round about way to get there but at the end with the mirror box he did the guy a genuine kindness.
With Taub seemingly REALLY gone ( he wasn’t in the credits) & Remy saying to House that she’s not coming back….perhaps a new team is in the works??
We’re finally getting back to the writing that made House the best show on TV…. Let’s see of they can build on this next week!
October 5th, 2009 at 11:31 pm
I enjoyed all of the aspects of this episode, but I don’t know about getting a guy from N.J. playing a Canadian, but I guess they figured David Marciano could pull it off after having worked with some of “those people” in Due South. :^)
October 5th, 2009 at 11:32 pm
@ luke:
House was prohibited from interacting w/ patients by Cuddy at the beginning of the episode b/c he doesn’t have his license back yet… “No procedures and no interaction w/ patients”
So unfortunately the most House could have done was watch through the window while standing in the hallway..
October 5th, 2009 at 11:36 pm
As soon as I saw the cardboard, I knew House would be using the “Mirror Box” that Ramachandran described in “Phantoms of the Brain”, an excellent, excellent book.
October 6th, 2009 at 12:13 am
A Random Question:
Where did Foreman get the lighter from at the end to burn the morgue sign in sheet? No one on the show has been seen to be a smoker so how was there one conveniently at hand for Foreman to use in House’s office?
October 6th, 2009 at 12:16 am
Who’d have thought that Chase had such a propensity and capacity for self-sacrifice?
Hugh L, go back & watch The Mistake & Cursed, also written by Peter Blake. It provides the explanations for where Chase is coming from – he’s done it repeatedly in the past, he sacrificed his childhood to his mother’s drinking & nearly his career for a patient & her family (House stops him). Those episodes also provide the framework for all the father-son parallels in this one.
October 6th, 2009 at 1:25 am
I was hoping for some scenes between a powerhouse like James Earl Jones and Hugh Laurie, good episode but what were the writers thinking??
October 6th, 2009 at 2:01 am
I saw a TV special a few years back that mentioned the usage of mirror boxes for phantom limb pain. As I understand it, the therapeutic effect wholly stems from *seeing* the reflection of the remaining arm: the subconscious perception of the missing limb overtakes the conscious understanding that it is not really there.
As such, wouldn’t David Marciano’s character, veteran Murphy, have to be *looking at* the reflection when he relaxed his arm for the therapy to work, which it did even though he wasn’t?
Oh, and as for previous posters’ concerns that mirror box therapy takes more than one session to take full effect, note the IMDb page for House s06e04; Murphy comes back for at least one more week: http://www.imdb.com/title/tt1503409/ (As a fan of The Shield, it’s nice to see these characters once again; now they just gotta book Michael Chiklis!)
October 6th, 2009 at 2:52 am
Chase did the right thing but this will have major repercussions for him. I think Cameron will leave him once she finds out and that is how Jennifer Morrison will be written off the show. It would be interesting to see House’s reaction to this as well.
One scene I really enjoyed was House doing pantomime and then having lymphoma on the shades at the end.
October 6th, 2009 at 2:53 am
What’s interesting about this case, the second with Foreman in charge is that House did not solve it. More importantly, Foreman was the one with the solution. It was only because Chase had faked the tests results that screwed up Foreman’s diagnosis.
BTW, did anyone else notice this is one of the rare times that Chase calls Cameron by her first name, Allyson? It happened just after Dibala confronted Cameron about her desire to kill him.
Overall, this is one of the better episodes to come out in a long while.
October 6th, 2009 at 3:43 am
Hugh L. quoted and noted:
“‘The needs of the many outweigh the needs of the few’ – So Chase kills one to potentially save 100’s of thousands from racial genocide…”
Not much of a justification; Spock was speaking of sacrificing his own life, not taking another’s.
October 6th, 2009 at 3:58 am
“Not much of a justification; Spock was speaking of sacrificing his own life, not taking another’s.”
Well in which instance Spock was using this is irrelevant, the logic still applies here.
October 6th, 2009 at 4:05 am
@ Mike Blake:
Is killing yourself to save people really all that different then killing a truly evil person to save people like Chase thought?
When you take someone’s life, good people that do it (like law enforcement) usually find they have had a piece of their ’soul’ (for lack of a better term) die as well so this is now the dilemma that Chase faces beyond the obvious legal implications for him and Foreman should they get caught.
The Ethical & Moral implications of this episode are truly cutting edge for Network TV which usually tries to shy away from such “Hot Topics”..But then again this show is on FOX in my area and they’ve been known to do well with shows that are controversial like Married w/ Children, The Simpsons, Family Guy, etc…..and now House.
I wonder how the writers can hope to top this episodes raw emotion at the end in future eps?
October 6th, 2009 at 4:43 am
I’ve so far read nothing here that justifies Chase’s behaviour as a doctor and as someone of presumed intelligence. Has he forgotten the Hippocratic Oath? Can anyone at that hospital even spell it? For the non medics, “I will not permit considerations of religion, nationality, race, POLITICS or social standing to intervene between my duty and my patient..etc” And talking bollocksticks. Is Chase that naiive to think the next leader won’t be worse? Guess he’s finally had his blonde moment.
October 6th, 2009 at 5:10 am
Man, fantastic episode that kind of almost makes up for Taub seeming to truly be gone. I hope he comes back for a couple episodes, just for some real closure. The scene where Dibali calls Cameron out on her cowardice was just excellent… Been a good while since we’ve seen doctor/patient interaction that powerful.
If I have to complain about something, the house/Neighbor storyline was pretty fun, but it didn’t seem like he was progressing. I know it takes time, so I suppose I can let it slide.
I also don’t know where all this “Jennifer Morrison is leaving” business is comnig from, but if she is, I could see Thirteen coming back to fill the “female” quota. Gotta give my props to Ms. Morrison for five great years of getting me ticked off at how nice Cameron is, haha.
October 6th, 2009 at 5:25 am
This was an awesome episode, my head was spinning after it was done.
I found the mirror box pretty unrealistic. Dr. V.S. Ramachandran wrote that the effects of it went away with people he tested the minute they took their arms out of the box.
October 6th, 2009 at 5:39 am
Good show , but I was kinda let down by the lack of a “super scene” between Jones and Laurie. As soon as I saw James Earl Jones in the beginning, I immediately got excited anticipating the interaction between him and the great doctor House. Nevertheless, I did enjoy the show and the questions of moral and ethical dilemmas.
October 6th, 2009 at 6:11 am
@ DrEvil
Are you out of your mind? The dictator basically said as soon as he gets back he will start killing the cockroaches. By curing him they would be harming people. I am surprised that nobody else beside Chase took action against him (but then he did not admit he would massacre people to others).
I will actually go further and say that given what Chase knew it was his moral obligation to kill the guy. Think about it, if one of Hitler’s doctors got killed him back in 1938 would not that be a moral act? Would not we applaud the doctor today?
October 6th, 2009 at 6:36 am
@batman
My impression was that the bleeding was part of blastomycosis, especially because it was the presenting symptom as well. He died because the blastomycosis was not being treated, if anything wouldn’t the steroids make it worse?
October 6th, 2009 at 6:46 am
It was nice to see the old gang back together again (”Oh my God, it’s three years ago!”), and it seems that this season goes back to its roots. We had some nice House moments (though not as many as I would like).
The moral dilemma was well conceived and well thought out, with a very nice twist at the end (Foreman discovering that it was not his error but Chase’s moral choice that killed the patient).
Still, the dilemma with Dibala was a bit contrived and “synthetic,” similar to the Chateaubriand (made famouse by Balzac) old mandarin parable, only in reverse. It was further weakened by the fact that Chase actually wanted to get away with it.
What was missing the most, from my point of view, was a confrontation between House and Dibala. The dictator was portrayed as an extremely astute and perceptive person, very eloquent and direct. Perfectly set, it seemed to me, for a nice head butting with House, but all those fine features only amounted to a confrontation with Cameron and Chase, who could not face him at his level. It felt to me like a missed opportunity.
October 6th, 2009 at 6:56 am
Really did want a scene between Laurie and Jones. Episode was very dramatic, I liked it. It seems like it’s been a long time since this show dealt with ethics and morals in medicine so it was kind of a refreshing break from all this personal stuff House has been through. Still, I missed Taub. The old team don’t really do much for me, especially Foreman.
