Trauma–Not good.

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Another fascinating mini-series by Dr. Bossypants is about to begin. Que: Dancing in the streets.

In upcoming blogs, we’ll examine an important and ubiquitous part of being human—stress and trauma. Dr. Bossypants believes that we are in a most precarious position in human history. Sure, we’ve always had wars, violence, sexual abuse, psychopaths, and natural disasters to deal with. Some of our fellow humans have these things for breakfast every day. This does not mean we should normalize suffering, nor any of these precipitators of suffering. In fact, it is time we get serious about eliminating sources of suffering and trauma.

True, we’ve always had war, and killing. But we haven’t always had nuclear weapons, nor have we had the glorious but potentially deadly Internet, nor the other technologies and forms of travel now readily available. Methinks we had better grow up fast here people. Fast indeed. The devastating degradation or complete annihilation of the planet and humans dwelling upon it is in play.

So we begin by examining responses to trauma:

Psychologists have a checkered history when it comes to assessing and addressing the effects of stress and trauma on human functioning. Dr. Bossypants has had significant professional exposure to these issues and, to no one’s surprise, strong beliefs as well.

Defining trauma is difficult and fraught with political and financial motivations that, when examined, are sickening. We, people and governments alike, want to pretend that trauma doesn’t exist, or that inflicting it has no cost.

The word itself comes from a Greek word that means “wound.” To be human is to wound and be wounded. But to be human is to also have choices, and assess consequences. We want what we want, and, tragically, we don’t want to be told that what we want might hurt others, or even cause long-term devastation.

For instance, though some of us may be loathe to bring him up, we must note that Sigmund Freud initially recognized and wrote about the tremendous wounds inflicted on women who were sexually abused. The (white, male, privileged) scorn heaped upon him for these astute observations precipitated a breakdown of sorts, and a recanting of his findings. For this, and many other wrong-headed actions and notions, Dr. Bossypants is not a big fan of Freud.

We will discuss the ubiquitous occurrences of sexual assault in later posts. We only note it here to say that humans are quite resistant to admitting the costs of trauma. Dr. Bossypants hopes to hammer this home in upcoming blogs. But for now, let’s move to the cheery subject of war and related forms of domination.

War is a common preoccupation of those who’ve ascended to power in human communities. It has, until recently, required boots on the ground. Boots with real human feet in them, and real deadly weapons strapped across their real, human hearts. The act of killing a fellow human being, or having a fellow human being try to kill you is traumatic. Period. It is not a sign of weakness or inadequacy to be traumatized by killing. In fact, if killing another human being is not traumatic for the one who kills, then something is wrong. We do not want to pathologize tender, caring, emotionally-mature human beings. Those who kill without pain and remorse are the aberrations of our species, and they need help and/or containment.

Dr. Bossypants isn’t being clear, here’s a summary. For the psychologically healthy soldier, war (of all sorts) is traumatic. This does not mean that that all soldiers will develop post-traumatic stress disorder, but many will. Rightly so. It is a terrible thing to kill other human beings and not feel a thing, even though we have many movies and television shows that would have us believe otherwise. For the general health and evolutionary development of our species, war is to be avoided. We need to go upstream.

In the USA, we are wildly privileged, wealthy, well-fed, lovely people. We need to win hearts and minds by being wise, generous, involved, honest, and fair. We need to embrace liberty and compassion for all, knowing we will get hatred in return for some time to come—there are many, many toxins that stay in the psyche for generations after war, violence, starvation, rape, theft, and brutality have been visited upon a community. But here’s the truth: Violence begets violence. Harsh judgment begets harsh judgment. Selfishness and greed beget selfishness and greed. We will harvest (or be harvested) by what we sow. Without significant healing and maturity, this is a psychological truth.

Therefore, we have to get smarter, kinder, and more generous. This is difficult, because we, too, have been traumatized. We are frightened and have become selfish—even greedy. But this is what Dr. Bossypants believes: We can acknowledge our pain, our own failings, and our woundedness. We can find the moral fiber to choose something besides endless repetitions of human mistakes. We need to open our borders intelligently, feed hungry people creatively, honor other people’s needs and beliefs, and do our best to contain the violence that is simmering near the boiling point on this beautiful planet. Otherwise, I think it will not be long before the planet will be rid of us, and get to heal itself without the pesky human beings now dwelling here.

