My mother who had terminal bone cancer was essentially given an assisted suicide in 1969 when she was down to about 50 pounds (the doctor gave hera high morphine dose that killed her). I don’t begrudge this, but I don’t glorify it. From my non-elite perspective, the elite enthusiasm for suicide seems jarring.
I have no opinion and no passion on the issue of legalizing assisted suicide along with abortion, and other hot button issues such as gun control that I don’t write about.
Several incentives converge for elites in this matter and that’s why they push it in TV shows such as The Pitt and RFDS: Royal Flying Doctor Service.
First is the autonomy ethic that dominates elite culture. In professional and media circles the highest moral language is choice, agency, and self authorship. Assisted suicide fits perfectly. It frames death as the final act of personal control. That resonates with people whose identity is built around self determination and mastery over circumstance. So storytellers instinctively treat it as dignified rather than tragic.
Second is status signaling inside elite coalitions. Supporting assisted suicide signals membership in the modern, compassionate, rational camp. It distinguishes the speaker from religious or traditional moral systems that emphasize sanctity of life. In elite cultural environments, especially in journalism, academia, and entertainment, signaling distance from traditional religious norms carries prestige.
Third is narrative convenience. From a storytelling standpoint assisted suicide solves difficult plot problems. A lingering illness is messy and undramatic. A chosen death creates a clear emotional climax. It allows characters to deliver speeches about love, freedom, and dignity. Writers prefer tidy moral arcs and assisted suicide provides one.
Fourth is identification. The people who write films and television imagine themselves in the role of the educated professional facing decline. Their fear is not poverty or violence. It is dependency, dementia, or loss of autonomy. Assisted suicide becomes a fantasy of control over the kind of ending they personally dread.
Fifth is the professional managerial mindset. Many elite institutions approach social problems through management and optimization. If suffering can be minimized through a controlled medical procedure, it appears rational. That technocratic framing shows up naturally in scripts and news coverage.
Sixth is coalition politics. Media, academia, medicine, and parts of the legal profession form a loose alliance around progressive bioethics. Promoting assisted dying aligns with broader commitments to reproductive choice, bodily autonomy, and secular moral reasoning. Cultural products often reflect the moral language that binds these alliances.
There is also a darker structural incentive that critics point out. Aging populations and high medical costs create quiet pressure to normalize earlier death in extreme illness. Even if no one says this openly, the cultural environment becomes more receptive to stories where choosing death is portrayed as responsible rather than tragic.
Assisted suicide stories flatter elite values. They celebrate autonomy, rational control, secular morality, and professional authority. That combination makes them very attractive themes for writers and producers operating inside elite cultural networks.
The Logic of Professional Autonomy
The emphasis on self-authorship creates a moral hierarchy where dependency is the ultimate failure. In professional circles, mastery over one’s environment is the primary source of status. When writers frame death as a final act of personal control, they transform a biological inevitability into a professional achievement. This converts the messiness of decline into a tidy, managed exit that reflects the values of the professional-managerial class.
Status Signaling and Secular Alliances
Supporting assisted suicide serves as a boundary marker. It separates the “rational” and “compassionate” elite from traditional or religious populations who view life as a gift rather than a property. By pushing these narratives, creators signal their membership in a modern, secular coalition. This alliance includes academia, media, and bioethics, all of which prioritize individual choice over communal or sacred constraints.
Narrative Utility and Economic Pressures
You rightly note that a lingering illness lacks the dramatic punch required for television. A chosen death provides a clear climax and a platform for scripted dignity. Beyond the writer’s room, the structural pressure of an aging society adds a darker layer to this preference. As medical costs rise, the cultural promotion of a “responsible” death aligns with technocratic goals of optimization and resource management.
That these stories flatter elite values makes them self-perpetuating. They validate the dread of dependency while celebrating the secular authority of the medical and legal professions.
The 2025-2026 series The Pitt serves as a textbook example of the incentives you described. It uses a real-time, 15-hour shift structure to create a pressure cooker where medical decisions carry extreme weight. Critics and viewers have specifically highlighted how the show handles the tension between professional expertise and the “broken system” of healthcare.
