Quid pro quo

Quid pro quo

Sometimes, if you want to understand how pervasive a concept is, you can look at the vernacular of a society. English speakers from Commonwealth countries have many expressions that suggest the basics of reciprocity are foundational for how we expect our society to function. “Quid pro quo,” Latin for “something for something,” appeared in regular usage in the 16th century. We also have “give and take,” “tit for tat,” and “if you scratch my back, I’ll scratch yours.” The meaning behind these expressions, which implies an expectation of reciprocity, is perhaps best summed up by another Latin phrase: “do ut des,” translated as, “I give, so that you may give.”

Canadian physician Norman Bethune was not a volunteer in the sense we often use the term now to describe activities that are an adjunct to daily life. His efforts to help others were completely integrated into his work and life. What made him a volunteer is that he did it of his own volition, at no obvious personal benefit. Therefore, his story provides an interesting example to really explore reciprocity. What do you get when you give? What kind of tensions are created when the two forces interact?

Norman Bethune grew up wanting to be a surgeon, inspired by his doctor grandfather. He completed his studies during the First World War, during which he also volunteered providing medical support on the battlefield. During the 1920s he practiced medicine in the United States and Canada, eventually settling in Montreal. He initially specialized in thoracic surgery and developed a solid reputation as a surgeon. However, he had an ongoing commitment to help people beyond what he did in his practice. This goal he pursued in a variety of ways.

During the early 1930s, while in Montreal, Bethune provided medical services free to the poor and established a free-of-charge clinic he ran once per week. He vocally advocated for universal health protection, explaining that many medical issues were created by poverty and negligent employers. In addition, and unique for the time, he used radio broadcasts to educate the public on tuberculosis. Bethune volunteered his time, energy, and intelligence to try to bring about meaningful improvements in the lives of the most impoverished.2

During the 1930s he became a supporter of communism and joined the Communist Party, mostly on account of what he saw of the benefits of the Soviet socialized health care system. These political beliefs took him further afield in his efforts to improve access to and outcomes in healthcare.

In 1936 in Spain during the Spanish Civil War, Bethune designed and developed a mobile blood transfusion unit. This vehicle could draw and store blood, was used to give transfusions, and most importantly, could be used on the front lines of the battlefield. It was a remarkable innovation that saved countless lives and inspired the medical approach used in World War II.

All of the work that Bethune did in Spain, and later China, was not for profit. The mobile blood unit and all his other surgical innovations and inventions did not make Bethune any money.3

In 1938 Bethune went to China, desiring again to help people. China was fighting a war with the Japanese, the Sino-Japanese War, and Bethune’s belief in communism led him to deploy his efforts in support of Mao and the Communist Party of China. He worked with the Communist forces to improve medical care in poorly equipped battlefield services.

Helping the Chinese in their fight, he again deployed his practice of bringing the surgeon to the battlefield, designing mobile operating equipment and improving the survival rate of the injured. He also extensively trained doctors and nurses and established hospitals in areas that had neither. In their article, “The Medical Life of Norman Bethune,” Deslauriers and Goulet write, “His courage, determination and will to fully employ his talents of ingenuity, aggressiveness and selfless response to social concerns when the time came is truly remarkable.”4 He accomplished so much in his 18 months in China that when he died of septicemia after operating on a soldier, Mao delivered his eulogy, describing him as “a man who is of value to the people.”5

Bethune became a celebrated figure in China, where his medical work and service were commemorated.

Bethune’s story, however, is not solely one of accolades and recognition, heaps of positive effects achieved as a result of a life spent trying to bring about good. He died at age 49 as a direct result of his efforts to improve health outcomes on the battlefield. The fact that he was a communist led him to be written out of Canadian history during the Cold War years, when communism was seen as a direct threat to Western democracy. His personal life wasn’t great, and his aggressive personality earned him enmity from many colleagues.

Normally one would talk about a life like Norman Bethune’s in terms of sacrifice. He sacrificed personal relationships, social acceptance, and ultimately his life in order to take actions in accord with his beliefs and values. But using the lens of reciprocity suggests there is another way to interpret the story.

In a paper on the health benefits of volunteering in adults, the authors explain, “The beneficial effects of volunteering on health outcomes have been well documented. Research has found that participation in voluntary services is significantly predictive of better mental and physical health, life satisfaction, self-esteem, happiness, lower depressive symptoms, psychological distress, and mortality and functional inability.”6 The cited research associates volunteering with better outcomes for volunteers. People may volunteer for many reasons, and the benefits can vary; an association alone does not establish how much volunteering caused an individual’s health or satisfaction.

The studies on the positive aspects of volunteering for the volunteer bring to mind the metaphor of reciprocity, in which an action has a return. Although volunteering is not governed by the laws of physics, using reciprocity as a metaphor can help us understand why volunteering appeals to so many people. And consequently, why some people make the choice to help others at seemingly great cost to themselves.

Helping others can bring satisfaction, belonging, or a sense of purpose. These returns need not take the form of repayment or public recognition. Bethune’s reception also varied: his political commitments complicated recognition in North America, while his service was celebrated in China.

Bethune’s story suggests that acting on his commitments may itself have been rewarding. That is an interpretation of his motivation, rather than a measured benefit or an equal return guaranteed by a law of nature. It leaves room for both satisfaction and sacrifice in the same life.

« Many, many men have been just as troubled morally and spiritually as you are right now. Happily, some of them kept records of their troubles. You’ll learn from them—if you want to. Just as someday, if you have something to offer, someone will learn something from you. It’s a beautiful reciprocal arrangement. »

J.D. Salinger 7