Friday, September 29, 2006

Engaging Zen Skeptically

I've a ongoing interest in Zen Buddhism, driven largely by the fact that I occasionally brush up against its edges in the course of my ongoing martial arts training. So I've been reading Zen and the Brain by James Austin with great interest. It takes a subject which has been the source of much bad modern writing and treats it in an intelligent and non-sensational fashion.

But I'm finding it difficult to reconcile Dr. Austin's views of the roots of Zen experiences with his approbation for the practice as a whole. The thesis of the book is that Zen experiences are a natural phenomena arising from within the brain; Dr. Austin explicitly discounts any sort of supernatural source. And yet, at the same time, he is very positive about the transcendent episodes that he refers to as "absorbtions".

The question keeps arising time and again is "How is Zen anything other than self delusion?". The absorbtions discussed in the book, especially the "ultimate" experiences of kensho/satori, are described in terms centering around the dissolution of the self/other boundary and the fundamental unity of all things. But these descriptions border on the supernatural, which Dr. Austin has explicitly rejected.

Dr. Austin refers to the illusory nature of the self/other boundary. But, if you accept that the world is real (as opposed to belief in Maya), as Dr. Austin seems to do, then aren't you also required to accept the actuality of the self/other boundary? "Self" and "other" are real categories; if I cut you, I will not bleed nor feel the pain, but you will. Granted, "self" and "other" can be blurred in a psychological sense; I may empathize with your pain when you are cut. However, you are still the one who is feeling the primary pain of injury.

In the same vein, it seems that the enlightenment of kensho is also incompatible with belief in a mundane material world. The feeling of the unity of all things has no material foundation; we're most distinctly not connected with the Universe in any "deep" sense of the word. We may be interconnected and interdependent, in an ecological and social sense, but there is no support to be found in the material world for some sort of transcendental, universal unity among all things.

This is what I mean when I ask whether Zen is just self-delusion. Zen practice does seem to have a salutory effect on people, but this salutory effect is based on ideas which are impossible to support without invoking supernatural phenomena of some kind. I actually came to this realization while I was reading Dr. Austin's description of "The Miracle of Marsh Chapel" (chap. 102 in my edition). After reading his description of the effects of psilocybin exposure on attendees at a religious service my first reaction was not "wow, the psilocybin really helped them deepen their religious experience" but rather "so the psilocybin made them more suggestible, big deal".

I guess my question comes down to this: Dr. Austin seems to reject the supernatural, so how can he endorse any practice which encourages belief in non-naturalistic phenomenon? I'm not prepared to accuse Dr. Austin of hypocrisy, since the apparent contradiction could quite easily be the result of ignorance on my part. But on the face of it Dr. Austin's position seems to be untenable.

Thursday, September 21, 2006

Not Entirely Convinced

I'm not entirely convinced that the grievances of the Prussian Blue family are wholly without merit; if the shoe were on a more favored foot would the reaction would be so salutary? If the family were gay, and the community distributed "No Homosexuality Here" flyers, would that be equally acceptable, or would the progressive community be taking them to task? I think that the key idea to consider are the tactics which are being employed. Regardless of the particular ideologies involved, is it appropriate to single out a family for this type of treatment? I'm generally of the opinion that people should be left alone unless they thrust themselves into the public sphere; rooting out private individuals with whom the greater society disagrees does tend to lead to witch hunts. The question, then, in my mind is whether the family in question has entered the public sphere with respect to their current community. Based on the news report whence all of this sprang it appears that they've kept to themselves since their arrival; they were identified based on a Primetime appearance which predated their move. Or is it the case that if you publicize yourself in any context you're fair game?

