Showing posts with label mortality. Show all posts
Showing posts with label mortality. Show all posts

Sunday 17 May 2020

Ethics by Numbers

Ethics by numbers:  

We might imagine that numbers can resolve an ethical dilemma.  Faced with two inescapable ethical choices, A and B: A will cause two deaths and B will cause one.  B seems the obvious ethical choice.  In the real world, ethical choices are rarely so straightforward.  In fact, even in the hypothetical world the choice isn't so clear.

Ethics 101

When I was a student in Ethics 101, Professor Glass presented us with this standard thought experiment. You are on a boat cast adrift at sea with six other passengers. You have supplies enough for six people to survive. There is no hope of rescue. If you do nothing all seven people will die. What do you do?  How do you decide the ethical or moral course of action?  The scenario allows only four options:
  1. Do nothing.
  2. Save yourself.
  3. Sacrifice yourself
  4. "The greatest good for the greatest number of people."
I used this scenario in a number of classes for varying reasons: sometimes as a “values clarification” exercise; more often just to teach vocabulary. The experience of presenting this scenario has taught me that when it comes to ethical dilemmas the immediate response is a combination of avoidance and denial. 

Types of ethical behaviour

Option 1:  Do nothing and everyone dies seems the obvious worst-possible choice.  But the combination of religion and Hollywood movies has conditioned us to believe that some unlikely, miraculous, heroic event will save the day.  To take a life would be immoral, therefore God will save us.  The hero will come up with some unimaginable combination of trickery and courage to save us all because that's what always happens in the movies.  

Option 2:  Save yourself. "Anybody but me" is the ethical axiom of egoism.  The ethical thing for you to do is to guarantee your own survival no matter what. Whatever choice is best for you--enlightened self-interest--is what is ethical. This is the point of view upheld by Ayn Rand in her book, The Virtue of Selfishness, and by her acolyte Alan Greenspan, Chairman of the Federal Reserve until shortly before the collapse of 2008.  This is the ethical position underpinning American capitalism.

Option 3:  Altruism.  Being ethical means putting others before yourself, operating in their interest rather than your own. Heroism?  A "messiah complex"? Naivety?  Wishful thinking?  The egoist loves--and feeds on--altruists!  In theory, this is the ethical basis of Christianity: "love thy neighbour as thyself" and "turn the other cheek."

Option 4:  "The greatest good for the greatest number."  This is the central maxim of utilitarianism.   According to Professor Glass, utilitarianism was the only viable, ethical position.  (Did I mention that Professor Glass was a Communist?) Young upstart that I was, I argued quite vigorously against the Professor's position.  The word "good" was synonymous with "moral" and "ethical"; therefore, the maxim "the greatest good" begged the question.  (This was back in the day when people understood what "to beg the question" meant.)  Actually, it was the worst degree of "begging the question" because it created a tautology:  "the most ethical" ("greatest good") is "ethical."  Well, duhh!

The COVID-19 boat

Here we are in the COVID-19 boat.  Of course, that's not quite true.  We are all in the same storm, but each of us is in our particular socio-economic boat. Still, the what-is-ethical scenario isn't just hypothetical anymore.  Governments, almost universally, have adopted utilitarian responses to the novel corona-virus.  Oddly the Swedes have proven outliers, adopting a laissez-faire, egoist ethical position.  Some gun-toting, Darwin-award-wining Americans have demonstrated against government-imposed restrictions in their state capitals.  And Donald Trump appears to have made getting back to "business as usual" his highest priority.  Egoism might be a credible ethical position but it can easily slide into the misguided notion that my privilege, comfort and convenience are more important than other people's lives.

"The Readiness is all"

The most common criticism of national governments has been the failure to adopt utilitarian measures quickly or strictly enough. China has been criticized both for doing too much and for doing too little:  imposing draconian quarantine measures on one hand and failing to provide information on the spread of the virus on the other.  Lack of preparedness is, as it should be, the prevalent preoccupation.  Bill Gates TED talk (2015) on the need to prepare for a pandemic and George W. Bush's speech (2005) on the same theme have circulated widely.  To the list of people who "told you so," we can add virologist Michael Kinch who is quoted in Bill Bryson's The Body, saying: “We are really no better prepared for a bad outbreak today than we were when Spanish flu killed tens of millions of people a hundred years ago."  In the modern version of the Cassandra effect, what people prefer to believe always trumps truth and prescience.

