To Do Or Not To Do, That Was the Question

It’s going to start looking like we’re playing favorites here, but following up on another of BCChase’s questions (I’ve got others that I’m going to pick up on yet) left in my post soliciting feedback from commenters, commenter and Guest Author Jaybird and I went back and forth via email for just over a week on the following,

Also, as a scientist this question intrigues me: as we learn more about how our thinking, morals, and attitudes are developed or inherent in the brain, what does that mean for ethics and morality? If a person is born with a sociopathic brain, to what extent are they responsible for their actions? To what extent would we be justified in changing someone’s mind (literally!) through drugs or targeted surgery in such a case? To what extent are we justified in changing how our own minds operate (ie Provigil)? Should drugs which affect memory retention really be available to the government?

The exchange is, well, wide ranging and was certainly very interesting and enjoyable for Jaybird and I. As to its value, we’ll let you be the judge of that.

Thanks to Jaybird for taking the time and, as always, for the intelligence, candor, and satisfying drop of irreverence he brought to the discussion.

Jaybird: When I first read that list of questions, I immediately start thinking about Buck vs. Bell, the famous Supreme Court case.

This case upheld a law that said that The State could sterilize the, ahem, “feeble-minded”. Well, as it turns out, Carrie Buck was not feeble-minded, but was raped by the nephew of her adoptive mother and was thrown into an institution because she was inconvenient to those in power.

The Supreme Court, under Chief Justice William Taft, had Justice Oliver Wendell Holmes Jr. write the famous 8-1 majority opinion deciding in favor of James Hendren Bell, Superintendent of State Colony for Epileptics and Feeble Minded.

Here’s a paragraph that gives me chills when I read it:

The attack is not upon the procedure but upon the substantive law. It seems to be contended that in no circumstances could such an order be justified. It certainly is contended that the order cannot be justified upon the existing grounds. The judgment finds the facts that have been recited and that Carrie Buck “is the probable potential parent of socially inadequate offspring, likewise afflicted, that she may be sexually sterilized without detriment to her general health and that her welfare and that of society will be promoted by her sterilization,” and thereupon makes the order. In view of the general declarations of the legislature and the specific findings of the Court, obviously we cannot say as matter of law that the grounds do not exist, and if they exist they justify the result. We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concerned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U.S. 11. Three generations of imbeciles are enough.

When I read those questions, I hear echoes of OWH… and answering those questions with anything but a “never, never, never” has me hear echoes of Carrie Bell.

It’s not that, under some ideal system, it wouldn’t be a good thing to chemically castrate the worst serial rapists, sterilize the promiscuous, and lobotomize the McMurphys… it’s that we’d be far, far more likely to institutionalize the inconveniently raped and have them sterilized for the good of Society.

When I read those questions, I think “we tried that… it didn’t work”.

I don’t trust the government enough to try it again. I’d rather take my chances with the criminals and feeble-minded.

Scott: Right, I agree about having a general mistrust of government in terms of providing corrective behavioral measure that are a.) irreparable and b.) potentially avoidable.

What immediately jumped out to me, though, and I think this plays into the kind of flippancy with which government and authority in general have approached questions of just such types of seeming morality, is the notion that morality itself can be boiled down to biology. Someone is bad because they have a a malfunctioning body part (generally brain).

Certainly we have a mounting pile of evidence that demonstrates how closely correlated certain subjective states giving rise to general trajectories of behaviour and particular brain states are, but I remain convinced that taking those correlations and claiming causation in terms of something as tantamount as morality is not just wrongheaded and reductionist, but also potentially dangerous for all the reasons you mentioned (I.e. in a Foucaldian sense it provides the perfect storm of reasoning for power/authority/government’s need to dominate via bio-power) and a whole host of others (I.e. we tend to stop looking at means of further developing and evolving our moral intuitions and agencies and take a fundamentally passive role in terms of our own actions).

I think an honest and critical broker needs to look at the underlying biases at play in the formulation of the questions themselves and then explore what about the questions might have some valuable cache in spite of said biases and what fuzzy edges of the questions’ implications are left out as a result of them.

Jaybird: It seems like there’s an attitude that biology is something that those other, lesser, folks have. We are free from the constraints of that crude matter, as Yoda so eloquently put it, and are masters of our own selves.

Those poor bastards? Man. They’re slaves to the flesh.

The real fun begins when people follow those thoughts up with “something ought to be done” and they start appointing themselves (or people who remind them of themselves) the protectors of society.

Scott: But riffing off of your recent refrain on morality as, ultimately, a matter of choice, if someone does have an alterable physical malfunction that places undue limitations on their ability to freely choose towards achieving the “good life” — and in this regard, let’s avoid using chemical castration as our example and go with, say, relatively severe bipolar disorder, instead — is there not an imperative to do what we can to aid them in overcoming that hurdle and better enable them to choose and thereby attain a greater degree of moral agency?

