There is a strong relationship between housing, healthy cities, healthy neighbourhoods and healthy individuals (Sawatsky and Stroick 2005).” Access to shelter is listed among the pre-requisites for health in the Ottawa Charter. Along with peace, adequate economic resources, food, a stable eco-system and sustainable resource use. These pre-requisites highlight “the inextricable links between social and economic conditions, the physical environment, individual lifestyles and health. These links provide the key to an holistic understanding of health which is central to the definition of health promotion (Ottawa Charter).”

affordable housing project, Ogden Road SE

Canada’s Gross National Product in 2010 was $1.600 trillion based on Statistics Canada data.

Calgary needs to control its urban sprawl which is among the worst in Canada. Higher density to limit the sprawl is crucial as Calgary anticipates to double its population over the next 50 years. Mayor Nenshi on Twitter argues that we need government housing for the really tough cases, nonprofit for some, and private sector for most. He is really promoting the concept of allowing secondary suites in Calgary neighbourhoods. It seems to me that the Attainable Housing initiatives are the only one on the block. What about economic diversity in every neighbourhood through a number of different initiatives not just secondary suites which are not ideal living situations? Calgary does not respond well enough to the need for rental housing for those earning less than the attainable homes initiatives target.

In some markets, the secondary market – the universe of basement apartments, apartments over storefronts, flats in single-and semi-detached homes and row houses, and rented condominiums – has acted as an important safety valve. But, it is a less stable source of supply, and so by itself cannot provide a long-term solution to the affordable housing shortage. (TD 2003).
Why is affordable housing located under Corporate Properties in the City of Calgary? When was it moved there?

Fact Sheet on Affordable Housing

    1. The federal government estimates that the cost of homelessness by 2007 had reached c. $4.5 – $6 billion annually. This includes costs of health care, crime and other social services (Laird, 2007: 5). Yet Canada’s Economic Action Plan for all kinds of affordable housing options only provides c. $500 million annually leaving most of the costs to the municipal level residential tax base. Canada’s Economic Action Plan provides $475 million, over two years; to build new rental housing for low-income seniors and persons with disabilities, and $850 million to provinces and territories over two years for the renovation and retrofit of existing provincially/territorially administered social housing. Overall, the Economic Action Plan includes $2 billion for the construction of new and the renovation of existing social housing, plus up to $2 billion in low-cost loans to municipalities for housing-related infrastructure. Canada’s Economic Action Plan builds on the Government of Canada’s commitment in 2008 of more than $1.9 billion, over five years, to improve and build new affordable housing and help the homeless. As part of this commitment the Affordable Housing Initiative (AHI) was extended for two years, bringing the total federal investment in housing under the AHI to $1.25 billion since its inception.
    2. Across Canada emergency shelter use is on the rise particularly in urban centers. By 2007 40,000 people every night including children used emergency temporary shelters (Federation of Canadian Municipalities 2007).
    3. Research suggests that on average moving a homeless person from an emergency shelter to stable housing saves taxpayers $9,000 a year (FCM 2011-04).
    4. On an annualized basis costs in existing responses, averaged across four cities (Vancouver, Toronto, Montreal and Halifax) in 2005 were: Institutional responses (prison/detention and psychiatric hospitals: $66,000 to $120,000; Emergency shelters (cross section of youth, men’s women’s, family and victims of violence): $13,000 to $42,000; Supportive and transitional housing: $13,000 to $18,000; Affordable housing without supports (singles and family): $5,000 to $8,000 (Pomeroy 2005). In terms of public policy then “Where the cost advantage of the supportive and affordable housing options become meaningful is in addressing future demand, which will inevitably increase as populations continue to expand. Directing new investment to the lower cost (and arguably more effective) supportive option is likely to be more cost efficient than investing in new prisons, psychiatric hospitals and
      emergency shelters (Pomeroy 2005).”
    5. “Approximately 35,000 Calgary families are having difficulty affording adequate housing. Over the past ten years [2000-2010?], housing prices have increased 156 per cent, yet incomes have increased only 34 per cent over that same time (OLSH).”
    6. “There is currently a waiting list of more than 4,200 individuals and families with the Calgary Housing Company (CHC), Calgary’s leading affordable housing provider  (OLSH).”
    7. In 2004 the estimated cost of building was c. $1,890/m2 ($175/sq. ft) for concrete and $1,512/m2 ($140/ sq. ft) for wood. In 2011 the average cost per sq. ft is $125 – 155 sq ft. Unit sizes affordable housing: one-bedroom units from 500 sq. ft, two-bedroom units 700-800 sq. ft [800 sq. ft. @ $150 = $120, 000 x 36 units = $4 320 000] and three-bedroom units up to 1,000 sq. ft.
    8. Since 1993, the Provincial and Federal governments substantially reduced the capital funding of new affordable housing. This was part of a widespread decentralization, devolution and deregulation process intended to make housing markets more fairly competitive by eliminating state involvement at the same time cutting public costs. This did not work to advantage on a number of social issues such as affordable housing which has resulted in unintended and very costly consequences.
    9. There is a fiscal imbalance between municipal, provincial and the federal governments that jeopardizes the municipalities ability to respond to affordable housing issues. Cities like Calgary are highly and almost singularly dependent on property taxes (92.7%) as the primary source of funding (along with user fees and intergovernmental grants) to finance service provisions (T.D. ECONOMICS, 2004) such as affordable housing and social services. This is inherently flawed. There are many reasons why property tax revenues are inherently flawed as a source of funding for cities’growing needs and are a poor match for funding in the area of income redistribution services (more).
From Land Use Amendment Proposal
  1. The market is unable to deliver new rental stock. An astonishing 95% of the housing starts in the most recent five-year period have been in the ownership market, with rental construction accounting for only 5% of the market. Just 15 years ago, the proportion was 75% ownership and 25% rental.
  2. “A1996 Cambridge University study  that compared the housing systems and housing policies of 12 Western  nations found that, compared to all other countries, “Canada has an essentially free market approach to housing finance.  Owneroccupation has the advantage of not paying capital gains tax, whilst there is very little support for investment in the private rental sector, and tenants receive very little support in paying rents” (Hulchanski, 2002: 7, citing Freeman, Holmans, and Whitehead, 1996: n.p. cited in (Sawatsky and Stroick 2005).”
  3. Existing formal rental stock has been demolished or converted to condos.
  4. A buoyant economy in Calkgary bolstered in-migration causing a higher demand for rental housing.
  5. Alberta’s minimum wage is the second-lowest in Canada (BC has the lowest). Alberta’s minimum wage is $8.80 per hour. A total of 11 Canadian provinces or territories have a minimum wage rate higher then Alberta. Full time hourly minimum wage workers in Alberta earn a total of $352.00 per week and approximately $18,304.00 per year (based on a 8 hour days and a 260-day work year).
  6. Social Assistance rates did not increase between1993 and 2002
  7. In 2008, “as the nation headed into a brutal recession, there were just over 3 million Canadians living in poverty using the standard measure, Statistic Canada’s after-tax low-income cut-off (LICO) (more).”
  8. Approximately 1.27 million households (or 12.4 percent of Canadian households) live in housing that requires major repairs, is overcrowded, and/or costs more than 30 percent of household income (more).
  9. One in five Calgarians lived in poverty in 2002.
  10. Minimal new social housing was built for people who cannot afford market rents. 2002
  11. In Canada the federal, provincial and municipal governments have roles and responsibilities to address housing issues. But most of the responsibility has fallen to municipal governments to find and fund solutions.
  12. According to a 2003 KPMG study of corporations in the United States, quality of life indicators were important key business environment factors. It was also important that a city had low crime, good access to health facilities, access to affordable housing and educational facilities (more).

