Quintessence

Recent trends to Marginalize Children and the Poor in Healthcare

2011-06-21T11:21:00.001-05:00

Without a doubt, the Medicaid and Medicare programs need to be reformed so as to ensure their long term sustainability. However, I am increasingly concerned that certain populations of people, namely children and the poor, are being increasingly marginalized and ignored for the sake of political power and economic profits.

Children and the poor have often been the subject of re-occuring and pervasive injustices throughout history, but two recent articles (one a Wall Street Journal news article, and the other an empirical study reported in the New England Journal of Medicine) suggest that here and now those who hold a greater share of power in its various forms continue to marginalize and disrespect those classed under these groups.

The Wall Street Journal article notes, in particular, that amidst budget talks and the pressing need to curtail federal spending, there is substantial bi-partisan support to make cuts to the Medicaid program, which provides public insurance to those with lower incomes who may not be able to obtain affordable private insurance. While it may be necessary that Medicaid undergo some cuts or other substantial reforms, it is deeply suspicious that many of those with considerable political power are not willing to make similar cuts or reforms to the Social Security Program or Medicare. Of note, is the fact that both Social Security and Medicare serve the interests of senior citizens who comprise a substantial voting block for both Republicans and Democrats. Thus, the willingness to make cuts to Medicaid without equal attention to other entitlement programs looks like an effort to keep a certain voting block happy at the expense of those who wield less political power, namely those with less disposable income and time to dedicate to political campaigns.

In this week's issue of the New England Journal of Medicine, a research study has been published in which researches coordinated and scripted calls by actors to 273 medical specialists' clinics in the Cook County, IL area with the aim of trying to arrange an appointment for a child with pressing medical conditions. The only variable amongst the actors making the calls was that some were trying to make an appointment for a child with public health insurance and others for a child with private health insurance. The results are disheartening to say the least. Over 50% of the medical clinics refused to accept any patients with public health insurance, but did accept private health insurance. Of the clinics that did accept both public and private health insurance, children with private health insurance had to wait only 20 days for an appointment, while children with public health insurance had to wait 42 days. Thus, for two children reporting identical symptoms, medical specialists consistently made children with public health insurance wait longer for an appointment than a child with private insurance.

I find the latter study to be especially saddening insofar as it presents evidence of a considerable injustice perpetrated against children who have little or no control over the factors on which they are being discriminated against.

Amidst the discussions about reform in health care, more must be done to protect the interests of those that are often marginalized in our society, namely children and the poor. Certainly, our health care system has to work with finite resources, and as such, difficult decisions are and will have to be made about how best to distribute all of those resources. But what these articles draw our attention to is that at least some in our political and health care systems either directly or indirectly sponsor further harms to those that lack substantial economic and political power. That is, some in our society are being pushed down so that others can rise up. One need not advocate for radical equality amongst all members of a society to recognize that where those with power act to keep others down or push others lower, that is always a wrong, and one that should be immediately redressed.

Caring for Mom and Dad: An Argument for Shared Responsibilities

2011-06-14T09:36:00.000-05:00

An article in the Wall Street Journal today highlights the increasing numbers of adult children that are caring for elderly parents with various medical conditions and ailments. Presently 10 million adults (50 and over) are caring for at least one living parent.

In line with past trends, women continue to provide the majority of care for elderly parents (in 1994, 9% of women provided care for an aging parent, and in 2008, 28% of women were providing care for an aging parent)

Interestingly, though, while only 3% of men provided care for an aging parent in 1994, 17% of men in 2008 provided care for an aging parent.

Thus, while women continue to do a disproportionate share of the caregiving work, there has been some progress in getting more men to share in caregiving responsibilities. The goal being that insofar as parents are the parents of both sons and daughters, men and women, there might someday be a nearly equal distribution of caregiving work between the sexes.

But perhaps a skeptic might resist striving for a more equal distribution of caregiving work between the sexes.

In response, besides the obvious point that any responsibilities that a daughter might have to care for an aging parent are equally shared by a son, there is a further point that caregiving work, while providing certain rewards, also exacts considerable costs. Economically, wages are often forgone so as to provide the necessary care for a parent. But further, caregiving for a parent that can at times be deeply forgetful, obstinate, and/or confused places considerable stresses on the caregiver who in turn can face increased risk of hypertension, diabetes, pulmonary disorders, and/or disposition to smoke or drink alcohol. To the extent that women do more of the caregiving work in our society, they also carry a greater share of the costs and stresses associated with caregiving. Such a burden should be more equitably shared between the sexes.

Thoughtful, meaningful, and personal care of aging parents is vital work that should be encouraged in our society. As more baby boomers age, this task will only become more pressing. But in the process, we need to be conscious of the historical tendency to allot caregiving work, along with its associated costs and stresses, primarily to women. At the very least, conversations need to take place about the dynamics of caregiving within families and amongst siblings. More substantially, men and women, sons and daughters should strive to provide support and care to aging parents so as to share the costs and stresses of such work.

In the process, perhaps, both men and women, sons and daughters will also share in the rewards of caregiving work, the potential for deeper relationships with parents and siblings, along with the development of an ethics of care that emphasizes the finitude and dependency that we all face as fragile human beings and the corresponding need for visible and present communities of support and care.

The Chronically Ill and Access to the Internet

2010-04-05T10:42:00.000-05:00

Over at Health Populi, they are reporting on a recent Pew research poll that details that individuals with chronic illnesses are significantly less likely to have internet access (62%) than those with no chronic health conditions (81%). Yet, when those with chronic illnesses are able to go online, they often are able to find new information as well as connect with a network of individuals that suffers from the same illness and can support and share information with one another. The impact that the internet can have on those suffering from a chronic illness is too significant to allow such a gap in access to persist. Efforts need to be taken to diminish the current digital divide.

The significance of this survey is to underscore the fact that a call to diminish the digital divide is not a call to ensure that everyone has access to the same entertainment channels or is able to maintain a Facebook profile or a twitter account. But rather, it is a call to ensure that individuals are able to access people and information that can help them maintain their very life in this world.

Of Marginalized Populations and Public Health Care

2009-12-15T09:00:00.002-06:00

Solomon Benatar has written, "Modern communication, transport, methods of money exchange, the creation of nuclear and other potential weapons of mass destruction and the emergence of new infectious diseases have shrunk distances and differences, and created common global risks. In this context, and with a deeper understanding of the impact of adverse forces shaping the wealth and health of nations, we need to appreciate how we are all deeply implicated in the lives of others, and cannot hide with moral credibility behind the barrier of physical distance while billions of people live impoverished lives."

Benatar's quote comes amidst a larger call on his part for a more robust discourse concerning public health ethics. That is, beyond talk about the rights of individual patients in a medical setting and the various ethical dilemmas that might arise for an individual (i.e. issues relating to in vitro fertilization, use of stem cells, euthanasia, refusal of care, etc.) which have been at the center of much of the current discussion in the domain of bioethics, there is an earnest need for consideration of how the health of populations is structured and maintained, even sometimes in conflict with the uncompromising autonomy of individuals.

In America we are immersed in a debate about the reform of our health care/health insurance system. It is a temptation, I think, in the midst of such a debate to lose sight of the broader implications of our decisions about the management of health in the United States. Benatar put it wonderfully, in this present world of fluid currencies, economies, pathogens, nuclear weapons, and Internet technologies, "...we are all deeply implicated in the lives of others..."The way in which we choose to manage the delivery of health care here in the United States will have global implications, whether we acknowledge that or not.

The threat of viral sickness that ravages populations across the globe affords an example of the importance of providing for effective care in our own country. The failure to provide the necessary medical care to a single individual, or groups of individuals represents a direct threat to the overall health of the population in the country, but also the world given the ease with which people can travel now.

Thus, when various state legislatures or the national legislature consider the question of whether various not for profit health clinics should provide medical services to illegal immigrants, they would be wise to remember that "...we are all deeply implicated in the lives of others..." A failure to take care of these individuals represents a failure to take care of the national population as a whole, and even the global population. To be sure, we live in a world of limited resources, and we simply cannot provide for everyone. But in a world where we are all so deeply connected to one another we should be sensitive to steep divides that provide some with enormous benefits and power and others with virtually no benefits or significant power. It may be true that a strictly egalitarian society is impossible, and perhaps is not even desirable, but this need not mean that we cannot provide a basic level of care for each and everyone in an effective manner that keeps an eye to the larger good of a population or society and not merely individuals alone.

Perhaps by coming to terms with our own marginalized populations here in the United States we can finally recognize the need to recognize and address the profound lack of health care resources in other marginalized populations throughout the world.

Moral Arguments for Health Reform and Current Legislation

2009-12-14T19:45:00.001-06:00

If an individual opposes the current health care reform legislation under consideration by the US Senate, is that person denying the moral argument that can be made for some level of basic care for human persons?

To begin, it should be admitted that the intentions of various opponents of health care reform legislation are diverse. Undoubtedly, there are some who oppose the reform of health care or health insurance for entirely selfish, and perhaps even sinister, reasons. If the moral argument for health care reform is sound, then these persons' opposition is indeed immoral. But by no means should we throw the baby out with the bath water, so to speak. Perhaps, just maybe, the opposition to current health care reform legislation resists overly general pronouncements and stereotypes.

