Again and Again

You will find yourself
Reaching out into that starry starry night
In that darkness between those voids
You will learn something very very true
You don’t matter
And all the things you thought you knew
Are stories that we tell ourselves
So why not love and share a few?

It doesn’t matter how are you try
It doesn’t matter how loud you cry
We’re all circling a cosmic drain
That empties to the universe’s rivers of oblivion
And I can’t wait
To be there with you
Shimmering black pools of nothingness
That meant something to us
That meant so much to us
That spirit running through us
Then disappearing again and
Again

You will lose yourself
To that boundless starry night
Yet piercing that darkness pinpoints of light
Twinkle from afar
Revealing a map
To nowhere in particular
The constellation’s consolation:
Indifference to the path we take

It doesn’t matter where we begin
It doesn’t matter where we end
Where we go is in between
Where we’ve been and the unforeseen
And I can’t wait
To go there with you
As motes of dust afloat slender beams of light
Held in a moment
Still for just a moment
Draw our breath one moment
Then let them go again and
Again

You will be yourself
Through each and every night
So tremble with the candle’s flame
And meet the darkness with light
So that someone somewhere might see that you
Made it this far along
Though brave little flames go out all the time
Their light goes on and on

It really matters that you are here
It’ll really matter when you disappear
Because we are all that we’ve got to give
To one another and receive from each other
And I can’t wait
To share with you
Sometime somewhere in between those starry nights
Before the stars fade
As the dawns break
On the days that
We’re not there
To see.


Questions to ponder on abdication

  1. Who are you and what responsibility have you shirked recently?
  2. I contend medical “authority” is an alloy of “trust” and “reliance”: one either must trusta medical practitioners judgment/decisions/actions because they do not (or cannot) know otherwise or must rely on the abilities of the medical practitioner. (One could of course both trust and rely on a medical practice.) Are there any other features that are necessary/sufficient to define medical authority?
  3. What gives rise to “legitimate authority” in the practice of medicine?
  4. Trust and reliance also factor into “power” over other individuals – defined here broadly as the ability to make others do things (they might not otherwise do). And indeed, medical practitioners may wield a great deal of power in their practice. Some decisions really are “life” and “death”. With great powers come, we are cliche-ly told, with great responsibilities. Reflecting on the Hippocratic oath and its various incantations, what are the responsibilities of a physician and how directly do they tie to the power they wield?
  5. Parent and child relationships introduce a bevy of power-imbalances, from the abilities of the adults to the autonomy of the children, and yet few would regard these relationships as “unjust” due to this inequity. How can “unequal” relationships be morally maintained?
  6. When a parent and a child disagree over medical treatment, how ought their differences of opinion be adjudicated? What about when a child’s and a parent’s thoughts around an “irreversible” medical procedure – like euthanasia or gender confirmation surgery – are diametrically/fundamentally opposed?
  7. Who do you hope to be when you “give up the ghost”?
  8. On average, is it better for medical authority to be single-voiced (as in the recent example of Dr. Anthony Fauci) or decentralized?
  9. On average / on-the-whole / in your Ideal World, would healthcare be more centralized or more decentralized? Should this centralization/de-centralization be instantiated by a government or be independent of a geographic sovereignty?
  10. At state and local level, healthcare access and policy drastically change, often “at the behest” of the local inhabitants via their “democratically” “elected” leaders. Many of these policies run counter to more progressive ethical positions (for example, ready access to reproductive technologies, the banning of certain genders from certain activities). These amplifications of local popular will can manifest in stark inequality. How/Can we ensure that local preferences still abide by global principles?
  11. When do you give up your place on the lifeboat? When do we have the responsibility to make others give up theirs?
  12. When is an individual responsible for an institution? When are they not?
  13. When/Will human beings “give up” on this world?
  14. If this were the final conversation you were to ever have, what would you want to talk about? 
  15. More broadly, what do you think the final human conversation will be about?

Questions to ponder on virtual reality

  1. Who are You™ and who are you virtually?
  2. Is the internet real?
  3. With the app-ification of the world, healthcare has seen more than its fair share of internet-delivered health interventions crop up. From mental health treatment (for anxiety, depression, post traumatic stress, OCD) to addiction mitigation (for tobacco, alcohol, cannabis) to physical health improvement (diet, physical activity, hypertension), hundreds of apps have been developed to cure what ails us. On the whole, are these healthcare apps helpful, harmful, or neutral? Put more pointedly, do they represent “the shape of things to come” in medicine or is this the same old snake oil in new bottles?
  4. Is this discussion a “virtual” discussion? Is it a real one? (Is it “virtually real”?) 
  5. Iserson (2018) posits that “use of VR in medical education should increase patient safety and societal confidence in clinicians’ procedural skills, because inexperienced students, residents and practicing physicians, nurse practitioners, and physician assistants will no longer need to use living and newly dead patients or animals as teaching fodder.” Do you agree with the general “gist” of that statement? Would you trust a newly graduated medical student who was taught primarily in “virtual” settings? What benefits are there to a medical education delivered “virtually” as opposed to one given in “reality”?
  6. In what ways can ethics be taught through virtual/extended/augmented reality?
  7. Is the reality of health care extending itself too far? No longer is a patient confined to the bedside for monitoring, often a physician will confirm a prediction first made by an algorithm, surgery is performed by robots: the human element slips away from the human science of medicine. Will these trends in the long run make for “objectively” better medical care?
  8. Has the internet made the world healthier?
  9. Physicians, it would seem, are already performing their work virtually. According to a 2013 study, a physician on average spends approximately 28% of their time directly treating patients, 12% of their time reviewing test results and records, 13% of their time in discussion with colleagues, and 44% of their time on data entry. The alarming figure of 4,000 mouse clicks a day entering and reviewing data was found. Physicians regularly speak of being overworked and interacting with patients less. Yet, more and more of their time is demanded in service of keeping records in lieu of treating patients. What can be done to mitigate physicians from becoming glorified data entrants? (Conversely, and in reference to question 7, what can be done to prevent data models from becoming physicians?)
  10. I understand that “killing” something playing a video game is not the same thing as “killing” something in reality. Yet, is there not some relation between the two? What does a consistent and readily available form of engaging entertainment involving mass violence do to people?
  11. Are you “accurately” represented by your social media presence(s)?
  12. Are “you” being tracked accurately by all those algorithms that find us? Could there exist a meta-bias for the types of algorithms you attract? (For example, do those with gambling problems preferentially face being presented with advertisements for sports betting?) And if so, what sort of “anti bias” training would we have to ensure these algorithms go through? 
  13. Can one be addicted to Internet?