8/16/17

Think with Krys Boyd (podcast)



Here's the podcast of my interview on KERA today.  Krys Boyd and I are both big fans of using tiny post-its to mark pages! Our books looked like twins.


8/14/17

More About Gene Editing


I'm still thinking about that Time op-ed that objects to gene editing because, in so many words, if my parents had used it, my brother wouldn't have existed.  I went along with this assumption about existence in my last post on the subject, but only for the sake of argument.  It's actually quite debatable.

Suppose parents do want to avoid having a child with a gene for a serious disease, like the serious heart defect that was eliminated by researchers.  They can already do this, as long as both parents aren't carriers for the gene, by using PGD—pre-implantation genetic diagnosis. Using IVF, multiple embryos can be generated and five-day-old embryos can be biopsied.  An embryo without the gene could be implanted and the rest discarded.  If people used this method, it's certainly true that certain possible people wouldn't be born. Looking at an actual little brother (Harry, let's say) with a heart defect, it's true to say if my parents had used PGD, Harry wouldn't have existed. The embryo that led to Harry would have been discarded.  Larry, not Harry, would have been born.

It's much less clear that this is true, if gene editing is used.  Using gene editing, the embryo carrying the faulty gene is allowed to develop, but the gene is edited out of it on day one, at the zygote stage.  Would Harry have existed if one of 20,000 genes had been eliminated from the same embryo—the one that actually led to Harry?  I think it's true that if an embryo is radically edited, it will lead to a different child being born.  But minor editing?  Is our entire genome essential to us, so we can't exist if even one gene is edited out?

We're not used to thinking about this, since an individual's genes have always seemed unalterable. It seems to me that we could easily get used to the idea that the same person could have existed with somewhat different genes, and the idea wouldn't be incoherent.  If I had the serious heart defect the researchers focussed on, and my parents had been offered the option of gene editing, and had been able to afford it, I can imagine wishing they had created me without the heart defect.  That doesn't sound like a metaphysical impossibility.

If that's the right way of thinking about things, the Time magazine author really has things all wrong.  PGD, which is already available, is the technology that could potentially have made the author's little brother not exist.  But that horse is already out of the barn.   CRISPR-cas9 would have given his parents the option of having his little brother, but protecting him or her from the disease he was born with.

If that's the right way to look at it—the same people can be born, despite gene-editing—then gene editing starts to look not just permissible in certain cases, but possibly even obligatory.  Suppose you knew your child might be born with a serious heart-defect, and you also knew you could check in advance whether he or she had the relevant gene, and you could eliminate it.  Certainly if there was a drug that would fix the heart defect, and you could take it during pregnancy, it would be fair to say you should take it.  It's really not clear why gene editing is different.

OK--there are a bunch of other puzzles here, having to do with who winds up being born, if either PGD or gene editing is used, but I'll save that for another day.


8/13/17

Radio Interview, Time Change

They're wisely devoting Monday's show to the events in Virginia, so I'll be on Wednesday at 1:00 instead of Monday.

8/11/17

Reviews of The Philosophical Parent

Nice review from Library Journal!
Library Journal  08/01/2017  Kazez (philosophy, Southern Methodist Univ.; The Weight of Things) begins by summing up the relationship between parenting and philosophy perfectly when she writes "having children turns every parent and parent-to-be into a philosopher." For this reviewer, the parent of two small children, that claim is as valid. The questions that arise for parents and would-be parents are numerous and cover a wide range of topics such as "Is there anything special about having a child?" to "Should parents reinforce gender?" Kazez helps with finding answers or at least showing the complexity of these questions by arranging the topics chronologically by stages of parenting and looking at them through the lens of different philosophical views and parenting experience. Most importantly, these chapters are also short and can be read individually so that parents can focus on topics of interest and actually finish reading them. VERDICT Kazez's combination of philosophy and parenting experience makes this work recommended for parents who are searching for answers to meaningful questions surrounding child-rearing.—Scott Duimstra, Capital Area Dist. Lib., Lansing, MI
There's also this Publisher's Weekly review, which I appreciate, but I disagree with what the reviewer says about my decision not to cover abortion.
Publishers Weekly  06/05/2017  Philosophy professor Kazez (Animalkind: What We Owe to Animals) uses a mix of philosophical proofs and science to explore a mix of theoretical and practical parenting questions. Questions in the former category include whether babies are lucky to be born and what parents are for; questions in the latter include whether to circumcise or vaccinate and whether to raise children with religious beliefs. She appeals to new parents’ innate sense of logic and ethics as alternatives to parenting experts. Kazez grounds her ideas in the Aristotelian perspective that a biological child is “another self, but separate” in order to understand parents’ intense identification with their children and the obligations conferred by this unique relationship. She picks and chooses her controversies carefully. For example, she explores the idea of when personhood begins while opting out of any discussion of abortion because, in her words, her intended reader is “deliberately pregnant and eager to become a parent,” but then dives into equally irrelevant questions regarding adoption and population control. Sections about how we treat our children later in life fit more into the parent-as-philosopher mode Kazez promises. Though her conclusions are far from groundbreaking, soon-to-be-parents will find thinking through her arguments a good way to engage their minds beyond the immediate practicalities of child-rearing. (July)
Important clarification: the intended reader of the whole book is not "deliberately pregnant and eager to become a parent." Different chapters focus on imaginary readers at different stages of becoming and being parents. In chapter 1, for example, the imaginary reader just wants a child, whether through procreation or adoption. So adoption is relevant there and discussed. In chapters 2-3, the imaginary reader wants a child, but worries about whether it's right or wrong to have one, given various worries, including worries about population. So overpopulation is relevant to the imaginary reader there.

