Cancelling Cancel Culture for Beginners

I’m not old enough to remember a time before cancel culture existed. In the 1950s in the US, anyone suspected of being a socialist was labeled a communist and blacklisted. Anyone who was gay or suspected of being gay (or otherwise queer) was forced to marry opposite sex partners for appearances in order to appear in any media. 

Atheists kept their religious beliefs secret if they wanted to hold any kind of community leadership position or even be accepted. Muslims were simply not seen or heard in the public arena. Many Jewish people in the public eye adopted names that would conceal their Jewishness. 

Non-white performers might try to “pass” as white in order to work, and those who could not were often prevented from even entering venues that would be appropriate. Many black performers watched in poverty as white performers gained wealth and fame off the art they stole. 

People were less offended? Lenny Bruce, who was taken off to jail for offending community standards, would have been surprised to hear it. People could criticise the government? The Smothers Brothers were fired and blacklisted from TV for daring political satire. 

Of course, cancel culture began long before the examples I gave, and it will continue long after. The difference at the moment is that people who are accustomed to censoring, and censuring, others are now finding that non-white, non-Christian, non-heterosexual, non-cis people have found their voices and have a thing or two to say. People aren’t now losing their voices. People are now finding their voices. 

Everybody’s Talking About Bioethics Now #COVID19

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Since this pandemic got rolling, it seems everyone wants to talk about bioethics “trolley problem” quandaries like how to decide which of three dying patients gets the one ventilator on hand or whether it is okay to lock up healthy people to prevent the spread of a deadly virus. All the boring stuff suddenly got real and real fast, but maybe it’s not that interesting.

You should give the ventilators to the people with the best chance of surviving, right? I think that is how triage works. And, oh, was it all right to tell people to turn off their lights when bombers were flying overhead in the middle of the night? Sometimes even the rugged individualists have to work as a group. The problem is that some of our rugged individualists have never really been put in a position to make tough decisions, so they aren’t prepared.

And that gets us to the real ethical issues here. It is really unethical to be unprepared for emergencies. Experts in many fields have been warning of coming pandemics for at least 15 years. Even George. W. Bush, bless his tiny heart, knew he had to prepare for pandemics, and he at least took at stab at it. And the ever financially minded Barack Obama prepared for pandemics and even dealt with one on his watch. His didn’t get quite so out of hand, of course, and no one should have to tell you why.

So, the important ethical decisions were made years ago, and many of them had to do with the most attention-starved principle of bioethics, justice. The failure to prepare for a public health emergency affects everyone, as we now see, but too many people have always seen efforts to protect public health as efforts to protect “people not like me.” This isn’t always a sign of racism; sometimes it is just pure classism. Some people just don’t hate based on skin color, religion, sexuality, or any of that stuff. They hate poor people of all types.

This is also not a matter of choosing between the “economy” and the needs of working people. Preparing for a pandemic would have meant having mechanisms in place for extensive testing, tracing, and isolation that would have prevented the need to shut down almost all business activities. With proper preparation, the world would have suffered but could continue functioning.

And I guess a lot of Americans really were satisfied with their employer-provided health insurance that they are now losing, because it turns out their employers really never valued them as much as they assumed. It would seem that intelligent and hard working people should always be able to get healthcare, and that’s what we’ve been trying to tell you. You can be hardworking and intelligent and also poor, and maybe it is good that more people are learning this rather difficult lesson right now. Maybe it will help in the future.

But public health isn’t all about health insurance, though turning infected people away from a hospital because they can’t pay is certainly not a good way to protect the public from a pandemic. No, protecting the public health, which is really protecting national security (and global security) is about being able to deal with emergencies, which would require not selling off all the equipment you might need. Most homeowners have never used a fire extinguisher, but the ones who used them successfully were pretty happy they had invested in buying one and taken the time to learn how to use it.

So, yes, more than a decade ago, epidemiologists, virologists, climate scientists, public health experts, public health ethicists, and environmentalists were warning that the world was becoming much more hostile. How do we prepare to ensure our own long-term survival isn’t really as much fun as debating who gets the last ventilator, maybe, but it can save many more lives.

And maybe you’re saying there’s no point in going on about this now as it’s too late. What’s done is done, you’re saying, but this ain’t over, folks. One way or the other, COVID19 will be resolved, but other pandemics will follow along with drought, flooding, mass migrations, and a host of other public health crises that aren’t that hard to imagine if you only try. You may think I’m crazy, but I’m not the only one. Plenty of experts in relevant fields are already imagining the worst and best case scenarios. Maybe it’s time to listen to them.

