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First, Do No Harm

On the 20th of February, 2023, Bret Stephens’ and Gail Collins’ joint column, The Conversation, at The New York Times, addressed (as it generally does) a range of political topics, including the columnists’ takes on various would-be presidential candidates.  A commenter named Paul Cabler, in San Francisco — taking the position that “Democracy requires that we all make a choice, even if it is a difficult one” — took Mr. Stephens to task for declaring that he might not even bother to vote if his choice was between a Joe Biden/Kamala Harris ticket and one of the myriad Republican Trump-enablers.

That topic — the dilemma of those who see both sides as, shall we say, less than stellar — is one that I have addressed before, many times:  see here, and here, and here, and here — and, also, the last chapter of my book

My response to Mr. Cabler (recycling themes from the first and last of those old links) was:

I sympathize — and even agree — with your point. But — to use an example that is purposely exaggerated to the extreme in order to make the point vivid — if what you offer me is a choice between Hitler and Stalin, can I be blamed for rejecting both and wishing, instead, that a pox descend upon both their houses?

Want me to vote? Please! Make sure you offer me someone worth voting for…

Interestingly, although I don’t see anything either offensive or overly provocative in what I posted — and, although my comments typically breeze right through the vetting process, sometimes within seconds — this comment took several hours to be approved and published.  Perhaps uttering the words “Hitler” or “Stalin” are enough, even with a disclaimer of deliberate exaggeration, to vector a comment onto an automated purgatory?

In hindsight, I fear that my comment was, at any rate, inadequate to describing my actual feelings on the matter, for it raised only indirectly, and left unanswered, the obvious question:

What is it that makes someone “worth” voting for?  Or not?

My primary answer — where I place the essential boundary — comes from the formal ethics developed for the practice of medicine — another discipline that, like democratic government, is supposed to be all about improving things for people subject to its practice:

First, do no harm!

A huge number of people — essentially everyone on the left, but also all the “never Trumpers” (count me among them) and, now, many “used-to-be Trumpers” — see Trump as immutably harmful.  Their common argument is, “You must vote against Trump (and against his Trump-lite Republican acolytes) because he is actively dangerous.  Anything is better than that!

And, there is a lot of truth in that position — but, only a lot of truth, not complete truth.  It may be conditionally true, but it is not fundamentally true.  It does not represent The Truth.

For, many people — not only ‘conservatives’ but, also, those on the ‘center right’ (like me) and on much of the ‘center’ left — would say that there are plenty of Democrats who could and would, in their own fashions, also actively cause a ruinous harm if we were to hand them the reins of power.

Bernie Sanders and AOC (and, to some extent, Elizabeth Warren) come to (my) mind — those who still believe that socialism works well despite its history of cruelty and abject failure, who believe that economic liberty is a bastard cousin to intellectual and political liberty that may and should be sacrificed on the altar of economic or social equity, and who believe that government (notwithstanding “defund the police” and the kinds of mass surveillance exposed by Edward Snowden and other litanies of government-sponsored abuses of its citizens) can be trusted with essentially unbridled power.

The “wokist” left comes to (my) mind — not those who are genuinely and sincerely woke, but those whose “wokeness” has made the leap from an enlightened awareness of the residua of historic injustices into the realm of paranoid hypervigilance or, worse, beyond that into a rabid, dogmatic, and obstinate cult of perpetual grievance.

The environmental catastrophists come to (my) mind — not those who have a legitimate and informed concern about changing climate and what to do about it, but those whose environmentalism is more spiritual than practical, whose ultimate goal is the destruction of capitalism at least as much as it is saving the planet, and whose vision for what a “saved” planet would look like is wrapped up in some kind of harmony-with-nature culling of both human aspiration and the human population more than it is in arresting the rise in global temperature.

