In today's gorgeous weather, I biked to work in a t-shirt. Outside, the students came out of hibernation, sporting sandals and shades, lounging on the grass, frolicking and flirting.
Then (of course) the wind picked up. A few drops fell from the sky.
They ran hard, in mobs, the girls clutching the bottoms of their skirts.
I gave blood on Friday. In fact, I've been giving blood regularly since 2003. Every time I donate, I have to check the "I have not have sex with other men since 1977" box.
"I don't like that question," I told the Red Cross worker.
"I know, I don't like it either," he said uncomfortably. He was a young guy with a full beard and a lip ring. I felt sorry for making him sit through my badgering.
"I just feel like I need to register my complaint," I said. "I don't have many options."
It feels sometimes like I'm riding the "whites only" buses - except that buses, unlike blood donations, don't save lives. A boycott is generally the right idea when businesses discriminate against gays. But if we were to launch such a campaign, patients would suffer. So even though I hate checking off that box, I don't know what else to do. Meanwhile, the Red Cross itself diverts responsibility by saying that it just follows the FDA's rule on the matter. Some gay friends of mine won't give blood as a way of protesting the FDA rule, but I don't see how that helps anybody. You can't protest by NOT donating blood that the FDA doesn't want anyway. Someone might say that the FDA might change its policy if a large number of people began boycotting. In fact, a potential decision of Santa Cruz schools might point that way. But while people were boycotting blood drives, how many people will die for lack of transfusable blood? So boycotting is out of the question.
The FDA prohibits men who have had sex with men - even once - since 1977 from donating because: "Studies have shown that men with a history of male to male sex since 1977 may be infected with HIV and/or may have evidence of a lifestyle that potentially exposes them to HIV." Follow the link for more information on the FDA's self-described "conservative" approach.
I searched the medical literature and found a 2003 study (Transfusion 43(1)) that endorses the FDA's screening criteria. The study computed the likely outcome if the FDA changed its rule to only bar men who've had gay sex in the last 12 months. The number of donations would increase by only 1.3 percent, while the number of HIV-contaminated units would increase by 8 percent, from 1 in 150,000 to 1 in 136,000 donations. (By the way, U.S. stats are rather poor compared to Canada, but not when compared to Zambia or other developing countries.) The authors of the study conclude that the gain is not worth the risk. When I discovered this study, my heart sank. It was a lot easier to criticize the FDA when its rule wasn't backed up by reputable evidence.
I'm obviously glad that the FDA takes precautions. A screening process is necessary because just testing the blood is not a fail-proof way of eliminating the HIV risk. But I'm not pleased that we can't be more creative in designing the screening process. The need for blood is expanding as more and more patients require C-sections, organ transplants, joint replacements, and other operations. Donated blood lasts just 42 days, so the nation's blood supply must be constantly replenished - and shortages are very possible. It seems to me that the FDA could safely expand its donor pool by asking people who would otherwise be excluded to present a recent negative HIV test. Or perhaps the FDA could admit men who haven't had gay sex in ten years, instead of thirty, or men in monogamous relationships. The current policy just seems ridiculous. If you acquired HIV in 1977, you'd know it by now. Since no one wants to end up in an ICU without blood, reforming the policy seems like something everyone should favor. Even a homophobe who won't shake hands with a gay person would probably take "gay blood" if the alternative were death.
A question: Suppose for the sake of argument that you (a man) had sex with another man. From repeated testing, you know for certain that you don't have HIV. Should you lie (and perjure yourself) to donate? Lying is generally wrong, but is it worse than withholding blood?
From the UK Independent: Abortion Crisis as Doctors Refuse to Perform Surgery (April 16, 2007)
"Britain is facing an abortion crisis because an unprecedented number of doctors are refusing to be involved in carrying out the procedure. The exodus of doctors prepared to perform the task is a nationwide phenomenon that threatens to plunge the abortion service into chaos, the Royal College of Obstetricians and Gynaecologists (RCOG) has warned."Distressing news. I'm not entirely sure what to do when health care "providers" refuse to provide. For now, I'll make an ethics-related point: I think this case reveals the inadequacy of rights-based moral thinking with respect to abortion. Many people recognize a human "right" to health that includes a women's "right" to an abortion. The Supreme Court decision on Roe v. Wade turns on a "right" to privacy. In bioethics, personal "rights" continue to dominate the moral framework; in global health and development, "human rights" has been established as the prevailing moral discourse. Yet rights-based theories fail to resolve conflicts of rights - when a women's right to choose counters a doctor's right to say: "Here I stand. I can do no other."
Are these news round-ups helpful? On one hand, I think that blogging is a more refined art than simply regurgitating the news with pithy commentary – fun as that may be. On the other hand, I'm often overwhelmed by the news and these collections help me reflect. Also, before I started bookmarking these articles, I hadn’t realized how much I was actually reading about heath, human rights, and international development. So in an implicit way, these round-ups don’t just disseminate news, but help identify life projects. If you find them a bore, though, let me know.
The “global health” theme is indicative of a recent shift for me. I spent my undergraduate years studying philosophy and ethics. I don't regret it, not even the long 18th century treatises, but I’ve found that the ethics of the most pressing global issues have already been addressed. No one debates whether nuclear war is just. Same thing with health inequalities. With this realization, my academic concerns have become activist ones as well. I decided that if I care about rights, responsibilities, duties, and obligations – the familiar jargon of the philosophy seminar room - then I had to learn more about public health, humanitarian aid, and the global economy.
