4.12.04

Friends And Organs

Online Organ Linkups Spur Debate, Alarm ... Patients and [organ] donors are incredulous that doctors might refuse them simply because they met on a website. They point out that family members and friends are permitted to donate. Doctors acknowledge that defining what is meant by friends can be difficult. For example, Dr. Douglas Hanto, chairman of the transplant surgeon society's ethics committee and chief of the division of transplantation at the Beth Israel Deaconess Medical Center, says he would probably perform a transplant on a patient taking an organ donation from a member of his or her church, if they fit other medical criteria for donations. But if the patient approached him with a donor he met on the tennis court a few weeks ago? "Probably not," Hanto said. ... Critics have objected that public solicitation of organs is easier for those who have money or who are computer-savvy. ... "People who contact us say, if it weren't for Cynthia's story, they wouldn't have considered donation at all," said Irma Woodard, speaking on behalf of her niece, Cynthia Gallardo. "Everyone assumes we're taking from someone else, but the fact is that a lot of these people wouldn't donate if they didn't feel a personal connection."

I can understand the modernist viewpoint that underlies defense of the waiting list system. It's hard to argue that certain people deserve an organ more than others, and to the extent that they do (e.g. if they lost their liver due to irresponsible drinking), that desert doesn't align with differences in ability to locate a willing donor. The solution, then, is to create a universal and formally fair system to allocate organs. If people are less willing to donate to the waiting list than to a particular person they have some connection to, that's just a sign of moral weakness -- after all, saving a life is saving a life -- and a price we must be willing to pay to make the system fairer.

But allowing donations by family and close friends undermines the modernist argument. It seems bizarre that one would be allowed to donate a kidney to a stranger or to a parent, but not to an acquaintance. It may perhaps be justifiable as a compromise, since people affected by severe illness are notoriously unwilling to accept the dictates of a system that is unable to validate and respond to their personal anguish. But there's a real philosophical inconsistency.

The inequality argument raises some issues as well. In our current health care system, there are countless advantages that the rich can get. But economic inequality is not the only form of equality that's relevant to health care. Social inequality -- differences in the amount, breadth, and strength of one's social network -- can be critical as well. Social connections can facilitate finding treatment, as in the case of getting a friend to donate a kidney. They also provide emotional support to people dealing with illness or recovery. I would suspect that there are real benefits to both parties when the donor and recipient know each other and can share the experience, rather than simply interacting individually with a bureaucracy.

As it happens, economic inequality is relatively easy to deal with (at least from a technical standpoint). The government can give poor people vouchers for donation websites, or even set up its own free organdonation.gov. Social inequality is more difficult, because you can't give someone welfare friendships. However, the internet offers the promise of leveling the playing field somewhat. My own anecdotal experiece suggests that people who would otherwise have the thinnest social networks -- introverts, members of geographically dispersed subcultures, those who are stuck at home -- benefit disproportionately from the social networking that the internet makes possible.
Stentor Danielson, 10:21, ,

2.12.04

Delawares Lose

Posting like a maniac today. I don't have time to comment on this now, but I thought I'd throw it out there since I wrote about this case when it was first filed:

Judge Rules Against Tribe On Claim That Could Have Led To Casino An American Indian tribe that says it was swindled out of land in Pennsylvania by William Penn's son isn't legally entitled to get 315 acres of it back, even if its claims are true, a federal judge ruled. The tribe filed its claim for the land near Easton as part of a plan to open a casino in Pennsylvania. In an unusual opinion based on colonial-era records and legal standards, U.S. District Judge James McGirr Kelly ruled Wednesday that Thomas Penn had king-like powers that had been granted to his father, the state's founder, by the English crown. Whether he was a crook or not, Thomas Penn was free to take Indian land any way he saw fit.

Stentor Danielson, 18:37, ,

Scarlet

Here we go with my last contributions to the Scarlet for the semester.



My column was a (not particularly cogent) restatement of the things I've already said here about the proposed North Woods National Park: Maine Debates Over North Woods. I think the comic turned out decently, though.
Stentor Danielson, 18:07, ,

Bride Price

I thought I might be going a little over the top in my previous post about abstinence-only education when I described its take on gender roles as "feudal" -- after all, the stereotype they're promoting is all too common even today. But reading through the whole report (pdf) (via TAPPED), I see that I wasn't too far off the mark. At least one abstinence curriculum appears to endorse the idea that women are the property of their fathers and husbands:

In a discussion of wedding traditions, one curriculum writes: "Tell the class that the Bride price is actually an honor to the bride. It says she is valuable to the groom and he is willing to give something valuable for her."

