Is assisted dying moral for patients with severe, deblilitating, and incurable mental illness?

April 14, 2024 • 10:00 am

UPDATE: I forgot one argument of which readers reminded me: the “slippery slope argument.”  To wit:

5. Assisted suicide laws could lead to a “slippery slope” condition whereby shady doctors allow people to be medically euthanized for curable conditions, or even to allow relatives to kill their grandmothers.  Yes, this is a danger, though one that can be ameliorated with sufficient stringent vetting laws.  The “kill your grandmother” argument can be prevented completely, and certifying certain doctors and shrinks for their objectivity in vetting would be another good step. But when weighed against the suffering eliminated by assisted dying laws, I think the slippery-slope argument, while surely worth considering, is outweighed.

________________________

Assisted suicide for people who have severe and incurable mental illness has always seemed a no-brainer to me, but I’m surprised at the number of people who push back when I bring this up.  But, if the procedure is implemented properly, the objections to it don’t seem tenable, and in the end seem to resemble arguments against abortion.  That is, the pusher-backers say that people in tough spots shouldn’t have control over their bodies, that the procedure might spread if it’s allowed, and, underneath the objections of many, we find religious feelings—in this case feelings like “God will take you when He’s ready, not when you’re ready.”

Yet it seems to me undeniable that some cases of mental illness, like the main one documented in the Free Press article below, are so severe that they resemble terminal illnesses—illnesses for which enlightened people would favor assisted suicide (I might use the term “euthanasia”) in this post.  If you’re terminally depressed, in horrible mental pain all the time, constantly thinking about suicide, and have tried every possible remedy without any success, then why aren’t you in a position similar to that of a cancer patient who, having tried all remedies, now faces a finite term of horrible pain ending certain death? (I presume you’re aware that even in states not permitting assisted suicide, doctors often mercifully end the lives of such patients by giving them an overdose of morphine.)

The difference with mental illness is that death is not certain and the pain will last a lifetime. Sure, maybe researchers will come up with a cure for an intractable mental illness, but that also holds for terminal physical illnesses. People with bad prognoses often hope that a cure will be discovered before they die.

Now for the state to effect euthanasia, there must of course be restrictions.  Beyond that, anybody has, in my view, the right to kill themselves by other means, like hanging, shooting, or jumping in front of a train. That kind of suicide is illegal, though I think the illegality is nuts. But for the government to help you die, it’s not proper to provide anybody with the means of euthanasia. There are many reasons, but I won’t enumerate them.

Naturally, in places where euthanasia is officially legal (see the map below), there are such restrictions for the physically ill:

Physician-assisted suicide is legal in some countries, under certain circumstances, including AustriaBelgiumCanadaGermanyLuxembourg, the NetherlandsNew ZealandPortugalSpainSwitzerlandparts of the United States and all six states of Australia. The constitutional courts of Colombia, Germany and Italy legalized assisted suicide, but their governments have not legislated or regulated the practice yet.

In most of those states or countries, to qualify for legal assistance, individuals who seek a physician-assisted suicide must meet certain criteria, including: they are of sound mindvoluntarily and repeatedly expressing their wish to die, and taking the specified, lethal dose by their own hand. The laws vary in scope from place to place. In the United States, PAS [physician-assisted suicide] is limited to those who have a prognosis of six months or less to live. In other countries such as Germany, Canada, Switzerland, Spain, Italy, Austria, Belgium and the Netherlands, a terminal diagnosis is not a requirement and voluntary euthanasia is additionally allowed.

Below is a map of where assisted suicide is legal throughout the world, and there aren’t many places. The states in the U.S. where it’s legal include Maine, Hawaii, Washington D.C., Washington State, Colorado, New Mexico, New Jersey, Vermont, and Oregon. But in no state is assisted suicide permitted for those with mental illness. For physical illnesses or other conditions that are likely to kill you in a few months, here are the general criteria in the U.S.:

  • an adult as defined by the state
  • a resident of the state where the law is in effect
  • capable of using the prescribed medications without assistance
  • able to make your own healthcare decisions and communicate them
  • living with a terminal illness that is expected to cause death within 6 months as verified by qualified healthcare professionals

Places where assisted dying is legal (see the key for variations):

Vgonzalez630, CC BY-SA 4.0, via Wikimedia Commons

Places that permit euthanasia for those with mental illnesses include only the Netherlands, Belgium, Luxembourg, Switzerland, and—perhaps after 2027—Canada. I haven’t looked up the criteria for state assistance for euthanasia for the mentally ill in all four countries, but here are the criteria for the Netherlands given in the Free Press article below by writer Rupa Subramanya.

Dutch law requires those seeking assisted suicide to show they are in great pain, have no alternative, and are acting of their own volition. They also must get sign-off from at least two doctors, including a psychiatrist. The process can take a few years, culminating with a doctor giving the patient a fatal medication or, if done by oneself, a cup filled with poison to drink. When it’s over, a government panel reviews the case to ensure everything was above board.

Click below to read the article. The woman pictured, Zoraya ter Beek, suffered her whole short life from depression, autism, and borderline personality disorder, and said she was in constant pain. Nothing helped, and eventually the doctors and shrinks said there was nothing more that they could do for her. Tired of living, she applied for and qualified for assisted suicide. She is still alive but scheduled to die in May. (That isn’t final, of course, for I’ve read of such patients who change their minds at the last minute, willing to go on but heartened by the fact that at any time they could choose to die.) Her boyfriend loves her, but agrees with her decision.

Here are some of the objections to assisted suicide for mental illness, and my responses (all text is mine).

1.) The patient could get better but, by taking their life, are depriving themselves of a livable and perhaps enjoyable future. Yes, but that’s true of even physical illnesses. Besides, the prognosis must be confirmed by several doctors and examined post facto by the state.  And I would ask those who make this argument, “Who are you to tell someone that they must go on living when they’re in intractable pain?”  For those of us who have been severely depressed, it’s hard to convey to others that this kind of severe and prolonged mental pain is fully capable of making you wish to die.

2.) It’s up to God to determine when you die, not you.  As an atheist, or even as a rationalist, I find this argument bogus. Here it’s similar to the religious argument against abortion, assisted suicide for physical illnesses, or, as Peter Singer discusses, euthanasia for newborn babies who have a condition that will cause them to suffer and, ultimately, kill them with certainty in a short time. Besides, are you going to base medical decisions on assuming that there’s a god for which we have no good empirical evidence? Isn’t medical treatment supposed to be based on empirical criteria?  Do you tell a dying atheist that you can’t increase the morphine drip because God doesn’t want that?

Here’s a quote from the article:

All this pointed to a “dystopian view of the future,” said Theo Boer, the healthcare ethics professor.

“Whether or not you’re religious, killing yourself, taking your own life, saying that I’m done with life before life is done with me, I think that reflects a poverty of spirit,” Boer told me.

. . . . Theo Boer, the bioethicist, acknowledged that none of the suicides in the Bible is condemned, but he added that they are not lionized or commemorated either.

“Suicide in the Bible belongs in the realm of the tragic, and the tragic should not be condemned—nor should it be regulated or celebrated,” he said.

This palaver, including the phrases “Life is done with me” and “poverty of spirit” seems to reflect religious belief, but it’s already clear from opposition to euthanasia in many places (especially the U.S.) that we shouldn’t cut short what is up to God to determine. But if God is omnipotent, wouldn’t He be behind a mentally ill person’s decision to have assisted euthanasia?

3.) It’s contagious.  There are several statistics given in the article about assisted dying increasing over time. Most are for physical conditions, with only one for mental illness (my bolding)

In 2001, the Netherlands became the first country in the world to make euthanasia legal. Since then, the number of people who increasingly choose to die is startling.

