The Profit Motive: Not Always Good

 Posted by on 19 September 2014 at 10:00 am  Ethics, Government, Medicine
Sep 192014
 

This is a horrifying story: Cancer doc admits scam, giving patients unneeded chemo. This doctor gave unnecessary chemotherapy — basically, he poisoned his patients — for money. (The profit motive is usually a tremendous force for good… but not always.)

Here’s the bright spot in this morally bleak story — the nurse who turned him in as soon as she saw (in a job interview) him doing wrong:

Angela Swantek, a chemotherapy nurse who blew the whistle on Fata to state authorities in 2010, was in the courtroom during Fata’s guilty plea. She said she was relieved to hear him admit to things she witnessed years ago in his office. “I’m numb,” she said in a court hallway. “I’m not surprised though; I wondered how his team was going to defend him. The charts don’t lie.”

Swantek, 45, of Royal Oak, said she went to Fata’s office for a job interview in 2010 when she saw patients getting chemotherapy in a manner that wasn’t correct. “I left after an hour and half. I thought this is insane,” she said. That same day, Swantek went home and wrote a letter to the state and suggested they investigate him.

According to Swantek, the state did nothing and notified her in 2011 that they had found no wrongdoing. “I handed them Dr. Fata on a platter in 2010 and they did absolutely nothing,” said Swantek, noting she was elated when she learned the federal government charged Fata in 2013.

“I started crying,” she said. “I thought about all of the patients he took care of and harmed.”

Kudos to her for reporting him to the authorities, rather than just walking away. If only those authorities had done their job…

 

My latest Forbes column is now up: “UK To Experiment on Cardiac Arrest Patients Without Their Consent“.

Here is the opening:

Soon, thousands of UK cardiac arrest patients may find themselves enrolled in a major medical experiment, without their consent. This may be legal. But is it ethical?

As described by the Telegraph:

“Paramedics will give patients whose heart has stopped a dummy drug as part of an ‘ethically questionable’ study into whether adrenalin works in resuscitation or not… Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which. The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection…”

First, I want to emphasize that this is a legitimate scientific question. Adrenaline (also known as epinephrine) has been a standard part of the resuscitation protocol for sudden cardiac arrest, along with chest compressions and electrical shocks. (Think of paramedics shouting “clear” on television medical dramas.) But more recent evidence suggests that adrenaline might cause more harm than good in this situation, helping start the heart but possibly also causing some neurological damage. There is a valid and important scientific question. My concern is not over the science behind the experiment, but rather the ethics…

(For more details and discussion, read the full text of “UK To Experiment on Cardiac Arrest Patients Without Their Consent“.)

There are two parts of the study that disturb me the most: (1) The drug trial itself, and (2) the decision to not actively inform relatives that any patient who died had been an involuntary participant.  I cover both aspects in more detail in the piece.

Note: I’m not fully settled on what (if any) experimentation should be allowed on incapacitated patients in an emergency setting without informed consent.  But I do think this should be an issue of active discussion, especially for the people whose lives are on the line.

And for a discussion of prior US medical experiments that have been alleged to be unethical, non-consensual, or illegal, see this Wikipedia list.

 

Ruth Chang on Hard Choices

 Posted by on 27 August 2014 at 10:00 am  Epistemology, Ethics, Values
Aug 272014
 

On Sunday’s Philosophy in Action Radio, I’ll answer a question about Ruth Chang’s TED Talk on Hard Choices. The question is:

How can a person make better hard choices? How to make hard choices was the subject of a recent TED talk from philosopher Ruth Chang. Her thesis is that hard choices are not about finding the better option between alternatives. Choices are hard when there is no better option. Hard choices require you to define the kind of person you want to be. You have to take a stand for your choice, and then you can find reasons for being the kind of person who makes that choice. Her views really speak to me. In your view, what makes a choice hard? How should a person make hard choices?

Yesterday, I listened to the TED Talk, and I really like it! I’ll summarize the talk on Sunday’s episode, but I’d still recommend taking a listen in advance:

For Ruth Chang’s academic work, check out her selected publications.

Sexism in the Tech Community

 Posted by on 18 August 2014 at 10:00 am  Business, Ethics, Feminism, Technology
Aug 182014
 

This Is What Tech’s Ugly Gender Problem Really Looks Like”. Wow, ugly is the right word. In addition to the lech who scheduled a business meeting and turned it into an attempt to get into sexual lean-in, there’s the story of the woman who struggled to be taken seriously as a coder:

When you’re a single mother, says Sheri Atwood, founder of SupportPay, it’s even tougher to be taken seriously. The child of a divorce and coming out of a divorce herself, Atwood built SupportPay, an online platform to help divorced parents manage and share child support. But almost as soon as she began pitching investors in 2011, she faced a barrage of doubt as to whether she could handle a company and kids at the same time.