On Being ethical

Obviously, reckless disregard for human life is unethical. If your religion tells you reckless disregard for human life is okay, there is something wrong with your religion.  Reckless disregard for human life in favour of economics, politics or even pleasure is immoral.  Egoism, altruism and utilitarianism all direct us to the same recommended ethical behaviours:  quarantine, social distancing, and hygiene.  However, the numbers in themselves will not solve the ethical dilemma before us.

Where are we?

As Angela Merkel, German Chancellor and scientist, pointed out, in her speech to the Bundestag, we are at the very beginning, not the middle and definitely not the end, of the pandemic.  The novel corona-virus will be with us forever, the pandemic for years.  Best-case scenario, a vaccine will be developed in a year, production of sufficient quantities of the vaccine and getting it into human bodies will take at least another year.  And the "best-case scenario" is always, by definition, optimistic.  Research into the HIV-AIDS virus has been ongoing for 40 years without producing a vaccine.

Mortality in Ontario

The Government of Ontario (the Canadian province where I live)  has forecast between 3000 and 15000 deaths from COVID-19 over a two-year pandemic with the current measures in place.   We will never know the exact death toll from COVID-19.   In each of the last three years, over 100,000 people have died--of various causes--in Ontario.  These numbers do not tell us that we should be blaisé about lives being lost, but they do tell us that the numbers alone will not dictate ethical behaviour.  Over the last three years, we have gone about our "normal" lives, taking the typical risks of contagious diseases, traffic accidents, and lifestyle-provoke heart disease and cancer, while thousands of people died around us of exactly those causes.  What has changed is a question of degree:  the degree of contagion of the COVID-19 virus and the degree of public awareness.  What remains is the ethical dilemma of how to behave in the face of a life-threatening, contagious disease.

What is and what should be

The last four chapters of The Big Picture--although the book is largely about physics and the author, Sean Carroll, a physicist--are dedicated to ethics.  Carroll's theme is captured in the maxim:  "You can't derive ought from is."  In other words, physics, the rules which describe nature, cannot provide the rules of morality, cannot tell us how people should behave. In his critique of utilitarianism, Carroll points out that "The attractive idea of 'quantifying utility' becomes slippery when we try to put it into practice."  One of the problems we can see in our present circumstance is that in practice, utilitarianism means decisions about what is good, moral and utilitarian are left to a handful of politicians.  To return to my objection to utilitarianism from decades passed, what is "good" is left unanswered let alone unquantified.

Finding serenity

Obviously, saving lives is "good."  However, surrendering everything that is "good" about life in order to preserve life is no answer.  We are still a long way from that ethical dilemma but it is before us.  In the immediate term, egoism, altruism and utilitarianism all tell us to remain vigilant, to keep a distance and wash hands.  Carroll's conclusion is that we "construct" morality as circumstances present themselves.  Making it up as we go along isn't very reassuring, but when the time comes we need to be able to tell ourselves that we did the best we could.  A version of the "Serenity Prayer" has never seemed more apt:  we must grant ourselves the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference.

Saturday 21 March 2020

How the World Ends

"This is the way the world ends
Not with a bang but with a whimper."
                                            T. S. Eliot  "The Hollow Men"

Asteroids and comets

The world will end.  The only questions are how and when.  On average, the earth is struck by an asteroid big enough to reshape if not devastate the planet every 100 million years.  The last major impact was 66 million years ago.  You might want to keep an eye on the sky for the next 34 million years or so.  Sudbury was hit nearly 2 billion years ago, so maybe we in Ontario, Canada, will be spared next time.

The Grapes of Wrath

Even if you are one of those people who believe that the speck of space dust we all live on, and everything else, was created by a fair-skinned old man with a long beard who made us "in his image and likeness" (though vice versa seems more likely to me), you must still accept that his Angel of Death will eventually cut us down with his sickle and cast us into "the winepress of God's wrath." The Biblical Apocalypse does promise heaven for some, the endless euphoria of "being with God," which, I have to admit, sounds like a drug-induced coma to me.  Descriptions of hell are a lot more motivating.

Galaxies in collision

The sun, which we depend upon for everything, will burn out someday.  However, before that happens it will get hotter, making this planet uninhabitable in about a billion years.  However #2, before that happens we are scheduled for another ice age in 50 thousand years--which might be delayed by another 50 thousand years by the build-up of greenhouse gases in our atmosphere. Whether the prognosis is burning or freezing, we need to be looking for a new place to live.  So far, astrophysicists have their eyes on one of the moons of Jupiter.  Unfortunately, long term, our galaxy, the Milky Way, is predicted to collide with the Andromeda Galaxy in about 4 billion years.  Eventually, we'll have to look for a gated community in a more distant galaxy.

