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Caring about Fairness February 18, 2010

Posted by Dwight Furrow in Dwight Furrow's Posts, ethics of care, Political Philosophy, Science.
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New research in neuroscience continues to have important implications for philosophical debates in ethics and political philosophy.

Via Colin Farrelly:

Political philosophers interested in abstract debates about equality vs priority and sufficiency should find this recent study in Nature Neuroscience of interest (as well as this News piece).

It is commonly assumed that the impulse to maximize one’s own self-interest is automatic and can be contrasted with the deliberative, reflective sentiments of prosocial actors who care about equality. But it seems that the decision-making of the latter is also automatic emotional processing. Here is the abstract of the paper:

‘Social value orientation’ characterizes individual differences in anchoring attitudes toward the division of resources. Here, by contrasting people with prosocial and individualistic orientations using functional magnetic resonance imaging, we demonstrate that degree of inequity aversion in prosocials is predictable from amygdala activity and unaffected by cognitive load. This result suggests that automatic emotional processing in the amygdala lies at the core of prosocial value orientation.

This is important research in support of an ethic of care and its political implications. It suggests that our concern for fairness and equality is rooted in the emotions, not in our capacity to reason impartially.

It supports my main argument in Reviving the Left.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

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Money for Nothing August 12, 2009

Posted by Dwight Furrow in Current Events, Dwight Furrow's Posts, ethics of care, Political Philosophy.
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If the problems of health care and global warming are not sufficiently difficult to solve, there is another issue looming on the horizon that I have been worrying about for some time. Gregory Clark in the Sunday NY Times gives it some exposure.

…the economic problems of the future will not be about growth but about something more nettlesome: the ineluctable increase in the number of people with no marketable skills, and technology’s role not as the antidote to social conflict, but as its instigator.

The battle will be over how to get the economy’s winners to pay for an increasingly costly poor.

As Clark points out, despite the steady advance of technology during the industrial revolution, unskilled labor was still very important to the economy and was paid rather well, especially in the late 20th century. Machines have not been able to replace human communication skills or fine motor skills.

But in more recent decades, when average U.S. incomes roughly doubled, there has been little gain in the real earnings of the unskilled. And, more darkly, computer advances suggest these redoubts of human skill will sooner or later fall to machines. We may have already reached the historical peak in the earning power of low-skilled workers, and may look back on the mid-20th century as the great era of the common man.

We can now carry out complicated transactions by phone with no human interaction and machines are increasingly able to perform routine physical tasks. ATM machines and automated food service kiosks are only the tip of the iceberg. There are now fully automated factories in the U.S., and with increases in computer processing speed and improvement in the software to drive voice and vision recognition systems, there seems little doubt that the workplace will become increasingly automated.

Clark asks the important question:

So, how do we operate a society in which a large share of the population is socially needy but economically redundant? There is only one answer. You tax the winners — those with the still uniquely human skills, and those owning the capital and land — to provide for the losers.

It is hard to imagine our current ethical and political systems, which presuppose a work ethic, individual responsibility, meritocracy, and powerful resistance to taxes, adapting easily to these changes. We must learn to think otherwise, perhaps along the lines of an ethic of care.

Some people, such as Robert Reich, see the increasing importance of symbol analysts as a source of new jobs but Clark is skeptical that everyone will have the cognitive ability to perform this work. The number of people dropping out of high school or finishing high school with few literacy or math skills supports Clark’s view.

Thus,

In the end, we may be forced to learn to live in a United States where, by stealth, “from each according to his ability, to each according to his need” becomes the guiding principle of government — or else confront growing, unattended poverty

I hope Clark is wrong about this, but he is not obviously wrong. The increasing importance of robotics looks inevitable to me.

It is impossible to predict how soon this will come about. But it is worth noting that today it was reported that in the second-quarter, non-farm productivity rose at a 6.4 annual rate, during a time of burgeoning unemployment. This means firms are squeezing more out of the workers they have. Many will be reluctant to hire those workers back—especially if new technology can replace them.

This brave new world may come sooner than we think.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

or Visit the Website: www.revivingliberalism.com

Do Republicans Lack Mirror Neurons? July 14, 2009

Posted by Dwight Furrow in Dwight Furrow's Posts, ethics of care, politics.
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I posted recently on the flap over Obama’s use of empathy as a criterion for choosing supreme court justices. But the moral cretins in the Republican Party still don’t get it. It is as if they were born without mirror neurons.

So it is worth revisiting the issue.