October 6th, 2009 at 6:58 am
I was shocked by this episode. I think it was seeing House and Chase acting as rogue doctors that upset me. Both of them decided what they thought the outcome of a situation should be and acted without regard to the law or professional standards to bring it about. House drugged the neighbor and tied him up in duct tape which would certainly land him in prison if the neighbor pressed charges. Chase could have landed in the next cell. House and Chase were practicing on the basis that the end justifies the means.
“B,” there have been quite a few articles on Jennifer Morrison’s departure. I will miss her a lot.
I am still not sure what initially caused James Earl Jones’ character to become ill in the first place. James Earl Jones is a treat to see in any circumstance.
Foreman is becoming very annoying. He has become a dictator in the workplace and arrogant in his personal relations. The dictator that James Earl Jones played had less arrogance with regard to his relationship with his son than Foreman showed towards 13 at dinner.
Thanks, Scott, for explaining all the medical pieces that flew past me in this episode.
October 6th, 2009 at 7:34 am
Great episode. With the old team reminded me why I loved the show in the first place.
Minor note: did Cameron call Foreman “Obi Van” or did I hear it wrong?
October 6th, 2009 at 8:00 am
Mirror Box therapy does work, A good site for more info is http://www.mirrorboxtherapy.com.
October 6th, 2009 at 8:15 am
Scott, you didn’t touch on House’s “treatment” of the neighbor. Did this method of relieving “phantom” pain from an amputated hand appear authentic to you? Was there any “literary license” applied, i.e. would such therapy actually work in a single exercise of a few second’s duration?
October 6th, 2009 at 8:41 am
WOW! Now that was an episode so strong as the classics we’ve seen on House so many times. It reminded me of Three stories, Don’t ever change, Wilson’s heart… So many good drama moments, moral issues a cocktail of all the characters making very, very strong appearances. I particularly enjoyed The Old Team – all the action there was great and the plot twist with Chase doing the Moral thing was awesome. I wish I could say that I agree with him btw but as a doctor even a mere dental doctor I cannot. The Hippocratic oath is sacred for any REAL doctor and even performing euthanasia is extremely difficult for a person who spend so many years training to FIGHT death. When you learn and learn and learn how to help people one really starts to forget about the moral fiber of who you are treating – I myself drank a lot of beers after treating somebody who I know actually deserves a good amount of tooth pain (which is one of the worst btw!) yet I never even puzzled leaving somebody in pain or hurting him in any way. If someday I am faced with the same dilemma I will probably say: “It is my job to treat, it is somebody else job to stop this man.” And it is probably what any doctor would say. What I liked about this episode is how well Chase actually sold us the story – he was so convincing I never even doubted for a moment his reasons his logic or his determination to go all the way. Bravo Jesse you have a great potential as an actor.
As for the medicine – I have to say it was about as sound as it could have been. My major complaint would be the one that D-r Scott just mentioned in blue – you cannot just give blood thinners to somebody who just had a bleeder from the lungs. It is a good way to fill the lungs with blood -which eventually happened. I’m assuming (although we never actually got i confirmed!!!) that the final diagnosis was blastomicosis. Even with Chase falsifying the test it could still be scleroderma – the real test could have been suggestive for scleroderma as well if they ever made it (and what a nice plot twist that would make!!!!).
My other major complaint is about the cause of death (no I am not commenting on chocking a flat line or trying to resuscitate bleeding lungs with defibrillator WITHOUT any anticoagulants of any sort – it was enough comment in the review) I can assume that giving steroids to a patient with an infection would cause him to worsen and probably push him into sepsis – and he will die from septic shock or probably from the plummeting BP (from the sepsis) which will cause multiple organ failure. But make him bleed out of his lungs? How on earth can blastomicosis cause so much blood in the lungs with or without steroids?
On the other hand could he really get worse THAT fast if it was really scleroderma? Is the whole Foreman “may be I was right to change the treatment but I was late” dilemma unrealistic? Questions, questions and I do not think we’ll ever get an answer…
October 6th, 2009 at 8:54 am
Wow, this was a really good piece of television, really made up for the previous episode.
I’m pretty sure taub will be back though. Or atleast I hope he will.
October 6th, 2009 at 8:55 am
Hi, I watched all previous five seasons of House over the last two months and read all the reviews on the site, but I never wrote a comments because I thought no on would be reading them by now
but there’s something that I would like to ask the doctors on this site, something that happens on many episodes including last night’s: House and the team go from one diagnostic to the next until they settle on the right one, but I always thought that they shouldn’t tell the patient what they’re thinking he or she has until they’re sure but on House they always do it, even if it’s cancer or worse
I don’t mind about the ethical stuff because that’s part of the fun on House but isn’t it just being bad doctors do that? even the Colonel complained about it last night
October 6th, 2009 at 9:57 am
@ H
Wait, you’re that naive to believe that if Hitler was killed the world would be a sunnier place nowadays ? Although you haven’t said that last part.
But man the complexity that derives from destroying such a huge pillar in history. It would have changed history drastically. What would be the effect of that ? Better or worse ? We can’t know that for sure, maybe Russia took over the rest of Europe, maybe the Iron Curtain wouldn’t have stand in Berlin, maybe it would have been better. We will never be able to know that since we live in a different timeline. And no timetravel isn’t a option for now or maybe ever, timetravel will have a devastating effect if we don’t know the consequences of it.
It is interesting to see how Chase dealt with the situation but is it really the right thing to do ? Though we ought first to define what right and wrong means since both are subjective terms. But this also rises the question how we can determine what really is right or what’s wrong if it’s subjective. We can’t determine it objectively or absolute but we definitely should try our best than abandon the whole concept of it, for sake of everyone.
In my terms it was wrong what Chase did, why should you ask, because doing right (according to me) means that you need to do your job. Especially as a doctor. Still not really a good argument, dive in deeper. Why should he as a doctor act or know better? His profession describes that he has to try at best to save lives. But this can’t always be the case, the doctor won’t be able to save all the patients he receives.
Does that mean he doesn’t need to try at all or at best ? No, since that will leave more patients dead than if he did his best. You need a objective line, doctors should never kill patients or device a method wherein their care isn’t enough to save a patient. Because else doctors are going to drawn their own lines to when and to who to save only because they had done right things. Different doctors will have different opinions about who did right and wrong and if the patient should be treated. But wait, if this is the case would the doctor doing his profession rightfully? No, would be answer. The objective line is that every doctor should try to save their patients as DrEvil points out with the Hippocratic Oath.
Really I don’t want to come in a hospital and the only doctor refuses to treat me because I did things wrong in his opinion. How could he know ? Has he lived my life ? Has he experienced the things I have ? Has he the same definitions of wrong or right or does he feel the same about the things as I do ? The answer will be no, in other words he won’t be able to answer every question. The same would be if a doctor would in a critical situation and won’t be treated by an other doctor because of difference in opinions ? That’s just wrong. You don’t want that to happen to yourself or anyone else.
/longrant with grammar errors
October 6th, 2009 at 9:58 am
@H
Um, no. If Hitler died before he did any of the horrible things he is known for, I doubt his murderer would be applauded. Until time travel is invented you can’t be guilty of a crime before it’s actually occurred.
October 6th, 2009 at 10:38 am
Great episode! Loved the old team back for a change, and what Chase did in the end was a total shocker. As for the moral/ethical dilemma – truly riveting. I understand posters above who say that doctors cannot be moral judges of what’s right or wrong, but then again somebody has to take a stand. That dictator had ALREADY started to commit genocide. So, Marionette, he is not being judged for crimes “before they occurred” , he’s already doing them. In either case, I hope whatever the developments in the next episodes, at least Chase doesn’t end up in prison.
As for Taub possibly being gone for good, I won’t miss him much. He’s ok but old team + Thirteen as Foreman’s on and off gf works fine for me.
The mirror box technique – pretty interesting as well!
I only wish the rumors about Cameron leaving are not correct (though they probably are). As much as her “niceness” may bug people we need one character like that on a show full of arrogant, dysfunctional and/or misanthropic doctors. Makes for better drama.
