ethics
Nussbaum and Rand on the Politics of Love
I’m currently reading Martha Nussbaum’s Political Emotions: Why Love Matters for Justice. Love is an important focus of the book, but it is certainly not the only emotion that Nussbaum considers important to a minimally decent society. Still, love (and its relevant associate, compassion) is an integral part of a stable and humane democratic society.
Nussbaum suggests that it is entirely appropriate for governments to encourage the development of political emotions that are absolutely necessary for a functioning society. Of course, totalitarian, repressive regimes often rise to power on waves of extreme patriotism coupled with xenophobia and violent anger. This is a risk of the state cultivating emotions, but it is also likely that inappropriate emotions arise because we shirk our duty to cultivate the correct emotions. Who decides which emotions are correct? Why, we political liberals, of course. Nussbaum is more optimistic than I about the ability to create a state that will encourage the appropriate arts and literature to cultivate emotions that will engender empathy and promote democratic feeling. Still, we are obligated to make every effort to counter those who would work to destroy both compassion and democracy.
Nussbaum recognizes the potential for paradox in her claim, but she defends her position with depth and detail. The fact that I agree with both her goals and method make it quite easy for me to follow along and hope, against all odds, that is possible to create a more decent society than what I currently see around me, even if I feel we must go it alone without the full support of government.
But all this talk of love got me thinking of Ayn Rand, of course, as many things these days get me thinking of Ayn Rand. She said that we should be selfish and never sacrifice ourselves to others. In contrast, many of us have foolishly believed that to love someone was, in fact, to be willing to sacrifice ourselves for his or her well-being. On this point, I think Ayn Rand was able to explain herself quite clearly. When asked whether we shouldn’t be selfless in our romantic relationships, she said,
She makes a good point. We sacrifice for those we love because we value them so much that their loss is a personal loss to us, and their suffering is a suffering we share. We do not love out of duty; we love for the pleasure it brings us.
For Rand, altruistic concern for strangers entails a denial of self-satisfaction and an indenture to others. By living for the needs of others, we deny our responsibility to determine and seek our own needs. It does not occur to Rand, as it does to Nussbaum, that is possible to value other humans with a love that extends beyond our realm of personal contact. It is possible that I want to preserve the lives of strangers thousands of miles away because I value them, even if abstractly, to the point that their suffering causes me suffering.
I don’t want to live in a world where millions of people starve to death each year, and I do not believe they are starving because of the poor choices they have made. I believe they are starving because of structural economic violence against them. In many cases, the world’s resources have been stolen by brute force (did farmers and fishers in Africa foolishly give their land to oil companies?). Poverty, addiction, and disease are largely a result of violence against people who are not recognized as being fully human, fully deserving of respect.
We don’t have to accept this reality. As Nussbaum says, “We should surely not assume that the form emotions take in the corporate culture of the United States reveals a universal and timeless truth about how things must be.” No, we can work to ensure that our moral imagination can perceive other human beings as beings worthy of respect, dignity, and, yes, love. If we seek to respect ourselves, we must demand respect for all.
Love is possible.
Health Law Helper – Affordable Care Act Interactive Tool
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Patients’ Rights Survey
Please take my patients’ rights survey. I am trying to learn about how patients (and potential patients: everyone) feel about informed consent, financial disclosure, medical research, and end-of-life decisions. There are only 20 questions and it is anonymous.
I will be most appreciative of all responses.
Being and Becoming Compromised: Conflicts of Interest in Bioethics
It is Time to Shed Sunshine on Informed Consent
Most patients realize doctors receive gifts from the pharmaceutical and device-
manufacturing industry. When we see industry logos on pens, clocks and posters, we don’t assume the doctors ordered these items from the merch page of these companies, but most of us aren’t aware of how lucrative the payments to doctors can be.
A story that ran in the New York Times described the experience of Dr. Alfred J. Tria, who made $940,857 in about two years for promoting products and training doctors in Asia to use them. The article notes that Tria’s experience may be exceptional, but in two and a half years, industry paid out $76 million to doctors practicing in Massachusetts alone. I’ve been reading about this subject for a while, and even I was surprised that someone could make half a million dollars in a year on a side job.
