Monday, May 03, 2010
Priorities, Evidence, and Integrity: A Plan for Humanity
We humans have serious problems. Thousands of us starve to death every day, the planet is becoming progressively less habitable, and we're killing each other on a regular basis. Our way of life is detrimental to our well-being, and current trends don't bode well for posterity. It's time for change. I propose the following three-part plan.
Part 1: The Establishment of Clear Priorities
Our priorities guide our decision making, and our choices shape the world we live in. Every day, individuals, groups, organizations, and governments make decisions. We choose between what's healthy and what's easy, between what's kind and what's profitable, and between what's best for everyone and what's best for us. If optimizing collective well-being were most important to us, our decisions would lead us in this direction.
Our choices reveal priorities that we might wish to deny. It would appear that convenience is more important to us than sustainability, that our happiness is more important than that of future generations, and that people in our country are more important than people in other countries.
Selfish behaviors may serve the interests of individuals in the present, but they lead to a society that is undesirable for the majority. These behaviors can be attributed to a lack of integrity and the absence of clear priorities. If our priorities aren't clear to us, then our decision making will be undermined. So, we need to establish clear priorities.
What do we, as a society, value the most? Well-being? Reason? Autonomy? It's not just our values, but the way we prioritize them that will guide ethical decision making. For example, if we value well-being more than autonomy, making helmets mandatory for cyclists would be a good idea. If we place greater value on the freedom to choose, we might keep helmets optional, but take steps to promote their use. The prioritization dictates the strategy.
I suggest the following as shared values (in order): human equality and sustainability, autonomy, collective well-being, and individual well-being.
Equality and sustainability are linked. Sustainability can be considered equality over time, or among present and future generations. Both pertain to access to the determinants of well-being. However, establishing equality need not improve collective well-being. In order for everyone on the planet to enjoy the same standard of living, and have it be sustainable, people in the West would have to make sacrifices. We might have to temper our well-being, or adjust our notions of what constitutes well-being, for the sake of equality and posterity.
I put collective well-being ahead of individual well-being because the collective suffers when we all put our individual needs first. When we put the collective first, individuals generally benefit.
Many of us use plastic and other environmentally harmful materials because they're convenient. Our individual contributions to pollution make the environment less habitable and lead to environmental illnesses and cancers. If sustainability and well-being are important to us, then these convenient individual choices are indefensible. Small things, like turning off the water when we brush our teeth or using our own bags for groceries may make us feel like we're doing our part; but these things don't compensate for the damage we do when we routinely put our own needs ahead of sustainability whenever we have to choose between the two.
If we agree that convenience is more important than sustainability, then we should accept that humanity will eventually run out of essential resources, and we should stop complaining about environmental ills. If we agree that sustainability is more important to us, then we should be prepared to make sacrifices. We should acknowledge our true priorities and make choices that reflect them.
I've placed autonomy ahead of collective and individual well-being because I think that people should have the right to make choices that affect their own well-being. It's debatable whether free will truly exists, but the perception of autonomy, at least, is important to most of us. Efforts to encourage healthy choices shouldn't destroy this perception. Public health campaigns, marketing, and persuasion tactics are fair game, but force is not.
An important clarification must be made on the point of autonomy. Just as individuals can make decisions that affect themselves, autonomous groups can make decisions that affect their constituents. As long as a consensus is established, the collective can ethically make decisions that will affect its members. Obviously, we can and should establish rules. We can't apply them to people who are outside our own collective.
If we hold autonomy as one of our core values, then we have to respect the autonomy of others. We can't choose other nations' democratic leaders for them. We have to respect the consensus decisions of other nations even when we disagree with them. This applies to morality as well. Suppose we decide that abortion should be legal if performed prior to 20 weeks of gestation. And suppose another nation decides that abortion constitutes murder and bans the practice entirely. A third nation decides to allow "abortion" and sets a maximum age of one year, stipulating that the child must be anesthetized for the procedure. If we expect the nation that has banned abortion to respect our decision, then we have to respect the other nation's decision. We can't expect our autonomy to be respected if we aren't prepared to respect that of others.
International organizations provide a way of managing moral outliers while respecting autonomy. If the moral outlier was represented in the decision making process, a consensus on the issue allows for ethical intervention. If we happen to be the outlier, however, we need to respect the decision of the international community. We can't go riding over other countries on our moral high horse in violation of international law.
Respecting others' autonomy may be a bit frightening. People are capable of despicable acts and it would seem that, given particular circumstances, whole cultures can behave in despicable ways. But acts of great enormity have been committed by such a wide variety of peoples and cultures that the behaviors themselves can't be attributed to a specific race, culture, or religion. True sociopaths are much rarer than the perpetrators of these crimes, which are often nurtured by circumstance. Where desperation, violence, and oppression are the causes, they won't be the solutions.
Human beings have the same basic needs and desires. Even when it seems that we want different things, we want these things in order to meet very similar fundamental needs. Despite our tendencies to organize ourselves into groups, and form group and cultural identities, we really aren't all that different.
