A cute, sad, and persuasive case for ending marijuana prohibition.
(via The Daily Dish)
In another must-read piece, the indispensable Atul Gawande pushes readers into an uncomfortable subject in order for them to reconsider how they look at the end of life.
The subject seems to reach national awareness mainly as a question of who should “win” when the expensive decisions are made: the insurers and the taxpayers footing the bill or the patient battling for his or her life. Budget hawks urge us to face the fact that we can’t afford everything. Demagogues shout about rationing and death panels. Market purists blame the existence of insurance: if patients and families paid the bills themselves, those expensive therapies would all come down in price. But they’re debating the wrong question. The failure of our system of medical care for people facing the end of their life runs much deeper. To see this, you have to get close enough to grapple with the way decisions about care are actually made.
Almost all these patients had known, for some time, that they had a terminal condition. Yet they—along with their families and doctors—were unprepared for the final stage. “We are having more conversation now about what patients want for the end of their life, by far, than they have had in all their lives to this point,” my friend said. “The problem is that’s way too late.” In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”
People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.
Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer. When Cox was transferred to hospice care, her doctors thought that she wouldn’t live much longer than a few weeks. With the supportive hospice therapy she received, she had already lived for a year.
Gawande makes us see it isn’t the soaring and budget breaking costs of prolonging
death “life” in the terminally ill that is the biggest problem, but rather it is that we’re making their own lives and those that love them worse. It isn’t a death panel to have patients voluntarily consult with a doctor before they can’t make decisions on their own about how they want to be treated near the end of their lives. Everyone and the medical profession itself has to think deeply about these difficult questions.
In an incredibly fun interview with Der Spiegel, Craig Venter talks about the genome, synthetic life, public vs. private science funding, and… Francis Collins.
SPIEGEL: Many fear what might happen if humans craft new life forms. They repeatedly say that you are playing God …
Venter: Yes, and I find them frightening. I can read your genome, you know? Nobody’s been able to do that in history before. But that is not about God-like powers, it’s about scientific power. The real problem is that the understanding of science in our society is so shallow. In the future, if we want to have enough water, enough food and enough energy without totally destroying our planet, then we will have to be dependent on good science.
SPIEGEL: Some scientist don’t rule out a belief in God. Francis Collins, for example …
Venter: … That’s his issue to reconcile, not mine. For me, it’s either faith or science – you can’t have both.
SPIEGEL: So you don’t consider Collins to be a true scientist?
Venter: Let’s just say he’s a government administrator.
Now Venter has beef with Collins because of their human genome rivalry, but really Venter is kind of a bad-ass anyway. This is also an amazing line:
Venter: There is currently no reason for us to synthesize human cells. I am, for example, a fan of the work that was done a short time ago that led to the decoding of the Neanderthal genome. But we don’t need any more Neanderthals on the planet, right? We already have enough of them.
I’ll just say I’m happy this guy doesn’t talk like a… government administrator. Awesome.
This blog has covered a fair amount of Rep. Paul Ryan, 1 Republican I know of who is willing to be serious even if I disagree with much of his short-term prescriptions. Here’s his interview with Ezra Klein.
Do you worry that even if you got your spending cuts, the American economy will suffer? A report released by the National League of Cities, the National Association of Counties and United States Conference of Mayors said they’ll have to lay off 500,000 people in the next few years if they don’t get some fiscal relief. That’s 500,000 people on the unemployment rolls.
I’ve always believed we need automatic stabilizers. We need a safety net. But I think it’s becoming equally important to show we’re not going to borrow endlessly. I also think it’s a bad idea to bail out states from making the necessary decisions they need to make to increase and fix their structural deficit problems. All you’re doing then is putting their liabilities on the federal books. And I assume those jobs are mostly public sector jobs. If you focus on those, that money comes from the private sector. The money isn’t free. It’s being taken out of the private economy and pumped through the private sector. The right path is to keep the money in the private sector and so they have money to invest. We should focus on growth in the private sector, not growth in the public sector.
