Doing Ethics

Selling or Sharing Kidneys?

2011-03-28T10:54:00.000-07:00

The ethical debate over whether US law should allow a healthy person to “sell” a kidney illustrates how health care debates may involve only consequential reasoning.

Those in favor of a law that would permit a market in kidneys for transplantation offer the following consequential arguments. First, the demand for kidneys now so greatly exceeds the supply that many persons on the list to receive a donated kidney will die before a kidney is available for them. Second, a greater supply of kidneys would enable doctors to choose the healthiest donors, which is better both for donors as well as for recipients. Third, the cost of maintaining people on dialysis is greater than the cost of kidney transplantation. And fourth, the growing demand for kidneys is stimulating a black market that not only encourages illegal activity, but also increases the risk that a patient will receive a kidney not properly screened to prevent the transmission of an infectious disease.

Those opposed to allowing the sale of kidneys also rely on consequential reasoning, but emphasize negative rather than positive outcomes. First, such a market would necessarily be global and thus could not be properly regulated. Second, without regulation the risks of transmitting diseases would increase. And third, such a market would likely increase unethical practices, such as exploiting poor persons and harvesting kidneys from unwilling “donors” who are not legally protected against such a theft.

An article appropriately entitled “The consequences of a donor kidney market” in the Los Angeles Times (http://www.latimes.com/health/la-he-pro-con-kidney-donors-20110328,0,4492170.story) presents these arguments. In this article the health professional who opposes an open market does support removing financial “disincentives” from the present system of kidney donations by providing health and life insurance to living donors who do not have this coverage.

It is worth noting that this debate often ignores arguments for intrinsic values. In the Times article there is no consideration of the ethical argument for the intrinsic value of encouraging persons to allow their kidneys to be harvested after their death. This argument values the character of a giving person and also resists the notion that our organs are “ours” even after we die. It urges us to see our organs as gifts that should be shared when we are no longer able to live and make use of them.

This sort of ethical argument may be raised to support changing US law that now presumes the healthy kidneys of a deceased person cannot be harvested unless the person has indicated in writing that she wishes to make such a donation. Viewing organs as gifts to be shared, rather than as rightful possessions or as commodities that may be sold, would be reflected in changing our legal presumption to allow the harvesting of any usable organ from the body of a deceased person, unless he has explicitly rejected organ harvesting.

With hope . . . Bob

Carpool lane fees?

2011-03-24T19:18:00.000-07:00

The Los Angeles Times supports permitting a single person driving a car to use carpool lanes, if the driver pays a fee.

The Times offers three arguments in favor of this policy change. First, it would bring in revenue for the government, which is badly needed. Second, “the new system would not only speed up commutes for the people paying to get into the carpool lanes but would ease traffic for those remaining in the other lanes as well (because the tollpayers wouldn't be there)." Third, “the money from the fees must be spent, by law, on transit or carpool improvements in the same corridor where the funds were generated . . . . And those improvements will benefit not only the people driving in the fast lanes, but those in the other lanes as well.” (http://www.latimes.com/news/opinion/editorials/la-ed-carpool-20110317,0,15024.story)

These are consequential arguments that the change is justified because the likely benefits outweigh any possible detrimental outcomes, such as being unfair to people with low incomes and setting a precedent of imposing fees for services the government has a duty to provide equitably.

One way to analyze this conflict in moral reasoning is to first define the ethical presumption at stake, which in this instance is the duty of government to provide roads for travel that may be used equitably, and then ask: Should this ethical presumption be ignored by allowing a driver alone in his car, who does not qualify to use a carpool lane, to do so by paying a fee?

Reasonable persons might come to different conclusions. Yet, if we agree that a government has a duty not only to act equitably, but also to provide for the common good, then allowing carpool use for a fee seems more reasonable. For in "selling" a benefit the government also creates, without any additional cost, another benefit for those unable to pay the carpool use fee, in that an increase of cars in the carpool lane reduces congestion in the other lanes.

With hope . . . Bob

Environmental Justice

2011-03-22T07:17:00.000-07:00

The Los Angeles Times reports: "A San Francisco superior court judge has put California's sweeping plan to curb greenhouse gas pollution on hold, saying the state did not adequately evaluate alternatives to its cap and trade program." Specifically, "the judge noted, officials gave short shrift to analyzing a carbon fee, or carbon tax . . . to a market-based trading system in their December 2008 plan."

The California lawsuit, which was filed by environmental groups representing low-income communities, asserts that: "a cap-and-trade program would allow refineries, power plants and other big facilities in poor neighborhoods to avoid cutting emissions of both greenhouse gases and traditional air pollutants." (See http://latimesblogs.latimes.com/greenspace/2011/03/california-global-warming-program-put-on-hold.html.)

This dispute involves a conflict of ethical arguments. The argument supporting California's cap and trade plan is consequential. Imposing the plan on industrial facilities emitting greenhouse gases would reduce these emissions. The argument for environmental justice also involves consequential reasoning, as it points to the likely consequences of such a plan for low-income communities. But its main ethical assertion is about the government's duty to act with justice, because the rule of law requires that the rights of citizens be given equal protection.

