Hallucinations that help: Psychedelics, psychiatry, and freedom from the self
Dr. Chris Letheby, a pioneer in the philosophy of psychedelics, is looking at a chair. He is taking in its individuated properties – its colour, its shape, its location – and all the while, his brain is binding these properties together, making them parts of a collective whole.
This, Letheby explains, is also how we process the self. We know that there are a number of distinct properties that make us who we are: the sensation of being in our bodies, the ability to call to mind our memories or to follow our own trains of thought. But there is a kind of mental glue that holds these sensations together, a steadfast, mostly uncontested belief in the concrete entity to which we refer when we use the word “me.”
“Binding is a theoretical term,” Letheby explains. “It refers to the integration of representational parts into representational wholes. We have all these disparate representations of parts of our bodies and who we were at different points at time and different roles we occupy and different personality traits. And there’s a very high-level process that binds all of these into a unified representation; that makes us believe these are all properties and attributes of one single thing. And different things can be bound to this self model more tightly.”
Freed from the Self
So what happens when these properties become unbound from one another – when we lose a cohesive sense of who we are? This, after all, is the sensation that many experience when taking psychedelic drugs. The “narrative self” – the belief that we are an individuated entity that persists through time – dissolves. We can find ourselves at one with the universe, deeply connected to those around us.
Perhaps this sounds vaguely terrifying – a kind of loss. But as Letheby points out, this “ego dissolution” can have extraordinary therapeutic results in those who suffer from addiction, or experience deep anxiety and depression.
“People can get very harmful, unhealthy, negative forms of self-representation that become very rigidly and deeply entrenched,” Letheby explains.
“This is very clear in addiction. People very often have all sorts of shame and negative views of themselves. And they find it very often impossible to imagine or to really believe that things could be different. They can’t vividly imagine a possible life, a possible future in which they’re not engaging in whatever the addictive behaviours are. It becomes totally bound in the way they are. It’s not experienced as a belief, it’s experienced as reality itself.”
This, Letheby and his collaborator Philip Gerrans write, is key to the ways in which psychedelics can improve our lives. “Psychedelics unbind the self model,” he says. “They decrease the brain’s confidence in a belief like, ‘I am an alcoholic’ or ‘I am a smoker’. And so for the first time in perhaps a very long time [addicts] are able to not just intellectually consider, but to emotionally and experientially imagine a world in which they are not an alcoholic. Or if we think about anxiety and depression, a world in which there is hope and promise.”
A comforting delusion?
Letheby’s work falls into a naturalistic framework: he defers to our best science to make sense of the world around us. This is an unusual position, given some philosophers have described psychedelic experiences as being at direct odds with naturalism. After all, a lot of people who trip experience what have been called “metaphysical hallucinations”: false beliefs about the “actual nature” of the universe that fly in the face of what science gives us reason to believe.
For critics of the psychedelic experience then, these psychedelic hallucinations can be described as little more than comforting falsehoods, foisted upon the sick – whether mentally or physically – and dying. They aren’t revelations. They are tricks of the mind, and their epistemic value remains under question.
But Letheby disagrees. He adopts the notion of “epistemic innocence” from the work of philosopher Lisa Bortolotti, the belief that some falsehoods can actually make us better epistemic agents. “Even if you are a naturalist or a materialist, psychedelic states aren’t as epistemically bad as they have been made out to be,” he says, simply. “Sometimes they do result in false beliefs or unjustified beliefs … But even when psychedelic experiences do lead to people to false beliefs, if they have therapeutic or psychological benefits, they’re likely to have epistemic benefits too.”
To make this argument, Letheby returns again to the archetype of the anxious or depressed person. This individual, when suffering from their illness, commonly retreats from the world, talking less to their friends and family, and thus harming their own epistemic faculties – if you don’t engage with anyone, you can’t be told that you are wrong, can’t be given reasons for updating your beliefs, can’t search out new experiences.
“If psychedelic states are lifting people out of their anxiety, their depression, their addiction and allowing people to be in a better mode of functioning, then my thought is, that’s going to have significant epistemic benefits,” Letheby says. “It’s going to enable people to engage with the world more, be curious, expose their ideas to scrutiny. You can have a cognition that might be somewhat inaccurate, but can have therapeutic benefits, practical benefits, that in turn lead to epistemic benefits.”
As Letheby has repeatedly noted in his work, the study of the psychiatric benefits of psychedelics is in its early phases, but the future looks promising. More and more people are experiencing these hallucinations – these new, critical beliefs that unbind the self – and more and more people are getting well. There is, it seems, a possible world where many of us are freed from the rigid notions of who we are and what we want, unlocked from the cage of the self, and walking, for the first time in a long time, in the open air.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Joseph Earp
Joseph Earp is a poet, journalist and philosophy student. He is currently undertaking his PhD at the University of Sydney, studying the work of David Hume.
To see no longer means to believe: The harms and benefits of deepfake
The use of deepfake technology is increasing as more companies devise different models.
It is a form of technology where a user can upload an image and synthetically augment a video of a real person or create a picture of a fake person. Many people have raised concerns about the harmful possibilities of these technologies. Yet, the notion of deception that is at the core of this technology is not entirely new. History is filled with examples of fraud, identity theft, and counterfeit artworks, all of which are based on imitation or assuming a person’s likeliness.
In 1846, the oldest gallery in the US, The Knoedler, opened its doors. By supplying art to some of the most famous galleries and collectors worldwide, it gained recognition as a trusted source of expensive artwork – such as Rothko’s and Pollock’s. However, unlike many other galleries, The Knoedler allowed citizens to purchase the art pieces on display. Shockingly, in 2009, Ann Freedman, who had been appointed as the gallery director a decade prior, was famously prosecuted for knowingly selling fake artworks. After several buyers sought authentication and valuation of their purchases for insurance purposes, the forgeries came to light. The scandal was sensational, not only because of the sheer number of artworks involved in the deception that lasted years but also because millions of dollars were scammed from New York’s elite.
The grandiose art foundation of NYC fell as the gallery lost its credibility and eventually shut down. Despite being exact replicas and almost indistinguishable, the understanding of the artist and the meaning of the artworks were lost due to the lack of emotion and originality. As a result, all the artworks lost sentimental and monetary value.
Yet, this betrayal is not as immoral as stealing someone’s identity or engaging in fraud by forging someone’s signature. Unlike artwork, when someone’s identity is stolen, the person who has taken the identity has the power to define how the other person is perceived. For example, catfishing online allows a person to misrepresent not only themselves but also the person’s identity that they are using to catfish with. This is because they ascribe specific values and activities to a person’s being and change how they are represented online.
Similarly, deepfakes allow people to create entirely fictional personas or take the likeness of a person and distort how they represent themselves online. Online self-representations are already augmented to some degree by the person. For instance, most individuals on Instagram present a highly curated version of themselves that is tailored specifically to garner attention and draw particular opinions.
But, when that persona is out of the person’s control, it can spur rumours that become embedded as fact due to the nature of the internet. An example is that of celebrity tabloids. Celebrities’ love lives are continually speculated about, and often these rumours are spread and cemented until the celebrity comes out themselves to deny the claims. Even then, the story has, to some degree, impacted their reputation as those tabloids will not be removed from the internet.
