There has been some discussion of the recent case in which the Children's Hospital of Philadelphia was accused of denying a three-year-old girl a kidney transplant solely on the basis of mental retardation. (The Hospital has apologized, and the parents have since suggested that it was perhaps merely one doctor rather than the hospital as a whole.) One thing I have noticed is that several people have raised the issue of triage as a defense of the original decision; some of these are interesting arguments, but unfortunately most of these appeals to triage principles don't show an understanding of what triage actually is.
The entire point of triage is that only need is considered. Triage systems were originally developed in a military context when field doctors started giving medical treatment not on the basis of rank but on the basis of need, as determined by purely medical criteria. This is what genuine triage is: it is a system, operating under a scarcity of resources significant enough to require careful discrimination of who actually receives those resources (most clearly in emergency or disaster, but resources do not necessarily have to be anywhere near that scarce to become an issue), where distribution of those resources is done purely on the basis of actual medical need according to established principles that only consider medical issues. Remember, it has always been the case that doctors have had to make hard choices based on scarce resources. Actual triage systems only developed when the principles governing those choices were no longer official rank, social status, subjective assessment, or any other nonmedical criterion. We can call those other resource-management systems 'triage' in a loose sense, but they are radically different for moral purposes, and cannot all be lumped together as if the justification for one were justification for another. Just as genuine triage management cannot, by its nature, be indiscriminate in the use of medical resources, so it cannot, by its nature, take into account anything other than medical need. And precisely the reason why triage is an important ethical as well as medical concept is that it operates in conditions of necessity according to principles wholly geared to dealing with the necessity; it's the medical necessity, and the proportion of means to the end of dealing with that particular necessity, that justifies triage decisions.
Precisely one of the worries in this case -- and whether it is right or not, the issue needs to be taken seriously -- is that we here have a case in which the discriminatory principles were not purely concerned with medical need, but involved making subjective or merely pseudo-objective judgments about something like future quality of life. If this were in fact true, it would mean that the system was not a genuine triage system, and that triage principles could not justify the action. Mere scarcity of resources and the need to make hard decisions is not enough; and you can only defend an action on the basis of triage principles if the principles involved were real triage principles. This is something that requires investigation, and cannot be merely assumed.
Thursday, January 19, 2012
2012 Edge Question
The 2012 Edge Question is What is your favorite deep, elegant, or beautiful explanation? The answers to Edge Questions are often a mixed bag at best, althought the 2011 one ("What scientific concept would improve everybody's cognitive toolkit?") actually had a lot of good answers. This year, I think, is one of the worst; most of the answers are not very good. For one thing, many of the answers seem to have weird assumptions about what an explanation is; they often propose something that, however useful, wouldn't be useful as an explanation at all (e.g., purely descriptive models, redescriptions of the explanandum, heuristics, practical arguments, metaphors, existence or nonexistence proofs for symptoms or correlations, and so forth). And, further, it seems clear that many of these people are simply unable to convey coherently what they mean by calling something deep, elegant, or beautiful, much less able to explain what it is about an explanation that makes it any of these things.
There are a handful of answers that are interesting, mostly from a few of the physicists. Dawkins's, I think, was actually the most interesting proposal; most of the others, at least the others that could be seriously considered as explanations of some kind and whose depth, elegance, or beauty was given an explanation, were rather trite examples of the sort you would expect -- not necessarily wrong, but also not necessarily indicative of having put any serious thought into the question.
There are a handful of answers that are interesting, mostly from a few of the physicists. Dawkins's, I think, was actually the most interesting proposal; most of the others, at least the others that could be seriously considered as explanations of some kind and whose depth, elegance, or beauty was given an explanation, were rather trite examples of the sort you would expect -- not necessarily wrong, but also not necessarily indicative of having put any serious thought into the question.
Wednesday, January 18, 2012
A New Poem Draft
Almost Half in Love
The rain on the eaves in the moonlight
was sparkling like pure diamond; it was so bright
that our eyes could hardly tell that it was midnight
and I was almost half in love.
Your hand was on my arm; it felt so nice
that I wouldn't have removed it for the world's price
and your eyes in light of moon had me so enticed
that I was almost half in love.
The memories of that night through each life-phase
have mingled with the ones in which we parted ways;
but who could ever lose the lessons of those old days
when we were almost half in love?
The rain on the eaves in the moonlight
was sparkling like pure diamond; it was so bright
that our eyes could hardly tell that it was midnight
and I was almost half in love.
Your hand was on my arm; it felt so nice
that I wouldn't have removed it for the world's price
and your eyes in light of moon had me so enticed
that I was almost half in love.
The memories of that night through each life-phase
have mingled with the ones in which we parted ways;
but who could ever lose the lessons of those old days
when we were almost half in love?
