The Journey of a Thousand Miles…

When it comes to the generations long struggle between the Israelis and Palestinians, I am no expert.  There is too much water under the bridge, and too many details of a history I was neither there for, nor had the time to study independently in depth.  I am aware of the complaints of the Israelis regarding their security in what they see as their ancestral homeland, and also aware of the complaints of Palestinians regarding their displacement and alleged subsequent mistreatment at the hands of the Israelis.

But as a father of two girls, there is one thing I am an expert in, and that is conflict resolution.  I am reminded somewhat of a situation in which my children were fighting in the back seat of the car, eventually coming to blows.  As I tried to sort out the situation, they just kept hitting each other and screaming about how the Papa Smurf toy was THEIRS.  In between hair-pulls and snatching the toy, both made reasonable semi-coherent points about why they should get the toy.  As I hurtled down the freeway, I said what I think most parents would say in the situation “Calm down, stop hitting each other and give me Papa Smurf!”  By stopping the violence, and removing the offending toy, I was hoping to determine with a clear mind a reasonable solution to the problem–though I knew it would inevitably involve some sort of sharing, and neither girl was likely to be completely satisfied.

The point is that the first step in this process was to stop the violence.  As long as the two girls were hitting each other, the argument would escalate and no agreement would be able to be reached.  While this analogy is unacceptably lighthearted for such a serious situation, and is no doubt imperfect (whither Papa Smurf and whither holy Jerusalem?), some important parallels can indeed be drawn.

The Palestinian argument for the violent Intifada, in plain English, can be boiled down to the basic sentiment “We need to stand up and defend ourselves, or else Israel will obliterate us and our homeland completely.”  The violent component of the Israeli response is summarized as “We need to stand up and defend ourselves against these violent peoples who threaten our security and our ability/right to exist”.  Is it any wonder than, that we have ended up in an ever escalating vicious cycle of bloodshed?

The only way out of this situation is to first, stop the violence.  And to do this, one side will need to have the courage to act first.  As the group claiming to be oppressed, that onus clearly falls to the Palestinians.  To claim oppression is to claim a certain moral high ground, which is the main weapon of the oppressed.  As long as they persist in violent uprising (or defense, based on one’s perspective), they will have ceded this all important moral high ground to those they accuse of oppression.  The only reasonable course of action currently is to insist on a total stop to all violent action (aggressive or defensive) on behalf of the Palestinians.

If, in fact, the Palestinians are right and Israel represents a group of aggressors committed to Palestinian oppression if not total annihilation, this will become abundantly clear as Israeli violence continues or itensifies in the face of Palestinian non-violence.  Such action would then stand glaringly obvious in the international spotlight, exposed for its ugliness.  If, however, Israel is correct in their assertion that their violent actions are merely defensive in nature, the entire impetus for violence directed against the Palestinians will disappear as Palestinians lay down their arms.  Peace can then move forward.

The Palestinians win either scenario.  Either Israel is exposed for the violent imperialist power that they believe it is, world pressure comes to bear, and the Palestinians are treated to world sympathy; or violence stops and peace prevails based necessarily on a two-state solution.  Yes, there will be short term losses, but those losses are already occurring.  And if Israel is truly the peaceful giant it claims to be, it likewise has nothing to fear and everything to gain from this turn of events.

The question comes up, where will the Palestinians find a leader strong enough to convince them that the non-violent resistance of Ghandi and King are potential answers to their problems?  A leader willing to forsake short term gains and demagoguery for long term solutions? A leader willing to admit that justice is less important than peace, the past less important than the future?  Hope continues that such a leader will arise from among them.  However, among the current players, only one possesses the credibility to advance such a solution–Hamas.  Hopefully they realize that in the struggle for peace, the best place to find a helping hand is at the end of their own arm.

Note to the reader: I realize this is an inflammatory topic and struggled with the decision of whether or not to post this at all for that reason.  However, I do believe this post accurately reflects my views, and as such do not fear in publicizing them.  I do fear them being misinterpreted however.  To reiterate, my intention is not to express my (essentially meaningless) support for either side in this existential struggle, but rather to emphasize that regardless of “right” or “wrong”, the initial steps towards peace are the same.  I implore any who choose to comment to keep their comments respectful of those with different viewpoints.

Destiny’s Child

“Our destiny is frequently met in the very paths we take to avoid it.”
Jean de La Fontaine (1678–1679) and Master Oogway (Kung Fu Panda, 2008)

The Reverand Thomas Robert Malthus (1766-1834) was once ostracized for his relatively obvious theory that human population would be limited by the ability of the earth to provide sustenance. As resources became rare, he postulated, “preventive checks” (such as abstinence and contraception) would slow population growth, while “positive checks” (such as disease, pestilence, and famine) would serve to maintain human population at sustainable levels.

