Does lack of healthcare “kill”?

Jerry Springer offers a hurricane of hyperbole in health-care debate

Fresno Bee, May 12, 2017

The health-care debate has caused a hurricane of hyperbole and hyperventilation.

Jerry Springer, the talk show host, compared Trumpcare to 9/11, saying that the Republican health-care act “will end up killing many more Americans than Osama bin Laden ever did.” Bernie Sanders has warned, “36,000 will die yearly” as a result of repealing Obamacare. A Washington Post headline stated, “Repealing the Affordable Care Act will kill more than 43,000 people annually.”

The rhetoric on the other side is equally heated. An article in the conservative National Review estimated that in 2015 there were 80,000 more deaths under Obamacare. This story took off in far right corners of the Internet under the headline “Obamacare Kills People.”

Data referenced on this topic are complicated, to say the least. The deaths under Obamacare cited in the National Review are linked to a general decrease in life expectancy in 2015. To conclude that Obamacare caused that decline is problematic. To imply that Obamacare actively killed people is absurd.

KILLING USUALLY INVOLVES AN AGENT OR DIRECT CAUSE.
INSURANCE – OR ITS LACK – DOES NOT KILL PEOPLE.

But it also problematic to say, as Idaho congressman Raúl Labrador did this week to a chorus of boos, “Nobody dies because they don’t have access to health care.” That seems obviously false. People do die when they lack health care. But that does not mean that they are actively killed.

Killing usually involves an agent or direct cause. A shark or a gunman can kill you. Health care may make death more or less likely. But insurance – or its lack – does not kill people. Rather, the underlying disease does the killing.

Complex debates in medical ethics focus on the difference between killing and letting die. At the end of life, it may be permissible to withhold or withdraw treatment and let someone die. But in the United States, we don’t permit actively killing people to put them out of their misery. Not everyone agrees about this. Some argue that active euthanasia is more humane than letting someone slowly die. Others argue that we should always make heroic efforts to preserve life.

Out intuitions about euthanasia may help us decide whether health insurance is a basic right or something extra or heroic.

If quality insurance is extra special but not required, then removing it is not morally problematic. We are not required to be nice to people. We are only required not to violate their rights. We are not required to keep people alive. We are only required not to kill them.

On the other hand, if we think that health care is a right, then it would be wrong not to provide it. If there is a right to health care, then removing it is like depriving someone of oxygen or water.

IN THE HEATED HEALTH-CARE DEBATE, THE IMPORTANT QUESTION IS
WHO – IF ANYONE – IS TO BLAME WHEN PEOPLE DIE FROM LACK OF HEALTH CARE.

Medical ethics also focus on the intentions behind our deeds. We ought to intend to benefit patients and fulfill their wishes. Killing becomes murder when there are malicious intentions.

So what are the intentions behind the health-care debate?

Liberals argue that Republicans intend to benefit the rich through tax cuts. But do Republicans actually intend to harm the poor? That is very unlikely. Republicans claim they want to benefit people and provide better care.

The question of intention is vexing. A person’s intentions are often unclear, even to themselves. We often have mixed motives. We can lie to ourselves. And as the proverb teaches, the road to hell is paved with good intentions.

In the heated health-care debate, the important question is who – if anyone – is to blame when people die from lack of health care. The related question is who – if anyone – has an obligation to save people from dying.

Liberals tend to think that society has an obligation to care for the sick. Conservatives tend to think that people should take care of themselves.

Now let’s return to Jerry Springer’s invidious comparison between Trumpcare and 9/11. More people may die without health care than were killed on 9/11. But that compares apples and oranges. Terrorists deliberately kill innocent people. Republican legislators do not have that intention.

Loose language and partisanship undermine critical thinking. Some provocateurs seem intent on killing rational debate with hyperbolic outbursts. The rest of us allow reasonable discussion to die when we fail to think critically and refuse to find common ground.

http://www.fresnobee.com/living/liv-columns-blogs/andrew-fiala/article150194067.html

May 5, 2017November 18, 2017

Religion and Education

Are education and religious liberty mutually exclusive?

