The veins in the big farmer’s arm stand out like ropes and the needle goes in easily. I release the tourniquet and begin to inject the Diamorphine, a tenth of a millilitre at a time, watching the tension, the pain and the sweat in his face. Listening to his breathing. Feeling the pulse with my free hand. Feeling rather alone at the end of the long road and the rough farm track.

‘You’ll feel better in a moment… Don’t worry…’

He opens his eyes and smiles a little.

‘Any different?’

‘It’s easing off a bit, I think.’

‘OK. Just rest back..’

I watch and wait for him to settle. Holding back half the syringe. ‘Could we have a bowl in case he feels sick please.’ His wife goes out briskly.

It is my weekend on duty and they are patients of one of the other doctors in the rota. It sounded like a coronary on the telephone and when I arrived it looked like one. It obviously felt like one.

I’m thinking what to do next. Whether to admit him to hospital or keep him at home. I decide to be frank with him. He’s no fool, he’ll want to know. ‘Now I think what’s happened is that you’ve had a slight… Hang on… Damn!’

He’s not listening. His eyes are rolling upwards. Even as my hands go to lift his chin he takes a convulsive unconscious inspiration, stops breathing and begins to turn blue.

This is not my favourite pastime… I slap the centre of his chest hard — worked once, but not this time. I make a space and swing his heavy body on to the floor, stick a plastic airway from my emergency bag over his tongue and begin to inflate his chest with my Ambu-bag. No pulse — so I start cardiac massage as well. His wife is looking on. What do I do next?

I suddenly remember my colleague who is on duty for the other practice and who I know has a defibrillator in his car which we might use to get his heart beating again. ‘Look, could you ring this number and ask Dr Bethell to get here as quickly as possible.’ I know it is stupid as I say it. He couldn’t possibly be here in less that twenty minutes and we haven’t a hope of saving him after more than five. She goes off anyway and I draw up some Adrenaline and inject it into his heart. Nothing. He is turning bluer so I go back to the respiration and the cardiac massage knowing that I am only doing it because I haven’t the courage to stop.

And then I feel the gentle touch on my shoulder and the soft voice of his wife, trying not to upset me too much, ‘I think he’s dead, doctor…’

I know that lady well now because she came on to my own list of patients when my colleague retired. After her husband’s death she had left the farm and moved to a smaller house. Now she keeps her new garden as full of brilliant flowers as she used to keep the old one. After the night of the great storm of October 1987 she told me that she had lain there, alone in her bedroom, hearing the trees crashing down onto her lawn, one after another. ‘I thought the end of the world had come,’ she said, ‘I didn’t mind very much, I just lay there and waited.’

You don’t need to tell me the number of different ways I could have treated her husband better, how much better equipped I could have been or how much better trained for that particular eventuality. Nobody could have felt these deficiencies more than I did. But her straight forward, common sense brought home to me just how irrelevant, how intrusive and how trivial such hi-tec interventions would actually have been.

There is no correct answer to the problem of how far to push the treatment of dying patients, the only answer is common sense. That’s why heads of state get such an appalling deal at the ends of their lives. Teams of the most distinguished doctors available are assembled and while the whole world watches in horror they struggle to prevent what is obviously inevitable.

Nobody, however senior or distinguished, can afford to be guided by common sense when their actions are spotlighted on the media stage. So Emperor Hirohito of Japan, President Eisenhower of the USA and General Franco of Spain went through days and weeks of unnecessary suffering because nobody had the courage to say the simple words, ‘I think he’s dying, doctor.’

When I die I hope that I will have a doctor who is free to use his, or her, common sense. I know from numerous remarks made to me by patients over the years that this is what other people want as well: to be able to trust a doctor to weigh up the situation and treat them as they would treat a member of their own family. No more. No less. Most people are far more afraid of too much treatment at the end of their lives than of too little and few expect their doctors to go on saving them for ever. But they do expect them to use their common sense. It is vital that we create a society which can respect such final wishes of its members.

I have tried to give some impression in this book of the wonderful cast of characters that peoples the world of one small town GP. I have quoted some of the things they say in order to show the wisdom, love, humanity of ordinary people, which the media phenomenon has somehow misled us into doubting.

It is individual people who are important in life, with their infinite variations, colours, strengths and failures. Yet, more and more people are asking what role there is for them as individuals in the impersonal, mechanistic society they increasingly live in. They feel that there must be more to life than just being an anonymous operative in a great machine, or an anonymous consumer, whose actions can be reduced to a series of statistical norms.

What I have tried to do is to go beyond the simple statement of an inner conviction. To express more than ‘just a feeling’ that without the human aspects of life, life would not be worth living. I have set out to show that there are excellent, logical reasons why society needs the common sense and integrity of individual people in order to sort out the tangle of proliferating technology that enmeshes us. After we have dealt with the cold logic of the matter, those who want to put the feelings back in again are free to join me in doing so.

