The Private Citizen 104: Triage is Too Logical for Germans

Hi Fab, just a quick feedback in case I forget on episode 104. As a member of a disabled community, there has been talk where triage may choose to save a able bodied human over a disabled person. In particular intellectually disability(ID). The article I found had people with ID put on a do not resuscitate (DNR) without their consent. It appears to me they are potentially saying, this person is not worth our scarce resources. Not because they are less likely to survive but solely because of their ID. I do understand what you are saying in if I am in a worse situation but “disabled” this law could force them to prioritize me to satiate the law it makes it tricky. The legislation may not be great, and yes doctors should be doing triage just based on the likelihood of survival of each patient. If however, you do not have enough ICU beds and have two patients equally sick; one able body, mind, etc the other disabled (but in no way affecting the disease) what will happen. I do not think the disabled person should get the ICU bed automatically but neither should they automatically not. Absolutely, the focus should be on increasing and maintaining ICU capacity, and perhaps a law is not the right way to address this issue. I do however feel there needs to be some protection for the vulnerable.

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I’m still listening to the episode, but as usual, thoughts start to circle around and if I don’t write this down, I will later not write anything (sorry for the several previous episodes).

This topic reminded me of some previous discussions about Net Neutrality in the US. And there as well there was a comment (in No Agenda, ITM!), that it’s silly, because you have to do packet prioritization anyway, you can define the rules, but you don’t have infinite capacity, and if needed, something will have to be dropped.

And this is for me the key point here. Putting aside the ethical question (which is important, and should be addressed), but in the end, the topic is about limited resources and how to allocate them.

Again, the topic reminds me of a hobby of mine, which is Strategy Games, I like the concept, and it teaches you that you have situations where you need to make a decision with regard to limited resources (rings a bell with a Magic the Gathering podcast?).

I get the feeling that for some it’s just wishful thinking: they wish to treat to people, which is understandable and appreciated, but this is not the question, the question is: who do you treat if you don’t have infinite resources? And how do you plan your capacity? Build infinite number of hospitals and hospital staff?!

I guess I got my point across.

Back to the ethical question: this brings to mind as well these nasty Trolley problem type of questions: How do you decide? How much time do you have to decide? What’s the cost of time?.. etc.

Interesting points for discussion and to try to define what are our core objective.

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Another point raised: @fabsh You were talking about the implication of having a law, and that doctors will be afraid from lawsuits for this.

This brings back my issue with regulations and laws: they add overhead, and I’m not always sure if the benefit justifies the overhead.

From there comes to mind:

When the Tao is forgotten, there is righteousness.
When righteousness is forgotten, there is morality.
When morality is forgotten, there is the law.

I’m not sure how can you regulate being humane!


Coming back after more listening: You are making the distinction between Law and Justice, but you said you’ll discuss later, so looking forward to that, as I think I get your point, but I’m interested to see what the definition for Justice (Law is almost clear: it is written down, and I will not raise the issue about interpretations here, too many worms).

Again, this reminds me of an article that I once read in Scientific American speaking about “Fairness”.

In short the argument was at least for two persons, you can divide a cake “fairly” by letting one cut and the other choose, but then how do you generalize.

I tried to look online, and found this interesting reading for later.


Continuing on: @fabsh You brought up again the topic about the ethics of Journalists, quoting:

You job as a journalist […], you are morally obligated to tell people […], the things as close as the truth as you can get.

So let me now disagree: I understand that it would be nice if all journalists adhere to what you are telling, but I don’t think that this is a good “strategy”.

My take, is that the assumption should always be that news/information should always be treated as opinion pieces, and not as statements about what is True. People should know and be encouraged in this mentality and try to get as many as possible different takes on the same events. Not what someone is trying to convince them as the Truth.

At the end of the show you actually said the same: that try to be objective as much as possible, but in the end it’s your point of view.

What I’m sure we agree on, is that opinions should not be confused with Truths.

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To be honest, I don’t think legislation will make the situation better: by definition you have a difficult choice as is at the hands of the person making the decision, and now you will further overload them with the need to be careful in order not to be sued.

For sure some people might take a different choice that what either one of us would take, but my only hope would be that, this person, being in that position to take the decision, is by itself a guarantee to his effectiveness to take the better choice.

It’s simply a lose-lose situation being made worse.

