Vaccines and Autism: Is There a Link?

I'll admit that this is more of a rant than an involved ethical discussion on the subject, but I recently had to read through a not-so-respectful exchange on whether or not vaccines cause diseases like autism, where people with no scientific or medical background apparently felt qualified to discuss highly specialized subjects in those fields.

The answer is No. Let me just say that one more time: there is no evidence vaccines cause autism. Period. The fact is that there is literally no scientific evidence which in any way connects infants who receive vaccines to children who later develop development disorders. No matter how many conspiracy articles/books/websites you read, the scientific community has unanimously denounced the connection.

What I think is particularly terrible about the way this rumor has (apparently) gained some legitimacy is that a) it preys on the basic fears of new parents, and b) to the extent that it is believed, it effectively denies helpless children medical care which saves lives. If you want to believe there's a gigantic conspiracy the government's managed to keep under wraps about the Kennedy Assassination for 60 years, or that the Bush Administration orchestrated the September 11th terrorist attacks, go ahead; if you think the End of the World is near, go build a cabin the woods and live off of Twinkies and Fanta. But *please* don't force your "alternative lifestyle" on children in a way that puts their lives in danger.

Shamless Plug

Check out the right-hand column of my blog...there's a poll asking how ethical of a person you think you are. Not that it matters for anything, but I'd love to have more than 5 votes. So come on, people I know who regularly check this blog, but haven't responded (hurrah for Google Analytics), click an answer and make me feel better!

Lies, Lies, Tell Me Sweet Little Lies

Apologies for the long break between posts, but I've been busy these last few days and have just now taken a look at this blog and realized I should write something! Today's topic has to do with lies (and, perhaps, the lying liars who tell them). More specifically, I want to consider the idea of white lies, those tiny untruths people tell mostly to try and make others feel better.

Let's start by considering a situation you've probably found yourself in:

Sofia, a co-worker of yours, comes by your desk and asks if you like her new dress. Maybe what she's wearing isn't quite as bad as this, but it's still something you don't think makes her too appealing. You also happen to know that Sofia herself really likes her new look, and would be hurt if you gave her your honest opinion. Is it okay to lie?

Most people who are really trying to answer ethically are going to say that no, you can't lie: after all, the truth sometimes hurts, but lying is wrong. But I don't think that this is exactly right.

Let's start by all agreeing that, generally speaking, people are obligated to be truthful to each other and that only some kind of special circumstance could justify or excuse lying. In the case of Sofia, the answer to whether or not you may lie has to do with what you think the answer to this question is: Does Sofia expect that you will tell the truth?

Let's assume that Sofia does not expect you to be brutally honest with her in your response. In that case, she's probably asking you in order to gauge the way that you frame your response. If you say "You look fantastic!", she'll think you like her new dress; if you say "you look fine" or "that's certainly an interesting choice," she's likely to read between the lines and understand that you don't think she looks fine, or that by "interesting" you really mean "stupid." If, on the other hand, she does expect you to tell her the truth, then, uncomfortable as it may be, you do need to be more literally honest (which of course doesn't mean you have to say "you look hideous!" One can be truthful and tactful at the same time).

To put it another way, Sofia is looking for you to be honest, which doesn't necessarily mean she wants you to be truthful. The concept of sarcasm acts in much the same way: if I make a comment like "that business meeting certainly did not make me want to shove my head into an oven!" my listener will probably realize my real intent. In both cases, it's the message I'm communicating that's important, and not necessarily the literal meaning of the words I employ.

Which of course brings us to an important point about the ethics of lying: namely, that our obligation to the truth has much more to do with communication, not the words that we use. I have to make an honest effort to ensure the idea I'm communicating to you is true, and I can do that through a number of different means, including some where I tell a lie.

Ask The Moral Guy: Epilepsy Made Me Do It

It's time again to Ask The Moral Guy, where I answer all your most difficult ethical dilemmas in 500 words or less. Today's question deals with medical conditions and when they excuse bad behavior.

