« It Worked | Main | »

August 13, 2009

Comments

Tom

Star Trek: TNG touched on this in an episode. One of the cultures the crew came across simply euthanized every person once they reached a certain arbitrary age.

I would think that the rationing of health care due to a single-payer system would preempt the decision: if there's only so much health care to go around and you need more than your fair share, then you're pretty much screwed. That seems to me to be a good way around the issue. I suppose another option is to get rid of subsidized health coverage altogether. That option is less egalitarian but is appealing from a Libertarian standpoint: if you can afford to keep yourself alive, you're more than welcome to try; if you can't afford it, you're screwed. Both of those systems seem better to me than the one we have now, where brain-dead people are kept alive through insurance claims, driving up the cost and availability of health care for everyone else.

nato

I think that Palin et al. simply don't believe that the Dems want what they say they want, and think it's a cover for something insidious. I remember being told that Obama planned to raise and equip a domestic army in response to his remarks that domestic service organizations should be given resources in the same manner as the military. There's just a lot of people who think that Obama et al. intends to aggressively subvert basically everything they care about. They don't think he's a citizen, and they think he's a muslim and etc. Palin doesn't subscribe to the zaniest of these conspiracy theories, but I do think she shares in the general expectation of bad faith.

ms

We touched on this issue awhile back when I argued that the elderly would get the short end of the stick in nationalized medical care. My point at the time was that these decisions need to be made at a local level to a large degree. Individuals differ so much. You have some 90 year old people who run circles around 70 year olds, some 70 year olds who are in better shape than 50 year olds, and so on down the line. So many factors go into these decisions that the idea of bureaucratizing them is odious. This is the basis of outrage for me--trying to shove everyone through the same door without input from those most closely concerned with the situation. We all know we can't live forever and if we are sensible we don't want to, but neither do we want to be shoved through the door of death for the convenience of the government.

Nathan Smith

Well, I'm not comfortable with Tom's position. Tom and I are coming from different places, since I presume he doesn't think suicide is immoral. I would start with the ethical question: Is it OK for an individual to choose to die rather than get a costly treatment with money that could save more lives somewhere else? Do the objections to euthanasia apply to such a case?

Nathan Smith

Making the decisions at a "local level" with "input from those most closely concerned" is fine as long as the *financing* comes from the local level. If it doesn't-- if it's provided by some statewide or nationwide medical insurance company or government-- then you'll just be giving the decisions to people who don't have any incentive to take costs into account.

Nathan Smith

In response to ms, it's fine to make decisions at the "local level" as long as the *financing* comes from the local level. If the financing is going to come from a nationwide or statewide insurance company, or from Medicare, then those who are financing the treatment need to have a say in end-of-life decisions.

I'm not clear on what the word "local" means here. Does it have some *spatial* meaning? If so, given the amount of geographical mobility in this country, we can't presume that those "most closely concerned" will be "local," still less that those who are "local"-- say, neighbors-- will be "closely concerned." Given the fluid and dispersed nature of the population, physical proximity and real ties of mutual responsibility don't necessarily have much to do with each other.

Tom

I think that suicide is immoral depending on the context. Suicide for a terminally ill patient is not immoral, whereas suicide for a healthy teenager with a good education, rich and caring family, and overall good prospects for the future would be immoral. Suicide, like killing a person in general, is a very gray area.

There was a case in the paper recently of a guy who was very well educated, had a great family, good health, well-liked in his social circles, but he was unhappy because of the perceived materialistic nature of humanity. So one day he went for a long hike with no food or water and never returned. His body was discovered recently and they determined the cause of death was starvation. He took some pictures of his final journey and recorded some things in a journal, and apparently he survived for 40 days or so without food. His trip was ultimately suicidal. He must have realized he was killing himself, but he did so simply by refusing to survive. So was his action/inaction immoral? Is it immoral to not try to survive?

The converse of the above situation is that of Jean Valjean or Fantine in Les Miserables. Jean was sentenced to 19 years hard labor because he stole some bread to feed his family, and Fantine became a prostitute and debased herself to support her child. In these cases, are they justified in doing something immoral in order to survive?

Gray areas abound. Jesus said let he who is without sin cast the first stone, and there is something profound in that statement. Each of us as individuals must act according to our own conscience. In the case of suicide, perhaps government and society should leave judgment to the poets and philosophers and to people's individual consciences.

Joyless Moralist

In Catholic moral philosophy, discussion of this issue tends to center around the question of what kind of care is needed. So, obviously they think (and I think) that suicide is wrong. But it isn't necessary to do absolutely anything possible to extend a person's life. The distinction they try to draw is between "ordinary" and "extraordinary" means of life preservation. Starving someone (yes, including yourself) is wrong (there can, of course, be sins of omission, as well as of commission), but failing to provide them with experimental surgery, or to sustain their life using very costly medications, isn't necessarily.