Are we always bound to be hands off because inevitably we will screw it up? Sometimes we don’t screw it up, though. Sometimes we can manage to do some good where we limit ourselves to things that are a.) not irreparable but also b.) unavoidable. As a society, do we approach something like greater collective moral agency by choosing to engage such issues in a responsible manner?

Jaybird: Well, if someone does have an alterable physical malfunction that hinders them, I think that it probably would be a good thing to help them overcome that surgically or chemically or whatever. (I am not going to veer off into health care unless forced.) It ought to be consensual, certainly… but if you have a paranoid guy refusing to take his pills because he’s certain they’re really cyanide… do we have the right to force them down his throat?

Are we always bound to be hands off because inevitably we will screw it up?

It certainly strikes me as the way to bet. There’s a great little show that Radiolab did a while back.

The segment is called “how to cure what ails you”. It’s there at the bottom of the page.

Listen to it when you can. Your jaw will drop.

If, however, you don’t have time (who does?) I’ll give the crappy text breakdown.

(There’s a better one here, but mine is shorter.)

Medical schools in the 1700s were pretty rudimentary. They needed corpses, and lots of them. People, being people, didn’t tend to want to donate their bodies to science. That’s icky. So, of course, there were people whose job it was to rob fresh graves and sell the bodies to medical schools (“resurrectionists”… isn’t that a delightful name?). When people found out that Papa was dug up and sold to the medical school, they tended to get their friends, light some torches, and burn the school down. (These things happen.)

Well, the government, being the government, said that something ought to be done and so they said that people who lived/died in the poorhouse would have their bodies donated to science. Repay their debt to us as a society with their corpses. Win-win, right?

Well, as it turns out, people who are poor have different levels of stress than people who are not. Their insides are different. Their glands are different. Their thymuses (thymi?) are smaller than normal due to stress and poverty and whatnot.

Well, years later, we (as a society!) had grown rich enough to start to investigate stuff like SIDS deaths of infants. Well, doctors would open up one of these babies and see a normal-sized thymus… and they reached the conclusion that the thymus was oversized. All of the medical textbooks said that a thymus was supposed to be yea big… and those SIDS babies had *HUGE* ones!

So hundreds of babies had their thymuses dosed with radiation in order to make sure that these thymuses would not strangle them in their sleep like those SIDS death babies.

I wonder how much medical science is doing the same sort of thing today.

How many stupid assumptions that we have every reason to be making and continue to be making are resulting in us doing stuff monumentally harmful?

And how many questions like “should we *REALLY* be doing this?” are getting answers like “do you want your baby to die?”

I don’t *KNOW* that we will screw stuff up with 100% certainty… but it’s the way to bet. If we must err, let’s err on the side of liberty.

“As a society, do we approach something like greater collective moral agency by choosing to engage such issues in a responsible manner?”

I don’t know what a “responsible manner” would be. If you start finding babies with thymuses much, much larger than any medical text has ever shown and you are seeing a spate of babies die in their sleep (just stop breathing!) would it be responsible to do anything but try to save these infants’ lives from their grotesquely oversized thymuses? Do you want infants to die?

See what I mean?

Well, let me ask you: how would you best avoid creep when it comes to helping people?

I imagine that you see the severe bipolar disorder as very much on the one side of the line.

How do you keep from crossing it?

Scott: That’s a good question.

On a theoretical level, my answer would have to be a healthy dose of skepticism in terms of certainty. Again, we all too often mistake correlation for causation because of what we think we know. I’m not nearly so pessimistic about the impetus to help as I hear you being, but I think that we need to be really upfront and honest about our limitations, to be aware of them and bear them in mind when we’re trying to help. Trying is not necessarily to be derided, but certain that we always can help is something of which one needs to be suspicious. The suspicion is, I think, bred of our unfailing belief that some system of knowledge can and will render us correct in all instances and that our job is to figure out which system that happens to be (if we aren’t already convinced that we know).

From a more practical position, I think that skepticism caches out as an empowered and engaged public and citizenry that is willing to enforce limitations against purveyors of authority and knowledge. This is why I bristle so quickly against faux populists like Saraha Palin and Ron Paul and notions of the “power of average folks”, the whole project smacks of underselling people their potential and reinforcing this notion of the masses vs. the elites. It’s a useful narrative, to be sure, but I think it reinforces its own prescribed reality in a rose-colored fashion.

Authority and government are much more susceptible to humility in the face of stern and steady questioning than I think we generally acknowledge, so if you’re looking to maintain a sense of forward momentum but still recognize and, when needed, enforce limitations and parameters, a chorus of question is the best way to do so. But that takes effort and skill and education. You have to want and be okay with striving towards a certain intellectual pursuit because, whether we care to admit it or not, that type of questioning is itself an intellectual exercise.

So when I see the obvious movements to house just that type of exercise (read: populist movements on both the left and the right) deriding intellectualism I think to myself that they’re strangling the animus of their own victory. With friends like that, who needs enemies?

As long as that remains the case, I think we’re generally bound to wind up in an anti-overreach-overreach like the one you describe. But the impetus to help itself, I think, is not to be scolded when it arises, it is, I think, itself an expression of just the kind of humanity that seeks to be engaged and affected that I so long for.