Fresno Bee, May 5, 2017

College education generally makes us less religious, according to a new study from the Pew Research Center. Educated Christians are more likely to go to church on a weekly basis than uneducated Christians. But college graduates are less likely to say religion is “very important” in their lives.

College graduates are also more likely to be atheists. Fifteen percent of those with advanced degrees do not believe in God, while only 6 percent of noncollege grads are atheists. Meanwhile, 42 percent of those without college education think that religious scriptures should be taken literally, compared with 14 percent of those with college degrees.

Science education make religious fundamentalism difficult to sustain. The Earth is a speck among hundreds of billions of stars. Our species evolved long after the dinosaurs went extinct. The land was once covered by ice powerful enough to carve out Yosemite Valley. None of this is recorded in ancient scriptures, which teach that the gods have a special interest in this planet and in human beings.

HISTORY AND ANTHROPOLOGY ALSO CHALLENGE RELIGIOUS FUNDAMENTALISM.

Traditional accounts of the soul are also being explained away. Biomedical science locates consciousness in the brain. And evil is explained in neurological or psychological terms instead of as a matter of demonic possession.

History and anthropology also challenge religious fundamentalism. The ancient Chinese or the Aztecs never heard of the Christian scriptures. Nor do Christian scriptures mention these ancient civilizations. This makes simplistic declarations about God difficult to understand. When we say “In God We Trust” in our diverse world, which God are we are talking about: Jehovah, Allah, or Quetzalcoatl?

Even within the Christian tradition there are disputes about God and revelation. Mormons, who comprise about 2 percent of the American population, believe that the Book of Mormon is a holy Christian scripture. Other Christians claim this is false.

Scriptural interpretation has evolved over time. The book of Joshua explains that God held the sun still in the sky in order to allow Joshua’s troops to slaughter their enemies. But after Galileo debunked the geocentric model underlying this story, it has been subject to reinterpretation.

Others have questioned the morality of a God whose miraculous power is used to slaughter an enemy. Evolving moral standards have led many Christians to reinterpret scriptures that contain morally problematic passages about slavery, the subordination of women, homosexuality, polygamy, divorce, and so on.

Religious belief has often been flexible and subject to reformation and reinterpretation. Religions evolve to take in new information and reflect new norms. We make sense of ancient texts in light of modern ideas.

Atheists may view all of this as an argument against religion in general. And indeed, a quarter of Americans have left religion behind – either affirming atheism or simply giving up on organized religion.

But religions are persistent. The diversity and flexibility of religious belief is a key to this persistence. Religions that don’t adapt go the way of the dinosaur. No one worships Zeus or Quetzalcoatl any more. But Christianity thrives because of the variety of Christian denominations. There are over 200 different versions of Christianity in the US. You can pick an interpretation that suits your preferences.

LIBERTY ALSO ALLOWS PEOPLE TO CHANGE RELIGIONS.
INDEED, ABOUT A THIRD OF AMERICANS CHANGE THEIR RELIGIOUS AFFILIATION.

Religious liberty thus helps religion to persist. Liberty allows for innovation and development. Liberty also allows people to change religions. Indeed, about a third of Americans change their religious affiliation.

In the free marketplace of religious ideas, religions sell themselves to people and reflect changing tastes. Catholics no longer say Mass in Latin. Protestants have embraced pop music. And Western faiths have incorporated meditation, yoga and other spiritual practices from Eastern traditions.

In the modern democratic and capitalist world, we value educated and informed choice. We want informed consent in health care, in financial transactions and in elections. We should also value informed choice when it comes to declarations of faith. In a democratic culture, we ought to learn about other faiths and shop around. We also ought to leave each other alone to pursue the religious quest in our own way.

Things may have seemed simpler when a common piety was enforced on the uneducated masses. Freedom and science do undermine traditional religious conformity. But modern democratic people have faith in the power of education and religious liberty to make this a better world.

http://www.fresnobee.com/living/liv-columns-blogs/andrew-fiala/article148835959.html

April 28, 2017November 18, 2017

Fake News and Media Literacy

It’s actually easy to tell real journalism from fake news. Here’s how

Fresno Bee, April 28, 2017

The fuss over fake news continues to unfold. In February President Trump accused The New York Times, NBC, ABC, CBS, and CNN of being fake news and the enemy of the American people. This week he said the “fake media” were falsely reporting that he had changed his position on the Mexican border wall. He also explained away recent reports about his low approval ratings as “fake news.”