One debate centers around the question of provision of nourishment. John Paul II indicated that the provision of food and water is "ordinary" means of life preservation, and thus must be provided if at all possible. But some people do raise questions about the level of artificiality in providing nourishment. If someone is capable of chewing, swallowing, and digesting normally, that's one thing. If they require expensive medical equipment in order to receive the nourishment, then there's more of a debate to be had about whether that qualifies as "ordinary means."

One thing to note: the mother who gives her child the last available food and starves herself would not be counted as a suicide (unless possibly she was, say, actually overfeeding the child while literally starving herself... but I think we're presuming that she's starving herself to keep the child alive, or at any rate keep her from suffering serious health risks.) That would be a pretty straightforward double-effect scenario. The intention in giving the child the food is to nourish her, and this is obviously a great good and indeed the parent's responsibility. The mother's own starvation is a foreseen but obviously unintended side effect -- if she could feed them both, she would.

I appreciate the problem about the agent of decision-making and the agent providing the funding needing to be connected. If doctors decide who gets what medical care, but taxpayers foot the bill, doctors will have no particular incentive to be cost-conscious and skyrocketing bills will be the result. But surely we could find an alternative somewhere between a strict libertarian pay-out-of-pocket solution and a totally socialized health care system. And actually, if Tom really wants to leave things to people's own consciences etc., a single-payer system will be intolerable, because the single payer may well make decisions that some people regard as gravely immoral (for example, to unhook Grandma's feeding tube, which many Christians and probably others too would find morally unacceptable) and there won't be any real recourse. This is another case where I think ms' comment about localized decisions has some merit -- any blanket rules or policies you might pass concerning health care are going to lead to a lot of really unfortunate applications. There's just too much variety in the sorts of situations that can arise.

So, can't we maybe find some middle ground, wherein people themselves shoulder *some* of the costs of their own health care, but perhaps not all, so that care could be subsidized for those who are willing to contribute a portion of the costs themselves?

Nathan Smith

A "middle ground" solution is possible-- it's more or less what we have-- but I don't see how it solves any of the moral dilemmas. Why should a single dime of my tax dollars go to help some elderly, permanently incapacitated stranger in, say, Florida, when they could save the life of an African orphan instead? And if removing grandma's feeding tube is wrong, why can't the family pay for it themselves? If the answer is: because it will bankrupt us, or at least severely reduce our standard of living (maybe Junior won't get to go to college, for example)-- will, an absolute moral commitment shouldn't be so easily relinquished as that? And if it does seem wrong to deprive Junior of college because one is obligated to keep grandma alive by "ordinary means," no matter how newfangled and exorbitantly expensive... well, what is your moral intuition telling you? I'm not taking a stand here, I don't know. But JM's position makes me uncomfortable. In a world of scarce resources it seems basically unjust.

Joyless Moralist

Generally speaking, the point of the "ordinary" vs "extraordinary" distinction is that the former *doesn't* include every newfangled, extraordinarily expensive new technology to come on the market. That's why it's "ordinary." As I've admitted, there are some hard questions when it comes to nutrition, because sometimes new technology opens up new ways of nourishing incapacitated people that are at least moderately costly, though not generally "exorbitantly" so.

But as for why your tax dollars should pay for it... well, you might have to start by wondering why your tax dollars should pay for *anyone's* health care. There's almost always going to be an African orphan that could be saved more cheaply, if you want to subscribe to a Peter Singer-type utilitarianism. So if all national entitlements are prima facie unjust then I guess it would be unjust here too. But I guess the idea is that, if every human life is valuable, there should not be a point past which it's just not worth lifting a finger to care for a person. The fact that grandma is old or sick might be some reason not to spend 100 grand on a new experimental surgery for her, but is it reason to stop feeding her? I think the point is that we have certain obligations to care for people that age or illness cannot simply erase.

If you aren't willing to countenance this -- that is, if you want the death panels, or some other legislative or administrative body, to set hard and fast rules for whose life is worth saving and whose isn't, you'll potentially have bureaucrats making some decisions that I for one certainly don't want to see in such people's hands. If you're not sympathetic to the case of the elderly, consider this issue (which I was reading about recently): now that most people get prenatal testing of various kinds, which lets them know beforehand of certain disabilities that their child might have, there is talk in certain quarters of refusing to provide even ordinary levels of support (e.g. public education, medicare access) to children with Down Syndrome, hereditary blindness or deafness, or other disabilities. Such people, it is assumed, will have such a low quality of life that it's not really worth the resources it will take to raise them, and anyway they will be less likely to be productive members of society. And since their parents refused to abort them (which, at least in the case of Downs, a large majority of parents do these days) then it's their problem how to provide for and educate the kids. Now, is *that* the sort of world in which you'd want to live? Nationalized health care, and a government that decides whose life is worth living and gives no (or significantly reduced) health care access to those religious crazies who aren't willing to kill their disabled children in utero?

