AiDA – Assistance in Dying Altruistically – featured in Liberty Equality and Fertility. Here’s AIDA’s picture. It likely depends on your mood as you look at the picture. She might make an AiDA option look attractive or add to its horror. Some people, particularly mothers, can be extraordinarily altruistic, and might think they could sacrifice themselves for the good of their children or grandchildren.
Others may well feel that a superficially caring end of life option just adds to the horror of our slide down a slippery slope.
The AI in this AIDA stands for Artificial Intelligence. She paints.
The TAiL in the title stands for Technological Assistance in Living – and echo the acronyms MAiC and MAiD below. TAiL immediately conjures up Dog as in Tail Wags Dog but in this case TAiL Wags God is more appropriate.
Fertility and Morality
Last week’s post was sent in early draft form as an email to a listserve I’m on, asking for their input. I was asking, I thought, about fertility not mortality. About birth not death. About medical factors causing infertility and a growing Medical Assistance in Conception (MAiC) to sit alongside medical treatments causing disability leading to Medical Assistance in Dying (MAiD).
The listserve has a varied and stellar cast of recipients. Their responses focused exclusively on MAiD. I was later told this was likely because very few people in Canada were now unaffected by MAiD. Strong and confusing feelings run deep on the issue.
But although the points I hoped would be picked up weren’t, the act of sending the email brought something into the frame that I may have been asking about in the first place but can put more clearly now. If we are moving from a world we have framed as Cradle to Grave to one where the frame is MAiC to MAiD, then life is becoming more and more TAiLored..
TAiLorism and Alienation
In the early 1800s, textile-workers in the North of Britain, who became known as the Luddites, and textile workers in South of France especially silk workers around Lyon, who became know as Communists, began protesting against the introduction of machinery into crafts. See From The French Revolution to Artificial Intelligence.
The machines weren’t just going to replace workers, they were going to replace skills. The French in particular saw this deskilling as an alienation – long before anyone heard of Karl Marx. The conditions in which machines were being used and the injuries and illnesses they gave rise to helped create both public health and occupational health. They also led Etienne Cabet in 1840 to create the Communist Party in Lyon.
The story of our gradual reconciliation to technology is told in Shipwreck of the Singular along with the story of how following a set of failed revolutions across Europe in 1848 the French Communist Party emigrated to Illinois – just south of where Chicago is now.
The early 1900s saw the creation of Taylorism, which explicitly aimed at adapting workers to the machines and the factory. Taylorism was the name given to idea of scientific management which meant adapting people to what were later called flowcharts and guidelines. It was adopted by both capitalism in the US and communism in the USSR. It was magnificently pilloried by Charlie Chaplin the movie Modern Times.
Max Weber at the same time had drawn attention to the bureaucratic equivalent to Taylorism. Where factory Taylorism seemed to suit the capitalists who wanted to squeeze everything they could out of workers, Weber saw bureaucracy as inherently socialist, a Deep State trying to stifle individual liberty.
Weber saw bureaucracy as inevitable in modern states but also argued we still needed leaders – and the role of the leader was to take decisions rather than follow protocols. A leader also takes responsibility for those decisions whereas almost no-one is responsible when a bureaucrat follows protocols. He compared a leader to a doctor who can get a people to take a medicine they may not like.
For Weber, medicine was sure to become a technical enterprise. He could not see where anything other than technology or technique could enter in except in a Deus ex Machina fashion. A hundred years ago he believed we would have technologies and techniques to facilitate the entry of people into the world and for disposing of them. This led Zygmunt Bauman to claim Weber foresaw the Holocaust – Modernity and the Holocaust.
Now in the early 2000s, with Artificial Intelligence, people are once again saying that technology dooms us. Not just that it will take our jobs but that it alienates us from our true selves. It will inevitably take over and we will be bit players in what we have viewed as the ‘human’ drama, ending up much like both individual ants and the ant colonies, which we see as bit players in the life on earth drama – when they might be better adapted to survive a coming holocaust than we are.
While leaning to different sides of specific technology questions, to take MAiC or not to, to take MAiD or not to, rather than being completely on different sides, most of us seem to believe or hope we can retain a mastery over technology
Can we maintain control over technologies, of which drugs are one, is the question at the heart of Charles Medawar’s concept of Pharmageddon. His Pharmageddon lecture featured in Pharmageddon and our HealthCare Climate, shows a certain stumbling toward expressing a point of view rather than any stridently expressed view. The stumbling and lack of stridency, as much as the words, seem to indicate where he stood – worried.
Could we control pharmaceuticalization? He thought not but equally seemed to think we have no option but to try. Having said that – Charles vanished soon after creating Pharmageddon. He stopped interacting with any of us whom he had bounced these ideas off. His abrupt incommunicado felt like the fate of the Tenant in Roman Polanski’s movie of the same name.
Leaders and Doctors
We now have a Fertility Crisis and Emmanuel Macron has fronted up – seemingly seeing a need to tackle it – Sex, Fertility, France and Serotonin. This is the other end of MAiD. If we aren’t going to march everyone off to the gas chambers say at the age of 80, or maybe 65 if they have any disabilities that cost money, or perhaps kill them by restricting Pensions to over 71s, as the British media are reporting this morning, we need more children.