President Trump seems to think that stories he doesn’t like are phony. But truth is independent of our desires. Not liking something does not make it false.

Journalists – like everyone else – have biases and opinions. But there is an important difference between biased stories and bogus ones. Every story has an angle. But objective reporting rests firmly on the ground of facts. Legitimate news organizations avoid lies and fabrications.

The objective truthfulness of real news provides the template that fake news imitates. Fake news stories are counterfeit. They look like real news. They appear to provide objective facts. But they do not. Rather, they try to sell us something.

Infomercials are fake news. Internet “click bait” is fake news. Newspaper advertisements written to look like news reports are fake news. The tabloids lining the grocery store checkout are fake news. Political propaganda is fake news.

Professional journalists do not produce fake news. The journalist’s code of ethics has four guiding ideas. Seek truth. Minimize harm. Act independently. And be accountable and transparent.

Mainstream news organizations sometimes exaggerate with attention-grabbing headlines and titillating teasers. But real journalists want to get the facts right. When they get things wrong, they admit it – or get fired.

It is not always easy to differentiate fake news from real news. That’s why we need substantial training in media literacy. We need to teach kids how to read a newspaper and how to avoid being suckered by online click bait. Kids need to learn the difference between objective news reports, the opinion page, commercials and outright propaganda.

We all need to understand that YouTube and other Internet sources offer suggestions based upon what the computer thinks we want to see. Some tech firms are proposing a technological fix for this particular problem. Google and Facebook are working to combat fake news by changing how search and news notification functions work.

The technological fix is good. But the problem of sorting out fact from fiction will remain with us. Fake news is an ancient problem. Socrates was executed because false rumors were spread about him. Charlatans and quacks have always taken advantage of the gullible and the ignorant.

Wisdom teaches skepticism and self-restraint. A story that is too good to be true is likely not true. We are often beguiled by our biases. We want to believe things that flatter our egos and reinforce our deepest beliefs. Psychologists call this “confirmation bias.” But wanting something to be true does not make it so.

So while technological solutions can help reduce the proliferation of fake news, the real solution is critical thinking and self-examination.

The most obvious key is to seek out multiple sources of information. You should also compare what you read or hear against commonly held background knowledge. Critical media consumers also ask some of the following questions:

▪ Who is speaking, what is the source of their authority, and what biases do they have?

▪ Is the story trying to sell me something or advance an agenda?

▪ Who is the intended audience? What is included in the message or left out?

▪ How does this story connect to other things I already know?

▪ What more would I need to know to evaluate this properly?

These kinds of questions should guide our reading of books, our evaluation of scientific reports, and our understanding of speeches, sermons and sales pitches. The process of sifting and winnowing is liberating and edifying. Critical thinkers make informed decisions in all aspects of their lives.

Critical thinking is essential for citizens in a democracy. In order to effectively participate in the project of self-government, we need to be able to distinguish between the phony and the factual. Let’s hope that the fake-news furor stimulates a renewed commitment to media literacy, objective reporting, and basic common sense.

http://www.fresnobee.com/living/liv-columns-blogs/andrew-fiala/article147400744.html

April 21, 2017November 18, 2017

Choose the simple life

Living in harmony with the Earth is a matter of simplicity

Fresno Bee, April 21, 2017

The recipe for living in harmony with the Earth is simple. We should reduce consumption and minimize our impact on the ecosystem. This is not easy to do in a culture of mass consumption.

We enjoy fast cars and air travel. We fill our large houses with manufactured goods. We have closets full of clothes, garages full of toys and an appetite for imported foods. We like comfort and pleasure.

Consumer culture is fun. Our economy is based upon the expectation of continued growth. New gadgets and gizmos create needs we didn’t know we had before. Marketing and promotion manufacture desires and leave us wanting more. It is hard to say no to consumption when everyone else is enjoying the goods of consumer society.

It is counter-cultural to talk about decreasing consumption. But simplicity has long been advocated by prophets and philosophers as a pathway to liberation. As an added bonus, a simple life is also good for the environment.

