Sharing Internet

Ever stuck in a hotel room with no wireless and only one plug?

This seems like a handy low tech solution http://www.engadget.com/2009/02/25/data-copy-and-internet-connection-sharing-dongle-explains-itself/

De-dev updates

Economic decline won't cause world war
http://www.theglobeandmail.com/servlet/story/RTGAM.20090223.wferguson0223/BNStory/crashandrecovery/home/?pageRequested=all

Niall Ferguson: “There will be blood, in the sense that a crisis of this magnitude is bound to increase political as well as economic [conflict]. It is bound to destabilize some countries. It will cause civil wars to break out, that have been dormant. It will topple governments that were moderate and bring in governments that are extreme. These things are pretty predictable. The question is whether the general destabilization, the return of, if you like, political risk, ultimately leads to something really big in the realm of geopolitics. That seems a less certain outcome. We've already talked about why China and the United States are in an embrace they don't dare end. If Russia is looking for trouble the way Mr. Putin seems to be, I still have some doubt as to whether it can really make this trouble, because of the weakness of the Russian economy. It's hard to imagine Russia invading Ukraine without weakening its economic plight. They're desperately trying to prevent the ruble from falling off a cliff. They're spending all their reserves to prop it up. It's hardly going to help if they do another Georgia.”

“I was more struck Putin's bluster than his potential to bite, when he spoke at Davos. But he made a really good point, which I keep coming back to. In his speech, he said crises like this will encourage governments to engage in foreign policy aggression. I don't think he was talking about himself, but he might have been. It's true, one of the things historically that we see, and also when we go back to 30s, but also to the depressions 1870s and 19980s, weak regimes will often resort to a more aggressive foreign policy, to try to bolster their position. It's legitimacy that you can gain without economic disparity – playing the nationalist card. I wouldn't be surprised to see some of that in the year ahead.

It's just that I don't see it producing anything comparable with 1914 or 1939. It's kind of hard to envisage a world war. Even when most pessimistic, I struggle to see how that would work, because the U.S., for all its difficulties in the financial world, is so overwhelmingly dominant in the military world.”

What's that the kids say? PWND?

Pretty awesome little story- scientist is invited to debate a "intelligent design" proponent, writes scathing email response. I have gone back and forth over whether or not this is card worthy, in the end I think yes if for nothing other than humor value. The comments are awesome (and where I stole the title of this post) it appears some science nerds have pretty good senses of humor.

Quote-

Academic debate on controversial topics is fine, but those topics need to have a basis in reality. I would not invite a creationist to a debate on campus for the same reason that I would not invite an alchemist, a flat-earther, an astrologer, a psychic, or a Holocaust revisionist. These ideas have no scientific support, and that is why they have all been discarded by credible scholars. Creationism is in the same category.

Instead of spending time on public debates, why aren't members of your institute publishing their ideas in prominent peer-reviewed journals such as Science, Nature, or the Proceedings of the National Academy of Sciences? If you want to be taken seriously by scientists and scholars, this is where you need to publish. Academic publishing is an intellectual free market, where ideas that have credible empirical support are carefully and thoroughly explored. Nothing could possibly be more exciting and electrifying to biology than scientific disproof of evolutionary theory or scientific proof of the existence of a god. That would be Nobel Prize winning work, and it would be eagerly published by any of the prominent mainstream journals.

"Conspiracy" is the predictable response by Ben Stein and the frustrated creationists. But conspiracy theories are a joke, because science places a high premium on intellectual honesty and on new empirical studies that overturn previously established principles. Creationism doesn't live up to these standards, so its proponents are relegated to the sidelines, publishing in books, blogs, websites, and obscure journals that don't maintain scientific standards.

NPR Intelligence squared

I recently learned of these NPR debates you can get as a podcast on itunes- search for intelligence squared. They are pretty awesome- there is a recent one about carbon limits, and a pretty badass one about hegemony entitled Should America be the World's Policeman?- In it Max Boot lays the smackdown on hegemony naysayers dubbing the US "Globo Cop".

You can also download more from the NPR website


In addition to just being interesting, these things are GREAT if you want to learn to debate well in front of lay judges at state tournaments, NFLS, CFLS, or other public oriented formats like Oxford style debates colleges often have. Listen to who gets the best crowd reactions, how they do so, and the style of arguments they make. You can see the better speakers using debate strategies like pre-empts, author indicts, and even pointing out "no offense".


EDIT- UPDATE

Here is the closest thing I could find to the Opening Boot speech in this debate for those hegemony card cutters out there:

To answer the question of why America should be the world’s policeman, start by asking yourself: Does the world need a police force? To my mind, that’s like asking whether San Francisco or New York needs a police force. I think we’d all agree that yes they do need a police force, for the very simple reason that as long as evil exits, you have to have somebody who will protect peaceful people from predators. The international system is no different in this regard from your own neighborhood, except that the predators abroad are far more dangerous than ordinary robbers, rapists, and murderers. They are, if given half a chance, mass robbers, mass rapists, and mass murderers.

