Is Morality Universal?

November 30, 2009
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Is morality a social construct or is it universal, transcending time and culture?  Or is it a little bit of both?  Read on to find out more about what we call “morality.”

Religions often act as “morality delivery systems.”  According to Jonathan Haidt in an NYT article titled “The Moral Instinct,” morality has 3 traits:

  • Morality must invoke “universal” rules. Prohibitions of rape and murder, for example, are felt not to be matters of local custom but to be universally and objectively warranted. One can easily say, “I don’t like brussels sprouts, but I don’t care if you eat them,” but no one would say, “I don’t like killing, but I don’t care if you murder someone.”
  • Immorality should be “punished.” Not only is it allowable to inflict pain on a person who has broken a moral rule; it is wrong not to, to “let them get away with it.” People are thus untroubled in inviting divine retribution or the power of the state to harm other people they deem immoral.
  • Morality differs from other psychological mind-sets. This is the mind-set that makes us deem actions immoral (“killing is wrong”), rather than merely disagreeable (“I hate brussels sprouts”), unfashionable (“bell-bottoms are out”) or imprudent (“don’t scratch mosquito bites”).

We know from history that some behaviors that were once considered immoral (e.g. divorce) are now considered morally neutral and some behaviors that were considered morally neutral (e.g. smoking) are now considered immoral (due to harm caused to others). Additionally, people have different morality “thresholds” (e.g. the continuum between sport hunters and vegans). In short, some of what passes for morality is preference alignment (meaning people who make the same choices I do are “moral” while those who don’t are “immoral”). We have a gut reaction that something is wrong, but we don’t really know why, so we try to explain or rationalize our response. This would be fine if those gut reactions didn’t differ so much from culture to culture and from era to era, and even from person to person within culture and era.  Even things that are major morality taboos for us have been “norms” in some other societies:

  • Sex with minors.  Older men initiating younger men into sexuality was a norm in ancient Greece.  Marriage in previous eras has been allowable pretty much as soon as the participants had reached puberty, much younger in the case of political alliances between dynastic families.  Large age discrepancies were far more acceptable in previous eras, especially to create financial security through the union.
  • Incest.  In our society, we have a very strict prohibition on sex with someone too closely related, but in Hawaiian royalty, sibling marriage was considered an obligation to keep the royal blood pure.  Likewise, even in our own society, marriage to cousins was quite common as recently as the 1800s.
  • Murder.  While we find intentional killing repugnant, it is often “allowed” or even encouraged when outside of one’s own ‘tribe.’  We currently call this war, but killing of outsiders has also been done throughout history as a method of purifying one’s race (killing neighboring infidels so that there will be no intermarriage) or appeasing deities (through human sacrifice of outsiders).
  • Cannibalism.  Again, this is about the worst thing imaginable in our current society, but some cultures had cannibalistic rituals such as eating the dead to inherit their spiritual properties or eating their victims slain in battle to honor them.  Whatever floats yer boat, I guess.

According to Haidt, there are 5 morality “instincts” that are universal:

  • Harm. The difference between sticking a pin in your own hand (ouch!) and sticking a pin in the hand of a child (!!). We might wince at the first, but we recoil in horror from the second.
  • Fairness. Accepting something for free that was due to a random error (lucky me) vs. something for free that was stolen from someone else (!!).
  • Community. Saying something bad about Mormonism to another active Mormon vs. saying something bad about Mormonism to an evangelical.
  • Authority. Slapping a colleague as part of a comedy skit vs. slapping your bishop or your boss as part of a comedy skit.
  • Purity. Actors in a play behaving in a silly manner on stage vs. actors in a play behaving like animals on stage (e.g. crawling around naked and urinating on stage).

So, while these might be the 5 morality “instincts,” they are still not truly universal for several reasons:

  • Different thresholds for each.  Even within a community, there are often different thresholds for all of these five instincts.  One person may consider something as “harm” (or abuse) that another person thinks is “tough love.”  One person might consider something a purity issue (e.g. washing hands in the restroom) that another person considers a matter of preference (I hope I’m not shaking hands with this person).
  • Different specifics for each.  While everyone may view someone as an authority, those authorities differ from person to person based on affiliation.  For example, depending on political affiliation, someone may deem Glenn Beck or Rush Limbaugh worthy of special respect as an authority, but may not afford the same respect to Nancy Pelosi or Barack Obama.  Likewise, I may view my parents as authority figures, but their parents didn’t necessarily view them the same way.
  • Conflicting morals.  At times, these 5 instincts are in conflict with one another.  Is it immoral to harm another person if it helps the community (i.e. “the needs of the many outweigh the needs of the one”) or if an authority commands it (e.g. Nephi killing Laban)?  Is it immoral to harm another person as a means to achieve fairness (e.g. death penalty or even corporal punishment)?
  • Morality vs. Preference.  Is it moral instinct or merely preference if the choice is inherently distasteful?  Once disgust enters, we cease to be rational.  What is the line between morality and squeamishness?  What makes one person feel squeamish doesn’t faze another.  For a person who is homophobic, their irrational fear of homosexuality may mean it is more of a question of (strong) preference than morality.
  • Self-Serving Morality.  And aren’t “moral” choices that are based on “community” and “authority” mixed up with what is “imprudent”?  IOW, is it morality or fear of retaliation from authority or fear of being ostracized by the community?  And is purity always tied up in our fear of “impurity,” therefore, more a matter of preference than morality?

