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Monday, April 4, 2011

The Needs of the Many Outweight the Needs of Few...

In one of the older Star Trek movies radiation is flooding a portion of the engine room.  To start the engines and save the ship someone has to go into the room, facing certain death from radiation, to start the engines.  Spock tells Kirk "the needs of the many outweigh the needs of the few" and enters the room to restart the engines - Spock dies.

There are many contexts today where this is apropos.  For example, the "50" at Fukushima who stayed behind to battle the reactor problems will, like Spock, no doubt face certain death.  But true to Japanese society these men believe that their personal sacrifice is required to advance the needs of Japanese society and so give to their society the ultimate sacrifice.

On the other hand, the classic counter example to this is the following: "During a war a family is in hiding while the opposing forces search their house.  The family has a crying baby.  If the baby cries out the family will surely be discovered and killed.  If they smother the baby their chances of remaining undiscovered are much greater."  What does the family do?

This discussion is also apropos in society today when we consider what society does for the benefit of all.  This occurs at many levels - medical care, taking care of the elderly, and so on.  But it also comes into play at a very fundamental level:  When creating paradigms for screening and triage - what should be done?

Everyone has seen the doctor take a flashlight and shine it into someone's eyes.  Why is this done?  To detect the reaction of the patients pupils to the light - which tells the doctor about the state of your bodies function.

This test is an example of triage - if you react one way to the test the course of subsequent medical events will likely go a different way than if you react a different way.

But all this is fairly straight forward.

On the other hand, what about people who do not react in a normal fashion to the classic forms of triage?  For example, due to some harmless neurological issue your eyes react differently than everyone else - but because you are unconscious you cannot tell the doctor.  Your test goes the wrong way, you receive the wrong treatment and you die.

Who's at fault?

Is this an example of the "needs of the many"?  After all, the neurological test works for most people, but it kills others.

As armchair quarterbacks we can sit back and watch the struggles in Japan as nuclear radiation spreads over the countryside.  Should everyone be evacuated?  This is not possible because many others are still missing or struggling with the aftermath of the earthquake and tidal wave.  Will they be safe doing as the government says "staying home and inside"?  Probably not in the long run as radioactivity will no doubt seep into their houses and contaminate them over the long term.

And what about the safety of those doing the evacuation?  Is it fair to ask them to give up their lives in order to save us?

At the same time defining what's done to only "save the many" - whether its a medical test or an evacuation policy - leaves out the fringes of the bell curve. 

And this is where the really interesting question arise. 

Take medical testing as an example.  Virtually every medical test known to man is not fool proof, i.e., there are always subjects with react differently than the expected norm.  Again, this is a bell curve.  The vast majority respond under the hump of the bell, but there are still "fringers" who do not yet are perfectly normal in every other way.

This means that "standardized" medical treatment will harm some instead of helping.

Is this fair?

Similarly, an evacuation order in Japan for those closest to the plant may do more harm than good - and what amount of harm and to what percentage of the people is the real issue.

Animals have developed a strategy of safety given objective danger: herding.

Are your chances better if you run with the herd and a lion attacks?  On the one hand the lion can only kill one of your brethren (or only you) - so if many are separated from the pack your chances are still good.  On the other hand, herding as in the case of buffalo, makes it easy for hunters with guns to slaughter the entire herd (or flu viruses that kill that are not in the standard "flu shot").  The lion might be able to separate one from the pack, but his chances of success are limited for a variety of reasons.

The individual animal is always free to make its own choice - there is always "safety in numbers" and their is only one lion.

Unfortunately there is no real answer to this, hence the phrase: "damned if you do, damned if you don't".  In the case of Fukushima this is certainly the case and we must not and should not criticize what the Japanese people choose to do - they are not like us and have their own standards for personal and societal sacrifice.

Similarly, we must not work to create artificial "herds" of like-minded individuals in our society, giant "herds of similarly thinking sheople".  Why not you might ask?

Very simply because the wisdom that creates the "herd" - whether it be a group receiving medical treatment, evacuation orders, or virtually anything else - does not behave in a predictable way and no matter how wise you are you cannot predict what the "herd"will do.  "Flu shots" are good example (I wrote about this in "Flu Shots and Magical Thinking").

If there is an earthquake in Manhattan and the power goes out people will walk home in mass groups - perhaps over bridges weakened to the point of failure by the quake.  What does the mayor do?  Normally walking home is safe - but perhaps just not today.

The only safety for humanity I think is that there is a bell curve and that everyone falls in a different place on it:

While there may be "safety in numbers" under the hump of the bell if there isn't a "Spock" (one of the few at the fringes) to restart the engines in the face of insurmountable personal danger the many will surely perish anyway.

When the lion attacks its likely someone will die - either from the lion, or from being trampled by the herd.

There are no guarantees in either case.

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