dignity

Teaching Ethics to Greedy Bastards

R. Horton3 Comments

When a corporate executive, high-powered lawyer, or well-funded medical researcher is exposed for egregious unethical behavior, we often say it would have been a good idea for that person to have had a class in ethics with some follow-up training. We’d like to think that with the proper ethics training even the most heartless sociopath could be encouraged to at least follow some of the rules.

And if we can’t (note: we can’t) encourage bad people to be good people, what are ethicists worth? Well, our roles fall into several categories: 1. Providing ethical answers to dilemmas. 2. Offering ethical analysis of a particular problem. 3. Teaching ethical decision-making, which makes a good-faith assumption that the decision maker is sincere in wanting to be ethical. 4. Holding wrongdoers accountable for their behavior.

The first category is offered to clients who don’t want to take complete responsibility for their ethical decisions. Once a professional ethicist has offered an opinion on whether something is above board, an organization can say, proudly, “All our policies and procedures have been reviewed by someone with extensive training and expertise in ethics and found to be compliant with all ethical and legal codes.” Indeed, it can be a very good idea for an organization to get an outsider to review policies for possible ethical problems.

The second category is related, perhaps a subset of the first. When institutions encounter a particularly sticky issue, they might ask an ethicist to help them work through all the ethical considerations and explore how various ethical theories can help them solve the dilemma. Again, a useful role for the ethicist.

The third category involves training. Rather than giving answers to ethical questions, the ethicist can teach motivated individuals to analyze various conflicts on their own. Most people know how to think ethically, but they sometimes forget some of the considerations that professionals might find to be second nature.  Developing a more thorough approach to ethical approaches can benefit individuals and organization alike. It cannot, however, turn a bad person in to a good one. Evil people don’t lack ethical tools—they lack a conscience.

So, what do we do about the evil people? An important role for ethicists, in my considered and passionately held opinion, is to cry foul when individuals and institutions engage in egregious behavior. And when ethicists disagree on what is an egregious action, fervent debate erupts in the public sphere, benefitting the public and everyone involved, or so it should be. When ethicists sound the alarm that some behavior is abhorrent and shameful, a public chorus against such actions can at least ensure that the bad actors confront public scrutiny.

Think it doesn’t work? Remember in 2011 when executives at Transocean received bonuses for their safety record after the explosion in the Gulf of Mexico killed 11 and sent millions of gallons of oil streaming into the water? After public outcry, the executives thought better of keeping those bonuses and donated them to the Deepwater Horizon Memorial Fund. Social regulation pushes and pulls behavior through honor and shame. In responding to abhorrent behavior, Kwame Anthony Appiah says, “Shame, and sometimes even carefully calibrated ridicule, may be the tools we need. Not that appeals to morality—to justice, to human rights—are irrelevant.”

Most of us evaluate ethical theories in the following way: Knowing that I am an ethical person, which ethical theory best fits my behavior? Following this method, we can all justify our actions through theoretical ethics as we simply seek out the theories that validate our behavior. Given that we all have justification for our behavior, public outcry is not likely to immediately shake our perception of what is appropriate, and, indeed, the public rarely speaks as one voice. Further, the common view is often wrong, or so I judge it to be. Bertrand Russell once said, “In view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible.” Indeed.

Many people, especially those in power, feel their behavior is beyond reproach. They seem to think they could not have gained power if they were not deserving of it. Public outcry and public discourse, can remind them that they are, in common with the rest of us, flawed and fallible human beings. What this means is that we must raise our voices, express what we find shameful and honorable, and join or create a conversation over morality, dignity, and justice. Only when we suppress our voices do we lose. Only our common humanity makes our salvation possible.

Modern Libertarians Hate Thomas Malthus

R. Horton3 Comments

Whether they are familiar with his work or not, many modern libertarians echo some of the ideas of Thomas Malthus when they advocate austerity in public policy. Most notably, Malthus claimed that the “poor laws” of England of his time deprived the poor of any liberty and independence. He felt that the poor would have more self-respect and freedom if they could provide for themselves and their families through their own labor.