There are, to be sure, many international laws on the books prohibiting genocide, land mines, biological weapons, and all sorts of other nasty things. But without enforcement mechanisms they are as meaningless as the Kellogg-Briand Pact of 1928, which outlawed war as an instrument of national policy exactly 11 years before the Wehrmacht marched into Poland. The hope of idealistic liberals for more than a century has been that some international organization would arise that would punish the wicked and protect the innocent. But the League of Nations was a dismal failure, and the U.N., as we are seeing recently, is not much better. It is hard to take seriously a body whose human rights commission is chaired by Libya, and up until a few weeks ago Iraq was going to be in charge of the disarmament commission. This sounds like a Monty Python skit, not what a serious world body should be about.

The U.N. provides a useful forum for palaver, but as an effective police force, it is a joke, as shown by its failure to stop bloodlettings in Bosnia, Rwanda, and many other places. Actually, I shouldn’t make light of it, because it’s worse than a joke. In Bosnia, the U.N. sent peacekeepers into Srebenicia, which it assured Muslim Bosnians was a safe haven. Then the blue helmets stood by as Serbs slaughtered 8,000 people in this supposed safe haven. In Bosnia the U.N. was far worse than a joke: it was an enabler of genocide. That’s the obvious reason we can have no faith that the U.N. is actually going to police the world and stop mass murderers like Slobodan Milosevic and Saddam Hussein.

The best multilateral alternative is probably NATO. Unlike the U.N., NATO has the advantage of being composed exclusively of democracies that share a common heritage and presumably common interests, although the French in particular seem to have forgotten this for the time being. But even before the current controversy over Iraq, it was already obvious that the NATO alliance was too large and unwieldy to take effective military action. As Kosovo showed, targeting by committee does not work very well. And there is no sign, given French opposition to anything America does, that NATO will become any more effective any time in the foreseeable future.

The European Union is perhaps the only other serious multilateral alternative, and it’s even less potent than NATO, since it can neither field an effective military force, nor agree on a common foreign policy. We hear a lot about transatlantic disagreements these days, but the most bitter feuds are now within Europe, among different European nations. Eighteen nations of Europe have signed letters essentially backing the US and our Iraq policy, while France, Belgium, and Germany completely dissent. Europe is completely divided, and even if it weren’t, it would not have the military force required to deal with any kind of threats like North Korea and Iraq. They just don’t have the mans to take action anywhere outside their own borders; they are completely reliant upon American military protection.

So the question I have tonight is: who does that leave to be the world’s policeman, if you agree, as I do, that the world needs one. Who has to play that role. Is it going to be Belgium? Bolivia? Burkina Faso? Bangladesh? Our friends in Paris? I think the answer is pretty obvious. It’s the country with the most vibrant economy, the most fervent devotion to liberty, and the most powerful military. In the 19th century, Britain battled the enemies of all mankind, such as slave traders and pirates, and kept the world’s seas open to free trade. Today, the only nation capable of playing an equivalent role is the United States of America. We have more power than Britain did at the height of its empire. We have more power than any other nation in history in either relative or absolute terms. Don’t get me wrong: we still need allies. But as Madeleine Albright said, America is the indispensable nation.

With all that power, I firmly believe, comes responsibility. I believe we need to use our awesome power for the good of the world. Not only to roll back aggression and stop the spread of terrorism and weapons of mass destruction, but also to stop the most egregious human rights abuses, such as the genocide that took place in the former Yugoslavia or Rwanda. As Theodore Roosevelt said: “A nation’s first duties are within its borders, but it is not thereby absolved from facing its duties within the world as a whole. And if it refuses to do so, it merely forfeits its right to struggle for a place among the people that shape the destiny of mankind.

Now I should add that this global policing role that I propose is not entirely a selfless undertaking. In the 1990s, a lot of people fell prey to the illusion that globalization was an inexorable process; that no matter what, the spread of markets and freedom would take place and magically transform the world in America’s image. Tom Friedman of the New York Times even coined his famous McDonalds Theory of conflict prevention, which held that no two states with a McDonalds had ever gone to war. Now that sounded pretty good until 1999, until America and Serbia went to war. And you know what? There was a McDonalds in Serbia.

That suggests that we could no longer rely on “soft power,” in Joe Nye’s phrase, our soft power ranging from McDonalds to Madonna to advance U.S. interests around the world. The notion that we can do so is exactly the same fallacy that much of the world fell prey to before 1914, when there was an assumption that economic interconnectedness was making war obsolete. Clearly, that illusion was shattered in the mud of the Western Front in 1914. I think history shows that there is nothing inexorable about economic progress of the sort that we have all come to take for granted in the past decade and more. Without a benevolent hegemon to guarantee order, the international scene can quickly degenerate into chaos and worse. The 1930s turned out as badly as they did because Britain abdicated its international leadership role and Uncle Sam refused to pick up the mantle. The post-1945 era, by contrast, turned out as well as it did in large measure because America has been willing to underwrite the security of the global economy, which has been much to our benefit and to the benefit of the rest of the world.