In chapter 5, the chapter this reviewer is quoting from, I do start with the conceit that the reader is finally pregnant and eager to have a child. The chapter is about the developing zygote-embryo-fetus and when it begins to be the individual who will later be born. Abortion could have had some relevance here, for people who want to be parents, but want to end a particular pregnancy, but the literature on the ethics of abortion is vast and complex. This didn't seem like the place to get into it.

8/10/17

Worrying about CRISPR

Scientists have developed a new technology, CRISPR-Cas9, for editing genes in day old human embryos. The technology (explained here with terrific graphics) was used to edit out a gene that leads to a severe heart detect, though the embryos were then discarded.

We won't be using this technology to create genetically modified people until there has been a lot more research. There's also going to have to be an ethical and legal debate. Is there something worrisome about editing an embryo's genes?  There might be, but we need to be careful to have the right worries.  It's very easy to have worries that just don't make sense.

Take this Time Magazine op-ed, by Joel Michael Reynolds.  The title says it all:  Gene Editing Might Mean My Brother Would've Never Existed. His brother Jason had muscle-eye-brain disease and had "muscular dystrophy, cerebral palsy, severe nearsightedness, hydrocephalus and intellectual disability." Jason was lovely and beloved, and so Reynolds questions a technology that would prevent Jason from ever existing.

It's no fun criticizing someone who reveals love and grief in the way Reynolds does, but this worry about a specific person not existing is the wrong worry to have.  There are many things we do to control who is born that are either neutral or mandatory, but would alter who exists.

  • Picture the debate that went on before contraceptives were available. An opponent of legalizing contraceptives could look at his unplanned little brother and say that if his parents had had access to contraceptive technology, the boy wouldn't have existed. That fact surely has no weight at all, however much it may be painful to imagine a world without a specific person. 
  • Imagine a woman being told by her dermatologist not to conceive a child while she's taking Accutane, because Accutane causes abnormalities. She ignores this advice and conceives a child with some abnormalities. Should she really feel good about her choice, because without it, her child wouldn't have been born? 

We are simply confused when we object to an action or practice because, if opted for, this lovely and beloved child wouldn't have been born.  At the time that we're choosing the action or practice, there are millions of possible children who could come into existence, and there's nothing that says that the one who actually will be born should be born.

Reynolds is concerned that Jason be born, but also that people like Jason be born.  He gives us this description of Jason's life, to convince us that that he wasn't worse off than other children.
He lived past his first year thanks to marvels of modern medicine. A shunt surgery to drain excess cerebrospinal fluid building up around his brain took six attempts, but the seventh succeeded. Aside from those surgeries’ complications and intermittent illnesses due to a less-than-robust immune system, Jason was healthy. Healthy and happy — very happy. His smile could light up a room. Yet, that didn’t stop people from thinking that his disability made him worse off. 
This reminds me of the old joke: "Aside from that, how was the play, Mrs Lincoln?" I don't see how a string of surgeries, complications, and illness, in someone who evidently died before the age of two, leaves very much to be good.  It's not ableist, but just realistic, to think Jason was worse off than other babies.