I disagree on transferring aid to the states, but if more Paul Ryans populated the Republican Party we’d all be better off.
(image by Joshua Roberts/Bloomberg)
David Leonhardt of The New York Times continues to put out great stuff one after the other. This latest piece excited as well as confused me.
Students who had learned much more in kindergarten were more likely to go to college than students with otherwise similar backgrounds. Students who learned more were also less likely to become single parents. As adults, they were more likely to be saving for retirement. Perhaps most striking, they were earning more.
Mr. Chetty and his colleagues — one of whom, Emmanuel Saez, recently won the prize for the top research economist under the age of 40 — estimate that a standout kindergarten teacher is worth about $320,000 a year. That’s the present value of the additional money that a full class of students can expect to earn over their careers. This estimate doesn’t take into account social gains, like better health and less crime.
This is really exciting news if it is true, but the “not yet peer-reviewed” findings, as Greg Mankiw also wondered about, seem to contradict the evidence that suggests even parents’ actions don’t have much of an effect on children’s adult outcomes.
Meanwhile Jonah Lehrer argues that preschool and early education programs don’t so much make you more intelligent but do affect our “non-cognative” abilities.
How does preschool work its magic? Interestingly, the Perry Preschool didn’t lead to a lasting boost in IQ scores. While kids exposed to preschool got an initial bump in general intelligence, this dissipated by second grade. Instead, preschool seemed to improve performance on a variety of “non-cognitive” abilities, such as self-control, persistence and grit. While society has long obsessed over raw smarts – just look at our fixation on IQ scores – Heckman and Cunha argue that these non-cognitive traits are often more important. They note, for instance, that dependability is the trait most valued by employers, while “perseverance, dependability and consistency are the most important predictors of grades in school.” Of course, these valuable skills have little or anything to do with general intelligence. And that’s probably a good thing, since our non-cognitive traits are much more malleable, at least when interventions occur at an early age, than IQ. Preschool might not make us smarter – our intelligence is strongly shaped by our genes – but it can make us a better person, and that’s even more important. (my emphasis)
That helps explain things a little, but I’m still unclear why our parents wouldn’t be able to effect those same abilities. Until that is settled, I still think the public policy implication is obvious: spend more on early education.
The economists calculate that, for every dollar invested in preschool for at-risk children, society at large reaps somewhere between eight and nine dollars in return.
Over at The Hannibal Blog a fun debate took place between me and some other commentators after Andreas posted his thoughts on culture of competition’s effect on violence (which linked my post on Ape/Human violence). One commentator suggested that since testosterone was linked to violence society would be better off if all males were castrated above a certain age.
If you’re game or interested enough to follow a debate on a topic like that read on. Note to readers: I’ve edited out many comments that aren’t directly relevant to this specific debate. Also I’ve rearranged the order of many comments to make it easier to follow. To read the entire text go to the original post (be aware that the original is not ordered by time so some comments seem out of order).
Since violence is almost wholly a male thing, and since it’s testosterone which fuels male violence, a solution to endemic violence would the mandatory castration of all males above a stipulated age.
hilarious phil! ;0
basically reduce the men to “sperm donor status”! ouch.
uh, i’m probably the only one laughing?
Actually, violence is almost wholly a YOUNG male thing. Has to do with evolutionary biology. Could we just give the 17-year-old lads an estrogen shot or something, to calm them down for a few years? That way, they could keep their jewels for their mellow later years.
My suggestion actually is serious. The innately violent male is a luxury our world can no longer afford. His psychology therefore has to change. Since his reading tomes by dead Greek and dead German philosophers won’t likely do this, his being castrated is the better option.
With innate male violence surgically removed through castration, there would, for starters, be no more wars and no more rapes and no more unwanted pregnancies. In this way, and in other undreamed ways, our world would truly be transformed.
There is, of course, the little matter of how the next generation would be produced. This would be looked after by having the male about to undergo castration, have a sperm sample taken, which would be stored under his name in a sperm bank.
