A recent theme in American-Israeli relations has been the supposed breakdown of a long history of trust with the election and policies of the Obama administration. A salient example of this is at http://www.politico.com/news/stories/1110/45471.html.
The article is insightful for a number of reasons, not all intentional. The sources of the quotes in the article almost all come from the Israeli political and foreign policy establishment (the exception is a block of five sentences on page 5 of the article that reports the opinions of two Palestinian leaders). So if we accept that caveat, the premise of the article, "View from the Middle East: President Obama Is A Problem," becomes instead, "View from the Israeli Government: President Obama Is A Problem," and which seems fairly accurate.
There is a significant break between politicians and the public on the wide range of crucial issues. A poll of Israeli attitudes from April 2010 exemplifies this break:
http://www.worldpublicopinion.org/pipa/articles/brmiddleeastnafricara/659.php?nid=&id=&pnt=659&lb=brme
The first table in particular demonstrates that a large majority of Israelis would trade not only settlement expansion, but most of the settlements, for peace, while only a minority believes that most Israelis would agree with that position. So the current Israeli policy is far to the right of Israeli public opinion, and, unsurprisingly, we see that the Israeli government is undemocratic. Furthermore, settling one's civilian population on occupied territory is itself a war crime under the Fourth Geneva Convention of 1949, Article 49:
http://en.wikipedia.org/wiki/Fourth_Geneva_Convention
Remember that this law were enshrined after World War II in order to prevent the worst atrocities of Nazi Germany and imperial Japan; therefore, it should greatly concern the United States when its closest ally is breaking this law.
One should also note that the aforementioned opinions are in accord with the consensus both internationally and within Israel and occupied Palestine as to how to solve the conflict. See page 16 of this report:
http://www.worldpublicopinion.org/pipa/pdf/sep10/IsPal_Sep10_rpt.pdf
To quote the relevant sections:
"Establishing a viable, sovereign state is the top priority for Palestinians, and the proposal “two states for two peoples – Israel and Palestine” is widely accepted by both publics. This option was found satisfactory by about three-fifths of both Palestinians (63%) and Israelis (61%) and unacceptable by about one-fifth of each public
(Peace Polls, 2/09 – see Table 4.1).3 Recently, a Truman Institute survey (3/1-14/10) found a
larger majority of Israelis (71%) than Palestinians (57%) support the “two-state solution” based
on “the establishment of a Palestinian state alongside Israel.” Surveys by the Institute for
National Security Studies have found that Israeli support for the “two states for two peoples”
concept (64% in 5/09) has run about 10 points higher than support for “the establishment of a
Palestinian state” (53% in 5/09). Two-thirds of Palestinians (68%) support going to the U.N. to
gain recognition for an “independent Palestinian state within the 1967 borders” (AWRAD,
12/09).
Peace Polls (2/09) found much less support among Israelis and Palestinians for a single “binational
federal state in which Israelis and Palestinians share power.” This option was found
unacceptable by 59 percent of Palestinians and 66 percent of Israelis (Table 4.1). Truman
Institute surveys (3/10) found two-thirds or more of both Palestinians (69%) and Israelis (70%)
oppose a “one-state solution for two peoples” in which Palestinians and Israelis would have
equal rights."
So, the factual "View from the Middle East" is that people of both countries want a two-state solution along the lines of UN Resolution 242, the dominant framework since 1967.
Bringing the discussion back to the main topic of this post, what is notable is the extent to which Obama's policies have mirrored those of GW Bush while media outlets (the Politico article is emblematic) seem to accept the premise that Israeli-American relations are much weaker now due to Obama's missteps. The current paradigm is GW Bush's Road Map to Peace, an agreement reached during his administration that stipulates:
"As first steps, Israel must immediately dismantle what are called settlement "outposts," extensions of Israeli colonies built in the Palestinian territories, and Palestinian leaders must immediately curb terrorism and take steps toward a democratic, accountable government." (http://www.cfr.org/publication/7738/middle_east.html).
Please note both that this language is democratic insofar as it is in line with global public opinion and significantly to the left of Obama's actual actions, which are mentioned in the Politico article.
Why then would Obama be perceived as harming Israeli-American relations compared to GW Bush, who was ostensibly much more at odds with the Israeli positions advocated in this article.
Israeli policies may have themselves become more untenable. There is an excellent analysis in the book "This Time We Went Too Far," about the Gaza War and its ramifications, including the Goldstone Report. It is a quick read (<200 pages) that I highly recommend. I think it is wrong to note that Obama's domestic politics or party affiliation (e.g., "Republicans are the party of national security") cause this putative change in media coverage, considering the orgasm of adulation greeting Clinton's various efforts in Israel-Palestine and Obama's even better command of the media and global public opinion just two years ago.
Virginia's New Anti-Abortion Law Will Increase Maternal Mortality
This bill (First-Trimester Abortion Clinics Should Be Regulated as Hospitals, http://www.washingtonpost.com/wp-dyn/content/article/2011/02/24/AR2011022407874.html) is not about protection of women, for access to legal abortion DECREASES maternal mortality. The American Medical Association has closely studied the decrease in maternal mortality due to abortion before and after Roe v. Wade:
"Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 death per 100 000 procedures), reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The risk of death from legal abortion is higher among minority women and women over the age of 35 years, and increases with gestational age. Legal-abortion mortality between 1979 and 1985 was 0.6 death per 100 000 procedures, more than 10 times lower than the 9.1 maternal deaths per 100 000 live births between 1979 and 1986."
http://jama.ama-assn.org/content/268/22/3231.abstract
Only a licensed physician is allowed to provide abortions in Virginia (http://law.findlaw.com/state-laws/abortion/virginia/). So abortion clinics are indeed already regulated, as one would expect.
This bill does not change any requirements in terms of the actual abortion. The bill would change nothing except restricting access.
According to foxnews.com:
"Virginia took a big step Thursday toward eliminating most of the state's 21 abortion clinics, approving a bill that would likely make rules so strict the medical centers would be forced to close, Democrats and abortion rights supporters said. Gov. Bob McDonnell, a Republican and Catholic, supports the measure and when he signs it into law, Virginia will become the first state to require clinics that provide first-trimester abortions to meet the same standards as hospitals. The requirements could include anything from expensive structural changes like widening hallways to increased training and mandatory equipment the clinics currently don't have. While abortion providers must be licensed in Virginia, the clinics resemble dentists' offices and are considered physicians offices, similar to those that provide plastic and corrective eye surgeries, colonoscopies and a host of other medical procedures."
http://www.foxnews.com/politics/2011/02/25/virginia-approves-likely-close-abortion-clinics/
If government officials want to protect women and children there are plenty of ways to do so. But in this case, "pro-life" has the usual ideological meaning: legislation that will increase maternal deaths, coming from the party claiming to abhor the governmental abridgment of freedom, and coated in the Orwellian rhetoric of "protecting women."
"Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 death per 100 000 procedures), reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The risk of death from legal abortion is higher among minority women and women over the age of 35 years, and increases with gestational age. Legal-abortion mortality between 1979 and 1985 was 0.6 death per 100 000 procedures, more than 10 times lower than the 9.1 maternal deaths per 100 000 live births between 1979 and 1986."
http://jama.ama-assn.org/content/268/22/3231.abstract
Only a licensed physician is allowed to provide abortions in Virginia (http://law.findlaw.com/state-laws/abortion/virginia/). So abortion clinics are indeed already regulated, as one would expect.
This bill does not change any requirements in terms of the actual abortion. The bill would change nothing except restricting access.
According to foxnews.com:
"Virginia took a big step Thursday toward eliminating most of the state's 21 abortion clinics, approving a bill that would likely make rules so strict the medical centers would be forced to close, Democrats and abortion rights supporters said. Gov. Bob McDonnell, a Republican and Catholic, supports the measure and when he signs it into law, Virginia will become the first state to require clinics that provide first-trimester abortions to meet the same standards as hospitals. The requirements could include anything from expensive structural changes like widening hallways to increased training and mandatory equipment the clinics currently don't have. While abortion providers must be licensed in Virginia, the clinics resemble dentists' offices and are considered physicians offices, similar to those that provide plastic and corrective eye surgeries, colonoscopies and a host of other medical procedures."
http://www.foxnews.com/politics/2011/02/25/virginia-approves-likely-close-abortion-clinics/
If government officials want to protect women and children there are plenty of ways to do so. But in this case, "pro-life" has the usual ideological meaning: legislation that will increase maternal deaths, coming from the party claiming to abhor the governmental abridgment of freedom, and coated in the Orwellian rhetoric of "protecting women."
Virginia's 'Pro-Child' Policies
Today the Virginia legislature passed a "bill [that] requires all facilities that perform five or more first-trimester abortions each month to be categorized as hospitals" (http://www.foxnews.com/politics/2011/02/24/virginia-votes-regulate-abortion-clinics-like-hospitals/).
Just to be clear, would this effectively shut down all abortion clinics in Virginia?
We might take this announcement seriously if it were consistent with Virginia's other 'pro-child' policies:
"Some of McDonnell's most significant cuts would come in funding for social-service programs for 1,400 at-risk children. He proposed eliminating services to those who have gone through the juvenile justice system and those who are mentally ill, saving the state $5 million. Children in foster care and special education would still be served. Legislators adopted a two-year, $78 billion budget in the spring that cut millions from education, health care and public safety - curtailing state spending more aggressively than any in generations. But by June, Virginia ended the fiscal year with a surplus of about $404 million" (http://www.washingtonpost.com/wp-dyn/content/article/2010/12/17/AR2010121706791_2.html?sid=ST2010031501317).
Just to be clear, would this effectively shut down all abortion clinics in Virginia?
We might take this announcement seriously if it were consistent with Virginia's other 'pro-child' policies:
"Some of McDonnell's most significant cuts would come in funding for social-service programs for 1,400 at-risk children. He proposed eliminating services to those who have gone through the juvenile justice system and those who are mentally ill, saving the state $5 million. Children in foster care and special education would still be served. Legislators adopted a two-year, $78 billion budget in the spring that cut millions from education, health care and public safety - curtailing state spending more aggressively than any in generations. But by June, Virginia ended the fiscal year with a surplus of about $404 million" (http://www.washingtonpost.com/wp-dyn/content/article/2010/12/17/AR2010121706791_2.html?sid=ST2010031501317).
Economic Globalization: The Homogenization of Culture and the Destruction of Public Health
This topic points to a number of issues. I will address: 1) the definition of globalization, focusing on economic globalization; and 2) the effects/risks of globalization, with particular attention to their implications for global public health.
Definition
One definition of globalization is provided by global capitalists and embodied in the meeting of the World Economic Forum in Davos, Switzerland, where capitalists coalesce to share ideas and network about production, investments and economics. The type of globalization supported by these people is referred to by Nobel Prize-winning economist Joseph Stiglitz as “economic globalization” (2007:4) or neoliberalization. These rules were famously enunciated by World Bank economist John Williamson (2000:252-253) as:
• “Fiscal discipline
• A redirection of public expenditure priorities toward fields offering both high economic returns and the potential to improve income distribution, such as primary health care, primary education, and infrastructure
• Tax reform (to lower marginal rates and broaden the tax base)
• Interest rate liberalization
• A competitive exchange rate
• Trade liberalization
• Liberalization of inflows of foreign direct investment
• Privatization
• Deregulation (to abolish barriers to entry and exit)
• Secure property rights”
In this paradigm, cultures are homogenized due to power imbalances, as dominant American (or Western) culture diffuses globally. This form of globalization is not only feasible, but in current operation.
Effects/Risks
The harsh consequences of these policies for poor countries are well documented. Chang points out that “since the 1980s, [Africa ] has seen a fall in living standards. This record is a damning indictment of the neo-liberal [sic] orthodoxy, because most of the African economies have been practically run by the IMF and the World Bank over the past quarter century” (2007:28) (italics in original). In a sickening twist that reveals the true motives of globalization, “practically all of today’s developed countries, including Britain and the US, the supposed homes of the free market and free trade, have become rich on the basis of policy recipes that go against the orthodoxy of neo-liberal [sic] economics” (2007:15).