I guess my idea behind the "middle ground" (and you could look for a middle ground that puts *more* of the costs on people themselves than in the system we presently have... and one that, like ours, relies partly on private insurance, not just on government sponsorship) is that it would enable people to get care in a way that would not be financially crippling to them or their families, but that it would still give people a serious financial reason not to regularly demand the very best treatment money could possibly buy. It's not really good for anybody when individuals or whole families are bankrupted by emergency medical situations, and it doesn't seem unreasonable to want to take steps on a community or societal level to cushion that, but there does still need to be some way of keeping costs from skyrocketing out of control.

ms

Because nations are communities and you help those in your own community before you help those who are not part of your commuity. Human societies have to be organized in communities smaller than the whole world or we cannot make sense of anything! We are the world and we should help other people in the world, but, as with families, your foremost obligations are to your own community. What if the elderly person is your mother or father, what then? No, of course an infinite amount of money cannot be spent on any one life, but if we value life, it IS necessary to keep grandma alive by "ordinary means." I'd say in this country, any Jr. who wants to work hard can afford college. These are not mutually exclusive.

Nathan Smith

re: "But as for why your tax dollars should pay for it... well, you might have to start by wondering why your tax dollars should pay for *anyone's* health care. There's almost always going to be an African orphan that could be saved more cheaply, if you want to subscribe to a Peter Singer-type utilitarianism."

I don't know what Peter Singer has to do with it, but yes, if *coercion* is going to be used, with whatever moral cost that involves, the money should be spent wherever the most quality-adjusted life years can be bought for it. And this idea that an African orphan is less deserving than an American old person... Isn't the point of the Good Samaritan story-- that one's "neighbor" is of the next nationality just as much as your own? It's not just a matter of cheapness either. An African orphan could have a full life ahead of him if, say, some AIDS drugs were provided; an elderly person has already lived that full life.

re: "Because nations are communities and you help those in your own community before you help those who are not part of your commuity."

I'm sorry, my conscience rebels against this. First, the idea that a nation is a "community" seems like an abuse of the concept. A community is people who know each other and love each other. Maybe at the 2nd or 3rd degree the term can still apply. But to say that I'm in a "community" with a homeless guy in Pittsburgh or Portland, whom I've never met, whom no one I know has ever met, who lives in a place I've never been, that I cannot accept.

The real significance of this argument-- again, I'm sorry to be harsh, but I have to speak the truth-- is that it's a rationalization for the use of coercive power in narrowly self-interested ways, ignoring the claims of justice, and cloaking it in pseudo-ethical reasoning. No one would say that a person was in the wrong if, having $10,000 to spare, they donated it to help orphans in Africa rather than to pay for expensive treatments for seniors in Orlando. That's because everyone knows the "a nation is a community" argument is nonsense. Now, if you donated $10,000 to help orphans in Africa rather than saving your father or mother or brother, people might object to that, because there the "community" argument actually applies and has some force. The reason to invoke this argument at the national level is, if you happen to be endowed with a vote which can be used as an instrument to take resources from a captive population of American rich people and redistribute it to yourself, it's mighty convenient. Any non-American whose mother dies because of this discrimination-by-nationality could see through it in a second.

The principle that you should help your own community first would make sense in a world that was more equal. If your village is just as poor as the next one, to say, "everybody take care of the people in their own village" is a sensible division of labor. If everyone in your village lives in palaces while the next village is starving, this argument is a monstrous sophistry. Again, I'm sorry to be harsh, but I just can't let this argument stand. I see how people can be led astray by it, but it is wholly false and a source of terrible evils. A Christian cannot allow mankind to be chopped up into little clubs, some rich and some poor, who try to pursue utopia among themselves and disregard the others.

I have sometimes argued that the distinction between patriotism and nationalism is the distinction between the feeling of admiration and the feeling of entitlement, the feeling of love for something greater than onself, and that of a prison gang member saying to another, "I got your back." Patriotism asks what you can do for your country; nationalism asks what your country can do for you. A nationalist wants his country to take care of him in preference to others. A patriot wants his country to be the best it can be, and that does not mean hoarding all its resources for itself.

re: "What if the elderly person is your mother or father, what then?"

I want to approach this subject in a certain way. I don't want to talk about whether the state, if it pays the bills, should decide who lives or dies. That brings in policy questions with a lot of complexity. I don't want to say that individuals are wrong to spend money saving their loved ones rather than strangers whose quality-adjusted life-years could be bought much more cheaply. On those two questions I am in doubt.

