All posts by Mike Schadone

Academia, Clinical, Emergency Medical Services, Health Care

Relationships Among Health Services Organizations

 As a critical care paramedic, I am fortunate enough to experience our health care system as an active participant, caring for the sick and injured, and as a passive observer, following the pathways of the patients whom I have treated. The health care system in the United States is, admittedly, fractured (Kovner & Knickman, 2008), but there are components that serve to create harmony and efficiency within this system, and I will describe just a few of them.

The primary care physician is meant to be the coordinator of all care for his or her patients. The importance of this role cannot be overstated, as it is the keystone to “health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses” (American Academy of Family Physicians, 2010, para. 7). When appropriately utilized, the primary care physician can coordinate a patient’s care to ensure efficiency and efficacy of treatment while ensuring safe and comprehensive care (Kovner et al., 2008).

There is a growing number of specialties and sub-specialties within the practice of medicine today (Bureau of Labor Statistics, 2010b). Specialists focus on their chosen area of practice and are an asset to the general practitioner, or primary care physician, who can concentrate on the coordination of the patient’s care. The inclusion of specialists in medicine is an efficient and effective means of offering the patient a level of expertise not otherwise available. One of these specialties is emergency medicine.

Emergency departments are necessary entry points into the health care system for victims of acute trauma and illness, but often times, the emergency department is used as the primary portal for those who lack insurance or other means of accessing health care appropriately (Committee on the Future of Emergency Care, 2006; Kovner et al., 2008). These patients tend to utilize the emergency room for even minor ailments, distressing this important component of the system, causing a “nationwide epidemic of [emergency department] overcrowding, boarding, and ambulance diversion” (Committee on the Future of Emergency Care, 2006, p. 19).

Laboratories and radiology departments are great assets to providers, allowing technicians to perform tests at the behest of the physicians and only requiring the physician to interpret the results of the tests. This seems to be a cost-effective and efficient component of the system, so long as the tests are performed timely and accurately.

Pharmacists have been regarded as patient-focused consultants who can provide both patient-specific and general information regarding over-the-counter medications as well as prescription medications. In our health care system, pharmacists have a valuable role of safeguarding patients from over-medication, as well as under-medication, medication compatibility, and also educating patients to the possible side-effects of their prescribed medicines (Bureau of Labor Statistics, 2010a).

In conclusion, the safest and most efficient use of our health care system begins at primary care. Though, in emergency situations, there is certainly a need to seek immediate care by other means, patients can suffer financial challenges as well as safety issues by trying to remove the primary care physician from the health care paradigm. Not only is this unsafe for the patient seeking primary care elsewhere, but misuse of emergency departments cause unnecessary delays for truly emergent patients. The health care system in the United States is vast and can be confusing. The primary care physician can provide a safe and efficient pathway of care that will save a patient time, money, and, possibly, his or her life.

References

American Academy of Family Physicians. (2010). AAFP policy on primary care. Retrieved May 1, 2010, from http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html

Bureau of Labor Statistics, U. S. Department of Labor. (2010a). Pharmacists. Occupational outlook handbook (2010-11 ed.). Retrieved from http://www.bls.gov/oco/ocos079.htm

Bureau of Labor Statistics, U. S. Department of Labor. (2010b). Physicians and surgeons. Occupational outlook handbook (2010-11 ed.). Retrieved from http://www.bls.gov/oco/ ocos074.htm

Committee on the Future of Emergency Care in the United States Health System. (2006). Hospital-based emergency care : At the breaking point. Washington, DC: National Academies Press.

Kovner, A. R., & Knickman, J. R. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Academia, Culture, Emergency Medical Services, Health Care, Politics, Public Health, Society

Health Care Costs, Quality, and Access

It is the general consensus that the structure and organization of the U.S. health care system is fractured and disorderly. For many health care consumers, especially those who rely on governmental health assistance, there is no motivation to seek appropriate care responsibly. Many of these consumers rely on the local hospital’s emergency department and municipal emergency services for their primary medical needs. The Committee on the Future of Emergency Care in the United States Health System (2006) states “[Emergency Departments] are an impressive public health success story in terms of access to care” (p. xiv), and continues to describe how the emergency departments have “become the ‘safety net of the safety net’, providing primary care services to millions of Americans who are uninsured or otherwise lack access to other community services” (p. xv). With health care comprising one sixth of the nation’s economy, doubling in the last 30 years, the focus should be to create a model of efficient and effective delivery of care so that we, as a nation, may be able to care for our sick and injured without becoming bankrupt (Kovner, Knickman, & Jonas, 2008; Mushkin et al., 1978).

