Fairness

Fifteen British sailors were released from captivity in April 2007 after being held hostage for two weeks by the government of  Iran. On their return, the Ministry of Defence  said that, in view of the exceptional circumstances, they were permitted to sell their story to the press.. Leading Seaman Faye Turner sold hers to the Sun for £80,000. That payment was headline news,  and the chief topic of conversation in clubs and bars for several days. Nearly everyone condemned it. There was general agreement that it was unfair. Some argued that it was  unfair  to allow  those servicemen, and not others,  to sell their stories.  Some pointed  out that other servicemen were more deserving, particularly those who had been injured in battle. Others argued that the money should rather have gone to needy families.

The concept of fairness that is called upon in that example is open to a variety of interpretations, each of which could lead to a different course of action. To illustrate the point  in a different context , suppose that you are a parent who has received a substantial sum of money that you wish to share fairly between your two adult offspring  Amy and Bessie. You are faced with the following choices:

-          for  fairness as  non-discrimination,  they get half each;

-          for  fairness as redistribution and supposing Amy to be the poorer, Amy gets more than half;

-          for  fairness as reciprocity and supposing Bessie to be more the more supportive, Amy gets less than half;

-          for fairness according to deserts and supposing Amy to be the more deserving, Amy gets more than half.

(The use of the word fair can also  lead to confusion of a different sort. It is not always clear whether it is intended to refer to the above  concept, or whether the it is intended to refer to one of a number of  other concepts. The confusion arises from the fact that the word fair is also used to mean reasonable  (as in  ‘a fair price’), honest  without cheating (as in ‘by fair means or foul’), conforming to an agreement or to established standards  (as in ‘fair trading’),  or   well-founded or accurate (as in a ‘fair estimate’). It is obvious that none of those other  concepts were in the minds of those who objected to Faye Turner’s payment. The following discussion is not concerned with any of those other concepts, except to note that, although they differ from the concept under  discussion, they sometimes tend to colour our attitudes to it.)

Psychological experiments (or ‘games’) have established that people have often been willing to make sacrifices in the interests of what they consider to be fairness. In a typical  bargaining game, A is given the opportunity to  share £100  with B, having said  how much of it  he is prepared to give to B.  If B accepts the offer, he gets what is offered and A retains the rest. If B rejects the offer, neither get anything.  If  both were to act rationally, A would offer a small sum and B would accept. But in practice  A seldom offers very much less than £50, and   B very seldom accepts  very much less. Each is willing to give up an advantage rather than agree to what he considers to be an unfair deal.  In money-burning games, players are given tokens that they can later exchange for money. An unequal wealth distribution is then  created by gambling or selective gifts and each subject is  charged a fee  for an opportunity  to change that distribution by  burning  other players’ money.  The results typically show a willingness to pay to make the distribution less unequal - and to pay more when the inequality had arisen ‘unfairly’ (from a selective gift), than when it had arisen ‘fairly’ (from successful gambling). The results have been shown to be inconsistent with the motives of altruism, self-interest or envy, and consistent only with a psychological drive for fairness.

The evidence shows that the drive for fairness can override any evaluation of consequences. So it can make all concerned worse-off  - except, that is, for the psychological satisfaction that is gained. But even that gain may be based upon an illusion. For example the achievement of getting people what they deserve may have no existence outside the decision-maker’s mind.

  

Misinformation ? 1200 needless deaths ?

"Fury as hospital staff let off over 1,200 needless deaths"

Newspaper readers on the morning of 7  February 2013 were asking themselves how  it could be that nobody had been called to account for the needless deaths of 1200 patients at Britain's North Staffordshire Hospital.  Few will have seen the need to ask the question "how do we know that?"   After all,  the statement that there had been 1200 needless deaths was attributed to the highly authoritative report of a public inquiry the Francis Report .  In fact, however, there was no such statement in the Francis report, only an expression of regret that the figure had been publicised

("It is unfortunate that the figure of 400-1200 excess deaths became so widely  publicized and sensationalized. These estimates are derived from 95% confidence intervals around the SMRs, and the intention was to redact them from the final report because of concerns that the public would not understand them" Appendix 8 par 5).

 The evidence  collected in the Francis inquiry had  consisted of witness statements  by patients about malpractices at the hospital.           The hospital's mortality rate had been the subject of an earlier  health commission inquiry).  A statistical study had been commissioned by that inquiry to find whether  its above-average mortality rate  over the period 2003-2006 could be attributed to any of a range of  "external" factors such as the age of its patients.  The study had concluded that a  residual number of deaths  remained unaccounted for,  after allowing for all such external influences - and that those deaths were  presumed to be attributable to factors internal to the hospital.  The study concluded that there was a 95 percent probability that the size of that residual lay between 400 and 1200,  after allowing for uncertainties  concerning the effects of the  external influences.  