Now when I suggest that America play Globo-Cop, skeptics reply that America has an isolationist past, and no desire to play world policeman. The Cold War, many suggest, was an aberration, and since the end of the Cold War America will somehow revert to its traditional isolationist traditions. In fact, if you look at the history, rumors of American isolationism are much exaggerated. Since the earliest days of the republic American traders, missionaries, and solider have penetrated to the farthest corners of the world. America even has a long record of military action abroad. In my book, The Savage Wars of Peace, I document 180 landings of U.S. Marines abroad between 1800 and 1934. Think about that: 180 landings in 134 years, more than one a year. And this at a time when most of us have been conditioned to think of America as isolationist. Far from isolationist, American soldiers, sailors, and marines were landing and fighting in all sorts of places: Sumatra in 1832, or Korea in 1871, Samoa in 1899. If you look at this pattern it does not suggest an isolationist nation. Far from it.

American intervention went up another notch, of course, in 1898. No longer were we landing forces for a few days at a time. Now the U.S. was staying longer in places like the Philippines, Cuba, and Panama, in order to shape the security environment more to our liking. In fact, in 1904 Teddy Roosevelt proclaimed the Roosevelt Corollary to the Monroe Doctrine...and I’m sure you will see my weakness for Teddy Roosevelt when I quote his words here. I think the Roosevelt Corollary is an important document. Roosevelt declared that “chronic wrongdoing, or an impotence that results in a general loosening of the ties of civilized society, may ultimately require intervention by some civilized nation. And in the western hemisphere, the adherence of the United States to the Monroe Doctrine may force the United States, however reluctantly, in flagrant cases of such wrongdoing or impotence, to the exercise of an international police power.” That’s exactly what I’m talking about tonight.

Now when Roosevelt wrote those words, the western hemisphere was the only place where America exercised military hegemony. In the rest of the world, we relied upon the Royal Navy to defend ‘civilized society.’ Today, however, America exercises almost as much power everywhere around the world as it once had only in the Caribbean. Thus, I think by Roosevelt’s logic, the U.S. is obliged to stop chronic wrongdoing for the simple reason that if we don’t , nobody else will do the job. And that is precisely what we have been doing for the past decade in places like Panama, Bosnia, Kosovo, Afghanistan, and shortly in Iraq.

As part of this mission, I believe we need to undertake the dreaded task known as nation-building...or as I prefer to call it, more accurately, state formation. Winning a military victory in a place like Kosovo or Afghanistan is meaningless unless you have some way of translating short-term battlefield success into long-term political success. The only way to do that is by forming a stable state that is capable of policing the area and preventing a recurrence of terrorism, ethnic cleansing, or other human-rights violations. Therefore, it is in our own interest to foster viable states in many lawless corners of the world. This I might add is not a new mission for the U.S. It is something we have done not only in Italy, Germany, and Japan, most spectacularly, but also before that in places like the Philippines, Cuba, Haiti, the Dominican Republic, and elsewhere. There’s a very long history of the kind of nation-building that we’re now undertaking in places like Bosnia, Kosovo, and Afghanistan.

Another name for what we’re doing, by the way, is liberal imperialism. That’s not a name that is traditionally associated with U.S. policy, but it’s apt to describe our mission in many parts of the world, and it’s not a name that we should necessarily shy away from. It used to be that only leftist critics of America talked of American empire; but I’ve noticed an interesting phenomenon occurring in the last few years. American empire has become respectable. It’s been featured on the cover of US News and World Report, the New York Times Magazine, the Weekly Standard, and many other publications. It’s also been endorsed, with varying degrees of enthusiasm, by such unlikely figures as David Rieff, Michael Ignatieff, and Christopher Hitchens — all well-known writers and intellectuals of the left. They understand that in a world full of murderous tyrants, the only protection that decent people can count on will come from the United States of America. They certainly can’t count on the French: they can’t deal with Ivory Coast, let alone Iraq. The only thing the French army is good for is teaching other armies to surrender properly.

Any talk of American empire and global policing inevitably brings warnings of blowback, the notion that by strongly asserting our power we will turn the rest of the world against us, and bring greater grief to our shores. This argument has some superficial plausibility, as witness, for example, the great resentment occasioned by the presence of American troops in South Korea, as we’ve seen recently. But there’s a funny phenomenon going on which I’d like to comment on, which is that while some countries want the Yankees out, many more want us in. In places like Kosovo, Bosnia, Afghanistan, and very shortly Iraq, ordinary people clamor for American intervention, and welcome U.S. troops as liberators. Once more, very often America’s reviled by the international community for not intervening. For instance, we’ve been heavily criticized for not doing more to stop genocide in Rwanda, to bring peace to the Middle East, to unify the Korean peninsula, to stop AIDS in Africa, and on and on and on. It sometimes seems as if we can’t win: We’re attacked either for being too interventionist or too isolationist. In other words, we get blowback for acting, and blowback for not acting.

Overall, however, I think the risks of being weak are much greater than the risks of being strong. The contrast was on vivid display after 9/11. When the World Trace Center and Pentagon were attacked, there was jubilation in many parts of the world. They were literally dancing in the Arab street. By contrast, three months later, when the Taliban fell, the expected uprising in the Arab street did not occur. Our victory in Afghanistan was met with a deathly silence in the Middle East.