As a concrete example, we might consider the remarks made by Harry Reid, "Instead of joining us on the right side of history, all the Republicans can come up with is, 'slow down, stop everything, let's start over.' If you think you've heard these same excuses before, you're right," Reid said Monday. "When this country belatedly recognized the wrongs of slavery, there were those who dug in their heels and said 'slow down, it's too early, things aren't bad enough.'" (Fox News)

Reid's argument here seems to be that if you oppose or at least try to slow down the implementation of current sweeping legislation aimed at reforming health care, then you are like those who tried to resist recognizing the wrongs of slavery. The underlying assumed premise is that those who opposed recognizing the wrong of slavery were immoral and wrong themselves. Therefore, according to Reid's argument, to the extent that opponents of the current health care reform legislation bear an analogous relation to those that resisted recognizing the wrongs of slavery, then they share in their immoral and wrong behavior.

The problem with Reid's argument is not in saying that those who resisted recognizing the evils of slavery were immoral and wrong, but rather, whether in fact his initial analogy can hold up, because that is the crucial point of his argument.

What Senator Reid appears to have made the mistake in doing is assuming that to oppose the current legislation addressing health care reform amounts to opposing health care reform altogether. He has made the legislation itself synonymous with the moral impetus for health care reform. But this is a false inference.

An example might help here. Imagine young Tommy who has been taught by his parents that he has a moral duty to help his neighbor when he has the means to do so. Tommy, reflects on this moral maxim, and resolves the next day to help the elderly woman, who is frequently sick and lives next door, to move some paint cans that he saw her struggling with recently out to the trash, and thus eliminate a chore for her. But in the midst of his "helpful" deed, Tommy spills paint all over the back yard and driveway, as he sloppily carried the cans. The elderly woman now has more work to do, as Tommy failed to clean up his mess.

In this example, Tommy's intentions are in line with honoring the moral maxim his parents taught him, but his actual practice of the moral maxim fails in substantial measure. Tommy's parents may accordingly call Tommy in and offer some constructive feedback, and suggest alternative practices in the future. By critiquing Tommy's actions, do his parents reject the moral maxim that Tommy sought to implement? By no means, rather it is because they believe in the good of the moral maxim that they want to see Tommy implement it in a way that respects its nature and goals.

We can carry the point over to Senator Reid, and other politicians, who have suggested that opposing current legislation regarding health care reform is morally wrong or evil, on level with those that sought to deny recognition of the evils of slavery. Reid, et al, wrongly assume that the implementation of a moral maxim is the moral maxim itself, and accordingly fail to see that the moral maxim is a general form, of which various concrete actions can come closer to or further from implementing. In our example, Tommy's parents in offering him constructive feedback about how he implements his moral duties did not seek to deny the moral maxim itself, but rather to inspire their son to more effectively enact the moral maxim in his daily life. Among the opponents of the current legislation regarding health care reform, there are likely those that assume something like the role of Tommy's parents. They recognize the moral urgency to provide some level of health care to all persons and reform the current system of health care, but disagree with how some of the politicians are attempting to implement that moral maxim in current legislation. Such opposition should not be confused as being immoral. In fact, such critique may be, in fact, morally praiseworthy in that it strives to more effectively embody the moral duty or ideal.

To return to our initial question, if an individual opposes the current health care reform legislation under consideration by the US Senate, is that person denying the moral argument that can be made for some level of basic care for human persons? Our answer ought to be, not necessarily. There are some critics of current legislation that precisely because they do recognize the moral argument for universal health care and health care reform reject current legislation as an inadequate attempt to embody the ideal that the moral argument sets forth. Far from being moral degenerates, such critics are morally praiseworthy insofar as they call us to a higher standard, wherein we can more faithfully discharge our moral duties.

The Healthcare Debate and a Politics of the Impossible

2009-12-13T15:48:00.000-06:00

Vaclav Havel once said, "Masaryk based his politics on morality. Let us try, in a new time and in a new way, to restore this concept of politics. Let us teach others and ourselves that politics should be an expression of a desire to contribute to the happiness of the community rather than of a need to cheat or rape the community. Let us teach ourselves and others that politics can be not only the art of the possible, especially if "the possible" includes the art of speculation, calculation, intrigue, secret deals, and pragmatic maneuvering, but that it can also be the art of the impossible, namely, the art of improving ourselves and the world."

Havel is calling here for a politics that rises above that kind of politics that claims a degree of "realism" and thereby supposes that in order to get anything done in a divisive world, morals must be compromised. Instead of a politics of the practical, the "realistic, the possible, Havel urges us to embrace a politics of the impossible, whereby individuals strive for a good that transcends themselves and ultimately leads to the flourishing of the community, the country. The politics of the impossible does not resolve itself to political efficacy in an intensely partisan climate, but rather, exhorts that partisan political system to change its methods and practices so as to conform itself to the good of the community. Certainly it is a matter of debate about what precisely the good of the community, the country, is, but at least in the midst of that debate the focus is on seeking to understand and cultivate a sense of the morally good that transcends selfish interests, campaign concerns, and absolute political ideologies that have forgotten the people they were intended to serve in the first place. Too often in the current political climate politics sinks to the lowest common denominator, this is the politics of the possible, it takes its cues from the corrupt, influence peddling ways, of small-minded politicians that lack a robust moral imagination. What we need now is a politics of the possible that seeks to conform itself to the best examples of human nature and human community, and implement an ideal that is not yet found in abundance amongst us in this world.

The current debate on health care reform, or as it more often seems to be, health insurance reform, is an excellent source of insight into a place where the politics of the possible are rife, and the politics of the impossible are elusive at best. It seems that every day we hear about political deals being struck between senators and congressmen on various portions of the legislative bills that claim to offer some promise of reform of health insurance and/or health care. Health care reform has become a deeply divisive issue in the country and in the government, leading to a wealth of partisan bickering, special interest lobbying, and shallow news coverage. More and more the effort to reform seems to be dictated by the attitude of "just get it done" rather than any attempt to carefully consider what effective reform means and the longterm implications of policy changes. In short, this is a political situation that is oriented to the least common denominator rather than any kind of morally praiseworthy ideal.

It should be troubling that our politicians are so committed to the politics of the possible even on an issue like health care reform. I happen to believe that there is a moral argument to be made for reforming how health care is delivered and seeking to care for the health of every human person. I think that many of us have intuitions about this moral argument when we talk about the need for compassion and mercy for our fellow human beings. Moreover, I think there are relatively few people that want to see any human being suffering and sick, unable to get the care they need. Nonetheless, we have lost sight of such moral clarity in the current political debate about health care. To date, I have heard recourses to campaign promises, political polls, and budget numbers, but I have yet to hear individuals make the moral argument for health care reform. Undoubtedly, there are those that will say that such an argument will not help us to determine the specific contours of the legislation, it can only stress the need for such legislation. But this view fails to account for the ways in which the ideal that such an argument projects before us then guides how we seek to carry out health care reform. For instance, if we genuinely believe that there is a moral argument for providing some degree of medical care and even health insurance for every human being, then a bill that only gives that care and insurance to 94% of the population is a failure, and simply is not good enough. The politics of the possible will not get us where we need to be on the issue of health care reform. Instead, we need a politics of the impossible that demands more of us, that inspires us to rise above ourselves and work for the good of the community. If we cannot do that on something as morally clear as ensuring that we care for the health and wellbeing of our fellow human beings, then we are in a desperate situation.

I do not believe all is lost, that this world is broken and without hope, such a view would merely capitulate to the politics of the possible. However, I do think there are intelligent and wise voices that have yet to be heard in the debate on health care reform, or at least have not been given their due. Today, to embrace the politics of the impossible, we need to look carefully at who is being allowed to speak, and who is not, who is being set forth as a representative example, and who is not. In short, we must question the authority of the government officials that claim to represent us in this debate on health care reform, an also question the authority of new channels, magazines, and newspapers that hold the keys to the proverbial microphone.

Are you ready to order? No, more transparency please.

2009-07-08T10:45:00.004-05:00

It is always frustrating when you enter a store, looking for something to buy, and none of the prices are on display. I have often found that this is particularly the case with things in fancy glass display cases that often house expensive things. Jewelery stores are often prime culprits of such behavior. The unsaid message seems to be, "If you knew how much this cost, you probably would not be looking at this, so first fall in love with the item, and then lets talk about price." On another level, the suggestion is that price should not be a significant factor in deciding whether you really want to buy some item that otherwise satisfies your needs and/or desires. But for most average human beings, price does matter, and thus the dilemma of mediating our needs and desires by shopping in stores seeking to maximize profit in a world of finite resources.