The importance of a person maintaining control of their online image is paramount as it ensures their autonomy and ability to consent. When deepfakes are created of an existing person, it takes control of those tenets.
Before delving further into the ethical concerns, understanding how this technology is developed may shed light on some of the issues that arise from such a technology.
The technology is derived from deep learning, a type of artificial intelligence based on neural networks. Deep neural network technologies are often composed of layers based on input/output features. It is created using two sets of algorithms known as the generator and discriminator. The former creates fake content, and the latter must determine the authenticity of the materials. Each time it is correct, it feeds information back to the generator to improve the system. In short, if it determines whether the image is real correctly, the input receives a greater weighting. Together this process is known as generative adversarial network (GAN). It uses the process to recognise patterns which can then be compiled to make fake images.
With this type of model, if the discriminator is overly sensitive, it will provide no feedback to the generator to develop improvements. If the generator provides an image that is too realistic, the discriminator can get stuck in a loop. However, in addition to the technical difficulties, there are several serious ethical concerns that it gives rise to.
Firstly, there have been concerns regarding political safety and women’s safety. Deepfake technology has advanced to the extent that it can create multiple photos compiled into a video. At first, this seemed harmless as many early adopters began using this technology in 2019 to make videos of politicians and celebrities singing along to funny videos. However, this technology has also been used to create videos of politicians saying provocative things.
Unlike, photoshop and other editing apps that require a lot of skill or time to augment images, deepfake technology is much more straightforward as it is attuned to mimicking the person’s voice and actions. Coupling the precision of the technology to develop realistic images and the vast entity that we call the internet, these videos are at risk of entering echo chambers and epistemic bubbles where people may not know that these videos are fake. Therefore, one primary concern regarding deepfake videos is that they can be used to assert or consolidate dangerous thinking.
These tools could be used to edit photos or create videos that damage a person’s online reputation, and although they may be refuted or proved as not real, the images and effects will remain. Recently, countries such as the UK have been demanding the implementation of legislation that limits deepfake technology and violence against women. Specifically, there is a slew of apps that “nudify” any individual, and they have been used predominantly against women. All that is required of users is to upload an image of a person. One version of this website gained over 35 million hits over a few days. The use of deepfake in this manner creates non-consensual pornography that can be used to manipulate women. Because of this, the UK has called for stronger criminal laws for harassment and assault. As people’s main image continues to merge with technology, the importance of regulating these types of technology is paramount to protect individuals. Parameters are increasingly pertinent as people’s reality merges with the virtual world.
However, like with any piece of technology, there are also positive uses. For example, Deepfake technology can be used in medicine and education systems by creating learning tools and can also be used as an accessibility feature within technology. In particular, the technology can recreate persons in history and can be used in gaming and the arts. In more detail, the technology can be used to render fake patients whose data can be used in research. This protects patient information and autonomy while still providing researchers with relevant data. Further, deepfake tech has been used in marketing to help small businesses promote their products by partnering them with celebrities.
Deepfake technology was used by academics but popularised by online forums. Not used to benefit people initially, it was first used to visualise how certain celebrities would look in compromising positions. The actual benefits derived from deepfake technology were only conceptualised by different tech groups after the basis for the technology had been developed.
The conception of such technology often comes to fruition due to a developer’s will and, given the lack of regulation, is often implemented online.
While there are extensive benefits to such technology, there need to be stricter regulations, and people who abuse the scope of technology ought to be held accountable. As we see our present reality merge with virtual spaces, a person’s online presence will continue to grow in importance. Stronger regulations must be put into place to protect people’s online persona.
While users should be held accountable for manipulating and stripping away the autonomy of individuals by using their likeness, more specifically, developers must be held responsible for using their knowledge to develop an app using deepfake technology that actively harms.
To avoid a fallout like Knoedler, where distrust, skepticism, and hesitancy rooted itself in the art community, we must alert individuals when deepfake technology is employed; even in cases where the use is positive, be transparent that it has been used. Some websites teach users how to differentiate between real and fake, and some that process images to determine their validity.
Overall, this technology can help individuals gain agency; however, it can also limit another persons’ right to autonomy and privacy. This type of AI brings unique awareness to the need for balance in technology.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Mehhma Malhi
Mehhma recently graduated from NYU having majored in Philosophy and minoring in Politics, Bioethics, and Art. She is now continuing her study at Columbia University and pursuing a Masters of Science in Bioethics. She is interested in refocusing the news to discuss why and how people form their personal opinions.
Big Thinker: Francesca Minerva
Francesca Minerva is a contemporary bioethicist whose work largely includes medical ethics, technological ethics, discrimination and academic freedom.
A research Fellow at the University of Milan and the co-founder and co-editor of the Journal of Controversial Ideas, Francesca Minerva has published extensively within the field of applied ethics on topics such as cryonics, academic freedom, conscientious objection, and lookism. But she is best (if somewhat reluctantly) known for her work on the topic of abortion.
Controversy over ‘After-birth Abortion’
In 2012, Minerva and Alberto Giubilini wrote a paper entitled ‘After-birth Abortion: why should the baby live?’ The paper discussed the moral status of foetuses and newborn babies and argued that after-birth abortion (more commonly known as infanticide) should be permissible in all situations where abortion is permissible.
In the parts of the world where it is legal, abortion may be requested for a number of reasons, some having to do with the mother’s well-being (e.g., if the pregnancy poses a risk to her health, or causes emotional or financial stress), others having to do with the foetus itself (e.g., if the foetus is identified as having a chromosomal or developmental abnormality).
Minerva and Giubilini argue that if it’s permissible to abort a foetus for one of these reasons, then it should also be permissible to “abort” (i.e., euthanise) a newborn for one of these reasons.
This is because they argue that foetuses and newborns have the same moral status: Neither foetuses nor newborns are “persons” capable of attributing (even) basic value to their life such that being deprived of this life would cause them harm.
This is not an entirely original argument. Minerva and Giubilini were mainly elaborating on points made decades ago by Peter Singer, Michael Tooley and Jeff McMahan. And yet, ‘After-birth Abortion’ drew the attention of newspapers, blogs and social media users all over the world and Minerva and Giubilini quickly found themselves at the centre of a media storm.
In the months following the publication, they received hundreds of angry emails from the public, including a number of death threats.
The controversy also impacted their careers: Giubilini had a job offer rescinded and Minerva was not offered a permanent job in a philosophy department because members of the department “were strongly opposed to the views expressed in the paper”. Also, since most of the threatening emails were sent from the USA, they were advised not to travel to the USA for at least a year, meaning that they could not attend or speak at academic conferences being held there during that period.
So why did ‘After-birth Abortion’ attract so much attention compared to older publications on the same topic? While the subject matter is undoubtedly controversial, Minerva believes the circulation of the paper had more to do with the internet than with the paper itself.
Academic Freedom and the Journal of Controversial Ideas
“The Web has changed the way ideas circulate.” Ideas spread more quickly and reach a much wider audience than they used to. There is also no way to ensure that these ideas are reported correctly, particularly when they are picked up by blogs or discussed on social media. As a result, ideas may be distorted or sensationalised, and the original intent or reasoning behind the idea may be lost.