If you think Macron’s move is anything other than a political stunt to counter Marine Le Pen’s immigration card in forthcoming European elections, the question is whether a Nation, any more than an individual, can make a difference? A nation can access more technical resources than an individual but would using technologies be morally appropriate or done morally if left to the State?. Do technique and morality interface?
Corporations legally it seems are individuals and as venal and short-sighted as any of the rest of us individuals. Are Nations also individuals? They can be pretty venal and short-sighted. But perhaps that’s part of the deal. We want our football team to win one way or the other – it need not be beautiful football. If you’re Irish you know you are doomed to a magnificent but maybe even tragic loss – as when we all knew the best rugby team in the world was not going to win the World Cup.
Is Macron leading in Max Weber’s sense – stepping beyond bureaucratic technique and taking the kind of responsibility bureaucrats don’t take. Unless someone leads, and like a doctor is able to get a Nation to swallow a medicine it might not like, the patient is doomed to die.
Good and Evil
This comes back to the question of Good and Evil. There is a line of thinking that says there is no such thing as an Evil Being. Evil is the absence of Good. Technologies, and techniques as in bureaucracy and propaganda, are inherently evil. Whether Good gets brought out of them, as in anesthesia for surgery or gas for the chamber, is down to us.
From a universal point of view – and the French pride themselves on being universalist – it makes no difference if life on earth ends up being predominantly African or Afro-Asian rather than French. Can magnificent resistance from one Nation make a difference? Is it worth trying to hold out for ‘our individuality’? Would it be moral to try?
A major factor getting in the way of the French being able to see an element of all our problems are the pharmaceutical developments they pioneered – from Thalidomide to psychotropics. I could have said petrochemical developments but the French are acutely aware of the petrochemicals all around us and see their role in causing infertility – Sex, Fertility, France and Serotonin. But they can’t see their twins, the petrochemicals we swallow – Medicochemical and Petrochemical Twins.
Has medicine become as Evil as the universe? Can we control this Evil and Bring Good out of the use of Poisons?
Bringing good out of the use of poisons was the original understanding behind medical professionalism. But even my most sophisticated medical friends, who seem to be on the same side of this argument as me (confused like Charles), recoil in horror when I frame things in terms of bringing good out of the use of a poison.
Since childhood, certainly if you are of a certain age, we have been taught that the Ends don’t justify the Means. The idea of doing Evil to achieve a Good outcome doesn’t compute for most people. A liberal elite, in particular, recoil in horror, sometimes claiming that the public will recoil with horror at this idea and need therefore for their own sake to be misled. Which is a dream for company marketing – the Democrats, Labour and Green Parties all become our unpaid sales staff.
The point behind a professional was to be independent of Church, State and Corporations.
But somehow a morally neutral technology like a computer, robot, drug or whatever has become a Good, which of course it is from a company point of view – a commodity that pulls in money. The Evil lies in us, which is does in a sense – the Good lies in us and when we don’t opt for the what all things being equal is the Good, the benefit to others option, we do Evil.
Our Drugs have become Sacraments. This transforms doctors into technicians. The clergy always were technicians. Their job was never to think for themselves. They take vows of Obedience after all but we don’t seem to notice that. Doctors find it increasingly impossible to think for themselves and Obedience to Guidelines that, where drugs are concerned, are based on an essentially fraudulent medical literature, is now written into their job contracts.
There are great problems when any of us try to do Good. The Road to Hell is paved with Good Intentions. Or as Gandhi put it – he who would do a Great Evil must first of all persuade himself he is doing a Great Good. But, lots of us figure the problems get even greater when a State tries to do good – To Err is Human but to really foul things up you need a Computer/Bureaucracy etc.
SoS is the International Distress signal in morse code. I was amused when some years ago, a very distressed Alastair Benbow of GSK, being grilled by Shelley Jofre for the BBC, refused to concede that paroxetine – Paxil, Seroxat – could cause addiction, dependence, withdrawal or even discontinuation reactions. He resorted to calling the after-effects of the drug Symptoms on Stopping, which has allowed me put SoS to good use ever since.
Many of us, me anyway, once figured SoS stood for Save our Souls. It doesn’t. Anyway if it once did, we have transitioned from an era where Holiness has been replaced as the key target in life by Health and Souls would now have to be replaced by Save our Skins.
In fact, SoS is like the universe – meaningless – it’s as technical as 0,1,0,0,0,1.
We once used to go to doctors, relatively rarely, essentially only when we had serious problems, when we were in distress, with an SoS message. Doctors though have now transitioned into calling us in to see them, commanding us to come in or be delisted, so that we can be put on Statins, or Blood Pressure or other pills, in order to SoS – Save our Salaries (doctors salaries).
As Weber wondered, where does morality enter into this? Doctors, like financiers in the financial crisis, are operating in a state of moral hazard. They give us products they must know risk blowing up in our face, or increasingly our children’s faces, and destroying our lives. They collect salaries and even bonuses provided they do not warn us beforehand or take our side afterwards – See Healthcare Gone Mad..
Is Anyone out there in this Void? Is the doctor we are going to capable of bringing Good out of the Void or will s/he Avoid doing so?
This post links to Disaster Sex Yes, No Sex Disaster on RxISK, where you will find Philippe Pinel 220 years ago echoing Charles Medawar:
As, translated for today, Pinel, one of the creators of modern medicine, said it’s great to have technologies but it’s an even greater art to know when to use them.