Category Archives: Politics

neither unprecedented nor revolutionary / bioethics, biopower and the pandemic

OK, this is gonna be a long one. And if the C19 situation is fraught for you, then consider this a content warning—I’m going to talk about mortality and our societal attitudes to such.

I’ve been wanting to write something like this for a good few weeks, but have frankly been too much of a coward to do so. I’m only now stepping into the arena because I can follow in the footsteps of Silvia Camporesi, an bioethicist currently under lockdown with her newborn child in Northern Italy. After setting the stage in the present, Camporesi returns us to the pivotal moment of serious outbreak, and to a well-intended attempt at medico-ethical transparency which ran afoul of the polarising morality-machine of media in an age of attention economics.

The document [that the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care] released in early March aimed to guarantee ventilators for patients with the highest probability of therapeutic success – that is, those with the ‘highest hope of survival’. The criteria adopted were utilitarian: age and pre-existing medical conditions were factors that pushed a patient down the line.

The document provoked an uproar. The media feasted on it, spreading the panic. The situation in Italy was certainly exceptional due to the sheer number of cases presenting themselves each day. It’s likely the first time that many of these doctors, especially the younger ones, were being faced with such harrowing choices. Yet, from an ethical point of view, the document was neither unprecedented nor revolutionary.

She goes on to compare the triage process to that used in deciding how to distribute organ transplants, while pointing out a significant difference, in that folk in need of transplants can conceivably sit in a holding pattern for some time before a suitable donor is found; a C19 patient may die very fast if they can’t be given a ventilator.

But here’s the important bit:

The fact that we Italians think that these decisions are exceptional reveals the ways that our privilege has concealed the reality of finite healthcare resources. One of my bioethics students, Caitlin Gardiner, is also an Accident and Emergency (A&E) doctor in the UK. She reminded me that, in her native South Africa, such balancing acts are the norm. There, as she told me, only the tiniest fraction of patients who are ‘not too sick’ – that is, not too old, not living with HIV/AIDS, not too ill or too premature, if they’re babies – get to receive intensive care. And death from tuberculosis (another infectious respiratory disease), after being denied access to intensive care, is entirely normal. There are lessons to be learnt from the Global South, such as how to have humane but open discussions about prioritising patients. It’s best to have this kind of conversation in a non-emergency situation, when the emotions of patients, relatives and clinicians aren’t running quite so high. Arguably, we should talk not just about whom to intubate, but also about when to withdraw ventilation if a patient with a better chance of survival were to arrive. Beyond the context of a pandemic, developed countries don’t typically face these quandaries, which explains the moral distress on the COVID-19 wards in northern Italy, where doctors and nurses have been reported weeping in the hallways.

Camporesi goes on to discuss the intergenerational dimensions of the lockdown responses, whereby (to simplify a great deal) the young and less-at-risk are being cooped up and, in many cases, put in a situation where their already precarious employment circumstances are totally hosed—this being the same generation that (unavoidably) will have to pay off the debt incurred by the lockdown response in taxes and (more likely than not) endure yet more years of austerity in state provision. She also points out that the evidence that any of this will be any more effective at dealing with the virus in the long term (by comparison to, say, the Swedish approach) is extremely thin, to the point of being almost entirely based on speculative models assembled quickly for an audience of policymakers—i.e. for people whose working notion of futurity is rigidly delimited by the current electoral cycle.

For the sake of clarity, this is not to endorse the UK government’s much-discussed early-phase “herd immunity” strategy; I’m not doing that, and I’m pretty sure that Camporesi isn’t, either. (Nor is it to side with the misinformed rent-a-mobs besieging statehouses in the US—though there is perhaps at least one level on which we should sympathise with them, even while believing their actions to have been purposefully misguided by manipulative hucksters and shills.) The point is to get beyond the prevailing moral binaries and start grappling with the really tricky shit… and we can start by reiterating a crucial distinction which is getting lost in the discourse. To re-quote Camporesi again:

The fact that we […] think that these decisions are exceptional reveals the ways that our privilege has concealed the reality of finite healthcare resources.

Over the last fifty or sixty years, those of us with the privilege to be among the middle class of the Global North have grown accustomed to the idea that no one has to die before their time. That idea is illusory on two levels.

