Maybe we should’ve picked someone less uniquely unlikeable.
The prevailing opinion in some sectors of conservative media is clear: The election is being stolen. But it isn’t. Sorry. There are established legal processes in place to review accusations of fraud. Those should be borne out, and every legal vote should be counted. And believe me, they will. Trump’s team will try every possible legal avenue to win this thing, and it certainly isn’t impossible. But with the latest numbers out of Pennsylvania, it is improbable.
Yesterday, I had posted on my Facebook page that I felt calling Pennsylvania for Biden was premature. Pennsylvania has a statute mandating that ballots be received by 8 pm on Election Day to be counted. Even though in-person voting with social distancing has been proven safe, the state government opted to ignore the statute’s text and extend the deadline to accommodate late-arriving ballots. It appeared possible, if not likely, that the Supreme Court would overturn this ruling, invalidating late-arriving, blue-leaning votes.
However, it appears that the USPS only processed around 4,000 ballots after election day in Pennsylvania. Frankly, I found this hard to believe as Washington State frequently processes 500,000+ votes after election day. Additionally, Pennsylvania’s June Primary featured over 60,000 late-arriving ballots. Still, if it is true that the pending litigation only affects 4,000 ballots, then Biden is the next President of the United States, and conservatives need to start accepting that. There will be no re-votes, and most of the accusations of fraud I’ve seen lose validity with about five minutes of research. If any hold water, they’ll be dealt with appropriately.
Don’t like this result? Me neither. Maybe it means we should’ve run someone less uniquely abrasive and unlikeable than Donald Trump. Understand: Any other Republican would’ve had this race in the bag by double digits. This was Trump’s election to lose, and his inability to stay off Twitter for two months to win re-election is why he lost.
Conservative friends of mine will point to rampant media bias and “big tech” manipulation. And they’re 100% correct: Legacy media and big tech were hell-bent on doing everything they could to oust Trump from the White House. Even with their influence, Biden barely won. Meanwhile, there were many tools within Trump’s grasp that could’ve won him the election. But unlike anyone with a modicum of character and integrity, he couldn’t manage to do any of them. Instead, he chose to tweet in all-caps at insane times of the morning to attack heroes like John McCain and question the integrity of the election. He has shown himself small-minded, selfish, and impulsive. He is a pathetic little man who couldn’t stop himself from pissing on the grave of a war hero from a vital swing state. That is why he is losing and will not receive a second term.
Further, Trump’s brashness and lack of shame are not why he won in 2016. Trump won because Hillary Clinton failed to turn out her Democratic voters. In multiple vital swing states, Trump underperformed Romney’s 2012 campaign and still beat Clinton. So no, Trump is not and was not some necessary character who won because he “took on the media.” In Washington State, Trump received fewer votes than every statewide Republican candidate except for the Insurance Commissioner. To be clear: The only statewide republican that Trump bested was a self-described “autistic savant” who failed to receive the endorsement of any party organization in the entire state. That is the only “republican candidate” who was less popular than Trump. The same situation replicated itself nationwide: Nearly everywhere, other republicans were more popular than the President. Please don’t mistake my indignity for glee – this is a grim statement of fact.
This doesn’t mean that there aren’t valuable lessons Trump taught us. The President increased his vote shares drastically for every single demographic except for white men. A Republican Party that runs under an anti-establishment, anti-globalist, pro-worker, pro-America platform has the potential for massive electoral success in the near future. The GOP coalition is far more stable than the Democrat coalition. Keep the policies, get rid of the personality, and you have a winning formula at every level.
This also doesn’t mean conservatives should try to “make nice” with legacy media and big tech. Our deep frustration continues to be that these institutions set the Overton Window (the window of acceptable discourse) without input from the 70 Million plus voters on the conservative side of the cultural divide. Our next nominee shouldn’t be Romney 2.0 – he or she should be willing to question the dominant narrative directly and forcefully. Regardless, Trump’s “never back down from anything ever” mantra is not a serious strategy, and it does not deserve another try.
This was Trump’s election to lose, and he lost it. It’s on him.
Of all the crazy things this year has been, more than anything else, it has been a distraction.
2020. The writers decided to start and end all the plot arcs at once, replacing the storyboard with the trash bin. Yet each thread – the virus, the masks, the election, the president, etc. – is, relatively speaking, a red herring. Each distracts from a philosophy representing a much larger danger to our Republic – one which threatens its very foundations. Yet it has existed and expanded within our universities and corporations for decades without serious challenge. I’m talking about “critical race theory” or “CRT.”
