The evil that is in the world always comes of ignorance, and good intentions may do as much harm as malevolence, if they lack understanding. On the whole, men are more good than bad; that, however, isn’t the real point. But, they are more or less ignorant, and it is this that we call vice or virtue; the most incorrigible vice being that of an ignorance which fancies it knows everything and therefore claims for itself the right to kill. There can be no true goodness, nor true love, without the utmost clear-sightedness. -Albert Camus, The Plague
An important anniversary passed recently without my notice. Over the past weekend, as I was “wasting” time on YouTube and Wikipedia, I realized my mistake. The discovery of what would soon be called AIDS happened thirty years ago. On June 5, 1981, a small paper in the CDC’s Morbidity and Mortality Weekly Report [ http://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm ] presented a cluster of five young, gay men in Los Angeles with Pneumocystis carinii pneumonia, a disease that, up to that point, only affected older individuals suffering from immune system degradation.
I realized then that I have lived through some epochal changing moments in my life: the creation of personal computers, the end of the Cold War, the advent of the hypertextual Internet that allows web searching, the events of September 11, 2001. I remember a world before these events. However, I am an individual born in the late 1970s, and I have no recollection of a world without AIDS.
In the intervening years, between 25 and 35 million people have died from the disease and an estimated 33 million people are currently living with HIV infection.1 However, now even children in the developing world know how HIV is transmitted and how you can prevent becoming infected. Humankind has discovered the zoonotic connection between HIV and the Simian immunodeficiency virus found in green monkeys and chimpanzees (thankfully, evolution is an unproven theory so we don’t have to worry about this). And, humankind has been able to create the “triple cocktail” of protease inhibitors and antiretrovirals that has allowed millions in the developed world to live nearly normal lives with a nearly normal life expectancy. But, people are still dying in the 21st century from a virus, an infectious disease.
AIDS came about at a time when government was cutting domestic spending not related to the military (e.g. the CDC went from over $300 million to less than $200 million between the 1980 and 1981 budgets2). AIDS came about as an oppressed minority group was making its first strides towards emancipation. Unfortunately, a major facet of that movement was in sexual liberation. For instance, the first case-control study done on AIDS in the first years of the epidemic demonstrated that the first cases of AIDS in the United States had on average 1,100 sexual partners.2 AIDS came about when that same minority group was still seen as an “abomination” (it is wonderful that this is no longer true). Religious leaders went on television and explained how AIDS was god’s punishment for homosexuality. Unfortunately, many people agreed and allowed fear to guide their decisions toward inaction.
It was not until the mid-1980s that the effects of inaction became too horrible to contemplate. Hundreds of deaths quickly progressed to thousands. Rock Hudson, a Hollywood leading man and closeted homosexual, became the first celebrity to die of AIDS. The Surgeon General’s report [ http://profiles.nlm.nih.gov/NN/B/B/V/N/ ] damned the actions of the government and described all that we had been doing wrong and outlined what we should be doing right (e.g. health and sex education in schools from the earliest ages, etc.). In November of 1991, Magic Johnson, among the brightest stars of sport at the time, announced that he was infected with HIV. I can personally remember seeing the press conference on the television in my mother’s day care center. I can remember that the common wisdom of the time indicated that he would be dead within five years (Magic Johnson is still alive as of summer of 2011).
The discoveries, the advances were still a few years away. Even so, the history of the AIDS epidemic in this country is one of failure. A nation created from the enlightenment, a nation that has lit the world with the light of freedom for more than two centuries, a nation that created the modern world of the middle class, a nation that split the atom and landed on the moon, that nation allowed an infectious disease to wipe out an entire segment of its population based on Bronze Age superstition. And, this segment was in the optimal productive phase of its life, 30 to 60 years old. It costs a society a lot to educate and raise children to the point where they then become the producers that carry the young and old. We cared not for this. We let them die because they were a danger to Judeo-Christian morals.
from The Normal Heart playbill logo
I began this writing with a quote from Albert Camus’s The Plague, a book that outlines the failure of a society in reacting to an epidemic. If you have never read it, I would suggest that you do so. If you are a public health professional and have never read it, I would demand that you do so. Or better yet, read The Plague at the same time that you read Randy Shilts’s And The Band Played On. Compare how little we have learned. Watch how history repeats. Read, or better yet, go to a production of Larry Kramer’s play The Normal Heart, a play with a name that originates from a line in a W. H. Auden poem, September 1, 1939 [ http://www.poets.org/viewmedia.php/prmMID/15545 ] (another period of humanity’s failure). The last line of a stanza is “We must love one another or die.” When we fail to see each other’s humanity because of ignorance, we invite, create, and become evil.