A Misuse of the Carbon Tax

Why do people believe that taxes are arbitrary things that can be raised and lowered at will? More importantly, why are some people nodding approvingly at Al Gore's plan to substitute the payroll tax with a carbon tax? Taxes exist to provide the various levels of government with the revenue that they need to do their thing. But that doesn't mean that governments can levy arbitrary taxes on arbitrary activities. A government should levy taxes on an activity in proportion to the amount of money it takes for the government to support that activity. This is a good rule in principle, but its difficult to calculate and execute the appropriate levy on arbitrary activities, which is why things like a general income tax are required in order to allow governments to pay for the support of activities which are not themselves taxed. Which brings me to my complaint about Mr. Gore's plan: its not appropriate to swap a payroll tax for a carbon tax because the two are supposed to serve very different functions. I think a carbon tax is a great idea; I've argued that people who cause environmental damage should be taxed in proportion to the damage that they do. But a carbon tax is not appropriate as a general fundraising tool because carbon emission is not a good proxy for the value of support that the emitter receives from the government. A payroll tax, on the other hand, is much more appropriate as a general fundraising mechanism, since income is a good proxy for the value of the support which the income recipient receives from the government. As an example, consider the case of a coal-burning power plant and a nuclear power plant. The nuclear power plant produces fewer carbon emissions than the coal-burning plant, but does it suck up fewer governmental resources? I'd argue no; nuclear power plants require special security and inspection regimes, which probably mean that they suck up more government resources per kWh produced than a coal plant. This actually argues in favor of a tax on nuclear facility to support the government's monitoring function rather than a general payroll tax, but it also demonstrate that a carbon tax is wholly inappropriate. In a nutshell: the amount that an activity is taxed must, when possible, reflect the actual cost to the government in supporting that activity. Any tax above that amount represents an unwarranted appropriation by the government. Since the amount of carbon emitted by an individual or corporation isn't a good proxy for the amount of resources the government spends to support that individual its inappropriate to use such a tax as a general revenue generator.

