Hatrack River Forum: Doctor and nurse build custom dialysis machine to save a baby girl

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Posted by Threads (Member # 10863) on :

Link.

quote:
Millie was born with a condition called gastroschisis, in which her bowels developed outside her body.

During an operation to correct the problem, her kidneys started to fail, and her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used.

Rebecca was warned that Millie was unlikely to survive.

However, Dr Coulthard, together with senior children's kidney nurse Jean Crosier, devised a smaller version, then built it away from the hospital. Millie was connected to the machine over a seven day period, allowing her own kidneys to recover.

To keep the good of the patient as the highest priority. (Hippocratic Oath)

[ August 05, 2008, 12:47 PM: Message edited by: Threads ]

Posted by Elizabeth (Member # 5218) on :

I can't think of any doctors who would not do this if they could.
It sounds pretty lucky, to have all those people there who were able to figure it out. It is wonderful, but I would switch the focus away from making less of other doctors and nurses and onto the brilliance of this effort.

Posted by Belle (Member # 2314) on :

Yeah, I mean - it's wonderful, and it's heartwarming, but I don't think it's appropriate to use this story to denigrate other doctors and nurses. Most doctors I know would do this too.

I know one doctor who was making tons of money in ob/gyn who gave it up to open a pediatric gynecology clinic and treat young victims of sexual abuse and assault for very little, sometimes no money. My ob/gyn gave up his vacation and drove in from the lake when I went into labor because he cared more about seeing my twins delivered safely without a c-section than he did his own vacation.

We give doctors a bad rap sometimes, assuming all of them went into the profession to make money and get good tee times at the country club. When, in fact, many have sacrificed a lot to be in this profession - years of school, lots of money for school, time away from their family - and what drives them is a desire to make a difference.

At any rate, wonderful story and I'm glad to se the little girl is doing okay.

Posted by Threads (Member # 10863) on :

How should I change my title and the post? I actually went through effort not to denigrate other doctors so I'm surprised my post came across that way.

EDIT: Ok I changed it. Sorry if I came across the wrong way.

Posted by katharina (Member # 827) on :

I think you're fine. I don't see anything wrong with your first post.

And I agree - this is above and beyond. [Smile]

Posted by MrSquicky (Member # 1802) on :

Threads,
I think it was the part about how you said most other doctors would have given up. I don't think you meant it this way, but it could come across as them not caring.

I think your original title was just fine. These people definitely went above and beyond the bounds of their job. The thing is, I don't know a single doctor or nurse who works in NICU who doesn't.

Posted by King of Men (Member # 6684) on :

I wonder how many children the doctor and nurse could save by funding vaccines or food reliefs to Africa? Building a dialysis machine is nice and all, but if the focus is on saving children as opposed to saving the particular upper-middle-class, white child with the fantastic good luck to be referred to me, then I think this is not the best possible use of resources. Of course, sending money to Africans doesn't let you use your 1337 machine-building skillz, doesn't get your picture in the paper, and the African children are quite unlikely to show up and thank you.

Posted by MrSquicky (Member # 1802) on :

You seem to be presenting these as if they are mutually exclusive things. This doesn't seem to be the case to me.

Posted by MattP (Member # 10495) on :

We can't help but have more empathy for those we are immediately involved with. Every time we buy a new consumer electronics device we're arguable killing a few dozen African children by not sending the money there instead. That's a hard thing to come to terms with if you attempt to do so. It is what it is.

Posted by King of Men (Member # 6684) on :

quote:
Originally posted by MrSquicky:
You seem to be presenting these as if they are mutually exclusive things. This doesn't seem to be the case to me.

To the best of my knowledge, only one of them happened. Do you have other information?

Posted by Synesthesia (Member # 4774) on :

huh?
I don't see why you can't do both. Help kids in Africa and help kids here.

Posted by ketchupqueen (Member # 6877) on :

The kids in Africa are not their immediate patients. This is a story of a team going out of their way to save a kid through innovation who WAS their patient. Like the story of the girl who was "born twice." When a doctor takes on a patient he is obligated to do all within his power to save her if she goes south. Now, in areas of limited supply, this may require triage, meaning the available resources are put toward saving the most likely to survive if no others can be procured. But the concept of triage doesn't apply when resources ARE available to save a patient immediately available vs. putting the same time, talent, and money toward people on another continent.

This is pretty well established medical ethics. It's great to see a team making innovations to save a child who would otherwise not have lived, IMO.

Posted by King of Men (Member # 6684) on :

quote:
Originally posted by Synesthesia:
huh?
I don't see why you can't do both. Help kids in Africa and help kids here.

Given some amount X of doctor time/attention/skill, that amount can be

a) Used only here
b) Split between here and Africa
c) Used only in Africa.

So far I take it we agree. In the story at hand, it appears that alternative a) was chosen. My point is that c) would likely have saved more children, because children dying from lack of water or vaccinations are clearly a lot easier to save than children dying for lack of correctly sized dialysis machines.

quote:
When a doctor takes on a patient he is obligated to do all within his power to save her if she goes south.

Granted. The error, therefore, lies in what children were chosen as patients.

quote:
But the concept of triage doesn't apply when resources ARE available to save a patient immediately available vs. putting the same time, talent, and money toward people on another continent.

And why doesn't it? Why shouldn't it? Are children dying on another continent not of equal value? If there are limited resources, they should be used where they do the most good; I don't see why that should change with the scale.

Now, you can perhaps argue that maintaining doctors in Africa is not all so simple, that there are costs to this which I am not considering, and that therefore the lives saved per unit effort aren't so lopsidedly in favour of Africa. But I don't see why you shouldn't make a calculation of that sort at all.

Posted by Dagonee (Member # 5818) on :

quote:
But I don't see why you shouldn't make a calculation of that sort at all.

So, what sort of calculation did you make that had you not going to medical school and then to Africa?

Posted by ketchupqueen (Member # 6877) on :

KOM, just because people need doctors in Africa does not mean people in wealthier countries don't need them, too. If all the doctors went to Africa to give vaccinations and treat parasites, malaria, and AIDS, there would be too many doctors in Africa and not enough elsewhere (and I should add that there are shortages of doctors in some specialties in parts of the developed world already.)

One problem is that many governments in parts of Africa where many people are dying are extremely corrupt. Some harass and intimidate and even imprison foreign doctors; that is why many organizations send doctors only for a limited time, to do what they can below the radar of the government, as it were, before they stay long enough to be seen as a threat. Many organizations and companies are more than willing to donate medications, supplies, water pumps, etc.-- except that because of corruption in the countries that need them, they wouldn't get to the people who need them most.

It's a lot more complicated than just shipping supplies and doctors to Africa.