Atwood says that while their concern is legitimate, it’s also a bit backward. She believes it’s because she’s a single mother—not despite it—that she’s a safe bet for investors. “I’m not doing this as a side project. I don’t have a spouse supporting me. I’m putting everything on the line, and I’m responsible for a child,” she says. “I’m going to do everything possible to make that work.”

But being a single mother wasn’t Atwood’s only problem. She’s also a coder. With all the recent efforts from Google, Square, and other organizations to get young girls interested in coding, it’s hard to imagine Atwood’s ability to code was a drawback when she was trying to get funded. And yet, she says, when she told her investors she had built SupportPay herself, they repeatedly doubted her. “No one believed me,” Atwood says.

Once, an associate at a venture capital firm even gave Atwood a bit of advice after turning her down for funding. “Hire a young guy in a hoodie,” he said. “I laughed,” Atwood remembers. “Then I said: ‘That’s a great point, but the reason why there’s no solution on the market today is because this isn’t a 21-year-old-kid-in-a-hoodie problem.’”

Luckily for Atwood, after about nine months of getting questioned on everything from her ability to run a business as a single mom to her blonde hair—one investor claimed brunettes are taken more seriously—Atwood landed $1.1 million in funding from several top angel investors, including Draper Associates, Broadway Angels, and Marc Benioff. “They got it,” she says. “They saw that my being a woman and my age was an asset.”

There’s good news in the article too, no doubt. But here’s the way forward:

Minshew says it’s been “heartening” to see men in the tech community listen to women’s stories and begin to talk about the problem themselves. That, she says, may be the first step toward real change. “Years ago, you could say really horrible, racist things, and people who didn’t agree would stay quiet because that was the time we were in. Now, we’re in a time where someone says something horribly racist, and other people say: ‘Shit, I can’t believe you just said that,’” Minshew explains. “My hope is we’re moving toward a world in which if one partner at a VC firm knows another partner is behaving inappropriately with female entrepreneurs, it’ll be the same sort of shock and outrage. It’ll be unacceptable.

People, that’s up to you!

Parenting by Belay

 Posted by on 18 July 2014 at 10:00 am  Children, Ethics, Etiquette, Parenting
Jul 182014
 

This is a good explanation of the principles of “positive discipline” parenting from The Libertarian Homeschooler:

On Belay

Do you punish your sons?
No.

How do they learn?
I let them experience the consequences of their actions.

Isn’t that the same thing?
No. In one instance, I’m meting it out. In the other, I’m not.

What does that look like?
I say, “This will end badly.” When they were little I would say, “That will hurt you.” They either stop and wait for help or it ends badly or it hurts them.

Does that work?
You bet it does.

What if they’re headed for catastrophic injury?
I step in, just as I would for anyone else. I am on belay but the climb is theirs.

When they were little didn’t you spend a lot of time running after them since they weren’t trained?
We baby proofed so they could explore in relative safety. They still banged into things and got hurt.

Did they pay attention to what you told them?
They figured it out pretty quickly. When I said, “That will hurt you,” pain was coming. But pain wasn’t associated with me. Consequences would still happen even if I wasn’t there. That’s key. I do not cause consequences. Even if I’m not here, there are consequences. A lot of children clearly don’t understand that and they behave differently when their parents aren’t looking.

Were both boys the same?
YS needs to learn from experience. Sometimes more than once. BA will hang back and avoid pain and injury.

Did you ever administer and emotionally or physically painful consequence instead of letting nature take its course?
Yes.

How did that go?
Poorly.

What do you mean it went poorly?
It put emotional distance between me and my child. I broke trust with him. Administering calm, collected punishments made him disdainful. He saw it as a control issue.

So you would not do it again?
If I could undo it, I would. It was an expensive lesson for me in terms of my son’s respect. He has little patience for someone who will encroach upon him or will try to control him and it is his nature to remember long.

What caused the most strife in your home when your children were little?
Parental failure. Lack of self discipline on my part.

What do you attribute that to?
Perfectionism. Impatience. Pride. Fear. Exhaustion. Boundary issues.

Do your children have those flaws?
There are family characteristics. My parents had them. They modeled them for me. I’m changing things and our sons will change things more. They share good qualities as well. We’ll keep those.

What’s an example of a parental fail?
Getting angry because they weren’t doing an adult thing. At three.

You did that?
I still do, sometimes.

