Who breaks a butterfly upon a wheel ?

Who breaks a butterfly upon a wheel ?

It now appears that Charlie Gard and his parents have lost their war. It seems that Charlie will die over the next few days and that his parents have decided that all hope of any improvement is lost. All they now seek is to ensure that their son dies with dignity and compassion.

They gave up their commendable battle when they realised it was now, after all the delays, too late to meaningfully help their son. They faced enormous challenges and met them with dignity and were, without any dubiety, an example to many of the power of parental love. The showed a steadfastness that was remarkable and kept on despite many difficulties.

In the last week there was a campaign mounted against them which is likely to have originated  from GOSH’s legal team. Articles appeared in the British press praising at the medical and nursing staff suggesting that they were doing their best for the child and his parents could not wish for better advocates for their baby.

It was then suggested that the staff had been intimidated by online harassment and threats. This is a common strategy by those under pressure as it has the two fold action of both stifling criticism and also suggesting that those on the other side of the debate are associated with violent thuggery. This was especially unpleasant as throughout this dreadful time Charlie’s parents remained dignified and reserved. They never called the motives of the staff caring for their child into question and said no bad things about them.

Charlie Gard will not see his first birthday. But in his short life he will hopefully have opened many peoples’ eyes to the dangers of giving away our freedoms to authorities who tell us that they will look after us. He and his parents will have achieved much more than most of us, they are modern heroes. Heroes don’t need to win their battles they just have to be heroic. Heroes are heroic not because they win but because they fought.

On finding a bundle of stones

It seems that the artistic urge is an important aspect of us all. Even when we were, as a species,  little more than savage animals it seems that the urge to create things of beauty was there. The cave paintings of figures and animals are testament to this desire to create art. Primitive man spent time making objects, or decorating places, with no functional intent other than to please themselves and perhaps others. In a life that was hard and precarious this argues that this desire to create artworks is exceptionally strong.

In the modern world has been a tendency for this desire to be taken away from the populace and made into a commodity or skill which can be traded. Now we are much more likely to see ourselves as consumers, rather than producers, of art. But each time we doodle, whittle or whistle it should remind us that this creative desire is still there.

I was reminded of this when I was walking the dogs this morning and came across this piece of artwork  laid out on the wall at the side of the road.

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At first glance this may not appear much more than a pile of detritus gathered on a wall but it clearly is a work of art. Someone had obviously taken time to collect the objects needed – stones, flower, ferns, leaves and feather – and then spent further organizing them into a pleasing pattern with considered symmetry and planning. I an not see that this was done for any reason other than to please the person who created it. I can see no utilitarian aspect to its manufacture. It a work of art, something made purely for the pleasure of perceiving it.

It is probably more a work of art than many items we currently grace with that term, such as songs, statues, or paintings, as this was made with no plan of sale. There was no intention to trade this item for something else or for money. Its manufacture and perception were its purpose. Also unlike other works of art there was no intention for the artist to receive any other reward such as fame or renown. He, or she, has remained anonymous, content to have the pleasure of the object alone.

As a work of art it has fulfilled the one other aspect of such items. It was left for others to enjoy. A work of art will usually be intended to bring pleasure to others. It would have been possible for the creator of this to make their artwork then brush the leaves and feathers off the wall leaving no trace. However, it was left on display to find and to please its audience, and, unlike many modern art displays, the audience did not have to pay either money or respect for the pleasure

Someone I will never know made something that brightened my morning and they will never know that they did that. The artistic impulse that has been with us from the dawn of our species still manages to break out and surprise us.

via Daily Prompt: Savage

In Loco Parentis – the terrifying tale of Charlie Gard

In Loco Parentis – the terrifying tale of Charlie Gard

As a doctor I have found the unfolding tragedy befalling Charlie Gard and his family extremely upsetting to follow.  This poor boy and his family are butterflies being crushed on a wheel to press home a legal point, they are unfortunates being punished having committed no crime.

Let us firstly be clear what this case is not about. Despite protestations to the contrary this case is not about the best interests of Charlie Gard. The best interests of the child (1)  are clearly important and made paramount both in the UN Convention of the Rights of the Child (2) and in British Law with the Children Act of 1989 (3) . It is clear that all the parties involved in this debate are acting because they have the best interests of Charlie at heart. The doctors and hospital feel that they, by virtue of their knowledge, know what is best to do. His parents, through love and affection, also believe that they can see the best plan and hope for their son. Both are acting in the best interests of Charlie, this is not the problem. The problem is who decides what exactly are Charlie’s  best interests.

