SOGURO’S DILEMMA IN DEALING WITH PARADOXICAL MEDICAL ETHICS DURING WORLD WAR II AS SEEN IN SHUSAKU ENDO’S THE SEA AND POISON

  

SOGURO’S DILEMMA IN DEALING WITH PARADOXICAL

MEDICAL ETHICS DURING WORLD WAR II AS SEEN IN

SHUSAKU ENDO’S THE SEA AND POISON

AN UNDERGRADUATE THESIS

  Presented as Partial Fulfillment of the Requirements For the Degree of Sarjana Sastra in English Letters

  By

BERTHA YENNI FINDRIANA

  Student Number: 044214100

  

ENGLISH LETTERS STUDY PROGRAMME

DEPARTMENT OF ENGLISH LETTERS

FACULTY OF LETTERS

SANATA DHARMA UNIVERSITY

YOGYAKARTA

2009

  

The wo rld is da ng e ro us pla c e to live in

No t b e c a use o f tho se who do e vil

But b e c a use o f tho se who se e it a nd le t it

ha ppe n.

  

(Alb e rt Einste in)

  

I DEDICATED THIS THESIS

TO

My beloved MOM and DAD

My sister CIPLUK

  

Grandpa SUPIT

Abe

and My best friends, MIA girls

  

ACKNOWLEDGEMENTS

  First of all, I would like to thank Jesus Christ because He always gives me spirit and strength in facing my life so I could accomplish this thesis with all of my effort. I also thank Him for providing me with many people who have been so kind and willing to help me in conducting the study and writing this thesis.

  I would like to express my gratitude to my advisor, Ni Luh Putu Rosiandani, S.S., M. Hum, who has willingly spent his precious time to read, reread and guide me in accomplishing this thesis. I would thank also to my co- advisor, Tatang Iskarna, S.S., M. Hum for giving me precious advices and revising my thesis. I would also thank my main examiner J. Harris Hermansyah Setiajid, S.S, M.Hum for giving me final advices.

  I thank to my parents, Sofie Yosefien Ngantung and Agung Widodo, S.H, who always pray for me and stand beside me. Thank you for my one and only sister, Selvie Febrianie, S.S., for driving me to my campus.

  Friends in need are friends indeed. I thank to all of my friends in English Letters 2004 especially MIA Girls (Eka, Eli, Ditha, Wulan and Yuli), Atik, Angga, Karisma Ditha, Riani nabu, Rina Rey, Oos, Karisma and the others.

  Thanks for being my friend and I would not forget our friendship. I would not forget to thank to the library staffs for helping me during my research finding. I thank to mbak Nik for always giving me valuable informations. I also thank to my my Sunday school teaching and mbak Arum for borrowing his printer. My gratitude also goes to Handa ‘Kripik’ for borrowing his computer and his home sweet home. The last but not least, I want to deeply express my gratitude to Abram ‘Abe’ Suseno, S.H., the right person in the right time, who has given his totality to help me.

  Bertha Yenni Findriana

  

TABLE OF CONTENTS

TITLE PAGE …………………………………………….………….............. i

APPROVAL PAGE ………………………………………………………….. ii

ACCEPTANCE PAGE ……………………………………………...…......... iii

MOTTO PAGE …………………………………………………………..….. iv

DEDICATION PAGE ………………………………………………………... v

ACKNOWLEDGMENTS ……………………………………………………. vi

LEMBAR PERNYATAAN PERSETUJUAN PUBLIKASI

TABLE OF CONTENTS …………………………………………………… viii

ABSTRACT ………………………………………………………………….. x

ABSTRAK …………………………………………………………………... xii

  CHAPTER I: INTRODUCTION A. Background of the Study ……………………………………………. 1 B. Problem Formulation ……………………………………………….. 5 C. Objective of the Study ………………………………………………. 6 D. Definition of Terms …………………………………………………. 6 CHAPTER II: THEORETICAL REVIEW A. Review of Related Studies ………………………………………… 8 B. Review of Related Theories ………………………………………… 9 1. Theory of Character and Characterization ……………………… 9 2. Theory of Medical Ethics ………………………………………. 11 3. Review on the Relation between Literature and Psychology….. 13 4. Theory of Dilemma …………………………………………….. 14 5. Theory of Personality ………………………………………… 18 6. Review on the human value during World War II ……………. 19 C. Theoretical framework………………………………………………. 22 CHAPTER III: METHODOLOGY A. Object of Study …………………………………………………….. 23 B. Approach of Study …………………………………………………. 24 C. Method of Study …………………………………………………… 25 CHAPTER IV: ANALYSIS A. The Characterization of Soguro …………………………………… 27 1. Empathetic …………………………………………………….. 27 2. Responsible …………………………………………………….. 31