Can’t you get that under control?
I do what I can. I own the mistakes I make. That’s the best I can do.

Do you think your children ever did anything wrong?
They were being children. They were learning. Being a child isn’t wrong. It is wrong to expect a child to behave like an adult and then label it bad behavior.

Do they pay attention to what you say now?
The less counsel you give, the more they want it. They pay more attention all the time.

Does it bother you when they ignore your advice and make mistakes?
We’re separate people. They make their own decisions. That’s healthy. I’m glad they can disagree with me. I want them to be able to say no. This is good.

Do you ever freak out?
Yes.

How does that work?
Badly. I lose their respect. That’s a consequence of my actions.

Do you freak out often?
Less all the time.

Because they’re growing up?
Because I’m growing up. Children do that to a person.

What if they’re disrespectful?
They lose my good will. That’s a consequence of their actions.

Who is in control in your house?
I’m in control of myself. They’re in control of themselves.

What would you say is your bottom line on relationship with your children?
I am me. You are you. We are individuals. I will love you. I will defend you. I will provide for you. If you like, I will advise you. I will acknowledge your decisions are yours and I will not take credit or blame for them.

Is it really that simple?
Yes.

Is it easy to do?
Eventually.

Is it hard to get here?
I’m barely here, myself. But it’s worth it.

Positive discipline rejects punishments and rewards. Instead, children are taught by natural consequences, setting limits, and more — while restraining them as necessary to keep themselves and others safe. I know a number of kids parented by this method, and they’re not perfect (no child is) but they’re all remarkably reasonable, polite, and easy to live with.

If you want to know more, I interviewed Jenn Casey and Kelly Elmore on this very topic on the 27 June 2012 episode of Philosophy in Action Radio. If you’ve not yet heard it, you can listen to or download the podcast here:

For more details, check out the episode’s archive page.

Apr 082014
 

Jason Crawford gives an excellent answer to the question: What can non-Objectivists and doubters learn from the works of Ayn Rand? I like these two points most of all:

If you feel burdened by unchosen obligations to your family, your friends, your community, or the world at large, Rand will help you see that the guilt you feel is unearned and that your own happiness is the moral purpose of your life.

If you feel like a chump for being honest and fair to others, if you feel that morality is impractical and that being unscrupulous is the only way to get ahead—Rand will show you that honesty, integrity and justice are in your own rational self-interest, and that a rational person seeks only win-win relationships with others.

Objectivism’s ethics of rational egoism makes possible win-win relationships with others — rather than playing the martyr or predating. That shouldn’t be so revolutionary in ethics, but it is.

Go read the whole thing!

Apr 032014
 

I was pretty well-amused by this funny column: 10 Things to Never Say to Women Who Don’t Want Kids. Here’s the one that I’ve heard most often:

7. “You’ll change your mind.”

Maybe I will change my mind about having kids, but I’ll never change my mind about you being tacky as hell. If you find yourself about to say this to a childless woman, please punch yourself in the face and then go home and watch Gigli five times as punishment.

It’s wildly rude to second-guess people’s life-choices in this way… and just imagine the uproar if childless people said that — or worse: “you’ll regret that someday” — to people with kids.

Here’s my basic perspective on the decision to have kids or not:

Because Paul and I chose not to have kids, I’ve been able to do tons of awesome things that wouldn’t be possible with kids, including graduate school, my career, and riding horses seriously. However… if we’d had kids, I’d be doing tons of different but still awesome things that are only possible with kids, like homeschooling or teaching my kids to ride horses.

“Should we have kids or not?” is major fork in the road of life. You might have a strong preference one way or the other, but please, recognize that not everyone feels the same way — and that life offers all kinds of fabulous joys, whichever path a person takes!

How Not to Advise a Disgruntled Teenager

 Posted by on 25 March 2014 at 2:00 pm  Ethics, Law, Parenting
Mar 252014
 

You remember that story of the teenager who sued her parents for support? Happily, the lawsuit was recently withdrawn, and she’s back at home. But here’s the kicker… her lawsuit was facilitated — and surely encouraged — by the father of a friend of hers.

“Canning had been living in Rockaway Township with the family of her best friend. The friend’s father, former Morris County Freeholder John Inglesino, was paying for the lawsuit.”

This father-of-a-friend deserves a bitchslap or two, particularly given that the girl has become such a public spectacle. What a mess.

