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safety, efficiency, cost of human lives and work

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My children watched part of Back to the Future III a few days ago and afterwards expressed surprise at the amount of walking on train tracks that happens in the show. “Isn’t that dangerous?” they asked and I fumbled to explain how the absolute risk wasn’t that high but that it was still a completely unnecessary risk, and thus why we don’t do it.

Then I was watching an episode of Star Trek Deep Space 9 and noting the scenes where the two kids, Jake and Nog, are always sitting on the balcony above the promenade, dangling their legs down, and all I could think of watching it is, why don’t they put a different type of railing up? Sure, they have Odo the security officer telling the kids to move, but wouldn’t it be more efficient to have a plexiglass barrier instead of the two horizontal rails?

So I’m thinking about safety things and how the standards of safety have changed and I can appreciate that I live in a safer more cushioned world than all the rest of human history. We optimize the railings of a balcony so that there is no skill or common sense necessary to go near it. We say even one death is too much, and make walking on railway tracks taboo. I’m not arguing against these things. Certainly I cannot imagine going to a nearby office building with three children if the balcony around the escalators didn’t have such a wonderful railing, and I don’t see any problem with staying off railway tracks. I like knowing that my three children are pretty likely to survive into adulthood.

Modern obstetrical care has done wonders to reduce the death rate for women and newborns, yet some people feel it has become to impersonal, too heartless and generally not trustworthy.  Online I’ve seen people say that a medicated birth or  a surgical birth isn’t really a birth at all. There are echo chambers online where people are told that homebirth or unassisted birth is inherently safer and better for their children because it is real and natural.

Yet then I visit a facebook page titled “Sisters in Chains” talking about doctors, mothers and midwives who face various levels of persecution for their participation in homebirths, and I glance down the list of names and I realize I recognize some of these names from news articles I’ve read. Some of the names are of doctors and midwives who have been charged for gross negligence. Some have lost multiple babies. Some take incredibly stupid risks (post-date footling breech etc). There are some incredibly unprofessional midwives who deserve to be reprimanded and prevented from risking others lives. Their supporters might argue that the risks happen everywhere, or that some babies just naturally die but they’re ignoring the fact that done differently many of the children could have lived. The abandoning of scientific techniques and the return to “let’s just follow instinct and trust” costs lives. While midwives and the lucky might think that the a 1% risk is not a serious concern, the 1% end up experiencing a 100% loss of their child.

We’ve upped the stakes. We no longer accept that children dying is a normal part of life. Most of us in North America don’t have extra children out of the hope that a percentage of them will live to adulthood. This is a good thing.

But there’s a weirdness too, and I’m trying to think how to pinpoint it. The weirdness is the question of how much is too much? How efficient is too efficient? When are children kept in such safety that they never learn to balance risks? When is food so efficient it is no longer really food and just some sort of fuelling up? Is there a benefit to having some level of imperfection?

I’m reading The McDonaldization of Society by George Ritzer and there’s a section talking about changes in sports. Now I’m not a sports person so normally I would skim over anything pertaining to sports, but it catches my attention partly because there was a very similar part in a book based on some lectures of Jacque Ellul, a French philosopher. Mr. Ellul was talking about how sports has become scientific, and athletes attempt to eliminate any idiosyncrasies in how they move and act. He called it the technological society (meaning technique loving society). Mr. Ritzer calls it McDonaldization, and describes it as an obsession of quantity over quality, scientific production and rationalization, and neither author thinks this is confined to just sports. Rather it is spread throughout almost everything in society. We want to find the perfect step by step guide for doing whatever it is we need to do. We are obsessed with getting the techniques right, whether it is running a restaurant, jumping the long-jump, writing a blog, or basically anything else.

So I’m thinking about the balance and how one defines the balance, and perhaps it makes sense to strive for perfection in situations where imperfection puts lives at risk but to stop the pushing and seeking of efficiency on other things. Yet at the same time, I know that just saying that makes no sense. There’s always the competitive aspect to the other things. The scientific aspect of sports allows athletes to attempt to do what they’ve always done – win. The scientific aspect of fast food restaurants allows them to be competitive and successful. So how does something that lead to good also create problems, and how do we know where the dividing line is? We can’t somehow say how much inefficiency makes things better.

Perhaps finding balance is about not measuring things by just one standard. Efficiency on something normally entails a sacrifice on something else. If we recognize the importance of more things we’re less likely to put up with those other things being sacrificed. And at the same time, we could still recognize that there are times (like birth) when it is important to sacrifice just about everything in exchange for the one goal (a healthy baby).