Stentor Danielson, 15:40, ,

The World Is Stupid

I don't know if it's just that I'm especially irritable today, but I seem to be running into a disproportionate number of things that make me feel angry (rather than just recognizing intellectually that they're outrageous). The post below is one example, although I tried to intellectualize it. Here's a few more:

• Via Kevin Drum, it seems that in Washington DC, "A majority of Metro directors, who set policy for the region's subway and bus system, say they have never ridden a Metrobus or can't recall the last time they did." What's being violated here is the basic utilitarian moral/empirical claim that underlies democracy and socialism: the people most affected by something have the greatest moral right (since their interests are at stake), as well as the greatest ability (since they have practical and ongoing familiarity with it), to make decisions about it. I happen to think that in many cases the converse empirical claim -- "the experts know best" -- is valid, particularly in instances like medicine where the choice of goals is unambiguous and there is a body of highly specialized knowledge about the means. But our society too often supposes that the empirical validity of expertism brings with it a moral validity, or assumes that the consent that could be given by affected people to the experts has been given. In the Metro case, though, the directors aren't even countering with a claim of expertism. They're defending their own privileged positions by claiming that social position (i.e. whether you ride the Metro) has no bearing on one's decisionmaking ability or authority.



• Via Morat, it looks like Christianity really is under siege in this country. Jesus' message of inclusion is apparently unwelcome on CBS or NBC because it might conflict with the policy proposals of Head Pharisee George W. Bush.

No Sex, All Patriarchy

Some Abstinence Programs Mislead Teens, Report Says Many American youngsters participating in federally funded abstinence-only programs have been taught over the past three years that abortion can lead to sterility and suicide, that half the gay male teenagers in the United States have tested positive for the AIDS virus, and that touching a person's genitals "can result in pregnancy," a congressional staff analysis [led by Rep. Henry Waxman] has found. ... Some course materials cited in Waxman's report present as scientific fact notions about a man's need for "admiration" and "sexual fulfillment" compared with a woman's need for "financial support." One book in the "Choosing Best" series tells the story of a knight who married a village maiden instead of the princess because the princess offered so many tips on slaying the local dragon. "Moral of the story," notes the popular text: "Occasional suggestions and assistance may be alright, but too much of it will lessen a man's confidence or even turn him away from his princess."

More evidence for why Henry Waxman is my hero.

The misinformation about disease and contraceptive failure rates isn't surprising. The ideology of abstinence-only sees premarital sex as a bad thing in and of itself. Concerns about pregnancy and disease are just tools to appeal to the self-interest of people who won't sign onto their moral code. If those purely self-interested reasons aren't sufficient to motivate people -- which, given the advances in contraceptive technology, they usually aren't -- then exaggeration is a logical step. This is why, instead of trying to justify their misinformation, the abstinence-only advocates always retreat to the slippery slope argument that presenting a less alarming picture of safe sex would lead to kids having sex.

What is surprising is contained in the last paragraph -- such outright teaching of conservative gender roles (literally feudal, in this case, since we've got a knight marrying one of his obsequious serfs rather than the uppity woman who outranks him). I tend to be a bit skeptical of those who see all conservative sexual opinions as part of a deliberate patriarchy promotion agenda, but sometimes it hits you over the head.
Stentor Danielson, 11:10, ,

1.12.04

NSF Suffers

Congress Trims Money For Science Agency Congress has cut the budget for the National Science Foundation, an engine for research in science and technology, just two years after endorsing a plan to double the amount given to the agency. Supporters of scientific research, in government and at universities, noted that the cut came as lawmakers earmarked more money for local projects like the Rock and Roll Hall of Fame in Cleveland and the Punxsutawney Weather Museum in Pennsylvania. ... The $388 billion spending bill for the current fiscal year, approved by both houses of Congress on Nov. 20, provides $5.473 billion for the National Science Foundation, which is $105 million less than it got last year and $272 million less than President Bush requested. -- via TAPPED

Maybe I won't be able to go to Australia after all.