So, without further ado… and in no particular order.
Human rights are under siege in Burma. Daring reporting from the Guardian explains how the Burmese regime has thwarted political activism, shut down the free press, and expelled the Red Cross. It continues to terrorize village groups with forced labor and gang rape. Perhaps the UN could do something about it – if only Russia, which supplies arms to and buys oils from the Burmese regime, hadn’t voted to keep the situation in Burma off the Security Council agenda.
People subsisting in refugee camps in northern Thailand have no birth certificates, no citizenship, no schooling, no health care, no property, and no recourse to a better life.
War, unsurprisingly, is bad for health, and Palestine – with the regular bloodshed and economic deprivation from the intifada – is no exception. Meanwhile, the Western suspension of aid to the Hamas-led Palestinian government has hurt everyday Palestinians. It doesn’t help that 60% of Gaza’s 1.5 million people are under the age of eighteen. That makes me quite angry, actually.
A new report from the Intergovernmental Panel on Climate Change shows that climate change will severely and negatively impact poor countries – that is, the people least responsible for it. I’ve written before about the ethics of global warming. Not only do the rich have the duty to aid those who will suffer, but far more importantly in this case, we have a duty not to harm.
The African Union hopes to produce its own medicines and reduce its reliance on the West.
The life expectancy in Zimbabwe has fallen from 60 in 1990 to 34 (for women) today.
In neighboring Zambia, rations provided the United Nations World Food Program may soon run out. Even though there is ample corn stored in Lusaka, U.S. regulations stipulate that the food it donates be grown and shipped from America. For that, we can thank American “agribusiness” and its powerful lobby on Capitol Hill. Bucking the trend, the Bush Administration has proposed that a quarter of the donated food originate in developing counties. Doing so would not only help generate business in these countries, but “could annually feed at least a million more people for six months and save 50,000 more lives,” according to USAID (NYT). For all the trouble in the world, it’s heartening to see Oxfam supporting a Bush Administration proposal.
President Bush may have allocated $15 billion to fight AIDS globally, but his administration and Congress have imposed absurd limitations on the distribution of those funds. They require that AIDS drugs already approved by the WHO be re-approved by the FDA, that a third of all prevention money be spent on abstinence education (which doesn’t work anyway), and that no money go toward supplying drug addicts with clean needles. These restrictions are sometimes called “earmarks or budget allocations”; bioethicist Ruth Macklin calls them “shackles.”
Intro
Tracy Kidder’s Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World shook me like few books do. Kidder, a Pulitzer Prize-winning journalist, follows Farmer through his daily routine, from Haiti to Peru to Paris to Russia to Boston, while telling the story of Farmer’s childhood, his first love, his medical school years, his years a maverick at the World Health Organization, and later as a leader. As a person, doctor, advocate, and reformer, Dr. Paul Farmer is utterly captivating – in short, he’s a mensch, but not the kind of mensch you'd want to marry.
We meet Paul at a young age and watch him grow through his various nicknames, P.J., Pel, Dokte, and so on. The central concepts in Farmer’s life also have nicknames, and I spent the week after I read Mountains Beyond Mountains talking in PIH-speak (the lingo of the organization he co-founded, Partners in Health). Having an “H of G” (a hermeneutic of generosity) means interpreting people’s intentions in a favorable light (215); “Love, ID” (infectious disease) is a shorthand response to the rather complacent TBMIs, the transnational bureaucrats managing inequality (216);“the poor” and if not that, “the soon dead” is Farmer’s preferred term for the world’s destitute populations (100); WLs (white liberals) are people who moralize that “things aren’t that black and white” as a way of obscuring AMCs (areas of moral clarity) which, if fully recognized, would compel these WLs to radically alter their lavish lifestyles (101).
I've been that “white liberal.” It's the person content to have the right ideas without necessarily the right actions; the person more enamored by the idea of justice than the work of justice. I am, I admit, more enthused by philosophical discussions of “human rights” than by the logistics of providing the “[c]lean water and health care and school and food and tin roofs and cement floors” that Farmer takes as a “set of basics that people must have as birthrights” (91). In the spirit of academia, I have learned to “problematize” the world but not to fix it – as if the life expectancy in Haiti (53 for men, 56 for women) were merely a moral conundrum and not, firstly, a moral outrage.
Between sitting in the dirt with his patients, lobbying at the WHO, working to lower prices for TB drugs, and shuttling from Boston to Haiti to Moscow to Peru to Paris, Farmer somehow manages to write academic works that are regularly reviewed in major medical journals. Between site visits, he gives presentations like the 2005 Tanner Lectures (PDF) at the University of Utah. I heard a version of that lecture when he spoke at Brown in 2006. Even though he arrived two hours late, six hundred students sat in a six hundred seat auditorium and waited. I did too.
I appreciate Farmer’s stance toward academia. He not only educates, but agitates as well. As a result, he succeeds as an academic where many others have fallen short. He sees academia not as a vain pursuit to enhance knowledge for its own sake, but as a forum for activism, for developing a plan to improve people’s lives. Indeed, one should always approach academia with caution, lest one succumb to its potential faults: “the arrogance, the petty infighting, the dishonesty, the desire for self-promotion, the orthodoxy” (195). As an aspiring academic (sometimes), I take that message to heart.