Moral Saints

 Posted by on 12 February 2014 at 9:00 am  Ethics, Philosophy
Feb 122014
 

On Thursday evening’s Philosophy in Action Radio, I’ll discuss one of my favorite articles in academic philosophy, namely Susan Wolf’s “Moral Saints.” I disagree with major elements of the article — as I’ll explain on the show — yet it’s a masterful dissection of the practical meaning of being a consistent practitioner of Kantian ethics or utilitarian ethics. (That’s what is meant by a “moral saint.”)

The article begins:

I don’t know whether there are any moral saints. But if there are, I am glad that neither I nor those about whom I care most are among them. By moral saint I mean a person whose every action is as morally good as possible, a person, that is, who is as morally worthy as can be. Though I shall in a moment acknowledge the variety of types of person that might be thought to satisfy this description, it seems to me that none of these types serve as unequivocally compelling personal ideals. In other words, I believe that moral perfection, in the sense of moral saintliness, does not constitute a model of personal well-being toward which it would he particularly rational or good or desirable for a human being to strive.

Outside the context of moral discussion, this will strike many as an obvious point. But, within that context, the point, if it be granted, will be granted with some discomfort. For within that context it is generally assumed that one ought to be as morally good as possible and that what limits there are to morality’s hold on us are set by features of human nature of which we ought not to be proud. If, as I believe, the ideals that are derivable from common sense and philosophically popular moral theories do not support these assumptions, then something has to change. Either we must change our moral theories in ways that will make them yield more palatable ideals, or, as I shall argue, we must change our conception of what is involved in affirming a moral theory.

In this paper, I wish to examine the notion of a moral saint, first, to understand what a moral saint would be like and why such a being would be unattractive, and, second, to raise some questions about the significance of this paradoxical figure in moral philosophy. I shall look first at the model(s) of moral sainthood that might be extrapolated from the morality or moralities of common sense. The I shall consider what relations these have to conclusions that can be drawn from utilitarian and Kantian moral theories. Finally, I shall speculate on the implications of the considerations for moral philosophy.

If you’d like to read the article in advance — and I think you’ll get more out of my discussion if you do — you’ll find the PDF here: “Moral Saints” by Susan Wolf.

Acting Badly Does Not Equal Being Bad Person

 Posted by on 21 January 2014 at 10:00 am  Character, Ethics, Justice
Jan 212014
 

Too often, when I say something like, “Mr. X acted unjustly toward Ms. Y” or “Mr. X, I think that you were not honest with Ms. Y,” the reaction of Mr. X (and defenders of Mr. X) is something like , “SO YOU THINK THAT MR. X IS AN UNJUST PERSON!” or “HOW DARE YOU CALL ME A LIAR!” (Yes, they’re often angry and yelling.)

Alas, such inferences are wholly unwarranted. The simple fact is that a person might act wrongly — even perhaps violating the basic demands of a virtue — without being a terrible or corrupt or vicious person. Perhaps the person acted in haste, without sufficient forethought. Perhaps the person acted on a mistaken principle. Perhaps the person didn’t see the full effects or implications of his actions. Perhaps the person misunderstands the proper application of the principle. Perhaps the person was ignorant of certain facts about the situation. Perhaps the person thought the principle didn’t apply in that case. And so on.

Basically, a person can act wrongly — meaning, in a way harmful to self or others — without intending to do so. A person might act contrary to a virtue, yet do so honestly.

That’s part of why moral judgments of persons for their actions need to be distinguished from moral judgments of persons for their characters. These are two different kinds of judgments, and they serve two distinct purposes. (That’s a critical point for my case against moral luck.) Of course, these two kinds of judgments are related: judgments of actions are the basis for judgments of character. Nonetheless, a single bad action does not a bad character make — just as a single good action does not a good character make.

Aristotle makes a similar point in Book 5, Chapter 8 of the The Nicomachean Ethics. (Note that to act by “choice” means that the person deliberates beforehand about his best course of action.)

When [a man] acts with knowledge but not after deliberation, it is an act of injustice — e.g. the acts due to anger or to other passions necessary or natural to man; for when men do such harmful and mistaken acts they act unjustly, and the acts are acts of injustice, but this does not imply that the doers are unjust or wicked; for the injury is not due to vice. But when a man acts from choice, he is an unjust man and a vicious man.

Now, I make more allowances than Aristotle does here. Deliberation can go awry for many reasons, even in good people. Still, I agree with Aristotle that a person’s chosen actions reveal his character more clearly than do his hasty, impulsive, or rote actions. Often, when a person deliberates, he ought to know better, and he ought to have acted differently.

As for the people who assume that any moral criticism means an accusation of vice… well, that kind of defensiveness suggests that they damn well intended to do what they did — or, in any case, they’re sure as heck not going to admit that they were wrong. I’d consider that a major red flag in a person.

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