ethics

Doctor, how much will this cost?

R. Horton2 Comments

When I was young, newly married, and in graduate school, I needed to have some wisdom teeth extracted. I went to a dentist near my home, and he took x-rays and explained what all needed to be done for the extraction. I had little money at the time and I asked, necessarily, how much it would all cost. He gave an exasperated sigh and told me we’d talk about that later. We wouldn’t, because I asked for my x-rays and left without scheduling the extraction.

Through family, I managed to find a dentist who was willing to do the extraction for a set Stethoscopeprice with the caveat that one always runs the risk of unexpected and unavoidable complications running up the costs. In the latter event, this dentist, knowing my family, agreed to work on a reasonable repayment plan. The extraction went well, I was able to pay for it, and we all went on about our business.

The remarkable part of this story is that I never again had a frank discussion with any healthcare provider regarding the cost of treatment, though I have often been shocked by the prices of tests, prescriptions, and other services.

Ideally, I think when doctors (or other providers) tell patients about a treatment’s risks, side effects, and benefits they should also talk about the treatment’s cost and whether there are cheaper alternatives. Sometimes, a cheaper alternative is just as efficacious as the expensive choice the doctor is prescribing. In this way, discussions of cost can be woven seamlessly into the informed consent process.

Of course, adding a discussion of price to the informed consent process will add another burden for doctors, who are already feeling pressured for time. In a column in the New York Times, cardiologist Sandeep Jauhar points out that reduced payments to doctors have forced doctors to take on more patients to maintain their income. As a result, doctors spend even less time talking to patients and feel even more rushed to move on to the next patient. Adding a discussion of cost to informed consent will only create more pressure for the doctor to hurry through each patient encounter.

Further, it is difficult for doctors to inform patients of something they don’t know themselves, and doctors are frequently unaware of the cost of medications and other services they prescribe or order. A 2007 paper by G. Michael Allan, Joel Lexchin, and Natasha Wiebe found that “Physicians’ awareness of the cost of therapeutics is poor. With only 31% of estimates within 20% or 25% of the true drug cost and the median estimate 243% away from the true cost, many of the estimates appear to be wild guesses.” If physicians knew the cost of their prescriptions, they might prescribe differently in many cases, so it would be a huge step forward if both physicians and patients could be better informed about healthcare prices.

Physician Peter Ubel wrote a blog post about his experience with getting a prescription from his own doctor that was $200, much more than he had anticipated. When Ubel spoke with his doctor, the prescribing physician admitted he had no idea the prescription would cost so much. Ubel asks whether we should expect doctors to research costs before prescribing. It may be too much of a burden to ask doctors to do more research, but this may be a case where the move to electronic health records (EHRs) may benefit patients directly.

If an EHR retains patient insurance information, then it should be able to calculate the cost of any treatment stored in database and automatically display it to the doctor when the prescription is entered. With a really expansive system, it might even show the cost of alternative treatments. The doctor could then easily present the patient with each treatment and its cost.

I have serious reservations about the growth of EHRs and massive databases of personal information that is not easily controlled or limited; however, if we have EHRs anyway, we might as well use them to save money for patients. In the meantime, I think we will all do well to bring up the issue of cost with healthcare providers at every available opportunity. By doing so, we will make our providers aware that cost is an important consideration in prescribing, and we may also slowly work our way toward much greater transparency.

 

Thought experiment: Financial Conflicts of Interest

R. Horton1 Comment

Believe it or not, many people see no problem with financial conflicts of interest in health care. People who receive payments say they are only doing the same job they would do otherwise, except with more resources. This, they say, enables them to provide better health care. People who make the payments will claim that they are only trying to ensure that their beneficial products are able to improve the lives of as many consumers as possible. Even patients defend conflicts, saying they don’t mind their doctors making a few extra dollars in order to provide efficient, state-of-the-art service. Patients see these financial ties as a way to ensure groundbreaking treatments reach consumers.

Slippery Slope
A rather beautiful example of a slippery slope.

I’m not a doctor, but there are analogies for me. If we look at financial ties in another industry, it may be easier to see the problem. In education, the stakes are lower, but some parallels to the medical industry remain. I will begin with actual practices and then ask you to imagine further practices that parallel the medical industry.

