Friday, March 25, 2005

What it means to apologize


Go Ahead, Say You're Sorry

Before Jessica and I were dating, I read part of Venus and Mars on a Date, a book about helping men and women learn to communicate, especially during the "five stages of dating". It said that during the engagement stage of a relationship, learning to give and receive apologies is important. In fact, the authors claimed that it is more important for a man to learn to apologize, and more important for a woman to learn to accept an apology. Apparently the authors believed that men accepted apologies easier and women gave them easier. But that's not my point here.

At least for my part, I took it as good advice to overcome pride, let down defenses, and apologize. I knew it was going to be a good spiritual discipline to cultivate for the lifetime of marriage ahead. In the movie, Love Story, Ali MacGraw's infamous deathbed words to Ryan O'Neal may have been "Love means never having to say you're sorry." But as experience shows, that only works in the movies!

Love says sorry plenty, or at least should. A sincere apology, well and simply stated, clears the air when somebody fails to love, honor and do the laundry.

Taking responsibility is a sign of maturity. It's immature to get defensive or tell the other person they did something worse than what you did. Responsible acknowledgment staves off bitterness and sets the stage for change.

Change, of course, is the operative word. An apology without at least some semblance of improved behavior is as vacuous as a political party's pre-election promises. For an apology to count, you have to want to change and then follow Nike's advice and "just do it."

A genuine apology offered and accepted is one of the most profound interactions of people. It has the power to restore damaged relationships, be they on a small scale, between two people, such as spouses, or on a grand scale, between groups of people, even nations. If done correctly, an apology can heal humiliation and encourage forgiveness in the injured party.

Despite its importance, apologizing is antithetical to the ever-pervasive values of winning, success, and perfection. The successful apology requires empathy and the security and strength to admit fault, failure, and weakness. But we are so busy winning that we can't concede our own mistakes. Security in Christ, and knowledge of our weakness and need for him, are key.

We may even think we're right, and think "why apologize?" But I think many times it's not about being right or wrong. A true word at the wrong time or for the wrong purpose is wrong. Apology is not about who's right. It's not about winning. It's about restoring relationships.

Tuesday, March 22, 2005

Life-extending treatments


Terri Schiavo passed her 15th year last Friday in what doctors call an awake but unthinking state, unaware of the latest melodrama swirling around her hospital bed in Pinellas Park, Florida. Patients in such a state have lived for up to thirty-five years.

When does one end life-extending treatment for such patients? And who gets to decide?

The question of what to do with patients in a persistent vegetative state is difficult, but important. Life is full of difficult decisions, but decisions that must be made nonetheless. We cannot usefully discuss this difficult case, however, without first getting clear more generally on the morality of withholding or withdrawing treatment.

Our civilization’s received medical tradition says that we should never aim at the death of a sick or dying person. Still, there are times when treatment may rightly be withheld or withdrawn, even though the patient may then die more quickly than would otherwise have been the case. How can that be? How can it be that, as a result of our decision, the patient dies more quickly, yet we do not aim at his death?

This is quite possible—and permissible—so long as we aim to dispense with the treatment, not the life. No one need live in a way that seeks to ensure the longest possible life. (Were that a moral requirement, think of all the careers that would have to be prohibited.) There may be many circumstances in which we foresee that decisions we make may shorten our life, but we do not suppose that in so deciding we are aiming at death or formulating a plan of action that deliberately embraces death as a good. So in medical treatment decisions the question we need to answer is this: Under what circumstances may we rightly refuse a life-prolonging treatment without supposing that, in making this decision, we are doing the forbidden deed of choosing or aiming at death?

The answer of our medical-moral tradition has been the following: we may refuse treatments that are either useless or excessively burdensome. In doing so, we choose not death, but one among several possible lives open to us. We do not choose to die, but, rather, how to live, even if while dying, even if a shorter life than some other lives that are still available for our choosing. What we take aim at then, what we refuse, is not life but treatment—treatment that is either useless for a particular patient or excessively burdensome for that patient. Especially for patients who are irretrievably into the dying process, almost all treatments will have become useless. In refusing them, one is not choosing death but choosing life without a now useless form of treatment. But even for patients who are not near death, who might live for a considerably longer time, excessively burdensome treatments may also be refused. Here again, one takes aim at the burdensome treatment, not at life. One person may choose a life that is longer but carries with it considerable burden of treatment. Another may choose a life that is shorter but carries with it less burden of treatment. Each, however, chooses life. Neither aims at death.