 

 

 

 

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Bossiness on Healthcare

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A roving reporter chanced upon Dr. Bossypants and did a quick interview for our edification.

Q:        For our listening audience, could you tell us by what authority does Dr. Bossypants issue her edicts?

A:       Yes. Here is an abbreviated list:

  • Some people like her.
  • She has a two masters degrees and a doctorate from an accredited institution of higher learning.
  • She was a professor for 24 years, and had the good sense to retire in a timely way.
  • She’s stayed alive and in shape for many decades, produced lovely children, marrying only twice, with the second attempt lasting over thirty years and counting.
  • She has faced a deadly disease.
  • She grows a fine garden and eats healthy food.
  • She thinks she knows what’s best, but she tries to be reasonable.
  • And, as mentioned above, some people like her.

Q:        What does Dr. Bossypants have for us to consider today?

A:        The topic for today, dear readers, is greed, government, and healthcare.

Q:        Well then, hmmm. What does Dr. Bossypants have to say about these important topics?

A:        Listen up, people. Dr. Bossypants has been a keen observer of human nature for many years. Humans are greedy. We don’t have to be, but most of us are. And corporations (posing as people, or not) are greedier. We all need some limits.

If you think, for one minute, that medical insurance companies have the health of those they cover at heart, you’re a fool. Admittedly, government is a clumsy expression of the common good. It functions only insofar as those comprising the “common” take responsibility and stay involved. Yes, Medicaid and Medicare are fraught with fraud and tomfoolery. All human institutions suffer from such. But the profit-motive in healthcare needs to be removed or minimized.

And yes, as humans, we will err. It’s better to err on the side of the collective good than on the side of making the rich richer. Eventually, things get top-heavy and dynasties topple. Dr. Bossypants hastens to assure everyone that toppling is something to avoid. Middle-class is a good, good thing. Trust us on this, dear reader.

Q:        So Dr. Bossypants thinks a single-payer medical system is the way to go?

A:        Basically, yes. Dr. Bossypants is not an economist, but she suspects in the long run, Medicare for all will cost less in taxes than random and inadequate emergency care provided to the poor and uninsured.

It is to a society’s advantage to attend to the health of its citizens. Healthy people are smarter people. They work more. They take better care of their offspring. They are happier. Of course, there are limits to what should be provided, but we can figure that out.

Q:        Where would Dr. Bossypants draw that line?

A:        Cosmetic surgeries that are for appearance only. People need to pay for their own hair implants or facelifts. Also, we need to pull back from excessive medical testing, when whatever the results are, we can’t fix it anyway. These are a couple that come to mind. Dr. Bossypants has a tiny modicum of faith in the collective wisdom of ethically-minded professionals who can develop these difficult guidelines. But the basics of health care should be provided collectively, by all of us, paying taxes. Period. First things first.

Q:        What are “first things,” Dr. B?

A:        Full availability of primary care, nutritional education, preventative care, emergency services, life-saving surgeries and treatments, every possible form of birth control, sex education, (K through graduate school), abortion for those who do not wish to bear a child, fantastic prenatal and postnatal care for all who do wish to bear a child, basic dental care, basic mental health care, and support and education for those who choose to smoke or are obese, to name a few. But I would defer to the collective wisdom of an appointed team—a team absolutely and completely stripped of any chance to benefit monetarily from the decisions the team needs to make.

Q:        My, you’re judgmental and a bit nasty.

A:        Indeed. And hopelessly optimistic. We can do this, people. We can. We do it fairly well for soldiers and those imprisoned, and my yes, for those in congress. We CAN do it for the rest of us.

Cue, here, the maniacal laughter necessary for such situations.

 

Ethics. Bioethics. Health Care. Oh My.

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Being human, we’re accustomed to eating contradictions for breakfast. Even if we eat little else. We intend to behave quite a bit better than we usually do, and we squabble over what it means to be moral, or to live a good, fulfilling, worthy life.

Even if we agree on a moral rule, or make a law, we might observe the rule or obey the law for radically different reasons, or break the law for reasons we believe to be moral. Yes, indeed, dear readers. Dr. Bossypants knows it’s difficult to sort this all out, even though she has tried mightily to blog about morality and ethics in a most intriguing and approachable manner. Now, we have one more lens through which we might view moral decision-making, and then a bit of a summary, so those of you determined to put these ethical thoughts into ethical actions might do so. Right away. Please.