Minerva is particularly concerned about the impact that this may have on research, believing that fear of a media frenzy may discourage some academics from working on topics that could be seen as controversial. She believes that, in this way, the internet and mass media may pose a threat to academic freedom.
“Research is, among many other things, about challenging common sense, testing the soundness of ideas that are widely accepted as part of received wisdom, or because they are held by the majority of people, or by people in power. The proper task of an academic is to strive to be free and unbiased, and we must eliminate pressures that impede this.”
In an effort to eliminate some of this pressure, Minerva co-founded the Journal of Controversial Ideas, alongside Peter Singer and Jeff McMahan. As the name suggests, the journal encourages submissions on controversial topics, but allows authors to publish under a pseudonym should they wish to.
The hope is that by allowing authors to publish under a false name, academics will be empowered to explore all kinds of ideas without fearing for their well-being or their career. But ultimately, as Minerva says, “society will benefit from the lively debate and freedom in academia, which is one of the main incubators of discoveries, innovations and interesting research.”
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY The Ethics Centre
The Ethics Centre is a not-for-profit organisation developing innovative programs, services and experiences, designed to bring ethics to the centre of professional and personal life.
Seven Influencers of Science Who Helped Change the World
We’re all familiar with the Einsteins and Hawkings of history, but there are many who have influenced the direction and development of science. Here are seven scientists and philosophers who have shaped how science is practiced today.
Tim Berners-Lee
Sir Timothy Berners-Lee (1955-present) is an English computer scientist. Most notably, he is the inventor of the World Wide Web and the first web browser. If not for his innovative insight and altruistic intent (he gave away the idea for free!), the way you’re viewing this very page may have been completely different. These days, Berners-Lee is fighting to save his vision. The Web has transformed, he says, and is being abused in ways he always feared – from political interference to social control. The only way forward is pushing for ethical design and pushing back against web monopolisation.
Legacy: The World Wide Web as we know it.
Jane Goodall
Dame Jane Goodall (1934-present) is an English primatologist and anthropologist. Over 60 years ago, Goodall entered the forest of Gombe Stream National Park and made the ground-breaking discovery that chimpanzees make and use tools and exhibit other human-like behaviour, including armed conflict. Since then, she has spent decades continuing her extensive and hands-on research with chimpanzees, written a plethora of books, founded the Jane Goodall Institute to scale up conservation efforts, and is forever changing the way humans relate to animals.
Legacy: “Only if we understand, will we care. Only if we care, will we help. Only if we help, shall all be saved.”
Karl Popper
Sir Karl Popper (1902-1994) was an Austrian-British philosopher, academic and social commentator. He is best known as one of the greatest philosophers of science in the twentieth century, having contributed a new and novel way of thinking about the methodology of science. Against the prevailing empiricist idea that rationally acceptable beliefs can only be justified through direct experience, Popper proposed the opposite. In fact, Popper argued, theories can never be proven to be true. The best we can do as humans is ensure that they are able to be false and continue testing them for exceptions, even as we use these assumptions to further our knowledge. One of Popper’s most enduring thoughts is that we should rationally prefer the simplest theory that explains the relevant facts.
Legacy: The idea that to be scientific is to be fallible.
Marie Curie
Marie Curie (1867-1934) was a Polish-French physicist and chemist. She was a pioneer of radioactivity research, coining the term with her husband, and discovered and named the new elements “polonium” and “radium”. During the course of her extensive career, she was the first woman to be awarded a Nobel Prize, and the first to be awarded two Nobel Prizes in two scientific fields: physics and chemistry. Due to the underfunded research conditions of time and ignorance about the danger of radiation exposure, it’s thought that a large factor in her death was radiation sickness.
Legacy: Discovering polonium and radium, pioneering research into the use of radiation in medicine and fundamentally changing our understanding of radioactivity.
René Descartes
René Descartes (1596-1650) was a French philosopher, mathematician and scientist. Descartes is most widely known for his philosophy – including the famous “I think, therefore I am” – but he was also an influential mathematician and scientist. Descartes’ possibly most enduring legacy is something high school students are very familiar with today – coordinate geometry. Also known as analytic or Cartesian geometry, this is the use of algebra and a coordinates graph with x and y axes to find unknown measurements. Descartes was also interested in physics, and it is thought that he had great influence on the direction that a young Isaac Newton took with his research – Newton’s laws of motion were eventually modelled after Descartes’ three laws of motion, outlined in Principles of Philosophy. In his essay on optics, he independently discovered the law of reflection – the mathematical explanation of the angle at which light waves are reflected.
Legacy: “The seeker after truth must, once in the course of his life, doubt everything, as far as is possible.”
Rosalind Franklin
Rosalind Franklin (1920-1958) was an English chemist and X-ray crystallographer who is most famous for her posthumous recognition. During her life, including in her PhD thesis, she researched the properties and utility of coal, and the structure of various viruses. She is now often referred to as “the forgotten heroine” for the lack of recognition she received for her contributions to the discovery of the structure of DNA. Even one of the recipients of the Nobel Prize for the discovery of the DNA double helix suggested that Franklin should have been among the recipients, but posthumous nominations were very rare. Unfortunately, this was not her only posthumous brush with a Nobel Prize, either. One day before she and her team member were to unveil the structure of a new virus affecting tobacco farms, Franklin died of ovarian cancer. Over two decades later, her team member went on to win the Nobel Prize in Chemistry for the continued research on the virus. Since her death, she has been recognised with over 50 varying awards and honours.
Legacy: Foundational research that informed the discovery of the structure of DNA, coal and graphite.
Noam Chomsky
Noam Chomsky (1928-present) is an American linguist, philosopher, cognitive scientist and social/political critic. While Chomsky may be better known as a political dissident and social critic, he also played a foundational role in the development of modern linguistics and founded a new field: cognitive science, the scientific study of the mind. Chomsky’s research and criticism of behaviourism saw the decline in behaviourist psychology, and his interdisciplinary work in linguistics and cognitive science has gone on to influence advancements in a variety of fields including computer science, immunology and music theory.
Legacy: Establishing cognitive science as a formal scientific field and inciting the fall of behaviourism.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY The Ethics Centre
The Ethics Centre is a not-for-profit organisation developing innovative programs, services and experiences, designed to bring ethics to the centre of professional and personal life.
Who's to blame for Facebook’s news ban?
News will soon return to Facebook, with the social media giant coming to an agreement with the Australian government. The deal means Facebook won’t be immediately subject to the News Media Bargaining Code, so long as it can strike enough private deals with media companies.
Facebook now has two months to mediate before the government gets involved in arbitration. Most notably, Facebook have held onto their right to strip news from the platform to avoid being forced into a negotiation.
Within a few days, your feed will return to normal, though media companies will soon be getting a better share of the profits. It would be easy to put this whole episode behind us, but there are some things that are worth dwelling on – especially if you don’t work in the media, or at a social platform but are, like most of us, a regular citizen and consumer of news. Because when we look closely at how this whole scenario came about, it’s because we’ve largely been forgotten in the process.