  4. Idealistic ……………………………………………………….. 35

  B. Soguro’s dilemma dealing with paradoxical medical ethics ……... 36

  1. Soguro’s dilemma in relation with Japan’s government ……... 41

  2. Soguro’s dilemma in relation with the Japanese doctors ……… 44 i. Toda ………………………………………………………… 48 ii.The Old Man ………………………………………………… 49

  C. Soguro’s decision making to manage his dilemma dealing with paradoxical medical ethics ………………………………………… 52

  1. Soguro’s decision making to manage his dilemma in relation with Japan’s government ………………………………………. 57

  2. Soguro decision making to manage his dilemma in relation with the Japanese doctor ……………………………………...... 58 i. Toda ………………………………………………………….. 59 ii. The Old Man ………………………………………………… 60

  

CHAPTER V: CONCLUSION ……………………………………………… 62

BIBLIOGRAPHY ……………………………………………………………. 66

APPENDIX........................................................................................................ 68

Summary of the Novel……………………………………………....... 68

  

ABSTRACT

BERTHA YENNI FINDRIANA (2009): SOGURO’S DILEMMA IN

DEALING WITH PARADOXICAL MEDICAL ETHICS DURING WORLD

WAR II AS SEEN IN SHUSAKU ENDO’S THE SEA AND POISON.

Yogyakarta: Department of English Letters, Faculty of Letters, Sanata

Dharma University.

  Medical Ethics had been functioned to protect the patients from any harmful conduct of physicians (doctor or nurse). The matter is how if the medical ethics is distorted in order to support the glory of war. The Sea and Poison reveals the inhuman conduct of Japanese doctors to their patients and the prisoners of war in Fukuoka hospital during World War II. It is ordered by the government in order to win the war. The medical ethics becomes paradox of the doctor’s crimes. However, Soguro, a doctor in that hospital, keeps his profession oath firmly and places the patient’s life as his first priority. He has deep empathy and loyalty to his principle as a doctor and citizen. It creates dilemma when he must choose to be loyal to his profession or his country.

  This study is to analyse the above issue by pointing three problems. The first is how the characteristics of the main character, Soguro are. This problem reveals Soguro’s characteristics that make him in dilemmatic situation. Second, what Soguro’s dilemma is. This problem analyzes Soguro’s dilemma and the conflict that makes him in dilemmatic situation. The third is how Soguro manages his dilemma. This last problem analyses Soguro’s motive to be a doctor and related with his decision making.

  The method that was conducted in this study is library research method by collecting the data and the theories that support this research. The writer applied psychological approach since the purpose of this study is to analyse Soguro’s characteristics in relation with his dilemma, the conflicts which place him in dilemmatic situation and how he manages it.

  The result of this thesis discovers that Soguro’s characteristics are empathetic, responsible, idealistic and unconfident. As a Japanese doctor and Japanese citizen, he faces dilemma when the government and his colleagues force him to choose his dedication to one of them. He is trapped in Avoidance-avoidance conflict, a conflict between two undesirable goals, when he must choose to endanger his own life or someone’s life by doing human experiment. He is also trapped in Approach-avoidance conflict, a conflict of positive choice and its negative consequence, when he realizes the opportunity of finding new healing methods behind the experiment. Soguro’s characteristics have significant role in facing his dilemma. His introverted attitude in decision making which is the most prominent of melancholic phlegmatic personality, Soguro’s personality, traps him into following what the environment expected him to do. He tends to be a follower and ignores his empathy, his responsibility, his idealism and his motive. He is trapped into his unconfidence and makes decision that does not create disagreement with his environment. He follows his safety need. His desire to escape from other’s

   ABSTRAK

BERTHA YENNY FINDRIANA (2009): SOGURO’S DILEMMA IN

DEALING WITH PARADOXICAL MEDICAL ETHICS DURING WORLD

WAR II AS SEEN IN SHUSAKU ENDO’S THE SEA AND POISON.

