Blood on Silk: The Violence of Medicine: Part VI Going under the Knife

The World Health Organization[1] defines violence as ‘the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.

Choosing to go under the knife, a slang expression for experiencing a medical surgical intervention, is a decision made within the power relationships of the medical system. Sometimes the results are as expected by the patient and at other times death or a greater level of injury may be the result. The World Health Organisation definition of violence brings into play when making the decision to proceed that there may or may not be high likelihood that going under the knife may result in injury, death, or psychological harm. Is it possible that a surgical procedure having a high general probability of death could always be considered violent or that the specifics of a patient could increase a lower probability of death to a high likelihood, changing the classification of the procedure from non-violent to  violent.

Surgical Risk Calculators are web-based systems that can provide a prediction of the risk of mortality for specific patients undergoing a specific surgical procedure. While the patient’s own data has usually been considered in this determining this prediction a hospital specific risk is generally not included. Subjective adjustments to the ranking or prediction are  allowed in some systems where the surgeon can alter the prediction based on their knowledge of the patient.  

On the other hand the American sociologist Deborah Lupton has argued that aggressive violent contemporary surgical and therapeutic treatments cause “alterations in the body which can mark and mutilate.”[2] The scars of amputation have been familiar signs of the violence of medicine for many centuries. They are now overlaid with physical scars from recently developed surgical treatments of cancers, heart disease, and numerous other chronic diseases. The scars from surgical wounds on the interior surfaces of the body as well as the exterior skin are the most obvious sign of surgery, and when these scars are the result of elective cosmetic surgical treatments it is easier to acknowledge that it is possible this is inherently a form of violence.


[1] World Health Organisation “Violence” 2017  http://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf;jsessionid=791B066607F2947EABFC141791FD7B70?sequence=1 accessed 26th August 2018

[2]Deborah Lupton, Medicine as Culture: Illness, Disease and the Body, (London: SAGE Publishing, 2003), 88.

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