It has always been the case that the parents of the child decide what is in the best interest of the child. This is as it should be as it reflects the natural law and ensures that the people most attached to the child’s interest are those who act as the child’s guardian. There are very few circumstances when this can be changed and they depend upon proving that the parent is being either negligent or malevolent. Neither of these factors are in play here and, if anything, the parents have taken extraordinary steps to secure chances for their child, well over and above what many parents would have been able to do.

It is interesting that, at the 24th hour, Great Ormond Street Hospital has made an application to court to revise its plans (4) possibly starting to realise that the parents’ opinion may have been closer to Charlie’s best interests, than had their own opinion been. So in this difficult calculus of what is the best plan of action it appears that Charlie’s parents may have been the better judge all along.

While these arguments over the ‘best interests’ may mean that the parent disagrees with the medical team it does not mean that the parent can compel a doctor to do something they feel is inappropriate or wrong. But again this is not the case in this situation. Charlie’s parents have never asked GOSH or the NHS to undertake treatments they do no agree with. They have gathered together sufficient resources to enable Charlie to receive this treatment by doctors who believe it is, worth a trial, in the child’s interests. This should have been the end of the dispute. Charlie and his parents should have used their money to go and try this last ditch attempt, to catch this glimmer of hope.

GOSH and its staff, however, stopped this. Their court battle stopped the treatment and refused the parents the ability to move their child. In their paternalism they not only refused to help but also stopped anyone else helping. The thousands of people who collected money to help Charlie were thwarted by this as well as Charlie’s parents and the other hospitals and doctors who wanted to help.

I am a very old-fashioned doctor and I don’t fear paternalism per se. A desire to act like a father, is a a desire to be benevolent, guiding, helpful and wise. In itself not a bad thing. It becomes bad when it belittles another party and reduces their agency. When doctors worked in a professional relationship with their patients, the doctor’s paternalism would drive them to seek the best for their patient and was usually leavened by respect for the patient’s autonomy. This combination could be valuable when there were difficult scenarios – when the future was unpredictable and  the efficacy of plans of action difficult to assess. Much of the placebo effect of medical intervention depends on this aspect of the relationship and large parts of the benefit of of healthcare comes from this caring, guiding, advisory aspect of medical care.

There was always one very good safeguard against this paternalism becoming intrusive or  belittling, when the relationship was between doctor and patient, the patient could always terminate the relationship. If they felt that the doctor’s approach was wrong they had no need to continue to use them. This was a way to safeguard the patient and also a way in which the doctor would know that they had overstepped the boundaries and they could learn where paternalism started to erode patient autonomy. But in the NHS this is difficult. The patient can’t change their doctor without a great deal of difficulty. If they change they will probably be labelled a “difficult patient” which might mar relations with their next medical practitioner.

In addition, under the NHS the patient is no longer the employer of the doctor in the UK. The most important relationship for the doctor is the one with his employer – the state, the NHS – not the the patient directly. It is the state who pays his wages, sets his targets and assesses his performance and we know “he who pays the piper calls the tune“. In this scenario paternalism is largely unchecked and can be very dangerous. Paternalism, appearing kindly and wise, can mask actions that are not in an individual patient’s best interest. Rationing and refusal of therapy is hidden as medical advice and choices are withdrawn from the patient. Doctors often find, when working in the NHS, that their attempts to maintain professional standards and a focus on their relationship with the patient can cause them difficulties. They are made to feel as if they are being disruptive when they call for what is appropriate for the patient. They can be told they are jeopardising the budgets, failing to be a team player by not following the organisation’s line, and generally made to feel awkward if they behave in a manner that was formed by their vocation and training.

In this case paternalism seems to be being employed to sweeten a bitter pill. The state wants to end Charlie Gard’s life before all options that are available have been tried. Despite having seen parents act heroically and selflessly for their child, without an ounce of malice, they would prefer Charlie died rather than allowing the parents to try all they can do. But rather than admit this we are told that they are the wise and kindly people who know what they are doing, we are awkward and unruly children causing a fuss.