Should he subsequently meet the Beloved of his dreams, and wishes her to bear his children, and she says yes, she would be inseminated with his stored sperm.
All this said, I don’t expect my eminently reasonable suggestion to bear fruit soon, if ever, because the male still runs things, and likely always will.
Has it crossed your mind that the problem may not be testosterone? It does not cause all males, or even the majority of them, to behave in a violent manner. It is a factor, not a cause. It is true that a reduction in testosterone also results in a reduction in aggressive behavior. But aggressive behavior is not always a bad thing. It is part of the reason that we take risks. It gives us test pilots, astronauts, entrepreneurs,football players, firemen, policemen, and capable soldiers who risk their lives to protect the rest of us.
Your solution is, to be blunt, too simple. Sort of like that extra chromosome thing that was once thought to be behind criminal behavior. We are complex creatures and there doesn’t seem to be universal answers to any of our possibly inherent problems.
Did it ever actually occur to you that your “solution” to violence is violence? Leave it to a male to think that is a good idea. Do you think males are just going to willingly agree to be mass castrated? To solve homelessness we could just execute the homeless too or when they freeze we could stack their bodies and build igloos to house other homeless. Jonathan Swift would be “proud” of your modest proposal.
If I were you I’d also consider reading or watching A Clockwork Orange.
Surgically removing testicles is no more violent than surgically removing an appendix.
However, males are still conscripted into armies despite that they don’t willingly agree to being conscripted.
As it is for conscription, why not also for castration?
You are painting with too wide a brush.
I’ve watched the film many times throughout the almost now 40 years since it came out. Beethoven hasn’t been the same for me since.
I don’t doubt this. However, men commit 90% and more of violent crimes.
Umm… the difference seems to be pretty obvious: People agree to have their appendix removed to save their lives; forced castration would be almost the exact opposite.
As it is for conscription, why not also for castration?
For one, I’m not a supporter of conscription. You’ll notice the US and many other civilized nations stopped that practice. Also, to conscript someone you have to be willing to commit violence against them if they refuse. What would you do to someone who refused (which would be the sensible thing I might add) castration? Lock them in jail? And if they resisted that because it’d be a morally injust infringement on their human rights – you’d have to violently force them (gun point probably), would you not? Do you really think forcibly castrating men isn’t violent!? Or no more violent than removing an inflamed organ that can cause their death?
On the homeless analogy to illustrate your extreme suggestion; I could make a case that my satirical suggestion is actually less appalling than your actual recommendation. After all, collecting frozen corpses would happen after their death, not while they are living. It’d mitigate future homelessness by providing shelter to the downtrodden. It’s even a green solution! No more environmentally unfriendly building materials – we are cutting down our forests at an unsettling rate after all – also our new “building blocks” are even organic!
Look I almost never throw out the Nazi card. But this is literally a policy the Nazis used. Except that they used it EVEN LESS universally than you are suggesting.
I’ll put down my broad brush if you put down your capacious scalpel.
Except that one is voluntary, the other is forced. And “forced” is always “violent.”
This bit of inanity ignores the protests and riots over the US draft in the late 60′s, not to mention the draft riots of the Civil War era and the numbers who fled to Canada or dodged the draft in the aforementioned 60′s.
I thought you were being facetious when you first suggested this, now I am a bit appalled at the fascism inherent in the suggestion.
Setting aside, for convenience, enquiry into the link between testosterone and violence, female violence and conscription, would you agree, Dan and Douglas that the victims, say, of Hiroshima, Nagasaki, Dresden, Berlin and London were neither consulted nor gave their consent?
And Andreas, do you say that sublimation eliminates raw human violence?
I am not sure what you are trying to say here. Victims of violence rarely give their consent.
As to the particular victims you mention, tacit consent is thought to be given by vote (Germany – election of Hitler and the NAZI party) or tradition (Japan – following the Emperor). We all are subject to the consequences of the actions of our governments. That, of course, is also the justification used by al Qaeda for attacking civilian targets, as well as by terrorists since the late 60′s.