Firstly, it relies on a quantitative metric whereby the goodness of a life is measured by its length. This contradiction has its ultimate expression in the absurd and tragic immortalist aspirations of the transhumanists, and is tied up with the logic of accumulation: if capitalism is the game of seeing who gets to die with the most stuff, then the longer you’re in the game, the better chance you have of placing high on the leader-board. But the contradiction at the heart of that morality is manifest in privatised and for-profit provision of social care, an oxymoronic project in which miserable conditions for workers and inmates alike do little to disguise the extractive logic of the underlying system. The fact that it is this same for-profit system of social care where so many of the C19 deaths are concentrated is perhaps the grimmest irony I’ve ever encountered in my life so far.

The second level of illusion was pointed out by Camporesi further up. It’s never been that “no one” should die before their time, it’s that no one like us should die before their time—nice white middle-class people with money. Outside of the Global North, people die “before their time” all the fucking time—indeed, increasing numbers of them die in the course of their trying to get into the Global North. But that doesn’t merit much of a response, save either fleeting feelings of pathos which can be alleviated by charitable donations, or a more callous (but in some respects more honest) dismissal of those lives as being less deserving of duration.

It is the collision of these two illusions, and their simultaneous shattering by an Outside Context Problem which has demonstrated that a system over-optimised to the point that it has no slack is a system with no long-term resilience, that is causing the ongoing epistemic rupture. The grief over loved lives lost is real, and a significant part of the societal trauma, but there is another level of grief at play as well—namely the grieving of the shattered imaginary world in which this sort of thing wasn’t meant to be possible: the grief for deaths, but also the grief for the rediscovery of death in the abstract as an implacable and fundamentally unfair aspect of being alive. Death doesn’t care about your class, your education, about where you were born or how hard you worked. Death just ends you anyway. And our ability to assume otherwise is, to reiterate, a pretty recent (and unevenly distributed) thing, as Hugh Pennington’s memories of the all-but-forgotten flu pandemics of the late 1950s and early 1960s make clear.

I am a socialist. I believe that the entire point of a collectivised healthcare system is to minimise the inevitable suffering of our mortal existence, and to distribute what suffering cannot be done away with as fairly as possible, without regard to the privilege of circumstance. That neoliberalism has twisted that ideal into this lottery of misery is beyond tragic, and has made me very angry for a long time. The C19 situation has only amplified that anger. I am not for a moment suggesting that the UK government’s herd-immunity approach was ethically valid.

But I think it’s long overdue that the reasons for its ethical invalidity were discussed truthfully. Yes, to have followed that strategy would have resulted in far greater numbers of deaths than are even now currently occuring—but that scale of deadliness is in no small part a function of the socioeconomic structuring of UK society as currently constituted. As the experiences of Germany and other countries have shown very clearly, the rate of mortality could be much lower—and that’s nothing to do with the virus itself, but rather the systems in place to deal with such an eventuality.

And so you get the UK lockdown situation, where the vast majority of people accept the need to endure the restrictions so as to minimise the deaths and suffering that would result from a less draconian response—because contrary to the Hobbesean mythology at the heart of liberalism, people are for the most part decent and compassionate, and would hate to think that they’d caused someone else to suffer through their (in)actions. But you also get a very successful manipulation of the narrative by the government, whereby the real and genuine horror of the consequences is positioned in such a way as to obscure the cause of their scale—a cause which was always-already political.

It is entirely right, and entirely human, to grieve for the deaths and suffering of individuals who contract a symptomatic case of C19. It is also entirely right, and entirely human, to point out and decry the systematic and wilful mismanagement of the social contract that has resulted in the number of those deaths being so huge, and to question what might be the long-term consequences of the panicked yet still highly performative and politicised responses to that circumstance; it is not a question of either/or, but a question of and/also. By keeping the focus on the immediate catastrophe, those same people whose actions have made the scale of the catastrophe possible are laying a trail down which they will abscond from responsibility, not just for the catastrophe itself, but for the decades-long aftermath to follow.

(And if that sounds cynical, well, hey: I grew up in Thatcher’s Britain, and then came of age in the ideological vacuum of Blair’s. I’ve seen the successful adaptations that neoliberalism selects for, and the vast majority of the current crop—on both sides of the house—seem like some tiny Pacific island crowded with moral mutants, the halting state of a game to determine who can best compartmentalise their own humanity in order to secure and hold an abstract notion of power for its own sake. None of them ever saw a catastrophe they didn’t fancy themselves fit to manage, because you don’t even make it onto the island if you don’t turn up with that mindset already fully internalised. I know we’re supposed to hate the game rather than the player, but I’ve rather lost patience with that position of late.)

It is my hope that the C19 crisis might do something to dispel the illusion of immortality that capitalism confers upon the privileged. This is not because I somehow relish the thought of people dying, or consider it “necessary”; if you’re looking for the social Darwinists in this situation, you should be looking at the architects of the lockdown, who are quite willing to exploit our emotional response (and, it seems, doing a bang-up job of it, too) in order to get away with retaining their own grasp on power.

