The power of apology

Good piece about Lee Taft in today’s Dallas Morning News. Lee is a skilled advocate for the transformational potential of aplogies.

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A big week for the Maguire Center, 21-25 September

Early in the week, we are co-sponsoring the Tate-Willson Lectures with the Graduate Program in Religious Studies. Nigel Biggar – Regius Professor of Moral and Pastoral Theology and director of the McDonald Centre for Theology, Ethics, and Public Life at the University of Oxford – will discuss “Behaving in Public: Christian Ethics in a Polyglot Secularity” in TWO LECTURES on Sept. 22 in 106 Prothro Hall. The first is at 11:30 a.m. (“Between Distinctiveness and Consensus”) and the second lecture is at 7:00 p.m. (“Behaving in a Polyglot Public”). Both lectures are free and open to the public. For more information, contact the Graduate Program in Religious Studies Office, 214-768-2432.

We are co-sponsoring two events in conjunction with the campus-wide observance of the 200th anniversary of Charles Darwin’s birth, along with the Biology Department, the Meadows School (and the Division of Cinema-Television), and the Dedman School of Law. Read all about it over here.

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Public health ethics

An article in today’s Dallas Morning News about H1N1 influenza did a pretty good job of covering the bases: vaccination (and vaccine safety and availability), prevention, and the possible effect of a pandemic on the ability of health providers to care for large numbers of flu sufferers. This part of the story caught my eye:

Last spring, news stories popped up about airlines pulling sick passengers from planes as a precaution against spreading the H1N1 virus. We could well see repeats of this scenario: ushers asking sick people to leave the theater, bus drivers yanking people out of their seats and depositing them onto the street.

These enforcement tactics are unethical, according to Carlo, who also is an expert in the esoteric realm of public health ethics. He said that removing symptomatic people from public places is discriminatory. For every sneezing and coughing person in a public place, there may be another contagious person who shows no symptoms at all but is just as dangerous as the sneezing person.

Carlo’s opinion is based on research in which flu patients report that they were never around anyone who appeared to be sick before they themselves got sick.

“Hence, asymptomatic transmission is used to explain this,” he said. “It’s really unfair to take enforcement action against people who have symptoms and leave the others alone. It’s unethical.”

I am not sure I get the logic of this. Just because there are infected people out there who are asymptomatic and therefore unknown to us, we can’t deal with the infected people who are symptomatic and therefore identifiable? Is that how we deal with TB? If the reason we isolate TB patients, even though there are others with TB who are asymptomatic and unknown to us, is because the threat to public health is greater than appears to be the case with H1N1 influenza, then fine, that’s a distinction I understand, but it’s not the argument being made by the health department.

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Kidney Donations–Some New Ideas

Tom Mayo and I have already posted some thoughts about organ donation in the US and elsewhere on this blog. I’ve just read two interesting recent articles about the problem with regard to kidney transplants in the US. Currently some 80,000 people are on a waiting list for kidneys, and they generally receive dialysis while they wait. About 16,000 people receive transplants each year. Many come from cadavers, although they tend not to be as useful. (My post from November 2, 2008 was concerned with agreements by living people to donate their organs after their death.) About 4000 people on the list die each year for lack of a suitable kidney to transplant. Both articles focus on donations of one kidney by a living donor, which is now much less of a hardship, thanks to new technology.

Virginia Postrel has written an excellent article in The Atlantic about this issue.

http://www.theatlantic.com/doc/200907u/kidney-donation

She writes with very understandable passion:

With 300 million people in the United States, the numbers shouldn’t be so daunting. Eighty thousand people wouldn’t even fill the Rose Bowl. Surely we could find enough kidney donors to end the list. But solving that problem demands creativity, daring, and, above all, a sense of urgency—a radical break with the fatalism fostered by dialysis culture. Kidney patients ought to command the kind of outrage that demanded a cure for AIDS. The list doesn’t have to exist. It is a result not of medical necessity or economic constraints but of public ignorance, conscious policy, and complacent institutions. Too many people are suffering unnecessarily.

Postrel explains an ingenious new system, the National Kidney Registry, that creates chains of unmatched donors and potential recipients that should be able to increase the number of transplants, given the current supply of willing donors. (She understands the economics behind such a system, having once helped to write the excellent “Economic Scene” column in The New York Times.) This system supplements the main organization overseeing the transplant of kidneys in the US, the United Network for Organ Sharing, which administers the waiting list. But Postrel thinks a system that pays donors is the best way to enlarge the donor pool. She is aware of the ethical objections to this, and gives a very intelligent response to them. I should mention that Postrel herself gave one of her kidneys to an unrelated acquaintance of hers.

