Encompass Magazine -- Winter 2017

A REPORTER'S NOTEBOOK

WRITING ABOUT WAR IN AFRICA

E THE EMERGING HEALTH CRISIS

FACTORY FARMING AND COLLECTIVE HARMS THE PROMISE OF LIFE

DEATH, DYING AND A BETTER WAY FREEDOM OF SPEECH AND SEXISM ONLINE

HITTING THE BACKSPACE

WINTER 2017

FIND YOUR MORAL COMPASS

ENCOMPASS

E W

elcome to Encompass! As always, we’re published, edited, and designed by a team of undergraduate students at the Kenan Institute for Ethics.

But this time, we focused on the voices of our community here at Duke: capturing them, understanding them, and bringing them into conversation with the world of ideas that exist both inside and beyond the Duke bubble. In putting together this magazine, our aim was to select pieces that explore authors’ real and imagined experiences both thoroughly and thoughtfully.

In the following pages, you’ll find stories of identity, ethical decision-making, and historical reflection. You’ll read the ponderings of a student exploring how we think about South Sudan, and one professor’s dealings in humanity-centered policymaking. And then, a thoughtful piece on universal human rights will make you reconsider everything you’ve thought before about the ideals of democracy.

Above all, we hope that you’ll learn something. We hope that one (or more) of these pieces will challenge something you believe. At the very least, we hope that, having rifled through this magazine, you’ll move forward in your daily life with something new to think and talk about. We are grateful to our contributors for helping to create such an experience through their extraordinary work.

Of course, we would be horribly remiss if we failed to acknowledge our incredible student team. We would be little more than

1

a zine if not for their long brainstorming and editing sessions, the hundreds of email and Slack messages they sent and received, and their consumption of heroic amounts of takeout in pursuit of a more perfect magazine. We also acknowledge and deeply appreciate the guidance, of both the thoughtful and smartass varieties, of Christian Ferney, former director of Team Kenan. Finally and most fervently, we thank Dan Smith, current director and dad of Team Kenan, for pizza money, for enforcing deadlines, and for providing us the agency and the skills to shape this magazine into something that we are so deeply, frighteningly proud of. (Is this what becoming a parent is like?)

Now, reader, back to you: are you doing something innovative, or academic, or just plain cool? Have you written something about it in the past? Would you like to write something in the future? Please email us at encompassmag@gmail.com with pitches, articles, questions, and polite commentary. You can also visit teamkenan.org/encompass to see older articles (for submission ideas, or for further thought).

Once more, with feeling: Welcome to Encompass! Thank you, thank you for taking a moment to read our magazine. We’re glad you’re here with us.

Truly, Madly, Deeply — Amanda Lewellyn & Alex Zrenner Editors in Chief

14 5 11 21 16 3 19 8 23 DIFFICULT CHOICES

SUCCESS OF THE

SECOND IS HUMAN SEX RIGHTS ACTIVISM ETHNOCENTRIC?

SOUND AND POLICY

THE PERFORMANCE

REWRITING AFRICA

NUMBERS, ETHICS, AND SAVING LIVES

FACTORY FARMING AND COLLECTIVE HARMS

HITTING THE BACKSPACE

2

Rewriting Africa_

I

t’s something of a perennial discussion: How do you write about Africa?

Binyavanga Wainana’s satirical essay for Granta, “How to Write About Africa” (2006), set some ground rules: “In your text, treat Africa as if it were one country”; “Throughout the book, adopt a sotto voice, in conspiracy with the reader, and a sad I-expectedso-much tone”; and “Among your characters you must always include The Starving African, who wanders the refugee camp nearly naked, and waits for the benevolence of the West,” among others.1 To be sure, these are sins that few, if any, Western writers have managed to avoid; prompting the apologetic introductions found in just about every journalistic survey of the continent. In fact, the idea of writing anything but of war and strife in Africa is something of a modern trend. It was only with the new millennium that there came a new perception: Africa Rising.

The continent became part of the global marketplace, became a part of the conversation, its voice limited, but broadcast nonetheless. Recently, however, there seems to have been

3

Rajiv’s travel essentials

Rajiv Golla, Trinity '18 backpedaling on the narrative (if the broad-stroke narrative could be considered progress in the first place).

A global oil crash and the slowing of China’s growth put a large dent in the coffers of resource-dependent governments. The continent has seen an epidemic of “third term fever”, with presidents in several nations chasing constitutional reforms to consolidate power and eliminate opposition. The rise of terrorist groups such as ISIS in Libya, Boko Haram in Nigeria, alShabaab in Somalia, and the fraying of Malian security to jihadist groups has done little to calm the fears of Western security analysts. In response to the shifting tides, in October, Jeffrey Gettleman of The New York Times published a piece entitled “Africa Rising? Africa Reeling may be more fitting now.”2 At their very core, “Africa Rising” and Gettleman commit the same cardinal sin, the first that Wainana enumerates: writing about Africa as if it was one entity, peddling stereotypes and painting with broad strokes. That is to say, we are still quite far off from reporting on Africa with the nuance it demands and the humanity it deserves.

But then the question arises, how do we report on war in Africa? How do we conscientiously write about Africa when the tropes of child soldiers, bush rebels, famine, tropical disease, and pickups full of young men with Kalashnikovs and camouflage fatigues are the reality? How do we convey the horrors of life without dehumanizing the subject and desensitizing an audience?

“

HOW DO WE CONVEY THE HORRORS OF LIFE WITHOUT DEHUMANIZING THE SUBJECT AND DESENSITIZING AN AUDIENCE?

”

In the summer of 2016, I spent four weeks reporting from South Sudan, the world’s newest nation, which has been embroiled in civil war since December 2013. “2 million displaced, tens of thousands killed, millions more facing severe food insecurity,” or so goes the typical line at the bottom of the newswire to give context to the war. South Sudan’s

story has fallen prey to many of the banal catch phrases promulgated by a media industry crippled by shrinking foreign budgets and attention spans— “chaos”, “horror”, “tribal warfare”, etc.

It seems that nothing has changed in our coverage of the beleaguered state since the brutal 1980s war that led to its inception in 2011. To be sure, South Sudan is not a place to overturn these stereotypes of African strife (and I myself am undoubtedly guilty of perpetuating the image in my reporting), but it is exactly the place that needs to have its story repackaged without the same old tired tropes.

I’ve been working around South Sudan for the last two years, since the onset of war, and have become quite familiar with its history and the actors that have defined it, both academically and personally. Nevertheless, as an expat writer only coming to the country for a few months a year, it is nearly impossible not to feel like a “parachute journalist”, a derogatory term lodged at those reporters that drop in when the story rears its head and jet off to the next headline with little investment in the community.

I arrived in Wau, South Sudan’s second-largest city, one week after a devastating attack that was broadcast as a rebel siege that allegedly killed 43 people. What I and the handful of other journalists that made the trip quickly found out was that this was no rebel attack—it was a massacre carried out by government-aligned troops that murdered upwards of 400 people. More than 100,000 of the town’s 150,000 people had abandoned their homes, taking to the surrounding bush or finding refuge in overcrowded schools, churches, and NGO compounds. What I had planned to be a four day trip became a two week stay as I found myself under the tutelage of a nun from southern India who showed me everything the NGOs wouldn’t, and helped me understand just how something like this could happen. It also didn’t help that the capital, where I had been staying, had become a battleground for government factions and rebel forces after the spectacular collapse of the fragile unity government.

The first thing you have to shed when you come to report in place like

South Sudan—which for the last 50 years has been wracked by conflict—is your idealism, your desire to change something. The most you can hope for in these situations is simply to understand. The standard prism through which South Sudan’s conflict has been seen, as many conflicts in

“

manipulation by outside forces over the last two hundred years. Then I would write of my extensive interviews with government staffers, governors, and military commanders, their roles in Wau’s story, and the political economy of violence that led to the bloody attack on June 23. But to ignore the ethnic

THE MOST YOU CAN HOPE FOR IN THESE SITUATIONS IS SIMPLY TO UNDERSTAND.

”

Africa are portrayed, is that of ethnic strife. Here, the refrain is that the Dinka will always fight the Nuer. But in Wau, there were no Nuer, only Fertit.

In Wau, the narrative quickly became that of Dinka versus Fertit. Never mind that ‘Fertit’ was a completely fabricated ethnic categorization (aren’t they all?) that denoted nothing more than those people that were considered to be slaves under pre-colonial tradition.

After attempting to piece the story together from interviews in the field, I understood why the ethnic narrative was so easy to latch on to. The Fertit neighborhood had been shot and shelled, burned to the ground. In the Dinka neighborhoods, adjacent to the military barracks, one could hardly tell anything was amiss. Stories of survival from the older men in the camps chalked the whole situation to a clear campaign of ethnic cleansing masterminded by Dinkas exacting their revenge for the excesses of Fertit militias of wars past. The narrative was simple: revenge and blood are surefire sellers, so, of course the conflict in South Sudan was distilled down to its ethnic facets.

The high road in this case would be to cautiously and carefully explain to the reader that ethnicity is but a single language of mobilization alongside religiosity and political affiliation. “It is no different that Ireland’s Troubles or the occupation of Oregon’s Malheur National Wildlife Refuge,” I would say.

I would further explain the history of these two ethnic groups and their

dimension in favor of lofty academic abstracts, and deny the realities of these communities and the very real hatred that has bubbled up through their “politically rational” histories, is also a disservice.

So where do you draw the line? It seems that imbuing seemingly chaotic and absolutely horrific events with rationality would undo the damage done by decades of reporting on the “chaos” and “madness” of Africa.

Defining the actions of ‘warlords’ in terms of economic desire, as we define the behavior of our own leaders, brings them closer to an audience half a world away. But then, what do I say of the mother whose child was shot in her arms for nothing more than failing to speak the Dinka tongue? What do I say of the 4,000 families now crowding a church compound in the center of town without food or security? How do I write about the military commander that oversaw the killing of hundreds of people but paint him by his strategy rather than his brutality? And how do I write an empowering story when the central character is a nun from a different continent?

But I guess the questions are moot.

There’s only so much real estate on a page, web or print, and only so much bandwidth a reader has to understand a conflict he’s never heard of. I sent in 2,000 words to my editor in Geneva.

They took 500, pasted in their own 1,200, published it, and paid me for all 1,700.