Some do not believe that morality is more than a social construct.  Do you agree or do you feel there is a universal form of morality that transcends time and culture?  How do you distinguish cultural norms and niceties from actual morality?  Can you readily identify a universal morality and cite examples?  If not, does this mean that there is no such thing as a universal morality or do differences in threshold and specifics mean that people have suppressed their understanding of the universal truth?  Discuss.

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44 Responses to Is Morality Universal?

  1. CarlosJC
    November 30, 2009 at 4:47 am

    -”Likewise, even in our own society, marriage to cousins was quite common as recently as the 1800s.”

    Einstein married a cousin too (2nd marriage) and they seemed quite happy.

    -”Incest. In our society, we have a very strict prohibition on sex..”

    Its still fairly common in Tongan culture for fathers to turn to their daughters when the wife is pregnant or unavailable for some other reason. I’m still amazed at how they will justify that arguing that its ‘the Tongan way or tradition’.

    -Off course it should be that morality flows from God and his way should be the only way but then we run into problems with things like divorce. So maybe a watered down version of God’s morality is the best option today.

  2. CarlosJC
    November 30, 2009 at 4:50 am

    “Cannibalism. Again,…”

    Maybe with chicken salt :)

  3. November 30, 2009 at 8:30 am

    Hawkgrrrl this is one of the best posts I’ve seen on here. So much to say! Wow.

    I’m hopping on a plane for NYC soon, but I wanted to touch on this before I left.

    I believe the problem with ‘morality’ is the word itself. The word is an amalgam of several divergent concepts, such as ‘empathy’ and ‘judgment’. You can’t have a lesson on morality without a judgment toward a person or behavior. This is where it gets sticky. Many people would call my lifestyle immoral. Their assessment would not be based on empathy, harm to myself or others; their judgment would be made based on the fact that I am different.

    We teach our children not just by what we say, but by what we do. (Unfortunately for most people). My mother used to jokingly say about my father; “Do as I say, not as I do” (he struggled a bit….ehem) Point is, our reaction to something we deem immoral is the groundwork for our children.

    I saw a bumper sticker that made me nauseous. It said (with an American flag, of course) “These colors don’t mix”. The part that made me sick? The back of the truck was filled with small children.

    If you boil Universal Morality into two concepts, it would boil down to these: Do no harm to other(s)(people or things) and strive for empathy.

    If you do no harm and strive for empathy, you wouldn’t rape, kill. You wouldn’t fight to keep people in love from binding their lives together. You wouldn’t fight to keep health care away from sick, uninsured people in need. These are acts of immorality.

    The concept of morality has been debased. It has been sullied by petty rules and personal preference and fear rather than empathy and doing no harm. As frightful as it sounds, ‘harm’ is subjective. Certainly war would fall under immoral. But what about war for a moral cause? Can we start a war based on not harming others and empathy? No, we can’t. Sometimes the way of life is immoral. But we ought to CALL it that rather than justify by using the ‘end justify the means’ theory; the end NEVER justify the means.

    Some cultures view cannibalism as okay. But if we apply the ‘do no harm’ and ‘empathy’ to it, it would be Universally immoral. Some cultures (ehem) view homosexuality as unacceptable. If we apply empathy and do no harm, it is not immoral in the least.

    So in terms of morality, I believe most, if not all of it is learned. Much of it is cross-cultural and cross-time and faith. But just because it’s deemed moral by the majority, doesn’t mean it is.

    I’m sorry if this seems disjointed, but I do so like your thoughts on this.

    Thanks for listening!

  4. brjones
    November 30, 2009 at 11:05 am

    For the most part I agree with JulieAnn. I think there are very few, if any, “morals” that are universal or absolutely inherent to the human condition. I think we can see even within the generations of the church, that different times and cultures have differing values, so that even religious groups that are using identical scripture as the basis for their morals, have varying ideas of “absolute” morals.

    JulieAnn, I would disagree with you on the point that the end never justifies the means. That seems like a difficult position to maintain when you’ve already conceded that it’s problematic to define harm. What if there is a situation where there is going to be harm regardless of what course you take? The more I think about it, the more I think an ideal like “do no harm” is simply unworkable in society. What about people who deserve to be harmed? What about violent criminals? Even if you don’t believe in capital punishment, doesn’t locking someone in a cage for the rest of their life constitute harm? Doesn’t killing another person in self-defense or to protect one’s family constitute harm to another, even though most would argue it’s completely justified? This just brings us back to the original question about subjectivity. “Do no harm” is just as subjective as any other rule or law. The point is, society must, in some way, determine what is moral and how such laws are going to be applied, and on a personal level each person must do the same. I think this is the beginning and the end of morality.

  5. Rico
    November 30, 2009 at 11:32 am

    Having already highlighted the problem with the Harm argument (I want to add that issues of harm are always embedded in a context and are therefore linked with notions of power) I would like to take a stab at the empathy argument.