References

Further Reading

External Links
Federation of Canadian Municipalities http://www.fcm.ca/CMFiles/bcmcfinal1LND-3282008-4938.pdf
Policy Alternatives http://www.policyalternatives.ca/publications/commentary/fast-facts-electing-house-canadians-or-not

http://www.policyalternatives.ca/publications/commentary/canadas-poverty-hole

http://www.calgary.ca/docgallery/bu/cns/homelessness/thresholds_locating_affordable_housing.pdf

(OLSH

Sawatsky and Stroick 2005
Ottawa Charter


1785 German philosopher Immanuel Kant () in his publication entitled “Fundamental Principles of the Metaphysics of Morals” translated by Thomas Kingsmill Abbott

1839 According to Rifkin (EC 2009:346) it was the German philosopher, Arthur Schopenhauer , (1788 – 1860) who was the first to clearly define the empathic process. In his paper entitled On the Basis of Morality (Über die Grundlage der Moral) submitted to the Royal Danish Society of Scientific Studies, Schopenhauer argued against Kant’s purely rational-based, prescriptive ethics and offered an opposing description of the source and foundation of morals. Schopenhauer made the controversial claim that compassion animated by feelings and emotions formed the basis of morality.

links

http://www.gutenberg.org/cache/epub/11945/pg11945.html

http://www.archive.org/stream/basisofmorality00schoiala/basisofmorality00schoiala_djvu.txt


In the 199os an artist-musician and close friend originally from Haiti, Emmanuel Printemps, used to visit us regularly on Friday evenings and we would ask him to share his music with us and our other guests. We always requested one of his most moving, enchanting Creole songs, the powerful but sad story of the local butcher who lost his livelihood during the pig slaughter. As I follow the events in Haiti since the earthquake, I think of these precious friends from another time and place; they and their families are in our hearts and prayers.

Rural peasants in Haiti raised a very hardy breed of creole pigs which along with goats, chickens, and cattle served as a savings account. It was argued that from 1978 to 1982 about 1/3 of Haiti’s pigs became infected with the highly contagious African Swine Fever (ASF) in an epidemic that had spread along the Artibonite River shared with the Dominican Republic whose pigs had caught the virus from European sources. At first peasants were encouraged to slaughter their own pigs but then the Haitian government proceeded on a total eradication program that virtually wiped out what remained of the 1.2-million pig population by 1982. Farmers argued that they were not adequately compensated for their losses. The more robust creole pigs were replaced with a sentinel breed of U. S. pigs that were not adapted to Haiti’s ecosystem or market. For Haiti’s rural peasants the loss of income due to the virus and the government’s controversial eradication and repopulation programs led to further impoverishment and greater hardship, ultimately resulting in greater political instability.

