Tag Archives: Paternalism

Help Me Imagine 2

Back in April I asked readers to help me imagine:

[Your] community was … so successful … that one hundred exact copies of [it] were made then and spread around the world. They copied all the same people, work and play roles and relationships, even all the workspaces and homes. … Consider … your attitude toward the other copies of your group. On one hand, … you might want to have nothing to do with those other copies. … On the other hand, you might be eager to maximize your chances to share insights and learn from the other groups. (more)

Today let me ask for help imagining a different situation.

A copy of you was made when you were ten years old. That was a century ago. Since then many thousands of (exact) copies have been made from that one copy. Most of these copies have grown up to do one of the few jobs where there is a big demand for copies of you. (Copies of you have tried other jobs, but so far they’ve not been competitive.) Every year a few dozen more copies are made and trained for these same few careers, but using slightly newer methods, to adapt to changing customers, techs, etc. Older versions of you often help to train younger versions.

Now here are my key questions:

  1. As an older copy, how free would you feel to push advice on younger copies? You could advice them on work, friends, love, etc. When there were consequences for you, how strongly would you want to insist that they follow your advice?
  2. As a younger copy, how much would you trust the advice of older copies of yourself? How eager would you be to get and follow such advice, even when you didn’t understand it? How willing would you be to get into situations where you had to do what they told you?

Today as parents, teachers, mentors, etc. we often give advice to kids, students, and junior co-workers. But our eagerness to advise is tempered by knowing that they are often quite different from us, and in addition times can change, reducing the relevance of our earlier experience. Our eagerness to listen to such advice when young is also tempered by the same reasons. Even so, the two sides often find themselves in conflict, with older folks pushing more advice than the younger folks want to take.

When the advisor-advisee relation is between an older and younger copy of at the same person, instead of between two quite different people, is there more or less conflict in the relation? Is more or less advice given and taken to heart? Do people feel more or less free and autonomous?

Added 5p: Today if asked in the (far-view) abstract, people say they’d want to take advice from those more experienced than they. But they often feel different when they get a specific (near-view) piece of advice that they don’t want to follow, or when they feel a rivalry with the person giving the advice. Then people look for excuses not to follow the advice. I’d think the same processes would happen even with copies of yourself. So I ask you to imagine particular near-view situations, and not just to consider the question in far-view.

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Idealizing Research

On Institutional Review Boards (= IRBs), I wrote in March:

It makes little sense to have extra regulation on researchers just because they are researchers. That mainly gets in the way of innovation, of which we already have too little.

To decide if academic studies are “ethical,” IRBs ask if the benefits of a proposed study to the world and to its subjects (= people studied) outweigh the risks to its subjects. And a standard rule is that financial payments to subjects do not count as benefits.

To an economist, this paternalism sounds pretty crazy. In the latest Bioethics, Alan Werthmeimer agrees. First he notes that no explicit arguments are offered for this “money isn’t benefit” rule:

Although the standard view has become a virtual mantra in research ethics, no [official] document contains an argument in its defense. … The scholarly literature also contains little defense of that view. For example, [an] important article … [says] ‘otherwise simply increasing payment or adding more unrelated services could make the benefits outweigh even the riskiest research.’

So Werthmeimer makes up seven reasons:

  1. A subject might think that having the money to purchase a big screen TV makes it sensible for him to accept certain medical risks. … IRBs should not incorporate such impoverished conceptions of a person’s interests into their decisions.
  2. IRBs are not well positioned to determine how much weight to assign to the benefit of payment as compared to risk.
  3. The standard view [is] a way to provide extra insurance that payment does not constitute an undue inducement.
  4. [Otherwise,] it would allow IRBs to approve risky research with economically vulnerable populations so long as investigators are prepared to pay subjects enough.
  5. The physician’s role is to advance the patient’s medical interests, and not her interests, writ large. And perhaps much the same could be said for the relationship between IRBs and subjects.
  6. Society may prefer that research not be viewed as an economic transaction and it may symbolize its commitments by not allowing such values to intrude on the assessment of risks and benefits.
  7. It is crucial that the public believe that research subjects are not abused or exploited. … Whereas society accepts with a relative yawn the fact that people incur job related injuries or deaths as coal miners, fishermen, and off-shore oil service workers, society seems to react with great intensity to research related injuries and deaths.

I hope you can imagine my incredulous stare. This goes way beyond sometimes overruling certain judgements because you think people sometimes make particular mistakes. Here regulators basically presume that all wanting of money is illicit and not to be counted. Reason #7 seems to me closest to the truth – the idea appears to be to preserve an ivory-tower image of research as a high pure far ideal thing not to be sullied if possible by money motives. Which if you think about it isn’t that far from the common medical ideal, that cost should not be a factor in medical decisions.

 

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