A Patient’s Right to Know
All professions have their problem members and the field of medicine is no exception. Fortunately, the percentage of bad doctor is rather low—but this small percentage can do considerable harm. After all, when your professor is incompetent, you might not learn as much as you should. If your doctor is incompetent, she could kill you.
The May, 2016 issue of Consumer Reports includes a detailed article by Rachel Rabkin Peachman covering the subject of bad doctors and the difficulty patients face in learning whether a physician is a good doctor or a disaster.
Based on the research in the article, there are three main problems. The first is that there are bad doctors. The article presents numerous examples to add color to the dry statistics and this include such tales of terror as doctors molesting patients, doctors removing healthy body parts, and patient deaths due to negligence, impairment or incompetence. These are obvious all moral and professional failings on part of the doctors and they should clearly not be engaged in such misdeeds.
The second is that, according to Peachman, the disciplinary actions taken by the profession tend to be rather less than ideal. While doctors should enjoy the protection of a due process, the hurdles are, perhaps, too high. There is also the problem that the responses to the misdeeds are often very mild. For example, a doctor whose negligence has resulted in the death of patients can be allowed to keep practicing with only minor limitations. As another example, a doctor who has engaged in sexual misconduct might continue practicing after a class or two on ethics and with the requirement that someone else be present when he is seeing patients. In addition to the practical concerns about this, there is also the moral concern that the disciplinary boards are failing to protect patients.
One possible argument against harsher punishments is that there is a shortage of doctors and taking a doctor out of practice would have worse consequences than allowing a bad doctor to keep practicing. This would be the basis for a utilitarian argument for continuing mild punishments. Crudely put, it is better to have a doctor who might kill a patient or two than no doctor at all.
This argument does have some appeal. However, there is the factual question of whether or not the mild punishments do more good than harm. If they do, then one would need to accept that this approach is morally tolerable. If not, then the argument would fail. There is also the response that consequences are not what matters—people should be reprimanded based on their misdeeds and not based on some calculation of utility. This also has some intuitive appeal.
It could also be argued that it should be left to patients to judge if they want to take the risk. If a doctor is known for sexual misdeeds with female patients but is fine with male patients, then a man who has few or no other options might decide that the doctor is his best choice. This leads to the third problem.
The third problem is that it is very difficult for patients to learn about bad doctors. While there is a National Practitioner Data Bank (NPDB), it is off limits to patients and is limited to people in law enforcement, hospital administration, insurance and a few other groups.
The main argument advanced against allowing public access to the NPDB is based on the premise that it contains inaccurate information which could be harmful to innocent doctors. Interestingly enough, this makes it similar to the credit report data—it is notorious for containing harmful inaccuracies that can plague people.
While the possibility of incorrect data is a matter of concern, that premise best supports the conclusion that the NPDB should be reviewed regularly to ensure that the information is accurate. While perfect accuracy is not possible, it would seem to be well within the realm of possibility for the information to meet a reasonable standard of accuracy. This could be aided by providing robust tools for doctors to inform those running the NPDB of errors and to inform doctors about the content of their files. As such, the error argument is easily defeated.
Patients do have some access to data about doctors, but there are many barriers in place. In some cases, there is a financial cost to access data. In almost all cases, the patient will need to grind through lengthy documents and penetrate the code of legalize. There is also the fact that this data is often incomplete and inaccurate. While it could be argued that a responsible patient would expend the resources needed to research a doctor, this seems to be an unreasonable request—a patient should not need to do all this just to know that the doctor is competent. A reason for this is that a patient might be in rough shape and expecting her to engage in all this work would seem unfair. There is also the fact that one legitimate role of the state is to protect citizens from harm and having a clear means of identifying bad doctors would seem to fall within this.
Given the above, it seems reasonable to accept that a patient has the right to know about her doctor’s competence and should have an easy means of acquiring accurate information. This enables a patient to make an informed choice about her physician without facing an undue burden. This will also help the profession—good doctors will attract more patients and bad doctors will have a greater incentive to improve their practice.
Nominations & Democracy
As the United States continues its ultra-marathon campaign season, the pundits speak relentlessly about the possibility of a brokered Republican convention and the inevitably victory of Hillary Clinton.
The Republican establishment is not at all pleased that Donald Trump has become the populist candidate. They wail because has harvested what they sowed and insist the wheat should go to the elite of their choice. The people should, as always, get the shaft. I mean, of course, the chaff. The current plan of the elite is for Cruz and Kasich to deny Trump the number of delegates he needs to secure the nomination and then have a desirable candidate selected at the convention. Trump has been expressing his dismay at this plan and his supporters have shared his orange rage. Thus, Trump will almost certainly arrive at the convention with significantly more delegates than his rivals, yet he might lose the nomination because of the way the rules work.
In the case of Bernie Sanders, the Democratic establishment has anointed Hillary Clinton as the once and future candidate. As some critics have noted, many in the media have joined in the chorus and stick to the script which says that while Bernie has not been locked out, he has no chance at all of winning. Bernie supporters point to what they regard as the chicanery of the super-delegate system and are not pleased with the way the primary process works.
While Bernie is losing to Hillary, there is the concern that her winning is due to the rules of the party and not her popularity with the voters. As such, the populists are facing similar plights: they face being blocked by the rules of the parties which rule America.