But perhaps jewelery stores are too far afield for our purposes here. To be sure, buying jewelery or any other luxury item is rarely a matter of need, but rather of sheer desire. So lets consider food, that basic building block of human life. It is a common experience for many that when they eat outside of the home in a restaurant, they are presented with a menu, and that menu has prices next to each of the items. Few people would eat at a restaurant that offered them no semblance of how much a meal would cost, as many would likely regard such a place as elitist or deceptive, or both. But yet, when we deal with doctors of most any stripe, it is something like going to a restaurant and choosing items from a menu without any attention to cost. And yet, we accept such a system of health care. The mentality is, if the doctor says so, then it must be good and right. But why do we play the part of the skeptical consumer looking for a worthy deal in every other area of our life, but not in the doctor's office?

Patients seem to rarely know how much procedures cost, and yet they consent to them as so called "informed patients." Is price really not a significant matter to be informed on in the world of health care? I think most patients would say it is significant when they eventually receive their bills. To be sure, life is life, and its value is beyond the ability and right of any human being to assign, but...(and yes there is always a "but" when health care must work within a system of limited resources) there is not necessarily any correlation between higher prices for treatment and increased effectiveness. Certainly there are times when the more expensive treatment is the best one, and perhaps even the only real option, but there are other instances where multiple treatments exist with radically different prices, and little to no data on whether one treatment is more effective than another. And there we come to the crux of the issue. Health care providers have shown little regard for controlling costs and rationing care wisely. Granted, such negligence is in large part due to the belief that a person's health should not be subject to the sometimes cold math of cost/benefit calculations. But that belief is mistaken insofar as it is out of touch with any real evidence of cost considerations being detrimental to patients. Studies examining the comparative effectiveness of treatments combined with cost/benefit calculations can offer a powerful tool in saving countless individuals from a bloated health care system that tolerates a shocking amount of waste and error, and subsequently passes on its mistakes in the form of rising costs to the patients it supposedly serves.

If we are frustrated when items in glass display cases have hidden price tags, and few of us would consider eating in a restaurant that offered us no prices for the food, but only a bill at the end of meal, then why do we put up with such behavior in the world of health care? I am not urging that the authority of doctors be usurped, but rather only that there be some degree of transparency about how much health care really costs. Perhaps in time such transparency will lend itself to the deeper question of whether any given thing should cost as much as it does, but everything begins with transparency.

Health care reform, not just health insurance reform

2009-06-29T09:37:00.004-05:00

In a culture obsessed with numbers and quantitative measures, it is little surprise that much of the debate about health insurance reform has focused on how much it will cost, how many are uninsured, and other suitably massive statistics. But in the midst of all of this, I think we need to ask some deeper questions, ones not easily answered with numeric assessments, and supposedly hard data. That is, what is it we are actually trying to pay for? Even if health insurance does get structured differently, what are we getting in terms of how health care is delivered? To be sure, health insurance does influence how the delivery of care is handled in hospitals and clinics throughout the country, but are we so naive to think we have the chicken and egg question figured out with respect to health care and health insurance? It is not unreasonable to imagine that even if the economics of health care change, the quality of and delivery of it may not substantially change.

It seems that we are slow to learn this lesson. The recent economic recession has revealed an ailing market system, and has invited a myriad of economic analysis from anyone with half an idea of what happened. We have heard that the problem was with bad credit swaps, debt defaults, subprime loans, and distorted interest yields. But amidst all of this, there has been little talk about the kinds of people that have been involved in both creating and manipulating this kind of economic system.

Today, the infamous ponzi schemer, Bernie Madoff, will be sentenced. Some part of me imagines that as the news goes out on the networks about his sentence, people will breath a collective sigh of relief thinking that greed and corruption have been put behind bars. America does love a good scapegoat. Don't get me wrong, I think Madoff is a crook, and should rightly be punished. But the idea that he is somehow an exception, or a lone bad sheep in an otherwise relatively good herd of financial investors and traders is a joke. Perhaps Madoff is an exception in order of magnitude, but to believe that his greed is somehow unique is wishful thinking. Such thinking was witnessed in the media coverage of the Enron debacle and CEO Jeffrey Skilling, where one person or company was highlighted as the problem, while the surrounding system remained unexamined. Perhaps this is a defense mechanism, because the truth is that if we admitted that greed and corruption are likely rife throughout the system then we will be forced to eventually see our own part in encouraging and benefiting from, even taking part in, such a system.

My point in all of this is to say this. Yes, the numbers of health insurance reform need to add up and be organized in such a way as to create a capable and comprehensive system of reimbursement and payment. But numbers are just numbers, abstract quantities of nothingness outside of the human persons that utilize them and assign them to meaningful things. The other shoe that still remains to drop in the debate around health insurance reform is preceisely the human factor in all of this. That is, what kinds of people are leading our health insurance companies, what kinds of people are we training our doctors and nurses to be, who are our hospital administrators, what kinds of people populate hospital or insurance company boards, who are the receptionists that are sitting behind the desks in waiting rooms? The list goes on, but the trend is the same, that is, a radical assesment of the character of the myriad of persons that either directly or indirectly hold other peoples' lives in their hands. If the human beings in the health care sector are anything like those human beings in the financial sector of our society, than I expect that a sizable amount of greed, corruption, laziness, and deceipt is to be found (along with much good as well). In which case, consideration of the human factor in health care leads us to also consider proper safegaurds, checks and balances, error controls, well-placed incentives/rewards, and disciplinary controls that can be incorporated into the delivery of health care.

My proposal here is that we not abandon talk of health insurance reform, but that if we are going to be serious about reform, than lets consider the whole system at play, otherwise we are merely doing an extremely expensive, but ineffective, patch on a system that has deeper issues than just numbers. We need to consider the character of people involved in every level of the delivery of health care, and be honest about both the good and the bad in everyone. Accordingly, we should strive to create a system of care that takes into account this dual potential in human beings and the various tendencies we have. In short, I am asking that we actually take on the monolithic beast of health care reform, and not merely health insurance reform.

Health Care Reform

2009-03-23T08:02:00.003-05:00

Since the election of President Obama, there has been considerable discussion about health care reform. Such discussion has been needed, as we surely have an ailing health care system. The problems rest with no particular entity, but are dispersed throughout the system of health care in America, and on every level of care and business. However, as I listen to such discussions, and particularly the call for universal health care, I cannot help but think about the deeper question being overlooked. Are we as a society prepared to sacrifice highly individualized and easily accessible advanced care for a common standard of basic care available to everyone? I am not here trying to set up a dichotomy between the current system and a system of universal health care, and I am not trying to imply that the former provides excellent care, while the latter provides merely "okay" care. My point in asking the question is to raise the fact that as Americans, we are not good at considering the big picture questions, and taking macroscopic concerns seriously.

In order to ensure a basic standard of minimum care for every single person in America will require that we re-configure what we expect when we go to the doctor's office. A system that supports everyone cannot indulge the whims of every patient that wants a full body scan without any significant symptoms to prompt such a diagnostic test. The list of exotic therapies can go on, but the trend is the same. As human beings, we are very good at looking out for ourselves alone, and even more so when we are sick or in pain. We often have a deep sense of entitlement to access advanced and expensive technologies and treatments that might possibly save or prolong our lives and those of our friends and family. However, such tunnel vision cannot persist if we are to adopt a policy of universal care. Universal care will require a greater appreciation for the ways in which medical resources and technologies are allocated across an entire population. We cannot expect that ourselves alone will have any monopoly on a medical team's time or available resources.

Though it may be true that, as human beings, we are deeply focused on ourselves alone, and subsequently experience a substantial amount of entitlement to the resources society has to offer, we should not regard this as a "game-stopper" for the advancement and reform of healthcare. Instead, we should strive to come to terms with our self-centered nature, and work to improve upon it by considering the real needs of our neighbors. A universal health care system will rise or fall on the backs of people that commit or do not commit themselves to grasping the needs of their community in addition to their own. It is understandable to consider one's own needs, and we will likely never leave these behind, but to consider our individual needs, blind to those of our neighbor, is a pressing failure that endangers real and substantial healthcare reform.

Health Care Ethicists Amidst the Crowd

2008-12-29T21:36:00.004-06:00

In my observations of hospital life, I have come to realize that among those most important things when you are sick are the people waiting for you when you are discharged from the hospital. While there is a certain amount of sterile loneliness in hospital examination rooms or operating rooms, those people that arrive to greet you and pick you up bring a sense of home and companionship that even in the best hospitals are missing. Whether family or friends, the distinction matters little, because the result is the same, that is, after being poked and prodded, studied and stared at, a friendly face is there to remind you of life in supportive communities outside of the acute care of a hospital.

I think that this observation is important because in the field of health care ethics it can be easy to see the patient and health care provider as the sole parties of interest in any given ethical dilemma. But such tunnel vision would fail to take into account the very real and important role that other individuals and communities play in any patient's life. At the end of the day it is not a doctor or nurse that a patient goes home with (or a health care ethicist for that matter), but rather it is a spouse, a brother, a sister, a mother, a father, a friend, a co-worker, or any number of other important persons in that patient's life.