Posted by King of Men (Member # 6684) on :

code:

KoM.setSelfishBastard(true);

I don't object to selfish bastards, as such. It's lauding them as saints of self-sacrifice that grates.

Posted by King of Men (Member # 6684) on :

quote:
KOM, just because people need doctors in Africa does not mean people in wealthier countries don't need them, too. If all the doctors went to Africa to give vaccinations and treat parasites, malaria, and AIDS, there would be too many doctors in Africa and not enough elsewhere (and I should add that there are shortages of doctors in some specialties in parts of the developed world already.)

Indeed. This is an argument about margins. Clearly, if you begin shipping the western world's doctors to Africa, then at some point you begin doing more harm than good. But we are nowhere near that point. What is more, we do the allocation by money, rather than need; the people with money get care that extends their lives from, say, 80 to 85; the ones without do not get the much cheaper care that would make the difference between 5 and 50. Clearly there is a lot of room for improvement here without going to the extreme you suggest.

quote:
One problem is that many governments in parts of Africa where many people are dying are extremely corrupt. Some harass and intimidate and even imprison foreign doctors; that is why many organizations send doctors only for a limited time, to do what they can below the radar of the government, as it were, before they stay long enough to be seen as a threat. Many organizations and companies are more than willing to donate medications, supplies, water pumps, etc.-- except that because of corruption in the countries that need them, they wouldn't get to the people who need them most.

Ok, this is an argument about hidden costs as I outlined above, and fair enough. How about India? Certainly there are any number of endemic diseases there that could readily be combated, without any threat from a corrupt government.

Posted by ElJay (Member # 6358) on :

Where did anyone do that? These people are lauded for being inventive and responding creatively to a need that came up with one of their patients. Who said anything about self-sacrifice.

And the benefits from what they did will probably go on to help a lot more people, eventually even ones in Africa more than likely. [Razz]

Posted by Puffy Treat (Member # 7210) on :

Saying that someone did a good thing is the same thing as saying they're flawless, perfect, and better than anyone else.

Right.

KoM, you have proof that these people never have and never will help someone of a different skin color? That they've never devoted time, money, and effort into helping the less fortunate? That you can somehow look into their hearts and judge their motive for helping this girl?

I don't think you do. In fact, I think you have no more info on them than the items included in the article.

Instead of bad-mouthing these people without cause, why not start a thread about helping the less fortunate in Africa?

Posted by ketchupqueen (Member # 6877) on :

We have one already. Bumped to the front page today, even. [Wink]

Posted by ketchupqueen (Member # 6877) on :

I should add that I agree with the above points. Just because a greater good could concievably have been done elsewhere with the resources had the resources been allocated there, does not mean that good was not done. And indeed, if someone had not spent a great deal of time, resources, and effort developing almost every treatment we have today, no one would be benefitting from it. Most treatments developed in first-world countries eventually spread even to the third world. And honestly, comparing dialysis with vaccines is apples with oranges because they require different resources to create, implement, and distribute them.

Posted by King of Men (Member # 6684) on :

quote:
Just because a greater good could concievably have been done elsewhere with the resources had the resources been allocated there, does not mean that good was not done.

Completely irrelevant. It is presumably good when I shave, because then my wife doesn't get her skin chafed. Therefore, if I spend a million dollars ensuring a nice smooth shave, I'm doing good. Would you seriously argue that this is a reasonable use of resources?

quote:
And indeed, if someone had not spent a great deal of time, resources, and effort developing almost every treatment we have today, no one would be benefitting from it.

True. An argument from cost/benefit, to which I have no objection.

quote:
And honestly, comparing dialysis with vaccines is apples with oranges because they require different resources to create, implement, and distribute them.

Possibly. Substitute 'doctor time', if you like, to get back to apples. Certainly there are any number of places where people are dying for lack of ten minutes' worth of doctor to diagnose them correctly and tell them what to do.

quote:
KoM, you have proof that these people never have and never will help someone of a different skin color? That they've never devoted time, money, and effort into helping the less fortunate? That you can somehow look into their hearts and judge their motive for helping this girl?

Indeed not. But I can judge the effects of their actions. There appear to be three possible explanations for their choice of who to help:

1. Their motive is "help people in the West, who (possibly coincidentally) are able to pay well and look like us".

2. The motive is "help all children", but they are not smart enough to apply their skills where they will do the most good.

3. They have done a cost-benefit analysis, including such factors as kq mentioned, and have reached the conclusion that I'm wrong, they are actually doing more good in the west than in Africa.

I suggest that if it is the first, that's not actually so very laudable as all that. If it's the second, they cannot be very bright outside their specialty, or at any rate they haven't thought very deeply on how to best go about their goal - possibly they stopped at "Hey, that makes me a good guy!". And as for the third, I don't see you arguing for it. Would you like to suggest a fourth?

Posted by Dagonee (Member # 5818) on :

quote:
There appear to be three possible explanations for their choice of who to help:

Ah, so the problem is simply your inability to come up with an actual likely motive.

Posted by AvidReader (Member # 6007) on :

Even if the doctor just went into medicine because it combined good pay and prestige with helping folks, how does that change the situation? He and his team did something amazing.

Yes, for a middle class white girl. But they live in Britain. Statistics say that the most likely groups for him to treat are middle class and white. That's just demographics.

I suppose the next question should be how much do we owe our neighbor? Where's the line between my comfort and their survival?

I agree that it would be wonderful if everyone in the world were healthy and well fed. I even give a few bucks a month to help that happen. But I have little interest in going out and making it happen with my own two hands. Sure, I could argue that with my immune system I'd catch the plague and die, but that's an after-the-fact rationalization. I just don't want to.

This guy went out with his own two hands and created something to help another human being live. I think that's awesome, even if he didn't move to a foreign country or give up all his money to do it. He still made a difference.

Posted by ketchupqueen (Member # 6877) on :

quote:
Certainly there are any number of places where people are dying for lack of ten minutes' worth of doctor to diagnose them correctly and tell them what to do.

Ah, but would this doctor be able to do it?

When my mom went to the Dominican Republic on a medical mission, the doctor who went along was a plastic surgeon. He made many, many mistakes that my mom (a pediatric nurse) and her friend (a pediatric nurse practitioner) had to fix in order to keep people from being killed by his mistakes. Yes, it was good he was there-- but he was unacquainted with the most common ailments present or how to treat them, especially in children. The doctor who made this machine is a highly qualified specialist and probably has lost touch with the vast majority of ailments that need treating in Africa. Not saying he couldn't re-learn them, but that kind of wastes his specialty training. Wouldn't it be better to say he could use the money and time spent treating this one child to treat, say, 5 children in need of dialysis and surgery in Africa? That would be more apples-to-apples in my mind.