I want to approach this as an ethical question, and it's easiest if one assumes that one's own life is (hypothetically) at stake. Suppose I were hooked up to a feeding tube, which costs, say, $50K a year to maintain. I'm incapacitated, but somehow I wake up long enough to have the situation explained to me and to respond to it. Now, what I would want to do is to say, "Please, please, PLEASE do something more worthwhile with these vast sums of money. Buy AIDS drugs for African orphans or bednets (anti-malarial) or something. I'm devoured by guilt at this waste. So many people are in such desperate need and here I am, who will never be able to help anyone again, absorbing tens of thousands of precious dollars. I know you meant well and I love you but I just don't feel right about this."

So here's my question: Would it be wrong of me to say that? If I can only have the right to say that, it's less important if my tax dollars go for whatever. I can turn the other cheek when the taxman comes; it's not really my responsibility to make sure that taxmen or thieves use my money well. But the guilt of wasting thousands on myself when others are in need is one I hope I can be spared.

Having said that, there's a woman I visit in the hospital who is paralyzed, and I really like to see her. It probably costs a lot to keep her alive, but I would be very sad to see her go. I don't want to go on a crusade to apply "Peter Singer" principles to everyone else. There's a lot I'm unsure of here. But would I be wrong if I asked for the feeding tube to be taken away?

ms

People in your nation are part of your community, just not part of your local community. This is why we all vote in the same elections, pay taxes to the same government (which ought to give us some privileges!) and sing the same national anthem. The old person in Florida is the parent of someone who goes to your church or lives on your street or works with you. I think the story of the good samaritan is that the samaritan saw and responded to suffering that was before him. Now, I'm not saying that we should not help children in Africa--we should. But humans are so constructed that their lives need to be bounded by smaller loyalties than the whole world. I admit that a nation is a large loyalty, but nations have been pretty successful so I guess it is not too large to do its work. A nation creates a certain culture, a certain way of caring for its citizens and running its institutions and citizens contribute and gain certain advantages from everyone being in it together and contributing to the whole. It is therefore not immoral for tax dollars to go for the old person in Florida (within limits as we have already stipulated) instead of the African orphan because this is part of how the community works. That old person has, in their lifetime, paid taxes to help other people as well.
About your feeding tube example--no it would not be wrong to ask that that money be used for something else if you knew you would never recover. This is why many people have living wills that stipulate that they would not want to be kept alive under the feeding tube scenario. But that is not the usual case. The more usual case is the one like your friend who is paralyzed or the old person in Florida who has managable health issues. These problems might be relatively expensive, but these lives are valuable and should not be sacrificed in favor of the orphan in Africa. Such an attitude would mean a breakdown in our own culture, which in many ways can serve as an example of what the African nation should strive to do for its own citizens. One last thought--it's a good thing your parents have more than one child! ;-]

Nathan Smith

re: "This is why we all vote in the same elections, pay taxes to the same government (which ought to give us some privileges!) and sing the same national anthem."

I don't think I've sung the national anthem in years. Imagine how many foreigners would learn the national anthem if it entitled them to be a part of the American nation! The mere mention of something as trivial as this as an example of how we're a community shows how feeble the concept is.

Elections and taxes show that we're part of one *polity*, not one community. As for the "privileges" that one gets from paying taxes... well, if it's just a matter of paying for services, can we leave that to private markets, please? Right now, the government is paying out far more in Medicare and Social Security to today's seniors than they paid in to the system, driving the system inexorably into bankruptcy, leaving my generation with (on present trends) nothing from the programs we're paying into. And yet they feel they're entitled to all that government largesse because they think they "paid for it," even though, objectively, they did no such thing. Pseudo-moral entitlements to transfers from the public purse in virtue of having paid taxes only cause trouble.

re: "The old person in Florida is the parent of someone who goes to your church or lives on your street or works with you."

Yes, and an old person in Mexico or India or Russia might be the mother or mother-in-law of your boss or your colleague or your best friend or your choir director. These webs of personal connections do not limit themselves to national borders, but spread out all over the globe. Such personal ties provide no justification for privileging the nation as a form of community.

re: "But humans are so constructed that their lives need to be bounded by smaller loyalties than the whole world."

I don't know if 'bounded' is the right word, but I agree that many strong local loyalties should have their place: families and churches, first of all, universities, academic disciplines and professions, groups of friends, hobby clubs, cities, ethnicities like Irish or Russians, speakers of common languages, political parties, etc. Discrimination in favor of fellow members of one's group is sometimes appropriate: one might invite only Republicans to write on a political blog, or economists to attend an academic conference, or Catholics to attend a religious service. But discrimination is a delicate issue: sometimes it can be a cause of flagrant injustice, e.g., if whites refuse to hire blacks. Discrimination by nationality in provision of publicly-financed health care seems to fall in the unjust category.

re: "It is therefore not immoral for tax dollars to go for the old person in Florida (within limits as we have already stipulated) instead of the African orphan because this is part of how the community works. That old person has, in their lifetime, paid taxes to help other people as well."

