Life is Not Perfectible

    David Ehrenfeld, in "The Arrogance of Humanism," uses “humanism” to mean a modern belief in the perfectability of all human enterprise.  To such humanists, all problems are solvable, either through natural or through social sciences and technology.  Ehrenfeld points out that such “arrogance” leads to the creation of residual problems that are unresolved by the “rules,” or are completely untouched by the rules, lying in the interstices of our recipes. 
    The accompanying figure (Figure X) is a heuristic device I have used for years to try to illustrate this thought process.  I refer to it as “The Path with Two Question.” 
    So, the first question asked in Figure X is “Is life perfectible?”  If you answer “yes,” you have found the path to Humanism.  Humanism, by this definition, is an ideology, an act of faith, the central tenet of which is that all human problems are, ultimately, solvable.  For those readers who see themselves as such “humanists,” I am likely to do an inadequate job of dissuasion.  Since there is no proof that the humanist is right or that we sceptics are right, we are arguing about a kind of religion.  One might seek out a copy of The Arrogance of Humanism at a library for a full disquisition.

Let’s be clear.  We are not asking, “Is life improvable?” or “Is progress possible?” Having had this conversation with hundreds of students, I am aware that questioning human perfectibility is often interpreted as questioning the potential for progress.  Too often, the statement “We can’t do everything” is heard as “We can’t do anything.”  Whether or not we are perfectible, progress is possible.  If we are perfectible, then progress is measured by the distance we have traveled towards that end.  If life is not perfectible, we can still make it better.  But our belief that there are some problems that humans will never solve, some things that humans will never know, sets boundaries on our hopes for progress.
    When one points out the large gap between where we currently are in solving an important problem and the distance we are from achieving the actual solution, the Humanist identifies the gap as “technological.”  Given sufficient money and time, the gap is, by the definition of the Humanist’s faith in perfectability, closable.
    For those who hold a different point of faith, that some problematic gaps are, in fact, not closable at all, then the gap may be “ontological.”  It arises out of the very being of the pursuit of a solution.  
    Believing that some problems may be beyond our ken can, oddly enough, ennoble our efforts.  It is common today to hear, among criticisms of our educational system, that not enough kids want to study math and science.  But if our problems are all solvable, then what is the nature of the challenge of cutting edge research?  “You can be the first!”  Nice, but if all problems are solvable, someone will get around to solving this one at some point in the future.  Why should we bother being first when, inevitably, someone else will come along, sooner or later, and do that same thing?
    No, the real adventure is trying to do something when you aren’t sure whether it can be done.  No one would climb mountains if they were absolutely certain that they could do it and come back alive. 
    What if, instead, we were to tell our students that humans are inherently limited, but in spite of those limits they have accomplished greatness?  Might you be the one to do something that others don’t even think is possible?  It is the potential for failure, the possibility of exceeding our perceived limits, that is the adventure.
    Yet, we live within a culture that assumes that all problems are solvable. We have a poor educational system?  We increase the technology of test-taking, and then use the results to weed out the bad teachers.  We have too many people in poverty?  Then we lower taxes on the rich, which will cause them to create more jobs.  The organization we work for is losing money?  A good management consultant can develop a new blueprint for success.  Want to increase the quality of healthcare?  Then simply develop measures of that quality, and then hold people to compliance with those measures.  Want to lose weight?  Go on this special diet.
    But let me ask you this: are your experiences more consistent with the promise of perfectibility or with a healthy dose of modesty about human affairs?  Do your own efforts tend toward the perfect or are they more like mine, pretty good, but often erring?  Are your co-workers exemplars of perfect problem-solvers?  Does your reading of public affairs suggest that human problems are on the road to all-encompassing solutions or that they are, at best, damnedly difficult to manage?  Perfectibility is an attractive ideology, but completely inconsistent with my own experiences.

Beyond Nature and Nurture

 What exists beyond Nature and Nurture?

I am fairly sure that I am about to lose a few readers at this point.  Because, if we want to find an answer to the question “Why should I care for the other?” and the material explanations (nature and nurture) are insufficient, we are going to have to talk about non-material things.  Call this spirituality or religion, it is something that many of my friends and colleagues don’t feel comfortable talking about.
    I never intended to be a religious person, and I certainly was not brought up that way.  But I made decisions early in my career that pointed me in the direction of using my professional skills towards meaningful ends.  And, as I taught others to do the same, I wondered why.  I began to walk a path towards religion when I realized that my urge to care was not completely explainable or understandable within the limits of nature and nurture.  It was clear to me, as I tried to argue in earlier postings, that some values transcended biology and culture.  Some values were fundamental to all human beings.  I adopted what the intellectual historian, William Barrett, called “the religious hypothesis” – that there exists meaning to life.
    We should note early in this discussion that I am not talking about Religion, with a “capital R.”  “Capital R” Religion is an organized approach to the pursuit of meaning, usually with a set of common beliefs, common practices and structured institutions through which groups of people seek out that meaning in relatively defined ways and share it with each other.
    No, “small r” religion is the simple acceptance that there are some values, some meaning, that transcend the material world, that are not dependent on nature and nurture.  It is faith in Transcendence, in a ground for these transcendent values.  If we choose to populate Transcendence with a set of beliefs and organize our approach to those beliefs, we enter into Religion.  But before there was Religion, there was religion. 
    I believe that this is what is most commonly meant by using the term “spirituality.”  And I adopted that term a number of years ago.  But since then, the baggage that comes with the label of “spirituality” is no longer worth the freight costs. 
    “Small r” religion is the simple belief that there is a source of meaning to our lives that is not an expression of our genes or of our culture.  And, therefore, these transcendent values are applicable to the affairs of all humans.  You and I can bond over our experience of this faith in Transcendence, but be quite split over what we believe those values to be and whether or how to “worship” them.  But that disagreement takes place in the context of Religion, not religion.