Yesterday in the Judiciary Committee hearings on Sonia Sotomayor’s nomination to the SCOTUS, Sen. Charles Grassley (R-IA) said

“This empathy standard is troubling to me. The Constitution requires that judges be free from personal politics … feelings and preferences.”

But this is an utter misunderstanding of how empathy works. Empathy is a fundamental moral capacity. It is, in part, what makes us moral beings. Any person, whether a judge or not, must have empathy to function as a social being because empathy enables us to discern how others are situated in the world, what their emotional state is, what their intentions are, etc. We could not accurately interpret human behavior without empathy. [See Vignemont and Singer, unfortunately behind a paywall.]

Judges especially need empathy. Whether the issue involves the equal protection clause of the 14th Amendment or disparate impact statutes in employment law, judges must determine how various interested parties will be affected by their rulings. When the law treats one group differently from another in the pursuit of a social goal, special justification is required

It is simply part of their job to assess outcomes.

Republicans wrongly think that judges who feel empathy must be allowing their preconceived moral ideology to influence their understanding of the law. They seem to think that judges must coldly apply the law as written without regard to consequences, which of course enables their privileged position as advocates for the ruling class to be smuggled in disguised as objectivity.

But empathy does not work that way.

Empathy is a necessary condition of impartiality—at least the kind of impartiality that humans (as opposed to machines) are capable of—because empathy makes us imagine, and thus come to know, how our actions affect others.

Responsible judges begin with the law as written, constrained by precedent and legislative history, and then ask whether the law so interpreted has the effect intended by lawmakers. One needs empathy to answer this question.

Empathy is not a conduit through which we splatter our preferences on an otherwise autonomous law. Empathy helps us discover the facts—it is fundamentally epistemological, not ideological.

Maybe Senators should be forced to undergo fMRI scans (to detect the presence of mirror neurons) before running for office. That would be the end of the Republican Party as we know it.

 

Cross-posted at Reviving the Left

 book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

or Visit the Website: www.revivingliberalism.com

Health Care Is Already Rationed But Not Rationally June 29, 2009

Posted by Dwight Furrow in Dwight Furrow's Posts, ethics of care, politics.
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In the Senate’s health care debate, Republicans are stonewalling progress by complaining about the health care rationing that is part of Obama’s plan to reduce medical costs. Obama wants to use Comparative Effectiveness Research to determine which procedures and medications are most effective and direct publicly administered insurance plans to pay for only those procedures that pass this test.

A group of Republican lawmakers led by Sen. Jon Kyl (Ariz.) are introducing a bill that would prohibit any move by the federal government to ration health care based on results derived from federally funded comparative effectiveness research.

But this is silly. We already ration health care

In our present system, medical decisions are guided not by evidence of results, but by what will produce profits for the medical community. Prevention, inexpensive generic drugs, and the avoidance of mistakes are deemphasized because there is little money to made on them. And people who lack insurance get very little care because there is no money to made treating them.

By contrast, people with expensive health plans are over-treated and undergo unnecessary procedures because someone does make a profit on these. This is because all the incentives in our health delivery system are centered around profit rather than what will produce better health.

This is rationing.

To make matters worse, insurance companies make their money by refusing much needed care.

Here is a summary of testimony before the Commerce Committee by Wendell Potter, a former head of corporate communications for CIGNA, the country’s fourth-largest insurer. Via Ezra Klein:

What drove Potter from the health insurance business was, well, the health insurance business. The industry, Potter says, is driven by “two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.”

Think about that term for a moment: The industry literally has a term for how much money it “loses” paying for health care.

The best way to drive down “medical-loss,” explains Potter, is to stop insuring unhealthy people. You won’t, after all, have to spend very much of a healthy person’s dollar on medical care because he or she won’t need much medical care. And the insurance industry accomplishes this through two main policies. “One is policy rescission,” says Potter. “They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment.”

And don’t be fooled: rescission is important to the business model. Last week, at a hearing before the House Subcommittee on Oversight and Investigation, Rep. Bart Stupak, the committee chairman, asked three insurance industry executives if they would commit to ending rescission except in cases of intentional fraud. “No,” they each said.

Potter also emphasized the practice known as “purging.” This is where insurers rid themselves of unprofitable accounts by slapping them with “intentionally unrealistic rate increases.” One famous example came when Cigna decided to drive the Entertainment Industry Group Insurance Trust in California and New Jersey off of its books. It hit them with a rate increase that would have left some family plans costing more than $44,000 a year, and it gave them three months to come up with the cash.

This is rationing too.

The problem is that this rationing is based on arbitrary criteria that have nothing to do with producing good health.