In a slightly different type of payout, Oregon recently concluded a court case against two doctors who “put heart implants into patients without telling them that a manufacturer’s training program put a sales representative into the operating room.” The doctors would receive between $400 and $1,250 each time they completed a surgery using Biotronik defibrillators and pacemakers. The state argued that patients should know when doctors’ recommendations may not be based entirely on the needs of the patient. One of the doctors in the case earned more than $131,000 from 2007 to 2011 through implant surgeries. Doctors also received speaking fees, expensive meals, and other gifts.
As part of the Affordable Care Act (Obamacare), the Sunshine Act now requires industry to start collecting data on payments to doctors now, and the information will be made available to the public next year on a government website. This will enable patients to learn how much their doctor receives from the industry each year, though there may still be hidden incentives.
For example, doctors may be in profit-sharing arrangements with facilities or they may actually be the owners of the facility. A recent study by Dr. Matthew Lungren found that doctors who had a financial stake at an imaging facility ordered tests with negative results at a much higher rate (33 percent) than doctors with no financial stake. In other words, it appears that doctors order unneeded tests because they are making money off of them, not because the patients need them. Lundgren suggests that patients should ask whether they are being referred to a facility in which the doctor has a financial stake. I say the doctor should volunteer the information.
Beginning next year, the Sunshine Act will make it much easier for patients to discover their doctors’ financial relationships with industry, and I’m thrilled for this development. For those who think Obamacare is a complete disaster, just take a minute to relish this one positive development. Still, I think the movement should go further. I think financial disclosure should be part of the informed consent process. When your doctor is telling you all the risks and benefits of treatment, I think he or she should also say, “I get paid $1,000 to do this surgery,” “I will make $100 off this MRI,” or “I own stock in the company conducting this medical research.”
I believe patients want this information, and I don’t think they feel it is their responsibility to search for it. True informed consent is only possible in light of complete financial disclosure.
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Corporate Greed Is Not The Problem
In the battle between conservatives and progressives, we are generally presented with a false dilemma. We are expected to choose between two positions: 1. Corporate greed is evil. 2. Profit is what drives innovation and improvements to our standards of living. Unfortunately, it is the progressives who are making the mistake here. Greed is only a problem because it results in human rights abuses, criminality, and grave injustice. We do better to focus on the abuses rather than the rather nebulous harm of greed itself.
When I talk to conservatives about specific instances of corporate criminality, they generally acknowledge that something should be done in such cases. For example, seven court cases from 1997 to 2008 resulted in convictions for slavery in Florida. Those convicted of slavery “threatened the immigrants, held their identification documents, created debit accounts they couldn’t repay and hooked them on alcohol to keep them working.” The workers were also beaten and forced to live in substandard conditions.
As the accounts of slavery came to light, activists organized and demanded that restaurants pay more for tomatoes in order to provide an actual wage for tomato workers. By May 2008, Burger King had joined McDonalds and Yum! Brands in meeting the demands of the Coalition of Immokalee Workers and paying more for tomatoes. It was a notable success, but the activism of the CIW continues. After progressive strides with fast-food restaurants, the coalition ran in to resistance from grocery giant Publix, which refused to join any agreements to improve working conditions. In 2010, a Publix spokesperson said, “If there are some atrocities going on, it is not our business.” Publix has not budged yet, but the Coalition of Immokalee Workers continue their work and will receive 2013 Freedom from Want Medal from the Roosevelt Institute.
When progressives argue that corporate greed leads to great evil, they may be correct, but they make it too easy for conservatives to simply point out all the innovation and convenience the profit motive has produced. When we argue against slavery, however, we force conservatives to either defend slavery or admit that the industry must be reformed in one way or another. It is not likely that progressives and conservatives will agree on what kind of reform is necessary, but at least the conversation has begun with some possibility of tangible results, as we see in the case of the Immokalee workers. Knowing of specific abuses, such as in the FoxConn factory in China or the sweatshops in Bangladesh, most consumers, both progressives and conservatives, demand reform, and corporations do listen to them. Progress is slow and frustrating, but it is progress.
It may be possible that severe and systemic structural reforms are required to eliminate slavery and other forms of corporate abuse, but it is the abuse and the desire to eliminate abuse that must motivate the change.