E

4

Andrea Renda, Senior Research Fellow at the Kenan Institute for Ethics and Centre for European Policy Studies

S

ome social sciences carry the ambition to capture everything with their models and theoretical frameworks. It’s like these social scientists could put the whole world in a funnel and observe it from a different angle, which enables comparisons, additions, subtractions, reallocations and other algebra tricks. And it is especially true for economics: the “dismal science” had high times during the 20th century, when it came to dominate all other social sciences, including psychology, sociology, anthropology. Mesmerized by the predictive potential of their models, neoclassical economists thought that they could explain everything, and some social sciences carry the ambition to capture everything with their models and theoretical frameworks. It’s like these social scientists could put the whole world in a funnel and observe it from a different angle, which enables comparisons, additions, subtractions, reallocations and other algebra tricks. And it is especially true for economics: the “dismal science” had high times during the 20th century, when it came to dominate all other

5

social sciences, including psychology, sociology, anthropology. Mesmerized by the predictive potential of their models, neoclassical economists thought that they could explain everything, and lost no opportunity to build their tools in IT ADOPTED A NUMBER a way that could OF ASSUMPTIONS AND enable “scientific” decision-making GENERALIZATIONS THAT on everything.

DO NO JUSTICE TO THE It was the age of economics’ WEALTH AND DIVERSITY OF imperialism PREFERENCES, EMOTIONS, (Lazear, 2000)1, VALUES AND NEEDS THAT and this trend CHARACTERIZE OUR is still visible in many universities SOCIETY, AND ALL OF US and policy fora AS INDIVIDUALS. around the world.

“

However, in this attempt economics got burnt, like Icarus on its way to the Sun. Its paper wings deteriorated quickly when it came to predicting and explaining catastrophic events such as the financial crisis, the Greek crisis, the deterioration of social cohesion in many industrialized

”

countries, the dramatic consequences of the rise of inequality everywhere around the world, and yes, also Brexit and the election of Donald Trump.

Economics entered into a Faustian “deal with the devil”: to become more powerful, it started presenting itself as a natural science, just like physics. It adopted a number of assumptions and generalizations that do no justice to the wealth and diversity of preferences, emotions, values and needs that characterize our society, and all of us as individuals.

A good example is “neoclassical” cost-benefit analysis, the most widespread and vetted decision-making criterion in public policy since Benjamin Franklin and Jeremy Bentham. In order to make it generally applicable and show predictive potential, neoclassical economists, facing the impossibility of comparing utilities across individuals, adopted income as a proxy for happiness.

They adopted the assumption that people’s happiness does not depend on how happy others are and postulated that an additional dollar always has the same value, no matter how rich or poor one is.

Here comes the syllogism that jeopardizes modern public policymaking: (1) most public policy is grounded

in neoclassical economics; (2) neoclassical economics ignores

feelings, preferences, values

and distributional issues; (3) hence, public policy ignores feel

ings, preferences, values, and distribution.

This problem has far-reaching consequences, in particular (but not limited to) in the areas of welfare policy, civil rights, migration, health, safety and the environment – indeed, the core of our public policies. It starts to surface in international debates, where inequality is increasingly presented as a “problem for growth”: but this mostly occurs because policies that exacerbate inequality create a lack of demand (and thus consumption) on the market, which eventually affects the potential for production to supply new goods and services. In other words, inequality “disturbs” the market. Is this enough? Probably not:

there must be a better way to reconcile the predictive power of social sciences with the need to reflect the actual reality and needs of human beings.

A first option would be to improve economics. Attempts have been made to “humanize” economics by incorporating human sentiments and behavioral biases, as well as by strengthening the modeling and understanding of happiness and wellbeing. The truth is that economics needs a degree of generalization: but as was observed already in 1838 by John Stuart Mill, “these generalities contain the whole unanalyzed experience of the human race”.

A second option would be to support economics with other social sciences. Indeed, this avenue may appear more promising: neither psychology, nor sociology or anthropology are characterized by the same degree of methodological individualism that affects economics.

But economic theory tends to downplay these disciplines as non-scientific, and the complexity they represent ends up threatening the formal elegance of economic models, leading to a degree of contamination that economists often cannot digest.

A third option is to partly abandon economics. To be sure, policymakers would find themselves orphans of a structured set of criteria that would inspire public policy. But they could still rely on theories of justice, fairness criteria and coherence with long-term sustainable development goals in those areas where distributional impacts and individual values and preferences appear to be strongest.

When all these options fail, one could try to rely on alternative ways to inspire more human public policy choices. This happened to me recently, when trying to conceive of a more effective way to advocate reform in migration policy in the Mediterranean, and beyond. The failure to humanize migration policy in Europe is leading to an unprecedented genocide in the Mediterranean, once the cradle of civilization and now a gigantic openair graveyard. Only in 2016, at the

time of writing, almost five thousand human beings have drowned in the Mediterranean Sea while attempting to cross it. Last year, more than a million managed to reach the Northern shores: and even when they made it, they often arrived in a state of shock. The ones escaping from war have landed in a perennial limbo, the ones in search of a better life have lost their memory on the way. Reading through their stories, one gets the sense that all those millions have died, not just the thousands that went down. Their ideas, values, dreams and expectations have died, bringing with them the promise of integration, the community of dialects (Koiné Dialectos) that once made the Mediterranean a land of shared values, and a land of welcome migrants.

How can one improve the availability of the extreme pain and suffering of Mediterranean migrants, thus triggering a more human, empathic reaction? News coverage abounds, but most often relies on statistics, figures, numbers, which are relatively easy to dismiss for the public opinion. This is why we need to make individual stories more available, and dig deeper into the reasons that led these human beings to leave their homes, as well as their dreams, expectations, hopes.

The Kenan Institute is doing this is an admirable way with inFlux and with individual projects led by students.

For example, Lily Doron and Olivia Johnson have just come back from a sixweek trip on the “Balkan route”, where they reported the lives of a few of the thousands of refugees fleeing outside Syria and Afghanistan in search for a better life somewhere in Europe.

Andrea Patiño Contreras and Gabriela Arp, a Colombian photographer and a film director from the U.S., recently went to Reggio Calabria in Southern Italy to create “Divided by the Sea”, a marvelous project that collects and contextualizes the stories of the thousands that arrived to that port.2 These attempts are uncovering another wave that is mounting in Europe, and contrasts with that of populism and nationalism. These are people, mostly youngsters, who leave their comfort zones to help, with their own hands,

6

Fatalities and arrivals in the Mediterranean in 2016, as of November 25, UNHCR or to report what’s happening. Those young travelers and reporters strive to preserve the memory of what is going to be lost forever: a gigantic Spoon River that not many are reading.

Is this going to be sufficient to inspire a new, better policy towards migration? Apparently, we need more. We need more “available” stories. But no one, unfortunately, can collect the stories of the ones that did not make it to the coast.

The little we know about these lives buried in the sea comes from a very authoritative source: the sea itself, which keeps denouncing the atrocity and indifference that surround the destiny of migrants in the Mediterranean by bringing back dozens, no, hundreds of bodies to its sparkling beaches. It sent back Aylan, a 3-year old child dressed like any Italian toddler on his way to daycare.

And it deposited almost a hundred corpses on the Libyan shores of Sabrata last July, who arrived as if they were still traveling as a group.

It sent one, ten, countless signs.

But even in those cases, despite the evident “availability” of these images, no tangible change was observed in public policy.

“

WE

So, maybe we need more than words and images. This is why I decided to try with music. Music can be powerful. It digs deep down in the soul of the ones that write, execute, narrate, listen: and it is a global language with its many dialects. It does not need to generalize, as it can speak to the heart of everyone in a different way. And coupled with images and stories, it has the power to magnify av a i l a b i l it y.

The ancient G r e e k s believed music penetrated both the body and mind, br i ng i ng them into equ i l ibr iu m.

Scientific studies have demonstrated that the brain is able to c o n v e r t music into stimulation of neural components that are usually associated with emotion, attention, and feelings of euphoria. The recent controversial Nobel Prize awarded to Bob Dylan reflects the poetry of his lyrics, but also the extreme political influence that certain of his songs have had (on a recent appearance at Durham’s DPAC, he sang again “Blowin’ in the Wind”).

His “The Lonesome Death of Hattie Carroll”, together with Billie Holiday’s “Strange Fruit”, John Lennon’s

NEED

MORE

‘AVAILABLE’ STORIES. BUT NO ONE,

U N F O R T U N AT E LY, CAN COLLECT THE

STORIES OF THE ONES THAT DID NOT MAKE IT TO THE COAST.

7

”

“Imagine” and Bob Marley’s “Get Up, Stand Up” have changed the course of history by influencing politicians and activists.

While I have certainly no ambition to come even closer to the impact that these champions of popular music have exerted on public opinion, I felt the urge to write songs and couple them with all the stories collected by students, activists, photographers and filmmakers. My documentary project, “Just a River”, is now in the making and is based on five songs, which document five different emotional states reported by several migrants and refugees interviewed by Lily, Olivia, Andrea, Gabriela and a few others.3 It uses images from Giorgio Cosulich de Pecine and paintings from Rodrigo Figueredo, and is aimed at stimulating empathy among civil society and possibly policymakers, and hopefully providing a small contribution to the promotion of a more comprehensive, human and sustainable solution to the problem of migration in the Mediterranean and beyond.4, 5 In a nutshell “Just a River” aims at exploring that “unanalyzed experience of the human race” that economists never see, and that policymakers end up sweeping under the carpet of their conscience.

Editor’s note: You can listen to Professor Renda’s music online at soundcloud.com/andrea-renda-1/ sets/songs-for-just-a-river/s-FooM0

E

NUMBERS, ETHICS and SAVING LIVES The desire to do good David Wohlever Sánchez, Trinity ‘19

S

o you want to do some good.

You want to make a difference.

But you’re not sure how. The first thing you should know is that you’re not alone. This seems to be a common desire among people, especially students, but learning how to make that difference is no easy feat.

Once you’ve decided you want to do some good, the next steps are not always so clear. The range of issues to care about, organizations to support, groups to volunteer for, and causes to donate to are never-ending and mindnumbingly complex. How can you know that what you’re doing is actually doing some good? How can you feel comfortable with the causes you support? Are they doing more harm than good? Where does the money you give actually go?

These are all good questions.

Fortunately, there are many resources and approaches that can help us in this endeavor to do good.

To be sure, actions like direct advocacy, movement building, volunteer work, and all kinds of options are other ways to good. However, this piece will

focus on charitable giving because the world of nonprofits is huge. In the United States alone, there are about 1.41 million nonprofits registered with the Internal Revenue Service.1 How could you possibly choose which one(s) to donate to? Which ones are best?