Thomas Malthus

It was Malthus, not Darwin, who first mentioned a struggle for existence. In his 1798 screed, “An Essay on the Principle of Population,” he
wrote,

“Restless from present distress, flushed with the hope of fairer prospects, and animated with the spirit of hardy enterprise, these daring adventurers were likely to become formidable adversaries to all who opposed them. The peaceful inhabitants of the countries on which they rushed could not long withstand the energy of men acting under such powerful motives of exertion. And when they fell in with any tribes like their own, the contest was a struggle for existence, and they fought with a desperate courage, inspired by the rejection that death was the punishment of defeat and life the prize of victory.”

In the essay, Malthus basically argued that hardship limits population but abundance leads to population explosions. For this reason, feeding the poor is a bad idea, as it will encourage wanton reproduction and the survival of infants into adulthood. By helping the poor survive, they would then multiply and deplete the planet of all its resources. It is the wealthy, of course, who consume the most resources, but even at that, Malthus did not have quite the same view of some austerity minded people of the 21st century.

For one, Mathus wanted to protect the value of farm labor. He said,

“Every endeavour should be used to weaken and destroy all those institutions relating to corporations, apprenticeships, etc., which cause the labours of agriculture to be worse paid than the labours of trade and manufactures. For a country can never produce its proper quantity of food while these distinctions remain in favour of artisans. Such encouragements to agriculture would tend to furnish the market with an increasing quantity of healthy work, and at the same time, by augmenting the produce of the country, would raise the comparative price of labour and ameliorate the condition of the labourer.”

Efforts to drive down the wages of farm labor are, then, anti-Malthusian. He also did not believe in leaving the poor with no help for work and redemption. While he objected to the “poor laws” of his day, he did believe in a tax-supported programs to provide employment for the poor. Thus,

“County workhouses might be established, supported by rates upon the whole kingdom, and free for persons of all counties, and indeed of all nations. The fare should be hard, and those that were able obliged to work. It would be desirable that they should not be considered as comfortable asylums in all difficulties, but merely as places where severe distress might find some alleviation. A part of these houses might be separated, or others built for a most beneficial purpose, which has not been infrequently taken notice of, that of providing a place where any person, whether native or foreigner, might do a day’s work at all times and receive the market price for it.”

Public works projects, such as those put in place by FDR, can alleviate much suffering while also benefitting the public good through improved infrastructure and public service. Note that Malthus did not advocate putting poor people in prison and forcing them to work for free.  Malthus did believe in treating the poor with respect and providing opportunities for honest employment for the betterment of society. Modern libertarians would do well to recognize the basic human desire for dignity and self-respect. When we help one another, we are free.

The proper way to grieve for a child

R. Horton11 Comments

I hate Galveston.

When I look out over the seawall, I find no peace in the sounds of wind and wave or comfort in the roiling swirls of water gently crashing into the jetties. I see only the bodies of children being dragged and slammed with senseless violence against the sand just beneath the waves. As I look out over the Gulf of Mexico, I see only a sadistic child-eating monster mocking the hole in my chest.

And May is the cruelest month, because it was Mother’s Day in 1992 that I lost my niece and nephew to the powerful spring rip tides along the coast of Galveston. My niece, Cindy, who was seven, was pronounced dead on the beach, but my nine-year-old nephew, Doug, was flown to John Sealy hospital and placed on life support. Although the doctors offered us no hope of his recovery, he was kept on life support for 72 hours to monitor his brain activity.

Image
The only photo I have of Doug and Cindy, from 1990.

During that agonizing 72 hours, we did what most families do. We held his hands, stroked his hair, talked to him, read to him, took him his favorite stuffed bear, massaged his legs, and loved him with every ounce of strength we had. At the moment they stopped life support, the Galveston radio station played his favorite song, “Born in the USA.” Yes, we were on the radio. We were on the news. Our family’s grief was broadcast on the nightly news. I avoided the cameras, but the children’s father was there, tears cascading down his face, explaining how he felt about the death of his children. Who needed this explanation?

Perhaps it is surprising, and perhaps it is not, that I decided to enter the medical humanities program at the University of Texas Medical Branch in Galveston. I spent years driving to Galveston and going into the hospital where my nephew died. Sometimes I avoided the building, but other times I went there and sat in the garden specifically to think of what had happened before. When I completed my required ethics practicum, I went on rounds with the doctors in the pediatric ICU—of all places.

