Author Archives: Kris Chari

Twitter and Aristotle

In “The Public-Shaming Pandemic,” author D.T. Max provides a telling anecdote about an influencer who is publicly shamed on social media for engaging in unsafe COVID activities in Milan. The article uses this anecdote to extrapolate a broader narrative about digital shaming in the age of this crippling pandemic. Finally, Max utilizes these particular examples to examine public shaming in general in the age of social media. I was fully enthralled by this piece, as it plays to a notion that I have strong feelings about. In this new age of hyper-”wokeness,” the bar for social acceptance and tolerance seems to be exceedingly high. There seems to be a wave of retroactively shaming people on issues they have maybe evolved on for political expediency. I believe this to be a dangerous precedent on both practical and ideological grounds, and I feel that two strains of ethical thought are deeply pertinent within this issue: aristotelian habit ethics and its conflict with Kantian Deontology.

Essentially, the issue boils down to the fundamental nature of human growth. The central notion of many spiritual pursuits is that humans are incomplete or flawed in some way, and most spiritual paths provide guidance and comfort along the journey to that sought completion. However, in this “cancel-culture” we have created, we seem to be treading into dangerous territory of retroactively shaming individuals for things they have said many years ago. We seem to be implying that human growth is not an arduous and complex process, that it should happen overnight. The ethical issue I found most pertinent here is the concept of Aristotelian habit ethics, which essentially outlines that we are defined by our character, our character is defined by our habits, and our habits are influenced by our many experiences. The crux of this philosophy is to try to pursue eudaimonia, and over time and experience, overcoming bad habits and achieving this utopic state. This is a fundamentally good idea because it allows humans to grow and love and learn and function in society. It also shifts focus away from micro-aggressions to true threats to the social fabric. By legitimizing public shaming of individuals we disagree with or that offend us, we are building a generation of individuals that will not be able to sustain the harsh realities of human life. We cannot “cancel” a difficult teacher, an impatient boss, or disobedient children. We have to learn to be firm in our convictions but tolerant and also tenacious when it comes to viewpoints that pluck at our sensitivities. 

Of course, as with any rule, I believe there are exceptions. We must learn to exercise judgement as a collective in order to discern which notions are out of line with our cultural norms and must be called out, but even then, there are meaningful and more conducive ways to pursue reform than calling people out on social media. Deontologists would argue that reason plays the heavy role in this balance of judgement, but in my own personal experience, I have found this strain of action to not only be ineffective in convincing the aggressor of their mistake, but also harmful, as it may reinforce stereotypes or prejudices the aggressor already holds. Elected office, community organizing, military service, law enforcement service! These are meaningful ways to truly affect change in our most impassioned issues, in our most needing communities. Sending a tweet honestly does very little.

I became very introspective on reading this article, and it ignited a passion within me to ponder the reality of this issue. I wonder if people chose offense based on their personal feelings about an individual. In essence, would we be angered to the same degree if someone we appreciated or strongly supported also had similar skeletons in their closet? 

A Vehement Critique of Authoritarianism

Peter Hessler, in his article “How China Controlled The Coronavirus,” provides an engaging personal narrative that describes his experiences in China with the thrilling subtext of the COVID-19 pandemic. Through this narrative he provides an accurate exegesis on the various methods that the Chinese government utilized to curtail the spread of the virus, and through deep personal, anecdotal evidence, he identifies the strengths and the successes of this method. He extrapolates on methods used such as strict lockdowns, health-trackers, and other severe, authoritarian measures, but Hessler goes further. He uses these strict measures and their success as a critique of liberal democracy, explaining that “those strategies could never be adopted in America.” The entire article seems to have the undertone of the ethical benefits of paternalism and beneficence, even when it curtails personal autonomy or individual freedoms. While I concede the undeniable truth that the United States and other liberal democracies could have bettered education efforts and been more stringent on public appearance and public health policy to combat the virus, I fundamentally disagree with the evident subtext of the article, which seems to be a critique of liberal democracy at large. While it may have failed us in this specific instance, liberal democracy has protected us from a plethora of evils that authoritarian regimes such as China actively use to subjugate their peoples. This virus should be considered the exception, and not the rule, to the efficacy and moral righteousness of liberal democracy.