This is not how the *community* works, it is how the *polity* works. Government agencies with the ultimate backing of men with guns take from X and give to Y. It is characteristic of *community* to use social pressure, sometimes quite intense; but when coercion is brought into play we're definitely talking about a *government*, and to use the word "community" is misleading.

But anyway, granting that the polity/"community" works this way, the question is: Should it? Polities can do wicked things: this is perhaps the #1 lesson of history. So can communities, discrimination against blacks by social clubs being the most well-known example in the American context. One needs a justification for "how the community works," but the community might be in the wrong.

The justification offered here, that the old person paid taxes to help others in the past, fails, because (a) the health care is not provided in virtue of past tax payments and Medicaid, as far as I understand, would be provided even to an old person who had never paid a dime of taxes in their lives, (b) even if the old person did pay taxes to help others, those payments may be far less than the cost of the treatment they are receiving, and (c) the benefits to the old person do not come from those they helped, but from younger generations who, on current trends, will live to see the programs go bankrupt.

re: "These problems [e.g., paralysis] might be relatively expensive, but these lives are valuable and should not be sacrificed in favor of the orphan in Africa."

Again, I'm not saying that we shouldn't help paralyzed Americans, I'm even sympathetic to the idea... but surely we can't accept this argument! It only makes sense on the assumption that the lives of African orphans are *not* valuable.

re: "One last thought--it's a good thing your parents have more than one child! ;-]"

I assume this is a jibe suggesting that with the attitudes I've expressed I'll be bad at taking care of my own parents in their old age. But I've said no such thing. On the contrary, let me emphasize again that *family* is a real community that entails special obligations. I think that the obligation to one's parents is very strong and that one ought to help one's parents even at great sacrifice to oneself and without too much regard for whether the resources thus spent could purchase more quality-adjusted life years, so to speak, elsewhere. But a *nation* is not that kind of community and should not be treated as such. That the system does operate this way is a function of the political power of American voters over American taxpayers. It is not based on morality.

re: "our own culture, which in many ways can serve as an example of what the African nation should strive to do for its own citizens"

To impose this concept of nation on the polities of Africa is ahistorical: most of them have borders drawn by European colonialists containing many different ethnicities and have little or no concept of shared nationality. It is *our* responsibility, as fellow human beings more favored by fortune, to order the world more justly so that Africans and other poor people have opportunities to better their lives. To fob off that responsibility on the cartographical fictions that the outside world has taught some African elites to call "nations" is an evasion. Note also that this argument is exactly the same as that made by apologists of South African apartheid, who created "homelands" for black South Africans and then disavowed responsibility for them.

Nathan Smith

Sorry to harp on this, but this statement bothered me too...

re: "Nations have been pretty successful so I guess it is not too large to do its work."

In what sense have nations been "pretty successful?" The rise of nationalism in the late 19th century led to WWI. Between the wars, nationalism inspired Nazism and fascism. In recent years, the paradigmatic humanitarian catastrophe has been "ethnic cleansing," which is basically a corollary of the organization of the world into nation-states, since hostile nations sometimes find themselves within the borders of a state and decide to kill each other. Wilson's "national self-determination" is essentially a program for ethnic cleansing, since in the real world people of different nationalities have overlapped and intermingled for generations, and the imperative "Make nation-states!" is often a trigger to fight over territories and drive out or kill minorities.

Another problem with nation-states is that the organization of the world into nation-states seems to increase global inequality: since 1870, there has been a large increase in global inequality among individuals, which is *more than* wholly driven by huge increases in inequality among nations, since within nations the trend has generally been towards greater equality. So nationalism seems to cause huge global inequalities as well as war.

In what sense have nations been "pretty successful?"

Nathan Smith

I do feel a little bad attacking ms this way, because the attitudes she's expressing are widespread and she probably hasn't thought through all their ramifications and is sort of taking them on faith-- an "everybody thinks this, there must be something in it" attitude. She means no harm I'm sure. But still.

ms

No--I have thought them through and I am not taking them on faith. Think about it--people fight and die for their countries. This is an important way of organizing human life and it is an important community. Like anything, it can go wrong on occasion, but on the whole loyalty to ones country is a positive thing, as CS Lewis pointed out in The Four Loves. I do not apologize for calling it a community. It is a polity too, but they are not mutually exclusive. I believe that if you can't have compassion for the near then you can't have compassion for the far. I do think you are right that we need entitlement reform. I agree with Joyless Moralist that old people need to expect only ordinary care. In a way we can blame our current dilemma on the wonderful medical advancements in the past 50 years. We certainly need to face the fact that every illness cannot take full advantage of medical technology--and that form of rationing will be very tough. It will have to be done, however, and I think it should be done. But a great deal can be done for people under an ordinary care scenario. My elderly father, for example, has been in the hospital for a few days every other year or so for various ailments. He had a hip replacement several years back, but has never had cancer or anything. I don't think this has been an extraordinary amount of care to provide to him. He has told me himself, however, that if he got a more serious illness, he is ready to go. That seems reasonable to me. I don't think elderly people expect heaven and earth to be moved to keep them alive, but just ordinary care to keep them going and comfortable until that serious illness comes.