Posted by ketchupqueen (Member # 6877) on :

quote:
Originally posted by Dagonee:

quote:
There appear to be three possible explanations for their choice of who to help:
Ah, so the problem is simply your inability to come up with an actual likely motive.

Yeah, I have to say, I can think of several other possible motives. These include the benefits of living near family, etc. Just because an individual feels MORE loyalty to the local community than the global community does not mean what he does is wrong.

Posted by King of Men (Member # 6684) on :

quote:
Originally posted by Dagonee:

quote:
There appear to be three possible explanations for their choice of who to help:
Ah, so the problem is simply your inability to come up with an actual likely motive.

Whenever you feel like suggesting one, as opposed to sneering, please feel free to do so. [Smile]

Posted by scholarette (Member # 11540) on :

Ultimately, there is only so much that any one person can do. These doctors saved a girl's life. That's a good thing. It may not have been the optimal good, but they still did good. Because this girl is white, middle class is her life not worth saving?

Posted by Mrs.M (Member # 2943) on :

KoM, you couldn't be more wrong about the demographic that will benefit from this machine.

quote:
saving the particular upper-middle-class, white child with the fantastic good luck to be referred to me

quote:
Granted. The error, therefore, lies in what children were chosen as patients.

First of all, no baby is "referred" to a NICU or "chosen" as a patient. If a baby born in a hospital requires immediate intensive care, he will be brought to that hospital's NICU or transported to the nearest one. No baby is ever refused care, for any reason.

Many (if not most) of the children in US NICUs are lower middle to lower class. A huge number of them are minorities. Poor and/or minority babies are at a higher risk of being born premature or with complications. Fortunately, Medicaid and Social Security cover whatever expenses the parents cannot. They will even cover whatever balance is left over if the parents' insurance tops out.

Neonatology is not a large specialty. It requires years of specialized training beyond medical school and brutal hours of gruelling and sometimes heartbreaking work. The pay is not that great, either, especially when you think about all the training and sacrifices that are required of these doctors. Every NICU in the US needs every single neonatologist it has, if not more. Also, your assumption that neonatologists are all white is incorrect. For example, 2 of Aerin's neonatologists were Indian, 1 was black, and 2 were Jewish. The other 3 were white Christians.

Lastly, that you would call any child born with their bowels outside their bodies lucky is shocking. Babies feel pain and the kind of pain associated with that condition is excruciating. No baby in any NICU is lucky.

Posted by Puffy Treat (Member # 7210) on :

But she's white and "middle class". That makes her automatically and innately lucky, no matter what the horrible reality of her actual situation. Any acts of goodness done towards her thus must be selfish and worthless. [Roll Eyes]

Posted by King of Men (Member # 6684) on :

quote:
Lastly, that you would call any child born with their bowels outside their bodies lucky is shocking. Babies feel pain and the kind of pain associated with that condition is excruciating.

And given this sort of pain, where would you rather be? Africa, or the West?

quote:
First of all, no baby is "referred" to a NICU or "chosen" as a patient. If a baby born in a hospital requires immediate intensive care, he will be brought to that hospital's NICU or transported to the nearest one. No baby is ever refused care, for any reason.

...which is why all those African children have this level of medical care, to be sure. And this child was chosen to receive that care, by that doctor, when the doctor chose where to work.

quote:
Every NICU in the US needs every single neonatologist it has, if not more.

There is an unspoken clause on the end of your sentence there. The clause is "or more Western children will die than is currently the case". This would be a bad thing. None the less, if you transfer a neonatologist to Africa - you can do it before all that effort is expended on the training, if you like, just make him an ordinary GP - then you will save ten or twenty African children for each Western one you kill. Are they less valuable?

I don't necessarily object if you say they are. I just want you to recognise that this is, in fact, the choice you are making. (Or rather, would make if the decision was yours.)

quote:
Many (if not most) of the children in US NICUs are lower middle to lower class.

Any child in the West (you should note, the story is from the UK) is the high end of the upper middle class when the relevant comparison is Africa.

quote:
Also, your assumption that neonatologists are all white is incorrect.

I made no such assumption. I read the story, and saw pictures of both doctor and baby. Both are white.

quote:
But she's white and "middle class". That makes her automatically and innately lucky, no matter what the horrible reality of her actual situation.

Yes, it does, actually. Not that I object to such luck, you understand, being a beneficiary myself. But I like to recognise its existence when I see it. The point I was making, however, is that resources are expended on single children, in the west, which might save twenty or thirty in poorer places. I think it is a good thing to recognise that this tradeoff is made.

Now, kq has argued that the ratio is not twenty to one; that is a very reasonable argument, one susceptible to analysis and empirie. The rest of you, however, seem to be locked in hysterical resistance to the very existence of a trade. Let me put it as a direct question: Given the choice between saving this child, or using the same twenty hours of skilled labour to save ten African children, which would you choose? And do you deny that such a calculation can be made, or should be made?

Please note, I don't insist on my numbers. It could well be that when you actually do the full analysis, you could only save one African child per western child due to the logistics or corruption issues; or even less than one. Nobody here is qualified to make that judgement on anything more than a guess-and-intuition basis. But given that such a calculation can be made, why do you apparently object to it?

Posted by ketchupqueen (Member # 6877) on :

And that's the rub, KOM-- I don't think that such a comparison should (or possibly can ethically) be made.

I think that we must accept the fact that the doctor has chosen to work in an environment where he can save white middle class children (among others) with lots of great resources, and think that it is a laudable goal to save every patient possible without considering the cost to children in Africa, since they are irrelevant to the situation. He has chosen not to be a doctor in Africa, but a specialist in Britain. Given that the choice is made and he has free will to make his own choices, we should move on from that point of the discussion.

Posted by King of Men (Member # 6684) on :

quote:
And that's the rub, KOM-- I don't think that such a comparison should (or possibly can ethically) be made.

Why not? Given some finite amount of resources, why would you not want to apply them to saving the maximum number of lives?

The doctor has free will, certainly; but there's such a thing as incentives. He is an NHS doctor, paid for (ultimately) by the British taxpayers. If they chose, they could elect a government which would pay doctors to work in Africa - perhaps at a premium, conditions there being rather worse.

Now, it is only human to prefer your money (ultimately, your sweat and hard work) to be used on your own children, and your neighbours' children. I don't object to this at all. But I think we ought to recognise what we are doing. Why do you not think that we should make that calculation, and recognise that choice?

Posted by ketchupqueen (Member # 6877) on :

quote:
why would you not want to apply them to saving the maximum number of lives?

Because it is impractical to do so, and if you try to do such an impractical thing, it is my guess that even less lives would be saved in the end, or possibly the same amount or even a few more lives, but at more of a cost.