What this goes to show, I think, is that the world is impressed by American strength and contemptuous of American weakness. We hoped in the 1990s that by not confronting terrorists and their sponsors we might be able to appease them, to avoid incurring their wrath. But it turned out that there was nothing we could do to appease these fanatics. They hate everything we stand for: sexual, political, and intellectual freedom; democracy; female emancipation; secularism – the whole bundle of things known as modernity. They hate it, because our very existence poses a threat to the worldview of these Islamist extremists. There is nothing we can do to appease them. Instead, by trying we only convince them that we could be attacked with impunity. When it comes to our implacable enemies, we will never be loved. I hope we will at least be feared.

But can America afford to police the world? Many critics argue that we can’t. They fear that an American empire will, like many of its predecessors, fall victim to imperial overstretch. That’s the argument made famous by Paul Kennedy in his 1989 bestseller, The Rise and Fall of the Great Powers. But if you talk to Paul today, even he admits that America is not declining as fast as he thought it would. In fact, during the 1990s the U.S. rose while most of our competitors — Europe, Japan, and Russia — fell by the wayside. Overstretch can be a legitimate worry for any nation, but given our vast resources, we are not anywhere near the redline yet. Our defense budget is larger than that of the next 18 nations combined, but it still consumes less than 3.5 percent of our gross domestic product, down from twice that during the Cold War on a typical level.

This is hardly unsustainable: if anything, I would argue that we’re not spending enough today, given the procurement holiday we took in the 1990s. And underspending on defense is often much more dangerous than overspending. The British Empire presents Exhibit A of what I’m talking about. Why did the British Empire ultimately collapse? As Neil Ferguson argues in his new book Empire, coming out in a month or so, the British Empire collapsed not because of native revolts, which were never that severe. The Empire ultimately collapsed because the British did not spend enough on defense. In its imperial heyday, from 1870 to 1923, London spent only 3.1 percent of GDP on defense. This created a potent navy but a very weak army. Bismarck was asked what he would do if the British army landed in Germany; he famously replied that he would send a constable to arrest them. Because the British did not spend enough to deter German aggression, they became embroiled in two world wars that bled them dry. It was ultimately the cost of winning those two wars, and not the cost of imperial policing, that cost Britain its empire. In retrospect, it would have been cheaper for Britain to spend more on defense if it would have helped to avert two catastrophic conflicts. For that matter, it would have been cheaper for America to spend more on defense in the 1920s and ‘30s if it might have averted the Japanese attack on Pearl Harbor.

This is a lesson worth remembering. If we need to spend more on defense to meet all of our obligations today, and I believe that we do, this is a small cost to pay considering the alternatives. And when I say alternatives, let me be clear: What I have in mind is 9/11. During the 1990s we essentially ignored Afghanistan. Who cared what happened in that small landlocked country far away? So said our foreign policy mandarins. The ‘so what’ question was pretty definitively answered on 9/11. The answer lies in the rubble of what was once the World Trade Center. Now I know that living on the West Coast the events of 2001 can seem rather remote. But let me tell you: I used to work in a building across the street from the World Trade Center. I was down there that day: I saw what happened. I saw the walls of soot and ash; I saw the towers fall; and I saw people dying. That is not something I ever want to see again, and what I saw that day was a direct consequence of the fact that we’d allowed Afghanistan to become a breeding ground of terrorism. And I say never again. Never again must we make that same mistake and lose thousands of American lives.

Now it is in our own self-interest as well as in the interest of local people in Afghanistan that we rebuild that country; that we foster democracy there; and that we ensure that it never exports terrorism again. What was true in Afghanistan is equally true of many other states that sponsor terrorism and scheme to acquire weapons of mass destruction. North Korea, Iran, Syria, Libya, and other states pose a major threat to world peace and to American lives. So do terrorist networks like Al-Qaeda. If we don’t stop the bad guys, who will? If we don’t police the world, who will? The job of policing these distant lands — places full of failed states, criminal states, or simply a state of nature — ultimately falls to us, which means that whether we like it or not, liberal imperialism appears to be in our future. It’s a big task, but as Kipling warned America, “You dare not stoop to less.” Thank you.