Reynolds chocks it up to ableism that many parents would like to avoid having a baby like Jason. But even he seems to admit there are health problems that ought to be avoided.
We, who are often still unable to distinguish between positive, world-creating forms of disability and negative, world-destroying forms — between Deafness, short stature or certain types of neurodiversity and chronic pain, Tay-Sachs or Alzheimer’s. It is with great responsibility that we as a society balance along the tightrope of biomedical progress. 
I don't know about putting muscle-eye-brain disease in the "positive, world-creating" list, as if babies could creatively construct their own distinctive way of life and identity, in the manner that some people with deafness and short stature say that they do.  The heart problem that was eliminated by the CRISPR research also doesn't seem to belong on the "positive, world-creating" list.

So what's the right worry to have? I do think gene editing could lead to far too much choosiness in prospective parents--too much constructing of the preferred child and too little receptiveness. It could be over-used. I don't think there's a good, coherent reason to think it should never be used.

8/5/17

The Page 99 Test

My book is featured today at The Page 99 Test.  I narrowly missed having to talk about a blank page.  Page 98 is one of those blanks you get when a chapter ends on an odd-numbered page.  Does page 99 reveal something about the whole book?  Yes, I think it does!  It reveals the way the book is scenario-driven instead of abstract, and some of the book's main themes and issues.  Thank you, Marshal Zeringue, for the invitation.

"Motherhood Isn't Sacrifice, It's Selfishness"

This New York Times op-ed by Karen Rinaldi has generated a huge number of comments, a lot of them negative. Goes to show that the way you say something is all important. Here's one of the more provocative paragraphs:
Motherhood is not a sacrifice, but a privilege — one that many of us choose selfishly. At its most atavistic, procreating ensures that our genes survive into the next generation. You could call this selfishness as biological imperative. On a personal level, when we bring into the world a being that is of us, someone we will protect and love and for whom we will do everything we can to help thrive and flourish, it begets the question, How is this selfless? Selflessness implies that we have no skin in the game. In motherhood, we’re all in.
Privilege? I have no idea why she says this. It's not as if we have to apply to become parents.  Everyone gets to become parents, if they're capable.  But "not a sacrifice" makes more sense to me and "selfish" makes some sense, but it's the wrong word. I think what she was really after, as a contrast with "selfless," is "self-interested." When we have a child "we bring into the world a being that is of us." Yes. Because my child is part of my extended identity, so to speak, when my child is better off, I'm better off. When my child is worse off, I'm worse off.  It's because we've enlarged ourself, thereby including our child as part of our extended identity, that caring for my child is self-interested.  But that doesn't mean it's "selfish." Selfish people don't enlarge themselves.

Since the self-interestedness of parenthood is really built in, and not just a feature of bad parents, she's off track when she writes that motherhood is a privilege (again, why a privilege?!) "that many of us choose selfishly."  But she gets back on track at the end of the op-ed.
If we start referring to motherhood as the beautiful, messy privilege that it is, and to tending to our children as the most loving yet selfish thing we do, perhaps we can change the biased language my mother used. Only when we stop talking about motherhood as sacrifice can we start talking about mothers the way that we deserve.
Again, there's the privilege talk, which I find bewildering.  But now the selfishness (no, self-interestedness!) is portrayed as built in.  It's not the bad mother who's selfish (no, self-interested), it's motherhood itself.  Much better!

8/4/17

Goodreads Giveaway

Enter the giveaway for my book!

Goodreads Book Giveaway

The Philosophical Parent by Jean Kazez

The Philosophical Parent

by Jean Kazez

Giveaway ends September 04, 2017.

See the giveaway details at Goodreads.

Enter Giveaway

7/31/17

The Metaphysics of Pregnancy


I wish I'd read this Aeon article on the metaphysics of pregnancy on time to include the topic it raises in my book, The Philosophical Parent.  Suki Finn asks a great question, which is explored in a forthcoming article in Mind by Elselijn Klingma: is a mother a container for her fetus or is the fetus part of her?  They've definitely succeeded at two things: making the metaphysics of pregnancy seem fascinating and making the part view seem like at least a contender.

Let's first list the possibilities, along with some sub-options.

I. On the container model, the mother contains the fetus, which is "a distinct entity in its own right" (Finn, Aeon). I would add that if the mother is a fetal container, there are many kinds of containers.  Something inside a container can be non-dependent on the container—like a watch in a drawer.  But something in a container can be completely dependent—a brain in a vat needs its container. Containment plus connection is a possibility, and surely that's the possibility most relevant to pregnancy. (I used to have an ipod charger that both contained the ipod and connected it to a charger. It wasn't quite as cute as the one on the right.)