In the Times article Bill Gallegos, executive director of Communities for a Better Environment, defends the court decision because: “It means that oil refineries, which emit enormous amounts of greenhouse gases and contribute to big health problems, cannot simply keep polluting by purchasing pollution credits, or doing out of state projects.”

The consequential argument for a cap and trade program rests on the prediction that overall there will be reduction in greenhouse gas emissions. The environmental justice argument affirms duties that must be fulfilled and rights that must be protected, and also weighs the overall estimate of greenhouse gas reduction against the likely deleterious consequences for low-income communities.

With hope . . . Bob Traer

Just Wars?

2011-03-21T08:34:00.000-07:00

The basic idea of a just war is very simple and ancient. If a community is attacked, fighting to defend the community is just. It is, however, more difficult to justify initiating a war. Yet, the religious traditions of Judaism, Christianity and Islam have each offered reasons for doing so.

In the Torah God tells the ancient Israelites to fight the peoples of Canaan, because God is giving the land to the people he has chosen. Deuteronomy presents a long sermon, attributed to Moses, which includes this passage: “When the LORD your God brings you into the land that you are abaout to enter and occupy, and he clears away many nations before you — the Hittites, the Girgashites, the Amorites, the Canaanites, the Perizzites, the Hivites, and the Jebusites, seven nations mightier and more numerous than you — and when the LORD your God gives them over to you and you defeat them, then you must utterly destroy them.” (Dt. 7:1-2)

This “holy war” is just, the Torah claims, because God is just, and God commands that the war be fought. At the end of the New Testament the Revelation to John ends with a vision of a battle between the forces of evil and the forces of good, which is assumed to be a just war because it is the will of God.

Nonetheless, Christians were pacifists until in the fourth century Emperor Constantine converted and made defending the Roman Empire not only a just cause, but also a Christian duty.

Islam teaches that Muslims have a duty to embrace jihad, which means defending the truth. In a time of peace, and within the Muslim community, this involves a quest for spiritual and moral purification. In a world of war, it means fighting for Islam against its enemies. As with Jewish and Christian notions of holy war, jihad is assumed to be just because it is God’s revealed will.

To check the dangers of holy war, theologians in the West developed a more philosophical understanding of what constitutes a just war. The principles of the just war tradition rely on ethical presumptions, rather than assertions of divine authority. In the thirteenth century Thomas Aquinas formulated these principles, and European political writers applied these principles to judge the wars of the sixteenth and seventeenth centuries.

The following moral presumptions sum up the duty of a government, as it contemplates war. To be justifiable, a war must:

Have a just cause.
Be declared by a proper authority.
Be based on a right intention.
Use just means.
Have a reasonable chance of success.
Result in more good than harm.
Be a last resort.

At the end of the eighteenth century revolutionary wars were fought in what would become the United States and in France. The British government certainly did not consider the American revolt to be justified, but instead asserted that British authority over the colonies was lawful. Likewise, the king of France did not believe the French rebels had any legitimacy.

Yet, the American and French uprisings in pursuit of new forms of representative government were successful, not only on the battlefield, but also in securing public support for the rights that each uprising affirmed. Both of these revolutions justified war in order to assert civil and political rights and democratic government.

Today, rather than relying on the just war tradition, Western nations evoke the revolutionary understanding of a just war to defend their military intervention in Libya.

With hope . . . Bob Traer

Arguments Against Torture

2011-03-20T07:45:00.000-07:00

What are the rules?

The Convention against Torture states more precisely the rights and duties set forth in Articles 7 and 10 of the International Covenant on Civil and Political Rights. Very clearly the Convention declares the moral presumption that torture is wrong, that governments have a duty to prevent it, and that there are to be no exceptions made to this moral and legal duty.

The United States has incorporated this presumption into its domestic laws and also into the Uniform Code of Military Justice (UCMJ, Articles 77-134). The McCain amendment to the defense spending bill, which was passed at the end of 2005, clearly prohibits “cruel, inhuman or degrading treatment of punishment” of anyone in U. S. government custody anywhere in the world. This amendment also requires that procedures in the Army Field Manual be followed in interrogating prisoners.

Consequential Reasoning

It would seem that nothing could be clearer than the moral and legal presumption not to torture. Yet, when President George W. Bush signed the bill that included the McCain amendment, he attached a signing statement affirming his right, as Commander in Chief, to bypass the law if he felt enforcing the prohibition against torture would jeopardize national security.

This statement by the President plus the treatment of prisoners in Abu Ghraib and the U. S. prison at Guantánamo Bay are evidence that consequence arguments are being used to try to justify torture. There are, however, strong consequence arguments against the use of torture.

Burton J. Lee III, a doctor in the Army Medical Corps who served as physician to President George H. W. Bush, writes: “The military ethics that I know absolutely prohibit anything resembling torture….Discipline and order in the military ranks depend to a large extend on compliance with the prohibition of torture….In addition, military leaders have long been aware that torture inflicts lasting damage on both the victim and the torturer. The systematic infliction of torture engenders deep hatred and hostility that transcends generations. And it perverts the role of medical personnel from healers to instruments of abuse.”

