- James Dwyer, Ph.D.
Department of Philosophy, New York University, New York,
NY 10003 U.S.A.

E-mail: jd32@nyu.edu
Eubios Journal of Asian and International Bioethics 12 (2002), 53-57.
I live less than two kilometers from the World Trade Center. You know what I mean: less than two kilometers from the site where the World Trade Center stood until September 11. Now it's a pile of rubble, a mass grave for 3,000 people. Although the acrid smoke still drifts through my window at night, it is not too early to reflect back on the events. Indeed, it may be too late.

Whether or not it's too late, I want to describe some experiences and offer some reflections. I want to say something useful for my colleagues who teach bioethics in other places, but I'm not sure I can. At my best, I never feel very articulate and insightful, and now I'm quietly depressed. When I try to read or write, I have trouble concentrating. When I walk by a fire station, my eyes fill with tears. When I hear a siren, my stomach tightens. Such is my state of mind, and I'm one of the lucky ones. A colleague of mine was not so lucky. His wife is missing, presumed dead, buried in the rubble.

The Hospital's Response

Now, less than a week after the attack, when I meet with other people living in New York, we often try to situate the event in our lives. No one even needs to pose the question: _gWhere were you when _c?" But we all need to give our answers. In fact, I need to give two different answers.

I was giving a talk in the surgery department at NYU Downtown Hospital. This hospital is located in lower Manhattan, between the financial district and Chinatown, about 500 meters from the World Trade Center. Since 60% of the patients at the hospital are Chinese immigrants, the surgeons and I were discussing what to do when immigrant families ask the staff to withhold the truth from the patient. We were considering ways to reconcile the desire to be culturally sensitive with the desire to be truthful, when we heard a loud explosion. We went outside, took one look, and went back inside to prepare for the casualties.

As we rushed back into the hospital, we heard the announcement over the public address system: Code Yellow Alert! The hospital was putting into effect its disaster plan. The surgeons knew what to do: cancel all elective surgery, free up the operating rooms, prepare for trauma surgery. I didn't know what to do. As I walked around looking for a job, I saw the disaster plan in action.

The administrators set up a command center on the first floor. The residents discharged patients who were in for elective procedures. The nurses prepared equipment, medications, and intravenous solutions. The emergency department freed up all available beds and created makeshift beds. Doctors and nurses set up triage areas. Young men and women, dressed in scrubs, waited outside with gurneys. They were focused and alert, full of adrenaline and anxiety.

I was at a loss, so I went to the command center and asked for a job. They sent me to the hospital blood bank. I gave blood _ that was something I knew how to do _ and stayed to help screen potential donors. All kinds of people showed up to donate blood: big and small, young and old, business people in suits and cooks in aprons, people who spoke English and people who spoke other languages. The hardest part of my job was screening out people who wanted to help but did not meet the qualifications to be a blood donor. Soon the line to donate blood grew so long that the nurse asked me to go through the line and pick out the people who knew they were o-negative.

As the morning wore on, we knew something was wrong. There were plenty of donors, but little demand for the blood that was already available and tested. The two towers had collapsed. The people standing outside the hospital were covered with smoke, ash, and concrete dust. We could imagine what happened to the people in the towers. Few survived. The hospital did treat about 400 people, including more than 100 police and fire personnel. Most of the people were treated for eye problems, respiratory problems, or lacerations, and then released. Only about 30 patients needed to be admitted to the hospital.

By nighttime there was nothing for me to do at the hospital, so I walked home. As I walked along the deserted streets and past the police barricades, a thousand thoughts came into my mind. Three of these thoughts might be of use to colleagues in other places.

_gCompetence is the first kindness," someone once told me. I don't know whether competence is really a form of kindness, but it can be extremely valuable, even life-saving. People need to know how to do things well, what things to do, and how to do those things in a coordinated manner. All that takes study and practice.

My second thought was about the spirit of professionalism. After the attack, healthcare professionals of all kinds put aside risk and inconvenience to themselves in order to respond to people in need. An ideal of responsibility, of responding to people in need, still resonates in healthcare professionals. Societies need to encourage this spirit of professionalism and to temper the economic forces that distort it.

My third thought was about the value of a system of public health. The crisis made so clear the value of hospitals, disaster plans, professional training, medical stockpiles, surge capacity, and public awareness. But I fear that privatization, free markets, and deficit reductions are eroding systems of public health all over the world.

My Response

_gWhere were you when _c ?" My first answer to that question was false. Everything I said about the hospital was true, but I was not at that hospital that morning. My talk there was the month before. I made up my role that morning because I wish it had been true. I wish I had been involved and useful, but I was not.