Wednesday, September 13, 2006

Theory Is Important

I had thought that I was done commenting about pre-implantation screening and its associated topics, but a recent comment by Evonne Acevedo requires my reply, at length:
One could use (and plenty have used) ornamental semantics and the premise of hypothesis to mask an agenda for eliminating any minority group. Frankly, and again, it’s evident to me that this post and its parent post are motivated more by intellectual argument for intellectual argument’s sake, and you, GG, are driven by the sheer momentum of making a detached, nebulous, clinical and ultimate “point”. And you’re very good at that – kudos. But the eugenic implications here are more than theoretical.
She is dismissing the entirety of my arguments on the basis that they're some kind of theoretical wordplay. If I were to pick a single theme for this blog, however, it would be that "theory is important". I'm going to make a statement of principle now... let's call it the Shiny Ideas Principle of Moral Reasoning:
It must be possible to reason about morality.
This is axiomatic; I'll defend it no further than to say that the alternatives provide no means to guide personal behavior. It follows from there that one must have a framework (a "theory of moral reasoning", if you will) to guide the decision making process. While we're at it let's declare a corollary about these frameworks:
Moral frameworks must be internally consistent.
Frameworks which are not internally consistent simultaneously prove and disprove a moral proposition; they cannot provide moral guidance either. These are the groundrules for discussion; anyone who disagrees with them should look elsewhere for conversation as I have no way to communicate with you. Ms. Acevedo (and anyone else who happens to read this) is welcome to accuse me of "ornamental semantics" (whatever that means). But to assert that my position is somehow invalid because because it is "intellectual", "clinical", or "detached" is totally without merit. The "point" which I'm trying to make is not "nebulous", its very specific: certain arguments against pre-implantation screening necessarily have implications for womens' reproductive choices.
Disability IS as intrinsic to individuality as is race, gender, sexuality, etc. – and “no legs” IS as good as “both legs”, just as “black” is as good as “white”.
I've never argued that disability is not intrinsic to individuality; a person's self-conception is certainly affected by their status w.r.t. ability/disablity. What I have asserted, however, is that focusing on ability vs. disability places an inappropriately high value on attributes which are not essential to a cognition-centered definition of "personhood". A person's particular self-conception has little or no bearing on their status as a "person". As far as "abled/disabled"/"black/white", I believe the comparison is inappropriate in this context; I'll address this shortly.
I of course understand that your stance is one of imposed practicality; i.e. you perceive that, for example, walking is better than not walking. But the barriers you suppose are presented by disability no longer are – and in the case of people who are neurologically atypical, may never have been – those of mechanics; we are a civilized society, and our potential for accommodation, just as, it seems, our potential for elimination, is immeasurable.
Ms. Acevedo is correct in that my stance is pragmatic, but her assertion that it is pragmatism unbacked by fact is fundamentally flawed. Society's potential for accommodation is not "immesurable"; it might more accurately be described as "large but finite". Nor is it the case, as she seems to be asserting, that disability is not the hinderance that it once was. Since the crowd reading this seems to value personal experience (less "clinical", perhaps?), I'll provide an illustrative example from my own life: Me. I'm a field engineer for one of the big computer companies. I travel from customer to customer, setting up computer equipment in their data centers. This position requires manual dexterity (for the plugging and the tying and the screwing...), plus the ability to lift heavy equipment over my head for racking. Were I to loose my hands I'd be SOL; no prosthesis yet devised provides the manual dexterity and carrying capabilities that my job requires. However, society could accommodate me, right? In theory (there's that ugly word again), yes. But what would such accommodation entail?
  • A substantial modification of the design of every data center that I might visit so that I could rack equipment safely.
  • A re-design of equipment cabinets, so that I can rack and cable without good manual dexterity.
  • A re-design of computer equipment in general so that it doesn't require the ability to plug tiny things into other tiny things.
That's a tall order... how much would that cost? A lot, I can tell you that much. But what, specifically, does this example illustrate?
  • Accommodation is an imperfect substitue for ability
  • Accommodation has associated costs.
The theoretical cost to retrofit the world's datacenters to accommodate handless engineers is just ridiculous. At some point the cost in terms of people, money, time, and effort must outweigh the individual's right to be accommodated; the alternative is unlimited expenditure. Wouldn't it make more sense to suggest that I become a design architect instead, since they do most of their work on paper? Which brings me to the next blockquote:
Why the majority seems to prefer elimination is beyond me – I suppose convenience is an unfortunate institution of civilized society. But we’re human.
The reason that the majority seems to prefer elimination is because they recognize the limits of accommodation. No society, no matter how well intentioned, can accommodate every disability in every situation, simply because there is a limit to that society's resources. This is an unavoidable fact.
And nature is not “blind”. Not, in any case, in the context you use “blind” – willy-nilly, haphazard, incidental, oblivious. (And neither, as a rule, are people who are blind. Thanks, blue.)
Though its tangential to this specific discussion, I'd ask Ms. Acevedo how she characterizes nature's behavior? Does she believe that there's some sort of a non-random pattern or purpose to the meeting of sperm and egg? If so, that would certainly have bearing on her argument against pre-implantation screening. However, it would seem to contradict the consensus among modern biologists.
The barriers (and what you presume make a disabled life less desirable) that exist are imposed by social discrepancies and bigotry.
Bigotry and social discrepancies are only part of the story. Certainly they cause a large amount of the problem. But even if you were to eliminate bigotry and social discrepancies you'd still be faced with some amount of "non-accommodation" due to resource limitations.
You know, of course, that to suggest that it’s best to pre-select white over black, or to “correct” black to white if a “defect” slips through, is offensive. And you of course understand why it’s offensive. And once the insult is made, falling back on technicalities (like “25 weeks”) means little to the group you have essentially placed on a lower rung of a perceived societal hierarchy. There is very little redemption to “I wouldn’t wanna be like you”.
I think this is the section of her post which prompted me to write at length; she's setting up a straw man by way of an invalid comparison. So I'll go ahead and play her game. No, Ms. Acevedo, I don't know that selecting white over black is offensive; you've stripped out all of the surrounding context. So let me do everyone a favor by performing a "context restoration": "Abled vs. disabled": This is a choice, made by a woman, of whether or not to implant a particular egg. The genetic status of the egg is material to the decision for reasons outlined above. "Black vs. white": The phrasing of this choice makes it sound like it is being imposed by an external authority, especially the bit about "correcting" a "defect". Its also an extremely improbable situation; how do the sperm and eggs from a single mother and father have the ability to create both "black" and "white" children? At best you could have mixed-race children, and the decision might come down to "whiter-looking vs. blacker-looking". Lastly, "whiteness" vs. "blackness" doesn't suffer from the same limitations as "ability vs. disability"; there is no theoretical limit to the number of black (or white) people that society can accommodate, and so consequently no reason to ultimately prefer one over the other. So here, then, is why the "abled vs. disabled"/"black vs. white" comparison is inappropriate. The comparison fails on the following 3 counts:
  1. Locus of control: The "abled vs. disabled" question presents a woman deciding whether or not to implant an egg; the locus of control is internal. The "black vs. white" question seems to posit enforced selection by an outside agency, in which case the locus of control is external.
  2. Mootness/applicability: "abled vs. disabled" is a choice which is currently faced by women undergoing screening. "Black vs. white" is not a choice which is currently faced by women undergoing screening; the closest approximation is "whiter vs. blacker".
  3. Material effect: "abled vs. disabled" has a material bearing on the question, as described above. "White vs. black" does not have a material bearing.
As far as taking offense goes, I'm now going to accuse Ms. Acevedo of being "nebulous". "Offense" is a poorly defined term that is bandied about to cut off discussion of a subject or defend an indefensible idea, and often boils down to "I don't like it". What, exactly, is there to be offended about? I argued extensively that deciding not to implant an egg with a defect does not automatically imply a devaluation of existing disabled persons. Hell, I even got Ampersand to agree to that. The fact that Ms. Acevedo does not agree with the practice of pre-implantation screening does not give her carte blanche to claim offense. Now, our respective summations:
That was my original point; I never really cared about the scientific nuances involved. I just discovered this discussion was carrying on without li’l ol’ me, and thought I’d best say something. Thanks to all who addressed the nuances, though. I’m crawling with Supertramp songs.
Ms. Acevedo is taking the position that the decision not to implant an egg with genetic abnormalities is never OK. In doing so she creates a class of embryos which must be carried to term, which has implications for womens' reproductive choice. Specifically, it holds that society (or some segment thereof) has a legitimate interest in compelling a women to have children in order to meet social goals. This position undermines the concept of reproductive freedom for women.

