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But even when the perfect liver became available a few days after she was put on the list, doctors could not operate. What made Nataline different from most transplant patients, and what eventually brought her case to the attention of much of the country, was that her survival did not depend on the availability of an organ or her clinicians or even the quality of care she received. It rested on her health insurance company.

Cigna had denied the initial request to cover the costs of the liver transplant. And the insurer persisted in its refusal, claiming that the treatment was “experimental” and unproven, and despite numerous pleas from Nataline’s physicians to the contrary.

But as relatives and friends organized campaigns to draw public attention to Nataline’s plight, the insurance conglomerate found itself embroiled in a public relations nightmare, one that could jeopardize its very existence. The company reversed its decision. But the change came too late. Nataline died just a few hours after Cigna authorized the transplant.

Mr. Potter was the head of corporate communications at two major insurers, first at Humana and then at Cigna. Now Mr. Potter has written a fascinating book that details the methods he and his colleagues used to manipulate public opinion

Mr. Potter goes on to describe the myth-making he did, interspersing descriptions of front groups, paid spies and jiggered studies with a deft retelling of the convoluted (and usually eye-glazing) history of health care insurance policies.

We learn that executives at Cigna worried that Nataline’s situation would only add fire to the growing public discontent with a health care system anchored by private insurance. As the case drew more national attention, the threat of a legislative overhaul that would ban for-profit insurers became real, and Mr. Potter found himself working on the biggest P.R. campaign of his career.

Cigna hired a large international law firm and a P.R. firm already well known to them from previous work aimed at discrediting Michael Moore and his film “Sicko.” Together with Cigna, these outside firms waged a campaign that would eventually include the aggressive placement of articles with friendly “third party” reporters, editors and producers who would “disabuse the media, politicians and the public of the notion that Nataline would have gotten the transplant if she had lived in Canada or France or England or any other developed country.” A “spy” was dispatched to Nataline’s funeral; and when the Sarkisyan family filed a lawsuit against the insurer, a team of lawyers was assigned to keep track of actions and comments by the family’s lawyer.

In the end, however, Nataline’s death proved to be the final straw for Mr. Potter. “It became clearer to me than ever that I was part of an industry that would do whatever it took to perpetuate its extraordinarily profitable existence,” he writes. “I had sold my soul.” He left corporate public relations for good less than six months after her death.

“I don’t mean to imply that all people who work for health insurance companies are greedier or more evil than other Americans,” he writes. “In fact, many of them feel — and justifiably so — that they are helping millions of people get they care they need.” The real problem, he says, lies in the fact that the United States “has entrusted one of the most important societal functions, providing health care, to private health insurance companies.” Therefore, the top executives of these companies become beholden not to the patients they have pledged to cover, but to the shareholders who hold them responsible for the bottom line.

Doctors and other health-care workers can provide patients and families with probabilities for improvement or recovery, but statistics are hardly what is wanted. Even after profound injury or the diagnosis of an illness that statistically is nearly certain to be fatal, what people hear is the word nearly. How do we not allow the death of someone who might be saved? How do we avoid the equally intolerable salvation of a clinically dead person?

Injecting political agendas into these end-of-life complexities only confuses the problem without providing a solution.

The questions are how, when, and on whose terms we depart. It is curious that people might be convinced to avoid confronting death while they are healthy, and that society tolerates ad hominem arguments that obstruct rational debate over an authentic problem of ethics in an uncertain world.

Any seriously ill older person who winds up in a modern CCU immediately yields his autonomy. Even if the doctors, nurses, and staff caring for him are intelligent, properly educated, humanistically motivated, and correct in the diagnosis, they are manipulated not only by the tyranny of technology but also by the rules established in their hospital. In addition, regulations of local and state licensing agencies and the federal government dictate the parameters of what the hospital workers do and how they do it, and every action taken is heavily influenced by legal experts committed to their client’s best interest—values frequently different from the patient’s. Once an acutely ill patient finds himself in this situation, everything possible will be done to save him; he is in no position to offer an opinion.

Eventually, after hours or days (depending on the illness and who is involved in the care), the wisdom of continuing treatment may come into question. But by then the patient will likely have been intubated and placed on a ventilator, a feeding tube may have been inserted, a catheter placed in the bladder, IVs started in peripheral veins or threaded through a major blood vessel near the heart, and monitors attached to record an EKG, arterial blood pressure, temperature, respirations, oxygen saturation, even pressure inside the skull. Sequential pressure devices will have been wrapped around the legs. All the digital marvels have alarms, so if one isn’t working properly, an annoying beep, like the sound of a backing truck, will fill the patient’s room. Vigilant nurses will add drugs by the dozens to the IV or push them into ports. Families will hover uncertainly. Meanwhile, tens and perhaps hundreds of thousands of dollars will have been transferred from one large corporation—an insurer of some kind—to another large corporation—a health care delivery system of some kind.

While the expense of the drugs, manpower, and technology required to make a diagnosis and deliver therapy does sop up resources and thereby deny treatment that might be more fruitful for others, including the 46.3 million Americans who, according to the Census Bureau, have no health insurance, that isn’t the real dilemma of the critical care unit.

the problem isn’t getting into or out of a CCU; the predicament is in knowing who should be there in the first place.