Rather, I hope we learn to become more accepting of the uncaring randomness of mortality for two reasons. On an individual level, I think it might serve to make us more appreciative of the time we get—and in a world where pandemics like this are likely to be an increasingly regular event, staged against the unfolding deep-time catastrophe of as-yet all-but-unadressed climate change, we’re going to need that ability to live for the moment.

But on the societal level, I believe that we need to get reacquainted with the randomness of mortality because it serves to remind us that, whether within privileged societies or more globally, the current distribution of death and suffering—and indeed of risk more generally—is mapped by class and race and gender.

We cannot defeat death. But we can seek to distribute it without making tacit decisions about who is more deserving of life—and the first step to doing that is accepting that we cannot expect to be kept alive forever, and that the quality of the time we get matters more than the quantity.

I don’t want older people to die in lonely agony for the sake of corporate profits and political advantage. Nor do I want younger people to live straitened lives of penury and panoptic sousveillance against a backdrop of ecological collapse.

Morality is easy. Ethics is hard.

synthesis is an ever-complicating process

Here’s a gloriously rambling thing from Matt Colquhoun that starts off talking about dialectics. Hence my choice of title—I’m currently undergoing a sort of dialectics of my understanding of dialectics (if that’s not too pompously meta a way of putting it), and I keep getting sychronicitous little gifts of other people’s thought, like this one, that arrive just at the right moment to prod me along.

The piece wanders around to Colquhoun talking about what his new book was (in part) an attempt to do, where this bit leapt out at me:

A death is one of those moments — if not the only true moment — where a person’s thought really starts to come apart from within. Without a self to maintain the boundaries, all sorts of things start flying out of it. And what we see emerging on the left, when faced with Mark’s posthumously rendered thought in particular, is either an attempt to cancel Mark outright or instead just a sheering off of his work’s unattractive bits. Either Mark doesn’t deserve any attention whatsoever because he wrote an essay like “Exiting the Vampire Castle” or we shouldn’t talk about that essay and just focus on the nice bits about party political organising.

Mark was so much more than either of those things. And this isn’t just because Mark was some great and complex thinker but because he was human. This kind of complexity is present within everyone. But today we live in a culture that rejects this absolutely, on the most mundane level which, I think, is the most damaging. Like, most will reject an argument like this with alarmist examples like the fact someone can be a member of the communist party and they can also be an abuser. That’s a alarmist contradiction of a certain type and one that must be cut out without a second thought. Of course I agree that abusers and bullies are really bad, and I have no interest in affirming their existence, and I’d be quite content bullying them out of the things I hold dear, but today we find people can be excommunicated for having far less troublesome contradictory thoughts than these. You can find yourself socially shadowbanned for simply not following The Narrative, and the people who will deplore this kind of whingeing the most are, of course, those involve in the sorts of institutions that maintain the narrative, whatever it may be.

I hadn’t read the infamous Vampire Castle piece before I bailed on social media, but when I finally did read it, I recognised in it not so much my own experience but the fears and anxieties that had been building up in me for some time before. Perhaps it’s indicative of a particular twisted form of narcissism (or, indeed, of the acute case of mental dysfunction I was going through), but at the time I was less worried about by being censured for broaching The Narrative than I was of finding myself pinned into a caricature of my own ideas. It took a while to realise that those are two sides of the same coin, and furthermore that the phenomenon is ubiquitous, albeit variable in degree depending on where you’re looking.

(And now I’m intrigued by the possibility that I preemptively shadowbanned myself, on the basis of an emotional calculus whereby it’s somehow less painful to exile yourself than to face the possibility, however marginal, of being exiled.)

It’s an indication of just how persistent and wide-reaching the issue is that—even now, even here, on this all-but-unread blog—I feel the need to caveat that point with a statement to the effect that “of course I’m not saying that Twitter is the problem, or that I have all the answers, or…”. So perhaps my synthetic path is to henceforth abjure further such abjurations in my work and in myself… which is easier said than done, given the extent to which those anxieties are a core feature of my psyche, and have been for as long as I can recall.