First, instructors are commonly asked to review books for publishers seeking feedback on manuscripts or new textbooks. This gives the publisher an opportunity to get feedback from potential customers while also enabling instructors to provide input to publishers. Instructors get better books, and publishers are able to improve both their products and their marketing. The instructor is, of course, paid a small honorarium for the time invested in reading and reviewing the book.

Second, once instructors have given feedback, publishers may invite them to be more involved in the production of the textbook. They may be asked to write an instructor’s manual to accompany the text or participate in developing workbooks or online supporting materials for students. (Disclosure: I know that these first two items are practiced because I have reviewed textbooks and written an instructor’s manual for pay.) Instructors, of course, know the most about what instructors need and how students may use various materials. Improving the product benefits publishers, instructors, and students.

Now, imagine that an instructor sees an improvement in students’ success rates and general aptitude. The instructor begins to collect data and may even present at a teaching and learning conference on how these materials have benefited students. A publisher might (I don’t know of this happening in real life) offer to pay the instructor to give the same presentation at additional conferences. On the surface, this does not seem harmful. After all, the students really did improve using these materials, and the presentation was not developed with the aim of getting payouts from the publisher. Certainly, no students will be harmed by these presentations.

Finally, imagine this instructor begins to accept regular invitations from the publisher to present on the benefits of the products and encourages others to adopt the same materials for their classes. The instructor notes that most of her or his students are now earning A’s and B’s when the class averages were usually a B or C before the materials were adopted. To reward the instructor for this amazing success, the publisher begins to pay the instructor $100 for each A awarded and $80 for each B awarded. Soon, this instructor is widely hailed for improving student success and completion rates at a college that struggles with generally high rates of failure and incompletion.

Now, these payments to the instructor come to the attention of the student newspaper, which publishes the amounts paid to the instructor and the increase in high grades in the classes. The public is outraged, but enrollments in the class continue to increase. The instructor counters that no one has shown that even one student who received an A did not deserve an A. Further, the instructor says that the improvements in student success were documented even before the payments began. The publisher responds by saying that the materials it produces are of the highest quality and that it is proud of the success rates of the students using the products. Without the relationship between the publisher and instructor, fewer students would have benefited from these outstanding educational materials and that would be a real tragedy.

Questions to consider: 1. Did students really benefit from the relationship? 2. Were cheaper alternative materials available that were equally beneficial? 3. Is it possible that students received inflated grades, even if proving it so is impossible? 4. What would it take to identify this relationship as a moral problem? 5. Are all financial relationships with industry unethical? 6. If not, when does the relationship become unethical?

I think it is extremely rare for someone to go into a job with criminal intent to capitalize on the system and take home as much money as possible regardless of possible harm. No, everyone begins with the best intentions and becomes blinded to the possible effects of their actions. And, precisely because each person has no malevolent intentions, each person feels insulted by even a hint of judgment and defends her or his practices vehemently. Because good people do X or Y, it is easy to think it is impossible that X or Y is a bad thing, especially when we can show that many people have benefited from these practices.

åIt is easy to be blinded by the fog of good intentions and financial influence, and ethicists are not immune. The job of the ethicist is not to be perfect but to be on guard. The job of the ethicists is to constantly strive to get a clear view through the fog and to help others stay on the paved path running alongside that slippery slope.

 

Why men don’t speak out against sexism and misogyny

R. Horton3 Comments

When we feel ashamed or judged, we have several possible ways of responding. One IMG_0516method of dealing with shame is to defend yourself vigorously, to deny anything is wrong, and to attack those who might think differently. We can imagine the loud protests of Hamlet’s mother, though perhaps Hamlet’s attack on his mother is equally revealing. A second method, which is my preferred method, is to try to suppress it, hide it, and pretend it does not exist, and I think I have plenty of company with millions of people struggling with feelings of inadequacy, guilt, and a myriad of shortcomings. This kind of shame destroys you from the inside out. The third and most difficult method of dealing with shame is to acknowledge it, confront it, and try to resolve it in some way. When we meet individuals who can do this, we admire them, praise them, and exalt them, which is as it should be. Think of a former member of the KKK who becomes a civil rights leader, for example.