In 2022, the most recent year for which there is data, Dutch officials recorded 8,720 cases of euthanasia, a 13.7 percent increase from 2021, when there were 7,666 cases. To put this in perspective, there were a total of 170,100 deaths in the Netherlands in 2022—meaning euthanasia cases comprised more than 5 percent.

“This upward trend, in both the absolute and relative numbers, has been visible for a number of years,” the country’s Regional Euthanasia Review Committee’s 2022 Annual Report states. What’s more, the number of euthanized people between the ages of 18 and 40 jumped from 77 in 2021 to 86 in 2022. And the number of people with psychiatric disorders who choose euthanasia is rising: In 2011, there were just 13 cases; in 2013, there were 42; and by 2021, there were 115

This trend is not limited to the Netherlands. From 2018 to 2021, countries where euthanasia or assisted suicide is most popular saw sizable increases in the number of people signing up to die: In the United States, where ten states and the District of Columbia have physician-assisted suicide, there was a 53 percent jump; in Canada, 125 percent.

But why wouldn’t you expect the numbers to rise as people become aware that they have this alternative? It’s not written about very often, so you have to see articles like this to find out about it.  But even so, this is a question of ethics, not of statistics.  If the regulations are sufficiently rational and stringent that they prohibit spur-of-the-moment suicides or mental conditions for which every possible cure hasn’t been tried, why should we care about the increase? And wouldn’t you want the ability to die a peaceful and painless death if you had a condition that could be terminated in a peaceful way, at a time and place of your choosing, and when you are surrounded by loved ones? (This is, as I’ve learned, the way it usually occurs.)

4.) It hurts those who are left behind.  I’ve heard this argument used often against those who discuss self-inflicted suicide. “If you kill yourself, think of all the people who will miss you and be in pain.” But this seems eminently selfish to me.  Everybody who dies before their friends, relatives, and loved ones (and that means all of us) faces that as a certainty.  If someone’s in intractable physical pain and dying of cancer, would you tell them to hang on for your sake? Of course not! The same holds for incurable mental illnesses. It’s selfish and boorish to ask someone to stay alive for the sake of your—or other people’s—feelings.

For #5, see the update at top. 

For some people, suicide is simply a no-go zone, which is why suicide hotlines exist to talk those who wish to die out of that wish. But that’s different, for someone who calls a hotline has a good chance that they’re simply emitting a cry for help, and want to be talked out of it. (However, some do kill themselves.) That’s why I think those hotlines are great things. But assisted dying with stringent criteria needed to qualify, and the use of drugs that assure a painless death, are not equivalent to a suicide hotline.

I’m sure that ethical philosophers have discussed this issue before, and feel free to cite articles below if you know of them (I don’t).  These are of course tentative ideas that I’ve thought about for a long time (note: I’m NOT a candidate!), and were given shape by the article above, but I’m willing to listen to other points of view. If you have them, or if you agree with what I’ve said, weigh in below. But do read the Free Press piece.

Jesse Singal on schools that help kids change their gender identity without notifying the parents

January 23, 2023 • 1:00 pm

In this morning’s Hili dialogue I mentioned a NYT article recounting the case of a biological girl, 15, whose school had been facilitating her gender change by letting her use the boys’ bathroom as well as a male name and pronoun. The kicker was that the parents weren’t informed, and found out this only about by accident. They had a fit, but the school told them that they were simply obeying state regulations, which I guess is true. (The child hadn’t yet had any medical intervention.)

This raises a sticky ethical question: should schools do this (or even go further), or should they report it to parents? My own view was that I thought state regulations should be obeyed (and questioned), but NO medical intervention should be promoted by schools without telling the parents. That is the very least that must be done.

But in his article on his substack site “Singal-Minded” (good name!), Jesse Singal shows his usual thoughtfulness about transsexual issues, and raises a point I hadn’t thought of. And that is that a substantial number of children with gender dysphoria have psychological problems that need to be addressed at the very time when schools are “helping” a child transition. The child may be on the autism spectrum, or have a form of gender dysphoria that might resolve into homosexuality rather than full sexual transition, or simply be in mental distress and seeking gender/sex change as a possible cure.  Because these issues are very common, they need to be addressed by professionals (i.e., therapists and doctors), for I think we all agree that therapy must precede any medical intervention that involves giving puberty blockers, hormones, or surgery to young people. (Once they’re over a certain age, say 18, I guess the teenager can make their own decision.) In general, then, Singal thinks that at some point the school has to tell the parents.

Click below to read his piece:

Now in some situations schools should NOT “rat a kid out” to their parents. Here are a few:

There are clearly some situations where school should be a safe haven for kids who are experimenting with different ideas or ways of expressing themselves, and where teachers should let them do so without the risk of parental interference. If a male student from a conservative religious household were, within the security of his school walls, dressing in a feminine manner, it would be quite inappropriate for a teacher to rat him out to his parents — for many of the same reasons it would be inappropriate for a student from a conservative religious household to be ratted out for reading Carl Sagan’s and Bertrand Russell’s arguments against Christianity in the school library. Minors do not have full autonomy, and adult supervision and/or permission are required in a host of different settings. But surely they should have some right to pursue their own path without their parents hovering over them every step of the way, even if reasonable people might differ on the specifics, and even if age clearly should be factored in (a 12-year-old and a 6-year-old are both minors, but no one would argue they should be granted exactly the same amount of autonomy).

But as Singal notes, changing one’s sexual identity is very different from examining abstract ideas:

But adopting a whole new identity, as a different gender under a different name, is a bigger deal than experimenting with fashion or atheism. For one thing, if a decision to socially transition that is kept from parents sticks, a young, developing person will then spend months, or maybe even years, living one identity at school and another among their family. That just can’t be psychologically healthy. It fosters distrust between students and parents, and it isn’t sustainable because the parents are inevitably going to find out (if schools think they can keep it a secret in the long term, that’s ridiculous).

For another thing, the teachers and school administrators participating in this agreement might lack certain basic information about the context surrounding the kid’s declaration that he or she is trans — information that could be vital for determining whether a swift social transition is appropriate.

And that basic information is psychological: what exactly is the kid going through. Is it confusion, homosexuality, or a form of mental illness that, they think, can be resolved with a gender or sex change? Singal cites the oft-cited World Professional Association of Transgender Healthcare’s (WPATH) Standards of Care, as well as the Cass Review of the Tavistock Clinic, which note that autism issues or other mental health problems very often accompany a kid’s desire to become transgender or transsexual. Both organizations recommend that healthcare professionals/therapists discuss these issues—and the benefits and risks of transitioning—with a gender dysphoric child.

Singal recommends that this also be done even for purely social transitioning:

In short, the decision even just to socially transition a kid like Jon is potentially fraught and complicated, and in some cases schools might not have all the background necessary to make an informed decision about whether it’s the right move. Jon’s school likely knew about hisautism, but what about his ADHD, his other mental health problems, his shifting identities, and pandemic travails? On what planet is a teacher or school counselor qualified — on the sole basis of a single child’s say-so and in the absence of a fuller picture of who that kid is and what they have experienced — to make this decision?

Finally, there’s one more issue to consider: gender identity and sexual identity are not the same thing, and schools don’t have the ability to separate them and treat children appropriately:

On Twitter, the philosopher and bioethicist Moti Gorin points out that this conversation is plagued by a lack of agreement on very basic concepts, including what it means to be transgender:

The difficulty here is that there is deep conceptual disagreement and confusion about the nature of the phenomenon. Is it like sexual orientation, or a mental health/medical issue, or a choice about membership in a subculture, etc? Schools vs parents cannot be resolved if there isn’t some agreement about how to conceive of what these kids are doing. And sadly the state of the discussion among those who should be figuring this stuff out is very poor.