As emergency medical services are considered as the health care gateway for many, allowing the emergency medical services to refer patients into appropriate pathways (e.g. primary care providers, urgent care clinics, psychiatric services) for their conditions would allow for more directed care for the patient with shorter wait times and shorter care times overall. Unfortunately, insurance providers, including Medicare and Medicaid, do not allow remuneration for such services, requiring the transportation component to trigger payment; therefore, the only option left is to transport these patients to the emergency departments. This promotes the inefficient use of such services and continues the current paradigm of inefficiency throughout the system. Though this change would increase insurance payments to emergency medical providers, increasing the initial cost of seeking health care, this would allow the provision of selecting more efficient pathways leading to more cost-effective care. Hopefully, this paradigm would result in an overall net savings.

This is only one example of modifying a current system to be more effective and help to promote efficiency throughout the health care experience. We need to consider where we can shift roles and responsibilities within the health care system in order to promote a more usable system, one that promotes integrity, efficiency, responsibility, and efficacy by both providers and consumers. Once we realize the opportunities that efficient use of current services will offer, we can realign the services to better fulfill the needs of the population where it comes to health and wellness.

References

Committee on the Future of Emergency Care in the United States Health System. (2006). Emergency medical services: At the crossroads. Washington, DC: National Academies Press. Retrieved from http://www.nationalacademies.org/nas/

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Mushkin, S., Smelker, M., Wyss, D., Vehorn, C. L., Wagner, D. P., Berk, A., … Louria, M. (1978, October). Cost of disease and illness in the United States in the year 2000. Public Health Reports, 93(5), 493–588. Retrieved from http://www.ncbi.nlm.nih.gov/

Academia, Emergency Medical Services, Health Care, Politics, Public Health, Society

Reducing our Health Care Expenditures

With the recent signing into law of the Patient Protection and Affordable Care Act (2010), more affectionately known as ‘Obama Care’, much of the health care discussion has turned from deciding what we should do to how we should do it. Many us acknowledge that the current state of our health care needs reformation; the only problem seems to be choosing the best approach. As a licensed out-of-hospital provider, I am in a unique position to observe patients entering our health care system, being treated by our health care system, and exiting (for good or bad) our health care system. I can see that our health care needs are not being met, and I can see both how patients approach their care and how practitioners approach their patients — inefficiently and ineffectively. We need to resolve these issues.

Canada is a fairly close approximation to the United States in locale, geography, economy, and political ideology (Doran, ca. 2000; “GNI per capita”, 2010). It might make sense for us to look towards Canada to see if they have adopted a plan that we could either emulate, or, in the very least, research for a sense of best practices. Kovner, Knickman, and Jonas (2008) describe Canada as having a national health insurance (NHI) system of health care, in that the system is provisioned by a mix of both public and private contributions. Two benefits of Canada’s health care system include a high life expectancy (77.4 for males at birth) and a low cost ($3,165 per capita, or 9.9% of GDP; Kovner et al., 2008, Table 6.2, p. 165). In comparison, Kovner et al. shows that the life expectancy for males in the United States is 74.8 under a system that costs $6,102 per capita (or, 15.3% of GDP). These numbers are significant because we need to understand what we can expect from our investments, and I feel that the average life expectancy is a great benchmark of a health care system as a whole. One worry that I would have, though, is if we were to adopt the same pharmaceutical cost controls, research and development in the industry may suffer, as well as any other technology burdened by cost-cutting measures. I have to assume that the free market would effectively drive these areas, however.

In order to adopt such sweeping changes of our health care system, both liberals and conservatives would have to negotiate their ideals. I am a fairly conservative citizen who believes in smaller government and spending constraints. If reducing our health care expenditures by realigning the modes and methods of health care delivery was realistic, I could be in favor of such a reform. Political agendas aside, Canada’s health care system is certainly one that we should further consider.

References

Doran, H. (ca. 2000). Politics and political parties in Canada. Internet sources for journalists and broadcasters. Retrieved on April 22, 2010, from http://www.synapse.net/radio/can-pol.htm

“GNI per capita, Atlas method (current US$)”. (2010). Data catalog. The World Bank Group. Retrieved on April 22, 2010, from http://data.worldbank.org/indicator/NY.GNP.PCAP.CD

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Patient Protection and Affordable Care Act of 2010, H.R. 3590, 111th Cong. (2010).