Well thank God for the fuss that Charlie’s parents have made;  it may not save Charlie but they will have opened the eyes of many people and might save future families from the horror that they have had to endure. They truly are a heroic family who deserve our support (5)

 

 

 

 


[1] https://en.wikipedia.org/wiki/Best_interests

[2] https://en.wikipedia.org/wiki/Convention_on_the_Rights_of_the_Child

[3] https://www.publications.parliament.uk/pa/cm201012/cmselect/cmjust/518/51807.htm

[4] http://www.telegraph.co.uk/news/2017/07/07/hope-charlie-gard-great-ormond-street-seeks-explore-new-evidence/

[5] http://www.charliesfight.org/

Snack Music

Snack Music

A few years ago I was diagnosed as having Type II Diabetes. It was quite a shock as I hadn’t felt unwell and had not realised just how bad my diet was.  In the first year I used a low carb/high fat diet to get my weight normal and to be able to stop taking medication. Since then I have paid better attention to my diet and started to exercise regularly, I have stayed off medication, my blood pressure and lipid levels  are better than when I was a younger man and I am fitter. I also feel fitter and stronger.

When I look back to see what I had done wrong to end up in this state, it was clear that snack food had been my downfall. Looking back it was obvious quick, easy to eat, high carbohydrate treats had taken over my diet.  Snacks had done it; a sandwich, a cake, a pie, a biscuit, a sausage roll .. there were many ways I could snack instead of eating regularly. I had developed a bad habit of eating easy food with a quick reward. There was no need for preparation, little need for thought, just eat and go.

Over the years this had done considerable damage to my body. I was three stones overweight, no amount of leaving my shirt outside my trousers could hide my belly, I could not run, and eventually my body started to fail. Fortunately I started to have to get up at night to pee and thinking I might have the other old man’s friend (prostate problems) I saw the doctor who, alarmed at the high levels of my blood sugar, started medication immediately.

I use the word “fortunately” as I am glad I found out the damage I was doing to myself before discovering it, too late,  after a heart attack, an amputated foot or after going blind. I have turned some things around and hopefully reduced my risks somewhat. But I was clear that snacks had been my downfall, they had messed up my diet and consequently messed up me.

However, recently I have been trying to learn from my mistakes. If I did this much damage unwittingly, what other damage might I be doing ? Are there other dangerous snacks I have been overeating ?

I realised that in cultural terms I was wreaking similar damage in other areas by snacking. I decided to tackle these problems also before they started to cause problems or disability. I have started first with music. I was aware that over the years I have started to prefer small, easily digestible pieces of music; pieces of music that require little thought or attention and which catch you quickly and satisfy instantly. I prefered the snacks of the musicalworld.

I had been led to this by the mp3 and the download. Rather than listen to a concert or an LP I would listen to a single track. Instead of listening to the whole opera I’d listen to the popular aria made famous recently by its use in an advertisment. I noted that my musical tastes have been coarsened and  are now much more reliant of rhythm and beat – the quick hit, the ‘carbs’ of the music world. I noticed also that often I was guided to music by the accompanying video which makes the emotional impact much more effective while, at the same time, taking away the need to think and consider. I think it is no surpise that the videos are becoming more important as it is not really the music that is being sold now. It is the quick snack, the fast food of the music world, rather than a balanced healthy diet.

I’m starting to see results. This morning was improved by listening to “A night on bald Mountain” and last night was spent in the company of the Dance Macabre  of Camille Saint-Saens. This has been much better for my health and soul than my previous diet and hopefully, over time, I’ll see similar amounts of improvement. Certainly I feel better and I am also much more aware of what I consume musically and that, in itself, is not a bad thing.


Night on Bald Mountain

Dance Macabre


via Daily Prompt: Snack

In Praise Of Failure.

In Praise Of Failure.

I watch and listen to my grandchildren growing up and I am aware of a major shift from the days of my youth. It is clear that rewarding and praising children is seen as very beneficial, as has always been the case, but it is also clear that there is a new emphasis on avoiding rebuke or expressing disappointment. There seems now to be a drive to give praise whenever possible, I note the most prosaic of actions being flattered and the most quotidian of results being rewarded. Failure seems something to be ignored, something to be avoided, something that needs to be brushed under the carpet and ignored.

In discussion with my offspring it seems that they are keen to keep any feelings of disappointment, or recognition of failure, away from children for a long as possible. Games are organised so that everyone wins and all get prizes, the belief is that this strategy will aid self-confidence and self-esteem by avoiding damaging early criticism. But is this the case?