Lee argues that: “reports of torture by U. S. forces have been accompanied by evidence that military medical personnel have played a role in this abuse and by new military ethical guidelines that in effect authorize complicity by health professionals in ill-treatment of detainees. These new guidelines distort traditional ethical rules beyond recognition to serve the interests of interrogators, not doctors and detainees.”

Character Argument

To these consequence arguments, Lee adds an appeal to character: “Torture demonstrates weakness, not strength. It does not show understanding, power or magnanimity. It is not leadership. It is a reaction of government officials overwhelmed by fear who succumb to conduct unworthy of them and of the citizens of the United States.”

With hope . . . Bob Traer

What Should We Do?

2011-03-05T19:10:00.000-08:00

“What should we do?” All philosophical and religious traditions affirm that there are right actions and ways of being good persons that have intrinsic worth. The prohibition against murder and being the kind of person who offers hospitality are cross-cultural examples. Each of these ethical imperatives may be justified by reasoning that is not utilitarian, and may also be defended with religious arguments.

Alternatively, consequential reasoning does not presume there are any intrinsically right actions or ways of being, but instead asserts that we should do whatever we think will probably have the best consequences. When stated as utilitarian ethics, the answer as to what we should do is whatever will likely result in “the greatest good for the greatest number.”

Problems with consequential reasoning include the limitations on our ability to predict the future, the difficulties of measuring and comparing happiness, suffering, loss of ecosystems, financial gain, etc., and the potential use of this reasoning to disregard the rights and welfare of those in the minority. We see consequential reasoning at its worst in trickle-down economic arguments for cutting taxes for the rich and in removing governmental regulations on corporate energy production as a way of realizing greater efficiency and lower consumer costs.

Yet, consequential reasoning also has practical benefits, as we all know. There are significant risks of acting only on our good intentions. Utilitarian reasoning supports democracy by valuing the happiness or suffering of everyone (at least in principle) who might be affected by an action. Jeremy Bentham and John Stuart Mill relied on utilitarian reasoning to justify social movements for prison and educational reforms. More recently, Peter Singer has made utilitarian reasoning popular by emphasizing the suffering of animals in his assessment of the consequences of the consumer lifestyle we enjoy and recommend for the world.

My approach in “doing ethics” is pluralist and pragmatic. It is pluralist, because I assess deontological and teleological arguments about what is intrinsically right and good, as well as consequential reasoning. It is pragmatic, because I recommend constructing an ethical presumption from the deontological and teleological arguments, and then testing this presumption by consequential reasoning.

Doing Ethics in a Diverse World applies this approach to issues such as health care, capital punishment, terrorism, economic justice, AIDS, and sexual conduct. Doing Environmental Ethics asks what we should do about air and water pollution, the preservation of wild places and endangered species, factory farming, economic development, and climate change.

With hope . . . Bob

We Shall Overcome

2011-01-17T07:29:00.000-08:00

Singing this song yesterday in church brought tears to my eyes. In 1965 I sung it in the Black churches of Benton County, Mississippi, a rural county where I was engaged in civil rights work.

I interviewed sharecroppers who were being kept in economic servitude by landowners and wrote affidavits that were sent to lawyers in the North who were preparing a lawsuit to redress this wrong. I taught "Freedom School" to help the kids of the Black community get ready for the integration of the schools under a court order that was to be enforced in the fall of 1965. I also documented the discriminatory practices utilized at the county courthouse to prevent Black residents from registering to vote.

All the "political" meetings concerning the assertion and protection of these civil rights were held in Black churches, and it was there that we sang songs such as "Keep Your Eye on the Prize," "I'm Gonna Do What the Spirit Say Do," "Woke Up This Morning with My Mind Set on Freedom," and "We Shall Overcome."

The faith and courage of Black American Christians sustained the nonviolence of the Civil Rights Movement and its leaders, such as Dr. Martin Luther King, Jr. These faithful Christians brought our country a step closer to what Dr. King called "the beloved community," and their witness transformed my life.

With hope . . . Bob

Nonviolence

2011-01-16T07:20:00.000-08:00

Two years after working as a civil rights worker in Mississippi, I marched for open housing with Dr. Martin Luther King, Jr in Chicago. The march into a Southwest neighborhood that was all white was nonviolent, but the reaction of the crowd was not.

We marched about eight abreast, with men on the outside closer to the angry neighbors protesting our presence in their community. I recall a large young man who was shaking all over, in his rage, as he jabbed his finger at me and shouted, "I'll kill you! I'll kill you!"

Our cars parked at a nearby public park were smashed and burned that day, so after the march the Chicago police brought in school buses to move us out of the neighborhood. Women were bused out first, and I recall leaving the area in the last bus. With stones shattering the windows, scattering broken glass over our backs as we huddled on the floor, the bus ran the gauntlet until, ironically, we were safe within the Black ghetto of Chicago's Southside.

Dr. King and the rest of us on this march were condemned by many citizens of Chicago for provoking the violence that occurred in response to the march for non-discrimination in housing.