         Thus the evidence concerning  what happened at the hospital is (a) evidence of persistent malpractice -  attributed by the Francis report to the hospital's "culture" ; and (b) the evidence of  a substantial number of deaths attributable to factors internal to the hospital.  What the Robert Francis  had added to that information was the judgement that the association between (a) and (b) had been that of cause and effect - in other words that the unnecessary deaths had been the result of the hospital's "culture". His statement at paragraph 55 of the report further suggested that what had happened at North Staffordshire might be happening throughout the NHS: 

("There are those who have  given evidence or written to the Inquiry suggesting that Stafford is not an isolated case, and that, on the contrary, similar stories could  be uncovered in other parts of the NHS. Clearly, it has not been a function of this  Inquiry to undertake a survey of the NHS  as a whole and therefore   I cannot draw conclusions about this understandable concern. However, patients’ stories very  similar to those I have  heard have  been reported from elsewhere  and with some frequency; examples can be found in the recent Patients Association report.")

That speculation prompted further media conclusions such as the Times headline "The NHS is run for the benefit of the staff, not the patients".

 Misinformation?  Certainly! Damaging? Possibly :  the phoney 1200 figure is unimportant compared with the harm that could arise from an attempt to solve the problem by assigning blame and imposing punishment.

         The possibility of harm arises from neglect of the possibility that some of the needless deaths had arisen for reasons other than a culture of uncaring self-interest.  Some might, for example, have been the outcome of the selfless endeavours of people who were overworked, underqualified or otherwise ill-equipped for the tasks they were assigned.  It would  be damaging  to deter such people from reporting what happened as a warning to others, or seeking advice about how their mistakes could have been avoided.  

       

Would Western Democracy be a Good Idea?