. . .Setting aside the many philosophical problems with the concept of gender identity as the term is used at present, all these fuzzy definitions make the situation in schools rather complicated. If a kid doesn’t have diagnosable gender dysphoria that needs to be alleviated, why would a school take it upon themselves to facilitate a social transition, especially one that is kept a secret from their parents? If a kid does have diagnosable gender dysphoria that needs to be alleviated, they might be a good candidate for social transition, but in this case how can you hide from parents that their kid has a mental health condition — one correlated with various negative mental health outcomes? Plus, how can you make sure the kid gets the comprehensive assessment that should precede a decision to socially transitionincluding a formal diagnosis of GD, if their parentsdon’t even know they feel this way?

It appears that from many schools’ perspectives, the answer to all these questions is  ¯\_(ツ)_/¯. At this point, as Gorin notes, the way we talk about sex, gender, and gender identity is so confused that it’s hard even to know where to begin.

His conclusion:

In much the same way the discourse over sex and gender is plagued by philosophical incoherence, it’s also plagued by the endless invocation of this comparison. Gender identity and sexual orientation are very different things, and they require different approaches. If coming out as gay required name and pronoun changes, and sometimes was the first step on a short path to permanent medical procedures for which the available evidence is lacking, and if experts believed that it was harder to reliably “diagnose” kids as gay if they had autism or other mental health problems or recent trauma or disruptions to their life… well, in this hypothetical universe, yes, you absolutely would need to loop parents into the process of a kid coming out as gay, at least as a general rule. But in the universe we actually inhabit, if a kid is gay, or thinks he’s gay, you don’t have to do anything. There’s no psychosocial intervention, so there’s no justification for notifying parents.

Being trans is different. Especially for younger kids, or even older ones with mental health and other problems that might lead them to be a bit developmentally stalled, coming out is a process that is going to require parents’ input and approval, at least if it’s going to go smoothly. That doesn’t mean parents should be automatically informed about a kid’s gender questions or statements as soon as they crop up — like I said, I can imagine lots of situations where some degree of discretion is warranted, and there’s obviously no reason for teachers to “report” students merely for gender nonconforming behavior.

It does mean we probably need to land somewhere between “Parents should be instantly notified whenever a young kid says they might be trans” and “Young minor kids get to unilaterally determine every aspect of their social transition, including whether their parents are informed at all.” But facile comparisons won’t help us work through these issues.

That seems sensible.  I suppose where it’s okay for the school keep gender identity secret from parents might be in using new pronouns and names, but not with respect to other stuff like bathroom or locker room use. And ANYTHING beyond that has to involve the parents.  For in all these cases therapy is going to have to be used at some point, and perhaps medical advice tendered as well.  I don’t think anybody would disagree that when professional advice is needed, as it always must be, the desire of underage children to change their gender should be brought to the attention of their parents.

Or do you feel that there is no case when the school shouldn’t tell parents? If you have kids, you may be stricter about this than I or Singal are, for I understand the desire of parents to have a part in such an important decision. Leave your comments below.

Under pressure from the benighted, Rhodes College refuses to disinvite Peter Singer but issues a “free speech but. . . ” statement

December 1, 2021 • 9:15 am

There are two main parties to this story (besides Rhodes College itself): Peter Singer, the famous ethical philosopher at Princeton, and Rebecca Tuvel, associate professor and Chair of Philosophy at Rhodes College. We’ve encountered them both before as parties to attempted cancellations.

Backstory: Singer got into big trouble when he proposed that under extreme circumstances it might be not only permissible but morally justifiable to euthanize newborns. Here’s what I wrote in July of 2017:

The question of whether one should be able to euthanize newborns who have horrible conditions or deformities, or are doomed to a life that cannot by any reasonable standards afford happiness, has sparked heated debate.  Philosopher Peter Singer has argued that euthanasia is the merciful action in such cases, and I agree with him. If you are allowed to abort a fetus that has a severe genetic defect, microcephaly, spina bifida, or so on, then why aren’t you able to euthanize that same fetus just after it’s born?  I see no substantive difference that would make the former act moral and the latter immoral. After all, newborn babies aren’t aware of death, aren’t nearly as sentient as an older child or adult, and have no rational faculties to make judgments (and if there’s severe mental disability, would never develop such faculties). It makes little sense to keep alive a suffering child who is doomed to die or suffer life in a vegetative or horribly painful state. After all, doctors and parents face no legal penalty for simply withdrawing care from such newborns, like turning off a respirator, but Singer suggests that we should be allowed, with the parents’ and doctors’ consent, to painlessly end their life with an injection. I agree.

Note that both Singer and I restrict this action to newborns who are doomed to die soon, probably painfully, or will live without any prospect of a meaningful or sentient existence. It was not meant to apply to disabled people who could live reasonably or happily (e.g. children with Down Syndrome or cerebral palsy), but only for extreme cases. But it didn’t matter. Disabled people demonized Singer, saying that his views cancelled or dehumanized all disabled people, and would put us on a slippery slope to euthanizing any unwanted child. This was not the case we were making, and of course we’d both put strictures in place: parents as well as several doctors would have to consent, and so on.

I wrote this in 2020, when Singer had been deplatformed in New Zealand, Germany, and Canada for his “inhumane” stand on euthanizing doomed infants:

It seems to me that an enlightened philosophy would allow people to be able to end their lives in a humane way if they’ve undergone proper medical and psychiatric vetting. Some form of this “assisted suicide” is already legal in Canada, Belgium, the Netherlands, Luxembourg, Colombia, Switzerland, Victoria in Australia, and and in some states of the U.S. (California, Colorado, Washington state, Oregon, and—by court order—in Montana).

I further believe—and I’ve gotten into trouble for this—that we should also allow newborns afflicted with incurable conditions—conditions from which they will suffer and die young—to be euthanized humanely. The conditions under which I think this is not only allowable, but ethical, were first laid out in this post of mine.  I was aware at the time that philosopher Peter Singer had agreed with and defended this view, but I can’t remember whether I arrived at it independently or read it in some of his writings. No matter, for it’s a view that people need to consider, and of course Singer has defended this view far more extensively and ably than I.

For his views, Singer has undergone considerable pushback, and has been not only deplatformed, but subject to calls for his resignation from Princeton (he splits his time between Princeton and the University of Melbourne). I, too, was subject to a surprising amount of publicity, nearly all negative, for my one website post about this. On her own website Heather’s Homilies, Heather Hastie defended my views, summarizing and answering some of the pushback I got (thanks, Heather!),  I also wrote about the surprising opposition to my views here and here.

See also Russell Blackford’s defense of Singer here.  I have to say that this topic elicited a fair number of very nasty emails and comments, with people accusing me of wanting to kill babies of all kinds. Since a newborn cannot make a decision for itself, someone has to step in—especially in the case of impending death—and I think Singer, a deeply humane and moral man—made the right call.

Now for Rebecca Tuvel. She’s a woman of extraordinary courage, which she demonstrated in the Hypatia transracialism controversy, in which she published a paper in that journal questioning whether there was a meaningful difference in seeing yourself as a member of another sex or seeing yourself as a member of a different race (Caitlan Jenner exemplifies the former; Rachel Dolezal the latter). For reasons that defy me, this was regarded as a taboo question (I see it as very meaningful), and Tuvel was attacked. There were calls for her to be fired, for the journal to retract the article, and Hypatia even apologized. But Tuvel didn’t back down, and the article still stands (you might want to read Tuvel’s piece, “In defense of transracialism“).

These two academics intersected in September when a group of philosophers, including Tuvel, invited Singer to be part of a panel at Rhodes College. The topic was “Pandemic Ethics”. Note that this had nothing to do with euthanizing infants. (That reminds me of Dorian Abbot’s cancellation at MIT not because he was talking about a verboten area, but because he had criticized DEI initiatives on his own, and privately, before his scheduled talk.)

But that didn’t stop the faculty and students at Rhodes College from calling for Singer’s disinvitation, and indeed, Rhodes College itself issued a “free speech but. . . ” statement defending Singer’s right to speak but deploring much of what he said previously.