Nick Confessore wonders whether this is just a bit of belt-tightening or whether it's rooted in the GOP's distaste for science. I suspect a little of both. Cutting the NSF budget by a few million dollars doesn't seem like a very productive battle in the war against science, so it doesn't seem like a policy that would be pursued on its own merits. But if you're looking to cut money somewhere, it's no surprise that creationists and climate change skeptics would not place high priority on making sure the NSF is flush with cash.

Confessore also speculates that, if the Democrats are able to get their act together, the various outrages contained in the spending bill would provide good fodder for discrediting the Republicans. In general, I would agree. But it's hard to see how the case of the NSF would contribute much to that rhetorical strategy. Shaving a few million dollars from an agency most Americans have never heard of isn't really going to make the public's blood boil. It would be more likely to reinforce the Al Gore image of Democrats as elite, cold wonkish types.
Stentor Danielson, 09:26, ,

30.11.04

Who's Responsible For The Backlash?

I've seen an interesting philosophical point come up twice recently with respect to two very different issues. The basic problem is this: if you do something that leads someone else to have a foreseeable reaction, and that reaction leaves you worse off with respect to your original goal, was your original action the wrong choice? Those who say "no" I'll refer to as "purists." They argue that one should be true to one's ideals. To calculate the likely success of an action is to compromise one's ideals. And if there's a backlash, it's entirely the fault of the backlasher, and thus has no bearing on the rightness of the original choice*. Those who answer "yes" are "consequentialists." They say that the only thing that matters in choosing a course of action is what the outcomes will be. If there's a backlash, you should have known better. Note that this does not absolve the backlashers of responsibility -- blame is not a zero-sum game. And indeed, because their choice was closer to the bad outcome, they would be more responsible than the backlash-provokers.

Case study 1: the war in Iraq. It's becoming increasingly clear that the war has made the Iraqi people worse off as well as compromising American security. Norman Geras argues that despite this, hawks were still correct to push for the war, because they were aiming at the right goals. The responsibility for the deteriorating situation lies with the insurgents who refused to cooperate with the American project. John Quiggin responds -- rightly, I believe -- with the consequentialist view. We should choose the course of action that leads to the greatest actual improvement in Iraqi and American well-being.

Case study 2: same-sex marriage. Marriage advocates did not do well on election day, losing all 11 fights against anti-marriage ballot measures. Many frustrated marriage supporters (e.g. Waddling Thunder) have blamed Gavin Newsom and the Massachusetts Supreme Judicial Court (really, we should blame the plaintiffs in the Goodridge case for filng their suit in order to win marriage rights, not the court for correctly interpreting the law). By pursuing same-sex marriage too quickly and too un-democratically, the argument goes, they provoked a backlash that left same-sex couples worse off than they were before. By this consequentialist reasoning, they should have bided their time until the country was ready for same-sex marriage. This argument has drawn responses (e.g. from Chris Geidner) in the purist mode -- Newsom and the SJC were aiming at the right goals** and should not be asked to wait for justice just because some homophobes will undo their work.

Consistent with my opinion in the war case and my general affinity for consequentialism, I have to side with Waddling Thunder's as the more valid argument in this scenario. If an advocate of any cause does something that leaves the cause worse off, then that action was the wrong choice, no matter how righteous the action was when considered on its own. That said, I believe that the same-sex marriage situation we experienced this past year does not match the empirical premises of the dilemma in question (it seems Geidner agrees with me here). The election-day backlash was a step back, but not as far back as we often think. Meanwhile, the actions of Newsom and the SJC were significant steps forward. Same-sex marriage has made a net advance in the last two years. Had Newsom or the SJC done their thing in, say, 1950, Waddling Thunder's reasoning probably would have applied. I'm sadly forced to conclude that it would apply if the US Supreme Court were to rule in favor of same-sex marriage today. There are times when small, cautious steps are pragmatically the best we can do. But I think the bold steps that provoked the election-day backlash were still, on balance, justifiable on consequentialist grounds.

The war case does, in my opinion, fit the structure of the dilemma in question. But hawks are on stronger ground when they claim that the empirical situation does not match the premises (i.e., that Iraqis are better off now) than when they claim that Iraqi welfare is irrelevant as long as we were trying to do the right thing.