Before we become ill, we tend to assume that everything can be treated and treated successfully. The prelate in Willa Cather’s Death Comes for the Archbishop was wiser. Approaching the end, he said to a younger priest, “I shall not die of a cold, my son. I shall die of having lived.”

best way to avoid unwanted admission to a critical care unit at or near the end of life is to write an advance directive (a living will or durable power of attorney for health care) when healthy.

, not many people do this and, more regrettably, often the document is not included in the patient’s chart or it goes unnoticed.

Since we are sure to die of having lived, we should prepare for death before the last minute. Entire corporations are dedicated to teaching people how to retire well. All of their written materials, Web sites, and seminars begin with the same advice: start planning early. Shouldn’t we at least occasionally think about how we want to leave our lives?

Flannery O’Connor, who died young of systemic lupus, wrote, “Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.”

Because we understand the metaphor of conflict so well, we are easily sold on the idea that we must resolutely fight against our afflictions (although there was once an article in The Onion titled “Man Loses Cowardly Battle With Cancer”). And there is a place to contest an abnormal metabolism, a mutation, a trauma, or an infection. But there is also a place to surrender. When the organs have failed, when the mind has dissolved, when the body that has faithfully housed us for our lifetime has abandoned us, what’s wrong with giving up?

Bishop Olmstead is not only castigating Catholic Healthcare West, the group that runs St. Joseph's Hospital, for saving her life but threatening them in order to force them to promise that doctors will never save a woman's life if it requires an emergency abortion ever again.

In a letter (PDF) to Lloyd H. Dean, President of Catholic Healthcare West, Bishop Olmstead calls the life-saving procedure "morally wrong" even though he doesn't deny that it almost certainly saved her life. The ACLU notes that he then "threatens to remove his endorsement of the hospital unless CHW "acknowledge[s] in writing that the medical procedure that resulted in the abortion at St. Josephs' Hospital was a violation" of the policy that governs all Catholic hospitals and "will never occur again at St. Joseph's Hospital."

it seems as if Dean and CHW have stuck to their position that not only were their actions moral and just, in this circumstance, but that they certainly would not promise not to save a woman's life or health if presented with a similar case in the future. In fact, they presented both religious and moral ethicists' opinions as support for the hospital's actions.

The ACLU claims that Olmstead's insistence that the hospital must never provide an emergency abortion procedure is actually a violation of federal law. Alexi Kolbi-Molinas, staff attorney for the ACLU, said in a statement this week: "Religiously affiliated hospitals are not exempt from federal laws that protect a patient's right to receive emergency care, and cannot invoke their religious status to jeopardize the health and lives of pregnant women. Women should never have to be afraid that they will be denied life-saving medical care when they enter a hospital."

The federal law, in specific, to which Kolbi Molinas refers is the Emergency Medical Treatment and Active Labor Act. The law protects patients' rights to receive emergency reproductive health care and Catholic hospitals cannot opt out. The law is necessary given that Catholic hospitals operate 15 percent of all hospital beds, according to the ACLU, and may likely provide the only or closest emergency care in a region.

the ACLU requests an investigation into violations of the federal law - not only as a result of the incident at St. Joseph's but after numerous reports of horrendous scenarios: We know that what happened at St. Joseph's was not an isolated incident. Catholic-owned hospitals across the country have refused to provide emergency abortions, as documented in a recent article in the American Journal of Public Health. For example, a doctor in the Northeast decided to leave a Catholic-owned hospital after he was forced by the hospital's ethics committee to risk a pregnant patient's life. The woman was in the process of miscarrying at 19 weeks of pregnancy. She was dying: her temperature was 106 degrees, she had disseminated intravascular coagulopathy, which is a life-threatening condition that prevents a person's blood from clotting normally and causes excessive bleeding. This patient was bleeding so badly that the sclera, the whites of her eyes, were red, filled with blood. Despite the fact that there was no chance the fetus could survive, the ethics committee told the doctor that he could not perform the abortion the woman needed to save her life until the fetus's heartbeat stopped. After the delay, the patient was in the Intensive Care Unit for 10 days, and developed pulmonary disease, resulting in lifetime oxygen dependency.

Still, Bishop Olmstead and the Roman Catholic Diocese are steadfast in their insistence that physicians and hospital administrators acted immorally when they saved the life of a pregnant mother of four children and are determined to ensure that pregnant women are not safe in the hands of Catholic hospitals across the country.

Ms. Ward filed suit in federal district court in the Eastern District of Michigan, alleging that the school violated her constitutional rights to free exercise of religion and freedom of speech.

she argued that counselors do not have a professional obligation to counsel all clients about all issues. Instead, she said, they are permitted to refer clients to other counselors if a client's needs conflict with the counselor's moral convictions.

For a complex and somewhat mysterious set of reasons, it is becoming increasingly difficult for experimental drugs to prove their superiority to sugar pills in RCTs

in recent years, however, has it become obvious that the abatement of symptoms in control-group volunteers — the so-called placebo effect — is worthy of study outside the context of drug trials, and is in fact profoundly good news to anyone but investors in Pfizer, Roche, and GlaxoSmithKline.

