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.
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.
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,
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.
A philosopher of mind,
It doesn’t matter who,
But it was Daniel Dennett,
Made a point of describing
To prove that animals might
React physically to pain
Without being conscious of it.
He illustrated this with the case of
Children who dissociate during
Sexual assaults. *
In a seminar, another prominent male
Philosopher turned to another and said,
“I dreamed I raped and murdered your wife.
Do I owe you an apology?”
A female philosopher left the room.
Thought experiments are expected to
Be free and provocative,
But haven’t we experimented enough
With thoughts of violence against
Women and girls to know where they lead?
*(Dennett said the child thinks, “’I’ am not undergoing this pain, “she” is.”)
Epidemiologists and public health ethicists have been grappling for some time with the near certainly of widespread disease pandemics resulting from climate change. Changes in non-human animal migration and human migration will bring extant pathogens to new populations as warming releases long dormant pathogens on the world once again. Large swaths of the population could be wiped out in an incredibly short amount of time. Addressing climate change isn’t a matter of preserving the beauty of the plant. Rather, it is a matter of promoting human survival.
A dying planet is a
Planet that kills.
Rising temperatures raise
The spectre of pestilence
In the form of pathogens
Newly released on
As other pests breed
Vociferously and march
Into new territories
In a murderous stampede.
The migration of
Pests and pestilence brings
Pandemic and pandemonium.
Rising waters drive life from
Coasts as rising temperatures
Dry the plains; bake the deserts.
Human refuse scatters into
Constant conflict, seeking refuge
Away from the water or away
From the drought, the ice, the disease.
The oceans killed the fish,
And the sun killed the crops.
Medical care is a memory,
And society is preserved
Only in bits and bytes
Scattered to the sands.
The few who remain
May be resilient enough
To restart the madness.
Lately I’ve been hearing people talking about how the young people need to learn to take a joke, because, one supposes, people back in the day were never offended by anything. Of course, people back in the day were offended by quite a lot of things, and we older folks know that, because we can remember just how offended our contemporaries have always been, so it isn’t immediately obvious what these old geezers are on about.
I mean, come on, Lenny Bruce was arrested for being obscene. The Smothers Brothers were fired for being political. Comedians have been offending people for as long as comedy has been around. Except, I think I know what they’re on about. What they mean is that they used to get away with saying things they are no longer allowed to say, and they don’t like being told to stay in their lane. They used to make jokes about women, racial minorities, and LGBTQ folks without fear of any sort of reprisal.
From their explanation, you would think this is because women, racial minorities, and queers used to just laugh along with them. I don’t think that’s true, and I don’t see how anyone can possibly think that’s true. Imagine a gay kid laughing at a dad joking about killing his kids to prevent them from growing up gay. I don’t think that ever happened.
Rather, I think what happened is that these marginalized groups did not feel empowered to speak up for themselves, but now they do, and I for one think that’s a good thing. I think it is really good that gay people (and anyone who thinks gay people deserve respect) say they are offended when someone jokes about killing them. I think it is good that trans people say a man in a dress isn’t obviously the funniest damn thing in the world. I think it is good that women feel empowered enough to say they don’t think jokes about rape are part of a good time.
Comedians have every right to make any joke they want, and the audience has every right to tell them they are assholes for making them.