The effects on the supplies and distribution of global pharmaceuticals have been horrendous. The Agreement on Trade Related Aspects of International Property Rights (TRIPS) expands American patent laws worldwide through the World Trade Organization (Delgado 2002:297-298). Using TRIPS, American corporations have been able to force intellectual property laws on developing nations, which increases profits through two primary mechanisms (Zerbe 298-300). First, American corporate patents are extended to poor nations, preventing generic development. Second, local knowledge can be patented, distributed and sold around the world without any remuneration for indigenous people. Unlike the earlier intellectual property regime, “the advanced industrial countries could at last use trade sanctions to legally enforce intellectual property rights” (Stiglitz 2007:117). Now, fines can be leveled on countries or corporations that violate TRIPS rules. TRIPS regulations regarding AIDS and other tropical disease drugs are a particularly insidious form of globalization, with large, rich corporations supported by their governments attempting to sabotage the development of generic life-saving drugs. It is likely that “if the issue of access to AIDS drugs were put to a vote, in either developed or developing countries, the overwhelming majority would never support the position of the pharmaceutical companies or of the” American government (Stiglitz 2007:132).
In her 2001 book, Betrayal of Trust: The Collapse of Global Public Health (2001), Laurie Garrett describes the effects of economic globalization on the people and public health systems of the ex-Soviet countries. After the collapse of the Soviet Union, “overnight millions of workers lost their jobs, and the majority of the people residing in the Eastern Bloc and former Soviet Union fell into poverty – perhaps 25 percent of them were, according to UNICEF, living in acute poverty within eighteen months of the breakup of the Soviet Union” (2001:166). In response, and on the advice of American policymakers, Russia embraced economic globalization, which “can claim credit for the impoverishment of 72 million people in only eight years” (Klein 2007:237-238) (italics in original). An astonishing number of Russians desperately turned to alcohol. “Some estimates were that eighty percent of all Russian men were alcoholics, consuming in 1999 – on average – 600 grams of booze a day, or roughly three liters of vodka every week. The male alcohol poisoning death rate in Russia was about 200 times that of the United States” (Garrett 2001:138) (italics in original). The consequences for the children of Russia were terrifying. “In late 1998 the University of North Carolina conducted a survey that revealed that all – 100 percent – of Russian children suffered iron deficiencies, most having only 3 to 4 percent of minimum daily requirement needs met in their terrible diets” (2001:169) (italics in original). Similarly, “in 1997 the Moscow Human Rights Research Center estimated that there were a million homeless children in Russia; the government said 700,000. No one knew how many more children had parents in homes but were left largely to survive on their own because of their parents’ alcoholism. In Russia a term was coined to describe these kids: the Lost Generation” (2001:140).
The consequences to the United States of embracing neoliberal globalization are being manifested most notably in the current recession. As Smith (2009) notes: “The economic crisis is far too fresh for any government agency or professional organization to have quantified the health consequences. But during previous recessions, researchers linked spikes in unemployment in the United States and Europe to increases in deaths from heart disease, cancer, and psychiatric disorders.” Yet the current recession tells only an incomplete story, for one should not forget the disastrous state of the profit-motivated American health care system, which I detailed in an earlier post.
Tabb (2008) contends that the primary implication of the current recession for American society has been a reexamination of the ideology of economic globalization. Indeed, if, as Krugman (2009) predicts, Keynesianism will return to the fore, this may strengthen American economic hegemony through more stable state capitalism, protectionism and regulation. The outcomes are unpredictable but unlikely to be beneficial to the Third World due to inequalities in economic and political power. Regardless of which direction the future will take the American economy relative to the world, the 2008 financial crisis heralds dramatic changes for globalization and public health both here and abroad.
Bibliography
Chang, Ha-Joon. 2007. Bad Samaritans: The Myth of Free Trade and the Secret History of Capitalism. Bloomsbury.
Delgado, Gian Carlo. 2002. “Biopi®acy and Intellectual Property as the Basis for Biotechnological Development: The Case of Mexico.” International Journal of Politics, Culture and Society 16(2):297-318.
Garrett, Laurie. 2001. Betrayal of Trust: The Collapse of Global Public Health. Hyperion.
Klein, Naomi. 2007. The Shock Doctrine: The Rise of Disaster Capitalism. Metropolitan.
Krugman, Paul. 2009. “How Did Economists Get It So Wrong?” New York Times Magazine. September 6.
Smith, Stephen. 2009. “The Ailing Economy Is Making People Sicker.” Boston Globe. January 25.
Stiglitz, Joseph. 2007. Making Globalization Work. WW Norton.
Tabb, William K. “Four Crises of the Contemporary World Capitalist System.” Monthly Review. October 2008.
Vreeland, James. 2006. The International Monetary Fund: Politics of Conditional Lending. Routledge.
Williamson, John. 2000. “What Should the World Bank Think about the Washington Consensus?” The World Bank Research Observer 15(2):251-264.
Zerbe, Noah. “Contested Ownership: TRIPs, CBD, and Implications for Southern African Biodiversity.” Perspectives on Global Development and Technology 1(3-4):294-321. 2002.
Taxing the Rich: Democracy or Tyranny?
The idea that the rich should be taxed more heavily than the poor is common both in practice and in theory.
For example, under the great conservatives Ronald Reagan, the income of the highest-earning Americans was taxed progressively (28%), while the poorest paid no incomes taxes. His policies were precisely in line with one of the doctrines of the Communist Party, i.e. "2. A heavy progressive or graduated income tax" (Marx and Engels. "The Communist Manifesto." Penguin Classics. 1985 ed. p. 104). Furthermore, according to reliable polls (e.g., Gallup: http://www.gallup.com/pollreasing-Taxes-Rich.aspx ), taxing the rich more heavily than the poor is supported by the majority of the American people and is thus consistent with democracy.
If wealth were distributed commensurate to people's work ethics or intelligence we would expect a society in which wealth was distributed as a bell curve. However, "even after incurring large losses in 2008, the wealthiest 0.01 percent of households held 5 percent of total income" (http://www.cbpp.org/cms/index.cfm?fa=view&id=3309 ) and the richest "95% of children born to parents in the bottom 6% of wealthholders [sic] will end up as poor [lowest 18%] adults. Children who start out life born to parents in the bottom 6% of wealthholders [sic] have only one-half of 1% chance of ending up even in the upper half of wealthholders [sic]" (McNamee. "The Meritocracy Myth." Rowman and Littlefield. 2004. p. 56).
So, if one is honest about it, one might say:
"The system of progressive taxation of the rich to fund social programs was carried out by Ronald Reagan. His policies were in line both with the visions of the intellectual fathers of the Communist Party and with the vast majority of the American people. However, I reject the democratic socialist policies of the foremost conservative president in American history and instead prefer that my government was more authoritarian and less responsive to the will of its citizens, because in my view, soldiers, health care workers, the elderly, the poor, women with infants, schoolchildren, college students, people who drive and receive mail, and others who benefit from social programs paid for by progressive taxation are stealing money from the richest people in our society, whose financial system was given trillions of dollars in slush funds (Stiglitz. "Freefall: America, Free Markets, and the Sinking of the World Economy." 2010. WW Norton. p. 110), who are bankrupting the country, and who threw tens of millions of Americans as well as hundreds of millions of people worldwide into poverty. I do not even believe in the more radical idea of a flat tax, far too radical for Reagan, for the rich would still be taxed more than the poor, but rather believe that everybody should pay the same, for example, $100 a month, from the invalid to Bill Gates, who "has as much wealth as the bottom 40% of American households" (Thurow. Building Wealth: The New Rules for Individuals, Companies, and Nations in a Knowledge-Based Economy." Harper. 2000. p. 130), who was born into a rich family, and whose company would not exist if the computer was not invented through massive government intervention in the economy. In my mind, such a system would be called fairness."
In reality, such a system is called anarchy, and it is a boy's dream.
For example, under the great conservatives Ronald Reagan, the income of the highest-earning Americans was taxed progressively (28%), while the poorest paid no incomes taxes. His policies were precisely in line with one of the doctrines of the Communist Party, i.e. "2. A heavy progressive or graduated income tax" (Marx and Engels. "The Communist Manifesto." Penguin Classics. 1985 ed. p. 104). Furthermore, according to reliable polls (e.g., Gallup: http://www.gallup.com/poll
If wealth were distributed commensurate to people's work ethics or intelligence we would expect a society in which wealth was distributed as a bell curve. However, "even after incurring large losses in 2008, the wealthiest 0.01 percent of households held 5 percent of total income" (http://www.cbpp.org/cms/in
So, if one is honest about it, one might say:
"The system of progressive taxation of the rich to fund social programs was carried out by Ronald Reagan. His policies were in line both with the visions of the intellectual fathers of the Communist Party and with the vast majority of the American people. However, I reject the democratic socialist policies of the foremost conservative president in American history and instead prefer that my government was more authoritarian and less responsive to the will of its citizens, because in my view, soldiers, health care workers, the elderly, the poor, women with infants, schoolchildren, college students, people who drive and receive mail, and others who benefit from social programs paid for by progressive taxation are stealing money from the richest people in our society, whose financial system was given trillions of dollars in slush funds (Stiglitz. "Freefall: America, Free Markets, and the Sinking of the World Economy." 2010. WW Norton. p. 110), who are bankrupting the country, and who threw tens of millions of Americans as well as hundreds of millions of people worldwide into poverty. I do not even believe in the more radical idea of a flat tax, far too radical for Reagan, for the rich would still be taxed more than the poor, but rather believe that everybody should pay the same, for example, $100 a month, from the invalid to Bill Gates, who "has as much wealth as the bottom 40% of American households" (Thurow. Building Wealth: The New Rules for Individuals, Companies, and Nations in a Knowledge-Based Economy." Harper. 2000. p. 130), who was born into a rich family, and whose company would not exist if the computer was not invented through massive government intervention in the economy. In my mind, such a system would be called fairness."
In reality, such a system is called anarchy, and it is a boy's dream.
David Brooks is a God Damn Clown
Does David Brooks have any serious economic qualifications, or does writing for the New York Times give such credibility that we are expected to be blinded to his clownishness?
My comments are in [brackets].
Make Everybody Hurt
http://www.nytimes.com/2011/02/22/opinion/22brooks.html?_r=1&hp
Over the past few weeks we’ve begun to see the new contours of American politics [what evidence do you have of this?]. The budget cutters have taken control of the agenda, while government’s defenders are waging tactical retreats. Given the scope of the fiscal problems, it could be like this for the next 10 or 20 years [where do these numbers come from? 10 or 20?].
No place is hotter than Wisconsin. The leaders there have done everything possible to maximize conflict [really? this sentence means nothing]. Gov. Scott Walker, a Republican, demanded cuts only from people in the other party [All people in unions are Democrats?]. The public sector unions and their allies immediately flew into a rage, comparing Walker to Hitler, Mussolini and Mubarak [evidence?].
Walker’s critics are amusingly Orwellian. They liken the crowd in Madison to the ones in Tunisia and claim to be fighting for democracy. Whatever you might say about Walker, he and the Republican majorities in Wisconsin were elected [does this therefore justify everything an elected official does? doesn't Brooks make his career based on criticizing politicians?], and they are doing exactly what they told voters they would do [when did he tell voters he would end collective bargaining?]. It’s the Democratic minority that is thwarting the majority will by fleeing to Illinois. It’s the left that has suddenly embraced extralegal obstructionism [which laws have they broken?].
Still, let’s [who?] try to put aside the hyperventilation. Everybody [who?] now seems to agree that Governor Walker was right to ask state workers to pay more for their benefits. Even if he gets everything he asks for, Wisconsin state workers would still be contributing less to their benefits than the average state worker nationwide and would be contributing far, far less than private sector workers [those greedy teachers!].
The more difficult question is whether Walker was right to try to water down Wisconsin’s collective bargaining agreements. Even if you acknowledge the importance of unions in representing middle-class interests, there are strong arguments on Walker’s side [yeah, fuck the middle class!]. In Wisconsin and elsewhere, state-union relations are structurally out of whack [yeah, fuck the unions! they must have caused these massive deficits, right?].
That’s because public sector unions and private sector unions are very different creatures. Private sector unions push against the interests of shareholders and management; public sector unions push against the interests of taxpayers [those greedy teachers! i wish we didn't have to pay them anything!]. Private sector union members know that their employers could go out of business, so they have an incentive to mitigate their demands; public sector union members work for state monopolies and have no such interest [the premise of this entire article is flawed. did the unions cause this recession?].
Private sector unions confront managers who have an incentive to push back against their demands. Public sector unions face managers who have an incentive to give into them for the sake of their own survival [survival?]. Most important, public sector unions help choose those they negotiate with. Through gigantic campaign contributions and overall clout, they have enormous influence over who gets elected to bargain with them, especially in state and local races [the unions are the puppet masters? that must be why they're getting slammed by the political establishment, even though you just noted that 'Everybody now seems to agree that Governor Walker was right to ask state workers to pay more for their benefits.'].