The fracas is described in two pieces, which you can see in the screenshots below.

From The Daily Nous, a philosophy site:

From Inside Higher Ed:

Three incidents are of special interest.

The faculty objects and urges Singer to be disinvited (from Inside Higher Ed):

Faculty in the Department of Anthropology and Sociology and the Africana Studies Program sent out an email to the college community that said, in part:

We, the faculty in the Department of Anthropology and Sociology and the Africana Studies Program, wish to express our deepest dismay at the invitation of Professor Peter Singer to our campus. We believe that proceeding with this event as currently structured could further alienate students, faculty, and staff, particularly after the unresolved racist “incident” [story here] against African Americans that occurred in early September. 

Professor Singer’s longstanding advancement of philosophical arguments that presume the inferiority of many disabled lives is dehumanizing and dangerous. The creation of a hierarchy of lives as a justification for the allocation or denial of limited resources (whether “pleasure,” medical care, insurance, etc.) is a logic that has a long and violent history. It is a logic that underlies eugenicist arguments marking various marginalized populations as unfit to be a part of the advancement of the human race…

Disability scholars have critiqued Singer’s body of work across a range of themes, and we encourage anyone who reads Singer to also read this rich scholarship. Salient among these themes for the purposes of a panel on pandemic ethics is the denial of some disabled people’s full humanity and the premise that certain disabled people have lives that are less worth living than “normal” people (with whom they might be competing for medical resources). Given that COVID is one of the most profound disability rights issues of our lifetimes, it would seem that any panel on pandemic ethics would include disability scholars (especially given their significant challenges to Singer’s credibility in this area). 

Rather than suggesting an alternative structure to the event such as the inclusion of one of the aforementioned disability scholars, though, the faculty instead says:

[W]e affirm our dedication to disability justice and urge the college to withdraw the invitation. We stand next to our students who are working hard to fight for their ideals of equality, fairness, and diversity, not as lip service, but as the basis of reflection and action. We cherish and advocate for freedom of speech and expression as long as it does not deny others their humanity. 

Note the erroneous characterization of Singer’s views as “denying some disabled people’s full humanity.”  That is simply hyperbole claiming that newborns doomed to suffer and die soon are “denied their humanity.” No, they are denied needless suffering. If your baby was born without a brain and would die within days, and was in great distress, would you be showing “full humanity” to let it suffer until it passes away?

These people either haven’t read Singer’s work or are signaling their virtue with or without understanding what Singer has to say.  I have had doctors and nurses write me privately by email saying that they’ve encountered situations like the one Singer envisions and absolutely agree that putting the infants out of their suffering is the right thing to do. I have had no medical professionals write me and say that they disagree with me. The letters I get are from people who are disabled but have meaningful lives, and accuse me, wrongly, of denying their humanity, or saying that I would have killed them had I had the say.

Some history faculty at Rhodes also sent out an email objecting to the event:

As historians, we the undersigned condemn Prof. Peter Singers’ abhorrent views that some humans have less value than others. We object to inviting him to Rhodes College to speak as part of a “Pandemics Ethics” panel. Positioning him as an expert on ethics only legitimizes his reprehensible beliefs that deny the very humanity of people with disabilities. Hypothetical philosophies on morality cause real violence. We historians are all too familiar with ideas that justify labeling marginalized, vulnerable, and minority populations as “life unworthy of life,” and the murderous consequences for those deemed “unfit” to live. Adhering to the College’s own IDEAS Framework that seeks to foster “a sense of belonging” and embrace “the full range of psychological, physical, and social difference,” we historians assert that Prof. Peter Singers’ blatant inhumanity has no place in serious academic exchange here at Rhodes.  

“Positioning him as an expert on ethics?” Give me a break—he’s the world’s expert on practical ethics. Note as well that they play the race card, mentioning “marginalized, vulnerable, and minority populations.” That is what’s really reprehensible, as race plays no role in Singer’s views on this issue.

The university gives hedged support for Singer.  Rhodes College issued this statement (my bolding):

Yesterday a member of our faculty informed us of his profound disturbance caused by the invitation of Princeton University Prof. Peter Singer to speak on a Rhodes “Pandemic Ethics” virtual panel next week.

We are writing to acknowledge that our institution’s spirit of supporting expressive speech does not prohibit Professor Singer’s participation in this virtual panel. At the same time, our community’s values compel us to denounce some of the views he has expressed repeatedly over years through various addresses, writings, and media interviews.

Fundamentally, Rhodes College is deeply committed to diversity, equity, and inclusion. These values extend to every member of our community, including individuals with disabilities. While we view the invitation to Peter Singer in light of our commitment to free and open dialogue at a liberal arts college, his views on disability are unequivocally antithetical to our institutional values of diversity, equity and inclusion. We reject and condemn in the most forceful manner possible any views that call into question the value and worth of all human life. It is within this context that we make the following affirmations:

    • We affirm our strong belief in an inclusive, diverse, equitable, and accessible community – as outlined in the College’s IDEAS framework – one in which the worth and dignity of all persons is championed and supported.
    • We affirm particular support for disabled members of our community who, justifiably, have expressed anger, outrage, and offense at some of Prof. Singer’s writings. Not only does Rhodes not tolerate discrimination on the basis of disability, the College also strongly believes that disabled people enrich our community by their presence on our campus. We affirm this while recognizing that we still have much work to do as an institution to support individuals with disabilities.

As an academic institution, we re-affirm our Statement on Diversity, which expresses our commitment to providing an “open learning environment,” where “freedom of thought, a healthy exchange of ideas, and an appreciation of diverse perspectives” are fundamental. It is this commitment to freedom of expression that allows academic departments to invite a variety of speakers to campus to enrich the educational experience of our students. Nevertheless, they should do so with responsibility, as well as with careful attention to our values as a diverse, equitable, and inclusive institution.

Note how weaselly this statement is. they should have just issued the first sentence in the second paragraph: “We are writing to acknowledge that our institution’s spirit of supporting expressive speech does not prohibit Professor Singer’s participation in this virtual panel.”  Period.  To affirm “institutional values” that many people doubtlessly disagree with is a view that chills speech.  First, they don’t understand what Singer has said, or willfully misconstrue it to get virtue points with disabled students. Second, people like me (and perhaps Tuvel) disagree with the “institutional values” that call for a doomed infant to suffer needlessly. But with that official position, which student or untenured faculty member would dare stand up to the Rhodes administration? If Rhodes adhered to Chicago’s Kalven Principles, it would not be making official statements on contestable and debatable moral issues.

Finally, although Rhodes pretends to favor free speech, they are giving succor to those people who don’t want free speech—who don’t want this fraught but ethically important subject to even be discussed.

The Rhodes Philosophy Department holds their ground. After that single faculty member (Charles Hughes, Director of the Lynne and Henry Turley Memphis Center at Rhodes College) objected to Singer’s appearance, the philosphers who organized the event this email to the College:

We write in response to one of our colleagues, who has publicly expressed concern about the Philosophy department’s invitation to Peter Singer—and he has every right to do so. The objection raised is apparently not to the topic, but to the speaker. We are of course aware that Professor Singer has advanced philosophical arguments on bioethical issues that many find not only disturbing but deeply offensive, a reaction by no means confined to members of the disabled community. Indeed, the organizers also take issue with some of Dr. Singer’s views.

Serious intellectual exchange about matters of significance cannot avoid sometimes causing anger, offense, and pain and no one should be cavalier about that fact. It is not clear to us, however, what follows from our colleague’s understandable expression of disturbance at some of Professor Singer’s views. Do those views disqualify Singer from participating in the exchange of ideas that ought to occur at a liberal arts college? If that is the conclusion, we respectfully disagree, for its premise is that ideas that cause anger and dismay ought not, for that reason, be part of the exchange and that premise, we think, is incompatible with our mission to teach students how to engage in productive dialogue even, and indeed especially, with thinkers with whom they vehemently disagree. 