As part of this experience, I was able to witness conversations with doctors and the parents of children who would never recover. The doctors were kind, caring, and professional, and every word destroyed me a little. I imagined the conversations the doctors and nurses must have had regarding my family in 1992. I imagined how they debated the proper course to take: how long to keep him on life support, how to break bad news to the family, and how to prepare for the death of a nine year old. I had thought this experience might help me come to grips with my past trauma, but I honestly cannot say it did.

As medical humanists, we study the ways people make meaning of suffering, but I want to tell you with great heartfelt certainty—there is no meaning in the death of a child. And when you try to make meaning of it, you rob me of my grief. I am entitled to my grief. My pain is my own. When you tell me the children were on loan from God, and he has called them home, I am only amazed that you worship a monster and call it God. When you tell me they are in a better place, I want you to know that the world they left behind is immeasurably worse for their absence. When you tell me anything, you amplify my pain and submerge me in the depths of despair with no comfort and no meaning.

What does someone grieving the death of a child need? Solitude. And comfort. Silence. And conversation. A distraction. A project. Time to do nothing. Time to think. Time to cry. Time to scream. Time to fall apart. Time to get it together. There is nothing you can do. But, really, you should try. And you should know when to back off.

I can remember talking to priests, ministers, social workers, counselors, and well-meaning friends. No one can really offer any comfort, but a few people managed to refrain from intensifying the pain. In particular, Robert Schaibly, who was the minister at First Unitarian Universalist Church in Houston at the time, offered sincere condolences with no advice, no explanation, and no demands. He was empathetic and shared my pain without taking it as his pain. No other clerical person I met was able to achieve something that seems so simple. Perhaps the simplest acts require the greatest art.

Related articles

Girls are raped; boys “lose their virginity” (unless it is to a man)

R. Horton

When women reveal that they first “had sex” at the age of 11, we call it rape, even if it was consensual, and rightly so. Often, these same women will go on to detail a life plagued by self-loathing, substance abuse, reckless behavior, and failed relationships. It may not be absolutely right to blame every single problem on these early sexual experiences (surely verbal abuse, physical abuse, and other factors play a role), but most of us agree that this is not the best way to become a healthy and satisfied sexual being. Having sex as a child is absolutely to be avoided.

Unless you are a boy and the person having sex with you is female. The latest in a long line of men bragging about their early sexual experiences is Josh Brolin, who says he “lost his virginity” when he was eleven to a girl named Greta. There is no mention of how old Greta was at the time. Men’s Journal also says that he stole cars and smoked heroin as a teen. His life follows a pattern we might associate with victims of child rape. He was most recently arrested on New Year’s Eve for public intoxication.

I certainly don’t know the facts regarding Brolin’s early experiences, and I don’t claim to know anything about him beyond what I’ve read in these reports, but I can’t understand why journalists can blithely report that a boy “lost his virginity” at the age of eleven. I can’t imagine anyone saying the same of a woman without at least mentioning the age of the person who had sex with the child or the possibility of child rape.

It is time to view sex with young boys in the same way we view sex with young girls.

Why my students love Ayn Rand

R. Horton16 Comments

I think my Introduction to Ethics class is fairly typical. We start with Epicurus and work our way through Aristotle, Jeremy Bentham, John Stuart Mill, and Immanuel Kant. After those heavy hitters, I try to lighten things up with some essays from contemporary philosophers (in the most general interpretation of the term). So, after reading some Kant, I move to an interview with Ayn Rand for a little break.

This may not be such as good tactic. When I first chose the assignment, I did so because the interview reveals Rand’s beliefs in a way that is stark and easily digested. I assumed anyone reading it would agree with me that her philosophy is reprehensible, and I would be serving the greater good of humanity by having them exposed to it. I try not to reveal my biases in class, and I really don’t want to tell them what to believe. I just hope they will hate Rand. I’m less concerned about what they will like.

Nonetheless, I always have a few students who declare that Rand is the first reading they have liked. I ask probing questions hoping to find that maybe they didn’t really get what she was saying, simplistic as it is, but I generally have to concede that they really do like what she says. As a result, I think I have created a small band of ardent Rand supporters over the years. The Tea Party can thank me. And I think I’ve identified the two reasons she is so popular with students:

1. As I mentioned, the assignment is easy to read and digest. After slogging through Mill and Kant, I can certainly understand why they would be relieved to find something they can understand on the first pass, even if the reading completely flies in the face of their supposed religious convictions. But the second point is more meaningful to me.