In the late 1970s, bioethics became a recognized specialty as hospitals and healthcare providers grappled with ethical decision-making in the increasingly contentious, conflicted, expensive world of healthcare.

Tom Beauchamp and James Childress identified four  guiding principles in the first edition of their influential book Principles of Biomedical Ethics:

  • Autonomy (Human beings should have authority over decisions affecting their health and well-being.)
  • Beneficence (Decisions should be made on the basis of doing good and being of help to others.)
  • Nonmaleficence (People should strive to do no unjustified harm.)
  • Justice (All people should be treated equally and benefits and burdens should be distributed fairly.)

Principles don’t offer concrete answers, but provide a framework to begin the hard work of ethical decision-making in the face of competing needs and limited resources.

Robert Bellah said “Cultures are dramatic conversations about things that matter to their participants.”

Listen, dear readers. Right now, we are engaged in a monumental conversation in our culture. We’re talking health care. Is it a basic human right? If so, how much health care should we make available in a world of apparently limited resources? Who should profit in the provision of health care, and how much profit is justified? Who should pay, and how should that duty be distributed?

Should we provide abortions to those who do not wish to be pregnant? Should we provide viagra to those who wish to have a pharmaceutically-assisted erection? Should we provide a means by which someone suffering, or near death, could choose to die with medical assistance? Oh, the inflammatory and politically-loaded questions just go on and on. They require deep thought. They require wisdom. These matters are seething with ethical quandaries.

Kant reminds us we should never treat people as a means to an end, nor deny anyone rights we would wish for ourselves.

John Stuart Mill reminds us we should choose paths, practices, and laws that insure the greatest possible good (health) for the greatest number.

Aristotle urges us to find the golden mean, the balancing point between excesses. And to be generous, courageous, and prudent.

Feminists remind us of the huge, destructive problems that arise when power is used to abuse others, to deny basic rights, and to enrich the already-rich.

Those who practice relationship-inclusive ethics remind us that we must always consider the direct impact of our actions–and our goal should be to take the most compassionate action possible.

The bioethicists offer us principles to consider, though admittedly these principles might actually conflict with each other sometimes.

We do not live in a perfect world. It is our job to make it better, not to give up in anger or despair. The ability to reason, converse, and find common ground is a human attribute we should treasure. Courage, dear ones. Be good people.

Ethics of Care

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Dr. Bossypants wrote much of this blog some years ago. Clearly, it has not changed the course of history yet. But onward, dear readers. Ever onward. Western ethical theories have been said to be driven by concern for individual rights, rather than informed by the intricacies of human relationships. Originally dubbed “feminist ethics,” the addition of a relationally-oriented moral viewpoint was ushered into Western view primarily by the work of Carol Gilligan. Gilligan worked with Lawrence Kohlberg, famous for his hypothesized six stages of moral development. Subjects in Kohlberg’s research had most often been boys.

In early studies that included girls, Kohlberg and associates found that girls were scoring statistically lower than boys in terms of moral development on their measures. This intrigued Carol Gilligan, and thus her groundbreaking research began. She and her research team conducted interviews with young women to better understand the moral substance of their reasoning and choices. She reported this research in her bestselling book, In a different voice.  Although her work opened new avenues in ethical reasoning and research, ironically, the original assumption of a difference between boys and girls, like many such assumptions, turned out to be false! Males and females attend to justice concerns at roughly equal levels in most research projects. Further, more current research shows that all adults make moral choices inconsistently, depending on the dilemma, and each person’s social and personal goals in that moment.

Care ethics argues that moral decision-making should directly include concern for others and their well-being. Emotions of love, compassion, and empathy motivate us toward the care of others, thereby enhancing the relationships around us, and Dr. Bossypants would argue, the general condition of humankind. Those who advocate care ethics draw sharp distinctions between care reasoning and the approach reflected in Kohlberg’s work, called justice reasoning.  Propensities toward one or the other orientation were initially purported to fall along gender lines, but in fact, males can be morally guided by concern for relationships and the welfare of others, and females by concepts of justice.