How to Become Homeless

People use the phrase “homeless people” as if it refers to a type of person instead of a type of circumstance. People without access to shelter are sometimes born into a homeless situation, but they are not “born that way” in the same way that tall people are born with genes for height.

If you spend any time at all talking to people without homes, you will quickly realize you are much closer to being homeless than you are likely to want to admit. I honestly believe this is why so many people avoid those conversations at all costs.

I suppose we are most affected by stories that relate closely to our own lives. At least, I know that is true for me, so I will never forget meeting a homeless man who taught at the same college as I. He was highly educated and had been living quite comfortably until a medical emergency left him in a coma for some time. He wasn’t expected to live, much less come out of the coma and leave the hospital, but sometimes medical miracles do happen.

When this man got out of the hospital, he found that his sister and nephews, thinking he was dying, had emptied all the money from all his accounts and gone on a cross-country spending spree. The money could not be retrieved, and prosecuting the thieves would mean sending his own family to jail. As he told me he couldn’t bring himself to file charges, tears rolled down his cheeks. He was still teaching classes while trying to hide the fact that he was homeless from his students and employer.

I spoke to hundreds of people who were in crisis, and I would say that the most common causes of their homelessness were medical emergencies that resulted in job and/or income loss, failed businesses or theft of businesses funds by unscrupulous business partners, failed romantic relationships, mental illness, grief, domestic abuse, and, yes, addiction. This last one (addiction) should simply fall under illness, but I recognize that many people believe that addiction is a personal choice, and this belief enables them to blame homelessness on the victims of depression, grief, or other factors that lead to addiction. No one chooses to become an addict and lose everything.

Another category deserves a separate post, really, and that is young people who are thrown out of their family homes for being different, usually for being LGBT+. These young people are extremely vulnerable to exploitation and abuse, including murder.

I suppose some people are wealthy enough to be insulated from the risk of homelessness, but many people I spoke to had lost all the things you have and take for granted. They had homes, cars, businesses, and all that goes with those things, including pride, self-worth, dignity and comfort. Many of the people I met were able to maintain their feelings of pride, dignity, and self-worth despite seemingly every part of their families, their society, and their government trying to take those away from them. I was and remain in awe of the people who have managed to fight their way back from the brink without being destroyed by their situation.

Many aren’t able to overcome the odds, and each death is a failure of society to look out for every member. Immanuel Kant famously said that if we will heartlessness to those who are victims of misfortune, we are willing indifference to our own suffering when our time comes. No one gets out of this world alive, so your time is coming. Have you acted in ways that make you worthy of compassion and respect?

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Talking Points for One Particular Left-Leaning Liberal

First of all, I guess you could get kind of crazy debating terms like “leftist,” “socialist,” “liberal,” “classical liberal,” and so on. And because of the risk of getting kind of crazy, I have no inclination to debate these terms. Let’s just say I believe in trying to make the world better by supporting things like accessible healthcare, accessible education, public libraries, maintained infrastructure, a habitable planet, and things of that nature. I try not to get freaked out by all the names thrown at people like me, and I try not to waste too much time trying to find the label that best fits.

But anyone would agree that I am not right-wing, conservative, alt-right, or any of that. So I think you’d say I’m on “the left” or “left of center.” What’s more, there are a few things I don’t like about the way other people on the left frame their debates. I wouldn’t dream of telling other people how to describe their own ideas, but I do dream of telling people how I like to describe my ideas, so here you go.

Free stuff—I don’t like all the talk about free stuff, whether it is education, healthcare, fire services, police protection, freeways, libraries, or air. Nothing is free, and we should all be able to agree on that. What I want is an equitable form of cost sharing. We all share the cost so that no one is left out. Why do I want my neighbor’s kids to get a free education, even if I don’t think I benefit directly? Because I want to live in a society where people are educated and empowered to share in the promotion of a functioning society. And I want their education to be useful beyond making them good employees.

Wealth distribution—Let’s face it, wealth is distributed. If wealth is going to exist at all, it will be distributed in some sort of pattern. It is absolutely pointless to say you are opposed to a patterned distribution of wealth. So you’re saying you’re actually just opposed to wealth re-distribution, which you imagine is a very different animal. You just don’t want your hard-earned money taken away through taxes to make someone better off. You can’t imagine that anyone else has done anything to make you better off, because you do not want to imagine that. Unlike some people on the left, I’m not saying rich people shouldn’t exist. I’m only saying that if rich people exist, poor people should not.