Here we are at the crux of the paradox. We want to define clear solutions to the problems we can see in the world. But as we do so we progressively destroy the essence of life itself. It seems to be an unavoidable rule that the precise definition of human affairs has the effect of killing humanity itself.

To put it another way, society is faced with the following problem; we understand the world we live in more completely than we have ever done before, and yet we understand it less. The near total triumph of our logical approach to quantifying and measuring and recording the world looks like coinciding with our final destruction, by one means or another, of that world. In other words, our logical approach to life is threatening to bring our life to a logical conclusion. And the irony is that our slide into the abyss will be understood and explained and recorded like the greatest cinema epic there has ever been.

As Robert M Pirsig said in his wonderful book, Zen and the Art of Motorcycle Maintenance:

‘…the crisis is being caused by the inadequacy of existing forms of thought to cope with the situation. It can’t be solved by rational means because the rationality itself is the source of the problem.’

As we hunt around, more and more frantically, for ways to describe and control the world more and more perfectly, we find that the problems don’t get less, they get more. Daily, we encounter the consequences of our failed perception. And all the time the answer we are seeking is there, not actually under our noses, but an inch or two above and behind our noses.

I don’t want to get involved in the familiar argument about whether or not our minds are machines. There can be no question that they have qualities of subtlety and mystery which place them far beyond our normal conception of what is meant by a machine. Whether the capacities for self-awareness, passion and free-will are ultimately explainable in solely mechanistic terms is beyond me, although I have my view. But what I would say is that if our capacity for understanding — this amazing ability which we take so much for granted — to hold an imaginary model of the world, to constantly improve it by comparison with experience, and then by applying something which we call imagination, to test out future courses of action and future possible developments — if this ability is the function of a machine, that machine is like no machine that man has ever created.

The modern assumption is that we have machines and systems which describe and therefore understand the world better than our minds could ever do. We assume that we have improved enormously on nature. But we are entirely wrong. Not only have we underestimated the magnitude of the task we have undertaken, not only have we failed to appreciate the power of our minds, but we have failed to see that the absolute terms in which machines are compelled to operate are incapable of describing life at all.

Machines are in their element when dealing with absolute terms; they are enormously superior to us at, for example, performing calculations. Computers, after all, compute. But when we extrapolate from this, as many people do, to the assumption that they will be correspondingly superior to us in understanding the world, we make what is, ironically, a glaring error of logic. We forget that performing arithmetic is hardly any more the purpose of a human mind than making a wake is the purpose of an ocean liner. The purpose of the human mind, which the evolutionary forces of millions of years have operated to perfect, is to model the world. Brains only compute as a by-product of their modelling; computers only model as a by-product of their computing.

It is important to recognise that there is a fundamental inequality in the comparison here. Ability in computing can be directly measured and compared — indeed that is exactly the kind of thing that computers are designed to do — so we know how much superior they are to us in this respect. Ability in modelling, on the other hand, can only be judged as an art form, and it is impossible to make absolute comparisons. Nevertheless, when we consider the perfection of other biological systems (you have only to think of the movements of an Olympic gymnast) it seems very likely that the human mind is as nearly perfect in its primary task of modelling the world as any machine could ever be. So, even if we were to succeed in creating such a machine, it would probably be very like a human mind. And we have enough of these already. Or if we haven’t we know how to make more.

The automatic maintenance of the ocean of ideas which is our conception of life is the purpose of much that is cleverest in our minds. There are good reasons why these functions are automatic, and therefore unconscious, and therefore forgotten. First, the ideas are too large to fit into the window of consciousness all at once. And second, their maintenance is too important to be left to the vagaries of the will.

Just the same need for maintenance arises with the complex ocean of ideas which defines a society, and exactly the same comments apply. The ocean of infrastructure which underpins society is what really matters, but it is unseen because society focuses its attention exclusively on the beaches of innovation and change.

We are going to hear much more about maintenance in the future. The concentration on the incongruent — the change — and the forgetting of the ocean has reached its apotheosis in the disposable society, the phenomenon of consumerism and the emphasis on surface rather than depth. Greedily we gobble up goodies — our houses, our photograph albums and our rubbish tips full of last year’s discarded toys. All the exciting things of life are there on the edges of the ocean, the surf washed up on the beaches.

As we romp along, drunk with the excitement of change, it is gradually becoming more and more difficult for even the cleverest people to ignore the compelling evidence that things are going wrong; that the processes upon which society depends must, in the end, be sustainable; that if we concentrate only on the beaches, the ocean will die; that more and more of the effort of life must in future be directed towards maintaining the artificial systems, technological and organisational, which make our lives possible.

