Imposing Values and Ideas: When and Why – An Armchair Ethics Post

The idea or desire to have everyone behave and act as you do is common and an underlying part of the human elements that make up who we are and how we interact. It is far easier to understand someone if they are “just like you” rather than something that is other or different. There is little effort needed to understand what motivates the person, what their needs and wants are, and what they are striving for in this life. Often today and especially more pronounced in the past, there has been an understanding that we should try and teach others to be more like us. To become “smarter” and behave the way we do which was seen as the best way to live and most advanced. Slowly in the late 20th century and into the 21st this idea that we should impose our values upon others to better them, has lost some prominence in the way people and nations interact. Now, common thinking is to learn about the other person and engage in a manner that values their unique identity.

At the same time as we can appreciate the other person or government as unique and from which lessons can be drawn, there are other times when the difference cannot be accepted. This is due to objective harms both major and minor that are caused by a particular behaviour, value, or idea. On the individual level, these behaviours can range from a generally rude and surly individual who puts down people that he comes across, to a husband who physically abuses his wife and bullies her into submission and servitude. At the national level, values and ideas that cannot be accepted are widely recognized as those which go against our fundamental human rights, cause harm to innocent citizens, and causes deadly international conflict.

With both a strong idea to allow for individuality and sovereignty and yet a desire to avoid harm and protect people from harm regardless of location, the question arises when can we impose our values and ideas on what is right and just. Knowing that such imposition requires justification, the reasons for why there can be this imposing upon another person should also be known. In the few paragraphs that follow, the example of an individual citizen will be used to explore what should be taken as a first approach when thinking of imposing values and ideas, the reasons for going beyond that first approach, and why it may be needed.

An example for the purposes of this discussion is the following:

Jeremy is a church fairing catholic who very much lives up to the teaching of the church and is steadfast that the word of God is the truth. Knowing the importance of the word of God, he believes it is his mission to spread the teachings to everyone he meets so that as many people can be saved as possible and the greatest good can be achieved. The values and ideas of the church are a part of his identity which he profoundly believes is the right path in life.

Ken is a transitioned man who was kicked out of his household at a young age for his differences in values and ideas from his typical nuclear family that while did not go to church, followed standard Anglo-Saxon values and beliefs. Ken is open to differing opinions, values, and ideas, and started as a hobby a small Not-for-Profit to raise awareness of the barriers and struggle for those in his community. His main job is for the same insurance company as Jeremy and in the same office space. The values and ideas of the LGBTQ2+ are a part of his identity which he profoundly believes should be respected as a fundamental human right.

Jeremy and Ken are both top performers at their jobs. While Ken is apprehensive or Jeremy knowing he follows strictly the teachings of the church, there have been no disagreements and office life has been normal. After a church sermon that asks the congregation to try and save through the teachings of God someone you know, Jeremy asks to meet with Ken after work to talk. When Jeremy and Ken meet, Jeremy has the intention of trying to impose his values and ideas onto Ken. Knowing Jeremy, Ken figures that the point of the talk is to try and convert him, and intends to respond by attempting to impose his values and ideas onto Jeremy.

The first question for discussion is what either intends to do plainly wrong? The concept of negative freedom might lead one to say that it is wrong. Under negative freedom, we are free from others inhibitions on our free will. Jeremy would be attempting to impose his values and ideas onto Ken in a way that would constrain Ken’s way of life. It would also be true, however, that Ken’s attempt to impose his values and ideas onto Jeremy could be seen as inhibiting Jeremy’s free will. Is this taking it too far though? Can we not suggest to other people, perhaps not impose, but suggest and argue for a change in values? Much in the same was as one political party staffer might try and persuade a supporter of the opponent. It seems intuitive that it can be attempted and that this is part of our human nature. Perhaps we can say the discussion itself is not plainly wrong, but at what point should it stop? At what point has it actually constrained an individual’s free will.

When thinking of negative freedoms it cannot be said that merely the attempt to change a person’s values and ideas, and therefore, their way of life, is constraining their free will. It actually must be the case that the imposition was effective and has changed the values and ideas and the person’s free will. There is quite a long way from the discussion to actual realization. In a free society, the imposition should stop when the individual makes it clear no change in values and ideas is desired. This upholds their freedoms. Perhaps, Jeremy makes it clear to Ken that he will not change his Sunday routine of going to church and following its tenants. If Jeremey has his freedom, Ken should not take further action to change the values and ideas of Jeremy. Similarly, if Ken is steadfast with his values and ideas, upon letting it known no change will be made, attempts to do so should be stopped. No measure beyond persuasion through dialogue can rightly be justified and indeed dialogue should be ceased in order to be respectful of the other’s decision.