    Firstly I believe true empathy is impossible and therefore it will tend (or could have the potential) to be a self-serving attachment to another’s situation. This will open it up to individual variation. Moreover if it will be our projection of what we believe about another’s experience this can also lead to harm. For example, Bruce Hafen’s attempts to understand, empathise and also teach the LDS doctrines concerning homosexuality have led to harm for some. Now you might argue that this is a warped empathy, but my argument is that there can be no other kind.

    Surely this depends on whether people believe in God and then whether they believe that he has a unviersal morality. Social history tells us that there is no universal morality there are only variations on how morality is manifest (even if some of these have some common character traits, like the ones mentioned in the post).

    Although I believe there is a universal morality I have no idea what it looks like and I am not convinced anyone else does?

  6. Henry
    November 30, 2009 at 12:07 pm

    Humans live by a moral code while animals do not.

  7. brjones
    November 30, 2009 at 12:16 pm

    #6 – Henry, what is the significance of this?

  8. Rico
    November 30, 2009 at 12:17 pm

    I just don’t think that is correct. There is a whole host of primate studies that would argue that they are capable of creating society with moral codes. This is contested but the fact that it is debated raises serious problems with your argument (or sorts?)

  9. jmb275
    November 30, 2009 at 2:41 pm

    Great post hawk! I find myself nodding with you, and each of the commenters. I’m not sure whether or not there is some universal morality. If there is, it seems it would have to be painted with such a broad abstract brush as to be almost completely meaningless. About the only thing I can settle on is love.

  10. Henry
    November 30, 2009 at 2:42 pm

    BR Jones:
    You are so condescending the way you address people.

    Rico:
    I would be interested in any info you may have on this.

  11. Hawkgrrrl
    November 30, 2009 at 2:56 pm

    From a Mormon context, I would think that “the light of Christ” is meant to express a belief in a universal morality – that all people have an inherent sense of what is right and wrong. But as seen above, this can be problematic. Perhaps there is an inherent morality that is able to be “unlearned” as well – through strong enough cultural motivations and incentives.

    I like the notion that “love” (which is probably a combination of avoiding harm to others and empathizing with them) is the one universally moral principle, although there have been so many cultures with low or different thresholds for the same over time that it has manifest in ways that are almost unrecognizable they are so different! I also think that the other morality types (e.g. purity, community, authority) often conflict with the principles of love and empathy. Racism can be a manifestation of someone’s (or a culture’s) self-defined purity or community, but that definition excludes a group of people as being eligible for love and empathy. Perhaps the key to living a moral life is to continue to increase the scope of who is included in our love and empathy (even to all living creatures) while also elevating our threshold for our personal behaviors – doing less and less harm to others through our increasing empathy for them.

  12. November 30, 2009 at 2:59 pm

    Henry,

    I don’t think BR was being condescending — He asked you a legitimate question about the relevance of your post. I don’t think that rises to the level of condescension. I didn’t see any relevance to the animal comment either.

    An interesting aspect of this discussion is the need to evaluate the intent of the actor. Morality is ultimately a subjective test, rather than an external objective one. Moral action comes from the intent of the actor, evil-harmful intent equates to immoral. Most criminal justice systems are built on a requirement that punishment is predicated upon a guilty immoral state of mind. This is how society justifies its immoral act of kidnapping and killing in the name of justice.

    I think the biggest irony is how little discussion is given to the basis for the morality in the religion, particularly given divergent social mores.

  13. Thomas
    November 30, 2009 at 3:20 pm

    #3 — “You wouldn’t fight to keep health care away from sick, uninsured people in need.”

    Watch me. Or, more specifically, watch me oppose a colossally unwise and unworkable scheme supported by simplistic notions like that above, bandied about by people uninformed and/or unconcerned with the devil-inhabited details.

    If a certain level health care can only be provided to sick, uninsured Person A by denying care to Person B (which is exactly how it works in Britain and other places where your mindset is followed), then how is that any more moral than the reverse? Robbing Peter to pay Paul will of course get the moral approval of Paul. Peter, not so much.

    As per the original post, the different ways in which the posited five universal moral imperatives are expressed in the practical morality of diverse cultures reflect different calculations of the trade-offs that inevitably arise when those imperatives clash against one another. I think rationalizing the tax treatment and regulation of health insurance, encouraging people to purchase high-deductible plans, and subsidizing coverage and treatment for the severely and chronically ill and impoverished makes more sense than what is about to be imposed on us. But that’s probably just my bias in favor of the moral imperatives of rationality and liberty overshadowing the competing concerns of … whatever moral thinking it is that favors the other alternative.

  14. Heber13
    November 30, 2009 at 3:24 pm

    I think there are universal morals, but not all morals are universal. The closer we come to understanding the real moral code, the happier we are, I think.

    I also find it gets garbled up in language and culture and how people define and understand it all.