In the aftermath of Elliot Rodgers’ mass killing, pundits, analysts, feminists, psychologists, and just about everyone else has jumped to understand and explain what may cause someone to want to kill with such intensity and drive. It appears that Rodgers dealt with feelings of deep shame and inadequacy because he felt he failed as a man because he couldn’t convince women to have sex with him. Many men, even those who have had their share of sexual encounters, share his shame, but fewer question the assumptions that create that shame. Men are expected to be on a constant mission to prove themselves through sexual conquests, and most men internalize this to one degree or another in the same way that women internalize attitudes toward body image.

It isn’t surprising, then, that many men reacted defensively to discussions of sexist attitudes and their dire consequences. Who is going to say, “I see now that I’ve bought into a dangerous belief system. I see that my way of thinking leads to mass murder.”? Not many, which might explain the emotional and unrelated defenses of Glenn Beck, Seth Rogen, and all the men who reacted negatively to #yesallwomen. Beck went on a long tirade against the idea that sexual assault and harassment is prevalent and suggested that people are calling normal, consensual sex rape. Rogen responded to Ann Hornaday’s critique of media that depicts women as trophies by tweeting, ““How dare you imply that me getting girls in movies caused a lunatic to go on a rampage.”

These men want to make clear that they are not part of the problem. They recognize that their attitudes and maybe even their actions are now being criticized as part of the problem, and they are saying, “Hey, don’t point the finger at me.” They may also realize they have internalized the values that oppress and torture men. We may want to respond to #yesallwomen with #notallmen, but the fact is that all men, at least in my culture, are familiar with the beliefs and attitudes that shame men for “purity” and women for “sexual prowess.” We feel it deep in our bones, and it makes us uncomfortable.

In the next wave, many women wonder why more “enlightened” men don’t speak up and stand with them. To be fair, many men have shown the courage to do this, but doing so requires us all to look inside and examine what we may prefer to hide and suppress. You don’t have to be a rapist or a murderer to recognize common feelings or assumptions you may have or may have once had, and it can create a kind of soul-burning shame.

Few tasks in life are as difficult as confronting our own shame. The attitudes and beliefs that define us as men and women touch us at the core of our being. A thoughtful, honest, complex, and courageous discussion of how to liberate and protect men and women will be lengthy and arduous, but a better world is possible.

PS: And let’s have a discussion about access to guns as well.

For more on shame, see the work of Brené Brown.

 

Performing masculinity and grief: A death of my own

R. Horton3 Comments

When I was fifteen years old, my 25-year-old uncle died in a fire

While some older adults had feared for his well being for some time, his death was sudden, unexpected, and extremely traumatic for me. In times of grief, we all experience mixed emotions, but I was overwhelmed by feelings of confusion and isolation.

In the days following his death, my time was spent among both close and distant relatives in the home of my grandparents. When people interacted with me at all, it was generally to tell me to give comfort to someone else (“Go hug your grandfather.” “Hold your grandmother’s hand.”). I did my best, and I got through it. I had been to funerals before, but this was the first time I was so close to the deceased and so aware of the judgments of the people attending the funeral and receptions at the home later. Someone, usually a woman, didn’t cry enough or dared to wear pants to a funeral. Someone else, usually a man, fell to pieces and couldn’t keep it together. Certain friends should not have dared to show their faces, and others had no excuse for not coming. Or so it was stated by the chorus of judgment and scorn.

I tried my best to assimilate funeral normativity, but it really didn’t make sense to me. Years later, I cried at my grandfather’s funeral. This seemed a reasonable to me, and I didn’t predict being judged for it. After the funeral, one of my relatives asked me what I did for a living. I told her I was a writer. She said, “I knew you must be some kind of sensitive artist or something.” So much for the freedom to openly grieve for a close relative at his funeral. Do women face this kind of judgment?