2. Rand is easy in another sense as well. She really doesn’t demand much of her readers. She tells them they must be selfish and pursue only what is truly gratifying to them. Now, Epicurus said that they should seek a pleasurable life through contemplation and serious examination of the world around them with great respect for their community. Aristotle tells them they must practice constantly to become virtuous in a way that will enable not only their personal flourishing but the success of their society. Mill tells them to seek their own pleasure but that they will derive the greatest satisfaction from pleasures that require much practice and refinement to achieve. And Kant tells them they can’t lie under any circumstances. Furthermore, they must help people who are worse off than they are. To follow Kant or any of the others, they would have to put out a great deal of effort to change how they live, but to follow Rand’s advice they don’t see that much more effort is required. In their minds, at least, they are already living Rand’s ideal life. And, they get to feel pretty self-righteous comparing themselves to recipients of government aid (my students do not consider low community college tuition to be a form of government support).

I suppose I am hopelessly naive to think my students will take my class looking for hints on possible self improvement. They are seeking validation for their current lifestyles, not ideas on how to improve.

Except when they are not seeking the easy way. It is easy for teachers to get discouraged and forget all the talented and hard working students who are in constant search of new information and new challenges. Many of my students have now gone on from the community college to universities and graduate school. They have admirable careers in fields such as law, science, health, and social work. I am humbled by them.

http://www.youtube.com/watch?v=K9mJpVf4dkc

For further reading:
1. 10 (insane) things I learned about the world reading Ayn Rand’s Atlas Shrugged
2. How Ayn Rand Seduced Generations of Young Men and Helped Make the US into a Selfish, Greedy Nation

What Makes the Trayvon Martin Case Different From Other Murders

R. Horton

I did not intend to make any comment about the Trayvon Martin case as I thought there was plenty of thoughtful commentary on it already, but I’ve been reading too  many blogs on it today, and it seems to me that many people are missing the point. As I see it, it does not matter whether George Zimmerman is Hispanic. It doesn’t matter whether Trayvon got into trouble in school (how many teenaged boys never get in trouble at school?), wore gold fronts on his teeth for a camera, or tried to act tough. If Trayvon’s problems make him deserving of death, then many people I love and admire would fall in the same category. How many of us want to be judged for the decisions we made when we were 16 and 17 years old? And it doesn’t matter that many other teenagers are murdered every year. This case is different.

It is different because of the police response to it. It is different because the police say they did not have enough evidence to arrest anyone, but they do not appear to have made much effort to gather evidence. They seem to have spent more time trying to find evidence Trayvon was up to no good than they spent trying to find out whether he was the victim of stalking and murder. The police seem to have dismissed the case as just another death of a young, black criminal. They seem surprised that anyone cared enough about Trayvon to pursue the case and try to get the facts.

Yes, it is a tragedy when anyone is murdered, but it is an outrage that young men of a particular color are viewed as disposable human beings by many in our society. That someone’s life could be of so little value that it is deemed unworthy of investigation is appalling.

Jana Pochop on Death and Dying (in song)

R. Horton1 Comment

For most of human history, it was ordinary for families and even close friends to be present for the death of a loved one. People knew the sights, sounds, and smell of death. For a sick person to die alone would be considered an extreme misfortune. But the 20th century moved death from home to hospital. As Philippe Aries wrote, “The hospital is the only place where death is sure of escaping a visibility—or what remains of it—that is hereafter regarded as unsuitable and morbid.” While it was once a great tragedy to die alone, many now consider it a tragedy when one must be present for the death of a loved one.

To be sure, no one who witnesses the death of a loved one escapes trauma. Death is painful, and even those who are prepared for it often panic at the last moment. When people plan to die at home but end up dying in a hospital, caregiver panic is frequently the reason. The last moments of life can be excruciating to watch, and caregivers often call an ambulance to bring relief for their loved ones.

Caregivers who have a home healthcare provider to reassure them do much better. When the family knows the process is normal and unavoidable, they are able to brace themselves against the pain and endure it to the end. The advantage of hospice over home death is that professionals are responsible for all medical decisions, and the family can focus on comforting their loved one, grieving, and saying farewell.