The Professional Managerial Savior
The show centers on Dr. Michael “Robby” Robinavitch, played by Noah Wyle. Robby is the embodiment of the “competency porn” you mentioned. He is depicted as a hero who must navigate underfunding, staffing shortages, and a “broken society” while maintaining professional authority. When he supports a family’s end-of-life wishes, the narrative frames it as a sacred, compassionate act of management. This reinforces the idea that an “organized” death is a victory of medical ethics over the chaos of an under-resourced hospital.
Assisted Suicide as Narrative Climax
The storyline of Roxie, a patient facing terminal illness, has become a central point of discussion among viewers regarding assisted suicide. Fans of the show often frame her potential choice to end her life as a rational, “ready” state, contrasting it with her family’s “unready” emotional resistance. This perfectly mirrors your point about narrative convenience: the show transforms the messy, slow reality of cancer into a high-stakes ethical climax where the “correct” and “compassionate” path is for the professionals to facilitate her autonomy.
Status Signaling and Cultural Impact
The USC Norman Lear Center conducted a study showing that The Pitt significantly shifted viewer attitudes toward end-of-life planning and advance directives. The show positions its characters as being on the “right side” of history by opposing “archaic laws” that prevent doctors from providing what some viewers call “the care she actually needs” (meaning assisted death). This aligns the show with the elite secular coalition of medicine and media, distinguishing its “rational” approach from traditional legal or moral constraints.
The Pitt uses its documentary-realism style to make these elite values feel like common sense. It portrays the hospital as a “workplace catastrophe” where a controlled, chosen death is one of the few things a doctor can actually “fix,” thus flattering the professional desire for mastery over circumstances.
The portrayal of Dr. Robby in The Pitt mirrors the logic of Carl Schmitt’s “state of exception” by placing the physician in a position of ultimate sovereignty. In the high-pressure environment of a modern ER, the “norm” is a set of legal and bureaucratic rules that often fail to account for the chaos of a “workplace catastrophe.” Robby functions as the sovereign who decides on the exception. When he steps outside standard hospital protocol to prioritize a patient’s “dignity” or “autonomy,” he essentially declares that the existing rules do not apply to this specific, extreme case.
The Doctor as Sovereign
Schmitt argues that the sovereign is he who decides on the exception. In The Pitt, the ER is a constant state of emergency. Robby uses his professional expertise to bypass the “broken system” of hospital administration and insurance mandates. This creates a symmetry between medical authority and political power. By facilitating a chosen death, the doctor exercises a form of “biopower,” where the professional managerial class determines which lives are “worthy” of a managed exit and which must be preserved by the “irrational” state.
Friend/Enemy Logic in the ER
The series also utilizes Schmitt’s friend/enemy distinction to build its moral landscape. The “friends” are the rational, compassionate medical professionals and the patients who accept their “self-authorship.” The “enemies” are the bureaucratic administrators, the outdated legal structures, and sometimes even the “unready” family members who cling to traditional sanctity-of-life arguments. This creates a tribal alliance. The show’s narrative logic pushes the audience to identify with the “enlightened” coalition against the “obstructionist” forces of tradition or bureaucracy.
The Illusion of Autonomy
While the show frames assisted suicide as an act of personal agency, through a Schmittian lens, it looks more like a surrender to professional authority. The patient “chooses,” but the doctor provides the means, the setting, and the moral justification. This reinforces the status of the professional class. That the audience sees this as a victory for the patient shows how effectively the “autonomy ethic” masks the underlying logic of elite control.
The shift from the porous self to the buffered identity is the engine that drives the moral logic of The Pitt. In Charles Taylor’s framework, a porous self sees the world as filled with spirits, grace, and cosmic forces that can penetrate the individual. Meaning comes from an external order. The buffered identity, which defines the modern elite, is an internal citadel. Meaning is something we create and protect within our own minds.
The Buffered Identity as a Medical Shield
In The Pitt, Dr. Robby and the terminal patients he assists represent the ultimate buffered identities. They treat the body as a machine or a vessel that the mind—the true self—must control. When a patient like Roxie faces a “lingering illness,” the horror for the writers is not the pain itself, but the threat to the buffer. Dependency is a hole in the armor. By facilitating assisted suicide, the medical professional acts as a technician who helps the patient maintain the integrity of their buffered self until the very last moment.
