The Doctors of Akira Kurosawa Films: Between Ethics and Paternalism

The Quiet Duel (1949) Directed by Akira Kurosawa, Starring Toshiro Mifune and Takashi Shimura

Kurosawa’s doctors can be interpreted to be his own alter ego transcribed into characters in his films. They reflect his own personal beliefs regarding moralities and what a human should strive for to obtain what he thinks would be a fulfilling life. American film historian Stephen Prince noted that for Akira Kurosawa, life’s meaning lies in the service of others. His life philosophy seems to enlighten him to direct three notable medical dramas in his revered film career—Drunken Angel (1948), The Quiet Duel (1949) and Red Beard (1965)—after all, the medical profession is essentially the embodiment of that philosophy of living to serve others as they diagnose, treat, and advise patients and the public at large. 

Kurosawa’s doctors emphasize the value of paternalism in medical practice. They will practically go out of their way, at times even without the consent of the patients, to diagnose and treat patients. These doctors make their own sacrifice in abandoning any semblance of personal life in order to devote their time to working in their clinic or hospital. And all his films mentioned above feature patients who will at some point refuse medical care and then highlight the negative consequences of their actions to accentuate the importance of health literacy among members of the public. Doctors are portrayed to be individuals of great expertise who know what’s medically best for the patients, and if bypassing consent and disbelief of their diagnosis would help those patients, then it would all be worth it in the end. But should concerns be raised on such paternalistic medical practice? 

The Paternalistic Kurosawa’s Doctors

Drunken Angel (1948) Directed by Akira Kurosawa, Starring Takashi Shimura and Toshiro Mifune

All three films by Akira Kurosawa that feature doctors consistently employ paternalistic methods to their healing procedures. Drunken Angel (1948) with its titular character Doctor Sanada (Takashi Shimura) is one of the most aggressive examples of this as he rudely and bluntly points out the stupidity of anyone who would refuse treatment and repeatedly aggravate yakuza Matsunaga (Toshiro Mifune) to seek treatment for his Tuberculosis diagnosis. These are not exclusively done in the confine of Sanada’s clinic, he would make frequent one-on-one visits with Matsunaga in absurd places such as the dance hall Matsunaga frequents in hopes of knocking some sense on the toxically masculine gangster as he keeps insisting on downplaying the seriousness of his TB.

 Sanada values the human body’s ability to heal itself if one were to not simply ignore their ailments and take it seriously. A highschool girl also with TB that Sanada was treating ended up recovering after she took all Sanada’s medical advice seriously while Matsunaga who kept drinking alcohol and living a reckless lifestyle saw his lungs breaking down in real-time. At the time, TB was a disease that shared similar stigma to present-day AIDS, it was an illness better to be left unsaid or risk shaming from others. Matsunaga embodies this type of mindset as he downplays his infectious disease from his gangster peers to maintain the appearance of the tough captain and the betrayal of his yakuza clan represents his betrayal of himself in not seeking treatment. 

The Quiet Duel (1949) tells the story of a young doctor Fujisaki (Toshiro Mifune) who contracts syphilis after being infected from the blood of a soldier he was operating on during the war. The trauma and repressed sexual desire after his infection led to him not only forced to abandon his fiancé but also drives him to take care of people unhappier than he is, that is, his patients. At some point in the film, Fujisaki meets Nakata, the now-war veteran who carried the syphilitic bacteria that traveled inside Fujisaki’s open wound in his hand during the operation. Instead of holding any sort of grudge for that man, Fujisaki has the typical Japanese shikata ga nai (it can’t be helped) attitude and maintains his professionalism as a certified doctor. 

Nakata keeps denying that he is carrying any sort of disease or that he unknowingly transmitted it to Doctor Fujisaki. And, of course, Fujisaki keeps insisting him to get treatment, especially after finding out Nakata also infected his wife who is now pregnant. Nakata keeps emphasizing multiple times that they have since cut ties in their relationship as doctor and patient, yet Fujisaki always alludes to the fact that the doctor-and-patient relationship dynamic will never end and that doctors are always responsible for the well-being of a sick person, even when they have wronged them personally or if they have not met for a long time. But this breach of the patient’s consent pays out in the film as Nakata succumbs to his untreated, aggravated syphilis while his wife who finally gets treatment is recovering.

Finally, Red Beard (1965) stars Toshiro Mifune as Doctor Niide, nicknamed ‘Red Beard’ for his literal crimson facial hair, who operates a clinic in a poverty-stricken rural area. Doctor Yasumoto (Yûzô Kayama), a physician from a prestigious medical family, is then posted in this dingy small-time clinic as the apprentice of the infamous Red Beard and we see his growth from a nihilistic, cynical doctor with more superficial views of the prestigious nature of being a physician into an empathetic person that finds more values in helping the poor and needy rather than obtaining some sort of high status. The reason for this change of heart is that Yasumoto is confronted by the adamant idealist Doctor Niide, who sees the greatest sides of humanity and the hope a doctor can bring to the populace. 

