Bureaucrats are always the handmaidens of authoritarianism.

From The Thing That Swallowed Britain by Dan Hitchens.  Bureaucrats are always the handmaidens of authoritarianism.

A doctor rushes to the side of a patient who has just collapsed on the way to the toilets in the emergency wing. He checks for signs of life—pulse, circulation, breathing. He has never seen the patient before. How serious, he wonders, could this be? The doctor calls out: “Does anyone know anything about her?” The senior nurse, who has just come over, looks shocked.

“Him!” she practically shouts at the doctor. “You refer to that patient as him!”

And the doctor thinks to himself: “So I’m supposed to check the patient’s pronouns before I check his pulse.”

This story—I heard it from the doctor himself, David Mackereth—illustrates a salient point about what I call the Thing, that combination of postmodern identity theory, religious fervor, pseudo-therapeutic “empathy,” dogmatic moralism, private bullying, and ritualized public humiliation which has swept through Western societies over the last decade. The Thing may seem an irresistible force, but in truth, it can only take possession of an institution if that institution has already lost its identity.

If an organization knows and cherishes its history, if it empowers its members, if they understand their role in society, their vocation and contribution to the common good—then it is significantly less likely to be captured by the Thing.

But when you talk to people in the National Health Service, or the labor movement, or the police, you hear an eerily similar account of what has happened: a forgetting of the social role that used to give that institution meaning; a transfer of power from those on the front line to a remote administrative class; vocation edged out by bureaucracy; pronouns instead of pulses.

David Mackereth’s faux pas outside the hospital toilets foreshadowed a more consequential disagreement. In 2018, he resigned from a role at the Department of Work and Pensions after being ordered to use “preferred pronouns.” Two employment tribunals have ruled that Dr. Mackereth’s beliefs, though rooted in his Christianity, aren’t protected by equalities legislation. The courts will surely have to revisit this subject. But of course, such matters aren’t only decided in court: They are also decided by the climate of fear in British life, not least in the NHS.

“If everybody who agreed with me on the issue of transgender pronouns had spoken up,” Mackereth says, “this would all be over in an instant.” But people are thinking of their kids, their mortgages. “A lot of the nurses, for example, who are treating men on women’s wards felt very strongly about it, but they wouldn’t speak up, because they knew that they would be sacked.”

What has made for such compliant souls? That brings us to another story: how the NHS, instead of nurturing the doctor-patient relationship as the heart of its identity, has prioritized the relationship between doctors and administrators. “When I qualified 30 years ago,” Mackereth recalls, “we just did medicine. We saw patients. And doctors were considered powerful.” They were also, he concedes, often unaccountable. Something needed to change. But the resulting bureaucratization has been overwhelming.