This response to T J Papadimos’s article1 outlines some of the relevant elements in Nietzsche’s philosophy in order to develop its conclusions. We find that Papadimos’s attempt to illuminate the causes of litigation against doctors in America fails through misunderstanding the analysis of convention and the idea of the superman in Nietzsche’s thought.

Papadimos’s perspective is rather odd; he points out that “Medical malpractice is of increasing concern ...” (p107)—that is, the physician’s improper or negligent treatment of the patient is worrying—but seeks a remedy in reducing patients’ litigiousness rather than improving medical practices. He suggests that “a primal cause of the litigiousness of the public against doctors results from resentment or “ressentiment”” (p107) but avoids stating the relationship between medical malpractice and resentment, perhaps because it is too obvious. He understands such litigiousness to have its 19th-century source in the American courts’ relaxing “the standard for institution of civil tort suits” (p107), but this remark does not indicate or explain the required just standard between doctors’ practices and patients’ health outcomes. Instead he seeks to offer Nietzschean ideas to explain and reduce the public’s apparent litigiousness against doctors.

Papadimos is a sympathetic observer of the health of American society; he thinks the medical community “must encourage health care for all” (p110), but the Nietzschean vehicle he has adopted to reduce litigiousness does not fire on all cylinders. The analysis he has developed bears little resemblance to Nietzsche’s thought, and it does remind us that Nietzsche is a subtle writer who does not expose his thought to the casual reader.

What one has in essence in healthcare in this context is one social group providing benefits for society at large. Generally the medical professions are highly privileged relative to their recipients and the legal business is available to protect …