As a result of these imbalanced incentive structures, states with public sector unions tend to run into fiscal crises [every state in the country is in a fiscal crisis because tax revenues have decreased due to the recession]. They tend to have workplaces where personnel decisions are made on the basis of seniority, not merit [evidence?]. There is little relationship between excellence and reward, which leads to resentment among taxpayers who don’t have that luxury [is there any evidence of this theory?].
Yet I think Governor Walker made a strategic error in setting up this confrontation as he did. The debt problems before us are huge. Even in Wisconsin they cannot be addressed simply by taking on the public sector unions [but we should take them on anyways??]. Studies done in North Carolina and elsewhere suggest that collective bargaining only increases state worker salaries by about 5 percent or 6 percent. That’s not nearly enough to explain current deficits. There are many states without collective bargaining that still face gigantic debt crises [oh wait, didn't you just say that 'As a result of these imbalanced incentive structures, states with public sector unions tend to run into fiscal crises?' hmm...maybe something else is going on here. Oh well, time to move on!].
Getting state and federal budgets under control will take decades [evidence?]. It will require varied, multipronged approaches, supported by broad and shifting coalitions [like cutting unions?]. It’s really important [like, really important] that we [who?] establish an unwritten austerity constitution [how the fuck would this work?]: a set of practices that will help us cut effectively now and in the future [what happened to the union-bashing?].
The foundation of this unwritten constitution has to be this principle: make everybody hurt [especially the teachers' unions and the poor! but not the bankers! it's called 'democracy'!]. The cuts have to be spread more or less equitably among as many groups as possible. There will never be public acceptance if large sectors of society are excluded [so is it everybody or is it large sectors?]. Governor Walker’s program fails that test. It spares traditional Republican groups (even cops and firefighters). It is thus as unsustainable as the current tide of red ink [is this economics or politics? where is he grounding this analysis?].
Moreover, the constitution must emphasize transparent evaluation [the unwritten one, right?]. Over the past weeks, Governor Walker increased expenditures to pump up small business job creation and cut them on teacher benefits. That might be the right choice, but if voters are going to go along with choices such as these, there is going to have to be a credible evaluation process to explain why some things are cut and some things aren’t [oh yeah, but i thought the voters elected Walker, so that is democracy, so then, if people criticize his decisions they must be anti-democratic. what happened to that line of argument?].
So I’d invite Governor Walker and the debt fighters everywhere to think of themselves as founding fathers of austerity [oh say can you see?]. They are not only balancing budgets, they are setting precedent for a process that will last decades [or like, you know, 10 or 20 years]. By their example, they have to create habits that diverse majorities can respect and embrace. The process has to be balanced. It has to make everybody hurt [and ignore the causes of the recession].
My comments are in [brackets].
Make Everybody Hurt
http://www.nytimes.com/2011/02/22/opinion/22brooks.html?_r=1&hp
Josh Haner/The New York Times
No place is hotter than Wisconsin. The leaders there have done everything possible to maximize conflict [really? this sentence means nothing]. Gov. Scott Walker, a Republican, demanded cuts only from people in the other party [All people in unions are Democrats?]. The public sector unions and their allies immediately flew into a rage, comparing Walker to Hitler, Mussolini and Mubarak [evidence?].
Walker’s critics are amusingly Orwellian. They liken the crowd in Madison to the ones in Tunisia and claim to be fighting for democracy. Whatever you might say about Walker, he and the Republican majorities in Wisconsin were elected [does this therefore justify everything an elected official does? doesn't Brooks make his career based on criticizing politicians?], and they are doing exactly what they told voters they would do [when did he tell voters he would end collective bargaining?]. It’s the Democratic minority that is thwarting the majority will by fleeing to Illinois. It’s the left that has suddenly embraced extralegal obstructionism [which laws have they broken?].
Still, let’s [who?] try to put aside the hyperventilation. Everybody [who?] now seems to agree that Governor Walker was right to ask state workers to pay more for their benefits. Even if he gets everything he asks for, Wisconsin state workers would still be contributing less to their benefits than the average state worker nationwide and would be contributing far, far less than private sector workers [those greedy teachers!].
The more difficult question is whether Walker was right to try to water down Wisconsin’s collective bargaining agreements. Even if you acknowledge the importance of unions in representing middle-class interests, there are strong arguments on Walker’s side [yeah, fuck the middle class!]. In Wisconsin and elsewhere, state-union relations are structurally out of whack [yeah, fuck the unions! they must have caused these massive deficits, right?].
That’s because public sector unions and private sector unions are very different creatures. Private sector unions push against the interests of shareholders and management; public sector unions push against the interests of taxpayers [those greedy teachers! i wish we didn't have to pay them anything!]. Private sector union members know that their employers could go out of business, so they have an incentive to mitigate their demands; public sector union members work for state monopolies and have no such interest [the premise of this entire article is flawed. did the unions cause this recession?].
Private sector unions confront managers who have an incentive to push back against their demands. Public sector unions face managers who have an incentive to give into them for the sake of their own survival [survival?]. Most important, public sector unions help choose those they negotiate with. Through gigantic campaign contributions and overall clout, they have enormous influence over who gets elected to bargain with them, especially in state and local races [the unions are the puppet masters? that must be why they're getting slammed by the political establishment, even though you just noted that 'Everybody now seems to agree that Governor Walker was right to ask state workers to pay more for their benefits.'].
As a result of these imbalanced incentive structures, states with public sector unions tend to run into fiscal crises [every state in the country is in a fiscal crisis because tax revenues have decreased due to the recession]. They tend to have workplaces where personnel decisions are made on the basis of seniority, not merit [evidence?]. There is little relationship between excellence and reward, which leads to resentment among taxpayers who don’t have that luxury [is there any evidence of this theory?].
Yet I think Governor Walker made a strategic error in setting up this confrontation as he did. The debt problems before us are huge. Even in Wisconsin they cannot be addressed simply by taking on the public sector unions [but we should take them on anyways??]. Studies done in North Carolina and elsewhere suggest that collective bargaining only increases state worker salaries by about 5 percent or 6 percent. That’s not nearly enough to explain current deficits. There are many states without collective bargaining that still face gigantic debt crises [oh wait, didn't you just say that 'As a result of these imbalanced incentive structures, states with public sector unions tend to run into fiscal crises?' hmm...maybe something else is going on here. Oh well, time to move on!].
Getting state and federal budgets under control will take decades [evidence?]. It will require varied, multipronged approaches, supported by broad and shifting coalitions [like cutting unions?]. It’s really important [like, really important] that we [who?] establish an unwritten austerity constitution [how the fuck would this work?]: a set of practices that will help us cut effectively now and in the future [what happened to the union-bashing?].
The foundation of this unwritten constitution has to be this principle: make everybody hurt [especially the teachers' unions and the poor! but not the bankers! it's called 'democracy'!]. The cuts have to be spread more or less equitably among as many groups as possible. There will never be public acceptance if large sectors of society are excluded [so is it everybody or is it large sectors?]. Governor Walker’s program fails that test. It spares traditional Republican groups (even cops and firefighters). It is thus as unsustainable as the current tide of red ink [is this economics or politics? where is he grounding this analysis?].
Moreover, the constitution must emphasize transparent evaluation [the unwritten one, right?]. Over the past weeks, Governor Walker increased expenditures to pump up small business job creation and cut them on teacher benefits. That might be the right choice, but if voters are going to go along with choices such as these, there is going to have to be a credible evaluation process to explain why some things are cut and some things aren’t [oh yeah, but i thought the voters elected Walker, so that is democracy, so then, if people criticize his decisions they must be anti-democratic. what happened to that line of argument?].
So I’d invite Governor Walker and the debt fighters everywhere to think of themselves as founding fathers of austerity [oh say can you see?]. They are not only balancing budgets, they are setting precedent for a process that will last decades [or like, you know, 10 or 20 years]. By their example, they have to create habits that diverse majorities can respect and embrace. The process has to be balanced. It has to make everybody hurt [and ignore the causes of the recession].
Animal Exploitation in Theory and Practice: Validating The Maxim of the Dominant
Major philosophers with significant ethical differences on human rights agree on the morality of animal exploitation . Aristotle outlined a hierarchical “ladder of life,” “reflecting degrees of perfection, and ranging from the zoophytes to man” (Bynum 1975:4). Moreover, “in his Politics, Aristotle wrote that ‘animals existed for the sake of man’ and nature made all animals for his sake,” principles echoed in the Talmud and Bible (Patterson 2002:18). However, ‘might makes right’ is the maxim of the powerful and ethically invalid in Aristotle’s conception of human affairs (Sandel 2009:193). Moral dilemmas at the limits of debate help illuminate ethical principles (Bayer and Fairchild 2004:475; Sandel 2009:24). This paper will examine two case studies with public health implications: experimenting on and eating animals.
Case Study 1: Experimenting on Animals
Human and animal experimentation provide stark ethical contrasts. The medical experiments practiced on Nazi victims are, to this author’s knowledge, essentially universally condemned. Arising out of this exploitation “was the basic belief that no individual should be required to participate in research endeavours [sic] – no matter how important for the public good – without his or her informed consent” (Bayer and Fairchild 2004:474).
Obtaining informed consent from those with whom one cannot communicate is obviously problematic. Yet in answering Kant’s self-imposed query on morality, he ventures that all humans, as de facto rational beings, would conclude that human rights are universal (Sandel 2009:122). (Interestingly, Sandel concedes that “most animals” are not rational (2009:109) while on the previous page contending that rationality “make[s] us distinctive, and set[s] us apart from mere animal existence” (2009:108).) Indeed, Rawls comes to the same conclusion, with his own cogito: I am human; therefore I want universal human rights, e.g., justice (Sandel 2009:141). Speaking for all humans who have ever lived or will live is unproblematic for these theorists; thus, surmising the will of other animals is well within the bounds of their ruminations. It is no more a cognitive leap to argue that human experimentation is a violation of elementary moral principles than it is to maintain that animal experimentation is, too.
Legalized animal experimentation in the United States is in accord with public opinion: 59% support and 34% oppose the practice (Gallup 2010). Furthermore, the ethics of animal experimentation is contested even within the animal rights movement. For example, Marcus (2005:220-221) argues that activists should avoid criticism of animal experimentation for tactical reasons, in order to focus public opinion on more egregious abuses.
Bentham provides an important counterpoint to Aristotelian disciples. He contends (1907: Chapter 17, note 122):
What else is it that should trace the insuperable line? Is it the faculty of reason, or, perhaps, the faculty of discourse? But a full-grown horse or dog is beyond comparison a more rational, as well as a more conversable animal, than an infant of a day, or a week, or even a month, old. But suppose the case were otherwise, what would it avail? the [sic] question is not, Can they reason? nor [sic], Can they talk? but [sic], Can they suffer?
Lethal animal experimentation has yielded vaccines that have saved millions of human lives. According to Chomsky (2003:49), “those who are seriously interested in understanding the world will adopt the same standards whether they are evaluating their own political and intellectual elites or those of official enemies.” Extending his argument, is it ethical to torture millions of humans to save the lives of millions of anything?
Sandel (2009:33-34) reveals another utilitarian critique of sanctioning torture or murder even if more lives are saved. “Allowing such a killing might have bad consequences for society as a whole – weakening the norm against murder.” Sharing this viewpoint, Patterson (2002:12) plausibly argues that “the violation of animals expedited the violation of human beings.” Thus, animal experimentation might weaken humanity’s moral code and outweigh the medical benefits.
Case Study 2: Eating Animals
Animal rights are closely linked with public health. The connections between disease and eating red meat are well known. Thorogood, et al. (1994:1669) conclude that there is a “roughly 40% reduction in mortality from cancer in vegetarians and fish eaters compared with meat eaters.” The American Heart Association website (2011) states that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease…, high blood pressure, diabetes mellitus and some forms of cancer.” Specifically, red meat consumption is correlated with higher rates of colorectal, esophageal, liver and lung cancers (Cross, et al. 2007). Consequently, the American Heart Association (Lichtenstein, et al. 2006:83-85) advocates replacing red with lean meats, while limiting processed meat (bacon, hot dogs, sausage, etc.), while the American Institute for Cancer Research (2010:18) recommends that individuals limit their consumption of red meats and avoid processed red meats entirely. Even accepting the dictum of the dominant, it is unclear that humankind benefits from eating animals.
The theory and practice of animal exploitation reinforce each other. Contemporary Americans implicitly accept Aristotle’s premise: currently, it is estimated that only 3.2% of American adults are vegetarians and 0.5% vegans (Vegetarian Times 2008). Although the percent of vegetarians who become so because of concern over animal welfare is unknown, two samples (n<100) have estimated the proportion at approximately one half (Jabs, et al. 1998:196-199; Fox and Ward 2008:427). Additionally, animal welfare has been found to be the salient factor in vegetarians’ decisions to continue not to eat red meat (Lindeman and Väänänen 2000:56).