So that is why it is so wrong for people to give up and let others do the job of trying to understand the world for them. Society’s collective image of the world is nothing less than a summation of the personal images of countless individuals. If people opt out of the process of forming this image it will be formed by a smaller and smaller and more and more specialised sub-group of individuals. This sub-group will be distinguished principally by its certainty that it is right — and therefore by the probability that it is wrong.

While society needs the free minds of individual people, it must also, of course, have rules and conventions, they are largely the things that make a society. We can’t all choose the voltage of our electricity supply or the side of the road we want to drive on. We all have to subjugate our selfish, short-term interests in a host of ways for the long-term interests of each and every one of the hierarchy of groups we belong to; our families, our neighbourhoods, our professional colleagues, all the way up to the world itself. Enlightened self interest (which can be defined as allowing someone to get out of a telephone box so that you can get into it), whether or not it is ultimately the only human motivation, is certainly the only way to live.

Society must have rules, individuals must have freedom. Defining a rule always excludes a degree of individual freedom and somewhere a balance must be struck. The point is that it is striking the balance, not thinking up the rules, which is the difficult bit. In the past the balance was achieved by default, lots of rules which nobody took seriously — midwives weren’t supposed to stitch but actually they often did, old people’s wardens were supposed to follow the rules but actually used their common sense etc, etc. Rules, we all knew, were made to be broken.

But now technology is being used to enforce the rules without fail and the detached machinery of law is being used to impose penalties without any understanding of the human reality. Computer systems are par excellence machines for the carrying out of rigid rules. As they become more established in our society there is a very grave danger that they will impose standard procedures and rigidity to an unprecedented extent. Many administrative and supervisory functions currently performed by people could and probably will be taken over by automatic audit systems. The important thing is that they should be carefully designed to reflect the real objectives of what is being done or entirely different objectives may be permanently built in. This defining of objectives is a task in which ‘ordinary people’ must become involved. It is absolutely vital that the narrow perceptions of experts are not cast into tablets of silicone.

None of this is the ‘fault’ of computers. It was never the sword that killed, but the man who wielded it. I have shown in my practice that computers can encourage independence, individuality and diversity. But there is a great danger that they will be used to impose uniformity and constraints to an undesirable extent. It is up to us to lay down the rules so that computers, and all other aspects of management technology, are developed as liberating tools, not as agents of constricting masters.

It is noteworthy that those people who are most thoughtful about the application of rules and most troubled by pointless ‘stone checks’ are the very ones who are most realistic about their own limitations. Perhaps this is because people who don’t think any rules matter aren’t worried by foolish ones. A colleague in postgraduate GP education in Wessex, Dr Roger Hillman, showed this with a study of how well doctors’ real performance matched up to the rules they thought they applied to themselves. He concluded that, ‘The only person who did anything near what he thought he did, was the one who thought he did least.’

If this is typical of people in other fields of life, as common sense tells us it is, then it means that rules which are going to be adhered to will have to specify minimum standards. These minimum standards, furthermore, will be much lower than the ideal standards which central controllers may think desirable. And very much lower than those to which some individual enthusiasts would otherwise undoubtedly aspire. Otherwise, the very act of imposing the wrong sort of rules will kill the initiative of those people who would previously have sought (sometimes unsuccessfully) to reach far above them.

We have seen that there are two possible ways for us to proceed. One is the automated, mechanistic, defined way and the other is the soft, instinctive, natural way. The first can’t cope with the complexity of life and provides no reason for living; the second leaves mankind blind, lacking in plan and vulnerable to all sorts of dangers.

So this is where we need human minds to make the balance. Enormous opportunities to improve this balance are opened up by technology. By producing a sort of summation of the thoughts and experiences of the entire world, analogous to the image of the world contained in each of our minds, we have the prospect of a new era of media scale super-understanding and even of media-scale super-wisdom. But before we can achieve that we have got to understand media scale super-distortion and grow out of media scale super-selfishness.

Although many people now suspect that civilisation is rushing towards the brink of a precipice, they have adopted the short term solution of closing their eyes.

‘You worry too much, James, why don’t you have a drink.’

If people can be killed by kindness then certainly society can be killed by progress. If you must sometimes be cruel to be kind, we must sometimes go backwards a little in order to go forwards. The backwards I have in mind is towards a respect for human values and for the common sense and integrity of individual people. Backwards to the personal, local scale where people feel they count and that what they do or don’t do is likely to make a difference. We need a simpler society, with fewer rules, not more. With a bias towards individual freedom and diversity and away from restriction and uniformity. Most of all we need to keep technology in its proper place, as the servant of the individual person, not the master. To make use of its enormous potential to enhance life. Whilst protecting ourselves from its enormous potential to diminish and imprison us.