As David Leonhardt wrote recently:

…There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.

[…]But flat-out opposition to comparative effectiveness is, in the end, opposition to making good choices. And all the noise about rationing is not really a courageous stand against less medical care. It’s a utopian stand against better medical care.

We have finite resources to spend on health care. We can never provide as much care as people want or need. So rationing is inevitable. The question is whether there is an ethical basis for the way we ration.

If you think wealthy people deserve more costly (though often ineffective) care than they need, and middle class and poor people deserve far less than they need, then I suppose you think the status quo is just fine.

Apparently, that is what Republicans think.

 

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

or Visit the Website: www.revivingliberalism.com

 

More On the Weakest Link April 30, 2009

Posted by Dwight Furrow in Current Events, Dwight Furrow's Posts, ethics of care.
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I posted earlier in the week on how the threatening ”swine flu” pandemic makes evident the limits of self-reliance as a virtue.

Unfortunately, that point continues to be reinforced.

The Centers for Disease Control and other health experts have been advising that if you feel sick you should go to your doctor and stay home from work.

But if you don’t have a doctor because you lack health insurance or if you aren’t entitled to sick days at work, your options for complying with the CDC are limited.

Sure, you can go to the emergency room and wait around for 12 hours infecting everyone else in the vicinity. And you can call in sick, take the hit on your paycheck, and pray your boss won’t fire you. These are options, but they are not good options and it is likely many people won’t choose them.

The consequences for the rest of us are dire.

There are now roughly 45 Million Americans who lack health insurance and the number is growing everyday. A recent Kaiser Poll suggests that 60 percent of Americans say that “they or a member of their household have delayed or skipped health care in the past year” and many are “substituting home remedies or over the counter drugs for doctors visits.”

And about half the workers in the United States lack the benefit of paid sick leave—most of the people who serve you food, for example.

Obviously, the free market is not distributing resources efficiently when events like the swine flu pandemic threaten. As Priscilla Wald, the author of the book Contagious (Duke University Press, 2008) writes:

In the telling of the outbreak story, the media present the pandemic as solely a medical problem. But it is a social problem as well. Poverty and inadequate health care are the most effective vectors for the spread of disease.

The lack of health care and other benefits is not just a problem for the people who lack them. It makes all of us more vulnerable. Hopefully, this time, this disease will weaken on its own.

A little luck is always a good thing.

The Weakest Link April 28, 2009

Posted by Dwight Furrow in Current Events, Dwight Furrow's Posts, Ethics, ethics of care.
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Cross-posted at Reviving the Left.

This latest outbreak of swine flu reminds us of the limits of self-reliance.

One of the main themes of Reviving the Left is that central currents in American thought encourage the idea that unbridled self-reliance is a moral virtue.

But this is a dangerous idea that continually leaves us vulnerable to potentially catastrophic events such as pandemics.

We like to think that our welfare is in our own hands—what happens to us is in the end our own responsibility. This assumption about personal responsibility is so pervasive that it seems written in the DNA of Americans. And it is encouraged by the fact that our dependence on distant others is often hidden from view. Modern marketing and technology is very good at covering up the origins of things—we are seldom forced to think about the anonymous people who grow our food or make our products.

So why should we care about inadequate public health resources in foreign countries like Mexico?

The news coming out of Mexico explains why.

Two weeks after the first known swine flu death, Mexico still hasn’t given medicine to the families of the dead. It hasn’t determined where the outbreak began or how it spread. And while the government urges anyone who feels sick to go to hospitals, feverish people complain ambulance workers are scared to pick them up.

A portrait is emerging of a slow and confused response by Mexico to the gathering swine flu epidemic. And that could mean the world is flying blind into a global health storm.

It isn’t obvious what we can do about inadequate public health in other countries. (We have our own inadequacies to worry about.) But this is another example, along with global warming, resource depletion, nuclear proliferation, etc., of a problem that requires collective solutions. And collective action requires levels of trust that only a greater willingness to be generous toward others will provide.

Whatever the particular solution to public health failures in other countries, that solution will require, from wealthy nations,  persistent, wise regard for the vulnerability of others, in part because their vulnerabilities can become ours.

This is more evidence that an ethic of care provides better moral guidance than more traditional moral theories.

h/t to Talking Points Memo

Torture Doctors Don’t Care April 15, 2009

Posted by Dwight Furrow in Current Events, Dwight Furrow's Posts, Ethics, ethics of care.
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A leaked report by the International Committee of the Red Cross (ICRC) concludes that medical personnel were involved in torturing terrorist suspects held overseas by the CIA, according to reports in the New York Times. The article highlights the fact that the medical personnel were violating codes of medical ethics.