Nathan Smith

re: "loyalty to ones country is a positive thing, as CS Lewis pointed out in The Four Loves"

But CS Lewis also points out in *The Four Loves* that the good kind of love of country should make it harder for one's country do bad things. At the present day America is committing injustice by excluding foreigners from finding better lives here through border restrictions, and from supplying an exorbitantly expensive medical social safety net to its own people with money that might-- and there is certainly room for debate about this part of the question, given the many problems involved in making foreign effective-- save orders of magnitude more lives if spent abroad. A true American patriot's love of her country should not make her complacent about these things, but should make her all the more indignant, lacking all the indifference with one might regard the injustice of a stranger... just as a good mother would be much angrier to see her own child telling lies or being cruel, than a stranger.

re: "if you can't have compassion for the near then you can't have compassion for the far."

We're all in favor of compassion for everybody, that's not the issue. The issue is, faced with scarce resources, who should we help? Suppose there is a flood, and a father arrives at his home to find that four of his children are trapped inside the flooded house. Three he can save easily, one is harder; so he saves the three first, and when he goes back for the fourth, he finds that this child has already drowned. Did the father lack *compassion* for the fourth child? No, he felt compassion, but faced with scarce resources he could not save them all, so he performed a utilitarian calculus to decide which of them to save. (To try to save the fourth might have meant leaving the other three to die.) Similarly, a redistribution of health care from American elderly to African orphans would not reflect any lack of compassion for the former, but a sober and reluctant calculation of what justice and the greater good demanded.

While I'm harping on the ethical questions because I think they are important, I'm not sure that ms and I are so far apart. When ms says, "We certainly need to face the fact that every illness cannot take full advantage of medical technology-- and that form of rationing will be very tough," I fully agree. This is really the heart of the matter. If we can get past the fallacy of thinking that every American human life must be saved at any cost if only it is possible, we'll be much better able to wrestle with health care issues in a wise and just way. In a way, I think there is something disordered about the whole modern attitude towards death, about our reluctance to talk about it, for example. Old people get less respect in our society than in most others, partly because they are closer to death and I think we feel that to be shameful, which in a sense it is-- that's why the Resurrection was a redemption-- although since all of us are mortal we are certainly not in a position to sneer.

ms

You can't open the borders wide and have the same culture that we have. If you have slow and controlled immigration then it is fine because people adjust to the culture they find instead of changing it drastically. I value the culture and institutions we have. Massive immigration from other countries all of a sudden would drastically change these and that would not be good. Check out Mark Steyn on this question. This kind of shifting of world populations would not even be good for other people and cultures. They may think they want to come to America--many do because it is relatively rich and glamourous, but in fact the culture that they have is also important and valuable. I think the brain drain to America to take advantage of education and high paying jobs is actually an unfortunate thing for the communities these people leave and even for the people themselves. Living near their families and within their cultures is good for them. They lose something when they leave. I have thought about this some because I am a person who likes to explore other cultures and places and I have wondered sometimes if I would want to live in a foreign country, maybe permanently. I always come to the same conclusion. No, I wouldn't, because my family and friends are here and this is the way of life that I know and love. I like to travel and I would live somewhere else temporarily, but my country, my culture, my people are HERE. And I hope and believe that is true for other people with regard to their country, culture and people. So I would just have to say that I think you are wrong about an injustice being committed by excluding anyone who wants to come from coming here. In fact, I think we are doing people a favor by not making it too easy for them to be lured away from their culture by the big city and bright lights, so to speak. We really should not have such an overblown sense of the value of our own culture as to think everyone else should come here, but neither should we undervalue it by inviting the world in to change it. Maybe you think that people in the world ought to have complete freedom of movement, but that is just unrealistic, if for no other reason than the cost. Beyond that, mobility takes a terrible toll on human community and connection and these are things we need to encourage and value, not discourage by ending restrictions on movement between countries. I would never be too draconian about this, but it would be foolish to pretend that attachments to national communities are unimportant.

Nathan Smith

How does one express adequate horror at ms's remarks? I mean, consider this:

"In fact, I think we are doing people a favor by not making it too easy for them to be lured away from their culture by the big city and bright lights, so to speak."