Yogyakarta: Jurusan Sastra Inggris, Fakultas Sastra, Universitas Sanata

Dharma.

  Etika medis telah berperan untuk melindungi para pasien dari segala tindakan membahayakan yang dilakukan oleh para pelaku medis (dokter atau perawat). Permasalahannya adalah bagaimana jika etika medis diselewengkan untuk mendukung kemenangan dalam perang.

  The Sea and Poison mengungkap perbuatan yang tidak manusiawi yang

  telah dilakukan oleh dokter- dokter Jepang terhadap pasien-pasien mereka dan para tawanan perang di rumah sakit Fukuoka selama perang dunia ke II. Hal ini diperintahkan oleh pemerintah untuk meraih kemenangan dalm perang. Etika medis menjadi paradoks atas kejahatan dokter-dokter itu. Namun, Soguro, salah satu dokter di rumah sakit itu memegang teguh sumpah jabatannya dan menempatkan nyawa pasien sebagai hal yang utama. Dia mempunyai empati dan kesetiaan terhadap prinsipnya sebagai dokter dan rakyat. Hal ini menimbulkan dilema ketika dia harus memilih untuk setia pada profesinya atau negaranya.

  Skripsi ini bertujuan untuk menganalisis persoalan di atas dengan merujuk pada tiga permasalahan. Pertama adalah bagaimana watak dari tokoh utama, Soguro. Permasalahan ini mengungkap watak-watak Soguro yang membuatnya dalam situasi dilematis. Kedua, bagaimana dilemma Soguro. Permasalahan ini menganalisa tentang dilemma yang dihadapi oleh Soguro dan konflik yang membuatnya dalam situasi dilematis. Ketiga adalah bagaimana Soguro mengatasi dilemanya. Permasalahan yang terakhir menganalisa tentang motif Soguro menjadi seorang dokter dan berhubungan dengan pembuatan keputusannya.

  Metode yang dilakukan dalam penelitian ini adalah metode penelitian pustaka denagn mengumpulkan data dan teori-teori yang mendukung penelitian ini. Penulis menerapkan pendekatan psikologis karena penelitian ini bertujuan untuk meneliti watak- watak Soguro yang terkait dengan dilemanya, konflik- konflik yang menempatkannya dalam situasi dilematis dan bagaimana dia mengatasinya.

  Dari penelitian ini ditemukan bahwa watak-watak Soguro adalah empatik, bertanggung jawab, idealis and tidak percaya diri. Sebagai seorang dokter dan rakyat Jepang, dia menghadapi dilema saat pemerintah dan kolega-koleganya memaksanya untuk memilih dedikasinya pada salah satu dari kedua peran tersebut. Dia terjebak dalam konflik Avoidance-avoidance, konflik antara dua pilihan yang tidak menyenangkan, saat dia harus memilih antara membahayakan nyawanya sendiri atau nyawa orang lain dengan melakukan percobaan manusia. Dia juga terjebak dalam konflik Approach-avoidance, suatu konflik dari pilihan yang positif dan akibat negatifnya, saat dia menyadari peluang untuk menemukan metode penyembuhan baru dibalik percobaan tersebut. Watak-watak Soguro dalam pembuatan keputusan yang mana paling menonjol dari kepribadian melankolik plegmatik yaitu kepribadian Soguro, menjebaknya untuk mengikuti apa yang diharapkan lingkungannya darinya. Dia cenderung menjadi pengikut dan mengesampingkan empatinya, tanggung jawabnya, idealismenya dan motivenya. Dia terjebak dalam ketidakpercayaan dirinya dan membuat keputusan yang tidak menimbulkan ketidaksepahaman dengan lingkungannya. Dia mengikuti kebutuhannya akan rasa aman. Keinginannya untuk menghindari penilaian orang terhadap dirinya dan tidak mengikuti kata hatinya membuatnya dicekam rasa bersalah seumur hidupnya.

CHAPTER I INTRODUCTION A. Background of the Study We live in the society in which all things are measured with right or wrong. If our morality works well as a measurement tool, we can live peacefully. Yet not everybody has the same quality of measurement tool. People tend to

  forget about the moral values they have and rebel to free themselves from all kind of social norms. It will be a crucial matter if the environment supports the crime.

  How about if the crime is conducted by certain group which should be the helper or the hope of people. The profession is only a cover to hide their crime.