Clearly, nonviolent protest in defense of an ethical principle may trigger violence as an unintended consequence. Yet, backing away from asserting an ethical principle because of the possibility of violence empowers those who embrace violence as a tactic to resist justice. There are times when patience is prudent, but prudence as a virtue should not be valued more than asserting and protecting fundamental rights.

Today in the United States violence and allusions to violence are being used to undermine respect for the rule of law. Were Dr. King with us, he would be marching not merely for civility, although this is crucial for the rule of law, but also for the rights that protect our human dignity and promise its realization within our society.

With hope . . . Bob

Rule of Law and Sin

2011-01-14T07:27:00.000-08:00

In "A Tale of Two Moralities" (http://www.nytimes.com/2011/01/14/opinion/14krugman.html) Paul Krugman writes: "Today’s GOP sees much of what the modern federal government does as illegitimate; today’s Democratic Party does not. When people talk about partisan differences, they often seem to be implying that these differences are petty, matters that could be resolved with a bit of good will. But what we’re talking about here is a fundamental disagreement about the proper role of government."

Krugman concludes: "We all want reconciliation, but the road to that goal begins with an agreement that our differences will be settled by the rule of law."

Civility alone will not yield a common morality. Because, as David Brooks reminds us: "Civility is the natural state for people who know how limited their own individual powers are and know, too, that they need the conversation." (http://www.nytimes.com/2011/01/14/opinion/14brooks.html). "The problem," as Brooks sees it, "is that over the past 40 years or so we have gone from a culture that reminds people of their own limitations to a culture that encourages people to think highly of themselves." Using theological language, Brooks asserts that "over the past few decades, people have lost a sense of their own sinfulness."

For guidance, he turns to Reinhold Niebuhr: "Nothing that is worth doing can be achieved in our lifetime; therefore, we must be saved by hope. ... Nothing we do, however virtuous, can be accomplished alone; therefore, we are saved by love. No virtuous act is quite as virtuous from the standpoint of our friend or foe as it is from our standpoint. Therefore, we must be saved by the final form of love, which is forgiveness."

A common morality that embraces the rule of law requires both an awareness of sin and faith in the power of love.

Celebrating a marriage

2010-08-15T18:52:00.000-07:00

Whenever I have conducted a wedding ceremony, as an ordained minister, I have celebrated the commitment of a couple to be faithful to one another. The mutual affirmation of committed love ”till death do us part” is what makes marriage so special.

As an ideal, marriage confirms a sense of love that is greater than physical attraction and deeper than the security of companionship. A marriage celebrates love as a gift of grace, a spiritual reality that transforms our material existence, a bond that expresses faith and hope as well as love.

I have not married two women, or two men, but I can see no reason why such a couple might not affirm the same understanding of their loving relationship as a man and a woman. Of course, the marriage of a gay couple might fall short of this ideal, but so do many marriages involving a man and a woman. Our inability to live up to our ideals is no reason not to celebrate our commitment to them, and to forgive one another when we fall short.

Rather than make it difficult for gay couples to marry, we should be grateful that many gay couples want to affirm the kind of committed love that we celebrate in a marriage ceremony.

With hope...Bob

Reasoning vs rationalizing

2010-08-10T21:17:00.000-07:00

A reason is “a statement offered in explanation or justification” that expresses “a rational ground or motive” and “supports a conclusion or explains a fact.” As a verb, reason means “to use the faculty of reason so as to arrive at conclusions.” Reasoning is thinking. Being rational refers to having a reason, being reasonable means “being in accord with reason.”

In moral philosophy arguing involves giving reasons for a conclusion. An argument, therefore, is not about opinions or beliefs, but about the reasons for our opinions or beliefs. In ethics, the goal of arguing is (or should be) not to win, but to clarify our reasoning.

This means unmasking rationalizations. In some disciplines of thought “rationalize” means “to bring into accord with reason,” but in ethics it means “to attribute (one’s actions) to rational and creditable motives without analysis of true and especially unconscious motives.” A reason is not a rationalization, in moral philosophy, because reasoning involves analyzing our motives. It is often difficult, however, to distinguish reasons from rationalizations.

For example, if I own land that I want to log to make a profit, but argue at a public hearing that logging should be allowed because it will bring jobs into the community, my public statement is a rationalization. If, however, I state publicly that I support logging because I will benefit from it and think that the community will also benefit, I am giving two reasons for my position. Self-interest is rational and is not a rationalization, unless self-interest is concealed or is the unconscious motivation for making an argument.

With hope...Bob

Predicting consequences

2010-08-09T21:18:00.000-07:00

Moral reasoning involves predicting the consequences of an action before we act. There are always consequences when we take the action we think is right, and when we try to be good persons, and usually these include unintended as well as intended outcomes.

When the likely beneficial outcomes of acting on an ethical presumption seem to outweigh the likely adverse outcomes, then predicting consequences confirms our presumption. But when we predict that the adverse consequences will outweigh the beneficial consequences, even when we are obeying an ethical rule or following an inspiring story, then we should consider whether to make an exception to the rule or to look to a different story for guidance.