Announcing Facebook’s sudden ban on Australian news content last week, William Easton, Managing Director of Facebook Australia & New Zealand wrote a blog post outlining the companies’ reasons. Whilst he made a number of arguments (and you should read them for yourself), one of the stronger claims he makes is that Facebook, unlike Google Search, does not show any content that the publishers did not voluntarily put there. He writes:
“We understand many will ask why the platforms may respond differently. The answer is because our platforms have fundamentally different relationships with news. Google Search is inextricably intertwined with news and publishers do not voluntarily provide their content. On the other hand, publishers willingly choose to post news on Facebook, as it allows them to sell more subscriptions, grow their audiences and increase advertising revenue.”
The crux of the argument is this. Simply by existing online, a news story can be surfaced by Google Search. And when it is surfaced, a whole bunch of Google tools – previews, summaries from Google Home, one-line snippets and headlines – give you a watered-down version of the news article you search for. They give you the bare minimum info in an often-helpful way, but that means you never click the site or read the story, which means no advertising revenue or way of knowing the article was actually read.
But Facebook is different – at least, according to Facebook. Unless news media upload their stories to Facebook, which they do by choice, users won’t see news content on Facebook. And for this reason, treating Facebook and Google as analogous seems unfair.
Now, Facebook’s claims aren’t strictly true – until last week, we could see headlines, a preview of the article and an image from a news story posted on Facebook regardless of who posted it there. And that headline, image and snippet are free content for Facebook. That’s more or less the same as what Facebook says Google do: repurposing news content that can be viewed without ever having to leave the platform.
However, these link previews are nowhere near as comprehensive as what Google Search does to serve up their own version of news stories for the company’s own purpose and profit. Most of the news content you see on Facebook is there because it was uploaded there by media companies – who often design video or visual content explicitly to be uploaded to Facebook and to reach their audience.
However, on a deeper level, there seem to be more similarities between Google and Facebook than the latter wants to admit, because the size and audience base Facebook possesses makes it more-or-less essential for media organisations to have a presence there. In a sense, the decision to have a strategy on Facebook is ‘voluntary’, but it’s voluntary in the same way that it’s voluntary for people to own an attention-guzzling, data sucking smartphone. We might not like living with it, but we can’t afford to live without it. Like inviting your boss to your wedding, it’s voluntary, but only because the other options are worse.
Facebook would likely claim innocence of this. Can they really be blamed for having such an engaging, effective platform? If news publishers feel obligated to use Facebook or fall behind their competitors that’s not something Facebook should feel bad about or be punished for. If, as Facebook argue, publishers use them because they get huge value from doing so, it does seem genuinely voluntary – desirable, even.
Even if this is true, there are two complications here. First, if news media are seriously reliant on Facebook, it’s because Facebook deliberately cultivated that. For example, five years ago Facebook was a leading voice behind the ‘pivot to video’, where publishers started to invest heavily in developing video content. Many news outlets drastically reduced writing staff and investment in the written word, instead focussing on visual content.
Three years later, we learned that Facebook had totally overstated the value of video – the pivot to video, which served Facebook’s interests, was based on a self-serving deception. This isn’t the stuff of voluntary, consensual relationships.
Let’s give Facebook a little benefit of the doubt though. Let’s say they didn’t deliberately cultivate the media’s reliance on their platform. Still, it doesn’t follow obviously from this that they have no responsibility to the media for that reliance. Responsibility doesn’t always come with a sign-up sheet, as technology companies should know all too well.
French theorist Paul Virilio wrote that “When you invent the ship, you also invent the shipwreck; when you invent the plane you also invent the plane crash; and when you invent electricity, you invent electrocution.” Whilst Virilio had in mind technology’s dualistic nature, modern work in the ethics of technology invites us to interpret this another way.
If inventing a ship also invents shipwrecks, it might be up to you to find ways to stop people from drowning.
Technology companies – Facebook included – have wrung many a hand talking about the ‘unintended consequences’ of their design and accepting responsibility for them. In fact, speaking before a US Congress Committee, Mark Zuckerberg himself conceded as much, saying:
“It’s clear now that we didn’t do enough to prevent these tools from being used for harm, as well. And that goes for fake news, for foreign interference in elections, and hate speech, as well as developers and data privacy. We didn’t take a broad enough view of our responsibility, and that was a big mistake. And it was my mistake. And I’m sorry. I started Facebook, I run it, and I’m responsible for what happens here.”
It seems unclear why Facebook recognised their responsibility in one case, but seem to be denying it in another. Perhaps the news media are not reliant – or used by – Facebook in the same way as they are Google, but it’s not clear this goes far enough to free Facebook of responsibility.
At the same time, we should not go too far the other way, denying the news media any role in the current situation. The emergence of Facebook as a lucrative platform seems to have led the media to a Faustian pact – selling their soul for clicks, profit and longevity. In 2021 it seems tired to talk about how the media’s approach to news – demanding virality, speed, shareability – are a direct result of their reliance on platforms like Facebook.
The fourth estate – whose work relies on them serving the public interest – adopted a technological platform and in so doing, adopted its values as their own: values that served their own interests and those of Facebook rather than ours. For the media to now lament Facebook’s decision as anti-democratic denies the media’s own blameworthiness for what we’re witnessing.
But the big reveal is this: we can sketch out all the reasons why Facebook or the media might have the more reasonable claim here, or why they share responsibility for what went down, but in doing so, we miss the point. This shouldn’t be thought of as a beef between two industries, each of whom has good reasons to defend their patch.
What needs to be defended is us: the community whose functioning and flourishing depends on these groups figuring themselves out.
Facebook, like the other tech giants, have an extraordinary level of power and influence. So too do the media. Typically, we don’t to allow institutions to hold that kind of power without expecting something in return: a contribution to the common good. This understanding – that powerful institutions hold their power with the permission of a community they deliver value to – is known as a social license.
Unfortunately, Facebook have managed to accrue their power without needing a social license. All power, no permission.
This is in contrast to the news media, whose powers aren’t just determined by their users and market share, but by the special role we afford them in our democracy, the trust and status we afford their work isn’t a freebie: it needs to be earned. And the way it’s earned is by using that power in the interests of the community – ensuring we’re well-informed and able to make the decisions citizens need to make.
The media – now in a position to bargain with Facebook – have a choice to make. They can choose to negotiate in ways that make the most business sense for them, or they can choose to think about what arrangements will best serve the democracy that they, as the ‘fourth estate’, are meant to defend. However, at the very least they know that the latter is expected of them – even if the track record of many news publishers gives us reason to doubt.
Unfortunately, they’re negotiating with a company whose only logic is that of a private company. Facebook have enormous power, but unlike the media, they don’t have analogous mechanisms – formal or informal – to ensure they serve the community. And it’s not clear they need it to survive. Their product is ubiquitous, potentially addictive and – at least on the surface – free. They don’t need to be trusted because what they’re selling is so desirable.