I think there’s a misunderstanding. Yes, pretty much everything a journalists writes is an opinion, or at least facts coloured by personally held preconceptions. But that doesn’t mean you shouldn’t strive for objective truth whenever you can. You can never really fully get there, but getting as close to that is, in my opinion, a journalist’s moral obligation. Which in practice mostly means: Tell people when something is obviously an opinion, don’t write about things you haven’t researched properly and admit when you made a mistake.

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Exactly. A good doctor will make what they think is the right choice independently of legal circumstances. And if a doctor is bad at what they do, I don’t think a law will fix that.

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Yet, sadly, the doctor that does just that usually quickly falls out of grace of their superiors, or gets legal problems, or (most often) both.

One of the sources of my constant amusement through the 20-odd years I’ve been in medicine (from being a medical student to, eventually, teaching at a medical university myself) has always been how much the old Latin saying “Salus aegroti — suprema lex medicorum” ("[Aiming for] the good of the sick [person] is the highest law of [all] the medics") is praised and preached to the students, and just how incompatible with real-life practice this noble motto actually is.

The doctors are very much used to the additional legal/financial/political/moral/whatever overload they are subjected to in their decisions. The good doctors worth their salt are even used to still manage to live by that old Latin saying. That’s just the way things are.

Which is to say, still, the additional overload we talk about here is stupid, illogical, unworthy of humanity, and highly unwelcome, of course. But nothing to really fret about. :wink:

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I agree with your argument presented in the show, that “additional overload”, as nekr0z describes it, is undesirable for what already must be a hard decision. This should be left to doctors, their professional associations, what medical schools teach, etc. So I’ll only comment on side points.

I’m wondering how it is that the constitutional court tells the legislature a law for a given purpose is needed. Does the legislature have to follow through, i.e. is it a power of the constitutional court to tell the legislature to make a law? Is this one of those fundamental differences between the German political system vs. the U.S. Republic or English based parliamentary systems? Or have I misunderstood?

Here in the U.S. I see statements from judges to the effect that if you want a different ruling you need new legislation or constitutional amendments to get there, cause this legislation or the constitution says X which I interpret to mean Y, which is not Z, what you appear to want. But that’s about as far is it goes. I think the judiciary has no real power here (except that of any citizen outside the court) to bring about the creation of a new law.

Also I was interested to learn that Germany no longer has conscription. My sister dated a German in the late 1980s, which was when I first learned of modern conscription, which we had none of in Canada by then. He had been allowed non-military national service from having pacifist views. I’d also seen a statement from Linus Torvalds about Finnish conscription and these two things just left me with this notion that most countries in continental Europe had conscription and continued to. So it was interesting to learn that Germany phased it out since then. And I see from Wikipedia that France got rid of it even earlier and a description of its drawbacks for having an effective army.

There’s a local professor and retired general, Andrew Bacevich, a sort of a darling of the left wing press since he’s been very critical of U.S. military adventurism over the last couple decades. I recall him favoring a new U.S. draft in the hope that if the sons and daughters of the political class had to be soldiers it might take more for soldiers to be sent into battle. I get his point but having an 11 yr old son I don’t want it for selfish reasons.

I feel it also has the advantage of teaching many things to young adults that they just don’t learn growing up anymore. Plus, it is a way to get them out of the house and to see a bit of the world or country in the process.

While I fully support having a military and the people in it, I do not support the current foreign policies that have countries sticking their military where they have no business. I have been very critical of that last part.

My friends in the militia wanted me to join, maybe half joking, saying I needed it to muscle up. Sure did work for them. That might have made a difference for me re. attractiveness to the opposite sex. And maybe the lack of mechanical aptitude I have could have been corrected. That partly lost me a job in combination with a kind of insubordination, which might also have been tamped down some by joining the militia (though I dunno – that’s maybe a stereotype – if anything the guys I’ve known who served are anything but compliant corporate sheep). Maybe I’d be better inclined to maintain athleticism these days too and not have to always think about limiting my time at the computer to avoid back and neck problems.

Still, I don’t like it. There are a lot of activities society might agree that the government could force on people of a certain age to improve them. To me it’s overreach. Young people might have other ideas of how they want to spend that time. And then there must be some cost to having a military large enough to employ so many (and have to try to make something of someone like young me if not expensive would not be fun for the officers). Or would that be offset by older troops not having to be employed as long and fewer enticements to join?