We each clearly have freedoms from others constraining our free will and what we hold as our values and ideas. Is there, however, times when going beyond just dialogue is justified. Can we say that although the individual wants the imposition to stop, it must continue until there is a change? Arguably it is when there is a known risk of physical or significant emotional harm. If either Jeremy or Ken held values or beliefs that would cause physical or significant emotional harm, it could be said that imposition of values and idea which do not cause those harms can be justified. Since neither Ken nor Jeremy holds values or beliefs that meet that criteria, both should be said to be allowed to live freely from someone imposing their values and ideas onto them. What if, however, there was an individual who if left to their free will, would cause harm to others? Then it would be permissible to impose values and ideas onto them to eliminate those harms.

There are several important necessities in life. At the top is freedom from harm. If there is only one reason why you can impose a change in the values and ideas of another person, the reason to be free from harm must be taken as absolute. If someone’s values and ideas may directly, and arguably even indirectly, cause harm, there is the right to change as best possible those values and ideas that would cause harm. If we think freedoms can be ranked, and perhaps not everyone does, but if we can, then freedom from harm must trump freedoms of belief and the values and ideas that accompany. A belief that causes harm should not be given freedom to propagate. Freedom from harm is a shared necessity as social animals. Those necessary benefits of security and freedom from harm, extend far beyond an individual, to neighborhood, city, country, region, and globally.

Freedom from harm, both physical and significant emotional harm, is such a core human right that all measures to be free from harm can be rightly seen as justified. Those measures include, as a base level, imposing values and ideas which would reduce future harm.

Throwing a person in front of a Trolley: When it’s Right and Why – An Armchair Ethics Post

Would you kill one person to save a group? Sounds like the worst choice anyone would ever have to make. How can you weigh one person’s life against another or multiple lives? Are all lives weighted in value equally? Are some people more worth saving than others, worth more than another person’s life? A commonly referenced moral dilemma that is used to explore this question is the Trolley Problem.

The Trolley Problem is the following. Imagine yourself standing beside tracks with a runaway trolley moving toward five tied-up people lying on the track. There is also a single person lying on a side track and you are close enough to the lever to change the direction of the trolley so that the five lives are saved and only the single person is killed. The standard question asked to students are:

Do you do nothing and allow the trolley to kill the five people on the track? or

Do you pull the lever, diverting the trolley onto the side track with only the one individual?

In some examples, the person must actually be thrown in front of the trolley from an overpass. How do we make that decision? There are a number of factors that need to be considered and it should be noted that not all ethical theories come to the same conclusion. For those familiar with Utilitarianism, one of the leading ethical theories today, the answer to this dilemma may seem fairly simple.

Under Utilitarianism, every rational agent must seek to maximize utility. Bring about the greatest good. Utility being often taken to mean happiness and pleasure. Through our actions, the happiness and pleasure that is generated, which is part of the outcome, is measured as utility. For example, if I spend time feeding the homeless, a consequence of that is that more people are happy, there is a greater good generated, and there is a lot of utility. On the other hand, if I spend time feeding myself, a consequence is that I am happy, there is a greater good generated, but there is not too much utility. Feeding many homeless versus myself generates more good. Within this logic, it is very clear that we should save many people over just one. The good that is generated from multiple people outweighs the good generated for just the one person. But under Utilitarianism, we run into difficulty. A critique has always been that perhaps the one individual would generate far more good i.e. utility, in the long term through his or her actions than the other five combined.

If the person that is saved goes on to invent the cure to cancer or writes a literary masterpiece, while the five others do very little and contribute little to humanity, it intuitively now seems true that we should save the one person. In response, it seems clear that we should not play with hypotheticals. Whether the one person can generate more good in the future than the other five combined is entirely unknown. Since you could easily say one of the five, or even two of the five, can just as likely do the same as the one, we must make the decision on what is known. In this example as shared, the only thing that is known is that either five lives will be saved and one life ended, or five people will die. Based on what is known, while not a simple decision, a clear and rational mind would choose to save the five by diverting the trolley to the track with just the one person.