Academia, Society

My Ethical Reckoning and Edification

In my study of ethics, I have had some difficulty understanding the application of theories in light of the arguments from competing camps. I am finding it more reasonable to define my own value system, then compare this with the virtues of others. Only then can I truly appreciate the applicability of the ethical theories presented to me.

The most problematic theory is the divine command theory. In Thiroux and Krasemann (2009), divine command theory is told to be a nonconsequentialist theory derived from a set of edicts put forth by some absolute ruler of the universe (p. 54). First, I oppose their categorization. As most religions have some villainous being to rule over an underworld filled with those who violate these edicts, it seems to me that the threat of eternal damnation is certainly a valid consequence for believers of these religions. In contrast to negative consequences for bad acts, the same religions tell of eternal bliss for following its rules, positive consequences for good acts. More to the point, as Thiroux and Krasemann (2009) so aptly point out, there is no rational foundation for the existence of such a being (p. 57). I agree with this view, as it is illogical to base morality in such a weak argument.

Kant’s duty ethics appear to have more validity. Kant recognizes that we have a duty to act morally (Thiroux & Krasemann, 2009, p. 59). Unfortunately, Kant does not go further to explain how this duty has manifested. Thiroux and Krasemann attempt to explain Kant’s theory as nonconsequentialist based on absolute moral rules relying on poor logic such as the example provided, “all triangles are three-sided” (p. 57). It does not take a mathematician to understand that all triangles are three-sided purely by definition and not by reason or logic. Therefore, any absolute moral rule must be absolute by definition, and it must have a reason in order to be reasoned as such. It is these reasons, such as the continuum or failure of society, that would make this theory a consequentialist theory, and all of the duties of this theory are based solely on the vitality of society. Ergo, it would only be moral to work for society, and it would be immoral to work against it. This would be valid if there was truth in that any particular society should flourish over another. Nazi Germany comes immediately to mind.

With his prima facie duties, Ross, on the other hand, admits to consequences having bearing on choices, but he cautions that their import should be minimized when considering right and wrong (Thiroux & Krasemann, 2009, p. 62). Like Kant, Ross gives no thought to the origins of his duties, though those that he did enumerate seem to provide for the good of the individual and for society. I can certainly appreciate better the motifs of Kant and Ross over the weak foundations of divine command theory.

To more fully understand my ethics, I had to look past my mundane habits and take a truly in-depth look at the origins of my beliefs, then I had to question the motivation for each. For one, I ultimately believe that killing another human being is wrong, but do I find it unethical, and if so, to what degree. Is the taking of a human life ever ethical? Further, in order to understand my own ethics, I feel that I must analyze the basic motivations of our instincts and how we have evolved from primitive organisms into the social creatures that we are. It is this social bonding, after all, that creates this sense of morality that I am questioning.

It is understood that at some point in our development as a species, we appreciated that we were more effective as a group than as individuals competing against each other. In order to live together, we must have realized the need to develop rules and boundaries as they relate to our interactions within this social group. I believe that these rules were based on our primal needs and were focused on the benefits of banding together. For example, I mentioned killing in the last paragraph. As an early social group, we would benefit from safety in numbers over individually facing predation. If this is a benefit of social grouping, then why would this type of open competition be favored within the group? It would not. Another example would be the primal need for food versus the act of stealing. The social group would condemn stealing another’s food, thus stealing, itself, becomes taboo. This, I believe, is the reason that we have morality, and we have gotten so far from this basic understanding of morality that our own personal ethics have become confused and complicated. All of the basic moral understandings that are common in many cultures can be traced back to the first pre-societies: dishonesty, gluttony, murder, sloth, theft, and later, apathy, despondency, greed, lust, pride, and vanity.

To me, it is permissible to take a human life. It is permissible to take the life of an innocent person. One example that epitomizes this position is in the face of a torturous death. The ability to, on request, peacefully end the life of someone facing death by torture is virtuous to me. Another example would be my belief in the usefulness of euthanasia. Are these examples of murder? I think not; murder involves malice, and there is no malice in these examples. With this thought, one can still hold that all murder is unethical while killing an innocent person.

As our social system evolved, so have our needs. We are no longer few in number with common basic needs, but we are many, within many societies, and with many different needs. Though, we are still human. From our origins, as I have described, we have created our rules, a common morality that should hold true in any society, except the most exotic. Within our newly formed societies, we have prescribed rules which have evolved with our societies and have grown as societies have grown and split into other societies. Cultures within societies will augment the rules, as will the various sub-cultures. Each and every amalgam, still, has evolved from a more singular set of basic rules.