This generates an ethical asymmetry. Facebook seem to have a different set of rules to the media. Imagine, for a moment, if the media chose to stop reporting for a fortnight to protest a new law. The rightful outrage we would feel as a community would be palpable. It would be nearly unforgivable. And yet we do not hold Facebook to the same standards. And yet, perhaps at this point, they’ve made themselves almost as influential.
There’s a lot that needs to happen to steady the ship – and one of the most frustrating things about it is that as individuals, there isn’t a lot we can do. But what we can do is use the actual license we have with Facebook in place of a social license.
If we don’t like the way a news organisation conducts themselves, we cancel our subscriptions; we change the channel. If you want to help hold technology companies to account, you need to let your account to the talking. Denying your data is the best weapon you’ve got. It might be time to think about using it – and if not, under what circumstances you might.
This project is supported by the Copyright Agency’s Cultural Fund.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Matthew Beard
Matt is a moral philosopher with a background in applied and military ethics. In 2016, Matt won the Australasian Association of Philosophy prize for media engagement. Formerly a fellow at The Ethics Centre, Matt is currently host on ABC’s Short & Curly podcast and the Vincent Fairfax Fellowship Program Director.
Space: the final ethical frontier
The German philosopher Immanuel Kant once famously said “Two things fill the mind with ever new and increasing admiration and awe, the oftener and the more steadily we reflect on them: the starry heavens above and the moral law within.”
It probably didn’t occur to Kant that there would come a day when the moral law and the starry heavens would find themselves in a staring contest with one another. In fairness though, it’s been almost 250 years since he wrote that quote. Today, those starry heavens play an increasingly important role in human affairs. And wherever there are people making decisions, ethical issues are sure to follow.
To get to know this final ethical frontier, I had a chat with Dr Nikki Coleman, Senior Chaplain Ethicist with the Australian Air Force. Nikki is a bona fide space ethicist to help us get up to (hyper) speed with all the new issues around ethics in space.
Is space an environment?
One of the largest contributions of the field of environmental ethics has been to encourage people to consider the environment as having value independent of its usefulness to humans. Before environmental ethics emerged as a field, many indigenous cultures and religions had already embedded these beliefs in the way they lived and related to land.
“The idea of space is that it’s a ‘global commons’,” says Coleman. “It belongs to all of us on the planet, but also to future generations. We can’t just dump space debris. We have to be careful about how we utilise resources. Like the resources on Earth, these resources are finite. They don’t go on forever,” she says.
This echoes one of the most common arguments about preservation and sustainability. We take care of the planet not just for ourselves, but for future generations. The challenge is helping people to understand that custodianship of space means thinking about the long tail on the decisions we make now. In fact, it might be even more difficult when it comes to space because, well, space is big, and it’s a long way away and we’ll likely never go there ourselves.
“What happens in space is the same as what happens on Earth, but it’s more remote,” Coleman tells me. And yet, despite this, what happens in space affects us profoundly. Just as we rely on trees, ecosystems and other aspects of the natural environment, we are reliant on parts of space as well. “Even though these objects feel further away from us, we still have an interdependency and a relationship with space,” explains Coleman.
What role should private companies play?
We’ve seen a lot of noise about space being made by private companies like SpaceX and Virgin – which is an enormous change from the time when travelling to space was something you could only do from a national space agency in a wealthy nation. But these companies have very different motivations for expanding into space.
“Space,” says Coleman “has become a very congested space.” “The cost of space operations has dramatically decreased, and we’re now seeing whole organisations devoted to their own space operations rather than as part of a government.”
This is where some issues can arise, “because what’s appropriate for a commercial operator in returning profits to stakeholders is not necessarily what’s appropriate for the whole of the planet.” Space is a ‘global commons’, it should be used to serve everyone’s interests – including future generations – not just the needs and wants of a single company or nation. It’s unclear to what extent commercial operators are taking the idea of a global commons seriously.
“We have someone like Elon Musk putting a car into space – which is the ultimate litter – or talking about putting 42,000 satellites into low-earth orbit, which obviously creates problems around congestion and space debris,” Coleman explains, referring to Elon Musk’s proposed ‘Starlink’, a network of satellites that could dramatically improve broadband speeds.
The interstellar garbage dump
Space debris is a big deal. We probably all remember in primary school learning about how different parts of a rocket break apart as they launch into space. Some of that burns up in the atmosphere, but lots of it remains in orbit. And it’s not just a few parts of rockets and a random Tesla. There is a lot of junk floating around in orbit around earth.
“Why that is problematic is it actually stays there for a really long period of time,” Coleman explains. “Some of it will decay in orbit and burn up in the atmosphere, but a lot of it could stay there for tens of thousands of years.”
But it’s not just that the debris sticks around. It’s that it can wreck a whole lot of important stuff whilst it orbits around the planet.
Coleman tells me that debris can interfere with our current satellites. ”The International Space Station is actually quite vulnerable. It only takes a small puncture to make it a life-threatening situation. And the issue is growing because we’re putting more and more satellites – including small satellites that don’t manoeuvre – into space.”
The worst-case scenario when it comes to space debris was depicted in the recent film Gravity, where the debris destroys satellites, generating even more space debris in a cascading process called Kessler Syndrome.
“The idea of having a whole area of space that is full of space debris will actually have massive impacts for the future,” Coleman warns. We use satellites for so many things: communication, food security, navigation… it’s not just about posting on Twitter and putting photos on Facebook.”
“The precursor for space debris is lots of things in space, so that’s why it’s problematic when someone talks about putting tens of thousands of satellites into orbit.”
The militarisation of space isn’t new
Coleman is quick to point out that space and the military have a long history. In fact, Sputnik was a Russian military satellite, which means “we have had a militarisation of space operations right from the get go.”
However, there are some changes in the way that militaries are thinking about space today. “Currently, military operations in space predominantly look at satellites and communication and dedicated military satellites for example, we’re with starting to see an increase in aggressive uses of military uses of space,” says Coleman.
The challenges here are myriad, but one significant one is that so much of what’s up in space is infrastructure that both civilians and the military need. Usually, the law and ethics of war don’t permit the targeting of infrastructure used by civilians when that would be disproportionately harmful to them.
“I would argue that a civilian satellite is not a legitimate target because it could have catastrophic effects for the civilians that rely on that satellite.”
“Space debris is climate change 2.0”
Ok, yes, we already talked about space debris but it’s so interesting we have to do it twice. See, space debris isn’t just garbage; it’s property.
“If you throw a bottle into the ocean, anyone can pick that up. That means that all the plastic in the middle of the ocean can actually be collected and recycled and made into something commercially viable,” Coleman explains. “But everything that goes into space is actually the property of the country that launched it.”
This means even if someone wanted to tidy up space, they couldn’t. Anyone can litter the global commons, but that doesn’t mean anyone can tidy it up. The rubbish belongs to someone.
This is where Coleman sees the analogy to climate change beginning. No one person or group can solve the problem. “We need to work together internationally to search to solve the problem of space debris,” she says. “I’m really excited that at the moment there is a large amount of discussion internationally about climate change, but there isn’t a lot being done around [space debris].”
The other, more frightening, climate change analogy is in terms of the threat posed by space debris. “It has the capacity to have a much faster impact on life on the planet,” says Coleman. “It could push us back to the 1950s.”