This article will attempt to provide you with some tools to answer these difficult questions.

The Parable of the Washing Machine Picture this: one day, you’re doing the laundry, and your washing machine breaks beyond repair.2 Since washing NOT ALL clothes is important to you, you immediately go to the NONPROFITS department store and scope ARE CREATED out your options. Being EQUAL a rational consumer, you want to pick out a good one. You want a machine that is reasonably priced, uses low power, washes clothes well, and is likely to last. After researching your options with sources like Consumer Reports or other industry experts, you settle on a great choice. This was the rational thing to do.

“

” 8

But if this approach is so reasonable in the context of shopping for goods, could we apply this reasoned approach to how we donate our money?

Helping people and saving lives Imagine that one day, you’re walking down the street and you see someone choking on a piece of lettuce.

It just so happens that you were recently trained in first-aid, and you know how to perform the Heimlich maneuver. What do you do? Of course you rush to the scene and save the person! This moment might go down as one of the best, most exhilarating moments of your life. Your action just saved a real person.

Here’s some more good news: this opportunity to “save the choking person” is available to people with just a little bit of surplus every single day. By donating to effective and efficient charities that put up malaria nets,3 deworm people in developing countries,4 or even give money directly to those who need it,5 you can literally save people’s lives. And you can save people’s lives in very, very costeffective ways.

Not all nonprofits are created equal You might be thinking to yourself, “Alright, doing good sounds nice, but how can I know that this nonprofit does good work? How are they using my money?”

Considering effectiveness is no easy task, especially when the stakes are so high. The two main areas to consider are the quality of the organization, and the quality of the outcomes, outcomes being the generally weightier consideration. There are plenty of organizations filled with passionate, well-meaning people, focusing on a type of intervention whose outcomes

9

might be questionable or even counterproductive.

The organization Excellence in Giving put together some useful factors to consider.6 When evaluating the organizations themselves, we should consider how realistic and measurable the vision is, their process for tracking outcomes, and how they react to new information and data. When considering quality of outcomes, some things we should consider include the staying power of the results, whether or not independent evaluations have taken place, and what the beneficiaries of the program think about its quality and effectiveness.

Though not all of these factors are quantifiable, it is possible to make rough estimates of actual effectiveness, at least when comparing organizations

“

IF WE TRULY WANT TO IMPROVE OR MAXIMIZE OUR IMPACT, THEN WE NEED TO SERIOUSLY RECONSIDER WHERE WE GIVE OUR MONEY.

”

to each other. Through robust evaluation processes, some charities have become known as much more effective than others.

An ethical argument for costeffectiveness A recent poll found that 35 percent of Americans have “little or no faith in charities.”7 To be sure, that lack of faith is often rational skepticism. Many charities mishandle money or engage in work that is simply ineffective, or even harmful.

However, this does not negate the fact that there are plenty of excellent, often under-reported organizations that work to alleviate extreme poverty, improve global health, mitigate existential risk, and “make a difference” in efficient, highimpact, low-cost ways. And if those charities do exist, and we truly value saving people’s lives, then we should prioritize giving to those charities over less effective ones. In a nutshell, this is the idea of cause prioritization: Premise 1: You ought to save those who you can at reasonable cost.

Premise 2: People have equal moral standing.

Premise 3: Distance is not a compelling moral consideration.

Premise 4: We ought to maximize the good we do with our resources.

Premise 5: Some NGO interventions save more lives per dollar than others.

Conclusion: To maximize the good we can do, we ought to give to nonprofits that have high expected utility-perdollar.

This might suggest that, with all else being equal, we should donate to charities that we know to be costeffective and high-impact. Let’s unpack these ideas a bit more, and figure out what they mean in practice.

Americans’ total giving in 2015 was $373.25 billion, amounting to 2.1 percent of GDP. But consider how Americans allocate funds to different types of interventions – only a miniscule 4 percent go to explicitly international organizations.8 Why could this be a problem? For one thing, it has been found that effective international organizations are able to do incredible amounts of good per dollar, far more than some others. For

Protect someone from malaria for three to four years, on average.

Protect Healthy Children

Against Malaria Foundation

example, according to GiveWell, “it costs the Against Malaria Foundation approximately $3,500 (including transportation, administration, etc.) to save a human life.9 Compare that with even the best U.S. programs: the NurseFamily Partnership and KIPP both cost over $10,000 per child served.”

If we truly want to improve or maximize our impact, then we need to seriously reconsider where we give our money.

Measuring “the good”: a not-soimpossible task In contrast to the conventional wisdom, measuring “good” is more possible than you might expect; in an interesting overlap of philosophy, ethics, science, and statistics, experts have devised a few robust methods of “measuring good.” The most popular of these, the DALY, is “one lost year of ‘healthy’ life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.”10 T h o u g h imperfect, DALY can

0

100

Protect six children from schistomiasis for one year.

Provide eyeglasses to a person in a developing country.

Provide safe water for 23 community members for one year.

Transport a woman to and from the hospital, on average.

Schistomiasis Control Initiative

Seva

Evidence Action

Fistula Foundation

at least primitively measure the cost- charities) called GiveWell conducts effectiveness of different interventions. rigorous research on different types of Below is a graph that shows the interventions from nonprofits.12 Their number of estimated saved DALYs current top recommendations include per $1,000 spent in 108 different health the Against Malaria Foundation,13 the interventions.11 The most effective Schistosomiasis Control Initiative,14 interventions are about 1,400 times the Deworm the World Initiative,15 and more effective than the least effective GiveDirectly.16 If you are looking at interventions. In other words, donating other organizations, be sure to do your $1 to the best organization examined research, and ask yourself how much would be the equivalent of donating good the intervention will actually do. $1,400 to the worst one. That’s huge, In conclusion, I recognize that and potentially revolutionary for the choosing where to donate is a personal fight against global health discrepancies

BY DONATING TO MORE EFFECTIVE and extreme poverty.

NONPROFITS, WE WOULD BE NOT This reality has ONLY MAXIMIZING OUR IMPACT FOR profound ethical implications.

If GOOD, BUT ALSO PLACING PRESSURE some nonprofits are ON LESS EFFECTIVE NONPROFITS TO clearly doing better REEVALUATE THEIR METHODS. work than others, then perhaps there is a case to be made for an obligation decision. However, I would simply to consider these arguments when encourage you to consider these ideas, determining giving habits. By donating and ponder what you value in a charity. to more effective nonprofits, we would If there truly is a “moral imperative be not only maximizing our impact for towards cost-effectiveness”, then we good, but also placing pressure on less must take into account the numbers. effective nonprofits to reevaluate their Only then could we begin to do the methods. most good we can do.

“

”

Meta-charities and closing thoughts One acclaimed meta-charity (a charity that works to improve or research other

200

E 300

Cost-effectiveness: DALYs per $1,000

10

SUCCESS of the SECOND SEX Duke’s demonstrated efforts to empower women

D

uke women are formed, like the diamonds we’re told, at convocation, that we’ll become, with pressure— between classroom and bedroom walls, on the field, in the dining hall, between relationships and internships, in mirrors and photos, in group messages and private counseling.

Most of the largest-looming limiting factors for the growth of Duke women are not new; rather, they’re remnants of old plagues renewed by history’s cyclical bent or invisible, nefarious influences that have been hushed but not eradicated by previous efforts.

Women at Duke have come a long way—1.8 miles and more than eight decades—since the Woman’s College opened as a coordinate to the allmale neogothic wonderland in 1930.

In the wake of the development of the Woman’s College, students, faculty, and administrators have worked to carve out women’s place at Duke University, acknowledging that their effort was to be done in a somewhat rigged system of larger societal trends.

11

Elizabeth George, Trinity ‘17 In its infancy, Duke catered exclusively to white, affluent, southern students. At the same time, conservative traditions and the Social Standards Committee told women undergraduates that their personal development at Duke would be that of “individuality within a provided framework.”1 While Design for a Duchess pamphlets detailing the best ways to dress and behave to please male peers are no longer disseminated, those same rules have evolved into implicit pressures that reinforce hindrances to undergraduate women’s growth.

When Nannerl Keohane became Duke’s first and, thus far, only woman president in 1993, she worked closely with the Women’s Center and prioritized the evaluation of women’s status at the University. A feminist scholar herself, Keohane communicated frequently with Jean O’Barr, who started Duke’s Women’s Studies Program and in conjunction with the Women’s Center, she implemented the Women’s Initiative, an investigation into the treatment

of women in faculty, administration, staff, and the student body at Duke.2 Donna Lisker was charged with the undergraduate arm of the research, deemed Duke Inquiries in Gender—a series of focus groups held in the 2002-2003 academic year. Emily Grey chaired the project her junior and senior years, reporting to both Lisker and Keohane.3

“

ENCOURAGING WOMEN TO GO TO CAPS COUNSELING OR THE WOMEN’S CENTER MAY TAKE MORE THAN THE POSTERS IN OUR BATHROOM STALLS.

”

Grey ran twenty focus groups composed of men and women from nearly every fraternity, sorority, and student group on campus. They met in the fall of 2002 at the Women’s Center to discern whether implicit social

“The expectation that one would be smart, accomplished, fit, beautiful, and popular, and all this would happen without visible effort. This environment enforces stringent norms on undergraduate women, who feel pressure to wear fashionable (and often impractical) clothes and shoes, to diet and exercise excessively, and to hide their intelligence in order to succeed with their male peers.”5

In the Women’s Initiative report, Keohane wrote:

“The ideal of ‘effortless perfection’ described eloquently by many Duke female undergraduates creates a climate for many students that too often stifles the kind of vigorous exploration of selfhood and development of enlightened respect for members of the opposite sex that one would hope to see at a place of the quality and character of Duke.”6

Lisker clarified Keohane’s concern, explaining that “effortless perfection” was at the root of why many undergraduate women tailored their behavior to a set of unspoken norms and suffered in the process:

“It’s an expectation that’s impossible, so it sets you up to constantly feel anxious, like a fraud, like a failure.

The women in the focus groups said they were always thinking, why is it so hard for me? Why am I struggling when everyone around me seems to be doing perfectly well with no issues? And of course they weren’t. They were just maybe better at hiding the struggle.”7

It’s a suffocating set of standards that replaced the written regulations for Woman’s College students with unspoken rules that can’t be shed by a vote in a student government meeting.