October 6th, 2009 at 10:44 am
Hasn’t the mirror box treatment been around for several years? Why wouldn’t that have been tried by then?
I was so thrilled to see that appear on the show. I just recently have found an interest in neurology and psychology after reading “The Man Who Mistook His Wife For a Hat” by Oliver Sacks and “The Brain that Changes Itself” by Norman Droidge. It was a fantastical idea when I read it, then boom there it is on my TV.
October 6th, 2009 at 11:43 am
I’ll admit I payed very little attention to the medicine in this episode, being too distracted by James Earl Jones. I like the ethical quandary, and I’m glad that they’ll be extending it into the next episode at least (and I disagree with DrEvil that Chase’s action violate the Hippocratic Oath on the grounds of political disagreements – genocide is not a political act, it is murder, and it is illegal. Now, one could certainly argue that he violated his oath for other reasons). I can’t say that I don’t have sympathy for Chase’s actions – I went to high school with a boy who barely escaped the Rwandan genocide, and I can’t even comprehend what he went through, but preventing something like that from occurring again, well…
I was wtf-ing a bit at House’s actions towards the downstairs neighbor. Breaking in (and only sort of)? Typical House. Drugging and tying up, even if the ultimate plan was to help him with his phantom limb pain? Really just… not okay.
October 6th, 2009 at 12:09 pm
Linda wrote “somebody had to take a stand. The dictator had ALREADY started to commit genocide”. Well let’s send Jack Bauer to the rescue and if he fails send in “Dr” Chase. Wait a minute. Wouldn’t House call that an oxymoron? Doctor death? Bit like Dr Evil.
October 6th, 2009 at 12:33 pm
I loved the episode like everyone else. I did feel, though, that if the situation in this African country was already close to the tensions of a Rwanda–which was implied–with a long history of hatred between two peoples, then, killing the dictator was not likely to defuse the situation. If his #2 (whom Cameron tried to convince that the dictator was non compos mentis) had seemed likely to reverse the old man’s policies, then Chase’s act might have some meaning. But he’s the guy who located and engineered the co-operation of the girl who had Lassa fever, right?
Then it just becomes a matter of killing the old man because he is evil, and that has no justification (especially for a Catholic, who in principle believes anyone can “convert” no matter how late in life).
However, it also occurs to me that Chase’s method was pretty bizarre. Why not just take the old man’s advice and inject an air bubble? Instead, he cooks up this faked evidence that the man has a disease which, when treated, kills him because of the disease he really has. This method (1) is detectable by autopsy or further tests; (2) might not work because the guy might really have scleroderma; (3) might not work because Foreman is stubborn; (4) if it works, implicates Cameron and Foreman in the crime, deceiving them into urging/consenting to a treatment which kills the patient.
To my mind, House’s kidnapping the guy in pain and showing him it can be cured is by comparison an honorable crime: although Wilson is somewhat at risk, House is really only risking himself, and curing pain is something he understands personally and cares about.
Interesting that it is Foreman, not House, who uncovers Chase’s crime and decides it was honorable (or else simply that he can’t afford to blow the whistle since he himself is implicated). That really should be House’s role.
October 6th, 2009 at 1:12 pm
Hi everyone…
I have two different opinions about the same episode… Just that, makes this episode one of the best ones i’ve seen in House.
I don’t agree with Chase on actually changing the blood samples in order to get the tyrant dead. He’s supposed to be a doctor, not a judge. If doctors start making choices on who’s saved and who doesn’t, then we are all in trouble. We’ll start seeing republicans and democrats hospitals, or black, indian and white hospitals, or spanish, mexican, american hospitals.
The doctor’s job is to save people’s life. That’s it. He did wrong.
On the other hand, I’m from Venezuela, and somehow you guys know that i could be tempted being in the same situation, you know, if by any chance i get to treat the guy in charge here. ;-)
The acting was superb. All the interactions were great. Now, seems to me, that Foreman’s “Epic Fail” is unraveling. He took the wrong call, he’s in trouble with his former girlfriend, and he’s absolutely sure that he won’t be in charge of the Diagnostics Dept in no time at all.
House is back. Good for him… Stay out of drugs, please man!
Heishiro
October 6th, 2009 at 1:14 pm
Hi. Long time lurker, first time poster. I thought this was an awesome episode, and I have to say that I have a big sympathy for Chase’s choice. As for those that say it didn’t help any, Chase states himself that he saw on the news that the moderate party now got spurred by the dictator’s death, and is taking over the country. Might be a bit naive and quickly done there by the writers, but the point they tried to get across to the viewers was that killing the dictator actually helped the country and saved hundreds of thousands of lives. So is it worth it, to kill one man to save hundreds of thousands? Yes, I think it is.
But I have one medical question for the doctors in here, something I see in every episode which bugs me constantly: Every patient, no matter what their sympthoms and conditions are, always have that small tube around their face, stuck in their nose. I assume that is oxygen? Is it standard procedure in US hospital to give every patient oxygen 24/7 no matter what they are suffering from? I might have understood the tub’s purpose, but it just bugs me. I hope someone can help me figure out this.
October 6th, 2009 at 1:17 pm
I can’t believe all those people saying Chase did the right thing! Chase is a DOCTOR for heaven’s sake!! Who died and made him God? His job is to do everything in his power to save his patients, whether they are Hitler or Mother Teresa. Yes, the patient was a monster, but Chase is not his judge, prosecutor or jury. Can you imagine what would happen if doctors saved only the people they liked? House would NEVER do something this moronic.
October 6th, 2009 at 1:23 pm
Official Comment
Anne,
Any patient with any sort of heart or lung ailment — which is most of House’s patients — will be placed on oxygen, at least initially at almost any US hospital.
October 6th, 2009 at 1:28 pm
Thanks, Scott, for the quick reply. I just found it odd as I’ve seen that tube on absolutely every patient in every scene in all the episodes of House.
As for Chase – I do agree that doctor’s shouldn’t decide for themselves to treat or not treat patiens depending on their own moral standards. But in extreme cases such as this, when you have clear evidence that this man is going to perform genocide if he got out again – yes, I think it makes up for it, personally. When it gets that far, I believe you have a moral obligation as a human being that goes above your job as a doctor.
October 6th, 2009 at 2:06 pm
Can you imagine what would happen if doctors saved only the people they liked? House would NEVER do something this moronic.
Actually he did – House didn’t want to treat Stacy’s husband, Mark, simply because Mark was married to Stacy. Cameron & Foreman didn’t want to treat Clarence, the death row inmate (& Foreman only changed his mind when it appeared there was a medical reason for Clarence’s psychopathic behavior). House also covered up Cameron’s euthanasia of Ezra. Whether or not (& how) to treat a patient based on who they were & what degree of autonomy they have in determining their treatment was a consistent theme in s1/2/3 that then got dropped with the new team.
I don’t believe what Chase did was morally right, but I do understand why he did it in this context. And I suspect Dibdala would have respected it at some level – what he didn’t respect was Cameron’s waffling attempts to keep her own hands clean. Plus Chase absolutely knows what he did was wrong & there was a clear signal at the end that he expects to be caught.
October 6th, 2009 at 2:11 pm
What Chase did made him no better than the dictator. You can argue all you want about Chase supposedly doing the right thing but it does not detract from the fact that he murdered the patient with malicious intent. He is a doctor, not judge, jury and executioner. What’s more, he has made Foreman an accessory to the murder.
As an individual, Chase is entitled to his personal views and beliefs. As a doctor, Chase is not entitled to personal views and beliefs. The patient may be an obnoxios, irritating, stubborn moron but a doctor’s duty is to provide the best possible care. If a doctor cannot do this, he should excuse himself which is what Chase should have morally done. Yes, Mr. Dictator was an evil man and he should die BUT think about it carefully, what is he was GWB instead?
In the end, judging a person’s guilt is for the law to decide. Chase basically broke his professional oath, destroy the patient-physician relationship, legally commited a crime and created a diplomatic incident. Now the whole incident has been covered-up just like what would have happened in that african country.
October 6th, 2009 at 2:45 pm
I was kind of disappointed to see Chase do something like that. Actually, disappointment doesn’t even begin to cover it. The Hippocratic Oath might be a bit antiquated (and seems to be very lightly treated on House in general) but the spirit of “Do no harm” seems to be mostly respected. Quite frankly I would like to see Chase (and Foreman as well) hung out to dry now.