If there’s life on Mars, can we live there?
It seems interesting that at a time when many societies are coming to grips with the harms and problems colonisation has had around the world, there are people seriously contemplating the colonisation of Mars. For Coleman, this reveals one of the central ethical questions – not just for space, but in any walk of life. How far do our moral obligations extend?
“Do we have a duty not just to ourselves but to others as well, and do we have a responsibility to future generations of humans or potentially future generations of whatever is growing on Mars?”
We accept that we have obligations to future humans, but it seems quite different to say that we have obligations to a microbial life form on Mars. However, Coleman poses a further question: do we also have duties to whatever that microbial organism might evolve to be in millions of years?
“If we find life, do we owe it the opportunity to grow and develop into something that might eventually turn into intelligent life?”
I, for one, welcome our new microbial brothers and sisters.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Matthew Beard
Matt is a moral philosopher with a background in applied and military ethics. In 2016, Matt won the Australasian Association of Philosophy prize for media engagement. Formerly a fellow at The Ethics Centre, Matt is currently host on ABC’s Short & Curly podcast and the Vincent Fairfax Fellowship Program Director.
Big tech's Trojan Horse to win your trust
Technology has created bad trust habits in all of us. We shouldn’t be tricked into giving tech our trust, but that’s exactly what happens when everything is about making life easier.
During this lockdown period, I’ve been thinking a lot about the difference between states and habits. Since the outbreak of COVID-19, we’ve all learned what proper hand washing hygiene looks like, how to prevent the risk of spreading disease when we’re in public and what kinds of places to avoid.
For many of us, health used to be a state that we enjoyed without having to develop too many of the habits that help guarantee that health. We’ve had all the benefit without the effort. However, we’re now recognising that if we want the best chance of maintaining our health in a time of uncertainty, we need to be intentional about the habits and behaviours we develop.
I think it’s helpful to think about trust in the same way. For many people and organisations, being trusted is a state: we want to be in a situation where people have high confidence in us. What hasn’t always happened is to think about the intentional practices, behaviours and habits that are likely to secure trust in times of crisis.
This is particularly true for technology and tech companies, who have enjoyed a disproportionately high level of trust for a simple reason: they make our lives easier. The convenience we receive by interacting with technology means we’re likely to continue to engage with them, even when there are very good reasons not to.
Take Uber, for example. Uber is highly reliable and very convenient, which means people are willing to get into cars with complete strangers. Their behaviour indicates they trust the service, even if they say they don’t (surveys find that people find taxi drivers more trustworthy than Uber drivers). This kind of behavioural trust, born of convenience, holds even in situations where people have very good reasons not to ride.
In 2016, in Kalamazoo, Michigan, Jason Dalton – an Uber driver – murdered six people whilst working his nightly Uber driving route. As news broke that there was a suspected murderer picking up rides via Uber, people continued to use the service. One rider who caught a ride with Dalton (thankfully, he wasn’t murdered) actually asked him ‘you’re not the one whose been driving around killing people, are you?’. Despite being aware there was a real threat to life, the convenience of a cheap ride home secured consumer trust in Uber.
Of course, it’s only trust of a certain kind. The trust we confer on convenient technology isn’t genuine trust – where we rationally, consciously believe that our interests align to the tech developers and that they want to take care of us. It’s implied trust; whether we believe the technology will deliver, we act as though it will.
This is the kind of trust we show in large tech platforms like Facebook. A 2018 YouGov survey commissioned by the Huffington Post found 66% of Facebook users have little to no trust in the platforms use of their data. Despite this, those users have given Facebook their data, and continue to do so, which is the kind of trust we provide when there’s something convenient on offer.
We cannot understate the significance that convenience plays as a trust lubricant. Trust expert Rachel Botsman, author of Who Can You Trust?, argues that “Money is the currency of transactions. Trust is the currency of interactions.” We need to add another layer to this: trust is the currency of conscious interactions, but convenience is the currency of the unthinking consumer (and we are all, at times, unthinking consumers).
This generates some real challenges for tech companies. It’s easy to use convenience to secure behavioural trust – to be in the ‘state’ of trust with customers – so that they’ll use your services, hand over data or spend their money, without developing the habits that generate rational, genuine trust. It’s easier to be trusted than to be trustworthy, but it might also be less valuable in the long run.
Moreover, the tendency to reward the convenience-seeking part of ourselves might generate problems with a very long tail. Some problems are not easily solved, nor is there an app to solve wealth inequality, climate change or discrimination. Many of our problems require a willingness to persevere; whilst technology can help, and might help resolve the symptoms of some of these issues, the underlying causes require rethinking our social, political and economic beliefs. Technology alone cannot get us there.
And yet, we continually look to technology as a solution for these woes. The Australian government’s first response to climate change after the 2020 bushfires was a large-scale investment in new climate technologies. Several people have released ‘consent apps’, aimed at preventing rape and false rape claims by having people sign a waiver to confirm they’ve consented to sex. There is no app to solve misogyny; no one technology that will fix our approach to the environment.
The reality is, trading on convenience can make us lazy – not just as individuals, but as a society. It’s bad for us. Moreover, it’s bad for business.
Although people often make decisions based on convenience, they pass judgements based on trust. This means they will often feel duped, exploited or betrayed, feeling ‘tricked’ into signing up to something just because it was convenient at the time.
This makes for a fickle customer and is an unreliable basis on which to build a business. Recognising this, a number of successful organisations are now seeking to build genuine trust. Salesforce CEO Mark Benioff recently stated, “trust has to be the highest value in your company, and if it’s not, something bad is going to happen to you.”
However, for people to trust you, they need to be able to slow down, think, form an ethical judgement. Today, one of the major goals of technology is to be frictionless. Hopefully by now you can see why that’s an unwise goal. If you want people to genuinely trust you, then you can’t give them a seamless experience. You need to create some friction.
Remember, convenience can be a lubricant. It might help you get people through the door more quickly, but it makes them slippery and hard to hold on to.
If you found this article interesting, download our paper, Ethical By Design: Principles for Good Technology for free to further explore ethical tech. Learn the principles you need to consider when designing ethical technology, how to balance the intentions of design and use, and the rules of thumb to prevent ethical missteps. Understand how to break down some of the biggest challenges and explore a new way of thinking for creating purpose-based design.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Matthew Beard
Matt is a moral philosopher with a background in applied and military ethics. In 2016, Matt won the Australasian Association of Philosophy prize for media engagement. Formerly a fellow at The Ethics Centre, Matt is currently host on ABC’s Short & Curly podcast and the Vincent Fairfax Fellowship Program Director.
Are we ready for the world to come?
We are on the cusp of civilisational change driven by powerful new technologies – most notably in the areas of biotech, robotics and expert AI. The days of mass employment are soon to be over.
While there will always be work for some – and that work is likely to be extremely satisfying – there are whole swathes of the current economy where it will make increasingly little sense to employ humans. Those affected range from miners to pathologists: a cross-section of ‘blue collar’ and ‘white collar’ workers, alike in their experience of displacement.