These rules must be relative to the needs of the members in order to be effective, creating a more relativist morality.

The rules of life have changed. As an American, I no longer value food, water, and shelter as much as I value my freedom and liberty. How can that be? At some point in the past, food, water, and shelter were abundant, yet people were probably prohibited or limited. Our ancestors fought hard to regain their freedom, and this appreciation of liberty has been passed down in such a way that I value it more than life, itself. This, too, is an evolution of morality. This is the point that my ethics cease to remain basic and evolve with the functionality of my society, where necessity triumphs over morality.

My understanding of morality is more or less bound to social contract theory in that, as a society, we have a better quality of life. Each decision that we make ought to reflect our willingness to participate wholly within society, lest be made pariahs. Within society and personal and business relationships, we engage in interactions that involve decision-making. It is these decisions that we consider when discussing ethics and morality. Within societies, there is competition. Competition within a society is a part of nature, part of evolution, and a healthy device to ensure survival. There are also rules within this competition. Unfortunately, our society has reversed many of these rules. As we have become more ‘civilized’, we have sought to provide a common mechanism to adjudicate morality, and in turn, project our personal ethics upon others. This is an aberration of justice, yet it is accepted as part of the process. The bane of society is regulating morality in such a way that is inconsistent with truth and integrity. We have certainly fallen far from our moral high-grounds in search of a harmonious existence.

It appears that I am getting an ‘ought’ from an ‘is’. This is correct. I feel that in order to fully understand how we ought to act, I need to know why we act as we do. There must be valid reasons. It is the same reasons that we must listen to intuition. Many early philosophers have regarded our ability to reason as the one trait that separates us from all other life on Earth. This reasoning is responsible for intuition, for gut-feeling, and it should not be ignored. If we feel that something is wrong, it is most likely wrong. We do not need to understand why it is wrong for it to be wrong, but we should accept that it is probably wrong and seek out the answer why. For someone to claim that they are a consequentialist, then examine the consequences of an act to determine if it is right or wrong is ludicrous to me. It is this cart before the horse thinking that has confused me in the classroom study of ethics. We must have faith in our ability to reason and that we have probably been faced with a similar scenario at some point in the past. Intuition will tell us so.

I cannot say that I align with any one of the three theories presented. At the same time, I can both appreciate some of the positions of each and can align with some of the arguments while I find portions of each incompatible with my views and beliefs. Every decision that we make has two alternatives to choose from, action and inaction. Though decisions can seem to be complex, they are various combinations of criteria in steps of action-inaction decision modeling. For each step, we determine the value of each decision and the higher valued path is the one chosen. Unfortunately, not many people have refined critical thinking skills to allow them to consider important possibilities that might otherwise be overlooked. The resultant anemic decision-tree usually offers little in the way of true value. For this reason, it is important to challenge one’s self frequently in the practice of making difficult decisions.

In summary, morality is based on both the individuals’ needs within a society and the continuity of the society, and there are consequences that need to be considered for each decision, some great and some insignificant. Also, a person does not have to subscribe to any particular theory in order to be moral. Any one person can feel that it is their duty to perform an act while believing in the hedonistic value of performing another act, still, while considering their benefit of performing another act. There can be no hard-line rule that encompasses how we ought to act in all possible circumstances. It is my view that we should pay more attention to descriptive theories than prescriptive theories. We are smart enough to have evolved, and we should take comfort in that.

References

Thiroux, J. P., & Krasemann, K. W. (2009). Ethics: Theory and practice (Tenth ed.). Upper Saddle River, NJ: Prentice Hall.

Academia, Society

Absolutism Versus Relativism

“Explain the need for finding a medium between absolutism and relativism for today’s global society, and then explaining the possibility of finding such a medium and achieving it.”

Asking me a question about absolutism relating to relativism is akin to asking an atheist to relate Catholicism to Judaism. First, I do not believe that there is any higher moral code than man’s. Second, I believe that morality is merely the mean, within a society, of the ethical beliefs of the whole of the membership. Each person, then, forms their own personal moral code by examining the interactions within their society. I feel that this is more of a political notion than an ethical one. This leads me down the path of nihilism where the only moral code is a personal willingness to accept (or, accept to change) societal values, these values having no transcendence beyond our own lives.