    Murder – Does that mean never go to war? What about self-defense? Does that mean don’t ever kill an animal and eat meat? What about killing a potato plant and eating that?? I think there is a right and wrong regarding murder that applies to all … but it is tough to express it clearly in words so we know what is murder and what is not. We’ve got volumes in our legal system about that one thing, but they still haven’t nailed it down universally.

    I think there are some morals that are inherent and universal and we just know it is wrong to go against them, other morals are established as the least common denominator among the group (which aren’t universal to other groups).

  15. Vaipato
    November 30, 2009 at 4:18 pm

    RE: CarlosJC’s comments
    -”Incest. In our society, we have a very strict prohibition on sex..”

    Its still fairly common in Tongan culture for fathers to turn to their daughters when the wife is pregnant or unavailable for some other reason. I’m still amazed at how they will justify that arguing that its ‘the Tongan way or tradition’.

    - I myself, a Tongan, and very aware of Tongan customs/tradition don’t know or ever heard of this as being part of our TONGAN culture. That is considered disgusting and unaccepted in Tongan culture. As A Tongan that was raised up by a respectable and traditional family, I’m appalled by your ignorance and slander on a culture, you obviously have no idea about. Tongan culture prohibits a brother/sister to borrow each other’s items of personal grooming, laying down in each other’s presence, being shirtless or showing excessive skin in each other’s presence, etc… let alone sleep w/ other. It is taboo for a daughter to touch any of her own father’s leftover food, having any contact with his scalp/hair, etc… let alone lie down w/ each other… You get punished by law for incest in Tonga even sometimes serving life in prison to even getting punished by hanging. So CarlosJC, please get your facts straight before blogging away fictitious fibs of a respectable and very moral culture!

  16. November 30, 2009 at 4:34 pm

    I think morality can be universal so far as we are wired similarly. (To the extent we are not…that’s where we come up with different moral systems)

    Namely, we are beings of subjective feeling and taste. The reason “harm” is “bad” is because we subjectively feel it to be bad. If there were no such negative feelings and effects of “harm” and “suffering” and things like this, we wouldn’t call them bad.

    The issue is that humans, because we have come from a similar process (evolution or…if you don’t want to believe in that, whatever got us here), react predictably to a great many things. MOST of us will feel “pain” if we are stabbed with knives, so we can agree that this is a negative feeling, and we can make similar conclusions about the desirability of this negative feeling.

    At the same time, this doesn’t provide much realm for an expansive universal morality. Because some harms, we say, are justifiable. (No pain, no gain…This is for your own good…one step back; two steps forward…better for x to feel pain so that y can avoid it) Or we disagree on whether some actions even cause pain.

    Similar things happen to other proposed bases for morality. What does empathy entail? What, specifically, is impure? What is fair? Who is in the in-group?

    Of course, I think we have to make it contextual. For example, “Killing is wrong”? That lacks context. “Murder is wrong” (where murder implies something other than killing…e.g., the killing of an innocent or something like that) has more to back it up. But even that may be insufficient…eventually, contextually-based moral statements that are universal will be so narrow that they become hindrances rather than helps.

  17. DavidH
    November 30, 2009 at 5:49 pm

    I enjoyed reading, and found quite persuasive, Marc Hauser’s Moral Minds: How Nature Designed Our Universal Sense of Right and Wrong, http://www.amazon.com/Moral-Minds-Nature-Designed-Universal/dp/0060780703 . Hauser is a professor of psychology and evolutionary biology at Harvard. He is referenced a couple of times in the article linked in the NYT magazine.

    I read the book, in part, because my daughter is completing a Ph.D. in evolutionary psychology at University of New Mexico. Her former roommate (Ilanit Tal) performed an interesting experiment in the biology of incest avoidance in human beings. As I recall, under the experiment, women were asked to smell shirts that had been worn by a number of different individuals. It turned out that the more closely the shirt wearer was related to the subject, the more repulsive the smell was. This suggests that even without a societal taboo on incest, in most cases humans would likely avoid incest anyway–by and large we are programmed that way. Of course, the repulsiveness of the thought of incest (which might be biologically tied to human instincts) may have given rise to the societal prohibition (a prohibition that was rarely violated, except in rare cases like the Pharoahs).

    Ilanit’s study has not yet been published, but some of the principles are discussed in D. Lieberman and I. Tal, Kin Detection and the Development of Sexual Aversions: Toward an Integration of Theories on Family Sexual Abuse,published in Family Relationships: an Evolutionary Perspective (C. Salmon, T. K. Shackelford, eds) (the article can be read on line through google books, but I cannot figure out how to post a like to it).

    Thus, I am persuaded, at least tentatively, that the Light of Christ operates partially through evolutionary adaptations or other biological mechanisms.

  18. Hawkgrrrl
    November 30, 2009 at 5:51 pm

    DavidH – excellent thoughts – thanks for sharing!

  19. brjones
    November 30, 2009 at 6:41 pm

    #10 – Henry, I apologize if I came off as condescending. I was really asking a sincere question, and to be honest with you, I was actually thinking that I was just missing the significance, as opposed to thinking that there wasn’t any. I’m surprised to hear myself accused of being condescending in the way I address people generally, as I think I do a decent job of making it obvious when that’s my intent. In any event, I apologize again for any offense, and I would honestly still like to hear your thoughts on the matter.