But How Do We Know?

    Assuming, for the moment, that you, the Reader, are comfortable with rejecting Materialism and accepting the notion of Transcendence, then you and I share a common perspective, that there exists meaning to our lives.  But what is that meaning?  How do we lead a life of Goodness?  And how do we know what is Good?  And can we be sure? 
    I once had a conversation with someone who was a lawyer for large financial concerns, what today we call “private equity,” but at the time we called “corporate raiders.”  I stated that I thought what I did for a living was morally superior to what he did for a living.  He was insulted, which is not a surprising response.  (I wish I had thought about that before I made my statement.)  But I believed that teaching people to shape a society that is healthier is morally superior to helping rich people make even more money, often at the expense of working people.  I continue to believe that today.  But where do I get off saying such a thing?
    It would be easier to live moral lives, lives of Goodness, if we were given a Rulebook.  To justify such a claim as I made, you might open the “Rulebook” and simply point to the appropriate Rule. 

    “Rule 756/3.  Academic work is morally superior to work in the private sector.”

Although that would support my claim, it is an absurd overstatement.  Maybe we could find a more subtle rule on another page of the Rulebook:

    “Rule 1003/11.  Teaching people to become members of a helping profession is morally superior to providing litigation services to people who are merely trying to make money, regardless of the impact on the worklife of others.” 

You can see how a Rulebook that was really complete would be really, really big.  And I’ll bet your intuition tells you that even a really, really big Rulebook couldn’t cover every moral judgment we are asked to make.  There will never be a Rulebook sufficient to help us live lives of Goodness and caring. 
    Yet, how much we want there to be rules!  We want there to be a perfect way of addressing our uncertainties, reducing them to specific formulae, the use of which fully informs our decision making.  But, as David Ehrenfeld argued in The Arrogance of Humanism, our belief in our ability to find perfect solutions to our physical and our social problems, what Ehrenfeld defined as “humanism,” is illusory. 
    (Some language ambiguity here:  “Humanism” has many useful definitions.  It can mean a desire to put human welfare above profit.  In philosophy, it can refer to a group of 14th Century scholars whose work defined much of what we think of as “the Renaissance.” [Encyclopedia Britannica] It is often paired as “ethical humanism” to deny a transcendent source of meaning.  We will use it differently.) 

Chicken Soup with Matzo Balls or Spaetzle

This soup is inspired by my mother’s recipe; she recommended the parsnips and the sage.  She also used to add what she called “dumplings,” but I have always thought that spaetzle is more descriptive. 

Arlene says she married me because of this soup.  Our friend Barbara couldn’t eat anything for the first five months of her two pregnancies except our once a week deliveries of a pot of this soup.  Hope it works for you, too!

Ingredients:    

One half of a cut-up chicken fryer plus one breast (with bone)

2 large parsnips

4 carrots

2 large stalks of celery

2 medium onions

2 t. kosher salt

1½ t. ground sage

1 t. dried dill weed

½ t. ground celery seed

½ t. garlic powder

Start with an 8 quart Dutch oven or stock pot.  Put the chicken in the pot.  (If you want a richer soup, you can brown the chicken on all sides in the bottom of the pot.  I do this sometimes, and sometimes I don’t.  Makes for a slightly richer, slightly tan colored broth.)  Do not peal the parsnips or the carrots, but cut off the ends, and then put them in the pot.  Peal the onions, cut them into 1 inch chunks, and then put them in the pot.  Cut the celery stalks in thirds and add them.  Fill the pot with water to about ½ inch from the top.  Bring to a boil.  Then reduce the heat to a rolling boil. 

In a while, there will be a foamy substance that rises to the top.  Skim this off.  You may have to do this a few times over 5 to 10 minutes to get it all.  Then add all of the seasonings.  In about one hour to one hour and fifteen minutes, the soup should be ready.  (It is not possible to tell whether soup is done if you try it right from the pot, because it is too hot.  So spoon some into a cup, let it sit for a couple of minutes, and then try it.).  Add salt if needed. If you want richer soup, let it cook for another fifteen minutes to a half an hour, but the yield will be greatly reduced. 