On another note, I did notice this was one of the few episodes where one of the regulars was addressed by their first name (Chase calls Cameron “Allison”)
@Hugh L.
It’s not completely unknown to have a lighter if you don’t smoke. Besides, the BOUO apparently came from Hammerspace, so why not a lighter too?
October 6th, 2009 at 3:05 pm
House wouldn’t have done it, but that’s because House only cares about his patients, and only in as much as they are HIS patients.
Chase was in a bind. He had several choices
1) Help save the evil dictator and be partially responsible for the deaths of millions
2) Refuse to help save the evil dictator and be fired. Evil dictator may survive anyway, but blood isn’t on Chase’s hands.
3) Kill the evil dictator openly and be jailed (and also make a martyr out of the dictator)
4) What he did — kill him in some sneaky way.
Chase chose the sneaky option, which fits his character, but I’m not so sure it wasn’t the best; note that Cameron, normally the show’s moral compass, chose a similar option! The duties of a doctor would seem to demand option 1, but I don’t think it’s that simple.
October 6th, 2009 at 3:30 pm
I question the use of blood to treat Lassa fever. Even if the girl had antibodies in her blood to fight the disease (which was rejected in the differential) wouldn’t they have to check her blood type? I’m not a doctor or in the medical profession, I’m just a huge fan of the show, but if they actually pursued this route wouldn’t they need to know both his and her blood type to prevent rejection?
October 6th, 2009 at 3:54 pm
Dr House (Season 2, defending treating a guy on Deathrow): “Good question. What makes a patient deserving? Is a man who cheats on his wife more deserving than a man who kills his wife? What about a child molester? Certainly not a good guy but he didn’t kill anybody? Maybe he can get antibiotics but no MRIs. What about you (Foreman)? What medical care should you be denied for being a car thief?”. Outside the room Chase says, “I’m against the death penalty in principle.”
October 6th, 2009 at 3:57 pm
@oxymoron
“What Chase did made him no better than the dictator. You can argue all you want about Chase supposedly doing the right thing but it does not detract from the fact that he murdered the patient with malicious intent. He is a doctor, not judge, jury and executioner. What’s more, he has made Foreman an accessory to the murder.
As an individual, Chase is entitled to his personal views and beliefs. As a doctor, Chase is not entitled to personal views and beliefs. The patient may be an obnoxios, irritating, stubborn moron but a doctor’s duty is to provide the best possible care.”
This is true, but why do we have these rules in the first place? So that medical care can be provided in a way that ensures the value of life is maximised, by preventing unreasonable discrimination? If so then what counts is ultimately the preservation of life; and if a different set of rules allow us to better preserve life, then we should be willing to adopt them.
In this regard I would argue that, under these terms, if the choice is between a world in which one person dies (the evil dictator) or a world in which tens of thousands of people die, we should go for the former. If we care about preserving life, then we should also be willing to take it, where there is no other option. Otherwise, what we care about is not preserving life, but ‘keeping our hands clean’, nomatter what the cost to others.
Of course you’re right that a system that allows people to make these kinds of decisions, might create more death and suffering overall. So maybe we should punish Chase for what he’s done, to prevent others from taking their patients’ lives into their own hands. Nevertheless, that doesn’t mean that Chase’s particular decision was morally wrong; indeed if tens of thousands of lives were saved as a result then I would argue that it was the right thing to do. It was just a decision that involved great personal sacrifice.
October 6th, 2009 at 4:03 pm
Shocking Dibala seemed bizarre to me too, and IANAD. However, I thought that maybe they were doing it just to put on a show for Dibala’s lackeys – to convince them that they had made every effort to save him.
October 6th, 2009 at 4:04 pm
But Chase didn’t enforce a “death penalty” for the crimes the dictator had already comitted. He did it to save the hundreds of thouands the man was going to kill. And that is far, far away from only treating patients you like, as has been mentioned earlier in this thread.
October 6th, 2009 at 4:12 pm
Outside the room Chase says, “I’m against the death penalty in principle.”
DrEvil, you need to finish what Chase says. He also says when push comes to shove he’s not losing sleep over people being executed & that he’ll do whats pragmatic, which there is not pissing off hiss boss, & making sure Clarence goes back to death row.
October 6th, 2009 at 4:12 pm
It’s slightly unfair to compare Chase’s opinion on the death penalty to Chase’s actions in this episode. Far be it from me to judge him right or wrong: I certainly don’t think he had the right to make that decision, but then again he was one of the only people in the position to do so. You can argue principles and morals and rights until the cows come home, but this was an extraordinary set of circumstances and unfortunately every principle held by any person will have its breaking point.
However, that’s not the issue I wanted to raise here. Chase’s opinion on the death penalty is based on the choice between killing an inmate and letting them remain alive in prison. Granted that the inmate poses some risk to others even while imprisoned, but in general, it is the choice between killing somebody because he has murdered somebody else, or simply ensuring that he does not have opportunity to do it again. Chase chose here to kill Dibala in order to prevent a future, and almost certain, genocide. Had he been given the additional option of having the guy locked up and removed from society, let alone power, I’m fairly certain that he wouldn’t have chosen the fake blood results murder. So it isn’t fair to imply that he is a hypocrite simply because he disagrees with the death penalty.
October 6th, 2009 at 4:33 pm
A very ballsy show. How boring the soap opera would be, without the constant, massive felonies.
They’ll probably never top when Cancer Girl tricked Chase into making out with her (that’s something you’d never see in a million years on any other show), but it still manages to entertain regardless.
October 6th, 2009 at 4:49 pm
@ DrEvil
The death row guy would not necessarily kill anymore people after being cured, at least he did not intend to but the dictator implied that he would commit genocide. So comparing the two cases is just plain stupid.
@ Marionette
By 1938 nobody had any illusions about Hitler. If somebody who has the means to do it threatens genocide and you can not use any civil means to stop him/her (like a trial, …) then killing him/her is a moral obligation. The fact that somebody might fill in his place and carry out that act is just ridiculous. Imagine someone not stopping a child rape saying “well chances are the kid is going to get raped by someone else anyway”. I am astonished and very troubled that people condemn Chase for a courageous moral act.
RE: Hippocratic Oath
The oath says do no harm and curing the dictator was going to do a great deal of harm. Also when you take an oath that does not suspend your moral obligations. A soldier takes an oath to be loyal to the king, now if the king orders him to kill civilians should he say oh well I had an oath so I can not refrain from shooting people? Of course not and after the revolution the soldier should rightly be tried in a court.
My sense is people who are appalled by what Chase did are basically in Cameron’s camp. In other words they know the right thing to do is to kill the dictator but they are too cowardly to do it so they hide behind Hippocratic oath or another equally crappy rationalization.
October 6th, 2009 at 5:31 pm
A great episode. I came out of it so angry with Chase on so many levels. Rant follows… Whether Chase’s action was right or wrong morally (utterly wrong IMHO) it was despicable in its method. If a doctor (or anyone) decides to act in a way they know to be morally questionable ‘for the greater good’ they should have to courage to act on their own. Chase involved Foreman (making the treatment decision) Cameron (to persuade Foreman – great speech btw), the lab techs who might be expected to spot the blood didn’t match blood from previous tests done for that patient etc, etc. And given that just hours earlier he was telling Cameron it was the wrong thing to do, its just too impulsive for a trained mind to switch positions that quickly and irrevocably without stopping a few days to consider it deeply.
its a long time since i got so motivated by an episode content.
James Earl Jones – magnificent & powerful.
Foreman – way predictable.
House – good to great – loved the mime.
13 – little screen time but strong emotionally
October 6th, 2009 at 5:46 pm
Fantastic episode! I was a bit apprehensive after the last one, but I was amazed!
As for Chase’s moral dilemma, he has shown his stance on euthanasia previously, in season 3’s “Informed Consent”, when he stayed while House intended to give the lethal dose of morphine. Though not the same as this episode, it shows that Chase acts on what he believes is right without regard to the Hippocratic Oath.
October 6th, 2009 at 5:58 pm
@ Barry D. Johnson:
What exactly does this mean please?