The populists have raised a rather reasonable objection against the way the system works: the candidate with the most votes should become the nominee for the party. That is, as Trump points out, the way democracy is supposed to work.
Trump is right, but also wrong. He is right that the process should be democratic in a democracy. Otherwise, there is a mere half-democracy in which people can vote for anyone, provided that person is put forth by the ruling parties. As one of my undergraduate political science professors used to point out, the difference between the old Soviet system and the American system was one party—they had one, we have two.
Trump is wrong in that the parties are not democratic systems. That is, they are not part of the government and are, in fact, private organizations like corporations and unions. As such, they are free to make their own rules in regards to how the candidates are selected. Trump might well think that the parties are supposed to work like a democratic system—after all, the primaries do involve voting via the official voting machinery of the state. However, this is like having Exxon or GE decided to conduct its election process through the state—they could presumably make that happen, yet can obviously set their own rules and determine the outcome as they wish.
The parties do, of course, prefer to claim that they are following the will of the people and certainly want to avoid the appearance that the elections are actually settled in backroom deals. However, the parties remain private organizations and those that control the party decided how the process will work. If a party does break its rules, a candidate could presumably sue (one of Trump’s favorite past times)—but as long as the rules are properly followed, the only recourse of a candidate would be to appeal to the people.
When Hillary is crowned the candidate for the Democrats, I suspect Sanders will stand beside her throne. Trump, however, would be king by his own hand—if he is “robbed” of the nomination, he might decide to run on his own. This would be ideal for Hillary—her victory would be assured.
Modern Philosophy
Here is a (mostly) complete course in Modern Philosophy.
Notes & Readings
Modern Philosophy Part One (Hobbes & Descartes)
#1 This is the unedited video from the 1/7/2016 Modern class. It covers the syllabus and some of the historical background for the Modern era.
#2 This is the unedited video from the 1/12/2016 Modern philosophy class. It concludes the background for the modern era and the start of argument basics.
#3 This is the unedited video from the 1/14/2016 modern philosophy class. It covers the analogical argument, the argument by example, the argument from authority, appeal to intuition, and the background for Thomas Hobbes.
#4 This is the unedited video from the 1/19/2016 Modern Philosophy class. It covers Thomas Hobbes.
#5 This is the unedited video from the 1/21/2016 Modern Philosophy. It covers Descartes’ first meditation as well as the paper for the class
#6 This is the unedited video from the 1/26/2016 Modern class. In covers Descartes’ Meditations II & III.
#7 This is the unedited video from the 1/28/2016 Modern Philosophy course. It covers Descartes’ Meditations 4-6 and more about Descartes.
Modern Philosophy Part Two (Spinoza & Leibniz)
#8 This is the unedited video from the 2/2/2016 Modern Philosophy class. It covers the start of Spinoza’s philosophy. It could not be otherwise.
#9 No Video
#10 This is the unedited video from the 2/9/2016 Modern Philosophy class. It covers Spinoza.
#11 This is the unedited video from the 2/11/2016 Modern Philosophy class. It covers the end of Spinoza and the start of Leibniz.
#12 This is the unedited video from the 2/16/2016 Modern philosophy class. It covers Leibniz.
#13 This is the unedited video from the 2/18/2016 Modern philosophy class. It covers Leibniz addressing the problem of evil and the start of monads.
#14 This is the unedited video from the 2/23/2016 Modern philosophy class. It covers Leibniz’s monads, pre-established harmony and the city of God.
#15 This is the unedited video from the 2/25/2016 Modern philosophy class. It covers the end of Leibniz and the start of the background for the Enlightenment.
Modern Philosophy Part Three (Locke & Berkeley)
#16 This is the unedited video from the 3/1/2016 Modern Philosophy Class. It finishes the enlightenment background and the start of John Locke.
#17 This is the unedited video from the 3/3/2016 Modern Philosophy class. It covers John Locke’s epistemology.
#18 This is the unedited video from the 3/15/2016 Modern Philosophy class. It includes a recap of Locke’s reply to skepticism and the start of his theory of personal identity.
#19 No Video
#20 This is the unedited video from the 3/22/2016 Modern Philosophy class. It covers Locke’s political philosophy.
#21 This is the unedited video from the 3/29/2016 Modern Philosophy class. It covers the first part of George Berkeley’s immaterialism.
#22 This unedited video is from the 3/31/2016 Modern Philosophy class. It covers the final part of Berkeley, including his arguments for God as well as the classic problems with his theory.
Modern Philosophy Part Four (Hume & Kant)
#23 This is the unedited video from the 4/5/2016 Modern Philosophy class. It covers the introduction to David Hume and his theory of necessary connections.
#24 This is the unedited video from the 4/7/2016 Modern philosophy class. It covers Hume’s skepticism regarding the senses.
#25 This is the unedited video from the 4/12/2016 Modern Philosophy class. It covers David Hume’s theory of personal identity, ethical theory and theory of religion.
#26 This is the unedited video from the 4/19/2016 Modern Philosophy class. It covers Kant’s philosophy.
#27 This is the unedited video from the 4/19/2016 Modern class. It covers Kant’s epistemology and metaphysics.