View

In two webviral posts entitled “The Hate and the Quake: Rebuilding Haiti” by scholar, historian Sir Hilary Beckles of the University of the West Indies, (Beckles 2010-01-19) that are now circling the globe , we need to do some memory work before we conclude that Haitians are the architects of their own impoverishment.

In this seminal retelling of Haiti’s history,  (Beckles 2010-01-19) reminds us all that when Haiti provided freedom and the right of citizenship to any person of African descent who arrived on the shores of the newly formed Haitian republic (1805), the newly formed nation-state (1804) was strategically punished by Western countries, through economic isolation ( (Beckles 2010-01-19)).

From 1805 through 1825 Haiti was completely denied access to world trade, finance, and institutional development in “the most vicious example of national strangulation recorded in modern history ( (Beckles 2010-01-19)).”

In 1825 in an attempt to be a part of international markets, Haiti entered into negotiations with France which resulted in payment of a reparation fee of 150 million gold francs to be paid to France in return for national recognition. The installments were made from 1825 until 1922. From 1825-1900 alone this amounted to 70% of Haiti’s foreign exchange earnings. Beckles (2010-01-) argues that this merciless exploitation caused the Haitian economy to collapse  (Beckles 2010-01-19).

Furthermore, when Haiti’s coffee or sugar yields declined, the Haitian government had to borrow money from the United States at double the going interest rate in order to repay their punishing debt to the French government (Beckles 2010-01-19) .

From 1915-1934 the United States occupied Haiti under orders of President Woodrow Wilson in response to concerns that Haiti was unable to make its considerable loan payments to American banks to which Haiti was deeply in debt. The brutal U.S. occupation of Haiti caused problems that lasted long after 1934.

Webliography and Bibliography

Beckles, Hilary. 2010-01-19. “The Hate and the Quake: Rebuilding Haiti.” Posted by Sir Hilary Beckles on Jan 19th, 2010 and filed under Caribbean.

Beckles, Hilary. 2010-01-31. “The Hate and the Quake: Part 2” Sir Hilary Beckles, Contributor

August 26, 2009


The concept of hyphen-ethics is most relevant in the field of bioethics where health care issues are inextricably linked with the market and the perceived needs of the health industry (medical professionals, pharmaceutical companies, fund-raising organizations such as cancer research fund-raisers) to enjoy economic health. It is not just about caring for the human need for well-being or even a freedom from suffering although this is the subject of current debates on universal health care. Who will decide what is a human need and what is a want in terms of defining basic, adequate, essential and/or discretional health care access. When and where do health resources end? What are the ends of medicine? What is the nature of medicine? What are the limits to imposed regulations and health care?

The calm witness in the debate on universal health care, a man married to a long-term cancer survivor, is concerned that proposed federal regulations, would deprive him of the current level of health care services his family needs. In a closer reading of his family’s story, his wife’s free access to a $60,000 treatment was through an act of philanthropy on the part of the treatment providers. Would this be affected by providing access to others who are lacking insurance or who have inadequate insurance? Her other medical bills were paid through his work plan. But what if he, like so many others today, suddenly no longer had an employer who provided a health plan? Perhaps what he is really expressing is gratitude for what he was able to receive and hope that others will be as fortunate when faced with a family health crisis.

In 1981 philosopher Amy Gutmann published an article entitled, “For and Against Equal Access to Health Care” in the Milbank Memorial Fund Quarterly. When the article was reprinted in 1999, the editors described how, “The Gutmann piece was written long before the failure of the Clinton plan but it still remains a classic argument for a national or universal health care system. A principal feature of her argument is that a one-class health care system, one for the rich, the middle classes and poor alike, promotes a health care system that caters to the needs of the better off as well as the poor, and this will strengthen the overall system level of benefits. Gutmann for practical political reasons acknowledges that a one-class system could not go so far as to forbid the rich from purchasing more health care outside the system, spending out of-pocket (Beauchamp; Steinbock 1999:253).”

“I suspect that no philosophical argument can provide us with a cogent principle by which we can draw a line within the enormous group of goods that can improve health or extend life prospects of individuals . . . The remaining question of establishing a precise level of priorities among health care and other goods is appropriately left to democratic decision-making (Gutmann 1981: 542-60)