“Besides, the BOUO apparently came from Hammerspace, so why not a lighter too?” – Somehow I think you may be referring to marijuana but I don’t want to assume so please enlighten me… :)
October 6th, 2009 at 6:00 pm
Actually I just remembered, BOUO = Ball Of Unknown Origin…Silly me for the wrong reference…
October 6th, 2009 at 6:25 pm
@ Bryce
Lassa fever was brought up and rejected not once, but several times during the differential, before House managed to bring Foreman around, in a way.
They’re only going to use the woman’s plasma for the antibodies; blood type is an attribute of red blood cells, but not plasma (if I’m remembering right).
October 6th, 2009 at 6:30 pm
@Anne et al. Perhaps I have the added advantage of knowing history. I seem to recall a certain African dictator in the 60s who left to attend an international conference. The government was changed before he could return and no death was necessary. Chase has convinced himself and apparently many on this page he was the only hope ignoring 113 countries contributing 88,862 military troops, police & observers towards the United Nations CAO, Force command and Secretary General. Still unconvinced.
October 6th, 2009 at 6:42 pm
awesome episode, favorite in a while.
also, the dude from oz (tobias beecher) is going to be in the next episode!!! not the patient, but still. awesome.
October 6th, 2009 at 6:57 pm
Dr. Scott, thank you for your medical insights. I have just one question about this episode. Dibala was afraid Cameron was going to inject him with an air bubble. Would this really kill a patient?
October 6th, 2009 at 7:55 pm
I barely watch House anymore (although I come here after each episode to read the critique; it’s fun!), but I watched last night with my roommate. I was barely paying attention until I heard that the team was attributing the eye problem to a lymph node of the retinal vein.
I work at an eye research institute, in a lab that works almost completely on the retinal vasculature. One of my coworkers is a post-doc. What is she researching? What pathways are responsible for the LACK of lymphatics in the retina. There IS no lymph node for the retinal vein, unless my entire lab has missed some important, new information about the retina.
October 6th, 2009 at 8:06 pm
Life in Zamunda really went downhill after the Rebels assassinated Eddie Murphy.
October 6th, 2009 at 8:13 pm
Much to ponder….
Was Chase right or wrong to do what he did?
Here’s an analogy… what if Chase had been a German doctor in 1939, and he had to treat Adolf Hitler. And then he did the same thing to Hitler that his character did to Dibala?
Would that have been wrong? Even if it saved millions of lives?
October 6th, 2009 at 8:15 pm
Mirror therapy is a very effective technique best used in conjunction with graded motor imagery which is a sequential process of laterality reconstruction, motor imagery and mirror therapy.
Check out the website – http://www.gradedmotorimagery.com
A quick 7 minute video with all the basic mirror therapy questions answered. Worth a look!
http://www.youtube.com/watch?v=hMBA15Hu35M
Cheers, Tom
http://www.noigroup.com
October 6th, 2009 at 8:26 pm
@Matt from MI
He wasnt necessarily afraid that she would inject an air bubble, he told her that if she wanted him dead, then he should inject an air bubble. In other words, have the guts to kill him directly, dont lie to his generals and hope they take him out for her.
October 6th, 2009 at 8:45 pm
A.– House smoked a cigar at the end of the episode with the poker tournament, lighter mystery solved.
B.–”The needs of the many outweigh the needs of the one” is an oversimplification in this case. I assume no one would argue here that it would be justified to intentionally kill an innocent person (lets say a 2 year old) if killing that person would somehow lead to a cure for cancer. Therefore, it is reasonable to conclude that Chase did not act out of altruism. Chase tried to help keep the guy alive until he confronted Cameron. Chase was acting out of vengeance, plain and simple. His speech to Foreman was just a rationalization.
October 6th, 2009 at 9:41 pm
Um, I didn’t say this before, because I thought it was obvious: Chase committed murder. Even worse, he committed murder in the context of a fiduciary relationship. New Jersey allows for the death penalty: I would definitely try this as a capitol offense.
The point is made about killing a Hitler, by whatever means. If you feel Hitler is so above societal conventions and laws that he allows you to skirt them then I have to tell you to stop worshiping Hitler. On the practical level, you kill Hitler, so you can possibly accept Himmler as the Fuhrer?
I have always said that no one ever considered assassinating George W Bush for more than 20 seconds: the thought of President Cheney reared it’s horrible head and that was that.
October 6th, 2009 at 10:29 pm
I have to agree with The Soff – Chase really screwed the pooch. And he had no way of predicting the result of his actions. I don’t think there’s any chance of him hiding the falsified results of the anticentromere antibodies test if an autopsy is performed.
I think Chase’ actions were a little out of the ordinary for his character. He was always the one who didn’t care. That bugged me a little.
October 6th, 2009 at 10:44 pm
@ The Soff
As I said just b/c Himmler might have continued the Jewish extermination does not mean that we should not take action against Hitler. That is an absurd argument. Also I don’t remember G. W. Bush ever even being accused of genocide (except maybe by some lunatic hippie). So your two examples are basically irrelevant.
October 6th, 2009 at 10:45 pm
Did anybody not notice the inside joke when House chided Foreman about his “breakup” w/ 13? The best line in this episode in a reference to numerous real-world mags listing Olivia Wilde as the hottest woman in the world (ie: Maxim), stated “it’s not like she’s the hottest woman in the world or anything.” Hi-larious
October 6th, 2009 at 10:47 pm
@ EJW (Part B)
Dude, in your hypothetical the 2 year old is not killing anybody, Cancer is and that is the major difference. Also Chase killing the dictator b/c of his behavior towards Cameron seems totally absurd.
October 6th, 2009 at 10:52 pm
@ DrEvil
“@Anne et al. Perhaps I have the added advantage of knowing history. I seem to recall a certain African dictator in the 60s who left to attend an international conference. The government was changed before he could return and no death was necessary. Chase has convinced himself and apparently many on this page he was the only hope ignoring 113 countries contributing 88,862 military troops, police & observers towards the United Nations CAO, Force command and Secretary General. Still unconvinced.”
Given that how many dictators come to UN every year and then go back to their country with no problems I would say the chance of a bloodless overthrow while the dictator is in the US is basically zero.
October 6th, 2009 at 11:50 pm
@The Soff
“New Jersey allows for the death penalty”
Not anymore. It was revoked a year or two back.
(And nobody had been executed since it was reinstated anyway.)
October 7th, 2009 at 12:39 am
Bryce; I’m not a doctor and not familiar with Lassa Fever, but I’m pretty certain they got the idea from a real life treatment (basically the ONLY treatment) for Ebola.
October 7th, 2009 at 1:32 am
@H: “Given that how many dictators come to UN every year and then go back to their country…etc” Now who’s being stupid? Do you have a figure for how many dictators are being invited to the UN annually and then returning to commit genocide oblivious to the rest of us? And how do you arrive at a statistical probability of “zero” when I have factual historical precedent? Many have argued here that if there were an alternative they may not support Chase’s action and i’ve given one. Need more?
October 7th, 2009 at 1:53 am
In addition to the 89000 people who’s actual Job IS “peacekeeping” perhaps someone can explain why Chase feels a disproportionate share of the moral burden as one doctor? Totally absurd.
October 7th, 2009 at 2:14 am
Nybbler
“House wouldn’t have done it, but that’s because House only cares about his patients, and only in as much as they are HIS patients.
Chase was in a bind. He had several choices
1) Help save the evil dictator and be partially responsible for the deaths of millions
2) Refuse to help save the evil dictator and be fired. Evil dictator may survive anyway, but blood isn’t on Chase’s hands.
3) Kill the evil dictator openly and be jailed (and also make a martyr out of the dictator)
4) What he did — kill him in some sneaky way.”