#28 This is the unedited video from the 4/21/2016 Modern Philosophy class. It covers Kant’s antinomies, God, and the categorical imperative
Is the Republican Party Doomed?
Despite the predictions of the pundits, Trump has done exceptionally well in his bid for the Republican presidential nomination. This is despite concerted attacks against him by what remains of the Republican intelligentsia and millions of dollars spent to try to bring him down.
Trump has, quite obviously, polarized the Republican party and has exposed the chasm between the party base and the party elite. Because of these facts, some pundits have predicted that the party will be torn asunder by the upcoming election.
On the one hand, the arguments for the doom of the Republican party have a certain plausibility. As Trump has demonstrated, there really is a chasm between the base and the elites that seems to mirror the economic chasm in America. It is, of course, ironic that the gilded Trump is seen as the champion of the common man. The common woman, though, seems to have serious worries about Trump.
There is also the long standing tension between those who are Republicans because of their economic values and the social conservatives—the social conservatives seem to have figured out that while the establishment gladly takes their votes, they have generally failed to deliver on their promises to roll back the clock to a dreamtime 1950s world.
The Republican Party has also run up against the fact that it is still trying to serve the interests of straight, rich, old, white men in a time in which women, the young and non-whites matter a great deal politically. While this will not tear the party apart, it does serve (so some pundits claim) to keep the party from recruiting new blood to help keep it going. This, some claim, will cause the party to fade away—provided that it does not burn out first.
On the other hand, the Republican Party seems to be facing the chaos only at the level of national politics—specifically presidential politics. The Republicans have solid control of Congress and, at the local level, dominate 23 states (holding the governorship, state senate and state house). In contrast, the Democrats only dominate 7 states. This is as of March, 2016 and these numbers can change.
While it might be argued that the Republican dominance is through trickery and misdeeds in the form of gerrymandering, voter suppression and the corrupting hand of big money, the fact is that the Republicans are essentially running most of the country. This, one might argue, is good evidence that the party is not about to explode or tear itself apart. Rather, it is the sign of a party that has its act together—in contrast to the Democrats who seem to excel at losing.
Some, such as devoted Democrats, might contend that this is a false vitality—that the Republican party is driven by the energy of dying desperation and, like a wolverine, is fighting hardest just before its death. It might also be pointed out that trickery and misdeeds can only sustain the party for so long, that eventually the party will be overwhelmed by the vast volume of voters who are not Republicans.
The counter to this is to point out that even if the majority of people will not be Republicans, winning elections is not about who is in the majority of people. It is a matter of being the majority of voters. As such, Republicans could keep winning as long as they get enough of the fraction of people who bother to vote to vote Republican. This could go on for a long time, at least as long as most people eligible to vote do not do so.
Another counter is to accept the Republican claim that they are the true party of inclusion and that they have more to offer non-whites and women than the Democratic party has to offer. That is, that despite all the apparent hostility to women and minorities and all the associated laws do not reflect the real soul of party. This soul, they could argue, wants to lovingly embrace all voters who will vote Republican. Perhaps this is true. There are, after all, some excellent people who are Republicans.
It might be suspected that I hope that the Republican party will either burn out or fade away. Actually, this is not true. While I am, by default, a Democrat, I recognize the importance of having a competent and effective opposition party (or parties). In my personal life, I accept that I cannot and should not always get my way. While I do think I am right in my views, I also know that many of them are wrong—I just do not know which ones. That is why I value competent criticism that can expose where I am in error. Likewise, I value political opposition.
I also accept that even if I am right, this does not necessitate that I deserve to get my way all or even most of the time. One mark of being an adult is getting that other people have legitimate needs and interests that conflict with one’s own and this entails that compromise is something that must be accepted in certain matters. It is tempting to always try to get what I want, which is why opposition is important to ensure that others can also get what they need.
Because of these views, I hope that the Republican party can either get it together or, if that fails, split and form at least one effective and competent opposition party. Then again, perhaps the party does have it together—except for the Trump thing.
A Philosopher’s Blog 2015 Available on Amazon
This book contains essays from the 2015 postings of A Philosopher’s Blog. The topics covered range from robotic assassins to the ethics of performance based university funding. Side adventures include the ethics of “bathroom bills” and technological immortality.
Trump & Abortion
Abortion is a contentious matter in the United States and politicians must expect to answer questions about their position. As such, Trump should have been prepared when the questions turned to abortion during Chris Matthews interview of him on MSNBC.
While Trump has expressed a pro-choice position in the past, he told Matthews that he was now pro-life. When Matthews inquired about the legal implications of an abortion ban in terms of punishing women, Trump asserted that the “answer is that there has to be some form of punishment, yeah.” Since Trump has routinely been rewarded for talking tough and expressing misogynistic views, he was probably genuinely surprised when he experienced a broad backlash for his remarks—most especially from anti-abortion advocates.
In response to this backlash, Trump’s campaign released a statement saying: “If Congress were to pass legislation making abortion illegal and the federal courts upheld this legislation, or any state were permitted to ban abortion under state and federal law, the doctor or any other person performing this illegal act upon a woman would be held legally responsible, not the woman.”
Interestingly enough, many anti-abortion advocates hold to this view as well (at least in public statements): women should not be punished for getting illegal abortions and the punishment should be limited to the abortion provider.