The emerging field of placebo research has revealed that the body’s repertoire of resilience contains a powerful self-healing network that can help reduce pain and inflammation, lower the production of stress chemicals like cortisol, and even tame high blood pressure and the tremors of Parkinson’s disease.

more and more studies each year — by researchers like Fabrizio Benedetti at the University of Turin, author of a superb new book called The Patient’s Brain, and neuroscientist Tor Wager at the University of Colorado — demonstrate that the placebo effect might be potentially useful in treating a wide range of ills. Then why aren’t doctors supposed to use it?

The medical establishment’s ethical problem with placebo treatment boils down to the notion that for fake drugs to be effective, doctors must lie to their patients. It has been widely assumed that if a patient discovers that he or she is taking a placebo, the mind/body password will no longer unlock the network, and the magic pills will cease to do their job.

For “Placebos Without Deception,” the researchers tracked the health of 80 volunteers with irritable bowel syndrome for three weeks as half of them took placebos and the other half didn’t.

In a previous study published in the British Medical Journal in 2008, Kaptchuk and Kirsch demonstrated that placebo treatment can be highly effective for alleviating the symptoms of IBS. This time, however, instead of the trial being “blinded,” it was “open.” That is, the volunteers in the placebo group knew that they were getting only inert pills — which they were instructed to take religiously, twice a day. They were also informed that, just as Ivan Pavlov trained his dogs to drool at the sound of a bell, the body could be trained to activate its own built-in healing network by the act of swallowing a pill.

In other words, in addition to the bogus medication, the volunteers were given a true story — the story of the placebo effect. They also received the care and attention of clinicians, which have been found in many other studies to be crucial for eliciting placebo effects. The combination of the story and a supportive clinical environment were enough to prevail over the knowledge that there was really nothing in the pills. People in the placebo arm of the trial got better — clinically, measurably, significantly better — on standard scales of symptom severity and overall quality of life. In fact, the volunteers in the placebo group experienced improvement comparable to patients taking a drug called alosetron, the standard of care for IBS. Meet the ethical placebo: a powerfully effective faux medication that meets all the standards of informed consent.

The study is hardly the last word on the subject, but more like one of the first. Its modest sample size and brief duration leave plenty of room for followup research. (What if “ethical” placebos wear off more quickly than deceptive ones? Does the fact that most of the volunteers in this study were women have any bearing on the outcome? Were any of the volunteers skeptical that the placebo effect is real, and did that affect their response to treatment?) Before some eager editor out there composes a tweet-baiting headline suggesting that placebos are about to drive Big Pharma out of business, he or she should appreciate the fact that the advent of AMA-approved placebo treatments would open numerous cans of fascinatingly tangled worms. For example, since the precise nature of placebo effects is shaped largely by patients’ expectations, would the advertised potency and side effects of theoretical products like Placebex and Therastim be subject to change by Internet rumors, requiring perpetual updating?

It’s common to use the word “placebo” as a synonym for “scam.” Economists talk about placebo solutions to our economic catastrophe (tax cuts for the rich, anyone?). Online skeptics mock the billion-dollar herbal-medicine industry by calling it Big Placebo. The fact that our brains and bodies respond vigorously to placebos given in warm and supportive clinical environments, however, turns out to be very real.

We’re also discovering that the power of narrative is embedded deeply in our physiology.

in the real world of doctoring, many physicians prescribe medications at dosages too low to have an effect on their own, hoping to tap into the body’s own healing resources — though this is mostly acknowledged only in whispers, as a kind of trade secret.

Suppose I concede to Prinz that reason cannot settle differences in moral values and sentiments. Difference of opinion doesn’t mean that there isn’t a true or rational answer. In fact, there are many reasons why our cognition, emotional reactions or previous values could be wrong or irrational — and why people would not pick up on their deficiencies. In his article, Prinz uses the case of sociopaths, who simply lack certain cognitive abilities. There are many reasons other than sociopathy why human beings can get things wrong, morally speaking, often and badly. It could be that people are unable to adopt a more objective morality because of their circumstances — from brain deficiencies to lack of access to relevant information. But, again, none of this amounts to an argument against the existence of objective morality.

As it turns out, Prinz’s conception of objective morality does not quite reflect the thinking of most people who believe in objective morality. He writes that: “Objectivism holds that there is one true morality binding upon all of us.” This is a particular strand of moral realism, but there are many. For instance, one can judge some moral precepts as better than others, yet remain open to the fact that there are probably many different ways to establish a good society. This is a pluralistic conception of objective morality which doesn’t assume one absolute moral truth. For all that has been said, Sam Harris’ idea of a moral landscape does help illustrate this concept. Thinking in terms of better and worse morality gets us out of relativism and into an objectivist approach. The important thing to note is that one need not go all the way to absolute objectivity to work toward a rational, non-arbitrary morality.

even Prinz admits that “Relativism does not entail that we should tolerate murderous tyranny. When someone threatens us or our way of life, we are strongly motivated to protect ourselves.” That is, there are such things as better and worse values: the worse ones kill us, the better ones don’t. This is a very broad criterion, but it is an objective standard. Prinz is arguing for a tighter moral relativism – a sort of stripped down objective morality that is constricted by nature, experience, and our (modest) reasoning abilities.

