A Critical Genealogy of Punishment and Its Chilling Effect on Medical Practice

Abstract

Julian Ungar-Sargon*

This article examines how the evolution of punishment from public spectacle to bureaucratic surveillance has created a pervasive climate of internal fear within medical practice, fundamentally altering physicians' psychological states and clinical decision-making. Drawing on Foucault's genealogy of punishment, contemporary sociology of the carceral state (Simon's "governing through crime," Garland's "culture of control," Wacquant's analysis of neoliberal penality), and my work on heretical medical ethics, I argue that the threat of criminal prosecution for pain management, off-label prescribing, reproductive care, gender-affirming treatment, and alternative medicine has transformed physicians from autonomous healers into risk-averse bureaucratic functionaries. This "carceral consciousness" operates through internalized surveillance that restructures clinical reasoning from patient-centered benefit to organizational risk avoidance. The article traces four mechanisms—legal indeterminacy, surveillance infrastructures, professional discipline, and institutional co-production with law enforcement—showing how they generate chilling effects across pain medicine, reproductive care, gender-affirming treatment, dual-loyalty contexts, and sites where policing infiltrates clinical spaces. I conclude with safeguards to restore ethical primacy and call for heretical resistance to this colonization of medical consciousness.

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