Tuesday, January 17, 2012
Farewell, Dublin Dr Pepper
The US's oldest Dr Pepper plant has in a sense been closed. This is big news in these parts, Texas being Dr Pepper Country. The Dr Pepper brand is a very complicated one, being mish-mash of all sorts of different licenses. The Dublin plant, although it was a very tiny plant, was particularly significant in that its original license predated the Big Switch among sodas from sugar to high fructose corn syrup (due to high sugar prices), and when that switch came, the owner of the plant refused to make the switch. And thus Dublin, Texas is one of only a handful of plants in the country that has always continued to make Dr Pepper with sugar rather than corn syrup. (It also continued using original 1920s equipment.) The taste is noticeably better: not as sharp and metallic. Because of this, it was in high demand; despite the fact that Dublin is tiny little town, it received over a hundred thousand visitors a year, simply because of the Dublin plant. However, this popularity was precisely its downfall. Dr Pepper Snapple restricted distribution to a small area around Dublin, TX itself, but it soon began to be bootlegged all over the state, and convenience stores began to go to great lengths to stock such a popular item. So last year Dr Pepper Snapple sued the plant for violation of the terms of its agreement, and a settlement effectively ended the era of Dublin Dr Pepper, the best Dr Pepper in the land of Dr Pepper.
It's a huge deal for Dublin, Texas, of course, since the plant was the mainstay of the local economy. It only employed forty people -- although, again, it's a tiny town of less than 4000 -- but it brought in customers from all over. They have a Dr Pepper festival every year, in which the town is officially named 'Dr Pepper, Texas' for one day, and at which a Miss Pretty Peggy Pepper is crowned. Dr Pepper Snapple insists that there will still be a plant, and that they will continue to support the Dr Pepper Festival. Likewise, the famous soda shop next door to the plant, Old Doc's, will continue operating. But the plant will bottle other things, and there will no longer be any such things as Dublin Dr Pepper. Likewise, Dr Pepper Snapple insists that it will continue supplying sugar-based Dr Pepper from other plants. But there are a lot of unhappy Texans over this; Texans have brand loyalty like you wouldn't believe, and while Dr Pepper is itself a homegrown brand, and thus will likely continue to have widespread favor, by shutting down the Dublin plant, Dr Pepper Snapple has angered a lot of people.
Which is interesting, actually, because we aren't talking a huge volume, here; the Dublin plant, besides being the oldest Dr Pepper bottler in the country, was also undeniably the smallest, and did about $7 million worth of business a year. Likewise, Dublin was not even the only sugar-based Dr Pepper plant in Texas -- Dr Pepper Snapple started rolling out its own retro version, also sugar-based, not too long ago, and the plant in Temple, Texas, a far bigger plant, bottles and distributes that (and, indeed, actually bottled Dublin Dr Pepper for bottles and cans that the Dublin plant couldn't). But perhaps that was the problem: Dr Pepper Snapple didn't have a problem with Dublin Dr Pepper when it was a little-known eccentricity and wasn't competing throughout Central Texas with another sugar-based Dr Pepper variety; other bottlers were obviously not going to be happy with that. Dr Pepper Snapple was in a tricky position. But so it goes.
It's a huge deal for Dublin, Texas, of course, since the plant was the mainstay of the local economy. It only employed forty people -- although, again, it's a tiny town of less than 4000 -- but it brought in customers from all over. They have a Dr Pepper festival every year, in which the town is officially named 'Dr Pepper, Texas' for one day, and at which a Miss Pretty Peggy Pepper is crowned. Dr Pepper Snapple insists that there will still be a plant, and that they will continue to support the Dr Pepper Festival. Likewise, the famous soda shop next door to the plant, Old Doc's, will continue operating. But the plant will bottle other things, and there will no longer be any such things as Dublin Dr Pepper. Likewise, Dr Pepper Snapple insists that it will continue supplying sugar-based Dr Pepper from other plants. But there are a lot of unhappy Texans over this; Texans have brand loyalty like you wouldn't believe, and while Dr Pepper is itself a homegrown brand, and thus will likely continue to have widespread favor, by shutting down the Dublin plant, Dr Pepper Snapple has angered a lot of people.
Which is interesting, actually, because we aren't talking a huge volume, here; the Dublin plant, besides being the oldest Dr Pepper bottler in the country, was also undeniably the smallest, and did about $7 million worth of business a year. Likewise, Dublin was not even the only sugar-based Dr Pepper plant in Texas -- Dr Pepper Snapple started rolling out its own retro version, also sugar-based, not too long ago, and the plant in Temple, Texas, a far bigger plant, bottles and distributes that (and, indeed, actually bottled Dublin Dr Pepper for bottles and cans that the Dublin plant couldn't). But perhaps that was the problem: Dr Pepper Snapple didn't have a problem with Dublin Dr Pepper when it was a little-known eccentricity and wasn't competing throughout Central Texas with another sugar-based Dr Pepper variety; other bottlers were obviously not going to be happy with that. Dr Pepper Snapple was in a tricky position. But so it goes.
Monday, January 16, 2012
Sunday, January 15, 2012
Gersonides on Well-Grounded Refutation
It is necessary that if someone wants to arrive at the truth on some disputed question that he try to defend each of the opposing theories as far as this is possible. Then the absurdity of the view he [wishes] to refute will be more easily established. For if he refutes any one of these theories but does not first try to argue for it (as far as possible), his refutation of that view is not well-grounded. This is obvious.
[Levi ben Gershom, The Wars of the Lord, Volume One, Feldman, tr. Jewish Publication Society of America (Philadelphia: 1984) p. 119.]
Thanks to Amazon gift cards for Christmas, I was able to attain the full three volumes of Feldman's translation of Gersonides's The Wars of the Lord without killing my wallet, which makes me very, very happy. Gersonides, of course, is one of the great medieval Jewish philosophers, and The Wars of the Lord is his major work.
Subscribe to:
Posts (Atom)