The ethics of eight (babies that is)

All over the blogosphere people are discussing the California woman who gave birth to 8 babies.  The media was quick to call it a miracle, but it seems it only took a few hours before bloggers, journalists, and doctors began to seriously question the mother’s intentions.  It seems crazy enough to want 8 kids at once, but now rumor has it that the mom is single, living with her parents in a 2 bedroom house, and already has six kids (all under the age of 7 nonetheless).

If you want to be entertained (or appalled), I recommend reading the comments section on articles discussing this woman.  You’ll see a variety of viewpoints expressed, from those who think we should just leave this woman alone, to those who think the government should mandate how many kids a person can have and restrict who can receive fertility treatments.

I guess I fall somewhere in the middle.  Read the rest of this entry »

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(Un)settling Down

Will Wilkinson reminds me of Reverend Merrill in A Prayer for Owen Meany.  Both are preoccupied with emotional concepts that most men accommodate as a matter of course, and both insist on viewing these ideas through the lense of their antitheses.  For the reverend faith and doubt were the two aspects of the inseparable duality.  For Will, its kids and happiness.  Responding to an article that appeared in Newsweek, he writes:

…the profundity of the experience of loving a child I think blinds many people to the very real costs of raising them. To accept that we have been made less happy in a real sense by our children threatens our sense of the profundity and the value of that bond. So people get upset when they hear this. But that’s not counter-evidence. Not all values move in one direction and it is a mark of maturity to be able to admit that some of the things we value most comes at a sometimes steep cost. We yearn to love our choices, and our lives, with whole hearts. But to do so is to lie to ourselves about ourselves, to close our eyes and cover our ears like children to the profundity of what we have given up.

I’m with him all the way to the final sentence which I find hard to interpret.  I think he is trying to express something akin to the socratic dictum that the unexamined life is not worth living.  If that is the case, I can understand and appreciate the sentiment, but I wouldn’t classify the desire to harmoniously integrate our past decisions with our present lives and future prospects as an instance of willful self-deception or woeful ignorance.

Recognizing opportunity costs when presented with a choice is good to the extent that it helps move you to a more efficient allocation of resources, but once the decision has been made (especially with respect to having children) those foregone alternatives become sunk costs–the hole down which they descend may well be deep, but spending time contemplating its profundity strikes me as a rather futile endeavor.  Just as Reverend Merrill eventually found his position advocating the dynamic juxtaposition of faith and doubt untenable, I’m not sure how Will can sustain the view that the essence of appreciation is regret.  Children and parents deserve wholehearted love that does not entail a nagging reminder of how good life would have been without the other.

~Fox

Schrodinger’s Children

“Think outside the box” is a popular phrase among groups dealing with complex problems. In fact, it has almost become a cliche in our fast-paced modern world where technological changes that once would have been regarded as revolutionary are today almost quotidian. Still, there are some who are lost so deep inside their respective boxes that the darkness that surrounds them must seem the equivalent of infinite space. Kevin Carey over at the Quick and the Ed seems a likely representative of this type of person.

In his latest post, Mr. Carey takes to task Michael Winerip for his failure to endorse expansive government interference in education. In his piece in the New York Times, Winerip suggests that the state should be shifting resources away from costly “accountability” programs and in favor of costly “anti-poverty” programs. I happen to think either alternative represents a mis-allocation of funds as both are likely to undermine rather than advance achievement of their stated goals (supporting arguments here and here, respectively). In this case, however, the cost-effectiveness of government boondoggles is not my primary concern. Rather, I am troubled by Mr. Carey’s perspective that seems to imply that there is simply no solution that does not involve the state.

Confronting the findings of the ETS report, Carey poses the question “Therefore, what?” which may be read as “What should the government do about this?” He then follows this question with a proviso: “If you’re not willing to answer this question concretely, you really don’t deserve a seat at the table.” And what, exactly, constitutes a response concrete enough to secure one a place in the debate? Apparently, advancing a policy of non-intervention, or even promoting interventions not directly aimed at the public school system is insufficient. Instead, if you want to speak, you must endorse statist intervention: “NCLB, by contrast, reflects an identifiable perspective and set of resulting policy conclusions.”

It strains credulity to present NCLB as a standard of clarity. To propose that it be used to set the scope of the debate is even more galling. Education is a complex process that each of us must engage in a unique way. Acquiring the skills and perspectives that will allow us to envision and establish an individual identity in the world is not a venture readily amenable to standardization. Uniformity is antithetical to personality. Government run schools fail, not because of insufficient funding, but because they lack the flexibility and responsiveness necessary to meet the needs of the parents and students they purport to serve. The further centralization of the administrative apparatus only hastens the ossification of the system, making it brittle and more constrictive. This is the problem of living in the box.