What of utilitarianism? Bentham (1907: Chapter 17, note 122) contends that killing animals can be morally permissible, since:
They have none of those long-protracted anticipations of future misery which we have. The death they suffer in our hands commonly is, and always may be, a speedier, and by that means a less painful one, than that which would await them in the inevitable course of nature….But is there any reason why we should be suffered to torment them? Not any that I can see.
Clearly killing nine billion (Mercy for Animals 2011) to partially feed three hundred million each year is perverse from a utilitarian perspective and thus the American social contract relegates animals to subhuman status. Or, as Aristotle justified it, “slaves and animals do little for the common good” (quoted in Patterson 2002:19).
Conclusion: Whose Maxim?
Applying the same standards to animals that are applied to humans leaves no doubt that eating and experimenting on animals violates basic principles of morality. However, whether one accepts animal exploitation depends on whether one accepts the credo that ‘might makes right.’ Even if one accepts this maxim and restricts his focus merely to the human species, then the notion that exploiting animals benefits humanity is far from clear.
Class Discussion
Major Question 1: Should universal rights be extended to animals? Why or why not?
Major Question 2: Do you agree or disagree with Aristotle’s “ladder of life?” Is this different from
“might makes right?”
Major Question 3: Even if animals are considered “less” than humans, is it ethical to experiment on
and/or eat animals?
(Insert picture of “ladder of life”)
Minor Question A: What separates humans from other animals? (Kant, Bentham)
Bentham asks (1907: Chapter 17, note 122), “Is it the faculty of reason, or, perhaps, the faculty of discourse? But a full-grown horse or dog is beyond comparison a more rational, as well as a more conversable animal, than an infant of a day, or a week, or even a month, old. But suppose the case were otherwise, what would it avail? the [sic] question is not, Can they reason? nor [sic], Can they talk? but [sic], Can they suffer?”
Minor Question B: If you were to be born as any animal, what would be utopia? (Rawls)
Animal experimentation has yielded vaccines that have saved millions of human lives. However, annually killing nine billion to partially feed three hundred million is ethically dubious.
Minor Question C: Does experimenting on animals violate the principle of informed consent? (relativism)
Human and animal experimentation provide stark ethical contrasts. The medical experiments practiced on Nazi victims are universally condemned. Arising out of this exploitation “was the basic belief that no individual should be required to participate in research endeavours [sic] – no matter how important for the public good – without his or her informed consent” (Bayer and Fairchild 2004:474).
Minor Question D: Does animal exploitation weaken humanity’s moral code? (utilitarianism)
Sandel (2009:33-34) suggests that torture or murder might be unethical even if more lives are saved, as in a ticking bomb scenario. “Allowing such a killing might have bad consequences for society as a whole – weakening the norm against murder.”
Minor Question E: Do the health benefits of eating animals outweigh the consequences? (utilitarianism)
The connections between disease and eating red meat are well known. Thorogood, et al. (1994:1669) conclude that there is a “roughly 40% reduction in mortality from cancer in vegetarians and fish eaters compared with meat eaters.” The American Heart Association website (2011) states that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease…, high blood pressure, diabetes mellitus and some forms of cancer.” Specifically, red meat consumption is correlated with higher rates of colorectal, esophageal, liver and lung cancers (Cross, et al. 2007).
Bibliography
American Heart Association website. “Vegetarian Diets.” http://www.americanheart.org/presenter.jhtml?
identifier=4777. Accessed January 20, 2011.
American Institute for Cancer Research. “Recommendations for Cancer Prevention.” http://www.aicr.org/
site/DocServer/Guidelines_Brochure.pdf?docID=1550&JServSessionIdr00q3q8xo3ga5.app46a. 2010. Accessed January 20, 2011.
Bayer, Ronald and Amy Fairchild. “The Genesis of Public Health Ethics.” Bioethics 18(6):473-492. 2004.
Bentham, Jeremy. An Introduction to the Principles of Morals and Legislation. Oxford. 1907. http://www.
econlib.org/library/Bentham/bnthPML18.html. Accessed January 20, 2011.
Bynum, William. “The Great Chain of Being after Forty Years: An Appraisal.” History of Science 13:1-28. 1975.
Chomsky, Noam. Hegemony or Survival: America’s Quest for Global Dominance. Metropolitan. 2003.
Cross, Amanda J, Michael F Leitzmann, Mitchell H Gail, Albert R Hollenbeck, Arthur Schatzkin, and Rashmi Sinha. “A Prospective Study of Red and Processed Meat Intake in Relation to Cancer Risk.” PLoS Medicine 4(12). December 2007.
Gallup. “Four Moral Issues Sharply Divide Americans.” http://www.gallup.com/poll/137357/Four-Moral-Issues-Sharply-Divide-Americans.aspx. 2010. Accessed January 23, 2011.
Fox, Nick and Katie Ward. “Health, Ethics and Environment: A Qualitative Study of Vegetarian Motivations.” Appetite 50(2-3):422 - 429. March/May 2008.
Jabs, Jennifer, Carol M Devine and Jeffery Sobal. “Model of the Process of Adopting Vegetarian Diets: Health Vegetarians and Ethical Vegetarians.” Journal of Nutrition Education 30(4):196-202. July/August 1998.
Lichtenstein, Alice H, et al. “Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee.” Circulation 114:82-96. 2006.
Lindeman, M and Väänänen, M. “Measurement of Ethical Food Choice Motives.” Appetite 34:55-59. 2000.
Marcus, Erik. Meat Market: Animals, Ethics & Money. Brio. 2005.
Mercy for Animals. “Vegetarian Leafleting.” http://www.mercyforanimals.org/leafleting.aspx. Accessed January 23, 2011.
Patterson, Charles. Eternal Treblinka: Our Treatment of Animals and the Holocaust. Lantern. 2002.
Sandel, Michael J. Justice: What’s the Right Thing to Do? Farrar, Straus and Giroux. 2009.
Thorogood, M, J Mann, P Appleby and K McPherson. “Risk of Death from Cancer and Ischaemic Heart Disease in Meat and Non-meat eaters.” British Medical Journal 308:1667-1670. June 25, 1994.
Vegetarian Times. “Vegetarianism in America.” http://www.vegetariantimes.com/features/archive_of_
editorial/667. 2008. Accessed January 20, 2011.
Case Study 1: Experimenting on Animals
Human and animal experimentation provide stark ethical contrasts. The medical experiments practiced on Nazi victims are, to this author’s knowledge, essentially universally condemned. Arising out of this exploitation “was the basic belief that no individual should be required to participate in research endeavours [sic] – no matter how important for the public good – without his or her informed consent” (Bayer and Fairchild 2004:474).
Obtaining informed consent from those with whom one cannot communicate is obviously problematic. Yet in answering Kant’s self-imposed query on morality, he ventures that all humans, as de facto rational beings, would conclude that human rights are universal (Sandel 2009:122). (Interestingly, Sandel concedes that “most animals” are not rational (2009:109) while on the previous page contending that rationality “make[s] us distinctive, and set[s] us apart from mere animal existence” (2009:108).) Indeed, Rawls comes to the same conclusion, with his own cogito: I am human; therefore I want universal human rights, e.g., justice (Sandel 2009:141). Speaking for all humans who have ever lived or will live is unproblematic for these theorists; thus, surmising the will of other animals is well within the bounds of their ruminations. It is no more a cognitive leap to argue that human experimentation is a violation of elementary moral principles than it is to maintain that animal experimentation is, too.
Legalized animal experimentation in the United States is in accord with public opinion: 59% support and 34% oppose the practice (Gallup 2010). Furthermore, the ethics of animal experimentation is contested even within the animal rights movement. For example, Marcus (2005:220-221) argues that activists should avoid criticism of animal experimentation for tactical reasons, in order to focus public opinion on more egregious abuses.
Bentham provides an important counterpoint to Aristotelian disciples. He contends (1907: Chapter 17, note 122):
What else is it that should trace the insuperable line? Is it the faculty of reason, or, perhaps, the faculty of discourse? But a full-grown horse or dog is beyond comparison a more rational, as well as a more conversable animal, than an infant of a day, or a week, or even a month, old. But suppose the case were otherwise, what would it avail? the [sic] question is not, Can they reason? nor [sic], Can they talk? but [sic], Can they suffer?
Lethal animal experimentation has yielded vaccines that have saved millions of human lives. According to Chomsky (2003:49), “those who are seriously interested in understanding the world will adopt the same standards whether they are evaluating their own political and intellectual elites or those of official enemies.” Extending his argument, is it ethical to torture millions of humans to save the lives of millions of anything?
Sandel (2009:33-34) reveals another utilitarian critique of sanctioning torture or murder even if more lives are saved. “Allowing such a killing might have bad consequences for society as a whole – weakening the norm against murder.” Sharing this viewpoint, Patterson (2002:12) plausibly argues that “the violation of animals expedited the violation of human beings.” Thus, animal experimentation might weaken humanity’s moral code and outweigh the medical benefits.
Case Study 2: Eating Animals
Animal rights are closely linked with public health. The connections between disease and eating red meat are well known. Thorogood, et al. (1994:1669) conclude that there is a “roughly 40% reduction in mortality from cancer in vegetarians and fish eaters compared with meat eaters.” The American Heart Association website (2011) states that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease…, high blood pressure, diabetes mellitus and some forms of cancer.” Specifically, red meat consumption is correlated with higher rates of colorectal, esophageal, liver and lung cancers (Cross, et al. 2007). Consequently, the American Heart Association (Lichtenstein, et al. 2006:83-85) advocates replacing red with lean meats, while limiting processed meat (bacon, hot dogs, sausage, etc.), while the American Institute for Cancer Research (2010:18) recommends that individuals limit their consumption of red meats and avoid processed red meats entirely. Even accepting the dictum of the dominant, it is unclear that humankind benefits from eating animals.
The theory and practice of animal exploitation reinforce each other. Contemporary Americans implicitly accept Aristotle’s premise: currently, it is estimated that only 3.2% of American adults are vegetarians and 0.5% vegans (Vegetarian Times 2008). Although the percent of vegetarians who become so because of concern over animal welfare is unknown, two samples (n<100) have estimated the proportion at approximately one half (Jabs, et al. 1998:196-199; Fox and Ward 2008:427). Additionally, animal welfare has been found to be the salient factor in vegetarians’ decisions to continue not to eat red meat (Lindeman and Väänänen 2000:56).
What of utilitarianism? Bentham (1907: Chapter 17, note 122) contends that killing animals can be morally permissible, since:
They have none of those long-protracted anticipations of future misery which we have. The death they suffer in our hands commonly is, and always may be, a speedier, and by that means a less painful one, than that which would await them in the inevitable course of nature….But is there any reason why we should be suffered to torment them? Not any that I can see.
Clearly killing nine billion (Mercy for Animals 2011) to partially feed three hundred million each year is perverse from a utilitarian perspective and thus the American social contract relegates animals to subhuman status. Or, as Aristotle justified it, “slaves and animals do little for the common good” (quoted in Patterson 2002:19).
Conclusion: Whose Maxim?
Applying the same standards to animals that are applied to humans leaves no doubt that eating and experimenting on animals violates basic principles of morality. However, whether one accepts animal exploitation depends on whether one accepts the credo that ‘might makes right.’ Even if one accepts this maxim and restricts his focus merely to the human species, then the notion that exploiting animals benefits humanity is far from clear.
Class Discussion
Major Question 1: Should universal rights be extended to animals? Why or why not?
Major Question 2: Do you agree or disagree with Aristotle’s “ladder of life?” Is this different from
“might makes right?”
Major Question 3: Even if animals are considered “less” than humans, is it ethical to experiment on
and/or eat animals?
(Insert picture of “ladder of life”)
Minor Question A: What separates humans from other animals? (Kant, Bentham)
Bentham asks (1907: Chapter 17, note 122), “Is it the faculty of reason, or, perhaps, the faculty of discourse? But a full-grown horse or dog is beyond comparison a more rational, as well as a more conversable animal, than an infant of a day, or a week, or even a month, old. But suppose the case were otherwise, what would it avail? the [sic] question is not, Can they reason? nor [sic], Can they talk? but [sic], Can they suffer?”
Minor Question B: If you were to be born as any animal, what would be utopia? (Rawls)
Animal experimentation has yielded vaccines that have saved millions of human lives. However, annually killing nine billion to partially feed three hundred million is ethically dubious.