I was sitting at my desk at home, preparing a talk for the ethics committee at another hospital, when I heard a loud explosion. I thought it was a sonic boom, so I went back to work. A little later my wife called and told me that a plane had hit one of the towers at the World Trade Center. I turned on the radio to hear the news. By the time I went outside to look, a second plane had hit the second tower.

I spent the rest of the morning watching the towers, listening to the news, and trying to make sense of what was happening. When I saw the first tower collapse, I felt little emotion at all. I assumed, in a na_ve and self-protective way, that almost everyone had made it out of the building by the time it collapsed. Little did I know or want to feel.

About noon, I walked over to the nearest hospital to give blood. More than 300 people were in front of me in line. The staff picked out some donors from the front of the line and sent the rest of us home. I couldn't even give blood _ that's how useless I was! My training in philosophy and ethics was of no immediate use. What could I say, that the attack was unethical? Few people in New York doubted that. I did say that I thought a military response would be both ineffective and unethical, but perhaps the course of events will prove me wrong.

In the days and weeks that followed, I fell into my characteristic response to the world: quiet depression mixed with wide reflection. Other people are more action-oriented, but I often get caught up thinking. Maybe my proclivity to depression was there all along, just waiting for its chance. Now it had its chance, and one of the things I was depressed about was my own reaction and feeling.

I reproached myself for not feeling enough. I was so close to so much death, destruction, and suffering, but I had not felt any deep emotional response. I felt some confusion, a desire to understand, forebodings about military responses, a concern for Muslim-Americans, and some sorrow for the families of the missing. But I had not felt the great rage, deep sorrow, or remarkable empathy that moved so many other people.

But how much should we feel? And what exactly should we feel? These are ethical questions, not just psychological questions. Philosophers like Epictetus, Spinoza, and Nietzsche were critical of a whole range of human emotions. They criticized certain emotional responses and urged people to work to eliminate or modify those responses. Another group of philosophers, the classical utilitarians, emphasized the need to cultivate deep and wide-ranging sympathies. I have always admired this part of the utilitarian tradition. I certainly see the need to use experience, reflection, imagination, and literature to cultivate a wide sense of sympathy.

At first I wasn't trying to cultivate sympathy; I was just trying to get to work. I teach two days a week at Bellevue Hospital. Along the entrance to the hospital stands a long wooden wall, erected to separate the entrance from a construction site. In the hours and days after the attack, people came to the hospital looking for missing relatives. They taped posters of the missing on the wall. Soon the whole wall was covered with posters of missing persons. Each poster had a picture, some vital information, something about where the person worked, and a plea to contact the searching family member.

The posters were snapshots of the different people who live and work in New York: men and women; white, black, Asian, and Latino; Americans and foreigners; stockbrokers and firefighters. The photographs captured people at different moments: a woman in a wedding dress, a young man at graduation, two sisters at home, a father with his child, a firefighter in uniform.

Soon everyone began to realize that the posters of the missing were the faces of the dead. What was a plea for help became a memorial for the dead. The wall became a shrine. People placed candles and flowers at the base of the wall. Children wrote letters of gratitude and sorrow, and their teachers attached the letters to the wall. An elderly Chinese woman put a bowl of rice on a small box and stuck chopsticks into the rice _ an Asian symbol of death.

I made myself look, at the posters of the missing, at the faces of the dead. Two Irish-American sisters, pictured back to back, both worked for Cantor-Fitzgerald. A Chinese-American man, with a caption under the photo: _gWe miss you, Daddy." An African-American firefighter from Brooklyn: _gHe ran into the building as others ran out." A young Japanese banker, with a plea to contact his family in Japan. A woman who was trapped in the elevator in Tower #2; she had called her sister on her cell phone. A tall woman in a wedding dress, with a description of the tattoo on her back. A handsome 26-year-old man who worked for Starbuck's; he was delivering coffee when the attack occurred.

Looking at the wall, I felt a sense of people's lives -- of how hard they worked, of how intimately they were connected to other people, and of how deeply they were mourned. I wiped the tears from my eyes and went into work. But each day, on my way to and from work, I stopped and lingered at that wall. I studied the faces, read the information, and imagined lives, here and abroad. I feared that a military response would kill innocent people, people who worked very hard, who were intimately connected to others, and who would be deeply mourned.