I’ve thought a great deal about this process and how it may improve our society if we once again become familiar with death and dying in a more personal manner. I honestly believe this experience gives people a deeper experience of life, grief, love, and loss. I’ve read about it, and I’ve written about it, but I was surprised to hear so many of my thoughts on the subject expressed in a folk song of just a few minutes.

Last night I went to see a performance by Susan Gibson, an extremely talented singer/songwriter. During the second set, Gibson invited Jana Pochop on stage to sing two songs. The first was about what you will do in the moment when your soul leaves your body. The imagery was compelling and profoundly sad. When this song is available, I would recommend it to help families prepare for the imminent death of a loved one. I also believe the song will be appropriate for a medical humanities curriculum.

I didn’t intend for this blog to ever have anything to do with folk music, but I also did not anticipate folk music intersecting my interests in medical humanities, caregiver narratives, home/hospice death, and survivor stories. The following video is not of the song in question, but it gives you an idea of Jana Pochop’s talents.

[youtube=http://www.youtube.com/watch?v=fnx_lNuyoNA]

Glenn Beck is shocked by bioethics blog about an article saying killing isn’t really wrong.

R. Horton

By now, commentary on Glenn Beck seems superfluous—his views are so patently divorced from reality, but this topic could use some discussion anyway. In this clip, he responds to a blog titled “Is it morally wrong to take a life? Not really, say bioethicists” by Michael Cook. Beck seems unaware that his comments are actually about an article titled “What Makes Killing Wrong?” by Walter Sinnott-Armstrong and Franklin G. Miller in the Journal of Medical Ethics. Cook, of course, is just commenting on the original article. Although the full article by Sinnott-Armstrong and Miller is available online, Beck obviously did not take the time to read it. Or, if he read it, he certainly does not want his listeners to.

Here’s the problem: Hospital Ethics Committees (or other hospital entities) must develop extremely precise procedures for organ harvesting. They do this because they do not believe it is ethical to kill patients for their organs, nor do they want others to believe, rightly or wrongly, that they kill patients for their organs. Sometimes, when someone is dying from an extreme and irreversible injury (such as a gunshot wound to the head), doctors will begin to remove organs only to have a monitor show a heartbeat or two. This event can be disconcerting.

I can see three alternatives here: 1. Turn off the monitors and declare the patient dead (changing the definition of death, if necessary). 2. Wait till there is no chance the heart may beat again and risk losing organs that could save another life. 3. Declare that the patient is alive but that killing the patient is acceptable.

Most ethicists have tended to suggest some variation of the first two options, but Sinnott-Armstrong and Miller think it is more honest to accept the third. If the heart may still beat, they argue that the patient is not dead but that it is morally permissible to kill that patient. The authors also make it more challenging by imagining a patient in this state for an extended time (on a ventilator or other artificial life support).

Unfortunately, their term for a patient in this state is “universally and totally disabled,” meaning that the patient cannot suffer, feel, think, or have any other function associated with being a living human being. Beck seizes on the term “disabled” and suggests they want to kill all the disabled people in the world. Is Beck being dishonest or did he just miss the point? Does it matter to you?

The final issue for Beck is that the authors said mere life is not sacred or we would not be able to pull weeds without violating the sanctity of life. So, Beck and his followers are incensed that they authors compared human life to weeds. But, of course, they did not.

No, Sinnott-Armstrong and Miller went on to distinguish between the sanctity of “life” and of “human life.” They follow the weed comment with this explanation:

 “Of course, what people mean when they say ‘Don’t kill’ is ‘Don’t kill humans’ (or maybe ‘Don’t kill sentient animals’). But why then are humans (or sentient animals) singled out for moral protection? The natural answer is that humans (and sentient animals) have greater abilities than plants, and those abilities give human lives more value. Humans can think and make decisions as well as feel (an ability that they share with sentient animals). But if these abilities are what make it immoral to kill humans (but not weeds), then what really matters is the loss of ability when humans (but not weeds) are killed. And then the view that human life is sacred does not conflict with—and might even depend on—the view that what makes life sacred (if it is) is ability, so the basic moral rule is not ‘Don’t kill’ but is instead ‘Don’t disable’.”

To be sure, the article in the Journal of Medical Ethics is provocative, and articles in ethics journals should be provocative. Many bioethicists, doctors, and lay people will disagree that killing is ever acceptable. Discussion of this issue is needed and welcome. Distortions, flag waving, and hysteria are not.

