Tag: ethics

Does a shot of vitamin B protect against Covid?

Thirty years ago there were some who envisioned a new united Germany combining the best of east and west: A vibrant market economy with an expanded commitment to economic justice, a confident democratic federal government balanced by a greater variety of states, and a commitment to individual liberty reinforced by the recent experience of dictatorship. A bridge between the solid democracy in America and the rising democracy in Russia.

Instead, Covid has revealed the modern Federal Republic as the combined worst of both systems: A timid central government in thrall to private business interests, unable to take decisive action to protect public health because of a lack of confidence that their authority would be seen as sufficiently legitimate. A resurgent right wing inspired by American and Russian ethnonationalists to express their individual liberty by rejecting even elementary public health measures. And now, a public vaccination campaign dominated by the financial and status needs of private physicians, and prioritising those people with high levels of what the East Germans called Vitamin B — “B” for “Beziehungen“, connections, the way scarce resources were distributed under socialism.

When the vaccination program started it was concentrated in large vaccination centres (Impfzentren). These were highly efficient, providing rapid throughput and simple logistics, and the official priorities of the Permanent Vaccination Commission (Ständige Impfkomission, or STIKO) — covering people over 60 years old, those with serious medical conditions putting them at elevated risk of Covid complications (including pregnant women and their companions), police, teachers, and government officials — could be securely monitored.

There were two major problems with this system: First, the physicians in private practice, for whom vaccinations were traditionally a great money spinner, felt that they were losing money and influence; Second, there was no unobtrusive path to providing priority immunisation to people who were important, influential, or just rich, threatening to lead to the sort of blatant corruption that just embarrasses everyone. This led the government* to bring the GPs into the vaccination program, paying them upwards of €50 per vaccine. The GPs, unsurprisingly, rushed to vaccinate their friends and favourite patients — particularly those patients with private insurance, who they are generally keen to hold on to, as the private insurance covers all manner of treatments that the public insurance won’t pay for, and the payment levels are generally significantly higher.

How should one respond to this? The Ethics commission is very concerned… that people who haven’t been clever enough to work the system might be jealous of the superior people who have. Here is a comment from a recent podcast interview with commission chair Alena Buyx:

AB: We shouldn’t confuse the people who have gone the extra mile and somehow managed to get it organised, or had a stroke of luck, with those who have cheated.

Spiegel: … It could be that someone who isn’t so resourceful… for various reasons, it could be social background, it could be language, it could be some lack of access to information –and I can understand that they might feel he or she feels like you’re taking something away from them.

AB: These are things that one couldn’t have imagined earlier. We have vaccine envy and also vaccine guilty conscience. But all I can say is: Good People, every vaccination is a good vaccination… Those who have been lucky, or who have profited from this “flexibility” — if they haven’t cheated anyone — they should enjoy their good fortune.

From there to full social Darwinism is just a small step, and that step was taken by one Christoph S. in the comments section of the national newspaper Die Welt:

In my social circle — definitely well off — is just about everyone vaccinated, and always the whole family, including the university-age children. None of them in the vaccination centre, always in the GP practice or through doctors they know personally. In other words, since the GPs have been doing vaccinations the prioritisation has fallen away de facto, at least for the “higher” levels of the population. This is not pretty, but as long as they’re managing to vaccinate up to a million people a day in Germany, I find it acceptable. One shouldn’t make a fuss about the people who try to cut ahead at the vaccination centres; Germany has much bigger problems than someone getting vaccinated a few days early. And, by the way, this is how it’s always been, that those who make the most noise prevail, and presumably that’s why Homo sapiens has managed to survive.***

* Just to be clear, this is not the official justification. This is a purely speculative exercise on my part. It’s hard to think of any other justification, though. It’s not as though the GPs were otherwise unoccupied, with huge amounts of spare capacity for taking on vaccination duty.

Continue reading “Does a shot of vitamin B protect against Covid?”

