Tuesday, July 11, 2006


In the last analysis, each and every one of us must come to their own conclusions about the current world. We can read newspapers and periodicals (my favorite is the New York Review of Books), peruse blogs and, I guess, watch Fox News for our information. We have all read history and tend to ramble on ad infinitum about things that happened in the past that reflect on current events, but in the end it is the here and now that is of the only importance.

How far back one goes in one's definition of history is also a individual's decision. Some of us are linked to vast and monolithic constructions of the past (e.g. the Catholic Church) that tend to inform our moral consciousness. Others have been drawn into more recent constructs (e.g. fundamental Christianity, the right wing of the Republican Party) for their backing. It is interesting to note that the framers of our Constitution (which has taken on a sacerdotal sheen recently as the result of attacks on its purview) were, for the most part, Deists. The history that they used in their thinking was as recent as their current century, i.e. the Enlightenment. Contrast that with the use of pre Christian Biblical exegesis by the fundamentalists, including our President. Instead of the Christian and Buddhist concepts of respect for others, we have the Old Testament "eye for an eye..."

I would say that most Americans, following in the footsteps of our founders, had until recently the ethic that accompanied the Enlightenment and Deism. A central precept of this ethic was the equality of all peoples. I fully recognize that Colonial society was unequal in that women and slaves were not franchised. But it was a start on equality and miles ahead of Western European monarchies (basically feudal) and particularly the East. And, it is no fluke that the most serious division in the first hundred years of our history was over slavery. I am no Jeffersonian scholar, but in spite of his commerce with slaves, there is ample indication that he recognized the inequality of the institution and that it would come to haunt us. Growing up in the South, I now know that we have still not exorcised that demon from our national soul.

So, I would argue that the very basis of our national ethic is the conception of fairness and equal treatment. I would further argue that this basic concept is under attack today on a massive scale. Examples of the breakdown abound:

1. Iraq. How can anyone argue that we are treating the people of Iraq as equals? If one of us in the United States dies, if a child dies, it can be national news. Every day there are scores of horrible deaths in Iraq, all the result of our actions (and inactions). Yet, at the very highest levels of our government, the President, Vice President and Secretary of Defense, there is an almost psychotic break with reality (please read Arthur Silber on this) in the lack of recognition of this horror. The course that our government has taken in that military action, from conception prior to 9/11 to the current moment, has been marked by a belief in American exceptionalism and Iraqi inferiority.

2. American Society. Under this heading is a wide variety of disorders of the body politic. The most glaring disorder is income inequality. Yesterday, the Washington Post published the compensation of top executives in the Washington area. It, to say the least, was obscene. This is the same time that many in the lower middle class, as I can attest from personal observation, are trying to make ends meet. Many families have become rich or poor because of the failure of our Society to distribute wealth. The mere suggestion of such a distribution brings cries of "communism" or "socialism" from those who have prospered. Let me emphasize that I think this is an ethical problem.

The crisis in health care is even worse. While many lower income people still receive decent health care, there are many who do not have insurance (over 40 million) and will soon be denied even basic services. There is no initiative in our government to solve this problem. Not even a recognition that it exists. Physicians are exhausted and facilities are stretched. Of course it is not as bad a Baghdad, but it should be much better. It is an issue of fairness. Defense is not the only activity that a government should provide.

But the saddest development, at least as I perceive it, is a breakdown of a level of civility that existed until recently. For instance, Washington, D.C. is our Capitol and should be the most glorious and the safest of cities. It is the opposite. Side by side with the opulence of the CEO's mentioned above is abject poverty and, even worse, a culture of violence. (If you doubt this, read John Aravosis from yesterday.) There are also things like road rage, out of control teenagers, and, sadly to say, a lack of compassion on the part of we medical providers. All a sign of mental exhaustion and anomie.

3. International Affairs (other than Iraq). Why can't we seem to get anything done on an international front today? Possibly, because of Iraq, no one trusts us any more. The single biggest threat to the world is nuclear weapons. We have done almost nothing to control their spread (Iraq, of course, had no such weapons.) Our President recently insisted that the Pentagon prepare for him a contingency to use nuclear weapons against Iran, a non nuclear state, without overt provocation. If this is not unethical under any set of beliefs, than nothing is unethical.

Under this same heading will be the dismissal of our government on multiple levels (The Presidency, Congress, the EPA, etc.) of the threats to our environment. As I have mentioned before, the recent review in the New York Review of Books on books and Al Gore's movie was very adamant that if we did not do something in the next ten years, it might be too late to stop disastrous effects of global warming. This is an ethical issue. It is how we, of this generation, interact with the generations to come. We will not be here to answer them so we have to do it now.

Many have said that America has faced life threatening crises before, and came through with flying colors. That we even came through stronger than before. However, it is my feeling that this time it is different. This is a different crisis. This is a crisis in the very foundation of our government. Above all else it is an ethical crisis.

In critical care medicine there is predictive power in the number of organ systems that are dysfunctional. If it is just the lungs that are failing, or just the kidneys, the prognosis is often good. If it is both the lungs and the kidneys, it becomes worse. Each system that is added increases the risk of death by 25%. If you add the liver and the brain, you might as well call your loved ones to come kiss you good-by.

Sometimes I fear that America is in the situation of multi organ dysfunction. I dread the day when it will be multi organ failure.


Griffon said...

Good summary, Doc. The system wants us always looking at the symptoms and not the causes (to continue the medical analogy).
And saying that one symptom is the cause of another symptom just because they are connected.

The symptoms go back to the cause i.e. the fundamental way our society is structured and the reasons it is structured this particular way. It is, in essence, hierarchical and therefore promotes exploitation. And exploitation and compassion are mutually exclusive. The more you have of one the less you have of the other. You can choose to help someone or use them - you can't do both at the same time.

Exploitation or power twists the thinking and perception of reality of the practitioner just as a drug of addiction does. It has the same prognosis, too.

I'm sorry to say it but I think our western civilisation is not going to get better but rather worse until it, like the addict, "hits bottom" - when reality comes crashing through the mirror.

Dr. C said...

Thanks griffon,
As pessimistic as I seem, I sometimes feel that there might be a way out of the morass. Certainly not the way we are going. But, we have changed before. We just need some of you young folks out there leading the way.