II. On the parthood model, the fetus is a part of the mother, like a tail is part of a cat (Finn, Aeon). Finn is not saying the fetus is really tail-like.  That example is just supposed to clarify what we mean by a part. If a fetus is a part of its mother, there are many sorts of body parts.  A kidney, a freckle, a tumor, some fat, some blood, a hand, a nose, the lower half of my body—they're all parts.  If you settle on the parthood model, your next question will be "what kind?"  Important clarification made by the authors: the parthood model doesn't rule it out that the fetus is a human being, or even a person.  The fetus might be a part of a human that's also a human being, like the mother. (More on that below.)

III. The parthood and container models are stated in such a way that they're mutually exclusive.  That's because on the container model, the fetus is not a part, but rather "a distinct entity in its own right."  Why not, though, contemplate an inclusive option? Could a fetus be both inside a container and a part of the mother?  I don't see why not.  Take a Russian doll.  The innermost doll is contained by the outer dolls.  At the same time, the innermost doll is part of the Russian doll. If it's missing, the Russian doll is incomplete.

The container model seems to be the received wisdom among philosophers, Finn and Klingma both say. In fact, I would say there's something a bit alien or even yucky about the notion of the fetus as a part of the mother. If fetuses grew on trees, we'd surely think of them as parts of trees (like apples are parts of trees).  It's a little weird to think of a fetus as being even remotely like a pre-plucked piece of fruit. Why?  Maybe that doesn't comport with what we see as the separateness and dignity of the baby-to-be. That dignity may not have to do with lofty notions like personhood and humanity. It might have to do with not-so-lofty notions of animalhood.  At the level of sheer gut feelings, I also find it odd to think of a fetal kitten as a pre-plucked piece of fruit.
These are real pears!!!
http://bit.ly/2we7aFo

But that's just a matter of initial gut feelings.  There are also some serious worries about the possibility of a human being having a part that's a human being, or a cat having a part that's a cat.  Finn discusses a puzzle about a person who's sitting in a chair, about to have a haircut.  Is the person minus the hair that's about to be a cut a part of the person who still has her hair?  If so, there would be two persons sitting in the chair, which is absurd. We can rule that out by postulating a "maximality principle":  a whole of a certain kind can't have a part of the same kind.  But that will stop a fetus, assuming it's a human being (at least at some point in gestation) from being a part of its mother.

I agree with Klingma (in the Mind article) that it seems odd to postulate the maximality principle in order to solve the haircut problem, and then apply it to the very different circumstance of pregnancy.  It's also true that we can easily think of things of kind K that clearly do have parts of kind K.  See picture on right.

All in all, I think Finn and Klingma make a convincing case that parthood is a contender.  I still think, though, that the container model (option II) is a contender.  There are a lot of features that make a fetus appear to be an entity distinct from the mother, and contained by her uterus, which is contained in her body.  I don't see why its connection to her, through the umbilical cord, and its total dependence on her throughout most of gestation, must make it a part of her. Think ipod in dock or brain in vat.

I'm pulled in both directions, which I think counts as success for Finn and Klingma. They have at least succeeded in making their case that there are two models worthy of consideration here, and not just one.

7/29/17

I Don't Recommend Parenthood

In which I recommend visiting Iceland, but don't recommend visiting the land of parenthood.  At the Oxford University Press blog today.  Fun fact: "I don't recommend" doesn't mean "I recommend not"!

7/27/17

I get mail

I'm still receiving email about my op-ed in the Dallas Morning News yesterday.  There have been about 30 friendly, supportive messages.  Wouldn't it be nice if the other 5 were friendly but in disagreement?  But no, what I've received from critics is all tirade, no reasoning.  It's as if they were deliberately trying to give me data to support my final hypothesis--that the bathroom bill simply comes from outrage over something conservatives can't understand.

A number of these e-critics seem to have exploded before reading the whole op-ed. They fulminate about the sentence "Why are bathrooms ground zero?" (when it comes to separating people based on biological sex) as if I had stopped there. But no, I didn't. That question is a lead-in to the next paragraph:
If there's a smart case for SB 3, there needs to be some sort of harm done by letting trans folk use the same bathrooms as cis folk. I suspect supporters of the bill think, deep down, that it's harmful for a cis woman or girl to suspect there may be a trans woman in the next stall because, well, because that person may be making use of a penis. 
And what of that argument?  To find out how I assess it, you have to go on to the next paragraph.  Generally, comprehension of an op-ed requires that you keep going, paragraph after paragraph.  Yes, that is how it works.

I'm awfully surprised that some of these low-comprehension email critics  are actually pretty accomplished people. In fact, some of them are very accomplished people. It's been fascinating reading their fulminations, but honestly it would have been even more fascinating if they'd actually read my op-ed and responded coherently.  I'm actually genuinely curious how conservatives think about these issues.