When the soup is done, discard the parsnips and the celery.  Take the chicken out of the pot and cut the meat from the bones.  Let the soup rest while you are doing this.  That will allow you to skim much of the fat off the top.  (If you want to get all of the fat, let the soup cool down, and then put it in the fridge overnight.  The fat will come off as a solid piece.)  Put the meat back in the soup.  And you’re done. You’ll have about 5 quarts of soup.

For the matzo balls, you have a basic decision to make.  Do you like them hard, medium or soft?  The following recipe delivers about 15 to 20 small, medium-consistency balls.  (If you want them hard, then leave the top off of the pot while they are cooking.)

Ingredients:

4 eggs

4 T canola oil (you can use chicken fat, if you wish)

4 T chicken soup (water will work, too)

2 t. kosher salt

1 t. onion powder

1/4 t. dill weed

1 cup of matzo meal

Beat the eggs lightly in a bowl.  Add the oil and soup (or water) and beat enough to combine the ingredients.  Then add the salt, onion powder and dill weed, stirring to mix them in.  Add the matzo meal and stir to completely moisten.  Put this in the refrigerator for about an hour until it is firm.  Bring about 4 quarts of water to boil in the Dutch oven.  (Two t. of salt is optional.)  Moisten your hands and form the matzo mix into one inch balls, dropping each into the rapidly boiling water as soon as it is formed. (Keep your hands moist, or this part won’t work.)  Put them in as fast as possible.  Once they are all in, give the water a very gentle stir to make sure none of the balls are stuck to the bottom.  Cover the pot tightly and cook for 20 minutes.  DO NOT open the cover; if you do, you will boil the balls, and they will become very dense.  Keeping the lid on steams them.  Serve two matzo balls in a bowl of the chicken soup. 

But honestly, if you like light and fluffy matzo balls, I think the Manischevitz Matzo Ball mix makes very good, very light, good tasting balls with very little trouble.  It is what I use. But again, be sure to leave the lid on for the full 20 minutes.

The spaetzle or dumplings are not suitable for Passover, as they contain flour.  But my kids love them, and always ask me if I have made enough of them so that they can have as many as they like.  This recipe will make a lot of spaetzle.

Ingredients:

4 extra large eggs

1½ c. of all purpose flour (or more)

½ c. of milk

1/8 t. of kosher salt

Break the eggs into a mixing bowl.  Beat with a fork for a few minutes.  Add the milk and beat until well mixed.  Add the flour ½ cup at a time.  After each portion is added, stir the egg and flour mix with a fork until all the lumps are gone.  (This won’t happen with the first ½ cup, but don’t worry, the lumps will disappear after the second.)  Make sure to incorporate as much of the flour as possible into the batter.  Keep adding flour until the consistency of the batter is such that when you scoop some up on the fork, it stays and then falls off in one solid clump.  If you don’t add enough flour, the spaetzle will fall apart in the soup.  If you add too much, the spaetzle will be too hard. 

Bring the pot of soup (after removal of the parsnips and celery and after you put the meat back in) to a rapid boil.  It has to be a rapid boil, otherwise the spaetzle will sink to the bottom and start to break apart.  Scoop up batter with the fork and let the clump of batter drop into the soup.  Keep doing this with all of the batter.  Gently stir the soup once (to unstick any clumps), reduce heat to a rolling boil, cover and cook for five minutes.  The consistency of these spaetzle will be much denser than matzo balls.

Serve soup a while after you have turned off the heat.  Otherwise the soup will be too hot to taste.  You will probably need to add salt to taste, as I have kept the salt to a minimum in this recipe.

Enjoy.

 

Does the urge to care come from culture?

The “Cultural Determination of Meaning”

