All posts by mcm87

Christmas 2020: Finding Hope in Trying Times

by Myles N. Sheehan, SJ, MD, Director, Pellegrino Center for Clinical Bioethics; Professor of Medicine; and Lauler Chair in Catholic Health Care Ethics

 From the December issue of The Pellegrino Report: Bioethics in Practice

Ethics can be about considering individual decisions, or it can consider who we are as persons.  The latter approach, known as virtue ethics, looks to how our decisions determine who we become.  It asks three questions: “Who am I?” What am I doing? “Who am I becoming by my actions?”

The past nine months have been an exceptionally trying time for our country and for health care clinicians.   There have been multiple crises, each of which is daunting, and, in aggregate, can be overwhelming.   For those who work at Medstar Georgetown University Hospital, the most immediate has been the Covid-19 pandemic.  But this explosion of a new infectious disease, which has strained the hospital and all who care for patients, has been in the context of new episodes of violence against people of color, of economic hardship, and of a bitterly divided country racked by conspiracy theories and distrust.

Despite all this, my experience at Georgetown, as someone newly arrived and beginning a new role as Director of the Pellegrino Center for Clinical Bioethics, I have found great hope.  Why? Because I see a group of doctors, nurses, therapists, and support staff who have answered the three key questions of virtue ethics in ways that reveal they are people who care, who show dedication and skill in caring for patients even at risk to their own health, and who are becoming an even better group for excellent and compassionate care as we, please God, move into a better future.

We can live in hope as we administer (or begin administering) the vaccination that will end the pandemic and allow us to return to something like our normal practice.  But those who have lived and worked in healthcare during this time are not going to be able to forget what they have gone through.  Walter Brueggeman, a theologian, ordained minister, and scholar of the Hebrew Scriptures, notes in a recent book that hope and faith occur in the context of lament, recognizing and mourning what has been lost. Only in a frank acknowledgment of how bad things have been can we integrate our experience, move forward, and have hope for a future that acknowledges the past and looks to something better.  Real hope is not glib and forgetful; it allows for healing and regret even while pointing to a better time.

The hope I have for the future is that we look to what we have lost and how we have been stressed but also acknowledge what has been done at MGUH.   St. Paul, in an insight that goes beyond Christianity, speaks of faith, hope, and love as three things that remain but acknowledges that the greatest of these is love.  Why? Faith without love easily turns into fanaticism and violence.  Hope without love is the precursor to the aphorism “Be careful what you hope for.”  The hope that I have comes from my witnessing the compassion of all the staff at MGUH in an extraordinarily difficult time: compassion is the expression of love for those for whom we care. 

We are not out of the woods yet, and the next few months will test our ability to continue to show compassion and to grow as persons who are seeking to do what is right and good.  Learning from these trying times and moving on to do better is at the heart of moral growth.   As the next few weeks roll out and there is ongoing challenge, please face it with hope, a hope that acknowledges the hardships but also looks to the love shown in compassion to so many patients by so many caregivers.

 

 

Good for You? Good for Me! Flattening the Curve through the Combinations of Altruism

By Will McCreadie and James Giordano PhD

The Arabian Babbler bird is unusually generous; babblers sing and dance together, give gifts to each other, groom one another, and even compete fiercely for the privilege of helping their peers.  They feed each other’s young and vie to guard the territory while the others in their group forage.  As a species, they exemplify traits of altruism – acts of benefiting others – along a spectrum of egoism (i.e.- eliciting some relative benefit to self). Within this spectrum is competitive altruism, wherein agents act in ways that appear “selfless”, but which enable their own gain by affording some advantage within and among others. As well, there is reciprocal altruism, which entails giving in order to obtain something in return. These are not mutually exclusive; altruistic behaviors often send strong social signals that can boost the giver’s reputation.  This can lead to upward mobility within a group, and augment self-worth and well-being, as sustained by their position and supportive actions of the group, in the future.

As we have noted, every altruistic act has an egoistic component. It’s how brains work: we sense and perceive the world (and our place and status within it) through the subjective lens of self-embodiment. On some level, whether subtly or overtly, we weigh our choices and decisions for action upon the consequences that will be incurred (for ourselves) in and along temporal scale (i.e.- “Being good to others affords some good for me now and/or good for me later”, etc.). It seems that competitive giving can result in more prosocial behavior than anonymous altruism alone. Competitive altruism plays an significant role in human generosity, and allows for a deeper understanding of how people are responding to COVID-19. In turn, this may allow better incentivization(s) for altruism. Such incentives characteristically appeal to the key factors of social signaling: visibility, credibility, and social resonance.

Visibility

For generosity to be a social signal, it must be noticeable – or at least recognizable. This helps to explain why very few donations are anonymous.  A 2019 study of GoFundMe data revealed that only 21% of donations were made anonymously, and the median anonymous donation was less than the median attributed donation.  This is consistent with prior work that has shown that people tend to be far more generous when their giving is public. Clearly, visibility of some form and level plays a critical role in most peoples’ giving.