Absolutism, as Thiroux and Krasemann (2009) explain it, is a belief that there are moral truths which transcend human life (p. 89). Relativism describes a belief system that is particular to a certain society, and though each belief may transcend the society, it is not necessarily so (p. 90). It appears that absolutism is flat in geometrical terms while relativity is three dimensional, and just as you can place a circle within a sphere but not the inverse, I believe that absolutism can exist within the confines of a greater relativism. It does not seem, however, that relativism can exist within an absolutist system of morals.

Coexisting moral codes can certainly conflict if two competing beliefs are thought to be absolute. However, I believe that many of the competing moral codes do not have to be unwavering. The members of the various societies of this world can certainly choose to interact or not interact with members of other societies in such ways that would allow their beliefs to compete. This is seen within the debates of religion versus science. Though the can coexist, they are not comparable in terms of values and, therefore, should not be compared. Unfortunately, when one chooses to live within a society, one chooses to abide by the governance of its moral code or should make attempts to change it.

References

Thiroux, J. P., & Krasemann, K. W. (2009). Ethics: Theory and practice (Tenth ed.). Upper Saddle River, NJ: Prentice Hall.

Academia, Society

“Preventive Medicine”

Passing judgment without the ability to review the context troubles me. Judging an act without seeing the evidence makes no basis for academic discussion regarding the motives or outcome. This exercise will have us judge the actions of a fictional surgeon, whose situations are probably based on facts, during the Korean conflict. Being that this surgeon is a character in a widely available syndicated television show, it surprises me that the particular episode is not available for review. I have taken the time to track down the episode and review it before making comment.

The text (Thiroux & Krasemann, 2009) does state that utilitarians believe that “everyone should perform that act or follow that moral rule that will bring about the greatest good (or happiness) for everyone concerned” (p. 42); however, this description fails to identify the scope and practice of such notions. Whom does this act or rule concern? When does this act or rule gain application? At what point does the actor have enough evidence to make the judgement?

With regards to the M*A*S*H episode[1] (Metcalfe, Reeder, & Mordente, 1979), who is to say that the actions of Col. Lacey did not ultimately save more lives through the heroism of those that he led? Was Lt. Col. Lacey on the verge of improving the tactics of the U. S. Army? Did the unnecessary surgery of Lt. Col. Lacey cost even more lives, then? Lt. Col. Lacey addresses his injured troops, “Your performance over the last few days has given me the confidence to submit a plan to ICOR, a plan for our BN to spearhead a counter-offensive up hill 403, and this time, men, we are going to take it.” This seems to suggest that Lt. Col. Lacey has developed and refined a tactical plan that he feels will prove successful.

In the next sequence, Capt. Pierce questions Col. Lacey’s motives but fails to allow him to answer, putting words in his mouth, and ascribing his own thoughts to Col. Lacey’s motives. After overhearing the Colonel speaking with his General, Capt. Pierce formulates his plan of removing, at least temporarily, Lt. Col. Lacey from his command, and after the successful harvest of a healthy appendix, more injured troops arrive at the 4077. Capt. Honeycut sums up his partner’s actions very simply, “You treated a symptom; the disease goes merrily on.”

After watching the episode and paying special attention to the premise, it seems, at least to me, that this episode deals more with the psychology of Capt. Pierce than with his ethics. It is the psychology of the situation that forces Pierce to act on the situation, in hopes that what he does has an overall positive effect. It does not. Separating ethics from psychology is a mistake, in my opinion. Our psychology changes our perspective and, therefore, should be considered when ethical questions arise.

Utilitarian? The motives of Capt. Pierce were of a self-interested nature. He wanted to feel that he did something instead of standing idle. In my opinion, Capt. Pierce did not have the requisite knowledge to make the utilitarian judgment. I would have done as Col. Potter did in this episode. He notified the upper command of his concerns so that they may be evaluated by people in the position to make a substantive evaluation of a battalion commander.

References

Metcalfe, B. [Producer], Reeder, T. [Writer], & Mordente, T. [Director]. (1979, February 19). “Preventive Medicine” [Television episode]. M*A*S*H. Los Angeles, CA: 20th Century Fox.

Thiroux, J. P., & Krasemann, K. W. (2009). Ethics: Theory and practice (10th ed.). Upper Saddle River, NJ: Prentice Hall.

Footnotes:

1. “Preventive Medicine” was the 22nd episode of the seventh season of M*A*S*H.

Academia, Society

Society’s New Morality?!

