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Interesting Links for 04-06-2014

Original post on Dreamwidth - there are comment count unavailable comments there.

My mother is a founding member of the We Hate Mother Teresa club.

There were t-shirts and everything.

That sounds pretty awesome. T-shirts make everything better.

My mother was of the view that she was evil. That her interventions actually caused much more harm than would have been caused had she done nothing. For example, she would set up “medical clinics” with little in the way of actual medicine or medical personal. Wards for infectious diseases would be large and general so people not quite dying of one disease could catch a second or third that would kill them. Lots of prayer, not enough antibiotics. People died as a result of her activities who otherwise would have lived.

She went on to suggest that Mother Teresa knew this or ought to have known this and was therefore negligent.

She also questioned whether her centres for poor relief actually provided much in the way of relief for the poor. Again, lots of prayer, not a lot of food and blankets.

Mum would get quite exasperated when, having explained to people what was happening, they still thought Mother Teresa was doing good.

I struggle with the validity of the "ought to have known this" argument. By whose standards ought someone to know something? If she did in fact know then this is a very different picture but I think one would need a reason to draw that conclusion.

Do you mean you struggle with the "ought to have known" argument in general or particularly in relation to setting up medical centres and hospices or specifically when doing so as non-professional?

Former as a principle. I'm not saying the argument has no weight - ignorance is not a defence in law for a reason - but the weight varies with context and I would be sceptical of anyone who tried to apply it to a culture with which they were not closely familiar.

Surely “Don’t you think you ought to have know the gun was loaded?” is a reasonable question to ask?

The culpability that comes from being in a position of “ought to have known” is, I think, a special case of “being in a more hazardous situation than usual and being therefore required to be more careful than usual”. It is in a family of liabilities along with driving without due care and attention or operating high voltage equipment. Clearly very few people deliberately crash their car in to another vehicle. When they do so, it is often because they weren’t paying enough attention and didn’t see the accident before it was preventable. Not unreasonable to require people to pay attention when doing dangerous things so they spot dangers before they manifest.

The levels of additional vigilence or areas where one ought to take pains to find out important relevant information clearly vary from occupation to occupation and from situation to situation. We’re into Clapham Omnibus territory.

But the alternative to having a standard of “ought to have known” is that you reward people in positions of delicate responsibilty for knowing less and taking less care by exempting them from the liability that would be exposed to if they did happen to know. On policy grounds that sounds like a bad place to be.

The Finance Director who checks a criminal records disclosure, hires a convicted fraudster who she thinks has probably reformed but who hasn’t and then defrauds the firm is in more trouble than the FD who never even bothered to check unless you have an “ought to have known” requirement. There is a clear incentive to take less, rather than more, care.

To get more into the specifics of the case I think Mother Teresa is clearly and wholly in an area where she ought to have known what acceptable standards for her operation were and ought to have known if her clinic was operating above, at or below those acceptable standards. The questions I would ask are 1) are you doing something that is riskier or has more significant consequences than ordinary business 2) is the area of business you are in sufficiently well understood that there is clear view on best practise and acceptable minimum standards.

Opening a medical facility is clearly something that affects people’s health. If it affects their health then clearly not doing it right could have serious, life-threatening consequences. That seems sufficiently above the bar for anyone thinking about opening a medical centre to stop and think “Do I know enough about this? Are there special rules, requirements, standard I should know about and apply?”

Opening a medical centre is something that lots of people do. I’d bet one opens in a developing country every day. I wouldn’t be surprised if there were a journal of Developing Nations Foundational Primary Care. So lots of experience to draw on. So, sufficiently easy for someone contemplating opening a medical centre to find out what the applicable standards are. We’re talking Florence Nightingale or Ignaz Semmelweis vintage attempts to do basic medical care better.

So, in this context I think Mother Teresa goes from the culture of being a spiritual caregiver to a medical one, and obviously so, and therefore ought to be held to the standards of the medic rather than the nun.

I'm afraid nothing in this comment changes my view on the last clause on my previous comment, which seems to me to be the significant one in this context.

Which is, I think, that you are of the opinion that because Mother Teresa was a Catholic nun she ought to exempted from the same standards of care that any other nurse or Director of Medicen would be held to.

Or have I misunderstood how culture and context are to applied here?

Nothing to do with Catholicism. She's not Western. She's not in a Western culture. I don't think we can legitimately have any conversation about what she (or anyone else in that culture) ought or ought not to know.

Are you suggesting that there are different standards of medical care for poor people in India than there are for poor people in the UK?

I'm not 100% sure what you're asking. If the question is "do I think poor people in India receive a different standard of medical care from poor people in the UK?" then my answer is "I think it's likely but I don't know." If your question is "should medical care in India be held to a different standard from medical care in the UK?" then the answer is "I think it's likely but I don't know." That's because I think you have to set standards in context. It depends what's achievable, what's affordable, what's culturally acceptable and what background you're introducing it into.

I think there are much more useful questions than about standards of medical care, such as "is introducing $newintervention going to improve matters?" or "is $newintervention the best use of the resources we have?" or "is $newintervention likely to achieve its stated goals?" But this is all slightly tangential to my main point, which is that I don't think that you or I are best placed to answer the questions, or even necessarily to determine what the most relevant questions are.

Robert Harris used to be a close friend if the Blairs, and was a key New Labour cheerleader. I don't recall why they fell out but I'm thoroughly enjoying the mudslinging.

Robert Harris is my new true love.

I suspect that mass grave is not going to be the only one and its going to be very interesting to see what happens and the language used to discuss something that in a further away country would be considered close to an act of genocide.