There is another interesting article in a recent New Yorker.

http://www.newyorker.com/reporting/2009/07/27/090727fa_fact_macfarquhar

(There is unfortunately only an abstract of the article on the site.) The author, Lisa MacFarquhar, focuses on another organization that is trying to increase the number of donors. It operates a website where potential recipients post descriptions and pictures of themselves, and invites people to donate a kidney to one of them. So in this system individuals can pick a particular person to give a kidney to, though they may choose not to have their identity revealed to the recipient. I found this other new system to be strange and unsettling, somewhat like the old TV show, Queen for a Day. On the other hand, MacFarquhar does a nice job of explaining the motivation of people who are prepared to give a kidney to a complete stranger. (Apparently doctors for a long time regarded such radical altruism with great suspicion.)

Both articles describe how certain creative outsiders have tried to supplement the authorized system for matching donors and recipients of kidneys. Of course, the professionals who run that system deserve tremendous praise for saving as many lives as they do, and for fairly carrying out a morally difficult task. But it seems that everyone who understands that system feels that Postrel’s sense of urgency is legitimate, since thousands of Americans a year are needlessly dying.

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Public Responsibility & Ethics

Perkins Theology School’s Dean Bill Lawrence had an absolutely outstanding commentary on KERA-FM this week. You can hear it here (MP3).

Dean Lawrence’s timely message concerned those who “ensmall” their spheres of responsibility and accountability vs. those who enlarge them. By defining down those things for which we feel any responsibility, anything outside that circle becomes “someone else’s problem.” Whether it’s the cold chicken entree served by a flight attendant (“I serve ‘em; someone else cooks them” (or doesn’t)), or Gov. Mark Sanford‘s ensmalling of his public and private obligations to the citizens of South Carolina and his family, if you can define your spheres of responsibility and accountability narrowly enough, lots of hard things become someone else’s problem.

This describes a lot of what’s going on in the debate over health care reform right now. “I’ve got mine. The 47 million uninsured are someone else’s problem, not mine.”

This is a middle-class fantasy to a large extent. Your insurance company makes money by collecting premiums and denying claims. It’s that simple. Hundreds of thousands, if not millions, of your fellow citizens have learned the hard way that medical costs can drive to the brink of financial ruin even those with “good” insurance policies. Medical costs are the number one cause for personal bankruptcies in America, and no small number of bankruptcy petitioners thought their insurance was up to the task, only to find out otherwise, with catastrophic financial consequences. Even the Wall Street Journal seems to get it: health care crises don’t happen only to “them.”

Apart from the fantasy, though, there is the matter of ethics and public responsibility. Half of those uninsured are children. Most of the uninsured live in working households, but their employers don’t provide insurance and they are priced out of the market for individual health insurance. Nearly 90 million were without insurance at some time during 2007 and 2008. They live in our communities. Their kids go to our schools. Our employment-based, market-oriented “system” for financing and delivering health care goods and services isn’t working for the benefit of nearly one-third of the country (by any conservative measure, and the number is almost certainly much, much higher). When does it become “our problem” and not just “their problem”?

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Explaining Morality Religiously

The Op-Ed page of the New York Times again has a challenging discussion of morality. The well-known atheist Sam Harris expresses some reservations about President Obama’s nomination of Francis Collins as Director of the National Institutes of Health.

http://www.nytimes.com/2009/07/27/opinion/27harris.html?ref=opinion

Harris recognizes Collins’ important scientific accomplishments. But he quotes some statements by Collins about religion and morality that trouble him (and me). Collins is well-known for claiming that religion and science are compatible. He accepts current accounts of cosmology and evolution, but also accepts evangelical Christianity. He is quoted as follows:

“After evolution had prepared a sufficiently advanced ‘house’ (the human brain), God gifted humanity with the knowledge of good and evil (the moral law), with free will, and with an immortal soul….

We humans used our free will to break the moral law, leading to our estrangement from God. For Christians, Jesus is the solution to that estrangement….

If the moral law is just a side effect of evolution, then there is no such thing as good or evil. It’s all an illusion. We’ve been hoodwinked. Are any of us, especially the strong atheists, really prepared to live our lives within that worldview?”

As Harris sees it, Collins’ religious views as such do not present an obstacle to his appointment. But he asks whether someone who holds these views is suited to oversee the enormous research budgets that the Institutes control.

As someone who believes that our understanding of human nature can be derived from neuroscience, psychology, cognitive science and behavioral economics, among others, I am troubled by Dr. Collins’s line of thinking. I also believe it would seriously undercut fields like neuroscience and our growing understanding of the human mind. If we must look to religion to explain our moral sense, what should we make of the deficits of moral reasoning associated with conditions like frontal lobe syndrome and psychopathy? Are these disorders best addressed by theology?