The insidious nature of this severe anxiety to live up to impossible expectations and do so without revealing any sense of struggle means that the women who internalize it most intensely are also less likely to seek help because they feel their faltering a reflection of inadequacy.

They’re also considerably less likely to be offered help because they hide it so well. Duke women find themselves in an environment abundant with resources, but walking in the door requires admitting that they’re in over their heads. For high-achieving students, that sensation is often akin to failure, and failure is the foreign stuff of nightmares.

Left unchecked, the effortless perfection phenomenon has very real and preventable consequences, but encouraging women to go to CAPS (Counseling and Psychological Services) or the Women’s Center may take more than the posters in our bathroom stalls. At the very least, by coining the term in their study, Duke Inquiries in Gender and the Women’s Initiative provided data confirming to struggling undergraduates that they were far from alone in feeling that pressure.

Normalizing the use of support services is the next necessary step.

The Duke Inquiries in Gender project also offered recommendations to combat the structural facets responsible for reinforcing stunted undergraduate women’s development.

Among these was the creation of the Baldwin Scholars program, a community of 18 women per class who would live in an all women’s housing section, have at least two courses taught by female faculty in an all-female classroom, and complete a paid internship ideally mentored by a woman with authority in her field.8 Donna Lisker was instrumental in the program’s development, recalling that “based on what we heard in the Women’s Initiative, women were craving a space where they could be with other women that was not a sorority, that was not social, but where they could be their full selves, intellectual, silly, and where they would be supported and challenged and mentored and encouraged.”9 Colleen Scott, the Baldwin Scholars Program Director, deems

“

WOMEN at

DUKE HAVE COME a

LONG WAY:

1.8 MILES and more than

8

DECADES.

“

regulations among undergraduate women were detrimental to their social and academic lives. The issues that most frequently emerged from the groups were body size and disordered eating, dating and hooking up, social status and hierarchy, safety and sexual assault, student leadership and activism, and classroom experiences.4 Out of those conversations, the term “effortless perfection” was coined into common campus parlance, defined as:

12

WOMEN S STUDIES DUKE

BALDWIN SCHOLARS

the environment a “Woman’s College oasis” within the coed framework of Duke,10 and Lisker echoed the sentiment. Nina Chen, a current Baldwin Scholar, described it as the most diverse group she has ever been part of and a space in which she and her peers feel they can be extremely vulnerable on intellectual and emotional levels. Many Baldwin seminar discussions elicited tears, she said, a display of authenticity rarely released in any other classroom setting.11 According to Scott, unanticipated results of the program have been an above average mean GPA, high involvement in extracurricular activities, and a majority of participants doing senior thesis work. Part of that, she believes, is confidence, and part is seeing their peers succeed in things and feeling encouraged by their success. More importantly, still, is their guaranteed connection to female role models within their own cohort as well as at the professional level.12 The strength the Baldwin Scholars Program derives from its intimate size is also its most critiqued weakness. “It was never realistic to think it was going to change the entire campus culture; it was too small a program, but we had hoped, and I think we have been successful, in creating a small, diverse sort of seed group of women leaders who could do transformational things at Duke and beyond,” Lisker said.13 So outside of the 72 undergraduate women who benefit directly from the program each year, what more permanent, structural work can Duke do to empower its women?

The faculty, staff, and students that compose the campus population arrive with their own well-instilled values regarding women’s place and purpose, and for undergraduates, their four years here can only do so much to reshape them. For example,

13

Grey, who now works with high school job prospects sometimes seem seniors applying to college, noted that inextricable from undergraduate social the “effortless perfection” pressure circles. begins while young women compete Replacing undergraduate women’s with each other in applying to highly reliance on imbalanced social selective schools, long before they even relationships with networks of mentors step foot on campus.14 In evaluating is among the most auspicious solutions Duke’s efforts to empower women, it’s to the conundrum of conformity to important not to hold the university unhealthy and belittling norms. Duke’s responsible for the latest effort, the Penny state of society; the Pilgram George Women’s WHAT MORE question should be, Leadership Initiative, rather, in what ways promises to connect PERMANENT, is Duke reinforcing or students with women STRUCTURAL stifling the success of mentors and alumni,16 WORK CAN DUKE and the effectiveness women once they get here?

DO TO EMPOWER of those relationships Both Lisker and could determine for ITS WOMEN? Scott asserted that many women whether the Greek system they value themselves on campus, though fairly integral to according to impossible social alumni contributions, is one of the standards or find a sureness of self obvious culprits in maintaining a knowing someone is there to encourage gendered hierarchy in student social and support rather than compete with life. Scott observed that sororities have them. a great deal of underutilized potential In the same vein, the alumnae to influence campus culture, but as I interviewed in this research all Lisker pointed out, that would require cited the importance of recruiting taking on structures of power that women to senior levels of faculty and sometimes benefit them, too: administration. In the University’s current presidential search, selecting “We heard all the time [in the focus a woman among the qualified many groups] that if you’re going to go to could speak volumes to Duke’s a fraternity party, you have to expect commitment to creating not just to get groped, like that’s just part of effortlessly perfect Duchesses, but the deal. And I remember asking empowered, driven, confident, healthy, okay, why would you put up with that? and happy women. Advocates and Why would you go back if that happened role models are invaluable in shaping to you even once? But the thing that undergraduate women’s expectations they articulated and articulated for themselves and each other, and well was that there was and still is a Duke has progressed enough decades social hierarchy at Duke, and there from the days of an all-male institution were people at the top, and getting to recognize its responsibility to attention from them, even negative provide a structure in which success is attention, was sometimes preferable to not determined by sex. no attention.”15

“

”

Untangling the ephemeral social benefit from the long-term, conditioned tolerance of disrespect is far from simple, especially as post-graduation

E

IS HUMAN RIGHTS ACTIVISM

ETHNOCENTRIC? A case for diversity

I

n 1948, United Nations General Assembly adopted the Universal Declaration of Human Rights. The sanctity of basic human rights such as the right to life, freedom, security, the exemption from slavery, torture, discrimination have since then been written into international human rights law. However, the Executive Board of the American Anthropological Association issued Statement on Human Rights in opposition, noting that the Declaration would be “a statement of rights

Angie Shen, Trinity ‘18 conceived only in terms of the values prevalent in Western Europe and America” given that the “definitions of freedom, concepts of the nature of human rights, and the like, have thus been narrowly drawn.”

The AAA Statement was seen as a prototypical criticism of ethnocentrism: judging another culture by the values and standards of one's own culture. In his article “The Relative Universality of Human Rights”, prominent human rights scholar Jack Donnelly argues that the In 1948, United Nations

14

General Assembly adopted the Universal Declaration of Human Rights.

The sanctity of basic human rights such as the right to life, freedom, security, the exemption from slavery, torture, discrimination have since then been written into international human rights law. However, the Executive Board of the American Anthropological Association issued Statement on Human Rights in opposition, noting that the Declaration would be “a statement of rights conceived only in terms of the values prevalent in Western Europe and America” given that the “definitions of freedom, concepts of the nature of human rights, and the like, have thus been narrowly drawn.”

of globalization and the general acknowledgment of egalitarianism by most modern civilizations.

The East Asian Challenge to Universal Human Rights East Asia is the region of the world that participates least in the international human rights system.

In the 1990s Senior Minister of Singapore Lee Kuan Yew argued that international human rights as defined in United Nations declarations and treaties were insensitive to distinctive “Asian values” such as preference for social harmony and collective wellbeing over individual liberty, strong family values, loyalty and respect towards figures of authority including

entirely different from those of the Western institutions. Furthermore, pro-rights scholars argue that a system of human rights is the most effective way to protect individual dignity. This argument makes the false assumption that all peoples of the world prioritize individual dignity above all other possible ideals such as collective wellbeing, and that individual dignity is an inalienable fundamental right that no one will voluntarily sacrifice.

This argument also fails to consider the possibility that other cultures and states may have developed effective alternative mechanisms for protecting or realizing human dignity. Lastly, the argument that natural equality of all human beings is supported by

THE EAST ASIAN CHALLENGE TO HUMAN RIGHTS “SHOWS THAT IT IS DIFFICULT TO DEVELOP A

COMPREHENSIVE FRAMEWORK OF RIGHTS THAT CAN RESPOND TO DIFFERENT CONCEPTIONS OF VITAL HUMAN INTERESTS IN ALL CULTURES OF THE WORLD.

”

The AAA Statement was seen as a prototypical criticism of ethnocentrism: judging another culture by the values and standards of one's own culture. In his article “The Relative Universality of Human Rights”, prominent human rights scholar Jack Donnelly argues that the opposition to universal human rights has become obsolete as “human rights are backed by the world’s preponderant political, economic, and cultural powers and have become ideologically hegemonic in international society.”1 Proponents of universal human rights argue that human rights have been increasingly accepted as international norm due to the standardizing impact

15

the government. Western leaders and activists have tended to view the position of these countries as excuses for political and cultural oppression of minority groups. Such tendency reveals their critical failure to step out of the Western frame of thought and give serious consideration to claims for cultural difference.

First of all, pro-rights scholars argue that the majority of the world share similar institutions and therefore should adopt the same human rights system to protect the interests of individuals. However, this perspective fails to take into account the fact that the rationale, configuration and purpose of those institutions may be

most ideologies in the world today contradicts empirical observations of the reality of many modern states and cultures where equality based on gender, race or sexuality has not been widely accepted as an ideal, not to mention realized.

A Different Cultural and Moral Framework In order to seriously evaluate the East Asian challenge to universal human rights, one has to be willing to imagine the possibility of a different value system where democracy and egalitarianism are not considered political ideals; or the possibility of institutions and traditions that achieve

similar outcomes like democracy and egalitarianism through a different philosophical and cultural framework; or the possibility of alternative methods of social control that sustain a state and nurture a culture distinct from “fundamental rights” enshrined in a legal system.

For example, obstruction of an individual or a group’s dignity might not be considered the most heinous crime that can be committed; upholding the honor, loyalty and moral purity of a community may be valued more than the dignity of an individual, and the choice to uphold those values may create a moral system that does not prioritize racial and gender equality. The government may be superior to the people rather than representative of the people, but it is still capable of protecting the interests of the people within the political hierarchy. While these values are not considered “modern” because they are not western, they should not be dismissed as primitive or obsolete.

A Case Study: The Chinese Political System The universally condemned authoritarian Chinese government is an example of a system that hinges on a fundamentally different cultural and moral framework. Western scholars habitually assume an oppositional relationship between the Chinese government and the Chinese people, making ethnocentric decisions about their interests, detaching them from the bigger picture of Chinese culture and history, and eventually leading to the irresponsible conclusion that the people are oppressed by the government.