So we know that five lives trump one. But what about the moral agent? Does the action of pulling the lever, or throwing the person onto the track to derail the train, imply the moral agent is doing something that is wrong? Another way to look at the problem is that by doing nothing, events unfold along the path that they are currently on. It is a difference of letting something happen that kills people and actually taking action that would kill someone. Many people do see this as a determining factor in whether to throw the person onto the track to derail the train or pull the lever. It, however, does not seem reasonable that a person’s conscience should be more bothered by letting five people die than to pull a lever that they are standing beside to save the five lives. That is actually what is being done. Rather than see this dilemma as an act of killing because a life is taken, it should be seen in its true sense as the act of saving five lives. For the bystander who must take the action, they should know that pulling the lever, pushing the person on the track, is the right thing to do because lives are being saved in that action.

Some thoughts on what “being mean” means

We have all been mean at some point in our lives. The act of “being mean” to someone is a common component of our societal lives. While it would be ideal if at all times we can treat each other with respect, compassion, and understanding, a part of our humanity leads us to at times doing just the opposite. We can be disrespectful, hateful, and bigoted. Is that though what “being mean” is? This short article discusses a few facets of what “being mean” means. First I will classify what we are talking about, then raise points on its effects, and will ask the question should it be our civic duty to forbid and cast judgement on people who are mean.

When someone is “being mean” to you, you know it. We learn that at a very young age. Whether it’s your brother or sister, or a school bully, we have this ingrained sense in our psyche to know even when there is a hint of sarcasm that may offend our sensibilities. A mean person is someone we do not like at that moment. That is not to say we cannot see past a moment of disrespect, for example when it is your sister, but it is certainly an action that generates a guarded response in the recipient. It can be said to be an action, verbal comment, gesture, or similar, that puts us on guard and causes use to dislike the individual. Is it just the opposite of being friendly? In many ways, it is the opposite. When the two are combined, I believe it is how we learn how to treat another person.

Can a person be mean and not know it? I think many would agree that, yes, a person can be mean and not be aware of it. It could be the mannerism a person has is not compatible with a new group of acquaintances who treat, for example, debating, as something which is not seen as a friendly activity but rather argumentative and confrontational. The example just given may, in fact, be extreme. There are many who see aggressiveness and assertiveness, even in the absence of debate and shouting, as not being entirely friendly and leaning on the side of mean. So we can add to how we are classifying it as at times a conscious action and at times an unconscious mannerism. But has this distinction now separated what it means to “be mean” and what it means to be immoral or bad? I think to an extent we can, in fact, say yes that with the conscious and unconscious element it is sufficient to say the conscious or active actions that put us on guard, in fact, are immoral and bad. If it is, on the other hand, an unconscious manifestation of the persons self, then it can be said to be “being mean”. It is interesting that we often in common language differentiate between saying “that person is mean”, and “that person is evil”. I believe the active and passive element is what provides the distinction between the two. The act of “being mean” is, therefore, not an action which a person is necessarily conscious of when they are said to be “being mean”.

So what does “being mean” to someone do? What are its effects? Without generating an exhaustive list I want to mention just two effects. The first is that it causes us to distance ourselves in the moment and in many cases for prolonged periods, from the person socially. It is often said a mean person is no one’s friend. The second is that it makes us often question what it is we as an individual did to perhaps cause the negative outward action. Thinking that it is surely something the individual did to cause or trigger the mean action is not uncommon.

If someone were mean to you, would you want to hang around them? Certainly, the answer is no. The action of “being mean” is an anti-social action. You are pushing someone away, albeit unknowingly, and can most often even see the disagreeing response immediately. It is from the response that we learn we have been mean. Is it inherently an anti-social action? I would say no. It can be a process whereby individuals in a group learn each other’s persona. It can be said to be a part of learning how best to be social with a particular person or group.

When someone is mean towards another person the one on the receiving end often wonders why. Why was this person mean to me? The act of “being mean” makes us at times question ourselves. This is a strange response. With common phrases such as “He woke up on the wrong side of the bed”, or “He’s just having a bad day” we reassure ourselves consistently that our question of whether it was our fault is, in fact, no, it was some other factor. Perhaps, someone he or she spoke to just before seeing the person who was offended. This supports the idea that “being mean” is not the same as being evil or bad, although often not differentiated.

With all of the above in mind, should we cast judgement on people who are mean? How far do we put up with a person whose characteristics are not compatible? I would suggest we do not cast judgement and see it as a part of the social phenomenon that is our existence. Rather than judgement and casting out the individual from the group or setting, we can ask why this person said or did those actions that they themselves may not understand as negative. A critic might say to tolerate mean spirited individuals as simply being misunderstood is a big ask. Why should we care what causes the action? It was the fact that a person was offended that matters. In response, it can be said that it should be tolerated because it is unconscious, and is a part of the socializing aspect where we learn the do’s and don’ts of a social group. “Being mean” in small measure may be a part of a person’s persona. Change cannot be mandated but must be the result of socializing of the individual into the norms and boundaries of a new group or person.

