Category Archives: Philosophy

Paying It Forward

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Earlier this week, I lost my University ID card (actually, two of them, for the University and the Hospital, clipped together) , which basically contains all my access on-campus. Pondering the pain of replacing them, I received a message via FB Messenger from someone I’d never met who’d found it in a parking lot. We arranged, via FB, for my wife to meet this angelic person at her work, and I got my ID back in less than 24 hours. And oh, by the way, Tamra Dale walked a mile through freezing temperatures to retrieve the ID for me.

So, feeling extra lucky, I go to my eye appointment. And I find someone’s open billfold at  the local establishment, clearly unintentionally left behind. I pick it up and give it to the ladies working at the optometry office, they identify the owner and call her, she comes to the office to get it.  As I happily sit anonymously enjoying her delight, the ladies say, “Don’t thank us — thank the doctor here who found it.” And she delightedly turns to me and says, “Thank you, doctor.”

Just a shout out to a momentarily orderly world, with kind and thoughtful people, using technology invented by other smart people, and working voluntarily together to make life a little better for each other, for no other reason than a shared sense of humanity.

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Filed under Chicago, Philosophy, Trust

Star Wars: The Force Awakens (Sort of)

“That’s not how The Force works!”  Han Solo to Finn, Episode VII

I saw the new Star Wars movie today. While a significant improvement on Episodes I -III, it still didn’t rise to the level of the original episodes IV – VI. It captured a bit of the original spirit, including the cheeky interplay between the original band of reluctant rebels. I didn’t find the hearkening back heavy-handed, although some did, with charming re-introductions of Leia, Han, and Chewy. The new droid, BB-8, deserves the attention he’s getting — the R2D2 for a new generation.

JJ Abrams is at his best with the action sequences, the tongue-in-cheek repartee, and the droid humanization. The newcomers Rey and Finn, are well done by Daisy Ridley and John Boyega. The story line with Finn’s struggles to move on from Stormtrooper life is a nice addition to the saga.

My biggest complaint, besides the comical Emperor, is the way the underlying “philosophy” of the Force is handled. Without giving away too much, its coherence as a combination philosophy, religion, training-method, and mentored ability isn’t consistently upheld. Abrams et al. don’t seem to grasp the essence of the thing, so it doesn’t hold together, in a distracting way. It leaves the plot lines dangling, too-often bringing the viewer out of the action, to wonder about how it fits together, and losing connection with the characters. The whole thing comes across overly hollow. I was fully with Han when he yells at Finn, “That’s not how The Force works.”

My kids (12, 9, 9), action movie gurus already, thought it was “good”, and they were intrigued enough to want to watch some of the originals.  And my oldest son can now apparently do this.

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Filed under Movies, Philosophy

Chicago Sadness

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I’ve been trying to figure out how I’m “supposed” to feel over the past 24 hours.  I spent the day away from my office in Hyde Park in response to a credible threat of “gun violence” reported to the University of Chicago by the FBI.

As it turned out, the person posting the threat online was a student at the University of Illinois in Chicago.  The threat was a response to the recent horrific shooting of a young African American man by a Chicago police officer.  The officer shot the young man 16 times, and this was captured on video; the video was released to the public recently, in conjunction with a murder charge against the officer.

One of the specifics of the student’s threat was to kill “white male students and/or staff”.  Which meant, had I gone to work, I would have been a prime target, had the threat been real and gone unnoticed. There is a reasonable chance I would have been walking across campus at the 10am time given.

One emotion I don’t feel is anger.  I keep searching my mind for such feelings toward someone who, knowing nothing about me, would put me in a category based on nothing by my gender and skin color, then decide that it might be reasonable to kill me.  Sorry, it’s just not there.

What I primarily feel is sadness.  Sadness for Laquan McDonald’s family for his unnecessary death; sadness for the violence in my city that sometimes seems unending; sadness for the fear this all generates for decent people; and even sadness for the young man who felt compelled to post, just for a moment, his rage at the world that seems stacked against him.  Realizing, that for his anguished moment of misplaced judgement, he now faces the possibility of 5 years in jail – and the agony his mother must feel for him.  May fate spare me anything similar.