Minor Question C: Does experimenting on animals violate the principle of informed consent? (relativism)
Human and animal experimentation provide stark ethical contrasts. The medical experiments practiced on Nazi victims are universally condemned. Arising out of this exploitation “was the basic belief that no individual should be required to participate in research endeavours [sic] – no matter how important for the public good – without his or her informed consent” (Bayer and Fairchild 2004:474).
Minor Question D: Does animal exploitation weaken humanity’s moral code? (utilitarianism)
Sandel (2009:33-34) suggests that torture or murder might be unethical even if more lives are saved, as in a ticking bomb scenario. “Allowing such a killing might have bad consequences for society as a whole – weakening the norm against murder.”
Minor Question E: Do the health benefits of eating animals outweigh the consequences? (utilitarianism)
The connections between disease and eating red meat are well known. Thorogood, et al. (1994:1669) conclude that there is a “roughly 40% reduction in mortality from cancer in vegetarians and fish eaters compared with meat eaters.” The American Heart Association website (2011) states that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease…, high blood pressure, diabetes mellitus and some forms of cancer.” Specifically, red meat consumption is correlated with higher rates of colorectal, esophageal, liver and lung cancers (Cross, et al. 2007).
Bibliography
American Heart Association website. “Vegetarian Diets.” http://www.americanheart.org/presenter.jhtml?
identifier=4777. Accessed January 20, 2011.
American Institute for Cancer Research. “Recommendations for Cancer Prevention.” http://www.aicr.org/
site/DocServer/Guidelines_Brochure.pdf?docID=1550&JServSessionIdr00q3q8xo3ga5.app46a. 2010. Accessed January 20, 2011.
Bayer, Ronald and Amy Fairchild. “The Genesis of Public Health Ethics.” Bioethics 18(6):473-492. 2004.
Bentham, Jeremy. An Introduction to the Principles of Morals and Legislation. Oxford. 1907. http://www.
econlib.org/library/Bentham/bnthPML18.html. Accessed January 20, 2011.
Bynum, William. “The Great Chain of Being after Forty Years: An Appraisal.” History of Science 13:1-28. 1975.
Chomsky, Noam. Hegemony or Survival: America’s Quest for Global Dominance. Metropolitan. 2003.
Cross, Amanda J, Michael F Leitzmann, Mitchell H Gail, Albert R Hollenbeck, Arthur Schatzkin, and Rashmi Sinha. “A Prospective Study of Red and Processed Meat Intake in Relation to Cancer Risk.” PLoS Medicine 4(12). December 2007.
Gallup. “Four Moral Issues Sharply Divide Americans.” http://www.gallup.com/poll/137357/Four-Moral-Issues-Sharply-Divide-Americans.aspx. 2010. Accessed January 23, 2011.
Fox, Nick and Katie Ward. “Health, Ethics and Environment: A Qualitative Study of Vegetarian Motivations.” Appetite 50(2-3):422 - 429. March/May 2008.
Jabs, Jennifer, Carol M Devine and Jeffery Sobal. “Model of the Process of Adopting Vegetarian Diets: Health Vegetarians and Ethical Vegetarians.” Journal of Nutrition Education 30(4):196-202. July/August 1998.
Lichtenstein, Alice H, et al. “Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee.” Circulation 114:82-96. 2006.
Lindeman, M and Väänänen, M. “Measurement of Ethical Food Choice Motives.” Appetite 34:55-59. 2000.
Marcus, Erik. Meat Market: Animals, Ethics & Money. Brio. 2005.
Mercy for Animals. “Vegetarian Leafleting.” http://www.mercyforanimals.org/leafleting.aspx. Accessed January 23, 2011.
Patterson, Charles. Eternal Treblinka: Our Treatment of Animals and the Holocaust. Lantern. 2002.
Sandel, Michael J. Justice: What’s the Right Thing to Do? Farrar, Straus and Giroux. 2009.
Thorogood, M, J Mann, P Appleby and K McPherson. “Risk of Death from Cancer and Ischaemic Heart Disease in Meat and Non-meat eaters.” British Medical Journal 308:1667-1670. June 25, 1994.
Vegetarian Times. “Vegetarianism in America.” http://www.vegetariantimes.com/features/archive_of_
editorial/667. 2008. Accessed January 20, 2011.
Animal Rights, Behavior Change and the Media: A Research Proposal
Title: The Effect of an Animal Welfare Media Campaign on Red Meat Consumption
Hypothesis: An animal rights media campaign targeted to sectors of the New Orleans population likely to become involved in animal rights activism and vegetarianism will decrease red meat consumption within this subpopulation.
Background: The connections between disease and eating red meat are well known. Thorogood, et al. (1994:1669) conclude that there is a “roughly 40% reduction in mortality from cancer in vegetarians and fish eaters compared with meat eaters.” The American Heart Association website (2010) states that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease…, high blood pressure, diabetes mellitus and some forms of cancer.” Specifically, red meat consumption is correlated with higher rates of colorectal, esophageal, liver and lung cancers (Cross, et al. 2007).
Consequently, the American Heart Association (Lichtenstein, et al. 2006:83-85) advocates replacing red with lean meats, while limiting processed meat (bacon, hot dogs, sausage, etc.). And the American Institute of Cancer Research (2010:18) recommends that individuals limit their consumption of red meats and avoid processed red meats entirely.
An extensive literature review (Freeman 2008:148-169) of animal rights communication reveals a lack of any study measuring the effects of animal rights media on meat eating. However, it is feasible that an animal rights media campaign would diminish a target audience’s consumption of red meat. First, in a survey (Jasper and Paulson 1995:500) of animal rights protesters, 72% of respondents reported that “things [they] have read” were “very important” in their activism, while only 31% indicated “friends and family” and 23% “news media.” Thus, to a large extent, animal rights protestors were recruited through educational materials they found alone or through strangers. Second, although the percent of vegetarians who become so because of concern over animal welfare is unknown, two samples (n<100) have estimated the proportion at approximately one half (Jabs, et al. 1998:196-199; Fox and Ward 2008:427). Moreover, animal welfare has been found to be the salient factor in vegetarians’ decisions to continue not to eat red meat (Lindeman and Väänänen 2000:56). Therefore, it is reasonable to assert that a significant number of vegetarians are motivated to change their diets due to animal welfare issues presented to them through advocacy campaigns.
Certain characteristics of animal rights activists (disproportionately white, female, upper-middle class, college graduate, atheist/agnostic) (Jasper and Paulson 1995:502-503) are highly congruent with the demographics of the American vegetarian population (Mika 2006:918). According to Jabs, et al. (1998:199), “many ethical vegetarians” reported that they became so during life transition periods, such as during college, a career change, or job loss.
Animal rights advertising campaigns should be targeted towards an audience that is more receptive to their message. Tulane undergraduates are excellent targets for an animal rights media campaign because of their demographics, accessibility and stage in life (college). Relevant student undergraduate demographics are: 73% white, 55% female and 74% out-of-city (Tulane University 2009a). “81% of full-time undergraduates receive some type of financial aid” (Tulane University 2009b:1) with undergraduates on average paying 47% of the bill out-of-pocket (stateuniversity.com), indicating upper-middle class status. College students are more likely to be nonbelievers than the general population (Zuckerman 2009:952), although information on Tulane atheists is unavailable. The students are easily accessible through advertisements in the weekly student newspaper, which is distributed free throughout campus (Tulane Hullabaloo 2009:2).
Objective: Discern the effects of animal rights ads on red meat consumption.
Indicator: The proportions of red meat to white meat and vegetarian sandwiches purchased in one month will decrease significantly (p<0.05) both at Tulane’s “Bruff To Go” sandwich shops and relative to any changes in adjacent Loyola University’s “Simply To Go” sandwich orders over the course of the study.
Methodology:
Study site. The study will be conducted at Tulane and Loyola Universities, New Orleans, La.
Data and specimen collection. Data on the proportions of red meat to white meat and vegetarian sandwiches purchased will be calculated for both Tulane and Loyola from September-November 2010. During October, one animal rights ad with photographs, information and a link to an online survey will be run each week in Tulane’s student newspaper. There will be no ad campaign at Loyola.
Data analysis. Data will be aggregated and compared across each of the three months in order to determine what effects, if any, the animal rights campaign had on red meat consumption. It may also be possible and useful to compare changes in weekly and daily purchases over time. Responses to surveys, which will include closed-ended questions in addition to one open-ended question (“What did you think about the ad?”), will be analyzed for quantitative or qualitative trends.
Timeline: Design, implementation and data analysis will be completed in the fall of 2010.
Budget: The Tulane student newspaper advertising rate is $917.00 for one half page color ad (Tulane Hullabaloo 2009:7). For a campaign of four ads over the course of one month, the total budget is $3668.00. Researchers will not receive compensation.
Anticipated Outcomes and Benefit: The habit of eating red meat is correlated with many of the largest killers of Americans. This study will provide data on a public health approach for decreasing red meat consumption that has not yet been researched. In addition, information on communication effectiveness will be beneficial for animal rights organizations.
Bibliography:
American Heart Association website. “Vegetarian Diets.” http://www.americanheart.org/present
er.jhtml?identifier=4777. Accessed February 20, 2010.
American Institute for Cancer Research. “Recommendations for Cancer Prevention.” http://www.aicr.org/site/DocServer/Guidelines_Brochure.pdf?docID=1550&JServSessio nIdr00q3q8xo3ga5.app46a. Accessed February 16, 2010.
Cross, Amanda J, Michael F Leitzmann, Mitchell H Gail, Albert R Hollenbeck, Arthur Schatzkin, and Rashmi Sinha. “A Prospective Study of Red and Processed Meat Intake in Relation to Cancer Risk.” PLoS Medicine 4(12). December 2007.
Freeman, Carrie Packwood. “Struggling for Ideological Integrity in the Social Movement Framing Process: How US Animal Rights Organizations Frame Values and Ethical Ideology in Food Advocacy Communication.” Unpublished dissertation. University of Oregon. June 2008.
Fox, Nick and Katie Ward. “Health, Ethics and Environment: A Qualitative Study of Vegetarian Motivations.” Appetite 50(2-3):422 - 429. March/May 2008.
Jabs, Jennifer, Carol M Devine and Jeffery Sobal. “Model of the Process of Adopting Vegetarian Diets: Health Vegetarians and Ethical Vegetarians.” Journal of Nutrition Education 30(4):196-202. July/August 1998.
Jasper, James M and Jane D Poulsen. “Recruiting Strangers and Friends: Moral Shocks and Social Networks in Animal Rights and Anti-Nuclear Protests.” Social Problems 42(4):493-512. November 1995.
Lichtenstein, Alice H, et al. “Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee.” Circulation 114:82-96. 2006.
Lindeman, M and Väänänen, M. “Measurement of Ethical Food Choice Motives.” Appetite 34:55-59. 2000.
Mika, Marie. “Framing the Issue: Religion, Secular Ethics and the Case of Animal Rights Mobilization.” Social Forces 85(2):915-942. December 2006.
Simonson, Peter. “Social Noise and Segmented Rhythms: News, Entertainment, and Celebrity in the Crusade for Animal Rights.” The Communication Review 4:399-420. 2001.
Stateuniversity.com. “Tulane University of Louisiana.” http://www.stateuniversity.com/
universities/LA/Tulane_University_of_Louisiana.html. Accessed February 20, 2010.
Thorogood, M, J Mann, P Appleby and K McPherson. “Risk of Death from Cancer and Ischaemic Heart Disease in Meat and Non-meat eaters.” British Medical Journal 308:1667-1670. June 25, 1994.
Tulane Hullabaloo. “Advertising.” http://thehullabaloo.com/advertising/. Accessed February 22, 2010.
Tulane University. “2009 Profile.” http://www.tulane.edu/~registra/archive/figs/ensu/093/prfun
093.shtml. 2009a. Accessed February 20, 2010.
Tulane University. “A Comprehensive Guide to Undergraduate Financial Aid: 2009-2010.” http://www.tulane.edu/~finaid/2009-2010%20Sourcebook%20Undergraduate%20
Comprehensive%20Guide%20Info.pdf. 2009b.
Zuckerman, Phil. “Atheism, Secularity, and Well-Being: How the Findings of Social Science Counter Negative Stereotypes and Assumptions.” Sociology Compass 3(6):949-971. 2009.
Hypothesis: An animal rights media campaign targeted to sectors of the New Orleans population likely to become involved in animal rights activism and vegetarianism will decrease red meat consumption within this subpopulation.