Credibility

The ethologist Amotz Zahavi was among the first to propose that an altruistic act can be a social signal, and this precept was a foundational element of what he called the handicap principle.  In this framework, making a sacrifice signals evolutionary fitness because it is a costly (and therefore hard to fake) sign that the giver is “well-off” enough to be generous. Thus, more significant acts of altruism send stronger – and better – social signals.

Social Resonance

Social norms also contribute to the valuation of particular signal. In the short- or long-term, the signal must convey something of benefit, both to the group and the giver about what is given, as well as what will be perceived as the relative value of the identity, role, and/or place of the giver within the social ecology, in order to make the signal of the altruistic act(s) worthwhile.

Altruism and COVID-19

There are two reasons to care about the spectrum of altruism as we fight the pandemic.  First, it explains acts of giving that might seem otherwise irrational. Most charitable behaviors appear to make little “egoistic” sense, because the cost of the action(s) is, by definition, to the giver, and not explicitly recouped. In other words, the proverbial “juice” does not seem to be “worth the squeeze”. But it depends on what juice, how much, and who’s savoring it.  Both reciprocal and competitive altruism expand constructs and contexts of costs and benefits to include status.  While there’s an initial cost to giving, the benefactor can increase their social status if the signal is visible, credible, and resonant.

Second, competitive giving can result in better outcomes for society as a whole. If one person donates an hour of their time to fighting the virus, someone else may contribute an hour and a half, escalating the social standard for acceptable contribution.  If these signals are visible and valuable, someone else – who perhaps wouldn’t otherwise make a contribution – may step in, feeling some socially related self-referential impetus to be at least as good as their peers. Scaling this dynamic across millions of people can radically augment our response to the virus.

Mask Wearing: Competitive Altruism Creating a New Norm

Masks are one of the most economically attractive coronavirus responses, because they offer considerable benefit for minimal cost. It’s been projected that if 95% of people wear a mask in public gatherings of any sort, 67,000 American lives could be saved by December 1st.

However, mask wearing is still far from universal. It’s been shown that men are particularly resistant to wearing face coverings, and are more likely to feel that masks are “uncool” and “signs of weakness”.

Competitive altruism could play a role in mitigating or reversing this trend. Masks are already visible and reliable signals (it’s hard to fake wearing one), but it will be important, and may be necessary to establish mask-wearing status competitiveness in order to prompt new social norms.

As we’ve noted before, it’s time for masks to be considered aspirational and ‘cool’.  Normalizing masks as an extension of personal identity and benevolent intent increases their social resonance. This sends signals that make it more “competitively desirable” for people to wear masks in public amidst the ongoing COVID crisis; establishing mask-wearers as “crusaders against COVID” and contributory to social welfare. In this way, they take on a heroically giving aspect to their social identity. And, if masks are considered fashionable, people can seek status by choosing expressive materials and creative designs. The more perceived effort someone puts into their mask habits (even if that perception is one of “I ordinarily would never wear a mask, but for the good of others, I will”), the more robustly reliable the signal, and the greater the potential for positive competition and its beneficial social effect(s).

If people can compete to protect each other (i.e.- competitive cooperative altruism), the greater the common good. Indeed, we can gain considerable insight from the past: Aristotle was right – doing good for others is rewarding for oneself. As we fight the pandemic, we should stop babbling about wearing or not wearing a mask, and embrace masks – and our actions for others – as a form of positive self-expression, with attributes for both ourselves and society.

 

Accept the Responsibilities of Participating in Public Health

By James Giordano PhD, Professor, Departments of Neurology and Biochemistry and Senior Scholar-in-Residence, Pellegrino Center for Clinical Bioethics

The SARS-CoV-2 virus is not taking the summer off.  Recent studies by Stephanhie Pfänder and colleagues at Ruhr University Bochum (GER) have shown that the virus remains viable for almost 18 hours at temperatures of 86 degrees Fahrenheit.

While many constraints on business openings and social gatherings have relaxed, COVID hasn’t cratered, and current efforts to regain socio-economic stability, while still being topics of contention in government, are in fact precariously balanced upon peoples’ participation in doing what it takes to sustain public health.

Public health is about us, but cannot happen without us; because we are that public. It is our health, individually and collectively, that is the goal, and as such we must be – and remain – committed to the process. Continue to maintain physical distancing when out in the community, and acknowledge and accept that being in public spaces requires your active role in public health.

So, when out and about, cover your nose and mouth:

ACCEPT THE TASK .  .  . WEAR A MASK.

Photo: St. Ignatius Masked at Loyola U Medical Center Maywood Illiniois. Photo courtesy Daniel Dillinger MD