One of the joys of working at the University of Chicago as a physician is all the interesting people from every imaginable background that I am privileged to meet, work with, care for, and get to know.  Mostly, I’m thankful to be taking care of people, often with deadly diseases, too often near the end of their lives.  Last week, I spent much of my Thanksgiving holiday talking with people in pain and distress about the rapidly approach end of their lives.  All of which made me thankful for the opportunity to do so and still be healthy enough to help.

I spent the unexpected day away from work with my family, a rare weekday to enjoy them.  I helped the kids with their schoolwork (they are in a unique Chicago school program which has them working “virtually” many days), took them to their gymnastics practice, and took a walk through our south side neighborhood.  My 12-year old son asked me why I didn’t go to work, and I tried my best to explain honestly what was happening.  He asked some appropriate questions, which I answered, again as honestly as possible.  He accepted this, openly, and moved on with life.  It seemed surreal – to have an extra day enjoying time with my kids as a consequence of other, slightly older kids enduring life’s awfulness, mostly due a societal inability to deal with differences between people due to the color of their skin.  All of this turned my sadness into a sort of variegated melancholy – an amalgam of sadness about the world we live in, satisfaction in keeping the violent ugliness out of my kids’ lives a little longer, and the difficult realization that I don’t really know how to control either one.

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Filed under Chicago, Philosophy, psychology

Vacation Kinetics: Purging the Matrix, Cleansing the Senses, Awakening the Spirit

Overloading

Vacations are a way to get away – in every way.  Yet in today’s hyperconnected, hyperkinetic modern world, it is more difficult than ever to disconnect, decelerate and rejuvenate.  Our two-week family vacation was strategically planned by my lovely wife to allow rejuvenation of mental energies away from work concerns near the end of summer, including long stretches in the car; in remote rural areas; and being out the country – in part, to discourage on-line time.  The 24/7 maw of the social media world that is drawing us into a Borg-like meta-community has a gravitational pull into its growing sphere of influence.  Disentangling from it has become the primary challenge for a successful vacation.

Academic physicians seem evolutionarily conditioned to have our attention swallowed up by the immediacy of our daily work lives.  Our nervous systems seem finely-tuned to reflexively respond to our daily sensory input of general need.  At work, we are confronted with the “emergencies of the moment” that consume our carefully planned schedules.  For me, this includes urgent emails from my boss, cell phone texts from mentees needing deadline-driven feedback on a paper, voicemails from professional groups on sudden changes to upcoming conference calls, faculty members unexpectedly out for personal reasons needing coverage, or a page[1] from a nursing home on an immediate patient concern.  The amygdala-jarring, guilt-reflex that each of these inputs ignites, reinforced by years of professional acculturation demanding immediate responses to all needs, makes ignoring them genetically impossible. Adding the barrage of input from overseeing a section in a department of medicine at a large academic institution (read: middle management) only raises the cortisol levels further. It is no wonder why, among academic physicians, burnout and turnover are so high.

Sometimes the only way to break the cycle is to eliminate the sensory input.  Everyone I told that I was going on an extended vacation enthusiastically encouraged me to “avoid all work-related activities”. Easier said than done!

Weaning

I was excited about our planned trip, even with the prospect of being locked in a car with my Eveready-bunny young boys for hours on end.  When I was a kid, we would jump in the old Datsun station wagon and drive to grandma’s house, twelve good hours of complete family immersion and outer-world isolation.  Playing “counting cows” and finding state license plates are over.  In our car, there are three smart phones, three tablet computers, and 2 regular computers, all internet-connection compatible. Perhaps the one advantage of my cell-phone service with Sprint is the relatively poor coverage it provides in non-urban areas and the ghastly charges they have for international service.[2]  Even worse, having identified “internet access” lying at the very base of Maslow’s hierarchy of needs, every place you stop along the way provides WiFi services.  It’s truly amazing watching people wander slowly about public places, slack-jawed staring at a phone, bumping into things.  In protest, I carry a book around with me everywhere, sitting and reading something in the open periods available.  Like other addicts, I spent hours each day in a cold sweat, trying not to connect my nervous system into the Matrix, slowly weaning myself off the electronic juice.  At the beginning of the trip, I wasn’t sure two weeks would be enough time.