I wish we lived in a perfect world, but since we don't, I'll work on problems close to home, where I have most control over the result, first, then work my way out. Not that I don't try to help worldwide, I contribute as much as I can afford to organizations that provide care in countries with poor health care every year. But PERSONALLY I try to worry first about my family, then my community, then my state, then my country, etc.

Posted by King of Men (Member # 6684) on :

Ok, I think I get it. You are objecting to the centralisation aspect, the idea of a Committee for Efficient Resource Use saying "this doctor goes here, that one goes there". Yes, fair enough, that wouldn't work. It's been tried. (I do note, in the absence of corruption, you could do it by a plain wealth transfer: Just give every African 1000 non-inflated dollars to buy whatever they chose. That would improve their health a lot, most of them, and no worries about government inefficiencies.) But I was suggesting that when we buy ourselves health care, or food, or whatever, we should (at least occasionally) stop up and consider that this is a resource use that could save X African children. In particular, applied to this dialysis machine, we seem to have a real poster child for a good twenty-to-one ratio. But people in this thread seem to be saying "No, you can't make that calculation even if you don't intend to act on it."

Posted by ClaudiaTherese (Member # 923) on :

I don't disagree with King of Man's general point. It is true that the resources spent on any one child in the NICU would -- if somehow tenably converted into resources in developing countries -- probably save many other children's lives.

If I am reading this correctly, he is arguing against giving praise to people who (we'll assume for the sake of argument) could be doing better ethically. Here might be where we differ: I am all for praise in this case, albeit alongside the caveat that more could be done by, well, everybody (and some more than others) elsewhere. I have no problem with noting that, especially if someone is lauding him or herself excessively, and doing it with the implication of sainthood or perfection.

I don't see that in the article, though. Not only do the physician and mother not seem to use "saintly" language, the reporter doesn't, either. (Am I missing it? Serious question.) There really isn't a focus on the physician and nurse at all, but rather on the machine and making it more broadly available.

So sure, this is a great innovative step. And sure, there is great inequality and injustice in the world, and more could be done (again, by everybody in the developed world, really) to address it. Where is the incommensurability here?

As an aside, the training of physicians represents an enormous amount of investment by the public of a given country, both through funding the sites of the training and on the literal backs of those communities (and hearts, and ears, and guts, and so on). I've read an estimate that a single physician's training just through medical school represents about $100,000 of investment. Specialty training would be much much more, over and above that. I don't think it is reasonable not to take into account the responsibility of physicians to work within the system that trained them as part of remuneration for the investment made in them by others.

Mind you, I am a US-trained physician getting licensed to practice in Canada. However, a good bit of my training was in the Canadian system, and I'll be licensed for practicing both sides of the border. I still do mull over my debt, though, and it remains at the forefront of my mind when I make my own decisions.

Posted by ketchupqueen (Member # 6877) on :

I don't object to making the comparison. I object to saying we SHOULD do that.

You are welcome to make that comparison and even base your decisions on it.

I choose to make the comparison now and then but make most of my decisions independent of it (though I do shy away from things that I see as wasteful in favor of spending that money alleviating a bit of suffering or hunger instead, often times. I've even been known to buy a less extravagant lunch than I wanted and spend the difference on feeding a homeless person lunch. But I digress...)

I think it is each individual's right to choose when and whether to make these comparisons, though. And personally, I do not choose to make such comparisons when talking about health care for my children (or safety for my children, or other peoples' choices for their children-- well, with the exception of when celebrities spend $180 on five onesies for their babies, that kinda irks me.) In general, you cannot value one life over one another, in my opinion. That means both that you can't value African children who need vaccines over a baby born with a severe birth defect in England just as much as you can't value that baby's life over African children who need vaccines. The decision of who gets saved isn't ours to make, it's chance, if you want to call it that, which children have access to what medical resources. That doesn't mean you can't compare-- but it still wouldn't be ethical for this doc to say "sorry, we can't save your daughter 'cause I'm working on vaccines to save African children." That is not his bailiwick.

Posted by ketchupqueen (Member # 6877) on :

And what CT said, too. [Smile]

Posted by King of Men (Member # 6684) on :

quote:
That means both that you can't value African children who need vaccines over a baby born with a severe birth defect in England just as much as you can't value that baby's life over African children who need vaccines.

I think that, as you have phrased that sentence, you not only can but must. If you had said, "you cannot value an African child over an English one", I would agree. But when you weigh two against one, you must choose the two. What other measure can there be?

Posted by Threads (Member # 10863) on :

KoM, you're making the assumption that everyone's goal is to do the greatest possible good to the entire world's population. Clearly this isn't the case so you should be trying to defend that assumption rather than trying to invent motives for everybody who disagrees with you.

For example, I disagree with your starting assumption. When taking into account whether or not to support/do an action, I take into account the relevance of that action to my own life. A rough ordering of the priority would be: my immediate family/friends, local community, town, state, country, allied countries, world. This does not mean that I don't support global charity efforts. It just means that the "harm" being done has to be greater for me to support a global action than a local action. It's why I'm more interested in undoing the patriot act than in stopping equivalent civil rights abuses in other countries. It's also why I wouldn't support invading another country unless it posed a significant threat to my own or was committing such egregious acts (ex: genocide) that the harm being done would warrant diverting significant resources from a local or national level to an international level. Using the example from the OP, it means that I wouldn't tell a child at the local hospital with a 90% chance of dying that the funds that could be used to potentially save him are better spent in Africa.

I think this is a semi-accurate generalization of many people's moral priorities (on a basic level). I also think this approach is less prone to error than yours in the long run. Your approach is top-down and if your initial analysis is incorrect then you lose big. This approach is bottom-up and is less prone to massive error since people will tend to deal with those issues most relevant to themselves (note: my approach does not exclude global charity). This leads to a larger pool of solutions than would be created by your approach. It's also worth noting that while the cost/benefit calculations you wish to perform are possible in theory, they are not currently possible in practice. We don't even know all of the variables to use in such a calculation.

Also, what is your objective measure of selfishness? I can think of many but I'm wondering why you felt the term adds meaning to this discussion.

Posted by ketchupqueen (Member # 6877) on :

But that's what I'm saying; it's an impossible choice. It's the classic debate of the life of one vs. the life of many. I guess we fall on different sides of that debate.

My opinion is when there's an immediate chance to save the 1 vs. a possible chance to save the many, you should choose the one.

I think it is admirable for one to sacrifice himself for the many, but I do not think that local doctors should make that choice; the one can only sacrifice for the many, IMO, when 1) there is no way to save the one anyway or 2) the one is one with a public or other responsibility (soldier to his countrypeople, parent to her children) and has a responsibility to make that choice or 3) one chooses of his own free will to make the sacrifice. A baby can't choose, has no responsibility, so if the chance to save her is there it should be taken.