Occurrences of these positive checks soon became known as Malthusian Crises. Crises are born of population growth out of proportion to resources, and consequently serve to reduce population levels back in line with resource availability.

Until recently, it was thought that modern technology had rescued us from this cycle, and made Malthus’ theories obsolete. Just as natural selection stops when civilization begins (another topic for another time), so too did our technological prowess shield us from the Malthusian cycle of population boom and bust.

The examples of technology being used in this way are manifold, but certain concrete examples are readily apparent. Newer agricultural technologies to help combat famine, the use of medications and vaccines to combat disease, epidemic, and pestilence, and greater communication and transportation technology to deliver these treatments, supplies, and personnel to necessary areas.  In this way, the advent of modern technology helped to sustain population levels out of proportion to “natural” resources.

With time, advances in computing technology have become such that many tasks which were previously relegated to human beings can now be handled by computers. In fact, whole fields have been decimated by the use of computers. Telephone operators, whether at a central switchboard or a company switchboard, have been almost wholly replaced by voicemail system.

Think of the lowly greeting card. In the past, there was someone hired to write them (Longfellow Deeds?), another to design them, another to print them. They then went to a distributor, who sold them to the local Hallmark store. The Hallmark store employee sold them to you. You put them in the mail, and the mailman delivered them. Currently, one can log on to any number of sites where electronic cards are available. With a few clicks of a button, you have fired the distributor, hallmark employee, and mailman (while at the same time hiring fewer programmers and internet engineers).

Thus, while technology can increase accessibility of scarce resources, it also serves in a very real sense to make other resources more scarce–those of jobs, and consequently wealth. In doing so, it encourages growth in a relatively resource poor environment, and sets up conditions to precipitate a Malthusian Crisis on a scale potentially much greater than those it has helped avert.

Unfortunately, there is no going back from this brink.  The fact remains that the world’s population continues to grow at a pace greater than the amount of human jobs needed to sustain it.  There are simply too many people, and too much automation, to allow for adequate levels of sustenance.  Through this lens, we see that unemployment and fiscal crisis are not necessarily direct results of the failed policies of one government or another, but a historical inevitibility.  As such, no amount of legislation or specific fiscal policy will be able to reverse it.  And, to top off the good news, the situation is likely to get much much worse before it gets better.  The logical end to this cycle is a “positive check” (the word positive is Malthus’, not mine) the scope of which may be unprecedented.  After all, the wheel of history cannot be stopped from turning.

Our Father, Who Art in Heaven

Celebrate the New Year with family, friends, and feast but then, be mindful.  For the next ten days, God will be watching what you do, and judging what benedictions to proscribe for you in the coming year.  And the tenth day… Oh the tenth day of the year, who can describe it’s holiness? Observe that day and respect it’s importance!  Fast on the tenth day of the year, attend services, and make sure you say your five prayers.  Pray for forgiveness, for enlightenment, recognize your sins and atone for them; for on that day shall God finalize his judgment of you, and as the sun sets on the tenth day your next opportunity for redemption will be a year away.

My Shia Muslim friends know well what I am referring to.  But so do my Jewish friends.  The above paragraph could just as well describe the first ten days of the (Shia) Muslim new year as the Jewish new year.  Starting tonight, my Jewish friends will observe the solemn holiday of Yom Kippur, the Day of Atonement.  During this day, they will foresake all other activities and distractions and fast and pray for forgiveness, that G-d may finalize His judgment of them, and seal the Book of Life with positive benedictions for them for the coming year.

In November/December of this year, my Muslim friends will do… exactly the same thing.  We will celebrate the new year with a feast, then spend the next ten days reflecting on our actions and remembering Allah in an attempt to purify ourselves.  On the tenth day, Yom-e-Ashura, we will fast and pray, and spend the day in services.  We will foresake all other distractions, so that Allah may judge our actions on that day and deem us worthy of His benedictions.

In then end, children of the same father are brothers; and the Jews and the Muslims, as children of Abraham, are truly brothers.  Though we may have many outward differences, our core is the same. The unity of those core beliefs should transcend the different manifestations of our faith.  It is that core that we must keep in mind, and love our brothers despite (or perhaps because of) our differences.

So, in the spirit of our fraternal bond, I wish all of my Jewish brothers an easy fast and a spiritually fulfilling day.  I know from experience that come Yom-e-Ashura, they will do the same for me.

Conrad Murray– A Smooth Criminal?