Virtue and Achieving Eudaimonia

Hi Ethic Nutters,

Just spending a little time today before the Superbowl seeing what is on YouTube on the subject of Ethics. CrashCourse is a great channel with a few videos on Ethics. I particularly like Virtue Ethics so I thought I would share this one first. It’s a perfect short summary with easy to understand examples.

Link: https://www.youtube.com/watch?v=PrvtOWEXDIQ

Enjoy,

Andrew

Thoughts on Aesthetic Judgments and Ethics

Often we think of what is right and wrong in terms of the outcome of academic reasoning which is not entirely tied to our physical world. Is that entirely what happens though when we come to think of an action or outcome as morally permissible or impermissible? This short post will provide a glimmer of some of my thoughts on a subject otherwise hidden from mainstream discourse.

When we see something such as a starving child, or the victim of a murder, is our judgment of that action (i.e. disparity, violence) based on what we have rationalized through reason as wrong, or is it that we are responding in a very human manner to the result of an action that is aesthetically appalling. When the question why is asked, there are already parts that are known but also parts that we do not know which matter deeply but which are in doubt. Read another way, I expect to cut through the cloud of doubt to an understanding of what sets into action our judgments. I have an idea of the answer formulated over time, although it will help to discuss and put into writing. I will not be mentioning the implications of this thinking which may be the subject of another blog post.

Typically speaking the history of morality and ethics has been usual suspects. Old white male academics in an ivory tower philosophizing on matters which frequency in the real world is up for debate. Through this questioning discourse, however, learning can happen that sheds light on matters of daily life. Is this really though the nature of morality? When I am insulted or my life is threatened, is it wrong because I have reasoned it to be so based on abstract moral principles or is it because that action is not agreeable to my senses? I believe truth is closure to the reactive nature in humans which is then rationalized afterward and explained.

So, when there is a pleasure to the senses, whether that be sight, touch, etc. there is agreement and we see that as good. When there is recoil and fear to the senses, we see that as not agreeable and quite correctly rationalize contributing factors as wrong and bad. It is clear that what has been built in terms of societal moral constructs is what is agreeable to our basic nature as social beings and our reaction to stimuli. The quest has always been to explain our response to nature. Read another way, input from the environment touching upon our senses, in a way that finds agreeability, is the good.

Subjectivity? No doubt this is subjective to what some may think of as an advanced degree. There are others who may say we share this environment and these senses with everyone and our responses to shared stimuli or often the same. Universals can become objective facts while the more mundane and individualistic experiences resting in the subjective. Neither its subjectivity or objectivity is of great importance for this post.

Art with its play on the senses is praised for its aesthetic value. We feel generally pleased when viewing the work of Monet and others, and it is in my opinion that indicates good or rightness. How we know this is our base of senses. Whether it is further rationalized through a moral theory to explain why we see that as good in a non-hedonistic view is not of importance. As I wrote in an earlier paper, found on this blog, there is an essential question to morality and that is whether pleasure is the only intrinsic good, and pain the only intrinsic bad. I think that is true. Furthermore, I believe that many moral theories have attempted to explain a truly pleasure-based morality in a rationalized approach for reasons of societal acceptability. Time has changed though and so too must our moral constructs.

Questioning the base of moral reasoning should be done. I have only mentioned above a few of my points. To summarize and highlight my opinion, the underlining purpose of action is to find agreeability with our natural response to the environments around us and our sensory responses to those environments, whether it is sight, touch, or other. It is the agreeability in its positive or negative that determines good or bad, right or wrong, and our objective should be to seek maximum agreeability without diverting to non-Hedonistic based moral theories.

 

CRISPR Babies – Update

Dear Ethic Nutters,

Every week as I read through the latest CRISPR news I’m cautiously optimistic about the progress and hope we can find a way to regulate before going too far.

link: https://www.technologyreview.com/s/614764/chinas-crispr-babies-read-exclusive-excerpts-he-jiankui-paper/

Regards,

Andrew

Will China’s Moral Difference Propel it Ahead of the West

Happy post-Halloween weekend Ethic Nutter’s. Today I saw an interesting article on SingularityHub about China’s use of CRISPR which I found compelled to write about.