Joan Tronto  wrote, “Care itself is not gendered.  Care is a species activity that includes everything we do to maintain, continue, and repair our world, so that we can live in it as well as possible.”

Care ethics place relationship in the center of the moral vision. Ecofeminist theorist, Karen Warren, stated:

If we dare to care, if we dare to enter into community with others through an honest recognition of our commonalities and differences, we will be poised to create generally respectful, nonviolent, care-based, intentional communities where commonalities and differences are just that . . . Such intentional communities are a creative alternative to violence-prone communities where order is imposed from outside through unjustified domination.

Western philosophical orientations are generally far more individualistic than Asian, African, and American Indian orientations.  Dr. Bossypants is worried that Western dominant culture is continuing on paths toward greater individualism, isolation, and commodified, single-purpose relationships, rather than communally-oriented and traditional, complex relationships.  Writer Jeremy Rifkin reflects on the moral power of traditional communities:

Membership in traditional communities also brings with it restraints on personal action.  Obligations to others take precedence over personal whims, and security flows from being embedded in a larger social organism. Commodified relationships, on the other hand, are instrumental in nature.  The only glue that holds them together is the transaction price.

Care ethics offers a moral alternative to an over-emphasis on individual notions of fairness and justice. It is centered both on immediate relationships and on the tapestry of relationships that extends to people of other races, creeds, and nations–and further, to all living things.

To understand how the tension between responsibilities and rights sustains the dialectic of human development is to see the integrity of two disparate modes of experience that are in the end connected.

While an ethic of justice proceeds from the premise of equality—that everyone should be treated the same, an ethic of care rests on the premise of nonviolence—that no one’s rights should be trampled, no one should be hurt. In the morally mature adult, both perspectives converge in the realization that just as inequality adversely affects both parties in an unequal relationship, acts of violence harm everyone involved. Mercy and justice are not mutually exclusive, people. We can do this. We can.

 

The Feminist Critique

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As faithful readers of Dr. Bossypant’s blogs, you may not realize how much restraint she has used writing about the moral/ethical information she has posted thus far. Regardless of the disparate views on ethics and morality summarized to this point, most originally shared a glaring omission. With the exception of the writings of John Stuart Mill, females were ignored, maligned, or “feminine virtue” was defined as women performing well in assigned positions of less influence and authority than their male counterparts. Aristotle believed that females were defective males, and punishment for doing badly as a man might be to come back as a female next time.

Taking his cue from Aristotle, St. Thomas of Aquinas wrote that in women, “reason flourishes very little because of the imperfect nature of their body.”  Freud believed that women lacked superego development, and were therefore morally inferior. Oh, sadly, there’s no shortage of such examples from religious and philosophical writings. For thousands of years with few exceptions, it has been morally permissible, or morally encouraged, to view and treat women as second-class, adjunct, inferior, and/or subjugated to men. As they say these days, Oh.My.God. What a load of hierarchical, wrong-headed bunk.

The truth is, since humans have been scratching ideas out on cave walls, women have been writing moral philosophy and psychology, often from a starting point very different from their male colleagues. But unless you take a course in the history of feminist ethics, the brilliant voices of these philosophers: Sappho, Hypatia, Hildegard, Heloise, Wollstonecraft, Harriet Taylor Mill, and Charlotte Perkins Gilman (to name but a few) are likely unfamiliar to you.

Of course, the current versions of the main ethical positions we’ve gone over in previous blogs have become, at least on the surface, gender-neutral. All humans are supposedly included. Further, feminist theorists and ethicists increasingly have a voice in the critique and evolution of moral philosophy.  And arising from Carol Gilligan’s pioneering research and thinking, feminists have added yet another lens through which we can explore and pursue moral lives. We’ll cover that one in the next blog, but for now, let’s consider…

The Feminist Critique

Over thirteen years ago, Harriet Woods wrote:

It is true that we still are far from fully represented in decision-making bodies and that politics remain a male game; but that’s no excuse for failing to use the power we have to make this a more livable world.

Dr. Bossypants is very disappointed to report that we still have a great deal of work to do to make this a more livable world.

In a word, the feminist critique of most traditional theories of morality is power.  Margaret Urban Walker wrote, “The most obvious way feminist ethics and politics connect morality and power is in examining the morality of specific distributions and exercises of power.”