The Rejection of the Porous
The show often portrays family members who resist assisted suicide as “irrational” or “unready.” From a Taylorian perspective, these characters often lean toward a porous understanding of life. They may see suffering as having a communal or even spiritual meaning that the individual does not fully own. The Pitt frames this as an intrusion. The narrative logic suggests that the family’s grief or traditional values should not “penetrate” the patient’s autonomous decision. The professional staff intervenes to reinforce the patient’s boundaries, effectively “buffering” them against the messy, porous demands of their own kin.
Secular Sanctity and the Professional Moral Order
That the show treats a managed death as “dignified” reflects what Taylor calls the “immanent frame.” There is no higher appeal to a divine order or a sanctity of life that exists outside human choice. Dignity is redefined as the successful exercise of the will. The doctors in The Pitt are the high priests of this secular order. They use their expertise to ensure that the patient’s “self-authorship” remains intact.
This creates a new kind of “purification ritual” similar to what Jeffrey Alexander describes. The hospital setting “purifies” the act of killing by wrapping it in the language of medical ethics, professional autonomy, and compassionate management. It removes the “stigma” of death and replaces it with the “prestige” of a rational choice.
In The Pitt, the medical procedure of assisted suicide functions as a purification ritual that converts a transgressive act into a symbol of professional excellence. Jeffrey Alexander argues that societies use these rituals to separate the “sacred” from the “profane.” In the elite moral universe, the “profane” is the messy, undignified, and uncontrolled death associated with traditional or “unmanaged” aging. The “sacred” is the autonomous, rational, and medically supervised exit.
The Hospital as a Sacred Space
The ER in The Pitt is not just a place of healing; it is a ritual stage. When Dr. Robby facilitates an end-of-life choice, the show uses clinical precision—the white coats, the calibrated dosages, the hushed professional tones—to “purify” the event. This framing strips away the existential dread and the moral weight of ending a life, recasting it as a triumph of medical ethics. The “messiness” of nature is replaced by the “logic” of the institution.
Maintaining Class Status
This purification serves a specific class function. By positioning themselves as the only ones capable of managing this transition with “dignity,” the professional class reinforces its own necessity. Only the credentialed expert has the “compassion” and “rationality” to navigate these waters. This creates a barrier between the “enlightened” professional and the “irrational” public who might still view such acts through a traditional moral lens.
The Symbolic Alchemy of “Dignity”
The ritual succeeds by changing the name of the act. That the show never frames these deaths as “tragedies” but as “victories of the will” shows the power of the elite narrative. The writers use the patient’s death to validate their own worldview. The patient becomes a martyr for the cause of autonomy, and the doctor becomes the priest who ensures the sacrifice is “clean.”
This ritual provides a sense of mastery over the one thing elites cannot actually control: their own mortality. By making death a “procedure,” they bring it within the realm of the professional-managerial mindset, where everything can be optimized.
The friend/enemy distinction in The Pitt creates a moral landscape where the hospital staff forms a protective circle around the patient to “defend” them from their own families. In this logic, the medical professional is the friend because they validate the patient’s autonomy. The family often becomes the enemy because they represent the “porous” claims of tradition, religion, or simple emotional refusal to let go.
The Family as the Obstructionist “Other”
The show frequently portrays family members as people who do not “get it.” They are shown as being in “denial” or acting out of “selfishness.” By contrast, the medical staff is “rational.” This creates a Schmittian boundary. The doctor’s office or the hospital room becomes a site where the sovereign (the doctor) and the subject (the patient) align against the “irrational” external forces of the family unit. The narrative treats the family’s desire to preserve life as a violation of the patient’s “buffered identity.”
Professional Expertise as the “Friend” Bond
This alliance is built on shared elite values. The doctor and the “enlightened” patient speak the same language of agency and self-authorship. When Dr. Robby side-steps a family’s wishes to fulfill a patient’s request for a “dignified” exit, he is declaring who belongs to his moral community. The family, with their “messy” grief and “unscientific” hope, is cast into the role of the enemy of progress. The show uses this tension to create drama, but the resolution almost always favors the professional-managerial perspective.