We must remember, however, that before we act we can never know for certain what the consequences will be.Therefore, we should take care in predicting what will result from acting on an ethical presumption.

With hope...Bob

Rules and stories

2010-08-08T19:53:00.000-07:00

Ask yourself: "What stories tell me how to be a good person?" Then call to mind the persons who care for you, and ask: "What have I learned from them about being good?"

Considering how to be a good person is different than thinking about the right action to take. These ways of reasoning are like our two eyes, which help us focus so we see clearly. Asking, "What action should I take?" and "What kind of person should I be?" helps to clarify our ethical choice.

We can’t make ethical decisions without considering rules and stories, but we all know that some stories involve characters who break "the rules" because they care deeply about doing what is right or for those who are in danger or suffering.

Sojourner Truth, after she gained her own freedom, broke the rules that made slavery legal in the southern states of the US in order to lead many, who were enslaved, to freedom. She put the biblical story of Moses leading the Israelites to freedom out of bondage in ancient Egypt above laws that asserted a duty to protect the property rights of those who owned slaves.

Her story reminds us that making moral decisions involves taking our feelings into account in our reasoning. We all understand what it means when a child says, “You hurt my feelings.” Adults also have feelings about what is right and good, and a healthy person has empathy for others.

Rules and stories reflect our feelings as well as our reasoning, but we are more likely to give reasons for rules and explain our feelings by telling stories.

With hope...Bob

Green Faith

2010-08-08T05:43:00.000-07:00

“Mostly I’m wondering,” my five year old grandson remarked. “Me, too,” I answered. When in our walk we came upon a spider web, he said: “Spider webs are magnificent.” Like all of nature, of course, spider webs are places of life and death, as well as beauty for those “with ears to hear and eyes to see.”

Green faith means accepting nature as it is — wondering about life amidst the cosmos, and being filled with wonder by life’s evolution and dynamic ecosystems. Wondering is a state of mind, a quest, a journey. Green faith is wonder-full.

For a brief meditation on “green faith” see http://christian-bible.com/Worship/Sermons/green.faith.htm.

Urban Ecology

2010-08-07T20:26:00.000-07:00

For many the phrase “urban ecology” is an oxymoron, as urban development disrupts and destroys ecosystems. Yet, with more than half the world’s population living in cities, we must learn to live more ecologically in urban environments. Solving urban problems begins with seeing each city, with its suburbs and surrounding countryside, “as a single, evolving system within nature.” This means that: “Nature in the city must be cultivated, like a garden, rather than ignored or subdued.”

Anne Whiston Spirn writes: "The city is a granite garden, composed of many smaller gardens, set in a garden world. Parts of the granite garden are cultivated intensively, but the greater part is unrecognized and neglected. To the idle eye, trees and parks are the sole remnants of nature in the city. But nature in the city is far more than trees and gardens, and weeds in sidewalk cracks and vacant lots. It is the air we breathe, the earth we stand on, the water we drink and excrete, and the organisms with which we share our habitat. Nature in the city…is rain and the rushing sound of underground rivers buried in storm sewers. It is water from a faucet, delivered by pipes from some outlying river or reservoir, then used and washed away into the sewer, returned to the waters of river and sea. Nature in the city is an evening breeze, a corkscrew eddy swirling down the face of a building, the sun and the sky. Nature in the city is dogs and cats, rats in the basement, pigeons on the sidewalks, raccoons in culverts, and falcons crouched on skyscrapers. It is the consequence of a complex interaction between the multiple purposes and activities of human beings and other living creatures and of the natural processes that govern the transfer of energy, the movement of air, the erosion of the earth, and the hydrologic cycle."

Anne Whiston Spirn, “City and Nature,” in Stephen M. Wheeler and Timothy Beatley, eds., The Sustainable Urban Development Reader (London: Routledge, 2004), 115.

Comfort care

2010-08-06T21:32:00.000-07:00

The AMA, the Catholic Church, and those who rely on utilitarian reasoning all support comfort care for those who are near death. The AMA sees it as reflecting a physician's duty to provide care in relieving pain even when there is no cure. The Catholic Church acknowledges that comfort care may hasten death, but points out that the intent is to reduce suffering and not to cause death. Utilitarians argue that comfort care will likely have more beneficial than adverse consequences for a patient and also for the patient's family than extraordinary efforts to sustain life. (And it will cost a lot less, too, which is relevant not only for utilitarian reasoning, but also for Catholic teaching, as cost is one of the factors that distinguishes extraordinary care, which is not a moral duty, from ordinary care, which is.)

Those who affirm a human right to health care would include the right to comfort care, but rights language is more commonly used to defend the right to die by declining life-support or the right to die with dignity by means of physician-assisted suicide (which is now legal in the states of Oregon and Washington). The Catholic Church defends the human right to health care, but opposed any notion of a right to die for it involves the intention to end life. But utilitarians might well support both the right to die and physician-assisted suicide, arguing that ensuring these rights is justified because more good consequences than not will likely be the result.