    We might be able to reject the argument that the urge to care comes from our biology.  But, the well-educated materialist might counter that pursuing the Good which is not explainable by biology is explainable by social science, that some caring may be genetic, and the rest is cultural.  Nature and nurture.  By this view, our impulse to do Good is a function of our culture.  The most expansive view of this is what I call “the Cultural Determination of Meaning.”  All values are a function of culture.  Note the italics.  There is no source of meaning outside of what we are taught by our culture, broadly defined to include parents, family, neighbors, teachers, leaders, popular media, etc.  It is all a matter of learning.
    The most extreme adherent to this rule I have run into was a student in a class in which I guest lectured, at a neighboring university in a friend’s class in health policy.  The other guest lecturer, an ethics professor, pulled out the old chestnut about 14 people being in a life boat with only enough water for 10 people to reach shore.  Who would you toss overboard and how would you decide?  (I am not fond of this kind of question, as I believe, as we will see in future blogs, that “all knowledge is experiential.”  Unless I have an experiential referent for such a choice, I actually can’t predict with any certainty what I would do.)  
    As the ethicist was taking the class through the exercise, one of the students was steadfast in her view that there was no external mechanism by which to judge any of the people in the boat.  We are all creatures of our environment, so none of us is less worthy.  There is no ground, under this worldview, from which to judge worthiness.  This caught my interest.  How about saving the pregnant woman?  Nope.  I asked the student if we might want to keep one of the people who was a specialist in treatment of dehydration.  Nope.  How about a sailor who could help navigate.  Nope.  I kept trying to get her to choose, and she steadfastly resisted.  Frustrated, I said, “You mean to tell me that if Hitler and Gandhi were in the boat, you couldn’t judge between them?”  Her response was to launch into an analysis of Hitler’s difficult childhood.  Although it was probably pedagogically inappropriate, I cut her off, saying that I wasn’t interested in defending Hitler as a mistreated youth. 
    Here was a person whose moral judgment had been excised by her unwavering commitment to being cognizant of the impact of culture and upbringing on human behavior.  But she was consistent.  If all values are a function of culture, then bad behavior is merely bad conditioning.  You might rue the horrendous impact of Hitler’s difficult childhood, but you can’t condemn the behavior outright. 

Poppycock

    This, of course, is poppycock.
    There is absolutely no doubt that some amount of our desire to care is instilled in us by our environment, by our culture, by our parents and religious communities, by our school teachers, by our mentors.  If I didn’t believe that you could teach people to be of sound character, I wouldn’t take as much pride as I do in our three children.  Or in the thousands of students I have been privileged to have in my classes. 
    So, it is a truism to say that some values are a function of culture.  But, the Cultural Determination of Meaning poses a much larger hypothesis: if all values are determined by culture, then there is no transcendent ground for moral value.  We teach our moral values to each other.
    The implications of the Cultural Determination of Meaning are significant.  The most commonly understood corollary is that no one culture is any better than any other culture, since all values are merely an expression of the culture in which they arise.  Under this view, my values are and can be no better than yours.  If there are universal human values, then it is because all human cultures have found it useful to produce those values.  If we were to find a culture that did not share an extraordinarily widespread value, it is not appropriate to judge that culture unworthy.  What is Good in all of those other cultures is not necessarily required to be Good in all cultures.  To condemn a culture for its values is to be culturally insensitive.  Under the Cultural Determination of Meaning, moral turpitude does not transcend culture. 

Do we really believe that?

    Unfortunately, this simply doesn’t fit our sensibilities.  You and I know that some things are not Good, no matter how embedded in another culture they might be.  Slavery was endemic to many cultures; that didn’t mean it was morally defensible.  Killing Jews, the Roma and homosexuals in Nazi Germany was not merely a cultural preference.  Female genital mutilation in Africa is not just “their thing.”  Beheadings by fundamental extremists is not solely an expression of a unique culture.  Genocide is wrong wherever and whenever it is committed.  The basic human rights of women don’t change from culture to culture; if a culture denies these rights, this is condemnable behavior.  Discrimination against and persecution of minorities are not acceptable just because the majority in a particular culture teaches these practices to their children. 

Will you shout?

    A thought experiment.  Imagine that you are walking down the street and you see a man about to step off of the curb.  You notice a car coming, and you realize the man hasn’t seen the car.  If he continues off the curb, he will be killed by the on-coming car.  There is time for you to shout and warn him.  Will you shout?
    Well, of course you will!  Wouldn’t everyone? 
    Really – everyone.  I am comfortable condemning a culture that produces people who wouldn’t shout.
    Imagine, this time, that you are with a companion.  The companion senses that you are about to warn the man, and urges you to be quiet.  “I’ve never seen anyone killed before,” your companion explains.  Would you be repulsed by this behavior and this comment?
    Well, of course you would!  Wouldn’t everyone?
    Really – everyone!  My hypothesis is that the moral virtue that attaches to the simple act of warning this man is one that is fundamental to human experience, regardless of culture.  That is to say, anyone who would not warn the man is likely to be condemned by the overwhelming majority of us who feel the call to do so.  And maybe  not all cultures would assign this responsibility, but almost all of us would condemn any culture that didn’t.

Values transcend culture

    Some values are transcendent of time and place and culture.  And to prove false the basic premise of the Cultural Determination of Meaning, that all values are a function of culture, all we had to do was find one value that transcends cultures.  Because, if one value transcends culture, then probably others do, as well.  Then the question is “Which do?”
    If we accept the Cultural Determination of Meaning, we must respect other cultures, even at their worst.  Who are we to judge?  But there are just too many times in human history when cultures ran amok, and the answer to the question, Who are we to judge?, was a simple statement.  “We” are the rest of humanity who has a moral responsibility for “the other.”  Although I want as much as most people to cultivate respect for the values of other cultures, I am not willing to eviscerate my own moral conclusions in the process. 
    So, the urge to care can’t simply be a biological imperative.  And it can’t simply be social training.  There might be a biological component, and there certainly is  a social component, but neither or both together are sufficient.  There must be something more.

