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December 2010 posts

A Moral Sentiments Perspective on Health Care

Jonathan B. Wight

Mark raised an important question, “Does health care have special moral status?”  Mark answers in the negative, using strong intellectual arguments.  These arguments are not wrong but I suggest here they are incomplete because they fail to consider important aspects of human nature.

There is a moral sentiments argument for health care that is plainly made by Adam Smith in The Theory of Moral Sentiments (III-3.4):

Smith starts with the famous line: “Let us suppose that the great empire of China, with all its myriads of inhabitants, was suddenly swallowed up by an earthquake…” 

Smith says that a person of great humanity in Europe would care very little about this calamity if he were far removed from the suffering.  Hence:  “If he was to lose his little finger to-morrow, he would not sleep to-night; but, provided he never saw [those suffering], he will snore with the most profound security over the ruin of a hundred millions of his brethren….” 

But Smith goes on to show that if offered the choice of sacrificing a finger to save those hundred million Chinese, the moral imagination swings actively into gear.  “Human nature startles with horror at the thought,” that if we could easily prevent suffering, that we would sit by and do nothing. 

Hence: “When our passive feelings are almost always so sordid and so selfish, how comes it that our active principles should often be so generous and so noble?” (emphasis added).

The bottom line is: The obvious lack of health care in some citizens, when it is widely viewed as resulting in pain that could be easily prevented or ameliorated, produces emotional shock that leads to active engagement to address the problem.  The same is not true for most other products. 

Example:  Let’s consider the case of last summer’s Copiapó mining accident in Chile. A purely intellectual analysis might conclude that Chileans (and others from all over the world) should not have devoted all those massive resources to saving the lives of the 33 trapped miners nearly a half-mile underground.  The miners understood the risks of taking the job, and were presumably paid a premium for that risk. 

Using cost-benefit analysis, one could show fairly easily that the money used to save these miners could save far more life-years used elsewhere.  Yet the reason the miners were saved is because the moral imagination was aroused.  This can be inefficient (it certainly is) and unjust (it likely is)—but it is an integral part of human nature. 

Hence, the pure libertarian view fails to consider the “externality” effect that pain causes on other citizens.  A pure libertarian might say, “Let them suffer—they made their own choices.”  But that runs counter to human biology (our mirror neuron system) as well as to religious injunctions (see the parable of the prodigal son).  Health care really is different because of the moral sentiments it arouses.

Procrastination featured on CBC's The Current Tuesday, December 28

Mark D. White

I'll be appearing on CBC's The Current program Tuesday morning, December 28, discussing procrastination alongside Piers Steel, prominent procrastination researcher and author of The Procrastination Equation: How to Stop Putting Things Off and Start Getting Stuff Done. I'll post a link to the online version/podcast as soon as I get it.

UPDATE: Here's the podcast.


Does health (or health care) have special moral status?

Mark D. White

I just came across a fascinating paper titled "Is Health (Really) Special? Health Policy Between Rawlsian and Luck Egalitarian Justice" by Shlomi Segall (Hebrew University of Jerusalem) in the Journal of Applied Philosophy. From the abstract:

In recent work, Norman Daniels extends the application of Rawls's principle of "fair equality of opportunity" from health care to health proper. Crucial to that account is the view that health care, and now also health, is special. Daniels also claims that a rival theory of distributive justice, namely luck egalitarianism (or "equal opportunity for welfare"), cannot provide an adequate account of justice in health and health care. He argues that the application of that theory to health policy would result in an account that is, in a sense, too narrow, for it denies treatment to imprudent patients (e.g. lung cancer patients who smoked). In a different sense, Daniels argues, luck egalitarian health policy would be too wide: it arguably tells us to treat individuals for such brute-luck conditions as shyness, stupidity, ugliness, and having the ‘wrong’ skin colour.

Segall takes issue with Daniels' analysis, but (with apologies to Segall) it is Daniels' basic thesis that interests me more. As regular readers of this blog may guess, even on utilitarian terms I would regard health (and by extension heath care) to be undeserving of any special moral status and, rather, just one component of a person's well-being which she can choose to pursue to whatever extent she wishes in conjunction with the other components (such as wealth, love, pleasure, etc.).

With respect to health care, Segall explains that

To say that health care is special was to say that it is morally significant in ways that justify distributing medical resources in isolation from the way in which other social goods, and wealth in particular, are distributed. The most obvious implication of the specialness account, understood this way, is that health care resources should not be treated as mere commodities... [they] should be distributed more equally than most other goods, and, in any case, independently of ability to pay. (p. 346)

He claims that this follows from commonly held beliefs regarding health care:

Such thinking about health care seems to correspond to a widely shared intuition: while many of us would not object to some people being wealthier than others, far fewer would condone a situation whereby greater wealth buys superior medical care. This intuition about health care as constituting a special and separate sphere is thus a well entrenched one. (Ibid.)