Erwin Schrodinger once came up with a vivid and somewhat gruesome example to demonstrate one of the more mystifying implications of quantum theory. He asked us to imagine a box containing a cat, a radioactive subtance, and a vile of acid. If you’re interested in the full details, go here. Basically, though, the idea is that the cat is in mortal jeopardy, yet we have no way of knowing his fate unless we open the box to check on him. Until then, he exists in a state of suspended animation, neither alive or dead, or maybe both (though it is hard to say which is worse.)

If we extend the analogy to education, this is the current predicament of children in our public schools. They are languishing in a cruel trap guarded jealously by social planners like Carey and his ilk who venerate the contraption while condemning those of us who wish to extricate their unwilling subjects. They prefer to tinker gingerly with the dimensions of the experiment instead of investigating the merits of the underlying motivations for and assumptions of the design. The talk endlessly about improvements, excluding those who dissent with the program. Meanwhile we all suffer the scarcity of choice.

~Fox

Prohibition doesn’t work (health care edition)

Normally when I say prohibition doesn’t work, I’m referring to current drug and alcohol laws which punish people who use responsibly and do nothing to stop the people who abuse or put others at risk. This time, however, I refer to a Missouri law (courtesy of the Baltimore Sun) that makes it illegal for a certified midwife to deliver babies. According to the article:

“A state lawmaker whose wife was aided by a midwife pushed through legislation this year that would allow midwives to practice freely in the state”

In round 1 of midwives vs. the medical establishment, the midwives won – the new law was passed and subsequently signed by current MO Governor Matt Blunt. But the medical establishment, who “argue that home births without physicians are perilous ventures”, couldn’t let it rest and fought to overturn the law. In round 2, the medical establishment won, and the law is currently awaiting its turn in front of the Missouri Supreme Court.

Do you really think the medical establishment (of which I will soon be a member) are arguing against this law because they believe home birth is “perilous”? No – they argue against it (or rather, a lobbying group that claims to represent their views argues against it) because it hurts their pocket books. Every woman who gives birth at home is a woman not paying for a hospital bed, nurse, obstetrician, anesthesiologist, laboratory technician, etc. And, surprise – most of them do just fine giving birth at home. It’s not like women have been giving birth without doctors for 200,000 years…oh wait…they have. I’m not saying there aren’t risks involved when giving birth at home – things can and will go wrong from time to time during labor and delivery. Mom can be hypertensive, baby can be breech or have the umbilical cord wrapped around, blood is lost – these may range from minor to very serious. They occur in the hospital setting as well, though in that setting there is a team in place to respond immediately (something which cannot be said about a home birth). Of course I would also argue that a lot of the procedures done in a hospital setting may put the mother at more risk than a natural birth (anesthesia always carries a risk, and cesarean sections are invasive and thus probably increase the risk of infection or serious bleeding).

Still, pregnant women are adults who can decide risks for themselves. It’s obviously very important to many of these women to give birth at home – not only are they choosing a midwife over a hospital physician, but they are willing to break the law and risk arrest in order to get what they want, and in the process are effectively creating a home-delivery black market. If these “medical establishment” groups really cared about the safety of the women, they would listen to their reasons for choosing a midwife or home-delivery, and they would try and compete:

“Kerr of suburban St. Louis said she had an easy time finding a midwife through friends. She said many women choose home births with midwives to limit hospital pressure to use drugs for pain or to have a Caesarean; to have a more intimate, controlled and personal birth; or because of religious beliefs that keep them away from hospitals. “

Hospitals are noisy and offer little privacy, and there probably is pressure from certain doctors to use drugs for pain even after the woman has made it clear she intends to go without. Bottom line – let the woman decide who she wants to deliver her baby, and in what manner she wants it done. The only time the law should intervene is if someone is masquerading as a health care provider – i.e. a person pretending to be a certified midwife or physician. These women are adults capable of making adult decisions, including evaluating the risks and benefits of each alternative. We should not force our values onto them, even if we strongly believe we are correct; we should not use the force of law to get these women back into hospitals (it hasn’t worked yet, and in fact only succeeded in creating an illegal market for midwives) – instead we should try and create alternatives within the hospital or physician setting in order win back their trust and create an environment where they would enjoy giving birth.

~ Lily

Regarding “LEGOS and cyanide” (or if you prefer, “Aqua Dots and GHB”)

My response to Jamelle from the blog “The United States of Jamerica” (which, btw, I enjoy) regarding my own “cavalier” attitude toward government regulation:

First, let’s not pretend that the government doesn’t already regulate much of what goes into our bodies – they do regulate things such as the consumption of water (bottled water products, tap water) and the consumption of hamburger (ground beef) – in fact, they regulate almost everything that is sold on our shelves in one form or another. Some may find these regulations make them feel safer, but I don’t think most actually protect us from anything. In fact, I would argue that all they do is coax us into a false sense of security (as we can see by the mass panic that is induced everytime another “lead in toys” case is discovered).