  20. Mike S
    November 30, 2009 at 8:02 pm

    I think there are natural “morals” or ways of living that are best for society. The best example I have encountered so far are in Buddhism. Many of the teachings are not necessarily black or white, but up to the individual and how it affects other people. These aren’t handed down from a “God” type being either, as God is essentially undefined, but are more the result of a pragmatic look at the results of various actions.

    An example is their view of sexuality. Sexual misconduct is conduct that injures another person. According to this, adultery is obviously bad, as it breaks a commitment of marriage. Incest is bad. Sex between 2 loving and committed partners isn’t bad. Taking advantage of someone, either within or without marriage is bad. Homosexuality is somewhat cultural dependent, but generally is looked at in the same light as above. If it doesn’t harm anyone else, it’s ok. It is actually a very coherent and logical approach.

    I would argue that all religions would be very similar if they actually stuck to the basics. The things that generally distinguish followers are “add-ons”. If we stuck to the core of Christ’s teachings, and didn’t worry about add-on’s like polygamy, earrings, varying interpretations of the Word of Wisdom, white shirts, etc., our daily actions would vary very little from Buddhists, Muslims, other Christians, etc.

  21. CarlosJC
    November 30, 2009 at 9:50 pm

    Thomas #13 “If a certain level health care can only be provided to sick, uninsured Person A by denying care to Person B (which is exactly how it works in Britain and other places where your mindset is followed)”

    You are so wrong about this. It doesn’t work like that at all.

    Vaipato #15,

    Ouch!

    I wrote that because I’ve heard it over and over again over many years from Tongan men who were being disciplined for incest. We have a large tongan community here and it was even larger in NZ, were I spent 3 years. They justified their actions with the ‘tongan culture’ thing. Because I’ve heard them, that is it isn’t gossip or hearsay, I wrote what is written above. But then again they were incestuous men so maybe that is why they claimed this. Anyway, they were excommunicated nonetheless. If you don’t do this at all, well all the better since it shouldn’t happen anywhere no matter what the culture or tradition is.

  22. November 30, 2009 at 10:15 pm

    Dear Doubting Thomas:

    “#3 — “You wouldn’t fight to keep health care away from sick, uninsured people in need.”

    Watch me. Or, more specifically, watch me oppose a colossally unwise and unworkable scheme supported by simplistic notions like that above.

    Actually it is the attitude you display that I believe number 3 was tweaking and you took the bait. If the attitude was how do we provide optimal health care for all (the most moral choice) then we could actually discuss and make progress. And before you completely bash our ability as a nation to provide health care, the United States has two of the best socialized medicine systems in the world — Medicare and the VA — both of which blow the doors off of private insurance. Don’t believe me? Ask any Medicare or VA benefit holder to give them up.

    So that I’m not too off topic, this illustrates the problem with defining morality. If morality is caring for the sick and needy, a very Christian concept, then Thomas’ attitude is by definition immoral. Thomas obviously carries a resentment of government programs and that trumps his desire to vote for welfare for the poor and needy, but is that attitude immoral? Does Thomas arguing politics and JulieAnn arguing morality, simply two different arguments? If the result of Thomas’ position is, as documented (I can get you the peer review study link if you like) that 44,000 people die in the United States every year from lack of health insurance does it matter whether he thinks it is a political and not a moral issue?

    We like things that blow up– Pearl Harbor — bad; 9/11 — bad; smashed cars with drunk drivers — bad. All the things that go bang are immoral. Someone dying quietly in their sleep because they contracted pneumonia and didn’t have health insurance that is just ” moral imperatives of rationality and liberty “.

    Now, Thomas before you get too upset, I was using this as an illustration of how difficult the discussion on morality can be, because from what I understand of both the Senate and the house bills, they do exactly what you suggested — tax and regulate the health insurance industry (good-bye pre-existing conditions and a reduction in the ability to deny claims) and additional subsidies for the poor and chronically ill.

  23. CarlosJC
    November 30, 2009 at 10:24 pm

    “this illustrates the problem with defining morality. If morality is caring for the sick and needy, a very Christian concept, then Thomas’ attitude is by definition immoral.”

    Yes there is a problem with definition. The majority around the world would also classify the invasion of Iraq as an immoral act and even criminal but many in the US see that invasion as honourable, necessary and morally correct because at least Saddam is gone.

    So it does depend a lot on which side of the fence you sit for this morality question.

  24. Mike S
    December 1, 2009 at 12:18 am

    #22:
    I do have to disagree with the oft-repeated characterization of the whole Medicare-VA thing that seems to be quoted so much.

    Medicare still works because there’s not really an alternative for the elderly. However, if Medicare truly followed the cost-of-living as it is supposed to, there would be a cumulative 20+% cut this Jan. Congress continually passes a bill punting the cumulative deficit forward a year. It is a broken system that can’t even pay what it is supposed to. Many physicians have closed their practices to new Medicare practices because reimbursements are already so low. If the 20+% cuts went through, it wouldn’t matter if you had Medicare or not, no physician would be able to see you.