Last week I had two people over to my house, one a good friend and the other more of an acquaintance I knew from work. While we were talking in my living room, the acquaintance (I'll call him Peter) stood up and jerked his hand out in front of him, breaking a picture frame and tearing a cherished family photo. Peter didn't apologize, though after a few days he did offer to pay for the frame. Later my good friend, who knew Peter better than I did, took me aside to tell me Peter had a medical condition which caused him to involuntary move his body. My friend seemed to think I shouldn't hold a grudge, but I'm not so sure. Even though Peter offered to pay for the damage, I felt I was still owed an apology. Is it OK for me to be upset about this, or am I just being insensitive to someone with a disability?

--Anonymous

Like a lot of ethical questions, it depends on the details of the situation, specifically whether or not Peter made any effort to avoid causing damage:

If Peter made an honest effort to make sure his condition didn't break that great picture of your little bro--if he tried staying away from breakable items and faced away from fragile objects--then he didn't do anything wrong. It would be no different than if your friend was careful, but tripped over your rug and shattered the expensive china--an unfortunate accident. We can't reasonably expect people who suffer from relatively minor medical conditions to become hermits and cloister themselves off in child-proof rooms.

If, on the other hand, Peter didn't care enough to avoid getting near the expensive stuff, and just assumed that his condition would excuse any minor destruction he might wreak, then he acted unethically: he knew he was running a risk picking the chair next to your valuables, and he chose to sit there anyway. In that case, he owes you an apology.

On a totally unrelated note, I toyed with the idea of calling this post "Conditional Excuses." Am I trying too hard for the cheap pun?

Circumstantial Luck: Another Response!

Very few things in life get me more excited than a response to one of my posts (OK, maybe more than a few, but it's still pretty great). This comment was a counterpoint to my July 1st post on the topic of circumstantial luck. I admit this post gets a bit technical, but I promise to try and keep it as layperson-friendly as possible (if you want an even more technical treatment, check out my response to Kyle's post, on that same page). Here we go:

Circumstantial Luck, or CM for all you sweet abbreviators out there, deals with the different ways we treat two people: the person who actually did do something wrong, and the person who would have done the same bad thing, but got lucky and was never put in a circumstance where he had to make that decision (recall my example of Mary, Joe and the Nazis). My argument is that we have to hold Joe, the guy who would have, but didn't do the bad thing, equally culpable as we do Mary, who actually did do the bad thing.

Kyle's response had to do with Joe. Here's what he said:

Even if, say, Joe told us he would act like a Nazi, we simply can't know for certain. There are surely people who think of themselves as unethical in certain ways but, when presented with an actual chance to act, choose rightly. In short, I'm not sure there is any substitute for acting like a Nazi.

That's definitely an interesting point, but I don't think it poses a problem to my example, for two reasons:

1. I think that we can know what people would do in lots of different circumstances. If I gave you a gun and said "shoot your parents," would you do it? I bet (for your mom and dad's sake!) you can truthfully say you wouldn't. The fact is that human behavior is awfully predictable most of the time, and even if there are some cases where we don't really know what we would do, we can still usually predict what our actions will be.

2. Even if it's impossible for us to know what we would do in some particular set of circumstances, that fact doesn't make us any more or less blameworthy. Let's say it really is impossible for me to know if I'd help the Nazis out if I lived in Germany in 1938. That doesn't change the fact that, if I were placed in that situation, I really would make a decision, either to collude or not to collude. Take a different example: I have no idea if I would be a courageous soldier if I enlisted and fought in a war, and I don't think I would know until I actually did it. But that doesn't change the fact that I am a courageous or cowardly person: I still have that attribute (courage or cowardice), and it just won't "show up" until I'm forced to act. In the same way, I still do have either a good or a bad moral character; I just might not know which one I have until I'm in a tough spot and have to make a decision.

And that brings me back to my original point. Assuming Mary did collaborate with the Nazis, and assuming we know that Joe would have collaborated if given the chance, shouldn't we blame them both the same?