The fundamental ethical dynamic of power largely influences my belief in this refutal. It boils down to a rather simple context: power corrupts; absolute power corrupts absolutely. Of course I am cognizant of the fact that for national security reasons, people in liberal democracies often forgo power for the greater good, but there should always be systems in place to remove and reclaim it. I also acknowledge the argument that with regards to the virus, the federal government in America should have taken a more active role in pursuing nationwide. Concurrently, I understand the notion that the author does not support all the policies put forth by China and does scrutinize them to such extent. My main issue is not with the strategies of China that the author praises but that it elevates China as a model as to pursuing those policies. If the virus is used as a model to forgo more power to the federal government, in a system like China, there is no system in place to remove that power. The only way to pursue the kinds of reforms that Hessler praises with the expediency he describes is to move closer to such a system, and I believe that to be incredibly dangerous. Processes under democracies take time and require patience by nature, but that is not a weakness, but rather a cogent strength. I am aware of our Federal Government’s failure to pursue stringent nationwide reforms for the virus, but I believe a more conducive and productive means of such reform is incentivization. For many other public health crises, we have used economic disincentivization to sway the public to the side of health. A prime example is the economic sanction imposed on cigarettes. The government could have incentivized states to push for stringent health policies through funding, but the localization of power is incredibly important. Education and leadership efforts could have been much better, but these largely revolve around rhetoric. Legislatively usurping power from peoples is the practice of aristocracies. 

Various ethical dilemmas can be used as cogent lenses to view the philosophical questions within Hessler’s argument. His main strain of ethical principle seems to be derivative of utilitarianism, because he argues that more lives can be saved through this authoritarian pursuit. That is fundamentally true. I do concede that authoritarianism breeds “results,” but in doing so, it runs the risk of viewing peoples and entities as means to an end. Quality of life, mental health, autonomy: these things matter. I know it seems like I am rashly against the intention and the truth of the article, but this is not the case. I see much merit in what Hessler puts forth. Even though I disagreed with some of the premises of the article and in my adolescent immaturity vehemently derided even the slightest praise of authoritarianism, the article did indeed provoke me to be a bit more introspective about the flaws of the American system. I began to wonder how more stringent policies and a stronger federal government initiative could have benefitted communities of color. I think it is important to find a balance between the two extremes, but I still believe that balance should be approached and achieved democratically. Slow and steady wins the race, and good things come to those who wait. 

A Rawlsian Analysis of the COVID-19 Vaccine

In “A Vaccine Reality Check,” writer Sarah Zhang provides a thorough exegesis on the current stage of the Coronavirus Vaccine, while using a complex array of historical precedents and contemporary analyses to examine the effectiveness and distribution of the vaccine. To briefly lay out the major points within the article, she examines the definition of a vaccine in general, elaborates on their implementation with respiratory illness, speaks on the specific development of various COVID vaccines, and examines the political implications of these developments. While these points clearly provide valuable insight into this issue, especially with the election nearing, I found the ethical dilemmas and theories that dictate the narrative within the article to be vastly more fascinating. 

With regards to development specifically, the question of ownership begins to govern how society views medical innovation: is it proprietary or collective? Zhang describes how the Trump Administration is encouraging many vaccine makers to invest in infrastructure and manufacturing systems to already prepare for FDA approval of the vaccine; while this may decrease the lag time between approval and availability, it raises the question of power imbalance in ownership once the vaccine is created. The two struggles are constantly at odds: the dichotomy between serving the public good by making these vaccines extremely affordable and the profit incentives for these companies to continue investing in manufacturing and infrastructure. If the medicine becomes specifically proprietary, then that allows companies to prioritize profits over public safety, but if the incentive of profit is removed, it reduces the economic interest of companies to invest in the first place. This ties back heavily to not only the ethical concept of ownership, but also to the essential idea of value-ordering. This will dictate how companies will act. In my opinion, a nuanced solution to this issue is a bit more free-market based. Instead of mandating companies to act a certain way, which I believe will largely de-incentivize their involvement to begin with, I believe the government should provide more market incentives for companies that make the vaccine more affordable. This may involve certain subsidies, but it will be more conducive to creating an economic equilibrium that also expedites the production of the vaccine. I strongly believe ethical principles should apply to institutions as well, because institutions are, in essence, a collective of individuals. Therefore, in respecting the autonomy of these collectives, I believe even more stringent government mandates would be a breach in the moral sense as well. Viewing pharmaceutical companies this way allows society to humanize them, and from that point, extrapolate a more nuanced solution. 