On one hand you sound a bit like House on the other – you seem to forget that there is always another option and one should not be narrowsided. How about this one:
5) Refuse to treat the patient at all from the very beginning – he might die, he might not – both cases not his problem and certainly not his responsability. Once he chose to TREAT however – there is no place for zig-zags. You treat you do not kill. There is a verry interesting side to my own specialty btw – a dental doctor (at least here in Bulgaria) is not obligated to treat unless and I quote directly our ethical codex here: “The refusal to treat is going to produce permanent harm to the patient or if the patient is in pain or if his general health and well-being are treatened if no action is taken.” That basically mean that I can refuse treatment – and I did – if I dissagree with the patient I do not like him in some way, or if it is 2:30 in the morning and I feel tired. I measure the gravity and urgency of the situation and make the decision. Once made it is done however – you treat you do not kill. So even with all the reasons he had Chase still did the wrong thing – he might have done the wrong thing for the right reasons but he did wrong anyway.
October 7th, 2009 at 2:23 am
Nearly forgot to mention – why oh why so many people place the responsability for the deaths of millions in chases hands? He is not God and he cannot be directly responsable for the fate of people in Africa. If he wants to be that – go in Doctors without borders become politician becaome an activist become a writer or a journalist do whatever you can to stop Genoside. If however you chose to become a doctor that you have the responsabilities of a doctor – and that is to treat people. And I am fairly surprised nobody even mentioned lawyers here – what if they know that the criminal is a mass murderer and guilty they shoud forget their duty and profession and make sure he is hanged drowned and quatered? Interesting idea that from all Chase defenders – let us all be moral judges and decide about life and death all the time. May be Cmaeron was a hipocrit and CHAse did the right thing here (and whoever said it we who are condemning Chase for his actions are hipocrits as well) but I cannot forget what House said once about Jews who follow tratditions only from time to time whenever it seems apropriate – “Do it all, do nothing or option C you are a lier and a hippocrite.” Chase is either a good doctor and a crappy freedom fighter or the other way around – or in his case option C he is a lier and a Hippocrite.
October 7th, 2009 at 4:35 am
@ H
You’re even changing the meaning of the Hippocratic oath now to back up your argument? Seriously? Well, since I’m Greek and Hippocrates was a Greek physician, let me know the meaning a little better than you. ‘Do no harm’ refers ONLY to a doctor’s patients. Chase, as a doctor, had a moral obligation to his patient, not to the people his patient would kill.
My country has a legal system for the last 2600 years. Believe it or not, even dictators have a right to a fair trial. And no, I’m not on Cameron’s side either. Do not assume everyone on this forum would commit murder if they had the guts or knew they would get away with it.
What Chase did doesn’t make him any better than the dictator. It’s very easy to judge and condemn someone from the comfort and security of your own home and workplace, which are thousands of miles away from that African Country and what you know is from TV. At least, the man who tried to kill Dibala had a reason. He had seen the atrocities first hand and even done them himself.
What’s worse, Chase wasn’t acting as a person with different personal beliefs. He was acting as a doctor. If he went in the room with a gun, shot Dibala in the head and turned himself in, that would at least be honest. He could have said ‘I killed him as a simple man who doesn’t agree with Dibala’s actions’. Instead, he used the knowlegde he acquired from his studies. Everything he was taught in order to save lives, he used it to end one. That’s what makes his action even more appaling.
October 7th, 2009 at 6:58 am
Way best episode in a long time, thanks to many things…return of the old crew, terrific performance by James Earl Jones, some great NONVERBAL humor by High Laurie
I was seeking an explanation of the mirror box when I saw the show. I thought that it somehow involved another amazing House diagnosis (thank you, Scott, for clearing that up), but it sounds like this is a treatment thing someone should have done a long time ago.
October 7th, 2009 at 7:04 am
H
I’m not so certain, Chase did the right thing. The whole medicine – ethical aspect aside, we have seen the other guy talking to Cameron about the prospects of the president – he seemed pretty ruthless to me. So I don’t see democracy coming, rather the opposite. (the dictator himself seemed to imply this, but he was a bit paranoid, like all dictators).
What I cannot accept is the easiness of the solution – the peace process is immediately possible, after the death of the dictator. One person responsible for all evil. Eliminate the person – the evil is gone. It just never goes like this (except in Hollywood action movies, that is). Russians for example learned that lesson in a tough way. They killed the tzar and the other one was far more brutal. What if Dibala’s troops and opposition start a bloody civil war instead of peace process? I actually believe this is far more likely. So Chase’s argument, that he saved millions doesn’t make sense to me – how can he be so certain? The opposite is just as possible.
What happened is that Chase acted exactly like the dictator – just on a smaller scale. Dibala also honestly believed he did what was necessary do protect his people and country from immediate danger. The impact his decision had was a lot bigger, while with Chase it ended with a single death – the following bloodbath hugely likely.
Dibala himself was an ambiguous character. He admitted that he’d made a mistake in the past and it ended really badly – something Hitler or Stalin wouldn’t be capable of admitting.
Plus – but I may be mistaken there, as English is not my mother language – he came to States to address the UN – does this mean he was to respond to the genocide accusation?
October 7th, 2009 at 7:28 am
Re the mirror box – someone’s seen VS Ramachandran on TED!
October 7th, 2009 at 8:02 am
A genuinely thought-provoking episode! A rare treat on network TV.
Would any jury convict Chase?
I can see him losing his licence, but I doubt that he’d ever go to prison. On the contrary, he could sell his story to Hollywood and make a fortune.
October 7th, 2009 at 8:09 am
“What’s worse, Chase wasn’t acting as a person with different personal beliefs. He was acting as a doctor. If he went in the room with a gun, shot Dibala in the head and turned himself in, that would at least be honest. He could have said ‘I killed him as a simple man who doesn’t agree with Dibala’s actions’. Instead, he used the knowlegde he acquired from his studies. Everything he was taught in order to save lives, he used it to end one. That’s what makes his action even more appaling.”
You make it sound as if Chase’s duties as a doctor transcend all other duties and responsabilities. As if, as long as he complies with these duties, he’s in the clear, nomatter how much death and suffering his actions create. As if the ‘code’ itself is what counts, not the preservation of life of the prevention of suffering: and if our decisions condemn tens of thousands to death, then so be it.
I ask the question: What’s more important, saving life, or upholding your professional obligations as a doctor?
October 7th, 2009 at 9:26 am
“the lab techs who might be expected to spot the blood didn’t match blood from previous tests done for that patient etc, etc.”
I was thinking of that yesterday, and then I remembered – silly viewers, the Cottages always perform their own blood tests! There’s no such thing as lab techs in House-land. LOL My first thought was “How did he get away with presenting a dead woman’s blood for testing and get away with it?” but then I remembered that they always run everything themselves.
And right or wrong, I don’t agree that Chase was acting out of revenge for the way Dibala treated Cameron. It was Dibala’s words afterward – I forget now what all he said – that showed Chase just how evil this man truly was. He had made Chase doubt earlier by glossing over and explaining away previous problems (the Youth League wasn’t his fault, it was other bad men who’d let it get that way, yadda yadda) but now his true character was shining through. You could see it in Chase’s eyes – I thought I understood this guy, but now I see the truth.
I agree he was upset about the way Dibala grabbed Cameron and spoke to her, but in the end that had nothing to do with his decision.
October 7th, 2009 at 9:39 am
As I remember it, Chase decided to kill the dictator when Dibala declared that his enemies were “cockroaches” that would be exterminated.
Before that, Chase had deluded himself into thinking that the stories about Dibala were exaggerated. This is how many people outside Germany viewed Hitler in 1938.
October 7th, 2009 at 10:18 am
i can’t comment about medicine but the layers of moral dillemma and the various character interactions and reactions were absolutely brillant! i love that other characters are being developed in such an interesting way, especially chase, who was qutie stagnant throughout the last season.
the moral dillemma was particularily captivating, life is sacred, but, is it morally justifiable to end someone’s life if you know that person is going to cause more death if he lives? very engaging
October 7th, 2009 at 11:11 am
NB the Hutu-Tutsi wars are still going on, under the moderate leader who ended the 1994 slaughter when he came to power in Rwanda:
http://www.nybooks.com/articles/23054
I remember in the early 90s my son’s geography book noted that Rwanda (or Burundi) had the densest population and lowest per capita income of any country in the world. If Chase wants to do something about Dibala’s country it might be a good idea to start with birth control.
