ethics

Talking Points for One Particular Left-Leaning Liberal

R. Horton

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

R. Horton

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

R. Horton

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.

adult doctor girl healthcare
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I’ve Seen You With Other Lovers (#poem)

R. Horton
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)

R. Horton
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)

R. Horton

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)

R. Horton
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.

Upon the Threat of Thought Experiments (#poem)

R. Horton2 Comments

20190408203131_IMG_7548.JPGA philosopher of mind,
It doesn’t matter who,
But it was Daniel Dennett,
Made a point of describing
Disembodied consciousness,
Or dissociation,
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.”)

Sisyphus in a Pickup (#poem)

R. Horton
yellow pick up truck on grey concrete road
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If this were a country song,
I’d say I’m so far down
I have to look up to
See the bottom.

I used to get more
Kicks than a horse in a
briar patch, but the old mare
Ain’t what she used to be.

I always heard that
Rock bottom is a lonely place,
But this domain is
Now well populated.

If misery loves company,
She’s become a promiscuous
Polyamorist, and we’re having
A resentment orgy.

We look up at the peak,
And get the idea a group
Of down and outers can climb up
To bring the Gods right back down.

Climate Catastrophe: Pandemic and Pestilence (#poem)

R. Horton

skull-208586_1920Epidemiologists 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
Unsuspecting vectors
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.
Infrastructure fails,
Transportation halts,
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.