I’m not immediately going to launch into a tirade against CRT. In writing on controversial issues, it is advisable to make one’s points with as much charity and precision as possible. Further, if the writer desires to critique a theory, he should endeavor to do so using the definitions put forth by the theorists themselves. This method is known as creating a “steel man” argument – the opposite of a “straw man.” In this series, I will utilize CRT’s founders and theorists’ source materials to expose its fatal flaws. In part one, we’ll first establish the case in favor of CRT. We’ll then examine the first way CRT poses a lethal threat to the West in what I term “Racial Determinism.”
As one final premise, I’ll note that none of my critiques of CRT should be taken as a statement that racial issues are exclusively a thing of the past (they aren’t) or that system-level analysis of bias has absolutely no place in our tackling of race issues in the United States.
The Case for Critical Race Theory
Though CRT technically arose out of legal theory, its primary growth strains came from literary and legal scholars who came of age in the Civil Rights Movement’s aftermath. These lawyers and academics had an important observation: Simple legal equality has been heretofore insufficient to bring about significant racial parity increases on achievement and opportunity. Further, it is difficult to address these enduring gaps without looking at how prejudice manifests itself in our unconscious assumptions and actions. All else being equal, these are both fair points.
It is from these observations that Attorney Kimberlé Crenshaw manifested her now-famous theory of “Intersectionality.” Crenshaw made waves when she asserted that identity categories act in a multiplicative fashion on an individual. In a lawsuit against General Motors, she showed that the company hired plenty of black men and plenty of white women. Yet somehow, they employed very few black women relative to the population. Thus, being black and female at the same time is said to be more disadvantageous than the sum of “black” and “female” alone – the identities “intersect” to form a larger effect. On its own, this is a fair point.
Beyond legal theory, the historical ancestors of CRT base their claims in an even more reasonable and important point: Race is a social construct created to justify real, actual white supremacy. Imperialist movements wrought by European nations wouldn’t have been morally acceptable for any significant period of time without some compelling narrative told about the people groups they were subjugating. Take, for example, this particularly repulsive colonialist narrative circa 1871:
The regeneration of the inferior or degenerate races, by the superior races is part of the providential order of things for humanity…. Nature has made a race of workers, the Chinese Race, who have wonderful manual dexterity, and almost no sense of honour; govern them with justice, levying from them, in return for the blessing of such a government, an ample allowance for the conquering Race, and they will be satisfied; a race of tillers of the soil, the Negro; treat him with kindness and humanity, and all will be as it should; a race of masters and soldiers, the European Race…. Let each do what he is made for, and all will be well.
Joseph-Ernest Renan, La Reforme intellectuelle et morale (1871)
Such de-humanizing narratives are part and parcel of strategies employed whenever one group seeks to commit atrocities on another. I am thankful we live in a society able to recognize them as such, and I’m further mindful of what these historical realities say about our human nature.
People often talk of race as a biological reality, but it isn’t that simple. Genetics can separate people quite reliably into ancestral populations based on geography – but not on skin color. With the exceptions of kidney function and sickle-cell anemia, medicine doesn’t find race very useful either, as our socially constructed conceptions of race don’t reliably correlate to genetic realities. Modern geneticists note that there is more genetic diversity within and among African populations than among all other population groups. Finally, and perhaps most compellingly, historical literature makes plenty of reference to tribes and people groups, but none concerning skin color or anything we would recognize as race. As it regards science, race isn’t real.
The average 21st Century white American might logically conclude from the previous paragraph that we ought to do away with race to pursue a “colorblind” society. Yet, continued research on the subject suggests that subtle biases against black individuals persist in our society. A “black-sounding” name on a resume gets fewer interviews than an identical resume with a “white-sounding” name. While police kill black persons in the US at a rate roughly proportional to the crime rate, they also have disproportionately more interactions with law enforcement; those interactions are also more likely to be negative in nature. Lastly, I’m sure any upper-middle-class African American can relate to the experience of being told, “Wow, you’re so articulate!” as if the expectation was that he or she would be “inarticulate.”
So, there is good reason to doubt our society’s ability to quickly “drop” race as a construct that influences our decisions and perceptions. And so long as it negatively affects our perceptions, one wonders to what extent such a cycle becomes self-perpetuating.