Does the urge to care come from biology?

Nature and Nurture

    If we want to know where the “urge to care” comes from, the obvious starting point is with the materialistic explanation.  “Materialism” is that school of thought that says that all values, all meaning, are a function of the material world, the world that my friend Chip says has “a high pokability quotient.”  Looking for explanations of behavior in the material world  is what we were taught in grade school.  Values, moral priorities, are the result of either nature or nurture, of our biology or of our environment.  Or, as recent science suggests, of some combination of those two.  But of nothing beyond the material world.  According to the materialist, to pursue the Good must be something that is producible out of our biological and/or social conditions, nothing more.
    Let’s see where this leads.

Nature

    First, biology.  Today there seems little question that some amount of human behavior is a function of our biological conditions.  I have been posing these materialistic alternatives (biology and culture) in my lectures for over 30 years.  Frankly, when I started, I included biology purely for the sake of completeness.  Then we had kids. 
    There is nothing like having three kids to demonstrate how much human behavior is hard-wired.  I remember one evening when (and don’t ask me why we agreed to this, because I have no idea) two of our children, one girl and one boy, had sleepover parties at our house on the same night. 
    Shortly after arriving, all six of the eight year old girls had dug deep into the “dress up chest” and were bedecked in satin and feathers. 
    Within minutes of “deploying,” my six year old son’s friends were armed to the teeth, with anything that could remotely pass for armaments, like a cardboard paper towel roll stuck into the belt, the better to play “pirate with a cutlass.” 
    I know – such differences could still be the result of complex, subtle and very early learning, but anyone who has had a two year old son knows that, when the “gun gene” kicks in, there doesn’t seem to be much relationship to environmental influences.  
    As of this writing, the literature on the genetic basis for human behavior, including complex emotions, is growing.  It is easy to make the natural selection argument on how human beings became a caring species.  Assume that we could view two tribes of our ancient protoancestors.  One tribe shares a mutated gene that causes a significant number of the members of the tribe to care for others within the tribe.  The other group never had this gene, and so everyone pretty much looks out for themselves.  In which group are members more likely to survive to the age of reproduction?  Given the harsh realities of their environment and the inherently social nature of human survival efforts, the members of a community that had sufficient numbers caring for each other would be more likely to survive to puberty than those members of a “every one for themselves” tribe. 

Could be, but . . .

    Thirty-five  years ago, when I was first forming these ideas, there were only a few people who were arguing that caring is a function of biology.  But over the decades, science has suggested that this source of caring can’t be ignored.  A few years ago, it might have been truthfully said that even the most ardent of materialists weren’t arguing that all morality could be explained by biology, but today that argument is heard, albeit with only a small credence yet assigned to it.  But that credibility is growing.
    It may be that someday science will offer convincing explanations that reduce morality to biology.  Were that to happen, human life would lose a measure of its nobility.  A heightened moral imagination, rather than something of which to be proud, would be merely the predetermined result of genomic causes.  Since today the science is far from that position, I choose to believe that the extraordinary experience of virtue I feel when I do Good or when I observe the virtuous behavior of others is more than a proteinomic response.  I choose to retain respect for the dignity of human Goodness beyond our DNA.

"Brown is flavor"

“Brown is flavor!”

I recently attended a week-long class in cooking at the Culinary Institute of American, in Hyde Park, New York.  An amazing experience.

One of the many lessons I learned was captured by the instructor/chef, when he was exhorting me to roast the baby artichokes I had prepared longer than I thought was a good idea.  “Brown,” he said, “is flavor!”  Same lesson when he told us to brown the mirapoix in making a gravy.  “Not ready,” he said.  “Brown.  Really brown.”

So, here is a quick, simple way to make brussel sprouts in a way that anyone (really. . . anyone!) will enjoy.

Preheat the oven to 425.  Rinse and drain the sprouts.  Then cut off the bottom stems, and cut them into halves, from top to bottom.  Put the sprouts into a large bowl.  Pour in “some” olive oil.  I don’t tend to measure, so I am not sure how much to put in.  If you pour too much in, there will be a puddle of oil at the bottom of the bowl when you remove the sprouts.  That is too much oil.  If you notice that many of the sprouts seem not to have any oil on at all, that is too little oil.

Sprinkle on a couple of good pinches of kosher salt.  Then grind some black pepper over the sprouts.  Mix them up well, so that the salt and pepper are evenly distributed.

Dump the sprouts onto a large rimmed sheet pan.  (Usually called a “half sheet,” 11 x 17 inches) Turn each sprout so that its cut face is facing downward, in contact with the pan.  One single layer.  (This is how you know you have too much or too few sprouts.  If you don’t get a layer covering the whole pan, too few.  If you can’t get them all in place, too many.)