That is an excellent letter—civil but firm. Tuvel then offered to run a reading group on the issue:

I realize that now is not the time to get into the weeds of Singer’s utilitarian ethics. Should there be interest at some point down the line, I would be more than happy to organize a reading group and/or zoom event where myself and other members of the Philosophy department can clarify Singer’s views on these incredibly sensitive topics. At some point, I think our community would also benefit greatly from an event devoted to discussing these delicate matters. On pains of intellectual and moral failure, such an event would absolutely need to include experts in disability rights (such as Professor Charles Hughes), parents of children with disabilities, and relevant others…

The Daily Nous also has a letter from philosophy postdoc Eric Sampson clarifying Singer’s misunderstood views.

Here’s a video of the whole Singer event—a Zoom panel. In Turvel’s first question (3:03), Singer responds to the controversy, and does a great job.

Rhodes College needs to get with the program and stop truckling to the mob. Disinviting someone of the stature of Singer, who is talking about a subject unrelated to the other controversy, is a cowardly thing to do. The administrators of Rhodes are simply invertebrates.

New NPR ethics policy raises questions about what journalists are permitted to say privately

July 30, 2021 • 9:15 am

National Public Radio (NPR) has announced a new ethics policy, a revision of the policy last revised a decade ago. It’s described in a new article on NPR. According to author Kelly McBride (the public editor of NPR with expertise in journalistic ethics), the change was spurred by the murder of George Floyd that, in turn, caused younger journalists to begin agitating for the right to both do journalism and to express their political and ideological opinions on public media, in writing, or by going to demonstrations.

This contravened previous standards (widespread in journalism) prohibiting reporting journalists or commentators (not op-ed writers, of course), from expressing their views in public on political or ideological issues. There was a reason for that, which of course is that if you know a journalist has strong views on an issue, you might judge their reporting or commentary on that issue to be biased. Because the younger NPR reporters wanted to be able to express their views publicly, the organization tried to forge a compromise.

Click on the screenshot to read, and if you want to see the entire set of NPR ethical standards, go here.

Here is the big change that was made:

The new NPR policy reads, “NPR editorial staff may express support for democratic, civic values that are core to NPR’s work, such as, but not limited to: the freedom and dignity of human beings, the rights of a free and independent press, the right to thrive in society without facing discrimination on the basis of race, ethnicity, gender, sexual identity, disability, or religion.”

As I’ll note below, it may not be so clear exactly what constitutes the “democratic civic values that are core to NPR’s work”.

Here’s what McBride characterizes as the most important changes in the ethics policy:

The new policy, which was shared with member stations by email on July 7, offers three revised sections: a rewrite of “NPR’s Guiding Principles,” a section titled, “Guideline: On Attending Marches, Rallies And Other Public Events,” and an update of the section on social media.

When comparing the new policy to the old, here are the other major developments:

    • The opening section lists core values of “honesty, integrity, independence, accuracy, contextual truth, transparency, respect and fairness” and adds a specific reference to the “democratic role as watchdogs.”
    • NPR names diversity as a key guiding principle, with a specific obligation to include voices that are routinely left out of the news.
    • The policy refines and narrows the list of staff who are expected to comport with the most restrictive elements of the policy. It’s a long list, but it boils down to whether you shape content in any way or hold an executive title. Other job titles, including those who work in research, archives and data, and those who write promotional copy for the programming division, are exempt from restrictions on their public behavior.
    • The new standards reinforce the difference between straight reporting and commentary. “NPR journalists with a role in covering the news should stick to reporting and analysis,” the policy reads.  “Commentators have more leeway to express opinions and may do so as long as they are respectful and grounded in facts.” A new addition to this section allows anyone who works in news or programming to publish a first-person story when appropriate.
    • In the sub-section of the Impartiality chapter on attending marches and rallies, NPR adds another list of universal values including human rights, a free press, anti-discrimination and anti-bigotry.

This seems pretty fair to me, especially coupled with the stipulation that journalists have to vet their wishes to express political views in advance to their bosses, and that the NPR newsroom now has a standing committee to review individual cases. And there’s still a wall between straight reportage and commentary or opinion. McBride gives examples of things that can be allowed:

Is it OK to march in a demonstration and say, ‘Black lives matter’? What about a Pride parade? In theory, the answer today is, “Yes.” But in practice, NPR journalists will have to discuss specific decisions with their bosses, who in turn will have to ask a lot of questions.

The carve-out is somewhat narrow. Protests organized with the purpose of demanding equal and fair treatment of people are now permitted, as long as the journalist asking is not covering the event. However, rallies organized to support a specific piece of legislation would be off-limits. Other events featuring a slate of political candidates from one party are also out of bounds.

And again, that seems fine. Although NPR is clearly on the Left given its editorial content and choice of subjects to cover, that doesn’t bother me. either.

But there’s one bit in the piece that does worry me. It’s the idea that there are some areas of human thought where no dissent can be permitted, because what is “right” is palpably clear. And, indeed, nearly everyone agrees that it’s wrong to have slavery, to kill someone just for the thrill of it, or to steal someone else’s property because you covet it. But, as philosophers like to point out, these “rules” are often not so clear cut.  What bothered me is something said by Keith Woods, the chief diversity officer of NPR and co-chair of the committee that drafted the new policy (emphasis is mine):

Woods said that he and others argued that it was important for journalists to keep many of their personal views private, in order not to distract from the primary focus of reporting facts. But he added that it was a mistake in the past to allow that balancing act to overshadow all expression.

“There are things in the world where we are not torn about where we stand,” said Woods (who is also former dean of faculty and my former boss at The Poynter Institute). “We are against bigotry, we are against discrimination and unfairness.”

That sounds good, and I agree about bigotry being a universal no-no, but what about “discrimination and unfairness”? Here are some areas where there are active questions about justifications for discrimination and unfairness:

  • Is it okay to discriminate against Asian students seeking admission to Ivy League schools in order to maintain equity for other groups? (This is a form of affirmative action.)
  • Is it okay to rectify past discrimination by applying present discrimination? (This is a tenet of Ibram Kendi’s anti-racism platform.)
  • Is it okay to assume that if we see inequities in organizations, schools, or firms, those imbalances are prima facie evidence of bigotry operating at present?
  • Is it unfair to allow medically untreated biological men who present as transgender women to compete in women’s sports or be incarcerated in women’s prisons?

I’m sure you can think of other problematic issues like these.

The problem is that the ideas of “fairness” and “discrimination” are slippery ones. Indeed, in all the cases above, fairness is said to require some discrimination.

I’m sure NPR will strike the right balance between journalistic practices and personal expression, but what we see above is an attitude that’s inimical to rationality and free speech. It is the basis of Wokeness as well. It is the attitude that there are some stands that are so right that they are not only unworthy of discussion, but should be taboo to discuss.

And this statement, given above, appears in the Ethics section on “impartiality”:

NPR editorial staff may express support for democratic, civic values that are core to NPR’s work, such as, but not limited to: the freedom and dignity of human beings, the rights of a free and independent press, the right to thrive in society without facing discrimination on the basis of race, ethnicity, gender, sexual identity, disability, or religion.

The same questions apply. Affirmative action, for example requires discrimination on the basis of some of the traits listed. Are NPR editorial staff not allowed, in their private postings, to express opposition to affirmative action? Or to oppose the participation of transgender women in women’s sports?

FFRF interview with Anthony Grayling

January 17, 2021 • 1:00 pm

Here’s a new 25-minute interview of philosopher Anthony Grayling by Dan Barker, co-President of the Freedom From Religion Foundation (FFRF). Anthony and Dan cover a surprisingly large area of ground in this short time (there’s the famous Ron Reagan’s “not afraid of burning in hell” commercial in the middle, which is still great), and rather than summarize what Anthony says, I’ll just write down the questions he fields:

What is your background? Why did you take up the study of philosophy? I did not know that Anthony grew up in what was then Rhodesia. His entrée into philosophy—and his explanation for why he never believed in God— are worth hearing.