The question this week revolves around a notion that society is becoming more ethical. Given weak evidence of this (Strom, 2003) which documents a single person who, for some unstated reason, is giving away his fortune and would like to give away his sole kidney, I can only think of the recent banking and insurance industries foray into subprime lending, the response to that by cities and towns by artificially inflating home values for increases in tax revenue, and people attempting to remove Haitian children from their country under the pretense of humanitarian aid, whether legitimate or not (Hojnacki & Shick, 2008; Tergesen, 2007; Cooney, 2010).

I guess we need to define the terms and the boundaries of the terms. Which society are we talking about? In India, children living in brothels are denied an education because their parents are considered criminals, thereby denying the rights of the children (Briski & Kauffman, 2004). Is this more ethical?

Since when? Which eras are we comparing? In the 1930’s and 40’s, Hitler’s Nazi regime perpetrated one of the most heinous genocides in history, except for China and Tibet in the 40’s, 50’s and 60’s, where Mao Ze-Dong killed off between 50 and 80 million people. Some more recent and notable genocides (as cited in Scaruffi, 2009):

1,700,000 dead, by Pol Pot in Cambodia, 1975-1979;
1,600,000 dead, by Kim Il Sung in North Korea, 1948-1994;
1,500,000 dead, by Menghistu in Ethiopia, 1975-1978;
1,000,000 dead, by Yakubu Gowon in Biafra, 1967-1970;
900,000 dead, by Leonid Brezhnev in Afghanistan, 1979-1982;
800,000 dead, by Jean Kambanda in Rwanda, 1994;
600,000 dead, by Saddam Hussein in Iran 1980-1990 and Kurdistan 1987-1988.

I believe that if there is a so-called ethical call-to-arms, it is merely a return to balance in the newscasting and reporting which is perceived as something it is not. Though, I would like a return to values, so to speak, but whose values should we value?

References

Briski, Z., & Kauffman, R. [Writers/directors]. (2004). Born into brothels: Calcutta’s red-light kids [Motion picture]. Los Angeles, CA: ThinkFilm.

Cooney, P. [Ed.]. (2010, January 30). Americans arrested taking children out of Haiti. Thomson Reuters. Retrieved from http://www.reuters.com/article/idUSTRE60T23I20100130

Hojnacki, J. E., & Shick, R. A. (2008, December). The subprime mortgage lending collapse – Should we have seen it coming? Journal of Business & Economics Research, 6(12), 25-36.

Scaruffi, P. (2009). 1900-2000: A century of genocides. Retrieved from http://www.scaruffi.com/politics/dictat.html

Strom, S. (2003, August 17). An organ donor’s generosity raises the question of how much is too much. The New York Times (New York ed.), pp. 117.

Tergesen, A. (2007, November 5). How to Reduce Your Property Taxes. BusinessWeek. Retrieved from http://www.businessweek.com/magazine/content/07_45/b4057079.htm

Academia, Society

Ancient Suffragette City-State

I am a little disconcerted after reading Solomon and Higgins’ (2010, Chapter 10) discussion of sexual inequality throughout the ages. Though they are quick to point out many patriarchal societies and how they negatively effect the carriage of any woman’s philosophy through time, they fail to recognize societies that recognize the female and hold her in as high esteem as her male counterpart. Citing Aristotle, they are quick to point out the male-centric society of ancient Greece, but fail to educate us on the Spartan woman.

According to the historian Richard Monk (2006), “Sparta had an entirely different view of gender. Essentially, it ignored it” (para. 5). He continues to describe the Hellenistic age, post-Peloponnesian War, where the women of Sparta were on equal footing with men. This was also true, in fact, of Athens at the same time, though it is neglected by most historical scholars (Scott, 2009, p. 34). The fourth century (B.C.E.) was certainly a turning point for women’s rights in Greece (Scott, 2009, p. 39).

Two other key societies worth mentioning are the Norse and the Iriqouis (Vivante, 1999, p. xv; Ward, n.d., para. 9).

My thoughts on the importance of women in sociopolitical philosophy are the same as my thoughts for men. I do not distinguish between them. Any person with a stake in a society should be able to choose whether to have their voice heard or not. Sometimes, a message not spoken has the weight, if not more, than one that is. Speaking of women, specifically, I feel that they should be afforded the opportunity to enjoy the same rights, roles, and responsibilities of any person within their society. Unfortunately, societies throughout history seemed to not share my view.

Many early female philosophers have been lost to time and suppression by the patriarchal societies that failed to notice their worth. One stands out: Hypatia. Unfortunately, where she found freedom to express her views in public, she also found a horrible death in public.