If such a narrative regarding our society bears any truth, the next question is, “what should we do about it?” In answering that question, we have to identify what we’re aiming for – and this is where things get interesting.
If asked to paint an ideal picture of America regarding race relations, most Americans would allude to core values with which we are all familiar: Equal opportunity for each individual, without regard to immutable characteristics. For many lay men and women, CRT appears compatible with this vision. After all, if an individual suffers an injustice committed by a non-individual (vis-à-vis systemic racism), it is still wrong. The empathy and compassion expressed here are understandable. So long as the Individual remains the locus of concern, this is a fine point. However, this is where critical race theory breaks from classical liberal values. I will endeavor to show that this is a fact, not an opinion. As you will see, most critical race theorists would not disagree with me on this point.
CRT’s opposition to Liberalism starts with “Standpoint Theory” or “Multiple-Consciousness Theory,” the brainchild of legal scholar Angela Harris. Standpoint Theory asserts that individual perspectives do not exist independent of social conditioning. Rather, a multiplicity of opposed “selves” constructed by external identity forces engage in an internal battle for supremacy.
In her words:
… we are not born with a ‘self,’ but rather are composed of a welter of partial, sometimes contradictory of even antithetical ‘selves.’
Angela P. Harris, “Race and Essentialism in Feminist Legal Theory,” Stanford Law Review 42, no. 3 (1990): 584.
Harris is not merely saying that multiple identity sources influence human self-perception. She asserts that these competing selves fundamentally form what we consider to be the “Individual.” (As an aside, Harris also just published an article advocating for the abolition of the justice system.)
Kimberlé Crenshaw also states this principle explicitly (though densely) in writing about race as identity as opposed to a secondary characteristic to personhood:
We all can recognize the distinction between the claims “I am Black” and the claim “I am a person who happens to be Black.” “I am Black” takes the socially imposed identity and empowers it as an anchor of subjectivity. “I am Black” becomes not simply a statement of resistance but also a positive discourse of self-identification, intimately linked to celebratory statements like the Black nationalist “Black is beautiful.” “I am a person who happens to be Black,” on the other hand, achieves self-identification by straining for a certain universality (in effect, “I am first a person”) and for a concomitant dismissal of the imposed category (“Black”) as contingent, circumstantial, nondeterminant.
Kimberlé Crenshaw, “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color,” Stanford Law Review 43, no. 6 (1991): 1224n9.
In plain English: Crenshaw openly denounces the idea that someone should first be valued as an individual over and above their race. Simultaneously, she advocates for the reinvigoration of race as a method for ‘empowerment,’ rejecting the view of race as “nondeterminant.” To her, the average American’s aforementioned vision of “Equal opportunity for each individual, without regard to immutable characteristics,” is not the goal. Although she readily admits that race is a social construct built to justify centuries of oppression, Crenshaw insists that the construct be re-valued, rather than done away with. I suppose in her version of the story, no contingent of genuine white racists seizes upon this racial reification for nefarious purposes. Instead, all white people embrace their identity as the ‘oppressor’ class, accepting a subservient role to even the scales, trusting in the oppressed class’s inherent benevolence.
(Understanding the deeper roots of CRT’s affinity for this revivification of race as a social construct requires an analysis of a method of literary criticism called “Deconstruction” – a product of the French postmodernist Jacques Derrida. We’ll table that part of the discussion until a later piece.)
The concept of racial consciousness as an internal “self” subject to opposition from alternate “selves” has real-world effects. Take, for example, this video. In it, a protestor screams at a black police officer, calling him a race traitor and “a f***ing black Judas.” In the minds of the protestors, the officer isn’t Black (note the capitalization). Instead, he is a black person possessed by a false “white” consciousness. Thus, despite being black, the officer is an avatar for white supremacy.
A worldview that attributes individual actions to false consciousness quickly does away with any possibility of personal agency or free will. After all, how is one to tell when they are acting out their “true” self rather than the “false” one?