But men who do not express emotions openly aren’t free from judgment or consequences, either. Kenneth Doka, an expert of grief counseling, said in an interview, ‘We do a strange thing with grieving styles. I always say we disenfranchise instrumental grievers early in the process. “What’s wrong with this person? Why isn’t he crying?”’ The man who manages his grief by working through it with projects, helping others, and so on is ignored. The man who emotes openly is criticized. Doka points out that more emotive grievers are penalized later (Why isn’t she over it yet?).

My uncle’s funeral may be when I first developed my revulsion at smug hypocrisy and self-righteous pity. I can remember one aunt declaring, loudly, “Well, if his death had anything to do with drugs, I just don’t want to know about it. That is not what is important now.” And this may also be when I first became aware of paradox. If she believed what she said, she would not have said it, and if she said it, she obviously didn’t believe it. (And a lifelong love of philosophy is born.) Anyway, I also developed my own sense of righteous indignation toward people who couldn’t offer condolences without poking people with daggers in the process.

In my first experience with traumatic grief, the people I would normally turn to for emotional support were all overwhelmed emotionally and intellectually. I don’t blame or resent anyone for it, but I was alone with my grief and my first experiences with this kind of loss. Shortly thereafter, an acquaintance was killed in a motorcycle accident, and I just never took the continued existence of anyone for granted again. I also accepted grieving as a solitary activity.

The next traumatic loss I experienced was described in an earlier post. My niece and nephew drowned on Mother’s Day (May 10) in 1992. The single most striking feature of this grief experience for me is the memory of many friends, coworkers, and family members coming to me to express their condolences and sincere concern for the suffering and recovery of my ex-wife. People lamented that it must be extremely hard on my wife, and I was admonished to take good care of her, as her suffering must be immense. I tried to do those things, of course, as I tried to manage my own emotions and continue to care for my children (I was an at-home dad at the time) and maintain a functioning household.

During this time, I had thoughts that terrified me and flooded me with shame. I began daydreaming, almost longing, for the death of someone who would be important to no one but me. A death that would bring me the kind of comfort and concern that had been reserved for my ex-wife during what was certainly the most challenging and traumatic event of my life to that point. I was horrified to think that I could wish anyone dead. Of course, no one in the world is important only to me. Everyone I love is loved by others as well. Further, I wouldn’t trade any of my loved ones for “good grieving.” (I will add that one friend in particular stood by me and cared for me throughout.)

The true fantasy, of course, was that someone would step in to help me through my current grief, not that I wanted anyone to die. Still, these thoughts became pervasive and persistent enough to plague me with guilt and interfere even more with my recovery. What I really wanted was to receive the same support I was expected to give. I don’t really want to be the only person in the world being cared for; I just want a reciprocal arrangement. I don’t know whether every man feels the same way, but I know I’m not the only one.

Why is it that being a man is to be sentenced to a life bereft of emotional support? When women say they want to meet a sensitive man, they generally mean they want to meet a man who attends to their emotional needs, not a man who openly expresses his own emotional needs let alone a man openly expresses his emotional frailty.

I dream of a world where grief is not gendered and where masculinity is not marked by solitary sorrow.

Horton’s Taxonomy of Racial Prejudice

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It seems we keep having people make racist remarks and then proclaim, defensively, that they are not racists. Some people are so hostile that their claims of innocence are both laughable and infuriating, but others seem genuinely bemused by the accusation that they are racist. It doesn’t seem possible that anyone could be so clueless, their critics think, that their attitudes would not be obvious to them. In other cases, people strive with everything they have against being racist, only to find to their dismay and horror that they have unconscious racial biases.

In order to sort things out, I think we need to recognize a few categories of racism:

1. Overt racial hostility. In this category we have white supremacists (or other kinds of supremacists, even, depending on your location and circumstances). People in this category believe other races are inferior and will not apologize for saying so. We can renounce them, but we aren’t likely to shame them, as they are quite self-righteous in their belief in their own superiority (leaving their latent fears and anxieties aside for the moment).

2. Racial Prejudice. Some people say they don’t hate anyone or want anyone harmed, but they just happen to believe it is a brute fact that people from different races are different and have different abilities and preferences. People in this category can be the most confounding, as they might say things that are outlandish to the rest of us and then become extremely offended that anyone could possibly accuse them of racism. “I don’t hate such and such people, but they sure hate hard work. God love ‘em.”