The Moral High Ground of the “Managed” Death
The purification ritual Jeffrey Alexander describes is used here to consolidate this “friend” group. By framing the doctor’s actions as “care” and the family’s actions as “interference,” the show performs a symbolic inversion. The act of ending a life is purified into an act of supreme compassion. Anyone who opposes this is not just “wrong” but is a threat to the patient’s dignity.
This reinforces the status of the professional class. They are the only ones who can truly “befriend” the patient in their final hour because they are the only ones “brave” enough to discard traditional morality for the sake of “rational” control. That the audience is led to cheer for the doctor over the grieving daughter or spouse shows how deeply these elite incentives have shaped the storytelling.
The alliance between media and the medical profession in The Pitt functions as a mutual validation machine. This partnership creates a closed loop where entertainment products normalize the professional-managerial class (PMC) worldview, while the medical establishment provides the “expert” veneer that grants the show its prestige.
The Media-Medicine Symbiosis
Entertainment creators need high-stakes, “authentic” settings to ground their narratives. Medicine provides this. In return, the medical profession receives a heroic portrayal that frames its specific bioethical preferences as universal truths. When The Pitt depicts assisted suicide as a “victory of the will,” it is not just telling a story. It is performing a service for the bioethics wing of the medical establishment. By branding these acts as “compassionate care,” the media helps the medical profession expand its sovereign domain over the beginning and end of life.
Defining the Enemy of the Alliance
The “enemy” in this larger alliance consists of any group that challenges the authority of the expert. This includes religious institutions, traditionalist legal groups, and populist movements that view the PMC with suspicion. By framing these groups as “obstructionist” or “anti-science” in the script, the show protects the alliance’s status. The narrative logic suggests that if you disagree with the doctor’s “rational” facilitation of death, you are not just making a different moral choice; you are an enemy of “dignity” itself.
The Prestigious Feedback Loop
This alliance is cemented through institutional accolades. When medical centers or public health organizations praise The Pitt for its “accurate” portrayal of “end-of-life options,” they are participating in the purification ritual. The show’s writers get the prestige of being “socially conscious” and “brave.” The doctors get a cultural environment that is more receptive to their technocratic management of suffering. That this collaboration feels “natural” to the audience is a testament to how effectively the alliance has merged media and medicine into a single “voice of reason.”
This symmetry ensures that the elite values of autonomy and control remain the dominant moral language of the screen. The “friend/enemy” distinction effectively silences the “porous” or traditional perspectives by making them appear dramatically and intellectually invisible.
In the urban healthcare landscape of The Pitt, the city itself is portrayed as a perpetual state of exception. The show presents a Chicago—and by extension, any major American city—where the normal legal and social order has failed. Underfunding, homelessness, and systemic decay create a crisis that the standard “norm” cannot fix. This justifies the doctor’s role as the sovereign who must make life-and-death decisions that bypass traditional bureaucracy.
The ER as a Sovereignty Zone
The hospital functions as a “camp” in the Schmittian sense, a space where the usual rules are suspended to manage a population in crisis. Within this zone, the doctor’s authority is absolute because the “system” outside is broken. When Dr. Robby facilitates a chosen death, he is not just treating a patient; he is exercising urban management. He decides that since the state cannot provide a “good life” for the terminal or the elderly in a decaying city, the medical profession will provide a “good death.” This technocratic solution to a social failure is the essence of the professional-managerial mindset.
Urban Policy and the Optimization of Death
The alliance between media and medicine uses the “urban crisis” narrative to frame assisted suicide as a logistical necessity. In a city with limited beds and exhausted resources, the “lingering illness” you mentioned is not just a narrative problem; it is a resource problem. The show subtly suggests that in a “broken society,” a controlled, autonomous death is the most “responsible” outcome. This reflects a darker structural incentive: normalize the exit of the “unproductive” or the “suffering” to alleviate the pressure on the failing urban infrastructure.