But credit where credit is due. I found this comment (by Brian Baldwin) at the DMN website interesting. It's not from a conservative, but from someone who does a rather nice job (I think) of entering the anti-trans mindset.  He describes what's going on in more detail than I did and offers some good food for thought.

7/26/17

The Bathroom Bill

I have an op-ed about the Texas bathroom bill in the Dallas Morning News today. In case you can't get past the paywall, I've copied it below. Sadly, SB 3 did pass in the Texas senate last night, but it hasn't been voted on in the house yet.  Possibly even worse, today Trump announced he plans on banning transgender people in the military (though the Pentagon says this is the first they've heard about that). It's puzzling that conservatives feel the need to go after trans people in this way.  In the column I cast about for arguments they might want to use, but in truth I think it might be the psychology of anti-trans animus that most needs explaining.


Why the smartest argument for the bathroom bill isn’t smart at all

One of my jobs as an ethics professor is to figure out what the best case might be on each side of any contentious issue. And so I find myself earnestly trying to understand what drives the proponents of Senate Bill 3, the bathroom bill. What's the very smartest thing they can say in support of it?

Take the proponents' explicit motivation, to stop would-be sexual predators from taking advantage of transgender women being in the women's room. The idea is that cis (non-trans) male opportunists could dress like women and get away with their incursions because trans women can be seen in women's rooms.

This can't be the smartest argument for SB 3, because it isn't smart at all. Imagine that trans men started using the women's room, as SB 3 requires. There would be people in the women's room who look just like men — sporting beards, even. Now cis male predators wouldn't even have to put on a dress before making their incursions into women's rooms.

No, if they've given it any thought, proponents of the bathroom bill can't really be trying to keep male predators from invading women's rooms. What they might really be thinking is that human beings fall into two natural kinds, with no possibility of movement from one box to the other. Bathrooms are ground zero for the separation.

But this, too, fails to impress. Parents already bring children of the other sex into the bathroom. Single occupancy bathrooms get occupied, alternately, by men and women. And besides, if we let the two kinds into the same airplanes, supermarkets, and churches, what's the problem with letting them into the same bathrooms? Why is the bathroom ground zero?

If there's a smart case for SB 3, there needs to be some sort of harm done by letting trans folk use the same bathrooms as cis folk. I suspect supporters of the bill think, deep down, that it's harmful for a cis woman or girl to suspect there may be a trans woman in the next stall because, well, because that person may be making use of a penis.

I wouldn't want to dismiss anybody's feelings, but we do need to consider all the feelings. Imagine, if SB 3 passes and people comply with it, the feeling of being a trans woman walking into a men's bathroom, being stared at and feeling threatened with verbal or physical abuse. Or being a trans man walking into a women's room, and being told you're in the wrong place. Or not drinking, in the Texas heat, because you want to avoid having to use the bathroom. Can our legislators really be asking us to be more concerned about the mere thought that there's a penis in use in the next stall over?

Finally, you might support SB 3, out of compassion for pre-trans kids: you (allegedly) want to make life harder for trans people to discourage the next generation from jumping from one gender box into another. This is a preposterous defense on many levels, but I'll just mention the dangerous slippery slope this would put us on. What measures will gender conservatives dream up next, to keep everyone in their proper box?

Try as I may, I can find nothing smart to say on behalf of SB 3. I suspect it simply functions to allow conservatives to express outrage about a phenomenon that they don't understand and can't (yet) get used to. It serves no coherent purpose and deserves to fail.

Jean Kazez teaches in the philosophy department at Southern Methodist University. She is the author of The Philosophical Parent: Asking the Hard Questions about Having and Raising Children. She wrote this column for The Dallas Morning News.




7/25/17

The Bathroom Bill

I'll have an op-ed about the Texas bathroom bill in the Dallas Morning News tomorrow. It's already online.  Short version: I can't think of a single good argument in support of the bathroom bill.

7/20/17

The Music of Parenthood

One of the main ideas in my book The Philosophical Parent is that children are second selves but separate. This may seem like a dubious, dangerous, narcissistic view, but I don’t think so. Loving another as yourself doesn’t have to lead to imposition and domination.  It can even make us receptive. I’ve particularly seen this in our family’s history when it comes to music.  (I discuss the view with respect to more consequential matters in the book.)