  For instance, the profession of doctor is a perfect and safe field to conduct the crimes. They have good reputation in society and this profession is really respected. They found innovation in healing incurable diseases. They give hope to the dying one to recover. However, because of this good image, they can cover their crimes perfectly. They can do anything to their patients without being realized by the patient or the patient’s family. They can perform such an experiment to their patients. For instance, they have the possibility to misuse their profession by performing illegal abortion. Surprisingly, the society supports this illegal conduct. This can be a dilemmatic problem to the doctors who still have moral values. They might be influenced by the immoral circumstances or defend their oaths to be good public servant.

  People have different motives when they act. For example, the motive of studying is to achieve better knowledge, to please their parents, to pass the examination etc. However, the motive of studying can also be used to support a crime such as mastering the security system of bank and later using it to steal the money. The motives can be different between one to another. In doctor’s case, the public is usually easily manipulated by the doctor’s motive. Meanwhile, they tend to see the doctor’s motive in curing their disease is to help them. However, the motive must be questioned. The public’s opinion on their motives can be true.

  Yet, they must look deeper at their real motives because they are also a human who can make a mistake and sin.

  A doctor’s motives can be good or bad. It means a good motive always brings and ends in the goodness of the patient but the bad one will bring goodness for the sake of the doctor’s himself (he will be selfish and ignore the patient’s life). However, in other case, both of the motives can be good. For example, a doctor is a part of society and the country where he lives. He wants to dedicate his life to serve his patient and his country as well. These motives can be dilemmatic and they can oppose each other. The dilemma will arise when the motives conflict each other, the satisfaction of one leads to frustration of the other. Even when only one motive is involved, conflict may arise if the goal can be approached in several different ways. Yet sometimes conflict arises between a motive and a person’s internal standard rather than between two external goals. However, it is uncertain whether the good or the bad one which is dominant among them. If the most dominant motive is bad, he or she will be an angel of death, every time he or she goes, he will bring his or her patient into death. How a doctor can be the angel of death, how the process to decide to do those crimes, what the motives behind those crimes are the polemics in the medical world.

  The doctor’s crime has been a ‘pathological diseases’ since the war began. The nations such as Germany and Japan have developed a biomedical experiment to support their victory of the war. The Germany with its Nazi’s doctor has killed mass of people. A Nazi doctor, Joseph Mengele, has performed many deadly human experiments such as injecting a chemical liquid to children’s eyes to change the eye color to blue and it caused immense pain and even blindness, removing limbs or sex organ without anesthesia, tossing babies into crematoria (a room which functioned like an oven), sending anyone with an imperfection (including imperfect weight) to the gas chamber, etc. He is like a serial killer, Jack the Ripper and ironically the government protects and supports his cruel experiments. Even, Japan’s government at wartime also allowed the experiment using human and developed a deadly virus and mass killing. Those facts are the bad records in the history of medical ethics. The motivation of the doctor has been changed. They are the killing machines of its country. Now the most frightening fact is doctor is a potential killer because they can kill anyone freely and the people will not be suspicious about their crimes. Yet, what motivate them to do those crimes is still questioned. Today the modern doctors still follow their ancestors to do the malpractice.

  The dilemma of a doctor is when his or her motives opposed each other, when the medical ethics is a paradox, when he or she must obey some authority in his or her country and the medical institution is only a cover to hide the crimes. The doctor must make a decision based on those conflicting motives. Sometimes the society influences someone in making decision. The condition or circumstances in the society can be the determinant key of the decision. Meanwhile, the society has important role in shaping the morality.

  The works of literature can be the best choice to solve the matter because they give a vision of morality. We can learn morality from each character’s experience in a novel, poem, play, etc. According to Hough in An Essay on

  

Criticism , literature can convey social phenomenon. Through literature the author

  wants to communicate his idea about the moral values in the society to a person, number of people, nation, a world in a higher level. The values suggested by a work of literature are suggested as significant to a group, a class, a nation, or to everyone (1966: 30). Novel is a part of literature which contains some values that can be valuable for human life. Clara Reeve states that a novel is a picture of real life and manner (Wellek and Warren, 1956: 216). Novel does not only give a fantasy and enjoyment for the reader but it contains moral values that govern human behavior.

  In the Shusaku Endo’s novel, The Sea and Poison, the medical crime is obviously depicted. This novel exposes the doctor’s crime during World War II.