Posted by King of Men (Member # 6684) on :

quote:
My opinion is when there's an immediate chance to save the 1 vs. a possible chance to save the many, you should choose the one.

I'm sorry, but my opinion of this is that you should start thinking with the part of your brain that does arithmetic.

Posted by ketchupqueen (Member # 6877) on :

And as I said, we have different opinions on that issue.

Posted by scholarette (Member # 11540) on :

KofM, so, why aren't you a dr treating children in Africa?

Posted by AvidReader (Member # 6007) on :

quote:
Given some finite amount of resources, why would you not want to apply them to saving the maximum number of lives?

Ah, but how do you save the maximum number of lives? See, this doctor may not be willing to be a doctor if it means living in Africa. So Africa isn't losing a potential doctor, Britain would be gaining one.

There's a pool of medical supplies that used in the West will save X babies. They'd save 5X in Africa - if they can get there undamaged. Since they're produced in the West, they have to be shipped to the country first where they pass through customs. If the government is corrupt, a certain amount is taken and kept for their use or to be sold for personal gain. Now they're shipped to the countryside where some of the convoys are attacked by rebel groups who destroy some and keep the rest to use themselves or sell to buy guns. Finally, a small amount reaches the medical outpost who may or may not be able to use them, depending on what arrived. In practice, could you actually save more African babies with the same resources? I don't know that you could.

None of that even begins to address the causes of disease. What Africa needs is clean water, food, basic sanitation, random strangers not trying to kill them, a government that cares about their needs, and lots and lots of bug spray. Medicine only addresses a tiny fraction of their problems and does nothing for most of the underlying causes. I submit that that makes sending a large portion of doctors and medicine there less efficient than using those resources in the West.

Posted by Dagonee (Member # 5818) on :

quote:
I'm sorry, but my opinion of this is that you should start thinking with the part of your brain that does arithmetic.

Why the hell are you coming into a thread celebrating an engineering achievement that will save lives when you spend all your professional time - and use findings derived from far more expensive pieces of equipment - that doesn't save ANYBODY's life in the present at has at best a speculative chance of doing so in the future?

You can joke about the selfish bastard bit, but it's clear you don't really believe that each person should do that which saves the most lives. So what's the point? The only reason you've given that even pretends toward consistency ("I don't object to selfish bastards, as such. It's lauding them as saints of self-sacrifice that grates.") has the fatal flaw of being irrelevant to a thread where no one lauded them as saints. Even the original thread title only spoke to the doctors' willingness to go beyond the mere requirements of their job.

Posted by MrSquicky (Member # 1802) on :

quote:
To the best of my knowledge, only one of them happened. Do you have other information?

How would I? As you correctly noted, no one would make any kind of fuss over the other one.

A basic epistemological precept that you should have learned in undergrad is "Absence of evidence is not evidence of absence." This can be overcome in cases where something occurring would very likely lead to some sort of evidence reaching you, but this is, as you yourself said, not one of those cases.

If we're going to talk about going above and beyond in one's profession, is that really the place to expose your failure in a basic area of your own ?

Posted by Trent Destian (Member # 11653) on :

Doctors are needed everywhere KOM and there are doctors everywhere. Some choose to be in their country and treat citizens and some choose to go abroad to help others. They can't all be ruled by numbers because sooner or later those numbers will become skewed. Should all trash collectors only work in the dirtiest city because they can pick up more trash there than anywhere else? Doctors are people too and maybe they don't want to uproot there family to leave for Africa. They chose the profession to help at the level the feel they can, not to get as much bang for their buck. When you donate do you give away all your money or just the amount you feel you can? They realize that even though they aren't there someone else is, maybe not enough, but someone. We do what we can as people who have our own lives but still want to help as we can. It may not be the best that we can do, but it's more than nothing and you can't demand more than that.

Posted by Mucus (Member # 9735) on :

quote:
Originally posted by ketchupqueen:
I don't object to making the comparison. I object to saying we SHOULD do that.

You are welcome to make that comparison and even base your decisions on it.

I may note as a partial aside from the argument, that we do implicitly make this comparison as a society with a couple differences. Rather than basing our decisions on what is cost effective, we base it on what is popular. What I mean by implicitly, is when we indirectly control politicians that direct, oppose, or approve of particular foreign aid policies such as sending aid to the victims of Hurricane Katrina or the Sichuan Earthquake.

After all, as previously noted, both foreign aid and health care are funded through the same tax revenues.

Posted by King of Men (Member # 6684) on :

quote:
They can't all be ruled by numbers because sooner or later those numbers will become skewed. Should all trash collectors only work in the dirtiest city because they can pick up more trash there than anywhere else?

Yes, they should, actually. Until the point where that city is no longer the dirtiest, at which point you assign the next guy to what was previously the second-dirtiest city. Do you really have no concept of the margin? It's like you think I'm saying "All doctors should work in Africa", when what I'm actually saying is "In the current situation, there is a benefit to moving doctors to Africa". I don't expect that situation to last forever if you actually start moving doctors! Please do not argue against such a straw man.

quote:
Rather than basing our decisions on what is cost effective, we base it on what is popular.

My point precisely. Whether we like it or not, we have already made a calculation such as I referred to above; it's just that we weight our own children higher than African children, by a factor five or ten or whatever it is.

quote:
A basic epistemological precept that you should have learned in undergrad is "Absence of evidence is not evidence of absence."

I'm glad I went to a good university, then, because absence of evidence is evidence of absence. In some cases not bery strong evidence, but evidence nonetheless. What is more, whatever our friend the doctor does that didn't reach the article, it is certain that for those hours he was working on the dialysis machine, he was not helping any Africans.

Posted by kmbboots (Member # 8576) on :

And the hours you are spending not helping Africans? Honestly, KoM, is this really an issue for you or are you just being a jerk? If the former, go do something useful. If the latter, go do something useful anyway.

Posted by ClaudiaTherese (Member # 923) on :

And we come back around full circle, to the perennially unanswered question:

So what have you done to save the world, King of Man? Or is this just about internet points, sturm and drang and easy-to-say-but-not-gonna-do-it-myself, no, you go and do it?

---

Edited to add: Uh, what kmboots said. [Smile]

Look, I don't think one has to be perfect before entering criticism of or input to the broader world. I do think there is just as much hypocrisy in adopting an air of self-serving sanctimoniousness when criticizing (but not doing, or not doing much) as there is in doing a little (but not all possible effort). Well, more, actually, come to think of it.

PS: Would be delighted to learn that you are an African neonatologist, BTW. Have no objection to eating crow because you are speaking from a position of solid and evidenced commitment to those principles advocated, yourself.

