the Electric Monk

Yesterday was the kick-off of yet another bioethics conference. From the perspective of an outsider like me–and a journalist to boot–”Ethical Issues in the Prioritization of Health Resources” seems like a hard sell. I struggle to imagine a less sexy title. (Perhaps “Academics Arguing about the Rights/Wrongs of Divvying Up Drugs and Doctors”?) But my prejudice was toppled by the following bizarre scene.

About 200 academics sat silently like parishioners in pews. Floating over their heads was a disembodied voice with a lilting Hispanic accent. It was Mexico’s Vice-Minister of Health, Mauricio Hernández, calling from his office to describe the difficult decision of how to stretch his limited budget to administer pneumococcal vaccines to his country’s children. The vaccine manufacturer recommends 3 doses, but it seemed to be more cost-effective to cut a corner from the standard of care and give only 2 doses. This is certainly the first time I’ve witnessed a politician on the phone with a packed room of academics, seeking their advice on a real-world, life and death dilemma.

Of course, deciding who should be given access to limited health resources is by definition a matter of life and death. But traditionally, philosophers who deal with the underlying ethics have not gotten their hands dirty with the real-world details. “Philosophers like us often say that we should learn about the issues from the experts who actually deal with them,” said Oxford bioethicist Roger Crisp. And rather than stopping there, “we should go on to try to make a positive difference.” This conference is supposed to be an opportunity for exactly this.

Crisp was the first speaker in a 3-man panel of academics who took the floor after the Vice-Minister. (Besides the Mexican vaccine dilemma, the conference learned about a dialysis machine shortage in Thailand and a new cancer drug that can extend life by a few months for an exorbitant cost. But more on those in a later post.) In contrast to the nitty-gritty of these real-world cases, the panelists battled it out on a very different plane–the abstract and esoteric world of moral theory. To give a sense of the flavor: Crisp added a new term to the menagerie of philosophical ‘isms (“sufficientarianism”); Alex Voorhoeve pondered whether it would be right or wrong to use a “philosophical laser” to prevent harm to one person from a plummeting meteor if not doing so would result in a greater benefit to another person; and JP Sevilla argued that redistributing people’s health (rather than money) was tricky because health is so “chunky”.

These are just caricatures of their arguments, of course. Abstraction is a necessary tool for teasing ethical issues apart. But the contrast between academic argument and real-world dilemma was dramatic. So I posed a real-world meta-question to the panel: Why does your work matter?

Voorhoeve considered his work in terms of national healthcare policies. “NICE is making some wrong decisions,” he said, referring to the ironically acronymed National Institute for Health and Clinical Excellence, the body that decides which drugs and treatments are not worth paying for in the UK. According to Voorhoeve, those decisions seem to derive ultimately from arguments made by another philosopher, All Souls don Derek Parfitt. So aside from the benefits to “mental hygiene,” he said, there are very practical reasons to get these philosophical arguments right.

With exquisite British self-deprecation, Crisp considered himself in the context of “all the philosophers over the centuries whose work is read and taken seriously.” Considering how vanishingly small that number is, he concluded, “I don’t think I matter.” But he went on to mount a poetic defense for the role of bioethics. “It’s like astronomy,” he said. The sky is filled with stars too dim to make out. “We’re trying to look deeper, helping each other to see a little farther.”

I was most touched by Sevilla’s reply. “What should I do to make the biggest difference for the benefit of all?” he wondered out loud. Public policy? Business? Even activism can have a more direct impact than academic bioethics. “The reason I do it is probably just that this is what I am best at,” he said. “Do I make a difference with these ideas?” He hopes so.

–John Bohannon

Does theism or atheism provide the best foundation for human worth and morality? That was the subject of a debate hosted by the Veritas Forum at MIT between well-known atheist philosopher Peter Singer and John Hare, a Christian philosopher from Yale Divinity School. The packed audience watched the intellectuals spar as the existence of God hung in the balance.