In terms of distribution of the vaccine, I could largely extrapolate ethical subtexts of utility and societal responsibility. The question then revolves around who receives the vaccines first, or at all. Zhang specifically describes a tactic used in 2009, in which states and hospitals used a system of priority status to determine high-risk individuals such as health care workers to get the vaccine first, in order to save the most lives. I felt uncertain about prescribing priority to anyone during a public health crisis, but I also realized that people must be prioritized due to medical scarcity and developmental struggle. So the ethical question shifted: how do we decide who gets the vaccine first? This intrinsic dilemma draws back on two central ethical tools from our study of John Rawls. The first dictates action, and the second prescribes it. This dilemma can be examined through the difference principle, or alternative distributive justice. Essentially, Rawls prescribes that it is okay, and at times expedient, for communities to stray from strict equality, as long as the lower echelons of society are better off than they would be under strict equality. Using this perspective, it makes sense that healthcare workers and high risk individuals would receive the vaccines first, because if strict equality was imposed, the scarcity that ensued would induce a distribution that would not benefit the lowest echelons of society. Saving the lives of healthcare workers, specifically in minority and underprivileged communities, directly helps save more lives, so the lowest strata are lifted up as well with this system of priority status. The second Rawlsian tool that would be most helpful with distribution is the Veil of Ignorance. While improbable, encouraging interest groups and various identities to examine how they would want this vaccine distributed if they did not know their medical details (i.e. age, predisposition, compromised immunity) would allow societies to determine who should receive the vaccine first. 

The article also evoked certain personal dilemmas from me. Zhang mentions that this virus can be used politically and the vaccine is no different. She also mentions the ensuing storm of misinformation and politicking that will follow. So I pondered how I could be helpful in a situation like this, and the most immediate solution that came to mind was voting. In exercising my constitutional right, I am not only electing a leader for the country, but also a global physician in a way. The next president will determine how the virus and the vaccine is handled, and it is an extremely important choice. I also wondered how this issue would play into systemic inequalities in the modern American paradigm. Having just finished The Immortal Life, I wondered how historically marginalized groups, Black Americans in particular would be affected by an improper distribution strategy. These questions only led me back to my first realization: it is extremely important that the will of the people is pronounced on Tuesday. In a moment of historic proportions, democracy is all we can look to for answers. 

Kantian Ethics and a Discussion on Decadence in Examining Henrietta Lacks

In Part II of The Immortal Life of Henrietta Lacks, Skloot dives deeper into the issues of unethical medical paternalism to provide a thrilling narrative about the theft and exploitation of Henrietta’s cells, focusing special attention on on the divergences between these two entities: 1) the person, who experienced tragic treatment and suffered from institutional poverty, and 2) the cells themselves, which to this day remain very much alive and well. The narrative begins with Gey requesting an autopsy, and the author here draws a clear distinction by mentioning that Gey had to get consent from Henrietta’s family in order to conduct the procedure. Here Skloot begins to introduce the theme that as a corpse, as a piece of biomedical material, Henrietta’s body is seen from an economic standpoint, which makes it easier to treat it as a commodity. This theme runs throughout this entire section of the novel. The story then details Henrietta’s funeral, and the author is sure to include another philosophical symbol, the storm. Henrietta’s cells are used to test the polio vaccine, and are vastly effective in developing it. HeLa grows in popularity soon after, but Dey, specifically, is hesitant to take credit. Three doctors then grossly misuse HeLa cells in their own practice through human experimentation, but nevertheless, HeLa cells become ubiquitous in the medical landscape. Meanwhile, Henrietta’s family suffers crippling hardship and destitution. Henrietta’s cells were being used to save lives, but her own family could not afford health insurance. 