I say all of this not to advocate for demolishing a confidential and private professional relationship between patient and health care provider, but rather to say that medicine and health care ethics are driven by their broader context, and should be constantly re-affirmed as such. In a hospital, where health care providers often stand at the edges of life and death with their patients, the everydayness of life can fade into the background as profound and acute medical issues arise that bring with them complex ethical problems. It is in a patient's best interests for a doctor to be substantially focused on the medical issue at hand, but the health care ethicist occupies a more qualified role, wherein they can bear the task of considering both life inside of a hospital and outside of a hospital when resolving ethical dilemmas.

Rather than an increased burden, such a mediating function is where the meaning of hospital visits is to be found. That is, it is life outside of a hospital that makes going to the hospital worthwhile in the first place. While health care providers may stand at the edges of life and death with their patients, it is the role of health care ethicists to stand with the patient amidst existence, to negotiate the relationships between past, present, and future, or more tangibly, between life outside of the hospital and life inside of the hospital.

Of Tattoos and Patient Autonomy

2008-12-14T00:00:00.003-06:00

When I was younger, I always saw tattoos as the definitive symbol of defiance and rebellion; a true sign of the independent spirit. It seems that my ideas were not so far off, though not perhaps in the ways that I imagined. A 79 year old women in New Zealand is tattooing the command "Do not resuscitate" onto her chest as a sign of her autonomy, that is, as her right to choose what medical treatment she receives. It seems that, amidst the swell of exotic lifesaving therapies in recent years, patient autonomy has become the rebel's cause as it inspires people like the woman in New Zealand to take ever more dramatic efforts to ensure that their wishes are honored in a medical setting.

As referenced in the article that the story was reported in, a looming concern is that doctors will not know what to do when confronted with the tattoo in an emergency room after this woman has had a heart attack or stroke. Has she changed her mind? Was she under compulsion when she got the tattoo? Was she depressed when she got the tattoo? A "yes" to any of these questions would certainly endanger the force of the "Do not resuscitate" command. And therein lies the problem, if the woman is unconscious, which way does the hospital err in providing care? Generally hospitals have erred on the side of resuscitating so as to preserve life, and thus the reason why this woman has taken such a bold effort to ensure that her message is loud and clear. It is very interesting, though, to observe that the greater effort a person goes to refusing medical care, or otherwise bucking the status quo of modern medical care, the more they are questioned and examined for signs of compromised autonomy.

To be fair, patients do change their minds, and sometimes they do things under some degree of duress that compromises their ability to make a fully informed decision. As such, it is somewhat understandable why medical providers hesitate to consider whether to honor a patient's request (particularly when they are unconscious). However, outside of epistemic humility, is there a failure on the part of the medical establishment to respect the value of patient autonomy? In the last 40 years, the four primary values utilized in the vast majority of medical ethics decisions have been autonomy, beneficence, non-maleficence, and justice. Oftentimes, discussions center around issues of autonomy, but do such discussions ever actually lead to a more credible place for autonomy in the medical clinic? Certainly beneficence is an undisputed part of the medical establishment. Doctors, nurses, and other health care providers are all dedicated to serving the needs of sick individuals and bringing about a great good in their lives through healing.

Sometimes, though, it seems that the medical establishment just does not know what to do with instances of patient autonomy? Certainly inside of a model of paternalism, where an attitude of "doctor knows best" reigns, we would expect some degree of dissonance with a patient's attempt to assert an alternative perspective that they expect to be honored against that of a doctor. But these are the days of the doctor-patient alliance, wherein doctors and patients collaborate to develop a treatment plan for medical care, right? It is worth wondering whether, after centuries of utilizing the model of paternalism in medical practice, the medical establishment has so quickly left the attitudes of paternalism behind. Could it be that the dogged inquisition of a patient that chooses to reject medical care or otherwise buck the status quo, is not a sign of epistemic humility on the part of medical professionals, but more sinisterly the specter of paternalism? If so, are these rebel patients, so to speak, to be regarded not as incompetent, but rather, as the brave individuals who dared to challenge an entrenched system of power?

From bedside to examination room, and back again

2008-11-12T08:30:00.005-06:00

New developments in technology ranging from secure email and chat to devices like Intel's digital Health Guide, are changing the way that medicine is being practiced. These new technologies allow patients and doctors to interact at a distance, from the home, from the office, or perhaps even while out for a morning walk.

In the case of Intel's Health Guide, the device is essentially a compact, portable computer that has been engineered to collect data from any number of medical devices such as blood pressure monitors or glucose readers, and shares the data with doctors in the clinic via the internet. The device also is designed to offer patients helpful health information as they need it, even videos on various subjects.

Once upon a time, it was not uncommon for doctors to make house calls, visiting patients amidst their illness as contextualized by their everyday life. Today such house calls are rare, and the examination room where doctors and patients meet in isolation from the busy world around them has become the central space for diagnosis and prognosis. However, with some of thes new technologies the dynamics are changing. While not physically present, doctors can interact with patients as they live out their daily life.

I think that this is an important development in medicine, and a trend to pay close attention to because I believe that it may change the way that we imagine the doctor-patient relationship. That is, particularly as patients interact with doctors via the internet, they have between them the vast potential of a wealth of third party health information from online databases and websites. Whether doctors like it or not, patients are and will continue to come with ever increasing ideas about diagnosis, treatment, and care. But then doctors are not without resources either, what the web offers patients, it also offers doctors. Both doctors and patients are interacting with more information then ever before, and this is going to change the way that medicine is done. One might imagine that it will lead to more creative treatments, better monitoring of dangerous drug interactions, faster peer review, more readily accessible support groups for various illnesses or disabilities, and maybe even more collaboration between doctor and patient.

There is a saying, give a man a fish and he will eat for a day, but teach a man to fish and he will eat for a lifetime. These new technologies are like teaching a person to fish. There real value is that, as potential avenues of good information and ongoing dialogue, they could help to switch the dominant medical model from treatment after the fact to establishing healthy habits and a lifetime of preventive care.

If this is the way that medicine is going, then we may need to re-think the kind of ethical issues that we occupy our time with. Issues of privacy and trust and truthfulness will loom large amidst the information revolution, but we will also need to complicate our concepts of the doctor-patient relationship. It is no longer just doctors and patients in the examination room together, it is also online support groups, recent medical articles, Google searches and electronic medical records with notes from multiple caregivers.

A-T-C-G Who Am I? A-T-C-G

2008-11-05T08:44:00.003-06:00

Who am I? What am I? It is questions like these that philosophers have considered and wrestled with for thousands of years. While many have offered answers to such questions, little consensus persists. These are challenging questions in which the personal stakes are high because the way that we answer them can affect the myriad of choices that we make regarding ourselves on a daily bases. How we conceptualize our identities as self-conscious living organisms sets the imaginative parameters on how we anticipate and react to daily events.

It is then sobering to consider that with the rise of personalized medicine facilitated by cheaper and convenient genetic testing, we as a society must come to terms with some kind of answer to these questions Who am I ? What am I? With a credit card and a spit sample I can now choose from one of several companies that will screen my genome for genetic markers of particular diseases, abilities, dispositions, and/or disabilities. When I receive the results, I am left wondering, what am I holding. Is this me? Does this genetic analysis set the boundaries for how I conceptualize who I am, what I am? And so I go to my doctor to help me interpret the results...but there lies the rub.

Doctors are increasingly going to be put in the difficult position of interpreting genetic screening results for patients that want an ever more personalized approach to medicine. On one level the patient's questions may be, How likely is it that I will develop symptoms of this or that disease? What kinds of treatments are available? What can I do to prevent this? Do or will my children face the same risks? But on the profound level, the question that will always hang in the medical examination room is Who am I? What am I? Am I merely the physical expression of this genetic readout of my genes?

Are doctors prepared to grapple with such questions? Do we as a society have an answer to supply the doctors? We, as a society expressed in collections of specific communities, need to deliberately wrestle with questions of identity, and specifically with what the implications of genetic identity might be.

A Film Review: Sick Around the World (2008)

2008-11-03T13:24:00.003-06:00

It is difficult to do a documentary film well. As such, it is refreshing when one comes along. The documentary is called Sick Around the World, and was released this past year (2008) by Frontline Documentaries, a PBS company.

In this film, Washington Post correspondent T. R. Reid travels around the world to get a look at how, outside of the US system, other advanced capitalistic countries organize and operate their health care systems. In a well balanced and engaging manner, Reid explores 5 different health systems (Britain, Japan, Taiwan, Germany, and Switzerland). As he interacts with politicians and doctors from each country, Reid asks a common set of questions in order to establish an excellent compare and contrast, wherein both pros and cons are considered. In particular, Reid's questions, as he makes clear in the film, are fueled by the crisis of the US health care system, which spends the most money in the world on health care, but is ranked 37th in terms of overall health, and moreover sees as much as 700,000 people go bankrupt each year from paying doctor's bills, while millions of Americans remain uninsured.

The principle of justice, as it bears down on particular ethical issues of care in medicine, often implicates the system that creates such problems. As such, discussions of health care policy reform loom large on the horizon. Anticipating such discussions amidst the serious crisis of the American health care system, Sick Around the World (2008) is a great resource to be utilized, and an important step towards allowing other people and cultures to inform policy decisions, and help us in navigating out of the moral quagmires that our American health care system so ably creates.