While some might claim that Trump’s initial position was an expression of misogyny, his inference was certainly justified given the usual approach to illegal actions. If abortion was criminalized and crimes should be punished, then it would follow that a woman who chose to have an abortion should be punished. This is the case with other crimes.
To use an obvious analogy, if Sally hires Jean to kill Jack, then Sally has committed a crime and should be punished for her role in it. A just court would and should punish Sally for her role in this crime. It would be patently absurd for someone to say “If Congress were to pass legislation making murder illegal and the federal courts upheld this legislation, or any state were permitted to ban murder under state and federal law, the assassin or any other person performing this illegal act for a woman would be held legally responsible, not the woman.” As such, if abortion were a crime (which opponents often consider murder), then it follows that the woman should also be punished.
Another analogy is with illegal drugs. If Sally buys illegal cocaine from Jean, then Sally has also committed a crime and should be punished. It would be ridiculous to say “If Congress were to pass legislation making cocaine illegal and the federal courts upheld this legislation, or any state were permitted to ban cocaine under state and federal law, the drug dealer or any other person performing this illegal act (providing cocaine) for a woman would be held legally responsible, not the woman.” Once again, if abortion were a crime, then the woman should also be punished.
Obviously, the analogies could continue through a multitude of crimes, thus showing that the position advocated by Trump and others is contrary to the usual workings of justice, namely that those participating in a crime are to be punished. That said, there is a way to hold to the position that the woman should not be punished and the abortion provider should.
Holding this position requires asserting that the woman lacks agency in the crime and is thus not responsible. One approach, which is not uncommon, is to argue that women in general lack agency. This sort of view was used to justify, for example, denying women the right to vote and treating them as property.
This approach would be analogous to that taken by some states in regards to child prostitution. Although prostitution is a crime, children lack the agency to consent to sexual relations and are thus not responsible for the crime. Instead, those providing or purchasing the sexual services are responsible for the crime. As such, they should be punished and the children should not.
While some might find this approach appealing, it is obviously problematic. One rather absurd implication is that denying that women have agency would give them this legal status across the board—thus undermining the possibility of fully holding women accountable for crimes they commit. There are, of course, so many other problems with this approach that it has no legitimate appeal.
Another option is to accept that while women have agency, they generally lack such agency when it comes to choosing to have an abortion. Or, rather, women do not truly choose to have abortions—they are coerced, tricked or beguiled into having them. If this were generally true, then the position that women should not be punished for illegal abortions while those performing them should be punished would be reasonable.
To use an analogy, if Jean kidnaped Sally and her daughter, then killed the daughter, Jean would be the criminal and Sally would be a victim. As such, Sally should obviously not be punished. The challenge is, of course, to show that abortion providers generally use coercion to compel women to get abortions against their will. This, however, seems contrary to the facts.
As another analogy, if Jean was able to beguile Sally into believing she was in terrible danger from Jane and only Jean could save her at that moment by killing Jane, then Sally should not be punished for agreeing to this. Likewise, if abortion providers beguile and trick women into having abortions that they would not have had without being under the mesmeric influence of the abortion providers, then women who have illegal abortions should not be punished. What would need to be shown is that abortion providers have such powers to beguile. This also seems unlikely.
It could be claimed that surely there are cases in which women are coerced or beguiled into having abortions against their will. This, I accept, probably does happen. I am also confident that people are also coerced or beguiled into committing other crimes. As with such cases, I would agree that the person who is forced or beguiled into participating in a crime should have any punishment reduced or eliminated based on the degree to which they lacked agency. Obviously enough, those that coerce or beguile people into crimes should be subject to punishment proportional to their contribution to the crime. This all assumes that the crimes are morally worthy of punishment—crime is a matter of law and there can be unjust laws.
Lest anyone be confused about my overall position, I would prefer that there were fewer abortions (as argued in another essay). But, I do accept that abortion is generally morally acceptable under the current social conditions. As such, I oppose banning abortion and certainly oppose punishing abortion providers or women who have abortions. My point is that those who wish to criminalize abortion need to accept that the punishment of women is entailed by this view. As such, the position that abortion is a crime and that abortion providers should be punished while women should not be punished for their role in the “crime” is an inconsistent and untenable position. This, naturally enough, is for cases in which abortion is not the result of coercion or deception.
North Carolina’s Anti-Antidiscrimination Law
Apparently eager to do some serious damage to North Carolina’s reputation and economy, the state’s Republican controlled legislature passed “the bathroom bill” and the Republican governor signed it immediately. This law seems to have been in response to Charlotte, North Carolina passing a city ordinance extending legal protection for LGBT people and allowing transgender folks to use bathrooms based on their gender identity.
The “bathroom bill” makes it so that local governments cannot pass their own antidiscrimination laws—the state law, which is more restrictive than the Charlotte ordinance, trumps all local laws. The reason it is called the “bathroom bill” is that it has the effect of forbidding transgender people from using the bathroom that matches their gender identity. Instead, they must use the bathroom that matches the sex on their birth certificate. Interestingly enough, the law also precludes any local government from passing its own minimum wage laws—the minimum wage falls under the antidiscrimination law.