Because of his close advisory position with President Obama on health care issues, Ezekiel J. Emanuel’s opinions are being scrutinized. In his article (1996-11/12) entitled “Where Civic Republicanism and Deliberative Democracy Meet,” seems to misinterpret Gutmann’s arguments as extremely dangerous moral skepticism. Emanuel assumed that she concluded, that there can be no principled mechanism to define basic health care services and, therefore, that the efforts to ensure universal access will always founder on the fear that guaranteeing any health care to all citizens means guaranteeing all available services. It suggests we should just give up on a just allocation of health care resources because we can never succeed (Emanuel 1996:13).” Emanuel misread her carefully worded debate in which she succinctly summarizes various perspectives on access to health care in the pre-Clinton health care debate period. In one scenario she traces the unintended consequences of imposed universal access in an imperfect world and goes on to suggest a pragmatic solution. In fact Gutmann concludes, “I began by arguing that a principle of equal access to health care was at best an ideal toward which our society might strive. I shall end by qualifying that statement. A sufficiently high level of public provision of health care for all citizens and a sufficiently elastic supply of health care would significantly reduce the threat to universal provision of quality health care of a private market in extra health care goods, just as a very high level of police protection and education reduces the inequalities of opportunity resulting from purchase of private bodyguards or of private school education by the rich. In the best of all imaginable worlds of egalitarian justice, the equal access principle would be sufficiently supported by other egalitarian social and economic institutions that a market in health care would complement rather than undercut the goals of equal respect and opportunity. But philosophers ought to resist basing their political recommendations solely upon a model of the best of all imaginable worlds (Gutmann 1999 [1981:253]).”

Emanuel (1996:13)

suggests that, “Regardless, a refined view has emerged that begins to overlap between liberalism and communitarianism. This overlap inspires hope for making progress on the just allocation of health care resources. This refined view distinguishes issues within the political sphere into four types: (1) issues related to constitutional rights and liberties; (2) issues related to opportunities, including health care and education; (3) issues related to the distribution of wealth such as tax policies; and (4) other political matters that may not be matters of justice but are matters of common good, such as environmental policies and defense politicies. While there still may be disagreement about the need for a neutral justification for rights and liberties, there is consensus between communitarians and liberals that policies regarding opportunities, wealth, and matters of the common good can only be justified by appeal to a particular conception of the good. As Rawls has put it:

Public reason does not apply to all political questions but only to those involving what we may call “constitutional essentials.”3 (Emanuel 1996:13).”

TBC

1960s the dominant social issue of the 1960s and 1970s was that of justice and equality. Given that context, it was hardly surprising that the field of bioethics saw a great surge of writing and debate on issues of justice and health care.(Daniels, Emanuel and Jennings 1996).

1970s the dominant social issue of the 1960s and 1970s was that of justice and equality. Given that context, it was hardly surprising that the field of bioethics saw a great surge of writing and debate on issues of justice and health care.(Daniels, Emanuel and Jennings 1996).

1972 John Rawls’ 1972 study A Theory of Justice “was not only a powerful work in its own right but perfectly in step with the times. Given that context, it was hardly surprising that the field of bioethics saw a great surge of writing and debate on issues of justice and health care. That was, and still is, a central topic. Far less important for many years was any serious discussion of the ends of medicine. To be sure, there was and is a field known as the philosophy of medicine that has given considerable attention to the nature of medicine. But the discussion in that field – which was often technical and historical in any case, self-consciously academic and scholarly – proceeded independently of the interest in health care equality. And vice-versa. In retrospect, that seems an odd bifurcation. How is it possible to have a full examination of a field as dynamic and fast-changing as health care without – simultaneous – asking some basic questions about what health care is supposed to give us and do for us? Norman Daniels, in his fine work on justice and health care, has come as close as anyone to attempting to find the specific link between the ends of health care and fair access to it. By his use of the concept of species-typical functioning as the goal of medicine he has sought to (Daniels, Emanuel and Jennings 1996).

1981 Philosopher Amy Gutmann published an article entitled, “For and Against Equal Access to Health Care” in the  Milbank Memorial Fund Quarterly. “The Gutmann piece was written long before the failure of the Clinton plan but it still remains a classic argument for a national or universal health care system. A principal feature of her argument is that a one-class health care system, one for the rich, the middle classes and poor alike, promotes a health care system that caters to the needs of the better off as well as the poor, and this will strengthen the overall system level of benefits. Gutmann for practical political reasons acknowledges that a one-class system could not go so far as to forbid the rich from purchasing more health care outside the system, spending out of-pocket (Beauchamp; Steinbock 1999:253).”

“I suspect that no philosophical argument can provide us with a cogent principle by which we can draw a line within the enormous group of goods that can improve health or extend life prospects of individuals . . . The remaining question of establishing a precise level of priorities among health care and other goods is appropriately left to democratic decision-making (Gutmann 1981: 542-60)

1996 Norman Daniels, Ezekiel J. Emanuel and Bruce Jennings co-authored the Hastings Center Report entitled “Is Justice Enough? Ends and Means in Bioethics. “There call be little doubt that the dominant social issue of the 1960s and 1970s was that of justice and equality. It inspired the development of many fresh welfare policies and was a potent motivating force in the advent of Medicare and Medicaid, both thought (mistakenly as it turned out) to be the forerunners of universal health care. John Rawls’ 1972 study A Theory of Justice was not only a powerful work in its own right but perfectly in step with the times. Given that context, it was hardly surprising that the field of bioethics saw a great surge of writing and debate on issues of justice and health care. That was, and still is, a central topic. Far less important for many years was any serious discussion of the ends of medicine. To be sure, there was and is a field known as the philosophy of medicine that has given considerable attention to the nature of medicine. But the discussion in that field – which was often technical and historical in any case, self-consciously academic and scholarly – proceeded independently of the interest in health care equality. And vice-versa. In retrospect, that seems an odd bifurcation. How is it possible to have a full examination of a field as dynamic and fast-changing as health care without – simultaneous – asking some basic questions about what health care is supposed to give us and do for us? Norman Daniels, in his fine work on justice and health care, has come as close as anyone to attempting to find the specific link between the ends of health care and fair access to it. By his use of the concept of species-typical functioning as the goal of medicine he has sought to (Daniels, Emanuel and Jennings 1996).