He then goes on to discuss (critically) Daniels' extension of this same status to health in general. I plan on reading the article carefully, and also Daniels' books in the area, Just Health Care and Just Health: Meeting Health Needs Fairly, both of which I ordered today.

I'm fascinated by this line of thinking, as well as the claim that this is a common intuition--and I agree that it very well may be--because I find it so profoundly wrong. Simply put, I fail to see why health or health care should be morally privileged when it is a matter of individual choice to what extent a person takes care of her own health, or seeks out health care in pursuit of it. (For more on this, see my earlier posts on health care here, here, and here.) Accordingly, I think there is more of a case (though not a good enough case to support it overall) for resource egaliarianism which provides more equal resources for individuals to use as they choose, whether on health (or health care) or not, without granting either one any special status. But I don't see why health or health care should be given more status than other goals individuals may pursue with their resources (however those resources may be earned or allocated).

Christmas, Religion, and a New God

Jonathan B. Wight

It’s Christmas Day, and snow is falling gently in Richmond, Virginia.  Yes, Virginia, there is a Santa Claus—if shopping malls are any indication.

Santa rules, but is there a God?  This is the subject of John Shelby Spong’s latest book, Eternal Life: A New Vision: Beyond Religion, Beyond Theism, Beyond Heaven and Hell (2010).  Spong is the controversial Episcopal bishop and prolific author who argued in previous books that Christianity had to modernize or die. Religion’s dogmas are deadening because they conflict with science and current common sense.  “One cannot restore life by doing a facelift on a corpse,” he wrote, in one of the memorable lines (p. 142). 

This isn’t particularly new; what is new is that an Episcopal bishop (now retired) is writing this.  Spong is speaking tomorrow in Richmond at my church—and the church he previously led—historic St. Paul’s Episcopal.  This is the church where, according to local legend, Robert E. Lee set the tone for the post-Civil War society by kneeling alongside a black man at the altar to receive communion. 

Spong is also willing to break with the past to forge a new direction for understanding religion and ethics.  Spong’s conclusion is that there is no God, at least not one of heaven and hell.  Rather, we must understand God (or love) as an internal link with the evolving consciousness of humanity.  This conclusion ends up being startlingly similar to Teilhard de Chardin’s thesis in his remarkable work, The Phenomenon of Man (1955). 

One is reminded of Adam Smith’s doctrine that belief in an afterlife is required if people are to develop self control needed for justice.  Is that an outdated notion?  Will humanity outgrow needing the threat of an afterlife (whether in Christianity, Islam, or Buddhism), by adopting a new universal consciousness?

Merry Christmas and happy dreams for the future…

New book: Friend v. Friend: The Transformation of Friendship--and What the Law Has to Do with It

FVF Mark D. White

I recently received Friend v. Friend: The Transformation of Friendship--and What the Law Has to Do with It, the latest book from Oxford University Press by Ethan J. Leib, professor of law at University of California-Hastings and one of the regular bloggers at PrawfsBlawg. It's a book that I'm anticipating enjoying immensely, and which I hope to blog about at Psychology Today when I have time to fully digest it.

More information from the publisher below the fold:

Continue reading "New book: Friend v. Friend: The Transformation of Friendship--and What the Law Has to Do with It" »

Externalities for Christmas

Mark D. White

Today's Pickles strip provides a valuable service to gungho-ho-ho regulators everywhere:


Why, this is going on in every neighborhood in America! Something must be done! I can hear them now: "We'll have to subsidize the decorators--no, no, we'll tax the nondecorators! Better yet, we'll make everyone buy holiday decorations, and tax penalize put coal in their stockings if they don't..."

Call for papers: Workshop on History of Economics as Culture

Mark D. White

From the indispensable Heterodox Economics Newsletter comes this fascinating call:

Workshop: History of Economics as Culture

April 8th, 2011 | the University of Cergy-Pontoise (near Paris, France)
Deadline for proposals is January 15, 2011

This is to remind you that we are organizing on behalf of the H2S (History of Social Science) group, Economix (CNRS FRE 2357) and THEMA (CNRS UMR 8184), the third workshop on "history of 'economics as culture' (Histoire culturelle des savoirs économiques)" to be held Friday, April 8th, 2011 at the University of Cergy-Pontoise (near Paris, France). Our intention is to bring together scholars from different disciplines to discuss from an historical vantage point, the place of economics in our culture. Below are some suggestions of topics that exemplify what will be at issue:

  • To consider the interactions between art, literature and economics;
  • To discuss the interactions between cultural or artistic objects such as magazines, books, maps, photographs, paintings, graphs and economic thinking and to consider economic texts as cultural items and to reflect upon the consequences their physical form had on their reception.
  • To consider economics as part of cultures (political, commercial, scientific, etc.) of past (including very recent past) societies; in particular, to discuss the economic representations (or culture) of specific social groups such as merchants, workers, businessmen, etc.