Facilitating such practices, which the Red Cross described as torture, was a violation of medical ethics even if the medical workers’ intentions had been to prevent death or permanent injury, the report said. But it found that the medical professionals’ role was primarily to support the interrogators, not to protect the prisoners, and that the professionals had “condoned and participated in ill treatment.”

This suggests that there is something especially egregious about medical personnel being involved. Torture is bad, but it is even worse when medics participate.

Dominic Wilkinson at Practical Ethics asks why:

But would it really make it better if the assistants were soldiers or CIA officers who had received some medical training? What if they were scientists or vets?

He goes on to argue:

Sometimes we hold doctors to higher standards than the rest of the community. We may, for example, feel particularly aggrieved if a doctor gossips about our health to another patient, but not be concerned (or as concerned) if this is done by our hairdresser. But the moral requirement not to torture or to assist in torture is not of this nature. It is something that should have equal force on a doctor or a CIA officer, a hairdresser or a vet…But the reason that it is wrong for doctors or other health professionals to assist in torture is because it is torture – not because they are doctors.

I am not convinced that the wrongness of the action is unaffected by the fact it is committed by medical professionals. And I think the ethics of care explains why.

We expect medical professionals to be at least in part motivated by care. Doctoring or nursing is a helping profession in which having the motive to help others is essential to being successful.

Medical professionals who assist with torture not only violate their medical code of ethics. They also are acting on a motive which is diabolical when it moves a medical professional, thereby amplifying the wrongness of their actions.

CIA officers (or hairdressers) need not have any special caring motive. Thus, although they violate a code of ethics by torturing prisoners, their motives are not in substantial conflict with the motives required to do their job.

Of course, all human beings ought to be motivated to some degree by care (on my view of an ethic of care). The act of torture by anyone (in most circumstances) is wrong because it (usually) lacks a caring motive. But for persons who are not medical professionals, that wrongness is not amplified by a motive utterly out of line with professional requirements.

There is more on torture of a different sort at Reviving the Left.

The Road to Imperial Ruin March 31, 2009

Posted by Dwight Furrow in Current Events, Dwight Furrow's Posts, Ethics, Political Philosophy.
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Cross-posted at Reviving the Left..

One of the main themes of Reviving the Left is that the ethics of care is relevant in the political arena in areas such as foreign policy.

Unlike moral theories that strive for universality, and thus focus on what human beings have in common, the ethics of care rests prescriptions on knowledge of particular persons, their circumstances, and their differences, and the cultivation of empathy and perceptiveness to gain such knowledge.

Matt Yglesias makes a point about our approach to Pakistan that implicitly reinforces the importance of an ethic of care.

In responding to the argument that we may not be able to trust the Pakistanis to root out the Taliban and Al-Quaeda from tribal areas he writes:

“This sort of thing is, in my view, really the achilles heel of the American imperial project….And when we get involved in things like the internal politics of Pakistan, or political reform in Egypt, or wars in the Horn of Africa, and so forth we’re dealing in situations where the level of understanding is incredibly asymmetric. If you go to pretty much any country in the world, you’ll find that educated people there know more about the United States than you do about their country. Nobody at highest levels of the American government speaks Urdu. Or Arabic. Or Amharic or Somali or Pashto or Tajik.

Lots of people at high levels in the Pakistani government speak English….they have a vast bounty of media outlets to peruse to gather intelligence. And year-in and year-out Pakistan cares about the same smallish set of countries—Pakistani officials are always focused on issue in their region and issues with the United States. Our officials dance around—the Balkans are important this decade, Central Asia the next, Russia and the Persian Gulf flit on and off the radar, sometimes we notice what’s happening in Mexico, etc.

In other words, in a straightforward contest of power between the United States and Pakistan, we can of course win. But in a scenario where we are trying to manipulate the situation in Pakistan in such-and-such a way and Pakistani actors are trying to manipulate the situation for their own ends, the odds of us actually outwitting the Pakistanis are terrible. They’re in a much better position to manipulate us than we are them.

This is one reason why so many of our foreign policy and foreign aid initiatives go wrong. We assume that other people are like us. We assume they share our interests, habits of communication, and ways of looking at the world because we assume our way is simply the human way.

And these assumptions are encouraged by our dominant moral theories (e.g. Kantian or utilitarian theories) that enjoin us to act only on prescriptions on which it would be rational for anyone to act. Our moral reflection tends to take place on a very general and very generic level.