1996-11/12 Ezekiel J. Emanuel’s article entitled “Where Civic Republicanism and Deliberative Democracy Meet,” cautioned that Gutmann and Daniels’ moral skepticism was extremely dangerous. [I]t suggests that there can be no principled mechanism to define basic health care services and, therefore, that the efforts to ensure universal access will always founder on the fear that guaranteeing any health care to all citizens means guaranteeing all available services. It suggests we should just give up on a just allocation of health care resources because we can never succeed (Emanuel 1996:13).”

1999 “Most books about ethics and health focus on issues arising from individual patients and their relationships with doctors and other health professionals. More and more, however, ethical issues are challenges that face entire communities, not just individual patients. This book is an edited collection of readings that addresses these public health challenges. Many of the issues considered, such as policy for alcohol and other drugs, newly emergent epidemics, and violence prevention, are public health concerns beyond the purview of traditional bioethics. Others, such as access to health care, managed care, reproductive technologies, and genetic testing, are covered in bioethics texts, but here they are approached from the distinct viewpoint of public health. The book makes explicit the community perspective of public health, as well as the field’s emphasis on prevention. It examines the conceptual issues raised by the public health perspective (i.e., what is meant by community, the common good, and individual autonomy) as well as the policies that can be developed when health problems are approached in population-based, preventive terms.” Amazon abstract of: Beauchamp, Dan E.; Steinbock, Bonnie. 1999. New Ethics for the Public’s Health. Oxford University Press. This book includes the

Limited preview – 1999 – 382 pages

2001 In his controversial article entitled “Terminating Life-Sustaining Treatment of the Demented,” Dan Callahan (Callahan 2001:93) claimed that euthanasia is necessary for patients suffering from terminal illness. Opponents claim that euthanasia is immoral and violates reason.

2009-07-17 Senator Edward Kennedy (1932-2009): “We will end the disgrace of America as the only major industrialized nation in the world that doesn’t guarantee health care for all of its people (Kennedy Newsweek).”

“Is there a relationship between defects in our medical ethics and the reason the United States has repeatedly failed to enact universal health coverage? I will begin to suggest an answer to this question by clarifying the locus of allocating decisions. The allocation of health care resources can occur on three levels. The social or, in the economist’s language, the macro level entails the proportion of the gross national product (GNP) allocated to health care. The patient, or micro, level entails determining which individual patients will receive specific medical services; that is, whether Mrs. White should receive this available liver for transplantation. Finally, there is an intermediate level called the service or medical level that entails determining what health care services will be guaranteed to each citizen. These socially guaranteed services have been called “basic” or “essential” medical services or what the President’s Commission designated as “adequate health care.” Clearly, these three levels are connected. A larger proportion of the GNP going to health permits coverage of more services. Similarly, as demonstrated by the end-stage renal disease program, providing specific services to a wider range of patients causes upward pressure on the proportion of the GNP going to health care and/or reduces the range of services covered as part of basic medical services. Despite these connections, these three levels are conceptually distinct.(Emanuel 1996:12)”

“The fundamental challenge to theories of distributive justice for health care is to develop a principled mechanism for defining what fragment of the vast universe of technically available, effective medical care services is basic and will be guaranteed socially and what services are discretionary and will not be guaranteed socially. Such an approach accepts a two-tiered health system- some citizens will receive only basic services while others will receive both basic and discretionary health services. Within the discretionary tier, some citizens will receive few discretionary services, and other richer citizens will receive almost all available services, creating a multiple-tiered system (Emanuel 1996:12).”

“Underlying the repeated failure of attempts to provide universal health care coverage in the United States is the failure to develop a principled mechanism for characterizing basic health services. Americans fear that is society guarantees certain services as “basic,” the range of services guaranteed will expand to include all-or almost all- available services (except for cosmetic surgery and therapies that have not been proven effective or proven ineffective). So rather than risk the bankruptcy of having nearly every medical service socially guaranteed to all citizens, Americans have been willing to tolerate a system in which the well insured receive a wide range of medical services with some apparently basic services uncovered; Medicare beneficiaries receive fewer services with some discretionary services covered and some services that intuitively seem basic uncovered; Medicaid beneficiaries and uninsured persons receive far fewer services (Emanuel 1996:12).”

“On this view, the reason the United States has failed to enact universal health coverage is not primarily political or economic; the real reason is ethical- it is a failure to provide a philosophically defensible and practical mechanism to distinguish basic from discretionary health care services. What is the reason for this failure of medical ethics?(Emanuel 1996:12).”