While the most plausible explanation for the law is prejudice against people who differ from the heterosexual norm, the proponents of the law obviously cannot make that the public reason for their support. Rather, there are two main reasons presented in defense of the law. The first is that the imposition of state control over local governments was an attempt to rein in “governmental overreach” on the part of Charlotte and other local governments.
There is a certain irony in Republicans passing a law that restricts the liberty of local governments—this is because the importance of local government and assertions about getting big government off the back of the people are stock talking points. However, many Republicans seem to be fine with local government only to the degree that the locals do what they want.
To be fair, there are legitimate issues here about the extent of the authority of local governments and the extent to which the state has the right to impose on local authorities. One approach is practical: having a hodgepodge of inconsistent laws across a state would be difficult for citizens and businesses—there are advantages to uniform, statewide laws. Another approach is a matter of ethics—the restrictions and liberties of laws should be the same across the state based on the principle of fairness. Of course, using a moral foundation for uniformity would require a moral assessment of the laws being imposed: having an unjust law imposed uniformly would be worse than a just law that was imposed in limited locations.
My own view is that antidiscrimination laws should be uniform but also just. As such, I do agree that the state (and federal government) should be setting these laws. But, these laws must be just. In the case of the North Carolina law, my view is that it is unjust because it codifies discrimination while forbidding local authorities from passing just laws. Hence, the state is in the wrong here. I now turn to the second justification for the law.
Proponents of the law contend that they do not support it from prejudice and that it does not discriminate. They claim that the law is needed in order to protect people, especially children, from being assaulted in bathrooms and locker rooms by transgender people.
On the face of it, the law does aim at meeting what I consider a basic justification of a restrictive law: it has the professed intent of protecting people from harm. This is an excellent justification for limiting liberty and is the principle that justifies, for example, forbidding companies from knowingly selling dangerous or defective products.
While the professed intent does matter, the proper assessment of a restrictive law aimed at preventing harm requires considering whether the harm in question justifies the restrictions being imposed. In the case of the bathroom bill, the easy and obvious answer is that it does not. The reason is that there seems to be an exceptional lack of evidence that transgender people will present a danger to others if they are permitted to use bathrooms based on their gender identity.
While it is certainly not impossible for a transgender person to engage in such an attack, the statistical evidence is that there have been no attacks. There are currently numerous states and many cities that allow people to use facilities based on their gender identity—so there have been many opportunities for such attacks.
The obvious reply is to point to claims that such attacks (or at least sexual misconduct) have occurred, thus refuting the claim that transgender people are not a threat. The counter to this is to point to the fact that such claims tend to be mere urban myths and that the evidence shows that the myth of the transgender bathroom assault is just that, a myth.
It could be countered that while there is currently no evidence that allowing transgender people to use bathrooms based on their gender identity, an attack could happen and this possibility, however remote, justifies the law.
The easy and obvious response to this counter is that basing restrictive laws on the mere possibility that something bad might happen would be absurd. This principle would warrant incredibly restrictive laws across the board and would also warrant violating most, if not all, rights. For example, men might attack women on hiking trails, so trails must be restricted to one gender to avoid the possibility of attack. As another example, a car might be used in vehicular homicide, therefore people should be forbidden from owning cars. Naturally, if it could be shown that transgender people pose a serious risk to the safety of others, then restriction would be justified. However, the threat would need to match the restrictions imposed by the law.
As a final response, a proponent of the law could say that when a case of a transgender person attacking someone in a bathroom is confirmed, that will show the law is justified. The counter to this is to point out that this principle is absurd—if a car ban were proposed, it would not be justified by pointing to a case or even a few cases of vehicular homicide. As noted above, what would be needed is evidence of a threat that warrants the restriction.
In light of the above discussion, the “bathroom bill” fails the basic test of restrictive laws: it imposes restrictions without the justification of preventing a sufficient harm. This should come as no surprise—the law is not about protecting people but about prejudice.
My Old Husky & Philosophy IV: Moral Decisions
The saga of Isis, my thirteen-year-old husky, continues. While she faced a crisis, good care and steroids have seen her through the storm of pain and she has returned to her usual self—ready for adventures and judging all lesser creatures.
Having a pet imposes morally accountability upon a person—the life of a pet is quite literally in one’s hands. When I took Isis in to the emergency vet she was in such rough shape that I thought that it might have been time for that hardest of pet decisions—to choose an end to the suffering of a beloved friend. It is my hope that I will not need to make this decision—I hope that when her time comes she will drift away in her sleep with no pain. I am hoping the same for myself. After all, no one wants to face that choice.
While some dismiss philosophy as valueless in real life, I have found my experience as a philosopher incredibly helpful in this matter. As noted above, I am morally responsible for my husky’s well-being. Having studied and taught ethics, I have learned a great deal that helps me frame the choices I have and will face.
When I brought Isis to the emergency vet, I knew that it would be expensive. There are, of course, higher fees for bringing a pet in outside of regular hours and Isis was in the sort of shape that usually indicates a large bill. So, when the vet showed me the proposed bill, I was not surprised that it was just under $600. I am lucky enough to have a decent job and fortunate enough to have made it through the financial folks driving the economy off a cliff a while back. While that was still a large sum of money for me, I could certainly afford it. While very worried about her, I did think about people who are less well off, yet love their pets as much as I love my husky—they could face a terrible choice between medical care for their pet and having the money for some essential bill or expense. Or they might simply not have enough money at all, thus being denied the choice. While there are those who do help out with the care of such pets, I am sure that there are daily tragedies involving those who lack the funds to care for sick or injured pets.