The trial of Dr. Conrad Murray, the physician involved in the death of pop sensation Michael Jackson, is well underway in a Los Angeles area courtroom.  Dr. Murray stands accused of involuntary manslaughter in Jackson’s death.  The accusation is that Dr. Murray used lethal doses of the anesthetic propofol and insufficient monitoring equipment to sedate Mr. Jackson (at his request), and that these actions caused the death of Mr. Jackson.

The real issue in this trial is not about doses of a medication or types of cardiac and respiratory monitors, however.  The over-riding and precedent setting issue of this trial is the charge against Dr. Murray and the type of trial being conducted.  Dr. Murray is accused of involuntary manslaughter, and is thus facing a criminal trial brought by the state.

When boiled down to its essence, however, Dr. Murray was hired for his medical services by Mr. Jackson.  In the performance of those medical services, Dr. Murray displayed incompetence in the dosing and usage of the medication propofol, and gross negligence in the monitoring of his patient.  This incompetence and gross negligence led to the death of his patient, Michael Jackson.  This is clearly an egregious case of medical malpractice, a civil charge brought by the family or other survivors.

The difference between these charges is extremely important.  Involuntary manslaughter, in this case, refers to “death during the commission of a lawful act which involves a high risk of death or great bodily harm is committed without due caution or circumspection”.  Medical malpractice, on the other hand, requires four components to be proven:

1) A duty of care was owed by the physician

2) The physician violated the standard of care

3) The person suffered a compensable injury

4) The injury was caused in fact and proximately caused by the substandard conduct.

Physicians deal daily with life and death decisions, and their actions, negligent or otherwise, can and do result in the death of those in their care.  This particular fact, combined with the fact that no other field is charged with such obligations, is the entire purpose behind the development of medical malpractice laws to begin with.  In a very real sense, medical malpractice laws exist to provide a rational exemption to physicians from charges such as assault, battery, and manslaughter.

I cannot and will not excuse or defend the actions of Dr. Murray, as they were by any standard incompetent and grossly negligent.  However, to try him for manslaughter when this is a clear example of malpractice is a distortion of the legal system which sets dangerous precedents.  Doctors are not immune to the law by any means, but during the act of practicing medicine, as the very practrice of medicine carries a high risk of death or great bodily harm, doctors are and should continue to be held to the standard of malpractice rather than criminal manslaughter.

The proper sanction against Dr. Murry would be revocation of his license to practice and malpractice proceedings along the most severe lines.  And in the case of almost any other plaintiff, this would have been the case.  This case, however, is different and to deny its differences would be false.  In my own medical community, a patient recently died when having an outpatient surgical procedure by a doctor who was not qualified to perform said procedure and gave the anesthesia himself (which he was also not qualified to do).  This incident made the local news, and may result in license revocation (probably with a stay if he takes certain useless “medical care” courses) and a fine.  But the fact is, this doctor has been busted for the same thing previously and no action had been taken to date.

But Michael Jackson? That’s a different story.  As a public figure and a relatively beloved one at that (we can go into the psychological scrubbing of ones images and selective memories of one’s actions after their death another time), the public outcry was likely irresistable.  A very public spectacle with very severe punishments (what, you mean he’s not even going to jail?) would be necessary for the appearance of justice to be done.

In the state of California, malpractice awards are capped.  One million dollar awards per occurrence, for a total of three million dollars a year.  Such awards would (rightfully) be viewed as a veritable joke to the Jackson family, and would in no way sate the hunger of the public for justice.  In contrast, the ensuing wrongful death suit after a manslaughter conviction will be uncapped, and substantial.

The fact is then, that just as different standards of care exist for the rich and the poor, so then do different standards of justice apparently exist for their doctors.  If we are to argue that health care standards should be equalized across the socioeconomic spectrum, which is no doubt a noble goal, we should also strive to equalize justice across the socioeconomic spectrum.  And the trial of Dr. Conrad Murray is in clear violation of that principle.

Allowing Dr. Murray to be convicted of manslaughter will set a precedent which will have far reaching ripple effects.  It will open up potential litigation against many doctors whose patients die during the deliverance of medical care, either careful or negligent (negligence need not be proven for charges to be brought, after all).  This will serve to render malpractice tort reform and capitation utterly useless.  Insurance premiums will rise and consequently availability of health care will drop.  Costs of health care will increase as defensive medicine is redoubled out of fear of criminal litigation.  In the end doctors and their patients will be harmed.

Dr. Murray should have known what he was getting into when he signed on as Mr. Jackson’s personal physician.  And if Michael Jackson had been any other Joe Somebody, he never would have allowed the deviances in care which he did with Mr. Jackson.  So perhaps it is poetic justice, if not real justice, that by treating his patient differently because he was rich Dr. Murray will now be exposed to a different standard of justice because of his patient’s wealth.