Wednesday, October 7, 2009

Compassion fatigue, Milgram's obedience experiments, and how our inaction results in unncessary deaths

My first blog! I'm so excited.

So I've been discussing on facebook, with my dinner group, and with roommates lately some sticky ethical issues,
healthcare reform, and the consequences of inaction unique to the human condition. The replies have been more
than brief, so I'm going to post some of the dialogue below.


Qui non obstat quod obstare potest facere videtur - He who does not prevent what he is able to prevent, is 
considered as committing the thing.

9 comments:

  1. "Oh c'mon, we are ALL decision makers on a death panel. Each day we hold on to the money in our wallets, for instance, we choose to let innocent
    people die. Are there not dozens of NGO's out there who can guarantee to save the life of
    an otherwise doomed child for a price, say, $950 per life for vaccinations or nutrition or medical programs? Yet most of us care more
    about the cold sore in our mouths than 10,000 starving refugees in
    Congo or 100,000 diseased and dying children in Indonesia." http://en.wikipedia.org/wiki/Compassion_fatigue
    http://en.wikipedia.org/wiki/Naturalistic_fallacy
    http://en.wikipedia.org/wiki/Milgram_experiment
    http://www.motherjones.com/mojo/2007/03/which-worse-murder-or-genocide

    Michael Madsen: I'm not quite sure what you are arguing but the comparison between a government run death panel and the allegation that we are each on death panels because we do not volunteer our money to NGO's is maybe a bit of a stretch. The difference is volition. If I had taken money from these poor people, and given them a promise that I would in return provide them with health care, and then decided not to provide such care because it was too costly, there might be a connection. The reason I find death panels or health care rationing to be so heinous is because it robs people of both their resources and their volition to do with their resources what they will, particularly in matters relating to life-extending medical treatment. To accuse people of sitting on a death panel because they make a decision to voluntarily allocate their resources other than to a given cause is a pretty serious accusation. I'm all for private charities and believe we have a moral obligation to serve others as a result of our own free will.


    Brad Carmack: Shannon- good call about the other side of compassion fatigue (sometimes the cynicism and depression can make you better at caring for others).

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  2. Michael- I think the difference of volition that you emphasize is a significant one. I don't yet know enough about health care rationing and government run death panels to evaluate how heinous they are- you may well be right there. In a strictly ends calculus, however, I stand behind the assertion that most of the people who read this facebook comment have the power to save lives and, because of their decision to act in certain ways, do decide who lives and who dies. An illustrating example would be a train conductor who approaches a switch point- just beyond the switch point are five men roped to the rail who will certainly be killed if the train continues on its course. If the conductor pulls the switch, the train will turn onto a siderail- but there is a man stuck on that rail too who will certainly be killed if the conductor pulls the switch. Therefore, the conductor has the power in this scenario to decide who lives and who dies (the one or the five) even though it requires an action on his part to select alternative #1 and merely inaction to select alternative #2 [compare to the choice-consequence illustration I noted. Choose not to donate to life-saving NGOs (inaction) selects alternative #1: the consequence is avoidable deaths. Choose to donate to life-saving NGOs (requires action): the consequence is fewer deaths]. A second illustrating example is the decision of most adults in our society to drive. It is well established that this decision results in the death and dismemberment of thousand across the country every year. Though none of us make a conscious decision to kill people, we nonetheless choose to engage an activity so dangerous that it is certain that even good drivers kill thousands of innocent people each year. If you were to evaluate a choice only by its consequences, and you claimed to value preservation of life above all other ends, it is obvious what alternative would be chosen in all three scenarios above. If, however, other ends are valued (such as an inviolable right to property) or there is more to evaluating a choice than the sum of its consequences, there might be room for appropriately selecting other alternatives. My point is that even deciding not to decide is a choice- the human condition is such that it is literally impossible to fence-sit because of the consequences that result from inaction. In that sense, we do sit on death panels in that our action or inaction determines whether people live or die.