How can we be moral without a god? Here Anthony espouses the humanistic philosophy and ethics that so many of us are familiar with. I’m not sure this bit will persuade those who require a god to be moral without one, but it’s nice to hear it expounded by someone who not only believes in humanistic ethics, but also has thought about this for decades.

How do we make it through hard times without a god? I didn’t know this, but Anthony’s sister was murdered just after she was married. How did he cope with it? And how, in general, do we deal with any tragedy without the consolation of religion? Anthony’s answer involves compensating: doing something good to mend the world, which at the same time may mend you as well. I have found this useful, and did my most ardent volunteer work during the darkest times of my life. It really helps; it’s hard to think about your troubles when you’re helping people who are as bad off or worse off.

How does one find meaning in life without God? We had a long discussion about this five years ago on this website.  Anthony gives a good answer, one that involves both buttressing your relationships (“good relationships are at the very heart of good lives”) and either immersing ourselves in our rich human culture or helping others to do so. I found this one of the best parts of the interview.

The one bit that I found somewhat wonky in Anthony’s musings was his idea that the universe is justified by its having produced a species—us—that has created on balance more good than bad. (But what about all those other species that are the results of evolution as well?). He concludes that it’s our duty to add good to the world “for the sake of the universe.” This resembles religious Jews doing mitzvahs (deeds commanded by G*d) in the world to hasten the coming of the Messiah.

What can philosophy teach us about dealing with the pandemic? Here Grayling evokes Stoicism, which seems to be popular these days (Massimo Pigliucci is another advocate) and almost sounds like a form of Western Zen Buddhism; but here I’m out of my depth. Grayling also calls out the British government for its stupidity in dealing with the pandemic.

Why are we in this predicament?I refer to the pandemic here, and Grayling’s answer leads to his next topic:

Why is there so much science denialism throughout the world? Again, another good answer.

What is Grayling’s next book? He’s got one coming out this spring, and it’s relevant to the question just above. His book The History of Philosophy also comes out February 2, and I’m going to read that one for sure.

Voilà: the interview:

 

Principles of ethical investing

December 29, 2020 • 9:15 am

by Greg Mayer

Investment policies–that is, where and for what reasons individuals and organizations place their money–have been at times invoked as a way to either encourage good behavior or sanction bad behavior. The most prominent example I know of is the campaign for divestment of assets from companies that did business in South Africa, which took place during the late apartheid era. Apartheid of course did end; I don’t know what role the divestment campaign had in this outcome. I imagine it is something historians have studied, but I don’t know the conclusions reached. The most prominent such campaign now is directed against Israel.

For individuals, picking stocks, market timing, and day trading are generally bad investment strategies. (“Bad” in the sense that you can’t reliably make money that way.) But large institutional investors have enough money, time, and expertise to vet investments for the behavior of the companies and assets involved. CalPERS, the California state employee retirement and benefit system, which manages a portfolio worth more than $400 billion, for example, has a fairly detailed set of Governance & Sustainability Principles.

Last month, on November 13, I received the following message from the Society for the Study of Evolution (SSE), indicating that the Society wanted to develop its own set of principles. (I’ve removed links to SSE’s internal web pages and information about individuals.)

Dear Gregory,

Earlier this year, at the request of SSE Council and the Finance Committee, SSE formed a committee to develop a set of ethical principles to guide the Society’s investments, which have a current value of ~$4.3M (learn more on the Financial Reports page). The committee’s proposed ethical principles can be found in this document.

To develop this set of principles, the committee surveyed the principles of other societies and considered different elements of a policy that are consistent with the mission of the Society and the values of our community. The goal of the committee was to develop a set of principles, not to specify exactly how to invest, which will be determined based on these principles in consultation with our investment advisors. We also note that using ethical principles to guide investing does not necessarily reduce financial returns and may even increase them.

We value our members’ feedback on these proposed ethical investing principles. Your input will help Council decide how to manage SSE’s investments and overall financial plan moving forward. Would you be willing to review the 1-page principles document and provide feedback in a short survey?

Or click here to view the document:

Or click here to view the comments form:  We will be collecting comments until November 30th, 2020. Thank you for your participation!

The draft principles were as follows.

Ethical Investing principles

The Society for the Study of Evolution is committed to investing in ways that support companies whose business practices promote environmental sustainability and social justice and whose governance promotes transparency. The SSE will use these values to guide investment decisions.

Environmental values

The Society for the Study of Evolution favors investment in companies that

  • Foster the protection of biodiversity.
  • Contribute to preservation of a safe, liveable, and stable climate.
  • Avoid increasing the risks associated with climate change.
  • Limit the use and discharge of toxic chemicals and pollutants into the environment.
  • Encourage practices that avoid overexploitation of terrestrial, aquatic, and natural resources.

Social values

The Society for the Study of Evolution favors investment in companies that

  • Respect and promote human rights, dignity, and well-being.
  • Protect personal data and respect customer privacy.
  • Foster an inclusive environment for all workers regardless of background or personal characteristics.
  • Improve and adopt anti-racist policies.
  • Follow practices that respect the dignity and rights of workers, including the ability for collective action by workers.
  • Strive to reduce disparities in economic and educational opportunities.
  • Respect the autonomy and voices of local communities and indigenous people.

Governance values

The Society for the Study of Evolution favors investment in companies that

  • Have a Board of Directors reflecting the diversity of communities they serve.
  • Ensure that financial reports are regularly reviewed by external auditors overseen by Board members who are not employed by the company.
  • Follow international standards to guard against fraud and corruption.
  • Commit to fair wages and equitable sharing of profits.

I wrote back to the Society on December 23:

When I received your invitation to participate in a survey concerning proposed investment principles for SSE, I began filling out the survey, with my initial response being that it was OK, but with minor changes. But as I attempted to compose a response, my “but” overwhelmed my “OK”, to the point that it became hard for me to see how the entire notion of a set of principles could survive.

Some of the principles are straightforward accounting principles– using external auditors, for example. The “Environmental values” do touch on some areas in which SSE could be said to have expertise– evolutionary biology is, after all, the study of the temporal and spatial patterns of biodiversity and the processes that generate them. But I note that these values are expressed without any endorsement of specific policies. “Foster the protection of biodiversity” is sufficiently broad that it might be a worthy principle to endorse. Ariel Lugo, who maintains that introduced species foster biodiversity, and Peter Marra, who argues that introduced species are a great threat to biodiversity, could both agree. I happen to think Marra is nearer to right on this, but I wouldn’t want the SSE to proclaim one or the other. On biodiversity, evolutionary biology does have disciplinary expertise, and intellectual standards for the evaluation of evidential support for propositions, so I could see some reason for the SSE to have something to say in this area.