I proposed at the discussion that a more objective morality could be had with the help of a robust public discourse on the issues at hand. Prinz does not necessarily disagree. He wrote that “Many people have overlapping moral values, and one can settle debates by appeal to moral common ground.” But Prinz pointed out a couple of limitations on public discourse. For example, the agreements we reach on “moral common ground” are often exclusive of some, and abstract in content. Consider the United Nations Declaration of Human Rights, a seemingly good example of global moral agreement. Yet, it was ratified by a small sample of 48 countries, and it is based on suspiciously Western sounding language. Everyone has a right to education and health care, but — Prinz pointed out during the discussion — what level of education and health care? Still, the U.N. declaration was passed 48-0 with just 8 abstentions (Belarus, Czechoslovakia, Poland, Ukraine, USSR, Yugoslavia, South Africa and Saudi Arabia). It includes 30 articles of ethical standards agreed upon by 48 countries around the world. Such a document does give us more reason to think that public discourse can lead to significant agreement upon values.

Reason might not be able to arrive at moral truths, but it can push us to test and question the rationality of our values — a crucial part in the process that leads to the adoption of new, or modified values. The only way to reduce disputes about morality is to try to get people on the same page about their moral goals. Given the above, this will not be easy, and perhaps we shouldn’t be too optimistic in our ability to employ reason to figure things out. But reason is still the best, and even only, tool we can wield, and while it might not provide us with a truly objective morality, it’s enough to save us from complete moral relativism.

perhaps the difference in opinions on this subject expressed by Shindell and Caldeira is nothing more than an academic turf battle over what it means for policy makers to focus on "climate" -- with one wanting the term (and justifications for action invoking that term) to be reserved for long-term climate issues centered on carbon dioxide and the other focused on a broader definition of climate and its impacts.  If so, then it is important to realize that such turf battles have practical consequences. Shindell's breath of fresh air gets the last word with his explanation why it is that we must consider long- and short- term climate impacts at the same time, and how we balance them will reflect a host of non-scientific considerations: So rather than set one against the other, I’d view this as analogous to research on childhood leukemia versus Alzheimer’s. If you’re an advocate for child’s health, you may care more about the former, and if you’re a retiree you might care more about the latter. One could argue about which is most worthy based on number of cases, years of life lost, etc., but in the end it’s clear that both diseases are worth combating and any ranking of one over the other is a value judgement. Similarly, there is no scientific basis on which to decide which impacts of climate change are most important, and we can only conclude that both controls are worthwhile. The UNEP/WMO Assessment provides clear information on the benefits of short-lived forcer reductions so that decision-makers, and society at large, can decide how best to use limited resources.

If we eliminated emissions of methane and black carbon, but did nothing about carbon dioxide we would have delayedThis presupposes that CO2 emissions can be capped at current levels without economic devastation or that immediate economic devastation is warranted.

For instance, in terms of education levels, we no longer live in a world that is divided into the West and the rest; our world today stretches from Canada to Yemen with all the other countries somewhere in between. There’s a broad spectrum of levels

even when people act within a fact-based worldview, they are used to talking with sterile figures. They are used to standing on a podium, clicking through slide shows in PowerPoint rather than interacting with their presentation. The problem is that companies have a strict separation between their IT department, where datasets are produced, and the design department, so hardly any presenters are proficient in both. Yet this is what we need. Getting people used to talking with animated data is, to my mind, a literacy project.

What’s important today is not just financial data but child mortality rates, the number of children per women, education levels, etc. In the world today, it’s not money that drags people into modern times, it’s people that drag money into modern times.

I can demonstrate human resources successes in Asia through health being improved, family size decreasing and then education levels increasing. That makes sense: when more children survive, parents accept that there is less need for multiple births, and they can afford to put their children through school. So Pfizer have moved their research and development of drugs to Asia, where there are brilliant young people who are amazing at developing drugs. It’s realising this kind of change that’s important.

The problem isn’t that specialised companies lack the data they need, it’s that they don’t go and look for it, they don’t understand how to handle it.

What is so strong with animation is that it provides that mindset shift in market segmentation. We can see where there are highly developed countries with a good economy and a healthy and well-educated staff.

At the moment, I’m quarrelling with Sweden’s Minister of Foreign Affairs. He says that the West has to make sure its lead over the rest of the world doesn’t erode. This is a completely wrong attitude. Western Europe and other high-income countries have to integrate themselves into the world in the same way big companies are doing. They have to look at the advantages, resources and markets that exist in different places around the world.

And some organisations aren’t willing to share their data, even though it would be a win-win situation for everybody and we would do much better in tackling the problems we need to tackle. Last April, the World Bank caved in and finally embraced an open data policy, but the OECD uses tax money to compile data and then sells it in a monopolistic way. The Chinese Statistical Bureau provides data more easily than the OECD. The richest countries in the world don’t have the vision to change.

‘database hugging disorder’

we have to instil a clear division of labour between those who provide the datasets – like the World Bank, the World Health Organisation or companies themselves – those who provide new technologies to access or process them, like Google or Microsoft, and those who ‘play’ with them and give data meaning. It’s like a great concert: you need a Mozart or a Chopin to write wonderful music, then you need the instruments and finally the musicians.