Most discussions of democracy are unduly circumscribed by awareness of its history. The innovators Pericles, Locke and Madison took previous innovations as given, and people nowadays tend to do the same. As a result, nobody questions the superiority of democracy and everyone lays claim to it. Even the most oppressive tyrannies call themselves democratic.
          Among interpretations of the idea, the system known as western democracy has so far been the most durable. But although it is a survivor of an evolutionary process, its survival is not evidence of superiority over possible alternatives. A visiting alien might see it as very imperfectly related to the concept of democracy. Its reaction might be similar to Ghandi’s who, when asked what he thought of western civilisation, said he thought it would be a good idea.
          The history of democracy is the story of a sequence of attempts to achieve the ideal of government in the interests of the governed. The solution adopted by the ancient Athenians was to give every citizen a vote, so that Pericles could say ‘we Athenians decide public questions for ourselves’. Under the influence of later Greek thinkers and of the Church, the concept of democracy gave way to that of the great chain of being, and its corollary of the divine right of kings. Those concepts dominated political thinking until the enlightenment, with only minor incursions from the Magna Carta and the Bill of Rights. It was challenged in the seventeenth century by John Locke’s contention that the true relation between government and governed is an implicit contract under which the governed gave up freedoms only in return for an obligation to defend their rights. That was taken to imply their right to replace any government that failed to meet its obligation, and was the intellectual justification for England’s Glorious Revolution. The institution of parliament being already in place, it was then adopted as the instrument by which governments could be restrained from violating the rights of the governed. Subsequently America’s Founding Fathers, influenced by Pericles and Locke, advocated representation ingrafted upon democracy. In that respect, and despite its many innovations, the essential features of the United States constitution were similar to that being adopted in England. With the embellishments that followed, western democracy came to be seen as the most successful of all political systems.
              It is tempting to regard the result as the ultimate step in an evolutionary progress toward the achievement of the democratic ideal. Unaware of its history, the hypothetical alien might consider it to fall short of that ideal. It might reasonably expect a democratic government to act in the interests of the governed as seen by the governed themselves – on the grounds that they would not willingly have given up their individual freedoms on any other terms. That expectation might lead it to inquire how decision makers in western governments go about discovering those interests. It might assume the electorate to have delegated the task of predicting the material consequences of their decisions to the decision-makers themselves, much as a patient delegates to a surgeon the task of predicting the material consequences of an operation. But it would expect the views of those consequences to have been sought from those affected in the same way that a surgeon is expected to seek the wishes of his patient. Its enquiries on that point would not be reassuring. It would find that there is nothing to prevent decision-makers from taking decisions without considering the preferences of those affected. It would not be able to find how often they act arbitrarily or paternalistically because their decision-making processes are carefully hidden from view. If it looked for established means of calling them to account, it would find that auditing of government activities is confined to the activities of those whose job it is to carry out their instructions. In view of their limited access to the necessary information, it would almost certainly have reservations about the effectiveness of parliamentary scrutiny. It would also be doubtful about the legitimacy of head-count consultations as a way of informing governmental decisions, fearing that their inability to register depth of feeling could lead to misleading results when, for example, the views of serious sufferers were outweighed by those of more numerous marginal beneficiaries. It would note the misleading results which consultations would give when those consulted were misinformed about material consequences – as they were about the MMR vaccine. It would be surprised to find very little published research about procedures for better-informed consultation, such as citizens’ juries and focus groups, and would be disappointed to find that they are used mainly in connection with voters’ intentions in marginal constituencies. It would regard possibility that members of parliament could help as remote, having discovered that their views are seldom representative of their constituents’.
             Our imaginary alien’s analysis is a reminder that the institutions of western democracy cannot guarantee compliance with the concept of government in the interests of the governed without doing something to ensure that government decisions were in fact being taken in their interests. It is often suggested that compliance could be achieved if more people took part in politics. Pericles saw participation as essential to the success of Athenian democracy and is reported to have said that We regard the man who takes no part in public affairs, not as one who minds his own business, but as good for nothing. Without going that far, it is nowadays widely held that voting is a public duty. Since voting without understanding would be fruitless, that implies an obligation to be politically well-informed. Locke’s concept of a social contract implies no such obligation. His implied contract does not require the citizen to understand the business of government any more than does the implied contract between patient and doctor require the patient to understand medicine. That is the way most people now see politics: they want to be assured that the government is doing its job, but they do not want to spend time and effort trying to understand how that job is being done.
                It is no more practicable to guarantee that a government will always act in the interests of the government than it would be to guarantee that every doctor will always act in the interests of his patients. The main protection against abuse in both cases is the existence of professional standards and of the public service ethos, and the preservation – as far as we can tell - of a reasonable semblance of democracy in western democracies has probably been attributable more to those factors than to institutional arrangements such as elections. But if we are not simply to take good behaviour on trust we need some check on government decision-making. Knowledge of its results would not be sufficient because unforeseeable developments can make a good decision appear bad; and good luck can make a bad decision appear good. Second-guessing would not be practicable and in ant case it would not be needed. All that would be needed would be assurance that due attention was being given to available information, including information about people’s preferences. An occasional check on selected cases would provide a reassurance (or otherwise) to the electorate. More importantly the prospect of its publication would impose a salutary incentive upon decision-makers, discouraging such aberrations as paternalism and the seeking of short-term electoral advantage.
             The idea of such an audit would probably encounter bitter opposition from politicians. Should it be taken seriously, however, the first question would be who shall guard the guardians? The answer would presumably involve either the selection of commissioners with the required combination of objectivity and investigative expertise, or the establishment of a two-tier body with investigators reporting to commissioners. The second question would concern their access to information. There might be a case for allowing them routine confidential access to papers but imposing limits upon the timing and frequency of follow-up inquiries and upon the publication of their findings. The third question would concern the consequences of an adverse finding. Should the conventions of collective responsibility and ministerial responsibility be allowed to continue to prevent the calling to account of those really responsible? The final question might be to whom should such an audit commission be responsible - to parliament, or directly to an electorate?
                    Would this be a good idea, or should we muddle along and hope for the best?

Learning from other people's mistakes

According to George Santayana Those who cannot remember the past are condemned to repeat it.

That can only mean that, unless we learn from our mistakes, we are apt to repeat them. Luckily. it has been found that similar mistakes have been made by very different people under very different circumstances. So we should take our mistakes to mean everybody's mistakes, not just our own mistakes. A study of past mistakes, has revealed that a relatively small group of factors have contributed to most of them - a fact that promises to make analysis simpler and more rewarding. A complication that cannot be avoided, however, is that it is very seldom that a single factor has been the sole cause of a mistake.

In view of the gains that might be expected from the analysis of past mistakes, it is surprising, that comparatively little effort has been devoted to the subject. Some important work is, however, being undertaken by health professionals. They have discovered a number of shortcomings of the present treatment of mistakes, the consequence of which has been that mistakes that could have been avoided are often repeated, imposing additional health service costs running into £billions. One of those shortcomings has been a tendency to conceal one's own mistakes and overlook those made by one's colleagues, fostered by a convention that it is best to find ways around the resulting difficulties and get on with the task in hand. Another has been a tendency to blame an individual and leave it at that - and so to overlook vital contributory factors.

The National Health Service has recently introduced a no-blame error reporting system and a retrospective review of each incident to identify what, how, and why it happened. Similar systems are in use by rail and airline operators. Other branches of government and industry are expected to follow suit. Major advances may be expected from the analysis of the information do collected

In the meantime there is a good deal to be learned from further study of the information already available.

The author of this blog has made a start on such a study in Mistakes, how they have happened and how some might be avoided  (available from Amazon).