AT: Cap Collapsing

P. J. O'Rourke the H. L. Mencken Research Fellow at the Cato Institute MA in English at Johns Hopkins University contributing editor at The Weekly Standard and is the author, most recently, of On The Wealth of Nations, Books That Changed the World Financial Times 2-10-09
The free market is dead. It was killed by the Bolshevik Revolution, fascist dirigisme, Keynesianism, the Great Depression, the second world war economic controls, the Labour party victory of 1945, Keynesianism again, the Arab oil embargo, Anthony Giddens’s “third way” and the current financial crisis. The free market has died at least 10 times in the past century. And whenever the market expires people want to know what Adam Smith would say. It is a moment of, “Hello, God, how’s my atheism going?” Adam Smith would be laughing too hard to say anything. Smith spotted the precise cause of our economic calamity not just before it happened but 232 years before – probably a record for going short. “A dwelling-house, as such, contributes nothing to the revenue of its inhabitant,” Smith said in The Wealth of Nations. “If it is lett [sic] to a tenant for rent, as the house itself can produce nothing, the tenant must always pay the rent out of some other revenue.” Therefore Smith concluded that, although a house can make money for its owner if it is rented, “the revenue of the whole body of the people can never be in the smallest degree increased by it”. [281]* Smith was familiar with rampant speculation, or “overtrading” as he politely called it. The Mississippi Scheme and the South Sea Bubble had both collapsed in 1720, three years before his birth. In 1772, while Smith was writing The Wealth of Nations, a bank run occurred in Scotland. Only three of Edinburgh’s 30 private banks survived. The reaction to the ensuing credit freeze from the Scottish overtraders sounds familiar, “The banks, they seem to have thought,” Smith said, “were in honour bound to supply the deficiency, and to provide them with all the capital which they wanted to trade with.” [308] The phenomenon of speculative excess has less to do with free markets than with high profits. “When the profits of trade happen to be greater than ordinary,” Smith said, “overtrading becomes a general error.” [438] And rate of profit, Smith claimed, “is always highest in the countries that are going fastest to ruin”. [266] The South Sea Bubble was the result of ruinous machinations by Britain’s lord treasurer, Robert Harley, Earl of Oxford, who was looking to fund the national debt. The Mississippi Scheme was started by the French regent Philippe duc d’Orléans when he gave control of the royal bank to the Scottish financier John Law, the Bernard Madoff of his day. Law’s fellow Scots – who were more inclined to market freedoms than the English, let alone the French – had already heard Law’s plan for “establishing a bank ... which he seems to have imagined might issue paper to the amount of the whole value of all the lands in the country”. The parliament of Scotland, Smith noted, “did not think proper to adopt it”. [317] One simple idea allows an over-trading folly to turn into a speculative disaster – whether it involves ocean commerce, land in Louisiana, stocks, bonds, tulip bulbs or home mortgages. The idea is that unlimited prosperity can be created by the unlimited expansion of credit. Such wild flights of borrowing can be effected only with what Smith called “the Daedalian wings of paper money”. [321] To produce enough of this paper requires either a government or something the size of a government, which modern merchant banks have become. As Smith pointed out: “The government of an exclusive company of merchants, is, perhaps, the worst of all governments.” [570] The idea that The Wealth of Nations puts forth for creating prosperity is more complex. It involves all the baffling intricacies of human liberty. Smith proposed that everyone be free – free of bondage and of political, economic and regulatory oppression (Smith’s principle of “self-interest”), free in choice of employment (Smith’s principle of “division of labour”), and free to own and exchange the products of that labour (Smith’s principle of “free trade”). “Little else is requisite to carry a state to the highest degree of opulence,” Smith told a learned society in Edinburgh (with what degree of sarcasm we can imagine), “but peace, easy taxes and a tolerable administration of justice.” How then would Adam Smith fix the present mess? Sorry, but it is fixed already. The answer to a decline in the value of speculative assets is to pay less for them. Job done. We could pump the banks full of our national treasure. But Smith said: “To attempt to increase the wealth of any country, either by introducing or by detaining in it an unnecessary quantity of gold and silver, is as absurd as it would be to attempt to increase the good cheer of private families, by obliging them to keep an unnecessary number of kitchen utensils.” [440] We could send in the experts to manage our bail-out. But Smith said: “I have never known much good done by those who affect to trade for the public good.” [456] And we could nationalise our economies. But Smith said: “The state cannot be very great of which the sovereign has leisure to carry on the trade of a wine merchant or apothecary”. [818] Or chairman of General Motors.

Schwartz AT: V2L is Neg

When faced with a K making a "no value to life" claim, may affirmatives read this schwartz card (below) or some variant that basically says euthanasia/nazi doctors prove that allowing external actors determine the value of someones life is bad/promotes attrocity, only an individual can decide whether their life has value.

This evidence flows neg. Here is why:

The general assumption the aff is making is that the negative has made the argument "you do XYZ, therefore I have determined that your life has no value". I.E. they presuppose that the negs argument is doing X causally results in you having no value to your life, according to me the arbiter of value.

I do not believe this is the claim the neg is in fact making. Instead, the neg is saying that some kind of system (capitalism, biopolitics) does not see value in life, and the affirmative propogates that system. This external system is then the actor who decides life has no value, and is the external system deciding the patients life has no value, so Schwartz would indeed be criticizing that system- which is what the neg is doing, hence this evidence goes neg.