  The immorality which happened in a prestigious institution is ironically done also by prestigious community. This image is misused to cover their malpractice. This is the paradox of medical ethics. Michael Gallagher, the translator of The Sea and

  

Poison says that, “This powerful novel describes the disintegration of Japanese doctor who is obliged to participate in the vivisection of the prisoners war” (Endo, 1972: 174).

  However, through this novel it can be seen the dilemma of Soguro, a doctor, who must face the shocking fact about paradoxical medical ethics during the war. The process of making decision involves his motive to be a doctor which is really different with the other doctor’s motives. No one in the hospital supports his motive. The dilemma is stronger when his sole motive to be a doctor is opposed with his close friend, Toda and a senior doctor, who is his role model, also violated the medical ethics. Through Soguro’s character, it can be seen the struggle of a doctor to keep his noble motive even though his surrounding environment does not support him.

B. Problem Formulation

  Referring to the title above, the writer states three problem formulations in order to guide the analysis as follows:

1. How is Soguro, the main character, characterized in Shusaku Endo’s The Sea

  and Poison ? 2.

  How is Soguro’s dilemma in dealing with the paradoxical medical ethics depicted through the novel?

  3. How does Soguro manage his dilemma in dealing with paradoxical medical ethics?

  C. Objective of the Study

  The focus of this thesis is the exploration of Soguro’s character in dealing with the paradoxical medical ethics. Given the problem above, the first problem formulation is meant to depict the characteristics of Soguro in resistance of the morality against the evil condition which is full of ambition for seeking important position, the malpractice and so on. The second is to find out Soguro’s dilemma dealing with paradoxical medical ethics. The next analysis will be on how he faces and manages his dilemma.

  D. Definition of the Term

  There are three terms to be defined in this study: ‘moral dilemma’, ‘paradoxical’ and ‘medical ethics’.

  1. Dilemma According to American Psychological Association Dictionary of Psychology, dilemma is a situation necessitating a choice between two equally desirable or undesirable alternatives ( Vandenbos, 2007: 282).

  2. Paradoxical In The New Oxford American Dictionary, paradoxical is something

  ‘having the nature of ‘or expressing paradox (a seemingly absurd or self contradictory statement or proposition that when investigated or explained may prove to be well founded or true) (Mckean, 2005: 1232).

  3. Medical ethics

  In International Encyclopedia of Ethics, the definition of medical ethics is the discipline that analyses the way in which moral decisions are made in the field of medicine (Roth, 1995: 538)

CHAPTER II THEORETICAL REVIEW A. Review on Related Studies Since it is difficult to find the sources from the published book, there are

  many sources that are taken from the Internet site. Michael Gallagher, the translator of The Sea and Poison says that, “This powerful novel describes the disintegration of a Japanese doctor who is obliged to participate in the vivisection of prisoners of war”. The other critics, Pung Yai, in his article entitled The Only

  

Thing Necessary for the Triumph of Evil, says that The Sea and Poison is one that

  delves into some very deep issues about morality and Ethics of passively accepting evil in one’s presence. (http:/www.amazon.com/Sea-Poison-New- Directions-Paperbook/dp/0811211983). The other comments comes from Mihoko Tokoro, she says that “This is a fiction based on what happened in Unit 731 (Japanese Imperial Army) in Manchuria where live vivisection and human experimentation were performed biological weapon. Doctors were young, innocent and ambitious and committed heinous sins on POW’s (Prisoners of War) (http:/www.amazon.com/gp/product/costumer-reviews/08112211983/ref).

  Nathan V. Bak, in an article entitled A Commentary on Morality states that Endo shows the different reaction which many Japanese felt in response to the experiment. Endo describes with enough detail to convey the atrocity, but the focus is upon the morality of the issues. (http:/www.amazon.com/Sea-Poison- New-Directions-Paperbook/dp/0811211983).

  In an article entitled An Exquisite Analysis of the Death of Goodness, there is stared that this dark novel (The Sea and Poison) by Endo explores the anguished feelings of various doctors and nurses in a fictional Japanese hospital during World War II. This work is a searing tragedy about the death of goodness as a result of ambition, exigency and human weakness. (http:/www.amazon.com/gp/product/costumer-review/08112211983/ref

  From the above comments, it can be concluded that the people tend to see moral values of The Sea and Poison. It is truly about the immorality of Japanese doctors. Those comments are right that The Sea and Poison depicts the degradation of morality, the death of goodness, heinous sins which are surprisingly done by the prestigious community, the Japanese doctors. The purpose of doing the human experiment is to invent the new technique in curing the sick person. Although it is morally wrong, the medical invention will be useful for the advance of medical treatment.