Place in the heated oven on a middle rack.  They will cook for a long time.  30 to 45 minutes?  Depends on the size of your sprouts.  You have to check them every so often.  They are done when they are seriously brown.  This is the only hard part of this recipe, waiting until they are really, really brown.  You can prove to yourself the benefits of waiting this long.  Take a sprout out before they are really brown, and try it.  It will taste like an OK brussel sprout.  Then, apply patience and take them all out when they are brown, really brown.  Try one of these and compare to the earlier taste. 

See?  Brown is flavor.

Serve without any sauce.  They won’t need it.  Make a lot more than you think you will need, because everyone will eat lots of these.  Really, lots. 

Caring for "the other," Part 2 - Real, abstract, related, unrelated

Seeking an Answer to “Why?”

    Most people who decide to earn an “MPH,” a masters in public health, find that someone in their family is inevitably going to ask, “What’s an MPH?”  When you try to explain, they will often ask, “Can you make more money with one of those?”  Actually, no.  In fact, you are probably going to make less money because of the degree.  So, why do it?
    Why, indeed.  I started out with an attempt to answer that question, but I quickly saw that the very same question can be asked of anyone who advocates for policies and programs that help other people, not just those in public health, but those in many of the “helping professions,” like teaching, medicine, nursing, therapy, social work.  Or of honestly motivated politicians.  On the scale of public policy, why ought individuals be inconvenienced or charged more in order to make the world healthier for other people?  I can understand why I would want it to be healthier for me, and certainly I would want it to be healthier for my family, maybe my neighbors and the members of my congregation.  But beyond that, why is that my problem?
    At some point, while I am quizzing my students, someone will finally say, “I want to help other people because I care about them.”  Do you know why you care?, I ask.  No, not completely, they say.  What if I called it an “urge to care?”  This seems to sit well with my students.
    And with me.  I believe that the genesis of the act of proposing good public health policy, or any policy proposal that attempts to do Good, is an “urge to care for the other.” 
    Who, then, is this “other?”

Dimensions of “The Other”

    Simplistically, anybody who is not “I” is an other.  But there is obviously a difference between caring for my family and my closest friends on the one hand, and, on the other hand, caring for poor African children orphaned by HIV/AIDS.  Both are “other” to me, but they are “other” in different ways, and the type and magnitude of care that I feel for them reflects those differences.
    My wife and children are my most immediate focus of caring.  They are concrete targets of my caring, and I understand clearly my relationship to them and the nature of my caring for them.  There seem to be two dimensions of this caring that affect my feelings.  First, they are people who are clearly “real.”  They are not abstract concepts or distant possibilities.  They exist, and I know that they exist.  I can clearly identify them.
    Second, I understand my relationship to them and the caring that grows out of that relationship.  They play a specific role in my life.  They are “other” in a very specific way.  I can understand how we are “related.”
    I can imagine people with whom I have a relationship, but that the relationship is more attenuated, or I am not as certain as to the role that they specifically play in my life.  Students, colleagues, neighbors, acquaintances.  So this dimension of “relatedness” is graded, from precise and immediate to unfocused and uncertain in time or place.  At the extreme are people whose relationship to my life is unclear to me.  I may be completely ignorant of how I relate to them.  It is not that I relate to them poorly or with ill will, but that I have no evidence one way or another as to how or if they are specified in my life.  At the most attenuated end of the spectrum, these people are not related to me at all.
    There is that first dimension of “the other” I spoke of above, in reference to my family.  The other may be “real” or they may be “abstract.” They may be flesh and blood people or they be not more much than a concept. This dimension is also graded, although a bit less so.  I tend to see people as either existing or not.  I can either identify their concreteness or I can’t.  But there are some hazy distinctions here, too.  For instance, the images of flood or famine victims on TV seem less concrete to me than my neighbor or even than the casual stranger I meet on the street on the way to work.  But those victims of natural disaster or human cruelty are more real to me than the millions of people around the world who will suffer from uncontrolled climate change, so remote in time, place and probability from my life. 
    From this we can pose a way of classifying “the other” on these two dimensions, as seen in the table below.  In each cell are examples of the kind of “other” that exists within that cross-section of the two dimensions.