The High Priest of the City
Dr. Robby becomes the hero because he “gets his hands dirty” in this state of exception. He is the one who can look at the “messy” reality of the city and impose a rational, secular order. By choosing when to apply the law and when to ignore it for the sake of “dignity,” he maintains the prestige of his class. The show validates this by framing his rule-breaking as the only “compassionate” response to a cruel world. That the audience sees his circumvention of the law as heroic proves the success of the elite “purification” of the act.
The “urban healthcare” setting provides the perfect backdrop for this. It allows the writers to portray the “enemies” of assisted suicide—like rigid hospital lawyers or religious protesters—as being out of touch with the “brutal reality” of the streets. This further cements the alliance between the media creators and the medical professionals as the only ones qualified to govern the state of exception.
The parallels between the medical sovereignty of Dr. Robby in The Pitt and the political strategy of Karen Bass in Los Angeles lie in the use of the “emergency” to bypass traditional democratic or bureaucratic friction. Both the fictional doctor and the real-world mayor operate on the premise that the “norm” is no longer functional. In a state of persistent crisis—whether it is a “workplace catastrophe” in an ER or a “homelessness emergency” on the streets—power shifts from the legislative or legal realm to the executive and the expert.
The Executive State of Exception
Just as Robby declares a moral exception to facilitate a patient’s exit, Karen Bass used her first act as mayor to declare a State of Emergency on homelessness. This declaration is a classic Schmittian move. It allows the executive to suspend certain zoning laws, procurement rules, and bureaucratic hurdles to achieve a managed outcome. In both cases, the “crisis” justifies a concentration of power in the hands of the professional manager. The goal is optimization: moving people off the streets or out of hospital beds through a controlled, state-sanctioned process.
The Purification of Displacement and Death
There is a shared ritual of purification in how both leaders manage uncomfortable realities. In The Pitt, the act of ending a life is purified through the language of “dignity” and “autonomy.” In Los Angeles, the clearing of encampments is purified through programs like Inside Safe, which frame the removal of people from public spaces as “service-led” and “compassionate.” Both strategies use the prestige of the professional-managerial class to strip away the “profane” or “messy” elements of the problem. They replace the chaos of the street or the lingering illness with a tidy, institutional solution that validates the authority of the manager.
The Alliance Against the “Inefficient”
Both Robby and Bass rely on a “friend/enemy” distinction to maintain their coalition. The “friends” are the experts, the non-profit industrial complex, and the media figures who celebrate the “bold action” of the leader. The “enemies” are the “obstructionists”—the NIMBYs, the rigid hospital lawyers, or the traditionalists who insist on a slower, more “porous” or communal process. By framing their opponents as “clinging to a broken status quo,” both the fictional doctor and the real mayor distinguish themselves as the rational vanguard.
This reflects the “technocratic framing” you mentioned. If a social problem like homelessness or suffering can be “fixed” through a controlled medical or administrative procedure, it appears rational to the elite. The moral language of “care” and “autonomy” binds these alliances together, making the suspension of normal rules feel not like a power grab, but like a sacred duty.
The managerial logic in The Pitt finds a striking parallel in the current transformation of Orthodox Jewish institutions. Both systems increasingly use professionalization to manage the “messiness” of human life, whether it is a terminal illness in a hospital or the “sustainable” management of a religious community. In both cases, leadership is being replaced by administration.
The Rise of the Rabbinic Administrator
Just as Dr. Robby uses his expertise to navigate a “broken system,” modern Orthodox leadership is shifting toward a model of “over-optimization.” Recent critiques, such as those by Paul Mendlowitz, argue that the “era of leadership” has been replaced by an “era of administration.” Rabbis today often function less as visionary prophets and more as CEOs of “tax-free real estate” and multi-million dollar institutions. They manage optics, narratives, and budgets rather than confronting the underlying economic or social crises—like the “tuition bubble” or the housing crisis—that suffocate their families.
Purification through Professionalization
The “purification ritual” Jeffrey Alexander describes is also at work in the Jewish communal world. Organizations like the Orthodox Union (OU) and various Federations have adopted corporate management techniques, using “objective metrics” and “data-driven” strategic planning to justify their authority. This professionalization “purifies” the community’s operations, making them appear “rational” and “modern” to a donor class that values efficiency.