“There are two opposing explanations. One explanation points to the inherent limits of ethics. Some philosophers, such as Amy Gutmann and Norman Daniels, argue that we lack sufficiently detailed ethical intuitions and principles to establish priorities among the vast array of health care services. Every time we try to define basic services our intuition “runs out.” As Gutmann once wrote:

I suspect that no philosophical argument can provide us with a cogent principle by which we can draw a line within the enormous group of goods that can improve health or extend life prospects of individuals . . . The remaining question of establishing a precise level of priorities among health care and other goods is appropriately left to democratic decision-making1

(Emanuel 1996:12).”

“Taken at face value, this moral skepticism is extremely dangerous; it suggests that there can be no principled mechanism to define basic health care services and, therefore, that the efforts to ensure universal access will always founder on the fear that guaranteeing any health care to all citizens means guaranteeing all available services. It suggests we should just give up on a just allocation of health care resources because we can never succeed (Emanuel 1996:13).”

“The second explanation holds the problem with definining basic health care services is not a general lapse of ethics, but a specific lapse of liberal political philosophy that informs our political discourse, including the allocation of health care resources. The problem is that priorities among health care services can be established only by invoking a conception of the good, but this is not possible within the framework of liberal political philosophy. Liberalism divides moral issues into three spheres: the political, social, and domestic. It then holds that within the political sphere, laws and policies cannot be justified by appeals to the good. To jusify laws by appealing to the good would violate the principle of neutrality and be coercive, imposing one conception of the good on citizens who do not necessarily affirm that conception of the good. But without appealing to a conception of the good, it is argued, we can never establish priorites among health care services and define basic medical services. This is Dan Callahan’s view with which I agree:2

. . . there can be no full discussion of equality in health care without an equally full discussion on the substantive goods and goals that medicine and health care should pursue . . . [U]nless there can be a discussion of the goals of medicine in the future as rich as that of justice and health has been, the latter problem will simply not admit of any meaningful solution (Emanuel 1996:13).”

[In his controversial article entitled “Terminating Life-Sustaining Treatment of the Demented,” Dan Callahan (Callahan 2001:93) claimed that euthanasia is necessary for patients suffering from terminal illness. Opponents claim that euthanasia is immoral and violates reason.]

“Fortunately, many including many liberals, have come to view as mistaken a liberalism with such a strong principle of neutrality and avoidance of the public good. Some think the change a result of the critique provided by communitarianism; others see it as a clarification of basic liberal philosophy. Regardless, a refined view has emerged that begins to overlap between liberalism and communitarianism. This overlap inspires hope for making progress on the just allocation of health care resources. This refined view distinguishes issues within the political sphere into four types: (1) issues related to constitutional rights and liberties; (2) issues related to opportunities, including health care and education; (3) issues related to the distribution of wealth such as tax policies; and (4) other political matters that may not be matters of justice but are matters of common good, such as environmental policies and defense politicies. While there still may be disagreement about the need for a neutral justification for rights and liberties, there is consensus between communitarians and liberals that policies regarding opportunities, wealth, and matters of the common good can only be justified by appeal to a particular conception of the good. As Rawls has put it:

Public reason does not apply to all political questions but only to those involving what we may call “constitutional essentials.”3 (Emanuel 1996:13).”

More expansively, Brian Barry has written:

Examples of issues that fall outside [the principle of neutrality include] two distinct kinds of items. One set of items (tax and property laws) contains matters that are in principle within the realm of “justice as fairness” but are subject to reasonable disagreement about the implications of justice . . . The other set . . . contains issues that in the nature of the case cannot be resolved without giving priority to one conception of the good over others . . . There is no room for a complaint of discrimination simply on the ground that the policy by its nature suits those with one conception of the good more than it suits those with some different one. This is unavoidable.4 (Emanuel 1996:13).”

“Thus it seems there is a growing agreement between liberals, communitarians, and others that many political matters, including matters of justice- and specifically, the just allocation of health care resources- can be addressed only by invoking a particular conception of the good (Emanuel 1996:13).”

“We may go even further. Without overstating it (and without fully defending it) not only is there a consensus about the need for a conception of the good, there may even be a consensus about the particular conception of the good that should inform policies on these nonconstitutional political issues. Communitarians endorse civic republicanism and a growing number of liberals endorse some version of deliberate democracy. Both envision a need for citizens who are independent and responsible and for public forums that present citizens with opportunities to enter into public deliberations on social policies (Emanuel 1996:13).”

“This civic republican deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity- those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations- are to be socially guaranteed as basic. Conversely, servuces provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia [13] [In his controversial article entitled “Terminating Life-Sustaining Treatment of the Demented,” Dan Callahan (Callahan 2001:93) claimed that euthanasia is necessary for patients suffering from terminal illness. Opponents claim that euthanasia is immoral and violates reason]. A less obvious example is guaranteeing neuropyschological services to ensure children with learning disabilities can read and learn to reason (Emanuel 1996:14).”

“Clearly, more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services. Perhaps using this progress in political philosophy we can address Dan’s challenge, begin to discuss the goods and goals of medicine (Emanuel 1996:14).”