Granted, this is an isolated incident, and it is doubtful that the persons in the video hold any real positions of influence or responsibility in our society. So, take a look at this graphic published by the Smithsonian National Museum of African American History and Culture. Titled “Assumptions of Whiteness and White Culture in the United States,” the infographic starts by affirming Angela Harris’ Multiple-Consciousness Theory. It then takes a list of basic Western principles and classifies them as part of the “dominant white culture.” This classification, of course, implies that the principles are not part of ‘black’ culture. The list includes the following:
“The nuclear family”
“Father, Mother, 2.3 children is the ideal social unit”
“Objective, rational linear thinking”
“Cause and effect relationships”
Protestant Work Ethic:
“Hard work is the key to success”
“Work before play”
“Plan for future”
“Progress is always best”
“English common law”
“Protection of property and entitlements”
So, according to the Smithsonian Institute, delayed gratification and rational thinking aren’t part of ‘black’ culture. Is it worth pointing out that David Duke would agree?
Now, lest the reader thinks that this is simply the work of a rouge intern who has since been fired, I point further up the ladder to CRT’s most fundamental educational text: “Critical Race Theory: An Introduction,” by Richard Delgado and Jean Stefancic. Each year, this book is read by tens of thousands of undergraduate students in introductory college courses.
In it, the authors restate the same principles found in the Smithsonian graphic:
Unlike traditional civil rights discourse, which stresses incrementalism and step-by-step progress, critical race theory questions the very foundations of the liberal order, including equality theory, legal reasoning, Enlightenment rationalism, and neutral principles of constitutional law.
Richard Delgado and Jean Stefancic, Critical Race Theory: An Introduction (New York: New York University Press, 2017), 3.
And again a few pages later:
[C]ritical race scholars are discontented with liberalism as a framework for addressing America’s racial problems.
Delgado, et al., 26
They don’t even pretend that critical race theory is a proper academic discipline:
Unlike some academic disciplines, critical race theory contains an activist dimension. It tries it not only to understand our social situation but to change it, setting out not only to ascertain . . . but to transform. . .
These views are fundamental to CRT. They’ve been taught carte blanche to impressionable undergraduates for decades. We shouldn’t be surprised when these ideas manifest themselves outside the university. And if after hearing the previous quote alongside all of the talk of “false consciousness,” you’re getting Marxist vibes – good, because they’re both direct derivatives of Marxian philosophy.
Now let’s take a minute to think about the practical implications of what we’ve just learned. If we take the Smithsonian graphic as gospel truth, how do we address these apparently irreconcilable ‘cultural’ differences? If emphasizing the scientific method is a construct of “whiteness,” should we steer black students away from STEM professions? This will make the earnings gap worse.
And what of English Common Law? If it’s a manifestation of whiteness, shouldn’t we create an alternate legal system for black individuals? What will that look like? How will these separate legal systems deal with interactions between races?
What about economics? If ‘black’ culture ‘doesn’t value’ delayed gratification and hard work, how do black individuals participate in the economy? How do you measure their productivity? Isn’t such measurement a product of the ‘white’ obsession with quantity and analysis? If the graphic is correct, we couldn’t subject black individuals to payment by the hour – that would be an imposition of the ‘white’ proclivity to value time.
Do I really need to point out how completely unworkable this is – much less how few black individuals would accept it as plausible? I challenge you to walk up to the next black person you see and treat them with the assumption that they don’t value hard work and thinking for the future. Do you feel cringy and racist yet? This isn’t practical. It isn’t supposed to be. Such a society would be feasible under only one doctrine: Apartheid. I’m reasonably sure we just spent the last 160 years fighting to defeat those ideas.
CRT activists usually claim to be motivated by compassion for the oppressed. Like any decentralized movement, many declared ‘supporters’ of CRT lack background knowledge on the subject. Such people often think the word “critical” in CRT refers to “critical thinking” – it doesn’t. Instead, it relates to the purpose of the theory: To “problematize.” A CRT activist’s mission is to find out how racism manifests itself in a given social scenario. Hence their heavy use of the word “problematic.”
For CRT activists, the question is not whether racism took place in a given situation, but how it took place. Everything we do is assumed to be tainted with a racial undercurrent that must be identified and called out in perpetuity. Again, don’t take my word for it. To quote Robin DiAngelo of “White Fragility” fame, alongside other academics, speaking on a 2014 panel (emphasis added):
“The question is not ‘Did racism take place?,’ but rather ‘How did racism manifest in that situation?’”
“Racism must be continually identified, analyzed, and challenged. No one is ever done.”
“The racial status quo is comfortable for most whites. Therefore, anything that maintains white comfort is suspect.”