And some few, like Kamala Harris (and, IMHO, both Bill and Hillary Clinton, though I accept that many would disagree), come to (my) mind — those who appear, like Trump, to have only a marginal (or lesser) grounding in any philosophy of governance beyond the utmost conviction that they should be in charge, and whose policy preferences, therefore, follow whatever popular and populist whim of the public they think will get them elected.

The harms any of those would inflict might not be as immediately obvious as the ones Trump has in mind — they may represent a storm gathering rather than a storm about to break — but they seem likely to be as potentially catastrophic in the long run, even if the catastrophe will take a completely different form or will take longer to reach its inevitable fruition.

Joe Biden ran as the ‘centrist’ candidate, in contrast to much of the rest of the Democratic primary field, and was arguably elected on that basis.  And, it is fair to say that his instincts do, indeed, appear to be mostly centrist.  I don’t have the same allergy to him that Mr. Stephens appears to (though I share his anxiety about what would happen under a President Harris should Mr. Biden’s age prove to be more of a problem than he and his supporters contend — not because she is temperamentally radical but because she appears to be venally opportunistic in an age of rising radicalism, and also to be generally inept at the actual art of governing).  Indeed, I voted for Joe Biden once when the alternative was Trump.  I could see myself voting for him again if my alternative is as appalling as it appears likely to be.

But, Joe Biden is not operating in a political vacuum.  And, when confronted with a decidedly less-than-centrist, obstreperous, and disproportionately prominent and influential activist wing of his own party, he doesn’t seem to be particularly interested in, or vigorous about, pushing back against their radicalism.

To be clear: the goal of that radical left appears to be — and they are really not shy about saying so — a wholesale re-ordering of American society, imposed by compulsion upon the large fraction of the citizenry that disagrees with them through a wholesale re-imagining of the proper role of government and the proper relationship between that government and the people it governs.  They are radical not specifically because they are “extreme” — though I contend they are extreme indeed — but because they are disruptive.  They want government to assume responsibility not merely for maintaining the basic formalities necessary to sustaining a stable social order, and for providing some basic help for the least fortunate among us, but for moderating all the vicissitudes of normal life — including a litany of petty vicissitudes that most people would shrug off as the common and natural give-and-take of living among other people with their all-too-human quirks and frailties.  To achieve that, they want government to manage, appropriate, and spend an immensely larger fraction of the country’s economic resources than it ever has before; and, to achieve that, they want government to assert and exercise a vast new authority to regulate their ever-expanding list of minutiae in the daily activities and personal interactions of the citizenry — both economic and cultural — to immure us within a communal cultural conformity and shackle us to a communal economic servitude.

Yes, I and many others believe that is a dangerous proposition.  Yes, I and many others believe that will destroy much of what makes America special and worth defending.  Yes, I and many others believe that will cause us all irreparable harm.

Which leaves us, when faced with candidates from the Left who seem determined to push us toward such a vision and from the Right who seem determined to push us toward some variant of fascism, with a Hobson’s choice: to choose with our vote not “Who will be best for us?” but, rather, “Who will destroy us more slowly?”  Do I shoot myself in the heart or in the head?

I want a candidate to vote for that won’t actually actively harm me!

Alas, all too often, I’m merely offered a choice of which harm seems less immediate and/or less painful.

Faced with that choice, I really would rather abstain…

And, faced with that choice, I refuse to accept the notion that I have an obligation — nay, a moral duty — to affirmatively participate in my own destruction by validating one form of harm or the other with my vote.  To the contrary: I stubbornly reserve the right to reject both as intolerable.


Update, 5/2/2023:

On their Just Between Us podcast at The Bulwark today, Charlie Sykes and Mona Charen discussed the topic I raised in this post using a different medical analogy: “Cancer vs. Heart Attack”.

In their analogy, the progressive agenda is a cancer, but Trump and Trumpism is a heart attack.  As Mr. Sykes averred, the cancer will, no doubt, kill us some day; but, the heart attack will kill us today — so, we have no choice but to focus, right now and with our full attention, on stopping the heart attack.  Only when we are safe from that do we really have the luxury of fighting the cancer.