References

Callahan, Dan. 2001. “Terminating Life-Sustaining Treatment of the Demented.” Bioethics Ed. John Harris. New York: Oxford University Press. p. 93.

Gutman, Amy. 1981. “For and Against Equal Access to Health Care.” Milbank Memorial Fund Quarterly. 59:542-60.

Emanuel, Ezekiel J. 1991. The Ends of Human Life. Cambridge, Mass: Harvard University Press. Chapter 4.

Norman Daniels , Ezekiel J. Emanuel , Bruce Jennings. 1996. “Is Justice Enough? Ends and Means in Bioethics.” The Hastings Center Report. 26.

Rawls, John. 1993. Political Liberalism. New York: Columbia University Press. p. 214.

Barry, Brian. 1995. Justice as Impartiality. New York: Oxford University Press. pp. 144-145.

Emanuel, Ezekiel J. 1996-11/12. “Where Civic Republicanism and Deliberative Democracy Meet.” Hastings Centre Report. November-December.

Beauchamp, Dan E.; Steinbock, Bonnie. 1999. New Ethics for the Public’s Health. Oxford University Press.


Arctic Adventurer: a Flicktion

Arctic Adventurer: a Flicktion,
originally uploaded by ocean.flynn.

In the few short months that I have spent in Nunavut, two mothers who had become my colleagues and friends, lost youthful sons to suicide. Within a brief period of two months, four youth in a community of less than 1,500 people committed suicide. Almost the entire community attended the funeral. The hall was filled with infants, toddlers, children, youth, adults and elders. The youngest children wove between chairs and family members comfortably a part of community life. Youth dressed in southern street-smart clothing respectfully gave their seats to elders. The shared pain in the room at the loss of their youth through suicide, was suffocating. At the graveside, it was cold and windy. It began to snow. As one mother witnessed the shovel-fulls of sand thudding onto her son’s coffin, another walked quietly alone to another fresh grave nearby. I stood there helpless feeling so overwhelmed I couldn’t move. I know many others felt the same paralysis. How many of us were mothers? How many of us had sons in their twenties?

The family of the young man, colleagues and friends provided support to the parents and to each other. On the return flight home, one man was unusually upbeat and talkative. Perhaps that is his way of dealing with the pain. I didn’t know who he was. He sat behind me. As I left the plane I asked the woman next to me who this man was. To my astonishment it was the *** for Nunavut.

Following the suicides, friends and acquaintances attempted to find ways of absorbing yet another tragedy. Some felt anger at the youth who committed suicide. Many expressed feelings of numbness. Some regretted their own inability to know what to do. They felt guilty for not knowing how to prevent it. Like many others I feel a sense of powerlessness.

November 21, 2003: (I hope things go well with you. I am writing to ask your favour in helping a bit on your recent (and future) expense claims. I know that S.H. is a bit harried, working herself as a full-time instructor as well as the financial manager on this project. I really do not want her — nor is it fair — working as a glorified clerk. Therefore, in her behalf, could you send her a claim that she can file without amendment — that is, typed or in pen, a correct excess baggage sum, and an amended per diem (given kitchen facilities, it should be much less than $70.) working with an actual cost or estimated at around $35 or $40. We are tight on this project, especially as I went the extra mile on the term appointment. Many thanks.)

December 11, 2002: While waiting for my plane at the Iqaluit airport I met a physician-researcher who had just completed a report on the Nunavut Ministry of Health. She told me about a two-hour conversation she had with a man called TNC in a hotel bar in Rankin Inlet. TNC had lost a friend to suicide. He was deeply bothered by his loss. He went to see a nurse. The nurse became very uncomfortable when Tommy mentioned he was depressed and upset by this suicide. She sent him to a Social Worker. The Social Worker was also ill at ease. She called the police. TNC spent the night in jail. They were concerned he might hurt himself. Because the small hamlet had no counselling services, TNC was flown to Yellowknife. He was separated from the only real support system he had — his mother and grandmother in Rankin Inlet. Later on the plane I sat beside a young man GRB. GRB worked for Baffin Correctional Centre. He started there in c.1996. He told me about a millionaire who made his fortune by buying high-end buildings in Iqaluit, then renting them at high rents to the Nunavut Government. GRB loved speed — the speed of the snow machine. His best moments were out on the land with a half a dozen friends on powerful machines. His work bothered him. He felt surrounded by uneducated, untrained fellow-workers — many of whom came from Halifax — who cared little for the young offenders. Many were there because they could earn huge salaries — especially with overtime. Some of them didn’t even have high school education and in Iqaluit they were earning much more than they ever could in the Maritimes. It frustrated him to see how these untrained workers wanted to work by the book to earn points from the supervisors. Sometimes a situation could be diffused before it became violent and ugly. By rigidly following the book, a small incident could escalate into an ugly incident very quickly. GRB came to know the offenders so he knew how to calm things. Increasingly the workers who lacked experience but were older than him, made the situations worse. GRB noticed the most improvement in the youth came through the on-the-land program. Youth would spend a couple of months with the elders. They came back healthier and more confident. He commented on the work of the psychiatrist Dr. Q He said that Dr. Q tried to prevent the worst from happening but he was not really in control of the situation. He was not able to make all the decisions that would be beneficial to the youth. GRB said that Iqaluit youth threatening suicide would be sent to the Youth detention centre. He would be stripped down, showered and then given ‘baby dolls’ to wear before being locked in a safe cell where he could do himself no harm. (What a contrast to the treatment my friend’s son received in Ottawa. )

June 2002: This text will change organically as the flicktion develops.