Self-esteem arises from our awareness of our talents. It is recognition of our worth based on our achievements. Any self-esteem gained through empty praise of unremarkable actions is surely false. An ego based on such flimsy foundations would indeed be weak. The stimulus of praise to guide us to achieve will be missing and it might prove difficult for children to know how to aim their endeavours.

The absence of the experience of failure will also mean that the child misses out on a vital corrective experience.Wisdom is created by experience, we need to know what fails so that we can avoid mistakes in future.  Since the ancient Greeks we have know that we need to try things in which we fail in order to develop :-

“Zeus, who guided mortals to be wise,
has established his fixed law—
wisdom comes through suffering.
Trouble, with its memories of pain,
drips in our hearts as we try to sleep,
so men against their will
learn to practice moderation.
Favours come to us from gods
seated on their solemn thrones—
such grace is harsh and violent.”

Aeshylus

and this is echoed in the maxim “Anyone who has never made a mistake has never tried anything new.” (Albert Einstein)

So far, I think most people would agree with me about the usefulness of the corrective effects of failure. But I feel that there is another wider reason we need to be able to compete and to learn what it is like to fail.  When we compete and win we learn about areas in which our skills excel, we learn which skills we possess in which me might take some pride and our confidence and esteem are bolstered as a consequence.

When we fail we learn another vital lesson, we learn that others may be better than us. They may be smarter, faster, stronger or wittier than we are. It is important to recognise this.  We are born egocentric and self-centred we need to learn that others are separate and equal characters. We need to know that in some areas other people may surpass us and that we are not the unique focus of the world. It is this balance of aiming for self-actualisation while at the same time respecting the autonomy and equality of others which allows us to develop fulfilling relationship in the world and to develop our character. Our individual and collective future depends upon this and I hope we are not undermining our options by these changes.

 

 

 

Will it never end ? Quebec’s terrorist attack.

Will it never end ? Quebec’s terrorist attack.

Another atrocity, six innocent men gunned down, while at their devotions, 19 others injured and 5 remain in a critical condition. Again we are witness to innocent people, slaughtered as thy try to get on with their lives and again we know that wives have been left widowed and children fatherless for no reason.

This time, it seems highly likely that a young man with right-wing nationalist views (Alexandre Bissonnette) is responsible for this horror. If it is he, we will no doubt discover that he, like Dylan Roof and  Omar Mateen and many others before him, was a warped young man unable to tolerate those he disagreed with, unable to tolerate those different to him. It is no surprise that these people choose their targets by features which mark out their group as different to his group; the white supremacist attacking those performing their religious duties while the jihadist identifies those participating in banned activities.

Terrorists from both groups are much more similar than they would like to imagine, both see themselves as warriors defending their group against the others or avenging wrongs done by the other group. While these are extreme members of their groups, this tendency to see politics and life in terms of groups is a major problem. It does not matter if the group is defined by religion or race, nation or class, heritage or any other  tribal banding, viewing the world in this manner distorts our society.

Humans are intrinsically social animals. We don’t survive in isolation and instinctively seek out our fellows. Despite what dystopian films and novels may tell us, in good times and bad we band together to cooperate, help and trade. We find ways to be with others that is mutually beneficial. It is important to recognise that xenophobia and fear of others is commonest in people who have little contact with other groups. When we have to opportunity to mix and mingle we find ways to make this benefit both ourselves and the others and fear quickly dissipates. When we are left to our own devices we create an emergent order which is beneficial to all. This only goes wrong when we are grouped and ruled.

This is not simply the old story of “divide and rule” but rather “categorise and control“. When we are encourage to see ourselves as members of groups ( American, Christian, Black, Lesbian, Working Class, Welsh, Jewish, Islamic, Aryan, etc) we are encouraged to see the differences we have with others. We are encouraged to view others as being not only different but wrong and potentially threatening. We are encouraged to feel under threat and in need of protection. And in responce to this perceived threat, there are usually a group of people (politicians, clergy, kings,  inspired leaders, etc) who will guard us and look after our interests. These are the people who benefit from this grouping, they now hold the power (and usually a great deal of the wealth) as they control how we may and may not interact to preserve our group. All their power comes from controlling spontaneous  activity by individuals  and disappears if people are allowed to interact freely.