Singer based his argument on the claim that human empathy is a product of our evolution as a social mammal–the ability to imagine each other’s feelings was vital to the success of our species. Singer went on to cite the failings of Christians in addressing the pressing issues of poverty and justice, particularly in the developing world. Hare had no satisfying answer to these statements, failing to cite any data that might indicate the importance of charitable giving by those holding Christian beliefs.

Hare based his argument on the claim that only God provides the overall reasoning, justification, and motivation for morality. With sophisticated philosophical wordplay, Hare explained that atheism fails to reconcile the conflicting values of personal self-interest and altruism. However, the sheer clarity–even simplicity–of Singer’s responses made Hare’s elaborate argument appear obscure and off-point.

The debate came to a climax with a question from the audience on what would make each of them switch sides and adopt their opponent’s position. Singer admitted that the problem of evil in a world overseen by a good, all-powerful God stood in the way of his adopting the Christian faith. Echoing the sentiment of 1 Corinthians 15, John Hare stated that if the resurrection were to be shown to be untrue, then his faith would be in vain and he would consider the claims of the atheist position. Singer quickly pursued this point, pressing Hare on how he would respond if irrefutable evidence against the resurrection were found. To the surprise of many, Hare again underscored the fact that the resurrection was an integral part of his Christian faith.

Watch the debate HERE. What do you think? Is atheism or theism the better foundation for human worth and morality?
–Cody Chambers

“Professing Ethics at the Universities of Sodom and Gomorrah.” In this provocatively titled talk, Leon Eisenberg, Professor Emeritus at Harvard Medical School, posed an equally provocative question: “What is our responsibility as members of the university community when we observe the university engaged in unethical activity?” Universities have multiple goals–like raising money and remaining independent–he pointed out to the 2009 National Undergraduate Bioethics Conference, so there are bound to be conflicts. But if academics avoid rocking the boat, injustices can fester. Eisenberg told five vignettes in which students or faculty took an ethical stand.

1. Students vs. university–students win. He recounted a case where Baylor college was bribing incoming freshmen to retake their SAT scores in order to boost Baylor’s national ranking. A brave reporter from the student newspaper broke this story and the Baylor administration publicly apologized for its actions.

2. Faculty vs. government–faculty win (at least morally). In 1914, at the beginning of WWI, Albert Einstein became politically active by being one of only a few to sign a letter renouncing the war. This action could have ended his scientific career as it was a full six years before he was awarded the Nobel Prize. History remembers Einstein’s stand.

3. Students vs. society–society wins (sadly). Eisenberg relayed a personal account of his own work with a student group called AIMS–the Association of Interns and Medical Students–while a student at the University of Pennsylvania school of Medicine in the 1940’s. The group was advocating for better working conditions for medical interns and universal access to healthcare. The group became a target of McCarthyism, depicted as socialists, and buried.

4. Students and faculty vs. society–students and faculty win (and so does society). In the mid 1960’s, there was only one “negro” medical student at the University of Pennsylvania and less than 3 percent of all medical students in the US were black–most of them at the two historically black medical schools Howard and Meharry. In 1968, right after the murder of Martin Luther King, the students and faculty at Harvard Medical School advocated for an affirmative action program to increase black enrollment at the school. A committee of 9, including Eisenberg, radically proposed that Harvard admit no fewer than 15 black students the following year. The fear was whether or not there were even 15 black students in the U.S. qualified to attend Harvard Medical School. The administration got behind the students and faculty and made a concerted effort to recruit. Applications from black students went up 6-fold and by 1973, Harvard more than met its goal. Eisenberg proudly announced that Harvard Medical School has now graduated more than 1000 African Americans. “Harvard Medical School used to be all white and gray,” he said. “Now it’s in technicolor.”