SingularityHub is a futurist source of news on issues shaping the future. In the article “Inside China’s Play to Become the World’s CRISPR Superpower” by Marc Prosser he reviews China’s ambition to become the victor in its race with the U.S.A. for genetic engineering dominance. Indeed, in the Chinese government’s latest five-year plan, gene editing will be propelled forward with fewer restrictions due to a planned easing of the surrounding bureaucratic framework.

Already China is using what is described by Reproductive biologist Jon Hennebold, as a brute-force approach at an astounding level with the use of animals that they need for research and necessary experiments. It is very clear that China and U.S.A., the only two real main players are going in different directions in terms of how the ethical questions are addressed. The example given is with U.S.A. legislators soon forcing NIH to end non-human primate experiments altogether, whereas China, on the other hand, is using large colonies of primates to run their experiments. The contrast is alarming. At the end of the article, the journalist describes this race as a “Sputnik 2.0 race”. While at the University of Toronto I led a breakout session for a Research Ethics Day event where I described the rise of gene editing research as a Genetic Arms Race. However described, the race is on.

What does this mean? We could very soon see the beginnings of a competitive divide between nations that will propel the economy and the well-being of citizens within nations who use and have integrated this technology, far ahead of countries who bar it. A nation is really driven by the minds and efforts of its citizens. Imagine a nation being pushed forward by people genetically enhanced. A science and technology sector for example full of scientists and engineers with IQs higher than previously imagined and who may have no need for sleep while being supported with advanced AI technology and loose regulations? Is that science fiction? Perhaps today but it certainly will not be in the not-too-distant future.

Do ethics get in the way? The question put another way is whether the U.S.A. can compete while being moral? It is really difficult to answer this question. Many may look at China’s rise and point out all of its moral shortcomings in a vain opposing position and say yes, you’re a superpower now but look how you achieved it. Look at your human rights, look at your labour economy, look at your environmental records. Many might say they did it but in some way, you could say they cheated while doing so. Others might say, terms like those just used are not applicable in this context and offer a so what response. They are a sovereign nation. They make their own rules. Their values and ethics instruct them that this is acceptable.

While I believe there is objectivity to ethics, I do not think that objectivity can be proven. We are left with one group of people saying it’s fine and another saying it’s not. Perhaps more accurately stated, one group of people saying it’s not fine the way you do it but it’s fine the way we do it. It is the way it is done, the process behind it, not the end result. Ideally, an international agreement will be achieved on how best to proceed and that approach enforced. Why there is seemingly nothing place at the moment is a gross oversight of the international community. It is not as though this scenario was not being discussed decades ago. Indeed my classmates, professors and I were discussing this technology and in great depth before 2005.

My prediction? Common use of genetic modification of humans for health benefits will happen in the next 25 years and for purely individually advantageous reasons within my lifetime. The promises of where it could take humanity will be too great to stop its development and use.

Governing the Internet – Understanding the need

This post is a short post with just a few things to think about in terms of Internet Ethics in the area of Internet Governance.

The idea that the Internet should be governed is a growing discussion point. What was once thought of in only negative terms with reference to the Great Fire Wall of China as a way to control what netizens could access has also developed a Western argument for its importance with recent foreign influence into the US elections and a concern that such influence through social media is only beginning. In this short post I will just bring up the subject with a thought on it.

Despite there being proponents of a more Cosmopolitan world, the truth is we are far from it in all areas other than with the Internet. While key economic drivers are still restricted through national regulations and policy such as immigration and trade, the Internet which has become the medium of information exchange, the driver of opinions and ideas of all kinds, is entirely a radical element of Cosmopolitism across the globe but unchecked or governed by anyone outside countries such as China and soon Russia. Will the Chinese or future Russian model in fact be a precursor to some toned down Western version? This may happen when realization reaches the point where it is no longer thought that a radically free internet where all subject matter and topics should be freely exchanged across borders is the best scenario.

At first discussion, the idea that ideas and opinions should be shared openly everywhere seems intuitively not only good but a moral imperative. To not allow for this would seem unnecessarily authoritative and restrictive on basic freedoms. The exchange of ideas over the Internet can be seen as almost a second Renaissance. However, with everything, there are bad elements. These elements are not sharing information for the betterment of society, in some enlightened form of progress, but rather are sharing information to persuade opinion and direct action for immoral causes. In radical cases with elements of the Internet for purely anarchist objectives. The most well-known example of what I am writing about is with the use of social media platforms such as Facebook to drive change in a direction beneficial to foreign interests. These groups who post advertisements, send tweets, or share information to groups are often developed with little expense and can easily target and reach large groups of the voting public.