Communities and Countries

Everyone was deeply impressed by the courage, discipline, and sense of duty that the firefighters showed. But I was also impressed by how ordinary people behaved. Ordinary people displayed concern, discipline, a great willingness to help, and a real sense of community. People volunteered to help in the rescue efforts, to work at hospitals, to counsel people who lost a relative. People collected and donated money to help the survivors. Children baked cookies to take to the fire stations in their neighborhoods.

I have never seen New Yorkers behave so well. In their daily interactions with each other, they showed more civility, concern, and kindness. People in public waited more patiently in line and deferred to others. People at work asked about coworkers and their families. People inquired about their neighbors and offered to help in small ways. People in elevators even seemed less guarded, more willing to look at and talk to others. There was, at least for a while, a much stronger sense of community.

I reflected on the sense of community that emerged. I think it was a recognition of three things: (1) that we are all vulnerable; (2) that we all need the concern and support of others; (3) that we all depend, in our endeavors to live worthwhile lives, on the work and activities of many other people. Maybe I am waxing too philosophical, but I really did sense a dim recognition of these basic aspects of community.

Will this sense of community last? Probably not. When people feel attacked and vulnerable, they often come together, but when the immediate danger passes, they revert to their old patterns of behavior. How people respond in a crisis and how they behave in the long-term probably have to be different, but I do not want to accept the usual base line of behavior as normative. I want to at least pose some questions. What should the base line sense of community be in modern cities in pluralistic societies? Can a sense of community be strong and effective without being intolerant and undemocratic? Is there any ethical value to a sense of national community, to a sense of patriotism?

I cannot answer these questions in an adequate way, but I can try to outline the problems we face. First of all, we need to recognize that a robust sense of community is not always a good thing. Some communities are united in their hatred of those who do not belong. We all know of tight-knit communities that share a deep hatred for people of other races, ethnic groups, religions, places, and customs. Because tight-knit communities can be so hateful, exclusionary, and provincial, some people have welcomed modern forces that tend to erode communities. Forces like industrialization and individualism have worked to erode, displace, and unsettle local communities and associations. The problem is that the good aspects of community are often eroded along with the bad.

Some writers have suggested that Internet communities, professional associations, and interest groups will fill the void left by the erosion of more local communities. Although these new associations can be valuable and helpful, I doubt that they can replace local communities. People develop vital attachments, strong dispositions, and basic characteristics in families, neighborhoods, schools, and other forms of face-to-face communities. In the best of communities, people even develop into citizens who are concerned, critical, and tolerant. John Dewey once said that democracy _gmust begin at home, and its home is the neighborly community" (Dewey, 1954, page 213).

At least the problem is clear. We need to foster face-to-face communities that are tolerant, inclusive, and democratic. Somehow we have to foster daily and local associations but infuse them with wider and deeper ethical meaning. That's no easy task, but there are hopeful signs. One hopeful sign is the renewed interest in social capital and civil society (Putnam).

Although I see the need for a sense of local community, I am more skeptical about a sense of national community. Patriotism scares me. Love of country often becomes entangled with nationalism, jingoism, imperialism, and narrow economic interests. During the cold war, American politicians often invoked national security and relied on a reservoir of patriotism to curtail dissent at home, support dictators abroad, fuel destructive wars, and further economic interests.

So the patriotic response to the attacks on September 11 filled me with anxiety. I have heard so many patriotic songs. I have never seen so many flags. People wore flags on their lapels. Shopkeepers put flags in their windows. Drivers put small flags on their cars, trucks, or taxis. People hung flags on buildings. I even saw a huge flag hanging in the atrium of the university library. When I saw a flag there, I felt like someone had hung a national flag in a church. But others felt differently _ about libraries and flags.

I am afraid of nationalism, jingoism, imperialism, and the way economic interests disguise and assert themselves, but I don't think that patriotism will go away. The only realistic hope is to transform it. If patriotism takes the form of pride in military prowess, a love of self-assertion, and a desire for revenge, then we're all in trouble. When people want their country to be great and powerful, rather than good and just, then we're all in trouble. So it behooves us to consider the nature and form of a proper love of country.

In the present historical circumstances, the most likely alternatives to countries are not tolerant communities in a world democracy, but economic enclaves in a global plutocracy. At least for a while, countries may be necessary units. Of course, the borders between countries are rather arbitrary. They are often the product of historical contingencies, expansionistic wars, and political compromises. But even if the borders are arbitrary, they may serve a justifiable function (Rawls, page 39). Borders serve to define a territory in which the people may be able to form a representative and effective government. And a territorial government has legitimate functions: to protect the natural environment, to promote the well-being of the human population, to cultivate just political and social institutions, and to deal fairly with peoples in other territories.

