Map of life expectancy at birth from Global Education Project.

Thursday, March 31, 2005

Turning it upside down

It is frustrating that current events have pushed Stayin' Alive to be mostly about Gettin' Dead lately. Like most people, I prefer to think about life rather than death and to devote the bulk of my political and intellectual energy to making life better. Death must be accepted, and learning how to accept it is essential to having a good life. But enough is enough.

A few weeks back I discussed the "rule of rescue." Quoting Jeff Richardson and John McKie in Social Science and Medicine (2005):

The "Rule of Rescue" -- the imperative people feel to rescue identifiable individuals facing avoidable death -- is closely related to the preference for helping the more severely ill, except that it applies to identifiable individuals rather than an entire category of anonymous individuals (those who are worst off) and the context is typically dramatic and unexpected. It is because an individual is identifiable, and in dire circumstances, that there is a powerful urge to rescue . . . . The priority accorded to identifiable patients in immediate peril is not based on the magnitude of the (health related) utility gains expected to result."

What this means in plain English is that people's ethical instincts lead them into a logical contradiction. It would be unethical not to do everything possible, to spend whatever it takes, to rescue a person in dire circumstances. By the same expenditure, we could prevent any number of persons from ending up in those dire circumstances in the first place, yet we don't do it, and we say that is because we can't afford it.

I have written before about those 29,000 children under five years of age who die every day from readily preventable causes -- contaminated water, measles, malaria, HIV. I don't see crowds of evangelical Christians demanding that Congress do something about this, standing outside the offices of the World Bank and the WTO and the IMF and AID chanting and praying, railing about the Culture of Death that allows this to happen. Yet I recall from my Bible studies that Jesus said, whatever you do to the least of these children, you do to me. So in fact what we are seeing in this country today is not a revival of Christian belief or Christian ethics at all -- it is a passion play, a drama enacted to appeal to a primitive impulse which drowns out reflection, overwhelms ethical reasoning, and aborts ethical action.

That's easy for me to say, but I am profoundly disturbed that I have not seen any visible, assertive, public movement by Christians to have an adult discussion about the ethics of public health and health care. To my Christian friends I have to ask, "Are you actually afraid of these people? Why don't you speak out?"

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