Kickbacks: The Easy Way To Get Great Patients

It's been long established by the American Medical Association that it's unethical for a physician to give another physician money for a patient referral--what many would call a kickback.

In other words, let's say I go to Dr. Bob, my primary care doctor, complaining of back pain. He takes a look at me and says I should go see a back surgeon, Dr. Sue, who will likely perform an operation that my insurance will pay $50,000 for. Dr. Sue is grateful for the referral, and to show her appreciation she gives Dr. Bob $5,000 for his efforts.

This scenario is a huge ethical no-no in the practice of medicine, but it might not be entirely clear why it's viewed as such a serious breach of good conduct. After all, in most business ventures it would be perfectly acceptable for me to, say, give my friend over at Circuit City $100 for sending a customer to The Moral Guy's Electronics Emporium (where we're obligated to give you a great deal!) for an item Circuit City didn't have in stock. The common explanation for this prohibition is that giving doctors money for referrals leads to a lower standard of care to the patient: if the doctors care more about referring their patients and getting a big payday when the patient has an expensive procedure, they'll be less likely treat the patient more conservatively and avoid major operations. Back to our example, maybe my back pain could have been treated with a simple steroid injection by my primary care doc; but because Dr. Bob wanted the $5,000 from Dr. Sue, he referred me over to her and caused me to go through a difficult, painful operation I didn't really need.

But what about the argument that a customer could be taken advantage of in the same way in any business transaction? After all, most people have a story about how a mechanic demanded $600 for some brand new parts the car didn't actually need replaced; doesn't the Latin phrase caveat emptor ("let the buyer beware") apply to all business transactions?

Here's my take: medical practice is fundamentally different from just about any other profession because of the inherently unequal relationship between the doctor and the patient. The fact is, when you go to a doctor because you're sick you aren't in the same position as when you go into buy a stereo at a store: you're going to a person who's had four years of medical school and at least two further years of residency and knows more about medicine than you ever will; the doctor has seen and treated dozens, hundreds, perhaps thousands of other patients; you're expected to talk to a complete stranger about the most intimate details of your life; and most importantly, you're there to treat a problem which could permanently affect your well-being or even cause your death. Going in to see a doctor can be a terrifying experience where no one could reasonably expect you to be a rational consumer.

That's why I believe in the oft-repeated adage about the medical profession: Lawyers and whores have clients--doctors have patients.

To be fair, I think a lot of these issues come up in the legal profession as well--a person facing a felony conviction is in much the same situation as a patient going to see a doctor. But the basic point remains: given the nature of the relationship between the two, physicians have a greater obligation to the well-being of their patients.

Do You Feel Lucky?

Well do you?

No, seriously, today's post, like this one from a few days ago, has to do with the problem of moral luck, which is just when we blame a person for something that isn't under her control. In the last post, it looked like we were blaming Bob more than we were Fred, even though the only difference between their two situations was totally outside their control. To push that same intuition even more, consider this:

When Germany was controlled by the Nazi's in the 1930's, many ordinary citizens were faced with a difficult dilemma: cooperate with the current regime and in some small way aid in their evil acts, or refuse and be persecuted and ostracized from their community. Consider someone, let's call her Mary, who was placed in this situation and made the wrong moral choice: she helped the Nazis.

We're assuming in this case that Mary made the unethical choice (fill in the details how you like to make that true), and as a result she clearly deserves some blame for what she did.

Fair enough. But what do we have to say about the person (calling him Joe) who would have done just as Mary did, but never had to face that difficult moral decision? Mary's certainly to blame--after all, she did something wrong. But do we just let Joe off the hook because he got lucky and never had to make a tough choice in his life? It doesn't seem fair to throw Mary to the wolves but give Joe the Ethical Guy Award if we know he would have done just as Mary did.

Here's what I think: the two are equally blameworthy.

***

Briefly, here's my reasoning: people aren't responsible for their actions per-se--luck plays too large a role in determining what we do--but for their moral character, which is their set of conditional dispositions, a fancy way of saying the way you would act if placed in different situations.

Check out this Wikipedia article if you want to read a bit more about moral luck.