Background: The connections between disease and eating red meat are well known. Thorogood, et al. (1994:1669) conclude that there is a “roughly 40% reduction in mortality from cancer in vegetarians and fish eaters compared with meat eaters.” The American Heart Association website (2010) states that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease…, high blood pressure, diabetes mellitus and some forms of cancer.” Specifically, red meat consumption is correlated with higher rates of colorectal, esophageal, liver and lung cancers (Cross, et al. 2007).
Consequently, the American Heart Association (Lichtenstein, et al. 2006:83-85) advocates replacing red with lean meats, while limiting processed meat (bacon, hot dogs, sausage, etc.). And the American Institute of Cancer Research (2010:18) recommends that individuals limit their consumption of red meats and avoid processed red meats entirely.
An extensive literature review (Freeman 2008:148-169) of animal rights communication reveals a lack of any study measuring the effects of animal rights media on meat eating. However, it is feasible that an animal rights media campaign would diminish a target audience’s consumption of red meat. First, in a survey (Jasper and Paulson 1995:500) of animal rights protesters, 72% of respondents reported that “things [they] have read” were “very important” in their activism, while only 31% indicated “friends and family” and 23% “news media.” Thus, to a large extent, animal rights protestors were recruited through educational materials they found alone or through strangers. Second, although the percent of vegetarians who become so because of concern over animal welfare is unknown, two samples (n<100) have estimated the proportion at approximately one half (Jabs, et al. 1998:196-199; Fox and Ward 2008:427). Moreover, animal welfare has been found to be the salient factor in vegetarians’ decisions to continue not to eat red meat (Lindeman and Väänänen 2000:56). Therefore, it is reasonable to assert that a significant number of vegetarians are motivated to change their diets due to animal welfare issues presented to them through advocacy campaigns.
Certain characteristics of animal rights activists (disproportionately white, female, upper-middle class, college graduate, atheist/agnostic) (Jasper and Paulson 1995:502-503) are highly congruent with the demographics of the American vegetarian population (Mika 2006:918). According to Jabs, et al. (1998:199), “many ethical vegetarians” reported that they became so during life transition periods, such as during college, a career change, or job loss.
Animal rights advertising campaigns should be targeted towards an audience that is more receptive to their message. Tulane undergraduates are excellent targets for an animal rights media campaign because of their demographics, accessibility and stage in life (college). Relevant student undergraduate demographics are: 73% white, 55% female and 74% out-of-city (Tulane University 2009a). “81% of full-time undergraduates receive some type of financial aid” (Tulane University 2009b:1) with undergraduates on average paying 47% of the bill out-of-pocket (stateuniversity.com), indicating upper-middle class status. College students are more likely to be nonbelievers than the general population (Zuckerman 2009:952), although information on Tulane atheists is unavailable. The students are easily accessible through advertisements in the weekly student newspaper, which is distributed free throughout campus (Tulane Hullabaloo 2009:2).
Objective: Discern the effects of animal rights ads on red meat consumption.
Indicator: The proportions of red meat to white meat and vegetarian sandwiches purchased in one month will decrease significantly (p<0.05) both at Tulane’s “Bruff To Go” sandwich shops and relative to any changes in adjacent Loyola University’s “Simply To Go” sandwich orders over the course of the study.
Methodology:
Study site. The study will be conducted at Tulane and Loyola Universities, New Orleans, La.
Data and specimen collection. Data on the proportions of red meat to white meat and vegetarian sandwiches purchased will be calculated for both Tulane and Loyola from September-November 2010. During October, one animal rights ad with photographs, information and a link to an online survey will be run each week in Tulane’s student newspaper. There will be no ad campaign at Loyola.
Data analysis. Data will be aggregated and compared across each of the three months in order to determine what effects, if any, the animal rights campaign had on red meat consumption. It may also be possible and useful to compare changes in weekly and daily purchases over time. Responses to surveys, which will include closed-ended questions in addition to one open-ended question (“What did you think about the ad?”), will be analyzed for quantitative or qualitative trends.
Timeline: Design, implementation and data analysis will be completed in the fall of 2010.
Budget: The Tulane student newspaper advertising rate is $917.00 for one half page color ad (Tulane Hullabaloo 2009:7). For a campaign of four ads over the course of one month, the total budget is $3668.00. Researchers will not receive compensation.
Anticipated Outcomes and Benefit: The habit of eating red meat is correlated with many of the largest killers of Americans. This study will provide data on a public health approach for decreasing red meat consumption that has not yet been researched. In addition, information on communication effectiveness will be beneficial for animal rights organizations.
Bibliography:
American Heart Association website. “Vegetarian Diets.” http://www.americanheart.org/present
er.jhtml?identifier=4777. Accessed February 20, 2010.
American Institute for Cancer Research. “Recommendations for Cancer Prevention.” http://www.aicr.org/site/DocServer/Guidelines_Brochure.pdf?docID=1550&JServSessio nIdr00q3q8xo3ga5.app46a. Accessed February 16, 2010.
Cross, Amanda J, Michael F Leitzmann, Mitchell H Gail, Albert R Hollenbeck, Arthur Schatzkin, and Rashmi Sinha. “A Prospective Study of Red and Processed Meat Intake in Relation to Cancer Risk.” PLoS Medicine 4(12). December 2007.
Freeman, Carrie Packwood. “Struggling for Ideological Integrity in the Social Movement Framing Process: How US Animal Rights Organizations Frame Values and Ethical Ideology in Food Advocacy Communication.” Unpublished dissertation. University of Oregon. June 2008.
Fox, Nick and Katie Ward. “Health, Ethics and Environment: A Qualitative Study of Vegetarian Motivations.” Appetite 50(2-3):422 - 429. March/May 2008.
Jabs, Jennifer, Carol M Devine and Jeffery Sobal. “Model of the Process of Adopting Vegetarian Diets: Health Vegetarians and Ethical Vegetarians.” Journal of Nutrition Education 30(4):196-202. July/August 1998.
Jasper, James M and Jane D Poulsen. “Recruiting Strangers and Friends: Moral Shocks and Social Networks in Animal Rights and Anti-Nuclear Protests.” Social Problems 42(4):493-512. November 1995.
Lichtenstein, Alice H, et al. “Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee.” Circulation 114:82-96. 2006.
Lindeman, M and Väänänen, M. “Measurement of Ethical Food Choice Motives.” Appetite 34:55-59. 2000.
Mika, Marie. “Framing the Issue: Religion, Secular Ethics and the Case of Animal Rights Mobilization.” Social Forces 85(2):915-942. December 2006.
Simonson, Peter. “Social Noise and Segmented Rhythms: News, Entertainment, and Celebrity in the Crusade for Animal Rights.” The Communication Review 4:399-420. 2001.
Stateuniversity.com. “Tulane University of Louisiana.” http://www.stateuniversity.com/
universities/LA/Tulane_University_of_Louisiana.html. Accessed February 20, 2010.
Thorogood, M, J Mann, P Appleby and K McPherson. “Risk of Death from Cancer and Ischaemic Heart Disease in Meat and Non-meat eaters.” British Medical Journal 308:1667-1670. June 25, 1994.
Tulane Hullabaloo. “Advertising.” http://thehullabaloo.com/advertising/. Accessed February 22, 2010.
Tulane University. “2009 Profile.” http://www.tulane.edu/~registra/archive/figs/ensu/093/prfun
093.shtml. 2009a. Accessed February 20, 2010.
Tulane University. “A Comprehensive Guide to Undergraduate Financial Aid: 2009-2010.” http://www.tulane.edu/~finaid/2009-2010%20Sourcebook%20Undergraduate%20
Comprehensive%20Guide%20Info.pdf. 2009b.
Zuckerman, Phil. “Atheism, Secularity, and Well-Being: How the Findings of Social Science Counter Negative Stereotypes and Assumptions.” Sociology Compass 3(6):949-971. 2009.
Paradox of The Spirit Catches You and You Fall Down: Why Did the Lees Keep Taking Lia to the ER if They Ostensibly Distrusted Western Medicine?
Interestingly, for all of the author’s anthropological acumen, she never directly addresses the ostensible paradox of why the Lees kept taking Lia back to the emergency room in spite of their mistrust of the medical community (see p. 25 for a description of the first ER visit). This question is also unaddressed in the academic literature (see ME Warner. “The Hmong and Health Care in Merced, California.” Hmong Studies Journal. 1998. Pp. 10-12). However, Fadiman obliquely addresses the topic, and in doing so, provides a number of partial frameworks for answering the question. In this essay, I will discuss three frameworks. First, the Lees considered the optimal treatment to be “a little medicine and a little neeb [a type of traditional Hmong medicine literally translated as healing spirit]” (100; also, chapter 9). Second, Hmong cultural beliefs, conflated with Lia’s placement in governmental custody, likely made the Lees feel coerced into accepting what may have otherwise been unacceptable treatment. Third, the Lees and other Hmong had witnessed the power of fast-acting antibiotics, so Western medicine was in some cases preferred to traditional Hmong medicine. For all of these reasons, taking Lia to the emergency room was sometimes viewed as a legitimate strategy. The author's statements notwithstanding, assessing this paradox through individual and interpersonal theoretical frameworks sheds further light on the Lees' actions.
For a time, the Lees believed that a combination of Western and traditional Hmong medicine was optimal for Lia (Aubrey, Innocence and Kathryn also make this point). As Nao Kao noted (100):
The doctors can fix some sicknesses that involve the body and blood, but for us Hmong, some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb, but not too much medicine because the medicine cuts the neeb’s effect. If we did a little of each she didn’t get sick as much, but the doctors wouldn’t let us give just a little medicine because they didn’t understand about the soul.
In this respect, interpersonal relationships were a key factor in compliance: the Lees trusted their American social worker Jeanine, who was able to train them on Depakene (112-116). Therefore, one could feasibly argue that there were times in Lia’s life when their choice of treatment for her may have improved her quality of life, the putative goal of any Western or “traditional” system of medicine.
Fadiman writes that many Hmong, including the Lees, felt coerced to accept unwanted medical treatment. Other Hmong reported that: “if you want to stay here you must let doctor [sic] examine the [sic] body” and “I already sign [sic] everything and the doctor going [ sic] to send me to jail if I change my mind.” (62). In addition, “most Hmong women did go the hospital to give birth, erroneously believing that babies born at home would not become US citizens” (72). After Lia was placed into temporary foster care, she “was to be reunited with her family after six months only if the court was persuaded that her parents would comply with her medication regimen” (85). It is bittersweet that the power of the state, perceived and real, held a great sway over the Lees and was one factor that may have helped give Lia “one of the richest [times] in her life” (106).
Antibiotics, which provided a quick, noticeable fix to some infections, were the “only form of medical treatment that was gratefully accepted by at least some of the Hmong in the Thai camps” (34). Similarly, “Hmong patients might not understand the doctors’ diagnoses, but if they had summoned the courage to visit the clinic, they wanted be told that something was wrong and to be given something, preferably a fast-acting antibiotic, to fix it” (69) (italics in original) (Erika, Min-Young and Jessica also points this out). More specifically, Foua “informed [Dr. Dan Murphy] that she didn’t think you should ever have to give a medicine forever.” Here, Fadiman opines that “it is likely that the only Western drugs Foua and Nao Kao had encountered in Asia were fast-acting antibiotics” (53).
Viewing this question through the lenses of individual and interpersonal behavioral models, it is fair to question the degree of autonomy the Lees actually had in “choosing” to take Lia to the emergency room. Here, the theories of reasoned action and planned behavior are useful, and their practical differences become muddled. Contrary to the health belief model, these two models stress that subjective norms meld people’s beliefs and actions, arguably more so than our perceived individual autonomy or self-efficacy. To extend these models a bit more broadly (or extremely), the notion that someone can function with more than a modicum of autonomy is debatable. Given the aforementioned three primary influences (empiricism, coercion and culture), the Lees may have been effectively constrained in their actions, as other Hmong were, and in practice forced to utilize the American medical system despite viscerally strong objections, which sometime even included a fear of eternal damnation. Thinking diagrammatically with respect to the theory of planned behavior, the “subjective norms” circle becomes so large as to encompass the remaining whole. Conceptualizing the individually-oriented theories of reasoned action or planned behavior as such essentially rehashes Berkman and Glass’ model of interpersonal social networks and the environment as the principle determinants of individuals’ “choices.”
In conclusion, it is incorrect to say the Lees’ actions represent a “traditional” practice, because it is fundamentally empirical. (See, for example, page 56: “The Lees had now decided that they liked Phenobarbital, disliked Dilantin, and were ambivalent about Tegretol” or pp. 90-91 for a description of the positive effect of Depakene and the Lees’ recognition of it). The Lees’ fears that the doctors were making Lia sick (213) were justified and ultimately correct (255). Thus, through a combination of empiricism, coercion and culture, the Lees “chose” to take Lia to the emergency room.