With the rise of disinformation, and I hesitate to use the word fake for obvious reasons, the question should be asked whether although allowing for the Internet to still be a beacon of free thought and information exchange, should we not at the very least begin to govern how it is accessed in our own counties? To not do so would seem to be a careless government. We would still have the internet although there would be rules on what could be accessed, shared, and who can add content in much the same way library’s do today.

Some may think any restrictions on freedom of thought is wrong in the same way as many see a library not carrying a particular book is now taken as a sign of unnecessary and damaging censorship. However, and to continue with the library example, if I can’t take out books from library’s in the province beside mine, it is hard to see how I can have access to hate propaganda from a country on the other side of the world without restrictions. Different library’s can have different rules for what is carried and who gets a card and for what. Similarly, as most library’s have public message boards, who can post on that board and for what types of events has rules.

It’s my opinion that if done properly and with due care, the Internet can remain the information superhighway it was created to be, while at the same time allowing for some form of national governance attached to maintain autonomy and protect against harmful elements.

A Very Short Brief on the Benefits of Palliative Care

The Benefits of Palliative Care: Beyond relief from suffering

***

This brief addresses the following question:

What benefits are there from palliative care beyond the usual relief from pain and suffering?

***

The benefits of palliative care beyond that of relieving pain and suffering are starting to come to light. Not only is palliative care showing signs of extending the life of terminally ill cancer patients by approximately 3 months, a feat that would be heralded by pharmaceutical companies had it been a drug, it is increasingly being seen as care which is to be used during the time that a person is getting treatment for a disease, in addition to when there are no useful treatments available.

Differing from hospice care, which focuses typically on the final 6 months or less of care and where death is known, palliative care is not limited to the end of life care, the hallmark of hospice. It has been rightly stated that “while all care that is provided by hospices can be considered palliative care, not all palliative care is delivered in hospices.” Indeed, palliative care within an integrated model of medical care is provided at the same time as curative or life-prolonging treatments.

Benefits of palliative care outside that of the normal relief of suffering are highlighted in the following excerpt:

Studies have shown that palliative care services improve patients’ symptoms, allow patients to avoid hospitalization and to remain safely and adequately care for at home, lead to better patient and family satisfaction, and significantly reduced prolonged grief and post traumatic stress disorder among bereaved family members. Palliative care also lowers costs, and reduces rates of unnecessary hospitalizations, diagnostic and treatment interventions, and non-beneficial intensive care. Particularly when initiated early in the disease course, palliative care also improves clinical and quality of care outcomes, and possibly survival.[1]

With the benefits of early palliative care starting to emerge there have been calls to change the paradigm for management of patients with advanced life threatening diseases. Not only is earlier and increasingly thorough assessments of options, goals, and preferences being called for, calls are beginning to being made for tailored care done throughout the course of illness.

Palliative care offers older people with advanced chronic illness, structured discussions, specialized care coordination, palliative care teams which increase patient and family satisfaction, a combination of medications and complementary therapies, and targeted interventions and individualized support. All of the above have been shown to increase family caregiver satisfaction. In one study by Marie Bakitas, patients with advanced cancer and who were enrolled in a palliative-care program reported “higher quality of life and better mood than patients not enrolled in the program.”

The data on the beneficial aspects of early palliative care is starting to come. Four particular studies of note are mentioned below.

  1. In a landmark study, patients with newly diagnosed metastatic non–small cell lung cancer who were randomly assigned to early palliative care integrated with standard oncologic care had a better quality of life (QOL), less depressive symptoms, and longer median survival than did those who were assigned to oncologic care alone. The ambulatory palliative care assessment in this trial focused on symptom management, patient and family coping, and illness understanding and education. In a later analysis, patients receiving early palliative care received the same number of chemotherapy regimens as did those in the control group but they were less likely to have chemotherapy continued close to death and more likely to enroll in hospice for a longer duration.
  2. Another randomized controlled trial (the ENABLE II trial) demonstrated higher scores for QOL and mood in patients with any life-limiting cancer (prognosis of approximately one year) who received psycho-educational palliative intervention in addition to standard care.
  3. A third randomized controlled trial of ambulatory palliative care compared to usual care demonstrated that comprehensive outpatient palliative care in patients who continue to pursue disease modifying treatment improves symptom management and patient satisfaction.
  4. In yet another trial, patients with late-stage chronic obstructive pulmonary disease and heart failure who were randomly assigned to in-home palliative care as compared to usual care reported greater satisfaction with care and were more likely to die at home.[2]

 

[1] Diane E. Meier et al. “Palliative care: Benefits, services, and models of care” pg.2

[2] Diane E. Meier et al. “Palliative care: Benefits, services, and models of care” pg.2-3

Subject-of-a-life

This paper summarizes Tom Regan’s theory of “subject-of-a-life” then through critical analysis of his main criteria examines how reasonable each criterion is in determining a “subject-of-a-life”. Regan’s theory is then tested on a specific ethical dilemma to see how applicable it is to everyday situations.