Market solutions—Some people anthropomorphize capital markets and claim they can fix all our problems. Sometimes entrepreneurs come up with some pretty good ideas, and that’s fine and dandy, but the people had good ideas, not the markets. Also, no markets are free. All markets are the products of the specific agreements various humans have put in place. Those agreements are constantly in flux and are subject to negotiation. “Free” markets do not exist. You will never find a market running wild in nature. I guess this is as good a place as any to say that I see no reason to completely eliminate private health insurance companies. It is only necessary to ensure that no one needs private health insurance.

Rights—to say everyone has a right to free speech is only to say I think society functions better when the government does not restrict speech in most cases. While some people believe “rights” come from God or nature or someplace else, you don’t have to believe that to use the word. It may annoy philosophers and political scientists, but a right is something someone thinks people should have. A “legal right” or “guaranteed right” is just something that was popular enough with people to be written in to law. Of course, it’s your right to believe whatever you want.

You might be thinking I should have some sort of summary conclusion or something, but I can assure you that I do not, so that’s that.

Essay: Some Conflicts of Interest Have Little Conflict

Let’s say you make a lot of money in some industry or another, and you’re lucky enough to get an appointment to an agency that regulates that very same industry. Your regulatory decisions could affect your bottom line, and so you have a conflict of interest and you should either be forced to give up your job as a regulator or get rid of all your financial interests in the industry with the provision that you may never acquire financial assets in the industry again. And if you’re a doctor on the payroll of a pharma company, your employment status most definitely affects your medical decisions.

That’s a pretty simple and obvious concept to anyone who doesn’t work in industry. People who work in any given industry tend to think “outsiders” wouldn’t know enough about the industry to regulate it, so of course you’d need someone with major conflicts to understand what really needs to be done. And so it goes.

But other people are described as being conflicted when they really don’t have any conflicts at all. Let’s say you are a researcher, and you apply to a corporation for funding for your research. Congratulations, you now have a huge grant from Megacorp Inc. to fund your lab, materials, research assistants, etc. in hopes of developing new products. You are now just a handsomely rewarded employee of Megacorp Inc. Your only interest is in developing new products for them.

It’s true that some will describe you as conflicted because they think you should be looking out for the public good, but that really isn’t in your job description. You’re just developing products.

And this is why we need public funding for research. So we can demand that researchers we are paying work for the public good and not in the interest of for-profit corporations.

man next to doctor
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Essay: A Non-Capitalist Approach to Biomedical Consent

Ask anybody about bioethics in the old days, like forty years ago, and they’ll talk all about autonomy and consent. It was all about how people didn’t have to do what you thought was good for them and how you couldn’t touch patients, even to help them, without it being some kind of battery or something. Everybody talked about all these famous examples where people were treated without wanting to, but most people only go to the doctor when they want and need to get treated. Most people these days only refuse treatment because they can’t afford it.

I’m sure a lot of them can’t afford the treatment but also don’t need it. It’s hard to argue with a doctor about that, though. If you want to feel better, stay healthy, live longer, or whatever; you’re going to listen to the doctor. You are paying the doctor to know more about it than you do. And the doctor may or may not be making money off every service you buy. It’d be good to know who makes money off what, wouldn’t it? It would also be good to know in advance exactly what everything would cost. It would be even better to be able to prepare costs.

In the early days of bioethics, it wasn’t all about costs, because most people could afford their healthcare bills. Money was a concern, of course, but people didn’t panic from fear that their life savings would be wiped out anytime they got sick. It wasn’t at the front of everyone’s mind, so when someone refused treatment, it was because they didn’t want to live longer, didn’t think the treatment worked, or something like that.

But now it’s all about costs. Can a doctor ethically prescribe you treatment knowing you can’t afford it? Can a doctor ethically not tell you about treatments you can’t afford? Should doctors help patients set up Go Fund Me accounts? How can anyone just stand by and let people die because they can’t afford insulin?

In the past, we didn’t notice how much autonomy and consent were tangled up in financial concerns. Most patients didn’t know doctors received so much money from industry. Most patients trusted their doctors, hospitals, and so on to have their best interests in mind, not to be focused on profit front and center. But things have changed, and bioethics can’t afford to have many debates that don’t deal with patients’ ability to access needed care.