This conclusion demonstrates the paradigm of an ethnocentric thought process. First, it assumes a contractual relationship between the government and the citizens.

One would reach the conclusion that authoritarian government oppresses people if one assumes the government and the people have consented to a social contract where the government’s legitimacy derives from the consent of the citizens, who expect the government to protect their “rights”. Second, it assumes people have certain natural “rights” that the

government should protect. Third, it assumes freedom is synonymous with lack of oppression or arbitrary interference of the government. One would claim that people ruled by an undemocratic regime are unfree if one assumes freedom consists in not being subject to arbitrary intervention by the government. All three assumptions reflect the core of Western liberal political theory.

It would be quite difficult to fathom an objection to these values without stepping out of the western frame of thought. A close examination of the history of the Chinese political ideology reveals that the relationship between people and the government was construed in radically different ways; the language of “rights” and “social contract” was entirely absent.

Most dominant ideologies in China throughout history have valued hierarchical social structure and benevolence. Mencius, one of the most prominent disciples of Confucius coined “government for the people” ( 以民为本) and “the people should be valued more than the government” (民 重君轻). The wellbeing of the citizens is championed based on ideas of justice and good will. The government should protect the people not because people have the inalienable right to life, liberty and property, but because it’s the just and good thing to do. The government is a guardian who holds ultimate authority rather than an equal party to a contract.

As a result of the historically grounded lack of appreciation of the concept of “civic rights”—words like “right” and “democracy”, along with Western legal treatises, were only translated into Chinese in mid-19th century. Chinese political institutions in the past and present that ostensibly resemble those of the West are in actuality conceived in fundamentally different ways. Critical questions such as what constitutes good government, how leaders and lawmakers ought to be chosen, and the extent of ruling by law are given vastly different answers.

The public’s criticism or protest of government policy is often motivated by communitarian concerns such as public safety, social stability or common resources like the environment, rather than defense of a fundamental “right”.

For example, many critics in China defend the need for a free press as a means to combat the widespread corruption which compromises public good. By contrast, in Western countries freedom of the press is considered a fundamental right of citizens. In his book The China Model, political theorist Daniel A. Bell asks the question, “Can a political system be democratically legitimate without being democratic?”2 He points out that “surveys consistently show majorities in support of guardianship discourse, or empowering capable politicians who will assume responsibility for the good of society, over liberal democratic discourse that privileges procedural arrangements to secure people’s rights to participate in politics and choose their leaders.” Echoing Bell’s observation, political theorist Doh Chull Shin, in his book Confucianism and Democratization in East Asia, argues that Confucian political legacies encouraged demand for a nonliberal democratic government that prioritizes the economic welfare of the community over the freedom of individual citizens.3 The Case for Diversity The East Asian challenge to human rights shows that it is difficult to develop a comprehensive framework of rights that can respond to different conceptions of vital human interests in all cultures of the world. The legal guarantee of universal human rights is not the only or even the most effective way to check the power of the government and protect individual dignity for all. Furthermore, because cultures define vital human interests differently, what counts as a human right cannot be universally agreed upon.

Despite its good intentions, international human rights activism reflects the ethnocentric impulse to reconstruct the world’s “oppressive” practices and even its moral configuration according to one particular value system and way of life.

While such activism may be promoting the well-being of individuals or groups, it is doing it at the cost of diversity of values and ways of life.

E

16

CHOICES

H

opefully you do not think about dying too much, and hopefully you don’t think much what it is like to be chronically ill with a disabling disease. These are uncomfortable, saddening topics after all, pervaded heavily by feelings of sadness, loss, and hollowness. But, for just one second, try to imagine it. Imagine that you are at the end of your life, or imagine you were diagnosed with a chronic illness like chronic kidney disease (CKD), heart failure, or something of the like.

How would you want to be treated?

How would you want to spend your time? Who would you want to be there with you, to comfort you, reassure you, be with you? In the broadest terms: how would you want the United States healthcare system to take care of you?

On July 30, 1993, my grandmother, Nancy Wilson Peterson, died of glioblastoma multiforme, a brain cancer that ended her life shortly before I was born. The cancer was invasive, wellentrenched in her brain at the time of diagnosis, and her doctors offered a few different options for treatment: radiation, chemotherapy, or surgery.

Options on the table, she went home after that diagnosis and returned to the hospital for palliative radiation therapy, which addressed symptoms affecting her quality of life. She died ten months later at age 63.

My grandmother’s story is not an uncommon one. In fact, it is perhaps the most common story that we can tell.

Every year, countless Americans fall

17

death, dying, and a better way

Graeme Peterson, Trinity ’17

ill, and burdensome illnesses, whether terminal or not, inevitably necessitate complicated choices about patients’ lives. Some of these questions are about life and death: should we elect an intensive chemotherapy regimen or enter into hospice? Should we opt for an invasive surgery by which a tumor may be removed from the brain, risking an adverse outcome? Still some are not terminal questions, but chronic ones about a course of care for a disease that will not necessarily be fatal. How does the CKD patient want dialysis managed? In both cases, the choices must hold in tension a conflict central to care for the chronically and terminally ill: what is an appropriate level of invasiveness for care?

Underlying this essential question are two broader schools of thought about how we take care of the terminally or chronically ill. First is a curative paradigm, which simply posits that care should be administered to try and fix whatever seems to be going wrong. For my grandmother, that would have meant chemotherapy or a risky brain surgery to remove the tumor. For a patient with advanced heart failure that might mean a bypass surgery. The second paradigm is a noncurative approach, commonly referred to as palliative care. Palliative care is a treatment regimen that is primarily concerned with relieving the stress of a life-limiting illness for patients and their families, rather than pursuing invasive medical procedures. An example is hospice care—a subset of palliative care devoted specifically to

terminally ill patients in their final six months of life. These paradigms need not be mutually exclusive – we can palliate while attempting to cure – but in their difference they lead us to a central question: what do we want the end of our lives, or the course of our chronically ill lives, to look like?

About 17 years after my grandmother died, the New England Journal of Medicine published a study conducted

by Jennifer Temel and her colleagues at Massachusetts General Hospital that examined the effect of early palliative care on patients’ outcomes.

Patients in the study had recently been diagnosed with metastatic non-smallcell lung cancer, and were randomly assigned to receive early palliative care concurrently with their oncologic care or simply standard oncologic care.

After 12 weeks, Temel and her colleagues evaluated quality of life, among other outcomes, in both of the intervention groups. The group that received early palliative care had better quality of life, fewer symptoms of depression, and far less aggressive end-of-life care, consistent with the tenets of a palliative care model. Most shocking, however, was this: the palliative care patients lived longer.1 Patients who received an ostensibly less rigorous treatment regimen, with fewer invasive treatments and curative procedures, outlived patients who received more rigorous curative treatments by nearly three months.

Yet, while these survival results were striking, the results regarding quality

of life were not, broadly speaking, a tremendous deviation from palliative and hospice care narratives. Palliative care has been shown to improve patient functioning; hospice care programs have significantly improved patients’ mental and emotional quality of life; and some studies suggest that palliative and hospice care cost less.2,3,4

f

Eight in ten people who die in the United States are covered by Medicare, the government’s social insurance program for the elderly and long-term disabled.5 Death, therefore, and care at the end of life, is an inescapable reality for Medicare, which devotes nearly 25 percent of its spending to care in the final year of patient’s lives.6 For a social insurance program that is in the dying business, Medicare recognizes that it has an operational imperative to answer end-of-life care questions. To address the challenging decisions that patients face at the end of their lives, in 2009 Medicare sought to cover beneficiaries for a wide variety of end-of-life measures – livings wills, advance directives, consultations with physicians about end-of-life care – as a part of the Affordable Care Act. The result was a political firestorm that nearly derailed health reform altogether. Politicians across the nation followed Sarah Palin’s lead, denouncing the measure with raucous, unfounded cries of “death panels.” 7 Reimbursing doctors to talk with patients about dying – and about what mattered to those patients as they faced chronic illness or death – was off the table.

Some of this is a cultural question.

The United States is a can-do sort of place, where more is better and bigger is better. Our medical care is no exception – between 1993 and 2000, for example, the number of patients who visited the emergency room in their final month of life cleared 25 percent.8 By 2009, more than 26 percent of Medicare beneficiaries visited an intensive care unit in their final month of life.9 This list goes on.

Put simply, the United States is long overdue for an honest, difficult conversation about sickness and dying.

While modern medicine provides patients an unprecedented array of curative options, it is essential that patients are educated about the tenets

and availability of palliative regimens.

Why? Because though intensive care units (ICUs) perform remarkable, lifeextending operations on a regular basis, many patients reach a point where they desire more than just a prolonged lifespan.10 They desire increased quality of life through greater autonomy and time with the people they care about.

They desire a comfortable, familiar setting and relief from intense pain. For those with these desires, palliative care offers hope.

And though palliative care is often seen as throwing in the towel, this perception is deeply misguided because caregivers can palliate patients’ symptoms while still working hard to cure them. At Massachusetts General, Temel and colleagues’ treatment group received a palliative care regimen concurrently with curative care. Palliative care, therefore, doesn’t always mean conceding a fight. What it does mean is taking a hard look at what is important, what treatment is worth it, and deciding how to prioritize treatment when disease courses are long or even terminal. For some patients, the curative option is worth the effort, and they can elect symptom palliation alongside that as they see fit. For others, palliation alone is enough.

f

In October 2015, Medicare announced that it would cover beneficiaries’ endof-life conversations with physicians starting on January 1, 2016. Six years removed from the notorious cries of death panels that reverberated around the United States, the nation’s largest healthcare payer took a tremendous step towards reimbursing what seems like it should be one of the most fundamental tasks of medical professionals: talking to patients about what it means to die.

While this policy shift is an important step in the right direction, truly reforming considerations about care at the end of our lives will require more than reimbursements. It will require introspection and careful conversation with those we love, whether they be terminally ill or chronically so, about what writer and surgeon Atul

Gawande calls “medicine and what matters in the end.”

My grandmother lived for 10 months after she was diagnosed. She received home hospice care throughout that period, spending time with people she loved and cared for, her pain and symptoms managed by a hospice nurse.