I would like to end with another quote, as art and literature is best suited at crystallizing concepts to a point of understanding, this time from the Bard himself. I would like this excerpt to be as a message that blazes out to the memories of every individual taken from us by this disease, to those angels crowding the streets of heaven, as Tom Hanks said in his Oscar acceptance speech [ http://www.youtube.com/watch?v=bBuDMEpUc8k ] for his role in Philadelphia. I would like it to be my metaphorical eulogy at their collective funeral. It is a quote from Macbeth. In the final act, the usurper is dead, but there has been a cost to gain victory. A father is being told that his son’s life has ended as lives end in a war.
ROSS: Your son, my lord, has paid a soldier’s debt:
He only lived but till he was a man;
The which no sooner had his prowess confirm’d
In the unshrinking station where he fought,
But like a man he died.
SIWARD: Then he is dead?
ROSS: Ay, and brought off the field: your cause of sorrow
This file photo shows a red ribbon symbolizing AIDS awareness displayed at the North Portico of the White House, Sunday, Nov. 30, 2008, in Washington. (Photo: AP/Haraz N. Ghanbari)
By Daniel Blake | Christian Post Contributor Thu, Aug. 04 2011 09:19 AM EDT
There were on average 50,000 cases of new HIV infections a year across the U.S. over the past four years, according to the Center for Disease Control and Prevention (CDC). However, according to science journal PLoS ONE, the largest increase has come among bisexual and men who have sex with other men (MSM).
The journal highlights that the new infection rate amongst black bisexual and black MSM had particularly “alarming increases”.
CDC Director Dr. Thomas Frieden has said, “More than 30 years into the HIV epidemic, about 50,000 people in this country still become infected each year. Not only do men who have sex with men continue to account for most new infections, young gay and bisexual men are the only group in which infections are increasing, and this increase is particularly concerning among young African American MSM.”
The study, which took place between 2006 and 2009, is the first that looks into HIV numbers with a test that can distinguish recent infections from existing infections.
The CDC has said that it estimates that MSM make up just 2 percent of the U.S. population, however, this group makes up a massive 61 percent of new infections in 2009. More than one-in-four of these new cases were from young men aged between 13 and 29 who had sex with other men.
Dr. Jonathan Mermin, director of CDC's Division of HIV/AIDS Prevention has told CNN: “We are deeply concerned by the alarming rise in new HIV infections in young, black gay and bisexual men and the continued impact of HIV among young gay and bisexual men of all races.
“We cannot allow the health of a new generation of gay men to be lost to a preventable disease. It's time to renew the focus on HIV among gay men and confront the homophobia and stigma that all too often accompany this disease.”
In 2009, the study found, that although blacks made up 14 percent of the U.S. population, the group accounted for 44 percent of all new infections; more than seven times that of caucasians.
The infection rate among black women was also found to be disproportionately high, with the group experiencing an infection rate 15 times that of caucasian women.
The overall number of new infections has dropped since the spike of the mid 1980’s but CDC says the level is still unacceptably high. Dr. Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention has said, “We have plateaued at an unacceptably high level. Without intensified HIV prevention efforts, we are likely to face an era of rising infection rates and higher health care costs for a preventable condition that already affects more than 1 million people in this country.”
According to CNN, Phill Wilson, founder & chief executive officer of the Black AIDS Institute has reported: “What these numbers tell us is we are not going to be successful in driving down new infections until and unless we invest in those populations most at risk, and in America today those populations are black Americans, men who have sex with men of all races and especially young, black men who have sex with men.”