But many of the proposed principles lie far afield from the values of science in general and evolutionary biology’s particular expertise. And it’s in those areas where evolutionary biology has the least to say that the principles try to say the most. Three examples.
“Improve and adopt anti-racist policies.” Anti-racism, sadly, is not opposition to racism, but a particular racialist ideology espousing an essentialist view of “races”, according to the ideology’s own notions of what “race” means. Anti-racism, which is fundamentally racialist, is sometimes even overtly racist. SSE should have no position on “anti-racism” whatsoever.
“Follow practices that respect the dignity and rights of workers, including the ability for collective action by workers.” ​I personally believe that the decline of unions has been a major factor in the growing concentration of wealth in the hands of a very few in the United States, and that this lack of equitable distribution of the fruits of economic progress is the greatest problem facing the United States. Its solution is of the utmost consequence for the future of the country as a democratic republic. But why would SSE have a position on this? If an evolutionary biologist in the United States supports his state’s anti-union “right to work” law, this has no necessary relation to his work as an evolutionary biologist. Why should such a person have his political views on an issue unrelated to evolutionary biology be repudiated by SSE? I don’t expect or want SSE to endorse my views on “right to work” laws, and I equally don’t want it to condemn the opposite view.
“Respect the autonomy and voices of local communities and indigenous people.” ​This is perhaps the most bizarre of all. Why should SSE have a view about the proper relations between levels of government? Are local communities always, or even usually, right about political, social, and moral issues? South Carolina wanted local autonomy over slavery in 1860. During the civil rights era, it was Federal override of the autonomy of local communities that brought about social progress. And what about today? We’ve seen wealthy local communities put up gates and threaten protesters with weapons– is that what SSE respects? And what about the wider world? Does SSE have an opinion on the fate of Nagorno-Karabakh, many of whose local residents want to be annexed to Armenia? The indigenous people of Hungary seem eager to keep out refugees– it’s their blood and their soil– does SSE respect this, too? Whether local autonomy or higher-level intervention has done more to bend the moral arc of the universe towards justice has varied from time to time and place to place. SSE need not engage with the question of under what circumstances local autonomy promotes justice, because it should have no opinion or policy on the matter at all.
There is, of course, a sort of reductio ad Hitlerum– “You wouldn’t want to invest in Krupp gun works or the makers of Zyklon-B during World War II,”– and, of course, you wouldn’t. But extreme cases make bad law, and do not provide a basis for the proposed principles.
A scientific society may legitimately advocate for science and for scientific values, especially as they pertain to the disciplinary expertise and intellectual standards of the society. But it is no part of the remit of such societies to take up positions on general social, political, and moral issues. Indeed, one of the values of science is to not allow popular passions, fashions, and prejudices to color what should be epistemic considerations.
I realize that this comes after the deadline of November 30, and thus will not influence the form of whatever policy you adopt; the response timeline, coming as my campus prepared to move to all virtual instruction over Thanksgiving, did not leave time for a considered response given my other commitments at that time. With the semester now over and with time to address the issues, I share my views with you in the hope that they might add to your understanding of them; feel free to share this with your colleagues among SSE’s officers and committees.

I received a cordial reply saying that all feedback will be considered.

Some sort of policy, such as following accounting principles, is desirable, but that sort of policy almost goes without saying. (I belong to several scientific societies; I don’t know what, if any, formal policies the other societies have.) But such a policy should address universally accepted accounting and governance principles, and perhaps concerns for which the Society possesses special disciplinary expertise and intellectual standards.

Have any readers encountered similar quandaries with organizations and institutions with which they are involved?

Did the CDC favor social-justice optics over American lives?

December 24, 2020 • 1:45 pm

When I heard that Illinois was giving covid-vaccine priority to all “essential workers” over the aged, I was puzzled. Not because “essential” workers should all queue up behind older people, but because some “essential workers” weren’t really essential in a sense that should give them priority over older people whose chance of dying from the infection was much higher. “Essential workers” include, according to Yascha Mounk, bankers, liquor-store employees, hardware-store employees, and movie crews. On what grounds, especially considering the differential risk of death or serious illness, should these “essential workers” be given vaccination priority over adults with high-risk medical conditions or older folks (over 65, 70, or 75, depending on the state and the ordering)?

Yet that is what the CDC decided not long ago, realizing, even by their own accounting, that such a decision would cause more people to die than if the order was reversed. The decision to let people die was apparently based on social-justice considerations, as older people were deemed to be more white than were essential workers.

In this article from Persuasion, Yascha Mounk, Associate Professor of Practice at Johns Hopkins University’s School of Advanced International Studies, argues that such a decision is unethical. Click to read:

Mounk begins with some premises that he thinks people will agree on about what what is just and unjust:

. . . there are also some bedrock principles on which virtually all moral philosophers have long agreed.

The first is that we should avoid “leveling down” everyone’s quality of life for the purpose of achieving equality. It is unjust when some people have plenty of food while others are starving. But alleviating that inequality by making sure that an even greater number of people starve is clearly wrong. The second is that we should not use ascriptive characteristics like race or ethnicity to allocate medical resources. To save one patient rather than another based on the color of their skin rightly strikes most philosophers—and most Americans—as barbaric. The Centers for Disease Control have just thrown both of these principles overboard in the name of social justice.

In one of the most shocking moral misjudgments by a public body I have ever seen, the CDC invoked considerations of “social justice” to recommend providing vaccinations to essential workers before older Americans even though this would, according to its own models, lead to a much greater death toll. After a massive public outcry, the agency has adopted revised recommendations. But though these are a clear improvement, they still violate the two bedrock principles of allocative justice—and are likely to cause unnecessary suffering on a significant scale.

He then recounts a talk that Kathleen Dooling, a public-health official, gave at the CDC, a talk that wound up undergirding the initial order of non-healthcare-essential workers > older adults that the organization mandated for vaccination. The decision was based on “feasibility [ease of implementing vaccination in an identified population], science, and ethics.” Dooling presented a chart, below, purporting to show that implementation was easier in a group based solely on age (true: it’s substantially harder to identify “essential non-healthcare workers” as well as define whether someone has a “high-risk medical condition”), and the science itself, she said, showed no difference in outcomes based on priority.  (The “+” signs are indices of priority, and are somehow combined to create the order of vaccination.)

The “science” bit is especially wonky. Although older adults without comorbidities are given the same science rating as essential non-healthcare workers (column 1 versus 3), Mounk says this:

According to the CDC’s model, prioritizing essential workers over the elderly would therefore increase the overall number of deaths by between 0.5% and 6.5%. In other words, it would likely result in the preventable deaths of thousands of Americans.

Remember, that is a model that supposedly takes into account all scenarios for mortality, including deaths produced by non-vaccinated “essential non-healthcare workers” who spread the virus to others:

Thus, deciding to prioritize non-healthcare essential workers over adults over 65 rested on grounds of “ethics” is deciding to prioritize “ethical considerations” over life (as if differential death was not an ethical matter!) Mounk says the “ethics” came down to race:

And yet, the presentation concluded that science does not provide a reason to prioritize the elderly. For, as Kathleen Dooling wrote in one of the most jaw-dropping sentences I have ever seen in a document written by a public official, differences in expected consequences that could amount to thousands of additional deaths are “minimal.”

This allowed Dooling to focus on “ethical” principles in selecting the best course of action. Highlighting the most important consideration in red, Dooling emphasized that “racial and ethnic minority groups are underrepresented among adults > 65.” In other words, America’s elderly are too white to be considered a top priority for the distribution of the vaccine against Covid. It is on this basis that ACIP awarded three times as many points to prioritizing the more racially diverse group of essential workers, making the crucial difference in the overall determination. Astonishingly, the higher overall death toll that would have resulted from this course of action does not feature as an ethical reason to prioritize older Americans.

As far as I know, Mounck is correct is stating that this is the basis of the decision.  It is based on social-justice optics. Now nobody would want to take a path in which one could foresee a worse outcome—in terms of death or anything else—for members of different races. If one could predict that the death rate among such groups would differ as a result of such a policy decision, that would violate the ethical principles above. But that’s not the outcome here. In fact, as Mounck notes, the proportion of people of color among essential non-healthcare workers isn’t much different from their proportion among the elderly, and it’s in fact conceivable that prioritizing column 1 over column 3 could lead to the deaths of more people of color than the other way around!

The difference in the percentage of white people across age groups is comparatively small. The difference in the percentage of infected people who succumb to Covid across all age groups is massive. Giving the vaccine to African-American essential workers before elderly African-Americans would likely raise the overall death toll of African-Americans even if a somewhat greater number of African-Americans were to receive the vaccine as a result.