“Fables should be taught as fables, myths as myths, and miracles as  poetic fancies.  To teach superstitions as truths is a most terrible  thing.  The child mind accepts and believes them, and only through  great pain and perhaps tragedy can he be in after years relieved of them.  In fact men will fight for a superstition quite as quickly as for a living truth often more so, since a superstition is so intangible you cannot get at it to refute it, but truth is a point of view, and so is changeable.” – Hypatia

 References

Monk, R. (2006, April 19). Greek civilization – What about the women? Retrieved February 25, 2010, from http://ezinearticles.com/?Greek-­Civilization-­%96-­What-­About-­The-­Women?&id=181596

Scott, M. (2009, November). The rise of women in ancient Greece. History Today, 59(11), 34-40. Retrieved from Academic Search Complete.

Solomon, R.C., & Higgins, K.M. (2010). The big questions: A short introduction to philosophy (8th ed.). Belmont, CA: Wadsworth, Cenrage Learning.

Vivante, B. (Ed.). (1999). Women’s roles in ancient civilizations: A reference guide. Westport, CT: Greenwood Press.

Ward, C. (n.d.). Sigríð stórráða Tóstadóttir: Queen Sigríð the Proud. The Viking Answer Lady. Retrieved from http://www.vikinganswerlady.com/SigridStorrada.shtml

Academia, Society

The Social Contracts of Hobbes, Locke, and Rousseau

Social contract theory indicates that we acquiesce to the demands of a society in order to benefit from membership within that society (Chafee, 2009; Solomon & Higgins, 2010). Some of these demands allow the formation of a power structure to guide the formation and growth of the society, while other demands cause the individual to relent to the values stipulated by the society. These values make up the morality of the society. Social contract theory was influenced, particularly, by Hobbes, Locke, and Rousseau (Solomon & Higgins, 2010, p. 291). Their theories are telling of the individual’s motivation for creating and belonging to a society, but I will explore how these theories relate to some of the constructs of society, namely morality and the roles and responsibilities of citizens within a society.

Before discussing societal constructs, it might be best to consider the ultimate nature of society and the power it holds over its citizens. The arguments appear to be two-sided: a) social contract, and b) entitled sovereignty (Chafee, 2009, p. 567). I argue that society is truly a social contract and any authority within society stems directly from this contract. Considering that the alternative is a rule by force, fear, and intimidation, one can only conclude that such a society is passively agreed with until a revolution is possible, which undermines the overreaching authority and replaces it.

This conflict arises between the populace (society) and government (a construct of society). Where there is no society, there can be no government, but in every society, there is a government (even an anarchist society has a form of governance, natural law). Hence, government is a by-product of society, which, by definition, is solely reliant on the social agreements of individuals indicating an equality within the creation of the contract, but not necessarily the execution of the contract. This is ideal in that it not only explains why uprisings and revolts occur when governments fail to work for the people, but it also explains why they should occur in these cases.

Tyranny is the unilateral enforcement of values placed upon a society. Morality is the cumulative set of values of a society, and it adapts to the constant change in these societal values. Justice, the governmental means of regulating morality, must have the participation of the society, lest tyranny takes hold. It is the responsibility of the individuals within a society to participate in every process of government to ensure that morality is even and that justice prevails. This participation need not be direct. Voting, military service, holding public office, or simply criticizing governmental policy are all ways in which individuals can participate. Hobbes, Locke, and Rousseau would agree that enforcing the social contract is the responsibility of every individual within a society, not only to ensure the status quo, but to ensure positive growth and continuity.

As a libertarian, I can appreciate the social contract theories of Hobbes, Locke, and Rousseau. In my view, do what you will so long as you do not infringe on the rights of others. Though many aspects of this philosophy can be argued against, it remains as good as any starting point to maintain freedom and equality within a society while still demanding responsibility for the outcome.

References

Chafee, J. (2009). The philosopher’s way: Thinking critically about profound ideas (2nd ed.). Upper Saddle River, N.J.: Pearson Prentice Hall.

Solomon, R. C., & Higgins, K. M. (2010). The big questions: A short introduction to philosophy (8th ed.). Belmont, C.A.: Wadsworth, Cengage Learning.