In the end, she slipped into a coma and passed away comfortably in her home, about as good a death as it could have been. Her final 10 months were the type of time that every terminally ill patient with such end-of-life priorities deserves—pain managed, in the company of loved ones, and in a setting of her own choosing. It was the type of time afforded her by palliative, and, more specifically, hospice care.

Illness and death will never be easy, but that does not mean they need to be painful and out of touch with patients’ goals. Both can be made easier for our families, our friends, and our providers, the very people who will comfort us, spend time with us, and seek healing if we pass away. Facing these questions will always require difficult conversations with the people we love, but these are conversations that must be had, for they speak not only to the course of ourt physical health, but also to the types of people we strive to be and the lives we seek to live. In his book, Being Mortal, Gawande writes the following: “the battle of being mortal is the battle to maintain the integrity of one’s life – to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.”11 Palliative care is an ally in this battle for integrity. It promises respite from the burden of disease. It promises time with loved ones. And it promises a passionate commitment to the present.

Above all, palliative care promises life.

f

E

25%

of all Medicare spending is devoted to the final year of life12

18

I

magine a world in which every as well as costs: meat from factory time you tied your shoes, you farms is cheaper than meat from freecontributed to a process that range animals, often about half the resulted in the unintended price. This is partly because factory death of thousands of people around farms allow animals to occupy less the world.1 In this world, like ours, space, which makes their production shoelaces are useful: they save time, cheaper, and this savings is passed on are a little cheaper than using Velcro to consumers. ties, and more convenient than wearing slip-on shoes. But when everyone ties Deadly Viruses & Resistant Bacteria their shoes, lots of people die, and But despite the gains to some, the many more suffer. costs to everyone—those who consume This is a strange world to imagine, factory farmed meat, and those who do but it is a lot like the world we live in. not—are staggering. And the costs are The culprit isn’t tying shoelaces, of not reflected in the sticker price of meat course, but consuming factory farmed in supermarkets and at restaurants. meat. Factory farms are wicked places Some of these costs come in the form – one of the last bastions of legally of zoonotic viral infections, like Avian sanctioned cruelty toward animals. flu and Swine flu.2 These often lifeBut more than this, they are bad for threatening strains spread between human health. animals, and from non-human animals Raising animals to people. In fact, all FACTORY FARMS in densely packed forms of the influenza conditions requires ARE WICKED PLACES... virus that currently a steady dose us probably BUT MORE THAN THIS, infect of antibiotics to derive from our initial prevent infections THEY ARE BAD FOR domestication of that would animals about 10,000 HUMAN HEALTH. otherwise run years ago.3 But the rampant. Some antibiotics are given modern practice of packing animals to cattle and pigs to marginally together on factory farms creates ideal speed up their growth. The biological conditions for new strains to emerge mechanisms through which and spread between animals and antibiotics promote growth aren’t well people.4 understood, but they do seem to work.

Zoonotic viral infections are one There are at least two reasons factory kind of cost, but antibiotics are the main farmers feed their animals antibiotics: threat to human health from factory to speed growth and prevent infection. farming. Contrary to popular opinion, Like many practices, there are benefits the problem is not that antibiotics are

“

”

19

passed along from animals to people who eat them, and that this is bad for our health. Instead, the problem is that the more antibiotics we give to livestock, the more we encourage the emergence and spread of antibiotic resistant bacteria.

By using antibiotics unnecessarily, we are not usually creating new kinds of resistance, but instead encouraging pre-existing resistance mechanisms to spread between bacteria, and for those resistant bacteria to proliferate.

Let me explain. Eukaryotes, which include people, can evolve rapidly through sexual reproduction.

As strange as sex is—each of two independent organisms swapping their genes to create a hybrid—the bacterial equivalent is even kinkier than a San Francisco night club. Bacteria reproduce by cloning themselves, but they evolve throughout their lives by promiscuously swapping genes with other bacteria and by extracting genes from the viruses that parasitize them. This allows them to adapt to new environments quickly: in a lethal environment a small number of bacteria are likely to have some advantage over the trillions that die.

And this advantage comes either from a random genetic mutation, or from the lateral transfer of genes from one bacterium to another.

Some genes allow bacteria to fend off the antibiotics that plants, animals, and other bacteria use to destroy them.

These naturally occurring antibiotics

Jonathan Anomaly, Lecturer at Duke and Research Professor at UNC

have existed for billions of years, as people—over time, strains of bacteria part of an unending evolutionary that are resistant to antibiotics can arms race with bacteria. Like their spread through trade and travel naturally occurring cousins, synthetic among people, and through soil and antibiotics made in a lab usually streams around factory farms. involve penetrating a bacterial cell The problem has been studied for a wall and disrupting DNA synthesis, or long time, and for more than a decade otherwise slowing or stopping bacterial the European Union has banned reproduction. antibiotics for growth promotion All a bacterium farm animals, A COMMON WAY TO in needs to survive and tried to impose HANDLE COLLECTIVE minimal standards an antibiotic onslaught is some HARMS IS TO BAN OR that increase animal way to either block welfare and reduce TAX THEM. the penetration of the need to use antibiotics by building up a thick antibiotics. The US has begun to follow cell wall, degrading the chemical suit, driven by consumer demand for with enzymes, or pumping out the antibiotic-free meat, and FDA threats chemical if it penetrates their bodies. of regulation. But most developing Once that happens, it’s off to the countries are moving in the opposite races. The lucky bacterium multiplies direction, with explosive growth of rapidly and spreads its resistance to antibiotic use in both people and other bacteria. animals in China, India, Pakistan, On factory farms, once new Egypt, and most sub-Saharan African resistant strains of bacteria emerge, countries.6 they are passed along to farmers who work with animals, workers who Pricing Pollution slaughter animals, consumers who eat Genes that confer resistance to meat, and people in the more general antibiotics can be thought of as a form environment. of pollution in our common microbial We live in a bacterial world. The environment. This is true whether average person hosts about 40 trillion antibiotic resistant bacteria come from bacteria at any given time, and we factory farms or hospitals. Either way, constantly swap bacteria with each the spread of antibiotic resistance is other, and with the environment a byproduct of the widespread use of around us.5 So even though the antibiotics—especially when antibiotics overuse of antibiotics tends to affect are used at sub-therapeutic doses, which those closest to the source of resistant is enough to kill off most but not all of bacteria—whether animals or the bacteria they are used to destroy.

“

”

A common way to handle collective harms is to ban or tax them. If we taxed antibiotics at a high enough rate, farmers would have powerful incentives to change their practices.

This would increase the price of meat, but as most Americans know, it is not especially onerous to purchase meat from restaurants like Chipotle, which only buys meat from animals that are treated reasonably well and never given antibiotics.

One of the benefits of pollution taxes is that they encourage socially beneficial behavior, and send signals to entrepreneurs to come up with better ways of creating products that reduce prices and pollution. For many years, scientists have been working on producing “in vitro” meat made in a lab rather than raised in a barn. Laboratory meat can even be created to be more healthy than traditional meat. While some find this process creepy, imagine the vast amounts of suffering we could avoid if we could create meat from stem cells rather than by inefficiently raising and slaughtering walking slabs of meat that can feel pain, get sick, and spread disease.

Imagine a world free of unnecessary pain to animals, a world without Avian and Swine flu, a world in which we used antibiotics for people rather than squandering them on animals made sick by production practices that will make our descendants wince.7

E

20

THE

PERFORMANCE

L

arry pulled up in the WalMart parking lot in his 2000 Ford F-150. He patted down the green sequins on his dress and shoved in his dick just a little more, then put on his favorite lipstick from the dollar store—Shade 67: Confident.

He finished with a touch of lip gloss and looked in the rear-view mirror.

Did red lipstick really work with a green dress?

He pursed his lips and saw he’d left his mining helmet in the backseat.

Each day blurred into the next at the mines. He woke up at 4 o’clock, drove up the mountains, got his assignment for the day, and started plowing rocks into the surrounding valleys. The mountains he’d grown up on were all blown to bits, and that was his fault.

Gone were the days when he would spend his time hiking up the trails and searching for molly moochers or ginseng. He figured that was why he’d made his drag name “Nature’s Kiss.”

The four other drag queens eventually pulled up into the parking lot. Though Larry had only recently joined the group, the conversations invariably commenced in a similar fashion:

“GURL!”

“GURL!” “GURL!” “GURL!”

Larry was new to this and didn’t exactly know why the drag queens got so riled up when he used “he” to refer to one of the queens. Each time he messed up, they would holler at him to use “she” when they were in drag.

“Queens,” he said, “Y’all are slaying tonight!” He waved his right hand in a downward motion and threw his head back and forth before swatting Bebe Fire with his hair. “Nature’s Kiss, you trying to bring Willow Smith back?”

21

Jeff Feng, Trinity ’17

Mockingly, he—no, she—tossed her hair around and screamed off key: “I whip my hair back and forth. I whip my hair back and forth.”

“Let’s not, okayyy?” she said.

Larry folded his arms over his chest.

He scanned over Bebe Fire’s radiant, red dress and flicked one of his green sequins before averting his gaze.

Larry first met Bebe Fire and the other drag queens at the LGBT Center of Charleston. They had been doing drag at Wal-Mart awhile, just to have fun but also to emphasize that queers existed in West Virginia. One of the men worked at Wal-Mart and had talked with his co-workers who were okay with it as long as they only showed up at night. Doing drag in the middle of night seemed like the only way they could be rainbow and glitter outside of the Center. If he showed up with even one lick of makeup at the mines…

They got in formation and made their way towards the Wal-Mart entrance. Along the way, one driver drifting out of the lot honked. Larry jumped. He looked down at the ground, not wanting anyone, let alone another miner to see him. But how would anyone recognize him in his dress and makeup? Bebe Fire, in the meantime, just smiled, held up both middle fingers, and grabbed her fake boobs.

Once inside, they started to take their positions. Larry rushed to find his spot. Was it next to the iceberg lettuce or the green beans? Seeing everyone in position, Montana gave the signal, and Bebe Fire turned on her speakers to TLC’s “Waterfalls.” They strolled towards each other, keeping to the beat.

At the chorus, Larry slid towards the vegetables once more, but this time he slanted his head towards the floor, pursed his lips and swayed past the other queen. Finally, after going to Wal-

Mart as a drag queen several times, he was executing his part perfectly. Water droplets bounced off the produce while Larry lifted his arms, waved his hands, and, euphoric, licked his lips to taste “Confident.” He wrapped his arms around his hips before bending back to the floor while Bebe Fire repeated “Waterfall” on her speakers until the sprinkling system stopped.