3. Racial insensitivity. Sometimes people genuinely don’t mean any harm at all but have no idea how their comments may hurt others. Assuming a person of a particular race enjoys a certain kind of music, dance, food, or whatever may seem completely reasonable to you while it reduces that person to a broad stereotype. Even if the person does happen to like that music or food, he or she may resent you making any assumptions about their taste based merely on race or ethnicity.

4. Racial privilege. A member of my family once said he couldn’t understand why certain groups were always complaining about police harassment. He mentioned that he had many experiences with the police and he had always been treated with respect and courtesy. It didn’t occur to him that his skin color, sexual orientation, and socioeconomic class had anything to do with his treatment. That certain groups are targeted for mistreatment seemed inconceivable to him because he never had to experience what others endure regularly. This is the nature of racial privilege. (Yes, many kinds of privilege exist, but they aren’t relevant to this discussion.)

5. Unconscious and undesired racial bias. Finally, we all have biases without realizing it. When people take psychological tests (you can take one here) to see what biases they have, they may be chagrined to find they are biased against others without wanting to, but some of us are even surprised to find we hold implicit biases against our own social groups. Even those who are aware of no bias whatsoever find that some biases are so deeply entrenched that they are difficult to detect. Ironically, those with the least ill feelings toward other races are, in my experience, more aware of implicit bias. Confront an obvious racist about overt racial attitudes, and he or she will often declare, loudly, that he or she is completely indifferent to race. In my experience, those who are most committed to ending racial prejudice are the ones who are also most willing to examine their own implicit biases. Such is life.

Gender Disparity: Paycheck Fairness Act is not enough

R. Horton

Before I start, let me say that I support any effort to address wage inequality and I believe strongly in the right to equal pay for equal work. If the Paycheck Fairness Act helps to bring more equity to the workplace, I’m all for it, but it will not eliminate wage disparities between men and women on its own.

Republicans are wont to point out that women make less than men not because of discrimination but because of lifestyle choices. (Read a fuller discussion of this in The Guardian.) Their argument centers on the fact that it is possible to pay every woman in any given job the same wage as every man in a similar job and still end up with wage disparity because more women are in lower-paying jobs. To Republicans, this means sexual discrimination is not a problem (everyone should just choose to be a petroleum engineer or investment banker, right?), but for the rest of us it means that sexism is a pernicious problem that will not easily be solved with a piece of legislation.

First, we might ask why the jobs more women choose pay less than the jobs more men choose. One proposed answer is that men choose jobs that are riskier and require a more “masculine” personality. Women, it is assumed, will choose safer and less demanding jobs. Another answer is that women gravitate toward jobs that require fewer hours (they need to get home to the kids, you know?). And another is that women choose jobs that require less training.

According to the 2013 Physician Compensation Report, male doctors earn 30 percent more than female doctors. The report explains the disparity thus: “There are fewer women in some of the higher-paying specialties. For example, in orthopedics, only 9 percent of the survey respondents were women, whereas in pediatrics, 53 percent of survey respondents were women.”

Interestingly, the lowest paid specialty in medicine is now HIV/Infectious Diseases, which also happens to be the specialty with the second highest rate of overall satisfaction (just behind dermatology). The other low-paying specialties are family medicine, diabetes/endocrinology, and internal medicine. Other high-paying specialties, after orthopedics, are cardiology, radiology, gastroenterology, and urology.

While I can’t see that the risk of treating infectious diseases is lower than the risk of practicing urology, I do see that the lower-paid specialties focus more on care and concern and require human interaction. (It still may be true that women are more risk-averse, which may be why they are safer doctors.) It seems to me that we value technical expertise over human and care and concern in most fields. At least we are more willing to pay for technical expertise and less willing to pay for the care and concern that we will all need.