The moral use of power is a complicated endeavor. This may come as a shock to you, but we don’t tend to select leaders based on their overall moral fiber. In an ideal world, those entrusted with power would be the more virtuous among us, and thereby freer from corruption, bias, and self-serving practices. The reality with which most of us are familiar is quite the opposite. The more power someone has to influence others and the social order, the more susceptible they become to misuse of the power.

Access to shared power is a global moral issue. In Beijing, at the UN Conference for women in 1995, Madeleine Albright stated, “Enter any community in any country, and you will find women insisting—often at great risk—on their right to an equal voice and equal access to the levers of power.” Still true. Still tragically costly. Holy ****, so very, very costly. Ok. Calm down, Dr. Bossypants. Social change take a very long time, requiring enormous sacrifice, enduring many regressions and backlashes….

So, dear reader, what is your experience with and attitude toward power? Have you seen individuals wield power in mostly positive ways or mostly negative ways? The need for power (or recognition or achievement) is a natural human need. Is it possible that racism, sexism, and all the other “isms” originate in the fear of loss of power? What is it like for you when you have power over others? What do you think is necessary so that power does not have a corrupting effect on people?

At this point in our “his” story, the earth is screaming for some answers and some new ways of being. We owe it to our species to get this figured out a bit better.

Ethics requiring heart and head

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Most of us know darn well that we have to make some tough decisions sometimes. Do we lie to save someone’s pride? Do we give the bum some money? Do we take just a tiny bit more than our share when no one is looking? Do we vote in ways that make OUR lives easier, but other lives much, much harder?

Back in 1966, Joseph Fletcher wrote a book called Situation Ethics. He wrote that the highest moral act in a given situation is based on love for everyone involved. Okay, it WAS the 60s, and yes, it sounds flaky, but it’s not. His use of the word love most closely approximates the definition of the Greek word, agape, which means selfless concern and compassion for all humankind.

The basic question is this:  Given all that I know about moral rules, and given the unique demands of this situation, what is the most selfless, compassionate, loving thing to do? Fletcher believed that there was a loving action available in every situation. He rejected both legalistic approaches, rooted in law and tradition and lawlessness (antinomianism), which may offer freedom and creativity, but has no foundation or basis for justifying one’s actions.  He wrote, “Our obligation is relative to the situation; but obligation in the situation is absolute.”

Fletcher noted that moralistic or legalistic people comfort themselves by “playing by the rules,” paying attention to the finest details of the letter of the law while hypocritically pursuing their own interests or ignoring the bigger picture—similar to Kant’s doing one’s duty for the appearance of it. You all know you can obey rules and laws that can lead to terrible, cruel outcomes. Fletcher insisted that we are smart enough to include the particulars of any situation. Authentic morality will sometimes demand that we break the rules, in the name of the only universal law—the law of love.

This may sound mushy–an easy way out. Au contraire, dear reader. Here’s what you need to do to be moral: explain how your action was the truest, most moral, and most loving action available, regardless of the rules, or our own needs or desires. This explanation will likely be a modern-day hybrid of Mill, Kant, and Aristotle (proudly featured in earlier blogs). Rather than let you off the hook, the situation ethics orientation may be the most demanding of all.

And then, there’s John Rawls to consider.

John Rawls, (1921-2002), proposed a method that free and rational persons could use to establish a just society. His ideas provide another way of thinking about Kant’s categorical imperative. What Rawls proposed we consider our laws and social customs from behind a veil of ignorance–in other words–we imagine ourselves absolutely ignorant of our own race, gender, age, disability, intelligence, strength, national origins and so on.

Rawls imagined that if free and rational people could be temporarily separated from all the attributes that made them unique, and see the world from behind this “veil of ignorance,” they would create a just society.  Think about it.  If you didn’t know your sex, race, financial status, size, sexual orientation, family situation, talents, and so on, and you were asked to make rules about how people should treat each other and get along, you would have no motives other than fairness for all.

Of course, it’s not possible to see the world through the veil of ignorance. However, the image provides another way to try and remove our self-interests in the pursuit of a just society.

Absolutes are hard to define, and even at their best, absolute moral rules are messier and more complicated than their definitions might suggest. Rigid adherence to set of “true all the time, true no matter what” kinds of rules can lead to questionable stances of moral superiority or narrow-mindedness.