If, Douglas, it is permissible to bomb Hiroshima and Nagasaki without the consent of those who live there, why is it not permissible to castrate without consent? Similarly, if it is permissible to bomb European cities without consent in the supposed furtherance or defence of civilisation, why is it not permissible to castrate for a like cause? The nature of consent is a separate question.
Well, first you would need to recognize what made bombing the cities mentioned “permissible” (as you call it). It is called “war” and targeting of non-combatants (i.e. civilians) is not permissible under the Geneva convention. What made the bombings permissible was the military industries in those cities and the inability at that time to make surgical strikes.
Second, individuals were not targeted by the bombings. They would be in a castration plan.
Third, the efficacy of a wholesale castration program is highly questionable because testosterone is NOT the trigger factor for violence, it is merely ONE factor in the violence equation.
I didn’t expect that my suggestion that all males be mandatorily castrated to bring about a violence-free world would be debated as seriously and thoughtfully as it has been in the above comments.
The issues raised may therefore deserve of wider currency.
So, Andreas, how about you suggesting to your employers at the Economist that this topic be the subject of one of those future on-line debates which the Economist periodically stages?
I can foresee all the people jumping at the chance to advocate universal forced castration now! Sorry Phil, not sure The Economist would be able to find someone serious enough for their platform who’s had their sense of morality sterilized.I have to ask, why haven’t you (I’m know I’m making a bit of a presumption right now) had yourself sterilized/castrated? We have the technology to freeze your sperm as you brought to our attention before. I’m seriously interested in these answers – feel free to have a go at my previous arguments as well. Forgive my rhetorical shots, as you seem to have noticed, I and others are seriously considering your modest proposal and I really do find it ethically extreme and abhorrent, but I’d like to pry into your thought processes a bit. Oh, and have you considered the tailor-made-for-you phrase: “The Ends Don’t Justify The Means”?
I’m happy to suggest it. Can’t guarantee it’ll happen. ;)
Does the Economist know this?
That’s for me to know and for you to find out.
I’m glad to learn this.
It’s difficult to please everybody.
You’d find it boring.
Without getting into the morality of specific bombings, battles, or wars – we don’t need the consent of those we’re fighting to use force to stop them from committing crimes against humanity. In a morally justified act of war, we’re not targeting innocent civilians (when we are or when we have: that would be morally wrong). Collateral damage is a can of worms I don’t want to get into now and doesn’t really seem germane to the discussion anyway.
Universal male forced sterilization would be purposeful targeting of innocents. Not every male is a violent problem after all. It’s also ridiculous to punish people for the potential to commit crime, isn’t it? Not even the intent – the mere potential. Where does that end? Eugenics at best, probably. Disturbing.
Please explain your implied assertion this is a discussion about specific bombings, collateral damage and a just war, Dan.
Are you able to define a crime against humanity in a way that separates warfare from other kinds of violence?Please explain your implied assertion that this is a discussion about international law, Douglas, and enlarge upon why individuals are not targeted, either intentionally or necessarily, in bombings.
Please explain your implied assertion that this is a discussion about international law, Douglas, and enlarge upon why individuals are not targeted, either intentionally or necessarily, in bombings.
Because (a) you brought up the bombings of extra-national cities and (b) read the Geneva Convention.
I really don’t like “red herrings”. You brought these issues up. I should have called you on the red herrings but didn’t, thinking you did it innocently enough.We, in the US, have something called “due process” which is mentioned in the 4th Amendment of our Constitution. We can’t even castrate sexual predators without their consent because it would be seen as “cruel or unusual” punishment which we are also protected from by our Constitution. These two things would seem to make a mass castration plan illegal in the US. Further musing on this, I think a Congress enacting such a plan would result in a revolt. Now, could we go back to rational and reasonable debate about violence in society?
Are you serious!? Thank you Douglas for already answering; this apparently needs to be hammered in a bit. (1) I specifically said this IS NOT a discussion about those things.