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  3. http://www.theirrationaleconomist.com/abstracts/Slovic_Thinking.pdf
    To help society prevent or mitigate damage from catastrophes, immense effort
    and technological sophistication is often employed to assess and communicate the numerical
    size and scope of potential or actual losses. This effort assumes that people can understand the
    resulting numbers and act on them appropriately. However, much behavioral research casts
    doubt on this assumption. Large numbers are found to lack meaning and to be underweighted in
    decisions unless they convey affect (feeling). As a result, we respond strongly to individuals in
    need but often fail to act effectively in the face of mass tragedies from nature or human
    malevolence. The numbers fail to trigger the emotion or feeling necessary to motivate action.
    This paper will call attention to the need to address this problem of insensitivity to mass
    tragedy by identifying circumstances in which it likely compromises the rationality of our actions
    and by pointing toward strategies that might lessen or overcome this problem.

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  4. http://www.youtube.com/watch?v=Rx42w02wQrE
    (Milgram's experiment)

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  5. www.theirrationaleconomist.com/abstracts/Slovic_Thinking.pdf


    Thinking and Deciding Rationally About Catastrophic Losses of Human Lives

    ReplyDelete
  6. #1--Great links--Wow! Gave me lots of food for through here. And your use of a Latin maxim at the top is quite impressive:). While I agree with the part that inaction can result in a degree of guilt, I think that Latin maxims were written in a non-global era. They probably meant “if you didn’t move the fig branch out of the way of the speeding chariot, thus resulting in a toppled chariot=your fault”. I don’t think they meant “if you don’t donate the mass of your livelihood to the myriad of NGOs in your community and foreign lands as featured on TV/internet then you are responsible for 1000s of deaths”. Talk about cry yourself to sleep at night! OH wait--we all have compassion fatigue. Nevermind, 1000s don't phase me ;).

    However, I think there is a proximity rule that should be applied in the responsibility of a person to their inaction. I picture it as the circles of influence model--the biggest impact is made directly where the rock falls in the pool, or closest to us. The waves decrease in size a few feet away until they seem to disappear completely or where we have no/little immediate influence. I think it is more fair to consider our responsibility to be relative to our circle of influence or proximity. Inaction may bear guilt, but I think an overly responsible mentality results in more guilt than is healthy, which in turn could lead people (at least me) to be less productive and feeling hopelessness at holding back the wave of suffering in the world. However, if I consider my greatest responsibility to be that which is directly in my control or influence, then I stand a chance at making a difference somewhere.

    Sometimes people uproot from their local sphere of influence to apply time, money, and energy at individuals or groups in a distant suffering countries for a few months or years (they might physically uproot, or they could just commit monetarily or emotionally), but when that happens, they aren’t usually maintaining the same degree of influence in their original location which would decrease their responsibility in the original location. I don't know if I'm making sense, but my vote is that we pick our battles and put energy and influence where we have the most skill and the most passion/fit/duty/ feeling of mission/ or however you make that choice. Once a battle is chosen, if we make a big splash, we may be providing the most 'net benefit' to the world and we should do so without guilt. This doesn't mean we fail to help where we can. But there is always an opportunity cost with any emotional/social/money resource--if we reassign some of our resources to a cause outside of our chosen battle, we should make sure we don't short change our ability to make an impact.

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  7. #1--Great links--Wow! Gave me lots of food for through here. And your use of a Latin maxim at the top is quite impressive:). While I agree with the part that inaction can result in a degree of guilt, I think that Latin maxims were written in a non-global era. They probably meant “if you didn’t move the fig branch out of the way of the speeding chariot, thus resulting in a toppled chariot=your fault”. I don’t think they meant “if you don’t donate the mass of your livelihood to the myriad of NGOs in your community and foreign lands as featured on TV/internet then you are responsible for 1000s of deaths”.
    >I can see that you don't agree with my application of the responsibility we have for inaction- but what's the basis for your interpretation of their meaning? Also, presuming that I misinterpreted or there is an insufficient basis for interpreting the maxim at all, I in the alternative assert the principle in English: you're responsible for the consequences you cause, irrespective of whether the causation is affirmative (via an action) or negative (via refraining from taking an action). Both acts of commission and acts of omission are within your agentic control- you merely select them in different ways. Would you take umbrage at that assertion? If so, please illustrate why.

    Talk about cry yourself to sleep at night! >You're argument here may prove compelling to an ends-focused utilitarian- but the deontologist would likely counter that you should refrain from obfuscating a reality even if that reality is troubling.