Mountains Beyond Mountains has its imperfections, minor as they are. The eccentricities of Farmer’s childhood are a bit overblown. It’s true that most people don’t grow up on a boat – too poor to afford a real house – but most have equally good stories to tell. Also, in some of Kidder’s exchanges with Farmer, I got the sense that Farmer was performing, i.e., that he was working too hard to shape a persona. Now there’s nothing terribly wrong with that. Malcolm X dictated his whole autobiography that way. But it sometimes compromised the aura of unrehearsed spontaneity that made this book so much fun to read. Take, for example, when Farmer tells Kidder: “I’m not truly humble. I’m trying to be humble” (289). But these are faults with the book, not with Farmer.
Can I find faults with Farmer? Before answering that question, I should ask why I even asked it. In reading this book, I felt as Ophelia Dahl – Farmer’s early love and now the long-time executive director of Partners in Health – did when this young man she just met seemed to do everything to perfection. Once in Haiti with young Paul, she set her alarm clock for five to beat out her companion. But she woke to the sound of his voice anyway. “I just want to do something better than him,” she thought. “For a moment.” I felt similarly sometimes. As a result, I am perhaps exceedingly eager to find faults with this giant, critiquing his work with moral scrutiny he doesn’t deserve. The question, I realized, was not: “Does Farmer have faults?” but rather, “Can I find any?”
I recognize that’s unfair. And I recognize that I’m just some joe with a blog and a dubious claim to moral authority. So you will have to take my comments accordingly.
Inequality
I was uncomfortable with his Robin Hood mentality; that is, the ease with which he can take from the rich to give to poor. When Farmer began to equip the laboratory of Cange’s clinic, he consulted a booklet from the World Health Organization that offered tips for planners working from modest resources. It recommended, for instance, that planners use a homemade solar-powered microscope to cut costs. Farmer tossed out the booklet. Kidder writes: “The first microscope in Cange was a real one, which he stole from Harvard Medical School. ‘Redistributive justice,’ he’d later say. ‘We were just helping them not go to hell’” (90).
I feel uncomfortable with it, but “uncomfortable” in the sense of choosing between evils. I suspect, though without terrific evidence right now, that first-world affluence is in large part responsible for the continued impoverishment of the third world, in ways often unacknowledged because the causality is indirect and mitigated by geography. There is a third world because there’s a first world. So when Farmer steals, it’s possible to construe this theft as some sort of “just redistribution,” even though the people of Haiti never owned that microscope in the first place. I also recognize that part of Farmer’s appeal – part of his heroism, even – is his willingness to f*ck the system. It’s a system both complicit and complacent in acting like poor people dying at middle age were a normal occurrence. To the extent that Farmer’s Robin Hood mentality makes us reconsider the legitimacy of the current world order, it becomes less blameworthy.
To put it another way, it’s still wrong for the food bank to steal your car.
To a Robin Hood, one reason why it’s acceptable to steal from the rich to give to the poor is because the poor gain more from the theft than the rich lose by the loss. So the theft increases overall well-being, even if some people are less happy as a result. I can’t help but think that Paul Farmer is in part motivated by this rationale: the observation that so much good can be done at little cost to the rich. Kidder writes upon their arrival in Paris: “As we entered the city proper, the great dove-colored epicurean city, he murmured something about how much could be done in Haiti if only he could get his hands on the money that the first world spent on pet grooming” (210).
Now, in brief sketch (with apologies), there are two major positions in ethics. Deontologists value principles above all, while utilitarians seek to maximize over well-being, even at the expense of individual freedoms and luxuries. Deontologists tend to fault utilitarians for failing to respect differences between people; utilitarians tend to fault deontologists for obscuring issues of fairness. In truth, we’re all both deontologists and utilitarians. I believe, for example, that what’s mine is mine, what’s yours is yours, and that people are entitled to spend their money however they choose. At the same time, though, I believe there’s something wrong with being very well-off when others are dirt-poor. Or put another way: There is something wrong (though it’s not clear what) with spending five dollars on a beer while another person dies for lack of a five-dollar bed-net.
Paul Farmer doesn’t deeply differentiate between persons. Anyone’s suffering is his suffering, and in fact, the suffering of us all. That’s a virtue, I think, especially in inspiring his donors to fund start-up medical clinics in the poorest areas of the world. His care for others is contagious. Nor does Farmer differentiate between persons with respect to himself. He returned to work shortly after coming down with a near-fatal case of Hepatitis A. He told Tracy Kidder, “The problem is, if I don’t work this hard, someone will die who doesn’t have to. That sounds megalomaniacal. I wouldn’t have said that to you before I’d taken you to Haiti and you had seen that it was manifestly true” (191). If Farmer had some superpower ability to restructure the world, he would divert the wealth of the affluent to those who need it to survive. He’d do it, I think, even if it made people in the first world worse off. I wonder how far he’d go, and I wonder how far I’d go.