Count no statue happy…

Count no man happy till he dies.

Sophocles, Oedipus the King (trans. Robert Fagles)

Must no one at all, then, be called happy while he lives; must we, as Solon says, see the end? Even if we are to lay down this doctrine, is it also the case that a man is happy when he is dead? […] for both evil and good are thought to exist for a dead man, as much as for one who is alive but not aware of them; e.g. honours and dishonours and the good or bad fortunes of children and in general of descendants.

Aristotle, Nichomachean Ethics, Book 1 (trans. W D Ross)

In all of the discussion of racist statues one fundamental point is rarely mentioned: Above all, public statues represent the unwillingness of “great men” to simply go away. Those who bestrode their narrow world like a Colossus are loath to let death remove them from the scene, so like the stuffed dodo in a diorama they have their effigies propped up in the public square.

While they lived they received the adulation of the crowds, and the opprobrium of their opponents. If the great one’s supporters need a public icon as a focus for their devotions, the icon will have to continue to participate in the hurly-burly of public life, including the scrutiny of their lives and deeds brought on by shifting ethical standards. If Winston Churchill were alive today he would rightly have paint and rotten tomatoes flung at him by those appalled at his racist ideas and actions. Reasonable can believe that his near-genocidal actions in Bengal, among others places inhabited by darker-skinned people, are more significant than a few well-crafted speeches that bucked up the spirits of the Island Race. Reasonable people did think so during his life. The place where one is beyond praise or blame is called the grave, and no one is suggesting disinterring WC’s bones — though an earlier generation of Tories did exactly that with Oliver Cromwell, after the tide of history turned against him.

His supporters are welcome to hide his statues away in private shrines, or public museums. If you put them up in public you have to accept that people are going to continue to engage with them. Sometimes angrily. Sometimes disorderly.

The sins of the fathers

I was just reading Kevin Drum’s article on the fallout from the hapless US military raid in Yemen last week. He lists the costs:

Our adventure in Yemen last week failed to kill its target; caused the death of numerous Yemeni civilians; resulted in one dead American sailor; and ended with the loss of a $70 million helicopter.

This is not unusual of the commentary, and I find it weird that it fails to mention that a US civilian was among those killed: the eight-year-old daughter of American renegade Anwar Al-Awlaki, given that the sanctity of American life is the bedrock of American antiterror policies. I suspect this reflects the atavistic sense that the child of an evildoer is tainted, and somehow deserves to be punished for his crimes. Of course, the new president famously vowed to “take out their families”.

Why don’t we throw people out of emergency rooms?

In discussions of market forces in health care, someone always points out that we don’t allow people to just die in the streets. Anyone who shows up in an emergency room must be treated (in the US this has been true since the Emergency Medical Treatment and Active Labor Act of 1986, I believe). Among the many other reasons why medical care does not respond to free market incentives, then, is the fact that the providers are not able to turn away customers who are unwilling or unable to pay.

But here’s what I’m wondering: This is always presented as an issue of basic humanity, or altruism. We can’t let the poor die of treatable injuries or illnesses because that seems too brutal. But is that the whole story, or even most of the story? My suspicion — and I’d have to go back to the debates on EMTALA to develop any clarity on this — is that the real reason we have a no-exceptions requirement that hospitals provide urgent care to the poor is that there’s a significant danger that the non-poor might be confused with the poor, particularly in times of medical emergency. Someone who has been hit by a car or has suffered a stroke and is disoriented is likely incapable of quickly identifying herself as an upstanding creditworthy citizen with health insurance. So the hospital is required to try to keep them alive long enough to allow them (or their relatives) to demonstrate that they are worth saving.

Which leads to a question: Supposing biometric databases become universal, and the hospitals are able to immediately ID anyone who comes through the door. Will we then relax the rules, and allow them to turn away the indigent, perhaps sending them off to some primitive alternative hospital for the poor?