Some people think this is a far too pessimistic view of the future. They point to a long history of technological innovation that has always led to the creation of new and better jobs – albeit after a period of adjustment.
This time, I believe, will be different. In the past, machines only ever improved as a consequence of human innovation. Not so today. Machines are now able to acquire new skills at a rate that is far faster than any human being. They are developing the capacity for self-monitoring, self-repair and self-improvement. As such, they have a latent ability to expand their reach into new niches.
This doesn’t have to be a bad thing. Working twenty-four hours a day, seven days a week in environments that no human being could tolerate, machines may liberate the latent dreams of humanity to be free from drudgery, exploitation and danger.
However, society’s ability to harvest the benefits of these new technologies crucially depends on planning and managing a just and orderly transition. In particular, we need to ensure that the benefits and burdens of innovation are equitably distributed. Otherwise, all of the benefits of technological innovation could be lost to the complaints of those who feel marginalised or abandoned. On that, history offers some chilling lessons for those willing to learn – especially when those displaced include representatives of the middle class.
COVID-19 has given us a taste of what an unjust and disorderly transition could look like. In the earliest days of the ‘lockdown’ – before governments began to put in place stabilising policy settings such as the JobKeeper payment – we all witnessed the burgeoning lines of the unemployed and wondered if we might be next.
As the immediate crisis begins to ease, Australian governments have begun to think about how to get things back to normal. Their rhetoric focuses on a ‘business-led’ return to prosperity in which everyone returns to work and economic growth funds the repayment of debts accumulated during the the pandemic.
Attempting to recreate the past is a missed opportunity at best, and an act of folly at worst. After all, why recreate the settings of the past if a radically different future is just a few years away?
In these circumstances, let’s use the disruption caused by COVID-19 to spur deeper reflection, to reorganise our society for a future very different from the pre-pandemic past. Let’s learn from earlier societies in which meaning and identity were not linked to having a job.
What kind of social, political and economic arrangements will we need to manage in a world where basic goods and services are provided by machines? Is it time to consider introducing a Universal Basic Income (UBI) for all citizens? If so, how would this be paid for?
If taxes cannot be derived from the wages of employees, where will they be found? Should governments tax the means of production? Should they require business to pay for its use of the social and natural capital (the commons) that they consume in generating private profits?
These are just a few of the most obvious questions we need to explore. I do not propose to try to answer them here, but rather, prompt a deeper and wider debate than might otherwise occur.
Old certainties are being replaced with new possibilities. This is to be welcomed. However, I think that we are only contemplating the ‘tip’ of the policy iceberg when it comes to our future. COVID-19 has given us a glimpse of the world to come. Let’s not look away.
The Ethics Centre is a world leader in assessing cultural health and building the leadership capability to make good ethical decisions in complexity. To arrange a confidential conversation contact the team at consulting@ethics.org.au. Visit our consulting page to learn more.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
You might be interested in…
BY Simon Longstaff
Simon Longstaff began his working life on Groote Eylandt in the Northern Territory of Australia. He is proud of his kinship ties to the Anindilyakwa people. After a period studying law in Sydney and teaching in Tasmania, he pursued postgraduate studies as a Member of Magdalene College, Cambridge. In 1991, Simon commenced his work as the first Executive Director of The Ethics Centre. In 2013, he was made an officer of the Order of Australia (AO) for “distinguished service to the community through the promotion of ethical standards in governance and business, to improving corporate responsibility, and to philosophy.” Simon is an Adjunct Professor of the Australian Graduate School of Management at UNSW, a Fellow of CPA Australia, the Royal Society of NSW and the Australian Risk Policy Institute.
BY The Ethics Centre
The Ethics Centre is a not-for-profit organisation developing innovative programs, services and experiences, designed to bring ethics to the centre of professional and personal life.
Philosophically thinking through COVID-19
In their recent article, ‘Who gets the ventilator in the coronavirus pandemic?’, bioethicists Julian Savulescu and Dominic Wilkinson note that we may soon be faced with a situation in which the demand for medical resources is greater than what is available.
At that point, decisions about who gets what medical resources ought to be just, they argue. The trouble with the article however, is that the two men seem to approach our present crisis as though it were just that, a present tense phenomenon. They view COVID-19 not as a something that has emerged over time as a result of our social configuration and political choices, but as something that appeared out of nowhere, an atemporal phenomenon.
Treating the pandemic as atemporal means that the two scholars only focus on the fact of this individual here and that one over there, suffering in this moment, from the same condition. They fail to ask how how this person came to be prone to the virus, or what resources that person has had at their disposal, let alone the socio-political and historical circumstances by which those resources were acquired. Karla Holloway, Professor of English and Professor of Law, makes the point that stripping away the textual details around our two patients simplifies the decision making process, but the price paid for that efficiency might be justice.
We know that there are systematic discrepancies in medical outcomes for marginalised groups at the best of times.We know that structural inequalities inform discrepancies around the degree to which people can practice social distancing and reduce the risk of infection. We know that those most likely to be most severely affected in the wake of the pandemic are those belonging to already marginalised communities. As public health medicine specialist, Papaarangi Reid, put it in a recent interview:
“We’ve got layers that we should be worried about. We should be worried about people who have difficulty accessing services … people who are stigmatised … While we are very worried about our elderly, we’re also worried about our precariat: those who are homeless; we’re worried about those who are impoverished; those who are the working poor; we’re worried about those who are in institutions, in prisons.”
Every time Reid says that we ought to worry about this group or that, I am confronted by Arendt’s take on just how difficult it is to think in that manner. I’m currently teaching a Clinical Ethics course for second year medical students, one of whose central pillars is Hannah Arendt’s understanding of thought. Standing on the other side of the catastrophe that was the second world war, she warned that thinking is incredibly difficult; so much so it demands that one stop, and it can be paralysing.
Arendt pointed out those algorithmic processes on the basis of which we usually navigate day-to-day life: clichés, conventional wisdom, the norms or ‘facts’ that seem so self-evident, we take them for granted. She argued that those are merely aids, prostheses if you like, which stand in the place of thinking – that labour of conceptually wading through a situation, or painstakingly kneading a problem. The trouble is, in times of emergency, where there is panic and a need for quick action, we are more likely to revert to our algorithms, and so reap the results of our un-interrogated and unresolved lapses and failures.
Australia today is a case in point. “The thing that I’m counting on, more than anything else,” noted Prime Minister Scott Morrison recently, “Is that Australians be Australian.” He went on to reiterate at the same press conference, “So long as Australians keep being Australians, we’ll get through this together.”
I’m almost sympathetic to this position. A looming disaster threatens the status quo, so the head of that status quo attempts to reassure the public of the durability of the prevailing order. What goes unexamined in that reflex, however, is the nature of the order. The prime minister did not stop to think what ‘Australia’ and ‘Australianness’ mean in more ordinary times.
Nor did he stop to consider recent protests by First Nations peoples, environmental activists, refugee and asylum seeker advocates and a raft of groups concerned about those harmed in the course of ‘Australians being Australian’. Instead, with the imperative to act decisively as his alibi, he propagated the assumption that whatever ‘Australia’ means, it ought to be maintained and protected. But what if that is merely the result of a failure to think adequately in this moment?