The prioritized list of values that I've suggested may not be perfect or complete. What's more important is that we give some thought to what our priorities should be and that we reach a consensus. Until this happens, we'll be like a group of people trying to row a sinking boat in different directions.
Part 2: Evidence-Based Decision Making
Once we've established priorities, consistent evidence-based decision making will help us to reshape our circumstances. The use of empirical evidence mitigates various forms of bias that can cloud our judgments. We'd never evaluate drug efficacy by simply asking a few people if they think the drug works. Similarly, we wouldn't want our leaders implementing programs and policies on the basis of their gut feelings. When making important decisions that affect everyone, reason and evidence are our best guides.
To optimize decision making we need to make a few changes in the way we use evidence. First of all, evidence-based practice needs to be more widely embraced. In the field of education, for example, many practices are rooted in tradition and theory, with little empirical support. Education is too important to be based on unsupported opinion and untested theory. Greater reliance on evidence would lead to more effective practices.
The relative strengths of different kinds of evidence are often conceptualized in a hierarchy, with less reliable, anecdotal evidence at the bottom and the double-blind, randomized controlled trial at the top. Other kinds of evidence (observational studies, for example) fall somewhere in between. This hierarchy is useful, but we can adhere to it too rigidly. The data from a single, poorly designed, randomized, controlled trial may not be as reliable as the data from multiple, well designed observational studies. The hierarchy is a guide. It doesn't replace the need for careful evaluation of study design and quality.
For complex decision making, the scope of evidence should extend beyond the quantitative paradigm. The hierarchy of evidence deals mostly with quantitative study designs, which emphasize objectivity and generate numerical data that can be analyzed statistically. There are other important kinds of evidence.
As Einstein said, "everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted." If we aim to understand a foreign culture, statistical data and facts won't be nearly as helpful as living in the culture for a few years. If somebody else spends time immersed in the culture and wishes to share his or her understanding, statistics and empirical data won't be the best way to do this.
The complexity of relationships, the meanings of gestures and cultural practices, and the power of human emotions are best understood through lived experience, and best communicated through qualitative means. Qualitative studies tend to be subject to a greater variety of biases and may be less reliable in some ways. However, these methods constitute the best ways to generate knowledge in some very important areas. Their value should not be under-appraised.
Researchers from quantitative and qualitative backgrounds need to gain a better understanding of the methods and value of the other paradigm. We can't expect to get as complete an understanding of a complex issue if we limit the kinds of evidence we'll consider. A broader scope of evidence will provide a more reliable foundation for decision making.
Ideally, decision making should integrate evidence from multiple disciplines. The complexity of the factors that influence the things that we value demands the synthesis of knowledge from different fields. If we aim to develop strategies to optimize well-being, then we need to consider all of the determinants of well-being; they are numerous and interdependent. They include things like income, education, and access to health care.
Consider the case of dentistry, which in North America, is one of the most expensive professional programs. Inability to finance dental education excludes applicants from lower socioeconomic groups. Upon graduation, new dentists may carry debts exceeding $200, 000. The associated financial strain may impair their psychological health. The high cost of education demands a high salary, which translates into high fees and reduced access to care for lower income individuals. If individual and collective well-being are priorities, then an array of evidence would suggest that current practices need to be revised.
While evidence-based decision making is best, we do need to recognize the shortcomings of our evidence. Even the pinnacle of the hierarchy of evidence, the double-blind, randomized, controlled trial, is subject to bias. This is a good reason to generate and consider evidence about our evidence.
Studies have shown that industry-funded research is more likely to yield results that are favorable to the industry. This should shape the way we view such research. We ought to be a bit skeptical of industry offerings, particularly if independent studies point to a different conclusion. Evidence about evidence can also inspire new policies relating to funding (a requirement for disclosure, for example), or to modification of publication practices, like improvements in the peer review process.
Evidence not only enables us to identify choices that are consistent with our priorities, but prevents disastrous choices that we might make otherwise. Actions that are guided by incorrect assumptions and prejudices can be damaging. Too often, decisions are made on the basis of assumptions that are very wrong.
Part 3: Leadership and Integrity
We typically think of leaders as individuals who possess certain traits, like charisma, savvy and 'people skills'. They are the 'faces of change' and the people we follow. I argue that leadership is simply the force behind a desired change, with the change being determined by the priorities of the leader.
With clear priorities and optimal use of evidence, the changes that need to be made become both clear and possible. The kind of leadership that will bring about the changes that we want to see must come from us. We need to demand that our governments make choices that are consistent with our priorities, we need to lead by example, and we need to champion integrity.
Since it is tempting to put our own immediate needs first, we also need to devise strategies to instill and reinforce our priorities, and to reward integrity. It is crucial that these strategies be consistent with our priorities. When it comes to implementing a system for guiding ethical behavior, the end doesn't justify the means. The means is the end.
Posted by Quinn O'Neill at 12:02 AM | Permalink