And my personal favorite:
“Resistance is a predictable reaction to anti-racist education and must be explicitly and strategically addressed.”
This is like ‘original sin’ in Calvinist circles, but without the redemption. Sin is always there, you’re never done fighting your sinful nature, you should never feel entirely comfortable in your faith, and resistance to admitting your sinfulness is to be expected. In Calvinist communities, you can even sometimes gain social status by wallowing in a public display of self-sorrow over one’s sinfulness. This stuff is not new. Non-falsifiable, self-fulfilling, but unlike Christianity, you’re also irredeemable. Those aren’t ingredients for a society which remains coherent
This piece’s point is simple: Critical race theory is not a plan for mere modification of our society. This is not a conversation about expanding the social safety net or reinstituting affirmative action. The fundamentals of CRT plainly conflict with the precepts of most left-leaning liberals in the United States. Indeed, CRT directly contradicts the Liberal governmental structures of countries like Finland, Sweden, and Norway – so admired by members of the American left. If this were about highlighting the nuanced ways in which bias continues to be a factor in economic outcomes for African Americans, I would not be writing this essay.
Rather, I would like for all of us to continue sharing this country and living our lives together, imperfectly, genuinely, and humbly. Problems with racial disparities and racism persist and deserve our attention. Critical race theory is not the solution.
I expect this piece to be controversial. I’d like to have a good-faith conversation with those who might disagree. Nevertheless, I might lose friends, and I might be called names. Do not expect comments expressing such sentiments to receive any attention from me.
Part 3 of this series will dig in to… something else. We’ll see. I’ll be back after another two weeks of annoying my wife with these subjects.
Do you know what it really means to be a “Full Code”? You should.
Last week, the proverbial dragon of chaos manifested itself in a simple sentence overheard while passing by a patient room. “Oh, okay, yeah we need to get him back in bed . . . like stat.” It wasn’t the sentence that stood out, or even the tone, but rather the source: The hospital’s rapid response nurse, Molly. She is a highly-trained nurse who floats among units, checking in on patients who may soon require a higher level of care – a COVID patient who might need a ventilator in the next few hours is a good example. Molly has seen it all, and she is unflappable. When she uses the word ‘stat’, it gets people’s attention.
Instinctively, I go and retrieve our unit’s “code cart,” which is exactly what it sounds like, containing all manner of invasive life-saving equipment. I return just in time to see the respiratory therapist slam the head of the bed down and begin pounding the patient’s chest. Okay, yup, this is real; no mistaking this. I call the emergency line, sending the “Code Blue” call out overhead. The experts are here, and more are on their way. I’m good to just get out of here, right? I’m about to scurry away when Molly’s voice interrupts me: “Alright Nathan, you’re next for chest compressions.”
I pause for a half-second before replying: “I’m next for chest compressions.” Basic and Advanced Life Support classes always emphasize the importance of closed-loop communication during hospital codes, confirming that you’ve received and understood your orders. At this moment, I’m thankful for that training. This small exercise of protocol helps me relax and remember that there is a protocol. I take a deep breath and try to remember my training: “Alright, compress to the beat of ‘Stayin Alive*,’ keep your arms straight, and push with your back, not your shoulders.”
The physician arrives and calls for a rhythm check. Everyone steps back, and I take the respiratory therapist’s spot in preparation. A robotic voice states, “No shock advised.” A nod from the physician and I place my hands, one atop the other, on the patient’s sternum. I begin compressions.
I always thought nothing could prepare someone for the experience of performing real-life CPR. Most medical simulations are painfully unrealistic, and I had no reason to believe that the CPR dummies were any exception. Where the dummies feature a pliable chest wall easily compressed, surely human bones and cartilage would put up a bigger fight. Wrong. Turns out, those dummies are incredibly realistic. This person’s chest was unnaturally, creepily soft. For a split second, I had the surreal feeling that this was all a fake code – an elaborate simulation designed to foment team-building. A glance at the patient’s face broke the illusion. Nope, this person is real.
In CPR training, we’re told that high-quality chest compressions are likely to cause some degree of trauma. “You’ll probably break ribs, and that’s okay,” they say. But this was different. The realization hit me like a brick: Just three minutes into chest compressions, this patient did not have merely a broken rib or two. Rather, their sternum and ribs were clearly in fragments, providing no resistance whatsoever to my compressions. This realization sparked another: If each compression really does need to reach a depth of 1/3rd of the chest wall – and it does – then is the only way it happens. Good CPR necessarily requires double-digit fractures.