At the beginning of this post, I called Farmer a mensch but not the kind of mensch you’d want you to marry. His devotion to improving the health prospects of the world’s poor means that he rarely sleeps and that he sees his wife and daughter every few months for a day (or at least that’s the sense I get from the book). Patients before family. Most people would carve out a larger space for family. It’s obvious that personal relationships pose special obligations that sometimes conflict with principles of impartiality and fairness. So I visit my friends when they are sick, but don’t visit people I don’t know. Though I donate to humanitarian relief, I probably spend more money visiting friends. It may be selfish, but I think I’d want to see my spouse more than once every few months.
I don’t mean to imply that Farmer is somehow acting wrongly in his personal life. I only want to note that Farmer has a different conception of his personal commitments than many other people have of their own. There is room for pluralism here, I think. In any case, the question of “love versus justice” has been hotly debated in the feminist literature under the code word, “the ethics of care.” Any person who starts a family will face these questions someday.
Incision
An incision is a surgical cut to reach the underlying cause of injury or disease. I use it here to signify a theoretical cut through surface level explanations for why the poor bear the bulk of the global burden of disease. A person who dies of cholera, typhoid fever, or dysentery hasn’t really died of the illness itself, but of shoddy municipal water systems that transmit waterborne bacterial diseases. Though a doctor, Farmer echoes my sense that economic well-being is the best medicine. He pays homage to the social determinants of health, maintaining that “the great burdens of disease in Cange were just a symptom of a general deprivation” (Kidder’s words, 91).
At a meeting of the World Health Organization where Partners in Health (PIH) was lobbying for resources to treat multidrug resistrant tuberculosis, many skeptics said that the funds simply didn’t exist. One PIH-er responded, “I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way” (162). PIH-ers see the public health mantra – that “resources are limited” – as a clever way of absolving oneself of responsibility for the poor. In Farmer’s view, it was uttered “without any recognition of how, in a given place, resources had come to be limited, as if God had imposed poverty on places like Haiti” (Kidder’s words, 175). Farmer’s broader view of poverty investigates why resources were limited – not just to work within the constraints, but to work to remove the constraints themselves.
Improving the social context is pivotal to public health, so I'm glad Farmer draws attention to dollars and cents and other less sexy aspects of health care like nutrition and access. If health care workers are really going to be the “natural attorneys of the poor,” as Farmer believes, they will have to learn not only to cure disease but also to prevent it. Prevention has never been the glory of medicine, but preventative efforts will have to expand in developing countries. Doctors will play an important part, I think, but development workers and public health officials – people without M.D.’s stamped after their names – will make equally great and perhaps greater contributions. For those of us with no health care skills and no plan to acquire them (i.e., me), pay attention.
Inadequacy
It is a feature of hero-ness that we expect things from heroes that we don’t expect from ourselves. That is, after all, why they are heroes: because they go “above and beyond.” We expect even more when they adjure us to reform our lifestyles. Responding to Peter Singer’s admonition to live cheaply and give the rest to the needy, many of my classmates found reason to attack Singer himself, ad hominem. “I bet he doesn’t live in a shack,” one of my classmates snarled. The same thing happens with Farmer. Kidder writes that “at some point … I realized that I’d become inclined to hold Farmer to a higher standard than I did most people, including myself” (153). Yet Farmer seems quite capable of meeting our expectations: he does live in a shack, if he lives anywhere at all.
Farmer tells Kidder: “‘When others write about people who live on the edge, who challenge their comfortable lives – and it has happened to me – they usually do it in a way that allows a reader a way out. You could render generosity into pathology, commitment into obsession. That’s all in the repertory of someone who wants to put the reader at ease rather than conveying the truth in a compelling manner’” (207).
I did want Farmer to leave me “a way out,” some assertion like, “Yeah, I’m really insane; no reasonable person would do this kind of work.” Of course that never comes. I doubt I was the only person to finish this book feeling terribly inadequate. Kidder quotes Farmer’s friend and PIH-cofounder Jim Yong Kim as saying, “Paul has a gift for making people feel guilty” (212). Farmer’s activities, from tending at the bedsides of patients to seeing them in prison to lobbying at the WHO, produced a jealousy in me that I hadn’t felt since my interactions with the rare peacemakers in Israel/Palestine who could converse fluently in both Arabic and Hebrew. It angered me because it requires skills I will never acquire and made me a coward by comparison.
On reflection though, my jealousy fizzled. Jealousy focuses on the self, as if improving my own well-being were the purpose of my volunteer work. Jealousy’s not one of the seven deadly sins for nothing. Yet jealousy, with its many vices, also has a certain usefulness: to the extent it overlaps with self-interest, it can inspire social action. I started volunteering in the prison system mostly to fight the injustice of “criminal justice,” but also out of curiosity. Curiosity is obviously different from jealousy, but self-interest is evident in both. Social activists, after all, are people, too.
I can imagine telling my grandchildren years from now that it was at this point in my life, after reading books on injustice, including Kidder’s book, that I decided I would lead a life whose luxuries wouldn’t drive me insane. Farmer, too, seems to have felt a similar motivation. Kidder notes that Farmer’s fanaticism (that’s my word) “freed him from the efforts that many people make to find refuge and distinction from their pasts, and from the mass of their fellow human beings” (219). We say, genuinely I think, that our primary purpose is to improve the lives of others. But another purpose, ancillary and usually hidden, is to avoid the “uneasiness that some of the fortunate feel about their place in the world.” Farmer isn’t so superhuman as to transcend it. Kidder says it’s “the thing he once told me he designed his life to avoid” (Kidder’s words, 295).