To view the film, visit the Frontline Website: Sick Around the World, or the film can be downloaded from the iTunes store for 2 dollars.

Tune in tonight to learn...that the news media exhibits considerable control over your perceptions of health and risk of disease

2008-10-30T08:34:00.006-05:00

"If it bleeds it leads," such is the adage of journalism, particularly broadcast journalism. There is a gross tendency to offer hyped and sensational stories to the public for regular consumption. And insofar as news companies function as companies looking to earn a profit, who can blame them? Sensational stories get the ratings, as viewers tune in night after night to follow a particular story, or maybe just to find out what new item from their daily life could be killing them. But as soon as we consider the other function of journalism, that is, the duty to serve the public with responsible news gathering that fosters their increased wellbeing, well then now these sensational stories seem out of place, even manipulative and harmful.

A recent study released in the journal, Public Library of Science: One, details how media coverage of certain diseases affects the publics' perception of the severity of diseases. It is a very interesting study, and well worth reading, but here I will only summarize. Diseases that are reported on frequently in the media (SARS, West Nile Virus, Anthrax infections, Avian Flu) were judged to be more severe by a selection of undergraduate psychology students and medical students than other less well known diseases (tularemia, human babesiosis, yellow fever, Lassa fever and hantavirus). However, when the diseases were described without names, test subjects rated the less well known diseases as more severe. The study presents compelling evidence that the media has a strong influence on the public's perception of risk regarding diseases and general health, and that it is generating ill founded conceptions of diseases and risk.

It would appear that just as sensationalism rules the media's choices of political and national coverage, so also it is guiding reporting on health matters. This is a failure on the part of journalists to effectively serve the public. The implications of a misinformed public about disease awareness and control are considerable and raise some ethical concerns. The media, unlike our friends, family, teachers, and coworkers represents a dedicated and organized network of information gathering and distribution, and as such its efforts are far more deliberate and effective on the large scale. This combination of deliberation and high potency on a broad scale combine to make broadcasters and print journalists culpable for their shortcomings in serving the public. I am not saying that it is the exclusive responsibility of journalism to educate the public, and while I can talk of journalism generally, there are admitted exceptions to the dominant trends when you look more closely at the journalistic landscape. However, journalists do have some responsibility, and often certain core or common stories are covered by multiple television networks, newspapers, and magazines. If journalists let sensationalism guide their reporting on health matters than they threaten an effective response to disease otubreaks when they do arise. Perhaps people will not even be aware of some disease outbreaks because they are not among those commonly selected for media coverage. Perhaps the public will react with fear and hysteria during some disease outbreaks because their awareness of the associated risk has been artificially inflated. The list could go on, but the point is that, when it comes to health, something that affects each and every person, journalists need to have a heightened awareness of the impact their reporting has on individuals.

The way that health concerns are reported in the media needs to be done differently than the way political or national coverage stories are hyped and presented. The objective presentation of well established findings and research should more often guide health reporters. When reports focus on a special case of a disease theatening an individual or community, there should be the proper contextualization of scope and actual risk. In turn, we, as a viewing public, should both demand higher standards of health reporting, and also break ourselves of the habit of being more tuned into sensational news stories.

Placebo Culture

2008-10-26T08:00:00.003-05:00

Why am I taking this medication? More patients may want to start asking this question when they visit the doctor’s office. An article in the New York Times recently highlighted the findings of a new survey of medical doctors in America that reveals that half of all doctors prescribe placebos of some kind. Placebos are prescribed when patients present with psycho-somatic conditions. In such cases, doctors may prescribe vitamins, large doses of Aleve or ibuprofen, or even antibiotics or sedatives. While these medications do have actual physical affects on the body, doctors use them primarily as a means to trick the patient’s brain into restored health, and thus qualify in a loose sense as placebos.

While I do not contest the value of placebo use in the case of alleviating psycho-somatic symptoms, the ethical issue of doctors lying to their patients looms large. Undoubtedly, this is a difficult position for doctors and patients because when placebos might be warranted, it would be contrary to the effectiveness of the placebo treatment for a doctor to tell the patient the truth about their medication. The doctor, while valuing trust and truthfulness, also values the restoration of health, both as a personal experience and verifiable fact. In the case of placebos the good of truth and the experience of health appear to be at odds with one another. The question then remains whether in this situation trustworthiness is damaged, and thereby, also, is the doctor-patient relationship where trustworthiness figures so prominently diminished as well? One might think that if the patient never learns of the deception, the trustworthy relationship persists as before, perhaps even bolstered by the experience of restored health. This type of thinking is reflected in the idea that what you don’t know can’t hurt you. According to that line of thought, the researchers of this particular study in question should not have even published their findings. But while it may be true that what you don’t know will not directly and immediately hurt you, it cannot be said that in the infinitely complex, but always interrelated chain of cause and effect and indirect relationships that we should be so nonchalant about our pursuit of knowledge. My concern is that whether patients know about the deception of placebos or not, there is a culture of deception that develops among doctors and other clinical professionals that are, so to speak, in the “know” about prescriptions versus the patients who are in the “dark.” Does this culture of deception inspire a sense of superiority, as the saying goes, “knowledge is power.” If this is happening, then the doctor-patient relationship built on trust is a mere façade for a power game that is operating subtly to establish traditional paternalistic notions of superior and inferior in the clinical examination room.

Immanuel Kant, a philosopher, held that the absolute ethical imperative to follow was, "Act only according to that maxim whereby you can at the same time will that it should become a universal law." So if a doctor lies to a patient about the nature of their medications for the sake of prescribing a placebo, that doctor must consider whether his or her action that appears to be justified then and there could be carried out by every single human being in all times. If every human being lied, there could be no discourse because there would be no reason to believe that anyone told the truth. The initial appearance of a justified case of lying breaks down when shown to be illogical on the grand scale. Although Kant's ethical ideal is a difficult one to follow, it does offer a rebuttal to any temporary, local justification for moral deception in the case of placebo use. Most importantly, Kant's thinking takes into account the larger system at play that is affected by individual choices at a specific time and place. And so we ask, what kind of cultures are created by the decisions and practices that we justify at specific times and places? Does the rampant use of placebos by medical doctors lead to a culture of deception? If so, then perhaps there is a need to restrict placebo use, or at least monitor it?

The Human Genome Goes Open Source

2008-10-21T17:39:00.004-05:00

Recent years have seen a boom in open source technologies (Can you say Firefox web browser, Thunderbird email client, OpenOffice, Audacity audio editor). These technologies have the fundamental feature that their programming code is open to anyone and everyone for modification and improvement. This is in contrast to proprietary software such as Microsoft Office suite, Internet Explorer, Windows operating system, etc, wherein individual companies and the programmers they employ have sole access to the code for modification and improvement of the software. But while binary digits, java applets, and html code might all have been common elements of free exchange before, there is a new code on the free market (or perhaps a really old one).

Yes, the human genome is now joining the open source revolution. It is called the Personal Genome Project, and its goal is to recruit thousands of volunteers to share their personal genomes in a database on the internet that would be available for public research. Immediately one might think about whether the informed consent procedures for this project are robust enough to ensure that responsible choices are made on the part of conscientious individuals. Will the individuals know what kinds of reaseach their genomic information will be used for? But hold on...perhaps we have this all wrong. How much does informed consent matter when it comes to sharing our own genomes with the larger world. Sure, it is my personal genome, but it was inherited as well. People besides myself contributed to my personal genome, and they share in it as well. While my own personal genome might have a few unique signifiers, the vast majority of it is shared with other individuals. Moreover, I am not my genes. My genes are merely an inheritance I came into at conception, which predispose me to certain traits and behaviors, diseases and disabilities, but do not dictate the sum total of my identity. So how much do I really have at stake in my genetic information? Or to return to the earlier discussion, how robust does informed consent have to be in the case of the Personal Genome Project given that the human genome is as much a communal enterprise as it is my own?

The Personal Genome Project is already making the headlines, and will likely inspire considerable ethical debate in their wake. My own contribution to this discussion is to ask what, I beleive, is a fundamental question which sets the terms of the debate. To what extent is my own genetic code truly my own, versus a shared information bank with my fellow human beings? The way we answer this question determines how we discuss informed consent and genetic information, and in the specific case of the Personal Genome Project raises the question of whether it is not only ethically permissable to contribute one's personal genome to the database, but whether there is an ethical duty to do so.