In his final book, Power and Prosperity, the late Mancur Olson argued that the state was a “stationary bandit”. A stationary bandit is better than a “roving bandit”, because the latter has no interest in developing the economy, while the former does. But it may not be much better, because those who control the state will seek to extract the surplus over subsistence generated by those under their control.

In the contemporary west, there are three protections against undue exploitation by the stationary bandit: exit, voice (on the first two of these, see this on Albert Hirschman) and restraint. By “exit”, I mean the possibility of escaping from the control of a given jurisdiction, by emigration, capital flight or some form of market exchange. By “voice”, I mean a degree of control over, the state, most obviously by voting. By “restraint”, I mean independent courts, division of powers, federalism and entrenched rights.

defining what a democratic state, viewed precisely as such a constrained protective arrangement, is entitled to do.

There exists a strand in classical liberal or, in contemporary US parlance, libertarian thought which believes the answer is to define the role of the state so narrowly and the rights of individuals so broadly that many political choices (the income tax or universal health care, for example) would be ruled out a priori. In other words, it seeks to abolish much of politics through constitutional restraints. I view this as a hopeless strategy, both intellectually and politically. It is hopeless intellectually, because the values people hold are many and divergent and some of these values do not merely allow, but demand, government protection of weak, vulnerable or unfortunate people. Moreover, such values are not “wrong”. The reality is that people hold many, often incompatible, core values. Libertarians argue that the only relevant wrong is coercion by the state. Others disagree and are entitled to do so. It is hopeless politically, because democracy necessitates debate among widely divergent opinions. Trying to rule out a vast range of values from the political sphere by constitutional means will fail. Under enough pressure, the constitution itself will be changed, via amendment or reinterpretation.

So what ought the protective role of the state to include? Again, in such a discussion, classical liberals would argue for the “night-watchman” role. The government’s responsibilities are limited to protecting individuals from coercion, fraud and theft and to defending the country from foreign aggression. Yet once one has accepted the legitimacy of using coercion (taxation) to provide the goods listed above, there is no reason in principle why one should not accept it for the provision of other goods that cannot be provided as well, or at all, by non-political means.

Those other measures would include addressing a range of externalities (e.g. pollution), providing information and supplying insurance against otherwise uninsurable risks, such as unemployment, spousal abandonment and so forth. The subsidisation or public provision of childcare and education is a way to promote equality of opportunity. The subsidisation or public provision of health insurance is a way to preserve life, unquestionably one of the purposes of the state. Safety standards are a way to protect people against the carelessness or malevolence of others or (more controversially) themselves. All these, then, are legitimate protective measures. The more complex the society and economy, the greater the range of the protections that will be sought.

What, then, are the objections to such actions? The answers might be: the proposed measures are ineffective, compared with what would happen in the absence of state intervention; the measures are unaffordable and might lead to state bankruptcy; the measures encourage irresponsible behaviour; and, at the limit, the measures restrict individual autonomy to an unacceptable degree. These are all, we should note, questions of consequences.

The vote is more evenly distributed than wealth and income. Thus, one would expect the tenor of democratic policymaking to be redistributive and so, indeed, it is. Those with wealth and income to protect will then make political power expensive to acquire and encourage potential supporters to focus on common enemies (inside and outside the country) and on cultural values. The more unequal are incomes and wealth and the more determined are the “haves” to avoid being compelled to support the “have-nots”, the more politics will take on such characteristics.

In the 1970s, the view that democracy would collapse under the weight of its excessive promises seemed to me disturbingly true. I am no longer convinced of this: as Adam Smith said, “There is a great deal of ruin in a nation”. Moreover, the capacity for learning by democracies is greater than I had realised. The conservative movements of the 1980s were part of that learning. But they went too far in their confidence in market arrangements and their indifference to the social and political consequences of inequality. I would support state pensions, state-funded health insurance and state regulation of environmental and other externalities. I am happy to debate details. The ancient Athenians called someone who had a purely private life “idiotes”. This is, of course, the origin of our word “idiot”. Individual liberty does indeed matter. But it is not the only thing that matters. The market is a remarkable social institution. But it is far from perfect. Democratic politics can be destructive. But it is much better than the alternatives. Each of us has an obligation, as a citizen, to make politics work as well as he (or she) can and to embrace the debate over a wide range of difficult choices that this entails.

it can be trained from very early in a child’s education. There’re ways that you can get quite young children to recognize what’s a good argument and what’s a bad argument. And as children grow older, it can be done in a more and more sophisticated form until by the time they’re undergraduates in universities they would be studying Plato’s dialogues for example and really looking at those tricky arguments and trying to figure out how to think. And this is important not just for the individual thinking about society, but it’s important for the way people talk to each other. In all too many public discussions people just throw out slogans and they throw out insults. And what democracy needs is listening. And respect. And so when people learn how to analyze an argument, then they look at what the other person’s saying differently. And they try to take it apart, and they think: “Well, do I share some of those views and where do I differ here?” and so on. And this really does produce a much more deliberative, respectful style of public interaction.

The second [quality] is what I call “the ability to think as a citizen of the whole world.” We’re all narrow and this is again something that we get from our animal heritage. Most non-human animals just think about the group. But, of course, in this world we need to think, first of all, our whole nation -- its many different groups, minority and majority. And then we need to think outside the nation, about how problems involving, let’s say, the environment or global economy and so on need cooperative resolution that brings together people from many different nations.