“Without getting into the morality of specific bombings, battles, or wars” “Collateral damage is a can of worms I don’t want to get into now and doesn’t really seem germane to the discussion anyway.” Honestly, did you even read what I wrote? (2) I only brought those things up because YOU started talking about them. I was trying to respond to your ridiculous comparison. “If, Douglas, it is permissible to bomb Hiroshima and Nagasaki without the consent of those who live there, why is it not permissible to castrate without consent? Similarly, if it is permissible to bomb European cities without consent in the supposed furtherance or defence of civilisation, why is it not permissible to castrate for a like cause? ” Honestly, did you even read what you wrote? I’m not even going to respond to the other question. As you noticed, it just isn’t relevant. Phil has decided to stop making productive comments.
“That’s for me to know and for you to find out.” “It’s difficult to please everybody.” “You’d find it boring.” I assume (or maybe “hope” is the word) that Phil realized his position is utterly indefensible so he’s ducking any responsibility to respond to my interrogation of his reasoning. I’ll hold out some faith that he’ll just admit his advocation of such a horrific policy was immoral and wrong. Can you at least concede that the policy would be violent, as I originally sought to point out? “Did it ever actually occur to you that your “solution” to violence is violence?”
Phil, it isn’t a bad thing to recognize that your idea, which you probably just tossed out off the cuff, isn’t as moral or peaceful as you first estimated.
I do admit, Dan, that I was hoping later to justify my comments, but in the immediate context I was seeking, politely, to redirect your focus on to the issue of consent. Never mind.
Since, Dan, we have not examined to a conclusion the relation of Phil’s proposal and consent, perhaps you will allow me to proceed direct to the object of that enquiry. That object is to ask you to say, if you will, why you align Phil’s proposal in particular with Nazism, ethical extreme and abhorrence and my consideration of it in general with support of eugenics.
I suppose this is why I didn’t even want to bring up the Nazi example – another tangent. But I thought I was pretty clear: I linked to wikipedia explaining that Nazis forcibly castrated people. Is that really that difficult to make a jump between forced castration of particular groups to forcing castration of all males? Isn’t it actually more extreme? It’s not like the Nazis didn’t think they were acting toward a higher goal – they didn’t think they were evil. They just were. You may think forcing castration on all males is a good thing to prevent future violence, but as I’ve tried to argue: that is evil (or at the very least: violent – that was my original point, which I don’t see how that is in dispute).
“By the end of World War II, over 400,000 individuals were sterilized under the German law and its revisions, most within its first four years of being enacted.”
The connection with eugenics is clear (for one, that’s why the Nazis did it). Also, I was extending the logic of taking action against someone for the potential to do something. i.e. stopping males potential for violence before they have even committed any violent acts. Eugenics prevents the potential to pass on “abnormal” genes. The Nazis and other eugenics supporters wanted to “purify” humanity’s genetic makeup. Phil wants to “purify” male’s inherent nature by altering its “inherently violent” hormonal makeup.
Have I yet expressed support or opposition to Phil’s proposal, Dan?
Did I say you have? I’m pretty sure I just directly answered your questions. If you’re confusing my “you may think” for saying “you think,” understand that I was making a rhetorical point. Reread the context. The “may” is the key word there. Feel free to substitute “one” for “you” if that makes it clearer for you.
To compare what I propose, to that which the Nazis did, is to compare chalk with cheese.
The Nazis castrated selected groups of men whom they saw as totally different to themselves, and whom they did not like. I propose castrating people (men) who, as men, are not different to ourselves, and whom we don’t totally not like.
Also, the intent of the Nazis was that they intended that the men they castrated not father any more children. What I propose contains the opposite – that men, by donating sperm before castration, can father children.
These are huge differences, I’m sure you’ll agree.
Your proposal takes away the opportunity for enjoyment, momentary though it may be, of the fathering process.
I wonder, have you volunteered for the procedure?
I just now picked up on the sublime/sublimate connection. Doh.