He added, “It is outrageous that over the last three years reported in this data, since 2006-2009, we see a 48% increase in new cases among young black men who have sex with men age 13-29. We have to build the infrastructure and the capacity in these communities to respond to this epidemic in an appropriate manner.”
The brief was written by Ronald Dworkin, Thomas Nagel, Robert Nozick, John Rawls, Thomas Scanlon and Judith Jarvis Thomson (an all-star roster if there ever was one). It argues against a Washington state law prohibiting assisted suicide. The philosophers hope to persuade the Court to strike down the law by invoking a “liberty interest” all men and women have in making their own “personal decisions” about the “most intimate … choices a person may make in a lifetime” including the choice to die. “Death is, for each of us, among the most significant events of life.”
The Court alludes to this argument in passing when it acknowledges that the “decision to commit suicide with the assistance of another” may be “personal and profound.” The point, however, is summarily dismissed in the same sentence: “but it has never enjoyed … legal protection” (Washington v. Glucksberg [ http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&navby=case&vol=000&invol=96-110 ], 1997). That is to say, while “abstract concepts of personal autonomy” (the Court’s phrase) may be interesting, they are not currency here in the world of legal deliberation. What is currency is the line of decisions preceding this one: “The history of the law’s treatment of assisted suicide in this country has been and continues to be the rejection of nearly all efforts to permit it.” Case closed. The editors of a leading jurisprudence casebook observe that “The Philosophers’ Brief arguments about autonomy seem not to have influenced the Supreme Court at all” (Jurisprudence Classic and Contemporary, 2002). Why should it have? The Court isn’t doing philosophy, it is doing law. Grand philosophical statements may turn up in a Supreme Court opinion, but they are not doing the real work.
The question is whether religion should be considered philosophy. For a long time, of course, philosophy was included under religion’s umbrella, not in the modern sense that leads to courses like “The Philosophy of Religion,” but in the deeper sense in which religious doctrines are accepted as foundational and philosophy proceeds within them. But for contemporary philosophers religious doctrines are not part of the enterprise but a threat to it. The spirit is as Andrew Tyler (38 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=38#comment38 ]) describes it: “to be skeptical, critical and independent so that you’re not so easily duped and frightened into submission by religious dogma.” Courses in the philosophy of religion tacitly subordinate religion to philosophy by subjecting religion to philosophy’s questions and standards. Strong religious believers will resist any such subordination because, for them, religious, not philosophical, imperatives trump. The reason religion can and does serve as a normative guide to behavior is that it is not a form of philosophy, but a system of belief that binds the believer. (Philosophy is something you can do occasionally, religion is not.)
But aren’t beliefs and philosophies the same things? No they’re not. Beliefs such as “I believe that life should not be taken” or “I believe in giving the other fellow the benefit of the doubt” or “I believe in the equality of men and women” or “I believe in turning the other cheek” are at least the partial springs of our actions and are often regarded by those who hold them as moral absolutes; no exceptions recognized. These, however, are particular beliefs which can be arrived at for any number of reasons, including things your mother told you, the reading of a powerful book, the authority of a respected teacher, an affecting experience that you have generalized into a maxim (“From now on I’ll speak ill of no one.”).
A belief in moral absolutes, as an abstract position, is quite another thing. It affirms no particular moral absolute (although it might lead down the road to naming some); rather, it asserts that the category of moral absolutes is full; and it does so against the arguments of those who assert that the category is empty, not with respect to any particular moral absolute, but generally. Wherever one stands at the end of a such a philosophical argument one will be committed not to any specific moral stance (like turning the other cheek) but either to the thesis, again abstract, that moral stances are anchored in and justified by an underlying truth about the nature of moral behavior or to the thesis that they are not.
“I believe in moral absolutes” and “I hold absolutely to the idea that men and women are equal” are propositions of quite different orders. It is only the first proposition that doesn’t travel; it doesn’t tell you anything or direct you to do anything, necessarily. The second proposition, if you affirm it sincerely, has already committed you to particular choices and decisions. So when Id (19 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=19#comment19 ]) imagines a Joe Schmoe who might say “But my moral beliefs do matter to my decision making,” my reply is of course, they do, but that in no way undermines my argument, which is not about moral beliefs but about a belief in moral beliefs. Moral beliefs are not the kinds of thing you believe in; they are the kinds of things you have, or, rather, they have you.