Abilities and Disabilities of Language

2008-10-18T11:05:00.003-05:00

The trouble with talk of disabilities is that it assumes a state of value laden normalcy, which is often highly questionable. For instance, deafness is often classified as a disability. But who exactly thinks that deafness is a disability? Is it people with hearing? Do deaf individual's themselves believe they have a disability? Undoubtedly the majority of hearing individuals regard deafness as a disability because they are operating on the assumption that having 5 working senses is normal, with the added value judgment that normal is the ideal to be sought after. Many deaf individuals would not see their deafness as a disability, but rather as a unique signifier and augmenter of their distinctive culture that arises from having their own language, American Sign Language. For many deaf individuals, deafness is similar to racial identity. Rather than a handicap, deafness contributes meaningfully to the valuable diversity of this world. Thus for these deaf individuals there is no talk of disability because they imagine themselves separate from a hierarchical spectrum where the more senses you have, the more enabled you are. The debate dramatically shifts when deafness is not talked about as a disability but as a unique trait that fosters and promotes a distinctive culture. So who gets the last word? Do hearing people get to set the terms of the debate because they are in the majority? The debate is not simple, and once made complex, questions such as these reveal the possibility of hidden power structures at play.

The asymetry of doctors and patients regarding community

2008-10-14T12:19:00.004-05:00

Substantial critiques of the concept of patient autonomy have been made in recent years. The driving edge of these critiques has been to see human persons as essentially relational rather than atomistic individuals. The pay out of such a critique is that the much lauded principle of autonomy becomes less clean and neat, and instead is as complex as the multi-level analysis of human community. I am curious about the flip side of the doctor-patient relationship.

Traditionally autonomy has been regarded as patient autonomy, but I wonder how the status of the doctor might affect our understanding of the status of patients. It seems to me that patients do not want their doctors to be autonomous individuals, insofar as autonomy means a purely self-determined individual. When our health is at stake, we want the collective wisdom and resources of the medical community to bear down on our particular situation. Peer-review and case consultations among doctors are a supremely good thing as they help to net out inevitable human errors and generally increases the likelihood of a favorable outcome being achieved. Thus, we have no problem imagining doctors as working within a community to deliberate and reach important decisions about diagnosis and treatment. Why then is it so often insisted that a patient exhibit a pure kind of individualistic autonomy when they are sitting in the examination room? On the traditional account of autonomy there exists an asymmetry of relational status between the doctor and the patient. But is this asymmetry with respect to recourse to community justified?

I am always curious about what happens when a doctor becomes sick. Do they take off their stethoscope and slip easily into the role of being a patient, at the mercy of another doctor's care? Imaginably there is a spectrum of behaviors among doctors, but I cannot imagine that they ever really leave behind their identifying role as a doctor. Conceivably, the same practices and behaviors that the doctor engages in while practicing are also brought to bear on their situation as a patient when they become sick. Thus the community entrenched doctor is also the community entrenched patient when he or she becomes sick. So why then should the average joe or jill patient be expected to operate in a different manner, namely as an isolated individual making sometimes very difficult decisions about their health? Patients bring their own communities into an examination room just as a doctor become patient would. So why the difference, why the asymmetry?

One Laptop Per Child

2008-09-07T00:59:00.004-05:00

If you do not yet know about the One Laptop Per Child Project, you should take the time to become educated. Visit this link http://laptop.org/ to find out more about this project than I could ever share or do justice to in this short blog post. However, to give a quick sense of things. Developed by an MIT professor, Nicholas Negroponte, the vision of the project is to provide a 100 dollar, rugged, waterproof, low-power laptop for children throughout the developing world to create a more vibrant learning environment that offers new avenues for collaboration and imagination. Working with people from across disciplines, the project has successfully led to the development of a 200 dollar laptop that is now finding its way into childrens' hands around the world. In 2010, researchers and developers working on the project plant to unveil the second generation of the laptop, featuring and entirely touch screen interface and a smashing price tag of 80 dollars. This upcoming Novemeber, it has just been announced that the One Laptop Per Child Project will partner with Amazon to sell the laptops in America. The way it will work is for 400 dollars, you will buy two of these laptops. One will be shipped to you along with a tax refund, and the other will be sent to a child in a developing country.

I note this exciting progress for two reason. First, the gap in technology between the developed world and the developing world is shocking. On closer examination, the World Wide Web is not in fact so world wide, at least in participation. Fortunately, through projects like this one, that gap is shrinking, and more and more voices will join the internet community where the potential for education and contributions of a meaningful kind are pervasive. This project represents a huge step forward in bringing about a greater sense of distributive justive in that influential but often elitist sector of advanced technologies. Secondly, in a previous post I noted workings out of the open source revolution. This project is one more example of how open source technologies and attitudes are shaping markets and people for positive change. Bucking any proprietary software, all of the software on the laptop is of the open-source variety, even the operating system, which is a modified version of Linux. A "geek" button (replacing the CAPS Lock button) on the keyboard allows children to view all of the code that the program is running on, and offers them an opportunity to tinker with it and improve upon the design. The list of features continues, and are well worth checkign out. Some of the things being done with this laptop have not even been seen on 4,000 dollar laptops.

Life Without A Car

2008-08-31T17:38:00.003-05:00

In July of this year my wife, Janelle, and I moved to the Rogers Park neighborhood in Chicago. With both of us having our own cars before we moved, we made a conscious decision to leave them behind, and begin a life by foot, bike, bus, and train in Chicago. Fortunately, an extensive public transportation system combined with accessible neighborhood resources has made this adjustment relatively easy. Undoubtedly, there are a number of advantages to leaving behind one's car, be they financial or environmental. However, the advantage I least expected, perhaps even anticipated, was that not having a car has changed the pacing of my life and helped me to more effectively encounter and experience the neighborhood and city.

Everything goes a little slower when you resolve to walk, bike, or take public transportation. And in the slowness you realize that the control-oriented insularity of being in your own car is gone. No longer do you buzz by people, places, and spaces encased in a bubble of metal and glass, alone in your air conditioning and music preferences. Instead, there is a necessary proximity with all of your travel. When walking and biking you cannot help but experience the metal and concrete of the neighborhood. You feel and see the cracks of streets and sidewalks and buildings in need of repair. You notice the mosaic of glass tiles placed in a small garden at the corner of a street. You smell aromas of restaurants or dumpsters that you pass by. In short, the sensory terrain of the neighborhood becomes a part of your journey between point A and B. A different kind of thing happens when you take a bus or train. Now you do not encounter so much the tactile experience of the neighborhood, but instead you begin to meet some of the people that are to one degree or another are your neighbors. Undoubtedly, conversations between you and other passengers are usually of the polite and mild manner, but fortunately the effect of our presence in one another’s lives is not by words alone. Instead, the very fact that we are placed in a space with other people that we usually have not intentionally chosen to be in proximity to invades our self-segregated comfort zone and makes us aware enough that we begin to take note of the people all around us. You begin to wonder about other people’s life stories, where they are going, where they have been. I do not pretend that these interactions can in any way be a substitute for the difficult task of cultivating a meaningful relationship with another person through ongoing discussions and interactions, but it is one step in the right direction, I think.

So what is the message? Cars are not evil, and they certainly can serve good purposes. But perhaps it is worth taking the time to explore life and places without a car. Certainly you will reap the financial benefits along with making a positive environmental impact, but you may also discover like I have that life slows down a bit, and in the slowness you discover more about you neighborhood, people, and yourself in the process.

A new kind of computing: The Open Source Revolution

2008-08-16T12:06:00.005-05:00

Whether you know it or not, you are probably benefiting from the open-source revolution in technology. Open source is a standard by which programmers across the globe collaborate together to develop and improve upon free software programs through access to the original source code of the program. Although not open-source in definition, the concept of Wikipedia is similar to that of open source. That is, people tweak and add to entries about various topics, and thus continue to grow the online body of information through a global community of interested peers. But for true examples of open source programming turn to the well known examples of Mozilla Firefox internet browser, or the Audacity audio editing program, or OpenOffice word processing suite. Open source is being seen in more and more places, and more than just a geek's monopoloy, the open source revolution is seeing mainstream success. People are dispensing with the familiar Internet Explorer for what many are deeming to be superior, Mozilla Firefox. And more of your friends might be leaving behind Microsoft's 400 dollar Office software for the free and reliable OpenOffice software. As you may have noticed, Microsoft is not the beloved play toy of open sourcers, in fact some have attributed the overly expensive, anti-comptetitive, and closed nature of Microsoft and its programs as a source of fuel for the open source revolution taking place.

The internet has always been a place of fluid change, but increasingly it is becoming a very different kind of place. The web is increasingly a place where collaboration in a free and transparent environment with tangible results reigns supreme. There is reason to pay attention, increasingly there are signs of the software behemoth Microsoft's decline or at least stagnation. In its wake comes a different kind of computing. One that will cause us to think differently about the ideas we develop, who our peers are, ownership, and what it means to be a member of a community. This is a trend worth paying attention to.

For links to some major open source projects see below...
The OpenOffice project
The Mozilla Project (Firefox, Camino, Thunderbird, etc)
Audacity Audio Editor
Linux Operating System

The Sound and Existence

2008-08-16T00:44:00.005-05:00

When I was a student at Calvin College, I attended a concert by a man I had never heard of at the time, Joseph Arthur. Since that time Joseph Arthur has become a much more well known musician, playing with the likes of REM's Michael Stipe and finding his way onto the Shrek movie soundtrack. When I first heard him in the Fine Arts Center of Calvin College it was a surreal experience. He was a one man act. He walked onto the stage with his electric guitar and proceeded to lay down a slow melodic riff, and then he tapped his foot against the pedal of a loops machine he was using on stage, and so it began. Layer after layer of loops, Arthur wrapped the room in a cloud of sound as he played his music, but then interacted with it again through loops that he created. As he left one rhythm to repeat through the speakers he began a new one that built on that one, and then another. By the end of the concert I was not sure exactly what I had heard, it was unlike much of what I had heard before, but it left a definitive impact that has since made me think.