    Doctors and nurses and therapists care for “real and related others” called “patients.”  Advocates on behalf of the welfare of my ethnic group appeal to my relatedness to this abstraction.  When I give a beggar a hand-out on the street, I am caring for a real, but unrelated person. 
    The target of public health is in the fourth cell.  The Truly Other.  When I was advocating for better pollution controls or laws to decrease cigarette use, did I know who was going to be helped?  No.  The beneficiaries were a complete, probabilistic abstraction with whom I could see no relationship.
    As we go from high to low on either dimension, it becomes harder and harder to care.  Caring for the “real and related” is relatively easy.  I find it somewhat less pressing to care for the “abstract and related,” but it is still not difficult.  But why am I called upon to care for those unrelated to me?  And how do I explain the need to care for the Truly Other, those who are an abstraction and of no relation to me? 
    I propose the phrase “moral imagination” to explain this.  It is “moral imagination” that allows us, or compels us, to care for those who are not related to our lives, nor fully real.   For those who wish to argue that we should be a more caring society, the appeal must be to the moral imagination of the citizenry.  And isn’t this is one of the most important functions of leaders – the ability to capture and direct the people’s moral imagination? 
     It is easy to find our moral imagination when dealing with our families.  And accepting moral responsibility for the well-being of our ethnic group, while not as pressing as for family and friends, is still well within most people’s “frontier” of moral imagination.  Some of us feel the tug of our moral imaginations when we see a stranded motorist.  It is hardest to conjure up moral imagination for the abstract and unrelated.  Caring for those “others” is exactly what makes public health a noble calling.
    Thus, my students are exhibiting moral imagination by seeking education in public health.  And they are demonstrating that their own moral imagination is enlarged sufficiently to recognize a call for help from the Truly Other.
    But this doesn’t really answer the question fully.  Why do they feel a responsibility to heed this call?  Why did I turn down a chance for wealth and prestige to pursue the Good?  What causes us to care?  In other words, where does this urge to care come from?

Caring for "the other," Part 1 - Why do we?

My Father Didn’t Understand

    My father didn’t understand.  As is typical of many immigrant parents, he was hoping that all of his kids would earn a good living, so that he could stop worrying so much about their survival.  And I, his last child, had gone to an elite law school, a gateway to wealth.  Why had I decided to take a job with a small, community-based not for profit, working as a community organizer and a lobbyist on behalf of strong air pollution control laws and aggressive anti-tobacco policies?  A job, mind you, that paid about half of what I would have made at one of the big downtown law firms where I had interviewed. 
    I tried to explain it.  I told him that I wanted to do Good.  I told him that a person has two sources of pride in their work – how well they did the work and what the work was.  Most lawyers, I said, could take pride in how well they performed.  However, I predicted that, after 20 years of doing the same thing over and over again, I would find it harder and harder to take pride in my skills.  The trouble was, as a lawyer, it was hard to find a career path that allowed you to take pride in what the work actually was.  In language I developed much later, I intuited that I could have a job, a profession or a calling.  I worried that if I didn’t respond to the calling, and only pursued the profession, I would soon end up with nothing but a job.
    A few years later, well after I had established a career in Doing Good, my father called and asked if I were interested in purchasing an immigration law practice from his cousin.  No, I told him.  “Why not?” he asked.  “She makes $200,000 a year, net,” he said.  I didn’t want to be an immigration lawyer, filing reams of papers, spending endless hours arguing with government agents, all in the service of corporate clients who wanted to keep their foreign professional staff in the country.  I was trying to do something “more worthwhile.”  I wanted to do “meaningful work, Good work.”  His practical suggestion was: buy the practice, run it for 10 years, live on half the profits and put the other half in the bank.  At the end of the ten years I would be a millionaire, and then I could go and “do Good.”  How, he wondered, could I pass up being wealthy?
    How could I?  By what standard did it make sense to pass up certain material well-being at the cost of only a delay in “doing Good?” 
    He didn’t understand.  Neither did I, completely.  I wanted to take pride in the work that I was doing, to finish a day of hard work and feel good about what I had tried to accomplish.  If the air was a little cleaner, if cigarettes were a little harder to buy or to use, if people with lung disease led slightly easier lives, then that would make me feel that my life had a purpose. 
    But why was that my responsibility?  I didn’t ask.

Why Be in Public Health? 

    Years later, I had earned another degree, in public health, and the School had offered me a job on the faculty.  I had never thought about teaching or writing, but it sounded better than trying to make an honest living, so I said yes.  Nobody ever told me how hard it was to teach!  It looked so easy — you just stood in front of people and talked!  I had been doing that since I was a toddler.
    While I was studying environmental health science, one of my professors asked me in a casual conversation what I thought the goal of public health was.  Lyn Babcock had a set of 40 or so little hand cut cards, with a different phrase on each.  He asked students to sort through the cards and find the ones that expressed what they thought the purpose of public health programs and policies was.  I don’t remember what was on the cards.  They were a mix of grand goals and mundane achievements, some ephemeral and some monetary.  But I remembered struggling with the question. 
    The first class I put together, Public Health Advocacy, was the first of its kind at U.S. schools of public health.  It taught students to think analytically about political change.  Assuming that you had identified a programmatic or policy problem, how might you define a solution and how might you advocate for that solution through the various policy-making processes that were available?  (I still teach this same material today, but usually in short courses for existing public health professionals.)  I wasn’t, however, asking the most basic question: Why bother?
    A couple of years later, the faculty of the School revised the curriculum for our masters of public health degree.  The new curriculum included a class called “Ethical, Legal and Political Contexts of Public Health.”  It was approved on the title alone. 
    I was asked to put this required course together, and I have been teaching it and its successors for more than 30 years.
    Somewhere along the way, on a bit of a whim, I asked the class why they were in public health.  I got the usual hems and haws.  Some thought it was a good career.  Others wanted the intellectual stimulation.   I always cautioned that anyone who was coming into public health for the big bucks ought to see me after class. 
    Sooner or later, someone in the class would say “Because I want to help people.”  Why?, I would ask.
    “Because they need the help.” 
    “Because I ought to help them.” 
    “Because it is the right thing to do.” 
    “Because that is what I want to do with my life.”
    “But why you?”  I wanted to know.  “What obligation do you have to other people?”  And why me?  What obligation do I have to other people?