But Doctor Niide is not a simple optimist wearing a rose-tinted glasses, he knows the bleaker sides of the human condition as he operates close to the bottom rung of society and knows how to achieve his goal realistically—one scene even has him sucking up to a government official in order to be able to continue operating his clinic. His sheer passion in universal healthcare for the poor with all their sufferings bring him to the most extreme case of paternalistic method seen so far between other Kurosawa’s doctors; Doctor Niide is willing to resort to actual violence, such as his fight scene with the yakuza of the red-light district, to treat his patients and save individuals. He will also literally lock up severely mentally-ill patients so they will not cause harm to other people, although this may reflect the lack of understanding for mental healthcare at the time. 

Doctor Niide’s unbridled hatred for diseases and his complete devotion to his patients make him perhaps the complete embodiment of Kurosawa’s humanism and his ideal medical worker. In fact, ‘Red Beard’ itself has become a term in Japanese medical circles to describe the perfect doctor who has abandoned their own self-interest to treat patients at any time, which brings us to our next section that discusses the level of personal sacrifice Kurosawa’s doctors make in order to satisfy their paternalistic urges.  

The Doctors’ Sacrifice

Red Beard (1965) Directed by Akira Kurosawa, Starring Toshiro Mifune and Yûzô Kayama

Another commonality between the three films by Kurosawa is that all of his doctors virtually abandon their personal lives in order to achieve the greater well-being of society. While this may be interpreted as a reflection of Japan’s collectivist tendency that strives to prioritize the group in contrast with the western world’s individualistic nature, the sacrifice that Kurosawa’s doctors make are often caused by their own selfish desires for their imagined greater good. They actively hurt their friends and families, casting them aside one-sidedly and devote all twenty-four hours, seven days a week of their lives in service of their patients. The line between their personal lives and professional lives have become blurred to the point of it being indistinct or even non-existent. 

In Drunken Angel, the house and clinic of Doctor Sanada is one and the same. These doctors’ professional lives are their personal life as well, there is simply no distinction between the two of them. Although Sanada is definitely in the lower end of the spectrum regarding this, while his humble abode is also his cramped run-down clinic, in the film he is shown to still have some semblance of his private life through his unhealthy drinking habits by going to bars and also through his various walks around his swamp-covered slum neighborhood where he occasionally shouts at children to get away from dirty puddles so they don’t catch typhus. He also still has some relationships and social contact with his female assistant and other people living in the neighborhood, although he seems to have given up in starting his own family. 

In a sense, Sanada’s blunt and rude behavior to help other people’s lives is a reflection of postwar Japan and its rampant social breakdown, he is earnestly rebelling against the corrupted system by not joining the traditional hospital industry that would net him a wealthy lifestyle as a certified doctor but instead focus his attention on aiding people living in the slums. But this is, of course, at the expense of the living standard and wealth ‘fitting’ for a knowledgable doctor like him, he chooses to live in poverty, or rather he is forced to not be a part of the system as his extremely paternalistic nature clashes with the traditional doctor, which Kurosawa finds to be somewhat lacking. 

For Doctor Fujisaki in The Quiet Duel, he has infused the rationality of his personal life and professional life, his pent up sexual desire due to being unwillingly infected with syphilis has created the mindset for him to always keep enduring in silence in order to always be capable of effectively treat his patients. After he was infected with the disease during the war, he did not treat the disease for some time due to him still being on-site overseas until Imperial Japan’s defeat, which aggravated the disease quite a bit.

Doctor Fujisaki: There are two kinds of patients, right? some scream in pain. Others put up with pain dripping with sweat.

Nurse Minegishi: Then are you the dripping with sweat type? 

Doctor Fujisaki: Because I don’t like losing…and I’m a doctor.

Nurse Minegishi: But doctors are human too, right?

A scene in The Quiet Duel (1949)

This brief snippet of Doctor Fujisaki’s reflective back-and-forth with Nurse Minegishi highlights his rationale in putting up with the pain in silence and not revealing his syphilis to his friends and family. He has personally seen the horrors of war victims and the suffering of his hospital patients, he is undermining his own trauma as he thinks he is unworthy of being in pain as many people have been more unfortunate than him. His self-blocking in the pursuit of happiness has led him to leave his fiancé in fear that she will wait for his syphilis to disappear, which might take years and waste her youth, ignoring the fact that he himself might be worthy and deserving of some amount of happiness after all the mental anguish he has undergone. It’s clear that he has intensified the self-sacrifice an ideal doctor need and destroys his love life and social life for the service of the people. 

Doctor Niide in Red Beard, on the other hand, is rather unique compared to Sanada and Fujisaki. While Sanada suffers from alcoholism and anger management issues and Fujisaki is chronically depressed and lacking the means to express his adversities, the Red Beard himself seems perfectly content with his almost solitary life in full service of the people, he has shown to be absent of any mental obstacles to his lifestyle and serves as the ideal doctor and mentor figure to Doctor Yasumoto. 