When I was taking a philosophy class on continental philsophy, particularly on the philosophy of Martin Heidegger, my professor would often refer to the orientation of our existence as "Going out on the basis of having already been with." The more I think about this statement, the more I realize how descriptive it is of my life and life generally in this world. I think that part of why I am so captivated by the memory of Joseph Arthur's concert now is that in hindsight I can realize that at that concert I was hearing the working out of "Going out on the basis of having already been with." As loop after loop was played, recycled, adapted, and and re-articulated Joseph Arthur presented variations and themes within a unified experience of a song, a concert. Life is a lot like that Joseph Arthur concert. In our daily life we make decisions, that is, we begin to strum a melody of sorts, and then we begin to interact with loops in the form of past moments gone by and the future moments we anticipate. Each moment is a different musical loop that we are interacting with, recycling, adapting, and re-inventing, but all the creative material of our lives is formed by our situatedness within a timeline that we are always a part of in the interestion of the present moment. I don't know, perhaps it is the aesthetics of the metaphor, but I find this imagery of sound and existence as compelling and offering an enriched view of my own life. I hope that it might offer soemthing as you work out your existence too.

The Boutique in the Forest

2008-08-12T01:22:00.005-05:00

A recent article on Slate.com comments on the start of the Planet Green Network Channel that showcases green lifestyle. In the article, author Troy Patterson asks the poignant question "If a tree falls in the forest, and there is no one there to talk about deforestation, does it represent a missed marketing opportunity?"

As someone that has been captured by a renewed emphasis on sustainability and a greener future I have been delighted by the growing movement to minimize the massive impact that we as humans have on this earth, especially here in the United States. However, one cannot help but notice that terms like "green" and "sustainability" are increasingly status terms to adorn the highly fashionable and wealthy of modern society. In all the buzz about "being green" and reconsidering our current lifestyle choices, the bottom has dropped out and we are swimming in a shallow pool of chic trends with little more substance than an eco-friendly clothing label or blurb in a magazine article. There is a term for this called green washing, wherein an individual or a company takes a small initiative like mandating direct bill pay instead of paper paychecks, and then marketing the company as an environmentally conscious community player. Green washing is a superficial effort that aims to exploit a marketing advantage or popularity appeal instead of reflecting a deeper commitment to the well being of the environment and communities.

I am not arguing that the work of seeking a greener future or more sustainable lifestyles need only be the work of a radical minority. I am not interested in advocating for still more exclusive clubs in this already class saturated society. Instead, at the risk of diluting terms like "sustainability" and "green" of all their compelling substance, a critical awareness should be cultivated with respect to the glut of green claims and sustainability tactics being peddled and shared in our society. Undoubtedly, the way to a cleaner, brighter, greener future will be through the hands of scientists and fashion designers alike as it will demand that we all contribute our own ingenuity and passion, but in the meantime questions need to be asked. How does this green effort or sustainability initiative mesh with the larger global picture? Does this merely perpetuate the materialistic, consumerist machine that has brought us to this present state of living beyond our means? What are the supporting sources of information for the claims being made? Our silence on these questions risks our integrity in caring for the earth. Where deep and thoughtful efforts are taken, these questions and others like them should be welcome.

Waiting and Working on the World to Change

2008-08-11T01:19:00.003-05:00

John Mayer is a talented young musician who received immense radio air time for his hit single, "Waiting On the World To Change," from his newest album, Continuum (2006). Initially I was very interested in the song because I thought it would be a song that expressed a yearning to change the world for the better. But to my dismay, the song was rather an overly repetitive excuse claiming that the older generation had messed things up, the younger generation has the vision and passion to change the world for the better, but that they cannot do anything because they do not have the positions of power yet and so in the words of the song...

"So we keep waiting (waiting)
Waiting on the world to change
We keep on waiting (waiting)
Waiting on the world to change
Its hard to beat the system
When we're standing at a distance
So we keep waiting (waiting)
Waiting on the world to change."

I am one of those people from the younger generation, and I fundamentally disagree with the attitude and lyrics of this song. It is especially troubling because I heard a number of fellow young people rallying around this song as a point of inspiration. I find it difficult to imagine that we, this younger generation referred to in the song, could be so naive to think that the tide of change in this world is merely waiting on the next generation of young people, that is us, to take the positions of traditional power in society. But there is evidence to suggest that such naivete is present.

The interesting effect is to show that the phrase "Waiting on the world to change" can have two wildly different meanings and intentions. It can have an active sense in which individuals are yearning for something that is healed and made whole, free from sickness, death, and tragedy. Or it can have a passive sense in which whether this type of vision for the world is held or not, the real change that makes the difference is when time moves along and allows a new generation to assume control. In the active sense, the dominant vision is a better world. Such a vision is so compelling that it will transcend people, time and place, and motivate the young and old of diverse skin colors and nationalities to seek it. However, in the passive sense, the dominant vision is for that moment when enough time has passed that the younger generation can assume control. Thereafter, the world may change for the better, but the real and crucial moment is about a power swap. As such, time is the architect of a better world apparently, and the younger individuals are left to merely wait.

As a young person I reject the passive sense of the phrase "Waiting on the world to change" that I hear expressed in John Mayer's song. Instead, I opt to join with those that have come before me and those still to come in a working out of that deep yearning for a better world.

Higher Fidelity to the Album's Story

2008-08-01T17:17:00.007-05:00

Movies are a powerful medium wherein we see the spectrum of human emotion and drama acted out. In fact, a key feature of a good story is often the integration of multiple aspects of the human experience: romance, comedy, tragedy, and so on. For instance, when I watch a movie like Castaway, starring Tom Hanks, I am looking forward to a film that offers me an engaging story that captures me with action, comedy, tragedy, and romance. Any number of films can be referenced as exhibiting this pattern. What is interesting though is our ability as an audience to bear with all of the ups and downs in a film. Comedy, tragedy, action, romance, we accept it all as part of a story with a beginning, middle, and end. By the middle of the film we may be wondering, "What in the world is going on? What is happening? Why would he or she do that?" But even amidst all of our questions and mixed feelings we hold on for the ride as we await the conclusion where we seek to rescue meaning from the experience. In short, movie going audiences adapt and readjust continuously through the film as they are held in suspense waiting for what will happen next.

It strikes me then that when we take the case of music, listening audiences are not usually as adaptive. Just as there is ample room in movies for drama, do we allow the same room in listening to a music album? My hunch is that we often treat music albums more as a collection of 10-12 individual songs, rather than a story that is being worked out in its own rhythm and language. The significance is that we then have a tendency to analyze each song on its own terms without listening to its context within the album. Take for instance Bruce Springsteen's album, The Rising. In the course of the album the boss details a lot of the various sentiments surrounding 9/11. If you were to stop at the middle of the album you might be depressed by the bleak feelings of loneliness. But if you listen through to the end, you find a song like "The Rising" that offers hope for the future. My point is that audio drama exists, and sometimes it takes place across more than one song on an album. We need to take the time to listen to an artist tell their story, we may be surprised by what we ultimately take away.

Re-imaging

2008-07-27T23:06:00.003-05:00

I came across this video on another blog that I visit, called Holy Skin and Bone. After watching the video I was struck by how challenging this short film is in its subversion of what is considered normal or acceptable communication. Please watch the film all the way to the end.

There are a number of fascinating aspects of the film to consider, but I am most struck by two key insights that it clearly articulates. First, communication is inseparably bound up in how we define and determine personhood. Second, how we define communication is seriously open to question. What if the exchange of spoken words and established mannerisms and expressions are not the only way to communicate? What if these are not even the best ways to communicate? The picture really begins to change when you no longer structure communication on the same continuum wherein spoken language and the development of symbols are at the top and everything else is understood as deficient to one degree or another. What happens when there are truly alternative ways of communicating, and thereby also different ways of imagining personhood and even this world?

Moral Imagination

2008-07-26T22:15:00.002-05:00

A song by the group called Flobots begins...

"Rival gangsters sit down to plan an after-school program
A religious fanatic posts footage of an interfaith service project
A group of teenage boys watches a video of a father playing catch with his son
An adult film star paints thumbnail portraits of elderly couples, fully clothed and smiling
A record executive records a demo of his apology
A policeman makes reverse 911 calls instructing residents to take to the streets..."

Each time I listen to this song, I am struck by the radical imagery of these words. Rigid stereotypes are shattered by a compelling vision infused with hope for better days.