Based on data from the Hubble telescope this image of Andromeda colliding with the Milky Way was produced by NASA.  So much for Eliot's claim of the world ending "not with a bang."

The Covid-19 paradox

Every year, in round numbers, 60 million people die on planet Earth.  As the mortality rate increases, with an aging population, and the birth rate declines, a zero global growth rate is being predicted.  Good news for the planet, but bad news for the stock market. Despite or rather because of the Corona-virus and the steps being taken to mitigate its impact, the morality rate for the year 2020 is likely to be lower than average.  With business, sport and entertainment venues closed, social distancing and heightened awareness of basic hygiene like hand washing, cases of Covid-19 will be reduced, and so will many of the other top causes of global mortality:  the flu, automobile accidents and tuberculosis.  Unfortunately, precautions against Corona-virus seem unlikely to affect the planet's 9th-leading cause of death, lack of clean drinking water, but we can anticipate a reduction in the number of airplane crashes and mass murders.

Political will

The response to the Covid-19 pandemic has belied the typical claims that we cannot solve global problems like man-made climate change, pollution, or poverty, or tuberculosis and malnutrition which are products of poverty.  The Covid-19 response has demonstrated what is possible when there is political will--and by "political will" I don't mean just the "will of politicians" but the will of the media, institutions, businesses, groups and all the way down the line to individual citizens' willingness to cooperate.  The response has demonstrated that we, as a species, are collectively better at avoiding self-annihilation than had previously been predicted.

There is no word for killing a human species

I was struck to learn from Harari's Sapiens: A Brief History of Humankind that millennia ago there were numerous species of humans, and a hint that we may have done away with our siblings--including the Neanderthals who had bigger brains than we did.  Quick and brutal beats brainy and reflective, apparently. There are many words in the English language to categorize types of murder--genocide (a race or nation), omnicide (everyone) and xenocide (others)--but no word for killing a single human species.  Of all the ways the world might end, doing it to ourselves is obviously the worst--and has always seemed the most likely.

Nuclear war

When I was ten, students at my elementary school were given instructions to crouch under their desks in the event of a nuclear attack.  A punch line to the instructions began to circulate that once in position to "kiss your ass goodbye."  In the small town where I grew up we even had a a super-loud siren to warn of an incoming nuclear-missile attack.  At the height of the Cold War, some genius decided it would be a good idea to test it.  I remember I was alone at the tennis courts where I was paid a healthy salary of 10 dollars a week to do the basic maintenance on three clay courts.  For about six and a half minutes, I believed the end of the world was imminent. I felt strangely calm.  I thought I should run home to be with my family.  Upon reflection I knew there was nobody home and our little A-frame house would provide no protection against a nuclear blast.  I just stood there until the siren stopped and the end of the world did not come.


Since that day, I have thought and assumed we would get better at avoiding self-destruction.  On the contrary, we humans seem endlessly creative in coming up with ways and reasons to kill each other and ourselves.  Religions, cultures, states, nations, identities, ideologies, wealth, power, and plain old short-term self-interest provide endless justifications for mutual destruction.

Is Corona-virus the common enemy we've needed?

It has long been hypothesized that what the human race needed was a common enemy to unify us all.  Maybe this Corona-virus will do the trick and we will finally turn the corner away from planetary suicide.  To paraphrase the poet, Fernando Pessoa, we are on the cruise ship Earth without knowing its port of departure or its destination.  Our only certain obligation is to take care of one another.

Monday 2 March 2020

Why Is the Coronavirus Getting So Much Attention?

Coronavirus disease versus the flu

According to the Johns Hopkins Medicine web site, as of February 6, 2020, the Coronavirus disease has caused 2, 810 deaths worldwide.  In comparison, the flu kills between 291,000 and 646,00 people every year.  Why has the Coronavirus gotten so much attention?  According to Dr. Bonnie Henry, a BC Health Inspector, the objective is to contain the virus.  In theory, once it has nowhere to spread, it will be restricted to the animal population from which it first emerged.