A more concrete example. Cap K. The idea that capitalism commodifies humanity and reduces us all to dollars and cents is not the neg saying "I, the 2NC, believe the affirmatives life has no value, because they endorse capitalism". It is saying the capitalist system that the aff props up is indifferent to life, and therefore it views lives as meaningless/mere commodity. So its like this

Neg- aff props up capital, capital views life as having no intrinsic meaning, that causes genocide
Aff- individuals should get to decide their own value of live
Neg- Agree- they should get to do that- capitalism prevents them from doing so- and you promote capitalism









Card in question (as an aside this is probably the weakest card to make this weak argument, its prevalence confuses me)
Those who choose to reason on this basis hope that if the quality of a life can be measured then the answer to whether that life has value to the individual can be determined easily. This raises special problems, however, because the idea of quality involves a value judgement, and value judgements are, by their essence, subject to indeterminate relative factors such as preferences and dislikes. Hence, quality of life is difficult to measure and will vary according to individual tastes, preferences and aspirations. As a result, no general rules or principles can be asserted that would simplify decisions about the value of a life based on its quality. Nevertheless, quality is still an essential criterion in making such decisions because it gives legitimacy to the possibility that rational, autonomous persons can decide for themselves that their own lives either are worth, or are no longer worth, living. To disregard this possibility would be to imply that no individuals can legitimately make such value judgements about their own lives and, if nothing else, that would be counterintuitive. 2 In our case, Katherine Lewis had spent 10 months considering her decision before concluding that her life was no longer of a tolerable quality. She put a great deal of effort into the decision and she was competent when she made it. Who would be better placed to make this judgement for her than Katherine herself? And yet, a doctor faced with her request would most likely be uncertain about whether Katherine’s choice is truly in her best interest, and feel trepidation about assisting her. We need to know which 110 Medical ethics: a case-based approach considerations can be used to protect the patient’s interests. The quality of life criterion asserts that there is a difference between the type of life and the fact of life. This is the primary difference between it and the sanctity criterion discussed on page 115. Among quality of life considerations rest three assertions: 1. there is relative value to life 2. the value of a life is determined subjectively 3. not all lives are of equal value. Relative value The first assertion, that life is of relative value, could be taken in two ways. In one sense, it could mean that the value of a given life can be placed on a scale and measured against other lives. The scale could be a social scale, for example, where the contributions or potential for contribution of individuals are measured against those of fellow citizens. Critics of quality of life criteria frequently name this as a potential slippery slope where lives would be deemed worthy of saving, or even not saving, based on the relative social value of the individual concerned. So, for example, a mother of four children who is a practising doctor could be regarded of greater value to the community than an unmarried accountant. The concern is that the potential for discrimination is too high. Because of the possibility of prejudice and injustice, supporters of the quality of life criterion reject this interpersonal construction in favour of a second, more personalized, option. According to this interpretation, the notion of relative value is relevant not between individuals but within the context of one person’s life and is measured against that person’s needs and aspirations. So Katherine would base her decision on a comparison between her life before and after her illness. The value placed on the quality of a life would be determined by the individual depending on whether he or she believes the current state to be relatively preferable to previous or future states and whether he or she can foresee controlling the circumstances that make it that way. Thus, the life of an athlete who aspires to participate in the Olympics can be changed in relative value by an accident that leaves that person a quadriplegic. The athlete might decide that the relative value of her life is diminished after the accident, because she perceives her desires and aspirations to be reduced or beyond her capacity to control. However, if she receives treatment and counselling her aspirations could change and, with the adjustment, she could learn to value her life as a quadriplegic as much or more than her previous life. This illustrates how it is possible for a person to adjust the values by which they appraise their lives. For Katherine Lewis, the decision went the opposite way and she decided that a life of incapacity and constant pain was of relatively low value to her. It is not surprising that the most vociferous protesters against permitting people in Katherine’s position to be assisted in terminating their lives are people who themselves are disabled. Organizations run by, and that represent, persons with disabilities make two assertions in this light. First, they claim that accepting that Katherine Lewis has a right to die based on her determination that her life is of relatively little value is demeaning to all disabled people, and implies that any life with a severe disability is not worth The value of life: who decides and how? 111 Write a list of three things that make your life worth living and ask someone else to do the same. Compare your lists. Are they identical? Why? Are they not identical? Why not? living. Their second assertion is that with proper help, over time Katherine would be able to transform her personal outlook and find satisfaction in her life that would increase its relative value for her. The first assertion can be addressed by clarifying that the case of Katherine Lewis must not be taken as a general rule. Deontologists, who are interested in knowing general principles and duties that can be applied across all cases would not be very satisfied with this; they would prefer to be able to look to duties that would apply in all cases. Here, a case-based, context-sensitive approach is better suited. Contextualizing would permit freedom to act within a particular context, without the implication that the decision must hold in general. So, in this case, Katherine might decide that her life is relatively valueless. In another case, for example that of actor Christopher Reeve, the decision to seek other ways of valuing this major life change led to him perceiving his life as highly valuable, even if different in value from before the accident that made him a paraplegic. This invokes the second assertion, that Katherine could change her view over time. Although we recognize this is possible in some cases, it is not clear how it applies to Katherine. Here we have a case in which a rational and competent person has had time to consider her options and has chosen to end her life of suffering beyond what she believes she can endure. Ten months is a long time and it will have given her plenty of opportunity to consult with family and professionals about the possibilities open to her in the future. Given all this, it is reasonable to assume that Katherine has made a well-reasoned decision. It might not be a decision that everyone can agree with but if her reasoning process can be called into question then at what point can we say that a decision is sound? She meets all the criteria for competence and she is aware of the consequences of her decision. It would be very difficult to determine what arguments could truly justify interfering with her choice. Subjective determination The second assertion made by supporters of the quality of life as a criterion for decisionmaking is closely related to the first, but with an added dimension. This assertion suggests that the determination of the value of the quality of a given life is a subjective determination to be made by the person experiencing that life. The important addition here is that the decision is a personal one that, ideally, ought not to be made externally by another person but internally by the individual involved. Katherine Lewis made this decision for herself based on a comparison between two stages of her life. So did James Brady. Without this element, decisions based on quality of life criteria lack salient information and the patients concerned cannot give informed consent. Patients must be given the opportunity to decide for themselves whether they think their lives are worth living or not. To ignore or overlook patients’ judgement in this matter is to violate their autonomy and their freedom to decide for themselves on the basis of relevant information about their future, and comparative consideration of their past. As the deontological position puts it so well, to do so is to violate the imperative that we must treat persons as rational and as ends in themselves. It is important to remember the subjectivity assertion in this context, so as to emphasize that the judgement made about the value of a life ought to be made only by the person concerned and not by others. Of course, this presumes that the