Good questions! Furthermore, I would note, it’s not just new disciplines like neuroscience that can help us to understand moral and immoral behavior. Political science, sociology, law and economics can, too. Turning elsewhere in today’s Times, and moving down from the cosmic scale, we find an enlightening treatment of a venerable moral question, namely, why are New Jersey politicians so corrupt?

http://www.nytimes.com/2009/07/27/nyregion/27jersey.html?ref=nyregion

Here are some of the things that are mentioned.

A decade-long building boom has flooded towns with millions of development dollars, as well as wealthy businessmen eager to secure sewer permits and zoning waivers. The Democratic Party firmly dominates local politics, turning most elections into sleepy coronations. The state’s news organizations, once vigorous watchdogs, have been decimated by a deep industry downturn.

Add to all that the fact that New Jersey is divided into hundreds of tiny fiefdoms, where part-time elected officials without much education and with small salaries wield considerable power, and the heady mix of arrogance, control and promised payoffs dissolves the will of even the most determined reformer….

Academics say that the state’s history of decentralized, small-bore government is to blame. There are 566 municipalities, many with paltry budgets and skeletal staff, whose leaders arrive in government with little training and salaries of less than $15,000 a year.

Some politicians hold two elected offices at once—allowed under state law—which makes them “really susceptible to corruption because they have a powerful role at two levels of government,” said Christopher J. Christie, the former United States attorney who has indicted a parade of New Jersey officials and who is now the Republican candidate for governor.

Secrecy prevails, sometimes for lack of resources, shielding the graft.

“You can’t even get a copy of the municipal budget online in many of these towns,” said Ingrid W. Reed, the director of the New Jersey Project at the Eagleton Institute of Politics at Rutgers University. “That structure does not exist.”

In that environment, she said, ethics is often the first casualty.

These factors, of course, don’t completely explain any individual politician’s wrongdoing because, thankfully, not every official in New Jersey takes bribes. But thoughtful study suggests that they have an influence on the occurrence of serious misbehavior. There is always something inexplicable and mysterious about any very marked act of wickedness or virtue, but the way forward, I think, is to work on the assumption that human behavior can be explained scientifically. This doesn’t mean that “there is no such thing as good or evil”. Part of what it means is we can get a better understanding of the causes of good and evil, which will enable us to change their relative proportions. Like Harris, I would like to know that the Director of the National Institutes of Health, among others, shares these beliefs.

Postscript:
Here are the letters the Times published today (7/28/09) in response to Harris:

http://www.nytimes.com/2009/07/29/opinion/l29collins.html?ref=opinion

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Peter Singer on the Value of Life

Yesterday’s New York Times Magazine had an article by the eminent utilitarian philosopher Peter Singer with the provocative title, “Why We Must Ration Health Care”:

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?ref=magazine

It is partly a defense of the idea of a national health insurance program, but it also discusses the idea of ‘rationing’ health care. Singer is brave enough to endorse this, so long as it is carried out according to utilitarian principles. He carefully explains what these are, and the sense in which they put a price on a human life (and on states of affairs like being cured of quadriplegia). Singer is not only a brilliant and powerful thinker, he is one of our discipline’s most effective writers. I highly recommend his article.

The only point I’d add is this. Singer explains nicely how economists have developed a way to quantify the badness of having a certain condition (like quadriplegia)–which, of course, also measures the goodness of avoiding it or curing it.

Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that…One common method is to describe medical conditions to people—let’s say being a quadriplegic—and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money.

I have read one psychologist (Daniel Gilbert, in Stumbling on Happiness)) who mentions something that might give us some pause in utilizing this method. He refers to some research which shows that when people who do not have a certain condition (like quadriplegia) are asked to say how unhappy they would be if they did have it, they tend to give more negative answers than do the people who actually have it. In other words, non-quadriplegics tend to think that quadriplegia is worse than quadriplegics themselves do. (Gilbert uses this finding to support his general claim that people are not good in imagining how happy they will be in the future.) Perhaps if what Singer is proposing to do takes account of both perspectives then the values we arrive at will not be biased in the way that Gilbert warns us about. But, in any case, I find Singer to be very convincing when he argues that some such calculation needs to be a part of any morally defensible public health insurance program.

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“The More Who Die, the Less We Care”

Nicholas Kristof, The New York Times columnist who writes the most about issues of global poverty and disease, has a discussion today of some of the recent work by psychologists and philosophers about empathy and its limits.

http://www.nytimes.com/2009/07/09/opinion/09kristof.html

Kristof has done his homework, and he cites some of the most important thinkers in these fields. It is astonishing and dispiriting to read this:

…in one study, people donate generously to Rokia, a 7-year-old malnourished African girl. But when Rokia’s plight was explained as part of a larger context of hunger in Africa, people were much less willing to help.