That’s complicated and it requires learning a lot of history, and it means learning not just to parrot some facts about history but to think critically about how to assess historical evidence. It means learning how to think about the global economy. And then I think particularly important in this era, it means learning something about the major world religions. Learning complicated, nonstereotypical accounts of those religions because there’s so much fear that’s circulating around in every country that’s based usually on just inadequate stereotypes of what Muslims are or whatever. So knowledge can at least begin to address that.

the third thing, which I think goes very closely with the other two, is what I call “the narrative imagination,” which is the ability to put yourself in the shoes of another person to have some understanding of how the world looks from that point of view. And to really have that kind of educated sympathy with the lives of others. Now again this is something we come into the world with. Psychologists have now found that babies less than a year old are able to take up the perspective of another person and do things, see things from that perspective. But it’s very narrow and usually people learn how to think about what their parents are thinking and maybe other family members but we need to extend that and develop it, and learn how the world looks from the point of view of minorities in our own culture, people outside our culture, and so on.

since we can’t go to all the places that we need to understand -- it’s accomplished by reading narratives, reading literature, drama, participating through the arts in the thought processes of another culture. So literature and the arts are the major ways we would develop and extend that capacity.

For many years, the leading model of development ... used by economists and international agencies measuring welfare was simply that for a country to develop means to increase [its] gross domestic product per capita. Now, in recent years, there has been a backlash to that because people feel that it just doesn’t ask enough about what goods are really doing for people, what can people really do and be.

so since 1990s the United Nations’ development program has produced annually what’s called a “Human Development Report” that looks at things like access to education, access to health care. In other words, a much richer menu of human chances and opportunities that people have. And at the theoretical end I’ve worked for about 20 years now with economist Amartya Sen, who won the Nobel Prize in 1998 for economics. And we’ve developed this as account of -- so for us what it is for a country to do better is to enhance the set of capabilities meaning substantial opportunities that people have to lead meaningful, fruitful lives. And then I go on to focus on a certain core group of those capabilities that I think ought to be protected by constitutional law in every country.

Life; health; bodily integrity; the development of senses, imagination, and thought; the development of practical reason; opportunities to have meaningful affiliations both friendly and political with other people; the ability to have emotional health -- not to be in other words dominated by overwhelming fear and so on; the ability to have a productive relationship with the environment and the world of nature; the ability to play and have leisure time, which is something that I think people don’t think enough about; and then, finally, control over one’s material and social environment, some measure of control. Now of course, each of these is very abstract, and I specify them further. Although I also think that each country needs to finally specify them with its own particular circumstances in view.

when kids learn in a classroom that just makes them sit in a chair, well, they can take in something in their heads, but it doesn’t make them competent at negotiating in the world. And so starting, at least, with Jean Jacques Rousseau in the 18th century, people thought: “Well, if we really want people to be independent citizens in a democracy that means that we can’t have whole classes of people who don’t know how to do anything, who are just simply sitting there waiting to be waited on in practical matters.” And so the idea that children should participate in their practical environment came out of the initial democratizing tendencies that went running through the 18th century.

even countries who absolutely do not want that kind of engaged citizenry see that for the success of business these abilities are pretty important. Both Singapore and China have conducted mass education reforms over the last five years because they realized that their business cultures don’t have enough imagination and they also don’t have enough critical thinking, because you can have awfully corrupt business culture if no one is willing to say the unpleasant word or make a criticism.

So they have striven to introduce more critical thinking and more imagination into their curricula. But, of course, for them, they want to cordon it off -- they want to do it in the science classroom, in the business classroom, but not in the politics classroom. Well, we’ll see -- can they do that? Can they segment it that way? I think democratic thinking is awfully hard to segment as current events in the Middle East are showing us. It does have the tendency to spread.

so maybe the people in Singapore and China will not like the end result of what they tried to do or maybe the reform will just fail, which is equally likely -- I mean the educational reform.

if you really don’t want democracy, this is not the education for you. It had its origins in the ancient Athenian democracy which was a very, very strong participatory democracy and it is most at home in really true democracy, where our whole goal is to get each and every person involved and to get them thinking about things. So, of course, if politicians have ambivalence about that goal they may well not want this kind of education.

when we bring up children in the family or in the school, we are always engineering. I mean, there is no values-free form of education in the world. Even an education that just teaches you a list of facts has values built into it. Namely, it gives a negative value to imagination and to the critical faculties and a very high value to a kind of rote, technical competence. So, you can't avoid shaping children.

ncreasingly the child should be in control and should become free. And that's what the critical thinking is all about -- it's about promoting freedom as the child goes on. So, the end product should be an adult who is really thinking for him- or herself about the direction of society. But you don't get freedom just by saying, "Oh, you are free." Progressive educators that simply stopped teaching found out very quickly that that didn't produce freedom. Even some of the very extreme forms of progressive school where children were just allowed to say every day what it was they wanted to learn, they found that didn't give the child the kind of mastery of self and of the world that you really need to be a free person.