The book The McDonaldization of Society identifies four aspects of McDonaldization. Efficiency is one. Calculability, or the obsession with quantifying everything, is another. Predictability and homogenization is a third and the fourth is making humans conform to the technology. It talks about how these are characteristics of fast food but also of the rest of society. We have McUniversities where students sit together in large lectures (sometimes via webcam) and write tests marked by computers. Medical care is less and less personal with people not knowing their doctor or dentist. Home pregnancy tests remove the need to go to a doctor to learn if one is pregnant. Self-check out aisles mean you don’t need to interact with store clerks. When’s the last time you had someone pump your gas and wipe your windsheilds for you? He defines McJobs not as dead-end jobs (the meaning the author of Fast Food Vindi  presumes and tries to rebut) but as jobs that any old monkey could do. McJobs are unskilled jobs. They are jobs where any need for thought and judgement, even just of the rawness of frenchfries, has already been taken away.

On the topic of calculability he talks about the Ford Pinto and how a change in design that would cost $11 per car but potentially prevent 180 deaths (their estimate) was too expensive. They came up with this calculation based on each death costing them $200,000 per person. He writes that: “although this calculation may have made sense from the point of view of profits, it was an unreasonable decision in that human lives were sacrificed and people maimed in the name of lower costs and higher profits.” I can agree that is a crazy thing to decide that the $11 is worth more than the people’s lives. Can we ask people to not make such calculations? We can never expect that nothing ever causes people’s death. There is no 100% safety. Could the problem be not the idea of calculating but that that $200,000 per person is to low?

When we think about prices to put on people I think also of those who have rare medical problems with expensive medical needs. Should there ever be a maximum amount of money put towards someone? To say so sounds heartless but to deny it sounds insane too, except on the basis that governments waste so much money on useless things (unnecessary military, for example, or fake lakes for political events) that it makes money seem unlimited, and then yes, an unlimited amount should go to anyone’s healthcare. And besides, how could decisions be made, anyway? How high a success rate would a treatment need in order to justify the expenditure? Perhaps I am too McDonaldized myself, that I so much in terms of calculations and cost-benefit analysis.

I read the book and I agree with so much of it and yet I also have doubts and questions. In the end of the book there are suggestions for combating McDonaldization. It comes with a disclaimer “Some of these suggestions are offered ‘tongue-in-cheek,’ although the reader should not lose sight of the fact that McDonaldization is an extremely serious problem.” Some of the suggestions include shopping at small, local or non-franchise businesses. When phoning a business try to choose the option that allows you to talk to a real person, not a machine. Try to keep your children out of “McChild care” and away from television.

I wonder about things like, if enough people choose not to use the auto-checkouts at grocery stores would grocery stores higher more employees? Or would the stores simply take it as a sign that people are willing to wait in line and not worry about it? Why would people be willing to wait in line anyway? What does it matter if there are a few more people hired to work there? It would be good if that meant a few more people had good livable incomes, but society as a whole would not be better off having them work there than taxing the store the equivalent of their incomes and giving it out as social assistance. Or perhaps having less employees and less expenses is the equivalent to taking the employees wages and divvying it up between all customers? Or does it just go into increasing the pay of the CEOs?

This is only a fraction of the questions I have about this whole issue, but I don’t have time to write more now so I’ll leave it here. I would like to invite comments. Please, if you have any comments in response to any of the issues I’ve brought up, write your thoughts!

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  • Savannah

    Hi, I am stopping by from Hip Home school Moms and I wondered if you would like to take part in my weekly feature, “Who Home Schools.” If you are interested please email me.

  • clarbojahn

    America is somewhere around 30 in health and births behind Slovenia and Cuba. Midwifery is way behind international rates. I would love to think that heath care is a right for everyone and not a privilege for the very rich or well to do. As our death rates climb from poor health care I would like to see how national health care competes with the problems or questions you raise. There is such a thing as priorities.

    Thanks for raising these questions. 🙂

    • christyk

      When you say Midwifery is way behind international rates, I wonder what you mean. Do you mean the percentage of births being supervised by midwives or do you mean the quality of midwifery care?

      Midwifery in the states is not properly regulated. There are women out there calling themselves midwives whom have only participated in twenty births and done a correspondence course.

      The larger an insurance program the more the super-large costs can be shared, so national healthcare should be able to handle rare expensive diseases better than smaller insurance programs. That said there’s always going to be questions of what treatment should be covered and perhaps some expensive private programs can offer a wider reach… more alternative and unproven treatments, in exchange for higher payments. I should look into it. I know some of the news stories I have hear from here in Canada about Canadian provinces not covering treatments have to do with times where the person or family members disagree with the doctors about what should happen. Sometimes it isn’t about rationing of health care as much as about people’s unrealistic expectations of what certain treatments can do.

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