I thought the House writers worked very hard to make it clear that Chase’s decision was not a simple matter of blasting the monster and winning the game. Dibala shows a variety of faces: his friendly comment on Chase’s accent, his fierce dignity in addressing Cameron about her discrediting him, his recital of the history of the conflict and his hopes for his country, as well as the cockroaches dialogue. His people also show a variety of faces: the the assassin, the plasma donor, and the #2 guy. This was not a simple choice between killing Dibala and sponsoring genocide. (Before Spock, there was the trial of Christ in which a high priest said that it was a good idea to sacrifice the one for the many.)
Chase’s method was tentative (very uncertain, and if successful but discovered could backfire horribly) and unethical (implicating the whole team and hospital if he was found out).
October 7th, 2009 at 11:36 am
@ H:
No, killing Hitler, or any other dictator would not be a moral action. Even if the guy is about to kill someone else/many other people, killing him to prevent it is still murder.
Self defense is the only way you can kill someone without committing an immoral action. Chase was not in a position of self defense. what he did was outright murder, and immoral.
I am not defending genocidal dictators or any such thing. It’s just a fact.
October 7th, 2009 at 12:10 pm
What I kinda wish this ep had done is end the way the M*A*S*H ep, “Preventive Medicine” did. In that ep, Hawkeye Pierce decide to perform an unnecessary appendectomy on a general who has brought the 4077th way too many wounded. BJ Hunnicutt refused to join Pierce in performing the surgery, telling Hawkeye he has no right to play god. The ep ends with Hawkeye having performed the surgery, on to have more wounded come in. BJ tells Pierce, “You cured the symptom. The disease rolls merrily on.” (Or words to that effect.) This is all Chase has done. He cured a symptom. But there will always be dictators. And it’s quite possible that Dibala will be replaced by one just as bad. Or maybe even worse. It’d be nice if a future hints at this.
I have also realized that this ep, “The Tyrant”, gives the creators one possible way to write Cameron out – she takes “credit” for killing Dibala, sacrificing herself for her husband. I doubt this is how they write her out, but it is one possibility.
October 7th, 2009 at 1:05 pm
I was expecting to see one of his generals to take over the dictator’s place and keep the genocide going, instead of the fairy-taled “the moderates are taking over, there is a chance for peace!”. That would have showed how meaningless (appart from immoral) Chase action would have been.
Hoping for too much I guess.
October 7th, 2009 at 1:11 pm
If there is an investigation of Dibala’s death, would the investigators expect to see the samples that Chase et al. used in the diagnosis? Specifically, wouldn’t they expect to find a sample of Dibala’s blood that will test positive for scleroderma? What might happen when they learn that “the sample has disappeared”?
If Chase is tried for murder, will it matter that he is (as far as we know) an Australian citizen?
October 7th, 2009 at 2:28 pm
I’m almost positive Chase can’t be charged with murder. Manslaughter, perhaps, but honestly at best he’d get hit with a giant malpractice suit, and possibly lose his license. About all you can actually prove is that he botched a blood test. The guy who days before helped stop an assassination attempt. There’s no way he’d ever be found guilty of murder even if charged.
October 7th, 2009 at 2:30 pm
“No, killing Hitler, or any other dictator would not be a moral action. Even if the guy is about to kill someone else/many other people, killing him to prevent it is still murder.
Self defense is the only way you can kill someone without committing an immoral action. Chase was not in a position of self defense. what he did was outright murder, and immoral.
I am not defending genocidal dictators or any such thing. It’s just a fact.”
It’s not a fact; it’s a contentious moral claim, and one many philosophers would disagree with. If murder is wrong because of the outcome – i.e loss of life, it creates, then why does it make sense to favour a decision that would lead to the net loss of thousands of lives?
Surely in these circumstances, when choosing between a world with less death or a world with more death, we’re obligated to select the former, even if it means getting our hands dirty.
October 7th, 2009 at 3:19 pm
Chase would never have done something like this, he has always been a coward. Anyway, how is he so well documented on what the dictator has and has not done, how is he so intelligent to know what other people could have lead the country and what would that have brought. From the looks of it it wasn’t even clear if the leader was evil or not, let alone if killing him can be justified or not! Chase would (could) never ever have done this. I think this was poor writing. I have to say I liked the first two episodes more than this, comeback of old team notwithstanding.
October 7th, 2009 at 3:30 pm
“It’s not a fact; it’s a contentious moral claim, and one many philosophers would disagree with.”
Which philosophers would disagree? I don’t believe there are many who argue in favor of cold-blooded murder as a moral act.
“If murder is wrong because of the outcome – i.e loss of life, it creates, then why does it make sense to favour a decision that would lead to the net loss of thousands of lives?”
Chase’s decision caused the death of one person. Whether he saved any lives or condemned billions to death is unknowable.
October 7th, 2009 at 3:42 pm
My point was that Chase engaged himself in an area outside his expertise and obligations as a doctor. Politics. (Foreign politics). The ramifications (obvious to a politician but less to a civilian doctor) may now include increased terrorist attacks, Health worker abductions, inability to
deliver and distribute aid in Africa because thanks to Chase health workers are now targets (resulting in more women and children dying). I could go on but I hope the picture’s becoming clear.
October 7th, 2009 at 3:44 pm
I was surprised by this episode.
1.House was apologising a lot.
2.Patient died.
3.Patients *supposedly* killed by Chase.
4.Foreman being an ass =)
5.Mirror box.
I think that if autopsy will reveal that Chase has nothing to do with patients death – it would be a nice twist.
Scene with House helping that veteran – it was very nice. As for time that a person with phantom pain should spend on the Box – i think that such fast treatment wasn’t *just* for sake of the episode – it was due to the fact that House stressed him. This guy scared and all – and adrenalin pumps up, andorfin pumps up – energy floats faster and all… (or something like that) so this thing worked.
October 7th, 2009 at 4:05 pm
By the way, people talk a lot about lupus being a recurrent diagnosis guess in House, but I think sarcoidosis is beating it by now.
October 7th, 2009 at 4:39 pm
“Which philosophers would disagree? I don’t believe there are many who argue in favor of cold-blooded murder as a moral act.”
Murder under most circumstances *is* immoral, and I don’t think many would argue otherwise. The question arises, when by murdering one person, you can prevent others from being murdered.
If you’re a consequentialist, you believe that murder is wrong, because of the *outcome* it creates (loss of life), so we should do what we can to minimise the number of people who are murdered; which in very exceptional circumstances may involve murdering others.
Deontologists on the other hand believe that breaking moral rules (such as those against murder) is in some way intrinsically wrong, so that even if less rules would be broken overall, by us breaking them in particular cases, we are not permitted to do so. The problem with this perspective however is that it does not allow us to easily isolate where the ‘wrongness’ of breaking moral rules comes from.
Why am I prohibited from breaking the rules, if it will prevent others from doing the same, and lead to more ‘compliance’ overall? That’s the question I posed, and to which I haven’t received a satisfactory answer.
“Chase’s decision caused the death of one person. Whether he saved any lives or condemned billions to death is unknowable.”
It’s knowable after the fact, at least. So we can retroactively assess Chase’s actions, to see whether they were ‘justified’.
Of course from Chase’s perspective things are different: he has to weigh up the potential possibility of saving tens of thousands against the near certainty of killing one. I don’t there’s an easy way to make that call.
What I’m saying is, we should imagine the situation as if we could save one life, or potentially save ten thousand. Suppose we know we can rescue a single stranded survivor, or, take a different course, and abandon him, but potentially save ten thousand people instead.
In every situation should we save the single person? Would you blame someone for not making that choice?
October 7th, 2009 at 6:07 pm
I have to agree w/ DrEvil on this one.
“The ramifications may now include increased terrorist attacks, Health worker abductions, inability to deliver and distribute aid in Africa because thanks to Chase health workers are now targets”
All probably very real possibilities as we have seen real life parallels to this in places like Rawanda, Somalia, Darfur, the Sandanistas, etc….
In this instance the only way Chase could have even begun to justify this is if he had airtight 100% certain knowledge that by eliminating Dibala someone more ‘pro peace’ would slide right in and assume immediate control of the country and begin to curb the inevitable rise in civil unrest that his death/assassination (let’s call it what it is folks….) will cause.