    A concrete example: in orthopedics, most hip and knee replacements occur in the Medicare population. Doing a fellowship in joint replacement used to be extremely competitive. Over the past 10 years, reimbursement for a joint replacement has decreased 65% by Medicare. Costs of running a physician office have gone up. Because of this, over 50% of the fellowship spots available for doing total joints went unfilled last year. No one wants to specialize in doing them anymore. Now, they want to decrease Medicare reimbursement to specialists even more to help the general practitioners. And all of this is in a setting of greatly increased demand – it is predicted that because of lifestyle and obesity, the number of knee replacements alone is going to increase 750% over the next 10-15 years.

    The VA. Any veteran who has other care goes outside the system. In private practice, a surgeon can do 4-5 joint replacements / day. At the VA, we were only allowed to do 2. We had a 90 minute lunch break between our 2 cases. We were done at 2:00pm. Our waiting list for joint replacements was 9-12 MONTHS long. We repeatedly asked to do more. The exact same team of attendings / residents / fellows could do 4-5 at a different hospital. We were told that they only had a certain amount of money, and if we did 4-5/day, they would be out of money by May or June and we wouldn’t do any at all for the rest of the year.

    So, when you state that Medicare and the VA “blow the doors off of private insurance”, you have to define what you mean. The reason people don’t want to give them up is basically because the recipient of care is insulated from the cost of that care. The government is paying for that care, through taxes and through accounting games where they increase future debt to our children to pay for care this year. When Medicare was started in 1965, it was predicted that Part A would cost around $9 BILLION per year by 1990. In reality, it cost $66 BILLION in 1990 for Part A. They were off by over 700%. So when they start talking about a $1 TRILLION cost of this plan, and knowing that the government is generally off 500% or more (in medicine, military, NASA, etc.) it makes me terrified.

    The system is obviously broken, but the proposed cure terrifies me.

  25. Rico
    December 1, 2009 at 4:45 am

    #10 – Shirley Strum & Bruno Latour have been my (brief) entry into this discussion.

  26. December 1, 2009 at 6:24 am

    Mike S,

    I didn’t want this to turn into a health care debate — this is about morality. Sure our government knows how to spend money and we spend it. The figures you quoted we’ve doubled or tripled to bail out financial institutions or blow things up, most recently in Iraq and Afghanistan. If our morality as a society is judged by how we chose to spend our money, then not only are our systems broke, we are a very immoral, evil society.

    Short side note on health care: Lots of Brits on this site, I’d love to hear if they want to swap health care plans with the Americans. And by “blow the doors off”, I mean anyone on VA and Medicare isn’t completely financially financially ruined if they become ill (and they keep their insurance).

  27. Rico
    December 1, 2009 at 6:41 am

    No. But then I don’t think I know i enough to really be informed. It has problems (sometimes big ones) but I like the NHS.

  28. Thomas
    December 1, 2009 at 12:30 pm

    Ulysses, you’re conflating assent to the general proposition that there ought to be public support for basic health care (moral) with assent to a particular legislative package.

    I’m familiar with your propagandizing study (by the co-founders of “the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program,” natch) and its 44,000 number. The methodology was simple: Check the health insurance status of 9,000 people (as reported in surveys in 1988 and 1994), and then check back to see how many were dead twelve years later. The sample had a slightly elevated rate of premature death than the general population, which the authors extrapolated out into the 44,000 premature deaths per year figure.

    See any problems with that methodology?

    How about this: Reporting onesself uninsured in 1988 does not mean that one continues to be uninsured for the next twelve years. In fact, a significant proportion of the various numbers of uninsured Americans consists of the temporarily uninsured — people between jobs, for example (which included me — expensively — several years ago. I rather dislike insurance companies, but like Keynes, I have no confidence that politicians are substantially more moral than businessmen.) The study made no effort to confirm health insurance status during the period immediately preceding death, which would seem to be the relevant criteria.

    In any event, as long as we’re bandying about studies (btw, “peer reviewed” is not a synonym for “infallible”), a study just came out that there are 10,000 unnecessary cancer deaths each year in Britain, resulting from delays in diagnosis. Britain’s population is about 60 million, versus 300 million for the U.S.; scaled up, those 10,000 dead Brits scale up to 50,000 dead Americans. So if we’re going by body count, socialized medicine (with its inevitable rationing of care) is more immoral than the greedy profit-riven American system — even if you accept the flawed Himmelstein and Woolhandler study.

    Speaking of morality: One of the features of the House bill is a provision that nobody can be charged more than twice the premium of the person who pays the least. So in other words, I — a struggling thirtysomething whippersnapper who takes reasonably good care of myself — can expect to subsidize care for my fiftysomething Harley-riding, hard-drinking, chain-smoking landlord, who is a hell of a lot wealthier than I am. In what possible universe is that “moral?”

