Bad medicine or cultural difference?

According to an article in The Guardian, an Indian couple permitted their 15-year-old son to perform a Cesarean section in order to get in the Guinness Book of Records. I don't have a lot to say about this, but I wanted to share it.

I think it is clear that permitting an untrained 15 year old perform surgery is unethical. I thought briefly that some might think it "cultural imperialism" to tell Indians how to conduct medicine, but I really have no evidence that Indians don't find it as appalling as everyone else in the world. According to the article (quoting the Hindustan Times), when confronted with his actions, the doctor (the father of the "surgeon") replied, "If a 10-year-old [in India] can drive a car and a 15-year-old can become a doctor in the US, what is wrong if my son, though not qualified, performs a surgery?" He answers his own question--if his son were 15 and qualified, the issue would be much more complicated. We might then be asking whether an otherwise qualified 15 year old can be mature enough to perform surgery, which raises all sorts of issues not present in the current case.

The parents now deny that their son performed the surgery, by the way, and claim instead that he only watched the operation. If it is proven he did perform the surgery, the parents could lose their licenses.

How to have a lawn that won't kill us all.

I've had several things to say about lawns. In the spirit of trying to offer alternatives, I will simply point you to an article from the UK both about the problems of lawns and the possible ways to deal with the problems. It is possible to live with beautiful gardens without pesticides, herbicides, fossil-fuel-burning and polluting lawn equipment, and water waste.

Of course, in the US, homeowner associations call the shots and insist on the destructive practices that the Guardian article is warning against. What is the solution? Fight the HOAs. Demand an end to environmentally destructive deed restrictions. We are not fighting to save the Earth. We are fighting to save ourselves.

More problems with lawns

Lawns continue to cause problems for the survival of animals such as humans. A New York Times article today reports on the problem of water conservation in Florida. In the article, Abby Goodnough notes that Florida residents use up to 75 percent of their water outdoors, mostly on lawns. Drought-resistant ground cover and artificial turf have both failed to catch on in big numbers. Why? Homeowner associations prohibit both. Instead, HOAs insist that homeowners have grass lawns, which require not only enormous amounts of water but also chemicals in the form of pesticides and fertilizers.

In other words, most Floridians (read: US citizens) are required to create environmental hazards around their homes. These hazards are harmful to animals, including humans, and are aesthetically bland at their very best. The fact that spending 75 percent of fresh water to maintain lawns is an unjust distribution of natural and financial resources seems self-evident to this author, but I've grown accustomed to being in the minority.

Perhaps HOAs are resistant because attractive alternatives do not exist. Artificial turf may not be the panacea some hope for as many find it less than beautiful. At least, many think they will find it less than beautiful. Perhaps to see it is to love it, but who knows? Some residents have also experimented with gardens made of rocks and hardy, ground-resistant ground cover. This gives a garden the look of a natural setting, which also seems upsetting to HOAs. A Zen garden filled with gravel and a few well-placed boulders might be attractive and encourage mindfulness at the same time, but I doubt HOAs will embrace the idea of Zen gardens soon, either.

What's to be done? Some ideas: 1. pass laws limiting water consumption. 2. pass laws limiting the use of environmentally harmful chemicals on lawns. 3. eliminate HOAs. 4. encourage creative lawn maintenance. 5. remove all laws or deed restrictions requiring maintenance of grass lawns.

We will have greater property rights, lawns will reflect more diverse forms of beauty, water will be more abundant, and we will have a more just world. Not bad for a days work. Just let property owners do what they want to do, anyway.

Is health care better when you pay more?

In a New York Times article today, Reed Abelson makes the bold statement that a new hospital study provides "stark evidence" that higher payments do not translate to better medical care. He is citing a Pennsylvania government study of the 60 hospitals in Pennsylvania that perform heart bypass surgery. Two of the highest paid hospitals also had the highest death rates. This could be for many reasons. These hospitals might take the most difficult cases or the most costly. Either example would cause higher costs and poorer results.

So, the study is too narrow to make sweeping generalizations about health care costs, but it does raise some questions. Noting that this particular study does not prove much, Abelson goes on to say, "Still, the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine."

Implied in the article is a call to adopt a pay-for-performance model for health care. The idea is that physicians and hospitals with better outcomes would receive higher pay. On the surface, this seems like a good idea, but there are potential problems. One way to improve outcomes is to deny service to high-risk patients. Abelson's article notes that Geisinger Health Care is offering a 30-day warranty on its cardiac surgery. Private hospitals are able to choose the best candidates for surgery and have a much better chance of making good on the warranty.

Public hospitals face other dilemmas. Hahnemann University Hospital now says that its record keeping probably did not give an accurate picture of how sick its patients were before coming for surgery. Public hospitals and teaching hospitals take all patients and do their best to save them. Those with the sickest patients are likely to have the worst outcomes. This is not proof of poor care.

The question of how to compare care at different facilities or among different doctors is not one easily answered. Most will agree that better performance should be rewarded, but getting an accurate picture of care quality will require more than counting deaths and dollars. Dr. Richard Snyder of Independence Blue Cross, is quoted as saying, "Philosophically, you're not going to get an argument from us. We believe we should pay more for high quality than poor quality." Implicit in his statement is frustration over how to measure quality. Recognizing the complexity of the question is the first step to formulating possible answers.