Value-free science? Many scientists think that science is about objectivity and “just the facts, ma’am.” Not so fast, philosophers, historians and sociologists of science have argued now for a number of decades. While I certainly have no sympathy for the extreme postmodernist position exemplified by the so-called “strong programme” in sociology of science — that science is entirely the result of social construction — there are several interesting and delicate facets of the problem to explore.

there are values embedded in the practice of science itself: testability, accuracy, generality, simplicity, and the like. Needless to say, few if any of these can be justified within science itself — there is no experiment confirming Occam’s razor, for instance.

Then there are the many moral dimensions of science practice, both in terms of ethical issues internal to science (fraud) and of the much broader ones affecting society at large (societal consequences of research and technological advances).

There is also the issue of diversity in science. Until very recently, and in many fields still today, science has largely been an affair conducted by white males. And this has historically resulted in a large amount of nonsense — say about gender differences, or ethnic differences — put forth as objective knowledge and accepted by the public because it has the imprimatur of science. But, you might say, that was the past, now we have corrected the errors and moved on. Except that such an argument ignores the fact that there is little reason to think that only we have gotten it just right, that the current generation is somehow immune from an otherwise uninterrupted history of science-based blunders.

Regarding Occam's Razor, there is a justification for it based on probability theory, see:http://www.johndcook.com/blog/2011/01/12/occams-razor-bayes-theorem/http://telescoper.wordpress.com/2011/02/19/bayes-razor/http://www.stat.duke.edu/~berger/papers/ockham.html

another interesting dimension of the relationship between values and science concerns which scientific questions we should pursue (and, often, fund with public money). Scientists often act as they ought to be the only arbiters here, and talk as if some questions were “obviously” intrinsically important. But when your research is costly and paid for by the public, perhaps society deserves a bit more of an explanation concerning why millions of dollars ought to be spent on obscure problems that apparently interest only a handful of university professors concentrated in one or a few countries.

At the other end of the spectrum, scare stories are - of course - a stalwart of media science. Based on minimal evidence and expanded with poor understanding of its significance, they help perform the most crucial function for the media, which is selling you, the reader, to their advertisers. The MMR disaster was a fantasy entirely of the media's making (www.badscience.net/?p=23), which failed to go away. In fact the Daily Mail is still publishing hysterical anti-immunisation stories, including one calling the pneumococcus vaccine a "triple jab", presumably because they misunderstood that the meningitis, pneumonia, and septicaemia it protects against are all caused by the same pneumococcus bacteria (www.badscience.net/?p=118).

people periodically come up to me and say, isn't it funny how that Wakefield MMR paper turned out to be Bad Science after all? And I say: no. The paper always was and still remains a perfectly good small case series report, but it was systematically misrepresented as being more than that, by media that are incapable of interpreting and reporting scientific data.

Once journalists get their teeth into what they think is a scare story, trivial increases in risk are presented, often out of context, but always using one single way of expressing risk, the "relative risk increase", that makes the danger appear disproportionately large (www.badscience.net/?p=8).

he media obsession with "new breakthroughs": a more subtly destructive category of science story. It's quite understandable that newspapers should feel it's their job to write about new stuff. But in the aggregate, these stories sell the idea that science, and indeed the whole empirical world view, is only about tenuous, new, hotly-contested data

Articles about robustly-supported emerging themes and ideas would be more stimulating, of course, than most single experimental results, and these themes are, most people would agree, the real developments in science. But they emerge over months and several bits of evidence, not single rejiggable press releases. Often, a front page science story will emerge from a press release alone, and the formal academic paper may never appear, or appear much later, and then not even show what the press reports claimed it would (www.badscience.net/?p=159).

there was an interesting essay in the journal PLoS Medicine, about how most brand new research findings will turn out to be false (www.tinyurl.com/ceq33). It predictably generated a small flurry of ecstatic pieces from humanities graduates in the media, along the lines of science is made-up, self-aggrandising, hegemony-maintaining, transient fad nonsense; and this is the perfect example of the parody hypothesis that we'll see later. Scientists know how to read a paper. That's what they do for a living: read papers, pick them apart, pull out what's good and bad.

there is no useful information in most science stories. A piece in the Independent on Sunday from January 11 2004 suggested that mail-order Viagra is a rip-off because it does not contain the "correct form" of the drug. I don't use the stuff, but there were 1,147 words in that piece. Just tell me: was it a different salt, a different preparation, a different isomer, a related molecule, a completely different drug? No idea. No room for that one bit of information.

Remember all those stories about the danger of mobile phones? I was on holiday at the time, and not looking things up obsessively on PubMed; but off in the sunshine I must have read 15 newspaper articles on the subject. Not one told me what the experiment flagging up the danger was. What was the exposure, the measured outcome, was it human or animal data? Figures? Anything? Nothing. I've never bothered to look it up for myself, and so I'm still as much in the dark as you.

Because papers think you won't understand the "science bit", all stories involving science must be dumbed down, leaving pieces without enough content to stimulate the only people who are actually going to read them - that is, the people who know a bit about science.

Compare this with the book review section, in any newspaper. The more obscure references to Russian novelists and French philosophers you can bang in, the better writer everyone thinks you are. Nobody dumbs down the finance pages.