I stand by my statement that every consumable good is potentially dangerous – anything ingested in a large enough dose is toxic, whether food or medicine. I don’t say this to downplay the dangers and rally for some regulatory “free-for-all”, but to point out that a universally “safe” level of regulation can never be achieved. It’s impossible – you cannot protect people from themselves in every possible situation. Sure, you can protect some, but every time our government expands in the name of “protection,” it always seems to restrict our personal liberty at the same time. That, is what I am opposed to.

Just because people aren’t capable of assessing the risk for themselves doesn’t mean the government has to be the one to step up and take care of it. I’m certainly not for keeping people in the dark, I just think that independent agencies tend to do a better job than government agencies. The government only has one guy looking at these toys coming into the US – hardly enough manpower to certify everything as “safe.” Instead of putting pressure on the government to fix our problems, we should put pressure on the companies that sell these products – they should be the ones making sure their products are safe, and if they aren’t you vote with your pocketbook (or sue if your child got really sick or died).

I would hazard to guess that the reason these companies aren’t more careful is because they don’t have to be – every time a kid gets sick we don’t point the finger at the company, but instead at our federal government who once again failed to save us. Obviously these companies are responding by pulling the toys off the shelves (or recalling Salmonella-tainted food, for example…contrary to popular belief they don’t actually enjoy injuring their customers) – if you want them to do more, then you need to put the pressure on them (and be willing to pay a little extra for a product). Or, you can continue to believe that our government is capable of providing a cost-effective means of analyzing and certifying everything that crosses our borders…a dangerous delusion far too many already accept.

Also, not to downplay the drug-laced “bindeez” aka “aqua dots,” but only a few kids have died, and only a handful more have gotten sick. Far more kids get sick every year from the lead paint in their homes, and far more kids around the world get sick and die from unsafe drinking water…but instead our country panics about this (it seems nothing more than a distraction from that which poses much greater risks).

~Lily

FDA rethinking use of cold medicines in young children

I’m a few days behind on this, but FDA officials are recommending that labeling for cold and cough medicines be changed under pressure that the medicines are neither safe nor effective in small children (less than 2-6 years of age, depending on the medicine). The medicine label would be stripped of any recommendations for parents to “consult a physician” before giving them to a small child, and may include a new label saying they are not recommended for use in children under 2. There are also recommendations to standardize the measuring system for children’s medicines to avoid confusion over correct dosage, and apparently some officials are even considering an outright ban on all infant cold and cough medicines.

The reviewers wrote that there is little evidence that these medicines are effective in young children, and there are increasing fears that they may be dangerous. From 1969 to 2006, at least 54 children died after taking decongestants, and 69 died after taking antihistamines, the report said. And it added that since adverse drug reactions are reported voluntarily and fitfully, the numbers were likely to significantly understate the medicines’ true toll.

Ok, let me first say that I think it’s really tragic any time a child dies (or any time someone dies before reaching an old age), but these numbers don’t seem to suggest some sort of major health crisis. Yes its unfortunate that children died after taking the drugs, but given the number of children that probably took the drug over that 30+ year period, 123 children is not that many. For instance, consider the backyard swimming pool – around 2000 kids are injured each year, and 300 die each YEAR. Assuming that number has been pretty standard over the past several decades (which may or may not be true), in the 37 year period that 123 children died due to cold medicines 11,100 died due to swimming pool related accidents. Are we banning swimming pools? No, because we leave it up to parents to take responsibility for their children – and given how many trips are made each summer to the local or backyard pool compared to the number of kids injured, they’re doing a pretty good job.

So why should cold medicines be any different? I don’t have any kids, but reading this FDA recommendation for a medicine-ban makes me think that they don’t either. If your kid is sick, you want to make them feel better, and you don’t always have the time to go to the doctor and sit in an office waiting for the physician to tell you that your child’s cold is viral so all you can do is treat the symptoms with an over-the-counter drug (as opposed to the more rare bacterial infection which might require antibiotics). And you certainly don’t want to go to the doctor and have them tell you there is nothing you can do for your crying, congested, coughing child since the FDA banned all cold and cough medicines. As far as standardizing the droppers/cups/etc – I have no problem with that, since it will likely make it easier for parents to figure out the correct dose and decrease the chances of an accidental overdose. I’m just afraid that any ban on these kids products will leave parents trying to use adult products on their children, and then there will be serious problems since they’ll have no idea what amount would be safe in kids. People need more information (how about more research into “safe” doses for kids?), not a regulatory agency that thinks parents will never know how to act in the best interests of their child. Personally I think it’s a bit ridiculous that we’re wasting time debating medicines that people find useful and that rarely cause a serious adverse effect, when there are other things that kill far more children each year (e.g. pediatric cancer). It’s not that I think its ok that young children die because of cold and cough medicines, but I think we have to be realistic about the fact that we live in a world with limited resources, and those resources should be targeted at areas where they will have the greatest impact.

Sources:

CNN – FDA: Stop giving cold, cough meds to toddlers

NY Times – Ban Sought on Cold Medicine for Very Young