  29. Hawkgrrrl
    December 1, 2009 at 1:49 pm

    I’m not going there with the healthcare debate, but the Iraq war was mentioned. I think justification for the Iraq war brings up a key point about morality. What it points out is that communities have a long standing practices of defining who is in or out and then acting on those boundaries by only protecting those WITHIN the community from harm and only enacting fairness to those people. If another group (say, neighboring countries or the UN, or the USA) define “community” more broadly, say the whole of humanity, they will seek to protect all of humanity from harm and unfairness. This is one reason other nations consider America too protectionist. When we interfere with other nations’ ability to harm or mistreat people living in their borders that they have classified as undeserving of protection or fairness, that results in war. The US (or other countries) may consider it a “moral imperative” to intervene on behalf of those individuals (e.g. the Kurds, the Shi’ites, child soldiers in Somalia, or the intervention of other nations during WW2 when Jews and occupied countries were being harmed) if our sense of “community” is more broadly applied. The problem is the feasibility of exacting morality where one does not have sovereignty.

  30. SUNNofaB.C.Rich
    December 2, 2009 at 12:35 am

    so…. whats your take on the morality of U.S. involvement in Iraq Hawkgrrrl from the 50′s til now….

  31. CarlosJC
    December 2, 2009 at 1:24 am

    #30,

    “so…. whats your take on the morality of U.S. involvement in Iraq Hawkgrrrl from the 50’s til now….”

    Its that it has change so much over the years that I often wonder which morality argument americans will come up with.

    -
    #29 “This is one reason other nations consider America too protectionist” I would say that they consider America interventionists.

    Note that the Kurds had some rough times under Saddam but mostly in the ’80s when the US backed him and the Shi’ites weren’t in that much danger during 2002. But the administration at the time as well as most democrats seemed to find moral arguments to justify the invasion anyway.

    They say that the first casualty of war is innocence. For me the second casualty of war is morality and it comes in a very close second.

  32. Hawkgrrrl
    December 2, 2009 at 10:34 am

    Sunnofa – One tricky thing, IMO, is that the US is not really an entity. Our leadership changes every 4-8 years, and the sentiments of the populace shift dramatically over the course of a 60 year period. Our behavior and interpretation of the international landscape can change dramatically from one administration to another, and while that’s certainly true of all countries, as a superpower, the US has the ability to act on those shifting sentiments.

    There are two types of rhetoric used in the US to engage the people in the cause of war (I’m probably not using the correct terms, but I’ll explain what I mean in each case):
    1 – protectionism. This is rhetoric like “We will be hailed as liberators,” and focuses on the injustices being perpetrated by that nation on its own people. We are protecting the citizens of a foreign nation from the mistreatment of its ruling body. This feels like a slightly more “moral” argument than the next one.
    2 – interventionism. This rhetoric often appeals more to the right wing in the US. We are openly protecting our own interests from a dangerous “rogue” entity in the world stage. This is the “weapons of mass destruction” argument (and frankly, I believe that an underlying sentiment of that argument was some evangelical fear-mongering that Saddam Hussein was the Nostradamus-prophesied anti-Christ who would attack the US; not only did we have an evangelical president, but evangelicals had a lot of political power under his regime). While morality can (and doubtless often does) coincide with self-interest, once self-interest enters the picture, can our actions be clearly identified as motivated by morality?

    Thomas Jefferson said that foreign policy should only ever be dictated by self-interest, not ideals. This was the argument to stay out of the French revolution, which had so much idealism in common with our own revolution (at least initially). I think it’s probably good policy. But I’m not sure it’s moral.

  33. brjones
    December 2, 2009 at 12:34 pm

    #32 – Hawk, your last statement once again brings us back to the original question about what morals really are and whether they are innate and/or universal. From a subjective standpoint, I think there could be a number of “morals” served by Jefferson’s foreign policy. I think your statement “I’m not sure it’s moral” only applies if you believe there may be some universal moral imperative that is being ignored by not being willing to engage in foreign conflicts unless it suits one’s self-interest. If you don’t believe this is the case, then it’s simply a matter of balancing competing morals and adhering to those that you see as paramount.

  34. Hawkgrrrl
    December 2, 2009 at 12:56 pm

    brjones – when I said I’m not sure it’s moral, I don’t mean to imply that I believe it’s immoral (doubtless some would, though, so there goes universality). I just meant that when self-interest is at play, it becomes unclear whether morality is the motivating factor; but I do acknowledge that morality doesn’t have to conflict with self-interest. Theoretically, as you state, you could draw two different conclusions about what to do that are both for “moral” reasons – because morality is not universal. So I agree with you if I understand your view accurately.

  35. RobertM
    December 2, 2009 at 1:12 pm

    So, what if we apply the self-interest part to all human action? Some believe that all human actions are inherently selfish or for a persons self-interest. You help a neighbor move because it is the right thing to do but, is that really why or is it to receive some type of perceived reward in return?

    Some cultures believe that being selfish is immoral, so if everything that a person does is for the receipt of a perceived reward then everything they do is immoral.

    I realize that this is a broad generalization and many have issues with the whole all human action is inherently selfish but, my experience shows that if there is not some kind of return on investment most people will quit investing.