Since there are many systems of ethics, there are many ways to approach the moral decision of costly (in money or time) pet care. The most calculating is, of course, a utilitarian approach: weighing the costs and benefits in order to determine what would create the greatest utility. In my case, I can afford such care and the good for my husky vastly outweighed the cost to me. So, the utilitarian calculation was easy for me.
Others are not so lucky and they will face a difficult choice that requires weighing the well-being of their pet against the cost to them. While it is easy enough to say that a person should always take care of her pet, people can obviously have other moral obligations, such as to their children. In addition to the ethics of making the decision, there is also to moral matter of having a society in which people are forced to make such hard decisions because they simply lack the financial resources to address the challenges they face. While some might say that those who cannot afford pets should not have pets (something that is also often said about children), that also seems to be another evil. While I would not say that people have a right to pets as they have a right to life and liberty, I would accept that a system that generates such poverty would seem to be an unjust system. Naturally, some might still insist that pets are a luxury, like education and basic nutrition.
Another approach is to set aside the cold calculations of utility and make the decision based on an ethics of duty and obligation. Having a pet is analogous to having a child: the choice creates a set of moral duties and obligations. Part of the foundation of these obligations is that the pet cannot make her own decisions and generally lacks the ability to care for itself. As such, taking an animal as a pet is to accept the role of a decision maker and a caretaker. An analogy can also be drawn to accepting a contract for a job: the job requires certain things and accepting the job entails accepting those requirements. In the case of a pet, there are many obligations and the main one is assuming responsibility for the well-being of the pet. This is why choosing to have a pet is such a serious decision and should not be entered into lightly.
One reason having a pet should not be taken lightly is that the duty to the pet imposes an obligation to make sacrifices for the well-being of the pet. This can include going without sleep, cleaning up messes and making a hard decision about the end of life. There are, of course, limits to all obligations and working out exactly what one owes a pet is a moral challenge. There are certainly some minimal obligations that a person must accept or she should not have a pet—these would include providing for the basic physical and emotional needs of the pet. The moral discussion becomes rather more complicated when the obligations impose greater burdens, such as burdens of time and money.
When Isis was at her low point, she could barely walk. I had to carry her outside and support her while she struggled to do her business. When I picked her up, I would say “up, up and away!” When carrying her, I would say “wooosh” so she would think she was flying. This made us both feel a little better.
She could not stand to eat or drink and had little appetite. So, I had to hold her water bowl up for her so she could drink and make special foods to hand feed her. I found that she would eat chicken and rice processed into a paste—provided I slathered it with peanut butter and let her lick it from my palm. At night, she would cry with pain and I would be there to comfort her, getting by on a few hours of sleep. Sometimes she would not be able to make it outside, and there would be a mess to clean up.
I did all this for two reasons. The first is, of course, love. The second is duty—I accept that my moral obligation to my husky requires me to do all this for her because she is my dog. If I did not do all this for her, I would be a worse person and, while I can bear cleaning up diarrhea at 3:23 in the morning, I cannot bear being a worse person.
I am certainly no moral saint and I freely admit that this was a difficult (though it obviously pales in comparison with what other people have faced). It did not reach my limits, though I know I (like everyone) have them. Sorting out the ethics of these limits is a significant moral matter. First, there is the moral question of how far one’s obligations go. That is, determining how far you are morally obligated to go. Second, there is the moral question of how far you can go before your obligations are breaking you. After all, each person also has duties to herself that are as important as obligations to others.
In my case, I accepted that my obligations included all that I mentioned above. While doing all this was exhausting me (I was dumping instant coffee mix into protein shakes to get through teaching classes), Isis recovered before my obligations broke me. But, I did have to give serious thought to how long I would be able to sustain this level of care before I could not go on anymore—I am glad I did not have to find out.
My Old Husky & Philosophy III: Experiments & Studies
While my husky, Isis, and I have both slowed down since we teamed up in 2004, she is doing remarkably well these days. As I often say, pulling so many years will slow down man and dog. While Isis faced a crisis, most likely due to the wear of time on her spine, the steroids seemed to have addressed the pain and inflammation so that we have resumed our usual adventures. Tail up and bright eyed is the way she is now and the way she should be.
In my previous essay I looked at using causal reasoning on a small sale by applying the methods of difference and agreement. In this essay I will look at thinking critically about experiments and studies.
The gold standard in science is the controlled cause to effect experiment. The objective of this experiment is to determine the effect of a cause. As such, the question is “I wonder what this does?” While the actual conducting of such an experiment can be complicated and difficult, the basic idea is rather simple. The first step is to have a question about a causal agent. For example, it might be wondered what effect steroids have on arthritis in elderly dogs. The second step is to determine the target population, which might already be taken care of in the first step—for example, elderly dogs would be the target population. The third step is to pull a random sample from the target population. This sample needs to be representative (that is, it needs to be like the target population and should ideally be a perfect match in miniature). For example, a sample from the population of elderly dogs would ideally include all breeds of dogs, male dogs, female dogs, and so on for all relevant qualities of dogs. The problem with a biased sample is that the inference drawn from the experiment will be weak because the sample might not be adequately like the general population. The sample also needs to be large enough—a sample that is too small will also fail to adequately support the inference drawn from the experiment.