In his excellent article, calling on the nation to learn from past epidemics, Yuggera/Warangu ophthalmologist Kris Rallah-Baker, writes: ‘This is just the beginning of the crisis and we need to get through this together; Covid-19 has no regard for colour or creed’. In one sense, he seems to arrive at a position that is as atemporal as that of Savulescu and Wilkinson, with a similar stripping away of particularity (colour and creed). It’s an interesting position to come to given the continuity between post-invasion smallpox and COVID-19 that his previous paragraphs illustrate.
Read another way, I wonder if Rallah-Baker is provoking us; challenging us to think. What if this crisis is not the beginning, but the result of a longstanding socioeconomic, political and cultural disposition towards First Nations peoples, marginalised groups more broadly, and the prevailing approach to social organisation?
Could it then also be the case that the effect of the presence of novel coronavirus in the community is in fact predicated, to some degree, on social categories such as race and creed? Might a just approach to addressing the crisis, even in the hospital, therefore need to grapple with temporal and social questions?
There will be many for whom the days and weeks ahead will rightly be preoccupied with the practical tasks before them: driving trucks; stacking supermarket shelves; manufacturing protective gear; mopping and disinfecting surfaces; tending to the sick; ensuring the continuity of government services; and so forth. For the rest of us, there is an imperative to think. We ought to think deeply about how we got here and where we might go after this.
Perhaps then, as health humanities researchers Chelsea Bond and David Singh recently noted in the Medical Journal of Australia:
“we might also come to realise the limitations of drawing too heavily upon a medical response to what is effectively a political problem, enabling us to extend our strategies beyond affordable prescriptions for remedying individual illnesses to include remedying the power imbalances that cause the health inequalities we are so intent on describing.”
You can contact The Ethics Centre about any of the issues discussed in this article. We offer free counselling for individuals via Ethi-call; professional fee-for-service consulting, leadership and development services; and as a non-profit charity we rely heavily on donations to continue our work, which can be made via our website. Thank you.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Bryan Mukandi
is an academic philosopher with a medical background. He is currently an ARC DECRA Research Fellow working on Seeing the Black Child (DE210101089).
BY The Ethics Centre
The Ethics Centre is a not-for-profit organisation developing innovative programs, services and experiences, designed to bring ethics to the centre of professional and personal life.
How to put a price on a life - explaining Quality-Adjusted Life Years (QALY)
In all the time I’ve spent teaching ethics – from trolley problems to discussions of civilian casualties at war to the ethics of firefighting – there have been a few consistent trends in what matters to people.
One of the most common is that in life-and-death situations, details matter. People want to know exactly who might die or be rescued: how old are they? Are they healthy? Do they have children? What have they done with their life?
What they’re doing, whether they know it or not, is exploring what factors could help decide which life it would be most reasonable, or most ethical to save, relative to the other lives on the table.
Moreover, it’s not only in times of war or random thought experiments that these questions arise. Every decision about where to allocate health resources is likely to have life-or-death consequences. Allocate more funding to women’s shelters to address domestic violence and you’ll save lives. However, how many lives would you save if that same money were used to fund more hospital beds, or was invested into mental health support in rural communities?
One widely-used method for ensuring health resources are allocated as efficiently as possible is to use QALY’s – quality-adjusted life years. QALY is an approach that was developed in the 1970’s to more precisely, consistently and objectively determine the effectiveness and efficiency of different health measures.
Here’s how it works: imagine a year of life enjoyed at full health. It gets assigned a score of 1. Every year of life lived at less than full health gets assigned a lower score. The worse off the person’s health, the lower the score.
For example, take someone who has to undergo chemotherapy for five years. They have full mobility, but have some difficulty with usual activities, severe pain and mild mental health challenges. They might be given a QALY score of 0.55.
Once we’ve gotten a QALY score, we then need to work out how much the healthcare costs. Then, it’s simple maths: multiply the cost by the QALY score and you get an idea of how much each QALY is costing you. Then you can compare the cost effectiveness of different health programs.
QALY’s are usually seen as a utilitarian method of allocating health resources – it’s about maximising the utility of the healthcare system as a whole. However, like most utilitarian approaches, what works best overall doesn’t work best in individual cases. And that’s where criticisms of QALY arise.
Let’s say two patients come in with the same condition – COVID-19. One of them is young, non-disabled and has no other health conditions affecting their quality of life. The other person is elderly, has a range of other health conditions and is in the early stages of dementia. Both patients have the same condition. However, according to the QALY approach, they are not necessarily entitled to the same level of care – for example, a ventilator if resources are scarce. The cost per QALY for the younger patient is far lower than for the elderly patient.
For this reason, QALY’s are sometimes seen as inherently unjust. They fail to provide all people with equal access to healthcare treatment. Moreover, as philosopher and medical doctor Bryan Mukandi argues, if two patients with the same condition are expected to have different health outcomes, there’s a chance that’s the result of historical injustices. Say, a person with type-2 diabetes receives a lower QALY score as a result, but type-2 diabetes is correlated with lower income, the scoring system might serve to entrench existing advantage and disadvantage.
Like any algorithmic approach to decision-making, QALYs present as neutral, mathematic and scientific. That’s why it’s important to remember, as Cathy O’Neil says in Weapons of Math Destruction, that algorithms are “opinions written in code.”
Embedded within QALY’s method are a range of assumption about what ‘full health’ is and what it is not. For instance, a variation on the QALY methodology call DALY – disability-adjusted life years – “explicitly presupposes that the lives of disabled people have less value than those of people without disabilities.”
An alternative to the QALY approach is to adopt what is known simply as a ‘needs-based’ approach. It’s sometimes described as a ‘first come, first served’ approach. It prioritises the ideal of healthcare justice above health efficiency – everyone deserves equal access to healthcare, so if you need treatment, you get treatment.
This means, to go back to our elderly and young patients with COVID-19, that whoever arrives at the hospital first and has a clinical need of a ventilator will get one. QALY advocates will argue that in times of scarcity, this is an inefficient approach that may border on immoral. After all, shouldn’t the younger person be given the same chance at life as the elderly person?
However, there is something radical underneath the needs-based approach. QALY’s starting point is that there are limited health resources, and therefore some people will have to miss out. A needs-based approach allows us to do something more radical: to demand that our healthcare is equipped, as much as possible, to respond to the demand. Rather than doing the best with what we have, we make sure we have what is necessary to do the best job.
You can contact The Ethics Centre about any of the issues discussed in this article. We offer free counselling for individuals via Ethi-call; professional fee-for-service consulting, leadership and development services; and as a non-profit charity we rely heavily on donations to continue our work, which can be made via our website. Thank you.
Ethics in your inbox.
Get the latest inspiration, intelligence, events & more.
By signing up you agree to our privacy policy
BY Matthew Beard
Matt is a moral philosopher with a background in applied and military ethics. In 2016, Matt won the Australasian Association of Philosophy prize for media engagement. Formerly a fellow at The Ethics Centre, Matt is currently host on ABC’s Short & Curly podcast and the Vincent Fairfax Fellowship Program Director.