Saving Babies

(Or, Which Ethical Paradigm Do You Choose?)

The Lost Thing Collins St at 5pm

I once facilitated a philosophical dialogue among 8 – 10 year olds about The Lost Thing, an animated short film based on Shaun Tan’s book by the same name. The kids began with the question of why a sad, lost and lonely being went unnoticed and forsaken by so many passers-by.

Harriet:  “They must have no conscience. We really should care.”

Oscar:  “There have to be some people in the world who care. It can’t be that no one cares that a bully targets a child; that someday every human being is going to die; that animals are getting extinct.”

Aurora:  “You can’t just walk past without helping. It’s like walking past a lost child in need.”

Nathan:  “I think the reason people don’t help is because they think is someone else is going to, so we don’t need to.”

Mia:  “What if everybody was like that, and nobody was there to help – then what would life be like? Everyone would be unhappy and selfish. So, this is a way to prevent it: you think about what life would be like if everybody did that.”

Me:  Do you think we need to live according to a rule, like ‘we have to think about what would be best for everyone, and act accordingly’?”

Harriet:  “We should… but we don’t have to. It’s a free world. It’s like, you don’t have to obey the law, but you choose to.”

Me:  “Are laws always protecting moral rules? Does behaving according to the law mean that you’re always behaving in an ethical way?”

Aurora:  “Behaving ethically or morally is doing what you have the right to do, in your opinion. But behaving legally is doing something right in someone else’s opinion.”

I recalled this dialogue the other day, in the middle of a rather different conversation among adults. I was visiting the FREO2 lab in Melbourne, where particle physicists and epidemiologists have been working towards saving lives in the developing world. Specifically, they’ve invented two new devices to stem the tide of infant deaths due to pneumonia. And in the process, they’ve been wresting with ethical questions of their own – questions that resonate closely with the ones the children were facing.

Momitforward World_Pneumonia_Day-Malawi-1995Image via momitforward

What exactly are our responsibilities to the millions of children who die each year from preventable disease? Is deciding on the most ethical course of action just a matter of opinion, or is it more objective than that? What, in fact, should motivate our actions? Should we obey Immanuel Kant’s ‘Categorical Imperative’, to act only according to principles that we are personally convinced should apply as universal laws? Or should we focus less on moral duties, and more on whether our actions have beneficial consequences … and if so, beneficial to whom? Should we consider all interests equally?

I’ll return to some of these questions later. They arise naturally in the business of addressing such devastating problems as infant pneumonia. Every 30 seconds, somewhere in the world, an infant dies a preventable death from this disease. In fact, pneumonia is the leading infectious cause of mortality for under-5s, ending more babies’ lives than malaria, measles and HIV/AIDS combined. And although I didn’t know it before, we already have the simplest of treatments: oxygen. Administered as high concentration oxygen therapy, oxygen is an essential medicine. Each year it could save hundreds of thousands of severely pneumonia-stricken babies and children, whose low blood-oxygen increases their risk of dying fivefold relative to other pneumonia patients.

 

What can be done?

During my visit to the lab, I learned that the FREO2 team has made ground-breaking progress in the area of oxygen delivery. To fully appreciate this achievement, we need to contrast the new FREO2 inventions with conventional means of supplying oxygen to infants. A well-established approach is to use an electricity-powered oxygen concentrator, which plugs into a power point and works by taking oxygen from the air.

Diagram oxygen concentrator

These machines are standard issue on paediatric wards across the industrialised world – but in developing countries like India, Nigeria and the Democratic Republic of Congo, where infant pneumonia deaths are most prevalent, doctors can’t rely on oxygen concentrators to save babies’ lives. In many places, there is simply no electricity supply, so oxygen concentrators are useless. Even in urban areas with relatively well-supplied hospitals, babies frequently die when electricity blackouts cause oxygen concentrators to fail.

A non-existent or unreliable electricity supply has traditionally been seen as an intractable obstacle to providing sick babies with the concentrated oxygen they need. Yet where many have been stymied, FREO2 researcher Dr Bryn Sobott ingeniously recast the problem. Recognising that a narrow focus on the deficiency of electricity supply was standing in the way of developing life-saving technologies, Dr Sobott turned his attention to a more foundational question: “How can concentrated oxygen be obtained without any electricity supply?”

He conceived and developed the Fully Renewable Energy Oxygen (FREO2) Siphon, a durable and low-cost electricity-free oxygen concentration system.

FREO2/Siphon

OLYMPUS DIGITAL CAMERAThe Siphon harnesses energy from a small stream of flowing water and uses a vacuum pressure system to separate oxygen from the surrounding air.

After years of research and development in collaboration with his team – including colleagues Assoc. Professor Jim Black and Dr Roger Rassool – Dr Sobott built a prototype, at a small creek in rural Gippsland, which succeeded in producing medical grade oxygen concentrations without electricity. This was a world first, and the results were published in the international peer-reviewed journal Pneumonia.

FREO2/LPOS

In addition to the Siphon, FREO2 developed a second innovative device, the Low Pressure Oxygen Store (LPOS), designed for contexts where electricity supply is unreliable.

The LPOS maintains a stable supply of oxygen to pneumonia patients during power outages. While the power is on, excess oxygen generated by a concentrator is channelled to a custom-made storage unit. When the power fails, the flow of oxygen to the storage cuts out and the stored oxygen is automatically released to the patient.