Wow! Hey, I know what we should do: Let's establish internal migration restrictions so that people from rural areas won't be "lured away from culture by the big city and bright lights." No West Virginians in New York! No Idahoans in San Diego!

re: "You can't open the borders wide and have the same culture [and institutions] that we have..."

Yes, I know, that's why I have always advocated a certain degree of control. We could absorb several times as many immigrants as we do, but public order and public health would at some point become threatened.

Though the "culture" argument is weak, because there are lots of different cultures in America, Irish and Italian and German etc., and to the extent that there is a common American culture of pop music and movies it is largely globalized already so that hundreds of millions could probably come to America and they would feel quite at home with us and we with them, and to the extent that there is a "civil religion" of hard work and opportunity and love of freedom many Americans don't have much of it and immigrants tend if anything to have it in special abundance since they're self-selecting for it. What really threatens America's civil religion is to keep immigrants *out*, since they provide an essential infusion of the values and attitudes of our immigrant ancestors.

re: "I think the brain drain to America to take advantage of education and high paying jobs is actually an unfortunate thing for the communities these people leave and even for the people themselves."

This has been considered by scholars but is generally rejected. 'Brain drain' increases the incentive for people in poor countries to get education, offsetting the losses of some educated people, and emigrants send remittances home. But of course, if we want to avoid disproportionately draining 'brains,' we can admit more less-educated people.

re: "I have thought about this some because I am a person who likes to explore other cultures and places and I have wondered sometimes if I would want to live in a foreign country, maybe permanently. I always come to the same conclusion. No, I wouldn't, because my family and friends are here and this is the way of life that I know and love. I like to travel and I would live somewhere else temporarily, but my country, my culture, my people are HERE. And I hope and believe that is true for other people with regard to their country, culture and people."

Now, there's something ironic about this remark, because I happen to know that ms's children are distributed all over the country and most of them live thousands of miles away from her. If that's close enough, well, just about any Mexican migrant to California has stayed closer to his family than ms is to hers. And please remember that most countries are much smaller than America, and if they were to practice the same degree of mobility as many American families, including ms's, practice, it would involve international migration.

But the main point, of course, is that just because ms wants to stay in her own country doesn't mean that other people would draw the same conclusion. She can stay if she wants to, but let other people do their thing. If ms doesn't want to listen to hip-hop music or get a belly-button ring or play professional violin, fine, but that doesn't entitle her to prevent others from doing so. It would not be a good thing if she were empowered to impose her particular preferences on the world; it would be a very bad thing.

And please bear in mind that we shouldn't imagine that the world consists of little Americas, each with its own fairly self-confident and self-sufficient culture and a wealth of internal opportunities. Some countries are lines arbitrarily drawn on a map by colonialists or the accident of war, with oppressive governments that barely pretend to represent large sections of their people. I suspect that tens of millions of people around the world-- I've met a lot of them-- feel culturally more at home in America than in "their own" countries, meaning the countries they are legally subject to, but that may have little use for them. Think of the Israeli Arabs for example, citizens in a Jewish state that despises and fears them. Can we ask them to feel the same affection, loyalty, and attachment to Israel that an American citizen with full rights and vast opportunities in his homeland feels towards to America? The notion is insulting. And there are tens of millions in a similar position around the world.

re: "Maybe you think that people in the world ought to have complete freedom of movement, but that is just unrealistic..."

I know, I've said this over and over again, but we should come as close to we can, and we should only exercise force to control immigration as a last resort and for very definite and narrow reasons, which include national security and prevention of epidemics, but not labor protectionism or protection of "culture."

I feel that I am in exactly the same position as an idealistic Southerner in the 1840s arguing against slavery. A defender of slavery in the Old South would be somewhat less culpable because of the influences he is under, and certainly the idealist should be as loving as he can. "Hate the sin, but love the sinner." But one the injustice, the falsehood, the lack of empathy, the double standards, the inappropriate sacralization of a "way of life" that is pervaded and made possible by that injustice-- against those horrors there must be no mercy. I must simply insist that ms's whole way of looking at this question is utterly wrong, that she must rethink it from the ground up, in the spirit of "Do unto others as you would have them do unto you."

Nathan Smith

Let me just say again that I write these words in all love for ms. If I convey any impression of malice or contempt I apologize and please believe that it is a misreading of how I feel. If the remarks came from someone for whom I felt no special love I could regard them with more equanimity. But I really want ms to see the truth.

Nathan Smith

I am sorry to get so heated. I'm sure ms's heart is in the right place. But when I think of the human suffering that results from attitudes like this, I can't let the sword of reason sleep in my hand.