Cutting the UN Budget to Fight the Dangers of Democracy and Empathy
The United Nations represents a threat to the people who own our country and run our government because support for the United Nations is an opinion, supported by the majority of the American people, that reflects concern for other people r...ather than buying crap.
"A large majority of the public believe that the United States should accept the jurisdiction of the International Criminal Court (ICC) and the World Court, sign the Kyoto protocols, allow the United Nations to take the lead in international crises, and rely on diplomatic and economic measures more than military ones in the ‘war on terror.’ Similar majorities believe the United States should resort to force only if there is ‘strong evidence that the country is in imminent danger of being attacked,’ thus rejecting the bipartisan consensus on ‘preemptive war’ and adopting the rather conventional interpretation of the UN Charter reiterated by the UN’s High-level Panel of December 2004 and the UN World Summit a year later. A small majority of the population even favors giving up Security Council vetoes, so that the United States would follow the UN’s lead even if it is not the preference of US state managers. On domestic issues, overwhelming majorities favor expansion of government programs: primarily health care (80 percent), but also funding for education and Social Security" (Chomsky, Noam. "Failed States," p. 229).
Furthermore, the United States is in debt to the United Nations. "United States debt to the United Nations, in both the regular and peacekeeping budgets, exceeded $1.5 billion at the start of 2009. After passage of the 2009 appropriations bills, U.S. debt for peacekeeping alone was over $1.3 billion. These arrears make the United States the largest debtor to the United Nations" (http://docs.google.com/vie
Further cutting the UN budget will make no significant dent in the deficit, whose purpose is redistributing wealth to bankers and defense contractors. The UN budget is being threatened because human empathy is a subversive value; it threatens the paradigm of exploitation.
"A large majority of the public believe that the United States should accept the jurisdiction of the International Criminal Court (ICC) and the World Court, sign the Kyoto protocols, allow the United Nations to take the lead in international crises, and rely on diplomatic and economic measures more than military ones in the ‘war on terror.’ Similar majorities believe the United States should resort to force only if there is ‘strong evidence that the country is in imminent danger of being attacked,’ thus rejecting the bipartisan consensus on ‘preemptive war’ and adopting the rather conventional interpretation of the UN Charter reiterated by the UN’s High-level Panel of December 2004 and the UN World Summit a year later. A small majority of the population even favors giving up Security Council vetoes, so that the United States would follow the UN’s lead even if it is not the preference of US state managers. On domestic issues, overwhelming majorities favor expansion of government programs: primarily health care (80 percent), but also funding for education and Social Security" (Chomsky, Noam. "Failed States," p. 229).
Furthermore, the United States is in debt to the United Nations. "United States debt to the United Nations, in both the regular and peacekeeping budgets, exceeded $1.5 billion at the start of 2009. After passage of the 2009 appropriations bills, U.S. debt for peacekeeping alone was over $1.3 billion. These arrears make the United States the largest debtor to the United Nations" (http://docs.google.com/vie
Further cutting the UN budget will make no significant dent in the deficit, whose purpose is redistributing wealth to bankers and defense contractors. The UN budget is being threatened because human empathy is a subversive value; it threatens the paradigm of exploitation.
The 2011 Republican and Democratic budgets: Setting the Terms of Debate for the Bankers
The Republican budget has little meaningful difference from Obama's budget, which sets the left course of the debate. Remember that Obama is proposing a freeze on "discretionary" (widely popular safety net) spending for five years, which, w...ith inflation and population growth, is equivalent to a 25% cut. So in an orgasm of bipartisanship and unity we will see that in people's times of need the ruling parties coalesce to run up massive deficits for wars and bankers and then almost immediately begin an Orwellian genuflection before the God of imaginary inflation, i.e., they do what the bankers want. If you take an economics course in college they teach you that this is called "the free market."
Basically two factors drive the deficit: health care and defense spending.
As to health care, despite being the richest country in the world, the United States is the only wealthy nation on earth that does not guarantee health care to all of its citizens, leaving some 50 million uninsured (Rabin, Roni Caryn. 2010. “Number of Uninsured Rises, Report Says.” The New York Times. November 16.; also, “the United States spent $6,401 per capita on health care in 2005 – more than double the median per capita expenditure ($2,922) of the thirty industrialized countries” in the OECD (Anderson, Gerard and Bianca Frogner. 2008. “Health Spending in OECD Countries: Obtaining Value per Dollar.” Health Affairs 27. 1718-1727. :1718)). Consequently, the United States has the highest infant mortality among rich countries (CDC. 2008. “Recent Trends in Infant Mortality in the United States.” http://www.cdc.gov/nchs/da
Myriad reasons, including a few red herrings, are offered for the bizarre structure of the American health care system. It is important to note that the current health care is not the result of Americans’ personal preferences; on the contrary, the system is patently undemocratic, with a large majority of Americans consistently expressing a desire for universal health coverage:
An NBC-Wall Street Journal poll found that ‘over 2/3 of all Americans thought the government should guarantee ‘everyone’ the best and most advanced health care that technology can supply’; a Washington Post-ABC News poll found that 80 percent regard universal health care as ‘more important than holding down taxes’; polls reported in Business Week found that ‘67% of Americans think it’s a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27% dissenting’; the Pew Research Center found that 64 percent of Americans favor the ‘U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes’ (30 percent opposed). (Chomsky, Failed States, 2007:225)
Quoting Princeton economic Uwe Reinhardt, Mahar (Money-Driven Medicine, 2006:81) notes that “the aging population accounts for ‘only about 10% of the recent growth in real hospital spending.’” Lawsuits are also unfairly demonized, as “malpractice payments represent less than 0.5 percent of health spending” (2006:xvi). More reasonable explanations are offered by viewing the American health care system through as an inefficient economic system. If we had universal health care, like every other rich country in the world, and in accord with the democratic values of the American people, our long-term budget deficits would almost disappear: http://www.cepr.net/calcul
Defense spending is a similar issue, and the facts are much better known. Nearly half of our budget is spent on imperial wars ("freedom") or the debt from past ones (http://www.globalissues.or
Serious attempts to address the deficit would deal with our bloated, inefficient health care system and our disastrous national "defense" policies. So the cuts in very popular social services are an attempt not to address the deficit but to use the recession to redistribute wealth from the people to the top 1%, who, despite having achieved the highest level of inequality in American history, want even more.
Basically two factors drive the deficit: health care and defense spending.
As to health care, despite being the richest country in the world, the United States is the only wealthy nation on earth that does not guarantee health care to all of its citizens, leaving some 50 million uninsured (Rabin, Roni Caryn. 2010. “Number of Uninsured Rises, Report Says.” The New York Times. November 16.; also, “the United States spent $6,401 per capita on health care in 2005 – more than double the median per capita expenditure ($2,922) of the thirty industrialized countries” in the OECD (Anderson, Gerard and Bianca Frogner. 2008. “Health Spending in OECD Countries: Obtaining Value per Dollar.” Health Affairs 27. 1718-1727. :1718)). Consequently, the United States has the highest infant mortality among rich countries (CDC. 2008. “Recent Trends in Infant Mortality in the United States.” http://www.cdc.gov/nchs/da
Myriad reasons, including a few red herrings, are offered for the bizarre structure of the American health care system. It is important to note that the current health care is not the result of Americans’ personal preferences; on the contrary, the system is patently undemocratic, with a large majority of Americans consistently expressing a desire for universal health coverage:
An NBC-Wall Street Journal poll found that ‘over 2/3 of all Americans thought the government should guarantee ‘everyone’ the best and most advanced health care that technology can supply’; a Washington Post-ABC News poll found that 80 percent regard universal health care as ‘more important than holding down taxes’; polls reported in Business Week found that ‘67% of Americans think it’s a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27% dissenting’; the Pew Research Center found that 64 percent of Americans favor the ‘U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes’ (30 percent opposed). (Chomsky, Failed States, 2007:225)
Quoting Princeton economic Uwe Reinhardt, Mahar (Money-Driven Medicine, 2006:81) notes that “the aging population accounts for ‘only about 10% of the recent growth in real hospital spending.’” Lawsuits are also unfairly demonized, as “malpractice payments represent less than 0.5 percent of health spending” (2006:xvi). More reasonable explanations are offered by viewing the American health care system through as an inefficient economic system. If we had universal health care, like every other rich country in the world, and in accord with the democratic values of the American people, our long-term budget deficits would almost disappear: http://www.cepr.net/calcul
Defense spending is a similar issue, and the facts are much better known. Nearly half of our budget is spent on imperial wars ("freedom") or the debt from past ones (http://www.globalissues.or
Serious attempts to address the deficit would deal with our bloated, inefficient health care system and our disastrous national "defense" policies. So the cuts in very popular social services are an attempt not to address the deficit but to use the recession to redistribute wealth from the people to the top 1%, who, despite having achieved the highest level of inequality in American history, want even more.