Posted by fugu13 (Member # 2859) on :

The city with the highest dirtiness is not necessarily the city where a trash collector's time will result in the largest marginal decrease in dirtiness. You aren't using marginal arguments correctly.

edit: also, a doctor treating patients where he is doesn't require he values those patients more than those elsewhere who might have a larger marginal benefit. He might have other reasons for remaining in one location, and given residence in a particular location, the highest marginal benefit for others is almost certainly going to be to treat people in that location.

Posted by ClaudiaTherese (Member # 923) on :

For the record, just to be clear: I do think we ought to be talking more about global inequalities and human tragedies in places less visible to us. Thinking, talking, and doing. Ｔhat can be done without sanctimonｙ.

Posted by Dagonee (Member # 5818) on :

quote:
Ｔhat can be done without sanctimonｙ.

But where's the fun in that?

Posted by Puffy Treat (Member # 7210) on :

My problem is, saying a doctor did a good thing by helping save the life of a little girl who would have died otherwise is a completely different thing from saying: "I don't care about poor people in Africa. They can just be sick and die!"

Why keep trying to force a connection between those two things? It's nonsensical, and distracts me from any valid point that can be made regarding what personal resources one can and should send towards those in need world-wide.

It's not a valid discussion technique, it's shock jock tactics.

Posted by King of Men (Member # 6684) on :

quote:
Originally posted by fugu13:
The city with the highest dirtiness is not necessarily the city where a trash collector's time will result in the largest marginal decrease in dirtiness. You aren't using marginal arguments correctly.

Substitute "where the trash collector will do the most good", by all means. That's what I was using 'dirtiest' as shorthand for.

quote:
edit: also, a doctor treating patients where he is doesn't require he values those patients more than those elsewhere who might have a larger marginal benefit. He might have other reasons for remaining in one location, and given residence in a particular location, the highest marginal benefit for others is almost certainly going to be to treat people in that location.

Which is indeed what I'm saying. As a society, we just don't care about those outside our own continent to anywhere near the extent we say we do. What reason do you suppose this doctor would like to give for not moving, if you showed him pictures of a child with worms in her eyes? I would bet a reasonable sum he would not defend the decision from first moral principles. But if you asked him why he became a doctor, he would be very likely to say something on the order of "helping others" or "making sick children better". So, why this child and not those children?

quote:
And the hours you are spending not helping Africans?

Tu quoque is not an argument, it is a way to not think about the problem. Let me be clear: I don't actually give a damn about any Africans. But you do. Or at least, you say you do.

Posted by katharina (Member # 827) on :

All horse and no cattle, then.

Posted by Dagonee (Member # 5818) on :

So KoM is taking others to task because they don't interpret a moral precept he doesn't hold in the way he would interpret it if he did hold it.

This makes sense why, exactly?

Posted by King of Men (Member # 6684) on :

quote:
My problem is, saying a doctor did a good thing by helping save the life of a little girl who would have died otherwise is a completely different thing from saying: "I don't care about poor people in Africa. They can just be sick and die!"

It is not different. It is precisely the same. Actions have consequences. This particular act has the consequence of saving one life; that is good. Notwithstanding that good thing, it is nevertheless true that it also has the consequence of not helping any number of other children, whose need is just as great and easier to meet. If you help the one, you cannot help the others. This is just a fact of physics. It is good to keep your eye on all the consequences of your acts, even the ones you don't like. How else are you going to know what actions to take?

Posted by ClaudiaTherese (Member # 923) on :

quote:
Originally posted by King of Men:
Let me be clear: I don't actually give a damn about any Africans. But you do. Or at least, you say you do.

Where?

Specifically, where are people claiming this while also claiming that there are no other competing and valid claims of obligation in the world?

I think you came into this farm looking for a fight, and you yourself are the one that raised up a strawman for fisticuffs. [Confused]

Posted by Puffy Treat (Member # 7210) on :

So, it was just another bout of pointless trolling, Gotcha.

Posted by kmbboots (Member # 8576) on :

Ah...so the latter, then. I was afraid of that. I don't know why I keep hoping for some substance from you, KoM.

Posted by fugu13 (Member # 2859) on :

Not only that, but even were there someone who wanted to do the most good, it isn't at all clear Africa would be the place. If we only looked at immediate improvement in health, yes, but there are significant complicating factors. Even significant work to treat specific diseases in Africa wouldn't necessarily reduce the child mortality rate very much, so it isn't at all clear there's the highest marginal benefit to treating African children.

This is before we even get into the other things people could be doing.

But yes, where has someone said they view their obligations to African children exactly as highly as their obligations to everything else in the world (not just other children)? More specifically, where has the doctor in the article said anything of the like?

Posted by ClaudiaTherese (Member # 923) on :

quote:
Originally posted by King of Men:
Notwithstanding that good thing, it is nevertheless true that it also has the consequence of not helping any number of other children, whose need is just as great and easier to meet.

I wouldn't argue with the broad point here, although I don't think it is the same argument that has been made throughout.

But "easier to meet?" Have you ever tried to go on a medical mission to Africa? I have helped coordinate these. The last one my group went on, the planning fell through on the Ugandan end, there was political fallout, and they were shuttled to a school to teach, not see patients. This after all of the prophylaxis and shots, and all that entails, and thousands of dollars out of pocket for each ticket, and updated passports, and 3 people back home to field paperwork and political issues that arose ... a dialysis unit in someone's garage from scraps? Not so much a problem.

Doing medicine in Africa as an outsider is not straightforward, open arms, just get here and we will find a use for you. It's paperwork and hoops and power plays and restricted access and a lot of hassle. It is getting affiliated with the local medical schools and bringing the right gifts. Worth doing, but not at all what it seems to me you are implying.

---------------------------------

PS: And getting licensed to practice long term in another country, other than the one you trained in? Trust me, not easy. There is politics and turf protection everywhere, and need does not change that. Not when it is an issue of positions of power.

Posted by King of Men (Member # 6684) on :

quote:
But "easier to meet?" Have you ever tried to go on a medical mission to Africa? I have helped coordinate these.

Ok, this is a reasonable objection. If the benefit per unit cost isn't really greater, that's something else again. Let's say "would be easier to meet in the absence of artificial barriers". But I note that several people here (kq, for example) have objected to making this kind of calculation even in principle.

I have no beef with anyone who is willing to straightforwardly admit "I value African children less than Western children". I do that, too. But again: Several of the objections raised in this thread have been to the idea that such a valuation exists; for example:

quote:
(Synesthesia)I don't see why you can't do both. Help kids in Africa and help kids here.

quote:
(Squicky)You seem to be presenting these as if they are mutually exclusive things.

quote:
(kq)But the concept of triage doesn't apply when resources ARE available to save a patient immediately available vs. putting the same time, talent, and money toward people on another continent.

(...)