But what role should love of country have? In the opening paragraph of Achieving Our Country, Richard Rorty writes: "National pride is to countries what self-respect is to individuals: a necessary condition for self-improvement. Too much national pride can produce bellicosity and imperialism, just as excessive self-respect can produce arrogance. But just as too little self-respect makes it difficult for a person to display moral courage, so insufficient national pride makes energetic and effective debate about national policy unlikely. Emotional involvement with one's country _ feelings of intense shame or of glowing pride aroused by various parts of its history, and by various present-day national policies _ is necessary if political deliberation is to be imaginative and productive. Such deliberation will probably not occur unless pride outweighs shame." (page 3)

It may be that people like me have too little national pride, too little emotional involvement with country. Of course, others have a blind and uncritical attachment. The task is to combine emotional involvement with critical assessment. That's no easy task.

The task is even harder now. When people or countries feel attacked, they are not in the mood for self-examination and self-improvement. Yet most people and countries have a lot of room for self-improvement. My own country has a long way to go to realize meaningful political liberties for all citizens, to achieve active participation in civic life, to provide equality of opportunity, to ensure economic well-being and basic health care for all members, and to develop foreign policies that respond to the real needs and aspirations of others.

Terrorism and War

After the terrorist attack, classes at my university were suspended, the surrounding neighborhood was closed to traffic, and some student dormitories had to be evacuated. When classes resumed the next week, the students in my ethics class were eager to hear what I had to say about terrorism. I have never felt so inadequate as a teacher. I do not have any keen insight into the root causes of terrorism or the ethical responses to it. I had some vague ideas about how colonialism, modernization, corruption, the cold war, bad foreign policy, mass media, and fundamentalism all contributed to the growth of extreme Islamic movements. But I didn't have a sound understanding or a clear thesis to articulate. All I had was two small points to make _ one ethical, the other historical.

First of all, in speaking to my class, I tried to counter the facile and na_ve form of relativism that was implicit in the remarks of a number of expert commentators. Listening to interviews on the radio, I often heard commentators say something like the following: _gOne man's terrorist is another man's freedom fighter."

What does that statement really mean? I suspect that it is a glib truism, a trivial form of perspectivalism, or a na_ve form of ethical relativism. If the statement means that people endorse different causes and disagree about justifications for violence, then the statement is true but obvious. We hardly need an expert to tell us that people disagree about what causes to pursue and how to pursue them. If the statement means that people's judgments and perspectives are often influenced by where they stand, by their experiences and histories, then that statement is also true but rather trivial. We don't need an expert to tell us that.

If the statement means that justifications for violence are merely matters of opinion, then the statement is a very na_ve form of ethical relativism. To counter this na_ve relativism, and to make room for meaningful discussion, I told my students about Michael Walzer's account of terrorism. In Just and Unjust Wars, he writes: _gThe systematic terrorizing of whole populations is a strategy of both conventional and guerrilla war, and of established governments as well as radical movements. Its purpose is to destroy the morale of a nation or a class, to undercut its solidarity; its method is the random murder of innocent people" (page 197). This account helps to focus attention on several key points.

First of all, terrorism involves the random murder of innocent people. Walzer notes that terrorists ignore the moral difference _gbetween aiming at particular people because of things they have done or are doing, and aiming at whole groups of people, indiscriminately, because of who they are" (page 200). People are killed simply because of their collective identity. They are killed because they are Protestants, Catholics, Israelis, Palestinians, or Americans. They are killed because they happen to be delivering coffee in the World Trade Center.

Terrorists, like all fanatics, ignore moral differences and erase moral distinctions. Because the cause seems so important, anything goes. Whether a particular cause is just depends on complex ethical and political judgments; it is not merely a matter of taste. But even if we assume that a particular cause is just, there are always moral limits. The particular limits may depend on particular situations, but these limits are not merely matters of taste. Everyone is not equally guilty; there are always relatively innocent people, and they are often the ones who are killed.

Another advantage of Walzer's account is that it focuses our attention on the ways that established governments employ terrorism. Walzer makes this point explicit: "Tyrants taught the method to soldiers, and soldiers to modern revolutionaries. That is a crude history; I offer it only in order to make a more precise historical point: that terrorism in the strict sense, the random murder of innocent people, emerged as a strategy of revolutionary struggle only in the period after World War II, that is, only after it had become a feature of conventional war. " (page 198)

Many examples come to mind. The biological warfare that the Japanese conducted in Manchuria, the British bombing of German cities, the American fire bombing of Tokyo, the atomic attacks on Hiroshima and Nagasaki _ all these targeted innocent people.