person deciding is conscious and competent to make the decision at all, which is especially complicated in cases when the patient is unconscious, immature or suffering from a mental illness, such as depression, that could distort their decisionmaking abilities. Thus, seeking patient choice is not always a viable option. Not all patients are capable of choosing for themselves. In Janet Johnstone’s case, and in the similar case 112 Medical ethics: a case-based approach of Tony Bland, the decision was made externally, by people involved in their care. In such situations, family or practitioners have been known to make the decision on behalf of the incompetent patient, usually because they claim to know what the patient in question would have wanted. Relatives and doctors of Janet Johnstone argued that her condition lacked the dignity and control she valued, and that her situation would not improve. Under the circumstances, the judge decided the quality of her life was so diminished that her life was no longer worth living and that Ms Johnstone herself would have reached the same conclusion. The same sort of proxy decision making occurs when a woman, or couple, decide to terminate a pregnancy based on antenatal screening and testing. Here, parents make the decision on behalf of a fetus or a child. In such cases the parents must decide if, on balance, their child’s life is worth living given the possibility of pain and suffering or such inhibited interaction with the world that it would be of no value to the person living it. Needless to say, this is a difficult and trying dilemma for anyone to face. It also introduces a concern that underlies all prenatal screening programmes, in that these are supported by the social values implied by screening, which direct women towards termination of positive tested pregnancies.3 In the past, women were barred from screening and testing for similar conditions if they had previously decided that they would not terminate a pregnancy if the fetus carried the genetic condition. Hence screening was meant to be followed by testing, and positive results were meant to be followed by termination of pregnancy. The conclusion this yields, like it or not, is that our screening programmes carry with them an implication that the lives of those who are affected with certain conditions ought to be terminated because they are of comparatively less value than the lives of those who are not. This is supported in law by Wrongful Life suits in which parents of people born with screenable genetic conditions, such as spina bifida, have successfully sued doctors for the burden involved in caring for those born with such conditions.4 The problems associated with screening will be discussed elsewhere in Chapter 8 (p. 146–147). They are significant here because they elucidate the third assertion made by supporters of quality of life considerations in the medical context. Equal or unequal value? The third assertion is that, as a result of subjective and relative determinations about the quality of a life, lives can be seen to be of unequal value. At the extreme, it follows that it is possible to describe a life as valueless, especially when it is compared with the value of a life that has greater quality. In the case of the unborn fetus affected by a debilitating inherited condition, the welfare of the parents and their other children can be invested with greater value than the potential good of a potential child born with a severe disability. This allows us to make relative judgements among or between lives of individuals or groups. This is especially useful in healthcare economics, where decisions about distribution of resources rely on comparative information of the effectiveness of treatments. In this way it can be determined that resources will be made available for treatments that are more effective at improving quality of life in The value of life: who decides and how? 113 Case 24 Screening/testing for Down syndrome A 42-year-old woman presented at an antenatal clinic with her husband to discuss the results of her recent amniocentesis. In addition to Down syndrome, echocardiography of the fetus showed cardiac abnormalities, including atrioventricular septal defect. After extensive discussion between the parents and the obstetrician, the parents decided that the fetus had too many problems and that it would be unfair to the unborn child and to their other four children to continue with the pregnancy. particular conditions and not where the quality of life is not improved or so diminished that improvements are too small to justify. This point will be developed more fully in the section on quality-adjusted life-years (QALYs) and rationing in Chapter 9 (p. 163). Here, it is important to point to the possibility of making comparative judgements based on assessments of the quality of life and to emphasize that such judgements can be used to inform decisions about distributing and rationalizing scarce resources. As a result, there is a concern about quality of life decisions being made for others without their participation, and about decisions imposed without their consent. Both these concerns are tempered by the second assertion of the quality of life ethic. This states that value must be personally assessed by the individual concerned, and imposed externally only in extreme circumstances where patients are unable to decide on their own behalf and their wishes can be reasonably determined. An advance directive can be highly useful in the latter case. If a balance is made between both subjective determination and comparative decisions, we can avoid classifying a life as of comparatively low value where the person possessing it does not agree. Basing value of life decisions on quality of life has strong advantages. It: • Is subjective: takes seriously personal assessments made by individuals about the quality of their own lives • Is flexible: recognizes the possibility that the subjectively determined value of one’s life can change • Is comparative: recognizes that the way one life is valued need not impose the identical value on a similar life condition • Permits rational suicide: recognizes that one can legitimately assert the relatively low value of one’s own life. No one denies the importance of a good quality of life, or one that is acceptable to the person who has to live it. However, some argue that it is not the sole criterion upon which to base value of life decisions. These people include considerations of quantity and sanctity in their determination. Quantity The value of the quantity of a life should not be underestimated. In the past, so much emphasis was placed on the quality of life lived that quantity was virtually forgotten. More recently, attitudes have changed and consideration is given to the possibility that a long life of diminished quality could be as highly valued as a short life of high quality. In some senses the comparison seems absurd, unless we consider cases in which patients have refused complicated or agonising treatments that they perceived would exacerbate their suffering rather than extend their lives. Other patients prefer to extend their lives at any cost or risk to them because they value their existence so much that they will sacrifice quality in favour of quantity. This indicates that quantity ought not to be mistaken for quality and that prolonging a patient’s life might be nothing more than a burdensome and painful extension of suffering for them and their loved ones. However tempting it is for doctors to provide whatever care they are capable of providing, there is a responsibility to ensure that the treatments are actually useful to the patient and not unnecessarily burdensome. This means that a cost–benefit analysis can be usefully applied to a care management plan for an individual patient. The aim is to determine the extent to which treatment will be helpful and where the healing stops and the burden begins. Quantity might not be identical with quality but, often, increased quantity in medicine can be equal to cure or control of disease and hence does enhance quality of life. The Compression of Morbidity principle cited by Downie and Calman is useful for guiding these decisions: 114 Medical ethics: a case-based approach Compression of morbidity principle: the objective of increasing life-span should be associated at the same time with an increasing quality of life or reduction of disability.5 So, provided quality of life is maintained or enhanced, quantity is a positive factor in healthcare. There is a sense in which quality of life judgements are made in a wider context and not just as they pertain to particular patients. Health economists have long tried to determine the appropriateness of costly treatments on the basis of their burdensomeness and effectiveness. The most famous of these is a system known as QALYs. QALYs stand for quality-adjusted life-years, and are a means of making comparisons between health states. Equally concerned with quantity and quality, QALYs can be applied to a ‘relative health states’ scale. The problem is that these scales are themselves value-laden. Such issues will be covered in Chapter 9, where the idea of QALYs will be discussed as they relate to rationing and distribution of resources. They are introduced here because they show how a model for decision making can include the notions of quality and quantity discussed in this chapter. QALYs help decide which healthcare needs will be met by identifying which yield: • the greatest amount of good for • the greatest amount of time for • the greatest number of people.