MARKETING AND PROMOTION MANUFACTURE DESIRES AND LEAVE US WANTING MORE.
IT IS HARD TO SAY NO TO CONSUMPTION
WHEN EVERYONE ELSE IS ENJOYING THE GOODS OF CONSUMER SOCIETY.

Thoreau and simplicity

In the American tradition, Henry David Thoreau is the great advocate of simplicity. Thoreau thought that enlightenment grew from simplification. He claimed that civilized people would “leave off eating animals.” He said, “water is the only drink for a wise man.” He thought that we often live like ants, our lives being “frittered away by details.” The solution is simplicity – a word that he repeated as a mantra in his book “Walden.”

It turns out that the vegetarian diet that Thoreau advocated is also environmentally friendly. Reduced meat consumption decreases the size of your carbon footprint. The same is true with regard to other exotic foods. Coffee, alcohol and imported foods have ecological costs.

Thoreau was not in favor of eating as a recreational activity. We eat more than we need to survive. Extravagant variety makes for delicious dining. But this is not healthy for us or for the planet. Obesity, diabetes and heart disease are problems, as well as climate change.

The solution is to realize that what’s good for the body is also what’s good for the planet and for society. Simple foods – raw and local fruits and vegetables – are nutritious. Vegetarian cuisine can be delicious – and fun.

There is adventure in experimenting with the variety of meatless foods. Sharing with others can spice up our lives. Happy dining has less to do with what you eat than with who you eat it with.

Walking or biking

Another Earth-friendly step is to drive less. Driving is easier and often more convenient. But there is adventure in riding the bus, including an opportunity to have more intimate contact with people in your community.

A walk or bike ride is good for the heart and the mind. Walking and biking show you the the world from a different perspective and a different pace. Broaden your horizons by leaving your car at home.

We can also reduce our use of consumer goods. Big homes inspire us to fill them. Big-box stores encourage mass consumption. And big cars are perfectly constructed to carry all of that stuff back home.

A WALK OR BIKE RIDE IS GOOD FOR THE HEART AND THE MIND.
WALKING AND BIKING SHOW YOU THE THE WORLD FROM A DIFFERENT PERSPECTIVE AND A DIFFERENT PACE. BROADEN YOUR HORIZONS BY LEAVING YOUR CAR AT HOME.

But there are activities other than shopping that can provide satisfaction. Have a picnic or visit a park. Join a sports league. Participate with a political group. Or visit a library. You’ll make new friends, learn new things and see the world in a different way. You will also save money.

Consumer capitalism provides pleasure. But it does not produce lasting happiness or a good life. Technological innovation makes some things easier. But there are diminishing returns. Cars are great. But traffic soon becomes a problem. Email is great, until we experience inbox overload. Easy access to delicious food is wonderful. But obesity and diabetes are dangerous. And so it goes.

Inner peace and spiritual growth cannot be generated by external means. This is the common teaching of the world’s philosophical and religious traditions. Simplicity was taught by ancient Greek philosophers, Asian sages and Christian ascetics.

Our consumer culture is not sustainable in the long run. There will be 8.5 billion people on Earth by 2030. We can’t all live as mass consumers. But we would be happier if we would reduce consumption. And the Earth would benefit if we would learn to find satisfaction in simple things.

http://www.fresnobee.com/living/liv-columns-blogs/andrew-fiala/article145900294.html

December 31, 2016December 10, 2017

Year in ethics 2016

2016 was a year of ups and downs in ethics

Fresno Bee, December 31, 2016

This was a stimulating year for ethical reflection. Incivility marred the election. Scandals emerged. And haters continued to hate.

But good Samaritans took risks to help others. Just this week, two students, Emily Elmerick and Sydney Antles, rescued crash victims from drowning in a canal on Highway 41.

Such courage should be applauded. We should also celebrate the steadfast decency of the majority of people who worked hard and paid their taxes.

Common decency often goes unnoticed. Nor do we notice the steady progress we are making toward alleviating poverty, improving health and advancing literacy around the globe.