B. Review of Related Theories

1. Theory of Character and Characterization

  According to Abrams, character is a person presented in dramatic or narrative work, who are interpreted by the reader as being endowed with moral and disposition qualities that are expressed in what they say-the dialogue-and they do-the action (1981: 20).

  Holman and Harmon also state their character definition that character is a complicated term that includes the idea of the moral constitution of the human personalities, the presence of creatures in art that seems to be human beings of one sort another (1986: 81).

  Stanton in his book An Introduction to Fiction stated that character could be described in two ways. Character is the “individuals who appear in the story and also the mixture of interests, desires, emotions and moral principles that makes up each of these individuals” (1965: 17)

  According to Murphy, the way to examine the characteristics of character is first, by personal description. Sometimes, it is more effective to describe someone’s personalities by describing his/her appearance and clothes. For instance, in describing a beggar, the author uses the words that related to dirty, thin, untidy, and so on. The second is to know the characteristics from the other character’s opinion or the author describes the character trough the eyes or opinion of another. This indirect way will give vivid information about the character. The third is from the speech. The author can give the reader view about someone’s characteristics by observing what the character says. It will give the reader the clue through his/her involvement in conversation with another, his opinion and the way the character speaks. The fourth way is by observing the character’s past life. Someone’s past life or events can give a beneficial clue to help the reader in shaping a person’s character. It can be seen from the author’s direct comment, the character’s thought, and conversation or through the medium of another person. The fifth is conversation of others. It is rather same with the third way but in fifth way the focus of the clue is in the thing they say about the character Murphy states that people do talk about other people and the thing they say often give us a clue to the character of the person spoken about (Murphy, 1992:167). The sixth is reaction. Someone’s characteristic can be seen from the way that character reacts to various situation and events. The seventh way is by observing the direct comment. In the novel, sometimes the author gives the author gives the clue about the characteristics by describing or commenting on a person’s character directly. The eight way is by observing the character’s thought. Murphy states that the author gives the reader direct knowledge of what the character is thinking about. Sometimes the author writes about the thing that he cannot do in the real life. It is like the imagination of the author. It can tell the reader what different people are thinking about. The last but not least, the ninth way is by observing the mannerism and habits, the author wants to tell us about the character personalities. Murphy’s theory is actually can make reader of the character personalities.

2. Theory of Medical Ethics

  Since the works about medical ethics, the theory of bioethics is also applied in order to support the analysis.

  Beauchamp and McCullogh in his book Medical Ethics, quoted the statement of Dr. Gregory, Professor of the practice of physics at Edinburgh, one of the world’s great medical school in the eighteen century begins his treatise on medical ethics with a definition of medicine that incorporates a clear expression of its moral purpose: “the art of preserving health, of prolonging life and of curing diseases” (1978: 32) According to International Encyclopedia of Ethics , medical ethics is a part of bioethics, the multidisciplinary study of ethical problem of humanity arising from scientific advances in medicine and technology examined in the light of moral values and principles (1995: 85). Bioethics is the part of Ethics. In discussing medical ethics, it cannot be separated from moral principles. In medical ethics, there is a familiar term that is Hippocratic Oath. In other words, it is called codes of ethics or principles of ethics. Talking about principles, there is a set of moral principles. According to Beauchamp and McCullogh, there are kinds of principles such as justice, liberty, respect for autonomy, equal treatment, beneficence and utility. Yet, the most important moral principles in medical ethics are the principle of beneficence (one should provide benefits and prevent or remove harms to others) and principle of respect for autonomy (one should regard others as rightfully self-governing (autonomous) in matters of their choice and actions, whereas beneficence requires us to provide positive benefits as well as to prevent and remove harmful condition. (1978: 14).