Nathan Smith

The basic problem with ms's position is that she wants to trap much of mankind in poverty and lack of opportunity, and she claims it's *for their own good,* even though it's against their will. In this respect she is exactly like the apologists of slavery who claimed that slaves were better off under their white masters, whatever their own preferences might be.

sds

Could the current discussion be broken down into three main lines of (possible) controversy? First, there is a divide between two ways of approaching ethical issues. A common modern approach suggests that in pondering my moral duties, I must treat all human beings as equally valuable, and hence must avoid acting on “arbitrary” features or distinctions, such as the fact that one person is part of my family, or my neighborhood, or in some other way is connected to me or visible to me. So it would be grossly immoral, and a huge and unjustifiable sacrifice in human welfare, for me to spend thousands of dollars to send my own son or daughter to college when the same amount might save the lives of a large number of children I have never met in some other corner of the world. A different approach acknowledges that morality is “morality for humans,” that humans are finite, embodied creatures, situated in and partly constituted by our relations to particular times, places, people, and communities, and that good, virtuous humans will recognize and act in accordance with these connections. By this view, the person who declines to give financial aid to a needy parent or children in order to contribute to UNESCO or whatever may be a bit unnatural, or not as admirable a “human” as the person who primarily takes care of those who are nearby and connected.

Obviously, there are different views on this divide. Ms seems pretty clearly to take the latter, “connected” view. Nathan’s views seem much more animated by the “detached” approach, but he doesn’t explicitly endorse it, and indeed he appears to acknowledge prior obligations to family, community (?), etc. So we might move to a different point of divide.

The question now, then, might be whether in fact, as a descriptive matter, people feel a sense of community with regard to their nations. Are nations genuinely “communities,” or merely “polities”? Since this is an empirical question, the answer will no doubt differ from time to time and from person to person. Communities are to some extent, as a famous book by Benedict Anderson puts it, “imagined”: they live in peoples’ minds, hearts, and passions. So some people will feel little attachment to their nation (or to any other community you might name, including family, church, school, or whatever); others will feel a great deal of attachment. Overall, though, as an empirical matter, it seems to me undeniable that millions of people, including millions in this country, feel a very deep sense of attachment to their countries. Their nations are, for them, communities of great importance. Evidence of this attachment is pervasive. Someone might say that she personally doesn’t feel this attachment and can’t remember when she last sang the national anthem, but to conclude from this that nations aren’t genuine communities would be like a person saying that because he personally thinks that sports are silly, childish games and doesn’t watch the Super Bowl, sports are not a significant cultural phenomenon.

So then the last question would be whether this widespread, deep attachment to nation-as-community is an admirable quality or, rather, a disreputable or regrettable one that we ought to try to overcome. This question seems complicated, and I doubt that there’s any easy, yes or no answer. Attachment to nation can sometimes be pernicious or destructive (just as attachment to family, or school, or companion, or any other human association can be). But love of country can also be productive of great good. Probably the answer varies from one nation to another. If we think of the large, sprawling, diverse nation-community usually just called “America,” then we surely would have to acknowledge both a lot of evil and a lot of goodness. Still, the people who risked their lives and fortunes to create the nation, and those who lived and fought and often died to maintain it, surely in many cases had the vision of a nation that would be a blessing to humanity, and I myself would find it hard to say that on balance they were wrong.

As it happens, I myself have never been inclined to feel any very strong sense of patriotism or nationalism. But I regard this as a deficiency in my character, and I think that people who feel a sense of loyalty or attachment to this nation are prima facie admirable (although of course sometimes prone to excesses or distortions that can turn this virtue into a vice). I accordingly find it to be a virtue for them to feel a special attachment to and hence responsibility for others within that community. (This conclusion of course leaves a great deal to be debated regarding the best form or health care or immigration policy.) And I haven’t seen anything in the “sword of reason” that would persuade me that this conclusion is mistaken. Indeed, I can’t tell for sure on which of the lines of controversy Nathan wants to challenge this conclusion, but I don’t discern anything that strikes me as a strong argument on any of them.

ms

I hardly think I deserve to be painted as a monster for defending the value of communities and cultures. I'm not trying to "trap" anyone. As I said, I would not be too draconian about discouraging movement between nations, but at the same time I think local cultures are valuable to and for the people who inhabit them. A colleague of mine is doing his dissertation on people who migrate to the US and return seasonally to their Mexican hometowns. He argues that the bits--sometimes large bits--of American culture that they bring with them are to the detriment of the traditional Mexican culture. Many local people resent and dislike the cultural imports from the North and wish those who go would simply go and not bring back American culture to polute the local culture they value. Yes--their village is poor, but it has institutions and ways of doing things that work. They work less well when gringo ways work their changes. I'm not a particularly patriotic person either, but I do think a lot about the dynamics of community and this is what I am defending.

The comments to this entry are closed.

My Photo

Only use a payday cash advance as a last resort.

Categories

Blog powered by Typepad