Indeed, a few people noticed and objected to this order:

In the days after ACIP published its preliminary recommendations, barely any epidemiologists or health officials publicly criticized its findings or its reasoning. But thankfully, prominent journalists like Zeynep TufeckiMatt Yglesias and Nate Silver publicly made the case against them. (So did I.)

You might look at the data in Silver’s tweet, since many people seem to trust him.

Finally, as the controversy grew, the CDC changed its recommendations, putting (after medical workers) Americans over 74 AND essential frontline workers in the second phase.  Mounk sees this as an improvement, but one that could still lead to higher deaths (for example, prioritizing frontline workers over those 65-74 could still lead to overall higher mortality).

Although I’m over 65, I don’t really have a dog in this fight. I will patiently wait my turn to be vaccinated whatever and whenever the state of Illinois decides. But what the CDC was trying to do originally—and may be doing to a lesser extent now—smacks of prioritizing the appearance of equity above the lives of Americans—and that includes black lives. I see no other explanation once you realize that the CDC is supposed to have done the math about overall deaths caused by their different strategies—and then opted for a ranking that would increase the number of dead. We all know the importance of optics (Glenn Loury calls it “ass covering”) over substantive and meaningful progress these days, especially when it comes to alleviating inequalities among groups. To use one example, optics rather than achievement is the basis of land acknowledgments.

In the end, Mounk uses this ranking as an example of why we shouldn’t even trust government institutions like the CDC, which is supposed to be using science to make its decisions. Although ethics has to figure in somewhere, if you can’t trust the CDC’s science, what can you trust? And I agree that there was a misstep in the CDC which only public scrutiny prevented. Mounk is especially exercised by the failure of the press to notice and call out the CDC’s priorities, unlike Nate Silver:

Until a few years ago, it was obvious to me that I can trust what is written in the newspaper or what I am told by public health authorities.

Now, I am losing that trust. I still believe that most people, including the journalists who write for established newspapers and the civil servants who staff federal agencies, are the heroes in their own stories. They genuinely mean well. And yet, I no longer trust any institution in American life to such an extent that I am willing to rely on its account of the world without looking into important matters on my own.

The reasons for this mistrust are perfectly encapsulated in the reports that mainstream newspapers published about the CDC’s recommendation. The write-up in the New York Times, for example, barely mentions the committee’s last-minute change of heart. A faithful reader of the newspaper of record would not even know that an important public body was, until it received massive criticism from the public, about to sacrifice thousands of American lives on the altar of a dangerous and deeply illiberal ideology.

Weigh in below; is Mounk’s take right or wrong?

Baptist leader tells us that God doesn’t want us to sacrifice the old

March 26, 2020 • 12:30 pm

Here we have the New York Times once again pandering to religion, publishing an article that says we should help save lives, including the lives of the elderly, not because of humanistic values, but because God says so.  The author, Russell Moore, is described as “the president of the Ethics and Religious Liberty Commission of the Southern Baptist Convention.”

Read and scowl:

 

Moore’s point, which many people have discussed without invoking religion or God, is whether we’re going to let people go back to work prematurely because the preservation of the economy (and other social values) is more important than the lives that would be lost by an early ending of the quarantine. Well, that’s basically true, but surely we’ll have to resume normal life before the world is entirely cleansed of Covid-19, so that itself is a form of tradeoff. A more important issue at the moment is how do we give care to young versus old people, or people who are immunologically compromised, when care is limited?

We have only a certain number of ventilators, and if there are two people competing for one, one 25 and the other 80, who do you choose? Reason would suggest that you’ll create the most well being, on average, by saving the greatest number of years to come. And that would favor the younger over the older, those likely to survive over those likely to die. That is the only humane decision, and you don’t need religion to make it (simple utilitarianism will do). Already, Italy is prioritizing Covid-19 care for those under 60, giving older people palliative care. When there are limited resources, priority must be given.

Of course Moore is correct that we shouldn’t—as Trump appears to want—blithely allow older people to die in the service of the Dow Jones Industrial Average, but such advice doesn’t require invoking God. So why does Moore stick the divine in?

For example:

A pandemic is no time to turn our eyes away from the sanctity of human life.

As opposed to other kinds of life?

We already are hearing talk about weighing the value of human life against the health of the nation’s economy and the strength of the stock market. It’s true that a depression would cause untold suffering for people around the world, hitting the poor the hardest. Still, each human life is more significant than a trillion-dollar gross national product. Stocks and bonds are important, yes, but human beings are created in the image of God.

There Moore is using the Bible as his source of ethics. Because humans (but not gorillas or ducks) are created in the eyes of God, we cannot automatically prioritize the economy and the fabric of society over people’s lives. But you don’t need the Bible for that. Try John Rawls, or Peter Singer (both atheists). And don’t forget that giving human life the highest priority over everything, including suffering, leads to spending millions of dollars to keep those in vegetative states alive, or to disallowing assisted suicide.

It goes on:

We must also reject suggestions that it makes sense to prioritize the care of those who are young and healthy over those who are elderly or have disabilities. Such considerations turn human lives into checkmarks on a page rather than the sacred mystery they are. When we entertain these ideas, something of our very humanity is lost.

Nope. Who gets the ventilator? The 25 year old or the 80 year old? Do we lose our humanity when we have to make such a choice? I don’t think so: we exercise our humanity.

But wait! There’s more!

. . .Vulnerability is not a diminishment of the human experience, but is part of that experience. Those of us in the Christian tradition believe that God molded us from dust and breathed into us the breath of life. Moreover, we bear witness that every human life is fragile. We are, all of us, creatures and not gods. We are in need of air and water and one another.

A generation ago, the essayist and novelist Wendell Berry told us that the great challenge of our time would be whether we would see life as a machine or as a miracle. The same is true now. The value of a human life is not determined on a balance sheet. We cannot coldly make decisions as to how many people we are willing to lose since “we are all going to die of something.”

You don’t need to see life as a miracle to come to ethical decisions about triage or ending pandemics.  You need consider only well being versus other things we value. After all, there are thousands of deaths every year due to car accidents, falls in the bathtub, accidental discharge of firearms, and so on. In 2000, 17,000 people committed suicide with a firearm.  Many people (though not I!) would say that the value of firearms outweighs those of the lives lost using them, and that the value of cars outweighs the 15,000 or so people killed in vehicular accidents every year. We make these decisions all the time, weighing known loss of life versus social goods. I don’t happen to think that we need guns, but I do think we need vehicles, despite Moore’s claim that every life is a sacred miracle.  And during this pandemic, as we’ve seen from Italy, you simply can’t treat everyone the same way. Does Moore think so? (He doesn’t say, but that’s the implication).

It angers me that Moore claims God and the Bible as his arbiter of moral behavior when humanistic values lead to exactly the same conclusions he reaches:

That means we must listen to medical experts, and do everything possible to avoid the catastrophe we see right now in Italy and elsewhere. We must get back to work, get the economy back on its feet, but we can only do that when doing so will not kill the vulnerable and overwhelm our hospitals, our doctors, our nurses, and our communities.

Duhhh! (But I note that the Italian form of triage is in effect “killing the vulnerable”, but through inaction rather than direct action. The result is the same).

Truly, I can see nothing in his article that a humanistic atheist like Peter Singer couldn’t write, and without invoking the false idea that we’re made in the image of God. (How does that matter, anyway? God, who made us in His image, saw fit to commit repeated genocides in the Old Testament, and that selfsame God allowed coronavirus to spread over the globe and kill tens of thousands.) The “image of god” idea grates on anyone who thinks we evolved, and on those who believe we can derive our ethics (better, ethics, actually) without consulting a nonexistent being in the sky.  So I could have written this last paragraph—except for the final seven words:

And along the way we must guard our consciences. We cannot pass by on the side of the road when the elderly, the disabled, the poor, and the vulnerable are in peril before our eyes. We want to hear the sound of cash registers again, but we cannot afford to hear them over the cries of those made in the image of God.

Why was this published?