Bebe Fire smacked Larry’s ass and whispered in his ear, “Yasss, Nature’s Kiss. What an entrance.

Your name sounds like an STI, but you almost make me want to have that.”

Larry grimaced.

“But now, you get to watch and learn from real royalty,” Bebe Fire said.

Larry ignored her and focused his attention on the beat of the next song.

Each of them lined up again before Bebe Fire sashayed down the middle of the frozen breakfast aisle. Larry was simply occupying space, silently watching as he always had. When Larry first met Bebe Fire at the Center, she was just the same and raved about her love for Foucault. As if she were delivering a sermon, her voice boomed in the room, with no one daring to interrupt her foray into Volumes 2 and 3 of the History of Sexuality. She had asked him what he thought, to which he could only stammer and agree to her thoughts. Clicking through the articles on

Out.com had never prepared the mountain and flashed his ID card.

One of them yelled “Don’t you him for such a discussion.

The security guard glanced cursorily see, you’re poisoning your own As Larry turned into at Larry’s face and waved him through. communities? How can you live with another aisle, he bumped He wound his way up and up the yourself?” into a man wearing the neon mountain to where they were going to “By providing for my family. I got orange and grey uniform start blasting. To his right, idle dozers enough money for a four wheeler, of surface miners. The man sat in a barren moonscape. To his left a flat-screen TV, and two cars, too,” gawked at him, and Larry was the last fully intact mountain Nathan yelled back. “That’s how.” quickly in the valley. His In an aside to Larry, he shook looked mining company his head and sighed, “Fucking tree ONE OF THEM away and had won the rights huggers. Dumb as shit.”

YELLED “DON’T darted to to the permit after a Larry paused, nodding slowly. the other lengthy battle with “Yeah. Fucking tree huggers.” He YOU SEE, YOU’RE end of env i ron ment a l i st s. stared at the folds of his orange and POISONING YOUR the aisle.

But, for now the grey uniform and occasionally bobbed OWN COMMUNITIES? mountain L a r r y soared his head while Nathan kept on.

HOW CAN YOU LIVE d i d n ’t above him, wrapped The protesters continued to chant. recognize in the arms of cool The wind was picking up and the WITH YOURSELF? him from wispy clouds, as lush protesters gripped the tree. Their long the mines, but then again and green as the landscape to the right hair scattered, twisting and turning everyone was kin in West was empty and grey. against the strong currents. One Virginia. He looked back and At the summit, Larry parked and woman pulled an additional pair of the man was still staring and saw a large crowd around a tree. Two pants over her jeans. Larry slipped his hadn’t moved. But at that environmentalists had set up a tent hands into his pants pockets and dug point, Bebe Fire made her in the canopy of the trees to protest the heel of his boot into the loosely entrance. She strode up to the permit and to slow the mining packed dirt, alternatively kicking up the man and gyrated to the company from completing the first dust and diverting his attention to the pop rock song playing on the step of clear cutting. The two women’s hair.

BY PROVIDING speakers before thrusting women were tied to each Na t h a n her butt in the air repeatedly. other and the tree. Dozens of FOR MY FAMILY. chuckled and The miner backed up against idle dozers sat a couple yards shook his head. the fridge. He left an imprint in front of the protesters. Some of the “Say, man. It’s been a crazy week. My on the door, obscuring the miners had megaphones to heckle pal Lee texted me this morning about bright and varied Ben & the protesters whenever they weren’t these homos running around WalJerry’s flavors. The man, chanting. Larry glanced around, to Mart in dresses,” he said. enraged, quickly stormed make sure the miner from last night Larry touched his face as if to make away as Bebe Fire continued wasn’t there and spotted a coworker, sure he’d removed all his make-up and to blow kisses at him.

Nathan, among the people hollering at tugged at his uniform to get some more The other queens started the protesters to give up. Nathan had air on his body. Nathan was looking giggling. Any time a miner been there when Larry first started at him, so Larry laughed softly and or man stared longer working surface. nodded again. than a couple seconds, Larry knew that Nathan took “Fucking Obama and his War on Bebe Fire would dance it on himself to be at every single Coal funding this shit,” Nathan said. around the spectators demonstration as a counter-protester in “Fags getting to run around and until she embarrassed support of the mines. At the most recent protestors screaming every single them into leaving. Any protest, his wife had gotten in a scuffle goddamn week.” such encounter also had with one of the environmentalists.

Larry laughed again and stared the effect of driving Larry Over the years, Larry heard Nathan at the two environmentalists, who away, too. He started to go screaming he would “send you to hell continued to chant. At nightfall, they towards the exit. myself” and “fucking kill you tree would probably pull out their sleeping Larry finally reached huggers.” Like almost everyone else, bags and subsist on the packaged food his car, jumped in, and though, he was all talk. It was bullshit. they had lugged up the tree. These two jolted out of the parking lot Larry couldn’t imagine Nathan outsiders were literally locked in for a as fast as he could. actually up and getting his shotgun. long haul, despite never having hunted But Nathan still believed he’d scare the or walked in the mountains like Larry he next protesters from ever coming back to had. At least they had each other. m o r n i n g , his holler.

Larry pulled “Stop Mountaintop Removal!” The “They has balls,” Nathan said. “I’ll up to the protesters chanted. “Stop Mountaintop give them that.” security gate at the base of Removal!”

“

”

“

T

”

E

22

women should | women should stay silent women should be raped women should be obedient women should get offline

HITTING BACKSPACE THE

Freedom of Speech and Sexism Online

T

he summer I set out to study the ethics of cyber harassment was also the summer that everyone else started thinking about it too. It was June 2015, just the second week of my research. Google had just announced they would remove revenge porn from its search results, and then John Oliver focused the June 21st broadcast of HBO's Last Week Tonight on explaining revenge porn, and cyber harassment generally.

Google’s ban on revenge porn was huge on its own: the biggest image search engine now removes revenge porn – the sexually graphic images of women that were posted without their consent. When Oliver covers a story, things may not get done immediately, but they do get talked about.1 Cyber harassment is best understood through examples.

Ironically, a great example is the comment section of the aforementioned John Oliver’s online harassment YouTube video. 2 Oliver

23

explained that men insult, degrade, and hypersexualize women. The commenters justified this hate as an exercise of free speech, claiming that they were protected under the principle of liberty. The only difference between these comments and most instances of cyber harassment is that Oliver serves simply as the middleman. Cyber harassment follows the general form of a man insulting or degrading a woman and then justifying it under free speech.

The harassment fits a larger trend of gender violence, which Rebecca Solnit articulates in her book Men Explain Things to Me. 3 Solnit connects incidents of violence against women that are typically spoken about in isolation: rape, sexual assault, domestic violence, etc. She writes, “Violence is one way to silence

Alex Zrenner, Trinity ‘17

people, to deny their voice and their credibility, to assert your right to control over their right to exist.” She writes about the struggle of women to speak and to be heard. She argued violence against women is used by men to control and silence women.

According to Solnit, men feel entitled to their power, and specifically their power over women.

Consider the fact that women were, and in some places are, the property of their fathers or husbands. You have ownership of and control over your proper t y.

Men have (or had) ownership and control of women. When men feel that their power over women is threatened – a woman says or does something that the man finds unacceptable – they use violence to regain that power.

A phenomenal example of the trend Solnit identifies is the #YesAllWomen viral hashtag. The catalyst for the #YesAllWomen campaign was the stated motives of the UC Santa Barbara shooter from May 2014.4 The shooter justified murdering six people and injuring fourteen others because women were not romantically interested in him. At the heart of his justification is that he did not receive the women to whom he was entitled, so he killed them for rejecting him. Not only is male entitlement to women’s bodies demeaning, it is also dangerous for those women who do not submit.

Then women decide to go online.

They begin to voice thoughts that make some men uncomfortable. They said, publicly for all to hear, “Yes all women face this threat of violence.

Yes all women are afraid that a man will harm them.” The women were forcing men to acknowledge the violent system of power in which men are implicated and from which they likely benefit.

I get it: acknowledging privilege sucks. We all want to believe that we are good people who don’t harm others. While some men are able to handle the reality of this system and stop contributing to it, others do not and lash out online.

Gendered cyber harassment, using Solnit’s words, is “trying

experienced online:

to silence and punish women for claiming their voice, power and the right to participate.” If women stopped talking about male entitlement or privilege, men wouldn’t have to change.

The counterargument about cyber harassment is that it is just speech, and as such cannot be restricted.

The obvious justification is the

“

Cyber harassment is not simply the act of holding an offensive opinion.

Cyber harassment is men, who are empowered, acting on an offensive opinion to silence women. Luckily, Mill comes to the rescue. He warned: “There needs protection also against the tyranny of the prevailing opinion and feeling; against the tendency of society to impose, by other means

NOT ONLY IS MALE ENTITLEMENT TO WOMEN'S BODIES DEMEANING, IT IS ALSO DANGEROUS FOR THOSE WOMEN WHO DO NOT SUBMIT. THEN WOMEN DECIDE TO GO ONLINE.

First Amendment: “Congress shall make no law abridging… freedom of speech.” Well, since Congress has not outlawed sexist speech, the truly relevant principle in question is liberty in a society. The United States is a liberal society, which brings us to John Stuart Mill.

Mill argued for his vision of a liberal society in On Liberty. 5 The fundamental argument is that government and society cannot restrict an individual’s thoughts and can only restrict their actions when it impedes the liberty of another person. With regard to the difference of opinion between two people, he wrote, “There is no parity between the feeling of a person for his own opinion, and the feeling of another who is offended at his holding it.”

Essentially, if you are offended, that is your problem. Taking offense does not directly impede upon your liberty.

”

than civil penalties, its own ideas and practices as rules of conduct on those who dissent from them.”

Mill argued that the right of the disempowered to speak and express ideas must be protected against both the government and the empowered.

Sexist speech is unacceptable when it is used to silence women.

Freedom of speech is complex and nuanced. It demands more than uncontextualized quotes. So the next time someone mansplains Mill to justify hate speech, I will recite Mill’s The Subjection of Women—in its entirety—to provide the necessary context.

Author's note: *#YesAllWomen knows not “all men” are violent, sexist time bombs. #YesAllWomen is about a system of privilege from which all men benefit.

Also, this system of privilege can be harmful to men.