Everything triggered a reflexive need to connect.  In reading a rest stop sign on the local history of Rome, NY – was it really the starting point for the building of the Erie Canal?  In seeing someone wearing a LeBron James jersey in Cleveland – how were the FIBA team practices going?  Had we heard back from anyone on our journal articles, especially the one to the Health Affairs Blog?  Slow, deep breaths…count to ten…ask someone a question…read your book…  This was work!  When did vacation become such hard work?!?

Purging

Recognizing the challenge ahead, my wife had brilliantly planned for us to spend many hours a healthy distance from the Matrix. First, living cozily in a small, rustic two-story motel on Old Orchard Beach — a lovely, genuinely historic locale inhabited primarily by thin, smoking French-speakers from Quebec. Meandering a mile barefooted down the silica, confronted by the sine-wave eternity of sandy saline, is a wonderful psychic purgatory.  We spent the first part of the trip at a local joint, catching an unexpected glimpse of a favorite celebrity, and hanging out with the bride and groom, moves the electronic buzz into the hazy periphery.  Being forced to stop at a local gas station, all gussied up, to get directions to the ceremony at “The Barn at Flanagan Farm” from a woman with a knowing smile, because the GPS won’t connect,  injects a healthy dose of humanity.  Spending the day-after brunch with across-the-country friends you’ve only interacted with on Facebook in over 20 years, and discussing foreign policy among the wild flowers with an intensity social media precludes, reconnects the vivid present to the unseen future through the past.  Hiking up a mountain, along sheer ravines with my adventurous sons, calves aflame, unable to send a reassuring text to my wife, calls forth a focus of intensity to block out the world. Staring through the cool, swirling mist of pulverized water on rock from the deck of a boat staring up at Niagra’s relentless falls, unable to snap pictures with your smart phone, forces you to simply enjoy the moment. Exciting the senses and calming the soul.

Awakening

As the sensory apparatus was revived by salty ocean breezes, fresh seafood, bright wild flowers, prickly briars, and cool mist, the cognitive gears began turning again.  Freed from the character confines of Twitter chatter, narratives of new friends emerged.  Shared struggles up a steep, rocky mountain invited bonding discussions of oceanside views.  Meeting Ricki inside her beachside Place, quicky, discombobulated bookstore/motel/knick-knack/beach-equipment rental encouraged bibliophile bonding, and some more books for the collection. Open enjoyment of a new marriage in a field of clover led to wide-ranging discussions of the entrepreneurial spirit altering the landscape of international relations. Touring the Joshua Chamberlain museum, some more pieces of history clicked into place, as the WWII-vet docent filled in more details.  And another Civil War history book went into the collection. Stopping at the Fort Erie historical site, engagingly led by a young local woman in period clothing, and punctuated by the firing of a mortar shell ordered by my son, I could almost feel the neurons reignite.

Contemplating

As the vacation flowed along, as my senses revived, as my brain engaged, I found the need to write creatively emerging.  Using my long-dormant blog, I spent time each night piecing my thoughts together, gratified to find others who shared my thoughts.  Why was I so intrigued by professor-turned-soldier Joshua Chamberlain?  What did I enjoy so much about used book stores? Why was   I found myself feeling happier than I have for some time, enjoying the simple vitality of being alive, letting my inner self choose the topic, rather than responding to the “emergency of the day”.

I finally had some space and energy to contemplate – to, as Dr. Suess would say, “think about thinks”.  The true value of an extended vacation is less to get away from things like the matrix, but to get close to one’s inner self.  The “getting away” is really just the first part, to clear the playing field, to blow out the engine, to pull the plug on the tub full of dirty water.  Or like a beach after high tide, when all the sand sculptures have been melted down, and the canvas again lies pristine. Once that’s done, one can really get to work, focusing all of one’s energy on the creative task at hand.   I now feel like I imagine my kids do when they start on the new sandcastle or master a new skill, happily creating something anew from nothing, investing all of one’s ample energy in the project at hand.