It is essential to emphasize that these criteria refer to treatments, not to lives. We may rightly reject a treatment that is useless. But if I decide not to treat because I think a person’s life is useless, then I am taking aim not at the treatment but at the life. Rather than asking, “What if anything can I do that will benefit the life this patient has?” I am asking, “Is it a benefit to have such a life?” If the latter is my question, and if I decide not to treat, it should be clear that it is the life at which I take aim.

Against that background, we can consider the use of feeding tubes for patients in a persistent vegetative state. Is the treatment useless? Not, let us be clear, is the life a useless one to have, but is the treatment useless? feeding may preserve for years the life of this living human being. Are we certain we want to call that useless? We are, of course, tempted to say that, in deciding not to feed, we are simply withdrawing treatment and letting these patients die. Yet, these patients are not clearly dying. And, despite the sloppy way we sometimes talk about these matters, you cannot “let die” a person who is not dying. It is hard, therefore, to make the case for treatment withdrawal in these cases on the ground of uselessness. We may use those words, but it is more likely that our target is a (supposed) useless life and not a useless treatment. And if that is our aim, we had better rethink it promptly.

Is the treatment excessively burdensome? Alas, if these patients could experience the feeding as a burden, they would not be diagnosed as being in a persistent vegetative state. We may wonder, of course, whether having such a life is itself a burden, but, again, if that is our reasoning, it will be clear that we take aim not at a burdensome treatment but at a (presumed) burdensome life. And, once more, if that is our aim, we had better rethink it promptly.

Hence, although these are troubling cases, I don't yet see good or sufficient arguments to make the case for withdrawing feeding tubes from patients in a persistent vegetative state. I have not suggested that we have an obligation always and at any cost to preserve life. I don't see a clear precedent in the Judeo-Christian tradition for focusing on the preservation of life for life's sake in this radical way. I have simply avoided all comparative judgments of the worth of human lives and have turned aside from any decisions which, when analyzed carefully, look as if they take aim not at a dispensable treatment but at a life.

Wednesday, March 09, 2005

House prices: still want to buy?


I came across this article in The Economist which suggests that the price/earnings ratio for the housing market is meager and in many countries it is cheaper to rent than to buy, which goes against the conventional wisdom that it is always better to buy a house because "rent is money down the drain".

Some of you reading this (perhaps me and Jessica too?) are in the category of possible first-time home buyers who have been "priced out" of the market and forced to rent.

The article does an average over nations as a whole. But maybe we could do a calculation of our local markets and see how much we're "saving" by renting. The article mentions a couple of examples. Suppose you're in the San Francisco Bay Area, where it's possible to rent a $800,000 house for $2,000 a month. Under reasonable assumptions (mentioned in the article), a buyer would pay $120,000 more than if he had rented at the end of seven years (the average time before the typical homeowner moves).

Tuesday, March 01, 2005

U.S. Consumption Scorecard


Each U.S. citizen consumes an average of 260 lbs. of meat per year, the world's highest rate. That is about 1.5 times the industrial world average, three times the East Asian average, and 40 times the average in Bangladesh (6.5 lbs). [1]

The U.S. population is 4.6% of global humanity, but it produces 24% of the world's carbon dioxide output, largely from the burning of fossil fuels. [1]

Directly or indirectly, each U.S. citizen consumes his or her own body weight in primary resources every day: oil, coal, other minerals, and agricultural and forest products. [2]

A child born today in the United States will have a lifetime impact on the environment that is 30 times greater than a child born today in a developing nation such as India. [3]

References: [1] UNDP, Human Development Report 1998; [2] Alan Thein Durning, How Much is Enough? The Consumer Society and the Future of the Earth (New York: W.W. North & Co., 1992); [3] Al Gore, Report of the President's Commission on Sustainable Development (Washington DC: June 1993)