"The Truth about PHEICs" (Public Health Emergency of International Concern)

Containment is a nice idea, but it has become obvious that containment and quarantine haven't been working and generally don't work.  In an opinion piece on the Ebola crisis, entitled "The Truth about PHEICs," Professor Emeritus Johan Giesecke, writing on behalf of the WHO [World Health Organization] Strategic and Technical Advisory Group for Infectious Hazards, observes that the "declaration of a PHEIC for the current Ebola outbreak would add no clear benefit  [. . .  .]."  Giesecke points out that "The public health community must recognize the close link between disease and trade [. . .]."  Although "WHO director-general Margaret Chan advised against imposing travel restrictions on Western Africa, saying they would worsen the crisis by keeping medical experts out of impacted areas," the Ebola crisis eventually became one of the five instances in which the WHO issued a PHEIC.

Why did the WHO issue a PHEIC for the Coronavirus?

Part of the reason Coronovirus has received so much attention is that the WHO has issued a PHEIC.  Given the predictable (predicted?) economic impact and the relative inefficacy of PHEICs, why did the WHO issue it?  According to WHO regulations, a PHEIC is
 “an extraordinary event which is determined, as provided in these Regulations:
to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response”. This definition implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action.
Diseases, in particular viruses, rarely respect national borders and the seriousness of Coronavirus relative to the flu and other viruses is in question.  What remains as an explanation for the issue of a PHEIC and perhaps the global panic which has ensued is that the disease is "unusual or unexpected."

The "Perfect storm"

For the news media, bad news is always good news.  A disease that is "unusual or unexpected" is motivation both for the WHO and the media.  Additionally, the virus offered another opportunity for China-bashing in Western media. Sometimes conspiracy theories are just irresistible:  Anyone with advanced knowledge of the WHO's intention to declare a PHEIC would have made a fortune by shorting the stock market.

Comparing SARS-CoV-2 and HIV-1M-AIDS

Like HIV ( Human Immunodeficiency Virus), the Coronavirus has numerous strains.  Of the eight strains of  HIV, HIV-1M is responsible for the AIDS (Acquired Immune Deficiency Syndrome) pandemic.  Of the five strains of Coronavirus, most create symptoms of a common cold.  CoV-2 causes the SARS (severe acute respiratory syndrome) now threatening the world.  (Why the WHO decided to call the disease COVID-19 remains a bit of a mystery.)  Like HIV which was transmitted from animals (monkeys, therefore, SIV; that is, Simian Immunodeficiency Virus), the Coronavirus virus responsible for "Covid-19" is believed to have begun in a fish market in China.  For some time, HIV-AIDs was thought to have started in 1980 with a flight attendant from Quebec but, as Jacques Pepin  establishes in The Origin of Aids, the fatal virus first entered the human population in Africa in the early 1920s.  CoV-2 is currently assumed to have begun in China in December 2019, but we may eventually establish a new origin and chronology.

This Year 40 to 70% of the world will be infected with Coronavirus-2

Harvard epidemiology professor Marc Lipsitch predicts that "within the coming year, some 40 to 70 percent of people around the world will be infected with the virus that causes COVID-19."  No, the end of the world is not upon us.  As this Atlantic article outlines, the reason quarantine and containment have not worked with this virus as they did in other cases, like H5N1 ("avian flu"), is that the fatality rate for COVID-19 is relatively low--less than 2%.   Not only are there more live carriers of Coronavirus-2, but people infected with the virus may experience only minor symptoms or no symptoms at all, making it all the more likely that they will be walking around and spreading the disease.

How many viruses do you have now?

Ultimately the COVID-19-causing virus will join the 380 trillion viruses that already occupy the human body.  The virus will prove fatal for some people with chronic illnesses and the elderly (people like me, I guess). The virus is highly infectious and will cause a pandemic.  Stop and consider the definition of a "pandemic":

The Snowball effect

When talking about the loss of human life, no one likes to compare numbers.  Every life is sacred, right?  However, at some point in the midst of global panic, we need to remind ourselves that every time we get into a car or board a plane or go to a hockey game or church or synagogue or mosque or have sex or visit a hospital or simply step outside, statistically, we are taking a risk that might cost us our lives.  Ultimately, the reason Coronavirus has been getting so much attention is that the Coronavirus has been getting so much attention.  

The Counter-Argument

Here is a strong counter-argument to the theme of this post.  (Thanks Dr. B.)  This article argues that the real issue is that global health services aren't nearly prepared enough to face the degree of contagion of COVID-19.  The article also crunches the numbers on the number of fatalities resulting at least in part from the under-preparedness of hospitals.  The article concludes by saying something I perhaps should have written:  "taking steps to protect yourself and your loved ones is the responsible thing to do."

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