5. Students vs. Big Pharma–stay tuned! Eisenberg talked about the current move among Harvard medical students to take on the conflict of interest that exists because of medical faculty members’ ties to pharmaceutical companies. While this issue has been a priority for the American Association of Medical Colleges for some time, Harvard has lagged behind many of other medical schools in weeding out Big Pharma’s influence over teaching, research, and clinical practice at the university.

Students frequently have more power than they realize to make positive changes to their institutions. Why, for example, do you think that China shut down the universities during the 1989 democratic uprisings? Are you putting your future career at risk if you speak out against injustices within your institutions? Absolutely. But, Dr. Eisenberg ended his talk with a challenge to the students in the audience: “If you don’t do it, it won’t happen.”

What do you think are the ethical issues festering on university campuses? What should students and faculty take a stand on that they are currently keeping quiet about?

–Andrea Kalfoglou

After the final dinner of the NUBC conference, Peter Singer spoke about global poverty. (There was a vegan option on the menu, of course.) The world’s most famous bioethicist came full circle to the idea that launched his career. His 1972 article “Famine, Affluence, and Morality” challenged readers with the following tale:  You come across a child drowning in a pond. You can easily wade in and save the child, but you will have to sacrifice your brand new expensive shoes. What should you do? “If you just walk on by,” Singer told us last night, “we consider you a monster.” But is that really so different from what you’re doing right now by not helping any of the millions of children around the world dying needlessly of poverty-related illnesses?

Singer has a new book out–The Life You Can Save–and a new strategy for convincing affluent people to help the poor: Encourage everyone to give a very small amount of their disposable income. Singer admits that the amount is far less, according to his theory, than people are morally obliged to give. “But as a utilitarian,” he said, his goal is to obtain the best outcome possible. Ask people to be saints, and only a few will step forward. Ask them to be slightly generous and far more people will give, adding up to a far greater total effect. At the time of this writing, his website lists 1,570 people who have pledged to donate the charity he requests, which is adjusted according to the donater’s income. He even provides a global map of where these generous people reside. (It’s an impressive distribution.)

After the talk, I asked Singer about his wrangle with Stephen Colbert. “For the record, how much of the cost of your book is going to save the world’s poor?” Singer’s answer would have been a good reply to Colbert’s jab. “100% of the profits I receive from the sale of the book go to charity,” he said, adding with a note of disappointment that his share only amounts to about 10% of its $22 price. The rest goes to Random House. Singer tried to convince the publishing company to donate a portion of its profits to charity as well, but they refused.

So for the record, Singer is clearly not a hypocrite. He walks the walk. But I wonder, is he doing the right thing by asking the world to give far less to the poor than they should? Or is it better for a radical leader to stick to his radical message? Imagine if Jesus, instead of telling people to “turn the other cheek” when wronged, said, “Take your revenge, but don’t hit back quite as hard as you usually do.”

Is the world worse off in some way, even if Singer’s pragmatic strategy pays off?

–John Bohannon

How much should a really rich guy give to the poor in order to not seem like “a complete A-hole?” Colbert asked last night. Singer’s answer: I don’t know, maybe 10%… Then Colbert notes that Singer’s book costs $22 and asks him how many lives that money could save.

I think Singer held his own. (It’s not his first time on the Colbert Report.) But what if he hadn’t? What if instead he came across as a hypocrite for not living up to his own philosophy? Should it matter for you and me? An idea should be considered on its own merits, not by the popularity or integrity of the person who puts words to it. Then again, most people have a different intuition, that you should “walk the walk” if you want to convince anyone of a radical idea, such as Singer’s claim that we should all be vegans who give away most of our disposable income to help those in the greatest need. (I’ll be checking what he eats tomorrow evening at the conference here.) [Editor:  See for yourself whether Singer is a hypocrite.]

But would it matter if Peter Singer turned out to be a meat-eating scrooge? Would his arguments be any less convincing?

–John Bohannon

Welcome to Electric Monk, a many-headed bioethics blog launched for the occasion of the 2009 National Undergraduate Bioethics Conference at Harvard University.