Despite my declaration that I stubbornly reserve the right to reject both as intolerable, I can’t fault Mr. Sykes’ logic, if for no other reason than that it acknowledges an ugly truth: even within the realm of medicine, “Do no harm” is an ideal that cannot always be honored in the practice.

In the case of a heart attack, when your heart stops the crash team will try to shock it back into operation using a defibrillator.  Even if they get your heart going again — an unalloyed good — the electrical shock that was their means to that end was not particularly good for you.  It undoubtedly caused some amount of collateral damage to your nervous system.  In the extreme, a doctor might cut into your chest and break some ribs to allow him/her to massage the heart directly.  That, again, may restart your heart — but, again, an open chest wound and broken ribs are far from harmless.

In the case of cancer, too, the traditional treatments — some combination of surgery and chemotherapy and radiation — are harmful in and of themselves.  In addition to immediate trauma and bleeding, surgery comes with a risk of adverse reaction to anesethics and an even bigger risk of sepsis.  Radiation and chemotherapy are toxins that work by poisoning cells and it is impossible to limit their effects only to the cancer cells you are trying to treat — it is always somewhat a race between the cancer cells and the cells in the rest of the body to see which will surrender to the poison first.  Moreover, radiation and chemotherapies suppress the immune system and make you highly susceptible to opportunistic infections.  A patient may be freed of cancer only to die, instead, from one of those infections — as I know, alas, from personal experience.

Yet, despite the harms those treatments cause, doctors — who have taken the Hippocratic Oath and pledged to “do no harm” — still use them.  Because, indeed, the alternative is worse.  Defibrillation or surgery or radiation or chemotherapy may hurt you.  In the worst-case, they may kill you.  But, in their absence, the heart attack or cancer will certainly kill you.  In a perfect world, the world of our medical and political fantasies, we might do no harm; in the real and fallen world, we balance one harm against another and do our best to figure out which compromise is likely to cause the least damage.

So, in the extreme, I do, indeed, reserve the right to reject both as intolerable.  I reject the notion that I “must” — as a matter of moral obligation — vote for any alternative, no matter how awful, just because it isn’t Trump.

But, I concede the point: in the end, I will weigh harm against harm and try to minimize the damage.

That is, however, not absolute.  Trump and his ilk are catastrophic.  But there is, nonetheless, still some shit I will not eat.

Pray that my choice doesn’t come down to that…


Update, 5/4/2023:

Upon reflection, I realize — in the context of the heart attack vs. cancer metaphor — that the fundamental question is this: What if treating the heart attack makes the cancer more virulent?  What if the actions required to save myself from the heart attack today cause the cancer to kill me tomorrow, instead of next week or next year?

It occurs to me that what I really long for in the upcoming election is a way to definitively reject Trump and Trumpism — which will, it appears in practice, mean accepting Biden/Harris — while simultaneously definitively rejecting the most extreme variants of the “progressive” (and “socialist”, democratic or otherwise) program for American transformation.

I noted that Biden ran as the ‘centrist’ in 2020.  That’s what I thought I was voting for.

But, the populist Progressive left treated Biden’s victory as if it were a mandate to go for broke, in the same way that, four years earlier, the populist Fascist right treated Trump’s victory as if it were a mandate to go for broke.  No doubt, they will treat another Biden victory in the same way. Although the Democrats (unlike the Republicans) are, at least for now, still occasionally grounded by some members who call out desperately from the reasonable middle, both parties are, in large measure, allowing their agendas, and especially their rhetoric, to be set and controlled from the extremes.

Alas, no matter how narrow the victory nor how broad the defeat in any given election, the lesson both parties insist on learning from it is not, “We seem to be out of step with the electorate,” but rather, “The problem was we were not extreme enough!“.

How do we change that?


© Copyright 2023, Augustus P. Lowell


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