Here goes, from the earliest days onward:

LITTLE KIDS
At first there were certainly impositions. A friend suggested Burl Ives as a much better alternative to Raffi, the “Bananaphone” guy. And so we were able to cut back a bit on Raffi and listen to great songs like “Big Rock Candy Mountain.” On the other hand, my tastes did change in response to theirs. Our kids (boy-girl twins) were obsessed with Thomas the Tank Engine, playing with the trains and watching the videos. The theme song sounded to me—no, not annoying, but like the uplifting soundtrack to their childhood.

By the time our kids were five, we parents decided we’d allowed our kids take over the airwaves long enough—this was before people plugged into their own private devices—and wrested back control with a lot of Beatles music. After that, there was a parting of the ways. Our kids expressed a mysterious hatred for the Fleet Foxes, cared little for Arcade Fire. Old loves of ours, like Leonard Cohen, were anathema.*

Meanwhile the two of them had discovered radio Disney and various now unmentionable and relentlessly cheerful hit-makers. By age 10, we could meet on the same ground by listening to Coldplay but on the whole there was our music and there was their music.

TEENAGERS
Then, when they became teenagers, things started to change. “Love the Way You Lie”, the Eminem song (featuring Rihanna), reverberated through our house in 2010—with lyrics that are an affront to feminism and ethics. I analyzed it, criticized it, condemned it … and loved it! Just as surprisingly, Kanye West’s egomania was not a barrier to my becoming enthralled with My Beautiful Dark Twisted Fantasy, which my son played constantly for the next year.

A year later, my daughter started playing what at first sounded like sheer cacophony to me: lots of Animal Collective (example: “For Reverend Green”) and Neutral Milk Hotel. What my kids liked, I listened to differently, and very often liked too. Later on, my tastes expanded still more—to Bjork, Sigur Ros, Sufjan Stevens, and on and on. And then, briefly, there was a period of perfect convergence—with Arcade Fire, Fleet Foxes, and an occasional Leonard Cohen song on the household playlist.

EMPTY NESTERS
Once my children left home for college two years ago, I wondered what would become of my musical tastes. Had they been permanently transformed? I find I still love the music they got me to listen to. But my pre-parenthood musical tastes are reasserting themselves. Yes, we are all going to see Sigur Ros and the Fleet Foxes this summer, but I’m listening to more opera, more classical music, more of my beloved female singer-songwriters, like Aimee Mann.

THE POINT!
If children are like second selves to their parents, that doesn’t mean we tyrannically control every inch of their lives. It means we easily put ourselves in their place, and are therefore open to experiencing their cares, concerns, and preferences. We try to see through their eyes, hear through their ears, but we keep our own eyes and ears as well. We are influencers, at least for a while, but out of identification, we are also influenced.


*My son can still recite this haunting lyric: “And just when I was sure that his teachings were pure, He drowned himself in the pool, His body is gone but back here on the lawn, His spirit continues to drool” (One of Us Cannot be Wrong) Thanks a lot!

7/14/17

Having Fewer Children Because of Climate Change

You care about climate change, so should you have fewer children?  Here's an article in the Guardian that argues for this, and the accompanying graphic.


The pitch here is to the individual. Like you might decide to recycle or wash in cold water or eat less meat, in response to climate change, the idea is that you should decide to have a smaller family, in response to climate change.  

I find this way too simplistic, for many reasons.

Many of the circles on the graphic have no downside. It's all good, if people recycle. However, it would be problematic if a lot of people had fewer children.  If you had one child instead of two, and so did a lot of people for the foreseeable future, that one child would be facing a very troubled future. She would be more burdened with responsibility for older members of society than we are at the present, and as she aged, she would suffer from there not being enough people to meet her needs. If the population decrease were dramatic, it could easily be true that her future would be far more marred by the population decrease than by climate change. It's notable that in countries (like Japan) where there is concern about climate change, but also a shrinking population, the shrinking population is seen as a curse, not a blessing.

Now you might say that these worries are misdirected. Very few people are actually going to have fewer children for environmental reasons. But if that's true, there has to be another worry. The children of the people who procreate less are more likely to care about environmental issues--people do tend to pass on their beliefs and values.  But then, you have to worry that governments are going to be less likely to take needed action on climate change when the voting population shifts to being created by the least environmentally concerned people.  For environmentalists to have fewer children might leave us with a world of Trumpians marching toward total eco-disaster.  Well, maybe!  (I'd like to see someone make a dystopian movie with this premise.)