Several posters complain that I can mount my argument only by rigging it, by excluding from the category of philosophy a whole lot of things most people would put into it — religion, moral commitments and a great deal else. Lindsey S (176 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=176#comment176 ]) asks, “Am I to understand that epistemology doesn’t matter. That philosophy of mind doesn’t matter? That political philosophy doesn’t matter?” Well, they certainly matter to those who do them, those who engage in the debates and controversies that impel an academic discipline. But I don’t see how they matter to people who are just living their everyday lives. Thinking is not directed or improved by your having an account of thinking, that is, an epistemology; your mind operates independently of whether or not you have a philosophy of it; politicians don’t have philosophical frameworks; they have strategies attached to some idea of what they want to get done. But, Tom (143 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=143#comment143 ]) objects, “the entire field of applied ethics … rests on the premise that a moral philosophical framework can guide moral decision making.” Then the entire field should shut down.
But what about the Tea Party? That question was raised by a large number of readers who made two points : (1) the debt ceiling controversy would have come to a better end if the participants had read and studied the right philosophical tracts, and (2) the trouble with the Tea Party is that it is guided by a bad philosophy, one that dictates its members’ behavior. The first point is clearly silly; it employs the same reasoning that leads some people to believe that if only terrorists, tyrants, and jihadists would read our constitution, the Federalist papers, and a few pages of John Rawls, they would come to their senses and become followers of democracy. As for the second point, according to its Web sites the Tea Party believes in limited government and free enterprise and opposes political schemes that assume the perfectibility of man and fail to recognize that we are motivated largely by self interest. (The view is a variant of Mandeville’s in “The Fable of the Bees,” that private vices make for public benefits.) These are certainly ideas and they are cited as support for the positions Tea Party members take; but “big government is bad” and “free enterprise is good” are slogans that speak to the discontent of those who feel disenfranchised; they amount to philosophy after the fact; they didn’t produce the Tea Party disaffection; they dress it up for public viewing.
Finally, let me reply to the charge that I am contradicting myself by doing philosophy while trashing philosophy. “Interesting that Dr. Fish would use such a ‘finely’ tuned philosophical argument to debunk philosophy” (43 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=43#comment43 ]). But I’m not debunking philosophy or saying that people shouldn’t do it. Philosophy is fun; it can be a good mental workout; its formulations sometimes display an aesthetically pleasing elegance. I’m just denying to philosophy one of the claims made for it —that its conclusions dictate or generate non-philosophical behavior — and there is no reason that my denial of philosophy’s practical utility should not take a philosophical form.
Hugh McDonald (112 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=112#comment112 ]) thinks he has me when he says that if philosophy doesn’t matter, “Then your philosophy doesn’t matter.” That’s right; it doesn’t, if by “matter” is meant that reading me will make a difference in the way you live. The only benefit one might derive from following my argument is the removal of a confusion; you might no longer think that getting your philosophical ducks in a row will lead to better and more moral decisions. But your new clarity will do you no more positive good — it will not translate into superior forms of action — than your former confusion did you positive harm.
If you have a problem to solve or a decision to make reading me won’t help you any more than chanting “I believe in moral absolutes” or “I don’t.” What will help are the usual ingredients of what Aristotle calls “practical reasoning”— an understanding of your goal, a survey of alternative ways of reaching it, a calculation of likely consequences, an effort to identify the relevant considerations, a recollection of what happened last time, and so on. Sabrina Jamil (83 [ http://community.nytimes.com/comments/opinionator.blogs.nytimes.com/2011/08/01/does-philosophy-matter/?permid=83#comment83 ]) has me saying that because there is no universal agreement on moral absolutes, we should “just drop it because it makes no difference … which interpretation one holds anyway.” On the contrary, it makes a great deal of difference and it is our obligation to work through to the interpretation (or judgment or decision) that seems right in the circumstances. In the course of our efforts many things (and not always the same things) will be of use, but moral philosophy won’t be one of them.
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