Tom Regan formulates an environmental ethics for animals using a concept he calls, a “subject-of-a-life”. To determine what is a “subject-of-a-life”, Regan uses a list of criteria to check if an individual is a “subject-of-a-life”. Under the criterion laid out by him, any being which fulfills the criterion would have inherent value and should not be seen or treated as receptacles.[i] The criteria are used to make that which has inherent value something which is more than just alive and conscious. One weakness of his criteria, however, is that he does not provide any rationale for them. He simply rejects that being alive and conscious is sufficient for providing something with inherent value without any justification for doing so. Furthermore, he provides no evidence as to why he chooses the criteria that he does. This lack of explanation weakens his argument, in that he does not initially show why being alive and conscious are not sufficient in determining what has inherent value.

There are four main criteria Regan uses in determining what is a “subject-of-a-life” and therefore has inherent value. The individual must have beliefs and desires, must have an emotional life, must have the same psychophysical criteria over time, and must care for the well-fare of their life.[ii]

The first mentioned is that of beliefs and desires. With regards to the belief aspect of the criteria, although it may seem reasonable, it would be extremely difficult to properly test. There are those in the epistemological community who could argue that we can not know if other people even have beliefs. Simply because someone is acting a certain way does not indicate we can know what their beliefs are or if they even have any. When looking at other people we assume that they must have beliefs, but no one has conclusively shown this to be true. Furthermore, even if other people do have beliefs the fact that people often go against their beliefs, in the case of someone on a diet eating pizza, questions the value and purpose of having such a criterion in the first place. The difficulties associated with this criterion are present among humans when looking at other animals which we cannot communicate with, the criteria of belief would be far too difficult to test for. Until it is shown how to test an animal to determine if it possesses a belief, Regan should abandon the belief criteria.

The desire criterion is just as troubling. It seems reasonable to assume that whatever an animal does on its own fruition, it desires to do. Someone might argue though that this is not necessarily true, animals are just going on instinct and so they do not really desire anything. If someone were working with the base assumption that one cannot have instinctual desires and that all animals have are instincts, the criteria would be impossible to pass. Regan must have had instinctual desires in mind as desires able to pass this criterion, or it would be extremely difficult to show that any animal could every pass, making the criteria too strong. Taking instinctual desires into account creates an opposite problem. Instead of a criterion too strong it becomes too weak. If instinctual desires are sufficient for fulfilling the criteria, it puts into question the ability of a conscious, alive being to fail this test. The reason for this is that if an animal were alive and conscious, it would at the very least have a desire to live. Thus, while the belief criterion is too strong, the desire criteria is too weak, nothing alive and conscious could fail it. If nothing can fail it, why test for it?

Regan’s next criterion is that in order to be “subject-of-a-life” it must be the case that the individual has emotional life. This includes things such as perception, memory, and a sense of the future. Of the four criteria, this one seems the least controversial. It seems that there are clear ways in which to test for these things without allowing every individual to pass or forcing them all to fail.

The third criterion Regan uses is that the individual must have a psychophysical identity over time. The individual must have continuous psychological experiences associated with the same body. The trouble with this is that it may rule out individuals with schizophrenia. Those who suffer from schizophrenia would not have a continuous psychological experience with the same body. They would have several psychological experiences with the same body. Hard to imagine that Regan thought that those with schizophrenia lack inherent value, but this aspect was certainly overlooked when developing this criterion.

The final criterion includes preference and welfare interests. The individual must care if their experiential life is good or bad. This is a good criterion in that it allows individuals to determine their own value, not others. If someone chooses not to care about their life then that is their choice, hopefully, an informed one. At the same time, it protects people from others determining what standard of life the person should live up to. It takes care of the messy standards of living judgments by leaving it in the hand of the individual affected the most and not some other party.