Jaybird: Megan McArdle, I think it was, broke it down something like this when it came to the “helping” matrix.

There are two options: Helping and Not Helping

There are two outcomes: Better and Worse

If someone does not help and things get better, eh, so what? He didn’t do anything!

If someone does not help and things get worse, can you believe that this guy didn’t help? What a monster!

If someone helps and things get better, MY HERO!!! HE SAVED US ALL!!!

If someone helps and things get worse, well, at least he tried! It’s more than what you did!

So, basically, helping has no downside and potential huge upside and not helping has huge downside and very, very little upside.

It seems to me that this is a recipe for creep. We helped those with severe bipolar… why not people with severe obsessive compulsive? Why not depressives? Why not autistics? Why not self-diagnosed Asperger’s? Why not alcoholism? Why not alcoholics in denial over whether they’re alcoholics? Why not marijuana users? Why not the promiscuous?

Additionally, since I see a huge amount of problems in which the government has its thumb as iatrogenic in nature, that makes the matrix even more frustrating.

Wanting to do nothing in response to an iatrogenic disease is, very much, trying to help.

I suppose that that is the fundamental disagreement that I have with both populist groups as described below.

I don’t know how one can actually succeed on a platform of “doing nothing” when there are people who respond (EVERY TIME!!! IT’S UNCANNY!!!) to “here, I’m totally promising you the moon.”

I hope that there’s a way around this other than the ever-reliable “anything that cannot last forever *WILL* stop”.

So. I ask you this: What is our best way forward *WITHIN* our present framework?

I’ve adopted basic opposition to whomever happens to be in power… as gridlock is, realistically, the best we can possibly hope for. I’m guessing that this is likely to strike you as needlessly obstructionist.

What say you? Realistically, I mean. How to bring about our realistic best case scenarios using the tools we honestly have?

Scott: Needlessly obstructionist?

No, I don’t think I’d say that. Needless, to me, would indicate that you were being obstructionist for the sake of obstructionism. You’re on the line to some degree, but at the end of the day your obstructionism is about a larger principle, it’s guided by a intuition about achieving an ultimate good: liberty.

But look, as a sort of closing statement I’m going to say that what I do think your position results in is a certain fatalism that I see as being counterproductive: we/government are/is always going to fuck things up, so we need to make sure we/it do/does as little possible. That outlook does little to motivate people and the best way to ensure government creep/overreach is to do what you can to have a disengaged populace. If this thing that we all act through called government is always going to fuck things up, then why bother getting involved?

The fatalism I see in your position is rooted in the same kind of certainty and essentialism that we started out talking about. Namely, government as the means by which we collectively act is always a bad thing that will always do bad thing. I don’t think you can make any such claims about government in an absolute sense. Yes, there are going to be ample demonstration of how government fucks things up that we can point to. But there will also be counter examples.

Government is neither inherently good nor bad, and assuming that it is always and forever bad is, to my mind, as unhelpful as assuming that it is always and forever good. It is sometimes one and sometimes another and we need to look at what is actually the case to determine the reality of the situation. Otherwise we’re just trading in concepts and speculation. Eventually people get tired of said exercise and they stop participating, which, as mentioned, is a sure fire bait for the kind of creep you abhor.

My sense of what we do is take a contingent approach and find as many ways as possible of getting as broad a cross section of people engaged as we can and stop looking to government and its representatives themselves to provide us with the impetus for its curtailing. In that regard, as mentioned with regards to criticism around other populist movements, I think we have all the tools we require. We just need the fortitude and determination to use them.

Jaybird: The fatalism, at this point, is due to us being on the right side of the equivalent of the laffer curve. Now, I’d say that the curve does not describe tax revenues but ROI for government intervention. Whether I were an anarchist, minarchist, night watchman libertarian, cosmotarian, or republican who wants to smoke pot, I would still say that we are not on the right vector to maximize… well, to maximize *ANYTHING* but government.

If we rode the vector (woo!) in the opposite direction for a while, not only would we increase the amount of liberty enjoyed by pretty much everybody, but narrowing the focus of government would result in more government effectiveness. I honestly think that any government-established health care will be to health care what the TSA is to airplane safety. It’s not that there isn’t some theoretical fix out there that might work. It’s that we can’t expect our government to get to there from where it is.

We need to move left on the (what do we want to call it?) curve.

With a smaller, more focused government, we might get something effective that would work. See, for example, (European Country).

But we don’t have that. We have what we have.

I’ve heard analogies between our government and a red sun before. Maybe there’s no going back. We can only stay a red sun or go supernova. In either case, I think that gridlock is the best option.

Maybe it is nihilistic… but how many DHSes or TSAs do we need before we can realistically say “okay, maybe we should stop trying this and start something else?” How many PATRIOTs?

And, I suppose, that might be my closing statement, such as it is.

This was fun. Thanks.

Tagged as: government overreach, liberty, public engagement, social assistance, state decided medical operations