Within Part II, numerous moral and bioethical issues are expressed, but the one I found most salient and profound was the distinct shift in focus from the issue of informed consent to that of ownership. While Henrietta was alive, doctors could exercise medical dominion over her under the guise of treatment and paternalism. The taking of tissue from Henrietta did not require consent, but the autopsy specifically did. This shifted the discussion from informed consent, which heavily relates to the living, to ownership, which largely dictates inanimate objects. This made me ponder the language surrounding the deceased and, more specifically, autonomy itself. Autonomy should refer to the living, but this societal reverence we place on the dead has highly autonomous language. I began to investigate the steps within the narrative to examine this unique relationship. Part of the reason for this difference, is that while she is alive, her cells are taken under the guise of curing and treating her, but after she has died, exploiting her body would specifically be for other reasons. They would be more directly “using her.” This significantly crosses the lines laid by Kantian ethics, which while allowing for people to be used as means, also dictates that those people are also the ends of the use. As a response to this however, Henrietta’s tissue becomes a medical commodity, transforming the issue into an economic consideration; once the issue becomes economic, it becomes easier to view her body and her tissue as biomedical material, and largely becomes an issue of ownership. I believe these ethical considerations to be well founded and strong arguments that build the subtext of the story. However, I do indeed pose some questions regarding their scope. If we abandon the Kantian interpretation and work within a utilitarian framework, I question if it can also be argued that since so many lives were positively impacted, the harmful actions of consent-overreach are negated or at least diminished in their immorality. I also question if Gey was genuinely trying to protect Henrietta’s privacy or if it was a matter of pride, guilt, and ownership.

This theme once again appears in the narrative during the discussion of the historical significance of “Night Doctors,” but this issue can be considered using other moral and ethical prescriptions as well. The narrative reveals that the practice and legacy of night doctors extends all the way back to slavery. This practice saw the commodification of black bodies and these entities were considered to be raw material. Once again this pulls on the notion of ownership and commodification, in that when viewing a patient or even a dead body as biomaterial instead of giving due reverence, it becomes vastly easier to view these issues through an economical sense, and treat these entities how we would treat any other economic commodity. Numerous ethical principles advise against such thinking, such as virtue ethics, which emphasizes the character, honesty, and individuality of the human form to be the most principled approach to ethics. I personally considered a philosophical theory I have been investigating independently to understand these issues: decadence. Decadence, from a societal and philosophical standpoint, largely refers to a perceived decay in standards, morals, honor, and discipline at the higher echelons of a state, and I believe this perspective can be a vital tool to understand the ethical dilemmas in this novel. I consider the systemic and institutionalized practice of these “night doctors” during the time of slavery, the subjugation of people of color described in the novel during the time of Henrietta Lacks, and the discussion in the novel of the current systemic practices in healthcare that disproportionately affect Black Americans to be emblematic of individual decay in cultural values and societal morals in the lack of reverence we award to people of color. 

However, this unique perspective also poses some interesting questions. If these practices are so systemic and institutionalized, how do we begin to ethically and fairly dismantle systems of marginalization? If we only view these issues from a perspective of decadence, how do we account for the progress that society has made in the realm of race relations? These two realities are not mutually exclusive. We can accept that we live in an institutionally racist society without discrediting the progress that we have made. In my opinion, this duality can be extrapolated to once again represent Aristotelian ethics, in that as a society, our habits are warring with our experiences, battling for the soul of our character. Through gradual changes in cultural attitudes, we are pursuing perfection in egalitarianism, and in that pursuit itself, I believe we are intrinsically good. 

An Examination of Buchanan and the Various Right-Claims to Decent Minimums

In this key excerpt from Securing Access to Health Care, Allen Buchanan explores the divergence between the universal right to decent minimums and practical policy of universal decent minimums. While he does assert that the universal right does not imply that such policy should be enacted, he also is cognizant of the fact that certain arguments do warrant such action. The crux of Buchanan’s argument resides in the key distinction between a right to overall, minimal, welfare floor of health for all and the availability of everything that can be done to ensure the overall health of all. A salient aspect of his argument that was specifically resonant to me was his “argument from special rights”. 