Academia, Health Care, Public Health

Health Promotion: Workplace Health Screening

Cardiovascular disease (CVD), diabetes mellitus (DM), and colorectal cancer (CRC) are all significant health concerns facing us today (Anonymous, 2005; Bagai, Parsons, Malone, Fantino, Paszat, & Rabeneck, 2007; de Koning, 2009; Korhonen, Jaatinen, Aarnio, Kantola, & Saaresranta, 2008; Matthews, Nattinger, Venkatesan, & Shaker, 2007). In the U.S., CRC is estimated to kill 56,000 people per year, while, in the U.K., the numbers are around 16,000. (Anonymous, 2005). CVD is on the decline but is expected to continue to have a global impact, taking off the most years of life, and DM creates a 4-fold increase of dying from CVD (de Koenig, 2009).

Through efforts at targeting healthy lifestyle changes, the mortality of these diseases has decreased over the past few years, but the numbers remain high, and studies suggest that identifying those people with risk factors or early signs of disease helps to both treat for the disease effectively and decrease the overall incidence (Anonymous, 2005; Bagai et al., 2007; de Koning, 2009; Matthews et al., 2007).

As Bagai et al. (2007) point out, health promotion activities focused on screening are notably scarce within the workplace. Researchers, Hamashima and Yoshida, have shown that early detection of CRC is effective at decreasing overall morbidity (as cited in Bagai et al., 2009). Bagai et al. attempted to apply this reasoning within the confines of a typical Canadian work environment by introducing CRC screening to the men and women of the Toronto police force. With workplace screening programs being limited in Canada, Bagai et al. hoped to show the effectiveness of these screening programs, and they were successful, but unfortunately, the participation in the study was limited.

Another study (Matthews et al., 2007) aims at increasing CRC screening among the residents of the Midwestern States in the U.S. The literature seems to suggest that participation in screening procedures is contingent on education and insistence by the physician, specifically.

Not only does this correlate to the thought that the primary care physician has an important role in screening and detecting disease, but in order for workplace screening programs to be successful, the physicians need to make the recommendation that the patient uses the screening programs available to him or her.

Korhonen et al. (2008) used the waist circumference criteria (women: 88 cm; men: 102 cm) set forth by the American Heart Association and the National Heart, Lung, and Blood Institute to assess the effectiveness of at-home screening for CVD and DM risk by using a simple questionnaire and a tape measure. Taking very little time and requiring little expertise, this process could be incorporated with any workplace screening program to increase its efficacy.

Increasing these screening programs, particularly within the workplace, should target the population most at risk to CRC, CVD, and DM. Targeting specific risk groups to educate about these diseases should ultimately lead to a higher survivability, decreased incidence, and lower morbidity rates. More research should be aimed at studying the effects of more targeted workplace health screenings to understand how this tool could be best implemented to provide better screening for CVD, DM, CRC, and, perhaps, other pathological processes.

References

Anonymous. (2005). Colorectal cancer: Not an embarrassing problem. Lancet, 366, 521. doi:10.1016/S0140-6736(05)67030-4

Bagai, A., Parsons, K., Malone, B., Fantino, J., Paszat, L., & Rabeneck, L. (2007). Workplace colorectal cancer–screening awareness programs: An adjunct to primary care practice? Journal of Community Health, 32(3), 157-167. doi:10.1007/s10900-006-9042-4

Cyranoski, D. & Williams, R. (2005). Health study sets sights on a million people. Nature, 434, 812. doi:10.1038/434812a

de Koning, H. J. (2009). Testing at home—the screening of the future? European Journal of Public Health, 19(1), 5–6. doi:10.1093/eurpub/ckn120

Geltman, P. L., & Cochran, J. (2005). A private-sector preferred provider network model for public health screening of newly resettled refugees. American Journal of Public Health, 95, 196-199. doi:10.2105/AJPH.2004.040311

Korhonen, P. E., Jaatinen, P. T., Aarnio, P. T., Kantola, I. M., & Saaresranta, T. (2008). Waist circumference home measurement – a device to find out patients in cardiovascular risk. European Journal of Public Health, 19(1), 95–99. doi:10.1093/eurpub/ckn090

Matthews, B. A., Nattinger, A. B., Venkatesan, T., & Shaker, R. (2007). Colorectal cancer screening among Midwestern community-based residents: Indicators of success. Journal of Community Health, 32(2), 103-120. doi:10.1007/s10900-006-9038-0

Smith, G. D., Ebrahim, S., Lewis, S., Hansell, A. L., Palmer, L. J., & Burton, P. R. (2005). Genetic epidemiology 7: Genetic epidemiology and public health: Hope, hype, and future prospects. Lancet, 366, 1484-1498. doi:10.1016/S0140-6736(05)67601-5