In these modern days cynicism abounds. One need look no further than the monstrous success of such professional cynics, John Stewart of the Daily Show and Stephen Colbert of the Colbert Report on television, who reduce much news to an experiment in the absurd or laughable. While their humor and satire is not wholly unfounded and even insightful at times, its popularity is alarming. Are we losing our ability to imagine a redemptive alternative to these present times? In the wake of failure and tragedy do we merely play in the ashes, or can we still find the resources and strength to rebuild and build better?

As a young person, I often feel that I am presented with two options, realism or idealism. By realism, I understand a certain grin and bear it kind of attitude that does little to change the status quo and everything to adapt to it. By idealism, I understand a certain propensity for baseless fantasies that never have and never will come to be. The realists define idealism, and the idealists define realism. Neither one appeals to me. I want a third option. I want to address the clear and present features of this world, and I want to imagine an alternative that is not whimsical or silly, but is grounded in the promise of a new kingdom and a new earth where weapons are beaten to the shape of tools, and we live together, everyone in peace.

To remember or not to remember

2008-07-26T21:21:00.004-05:00

Last night I watched a good movie called The Great Debaters (2007) that starred Denzel Washington and Forest Whitaker. The plot in the film dealt with the inspiring account of an African American debate team that led a near undefeated season in 1935, and garnered the attention of the nation. The pervasive tension in the film was the rampant racism that existed in the south so clearly at the time. At different moments in the film I found myself screaming inside and groaning when I thought about the disgusting hatred that many white individuals exhibited towards African Americans not so many years ago. The film reminded me that the memory of intense and gross racism as the status quo in many parts of America is not so distant as we might imagine. I wonder if now as a new generation comes of age that has not witnessed the passionate conviction of the civil rights movement in the 1960's, do we risk forgetting the gross specter of blatant and despicable racism in this country's history? Do students today see racism as something that lives within the confines of school history books? Do we pretend that the deep wound of racism has been healed, and that now we all live on some enlightened plain? to do so would be a failure to remember.

It is easy to imagine the past as some secluded island of days detached from this present moment. But to do so is to fail in that crucial task of remembering. To remember is to see this present moment refracted through the succession of moments that have created it. Generations and places may separate us, but in this moment we are bound together still. As such, in America, we cannot pretend that racism is eradicated. Some say that time heals all wounds, but I believe that is a lie, and a dangerous one at that. Time merely makes forgetting easier. And in the forgetting we are doomed to repeat our mistakes.

Movies: Re-Interpreting Books since 1920

2008-07-12T16:55:00.004-05:00

Recently I saw a t-shirt that said "Movies: Ruining Books Since 1920." Sadly, this t-shirt reflects the traditional attitude that "the book is always better than the movie." I say sadly because I think that this kind of attitude adopts an overly narrow perspective on meaning, interpretation, and creative mediums.

This attitude that "the book is always better than the movie" implies that the function of a film is to visually replicate the written text. However, this assumption misses the fact that movies are a wholly different medium than books. Movies are not merely at the service of books, but rather, movies, at least well done ones, offer up something new and original. Allow me to unpack this.

Movies play by an entirely different set of rules than that of books. For instance while books can plumb the interior life of characters with agility and ease, this remains the peculiar hurdle of filmmakers and their movies, wherein the best material is shown rather than told. While the author of a book can in the space of a few paragraphs unwind the mental life of a character through a thoughtful monologue. The ability of a filmmaker to do the same is far more limited. You might say that a filmmaker could simply use well positioned voice-overs to emulate the techniques of literature, however this tramples the very magic that is the movies, namely its visual storytelling ability over and against words alone. While voice-overs can have their place in a film, certainly the voice of Morgan Freeman narrating the movie, The Shawshank Redemption, is an outstanding example, more often than not, though, they are crutches utilized by filmmakers that have failed to effectively show in motion, expression, and light the compelling interior drama enacted on the exterior world.

As a discrete creative medium, movies offer viewers new avenues into books and other creative material. For those of us that read the Lord of the Rings books, there was a certain magic created in our imaginations as we read the words. But equally so, who can deny the magic that director Peter Jackson unfurled in his enactment of the Lord of the Rings trilogy on film. Characters were changed, events left out, descriptive details added in order to show rather than tell, but the result was a story that was enchanting and compelling, and helped many to re-discover the books, or even garner new readers. My point is, if we move away from this overly rigid view that the movies must imitate the books then we can begin to see the original and creative ways that movies can help us to explore older material all over again. In this way the archetypes and myths that are shared between societies ancient and modern continue to be passed along as they are re-interpreted and adapted, but still preserved. In this manner, the creativity that an original author first began when setting pen to paper continues through the work of others.

Get Smart (2008) and Go Check this Film Out

2008-07-12T13:24:00.004-05:00

In the land of Hollywood films there seem to be only two kinds of spies; the insanely stupid and the unflinchingly suave and cool. Director Peter Segal, though, offers us something new with his 2008 spy comedy, Get Smart, starring Steve Carell, Anne Hathaway, Dwayne Johnson, and Alan Arkin. While the plot is straightforward with its requisite villain, double agent, and hero, the antics are clever and will leave you laughing for much of the movie. Though I am of a generation that did not grow up watching the original Get Smart TV series, in my opinion, Steve Carell does a phenomenal job as the geeky but intelligent Maxwell Smart who in his own quirky way gets the job done. But while Steve Carell is undoubtedly the star of the film, he benefits from a well chosen collection of cohorts in his adventures. Alan Arkin is the delightful chief of Control, the soviet era spy agency battling Chaos, who refuses the all too typical distant role of onlooker and is more often found amidst the action. Known better by his wrestling name, "The Rock," Dwayne Johnson continues to demonstrate his diverse talents as Agent 23 in the film, and offers an amusing foil to Steve Carell's Maxwell Smart. Though at times Anne Hathaway, Agent 99, seems to be advertising more the clothing and accessories she is wearing in the film, she offers up a good performance that continues to add to her diverse blend of roles spanning The Princess Diaries (2001, 2004) to Brokeback Mountain (2005).

Why you should see this film: As I began this short review, spies in the movies often are either the ridiculous and stupid kind or of the suave and cool variety, but Maxwell Smart, played by Steve Carell, resists either of these categories, and instead gives audiences something refreshingly new. Get Smart is a movie that sits comfortably between Naked Gun and James Bond, and in doing so it offers up something for everyone while keeping things clever, amusing, and exciting. Kudos to Steve Carell for his continued ability to offer up a hilarious and original comedic performance. These days when comedies all too often seem to go the way of childish sex romps or gross physical humor, Steve Carell offers us something new, or perhaps old as he establishes himself in a tradition of capable and intelligent comedians like John Candy, Chevy Chase, Leslie Nielson, and Steve Martin. For a fun weekend film that is sure to make you laugh, be sure to check out this film.

Be Kind Rewind (2008) because VHS is cool again

2008-07-03T18:42:00.004-05:00

When you encounter the work of director Michel Gondry, you are sure to be in for a unique experience. Gondry is remembered especially for his film Eternal Sunshine of the Spotless Mind (2004), which starred Jim Carrey and Kate Winslet as they journeyed with audiences into the fluid landscape of the human mind. But where Eternal Sunshine was a wild ride that demanded careful concentration and deliberation from its audience, Gondry's newest film, Be Kind Rewind (2008), offers audiences a fun and enjoyable escape to the days of VHS and small town video stores where the phenomenal cast of Jack Black, Mos Def, Mia Farrow and Danny Glover entertain us with the wildly inventive process of "sweding." Sweding is the process of remaking a movie with yourself in it using whatever materials are readily available.

Why you should see this film: The film is beautifully simple. It offers a straightforward plot that allows the hilarious comedic duo of Jack Black and Mos Def room to move and entertain. In its simplicity and comedy, this film reminds us that the best films need not come from Hollywood, but rather the meaningful and the delightful is near at hand for all of us. For those of you out there that have ever tried to create your own films, you will be sure to find extra joy in this film as you recognize and empathize with the ridiculous things that low budget filmmakers do. For those that want to probe a little deeper, the film also raises interesting questions about authorship and the fluid nature of films and stories as they are appropriated and reappropriated by different communities at different times and places. In short, this is an independent film that is sure to make you laugh and feel good about the power of movies to bring people together. So next friday night when you are looking for a film to watch with friends, check out Be Kind Rewind.

Bella (2006) is bellisimo

2008-01-20T00:36:00.001-06:00

Occasionally you catch glimpses of how beautiful life really is. The film, Bella, directed by Alejandro Gomez Monteverde, provides just such a glimpse. Tracking the story of two people over the course of one day spent together, the film expertly portrays the depths of human emotion and energy. A reminder of what it means to care for another human being, and all the love, anguish, joy, and heartache that is peculiar of the most meaningful relationships in life, Bella is nothing short of spectacular.
Why you should see this film: This is a film that offers a rich view of human life and relationships, and does not retreat to easy stereotypes, cliches, or otherwise overly simplistic conventions. As such, it is a refreshing perspective in a culture that so often fails to admit the real complexity of life. Further, in the sometimes desperate struggle of human existence, Bella reminds us of those remarkable things, love and hope.