Inspiration
Certain images from the book stay with me: A young Farmer diving through bullets to take wounded Haitians to the hospital, popping up from Haiti just in time for his med school exams in Boston, crying when a patient miscarries, sitting on a patient’s bed at Brigham’s, carrying bundles of gifts through the Miami airport, writing AIDS and Accusation from a rocky Haitian hilltop. I imagine it sometimes like the hilltop in Be’er Sheva that I used to climb at twilight: a place to reflect on the city, away from the city. These are images of work, yet they return at night. They are images of a man, yet they exemplify an idea.
I wasn’t as inspired as the book cover said I’d be, but Mountains Beyond Mountains affected me in a different way. I’d say that I am more agitated than inspired. I am agitated by questions about our obligations to far-away others - people dying of diseases I’ve never heard of. I am frustrated because I want to help but I’m not sure how. I am anxious about conveniently blurring their interests – whatever those may be – with my own. So for now, I'm going to do the one thing I know best: read more. I purchased Farmer’s most recent book, Pathologies of Power: Health, Human Rights, and the New War on the Poor. Perhaps I should have bought Infections and Inequalities, a book Farmer published in 1999, when he wasn’t receiving hundreds of emails a day. He may have had more time to invest in book-writing then – though something tells me: no, probably not.
Today's Washington Post has a story about the annual White House Easter Egg Roll ("Kids Go on White House Easter Egg Hunt"). I wasn't expecting to find anything to marvel at (don't ask why I was reading the article), but I was pleasantly surprised.
The reporter noted:
"Across from the White House, meanwhile, a handful of activists at Lafayette Park hunted for brightly colored tennis balls in an alternative 'Easter cluster bomb hunt,' intended to dramatize the fact that many areas of the globe, such as South Lebanon, are not safe for children because of persistent fighting and unexploded munitions."Well done, unidentified activists.
Borrowed from Catholic liberation theology and developed most recently by Paul Farmer, a "preferential option for the poor" says that we owe special consideration to the voiceless and powerless, or in the words of the Bible, to the widow and orphan. The idea is frequently cited and rarely denied. Why then, I wonder, does it have so little actual currency? Can it so easily become pious verbiage repeated on Church mornings and "social action days" but otherwise ignored?
Maybe the rich don't see the poor from their perch of affluence. That's certainly part of it. The poor are rendered invisible by social and geographic distance, their dire situation compounded by lack of political clout. But that doesn't explain the inaction of the many people - the "white liberals" of the American middle class - who do know, however suppressed the information may be - about the pitiful life prospects of the global poor, or even the poor in adjacent neighborhoods. So if it's not the invisibility of the poor that obstructs their social mobility and health access, then what is it?
It's a policy objection, at least at first. It begins by saying that the health care pie is only so big, so those who may deserve access sometimes have to do without. Why? Because in times of scarcity, there is no "right" to health care. And yes, that's true: No one has an immediate right to something that is scarce. Then, they say, it's not morally wrong to deny people something which they were never owed in the first place. Without a right to health care, there's no responsibility to provide it. In such situations, the needy must use their own resources to achieve their goals. The upshot of the argument, then, is that the idea of a "preferential option" disintegrates in a free market system. Thus "white liberals" can bemoan the situation of the poor but feel no duty to ameliorate it.
The response to this clever footwork, while historically complex, is morally straightforward. With an eye to the history of development, it examines the evolution of the current world order. It assesses the effects of our economic exploitation and colonization of the "third world" - both in the present day and in centuries past. With this broader perspective in mind, the moral basis for the preferential option is much stronger. Now, when "rights" fail us, responsibilities won't. I know this assertion breaks somewhat with the rights-based discourse of the day, but I don't think it makes sense to subsume the question of "the good" - be it health or happiness or something else - into a framework of "human rights." To promote a preferential option for the poor - even when resources are few - we must see their need not as a matter of rights, but as a matter of justice.
As a cyclist, I often debate whether to obey traffic laws. When I am alone at a stoplight without a vehicle in sight, or worse, when it's raining and cold as it often is in upstate NY, I usually ride through. Yet biking through red lights undermines my claim to be a law-abiding citizen.
Then there are one-way streets. When I'm running late to work, I sometimes bike the wrong way on the one-way street leading to my office. The alternative is a busy three-street detour. Today, as I came breezing down (or up) the one-way street at 7:58 AM - just barely on time - I saw the boss, the agile and jocular director of my bioethics center, parking her car - and she saw me.
Later, in the office, we discuss:
"I usually obey traffic signs," I tell her, "but not if I'm running late, or alone."
"Integrity is doing the right thing when no one is looking," she prods.
"The question then," I say, "is whether blind respect for law is the right thing."
"But suppose," she says, "that cultivating respect for law reinforces general moral behavior."
"Obeying traffic laws as a 'vehicle' to moral behavior...." I muse. "But wait, not all laws are created equal. First one should ask whether the law - as it stands - is just."
"Whether the law is just," she says jestingly, "or just personally convenient?"
I think she won that one.
Email is a distraction from work, blogging from email, newspapers from blogging. I read dozens of newspaper articles a day. I've decided to combine these various distractions by sharing some of these news stories in the form of a “news round-up.” Over the last month or so, I’ve collected enough links to sort these stories by theme. Welcome to the health & feminism edition.