The LPOS can provide a child with oxygen for 8 – 10 hours, compensating for even a lengthy power failure. The system works consistently without being manually controlled or monitored – an especially important feature given that in many medical facilities in the developing world, nurses have not been trained in oxygen use.

 

Potential impact and hurdles

The two inventions are elegant in their simplicity. They provide technically viable answers to the medical challenges of concentrated oxygen supply for babies and children virtually anywhere in the world. They hold a promise of winding back infant pneumonia mortality rates and improving health equity on a massive scale worldwide. They could make a singular contribution to achieving the United Nations’ Sustainable Development Goal of ending preventable deaths of newborns and young children by 2030, and play a central role in ensuring that every sick child has access to the oxygen they need to get well (as stipulated in the World Health Organisation and UNICEF’s Integrated Global Action Plan).

If the problem were simply an engineering one, FREO2 would have solved it already. But there are unwieldy social, geopolitical and financial dimensions. Any solution needs to be usable by health workers in challenging conditions (which is why FREO2 plans to field-test its devices soon, in Mozambique). FREO2 needs buy-in from governments and aid organisations working on the ground, as well as from those coordinating regional efforts. It needs effective equipment distribution and installation processes. And it has to convince funding bodies that all the investment is worthwhile. Appropriately enough, funders demand rigorous evidence of need, which means long-term data analysis to determine actual oxygen requirements in remote clinics.

UNICEF PneumoniaImage © UNICEF/NYHQ2006-2554/Giacomo Pirozzi

 

A dilemma

While increasingly accurate data are being collected, while grant applications are being written, and while organisational relationships are being managed, babies are dying. This is unforgiveable. Or utterly necessary. It depends on how you look at it.

Which ethical paradigm do you choose?

Funding bodies use a hard-headed utilitarian calculus to assess life-saving interventions, weighing up dollar costs against lives saved. While this bottom-line analysis makes distressing delays unavoidable, it does at least avert crises of misspent millions. By contrast, innovators may prefer to take a Kantian deontological approach, acting immediately out of a sense of duty, and agreeing with the children in our opening dialogue that “we really should care” and “you can’t just walk past without helping… what if everybody was like that?”

Indeed, the FREO2 team is driven by the belief that each and every child in the world has the right to access medical care. It’s easy to share the innovators’ impatience in response to dragging bureaucracies which – while painstakingly evaluating the most effective interventions – appear to fiddle while Rome burns. Meticulous evaluation may eventually maximise the number of lives saved, but at what moral cost in the shorter term? And for that matter, who’s to say that the measure of success should be number of lives saved, rather than some other desideratum, like the quality of those lives? FREO2 researcher Assoc. Prof Black is all too familiar with the philosophical tension here. “I’m a deontologist at heart,” he says, “but for my grant applications, I have to be a utilitarian.”

The FREO2 team has already garnered a host of impressive awards, as well as major but ever-insufficient funding from (among other sources) the Bill and Melinda Gates Foundation. Meanwhile, as his work continues, Dr Sobott is keenly aware of the human cost of delaying FREO2 implementation. Utterly dedicated to his mission of getting oxygen to pneumonia patients, he considers everything else a distraction. “At this stage, my boss isn’t Bill Gates,” he says. “It’s the mother of the next dying baby.”

Peter Power : Globe and Mail Somalia

Image © Peter Power / Globe and Mail

 

You can help

The FREO2 team has requested public support on social media. Here’s how you can help:

 

 

Photo credit for this post’s featured image (appearing on our blog homepage): ERproductions Ltd/Blend Images/Corbis.

 

The Philosophy Club runs co-curricular and extra-curricular workshops for children, professional development for teachers, and training for facilitators in the art of collaborative philosophical enquiry.

 

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One response to “Saving Babies

  1. I happened to read a facebook post by Matt Bell that addresses questions about how best to analyse the effectiveness of charities. I found it useful – and relevant to this blog post – so I’ll quote an excerpt here:

    “…suppose you decide that all lives on Earth are equally valuable. The low-hanging fruit for saving lives will all be in third world countries. Curing someone of blindness in the US is a lot more expensive than curing someone of blindness in the third world, since third world countries often lack basic immunizations and medical care. Thus, a maximally effective charity fighting health issues will pour most of its efforts into the third world. This can often lead to local resentment…

    Actions also have secondary consequences, and that makes things complicated. It’s very likely that a Trump presidency vs a Hillary presidency would dramatically increase global poverty. Thus, is it more effective to spend money to prevent Trump from getting elected than it is to directly spend money fighting poverty? …

    There are also tradeoffs between taking present action and taking actions that pay off in the future. Do you donate to treat people with malaria now, or do you donate to develop a cure for malaria that will ensure that malaria is eradicated in 10 years?…

    Ultimately there aren’t easy answers to a lot of these questions, and it’s easy to get overwhelmed and do nothing. That said, thoughtful action given some limited amount of research is more effective than no action. You can consider a range of axioms for deciding how best to do good in the world, decide on what axioms you believe in, think analytically about how best to invest given those axioms, donate your money or time in those directions, and then share your thought process with others. Different people will take different directions, but there is so much room for improvement in general relative to the status quo that it’s best not to get into religious fights about some of the axioms themselves.”

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