E

27% 22% 6%

called offensive names

purposefully embarrassed

sexually harassed

Source: Pew Research Center

24

MEET THE TEAM LEADERSHIP

AMANDA LEWELLYN

ALEX ZRENNER

GAUTAM CHEBROLU

TOMMY KLUG

T'17

T'17

P'17

T'18

EDITOR IN CHIEF

EDITOR IN CHIEF

DESIGN HEAD

DESIGN HEAD

DESIGN

HAL LIN

P'20

CLAYTON DELP

T'20

EDITING

KAT HEFTER

P'20

25

DAVID WOHLEVER SÁNCHEZ

T'19

LUCY DONG

T'20

BONNIE WYATT

T'20

SOURCES

CITATIONS

“Reporter’s Notebook” - Golla 1. Wainaina, Binyavanga. "How to Write About Africa." Granta. N.p., 19 Jan. 2016. Web. 2. Gettleman, Jeffrey. "Africa Rising? Africa Reeling May Be More Fitting Now." New York Times. N.p., 17 Oct. 2016. Web. “Sound (and) Policy” - Renda 1. Lazear, Edward. "Economic Imperialism." The Quarterly Journal of Economics 115.1 (2000): 99-146.

Print.

2. See Contreras and Arp’s work: http:// dividedbythesea.com 3. Music from Renda’s upcoming documentary: https://soundcloud.com/andrea-renda-1/sets/ songs-for-just-a-river/s-FooM 4. See De Pecini’s work: http://www.giorgiocosulich.it/ 5. See Figueredo’s paintings: https://facebook.com/ rodrigofigueredoart/ “Numbers, Ethics, and Saving Lives” - WohleverSánchez 1. McKeever, Brice. "The Nonprofit Sector in Brief 2015: Public Charities, Giving, and Volunteering."

Urban Institute. Urban Institute, 10 June 2016. Web. 2. Eisenberg, Richard. "How To Make A Real Difference Giving To Charity." Forbes. Forbes Magazine, 4 May 2015. Web. 3. See more: https://againstmalaria.com 4. See more: https://www.imperial.ac.uk/ schistosomiasis-control-initiative 5. See more: https://givedirectly.org 6. Penley, Paul. "How to Evaluate Charity Impact."

Intelligent Philanthropy. Excellence in Giving, 31 Oct. 2012. Web. 7. Perry, Suzanne. "1 in 3 Americans Lacks Faith in Charities, Chronicle Poll Finds." The Chronicle of Philanthropy. The Chronicle of Philanthropy, 05 Oct. 2015. Web. 8. "Giving Statistics : Charity Navigator." Charity Navigator. N.p., 2016. Web. 9. "Your Dollar Goes Further Overseas | GiveWell."

GiveWell. The Clear Fund, n.d. Web. 10. "WHO | Metrics: Disability-Adjusted Life Year (DALY)." WHO. World Health Organization, 2016.

Web. 11. Ord, Toby. "The Moral Imperative Towards Costeffectiveness." Effective Altruism Forum. Effective Altruism Forum, 9 Sept. 2014. Web. 12. See more: http://givewell.org 13. See more: https://againstmalaria.com 14. See more: https://www.imperial.ac.uk/ schistosomiasis-control-initiative 15. See more: https://evidenceaction.org/ de wor mt he world /#t he - s olut ion - a - si mple treatment 16. See more: https://givedirectly.org “Success of the Second Sex” - George 1. Design for a Duchess serial, 1942.

2. President Keohane Records. Duke University Archives.

3. Emily Grey (Chair, Duke Inquiries in Gender), in discussion with the author, June 2016.

4. Duke Inquiries in Gender Report. 2003. Duke University Archives, Baldwin Scholars Records.

5. Duke Inquiries in Gender Report. 2003.

6. Nannerl Keohane. 2003. Women’s Initiative Report. Duke University Archives.

7. Discussion with Donna Lisker.

8. Colleen Scott (Baldwin Scholars Program Director, Duke University), in discussion with the author, June 2016.

9. Discussion with Donna Lisker.

10. Discussion with Colleen Scott.

11. Nina Chen (Duke University undergraduate and current Baldwin Scholar), in discussion with the author, June 2016.

12. Discussion with Colleen Scott.

13. Discussion with Donna Lisker.

14. Discussion with Emily Grey.

15. Discussion with Donna Lisker.

16. Duke Student Affairs. 2016. The Penny Pilgram George Women's Leadership Initiative.

“Is Human Rights Activism Ethnocentric?” - Shen 1. Donnelly, Jack. "The Relative Universality of Human Rights." Human Rights Quarterly 29.2 (2007): 281-306. Print..

2. Bell, Daniel. The China Model: Political Meritocracy and the Limits of Democracy. Princeton: Princeton UP, 2015. Print.

3. Sin, To-chʻŏl. Confucianism and Democratization in East Asia. New York: Cambridge UP, 2012. Print.

“Difficult Choices” - Peterson 1. Temel, Jennifer S., Joseph A. Greer, Alona Muzikansky, Emily R. Gallagher, Sonal Admane, Vicki A. Jackson, Constance M. Dahlin, Craig D. Blinderman, Juliet Jacobsen, William F. Pirl, J. Andrew Billings, and Thomas J. Lynch. "Early Palliative Care for Patients with Metastatic Non– Small-Cell Lung Cancer." New England Journal of Medicine 363.8 (2010): 733-42. Web. 2. Donald H. Taylor, Jr, Janet Bull, Xiaoyin Zhong, Greg Samsa, and Amy P. Abernethy. Journal of Palliative Medicine. October 2013, 16(10): 1227-1231. doi:10.1089/jpm.2013.0040.

3. Stephen Dyar, Mary Lesperance, Robert Shannon, Jeff Sloan, and Gerardo Colon-Otero. Journal of Palliative Medicine. July 2012, 15(8): 890-895. doi:10.1089/jpm.2012.0014.

4. Morrison, R. S., J. Dietrich, S. Ladwig, T. Quill, J. Sacco, J. Tangeman, and D. E. Meier. "Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries." Health Affairs 30.3 (2011): 454-63. Web. 5. Cubanski, Juliette, Tricia Neuman, Shannon Griffin, and Anthony Damico. "Medicare Spending at the End of Life: A Snapshot of Beneficiaries Who Died in 2014 and the Cost of Their Care." Kaiser Family Foundation - Health Policy Research, Analysis, Polling, Facts, Data and Journalism. N.p., 14 July 2016.

Web. 6. Riley, Gerald F., and James D. Lubitz. "Long-Term Trends in Medicare Payments in the Last Year of Life." Health Services Research 45.2 (2010): 565-76. Web. 7. Holan, Angie Drobnic. "PolitiFact's Lie of the Year: 'Death Panels'" PolitiFact. N.p., 18 Dec. 2009. Web. 8. Earle, C. C., M. B. Landrum, J. M. Souza, B. A. Neville, J. C. Weeks, and J. Z. Ayanian.

"Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?" Journal of Clinical Oncology 26.23 (2008): 3860-866. Web. 9. Teno JM, Gozalo PL, Bynum JPW, Leland NE, Miller SC, Morden NE, Scupp T, Goodman DC, Mor V. “Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009.” JAMA. 2013;309(5):470-477. doi:10.1001/ jama.2012.207624 10. Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. “Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers.”

JAMA. 2000;284(19):2476-2482. doi:10.1001/jama.284.19.2476 11. Gawande, Atul. Being Mortal: Medicine and What Matters in the End. New York: Metropolitan , Henry Holt, 2014. Print.

12. Pianin, Eric. “Why 4% of Patients Consume 25% of Medicare Spending”. FiscalTimes. N.p., 15 Jul. 2016. Web. “Factory Farming and Collective Harm” - Anomaly 1. For the best recent estimates of deaths and other health costs from antibiotic resistant bacteria, see Jim O’Neill et al, 2016, Tackling DrugResistant Infections Globally: Final Report and Recommendations in The Review on Antimicrobial Resistance: https://amr-review.org/ 2. For the latest WHO assessment of the threat of zoonotic viral infections, see this summary report: ht t p: // who. i nt /i n f lue n z a / hu m a n _ a n i m a l _ i nt e r face / I n f lue n z a _ Su m m a r y _ I R A _ H A _ interface_06_13_2016.pdf 3. Dorothy Crawford, 2000, The Invisible Enemy: A Natural History of Viruses. Oxford University Press.

4. Greger, M, 2007, The Human/Animal Interface: Emergence and Resurgence of Zoonotic Infectious Diseases in Critical Reviews in Microbiology, 33, 243–299: http://all-creatures.org/articles/argreger-emergence.pdf 5. Ron Sender et al, 2016, Revised estimates for the number of human and bacterial cells in the body in BioRxiv pre-publication preview: http://dx.doi.org/10.1101/036103 6. Thomas van Boeckel et al, 2015, Global Trends in Antimicrobial Use in Food Animals, PNAS, 112(18): 5649–5654: http://pnas.org/content/112/18/5649.abstract 7. The main ideas in this essay come from two of my recent publications: (1) Jonny Anomaly, 2015, What’s Wrong with Factory Farming?, Public Health Ethics 8(3): 246-254: https://philpapers.org/ archive/ANOWWW.pdf (2) Jonny Anomaly, 2017, Ethics, Antibiotics, and Public Policy, Georgetown Journal of Law and Public Policy (forthcoming): https://philpapers.org/archive/ANOEAA.pdf “Hitting the Backspace” - Zrenner 1. Felder, Adam. "The Limits of the Late-Night Comedy Takedown." The Atlantic. Atlantic Media Company, 17 Apr. 2016. Web. 2. See more: https://youtube.com/watch?v=PuNIwYsz7PI 3. Solnit, Rebecca, and Ana Teresa Fernandez. Men Explain Things to Me. Chicago, IL: Haymarket, 2014.

Print.

4. Feeney, Nolan. "The Most Powerful #YesAllWomen Tweets." Time. Time, 15 May 2014. Web. 5. Mill, John Stuart, and David Spitz. On Liberty.

New York: Norton, 1975. Print.

IMAGE CREDITS

Cover and pp. 3-4 images courtesy of Rajiv Golla p. 8 UNHCR. "Mediterranean Sea Arrivals- Regional Overview", 31 Dec. 2015. Web. p. 10 The Life You Can Save. "Ten Reasons Why People Don't Give to Charity". 18 Aug. 2016. Web. p. 15 courtesy of Kyodo News p. 17 courtesy of AmazingBeautifulWorld.com pp. 19-20 courtesy of Darlene Genoway p. 23 UN WOMEN. "UN WOMEN Search Engine Ad Campaign". 16 Oct. 2013. Web.

26

Celebrating 20 Years