The fourth step involves splitting the sample into the control group and the experimental group. These groups need to be as similar as possible (and can actually be made of the same individuals). The reason they need to be alike is because in the fifth step the experimenters introduce the cause (such as steroids) to the experimental group and the experiment is run to see what difference this makes between the two groups. The final step is getting the results and determining if the difference is statistically significant. This occurs when the difference between the two groups can be confidently attributed to the presence of the cause (as opposed to chance or other factors). While calculating this properly can be complicated, when assessing an experiment (such as a clinical trial) it is easy enough to compare the number of individuals in the sample to the difference between the experimental and control groups. This handy table from Critical Thinking makes this quite easy and also shows the importance of having a large enough sample.
| Number in Experimental Group
(with similarly sized control group) |
Approximate Figure That the difference Must Exceed
To Be Statistically Significant (in percentage points) |
| 10 | 40 |
| 25 | 27 |
| 50 | 19 |
| 100 | 13 |
| 250 | 8 |
| 500 | 6 |
| 1,000 | 4 |
| 1,500 | 3 |
Many “clinical trials” mentioned in articles and blog posts have very small samples sizes and this often makes their results meaningless. This table also shows why anecdotal evidence is fallacious: a sample size of one is all but completely useless when it comes to an experiment.
The above table also assumes that the experiment is run correctly: the sample was representative, the control group was adequately matched to the experimental group, the experimenters were not biased, and so on for all the relevant factors. As such, when considering the results of an experiment it is important to consider those factors as well. If, for example, you are reading an article about an herbal supplement for arthritic dogs and it mentions a clinical trial, you would want to check on the sample size, the difference between the two groups and determine whether the experiment was also properly conducted. Without this information, you would need to rely entirely on the credibility of the source. If the source is credible and claims that the experiment was conducted properly, then it would be reasonable to trust the results. If the source’s credibility is in question, then trust should be withheld. Assessing credibility is a matter of determining expertise and the goal is to avoid being a victim of a fallacious appeal to authority. Here is a short checklist for determining whether a person (or source) is an expert or not:
- The person has sufficient expertise in the subject matter in question.
- The claim being made by the person is within her area(s) of expertise.
- There is an adequate degree of agreement among the other experts in the subject in question.
- The person in question is not significantly biased.
- The area of expertise is a legitimate area or discipline.
- The authority in question must be identified.
While the experiment is the gold standard, there are times when it cannot be used. In some cases, this is a matter of ethics: exposing people or animals to something potentially dangerous might be deemed morally unacceptable. In other cases, it is a matter of practicality or necessity. In such cases, studies are used.
One type of study is the non-experimental cause to effect study. This is identical to the cause to effect experiment with one rather critical difference: the experimental group is not exposed to the cause by those running the study. For example, a study might be conducted of dogs who recovered from Lyme disease to see what long term effects it has on them.
The study, as would be expected, runs in the same basic way as the experiment and if there is a statistically significant difference between the two groups (and it has been adequately conducted) then it is reasonable to make the relevant inference about the effect of the cause in question.
While useful, this sort of study is weaker than the experiment. This is because those conducting the study have to take what they get—the experimental group is already exposed to the cause and this can create problems in properly sorting out the effect of the cause in question. As such, while a properly run experiment can still get erroneous results, a properly run study is even more likely to have issues.
A second type of study is the effect to cause study. It differs from the cause to effect experiment and study in that the effect is known but the cause is not. Hence, the goal is to infer an unknown cause from the known effect. It also differs from the experiment in that those conducting the study obviously do not introduce the cause.
This study is conducted by comparing the experimental group and the control group (which are, ideally, as similar as possible) to sort out a likely cause by considering the differences between them. As would be expected, this method is far less reliable than the others since those doing the study are trying to backtrack from an effect to a cause. If considerable time has passed since the suspected cause, this can make the matter even more difficult to sort out. The conducting the study also have to work with the experimental group they happen to get and this can introduce many complications into the study, making a strong inference problematic.
An example of this would be a study of elderly dogs who suffer from paw knuckling (the paw flips over so the dog is walking on the top of the paw) to determine the cause of this effect. As one might suspect, finding the cause would be challenging—there would be a multitude of potential causes in the history of the dogs ranging from injury to disease. It is also quite likely that there are many causes in play here, and this would require sorting out the different causes for this same effect. Because of such factors, the effect to cause study is the weakest of the three and supports the lowest level of confidence in its results even when conducted properly. This explains why it can be so difficult for researchers to determine the causes of many problems that, for example, elderly dogs suffer from.
In the case of Isis, the steroids that she is taking have been well-studied, so it is quite reasonable for me to believe that they are a causal factor in her remarkable recovery. I do not, however, know for sure what caused her knuckling—there are so many potential causes for that effect. However, the important thing is that she is now walking normally about 90% of the time and her tail is back in the air, showing that she is a happy husky.