Kristof comments:

Perhaps this is because, as some research suggests, people give in large part to feel good inside. That works best when you write a check and the problem is solved. If instead you’re reminded of larger problems that you can never solve, the feel-good rewards diminish.

I hope that people who give to causes that relieve hunger, for example, ‘feel good’ when they do so. But Kristof rightly notes that if this is the reason why they give to these causes, then we will get less famine relief than if they give for other reasons. I take Peter Singer, one of the important writers Kristof mentions, to be saying that a better reason to give is that this will relieve suffering. If you think about it that way, then the more suffering you help to relieve, the better your action—even if you haven’t relieved all the suffering that there is.

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Mortgages and “Homer Economicus”

I’ve blogged a few times now about the causes of the meltdown and some of the commentators on it that I’ve found to be helpful. (As a moral philosopher interested in character I’ve tended to concentrate on writers who have looked at the imprudence and irrational optimism that affected so many people.) A recent column by the economist Richard Thaler, of the University of Chicago, about these issues is worth reading.

http://www.nytimes.com/2009/07/05/business/economy/05view.html?_r=1&scp=1&sq=Thaler&st=cse

Thaler is one of the leading figures in ‘behavioral economics’, an important new field that he explains briefly. He takes it as a given that many people do not make financial decisions completely rationally. So we need, Thaler says, to think about the financial decision-making not of the mythical ‘homo economicus’ but of ‘Homer [Simpson] economicus’. He here discusses the recent proposal by the Obama administration to make mortgages more understandable and comparable. (His co-author Cass Sunstein, a member of the administration, presumably had a hand in this.)

As the administration plan describes it, lenders could be required to offer some mortgages they call “plain vanilla,” with uniform terms. There might be one vanilla 30-year, fixed-rate mortgage and one five-year, adjustable-rate mortgage. The features of these plain mortgages would be uniform, much as in a standard lease used in most rental agreements.

Lenders would also be free to offer other exotic mortgages–perhaps called “rocky road” mortgages?–along with the vanilla variety, but these offerings would receive more intense scrutiny from regulators.

Although the details of this dual ice-cream approach have not been fully specified, the concept has two main selling points.

First, inexperienced borrowers are steered toward the vanilla mortgages, the terms of which are chosen to be easy to understand. Vanilla mortgages would be the equivalent to the green runs at ski resorts that are intended for novices. The rocky-road mortgages would at least come with warning labels (“Don’t even think about going down this run unless you are an expert skier, or have a trusted professional instructor by your side”), and it is possible that for very exotic mortgages, borrowers might have to demonstrate that they understand the risks or have been aided by a certified mortgage planner.

Second, because the terms of the vanilla mortgages are all the same, they are more easily comparable; just as in the good old days, the A.P.R. will be a good basis for assessing the cost of the mortgage.

Here we see some nice thinking about how society can try to curb excessive risk-taking, and in that sense act ‘paternalistically’, without completely eliminating options for those who may have special expertise or needs. I wonder, though, how effective this sort of proposal can be if lenders or brokers have strong incentives to induce people to take out loans which are riskier, even if they are somehow so labeled.

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Ethics Curricula in Colleges and Universities

I recently ran across a good paper, written in 2005 and posted to the SSRN website: “A Survey of Ethics Courses in State College and University Curricula,” by Angela Hernquist. Her final question is one that students should be asking their professors and deans in every department and school on this campus: “If the manner in which ethics is incorporated into the undergraduate curriculum is a direct reflection of the goals and priorities of the institution, what constitutes a ‘well-educated’ student at your institution?” Hernquist poses some well-worn but still important questions about the choices available to faculties (stand-alone ethics electives vs. integrated ethics material, for example), and she does a nice job of surveying faculty teaching objectives and student learning objectives. After a semester that has seen some skepticism about the value of ethics instruction in higher education, the question her paper poses is just as pressing (and just as resistant to pat answers) as ever:


On a regular basis, we have seen the headlines in the news implicating governments, companies, and individuals for unethical conduct and it is apparent that ethics are an integral component of the challenges and opportunities that present themselves in everyday life. Certainly, higher education is not the only answer to the teaching of ethics. However, it seems only logical that a well-educated individual who successfully graduates from an institution of higher education should have developed and exercised some critical thinking and reasoning capabilities to deal with the complexities and issues involved with ethical dilemmas as part of their education and preparation for professional practice.

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