Almost two million children in the U.S. don’t have health insurance.
The U.S. will make it easier for children of illegal immigrants to get Medicaid.
South Carolina officially banned gay marriage with a constitutional amendment. Sigh.
There’s more to sex-ed than putting a condom on a banana. There’s communication and consent and dynamics of power, too. High school and college students ought to learn about it.
Circumcision limits transmission of HIV. But a few words of caution are in order.
People who sell fake drugs to developing countries should be prosecuted for murder.
Strange as it sounds, approximately 46% of rural women of India haven't even heard of HIV/AIDS. Nationwide, only 57% of women and 80% of men have heard of the disease. Illiteracy is a big cause of this ignorance, seeing how only 54% of women and 76% of men in India can read. So far, HIV/AIDS prevention efforts have focused on commercial sex workers, injection drug users, and other high-risk groups; but the government says the general population is next on the list.
Facing a looming gender imbalance crisis, the government of India has proposed that couples put their unwanted female children in government-funded orphanages, rather than aborting them in utero. In some areas, the imbalance is now as skewed as 800 girls per 1000 boys. I’m glad the government is concerned about the demographic problem, but this proposal just "solves" one problem by creating another. Now India will have lots of girls without parents.
A Colorado court ruled against “Ladies’ Night,” a practice where clubs charge women lower entrance fees and drink prices. The court’s rationale – that Ladies’ Night discriminates against men – generated lots of sarcastic commentary on feminist blogs, which tended to fault the practice of “Ladies’ Night” for encouraging women to drink and increasing the incidence of rape.
I was floored by the hypocrisy of Newt Gingrich, who pursued Clinton over the immorality of his affair with Monica Lewinsky, while Gingrich himself was cheating on his wife. Yuck.
It seems that many presidential contenders have slept around... Among the three Republican front-runners — thrice-married former NY Mayor Rudy Giuliani, twice-married Sen. John McCain, and Gingrich — there are eight current and past wives. The point was underlined by the wife of former Massachusetts Gov. Mitt Romney, who said, “The biggest difference between Mitt Romney and the other candidates,” is that the Mormon candidate has “only had one wife.”
I recently saw the Golden Globe-winning film Paradise Now (2005). It follows the relationship of two Palestinian men, best friends Said and Khaled of Nablus, over a tough two days as they decided whether to carry out a joint suicide attack in Tel Aviv. We see them drinking tea, smoking hookah, jesting with their families, and discussing life under occupation.
The trailer calls the film “a bold new call for peace,” and in many ways, it is. But the message is never explicit. Khaled’s view, that “the occupation defines the resistance,” features prominently in the film. But Suha, in love with Said for reasons never made clear, has an alternate view, especially regarding her father, a well-known “martyr”: “I'd rather he'd still be alive than be proud of him.” In fact, she’s not proud of him at all. I left the theater hearing the admonition of the film’s moderates: that the Palestinians must wage a moral resistance to the wrongs of the occupation. But the film also brings across the humanity of the radicals. I remember how Khaled interrupts his suicide video, with an AK-47 in one hand, to tell his mother, whom he clearly loves, where we she can get a good price on dish detergent. He’s thinking about the future. And the future is his ultimate aim: He somehow believes that blowing himself up on a Tel Aviv bus will benefit the Palestinian cause.
This poem caught my eye.
When It Happens--F.W. Deavia (in Verbal Seduction, vol. v, issue 8, Autumn 2006)
Sometimes when I watch
the rusty leaves
blowing in the wind,
and the grey clouds
hurry by the darkening,
evening-blue sky,
I pray to God that I am still around
to see the world end
because nothing
will ever look more beautiful.
Since somebody asked...
I read John Irving's The World According to Garp last summer, on my second-story porch, in a wicker chair, watching the sun set. It was Hollywood-esque, out of a commerical, the perfect setting for a celebrated book whose great wisdom sometimes succumbed to cliché. Take as an example, Irving's description of an awkward attempt at flirting between young Garp and young Cushie Percy: “‘You’re nice,’ Cushie told him, squeezing his hand. ‘And you’re my oldest friend.’ But they both must have known that you can know someone all your life and never quite be friends” (105).
I loved this book. It fit the genre I tend to favor: novels that stretch across generations, with winding plot lines unforeseen from the beginning chapters. As the book moves from Jenny Field's younger years, through the birth of her son, affectionately named T.S. Garp, through his adolescence, his marriage, his children, his affairs, his career, and eventually his death, The World According to Garp sometimes resembles East of Eden or A Hundred Years of Solitude, just slightly more accessible and without a Nobel Prize. I read a tattered old copy – at least twenty years old, priced at 75 cents, held together by tape – that I found on my parents’ shelf before I left home for my first real job. So again, the generational theme. As I read this book out on my own in a city I didn't know, I felt like I was growing up with Garp: Garp the wrestler, the writer, the scared lover, the traveler; Garp the chronically unsatisfied, overly ambitious, compulsive, self-doubting, tragic hero. Take this passage:
“But sports did not feel like recreation to Garp. Nothing felt like recreation to Garp. From the beginning, he appeared to believe there was something strenuous to achieve. (‘Writers do not read for fun,’ Garp would write, later, speaking for himself.) Even before young Garp knew he was going to be a writer, or knew what he wanted to be, it appears he did nothing ‘for fun’” (73).