I didn’t have time to consider the weight of these realizations, and I kept my attention on the task at hand. Two minutes later, my time was up and I yielded to my replacement. Despite another twenty minutes of herculean efforts, the patient did not survive.
Honestly, I wasn’t particularly torn up. I had not been assigned to this patient during my shift – I had simply been in the right place at the right time. But the experience did make me consider whether we do a good job educating patients on what CPR is actually like, especially concerning its efficacy and side effects. You see, not only is CPR incredibly traumatic (I wasn’t joking, this study estimates the average number of fractures at about 11), but it is also not nearly as effective as the general public believes. The American Heart Association, an organization with every incentive to pump up the efficacy of CPR, reports that among patients 65 and older, just 18% who code in the hospital survive to discharge. Outside, very few make it to the emergency room alive.
Much of the misperception surrounding the efficacy of CPR can be traced back to Hollywood. Hit shows like “ER” regularly portray codes, and nearly three-quarters of them depict the patient surviving their cardiac arrest. This leads to an all-too-common scenario wherein patients and doctors don’t even discuss code status when admitted to the hospital. Since CPR is thought to be effective, patients assume “Do Not Resuscitate” orders to be reserved only for those clearly approaching their final days. This is not true.
Now, don’t misunderstand me. I’m not telling you to refuse life-saving or sustaining interventions. If you want us to do everything we can, we will. And of course, survival statistics are much better for the “healthy dead”; those who are young and without co-morbid conditions. However, if you’re of advanced age or poor health, you need to ask yourself whether you want your last minutes to be spent with a crowd of strangers traumatizing your ailing body with little chance of a positive outcome. Given the choice, perhaps you’d rather spend that precious time surrounded by your loved ones. You have a right to make an informed decision on this matter.
So, if you are admitted to the hospital for any unexpected reason, you should insist that you speak with your physician about your code status. Before you decide you want the full extent of the ‘miracle’ of modern medicine, you should know what you’re buying.
*Yes, this is often part of official curricula – compressions need to be done at 80 to 100 beats per minute, and singing “Stayin’ Alive” in your head is an effective way to keep pace.
Edit: Original Title and Byline appeared as “Double-Digit Fractures” and “Do you know what you’re getting into with the “miracle” of modern medicine? You should.”
How much quality of life and life-expectancy should we be expected to sacrifice to flatten the curve? The answer is not “infinity.”
(The following piece was originally published on Medium on March 24, 2020.)
The past few days at work have been surreal. In preparation for an expected influx of COVID-19 patients, and to preserve our dwindling supply of personal protective equipment (PPE), all elective surgeries at my hospital have been canceled. This leaves me, a standard surgical floor nurse, without the majority of my usual patient population. In the calm before the storm, it strikes me as strange that the rest of the world isn’t functioning. I casually chat with a co-worker who tells me that her small business is now underwater. Everyone I speak with knows someone who is now suddenly out of work.
And in some sense, this is necessary. I learned early in college nursing classes about the importance of social distancing and public quarantine interventions when addressing a pandemic. During the Spanish Flu, cities that implemented interventions early saw relatively few casualties, and those that did nothing were immediately overwhelmed. Businesses and individuals can stand to pause for a while for the sake of their fellow citizens — lives are on the line, after all.
But the preceding moral proclamation, righteous as it feels, leaves one serious element unspecified: Time. How long exactly can our country remain at a standstill? Waiting even six months seems likely to fundamentally disfigure the society we’re trying to preserve. I’m not saying I know exactly how much economic growth is proper to sacrifice to save a life, but it isn’t unlimited. In a capitalist society, gainful employment is health and well-being. The consequences of sky-high unemployment will manifest in population health statistics years down the line.
The issue here is … well, death. Won’t people die if we lift restrictions too early? First, remember that people will die no matter what; it’s how many that matters. Second: We have no reliable data on which to base our decisions. We’re instituting widespread quarantine based on nothing because the consequences of betting wrong at this stage of the game are near limitless. However, the appropriate length of societal shutdown expands or contracts based on answers to the following questions:
What percentage of overall cases require hospitalization?
What percentage of hospitalized patients younger than 65 require ICU care?
How many intubated patients above age 75 survive?
What percentage of intubated patients suffer lifelong morbidity related to chronic lung injuries?