Tuesday, September 12, 2006

If You Weren't A Moron You'd Realize That You Just Answered Your Own Question

Bret Stephens has a horrendous column (subscription required) on the editorial page of today's WSJ. Though I suppose that, from his myopic, blindered viewpoint it makes perfect sense. Bret, let me let you in on a little secret. Islam isn't out to get anyone; its people who are out to get us. Particular people, with particular agendas and particular theologies, who cannot be said to represent Islam as a whole. The reason that liberals find it difficult to confront Islam because we understand this fact. Muslims have a right to exist and practice their preferred religion in peace. The fact that some individuals who wish us ill operate under the guise of Islamic theology doesn't give us carte blanche to suppress Islam in general. Though I suppose that, if you refuse to acknowledge the distinction between one Muslim and another, your article makes perfect sense. Otherwise you are faced with the daunting task of selectively fighting particular individuals and ideologies while simultaneously defending the rights of individuals and ideologies which look superficially similar. That, in a nutshell, is why liberals don't want to just charge in and nuke the entire Middle East back to the stone age.

Sunday, September 10, 2006

Danger!, Will Robinson, Danger!

As long as I'm on the subject of airport security... another random thing that I noticed while in the airport today; airports are still at "Orange" status. Are they just going to stay at Orange indefinitely (along w/ the bloody inane ban on liquids) or are they eventually going to come back down to Yellow? Remember, they caught the guys in Britain; that means that we're safer that we were prior to the announcement that some people were going to try to blow shit up with Pepsi bombs. They were under surveillance for a frickin' year... it hardly merited raising the alert level to begin with, and it certainly doesn't merit keeping it elevated. No matter how I slice it airport security (and the whole alert rainbow in general) looks like some kind of Kabuki. It has nothing to do with actual security and everything to do with making it look like someone is doing something about security. That's a deeply cynical view to take, but any other interpretation requires you to take the facts our to the woodshed and give them a good cornholing before they'll line up.