Let's dig a little deeper.  It's interesting what's on the graphic and what isn't.  You can certainly suggest to people that they buy hybrid cars and wash their clothes in cold water, but certain things are beyond the pale.  There's no circle for ending your life at age 40. But that circle would be huge (about half as big as the one-less-child circle).  There's no circle for refusing medical care after the age of 70, even though that tends to involve a lot of energy and resources.  That would also be a big circle. Some sacrifices can't be expected--they're of a different order altogether.  Sacrificing a second child is that sort of sacrifice for many of us. Why?  My new book explores this in the first several chapters.  Even without a long further story, you can see the graphic is odd. It's not clear skipping child number two should be on the graphic, side by side with changing lightbulbs and washing in cold water.

Bottom line: I don't think any individual should think "I must have fewer children, because of climate change," especially if they live in a society where procreation is already at the replacement rate. Climate change is a problem but population shrinkage is also a problem, so it's not at all clear that one is the best solution to the other.

But if you do live in a society with a growing population, it's another story.  In that case, there may be ways for change to take place without individualistic moralizing.  Such a society shouldn't valorize huge families and shouldn't stigmatize people who have no children or very small families. In ballooning societies, it's all to the good, environmentally, if people don't think of having a family as their primary vocation.  I'm just not convinced that it's either convincing or reasonable to say, even to those people, "you should wash in cold water, recycle, and skip your longed for second child."


7/13/17

Choosing life, choosing death

Julian Savulescu and Peter Singer take a position that seems right to me on the question of Charlie Gard--see their opinion on the matter here. They think the parents ought to be allowed to take the baby to New York for further treatment. But their reasoning puzzles me. Here's how Savulescu and Singer support their stance on Charlie Gard: in cases of "reasonable disagreement, we believe that we should accede to the wishes of the parents and err on the side of a chance of life. The alternative is certain death." I'm puzzled because "acceding to the wishes of the parents" can't always go along with "erring on the side of a chance of life," since some parents prefer death.

There's a moving example of this in a (New York Times) Stone column written by Gary Comstock. In this case there was probably reasonable disagreement, but the parents' wish was to let their baby die. What then? Should the wishes prevail, or should we "err on the side of a chance of life"? I wonder how serious Savulescu and Singer are about the second part. Should we "err on the side of a chance of life" even against the preferences of parents?

How decisive is it that parents prefer life, or don't prefer life, in these kinds of tragic cases which involve reasonable disagreement? If Charlie Gard's parents turned around and decided they wanted to withdraw life support, I wonder what Savulescu and Singer would say. Now "acceding to the wishes of the parents" would mean supporting them, but "erring on the side of a chance of life" would mean wresting away control. I think parents get to make these decisions (when there is reasonable disagreement), and not just when they choose life.

7/6/17

The Charlie Gard Case

http://nyti.ms/2su9HcY

The basic facts of the case are covered here.

Dominic Wilkinson has written an interesting commentary at the Practical Ethics blog--he sides with the decision of the UK court, which has been upheld at higher levels. He argues that there is too much suffering involved in continued treatment, considering the tiny chance of further treatment being beneficial. Julian Savulescu thinks, by contrast, that the parents ought to be able to bring the child to the US for experimental treatment, which has been offered by a US physician and has already been crowd-funded online. He's written several commentaries on the case, here and here.

Wilkinson links to a very interesting paper he (and others) have written on the difference between the legal approaches to these kinds of problems in the US and UK. They write that courts in the UK apply a best interests of the child standard, whereas in the US, courts give more weight to parental preferences and patient autonomy. However, he says the emerging consensus among medical professionals and ethicists in the US is that the best interests of the child standard is the right one.

After years of shifting standards on medical treatments, there is now a strong consensus in the medical and ethical literature in the United States that it is the best interests of the patient not the desires of the family or the personal predilections of the physician which ought to prevail. That standard does not rest on autonomy or an attempt to determine what the patient would have wanted, but solely on a concern for the patient's welfare. Such protection is particularly important with regard to infants and children because with it they are now seen not merely as the pawns of parents, but as patients in their own right. The implication is that although parents may continue to be involved in decision making for their children, they do not have an absolute right to refuse— or to require—medical treatment for their child. It is the child's best interests, and those alone, that are to be the focus and goal of medical treatment decisions made on behalf of children. 
Children are not "pawns of parents,"  the authors say. In his most recent blog Wilkinson says it another way:  children are not "property of their parents."  It seems to me that if we leave it at that--not pawns, not property--and say nothing more about what children are to their parents, then it's very hard to make sense of a part of the approach Wilkinson supports. Why is it that, though parents don't have an "absolute right to refuse," they "may continue to be involved in decision making for their children"?