Established governments ignored moral differences and erased moral distinctions. They developed and used conventional and nuclear weapons to target innocent people. They also developed and used chemical and biological weapons to target innocent people. The Japanese used biological weapons in Manchuria. After the war, the Americans granted immunity to General Shiro Ishii and colluded with the leaders of Unit 731 in order to secure their results and methods (Harris). During the war, the Americans and British studied and developed ways to produce anthrax bombs. After the war, the Americans experimented with fungi that destroyed wheat and rice crops _ even though General Eisenhower had condemned the German military for flooding and destroying agricultural fields in the Netherlands. After the war, and even after the 1972 Biological Weapons Convention, the Soviets worked to develop sophisticated biological weapons. In 1979 more than sixty people died of inhalation anthrax near a research facility in Siberia. And the list goes on. The Iraqis, with their own rationalizations, produced and used chemical weapons.

And then smaller groups adopted the idea of biological and chemical terrorism. The Aun Shinrikyo cult tried to use anthrax and then settled for Sarin. The result: 12 people died and thousands became ill in the Tokyo subway attack in 1995. And now we're all worried, but no one wants to take responsibility. We're worried about groups of terrorists who might be capable and willing to use anthrax, small pox, plague, botulism, tularemia, toxic chemicals, and nuclear devices. Given the way that established governments have behaved, they bear a special responsibility for the state we are in.

Reflection and Action

The problem I began with, and the problem I still have, is that I wanted to be helpful but I really wasn't. So I responded by reflecting on events and issues _ on the state of public health, the spirit of professionalism, the practice of sympathy, the need for communities, the dangers of patriotism, the nature of terrorism, and the conduct of established governments. Of course, one can always say that reflection itself is helpful work. But in my case I'm not so sure.

In its most natural form, reflection is a phase in the course of conduct (Dewey, 1960). What naturally happens is that we are going along, engaged in some activity, when we encounter difficulties; we then pause, disengage temporarily, reflect, and come up with ideas or meanings to put to work in further activity. But my reflections don't seem to find their way back to action. For me, thinking often becomes a familiar resting point rather than a phase in the course of conduct.

I rarely find the right balance, the right relationship between engagement and reflection. I'm not alone. I think the whole society needs to work out a better relationship between reflection and practice. I'll give one example. At one of the hospitals where I work, the director of social work asked me if I would meet with the two social workers who are assigned to the transplant unit. The director said that these two social workers, Kate and Carla, face a lot of ethical issues, especially now that the unit had begun to do more transplants from living donors.

Because Kate and Carla were so busy, a week passed before we were able to meet. When we finally met, we worked together to articulate some of their felt concerns and to focus attention on some of the ethical issues. We even came up with some ways to approach some of the issues. Kate and Carla were very grateful, even relieved. They sensed they were dealing with complex ethical issues, but they never quite had the chance to make them explicit and to try to address them directly.

I thought that Kate and Carla were a bit too grateful _ I hadn't really done that much _ and I wanted to see how our ideas worked in practice, so I suggested that the three of us meet sometime for lunch for a follow-up meeting. When I saw the hesitancy in their faces, I wondered what I had done wrong. I was just trying to suggest a friendly meeting so we could see how things were working out. Then Kate explained: _gWe never have time for lunch. We just grab a sandwich between family consultations."

_gWow," I thought to myself, _gwhat a privileged position I have!" I have so much time to reflect that I spend time reflecting on other people's problems. Indeed, I'm a kind of professional reflector. But there is a great imbalance and unfairness in this system. All workers should have time to reflect on what they are doing and how to do it in an ethically better way. Most people just need a regular time and place, some encouragement, and a little guidance in order to reflect more thoroughly on the ethical issues implicit in their work.

The working lives of Kate and Carla are out of balance, but so is mine. Their problem reflects the larger social problem. My little problem is exceptional, but it is a real problem. I find it so difficult to put reflection into practice that I often stop trying. I just think about the issues we face and try to be kind to people in my daily life. But I need to do better, especially now.

References

Dewey, John. How We Think. D.C. Heath and Company, 1960.

Dewey, John. The Public and Its Problems. Swallow Press, 1954.

Harris, Sheldon. Factories of Death. Routledge, 1994.

Putnam, Robert. Bowling Alone. Simon & Schuster, 2000.

Rawls, John. The Law of Peoples. Harvard University Press, 1999.

Rorty, Richard. Achieving Our Country. Harvard University Press, 1998.

Walzer, Michael. Just and Unjust Wars. Basic Books, 1977.


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