How much extra capacity has our health care system added to prepare for a surge in critical patients?
How much damage has our economy sustained so far, and when will the damage begin to cause fundamental and irreversible insults to mobility and quality of life?
Right now, we don’t have good answers to any of these questions. Pundits who speak or write as if we do are speculating at best. However, in a few weeks, we may finally have some decent answers (in the form of slightly tighter ranges of outcomes) to these questions. Each possible scenario will result in a certain amount of lives lost to COVID-19, and our leaders will have to pick the range of outcomes they deem most bearable. The wider the range, the less clear the decision. I am not a public health expert, but I worry that the majority of these scenarios will involve a choice between continued economic shutdown for six months or more and an epidemic curve that outstrips hospital capacity.
I’m not excited about the idea of outstripping hospital capacity. This will put me — and more so the physicians I work with daily — in horrible ethical positions of deciding who lives and dies. The trauma and stress will be overwhelming. The lives lost will be real — they will not have been expendable. They will include people like my aunt and uncle from Enumclaw, WA. Mobile and vivacious in their 70s, their “retirement” consists of full-time volunteering with senior services like meals-on-wheels, as well as full-time caregiving for my wife’s WWII veteran grandfather. Words cannot describe the level of grief and despair my family would endure with their loss to this terrible disease. This is personal.
Equally traumatizing will be the depression and despair of millions left unemployed, hopeless, and poverty-stricken. Not to mention the early deaths and chronic diseases associated with impoverished health behaviors. No one gets out of this alive and intact. Make no mistake: Six months of an economic shutdown will cause a depression that makes 2008 look like the roaring twenties. The American experiment may well cease to exist, at least as we currently understand it.
I’m not saying I know how to strike the proper balance. However, as we approach this conundrum, consider this: Everyone understands that there is a difference between death resulting from negligence and death resulting from tragedy. If a nursing home resident gets COVID-19 because an employee didn’t wash their hands, this is negligence. A human caused the infection through willful blindness, and this rightly triggers a sense of moral outrage at such injustice. However, notwithstanding regulatory negligence on the part of the Chinese government, no human “caused” this virus. At least as it regards our current predicament in the United States, there is no one to blame for this tragedy. Our cries of outrage and grief go up against the fabric of existence itself; even against God if we haven’t quite killed him yet. And now, we’re faced with a horrible truth: Endless preservation of life will become destructive to its ends. Though politicians and pundits obfuscate and pretend that this amounts to ageist genocide, it is at this vital moment that these honest conversations must take place.
Now, no matter how carefully I edit and revise this post, some people will find a way to accuse me of “hating old people” or something similarly slanderous and absurd. That is fine. I have worked in nursing homes and hospitals with this 65+ population for my entire nursing career. I am happy to let their consistent words of thanks for my compassionate and high-quality care to do the talking for me. Still, I will remind readers of what I’m NOT saying:
We should lift restrictions right now (we shouldn’t).
The economy is more important than the lives of the old and/or senile (it isn’t).
We should not make substantial economic sacrifices to save hundreds of thousands of lives (we should).
Rather, I’m simply stating what we already know, but are too afraid to say clearly: The level of our sacrifice should be substantial, but not unlimited. There is a limit, and it can only be defined if we’re both courageous and humble enough to admit its existence.
Recent studies reveal a strange truth about the nature of our societal divisions.
I got an email a few weeks ago from the Washington State Nursing Care Quality Assurance Commission (NCQAC). As a Registered Nurse, I’m used to receiving occasional emails from them about various regulatory and public health matters. However, this email was different: “COVID-19 Information.” This appeared to be worth my click.
What followed was an official COVID “myth-buster” from the Washington DOH. For the most part, it was fairly benign, busting various myths such as “I should probably stock up on some more groceries” and “These wipes are flushable.” However, the second-to-last myth-bust stood out from the others.
The “Myth” was fine, if somewhat out-of-place for an email to the state’s nurses: “Myth: We’re going back to normal after this.” Most of the answer was also fine, centering around the acknowledgment that we won’t go back to “normal” again in the same way. The author went on to speculate regarding the possible ways in which our society might change.
“Maybe we’ll hug our people tighter, maybe we’ll savor our time together more.”
Yeah, maybe it will increase our appreciation for each other. No problem here. Sure thing.
“Maybe we’ll help to keep the air clean by working at home more often.”