As I said before, Doctor Niide is the culmination of Kurosawa’s endeavor in tackling medical dramas and represents the true quintessential doctor figure with his ‘perfect’ mix of paternalism and humanism without the psychological baggage. He himself as well as the other doctors and nurses all live-in inside the hospital itself and take care of the patients irrespective of the time of day, they are offered no social life outside of their patients and each other’s professional company. Doctor Niide is the ultimate man of virtue and gentleman but he would probably not be capable of supporting a family of his own, but the question is, is a family even necessary if you truly live for the people? Kurosawa seems to ask this himself. 

It can stand to reason that Kurosawa’s depiction of his doctors can be quite problematic and offer unrealistic and unhealthy expectations of what doctors ideally should be. Indeed, doctors are humans too and they should be able to enjoy their own private lives and have families, but these individuals also represent what kindness and compassion could be for humanity if one takes away the self-sacrifice. The companionship and aid of other people near you should be welcomed instead of avoided, and an optimistic outlook of human nature may be cultivated within a healthy environment rather than a self-destructive one. 

The Ethics of Medical Paternalism: Is there a place for it in the modern world?

Toshiro Mifune in The Quiet Duel (1949)

Paternalism can be quite problematic if one were to see it through the lens of modern biomedical ethics. And what we see in Kurosawa’s doctors is the most extreme cases of paternalism where the doctors vigorously pursue their patients for treatment without any of their say in the matter. The patient’s autonomy and agency are taken away, and while it may be for the ‘greater good’, doctors are still humans that make mistakes and errors, and as such, excessive paternalistic methods have the potential to do harm.

According to the American Medical Association’s Journal of Ethics, ‘Selective Paternalism’ may be the desired alternative, where the medical experts will respect the patient agency in decision making and involve them directly in the decision-making process. But in the case of when the family or patient is unable to decide on a plan of care, physicians should step up and take a more paternalistic approach according to their professional responsibility and integrity. This is in hopes that the best decision will be reached for the benefit of all parties involved, the patient will still be able to choose their preferred medical plan but when it is vital, the doctors must be the one to choose the best possible route. 

In the current COVID-19 pandemic where anti-mask protests are held in the United States and even Japan, governments’ lax leadership and lack of ability to enforce a concrete requirement to prevent the spread of the coronavirus has led to the rising numbers of cases that see no signs of decreasing. With over 166.000 death toll, the United States are reopening schools and businesses. What this does is essentially giving legitimacy to the people who claim that the pandemic is a fabricated hoax or that the mortality rate is exaggerated. Pandemic experts’ advice in the United States like Anthony Fauci is ignored in order to push a populist agenda. Complete autonomy and agency are given to the populace to an absurd degree in regards to their choice of whether or not they are taking the necessary precautions and preventions of the virus’ spreading. Like Nakata in The Quiet Duel who denies his syphilis diagnosis and Matsunaga in Drunken Angel that ignores his tuberculosis, anti-maskers and coronavirus-deniers are essentially adversely affecting their own well-being as well as others around them. 

Some amount, not all, of the paternalism and empathy shown in Kurosawa’s doctors, may perhaps be the thing we need right now to overcome the pandemic. If we go through the stages of selective paternalism, we have gone way past the part where the population could not decide themselves the best possible care plan. Medical experts’ words should be trusted and they should be the ones that have the authority to instate pandemic-related policies that are protected by and enforced under the rule of law. Perhaps we have gone past the possibility of taking into account the patient’s involvement in decision-making at the current stage of the crisis with all the conspiracy theories and ignorance spreading about the virus.

But this topic is certainly not conclusive, paternalistic approaches can be quite controversial and it should be noted that we are still discussing paternalism within healthcare and we best be careful when discussing the term in other political spheres. And even within healthcare, we have seen things like anti-vaxxers who rebel against government requirements to vaccinate, paternalistic approaches, in this case, should be encouraged as it concerns the welfare of other people around them.

In any case, in our current era, the optimistic but realistic outlook on the human condition from someone like Doctor Niide should perchance be the new ideal.  The cultivation of empathy within the populace is crucial as it will make them more susceptible to listen to medical experts’ advice when they know they are helping the society at large and not just themselves.

References

Asai, A., Maki, S., & Kadooka, Y. (2012). Ethical reflections on the thoughts and lives of Kurosawa’s doctors. Medical Humanities, 38(1), 38–43. doi:10.1136/medhum-2011-010079 

Drolet, B. C., & White, C. L. (2012). Selective Paternalism. AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/selective-paternalism/2012-07#:~:text=Broadly%20defined%2C%20paternalism%20is%20an,distribution%20of%20resources%20to%20patients.

Nakayama, D. K. (2009). Professionalism in Kurosawa’s Medical Dramas. Journal of Surgical Education, 66(6), 395–398. doi:10.1016/j.jsurg.2009.06.001 

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