Will technology destroy heroism?

R. Horton1 Comment

While heroism is a concept without rigid definitions, I will loosely define it as putting one’s own life at great risk for the benefit of others. We may say that someone who developed lifesaving technology is a hero, but his or her laudable actions may or may not fit the description of heroism I’m trying to describe. For example, developing a life-saving vaccine is a laudable achievement for anyone, but some people have developed such vaccines by their willingness to first try inoculating themselves, knowing that their inoculations could kill them.  Similarly, those who may fly test aircraft they designed put their own lives at risk in order to benefit others.

In the past, technology created a heroic elite of sorts. Not many people had an opportunity to be the first person in space. Also, not many people had the education or experience to dream of how to inoculate someone against smallpox. People with the most advanced training would put their lives on the line to test new technology, leading to even greater advances in both knowledge and skill. These people saved lives, won wars, and opened the wonders of the universe to us all. They used technology to expand their opportunities to demonstrate their courage and commitment to human advancement.

It seems to me that something has changed, though. Unmanned spacecraft are now going deeper and deeper into space to return information we only dreamed of before, but the risk to humans has now been minimized. The space explorer now sits comfortably on earth as a machine takes all the risks of space travel. Unmanned drones now conduct what would have been extremely dangerous operations only a few years ago. We still need humans to fly and take great risks, but we can now imagine a time when all flight operations may be automated. The fighter pilot and astronaut may both become obsolete.  In medicine as well, new developments are frequently mechanized with risk to humans greatly reduced.

It is hard to find a reason to complain about this development. I would much prefer to have a robot disarm a powerful explosive than to have a human risk being blown to bits. Technological advances that reduce risk are welcome, and they will never eliminate heroism. What they do, though, is shift an emphasis from the elite heroes of the recent past to the more mundane heroes known throughout history. People will always risk their lives for others without the benefit of advanced aircraft, space travel, or obscure scientific knowledge.

People will continue to rescue others from fire and drowning. Foot soldiers will continue to fight battles on the ground, often in primitive forms of combat our ancient ancestors would recognize. People with brilliant but controversial ideas will continue to express them in the face of public hostility and aggression. And people will continue to put their lives on the line to defend democracy, freedom, and human dignity.

Brooks and the Milquetoast Revolution

R. Horton3 Comments

In today’s New York Times column, David Brooks mocks the Occupy Wall Street protesters for offering only mild and ineffective solutions to the country’s problems, rather than radical changes that would significantly alter the American system. It’s funny, but I haven’t seen or heard any OWS protesters claiming to be radicals or to want to overthrow the American system. Rather, I have seen people who love their country and want to let their leaders know they are not expendable. This should not be radical; in fact, no one should ever have to assert this position. We should assume all Americans are of value and that repairing our nation will require shared sacrifice.

He says, “They will have no realistic proposal to reduce the debt or sustain the welfare state. Even if you tax away 50 percent of the income of those making between $1 million and $10 million, you only reduce the national debt by 1 percent, according to the Tax Foundation.” I happen to think that removing the Bush-era tax cuts, ending corporate subsidies for corporations making huge profits, and closing tax loopholes that enable rich individuals and corporations to pay taxes at an exceptionally low rate or not at all, you will have an impact on the national debt.

But what if I am wrong? I am a humanist and not an economist, after all. I don’t have the solutions for the economic problems of the country, but I do feel that everyone should be subject to the same laws, same punishments, and same regard. After the financial collapse in 2008, we were told that banks were too big to fail and that we must rescue them. Taxpayers bailed out the banks only to see them become even larger through mergers and continue the same dangerous behaviors that caused the economic failure in the first place. We rescued them, rewarded their bad behavior, and are now being treated as if our voices do not matter.

If the banks are too big to fail, and the government won’t break them up, we must make them smaller ourselves by moving our money to credit unions and smaller banks. We must hold corporations accountable for their crimes. We must ask them to pay their share of rebuilding our country. Mr. Brooks is correct; this is not radical. He may also be correct that it will not solve all the financial problems of the United States, but it will be fair.

It is more important for me to live in a fair and just society than it is to live in a prosperous society. We should not need a revolution to achieve this.