Friday, February 10, 2006

NPR, rationing, and remembering

So little time, so much to do. So instead of working on my conference paper or my departmental committee work, or even further prepping my classes, I know, I'll write a little blog.

Every morning at an ungodly hour, my radio starts up by itself, the magic of technology tuned to NPR. Usually I'm awake before it starts, and this morning was no different. I intended to get up when I woke, but I didn't, instead huddling in the warmth and glad I wasn't out in the new snow.
The first article I heard this morning when the radio came on was NPR's item on the likelihood of health care (primarily critical care, esp mechanized ventilation) rationing in the case of a flu pandemic. Basically, the gist was that if/when a pandemic hits, people are going to need critical care in large numbers, and we as a society just don't have the equipment (or health care workers), nor can we afford to have the equipment available, realistically. That means that some people are already beginning to think about the ethics of rationing care, and how that care should be rationed, and how health care workers can be protected from lawsuits if they have to ration care.

Health care is already rationed, of course, it's availability ruled at least in part by access and money. Seriously, try getting health care when you live in a rural area and tell me there's no rationing right now. There are probably 10 plastic surgeons in the LA area for every GP/FP in Alaska or the rural upper midwest.

But money/access based rationing seems "natural" under our system. So what they're talking about is rationing based on something other than money, based on something other than individual need, based on perceptions of the greater good. The numbers NPR cited convinced me that if/when we get a pandemic, we're probably better off trying to ration based on perceptions of the greater good than on money. It's a complex problem.

The NPR item reminded me of an exercise we did in a social studies class when I was a kid. The idea of the exercise was that we were supposed to imagine that the bomb had gone off, and that we were supposed to manage a bunker system or something, and had a list of people who wanted "in." But, of course, we couldn't accept all of them, so we were supposed to choose a limited number from the list.

Yes, it was the 60s or 70s, can you tell?

As I recall, all the men were merely labeled by age and job/education: a 24 year old medical student.

The women were labeled by age, and parental status, with only two identified by education/job.

Only one black man was identified by race.

Then there was the 20 year old childless co-ed. I remember her because I had to ask what a "co-ed" was, and was confused when told the term stood for "co-educational" because I thought that just meant anyone who went to a school where there were boys and girls (as I did). But then I was told that it was a special term for women (called "girls" then, usually) in college. Why was there a special term? Evidently, women weren't generally in college. (I hadn't yet figured out that only one of the women I knew from my neighborhood had actually been to college, and that only one woman in my family had graduated from college.)

The only other specific person I remember is the 50-something year old female doctor, childless.

Either the set up aimed us in that direction, or our budding hormones put us there, but most of the discussion in my group (once we figured out that a co-ed was a female student) centered on female breeding status, to be blunt. Most of the group wanted to eliminate females who couldn't breed, and retained males preferentially, since we all assumed that men could actually work, and women could just pop babies, except for the female doctor, who got kicked out for being too old to breed.

For some reason, I kept arguing for the 50 year old female doctor, I guess because I thought having a doctor might be useful, and it didn't bother me that she couldn't have kids (as we were told by the teacher) because I figured she'd be so busy as a doctor that she'd more than earn her keep without breeding, or something. I lost, of course.

Retrospectively, of course, the whole set up just seems horrific. Being little kids, of course, we weren't encouraged to question any of the basic assumptions:

We weren't encouraged to ask if, having destroyed pretty much everything, humans were worth trying to preserve as a species. Now were we encouraged to think about how stupid it was to imagine repopulating an atomic Earth, or how maybe the survivors would wish they hadn't survived.

We never questioned whether individual men were fertile (just as well, given our ages and lack of real information about sexuality). Someone in the group "knew" that men could be fathers at any age, so we didn't worry about that. Nor about the possible effects of radiation on any potential kids that might be born.

Nor did we worry that some people just might not want to breed.

Instead, we hummed the theme from "Gilligan's Island" and wondered why Mary Anne and Ginger weren't making babies so that the island population would survive or grow. Our group solution to the problem clearly reflected our culture which valued youth, maleness in general, women as breeding stock, and whiteness. (Disclosure: I'm white. We were unwitting racists, mostly raised to think that race shouldn't matter in a larger society where it mattered more than our parents wanted to admit. We wanted not to be racists, and we were racists.)

Times of crisis put our cultural values under stress; that can be paradoxically valuable because it can make us think through our values and question them in useful ways. As nasty as that exercise was, I learned about my values, and the values of my culture and classmates. (I might have learned more, of course, but the fact that I learned anything in school sometimes shocks and surprises me.) If/when we experience a flu epidemic which acutely challenges our system (as opposed to the chronic challenges it faces all the time), we're going to really need to recognize and think through our values.

The NPR article opened up a potential dialogue, which we all need to take part in. These decisions are too important to be left to a small group, no matter how good-willed and well-meaning.


  1. I think about this sort of thing a lot with respect to peak oil. If we really have a massive oil crisis, and there's not enough petroleum even to make fertilizers to provide the massive amount of food necessary to feed the world, there could be a serious reduction in population. Not to mention that EVERYTHING in the world needs cheap oil to run/be produced/etc, so it's not going to be a pretty world to live in.

    Having said that, is it morally conscionable to bring a child into that world? On one hand, someone has to keep the human race going (or do we?), but on the other hand, it'll be a difficult life for the children.

  2. Good point, Ianqui.

    I also question the morality of choosing to reproduce, especially given the current overpopulation and population growth.

    I don't think the human race is going to "die out" because of under-reproduction. I think the world all be much healthier if the population were something like a quarter of what it is now, or less. But I don't see an ethical way to get there without convincing people to choose not to reproduce, and that doesn't seem to be widely successful (and it SURE isn't going to happen with the "abstinence only" crap!).