In the mid-80s, when I was a teenager, I had a brief conversation with a successful, well-off doctor. I wasn’t a patient. This person was sort of a family friend. In that conversation he said matter-of-factly but with the air of a let’s-be-real statement that he wouldn’t want to treat AIDS patients because he didn’t want to run the risk of getting AIDS himself.
Some context is important. This was still very early in the AIDS epidemic. The first blood test for HIV only became available in 1985. This was not a callous or uncaring man. And, at least at the margins, it wasn’t yet as clear as it would eventually be just how much risk physicians faced. But the comment stuck with me and I kept thinking about it. I still haven’t forgotten it 40 years later.
I was not in any way some teenage AIDS activist or a crusader in any sense on that or really any other topic. I probably knew a bit more about AIDS than your average teen because there were a number of gay men in my family’s social circle, at least two of whom eventually died of AIDS. But my main experience or feeling or thought about the entire topic was pure fear. I could totally relate to not wanting to be in any contact with bodily fluids of anyone suffering from AIDS or fumbling around with a hypodermic needle being used in their care.
But I wasn’t a doctor.
I didn’t have the title or the prestige or the really nice house.
Doctors have a great deal of prestige in our society and access to a lot of wealth. That is to a great degree because doctors have some control over the great matter of life and death. But that’s not the only reason. Historically they also ran real risks. Much more than is the case today, treating the sick meant exposing oneself to the same illnesses. Look at the history of diseases and plagues and it’s a constant issue. Today the big diseases and conditions people fear most tend not to be readily communicable ones. But we got a reminder of it during the COVID pandemic, especially the first weeks and months when hospitals overflowed with the sick and the dying and even the most basic protective gear was in short supply. (AIDS, of course, was and remains another very big reminder.)
The principle is a basic one. With many professions and with certain institutions we as a society afford the benefits of prestige, power and wealth. But we usually do so, implicitly or not, with the expectation of things in return. I think we all remember in the first weeks of the pandemic those harrowing and often inspiring images. Why? Because they were doctors. Doctors, nurses, the whole panoply of care-giving professions. It’s not just about medical ethics. Doctors have a contract, albeit an implicit one, with society at large. Those horrible weeks were when some of that contract came due.
Of course, that contract is often honored in the breach, as that conversation I remember shows. But that doesn’t make it any less real.
This small recollection from 40 years ago has been rolling around my head recently as we watch the debate among universities on how the react to Trump’s lawless drive to tame them and bring them to heel. A number of universities targeted by Trump face losing hundreds of millions of dollars of grants and contracts. That means potentially shuttering labs, laying off hundreds, maybe thousands of people. I know from my own long experience that it’s easy to talk a big game until you have to make payroll. But I said a couple days ago that former President Obama is right. Universities need to fight Trump, not as an explicitly partisan matter, but for their independence and integrity as universities. And to do that, universities need to be prepared to forego federal funding if necessary to preserve their independence. As a society we grant these institutions great benefits of prestige, power. Some build up massive endowments, not private wealth but still, at the largest and most storied institutions, vast wealth.
They too have a contract.
Looked at from one angle, the great universities are mere finishing schools for the elite. Those with the deepest sense of mission may draw from outside the elite but the best certainly all produce into it. But this single dimension of the universities’ role wouldn’t justify all that power and prestige and wealth. Those of us who recognize their importance see that the universities, in concert with the colleges and the whole spectrum of higher education, are one of the pillars of power outside the state. They’re one of the great pillars of civil society. They’re laboratories of human intellection and experiment with great insulation from the demands of power and might. For all academia’s many faults, we should see the critical importance of that in a moment where an Elon Musk or a Donald Trump are bestriding our society, casting broad penumbras of fear and creating whole new fraudulent realities through the force of untrammeled wealth and power. Certainly those who run universities must believe in this broader importance because otherwise what’s the point?
Like doctors, the universities also have a contract, albeit not always explicit. In natural disasters, we expect doctors to run in and treat people. Right now our whole society is in the midst of a vast civic disaster, in its own way just as dire as the worst natural disaster. For the universities, this is their COVID pandemic. This is when they have to work shift after shift exposing themselves to a little known disease.
I know this might all sound frothy and over-grand. But it is true. The only real justification for building up these massive endowments is the independence they grant these institutions. And if not for a time like this, then when? This is when their contract is due. I don’t like it any more than you do. And I’m cautiously optimistic that if they’re resolute, smart and, critically, acting in concert with other academic institutions, they will not have to face any real sustained damage. But on the big question, I don’t think they have a choice.