Looking For A Rationale: Expedited Security Screening Of Premium Passengers

As y'all may or may not be aware of, some airports offer special screening lines for passengers which the resident airlines have designated as "premium". The problem with this practice is that there doesn't appear to be any supporting rationale. And before y'all go complaining that I'm just jealous I'll point out that I've medallions on a couple of airlines, so I frequently have the opportunity to use such lines myself. I fully support the right of airlines to have frequent flyer programs, provide expedited check-in, etc. etc. etc. Those are all legitimate marketing tools related to services provided by the airlines themselves. But security screening isn't an airline function; its a security process imposed by the Federal government. So the question, then, is whether expediting security screening for premium passengers somehow furthers the cause of air travel security? That's a no-brainer; the order in which a passenger is screened has exactly 0 bearing on the efficacy of the screening process. You can argue that these special security lines have less traffic and, as such, screeners are more likely to do a thorough screen of each passenger. That may be the case (or maybe not, see below), but in order to make such an argument you must also argue that premium passengers are somehow more suspect, as a whole, than the general passenger population and thus merit special screening. Otherwise you could open up the special security lines to all passengers, thus reducing load on the standard lines and increasing the quality of their screening process. I'd argue the opposite, that premium passengers (at least those that get their status through frequent travel rather than just purchasing a first class ticket) are less of a security risk, since their frequent travel makes them much more of a "known quantity" than a random holiday traveler. But that raises an interesting question, what about people who get premium status through the purchase of a first class ticket? Could this mechanism actually be used to subvert overall security? I think there's a plausible argument that it could. Providing separate screening for premium passengers sends a subtle signal that these passengers merit special consideration. In the context of security this means that screeners are more likely to give them the "kid gloves" treatment; I'll bet you a buck that screeners are less likely to give passengers in the premium line a hard time in comparison to passengers in the cattle chute. Admittedly this is speculation, but its testable speculation and seems to dovetail with the facts on the ground, so let's let it slide for the time being. Assuming, then, that passengers in the premium screening line are less likely to receive a thorough screening, could this be exploited? Yes; as noted above you can buy your way into expedited screening for the price of a first class ticket. The terrorists, as Our Fearless Monkey is fond of telling us ad infinitum, are really resourceful; surely they can swing the cost of a first-class ticket? Oh shit, I shouldn't have just said that! NOW THEY KNOW HOW THEY CAN PWN US!!!1!!11!!!! On the balance the arguments against separate screening lines for first-class passengers outweigh the arguments in favor. This is sort of a "Well, duh" situation; I don't think that anyone argues that premium passengers are being selected for expedited screening to increase security. The TSA permits special lines to grease their relations with airports and airlines. Which probably makes the lives of TSA administrators easier, but doesn't contribute to the cause of security. The TSA has a monopoly on screening; its not like airlines have any choice but to go along. Again, if you're going to seriously propose that the whole airport security thing is anything other than a dumbshow then you need be a totalitarian about it. Everyone needs to get the anal-probing; there can't be ways to game the system. What I do support, however, are things along the lines of Registered Traveler. A person who has submitted to a background check has lowered their risk profile; they require a lesser level of screening than a random traveler. I'm going to sign up for it as soon as it comes to my home airport; the government already has all that crap on me anyway on account of my security clearance, so why not save myself some additional hassle?

More Fear-Mongering

Watching CNN right now and Wolf Blitzer is going on and on and on and on with his guests about whether people should worry about flying tomorrow because its the 5th anniversary of 9/11. His guests (to their credit) keep saying "no"; one of them sensibly points out that air travel is safer that getting into your car. And still Wolf keeps asking "Is there going to be an Al-Qaeda attack?". I want to grab him and shake him vigorously and yell "Asked and answered, move on already".

Wednesday, September 06, 2006

From The Files Of The "Biology Is Not Destiny" Department

Harry at Crooked Timber links to a paper by David Velleman arguing against having children via anonymous donors. His basic thesis seems to boil down to the following:
Much as we love disadvantaged children, we rightly believe that people should not deliberately create children who they already know will be disadvantaged. In my view, people who create children by donor conception already know -- or already should know -- that their children will be disadvantaged by the lack of a basic good on which most people rely in their pursuit of self-knowledge and identity formation. In coming to know and define themselves, most people rely on their acquaintance with people who are like them by virtue of being their biological relatives.
Firstly, though this is not the primary source of my objection to the argument, recent debate here has demonstrated that not everyone accepts as self-evident the proposition "that people should not deliberately create children who they already know will be disadvantaged". My concern is with the assertion that children will necessarily be put at a disadvantage by not knowing their biological relatives. David is correct in asserting that most people rely on their biological relatives in forming their self-identity. I maintain, however, that biology has relatively little to do with this process; it is simply the pre-text that brings a group of people together in a permanent community. Once the people are brought together biology doesn't matter all that much. Consider, if you will, the situation of an adopted child. Further assume, as sometimes occurs, that this child is not aware that they are adopted. They have a family unit which helps them construct their personal narrative and identity in the same fashion as a child who is surrounded by their biological family. If the child doesn't know that they are adopted then this process would, in fact, appear to be identical to that of a child who is biologically related to their family. This, in turn, would seem to demonstrate that having a biological relation to the people who make up your family is not a necessary component for normal psychological development. Now consider that same adopted child, all grown up, who suddenly finds out that they are adopted. A natural reaction may be to seek out their biological parents. But why, I ask you, does this reaction occur? The adopted child has already constructed their personal narrative. The biological parents, having had no contact with the child, were not a part of the process of identity formation. The child's personal identity is in no way informed by the their parents. Again I'll ask why is it so important that they get to know their biological parents? From where I'm sitting it looks to be a self-fulfilling prophecy. We live in a society which places inordinate value on biological relations, even when those relations have, at most, a tenuous influence on identity and personal development. It becomes important for the adoptee to find their biological roots not for any rational reason, but because they've been told that its important. The feeling of loss at not knowing your biological parents is socially conditioned rather than the result of some inherent deficit. Consider now the child who knows from their earliest years that they are adopted. Assume also, if you will, that the child has been brought up to believe that personal bonds are far more important that mere biology. How will this child grow up? Will they be at a deficit, as David argues, or will they construct their personal identity based on their adoptive family in much the same way as an ordinary child? Restated briefly, my fundamental objection to David's argument is that biological ties are only important because we deem them so. The thought experiment featuring the adopted child who is unaware of their condition demonstrates as much. What really affects a child's self-image and personal narrative is the family grouping, something which has an existence independent of biological relation.