However, this mirrors the “autonomy ethic” in The Pitt. By emphasizing “best practices” and “measurable outcomes,” these institutions create a “buffered identity” for the community. They attempt to protect the “hardcore learner” model or the institutional status quo by “managing” any external or internal “messiness”—such as the “dropout” crisis or the influence of the internet—through committees and proclamations rather than direct engagement.
The Emergency as a Tool of Governance
Similar to Karen Bass’s use of emergency declarations, Orthodox institutions often use a “crisis” framing—whether it is a “crisis of faith” or an “existential threat” from secular culture—to centralize control. This allows them to declare a “state of exception” where traditional communal debate is suspended in favor of “rabbinic authority” or “daas torah.”
In this framework, the “friends” are those who follow the institutional “management plan,” while the “enemies” are those who expose the system’s “dishonesty” or suggest that the current model is unsustainable. This creates a symmetry with the urban governance of Los Angeles: the “expert” (the mayor or the rabbi) is the only one who can navigate the “emergency,” thus making their power appear both necessary and compassionate.
The Professional Manager as the New Sovereign
Ultimately, the physician in The Pitt, the mayor in Los Angeles, and the rabbinic administrator in the Orthodox world all represent the same figure: the professional-managerial sovereign. They all treat the “porous” and “messy” aspects of human life—death, homelessness, or religious struggle—as technical problems to be solved through optimization. This “managerial mindset” validates their status while ensuring that the underlying “states of exception” remain the permanent mode of governance.
The administrative turn in Orthodox Jewish life mirrors the tension Stephen Turner identifies between explicit expertise and tacit knowledge. Turner argues that expertise often fails because it cannot capture the unarticulated, lived practices that actually sustain a culture. In The Pitt, Dr. Robby relies on the explicit, technical rules of bioethics to manage death. Similarly, the rabbinic administrator relies on the explicit, technical rules of institutional management to govern the community. Both ignore the tacit “know-how” of the people they serve.
The Erosion of Tacit Tradition
For Turner, tacit knowledge is the “underground” wisdom that allows a tradition to function without a manual. In Jewish life, this is the minhag or the lived atmosphere of the home and street. When an organization like the OU or a large suburban synagogue professionalizes, it replaces this organic, tacit transmission with explicit “programming.”
They create “engagement metrics” and “strategic initiatives” to manufacture what used to happen naturally. This is the “managerial optimization” you noted. It attempts to turn a porous, lived experience into a buffered, managed product. The result is an institution that looks “rational” on paper but feels hollow to those who remember the “messy,” unmanaged community of the past.
The Failure of the Expert Sovereign
Turner’s critique of expertise is that experts often “solve” problems by destroying the very social fabric that made the problem manageable in the first place. In The Pitt, the doctor “solves” the problem of suffering by ending the life, bypassing the tacit communal process of grieving and care.
In the Orthodox world, the administrator “solves” the tuition crisis or the housing crisis with a new committee or a fundraising campaign. However, they rarely address the tacit social pressures—the “status signaling” and “coalition politics”—that created the crisis. Because the administrator operates in the realm of explicit management, they are blind to the tacit “logic” that actually drives the community’s behavior.
The Alliance of Experts
This creates a “friend/enemy” distinction between the expert and the practitioner. The “friends” are the fellow professionals who speak the language of “best practices.” The “enemies” are the “uninformed” laypeople who feel something is wrong but lack the professional vocabulary to explain it.
The media-medical alliance in The Pitt validates the expert over the family. The administrative-rabbinic alliance validates the institution over the individual family’s economic reality. In both cases, the “state of exception” (the crisis) is used to justify the expert’s rule, while the tacit wisdom of the “porous self” is dismissed as irrelevant or “unready.”
That these elite institutions prefer explicit management is not an accident. Explicit rules can be audited, scaled, and used to signal status. Tacit knowledge is local, stubborn, and resistant to professional control. By pushing explicit expertise, the elite maintain their “sovereign” position as the only ones who can “properly” manage the tradition.