In this argument, Buchanan identifies three groups that should be given precedence in determining if they have a right-claim to universal decent minimums: historically marginalized groups such as African Americans or Native Americans, groups that have been harmed by a specific health risk such as victims of chemical exposure, and groups that have incurred harm through some sacrifice to the greater good such as veterans. These arguments, at the surface level and even to some scrutiny, hold up very well. They tie back to the central notion of injustices being redeemed or sacrifice being rewarded. I found a strong correlation between these philosophical relationships and prescriptions and the larger ethical ideas of Virtue Ethics, which emphasize mind, character, and sense of honesty. Assisting those who have sacrificed significantly relates to character, and repairing injustices speaks to a notion of honesty. 

Generally, I agree with this premise that Buchanan puts forth. However, upon closer examination, his ideas do have some inconsistencies. For example, the definition and scope of “injustice” is very subjective. People may define systemic injustices differently and believe that different groups are deserving of the preference and right-claim that Buchanan supports. This makes forging domestic healthcare policy very difficult. The same can be argued about his notion of sacrifice. Some may believe military service to be a sacrifice for the greater good, but others may deem it an unjust act. Empirically, this can be seen in the treatment of veterans after the Vietnam War. Exactly which groups are deserving of this treatment becomes very ambiguous in such cases. However, extrapolated to a more nuanced understanding of such policy, these ethical ideas may in fact function if and only if they are implemented as one aspect of a multifaceted healthcare objective.

A Broader Critique of Alan Goldman’s Value Orderings

In “Refutation of Medical Paternalism,” an excerpt from his larger work The Moral Foundations of Professional Ethics, Alan Goldman enumerates a plethora of cogent critiques against strong medical paternalism, but perhaps the most salient aspect of his argument is in articulating that the paternalistic notion that patients always prioritize health and prolonged life when seeking medical care is vastly unfounded. In order to do this, he begins by examining the definition of harm. While admitting that prioritizing the autonomy and self-determination of the patient may bring about some physiological and medical disadvantages, he believes that the subjugation and suppression of the patient’s free thinking and moral autonomy poses a broader and more significant threat to his identity. In order to substantiate this train of thought, Goldman particularly examines what he believes to be the core of an individual’s identity: value orderings. By altering the state of affairs through interference without consent, medical practitioners risk bringing about a state of affairs that are lower on the patient’s scale of value orderings, since values are intrinsically subjective and operate on a deeply personal basis. 

In order to truly understand this strain of Goldman’s argument, we must analyze its central component of value orderings. He poses a number of scenarios in which rational persons would not solely prioritize the minimization of the loss of life, such as choosing not to devote the entire federal budget towards healthcare or opting to engage in defensive war. He expects this same level of moral and ethical nuance to be applied to the practice of medicine as well. Indeed, these positions are not without merit. Rational thinkers with strong religious convictions, for example, prioritize their values vastly differently from members of the scientific community. There are people who may choose a medical treatment plan that, while being less effective in curing a particular ailment or prolonging life, may provide more comfort and better quality of life to the individual. An autonomous, self-determining individual has every right—nay, obligation—to allow his convictions to dictate which course of treatment he chooses. In further critiquing Goldman’s ideas, I analyzed them through the lens of larger ethical theories, and I began to see his argument as, essentially, a critique of utilitarianism. He understands that the weakness of the formula of utility is that it only focuses on the consequences of the actions, and not the moral intent or inherent character of the actions themselves. I found this to be an extremely compelling understanding of how strong paternalism prioritizes only the mere biological existence of patients, even at the cost of their subjective values.

However, there are some practical issues with Goldman’s arguments. He assumes that every patient is a rationally thinking individual who may only refuse certain treatments due to his personal convictions, but he fails to consider the actions of mentally disabled patients. These patients do not have the cognitive capacity to develop this “value-ordering” he prioritizes, and hence, are not able to distinguish between various medical states of affairs and the harm those scenarios may cause to their subjective values.