The workshop will comprise of 5 or 6 papers containing genuine unpublished research. If you have an interest in these topics, please send us a proposal of no more than 1000 words or a draft paper of what you want to present before January, 15 at the following address: [email protected]

If you are interested in the subject but are unable to send a proposal, feel free to contact us at the same address for further discussion/information. Also, last year program is available here: http://economix.u-paris10.fr/fr/activites/colloques/?id=113

The Moral Psychology of War (tpm's Idea of the Century #42)

Mark D. White

Sherman As Jonathan noted previously, the philosophers' magazine (tpm) has been running a series of the top 50 Ideas of the 21st Century, and today's entry, #42, is "The Moral Psychology of War" by one of my favorite philosophers, Nancy Sherman, author of The Untold War: Inside the Hearts, Minds, and Souls of Our Soldiers, Stoic Warriors: The Ancient Philosophy behind the Military Mind, Making a Necessity of Virtue: Aristotle and Kant on Virtue, and The Fabric of Character: Aristotle's Theory of Virtue.

From the article:

Going to war inevitably turns policymakers and academics to philosophical justifications of war and its conduct. And so, unsurprisingly, there has been a renaissance over the past ten years in just war theory. But what we need moral clarity about is not just whether a war or its prosecution is justified, but how soldiers bear the moral weight of war. Soldiers go to war to fight external enemies, in Iraq and Afghanistan today, or in Europe and the Pacific in my father’s era. But most, at least the honest among them, fight inner wars as well. They wrestle with the guilt of luck and accident, and the uneasy burden of killing and leaving the killing behind. For some, what weighs heavy is the sense of betrayal that is part of the moral shadowland of wartime interrogation – of building intimate rapport with a detainee only to exploit it. For others, the moral burden comes with killing civilians, as part of the permissible, but no less wrenching collateral damage of war.

Call for papers: International Network for Economic Method, Helsinki, September 2011

Mark D. White



IX Conference of the

International Network for Economic Method

 Friday-Saturday 2-3 September 2011

Helsinki, Finland


The ninth INEM conference will be hosted by TINT at the University of Helsinki. Proposals for contributed papers as well as symposia are welcome in all areas of economic methodology and cognate disciplines.

Please send an abstract of 500-1500 words (for symposia 1500-3000 words) to [email protected]. Attach contact details of the author (name, affiliation, email address) on a separate page.

The deadline for submissions is 1 April, 2011. Acceptance will be communicated by 15 May, 2011.

Acceptance to present a paper at the conference will be based solely on the abstracts. If, however, you send a full paper to the conference organisers by the 1st of July, and your abstract has been accepted, then a discussant will be assigned to your paper.

The selection committee and special keynote speakers will be announced later.

Local organising committee: Uskali Mäki, Till Grüne-Yanoff, Aki Lehtinen, Caterina Marchionni, Tarja Knuuttila, Jaakko Kuorikoski.

On Artifical Intelligence and Personhood (with thanks to Isaac Asimov)

Mark D. White

Thanks to Larry Solum's Legal Theory Blog, I became aware of F. Patrick Hubbard's new paper "'Do Androids Dream?': Personhood and Intelligent Artifacts," forthcoming in Temple Law Review, which considers the issue of granting the status of personhood to an artificial intelligence:

This Article proposes a test to be used in answering an important question that has never received detailed jurisprudential analysis: What happens if a human artifact like a large computer system requests that it be treated as a person rather than as property? The Article argues that this entity should be granted a legal right to personhood if it has the following capacities: (1) an ability to interact with its environment and to engage in complex thought and communication; (2) a sense of being a self with a concern for achieving its plan for its life; and (3) the ability to live in a community with other persons based on, at least, mutual self interest. In order to develop and defend this test of personhood, the Article sketches the nature and basis of the liberal theory of personhood, reviews the reasons to grant or deny autonomy to an entity that passes the test, and discusses, in terms of existing and potential technology, the categories of artifacts that might be granted the legal right of self ownership under the test. Because of the speculative nature of the Article's topic, it closes with a discussion of the treatment of intelligent artifacts in science fiction.

Skimming through this fascinating paper, I am especially grateful for the extended treatment (pp. 82-88) of Isaac Asimov and his conception of robotic artificial intelligence from his R. Daneel Olivaw novels (as well as his many short stories on robots), a longtime devotion of mine. (Did reading about the Three Laws of Robotics lead to my embrace of Kant later in life? Who knows...)