Once an individual has fulfilled these four criteria, Regan believes that they are “subject-of-a-life” and have inherent value. Individuals with inherent value are of equal value to everyone else who has inherent value, and no additional weight is given to someone over the other.[iii] Everyone is treated as having morally equal weight. The biggest problem though of Regan’s attempt to provide animal rights is that this “subject-of-a-life” is too abstract to be of help in specific situations where it would need to be applied. Not only are many of the criteria questionable as to how it counts towards providing an individual with inherent value, but it is even harder to imagine how most of the testing could be done. This is clear when having to use Regan’s theory to determine whether to save a pet dog or a comatose old man from a burning house.

How would the dilemma of having to save either your pet dog or a comatose old man be resolved under Regan’s theory of “subject-of-a-life”? In order to solve this dilemma the first step would be to test each individual against the criteria Regan provides. This will determine if both parties are to be weighed equally. If either pass or both fail the criteria then they will have the same amount of inherent value and one could not be weighed against the other. Only if one passes and the other fails would a clear answer be provided to the situation. Furthermore, it seems that Regan takes all of the criteria to be necessary and only all of them together with sufficient in determining who is “subject-of-a-life”. It is unlikely with all the difficulties in the criteria already mentioned, and that each criterion is necessary that a clear solution could be found.

When dealing with the comatose old man, it is reasonable to view him as someone who is asleep. Being in a coma is often described as being asleep, and by looking at it this way it would be helpful in evaluating the situation since it is then possible to draw on some personal understanding of what the old man is experiencing. If the old man is looked at as being asleep, then he would seemingly fail the desire criteria and perhaps depending on what one considers a belief, the belief criteria. The desire criterion fails because, in a state of unconsciousness, such as sleep or in a coma, the individual does not experience any desire. Only basic body function is maintained, nothing at the level needed for a desire. Whether there are beliefs is more difficult to determine. It can be argued that if someone has a belief prior to the unconscious state they enter, then they keep that belief with them at least until they exit the state of unconsciousness. Even if this were accepted the old man would still have failed the desire part. The old man also does not pass the second criterion of an emotional life either, since he does not have any sense of the future, nor could he have a sense of perception. Neither of these is present while someone is asleep, and so they are also not available to someone in a coma. The third criterion, psychophysical identity over time, is the only criteria the old man would pass. He maintains a psychophysical identity over time, just as it would be said someone asleep does not lose their psychophysical identity, nor does it make something to any meaningful degree non-continuous.  The final criterion of preference and well-fare interests also seems to indicate that the old man does not have inherent values. When someone is asleep it would be hard to say that they have a preference and well-fare interests. It seems more reasonable that the person is in such a state that they cannot make a preference, thus failing the final criterion as well. The comatose old man fails most of the criteria, and therefore he has no inherent value according to Regan.

The problem with the comatose old man failing the criteria should seem clear. If someone in a coma fails to have inherent value, what does that mean for people who go to sleep at night and enter into a similar state of mind as the old man in the coma? This is clearly a problem Regan needs to address. One possible response might be that in the instance of someone in a coma, them coming out of that state is largely unknown, whereas it is reasonable to assume people will wake up after falling asleep. How this makes a difference is unclear though, and something Regan needs to examine.

Does a dog have inherent value? Regan does not provide enough evidence on how to test for things such as beliefs, desires, and whether or not the individual cares about their well-being. This is a problem when dealing with animals since it really boils down to guesswork, due to the communication barrier. It is difficult to comprehend how we could ever know that another animal has beliefs. Because it fails the very first criterion, belief, it must be concluded that under Regan’s theory of “subject-of-a-life” a dog does not have inherent value. When balancing a choice between a member of one’s own species to that of another, when they are of equal inherent value, in this case, no inherent value, it must be that the right choice is to choose the old comatose man.

Tom Regan wants to use “subject-of-a-life” theory to show what does and does not have inherent value in order to protect animals. He does not feel that something which is merely alive and conscious is enough to grant an individual with inherent value and this is where he first goes wrong. Many of the criteria used in determining “subject-of-a-life” require tests which may not even be possible or can be tested but virtually everything would pass or fail it puts into question the need for it in the first place. The most troubling part is that his theory is far too broad to implement in a practical setting where someone may have to make a quick decision. Despite all the difficulties with the “subject-of-a-life” theory it should not be abandoned altogether. Regan is at least on the right track, attempting to provide animals with some degree of protection.

[i] Tom Regan. The Case for Animal Rights (Berkeley: University of California Press, 1983), p.321

[ii] ibid

[iii] ibid