Teachers work hard and take many risks but will never earn as much as petroleum engineers. Ah, but petroleum engineers fatten the bottom line for their employers, you say. Let them try to survive without teachers to get them there. Let all the hard-working risk takers make it through life without the people who cared for them and helped them become successful. And men have always said this, haven’t they? We have clichés such as “Behind every successful man is a woman.” And women have done their work, largely, for free—because they had no other choice. So the work women have done is devalued (though prized in way) and undercompensated. If fewer people were willing to do “women’s work,” the price of such work may indeed rise, but I don’t see this happening any time soon.

And men sometimes choose work that may be seen as “feminized.” When they do, men also earn less because their work is undervalued, too. If the work were not undervalued, I aver that more men would choose different careers. After successful careers in industry, some men choose to leave their jobs for more “meaningful” work after middle age. The work people describe as “meaningful” or “rewarding” is almost always related to either caring relationships or creative enterprises; these are the activities that make life seem worthwhile.

Because these activities bring so much personal satisfaction, people are willing to do them for less pay. If petroleum engineering did not pay so well, I’m sure some people would still choose it as a profession, but many people choose it now only because it pays well and not because it enriches their lives in any other way. Many men are starting to reject the idea that they must choose careers based on how well they pay. Some men in the men’s movement reject being treated as “success objects.” Nonetheless, I think women are more likely than men to feel free to choose careers based on satisfaction rather than remuneration, and men are more likely than women to feel they must choose a career that pays well. There are many, many exceptions, of course, but not enough to close the pay gap between men and women.

So, what should we do to address the problem of wage disparity? First, stop devaluing “feminine” work. Recognize the true value of education and care. Second,  stop treating men as “success objects.” Remove the stigma from rejecting a high-powered career for a more rewarding and meaningful life. Finally, make it possible to find a balance between a career that pays well and a meaningful life. Some women may pass up high-paying professions because they do not want to neglect their family relationships or similar concerns. At the same time, some men neglect relationships and personally rewarding work because they feel obligated to earn as much as possible. Men and women would both behave differently if it were possible to enter any career without having to sacrifice family relationships, volunteer opportunities, and creative outlets. Another world truly is possible.

Is there a wrong way to grieve?

R. Horton6 Comments

Over the past few months, I’ve written of several philosophers of the ancient past who taught that grief should not overwhelm us before themselves becoming overwhelmed by grief. Stoic philosophers taught that we should understand that death is nothing to fear or mourn, if only we can have the proper understanding, but the emotion of grief trumps rational explanations every time. I would conclude, then, that we should not attempt to suppress or diminish our grief but should let it unfold naturally and grieve for as long as necessary. Criticizing the grief of others seems counterproductive at best.

But this left me wondering whether there is a wrong way to grieve. What obligations can the bereaved have to others? Obligations to the dead? Does grief suspend normal obligations?

Like the rest of the world, I don’t know what caused Spc. Ivan Lopez to go on a shooting rampage at Ft. Hood. He certainly had experienced a great deal of stress in his life and had good reason to experience problems with mental health. According to a CNN article by Ray Sanchez, Lopez’s father said the recent deaths of his mother and grandmother, medical treatment, and changes related to transfer of military installations “surely affected his condition.” Grief often becomes unmanageable when it is combined with other complications, obstacles, and challenges. We do well not to ignore the impact of grief on those around us. We are part of a community, and the health of the community deals in part on how well we respond to grief.

For an example from fiction, I’m reminded of “A Rose for Emily” by William Faulkner. Emily has much to grieve for: When she loses her father, she loses a loved one but also status, wealth, predictability, and honor. She responds by simply refusing to acknowledge her loss. In the beginning she denies that her father is even dead. Eventually, she relents and permits him to be buried, but continues her life as if nothing has changed. Her neighbors go along out of pity, not respect. As you probably remember, Emily eventually takes a lover from out of town, kills him, and sleeps with his body for the rest of her life.

Emily’s neighbors had tried to offer condolences to her when her father died, but she denied his death. After his death, the neighbors reacted to her with a mix of compassion, respect, suspicion, and disgust, but they also lacked the will to intervene as Emily continually pushed them away. They left Emily with her privacy and, as much as possible, a little dignity, which only led her to more extreme and destructive measures.