Well, Washington already has very clean air . . . but working from home is a good thing. I don’t have an issue with this.
But then the other shoe dropped:
“Maybe we’ll decide it’s important for everyone to be able to get health care when they need it.”
Uh-huh, because right now, “we” don’t believe it’s important for people to be able to get health care when they need it. Sure.
The author’s subtext reads like a disapproving mother scolding her stubborn children. It is obvious who the author is talking about: Those evil conservatives, holding society back with their desire to maniacally withhold healthcare from poor people. What a perception to have about an entire side of the political spectrum, putting aside the fact that the biggest issue in our health care system is cost, not (as much) access or outcomes (more on that in a future post). And shouldn’t an official governmental regulatory body be above partisan political jabs?
In reality, the author almost certainly does not see herself (assuming the author is female) as a political partisan trying to prejudice the opinions of Washington nurses. Rather, she is falling prey to a filter bubble that cuts her off from a nuanced understanding of conservative political thought. This is increasingly the case for members of both sides of the political spectrum. But you already know that – there has been plenty of media attention on this reality over the last several years. What you might not know is that one aspect of this increasing polarization is unbalanced in its distribution.
You would think that increasing polarization would lead to an equal and mutual lack of understanding of divergent political views. A study by Dr. Jonathan Haidt (written about in his remarkable book “The Righteous Mind”), suggests this is not the case. In the study, participants were challenged to guess how a person of a differing political viewpoint would rate (agree vs disagree) a given moral statement, examples including, “One of the worst things a person could do is hurt a defenseless animal” or ”Justice is the most important requirement for a society.” Liberals assumed that conservatives would disagree with these statements.
The results were clear and consistent. Moderates and conservatives were most accurate in their predictions, whether they were pretending to be liberals or conservatives. Liberals were the least accurate, especially those who described themselves as “very liberal.”
[There are many books to be written about Haidt’s contribution to the political landscape, particularly regarding his Moral Foundations Theory, but suffice it to say that Liberals base their moral decisions based on Care and Fairness, whereas Conservatives base theirs evenly across Care, Fairness, Purity/Sanctity, Authority (Respect for), and Loyalty (to one’s group).]
This liberal blind spot is a product of many overlapping factors, but none more so than their domination of our education and media spheres. Studiesrepeatedlyshow that liberals vastly outnumber conservatives in higher education, in some departments by ratios as high as 20:1 in Journalism and 11.5:1 overall. Similar ratios prevail for primary and secondary education. This unavoidably creates a scenario wherein children growing up in liberal families today might never encounter a single cogent conservative argument for the entirety of their education. So while the kids in conservative families are repeatedly exposed to both sides, liberal kids are not.
Similarfigurespervade regarding the political leanings of current journalists. As few as seven percent of journalists identify as Republicans, compared to sixty percent or more who lean Democrat.
All of these factors combine to create a situation where left-leaning thought is automatically equated to “normal” opinion – an infuriating position for a moderate conservative to be in when he or she self-censors for fear of being labeled and shamed for a relatively benign opinion. I recall a situation back in 2016 wherein a leader of a scholarship program I had participated in during college, upon learning that my then-girlfriend was doing an internship with Rep. Cathy McMorris-Rodgers, narrowed her gaze and muttered with disgust ” . . . she’s a republican.”
What in the world? Did this person really think that her public scholarship program only sponsored left-leaning students? Apparently so, as I demurred “Well, uh, I mean we’re all pretty moderate . . .” and scurried away to end the tension.
My purpose in writing all of this isn’t to cast myself as a victim. I am far from victimized here, or in any other area of my life. Regardless, I think a path toward a society that prospers and remains united for another hundred years requires a dialogue set on equal footing. Both sides have their crazy radicals to police, but it is clear that the left has some unique work to do in regard to understanding moral foundations, especially considering their unique domination of academic and media spheres.
Now, perhaps I’m not the best mouthpiece for this message. As a conservative, a message from me is unlikely to be heard in quite the same way as it would from a good-faith liberal – who do, of course, exist. So, if you’re a left-leaning friend or co-worker of mine bristling at the idea that the party opposing Donald J Trump has the real soul-searching to do, I’d encourage you to ignore me, and go read Jonathan Haidt’s “The Righteous Mind.” Seriously, if you’re interested, I will buy you a copy. I’ve already bought like 15 copies of this book for other people.