Quotes from What's the Matter with Kansas? by Thomas Frank
- ‘This derangement is the signature expression of the Great Backlash, a style of conservatism that first came snarling onto the national stage in response to the partying and protests of the late sixties. While earlier forms of conservatism emphasized fiscal sobriety, the backlash mobilizes voters with explosive social issues – summoning public outrage over everything from busing to un-Christian art – which it then marries to pro-business economic policies. Cultural anger is marshaled to achieve economic ends. And it is these economic achievements – not the forgettable skirmishes of the never-ending culture wars – that are the movement’s greatest monuments.’ (5)
- ‘Values may ‘matter most’ to voters, but they always take a backseat to the needs of money once the elections are won. This is a basic earmark of the phenomenon, absolutely consistent across its decades-long history. Abortion is never halted. Affirmative action is never abolished.’ (6)
- ‘Backlash theories, as we shall see, imagine countless conspiracies in which the wealthy, powerful, and well connected – the liberal media, the atheistic scientists, the obnoxious eastern elite – pull the strings and make the puppets dance. And yet the backlash itself has been a political trap so devastating to the interests of Middle America that even the most diabolical of string-pullers would have had trouble dreaming it up.’ (7)
- ‘For the Republican Party to present itself as the champion of working-class Americans strikes liberals as such an egregious denial of political reality that they dismiss the whole phenomenon, refusing to take it seriously. The Great Backlash, they believe, is nothing but crypto-racism, or a disease of the elderly, or the random gripings of religious rednecks, or the protests of ‘angry white men’ feeling left behind by history. But to understand the backlash in this way is to miss its power as an idea and its broad popular vitality.’ (8)
- ‘In the backlash imagination, America
- ‘Beginning in the sixties the big thinkers of the meat biz figured out ways to routinize and de-skill their operations from beginning to end. Not only would this allow them to undercut the skilled, unionized butchers who were then employed by grocery stores, but it would also let them move their plants to the remotest part of the Great Plains, where they could ditch their unionized big-city workers and save on rent.’ (52)
- ‘By the early nineties this strategy had put the century-old stockyards in Chicago Kansas City Southeast Asia , Mexico
- ‘Even though Republicans legislate in the interests of society’s most powerful, and even though conservative social critics typically enjoy cushy sinecures at places like the American Enterprise Institute and the Wall Street Journal, they rarely claim to speak on behalf of the wealthy or the winners in the social Darwinist struggle. Just like the leftists of the early twentieth century, they see themselves in revolt against a general tradition.’ (119-120)
- ‘To believe that liberalism is all-powerful gets conservative lawmakers off the hook for their flagrant failure to make headway in the culture wars.’ (125)
- ‘To backlash writers, the operations of business are simply not a legitimate subject of social criticism. In the backlash mind business is natural; it is normal; it is beyond politics.’ (128)
- ‘The erasure of the economic is a necessary precondition for most of the basic backlash ideas. It is only possible to think that the news is slanted to the left, for example, if you don’t take into account who owns the news organizations and if you never turn your critical powers on that section of the media devoted to business news. The university campus can only be imagined as a place dominated by leftists if you never consider economics departments or business schools.’ (128)
- ‘Where the muckrakers of old faulted capitalism for botching this institution and that, the backlash thinkers simply change the script to blame liberalism.’ (129)
- ‘ ‘Just as Reagan seems incapable of believing anything good about ‘govment,’ ’ wrote Gary Wills in 1987, ‘he is literally blind to the possibility that businessmen may be anything but high-minded when they lend their services to government.’ ’ (144)
- ‘When I ask what she thinks about progressive taxation, she tells me first that it’s impossible to raise taxes on the wealthy, because they just pass the increased costs on to the rest of us, and then declares that progressive taxation is theft, plan and simple. ‘Why should we be penalizing people for being financially successful?’ she asks.’ (171)
- ‘In the happy times before the sixties ruined everything, abolitionists were generally presented in school textbooks in just this way: as intolerant moralists, screeching proponents of a dictatorship of virtue who, through their self-righteous intolerance, did no less than cause the Civil War. Identifying oneself with them was a tactic of far-left groups such as the Weathermen and the Communist Party. Abolitionism only became respectable – and suitable for purposes of conservative legitimacy-building – thanks to the efforts of radical and, yes, revisionist historians of the sixties and seventies.’ (187-188)
- ‘The corporate world, for its part, uses anti-intellectualism to depict any suggestion that humanity might be better served by some order other than the free-market system as nothing but arrogance, an implied desire to redesign life itself. The social conservatives, on the other hand, use anti-intellectualism to assail any deviation from a system of values that they alternately identify with God and the earth-people of Red America.’ (193)
- ‘William Jennings Bryan hoped to accomplish exactly the opposite by defeating evolution. In his mind evolution led irresistibly to social Darwinism and the savagery of nineteenth-century capitalism; undermining it would make the country less capitalist, not more.’ (207)
- ‘Let us pause for a moment to assess the delusions of martyrdom that all this requires the Cons to embrace. What they mean by persecution is not imprisonment or excommunication or disenfranchisement, but criticism, news reports that disagree with them: TV anchormen shaking their heads over Kansas Topeka
- ‘On the other side are the opportunists: professional politicians and lawyers and Harvard men who have discovered in the great right-wing groundswell an easy shortcut to realizing their ambitions. Many of them once aspired to join – maybe even did join – the state’s moderate Republican insider club. Rising up that way, however, would take years, maybe a lifetime, when by mouthing some easily memorized God-talk and changing their position on abortion – as Brownback and other leading Cons have done – they could instantly have a movement at their back, complete with superdedicated campaign workers they wouldn’t have to pay and a national network of pundits and think tanks and talk-show hosts ready to plug them in.’ (226-227)
- ‘In the seventies, and especially while the war was still going on, the victimhood of Vietnam
- ‘Applied to the historical Vietnam War itself, this way of thinking implies that the army suffered no disobedience, no griping, not even any of the jolly countercultural troublemaking seen in feel-good war films like Good Morning Vietnam. Dissent was the sole province of the hippie traitors at home.’ (230)
- ‘We can say that liberalism lost places like Shawnee and Wichita with as much accuracy as we can point out that conservatism won them over.’ (242)
- ‘Take your average white male voter: in the 2000 election they chose George W. Bush by a considerable margin. Find white males who were union members, however, and they voted for Al Gore by a similar margin. The same difference is repeated whatever the demographic category: women, gun owners, retirees, and so on – when they are union members, their politics shift to the left. This is true even when the union members in question had little contact with union leaders. Just being in a union evidently changes the way a person looks at politics, inoculates them against the derangement of the backlash.’ (246)
- ‘The movement speaks to those at society’s bottom, addresses them on a daily basis. From the left they hear nothing, but from the Cons they get an explanation for it all. Even better, they get a plan for action, a scheme for world conquest with a wedge issue.’ (248)
- ‘The fever-dream of martyrdom that Kansas follows today has every bit as much power as John Brown’s dream of justice and human fraternity. And even if the state must sacrifice it all – its cities and its industry, its farms and its small towns, all its thoughts and all its doings – the brilliance of the mirage will not fade. Kansas
- On the morning after the [2004] election the country’s liberals were astonished to hear that, according to exit polls, at least, ‘moral values’ outranked all other issues in determining voters’ choices.’ (261)
- ‘ ‘If we’re $700 million in the red,’ the conservatives think, according to Burdett Loomis, a professor of political science at the Quotes from Six Months in Sudan, by James Maskalyk
- ‘I was kneeling besides the bed of an infant who was feverish and had stopped drinking. I was trying, with another doctor, to find a vein. The baby’s mother sat helpless on the bed as we poked holes in her child. She was crying. She wanted us to stop. Small pearls of blood dotted his neck, his groin. We failed, his breathing worsened, and he died. I stood up, threw the needles in the sharps container, and walked away to attend to someone else. Behind me his mother wailed. I can see my flat face. Who was that person? I am not sure if I know him, not sure that I want to.’ (4)
- ‘The people I left behind in Sudan
- ‘Just as our friends wonder at our distance from their familiar world, we marvel at theirs from the real one. We feel inhabited by it. We plan our return.’ (5)
- ‘This book started as a blog that I wrote from my hut in Sudan
- ‘For my residency, I chose emergency medicine because it would give me the widest set of skills and wouldn’t require me to have a patient practice. I would leave no one in a lurch when I leftCanada
- ‘For my residency, I chose emergency medicine because it would give me the widest set of skills and wouldn’t require me to have a patient practice. I would leave no one in a lurch when I left
- ‘In a classroom in Bonn, with thirty others bound for different places, I was told for the first time that I could expect to come back different, that my friends wouldn’t want to talk about the things that I would, that I would have less in common with them than ever before.’ (9)
- ‘I said I would go anywhere, that I wasn’t afraid of being isolated, that I had a wide complement of medical skills and could do a little of everything. I could work in a small team with little backup, improvise if necessary. If there was a time in my life where I could go to a place that required close attention to security, it was now. No wife, no ids, no house, no debt, no one waiting for me to get back.’ (12)
- ‘I would have no access to x-rays in Abyei, no basic lab tests. The nearest surgeon was three hours away, and the road to him was not always safe. I would be expected to birth babies and handle trauma. I was asked if I would perform an abortion if it was medically necessary. I was that I would.’ (15)
- ‘After two days of briefings, they were nearly done. My last meeting was with a woman in the communications department. I explained to her my intention to write a blog, and my hope that it would allow a different exposition of life in the field. It would be insistent, rough, and fresh. It would fit our mandate of témoignage, of bearing witness. MSF Canada was fully supportive, had set up space on their web page that could be updated by text email, even by SMS. I was going to be the first to try it out. The communication liaison was reluctant. She explained to me that an MSF worker, the year before, had kept a blog in Sudan Khartoum Khartoum Khartoum Canada
- ‘From the center of Sudan
- ‘It was obvious who was on their way to the field and who was coming from it. Those who were leaving were well dressed and curious, their eyes full of questions. Those coming home wore their months on drawn faces, curiosity stamped out.’ (19)
- ‘I would be responsible for all of the inpatients in the hospital, and all emergencies. I would be supervising one Sudanese MD, newly graduated, and two Sudanese medical technicians, both of whom had done a short training course and could diagnose and treat simple things, like dehydration and malaria. Second, there was the therapeutic feeding center…I would be responsible for collecting statistics and monitoring epidemics. There had been some deaths from meningitis in a nearby military camp, and Abyei was cinched, with much of Sudan Africa ’s meningitis belt. Further, a couple of cases of measles had been diagnosed nearby. The last vaccination campaign in the area had been years before. Finally, I should be prepared to handle several wounded at one time. There wasn’t just the threat of multiple casualties from an outbreak of war, but a week ago a vehicle collision had sent thirty people to the hospital.’ (30-31)
- ‘Like in most MSF missions, national staff make up the vast majority of employees. Nurses, cleaners, cooks, drivers, guards. Of the forty or so people who work for MSF in Abyei, only five of us are expats.’ (50)
- ‘When I ask people in the hospital where they are from, they answer in days. ‘Three days away.’ ’ (62)
- ‘I visited compound 2 on my first day, with Bev. Haven’t been back since. I don’t go to the market anymore. Nor anywhere else. I talked with patients through a translator, or Mohamed when he is around, and only some of the Sudanese nurses speak English. Most of the time I walk around in a bubble.’ (69)
- ‘If there is any ethical imperative for a central administration to assume some responsibility for the health of its people, it is tempered by our presence. The people here are getting free care. Why hurry?’ (79)
- ‘I asked a first-mission nurse, disheartened midway through her nine-month mission, what she found most difficult about the job. ‘No feedback.’ This work is not what one does if he is interested in being told that he is doing the right thing. We are expected to know. The work is not easy, not for anyone, and it never ends. If you keep on looking over your shoulder, waiting for a pat on the back, you’ve missed the point. It’s not about you. If you are expecting it to be, better you stay at home. Still, at the end of a long day, it is an easy thing to miss. My blog is good for that. I’m lucky.’ (102)
- ‘This is not my country. I can’t meet someone in the market and make a friend, I can’t make a joke with my patients. So when I seem frustrated, it is not with what you are doing. I promise. It is because I feel helpless. Okay?’ (127)
- ‘I don’t think that I will end up ruined, but there are certain things that are going to be tough to share. Things that would make poor dinner conversation (Hey, have you ever heard an infant’s heart stop? Don’t you think it is like the silence must be after a train wreck, deep in the forest? Once the metal has stopped creaking? Like all this activity, and then this final vacuum in place of all the sound?” I can imagine meeting people on the street, and being asked how my ‘trip’ was. (…you know the feeling when you and your friends are cleaning up after some young mother dies and you can hear her baby cry and you’re all praying to yourselves, please don’t let anyone look me in the eye? You know that feeling?)’ (170-171)
- ‘As a doctor at home, it is rare to have one of these experiences, but when you do, you often bear it with others. Another doctor, or nurses whom you know. You sit and talk about it. It doesn’t make it go away, but it diffuses some of the weight. I don’t do that here.’ (171)
- ‘The damage done by bullets designed to kill humans is different than ones we use to hunt animals. When we fire a bullet towards an animal, we hope to kill and eat it, not destroy it. The ones made to shoot people are designed to tumble and fragment after they penetrate the tissue, transferring as much energy as possible to the body, creating as large a hole as possible.’ (174)
- ‘As the MOH designate, it is Sylvester’s job to act as coroner. The arriving soldiers were not satisfied and demanding their own inspection of the body. They charged past, ignoring Marco’s request to leave their weapons at the gate. Soon a swarm of armed soldiers was milling among our patient beds, asking questions. At least three of the families in the feeding center left. We evacuated all MSF staff from the hospital. It was Marco’s only card to play, to withdraw activities. If such impositions continue, we close the mission. They lose the free care for their soldiers and their families, and gain the ill will of a community.’ (181)
- ‘We could easily take one of our cars, the pickup for instance, and offer the family some relief from a cruel day. But we don’t. We cannot be a hospital and a hearse service. Nor when someone knocks on our compound door, his eyes as big as moons, and says ‘My wife, she is delivering at home, but the baby is stuck, can you take her to the hospital,’ can we be an ambulance service. No, we say, you need to find a way, and quietly close the gate. These are impossible decisions because their wisdom is easy to see, but they are contrary to one’s spirit.’ (188)
- ‘Everyone in our mission smokes furiously. MSF. Part of the reason is the isolation, the idle minutes. As it has been said in many languages, when you have a cigarette, you always have a friend. The other part is that in the face of all the sickness and early death, one’s health falls from constant focus. You look around at the other passengers, and from all accounts, if it looks like the plane is going down, smoke ‘em if you got ‘em.’ (195)
- ‘I remember talking with friends about how I could manage to work, during my residency, 30 sleepless hours in the hospital, leave it to sleep, then return. I explained that the last thing to go was my capacity to perform medical duties. I could sort out a high potassium at five in the morning. What I lost was my ability to offer the patient something beyond the task. I would walk in, inject the proper drugs in the correct amounts into their IV, mumble something neither of us understood, then stumble out to do something else. The tiredness I feel now is different. It has been a slow erosion.’ (208-209)
- ‘One of my friends told me once that, when she was having a personally difficult time (someone in her family was sick and her relationship was crumbling), she poured herself into her general practice. The more she worked, the more patients would stop on the street and say ‘Hello, Doctor Soandso,’ the more they would send flowers. Not only was she caring, she was being cared for. Of course, in the end, this was not an equitable relationship, not the true contact someone needs to feed their bruised spirit, and after several months, she burned out.’ (209)- ‘ ‘This is the maternity ward,’ I say, standing at the doorway. ‘Basically, I have no idea what is going on in there. We had a midwife, but she split.’ Angela’s eyes are wide. Around us, children cry, mothers mill about, forty outpatients are queued at the front, some holding babies, others with their heads in their hands. One of our cleaners starts our gas water pump, and it roars to life. He puts one end in a blue barrel, filling it. As he pulls it into the next, it sprays loudly, splashing us in the transition. Chaos. ‘Don’t worry,’ I say. ‘It gets smaller.’ ‘I wasn’t expecting this,’ she says. ‘Where do you start?’ ’ (229)