So, if you are dealing with public health ethics and planning for pandemics, you might want to consider how many patients will walk around shedding viruses simply because they can’t pay for a visit to the hospital. And if people are forced into quarantine at hospitals, you might want to consider who will get the bill for that. It’s the same with vaccines. At least some people are opposed to vaccines because they think, right or wrong, that they are just being made to create more profit for pharmacy companies, clinics, and doctors. It’s just another way, they think, to get in people’s pockets.

I’m not saying that no one writing in bioethics is dealing with these topics. Great work is being done. What I’m saying is that all work in bioethics must include a discussion of economics and an expressed concern for how access to medicine can be guaranteed for everyone who needs it. You can have lots of detailed and technical disagreements over how much medicine is actually needed and what are the best ways to deliver needed medicine without bankrupting an entire country, but the focus should be on creating a society of healthy, financially secure people. That’s all anyone wants, I think, and anyone who doesn’t want it isn’t really worth my trouble.

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I’ve Seen You With Other Lovers (#poem)

man and woman kissing near green plants
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I’ve seen you enveloped in passion
Entranced and wandering aimlessly
In all consuming lust as you fold
Into taut skin stretched over
A well-tuned bicep shimmering
With the sweat of ones who
Would possess you,
Confiscate your love,
Loyalty, lust, passion, devotion,
Breasts, lips, thighs,
And even your new mountain bike.

I’ve seen you capitulate to complete
Sexual abandon and forget
Your past, your future, and your
Unpaid mortgage. On some
Occasions, you switched from
Lover to lover in your bed
Like a child trying different
Ice creams at the shop with
So many flavours.

I’ve seen you soak the sheets,
Draw blood with your nails,
And shriek till the rafters shook.
You took it all in,
You put it all out.
You forgot who you were.
You looked through me,
Past me, beyond me.

You forgot I existed,
And when you remembered,
You laughed.

You laughed.
Then you shouted.
I had no business blocking
Your way to paradise.
I had no reason to be in your way.

But as you stroke my back,
I open my eyes,
And remember why I came.

No One Will Be There But Jesus (#poem)

statue of jesus
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As friends solemnly told him to call
On them if ever he needed anything,
Only his pastor was candid enough
To tell him Jesus alone would stay.

And so it was as it had always been,
Walking alone on the beach, in town,
Along the highway, and in the upstairs
Hallway with no memory of being carried.

He supposed Jesus was a faithful companion,
But a bit quiet, and not much help when
A flat needs fixing. He’s someone you can
Always talk to, but feedback is lacking.

And why should Jesus be different from the
Others? Why would the Son of God care
That he was lonely? Why would he look
For Divinity in the deep pools of loss?

Randall Horton

Leggett, Texas (#poem #lyrics)

Screenshot 2019-07-05 at 11.18.56You’ve been all over the world,
But you’ll never know where I’ve been.
The lonely street in this lonely town
Took me to hell and back again

If you’re lost in Legget, Texas
You must be broke down
Cause there’s only one road
In this ol’ one-horse town

You’ve seen more things than I will ever know.
And you’ve done things I’ve only dreamt about.
But my heart’s a path well trod.
The things I’ve seen make me want to black out.

You can find my family if you look
In the cemetery behind the church.
But you don’t want a complete history,
So I think you should just end this search

This town always had a story
That most are too afraid to tell.
Don’t ask too many questions
Or you might meet me in Hell.

If you’re lost in Legget, Texas
You must be broke down
Cause there’s only one road
In this ol’ one-horse town

Randall Horton

Dangers of Anthropomorphism in Medicine (#poem)

chimpanzee sitting on gray stone in closeup photography during daytime
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It is most important, he said, to never
Ascribe to your subjects the feelings,
Intentions, and desires of humans.

You must make assiduous reports
Of behavior devoid of motive or
Explanation. The maternal adult screamed

But never wailed in sorrow, for
We cannot assume she is capable
Of sorrow. We cannot assume

Her frantic clamoring expresses
Either desperation or lamentation for
The infant stolen from her hours before.

We cannot assume she feels what
Humans feel or, indeed, is capable
Of thoughts or intentions at all.

But do remember that our work
Is important, as these specimens
Are perfect subjects for the study

Of human medicine. Their biology
And neurology is so similar to human
Biology that we can safely assume

That any treatments developed
For them will have similar effects
On their human counterparts.

What is safe for your subjects
Will be safe and beneficial for
Humans. Any deleterious effects

Must be recorded, of course,
As you have an obligation to humanity.
Your aim is to improve human well-being.