*I'm not confident enough to put this observation outside of a footnote, but the purist rationale strikes me as somewhat Kantian. Purists are acting in a way that would be beneficial if everyone were trying to do the right thing.
Stentor Danielson, 09:13, ,

28.11.04

McCain's Strategy

No McCain, No Gain Patrick Michaels, an environmental fellow at the right-leaning Cato Institute who teaches environmental sciences at the University of Virginia, griped that McCain's climate-change initiative is nothing more than a political gambit to position himself for a presidential campaign. "He is doing all this strictly for political gain," Michaels told Muckraker. "He needs something to separate him from the Republican competition for 2008. He wants to be the GOP authority on this issue, and my sense is that he's going to do everything he can in the next four years to make his mark on this issue." McCain has been tenacious enough in pressing for action on global warming that it's hard to believe it's all a political ploy. But some folks deeply concerned about the climate wish he had been more tenacious still and supported the presidential candidate who actually would have done something about this looming problem.

I think the author's desire to defend her allies has given her view of McCain a bit of a rosy hue. Certainly I support what McCain has and will do to get the US to take climate change seriously. But I don't think his tenacity on the issue weighs against the hypothesis that he's doing it as a political ploy. Certainly it's not the kind of plotical ploy we're most used to, the kind beautifully illustrated by both John Kerry and George Bush: the flip-flop. Flip-flops happen when a politician is reacting to the public and to the conventional wisdom, trying to get on the "right" side of an issue so that people will like him. McCain has rarely been one for that kind of maneuver. Rather, he plans for the long term. Tenacity can be itself a ploy, as McCain has a lot invested in his image as a straight-shooting maverick. Climate change works well for him, as it makes him distinctive and gives him opportunities to reach across the aisle. This wins him the adoration of liberals who forget the conservatism of his voting record on issues that are not his signature ones. And it makes the party work for his loyalty, out of fear of defection and desire for the PR of having him stand up in the end and endorse the GOP.
Stentor Danielson, 19:25, ,

North Woods Failure

Park Debate Is A Battle Over The Future Of Maine ... Infuriating her neighbors, [Roxanne] Quimby has banned hunting and plans to end snowmobiling on what she calls her "sanctuary." And her long-term goal is about as palatable to some rural Mainers as tofu with their venison: a 3.2 million-acre national park that would be larger than Yosemite and Yellowstone combined, and where hunting, snowmobiling and logging would be heavily restricted. ... "For generations, the paper companies sort of managed everything for us up here," said Patrick K. McGowan, commissioner of Maine's Department of Conservation. "They gave sportsmen pretty much free rein, and in turn the people up here helped out as stewards of the land. But with all of these new buyers, nobody knows quite what will happen now, and people are getting nervous." ... "I think there's enough land here for all of us to use the way we want to. I never expected such controversy, but at this point I have $20 million at stake in this argument," said Quimby, who splits her time between Winter Harbor, Maine, and Palm Beach, Fla. "At the end of the day, I insist that this is my property. I paid for it, and I paid to control its fate while I own it."

This is an interesting story, since it's the environmentalists who are defending the prerogatives of private property while their opponents are insisting on the continuance of an unofficial commons. At the risk of sounding Marxist, though, it's not all that strange. Those who own have a vested interest in the benefits that a private property system gives them, while those who merely use have a vested interest in extracting obligations from owners.

I see this story as an indication of environmentalism's failure. The people of rural Maine are the perfect place to begin expanding environmentalism's base, undoing the perception (and all too often reality) of environmentalism as an elitist movement. To judge from the presidential election results, Mainers are already more liberal than the people in most rural areas. But they also share that conservative conservationist ethos, a respect for the aesthetic as well as livelihood-supporting functions of nature and a tradition of (quasi) common property based around hunting and fishing.

The environmentalists could have approached the issue from a democratic perspective. They could have started off by trying to understand how the people of rural Maine manage their environment and what their values are. They could have found common ground, promoting a mixture of both groups' interests while working together against common enemies like the fickle timber industry (carefully distinguishing corporate higher-ups and the global market from local jobs). Instead, they plowed ahead with an a priori model of wilderness preservation, creating a backlash against outsider interference. Preserving the north woods doesn't have to come at the expense of Mainers' way of life, but they won't believe that unless they can be given some sort of "ownership" in the process and outcome.
Stentor Danielson, 10:06, ,