KOM, just because people need doctors in Africa does not mean people in wealthier countries don't need them, too. If all the doctors went to Africa to give vaccinations and treat parasites, malaria, and AIDS, there would be too many doctors in Africa and not enough elsewhere (and I should add that there are shortages of doctors in some specialties in parts of the developed world already.)

(...)

And that's the rub, KOM-- I don't think that such a comparison should (or possibly can ethically) be made.

quote:
(Mrs M)Every NICU in the US needs every single neonatologist it has, if not more.

Posted by ClaudiaTherese (Member # 923) on :

quote:
Originally posted by fugu13:
Not only that, but even were there someone who wanted to do the most good, it isn't at all clear Africa would be the place. If we only looked at immediate improvement in health, yes, but there are significant complicating factors.

Not always even this. For Canadian physicians, bang-for-the-buck medicine is treating Native populations far north without access, not Africans. No licensing issues, no passport concerns, no additional vaccinations, infrastructure in place, heavy infant mortality and shortened lifespans. Close to home work wins there, and not enough is being done.

Bang-for-the-buck overall in the world isn't medicine at all, but sanitation (as noted above). Clean water is the foremost problem.

Theory is simple and streamlined and aesthecially satisfying. Practice is warty and bumpy and not nearly as much fun as ascetic contemplation. Often that is why we who are further removed do not understand why the solutions that look so simple to us are not being put in place by others.

Posted by ClaudiaTherese (Member # 923) on :

quote:
Originally posted by King of Men:
Let's say "would be easier to meet in the absence of artificial barriers"

Yeah. Shame that there is no accessible world without those sorts of barriers. The world of imagination is much more clean and asthetically pleasing, and it would be nice if we could all live there instead.

Posted by kmbboots (Member # 8576) on :

quote:
Originally posted by King of Men:
I have no beef with anyone who is willing to straightforwardly admit "I value African children less than Western children".

But it isn't just the children in the balances. You are making it sound like there are no factors involved in the decision other than the ethnicity of the children. A doctor isn't just a doctor. He or she is also a person with their own aspirations, family obligations, home, life, interests, friends. Also, practicing medicine in Africa is not without actual danger. You also need to weigh all that in the scale.

You might say with somewhat more validity, that people value the lives of western children and their own lives, family, friends, and so forth, more than African children.

Posted by King of Men (Member # 6684) on :

Those are all costs to the doctor of moving to Africa. They can reasonably go into a cost/benefit calculation. They do not affect the quesiton of whether such a calculation can be or should be made. And again, this is also a decision we make as taxpayers and voters, when we do not pay for high stipends for charity work in other continents, and do not impose effective sanctions on corrupt regimes.

Posted by fugu13 (Member # 2859) on :

Yes, we make such decisions, based on what little, imperfect, intuitive evidence we can scrape tother. You seem to be asserting that you do not because you do not value the lives of African children, but that is a decision in itself.

Posted by kmbboots (Member # 8576) on :

KoM,

Right. And that is different than "You value Western children more than African children."

Posted by King of Men (Member # 6684) on :

Well, yes, I'm also making the assertion that even after all these factors have been accounted for, nonetheless there would be a greater benefit per cost in sending resources to Africa. If you don't like doctors, how about poodle stylists?

Posted by Threads (Member # 10863) on :

quote:
Originally posted by King of Men:
It is good to keep your eye on all the consequences of your acts, even the ones you don't like. How else are you going to know what actions to take?

This is a strawman. Who here is arguing that we shouldn't look at the consequences of our actions?

quote:
Originally posted by King of Men:

quote:
A basic epistemological precept that you should have learned in undergrad is "Absence of evidence is not evidence of absence."
I'm glad I went to a good university, then, because absence of evidence is evidence of absence. In some cases not bery strong evidence, but evidence nonetheless.

This isn't true at all unless you are using an odd definition of evidence. Using a Bayesian definition, something can be considered evidence if it causes the posterior probability of an event to change from the prior probability.

quote:
Originally posted by King of Men:
I have no beef with anyone who is willing to straightforwardly admit "I value African children less than Western children".

I think kmbboots hit the nail on the head with her response. Your argument is flawed because you are only viewing the problem in one dimension. I had meant to mention this in my post last night but I kind of ran out of steam and it was late. Nobody's goal is "only" to save children so it does not follow that people are being inconsistent with their actions if they do something that saves only one children instead of two.

Posted by MrSquicky (Member # 1802) on :

quote:
Originally posted by Threads:

quote:
Originally posted by King of Men:

quote:
A basic epistemological precept that you should have learned in undergrad is "Absence of evidence is not evidence of absence."
I'm glad I went to a good university, then, because absence of evidence is evidence of absence. In some cases not bery strong evidence, but evidence nonetheless.
This isn't true at all unless you are using an odd definition of evidence. Using a Bayesian definition, something can be considered evidence if it causes the posterior probability of an event to change from the prior probability.

Which, as I noted, can be the case in a situation where there can be an expectation of observing some sign if the condition existed. However, right here we're talking about two people that we know nothing about before this article and your (KOM's) assertion that because you have no evidence that they send money to Africa, you can treat the situation as if they don't send money to Africa.

That would be foolish even without you explicitly stating that them sending money to Africa would not get them any recognition.

I've never seen an indication that you went to a good university, KOM. Maybe your conception of what constitutes good there is as shaky as your grasp of basic concepts in epistemology.

Posted by King of Men (Member # 6684) on :

quote:
This is a strawman. Who here is arguing that we shouldn't look at the consequences of our actions?

ketchupqueen, for one; see my quote of her previously.

quote:
Which, as I noted, can be the case in a situation where there can be an expectation of observing some sign if the condition existed.

But this is always the case, even though the probability may be small. Consider: There is a small, but finite, probability that the article will mention "Dr Whosis is also a contributor to charity X, and spends his free time making balloon animals for victims of left-handed drunk drivers", if those things are true. (And a smaller probability that the article will include this if they aren't true.) Therefore, the absence of this sentence is weak evidence for the absence of such activities. And this is true for any finite probability, however small. You can't ignore it just because your personal "never-happen threshold" lies around 3% or so. Events with 3% probability happen around one time in 33, in spite of the binary intuition that tells us otherwise.

Posted by MrSquicky (Member # 1802) on :

quote:
There is a small, but finite, probability that the article will mention "Dr Whosis is also a contributor to charity X, and spends his free time making balloon animals for victims of left-handed drunk drivers", if those things are true.

And that would be relevant if not for another epistemological error you are making.

There is a finite probability that the article will mention that the people involved do not do these things that is at the very least on close order of them mentioning that they do do it.

You're making baby Francis Bacon cry.