But nothing worth doing is ever easy, is it?

amphibiosis / the war against viruses will not take place

A fairly Harawayian staying-with-the-trouble perspective on the politics of this pandemic and all the other pandemics yet to come, from Charlotte Brives:

It is not against viruses that we should be waging a war, but against the political and economic systems which, far from being conceived as protection against the precarity (this itself being variable!) of human and non-human lives, use it and accentuate it because it is inherent and indispensable to the domination of neoliberalism and its way of operating. But these systems accelerate both the production of pathogenic agents, thanks to the industrialisation of farming and agriculture, and their dissemination, thanks to highly intensified exchanges within the general interconnectedness of spaces. Systemic standardization is incompatible with amphibiosis – with the amphibiotic condition of living beings.

[…]

If there is any meaning to the idea of political ecology, it’s about seizing on the diversity of the common futures of humans and the multiplicity of other living entities, in order to establish other conceptions of living environments long devastated by current economic systems. This will require using whatever administrative means necessary to act against the harmful effects of industry and mad financial logic, for example, and in favour of restoring adept public health services (with the budget and tax implications that entails). Our futures, which we necessarily share with others (human and non-human), depend on it. Because the next virus will be different. And our response to its emergence needs to be different as well.

the caricature of a time that is no longer ours

Oncle Bruno on the radical ecological potential—or perhaps the lack thereof— of the current moment:

The originality of the present situation, it seems to me, is that by remaining trapped at home while outside there is only the extension of police powers and the din of ambulances, we are collectively playing a caricatured form of the figure of biopolitics that seems to have come straight out of a Michel Foucault lecture. Including the obliteration of the very many invisible workers forced to work anyway so that others can continue to hole up in their homes – not to mention the migrants who, by definition, cannot be secluded in any home of their own. But this caricature is precisely the caricature of a time that is no longer ours.

There is a huge gulf between the state that is able to say “I protect you from life and death,” that is to say from infection by a virus whose trace is known only to scientists and whose effects can only be understood by collecting statistics, and the state that would dare to say “I protect you from life and death, because I maintain the conditions of habitability of all the living people on whom you depend.”

[…]

… there is another reason why the figure of the “war against the virus” is so unjustified: in the health crisis, it may be true that humans as a whole are “fighting” against viruses – even if they have no interest in us and go their way from throat to throat killing us without meaning to. The situation is tragically reversed in ecological change: this time, the pathogen whose terrible virulence has changed the living conditions of all the inhabitants of the planet is not the virus at all, it is humanity! But this does not apply to all humans, just those who make war on us without declaring war on us. For this war, the national state is as ill-prepared, as badly calibrated, as badly designed as possible because the battle fronts are multiple and cross each one of us. It is in this sense that the “general mobilization” against the virus does not prove in any way that we will be ready for the next one. It is not only the military that is always one war behind.

I keep trying to sit down and write about those extended police powers which, as they’re explained to me by friends and loved ones back in the UK, are scaring me way more than the virus, and to some extent more even than its economic aftermath; from my point of vantage in cautious and (seemingly) hyper-rational Sweden, it’s dizzying stuff. But my mind keeps sliding off the sheer, glassy enormity of it all; I can’t grip it in a way that gives me any analytical purchase. The last time I felt like this was the London riots of 2011. That seems a lifetime ago now.

Maybe Latour is right, and there’s no promise in the pandemic of a better state response to the environmental crisis. But that assumes a continuity of the state as currently constituted, and right now the continuity of any major institutional form seems like a pretty long-odds bet. What’s different now by comparison to 2011 is that the TINA doctrine of neoliberalism has been shown to be the fiction it had always been. I am obliged to believe that’s an opportunity for change, in order that I might work as if it is.

better isn’t best, but

Sean Guynes drops his second of two essays on Le Guin’s The Dispossessed. If it’s a book you know, or if it’s a book you simply know of, I recommend this piece wholeheartendly—and on that basis, the rest of Guynes’s Le Guin re-read to come at Tor.com. (And if you haven’t even heard of it, ehrmahgehrd get yourself a copy and fix that right away.)

I’m clipping this bit in particular, though, because it’s such an elegant and eloquent summary of an argument I’ve been pushing for more than half a decade, and intend to push for the rest of my forseeable:

If utopia can capture so much, including ideologies that are directly at war with one another, what matters then is how the utopian impulse—the always unfinished drive toward utopia—responds to the ambiguities inherent in the very idea of utopia. Why is an ambiguous utopia—in other words, any utopia—worthwhile if it won’t be perfect? I might be a smart-ass and say, well if you’re going to ask that, then ask yourself why anything is worthwhile. But to tamp down the snark and get real: Life sucks, why not (try to) make it better? Better isn’t best, but it sure beats this. Utopia isn’t the destination, it’s the journey.

Yes, exactly this. And now is a moment in which we need to remember and rehearse that attitude more than ever.