    OH wait--we all have compassion fatigue. Nevermind, 1000s don't phase me ;).
    > I think compassion fatigue is a regrettable facet of being human, and because of the reality's substantial contribution to human suffering historically find it sobering rather than humorous.

    However, I think there is a proximity rule that should be applied in the responsibility of a person to their inaction. I picture it as the circles of influence model--the biggest impact is made directly where the rock falls in the pool, or closest to us. The waves decrease in size a few feet away until they seem to disappear completely or where we have no/little immediate influence. I think it is more fair to consider our responsibility to be relative to our circle of influence or proximity.
    > I think I agree with your point. However, in our globalized world, the effective zone of our circle of influence can no longer be reasonably said to be as geographically limited as your proximity rule implies. Due to the approaches of numerous NGO's, It really is quite easy for a person to sit at a computer in Oregon and help change the condition of life in Indonesia, at least for some few.

    Inaction may bear guilt, but I think an overly responsible mentality results in more guilt than is healthy, which in turn could lead people (at least me) to be less productive and feeling hopelessness at holding back the wave of suffering in the world.
    > Again, the utilitarian/Kantian tension: you may be right about the consequence bundle, but if a morally upright person would buck up to the reality anyway, then the categorical imperativist would give you an F for inappropriately limiting your sense of responsibility.

    However, if I consider my greatest responsibility to be that which is directly in my control or influence, then I stand a chance at making a difference somewhere.
    > A reasonable conclusion, though again I argue that social ventures such as tippingbucket.org put "making a difference" in the direct control of everyone with a credit card number.

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  8. Sometimes people uproot from their local sphere of influence to apply time, money, and energy at individuals or groups in a distant suffering countries for a few months or years (they might physically uproot, or they could just commit monetarily or emotionally), but when that happens, they aren’t usually maintaining the same degree of influence in their original location which would decrease their responsibility in the original location.
    > I disagree. In many outreach modalities (such as helping to develop the Pill, which empowered women around the world, or in donating money to distant causes, one's local influence doesn't necessarily decrease. Often, for the world's relatively affluent (which includes the majority of Americans), merely donating to a verified-impact charity rather than purchasing a good or service brings more net global utility/dollar. What matters from the utilitarian perspective you've relied on thus far is net world benefit, rather than discriminating against non-local persons in favor of those who happen to be proximal to you. Thus, if you can do greater good per unit investment of time/money/energy in distant rather than local causes, then it is morally advisable to do so.

    I don't know if I'm making sense, but my vote is that we pick our battles and put energy and influence where we have the most skill and the most passion/fit/duty/ feeling of mission/ or however you make that choice.
    > That's a reasonable ethical conclusion, except that now your justification has switched horses, in that such a position makes sense from a deontological perspective (the duty created by your proximity and passion/fit principles) but not from the utilitarian/greatest net benefit perspective that you've used up 'til now. The calculus that matters is the benefit/input ratio, not necessarily the skill or proximity/input ratio. Example: you could be very skilled at helping local rich ladies choose which pair of shoes to buy, but your 6 volunteer hours doing so likely won't benefit the world as much as working six extra hours, and donating those wages to a water project in Belize.

    Once a battle is chosen, if we make a big splash, we may be providing the most 'net benefit' to the world and we should do so without guilt. This doesn't mean we fail to help where we can. But there is always an opportunity cost with any emotional/social/money resource--
    >Strong point: opportunity cost is vital to include in your allocation decision. And, though the calculus is fuzzy, it could be that your battle-choosing approach results, as you claim, in greatest net benefit to the world. If so, your ethical justifications may be, thus far, consistent.

    if we reassign some of our resources to a cause outside of our chosen battle, we should make sure we don't short change our ability to make an impact.
    > Great thoughts, thanks.

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  9. http://www.jewishjournal.com/jews_and_mormons/item/a_mormon_zionist_at_brandeis_39100810/

    An example of someone being "anxiously engaged" (PS Have you seen that movie? It is quite funny.). I agree that it is important that each of us do something for the 'betterment' of society. The beauty of it all is that we can each make a splash in a different way. I think it is important to be passionate about something. Then learn all you can about it and work to further advance it (or society with it). Deep passion will keep a person from getting caught up in the menial day to day details of life, which can cause him to forget about his goals and aspirations to change the world.

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