Uploaded by ocean.flynn on 30 Nov 06, 9.15PM MDT.


“Keep alive in your hearts
the feeling of confidence
that the light of knowledge
will inevitably dispel
the clouds of ignorance,
the conviction
that concern for justice
will ultimately conquer
hatred and enmity.
[… The] proper response to oppression
is neither to succumb in resignation
nor to take on the characteristics of the oppressor.
The victim of oppression
can transcend it
through an inner strength
that shields the soul
from bitterness and hatred
which sustains
consistent principled action.” UHJ 2009

There is such a contrast between the use of the term “principled action” when used here for healing the human spirit and the way it is used in writings referring to doing ethics, applied ethics, ethics talk. Is it about words or deeds?

“Keep alive in your hearts” calls to all of us to sustain consistent principled action freed from bitterness and hatred even when oppressed, refuse to resign to victimization,  be careful not to respond to oppression by taking on the characteristics of the oppressor, struggle to continue to believe that knowledge will overcome ignorance, that justice will conquer injustice, nurture and maintain  inner strength that will sustain us through the most ethically distressing dilemmas of our lives, nurture confidence when you feel doubt, seek knowledge instead of vengeance. This far transcends concepts of ethical codes and minimal ethical standards.

“Some people confuse acting in good conscience with “doing ethics”. While personal good conscience is necessary for acting ethically, it is not sufficient.  There is also confusion of so-called “codes of ethics’ which are really codes of professional etiquette – for instance, between physicians or between lawyers – or which define unprofessional conduct, with codes of ethics properly so-called. Just because certain conduct does not breach professional norms, does not necessarily mean that it is ethical […] “Doing ethics”, especially by an ethicist, requires one to undertake an informed structured analysis that will assist in the identification and prioritisation of the full range of values relevant to, or affected by, the various decision options that are open in any given situation. It is inevitable that one’s own values come into play, but they should be identified as such and the other people involved advised of this. I sometimes imagine that “doing ethics” can be compared with opening a beautiful, intricately painted fan. The struts are the different schools of ethics, or the fundamental bases of the alternative analyses that could be used. The fabric that joins the struts may display one or several scenes. When we all agree on the outcome, although we do so for different reasons, we are choosing a different location in the one scene. When we disagree on the outcome, we are identifying several scenes and arguing that one scene is fundamental and should take priority in setting the overall tone or interpretation of the painting that the artist has portrayed on the fan, and that the other scenes must be interpreted in light of this. We all need to learn how to do ethics, even if we do not always succeed in doing this. “Doing ethics” is not a simple task; it is a process, not an event; and, in many ways, no matter in which capacity or context we do ethics, it is a life-long learning experience. The most important requirement, however, is that we all engage in that process, that is, we all participate in “ethics talk” (Somerville 2006).



Following in the footsteps of great Western philosopher’s peripatetic origins (Socrates, Nietzsche, Rousseau, Kierkegaard and Walter Benjamin) Writer and Director Astra Taylor invited Cornel West (Cultural Studies scholar and campaign advisor to Barack Obama), Avital Ronell (who co-taught a graduate course with the late Jacques Derrida), Peter Singer, Kwame Anthony Appiah, Martha Nussbaum, Michael Hardt, Slavo Zizek, Judith Butler and her own sister Sunara Taylor to walk the talk while examining contemporary social and ethical issues in her 2008 documentary The Examined Life. Following Philadelphia curator and academic Aaron Levy’s suggestion that camera shy or timid speakers might be more comfortable walking, and enthused by Rebecca Solnit’s book Wanderlust, “a magisterial history of walking,” Astra Taylor decided to ask the big questions using the peripatetic approach. She filmed Cornel West in the back of a New York city cab as it wove through traffic. Peter Singer navigated Manhattan’s Fifth Avenue , a high-end shopping area with luxury items reflected in windows and on shopping bags flashing behind him. She chose a garbage dump as backdrop for Slavoj Zizek’s conversation on ecology. In this a series of vignettes she attempts to demonstrate the accessibility of philosophy, reiterating Isaiah Berlin and Bertrand Russell that, “the central visions of the great philosophers are essentially simple.” Through this documentary she stresses the urgency for a philosophy with a cosmopolitical point of view as “the myriad problems facing us [in our broken world . . . one beset by problems both interpersonal and political], demand more thinking than ever, not less.” Philosophy helps us to “search for meaning and our responsibilities to others in a [world] full of inequity and suffering.”

 

http://www3.nfb.ca/webextension/examined-life/medias/pdf/ExaminedLife.pdf

www.nfb.ca/examined-life

www.nfb.ca/press-room/photo-gallery

http://www.calgarysun.com/entertainment/movies/2009/04/17/9142811-sun.html

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