DS

Measurement, again: Assessment is greater than measurement

Why might things be “beyond measure?”

If I am right, that not everything is measurable, why might that be the case?  There might be a lot of answers to that question.  Here is one response. 

            We live our lives as a continuity, as an on-going experience of every moment.  Life is continuous.  Our appreciation of life is in analog, like an old-fashioned vinyl LP or a truly analog watch (the kind you have to wind up).  Your love of family or your passion for your work isn’t divided into “chunks.”  You live them as a sweep of inseparable experiences.

In order to measure things, you have to make them digital, discrete.  Measurements of life have to fit with the “chunked” digits on our scale.  Inevitably, when you measure something that is part of our lived experiences, you will lose some acuity.  This reductionism is inevitable.

In addition, some aspects of our experiences are inherently qualitative.  They require a “perceiver of quality” to exist.  In other words, there is no experience of quality without someone who actually experiences that quality.  But to measure things, we want to eliminate the impact of that perceiver. 

In the social sciences and in epidemiology we call this impact of the perceiver “bias.” We want to eliminate the bias so that we are left with the “objective truth.”  But when you eliminate bias, when you eliminate the perceiver of quality, you are no longer assessing a qualitative experience.  You have reduced it to only quantity.  But bias is the essence of quality.  Eliminate the perceiver of the quality, and you have eliminated the quality.

Assessment is Larger Than Measurement

Inevitably, by this far into the argument, some reader is thinking “But if we can’t measure things, then how can we know we are doing a good job?”  The assumption is that the only adequate assessment is measurement.

But that, too, is simply not true.  There are plenty of good ways to assess success without measuring that success.  You know who your good teachers are, without a measurement.  You know who your friends are, without being able to put your friendship against a yardstick.  For those of you who have had staff working for you, you know who your good workers are, and who your bad workers are.  In the hospital, if you want to know who provides the quality of care I was talking about, just ask the nurses.  They know. And without measuring anything.

Who knows who the good teachers are and who the bad teachers are?  The students.  The principals.  The parents.  The alumni.  And the other teachers.  We have an abundance of evidence with which to assess our teachers, all of it based on an abundance of experience.  Yet we want to disregard all of that and instead stake our evaluation on a three hour test that the students take on one day during the year.  Really?  Does that make sense to you?

So, we can assess.  We can evaluate.  We can judge.  Sometimes there will be inputs that are measurable, and sometimes we won’t have that.  Most often, it will be a mix of both.  And we can then make the decisions that we have to make, as managers and as policy-makers and as political leaders.  In short, assessment is larger than measurement. 

Is this “scientific?”  Well, if you think that the sine qua non of science is measurement, then maybe this isn’t good science.  But if the essence of science is the careful examination of our experiences in the world, and our measurements are merely more or less good representations of those experiences, then this is quintessentially scientific.

Why not try to measure everything?

            But, you might ask, so what?  What is the harm in trying to measure things, even if they are not measurable?

            It’s about the guy who sees someone, obviously drunk, on his hands and knees patting the ground under a lamp post.  “What is wrong?” asks the first man.

            “I dropped my keys a couple of blocks down the road, and I am looking for them,” says the drunk.

            “But why here?”

            “Ah, the light is better here!”

If, when we think we can measure something, that belief has consequences.  We start contorting our standards to fit what measurements we have, even if they are admittedly inadequate or wrong.  We look for measurable things, and miss the unmeasurable, because, as the drunk says, “the light is better here.”

When we fetishize measurement we find, to rethink my colleague’s maxim, that “only that which is measured gets managed.”  We start teaching to the test.  We accomplish what we try to measure, rather than what we really want to achieve.  We train our staff to meet the metrics, rather than educate them to fulfill the organization’s mission and their own passions.  (The verb “to train” comes from the notion of “dragging behind us.”  The verb “to educate” comes from “to bring up, to raise.”  Which is a better metaphor for managing staff?)  You don’t get good cooks by focusing on only the measurable aspects of being a chef.  You don’t get good parents by focusing on the measurable competencies of parenting.

By attempting to measure what can’t be measured, we waste precious resources chasing illusions.  And we run the risk of missing that which brought us to the effort in the first place.  We misplace our potential, and we by-pass our passion.

That can’t be the right thing to do.