Instead we fixate on hot button issues. This year, transgender rights and Black Lives Matter grabbed headlines. Assisted suicide became legal in California. Some states restricted abortion rights. And marijuana legalization was in vogue. Any of those issues will provoke heated conversation.

SELF-DRIVING CARS NEED MORAL ALGORITHMS TO GUIDE THEM. BIOTECHNOLOGY IS OPENING A NEW WORLD OF GENETIC ENGINEERING. THE SIXTH MASS EXTINCTION IS BEING CAUSED BY POACHING, POLLUTION AND HUMAN POPULATION PRESSURE. GLOBAL TEMPERATURES AND CO2 LEVELS ARE AT ALL-TIME HIGHS.

Major moral problems loom on the horizon. Self-driving cars will require moral algorithms to guide them. Biotechnology is opening a brave, new world of genetic engineering. The sixth mass extinction is being caused by poaching, pollution and human population pressure. Global temperatures and carbon dioxide levels are at all-time highs.

Despite these new challenges, some things don’t change. California voters retained the death penalty. War, crime and terrorism continue to afflict us. And men continue to disrespect women.

This year, we heard Donald Trump brag about grabbing women’s genitals. Anthony Wiener sent more lewd photos. New allegations emerged against Bill Cosby, Roger Ailes and others.

Meanwhile, the White House’s glass ceiling remains intact. Some blamed misogyny, racism and xenophobia for Hillary Clinton’s failed presidential bid. Others saw conflicts of interest in the Clinton Foundation, dirty deeds in the DNC and that pesky email scandal.

The sports world was a welcome distraction from politics. The Cubs inspired hope, as did Olympic champions. The moral highlight of the Rio Games occurred when Abbey D’Agostino helped an injured Nikki Hamblin complete the 5,000 meter race.

But the Olympics were marred by Russian cheating scandals and fear of Zika. Social unrest in Brazil haunted the Games just as racial tensions in the U.S. prompted Colin Kaepernick’s flag protests.

Sex scandals emerged in USA Gymnastics and in British soccer clubs. And in Rio, Ryan Lochte got drunk and vandalized a service station. He lied about it and got caught, demonstrating that the cover-up is often worse than the crime.

NEPOTISM AND GREED ARE A VOLATILE MIX, WHICH IS KEEPING ETHICS WATCHDOGS ON ALERT AS DONALD TRUMP HEADS TO WASHINGTON, D.C. CRITICS WARN OF POTENTIAL CONFLICTS OF INTEREST.

In addition to liquor and lust, greed also caused moral disaster. Several corporate scandals emerged this year. Wells Fargo opened phony accounts for 2 million customers. The scandal has spread to Prudential insurance. Thousands of employees were fired, and CEO John Stumpf stepped down.

Profiteering was a problem for makers of the EpiPen, whose price rose by hundreds of percent in recent years. The CEO of the company that makes the EpiPen is Heather Bresch. Her father is a U.S. senator. Her mother headed the National Association of State Boards of Education, which urged schools to purchase these devices.

Nepotism and greed are a volatile mix, which is keeping ethics watchdogs on alert as Donald Trump heads to Washington, D.C. Critics warn of potential conflicts of interest. Others, such as Newt Gingrich, argue that a billionaire president should not be bound by customary ethics regulations. Meanwhile, prosecutors have blocked Trump’s attempts to close his charitable foundation, since it is under investigation.

So what have we learned this year? Most scandals involve the same basic causes: sexual desire, drunkenness, overweening pride, a penchant for secrecy and deception, conflicts of interest, and the unbridled pursuit of profit.

The basic lessons of ethics are simple. Keep your ego in check and your pants on. Value sobriety and self-control. Tell the truth. Keep your promises. Don’t cheat. Respect people and treat them fairly. Don’t enrich yourself or your family at the expense of others. And apologize when you do something wrong.

As we enter the new year, let’s resolve to be moderate, humble, honest and kind. Let’s remember that decent people and good Samaritans do exist. Let’s celebrate the progress we have made in improving ourselves and our world. And let’s be slow to blame and quick to forgive, since everyone is tempted by pleasure, profit and pride.

http://www.fresnobee.com/living/liv-columns-blogs/andrew-fiala/article123792204.html