Once in our groups we are encouraged to view all problems in terms of this. It leads to partisan and transactional politics. Our group is always right, the other always wrong. Our problems come from the malevolence of the other group. While watching the coverage of Quebec I noticed on social media the cheerleaders of each group swinging into action. Those on the alt-right ecstatic when it looked as if a muslim might have been involved (erroneously), the progressives cock-a-hoop at having another timely white nationalist terrorist just in time for the fight with Trump about closing borders. Our politics have descended into this. We are unable to discuss issues without this being along the lines of our group identities. This means we fail to develop and change as quickly as we might otherwise be able.

The Quebec tragedy will end up being defined as a battle between those fearing islamophobia and those fearing islamofascism. Left to their own devices, followers of different faiths would cooperate happily and beneficially. When they are individuals they find a way to coexist in a way that benefits all, it is only when they are pushed into groups that hatred such as this arises. It is leaders who lead us down these dark alleys of discrimination and violence.

Remember the men who lost their lives in Quebec, remember them as real people like you or I, remember them as fathers or sons like you or I, remember them as individuals.  Don’t think that their religion makes what happened to them explicable in any manner, nor does it explain their murderer’s actions.  Don’t force them into a group and don’t let yourself be forced into a group. When we stay as individual units we remain individually responsible and recognise that we have the same rights as everyone else. Maintaining this is our only hope of preventing future tragedies. The first step in murder and maltreatment is making the victim an exemplar of a group rather than an individual. The second step is removing our own individual responsibility by passing it to a higher authority.  Don’t be pushed to take these dangerous steps.

 

 

Exquisite Irony – Milo’s “Dangerous”

I felt that there was an  exquisite irony dangerouswhen I noted that Milo Yiannopoulos’ book ‘Dangerous‘ was heading the amazon best sellers list before his book was even available for sale. Since his book deal with Simon & Schuster was announced there has been a flurry of critical press. As the glamour boy of the alt-right Milo has also become the bogey man of the  left’s twitterati and social media groups.

There were early calls to ban the book from Sarah Silverman and Jud Apatow (1) and The Guardian’s comment pages were awash with calls to ban the book.  Later the Chicago Review of Books announced (2) that it would not review any of Simon & Schuster’s output in 2017. A storm of indignation was raised before a single word of the book was available to be read.

The liberals were apparently oblivious to the illiberal calls they made – book banning, book burning and suppression of authors are tactics whose history is often associated with the totalitarian right (Though as George Orwell described in ‘Nineteen Eighty Four’ the totalitarian left has become very able at this strategy).

But more importantly the liberals have forgotten the reasons that book-banning and censorship is a bad idea. Sure, it is morally wrong to try and suppress ideas discordant with your own as it denies the equality of other peoples’ opinions. Also, it is rather silly as it is unlikely that you can presume you will always be correct and, come the time you are wrong, you will need access to different ideas to adapt to new circumstances. But, at a very basic level, it is also a bad idea because it does not work. Refusing to discuss issues with people who think differently never causes them to change, indeed it may tend to promote in them a confidence that their views are correct. Your refusal to debate is not seen as a sign of moral strength but rather as a sign of weakness, a sign that you can’t debate, and a sign that you are aware that your argument is inherently weak.

However, at the very basic level it should have been clear that this was a stupid strategy because it is likely to backfire and be counter-productive. It should have been obvious that much of the success of the alt-right, and Milo in particular,  rests on the pleasure gained from upsetting the hierarchy, the pleasure found by saying the unsayable, and the simple pleasure from witnessing easily prompted outrage and indignation. To deliver these shows of outrage and upset feelings before a word had been printed was a free gift to the alt-right’s keyboard warriors who quickly booked their pre-orders for the book.

No matter what review the Chicago Review of Books may have given Milo’s book, whether it be good, bad or indifferent they could not have given more publicity, and increased sales, than had they tried. They have not only guaranteed home more sales and a wider initial audience, they have also increased his profile and cemented his poster-boy status.

The only thing of which we can be certain is that following this campaign more people will have read the book  than would have done otherwise. It certainly helped the sales of Lady Chatterley’s Lover and, as Oscar Wilde stated, “The only thing worse than being talked about is not being talked about.”

 

via Daily Prompt: Exquisite

 

  1. http://heatst.com/politics/sarah-silverman-and-judd-apatow-join-movement-to-stop-publication-of-milos-book/
  2. https://www.theguardian.com/commentisfree/2017/jan/04/simon-schuster-alt-right-hate-breitbart-milo-yiannopoulos
  3. https://en.wikipedia.org/wiki/Nineteen_Eighty-Four