In advanced literary circles, it’s seen as terribly immature to “identify” with the protagonist, but with some exceptions, that’s exactly what I did. I'm not sure that the book would be so memorable if I read it again. The timing of a book in one's life is as important as its content. Ya know, that's exactly the sort of profound platitude I'd expect from John Irving's pen. So who knows, maybe I would like it again. If I'm ever looking for fun - as much fun as I can handle - this book might be it.
The snow's been here for months now. I'm used to it. I know that in snow storms, visibility stops at 20 feet, that even car alarms are easily drowned out by the howling of the wind. I try to remember the summer, when the sky, now white as the ground, used to be blue. Certainly there are things I appreciate about the winter: the crispy air, the snowball fights, the hot chocolate. The fresh snow is elegant, endearing. But today, against this regular backdrop...
I stopped walking. I froze. I stared.
A patch of grass.
An involuntary smile.
This is how Noah must have felt when the waters receded.
I would bet that most unethical acts occur not because people can't figure out that money laundering, tax evasion, adultery, etc. are wrong, but because they don't care. The question is not "what is ethical?" but rather, "why be ethical?" - not "what should we do?" but "why should we do it?" Now I don't want to overstate the case. Certainly there are many issues still up for debate (e.g., how to distribute wealth or say, transplantable organs). Even so, one salient and often overlooked question is: why bother? Why bother lobbying against genocide or animal cruelty or violence to women? Okay, those are easy cases: I care - nearly everyone cares - because these injustices "shock the conscience" - a phrase Michael Walzer uses to explain when humanitarian intervention is justified. The harder questions are cases of unethical behavior that don't shock the conscience: leaving chewing gum on the sidewalk, stealing a candy bar from WalMart, cheating on a girl/boyfriend, etc. It's the petty things that trouble me, the things that happen so often as to be hardly worth mentioning.
I'm going to suppose that most people who steal and bribe and evade their taxes know that their actions don't pass the "what would Jesus do" test. Sometimes they "rationalize" their unethical behavior, comparing themselves to Robin Hood as they steal from WalMart or telling themselves "that it doesn't count in a different state" as they cheat on their spouses. But most of time, they're fully aware that that stealing and bribery and adultery are plain-and-simple wrong. For adulterer, it's that s/he is too consumed by passion to put ethics on top. Or if it's not passion, then it's laziness (not recycling) or self-advancement (bribery, plagiarism) or greed (tax evasion, money laundering) and so on. The great challenge of ethics education is not teaching people to think through ethical dilemmas, but teaching them to prioritize the ethical choice. To do that, we'll need compelling answers to the question that leads off this post - answers that'll come when I have time for more than two paragraphs.
To mark International Women's Day, the powers of the blogosphere have named today Blog Against Sexism Day. Here's my humble contribution: a look at the status of women's freedom across the globe.
From the United Nations (verbatim):
* Violence against women is the most common but least punished crime in the world.
* It is estimated that between 113 million and 200 million women are demographically "missing." They have been the victims of infanticide (boys are preferred to girls) or have not received the same amount of food and medical attention as their brothers and fathers.
* The number of women forced or sold into prostitution is estimated worldwide at anywhere between 700,000 and 4,000,000 per year. Profits from sex slavery are estimated at seven to twelve billion US dollars per year.
* Globally, women between the age of fifteen and forty-four are more likely to be maimed or die as a result of male violence than through cancer, malaria, traffic accidents or war combined.
* At least one out of every three women has been beaten, coerced into sex or otherwise abused in her lifetime. Usually, the abuser is a member of her own family or someone known to her. Domestic violence is the largest form of abuse of women worldwide, irrespective of region, culture, ethnicity, education, class and religion.
* It is estimated that more than two million girls are genitally mutilated per year, a rate of one girl every fifteen seconds.
* Systematic rape is used as a weapon of terror in many of the world's conflicts. It is estimated that between 250,000 and 500,000 women in Rwanda were raped during the 1994 genocide.
* Studies show the increasing links between violence against women and HIV and demonstrate that HIV-infected women are more likely to have experienced violence, and that victims of violence are at higher risk of HIV infection.
Sources: Secretary-General's in-depth study on violence against women (2006). Vlachovà, Marie and Biason, Lea, Eds. (2004) Women in an Insecure World: Violence Against Women - Facts, Figures and Analysis. Geneva Centre for the Democratic Control of Armed Forces. [The UN also provides this helpful background paper titled, "Ending Impunity for Violence against Women and Girls."]
I recently saw the documentary Invisible Children. The film is about child soldiers in Northern Uganda, but it's also a fairly narcissistic look at three 20-something year-old guys who spend the first fifteen minutes of the one-hour film introducing themselves before they then run off to “Africa” - with all its safari-like landscapes and poverty-ridden, “desperate” people – to find a story, any story really, worth telling. Nevermind that Africa is a continent of 54 countries, 900 million people, and 1000 languages. At the outset, the three adventurers plan to investigate the Sudanese civil war but they don’t get far beyond chopping up a snake and setting bushes on fire. So they head south to Uganda where they find their story: child soldiers. I’m cynical about their expedition. When they set out, they are three immature guys out for an adventure, and the whole film is as much as a coming of age story as a documentary. In the end, though, I don’t doubt that they’ll stay involved in the issue and will work for the betterment of Uganda’s children for years to come.