  36. brjones
    December 2, 2009 at 1:38 pm

    #35 – That’s an interesting question, Robert. Speaking for myself, I’m not sure I can answer it completely. If my neighbor helps me move, I would do it ostensibly because it’s the right thing to do, but if no one was going to know if I did or didn’t do it, would I still do it? Maybe not. I hate helping people move, but I also don’t want to be perceived as an inconsiderate jerk. I think the question becomes more muddled when you throw religion into the mix, because when you boil it down, I think any action that is motivated by the idea that the religion or god or jesus or the scriptures commanded, or even suggested, it, is ultimately motivated by the desire to please god and get to heaven. I think all this helps explain why we, as humans, feel the need to have an established moral code, so that we can just “know” what we should and shouldn’t be doing, without having to have this conversation every time we do anything.

  37. brjones
    December 2, 2009 at 1:39 pm

    #36 – Should say “if my neighbor asks me to help him move”.

  38. Hawkgrrrl
    December 2, 2009 at 1:52 pm

    RobertM – I tend to agree with the thinking here which is also one of the key points of Ayn Rand’s The Virtue of Selfishness. Most sociologists would agree that altruism is motivated by self-interest. For example, if you know your actions are being watched, you tend to be more generous. Isn’t that the ostensible point of tithing settlement? But Jesus advocated transcending self-interest as a motivator (do your alms in secret). I’m not sure it’s a realistic destination, but it seems like a valuable journey.

  39. Mark D.
    December 2, 2009 at 11:39 pm

    Clearly morality as implemented in any social context is in part a socially constructed and relative concept. No one disputes that.

    The real question is “Do all moral precepts worthy of the name have a non-subjective aspect to them?” The position that answers in the affirmative goes by the name of “moral realism”, also well known by the term “natural law theories”.

    And with respect to this more subtle position, we can say absolutely one thing, if moral realism is false, all normative religions and codes of ethics are too. That includes all “relative” codes as well, because the very idea of promoting or propagating any ethical concept whatsoever (including the concept that no one should follow any ethical concepts) has an objective component, namely the proposition that anyone should adopt any ethical concept. Moral relativity never goes all the way down.

    Any statement about ethics betrays the position that there is something objective about ethics. The only way to avoid objective talk about ethics is never to say or think anything about them at all.

  40. December 3, 2009 at 8:33 am

    re 39:

    The idea of propagating any ethical concept whatsoever need not have any objective component. The proposition that someone should adopt some ethical concept can also be subjective…

    If moral realism is false, then we simply know what’s what: the universe doesn’t care if someone does or does not adopt any ethical concept, but we can still care due to our subjectivity. So, even if moral theories are in error, we are at this standstill of, “So what?”

  41. Hawkgrrrl
    December 3, 2009 at 10:34 am

    #39 – not necessarily. What if God’s ethics are subjective (e.g. God is an ultra-enlightened man, not equivalent to the mystic divine universe)? That makes him a standard to align with, but not a source of all wisdom. Just an idea.

  42. brjones
    December 3, 2009 at 11:46 am

    “The only way to avoid objective talk about ethics is never to say or think anything about them at all.”

    This is an idea I could get behind for myself, but I’m not sure I’d be comfortable with anyone else adhering to it.

  43. December 3, 2009 at 4:08 pm

    I think morality is universal, perhaps in the same way that “art” is universal. Each culture has a different idea of what “good art” is… some have theaters, some have geometric architecture, some have film, or heavy metal. I think we are focusing on the particulars of “which moral seems to be universal or objective?” which is fine, but I think more interesting is why we seem to have a drive towards developing morality at all. Especially morals that seem to be counter-intuitive to what natural selection has passed down to us. Particular “morals” don’t seem to be universal, but “morality” does seem to be.

    Even those who profess to only live and die by science try to develop an objective moral stance that transcends science. For instance, some of Sigmund Freud’s followers who complained that some of his theories were sexist. It’s a strange inconsistency, isn’t it? If it’s true and falsifiable, then it doesn’t matter if it’s sexist (from the perspective of the Scientist).

    Not only is it strange that we have a set of morals, it’s strange that we attach value judgments to anything. Anyone who has ever said “I hate that song” knows what I’m talking about. You hate it why? Did you use the scientific method to arrive at this conclusion? Does it make you less fit to pass your genes on to your offspring? Or, even stranger, are you EXPERIENCING it differently than I am? Does it sound different to you than it does to me? Is the “qualia” different? If not, what’s the difference then?

    But back to morality. There are some even stranger things about morality. Namely, why does someone do something wrong even if they feel it’s wrong? Some people break laws without any apparent gain (vandalism perhaps). When I was a teenager I liked to spray paint things. I feel bad about it now. Sort of. But anyway, I did it because I thought it was fun, even though I would have admitted it was wrong. Not only do people do things they think are wrong, morality seems to differ from one individual to another. There are pedophiles who don’t know or think there’s anything wrong with their actions. There are some pedophiles who think that their actions are consensual. Not only do cultures have different ideas of what is right and wrong, individuals seem to have different ideas as well.

    But again, this is not quite as interesting to me as the idea that we assign values at all.

  44. CarlosJC
    December 3, 2009 at 4:29 pm

    re 42

    “This is an idea I could get behind for myself, but I’m not sure I’d be comfortable with anyone else adhering to it”
    :)