There is some kind of special entitlement of parents to their kids that is not respected if we seriously, literally, across the board, adopt the best interests of the child standard. If we really did so, in all domains, many parents wouldn't even be allowed to have custody of their biological children, considering the availability of better equipped adoptive parents. But no--they're your children, so you get to keep them and you have quite a lot of decision making power when it comes to the way they are raised and treated.  I believe this is the consensus, both in the US and the UK.

But there are limits.  When parents start to make decisions that are too extremely at odds with professional medical judgment, they lose their prerogatives. So it's not that the best interests standard is the only one, and is allowed to prevail in every situation. It starts to trump everything else when the stakes start to be greater. Parents are not allowed to make terrible medical decisions on behalf of their children.

If that's right, the question in the Charlie Gard case is not simply whether it would be better for Charlie to be taken off of child support, but whether it would be glaringly, obviously better.  Are the parents making a huge mistake by trying to take him to the US, a mistake of the type that should remove them from making the ultimate decision?

Elysha Waldman, a palliative care pediatrician, sides with the parents in this New York Times op-ed. She says parents get to decide, but not no matter what.  US courts do sometimes step in and insist on what's in the best interests of a child, she points out. Unfortunately, she sides with the parents for the wrong sort of reason.  She doesn't say that taking Charlie to the US makes some medical sense.  She writes:
In the end, it doesn’t matter that Charlie Gard has become a household name. He is, ultimately, the child of Connie Yates and Chris Gard and they know better than hospitals or the courts about what is best for their terminally ill son.
No, parents don't magically possess a better understanding of what's best for their children than anyone else.

For me to think think the parents should decide, I'd have to think what they want does make some medical sense.  From all I have read, it sounds like they want to make a bad decision (Wilkinson is convincing about this), but I'm not sure if it's bad enough that they should lose the usual prerogatives that come with being parents.

6/29/17

Compassion or Indignation?

Conservatives in the house and the senate are trying to get rid of the  Affordable Care Act's individual mandate, the requirement that everyone must purchase health insurance or pay a fine.  When you get rid of that, you reduce the number of relatively healthy people who would have been in insurance pools, so that those who remain have greater needs and have to pay higher premiums.

Liberals who think we need the individual mandate tend to talk the language of compassion.  "These poor, benighted people are sure they won't need medical care, but they could be blindsided by some catastrophic illness or accident or crime.  So they may be in trouble down the line, in addition to those who may wind up with no health insurance, because they can't afford the premiums." But there's another way to talk about the problem with getting rid of the individual mandate. Conservatives--and they're the ones in power, so we have to care about how they think--tend to care a lot about people being freeloaders and deadbeats and welfare queens and moochers. We're supposed to work hard and pay our own way, not depend on others.  In fact, it strikes me that this indignation over dependency is one of the most deep-seated elements of the Republican outlook. And so if we can talk about the individual mandate in terms of dependency, that would presumably be very convincing to many Republicans.  They'd have a reason to retain the individual mandate that didn't involve caring about people and their health problems.

But surely there is a reason to insist on the individual mandate that has nothing to do with compassion, and everything to do with indignation.  People who decide not to get health insurance, but wind up with a catastrophic medical problem, do wind up being deadbeats and freeloaders and all the rest--if you want to use that very colorful, judgmental language.  They wind up using the health care system that they didn't care to pay for, before they needed it.  There it will be, all ready for them, and they will not have paid their fair share for it.  Not only will it be available, not at all to their credit, but if they're sent bills post facto, they may never be able to pay them.  Conservatives should be appalled, considering they are appalled by all sorts of other dependency and freeloading and irresponsibility.

Of course, you don't want to be disingenuous, speaking a language you don't actually take seriously.  But liberals can talk this talk--if fact, they do so on occasion, just not so much in the context of the Obamacare debate. You're speaking this language if you think everyone ought to have their kids vaccinated, instead of counting on the herd immunity that's conferred when most other people have their kids vaccinated.  If you can get indignant about non-vaccinating parents, you can get indignant about people who don't plan for unexpected health problems and get themselves health insurance.

Why on earth do conservatives not see the similarity between their old enemies the welfare queens and deadbeat dads and the like, and the healthy folks they want to liberate from having to purchase health insurance?  I think they don't see it because the prototype of an uninsured person is a healthy, white, male independent contractor. They like the feisty independence of these people, but this can easily be reframed. Feisty independence? No, these are just freeloaders, people letting others create the system of care they themselves may ultimately need.

Sure, I'd rather speaking about care and compassion, but let's frame the issue about the individual mandate in the way that resonates with the people who have the votes!