If I say that Emily grieved unethically, you may say that grieving wasn’t the core problem; rather, she was refusing to accept change. But grief is always a reaction to change, and all change is annihilation. The bereaved will often say the whole world changed, and that is exactly what has happened. Emily’s world changed, but she refused to accept either her father’s death or her change in fortune. By killing her lover, she tried to preserve a moment forever. Emily’s response to grief was understandable but not excusable. Then again, perhaps her neighbors did not respond ethically to Emily’s grief. The neighbors did reach out to Emily, even with follow-up visits, but failed to intervene more forcefully. Are they obligated to take matters into their own hands?

I recently had the opportunity to hear author Cheryl Strayed speak on her latest book, Wild, which is about Strayed’s own response to her mother’s death. Strayed is a talented and courageous writer and proficient speaker. As she talked about her grief journey, she only lost her composure once. She said that after her mother’s death she became the kind of daughter her mother would not have wanted her to be. She described her adultery, promiscuity, and substance abuse through tears that evaporated as she moved on to discuss how she began to manage her grief more positively (ethically?).

I ask whether there is an ethical way to grieve. We can see that people, overcome by grief, behave in ways that are certainly unethical in most contexts, but we may have such compassion for the bereaved that we soften our judgment of them. “What she did was wrong,” we may say, “But I can see why she did it. I might have reacted the same way.” But this may be true anytime someone acts unethically. In the exact same situation, I may have acted as Bernie Madoff acted. In fact, we have all acted in unethical ways. We had our reasons (grief, exhaustion, addiction, depression, or whatever), but our actions were unethical.

So what helps people behave more ethically? Jean-Paul Sartre, the famous Existentialist philosopher, says that with each of our actions we choose “the good.” He doesn’t mean we always make good choices, but given our options, we choose the one we thought was best, which means we write our ethical values for public view by the actions we choose. In this environment, other people become our hell. Nothing is more damaging to us than being trapped by the others’ perceptions of us.

When we choose an action, we are choosing the one that seems best to us at the time. The problem is that some of us have run out of good ideas for what to do. We often explain ourselves, rightly, by saying, “I didn’t know what to do!” If we had more ideas, we would have more choices and could make better decisions. Sartre claimed we have absolute freedom, but really we can increase our freedom by increasing the number of actions we have in our consciousness. Sartre saw others as our judge, jury, and executioner, but they can also become our community.

It is Sartre’s companion and lover who had a broader vision for existentialist ethics. Simone de Beauvoir was able to see the positive importance of others in our lives. Beauvoir declares “freedom can be achieved only through the freedom of others.” If we want to be free, we must seek our freedom through the freedom of our community, and our freedom grows out of our love. Beauvoir says, “If we do not love life on our own account and through others, it is futile to seek to justify it in any way.” Without valuing others, our life truly loses meaning, and we will lose all hope.

When I was in China, I once thanked someone for helping me with a problem, and she responded, beautifully, “When we help each other, we are free.” Indeed, it is the only way for us to become free. And it is the only way for us to have more good ideas of what we can do.

Why I hate Steak and BJ Day

R. Horton12 Comments

On March 14, I learned of a new holiday known as Steak and BJ Day. Known as a humorous response to Valentine’s Day, the idea behind Steak and BJ Day is that women get all the attention on Valentine’s Day (men spend about twice as much as women) and there should be day for men to get what they enjoy, which is, obvious to the creators and celebrants of this day, steaks and blow jobs. It’s just a joke. It’s all in fun. If you don’t like it, don’t participate.

Many women seem to feel this is a fair way to compensate men for being so generous on Valentine’s Day, apparently having no qualms describing their romantic relationships as blatant prostitution. (“After all the trouble he went to for Valentine’s Day, I owe him something. Teehee.”) If people want to live their lives exchanging gifts for sexual favors and cooking services, I have no problem with it, so long as everyone knows what is going on and feels comfortable commodifying relationships. I have a different problem with this holiday.