  According to Thomas A. Shannon, in his book, Medical Ethics, autonomy also involves the concept of personal responsibility (1990: 39). It means that human are subject to a variety of personal and social status and responsibilities. According to principles of Medical Ethics, Beauchamps and Chidress interpret the Hippocratic Oath to describe two often-quoted duties of the Physicians: a bias toward patient care and correspondently to avoid patient harm. The Hippocratic Oath said “ I will use the treatment to help the sick according to my ability and judgement. I will not use it to injure or wrong them (1995: 42).

  According to Shannon, there are principles of double effect in medical ethics. The basic principle of medical ethics is “First of all, do no harm”, it means the physicians can benefit someone, then at least they should do that person no harm (1995: 6).

3. Review on the Relation between Literature and Psychology

  Psychology and literature cannot be separated. In the literary works, there are a lot of authors who apply issues in psychology as their basic idea. According to Wellek and Waren in Theory of Literature (1956: 81), psychology and literature are closely related in which some literary works take the basic idea in psychology. The term psychology of literature has four possible meanings. The first meaning is the psychological study of the author as a type or as an individual.

  The second meaning is the study of creative process. The third meaning is the study of psychological types and laws presented within works of literature, and the last is the effect of literature upon readers (1956: 81). In the literary works, there are a lot of ways and interpretation to explore human’s life which is related to how the human’s behavior can be understood and predicted by a set of psychological theory. According to Cohen in Humanistic Psychology, “in a variety of ways, a psychological approach has opened new avenues to the study of literature” (1958: 189). There are many issues in psychology that can be brought by the authors to be their inspirations in their literary works such as dilemma, conflict of motives and personality of the character. Those issues will be explored deeply in this study.

4. Theory of Dilemma

  According to Gilbert Ryle, dilemmas result when the conduct of the new conscript diverges from the imposed standard. A well-tried control fails to control it. According to American Psychological Association Dictionary of Psychology, dilemma is a situation necessitating a choice between two equally desirable or undesirable alternatives (Vandenbos, 2007: 282). In International Encyclopedia of

  

Ethics , dilemma is choices (usually forced) that, no matter how they are decided,

have negative consequences (Roth, 1995: 228).

  The dilemma which is analyzed in the novel is closely related with physician’s dilemma dealing with his codes of ethics and the external factor.

  When physicians must face this ethical dilemma, they do not have the luxury of referring to comparable paradigm cases. They must recognize and resolve ethical dilemmas based on the accepted principles of medical ethics, the policies and standards of their institutions, and the law of the land.

  Like most physicians, they have direct contact with the institutions with which they are affiliated. In addition, they frequently have direct contact with the patient and the society as well. Some of the ethical dilemmas that are encountered by physicians are directly linked to the individual, the institution, and the community at large.

  The ethical dilemma comes from the responsibility of the physicians to this patient. They must decide what the good of their patients. In other hand he also has responsibility to the institution, where the patient is treated. What is the good for the patient is not always good for the institution. For example, a poor patient should pay his treatment bill. He cannot afford to pay the bill. Should the physicians pay his bill or should he let him died without treatment or let him ‘died’ in the hand of the institution. It is really complicated.

  The ethical dilemma involves society. The society’s perspective is different with the physician’s ethics. The society’s norms are sometimes opposed with the medical decision. For example, euthanasia, assisted suicide, in the society is a killing, but in medical world it obeys the principle of autonomy. It is the patient’s demand to end his life because maybe he cannot endure his illness.

  There is a fourth cause of ethical dilemmas. It is the physician’s responsibility to self. The physician sees a wide variety of patients with an even wider variety of conditions but has a very limited amount of time with each patient. Physicians do not have time to examine each case in detail to determine whether it presents an ethical dilemma, and then to weigh all the alternatives to arrive at the right solution. Physicians must recognize the subtle ethical dilemmas encountered in each case and construct a framework for evaluating them when they occur. (http://www.residentandstaff.com/issues/articles/2006-10_01.asp)

  The responsibility of physicians to their institutions, their societies and their self trap them in a conflict. Sometimes their responsibilities to their patients are opposed with his responsibility to their institution or their society. The belief in their society is opposed with the belief of their institution or themselves.

  According to Borisoff and Victor, different belief or value system are likely to produce a conflict when individuals harboring these fundamental differences for goals in such a way that they perceive that one goal only can emerge (Beaty, 1989:60).