Although it might be nice if we were all perfectly and completely humble, such is not the case. When do you suffer from moral superiority syndrome? Which groups get your secret or overt scorn? Smokers? Health fanatics? Welfare queens? The filthy rich? Republicans, Democrats, environmentalists, ranchers?  Of course, Dr. Bossypants is not suggesting that you must be equally accepting of everyone in the world. However, she is suggesting that you be aware of your occasional lapses of intolerance, and she urges you to get out there, using your best moral compass to lead us onward. As Michelle Obama said, “When they go low, we go high.” It is definitely the narrower path, but the views are spectacular.

 

Utilitarian Ethics–a Tall Order

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Let’s face it folks. We live in a broken world. Let’s not get into who broke it, but we can all pretty much agree things are far from ideal, or perfect, or even as good as they could be. So how do we make it better? We ask ourselves the question made famous by Jeremy Bentham and his protege (and admirably early feminist) John Stuart Mill, the forefathers of Utilitarian Ethics. The question is this: What action will bring about the greatest good for the most people?  This approach is also known as consequentialist or teleological ethics–the focus is on the outcome of an action. It is a good, or moral, action if it beings about the most good possible for the most people.

Englishman, Jeremy Bentham (1748-1832), believed that pleasure or happiness was the “substance” that should be measured in this equation. To evaluate the moral merits of one action over another action, you assess how many people would be made happy, or be given pleasure by each action. Bentham wrote, “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure.  It is for them alone to point out what we ought to do…”

Bentham’s thinking was heavily influenced by the enormous social upheaval that gripped 18th century England.  He witnessed tremendous affliction all around him and sought a basis for morality that was both practical and social in nature. Bentham’s claim was that all acts and institutions must justify themselves by their utility—hence, the label “utilitarian.”

John Stuart Mill (1806-1873) was Jeremy Bentham’s godson and Bentham was a close friend of the Mill family. Though in basic agreement, as Mill developed his thinking, he came to believe that Bentham was wrong on one important point. Bentham believed that any kind of happiness was of the same value as any other kind of happiness. Mill argued that some forms of human pleasure was of higher quality than others, and therefore worth more in the utilitarian equation. He argued for the betterment of all humankind.

People are social beings. We tend to want to be in harmony with our fellow human beings.  Mill believed that at our core, people want the best for each other and are inclined to promote the common good. Wouldn’t it be nice if he was right about this??

Modern day utilitarians no longer try to quantify or qualify pleasure in a specific equation. They simply assert that morality is based on finding outcomes that will increase the common good, and decrease human suffering.

In contrast to deontological approaches (see the DUTY blog), utilitarians abandon any claim to moral certainty, because as I noted at the beginning, we live in an imperfect and fluid world. How could anyone assume moral certitude in an uncertain world? The best we can hope for is finding the greatest balance of good over evil in a world that has no perfection, no absolute goodness.

Many social reform movements can be seen as expressions of broadly-defined utilitarian thinking.  The welfare of the weak and disenfranchised members of society is counted as having equal weight and import in the overall fabric of society.  For instance, John Stuart Mill along with his wife, Harriet Taylor, was an early and articulate advocate for equal rights for women.

He wrote “…the principle which regulates the existing social relations between the two sexes—the legal subordination of one sex to the other—is wrong in itself, and now one of the chief hindrances to human improvement; and it ought to be replaced by a principle of perfect equality, admitting no power or privilege on the one side, nor disability on the other.”

Democracy, as a form of government, could also be seen as an expression of utilitarian orientation. Robert Bellah and his co-authors have pointed out that the right to vote in a democracy is one in which we ask the individual to assess and support the common good.  If a politician makes decisions based only on personal gain, we consider that politician corrupt (or at least, we used to…). This is equally true of the voter who votes not for the common good, but for their own personal gain. As moral citizens in a democracy, we are charged to evaluate and support what is best for the whole community.

In summary, utilitarian morality requires that we consider the outcome of our actions, and act to bring about the greatest good for the greatest number of people. It is immoral not to do so. This requires us to go beyond our own desires and preferences, and act in ways likely to enhance the lives of everyone around us, close by and far-flung. We are increasingly connected globally as a human community. floating along on our little blue earth. The moral challenge, to consider the common good, has never been more complicated, nor has ever been more crucial.