Statistics are what causes the most fear for reporters, and so they are usually just edited out, with interesting consequences. Because science isn't about something being true or not true: that's a humanities graduate parody. It's about the error bar, statistical significance, it's about how reliable and valid the experiment was, it's about coming to a verdict, about a hypothesis, on the back of lots of bits of evidence.

science journalists somehow don't understand the difference between the evidence and the hypothesis. The Times's health editor Nigel Hawkes recently covered an experiment which showed that having younger siblings was associated with a lower incidence of multiple sclerosis. MS is caused by the immune system turning on the body. "This is more likely to happen if a child at a key stage of development is not exposed to infections from younger siblings, says the study." That's what Hawkes said. Wrong! That's the "Hygiene Hypothesis", that's not what the study showed: the study just found that having younger siblings seemed to be somewhat protective against MS: it didn't say, couldn't say, what the mechanism was, like whether it happened through greater exposure to infections. He confused evidence with hypothesis (www.badscience.net/?p=112), and he is a "science communicator".

how do the media work around their inability to deliver scientific evidence? They use authority figures, the very antithesis of what science is about, as if they were priests, or politicians, or parent figures. "Scientists today said ... scientists revealed ... scientists warned." And if they want balance, you'll get two scientists disagreeing, although with no explanation of why (an approach at its most dangerous with the myth that scientists were "divided" over the safety of MMR). One scientist will "reveal" something, and then another will "challenge" it

The danger of authority figure coverage, in the absence of real evidence, is that it leaves the field wide open for questionable authority figures to waltz in. Gillian McKeith, Andrew Wakefield, Kevin Warwick and the rest can all get a whole lot further, in an environment where their authority is taken as read, because their reasoning and evidence is rarely publicly examined.

it also reinforces the humanities graduate journalists' parody of science, for which we now have all the ingredients: science is about groundless, incomprehensible, didactic truth statements from scientists, who themselves are socially powerful, arbitrary, unelected authority figures. They are detached from reality: they do work that is either wacky, or dangerous, but either way, everything in science is tenuous, contradictory and, most ridiculously, "hard to understand".

This misrepresentation of science is a direct descendant of the reaction, in the Romantic movement, against the birth of science and empiricism more than 200 years ago; it's exactly the same paranoid fantasy as Mary Shelley's Frankenstein, only not as well written. We say descendant, but of course, the humanities haven't really moved forward at all, except to invent cultural relativism, which exists largely as a pooh-pooh reaction against science. And humanities graduates in the media, who suspect themselves to be intellectuals, desperately need to reinforce the idea that science is nonsense: because they've denied themselves access to the most significant developments in the history of western thought for 200 years, and secretly, deep down, they're angry with themselves over that.

had a good spirited row with an eminent science journalist, who kept telling me that scientists needed to face up to the fact that they had to get better at communicating to a lay audience. She is a humanities graduate. "Since you describe yourself as a science communicator," I would invariably say, to the sound of derisory laughter: "isn't that your job?" But no, for there is a popular and grand idea about, that scientific ignorance is a useful tool: if even they can understand it, they think to themselves, the reader will. What kind of a communicator does that make you?

Science is done by scientists, who write it up. Then a press release is written by a non-scientist, who runs it by their non-scientist boss, who then sends it to journalists without a science education who try to convey difficult new ideas to an audience of either lay people, or more likely - since they'll be the ones interested in reading the stuff - people who know their way around a t-test a lot better than any of these intermediaries. Finally, it's edited by a whole team of people who don't understand it. You can be sure that at least one person in any given "science communication" chain is just juggling words about on a page, without having the first clue what they mean, pretending they've got a proper job, their pens all lined up neatly on the desk.

1. The harm principle bases our ethical considerations on other beings’ capacity for higher-level subjective experience. Human beings (and some animals) have the potential — and desire — to experience deep pleasure and happiness while seeking to avoid pain and suffering. We have the obligation, then, to afford creatures with these capacities, desires and relations a certain level of respect. They also have other emotional and social interests: for instance, friends and families concerned with their health and enjoyment. These actors also deserve consideration.

2. If we have a moral obligation to act a certain way toward someone, that should be reflected in law. Rights theory is the idea that there are certain rights worth granting to people with very few, if any, caveats. Many of these rights were spelled out in the founding documents of this country, the Declaration of Independence (which admittedly has no legal pull) and the Constitution (which does). They have been defended in a long history of U.S. Supreme Court rulings. They have also been expanded on in the U.N.’s 1948 Universal Declaration of Human Rights and in the founding documents of other countries around the world. To name a few, they include: freedom of belief, speech and expression, due process, equal treatment, health care, and education.

3. While we ought to consider our broader moral efforts, and focus on our obligations to others, it is also important to place attention on our quality as moral agents. A vital part of fostering a respectable pluralist moral framework is to encourage virtues, and cultivate moral character. A short list of these virtues would include prudence, justice, wisdom, honesty, compassion, and courage. One should study these, and strive to put these into practice and work to be a better human being, as Aristotle advised us to do.

most people already are ethical pluralists. Life and society are complex to navigate, and one cannot rely on a single idea for guidance. It is probably accurate to say that people lean more toward one theory, rather than practice it to the exclusion of all others. Of course, this only describes the fact that people think about morality in a pluralistic way. But the outlined approach is supported, sound reasoning — that is, unless you are ready to entirely dismiss 2,500 years of Western moral philosophy.