I read more about Bacevich in wikipedia. If that’s a good summary his issue maybe was less about the political class (though I thought I heard him say something like that on Democracy Now) as the unrealistic perception the public has of war and what soldiering involves. Also he was a Colonel not a General, but to me he’s more impressive than many of the Generals I see trotted out on the news in support of the latest invasion.

But this argument to me is worse. To notice a weakness in the voting public’s knowledge and views and for the solution to be a government program of forced service is the tail wagging the dog.

I dunno. So far, it seems to have been that way in Germany. Usually doctors will band together and defend each other if the actual medical decision was correct.

I think this must be very different in different jurisdictions. Because this is not the case here. Or wasn’t up till 2019. At least from my (limited) exposure to doctors and nurses.

I’m not quite sure. This is definitely very new for Germany. This is the first time ever, as far as I can tell, that regulation is being introduced that subordinates the judgement of medical professionals to that of the government. Even with abortions, which used to be illegal and are still somewhat semi-legal in some circumstances, when the mother’s life was at stake, all bets were off and the legal limits did not matter.

Yes. The BVerfG can tell the government to change laws. Or to pass new ones if they deem this to be necessary.

Well, we never had conscription in the US sense. But we had a mandatory year of basic military training (for men only). It has also not been phased out. The laws are still there, it’s just paused. It could be reinstated at a moment’s notice.

Good idea in theory, never works in practice. They always weasel out of it. Those in power look after themselves. Just look at the Bushes, Kennedys, Bidens and Trumps of the world. There a few good songs by Fogerty about this phenomenon…

You could also have a system where kids are forced to do that without shouting at them endlessly and having them trudge through the muds of the Lüneburg Heath or Brandenburg. Also with less training to kill other people. :wink:

I agree with Petit-Michel. If you want to look good, just work out. I had several colleagues who did their mandatory military training who were always going on about how cool it was to learn shooting. Well, I just joined a civilian gun club. I bet I shoot better than them these days.

@fabsh Don’t make me envy you Germans more than I already do! :wink:

I wouldn’t say I got trained to kill people. I got trained in basic hand to hand combat for self defense, and basic rifle training that gave me a healthy respect and understanding of rifles. Most of my training was around self discipline, teamwork, and mechanical maintenance and repair, and I use both of those all day every day in my life now. Can’t say I trudged through any mud, and hollywood has done an excellent job of exaggerating the yelling that goes on. I got yelled at a couple times, but I very quickly figured out that self discipline prevented that from happening.

Either way, my idea of conscription is closer to what Germany had. I work with some German and Hungarian immigrants who share they stories of that time in there life with me. More of a basic training and skills building system to prepare people for life. Our school system sure doesn’t do that anymore.

Well, since that is the job of the military, when it comes down to it, I can’t say that’s good training. We don’t have them Leopard 2s to go duck hunting, you know… :grinning_face_with_smiling_eyes:

Military service was mandatory when I was 18. Which means more than 50% of all my male friends went through it (well, a bit less since most my friends were uni students and they tend to bail on it for civil service instead). So I certainly don’t have my idea of what Grundwehrdienst was like from Hollywood, mate. :wink:

Yes, but even with the Leopard 2 being a great all around machine, you still need people that are trained to fix them. I remember reading somewhere that for every fighting soldier there are 10 others in support roles. And everyone likes food, which also comes from somewhere.

True. But the thing about mandatory military service is you can’t chose what you get to do. And everyone also gets trained to be a rifle-bearing grunt who has to trudge through the mud. Everyone gets taught how to use the G36. The G36 is not a weapon that’s build to defend things. It’s made for killing things, more specifically people.

This is the reason why the easiest way to get out of mandatory military service in Germany and into civil service back then was to say you can’t kill another person.

Don’t get me wrong. These days I very much believe that we need a military. And that, sometimes, killing people is justified if you have no other choice. But mandatory military services is still dumb. It was a good idea when Napoleon introduced it, but the world has changed since then.

Especially people in the military, if you get them to speak candidly without toeing the official propaganda line, agree with this. If you train an 18 year old today in using a G36 and fixing a Leopard 2 and the THE RUSSIANS (sorry, Evgeny :wink:) attack fifteen years later, that dude won’t even remember how to load that rifle. Let alone shoot it or fix that Leopard. There’s a good chance we have the Leopard 3 by then anyway, or the Armata will kick our ass anyway.

We need a military made up of professional soldiers. If you want to teach kids teamwork and discipline, do that in school. Or have some kind of youth organisation (historically not a good look in Germany, tho).