Philosophy & My Old Husky II: Difference & Agreement
As mentioned in my previous essay, Isis (my Siberian husky) fell victim to the ravages of time. Once a fast sprinting and long running blur of fur, she now merely saunters along. Still, lesser beasts fear her (and to a husky, all creatures are lesser beasts) and the sun is warm—so her life is still good.
Faced with the challenge of keeping her healthy and happy, I have relied a great deal on what I learned as a philosopher. As noted in the preceding essay, I learned to avoid falling victim to the post hoc fallacy and the fallacy of anecdotal evidence. In this essay I will focus on two basic, but extremely useful methods of causal reasoning.
One of the most useful tool for causal reasoning is the method of difference. This method was famously developed by the philosopher John Stuart Mill and has been a staple in critical thinking classes since way before my time. The purpose of the method is figuring out the cause of an effect, such as a husky suffering from a knuckling paw (a paw that folds over, so the dog is walking on the top of the foot rather than the bottom). The method can also be used to try to sort out the effect of a suspected cause, such as the efficacy of an herbal supplement in treating canine arthritis.
Fortunately, the method is quite simple. To use it, you need at least two cases: one in which the effect has occurred and one in which it has not. In terms of working out the cause, more cases are better—although more cases of something bad (like arthritis pain) would certainly be undesirable from other standpoints. The two cases can actually involve the same individual at different times—it need not be different individuals (though it also works in those cases as well). For example, when sorting out Isis’ knuckling problem the case in which the effect occurred was when Isis was suffering from knuckling and the case in which it did not was when Isis was not suffering from this problem. I also looked into other cases in which dogs suffered from knuckling issues and when they did not.
The cases in which the effect is present and those in which it is absent are then compared in order to determine the difference between the cases. The goal is to sort out which factor or factors made the difference. When doing this, it is important to keep in mind that it is easy to fall victim to the post hoc fallacy—to conclude without adequate evidence that a difference is a cause because the effect occurred after that difference. Avoiding this mistake requires considering that the “connection” between the suspected cause and the effect might be purely a matter of coincidence. For example, Isis ate some peanut butter the day she started knuckling, but it is unlikely that had any effect—especially since she has been eating peanut butter her whole life. It is also important to consider that an alleged cause might actually be an effect caused by a factor that is also producing the effect one is concerned about. For example, a person might think that a dog’s limping is causing the knuckling, but they might both be effects of a third factor, such as arthritis or nerve damage. You must also keep in mind the possibility of reversed causation—that the alleged cause is actually the effect. For example, a person might think that the limping is causing the knuckling, but it might turn out that the knuckling is the cause of the limping.
In some cases, sorting out the cause can be very easy. For example, if a dog slips and falls, then has trouble walking, then the most likely cause is the fall (but it could still be something else—perhaps the fall and walking trouble were caused by something else). In other cases, sorting out the cause can be very difficult. It might be because there are many possible causal factors. For example, knuckling can be caused by many things (apparently even Lyme disease). It might also be because there are no clear differences (such as when a dog starts limping with no clear preceding event). One useful approach is to do research using reliable sources. Another, which is a good idea with pet problems, is to refer to an expert—such as a vet. Medical tests, for example, are useful for sorting out the difference and finding a likely cause.
The same basic method can also be used in reverse, such as determining the effectiveness of a dietary supplement for treating canine arthritis. For example, when Isis started slowing down and showing signs of some soreness, I started giving her senior dog food, glucosamine and some extra protein. What followed was an improvement in her mobility and the absence of the signs of soreness. While the change might have been a mere coincidence, it is reasonable to consider that one or more of these factors helped her. After all, there is some scientific evidence that diet can have an influence on these things. From a practical standpoint, I decided to keep to this plan since the cost of the extras is low, they have no harmful side effects, and there is some indication that they work. I do consider that I could be wrong. Fortunately, I do have good evidence that the steroids Isis has been prescribed work—she made a remarkable improvement after starting the steroids and there is solid scientific evidence that they are effective at treating pain and inflammation. As such, it is rational to accept that the steroids are the cause of her improvement—though this could also be a coincidence.
The second method is the method of agreement. Like difference, this requires at least two cases. Unlike difference, the effect is present in all the cases. In this method, the cases exhibiting the effect (such as knuckling) are considered in order to find a common thread in all the cases. For example, each incident of knuckling would be examined to determine what they all have in common. The common factor (or factors) that is the most plausible cause of the effect is what should be taken as the likely cause. As with the method of difference, it is important to consider such factors as coincidence so as to avoid falling into a post hoc fallacy.
The method of agreement is most often used to form a hypothesis about a likely cause. The next step is, if possible, to apply the method of difference by comparing similar cases in which the effect did not occur. Roughly put, the approach would be to ask what all the cases have in common, then determine if that common factor is absent in cases in which the effect is also absent. For example, a person investigating knuckling might begin by considering what all the knuckling cases have in common and then see if that common factor is absent in cases in which knuckling did not occur.
One of the main weaknesses of these methods is that they tend to have very small sample sizes—sometimes just one individual, such as my husky. While these methods are quite useful, they can be supplemented by general causal reasoning in the form of experiments and studies—the subject of the next essay in this series.
A Philosopher's Blog 
1 comment