Monday, September 04, 2006

Can Individuals Be Compelled To Take Preventive Medical Treatment?

My wife posed an interesting medical conundrum to me this evening: what is the appropriate response to a patient who is unwilling to take care of their chronic condition? It may not be immediately apparent what I mean by this, so let me elaborate. My wife, in her position as an ED physician, regularly treats patients with chronic conditions. Most of these patients arrive in the ER through no fault of their own, and do not make subsequent return visits. However, there is a small (but meaningful, in terms of time and resources to treat) subset of these individuals who return to the ER time and again because, it seems, they can't be bothered to undertake the appropriate preventive treatment. For example, my wife regularly sees several individuals who have diabetes-induced kidney failure but don't get dialysis when they are supposed to, requiring another trip to the ED. So that is the situation, what is the appropriate response? It seems that there are three choices in terms of response:
  • Status quo
  • Deny continuing medical treatment
  • Compelled treatment
I'll now go over each of these in more detail. Status Quo In this case we continue to treat the patient when they arrive in the ED subsequent to failing their regimen of preventive care. The main reason that this approach is suboptimal is that it requires the unnecessary expenditure of medical resources. It is a lot more efficient, resource-wise, to provide preventive care than to provide emergency care. If we accept that healthcare is a limited resource then there seems to be a burden (be it moral or economic) to ensure that it is used efficiently, in which case the status quo needs to be changed. To compound the matter further many of the individuals who require such care are medically indigent, being on one form or another of government insurance (usually Medicaid). So not only is there the problem of the inefficient use of medical resources, but there's also the issue that other people are footing the bill for their neglect. So how do we proceed from here? Deny Continuing Treatment If we decide that the status quo needs to change, one approach is to deny continuing medical treatment to these individuals. This would resolve the issue, but its not clear whether such an action is morally defensible. To ascertain if it is we need to answer two questions:
  1. Is there a moral obligation to provide treatment?
  2. If there is an obligation, what are its boundaries?
The consensus regarding Question 1 seems to be "yes"; I'll assume this to be so since arguments to the contrary exceed the scope of this particular post. But the boundaries question is fair game, so let's take a look at that. Why do we provide treatment? There are many ways to phrase the answer, but they all boil down to "its the humane thing to do". If a person abuses the system, or fails to be an active participant in their treatment, does this lessen our obligation? I would think not, since it doesn't challenge the underlying rational for treatment in any way. "But wait", you say, "can't a person decline treatment?". Most certainly, but the person doing the declining needs to be making such a decision in a rational manner. In the cases which I've discussed above there doesn't seem to be a well thought out decision to decline treatment for their illness; the fact that the patient continues to return to the ED indicates that treatment is desired. So it would seem that we can't deny treatment to these problem individuals either. Which brings us to the third alternative. Compelled Treatment If the status quo is unsatisfactory, and we decide that we cannot deny treatment, what options remain to us? The patient must be wheedled, cajoled, enticed, and ultimately compelled to engage in an appropriate regimen of care. This seems like a blow to patient autonomy, but consider the following question: Can a patient who prefers multiple trips to the ER over preventive care be said to be behaving rationally? I would argue that they are not; what end is served by such behavior? If they are not behaving rationally, not capable of making reasoned judgments about their medical care, then isn't there ample precedent for overriding their judgement and compelling care? But there's a complication with such an approach when you apply it to persons with chronic conditions. In that case you're not talking about compelling them to accept medical treatment for the duration of their stay in a hospital setting. Rather, you have to make sure that they are getting appropriate treatment for the rest of their natural lives. How does one do that, other than forcibly committing people to some sort of government-run treatment facility? That's a sticky question, yes? Anyone have any ideas?
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