The Personal is Political

For decades now, feminists have been telling us that what goes on in the private sphere affects the public sphere. The rallying cry of "The personal is political!" was heard by many. Some, such as Susan Okin, even predicted the problem this would cause for men. In order for women to enter the public sphere, men would have to enter the private sphere. If women were paid less and given less respect because their commitment to their jobs was diluted somewhat by family obligations, employers were likely to be even more harsh with fathers who wanted to be part of family life.

Though the warnings were unheeded, they were not unjustified. Katherine Reynolds Lewis has just published an article describing the struggles modern fathers face. It was assumed in the past that fathers would rather not take responsibility for changing diapers, taking sick kids to the doctor, and going to meet with teachers. This assumption turned out to be false. Fathers in the past were afraid that if they were more involved in the private sphere of home and family, they would be punished by their employers. Their fears have been realized. Fathers have been passed over for promotions and even fired after insisting on taking leave to be with their children.

Liberating women for equal pay will require liberating men as well. As society we should assume that all parents love their children and want to be with them to ensure their healthy development. Some fathers and mothers are not good parents to be sure, but rewarding rather than punishing those who are will benefit us all.

How free can we be?

I'm a little behind the curve on this, but a Jan. 2 article by Dennis Overbye in The New York Times deals with free will and the latest developments in cognitive science regarding free will. Overbye cites the work of Benjamine Libet who demonstrated (to his satisfaction, anyway) in the 1970s that people act before becoming consciously aware of their choices. Consciousness and apparent free choices seems to follow the mechanism we call our body rather than direct it. It is compared to a monkey riding the back of a tiger and making up a story about how the monkey directed the tiger's actions.

To some extent, I guess we all believe that actions are caused by physical laws and past events. Whenever someone commits a horrible crime, we ask, "What would cause someone to do such a thing?" We believe there is an answer, and scientists seek the answers. People who argue most strenuously for free will will generally back off when confronted with their own shyness, depression, impatience, or other trait they've tried for years to modify.

A simple test for free will involves the compulsion to crunch on ice. For reasons I don't understand, people with an iron deficiency will crunch ice compulsively, annoying co-workers, family members, and passers-by. Give them iron, and suddenly they "choose" to stop crunching ice all the time.

So, is this cause for despair or optimism? Understanding the causes of our actions gives us more tools to help control them (giving iron supplements, for example). At the same time, knowing our actions are caused makes us doubt the free will of the soul (or mind, if you prefer). We feel a loss of dignity, for some reason. Daniel Dennett argues consistently and persistently that recognizing and understanding causal relationships gives us more freedom, not less. When he says "more" freedom, though, he really means more than none, which isn't comforting to the hard-core indeterminists in the world.

One problem is that punishment becomes meaningless if people are not free, or so it is claimed. Spinoza answered this by saying that you would control the actions of a rabid dog in the same manner regardless of whether the dog chose to be rabid. The same, he claimed, should apply to humans. Punishment is no longer retribution, though, it is now simply a necessary condition of life.

On the other hand, William James claimed that we are forced to believe in free will because we are forced to make choices every day. If we do not believe in free will, we cannot make any choices, so we are paralyzed. From a practical standpoint, we feel we are free and must act as if we are free.

This may be as good as it gets.

Is your lawn actually yours?

Linda Ballew went to court rather than mow her back lawn, but now she is reconsidering. Most people, including the judge, seem to think she is unable or too poor to mow her grass. This seems unlikely. She agreed to mow her front yard and made good on the promise. This is most likely a moral choice (0ne she feels strongly about) rather than mere negligence. Her neighbors are complaining that she has created a habitat for wildlife including nutria, skunks, and snakes. Apparently, neighbors don't enjoy having wildlife experiences in the neighborhood.

This begs the question of what property rights owners have over their own property? If Ms. Ballew wanted to create a habitat for wildlife, is this not her right? Why do the rights of developers to destroy animal habitats seem to take legal precedence over those who would create or replace habitat? Ms. Ballew's yard is described as "overgrown," which means it is full of green plants that will reduce temperatures and cleanse the air. She is creating a green environment, an apparent evil in the US.

Millions of people around the world live in concert with nature rather than in a position of domination. Ms. Ballew challenges her neighbors to learn to live with nature rather than against it. She also challenges them to respect the idea that property owners can make choices about how their property is maintained. If she is, indeed, endangering her neighbors, there is a case to be made that she must stop endangering them, but this may not mean she must completely eliminate the wildlife refuge she has created.

Her righteously indignant neighbors probably have lawns filled with pesticides and dangerous additives that seep into the soil and everything else surrounding the lawn causing damage to animals, including animals of the human variety. These same neighbors surely never even question whether their actions may be causing harm to the environment, wildlife, or humans. Certainty is good when you can find it, but it is rare and should always be held in suspicion.

It is time to question the commitment most in the US have to the bland, overly-manicured lawn, and evaluate what values promote a better good overall. It is also time to recognize that those with differing values may have something to teach us. The answers to life's questions are rarely clear, and opposing views help us explore our own ethical intuitions.