The movie is belabored by technological frivolities such as overly dramatic music and slow-motion camera pans. I think the tackiness is partly intended (it goes along with the we're-three-idiots-exploring-Africa theme), but there's no need to augment the extraordinary. A ten year old kid marching in formation, shooting an AK-47, and seeing his best friend killed as an example is horrible enough as it is. Still, the film does have its powerful moments. It includes candid interviews with parents of slain and abducted children, condemnations of the apathy of the world media, and even a few stirring lines, such as when the movie’s title, “invisible children,” flashes onto the screen, followed by the words: “because their own armies deny they exist.”
The film, unfortunately, has little educational value. Over and over again, it reinforces the magnitude of the problem without really explaining what the problem is, saying little about the political, economic, social, and religious aspects of the conflict. It says that the Lord’s Resistance Army – the primary abductor of children – is a “spiritual” movement. What does that mean? I left with many basic questions unanswered: How many people live in Uganda? How many children are abducted? How long have rebel militias been abducting children? What happens as the children grow older? Do they stay, do they escape? Why is northern Uganda in shambles while the south is apparently fit for Hollywood? What kind of government does Uganda have? Besides dodging the basic questions, the film doesn’t even attempt to examine the structural issues: why so many children are orphans, what’s happening to the exploding orphanages, how HIV/AIDS has affected the country, whether international aid groups are present, etc. I also wonder about the female children. You’d think, watching this movie, that all Ugandan children were boys.
I left the movie as ignorant as when I entered, more agitated than empowered, and utterly pessimistic about the state of world. And the movie offers no hope, except of course, to say that the answer lies in my wallet.
For more, see the film’s official website, the whole one-hour movie on Google Video, background on the Lord’s Resistance Army via Wikipedia, a recent NYT Magazine article by former Sierra Leone child soldier and current Brooklyn resident Ishmael Beah, and the first chapter of his book, A Long Way Gone: Memoirs of a Boy Soldier. This particular film may not have stirred praise, but its shortcomings don't diminish the issue it addresses. The problem of child soldiers is one of the greatest injustices in the world today. Visit the Coalition to Stop the Use of Child Soldiers (also here) to take a small step toward making the world a better place.
10. To merit my title as TIME's 2006 Person of the Year.
9. To define my interests. Seriously. Sometimes it seems that not much holds these posts together, but I like to believe that my defining thread runs through ethical issues in public life. I do expect to specialize one day, and when that time comes, I look forward to segway-ing to a group blog, in the style of Feministing or the editor's blog of the American Journal of Bioethics.
8. To be controversial. Or rather, to be controversial in public. To shed my cowardice.
7. To overcome the temptation to say, "Oh gosh, there's too much" and then write nothing at all. On almost every topic I write about, there's WAY too much to say. The same paralysis afflicts those of us who want to improve the world, but feel crushed by the burden of "everything."
6. To be concise. Digestible chunks. Short soundbites. People then read.
5. To remember how to write, artfully.
4. To prosyletize, about reproductive rights, global health, vegetarianism, and so on.
2. To stay in touch. It's a pleasure to hear from you readers.
1. To find new reasons to blog.
I sometimes think: Would it have been a bad thing if I had never been born?
I corresponded with a friend this morning who, for the first-time, met his biological family two weeks ago. This friend was raised by his adopted family, but when his parents (by which I mean, his adopted parents) died, he decided to contact his biological siblings. As I think about it, I'm very happy his biological mother carried the pregnancy to term. If she had aborted the fetus who would later become the person I call my friend, then I would never have met him. At the same, though, I am a strong proponent of the legal and moral permissibility of abortion.
I don't think it's a contradiction to say, on the one hand, that the world is a better place because I was born, and on the other hand, to say that it would not have been a bad thing if the fetus-who-became-me had been aborted. Imagine lamenting that the woman who would have become my wife was aborted before birth. It's no way to live a life, and more than that, I think it represents a superficial view of how we develop our emotional intelligence, life goals, romantic interests, and personalities. I don't see why a fetus constitutes a living being (or at the very least, a living being with personhood). It is no tragedy whatsoever to abort something without personhood (or at least not more of a tragedy than to refrain from reproducing in the first place).
A friend pointed me to the following commercial (seen on the Christian Life Network; not sure why she was watching that...). It puts forward exactly the argument I reject. It's manipulative and false. Aborting a fetus is TOTALLY different from killing a person once s/he's been born. Anyway, here it is:Is it morally wrong to fight in an unjust war? To what extent are non-combatant soldiers and say, even civilians, responsible for the war effort? Do tax-payers whose dollars fund the war effort face a moral choice? Is it the responsibility of soldiers to judge whether a particular war is just? Are soldiers any more responsible for that judgment than the decision to follow orders? Should it matter why soldiers joined the army in the first place, e.g., to topple Saddam, to defend the nation, to pay for college? Assuming it's wrong to fight in an unjust war, is it more wrong to voluntarily enlist than to be conscripted? Is the soldier who shoots and kills more at fault than the person who ordered him/her to shoot? Or than the senator who approved the war? Or the voters who elected the senator?
Why is it that all the just wars - Rwanda, Darfur, etc. - are the wars that are never fought?
More questions, and maybe a few answers, when I'm not at work.
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