(except for the lack of specific racial group targeted)

Once the Republicans in America finally get rid of abortion, contraception and welfare, we'll get to see this happen in the US too!

I personally am hoping for abortion ninjas, but the likelihood is low. :(

Jane says, “We did it before. We can do it again.”

That 796 babies thing is interesting. It seems that in 1975 two children found a concrete container filled with "tiny bones" at the time it was assumed to be from a 19th century famine (and you'd assume Ireland has plenty of such containers). I don't know about you but I find it actually hard to imagine a group of people piling dead bodies into a container for 35 years just on grounds of practicality (by the time you put 796 in there then you're putting it on top of 795 in different states of decay). Then, people do get used to some strange ways of behaving. I guess it does say a lot about Ireland's history that on finding a container full of children's bones they shrugged and reburied it (or course a more sinister interpretation is that the people involved in those burials would still be around and able to influence that decision).

Apparently the reason they are believed to be there (in that container) is that the historian can find no records of them being anywhere else so she assumes they are there. That said there is also some record of this container being used for burial.

The state of child mortality in the first half of the 20th century in Ireland was horrible so there are probably a huge number of unmarked graves about the place... apparently in this children's home the mortality rate was about four times the national average. I wondered how bad that was compared with other countries. For comparison I took a look at a paper on social class differences in mid 1980s England and Sweden in all causes infant mortality to see what difference we should expect:
For post neonatal (1 month to 1 year) deaths in England and Sweden children born to single mothers or families with no employment were twice as likely to die as those born to families in non-manual jobs. It's hard to work out how that would translate to orphans and the very poorest but I guess it would not be hard to imagine that the figure would be larger than twice as likely maybe as much as four times. I'm left wondering what the mortality difference nowadays is between children growing up in social care and those with parents in good jobs. This graph is telling:
Take home lesson, if you're going to be born in England try to be born to wealthy parents in the south east.

Those two graphs don't help you avoid the ecological fallacy. I can't tell from them if:
1) wealth makes region irrelevant, and it's just there's more wealthy people in the south east;
2) region makes wealth irrelevant, and there's just more south east people in the "wealthy" category
3) region and wealth both count, and, yes, you *should* try to be born to wealthy parents *and* in the south east.

Hmm... you are correct... any effect of wealth which appeared could be a disguised effect of region or vice versa. As a statistician I should be more pedantic about these things. (I'd never heard the term ecological fallacy for this so thanks for that).

However, if you choose to be born in the southeast making no determination about your parents wealth and it's a wealth effect you are more likely to be born to wealthy parents. If you choose to be born to wealthy parents and it's a regional effect you are more likely to be born in the south east.

So picking either south east (and leaving wealth to be drawn from the distribution of south east people) or wealth (and leaving region to be drawn from the distribution of wealthy people) increases your posterior chance of survival over base line of not having a choice about where you are born or what wealth your parents are. (Which is unfortunate as, as far as I'm aware, you can't choose who you are born to).

However, you are correct, it may be that there are separate wealth and regional components and there is a smarter choice than wealthy and southeast if you had fuller data (e.g. being born to wealthy parents in the north east would be better than wealthy parents in the south east but the comparative poverty of the region offsets the health benefits).

It's a curious paradox really from those graphs we can determine:
1) Picking south east (and leaving wealth random) increases your survival chance more than any other region pick.
2) Picking wealthy (and leaving region random) increases your survival chance more than any other wealth pick.
3) Picking south east and wealthy does not provably increase your chances versus any other region and wealth pick and (for extreme cases which are unlikely in the real world) might be exactly the worst case scenario.

Without thinking this dataset through properly, isn't this Simpson's Paradox? (Which is awesome, and takes the statistics/causality firepower of someone like Judea Pearl to resolve satisfactorily[PDF].)

Edited at 2014-06-06 02:34 pm (UTC)

I think Simpson's paradox is a subset of the ecological paradox where the specific bad outcome is a complete reversal of sign after conditioning.

And here's why the actual proper news sources didn't run with this. Now the historian is saying she never said anything about 800 children being buried in a septic tank and the actual story is "Children's home which housed children abandoned by parents had mortality above national average". One of the kids who found the location says:

Between them the boys levered up the slab. “There were skeletons thrown in there. They were all this way and that way. They weren’t wrapped in anything, and there were no coffins,” he says. “But there was no way there were 800 skeletons down that hole. Nothing like that number. I don’t know where the papers got that.” How many skeletons does he believe there were? “About 20.”

Not to say that the scandal of child mortality in Ireland in that period was not a scandal but I think it's important to focus on that scandal rather than some cartoonish image of villainous nuns throwing 800 dead babies into a septic tank. [Seriously, I think people will believe almost anything evil if you attribute it to the catholic church.]

Edited at 2014-06-07 06:38 pm (UTC)

There are plenty of good reasons for that.

But in this case, I shall hope that reality is somewhat nicer.

Well, it looks like the reality is a lot of dead babies across the whole of Ireland for the early 20th century in a time where the rest of Western Europe was in much better shape... which anyone who cared to know has known for a long time. It's a less eye-catching story... whether it is "nicer" than an isolated incident where evil nuns were responsible for a one-off atrocity... I guess that's in the eye of the beholder.

Oh, and thanks for the update!

To avoid misunderstanding, response is not meant as a criticism of you. A lot of people posted this story and your journal is somewhere where I can post "what, really, this doesn't seem realistic" and get a reasonable response.

I didn't think it was :->

And I actively rely on people telling me when I've posted something that turns out to be rubbish. I'd rather have people (politely) tell me that I'm wrong that carry on being wrong.

Unlike, it seems, most of the internet.

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