Hearing from a 3rd party that now more “moderate” forces MAY be able to take control, well that’s not a certainty by any means and ties in to the scenario of someone WORSE then Dibala coming to power if he lost an election. So Chase rolled the dice in a big way and may have lost more then a part of his humanity as a result of his playing ‘god’ not with one man’s life but with a whole country!
Chase may have done a very WRONG thing for what are being perceived here by some as the RIGHT REASONS but at the end of the day, Chase doesn’t live in that country and he certainly doesn’t have to deal with the political as well as social issues his brand of “Diplomacy” may have brought to the region as a destabilizing force.
Kinda like when bomber pilots feel ‘disconnected’ when they drop bombs knowing there will be civilian casualties because they are not up close and personal to the chaos and human misery they cause.. Chase had & has no idea what the long term ‘human cost’ will be for his personal act of moral consciousness..
A fitting scenario would be for Chase and Foreman to be sentenced to live in Dibala’s home Village for a couple of years, to get a taste of the life that Chase (and Foreman when he became a part of the conspiracy by staying silent) decided those people should have….
October 7th, 2009 at 6:57 pm
I loved this episode, aside from one minor (ok, actually it was pretty major) thing… Chase basically KILLING the patient on purpose (and indirectly)…and THEN, Foreman trying to cover it up!
It’s been in House’s nature to do completely immoral or illegal things in order to save his patients (breaking into the patient’s home, anyone?)
Chase though…I’d like to ask a question, Scott:
Assuming for a moment that House was real life, isn’t it against basically EVERY oath you take as a doctor to mislead a diagnosis or stall for time, hoping the patient would die in the meantime? (Which is exactly what Chase did.)
And let’s say he really hated the patient (which he obviously did towards the end) … wouldn’t you recuse yourself from the case, citing that you don’t agree with things he’s done, and therefore are unwilling to be his caretaker? I’m sure it’s a legitimate concern, and you wouldn’t likely be fired for something like that.
I understand it’s partly a soap opera (and damn good one at that), but really…it’s so much simpler to ask to be excused from a case than to go out and do something completely illegal (and probably mostly immoral as well, depending on your views.)
In fact, Cameron refused to care for Ezra Powell back in “Informed Consent” from season 3.
Otherwise, this was a great episode, and as usual, thanks for the medical info, Scott!
-Bryan
October 7th, 2009 at 7:42 pm
I’m just too dissapointed, my all time favourite villain again was killed without any consequences
October 7th, 2009 at 10:34 pm
“Murder under most circumstances *is* immoral, and I don’t think many would argue otherwise. The question arises, when by murdering one person, you can prevent others from being murdered.”
Can you? Maybe you can link me to a good argument for this. I’ve read some hypothetical scenarios where an individual gets to kill an innocent because s/he somehow knows that an atrocity is about to be committed and there’s no time to consult with others. It’s the “somehow knowing” that bothers me.
I’ll probably have to watch the episode again, but it didn’t seem to me that Chase had any special knowledge of the situation that entitled him to act on his own.
“If you’re a consequentialist, you believe that murder is wrong, because of the *outcome* it creates (loss of life), so we should do what we can to minimise the number of people who are murdered; which in very exceptional circumstances may involve murdering others.”
I think I understand the general idea well enough. The details always seem to involve committing murder for the sake of saving people who might perhaps have been murdered otherwise. I’m just not comfortable leaving this kind of decision up to random individuals. If you’re going to do this sort of thing, it’s only fair that you face a judge and jury afterwards and convince them that you’ve actually prevented murder by committing it yourself.
“Deontologists on the other hand believe that breaking moral rules (such as those against murder) is in some way intrinsically wrong, so that even if less rules would be broken overall, by us breaking them in particular cases, we are not permitted to do so. The problem with this perspective however is that it does not allow us to easily isolate where the ‘wrongness’ of breaking moral rules comes from.”
I’ve never been able to make sense of this.
“Why am I prohibited from breaking the rules, if it will prevent others from doing the same, and lead to more ‘compliance’ overall? That’s the question I posed, and to which I haven’t received a satisfactory answer.”
Personally, I don’t have any problem with you breaking the rules, as long as you don’t hurt anyone.
“It’s knowable after the fact, at least. So we can retroactively assess Chase’s actions, to see whether they were ‘justified’.”
I don’t think you can do this. You would need to compare the “averted” future (which Chase has destroyed) to the one that actually happened. Even if you can, I’d prefer justification first, then murder.
“Of course from Chase’s perspective things are different: he has to weigh up the potential possibility of saving tens of thousands against the near certainty of killing one. I don’t there’s an easy way to make that call.”
No it’s not easy, and I don’t think it was his call to make. It’s a job for governments and international organizations, not one ill-informed medical doctor acting alone.
“What I’m saying is, we should imagine the situation as if we could save one life, or potentially save ten thousand. Suppose we know we can rescue a single stranded survivor, or, take a different course, and abandon him, but potentially save ten thousand people instead.
In every situation should we save the single person? Would you blame someone for not making that choice?”
The worst that can happen in this case, barring comical mishaps, is that you fail to save anyone. There wouldn’t be any blame to distribute unless you had some obligation to save at least one. I guess it’s probably better to save the one you’re sure of, but I’d be tempted to try for the ten thousand.
October 8th, 2009 at 12:29 am
Wow, wonderful episode. Best in a really really long time.
@oxymoron
What’s more, he has made Foreman an accessory to the murder.
Not to be a nitpick, but I’d just like to say Chase didn’t make Foreman become an accessory for murder. After finding the facts, Foreman chose entirely in his own free will to be. Sure, he’d rather not be in that position, but he had a choice.
Also, I’m personally surprised at the amount of disagreement to Chase’s decision. I found it to be a lot like Cuddy’s initial dilemma about the donation of the blood (something along the lines of “I’d rather have a pin-prick on my conscious than the blood of her family”). I know the magnitude is much much more extreme, but the underlying logic is the same. What would you rather live with, morality wise?
October 8th, 2009 at 12:42 am
The twist at the end certainly was a shocker. I’d heard a rumor that Chase would figure more prominently this season, but I didn’t expect it to happen quite that way.
What a classic setup: Character A half-wishes aloud that someone would die, character B chides character A for feeling that way, then character B is the one who actually makes it happen.
But what if Cameron really was responsible for Dibala’s death, and Chase is covering up for her? (Just a thought.)
October 8th, 2009 at 1:12 am
Moral absolutism is boring.
October 8th, 2009 at 3:18 am
“I guess it’s probably better to save the one you’re sure of, but I’d be tempted to try for the ten thousand.”
And that is what Chase did.
October 8th, 2009 at 3:42 am
“What I’m saying is, we should imagine the situation as if we could save one life, or potentially save ten thousand. Suppose we know we can rescue a single stranded survivor, or, take a different course, and abandon him, but POTENTIALLY save ten thousand people instead.”
One key word here and your whole argumentation is in ruins. Chase couldn’t of known. He couldn’t of measure the risks and as a result his actions might have been honorable but were based on unproven assumtions. He decided to kill the guy whitout even beeing surte that it would work – he basicly rollee a dice saying: “Let it be up to fate: he might die he might live, but if he dies he is guilty anyway for so much murders so no guilt here, if he does not die – It is God’s will (Chase is a Catholic remember and he has proven time and again that he is scared from God so believes even while saying he doesn’t). I did my best to leave it up to fate and and not feel guilty about it” I must say – Chase did convince me that he did it for the right reasons and that is why Jesse Spenser is a brilliant actor however what his character did is still immoral wrong and let us not forget UNETHICAL from medical point of view in every aspect possible.
Since the main argument from the pople who are defending Chase’s actions is “killed one but (may be) saved thousands” how about you guys all think about this: He did killed just one, he did REALLY saved thousands in this country. But thatn he is discovered arrested loses his medicla liscence, all the people from his team also lose their rights and the Hospital is downgraded or even closed for being implicated in a international scandal. How many people would die because the Hospital and all the doctors there are not available to wrok and help people? How many peoples lifes would be ruined because Chase took a decision thinking only about himself and HIS resons to act? Basically – would the results of his actions affect only HIM and the people he saved or there will be others who would suffer a fate even worst than the one he prevented. I just remembered this great movie – “The butterfly effect”. Just a minor tweak, an insignificant change to prevent harm – and the results? Chatastrophe!!!