Good Articles - 2-5

New Kagan- http://www.washingtonpost.com/wp-dyn/content/article/2009/02/02/AR2009020202618_pf.html

New AT: Kagan - http://www.salon.com/opinion/greenwald/2009/02/03/kagan/

Leftist Forum Ends in Amazon; Capitalism Seen Dying

from *Common Dreams* | News & Views by andrea

BELEM, Brazil - The world's biggest gathering of leftist activists ended on Sunday, after six days of discussions and protests that participants said showed there was an alternative to a crumbling global capitalist system.

Arab analyst blames Opec for collapse in prices

from Peak *Oil* News

A prominent Arab energy analyst has blamed Opec for the collapse in crude prices, saying the oil cartel has failed to fully comply with output cuts and kept sending contradicting messages to the already sceptic market.

Protectionism and stimulus (wonkish)

from Paul Krugman by By Paul Krugman

Should we be upset about the buy-American provisions in the stimulus bill? Is there an economic case for such

Greens Are Radioactive

from The Daily Dish | By Andrew *Sullivan* by Andrew Sullivan

In a good way:

“I think a number of other greens are slowly going to make the decision that nuclear power is better

Permanent vs. temporary increases in government spending, a Keynesian approach

from Marginal Revolution by Tyler Cowen

Let's say government can spend $100 billion today or spend the present expected value of $100 billion, stretched

Generals Seek To Reverse Obama's Iraq Withdrawal Decision

from Breaking News and Opinion on The *Huffington Post* by The Huffington Post News Editors

WASHINGTON, Feb 2 (IPS) - CENTCOM commander Gen. David Petraeus, supported by Defence Secretary

Feb 2, 2009 (3 days ago)

Joseph Romm: Can Obama stop the nuclear bomb in the Senate stimulus plan?

from Breaking News and Opinion on The *Huffington Post* by Joseph Romm

A radioactive dirty bomb has been dropped on the Senate stimulus package.

Javier Sierra: Coal is Dirty. Period.

from Breaking News and Opinion on The *Huffington Post* by Javier Sierra

Just as a mother makes her child wash his mouth out after telling a lie, one of the worst ecological catastrophes in our country's history is making the coal industry wash off its face, which is full of soot.