Love and marriage

2010-08-04T22:13:00.000-07:00

Common sense about marriage may finally triumph. There is no evidence that same-sex couples are a danger to society. In fact, all those who believe marriage is a celebration not only of love but of fidelity should rejoice that couples in same-sex relationships share this commitment. For it is fidelity in love that sustains families and, through families, the bonds of community.

As for God, I'm sure She is smiling. How silly we humans are to think that we can confine the gift of love to heterosexual relationships. The grace of God is more abundant that we can imagine.

With hope...Bob

A “Good Sam” Health Care System

2010-03-19T06:40:00.000-07:00

The story of the Good Samaritan is a well-known parable in the New Testament that Jesus tells after an exchange with a lawyer, who asks: “What must I do to inherit eternal life?” Rather than answering, Jesus responds with a question: “What does scripture say?” The lawyer quotes two verses, Deuteronomy 6:5 and Leviticus 19:18. “You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind; and your neighbor as yourself.” “Do this,” Jesus says, “and you will live.”

Unsatisfied by this answer, the lawyer asks: “But who is my neighbor?” His question might well be our question, as Jesus has not explained how to distinguish neighbors from those who are not our neighbors, or specifically what it means to love one’s neighbor as oneself. Jesus answers this question with the parable of the Good Samaritan.

This parable tells of a man who is robbed, beaten and left “half dead” beside the road. A Jewish priest and then a Levite (a Jewish layman active in religious affairs) come upon the man, but each continues on his way. A Samaritan, however, stops and helps the injured man, who we may assume is a Jew, as Jesus was a Jew and the lawyer who knew Jewish scripture was clearly also a Jew. As Samaritans and Jews had been enemies for five hundred years, making a Samaritan the good neighbor in a parable told to Jews adds to its impact.

The Samaritan interrupted his journey to help the injured Jew, took him to an inn, stayed with him, and when he left the inn gave the innkeeper enough money to provide for the health care of the injured man. “Which of these three,” Jesus asks the lawyer, “do you think, was a neighbor to the man who fell into the hands of the robbers?” “The one who showed him mercy,” the lawyer says. “Go,” Jesus replies, “and do likewise.” (Luke 10:25-37)

For centuries Christians have responded to this parable by providing health care for those in need, which is why we have so many Good Samaritan hospitals in the world. This is Christian faith at its best. So why aren’t Christians in the United States actively supporting health care reform that would extend insurance coverage to all those who need it?

Many of those opposing legislation that would provide health care insurance to those unable to afford it, claim to be resisting increased government control of health care. Yet, seniors making this claim also demand no change in “their” Medicare coverage, and politicians opposing health care reform fan this fear. “Hypocrites,” Jesus would say, of those who enjoy the benefits of a government health care plan but oppose providing these benefits to others in need.

The same is true of those who believe we can’t afford to help people without health insurance, for they also believe we can afford the insurance benefits they have. To be sure, costs must be carefully managed, but this is true for our entire health care system. It is hypocritical for those who benefit from present health care spending to resist health care reform that would extend insurance coverage to those lacking it.

A recent study of health care systems around the world by veteran journalist T. R. Reid, entitled The Healing of America, concludes that costs can be contained while universal health care is provided when a society believes that providing health care is a moral responsibility. This is true whether the health care system is directly managed by the government, as in the United Kingdom, or is primarily private, as in Japan and France. When there is a commitment to health care as a human right, the politicians, hospitals, physicians, insurance and pharmaceutical companies, and voters figure out how to provide coverage and contain costs.

In the United States we do not have a moral commitment to health care as a human right. This is, I suggest, largely because Christians in the United States are more concerned with other moral issues than with health care for those who need it.

The Catholic Church supports all the human rights affirmed by international law, including the right to health care, as “the social conditions necessary for human dignity.” As the Catholic Church is the largest religious organization in the United States, one would expect substantial support among Catholics for health care reform that would extend insurance coverage to the millions who in our present system cannot afford it. But vocal Catholics bishops are mainly concerned with opposing the use of health care insurance for abortions.

Holding the line against abortion is also an issue for evangelical Protestants, but their main talking point is the threat that public health care expenditures pose for a free society (except for the programs that already benefit many of them, such as Medicare or veterans’ benefits). These Christians do not share the moral conviction of Catholics that health care is a human right, a social condition necessary for human dignity. Therefore, they do not support the idea that our government has a proper role to play in ensuring access to health care for everyone.

Those who claim the United States is a Christian nation are wrong not only because they misrepresent the human right to religious freedom, as it has evolved in American history and law to protect secular society as well as religious convictions. They are also wrong because our nation is hardly “Christian” when it comes to health care. We may have more Good Samaritan hospitals than any other nation, but our health care system does not embody the moral conviction of a good neighbor.

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2010-03-18T07:23:00.001-07:00

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Bob the Builder

2009-09-18T08:50:00.000-07:00

I first heard of Bob the Builder stories from my youngest daughter, who as a medical student told me about a party with her friends that involved dressing up in working clothes and singing songs that everyone knew from the television show. These stories are designed to show children that happiness involves developing the virtues of industry and perseverance.