  According to Kurt Lewin in Psychology, there are two kinds of conflicts. First is intrapersonal conflict. This kind of conflict happens in the person’s self. Furthermore, this kind of conflict is divided into four types. The first type is Approach-approach conflict. It results when the individual is motivated to approach two positive goals but can attain only one. It means the closer one is to the goal, the stronger will be the drive toward that goal. The second is Avoidance- avoidance conflict. This type of conflict occurs when the individual must choose between two equally unattractive goals. It means that whenever the individual gets near to one negative goal, the drive to avoid that goal increases. The third is Approach-avoidance. This type of conflict involves only one goal that has both attractive and unattractive qualities associated with it. It means the individual’s own desire to both obtains the goal and escape from it traps him in conflict. The fourth is double approach-avoidance. This type of conflict can involve having to choose between two goals, each of which has positive and negative aspects. It means that the individual involve in choosing whether to approach or avoid a goal that has two positive and two negative aspects. The other type of conflict instead of intrapersonal conflict is interpersonal ones. Interpersonal conflict involves two or more persons ( Stagner, 1952: 493).

  The conflict is closely related to motive because the choices lead to goal- oriented and human’s behavior with their motives in achieving the goal.

  According to Dictionary of keywords in Psychology, motives is a hypothetical state in an organism used to explain its choices and goal-oriented behavior (Bruno, 1986: 141). Motive arouses and directs our behavior toward some goals.

  Motivation is the forces that initiate and direct behavior and the variables that determine the intensity and persistence of the behavior. The initiation of behavior can be prompted from the external environment. For example, we might be hungry because the blood sugar level in the body decreases (internal cue) or because we just see a delicious looking dessert (external cue). Motivation determines the intensity and persistence of our behavior. Intensity has to do with how strong behavior is. For instance, if you are only a little hungry, you might eat if food is readily available, but if there is no food in immediate vicinity you would probably engage in some other behavior. On the other hand, if you are extremely hungry, you would most likely look for something to eat, doing whatever it took to obtain goal. How motivated we are will likewise influence our persistence. Sometimes, we will persist in obtaining goal for along time, while at the other times we give up after a brief try.

  Human motivation cannot be separated from their needs. According to Abraham Maslow with his humanistic theory, stated that theory of motivation must take into account the whole person and should be based on a hierarchy of needs. There are five hierarchies of needs. The first is physiological need. This need cover biological drives such as hunger, thirst, sex, exercise and rest. This need can be found in most people in our society. After the first need is satisfied then human tend to seek safety need. This second need in the hierarchy consist of security. Protection, freedom from fear, anxiety and need for structure and order. The third is belongingness and love need. The characteristic of this need is feeling for desire for friend, family and social contact. We need to belong to a group or family. The fourth is esteem need. This need cover a high evaluation of oneself, self-respect, achievement and recognition by others. Someone reaches achievement to gain people’s respect. The last is self-actualization. This need refers to the attainment of one’s individual abilities.(Atkinson, 1953: 210)

5. Theory of Personality

  According to Florence Littauer who has adopted and developed Hippocrates theory of personality, states that every people has unique characteristics that differentiate him with the other (1996: 4). According to APA Dictionary of

  

Psychology , personality is the configuration of characteristics and behavior that

comprises an individual’s unique adjustment to life (Vandenbos, 2007: 689).

  Therefore, every individual have different response in facing and solving their problems.

  Human personality is divided into four types. They are sanguine, choleric, melancholic and phlegmatic. This theory deeply explains the weaknesses and expertise of each type of person. The type of character and how he deals with the problem can be easily observed. Sanguine is an open-minded person and optimistic. The dominant characteristic is impulsive and demonstrative. They are easily adaptable with other person and friendly. However, they are not deeply thinking about the matter and quickly deciding without thinking the consequences. They are not tough in facing their problem (1996: 22). The second type is choleric. Choleric person is ambitious, highly motivated, manipulative, good leader. His weaknesses are individualistic and difficult to cooperate with other. When this type of person faces problem, he will solve it strategically and systematically.( 1996: 26)

  The third is melancholic. Melancholic person is difficult to have friend, likes to be alone, conservatives, thinker, dreamer, loyal, good listener and observer, perfectionist, selective in friendship. The weaknesses are unrealistic, postponing something, easily depressed. When they face a problem, they will think it deeply and decide it. (1996: 24). The fourth is phlegmatic. The phlegmatic person is flexible, easily have friend, peaceful, not like to be exposed, and comfortable.