Posted by Threads (Member # 10863) on :

quote:
Originally posted by King of Men:

quote:
Which, as I noted, can be the case in a situation where there can be an expectation of observing some sign if the condition existed.
But this is always the case, even though the probability may be small. Consider: There is a small, but finite, probability that the article will mention "Dr Whosis is also a contributor to charity X, and spends his free time making balloon animals for victims of left-handed drunk drivers", if those things are true. (And a smaller probability that the article will include this if they aren't true.) Therefore, the absence of this sentence is weak evidence for the absence of such activities. And this is true for any finite probability, however small. You can't ignore it just because your personal "never-happen threshold" lies around 3% or so. Events with 3% probability happen around one time in 33, in spite of the binary intuition that tells us otherwise.

It depends on what you mean by "ignore". I don't see why such an omission would change the probability by an appreciable amount and therefore the slightly increased probability that the doctor does not help African kids does not noticeably change any of my judgments. Clearly you've determined that there is a large enough probability that this doctor doesn't help African kids to make a character attack on him. How do you justify that?

Posted by fugu13 (Member # 2859) on :

Not only that, but the attack on his character is only valid if the doctor shares a position on equality of value that many people clearly do not.

Btw, nothing in your quotation by kq says she views all lives as exactly equal. I happen to disagree with her that a comparison can be made, and in fact she makes a comparison: in her value system, the doctors in places in the US are needed. That tells us something about her value system right there, and it doesn't look like the one you are asserting she has.

Posted by King of Men (Member # 6684) on :

quote:
Originally posted by MrSquicky:

quote:
There is a small, but finite, probability that the article will mention "Dr Whosis is also a contributor to charity X, and spends his free time making balloon animals for victims of left-handed drunk drivers", if those things are true.
And that would be relevant if not for another epistemological error you are making.

There is a finite probability that the article will mention that the people involved do not do these things that is at the very least on close order of them mentioning that they do do it.

You are mistaken. The chances of the doctor's charitable contributions being mentioned, if they exist, are at least 0.1%; journalists like that kind of thing. Who is going to write "The doctor doesn't contribute to charity" in a feel-good fluff piece? Even if it is true? I would put this probability much lower.

Posted by MrSquicky (Member # 1802) on :

Do you not understand what close order means?

Posted by ClaudiaTherese (Member # 923) on :

Of note, most physicians I know who donate to charity do not tend to speak freely of it. Those that do charitable work outside the country do speak of it, presumably because people will notice they are gone for weeks at a time, and coverage must be arranged But pro bono work and straight donations, not so much.

Why assume the journalist would know about it, even if he or she asked? Especially given that this is an article not about charity, but about the technology?

Posted by King of Men (Member # 6684) on :

quote:
Originally posted by MrSquicky:
Do you not understand what close order means?

It means "of the same order of magnitude".

Posted by MrSquicky (Member # 1802) on :

I'm not talking about in straight mathematics. I'm talking about comparing two probabilities. Do you know what saying that they are on close order means?

---

edit: Putting it another way - and leaving aside that you're just making up numbers without any solid basis - the probabilities here can't really be expressed as any thing as clear cut as a single number. Because of the various sources of error and the large number of unaccounted variables, what we're really dealing with is two fuzzy clouds that cover pretty much the same area. Thus, in any sort of valid analysis, the probabilities can only be treated as essentially equivilent.

Posted by King of Men (Member # 6684) on :

Apparently not. Why don't you enlighten me?

Edit: I disagree. I admit to making up numbers, but I don't see how

"The probability of a charitable contribution being mentioned, given that it exists"

is anywhere near

"The probability of the nonexistence of such contributions being mentioned, given that they don't".

I put the former around 0.1%, the latter in the millionths, and the uncertainties small enough that there is no overlap.

[ August 06, 2008, 03:04 PM: Message edited by: King of Men ]

Posted by Dan_raven (Member # 3383) on :

It has been my experience that heroes and villains are treated strangely in our society.

villains are expected to eternally live down to their lowest moments. If they do not, and who can be eternally evil, we treat each moment of their greater than vileness as a sign of redemption and heroic temperament.

Heroes are expected to eternally live up to their greatest moments. If they do not, and who can be eternally perfect, we treat each moment of their less the perfection as an insult and cause to vilify the hero.

Darth Vader kills a room full of children, then goes on to a life of darkness and destruction, but the moment he tries to save the life of his grown son, all is forgiven and he goes to Jedi heaven.

Here, a team of doctors and nurses go to good lengths to save the life of one child. Yet KoM wants to deny their heroic name because they didn't give their lives to the ill in Africa.

It is only by applauding doctors and nurses who go that extra mile that we will teach the next doctors that such extra work is worth while.

KoM's criticisms will only result in doctors who say, "Why bother. Nothing is good enough."

Posted by King of Men (Member # 6684) on :

Please note that I also harshly criticize people who did give their entire time to helping the poor, such as Mother Theresa, when they don't do it the right way.

Posted by Threads (Member # 10863) on :

quote:
Originally posted by King of Men:
Apparently not. Why don't you enlighten me?

Edit: I disagree. I admit to making up numbers, but I don't see how

"The probability of a charitable contribution being mentioned, given that it exists"

is anywhere near

"The probability of the nonexistence of such contributions being mentioned, given that they don't".

I put the former around 0.1%, the latter in the millionths, and the uncertainties small enough that there is no overlap.

I think Squicky was talking about the probability of a charitable contribution being mentioned versus the probability that such a contribution would not be mentioned.

Posted by MrSquicky (Member # 1802) on :

quote:
I put the former around 0.1%, the latter in the millionths, and the uncertainties small enough that there is no overlap.

As long as you're talking about a world that doesn't actually have to correspond to reality, I'm fine with that statement.

When I do probablistic analyses, I have to deal with the real world - the rules of which make it so that there is no evidence that these people don't send money to charities in Africa, so I don't think your way of doing things will work for me. But man, that would make research so much easier.

Posted by ketchupqueen (Member # 6877) on :

quote:
He might have other reasons for remaining in one location, and given residence in a particular location, the highest marginal benefit for others is almost certainly going to be to treat people in that location.

That is exactly what I tried to say last night but much clearer. Thanks.

As for the rest of it, I tried to express several ideas, none of which I got through very clearly.

I think I'm going to bow out for right now, since it seems rather fruitless when others are expressing myself better than I could. [Wink]

Posted by ElJay (Member # 6358) on :

I would have put the period after "fruitless", myself.

Posted by Wendybird (Member # 84) on :

Thank goodness Dr. Salk decided to stay here in rich America spending all those resources developing the vaccine for polio and pioneering the science of vaccines so we actually have something to take to the poor African children we want to save.

Hmmm, thank goodness this British doctor spent his own time and resources coming up with a machine that could eventually be produced on a mass scale and allow doctors in every country to save the lives of babies that previously couldn't be saved - perhaps someday in Africa too.