The show’s website includes this exuberant affirmation: “Bob the Builder knows that the fun is in getting it done! With his business partner Wendy and his original can-do crew: Scoop the digger, Muck the digger/dumper, Lofty the crane, Roley the steam roller, and Dizzy the cement mixer, Bob has been getting jobs done all over Bobsville and beyond, and no matter what the job, he always has the right tools—teamwork and a positive attitude!”

Of course, all this construction work involves using natural resources and digging up the earth. In this sense, Bob the Builder exemplifies the American myth that nature is there to be improved by our ingenuity and hard work. Until recently in this television program, there was no hint of environmental problems or of any related ethical issues, but that has changed.

The section of the website called The Builder’s Log now describes a new project in Sunflower Valley. To prevent a city from being built that would pollute the valley, Bob has devised “a plan that would fit in to the environment.” Moreover, while watching a recent episode of Bob the Builder with my young grandson, I learned that the three Rs now stand for environmental virtues—“reduce, reuse, and recycle.”

Ordinary care

2009-09-12T16:13:00.001-07:00

When my dad at age 90 suffered a stroke that left him paralyzed on his left side and unable to swallow, but alert and able to talk, he chose to have his IV removed in order to let nature take its course. He said that he had lived a full life, was ready to die, and didn’t want to be kept alive by machines when his body couldn’t care for itself.

His death took four days. He was not on medication for pain, and by the second day he was unable to speak. By the third day he was unconscious. About thirty minutes before he died, his breathing slowed, with a long pause between each deep breath. I recited psalms and prayed for him, until he was still.

At his memorial service I shared with other family members and friends of my father that I was moved by the way my father faced death. He wasn’t afraid or depressed. He was grateful for his family and for the years he had lived, and he saw accepting his death as a way of expressing his gratitude for the gift of life.

In the university ethics class I teach, I mention my father’s death when we discuss health care, because it illustrates the right of a patient to withhold consent for medical treatment. In the 1990 Cruzan decision the US Supreme Court upheld this right, citing a “liberty interest” in the 14th Amendment of the Constitution and the common-law tradition supporting the right not to be touched by another person without consent or legal justification.

International law also supports the right of informed consent, which creates a duty for those providing health care to adequately inform patients of their condition, possible treatment, and their right to consent or decline treatment.

The story of my father’s death illustrates why Catholic moral teaching requires only health care that offers a reasonable hope of benefitting a patient and is not excessively expensive, painful, or inconvenient. This “ordinary” care is distinguished from “extraordinary” care. Catholic teaching supports using medication for a terminally ill patient to reduce suffering even if this may shorten the patient’s life. For medication is ordinary care and, if it hastens death, this unintended consequence does not outweigh the duty to reasonable means that are not excessively expensive to alleviate suffering.

My father was not Catholic, nor am I. But as a senior now, I support limiting health insurance to coverage for ordinary medical care, and I urge other seniors to do the same for the sake of the common good. We can help those who are younger overcome their fear of death by facing this fear ourselves. We should support health care as a human right for all, which is Catholic teaching and international law as well, but we should also affirm our right to decline medical treatment. And when treatment is very costly and offers only a short-term benefit, why not affirm life by accepting death?

With hope...Bob

Fair-minded words

2009-05-18T07:35:00.000-07:00

President Obama's speech at Notre Dame's graduation included a call (and a pledge) for open hearts, open minds, and fair-minded words when we address our differences and look for ways of working together.

In that speech Obama reflected on his work as a community organizer in Chicago where he was "touched by the words and deeds of men and women" he worked with from many Catholic parishes. "I'd like to think," Obama said, that in our community service "we touched the hearts and minds of the neighborhood families whose lives we helped change. For this, I believe, is our highest calling."

Obama's fair-minded words at Notre Dame about the moral debate over abortion offer us a model for doing ethics. Finding common ground and making real progress in addressing moral issues and creating greater justice requires respect for those with whom we differ. And "fair-minded words" are one way that we manifest this respect.

With hope...Bob

Economic inequality

2009-03-02T07:31:00.000-08:00

In an op-ed piece published in The Washington Post on March 2nd, E. J. Dionne Jr. argues that Obama is right to try to correct the growing economic inequality in the US. Dionne quotes Peter Orszag, Obama's budget director, who points out that: "Over the past two or three decades, the top 1 percent of Americans have experienced a dramatic increase from 10 percent to more than 20 percent in the share of national income that's accruing to them."

"The ethical measure of an economic policy," I argue in Doing Environmental Ethics, "is its contribution to the common good. This not only requires political decisions that protect the environment, but also economic policies that ensure a fair distribution of the economic benefits that are realized."

Obama's budget calls us to work for greater economic justice in the US.

With hope...Bob

Language matters

2009-01-29T07:22:00.000-08:00

In Obama's recent interview with the Al Arabiya news network he said, "The language we use matters." This might be understood to mean simply that we should try to be as persuasive as possible in promoting our ideas. But in the context of this interview about relations between the US and Muslim nations, Obama is affirming a commitment to respecting others even when we may disagree with them.