Steak and BJ Day is based on a crude masculine stereotype that is inoffensive to men who live for their next steak and treat of oral sexual gratification. All men are supposed to want this. Any man who doesn’t love and know how to prepare steak, in fact, should turn in his man card, according to this web site.  Again, it is just a joke. If you don’t love steak, you are just a girl. Hilarious. I mean, who would want to be a girl? It isn’t meant to offend anyone. Any man who objects to this stereotype is himself at risk of being told he is too sensitive or not a “real man” or a “typical man.” People who are less kind will tell him he is a sissy, wimp, girl, or any number of nastier anti-gay slurs.

So, men who don’t want these things should turn in their man cards (see this site for an uproariously funny rendition of this ). “Turn in your man card” is the functional equivalent of “you throw like a girl.” As much as people insist this is all just a joke, the consequences of masculine stereotypes are severe. Children who fail to express their gender in expected ways are more likely to be bullied and abused and suffer from depression and PTSD (see a study on the risk here). You may have heard what happened to a boy who liked My Little Pony. Further, anti-gay attacks are typically in reaction not to sexual activity but to perceived non-conformity to gender stereotypes (a 1982 study by Joseph Harry found that “effeminate” men are twice as likely to be victims of gay bashing than gender conforming men), which means gay-bashing victims include many heterosexuals or children with no obvious sexual orientation or identity at all.

This bias against unmanly men is nothing new. Through an essay by Elizabeth V. Spelman, I found a passage in Plato‘s Republic describing what kinds of men would be inappropriate for a decent society:

We will not then allow our charges, whom we expect to prove good men, being men, to play the parts of women and imitate a woman young or old wrangling with her husband, defying heaven, loudly boasting, fortunate in her own conceit, or involved in misfortune and possessed by grief and lamentation—still less a woman that is sick, in love, or in labor.

People sometimes want to credit Plato with an early form of feminism, because he felt women should be trained in the mode of men. Like many today, he felt it was quite admirable for women to strive to “achieve” masculine traits. Men being the highest form of human perfection, Plato thought it made sense for women to strive for the masculine ideal. The man who would follow the lead of women, however, would be lowering himself below his station and be pathetic at best. His view persists as we encourage girls in sports, mathematics, and leadership, but forbid boys from nurturing, crying, creativity, and careers related to care and empathy. It seems odd to me that eating meat is considered particularly masculine, but vegetarian men are portrayed as being the least manly of all. The hatred and devaluation of “feminine” men is an extension of the oppression of women. Feminist philosopher Jean Grimshaw points out that the conception of a feminine ideal depends on “the sort of polarization between ‘masculine’ and ‘feminine’ which has itself been so closely related to the subordination of women.”

The hatred of “effeminate” men is an extension of the devaluing of the feminine, but it leads to violence and oppression of both men and women. In order to be free, we must assign equal value to all human activities and emotional dispositions. Leadership and assertiveness have their value, but we will not last long in a society devoid of nurturing, care, and concern. Another feminist philosopher, Genevieve Lloyd, puts it this way:

If the full range of human activities–both the nurturing tasks traditionally associated with the private domain and the activities which have hitherto occupied public space–were freely available to all, the exploration of sexual difference would be less fraught with the dangers of perpetuating norms and stereotypes that mutilated men and women alike.

I added the emphasis on the word “mutilated,” because I am grateful to her for using such strong language to describe accurately what sexist stereotypes have done to us. I often hear women struggle to describe how sexism hurts men. Some say it discourages men from working hard or from caring for others, but they miss the fact that sexism destroys men from the inside out. Very few men escape childhood without having their masculinity questioned and challenged. And too many men have responded violently to a woman who has taunted them with, “If you were a real man, you’d . . . !” The constant demand that a boy or man prove his resilience, indifference to pain and fear, and lack of compassion rends men from their humanity. Those who resist are often trampled under foot and left with depression, addiction, anxiety, and self-loathing. Too often, it ends in self-destruction through addiction, isolation, or suicide.

You may be thinking I take things a little too seriously. No one would kill himself over Steak and BJ Day. I agree, but I am asking you to consider the good of masculine stereotypes, and I tell you they serve no purpose and provide no benefit. The cumulative effect of such stereotypes is to prevent men from being whole and to destroy those who are uninterested or unable to fulfill the social expectations such stereotypes are designed to enforce.

For the love of humanity, please free us all.

See also: Why I Hate Valentine’s Day