This fascinating debate was leading to an examination of the nature of aggression and an enquiry into why an advanced civilisation suddenly resorts to primitive brute force. Unfortunately, it has descended to pejorative. Your intervention is soothing, very feminine and welcome. I weary a little and will take my leave.
I surmise that chimpanzees jumping up and down and screeching furiously at each other are saying the same sorts of things to each other in their chimp language as were said in sadly all too many of the above comments.
Given that well-nigh all the comments appeared to come from males allegedly human, they were as good an example as any of innate male irrationality and stupidity.
I too am weary and will take my leave.
I can’t help but assume that you two consider my comments part of the screeching chimp “irrationality and stupidity” that has “descended to pejorative.” I won’t spend my time focusing on the hypocrisy contained in that sentiment. But can someone please point out (if it applies to me) my “primitive brute force,” my “screeching,” and my “irrationality and stupidity?” I honestly thought I was just seriously engaging in your actual proposal to forcibly castrate all males. If strong language can’t be used to discuss a topic such as that I’m afraid you may be more interested in the lack of critical scrutiny than true debate.
Was it the Nazi reference? Is it really “pejorative” to point out a direct connection to a policy if I actually believe it is comparable? I’m not calling you a Nazi; I’m pointing out the policy you advocate is a policy that Nazis used (even if for a different rationale). Anyone is welcome to refute that and I’ll happily recant.
I didn’t spend the time to engage each of your arguments line-by-line in order to make frivolous personal remarks. Phil, how did you go from believing your suggestion was being “debated as seriously and thoughtfully” to believing the conversation was more primal shouting than honest consideration laced with a bit of humor? Most of my strongest comments even came before you acknowledged it was being debated with sobriety even if with vigor. What changed?
I apologize if I gave anyone the impression I wasn’t commenting with the highest intentions for genuine discussion. I enjoy a good barb but always wrap it around an earnest argument; didn’t mean to sting anyone’s integrity. I thought we were being Greek. All the best.
How bizarre. I’m with Dan on this: Following your debate with enormous interest, I also assumed that you were all “being Greek”.
In fact, I still think you were. That was good debate. have more of them.
Well, there it is. We all part from this friends.
Glad to hear. May we meet in
thisAndreas’s rhetorical assembly again.
I fear you cut straight through a fragile thread which led to treasure, Dan.
I do my best ;)
(image from Wikipedia: testosterone structure)
Martin Wolf explains the politically brilliant but economically preposterous idea that changed Republicans from minority to majority party and from conservative to “extreme radicals.”
Supply-side economics liberated conservatives from any need to insist on fiscal rectitude and balanced budgets. Supply-side economics said that one could cut taxes and balance budgets, because incentive effects would generate new activity and so higher revenue.
[T]he Republicans were transformed from a balanced-budget party to a tax-cutting party. This innovative stance proved highly politically effective, consistently putting the Democrats at a political disadvantage.
Since the fiscal theory of supply-side economics did not work, the tax-cutting eras of Ronald Reagan and George H. Bush and again of George W. Bush saw very substantial rises in ratios of federal debt to gross domestic product. Under Reagan and the first Bush, the ratio of public debt to GDP went from 33 per cent to 64 per cent. It fell to 57 per cent under Bill Clinton. It then rose to 69 per cent under the second George Bush. Equally, tax cuts in the era of George W. Bush, wars and the economic crisis account for almost all the dire fiscal outlook for the next ten years (see the Center on Budget and Policy Priorities).
This is extraordinarily dangerous. The danger does not arise from the fiscal deficits of today, but the attitudes to fiscal policy, over the long run, of one of the two main parties. Those radical conservatives (a small minority, I hope) who want to destroy the credit of the US federal government may succeed. If so, that would be the end of the US era of global dominance. The destruction of fiscal credibility could be the outcome of the policies of the party that considers itself the most patriotic.
(emphasis is mine)
I couldn’t agree more on the danger of having a 1 of the 2 major political parties being completely untethered to economic reality. We don’t have a mainstream conservative opposition in America today – we’re poorer for it.