In the language of ethics, virtues matter. We should be concerned not only with taking the right action, but also with how we are as we act. Are we being civil by listening carefully and trying to understand others? Are we expressing gratitude when those who do not agree with us are, nonetheless, civil?

This is doing ethics. Who you are, as well as what you do, matters, not merely to you, but to others.

With hope...Bob

Hard choices 2

2009-01-23T08:48:00.000-08:00

In my first blog on hard choices I noted President Obama's assertion that the economic crisis wasn't simply the result of "greed and irresponsibility on the part of some," but a consequence of "our collective failure to make hard choices and prepare the nation for a new age."

Hans Morsbach, my brother-in-law and a successful businessman, responded with this comment: "Greed is a big part of the problem. The system allowed financial expert to collect commission on services of no value. Experts bundled mortgages of which they should have known that they were of less value than their label suggested. They did not care and just collected the service fee. When the bubble burst, they had their money and the taxpayers had to bail them out."

"Much of the blame rests with the SEC and Bush's failure to regulate. He preferred to think that no regulation was necessary as the free market would do it. He was wrong. Financial executives made millions (which are not recoverable) and the taxpayers pay the unearned income of the financial experts and also the shortfall of the value of mortgages mislabeled. The 'system' worked as the investment houses made money all along. It is like the Ponzi scheme which works smoothly until the market forces expose the problem."

I agree with Hans. Our economic system will not be responsible and just without effective regulation by the federal government. Ethics requires enforceable rules as well as encouragement and recognition of good conduct.

With hope...Bob

Renouncing torture

2009-01-22T12:06:00.000-08:00

Affirming that “our ideals give us the strength and moral high ground” to combat terrorism, President Obama today signed executive orders that will end the CIA's secret overseas prisons, ban coercive interrogation methods, and close the Guantanamo detention camp within a year.

I applaud the President's commitment to the rule of law. A chapter in Doing Ethics in a Diverse World is devoted to the war against terrorism and explains that the right not to be tortured is a human right under international law. The chapter also presents character and consequential arguments against the use of torture.

So, what should we do with the "bad guys" now being held in secret CIA prisons and at Guantanamo? Apply the rule of law. A prisoner of war is protected by the Geneva Conventions as well as US law. Anyone detained for allegedly committing a crime should be presumed innocent and tried in a court of law.

With hope...Bob

Hard choices

2009-01-21T09:10:00.000-08:00

In his inaugural address President Obama told us that the economic crisis wasn't simply the result of "greed and irresponsibility on the part of some," but a consequence of "our collective failure to make hard choices and prepare the nation for a new age."

He was talking about ethical choices. Doing what is right and being good persons even when it seems that we might profit by doing what is wrong, or when we want good government but are unwilling to pay the taxes necessary for government that works.

But accepting that we are part of the problem should give us hope, for it means that we are part of the solution. What we do, and who we are, matters.

For those who have visited this blog, I hope you will take a few moments and share your ideas about what we should do. For my take on how we might respond to climate change and our economic crisis, I invite you to look at Doing Environmental Ethics.

With hope...Bob

Embracing crisis

2009-01-20T10:44:00.000-08:00

In his inaugural address this morning Barak Hussein Obama quoted these words of George Washington: "Let it be told to the future world...that in the depth of winter, when nothing but hope and virtue could survive...that the city and the country, alarmed at one common danger, came forth to meet it."

President Obama's call to renew the spirit of America is a call to an ethic of duty, virtue, and compassion. Rather than blame, we should build. Rather than giving up, we should give to others. Rather than worry, we should work harder for what is right.

How are we to embrace this great and difficult challenge? Each of us, in our own way.

Begin today and then share your beginning with others. No sincere effort is too small, too insignificant. You matter, and what you do matters. Each of us can do our part.

With hope...Bob

Gay love

2009-01-19T16:11:00.000-08:00

Singer and musician Melissa Etheridge recently said about homosexuality that: "Love is all there is, and love is never wrong. Why should we be threatened by love?"

The subtitle of the chapter on "Sex" in Doing Ethics in a Diverse World is "Consent Plus What?" Love is a good answer, as long as by love we mean mutual respect and commitment and not only passion.

In the law we presently have a clash of rules. Marriage in most places is heterosexual by definition, but the human right of nondiscrimination weighs in favor of gay marriage if civil unions do not provide rights equal to marriage. In the US civil union laws in several states do not override federal laws, which do not recognize civil unions as creating rights equal to marriage.

Do our stories about character and relationships help to resolve this conflict of duties and rights? Melissa Etheridge seems to think so, and I agree. How about you?

Welcome

2009-01-18T09:52:00.000-08:00

Hi. I'm glad you found your way to this blog.

I explain my ethical approach in Doing Ethics in a Diverse World, written with Harlan Stelmach, and Doing Environmental Ethics. To read more about each, or to purchase either, click on the hyperlink.

Also, I invite you to visit my Doing Ethics website.

In this blog I want to share new ideas and learn from the comments of you and others who visit the blog. We face many tough moral issues, and how we respond matters. So, let's help each other figure out what to do and who to be.

I'll share some ideas here, but I hope you will share your thoughts as well.

With hope...Bob