I’m grateful to my wife for planning this vacation, finding a way to detach us from the persistent buzzing of our Web-ensnared devices, nudging us out into the wilderness of reality, allowing us to engage with the wider world.  I’m thrilled that she was rewarded in many ways: recognizing a favorite sit-com star who flashed across her field of vision, re-engaging with an old friend at the wedding (both wearing beautiful lavender dresses), playing on the beach with her boys, and enjoying another birthday dinner with me.  We’re now a little older, a bit wiser, and more thoughtful – and perhaps, a smidge happier.

[1] Yes, a pager. I suspect doctors are the only professional group that has failed to give up this antiquated, annoying form of communication.  Mostly symbolic, like stethoscopes and white coats, that allow physicians to maintain a professional identity, to the detriment of job function.

[2] As we discovered during our recent trip to the Black Hills of South Dakota, Sprint has absolutely no interest in providing any cell service whatsoever in that area.  They really ought to change this into a “feature” for vacationers like me, guaranteeing “absolutely no service, no matter the urgency of the matter”.

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Filed under Aging, History, Philosophy, psychology, vacation

Robin Williams, Jimmy Wales, and Holes in the Universe

Many years ago, during my first stint living in the Windy City, Jimmy Wales of Wikipedia fame lived with us.  During that time, he told us a funny story.  He was in a park in a major city, I believe it was Central Park, but I can’t be certain.  He saw an aggressive mime bothering someone in the way mimes do, although this one seemed even more active and annoying than usual.  Suddenly, the man serving as the “audience” for the mime just slugged the mime, knocking him down.  I laughed – haven’t we all wanted to do this at some point in our lives?

This would have just been a cute story, except that Jimmy related seeing Williams on a talk show many years later – TELLING THE SAME STORY!  Only in that version, Williams was the mime being slugged.  I was laughing hysterically now, imaging my favorite comedian, being punched by some stranger who never knew his brush with fame.

All these many years later, I’m as stunned as everyone else at Mr. Williams’ death from suicide. Even as a physician who cares for many patients with depression, knowing the dangers it brings, I feel as sucker-punched as Williams-as-mime must have.

I vividly remember the first time I saw Williams on TV – in his role as Mork from Ork on my favorite childhood show, Happy Days.  His appearance on that family sit-com, in justice, should have been the “jump-the-shark” moment for the original “jump-the-shark” moment.  We would be calling such derailments of successful shows that have over-run their course the “alien-from-Ork” moments, I believe – except that Williams was just so damn funny.

I heard that, during the try-outs for the part of Mork, each applicant was asked to sit like an alien.  Williams spontaneously chose his now-famous head-down/ass-up posture, which nearly won him the role by itself.

There is nobody I can think of who filled my life with laughter as much as Robin Williams.  I watched Mork and Mindy religiously.  Even as a kid, I would stay up late, after begging my parents, to see him on the Tonight Show with Johnny Carson.  I watched every one of the charity specials that he co-hosted with Billy Crystal and Whoopie Goldberg.  I have seen virtually all of his movies, especially the comedies. I love to laugh, and nobody made me laugh more than he did.  The manic craziness, combined with the abstract flight-of-ideas, and the obvious delight in response of an audience – any audience – was infectious beyond belief.  There is just nothing like it.

I have read that one of the “reasons”, if such can be adduced after someone suffering from depression kills themselves, that he committed suicide was a recent diagnosis of Parkinson’s Disease. Since I treat many people with this disease, I wanted to comment that I hope that’s not true.  Many people with PD have a wonderful quality-of-life with the diagnosis, receiving treatments for it.  But I can’t help but wonder if, after playing the role of neurologist Oliver Sacks in the movie Awakenings, Robin was reminded of the unfortunate outcomes from that initial episode of using carbidopa/levodopa to treat a variant of PD.  But it is haunting to watch that film and not wonder a bit.

Now that Mr. Williams has written the final chapter of his life, he has left a hole in the universe, it seems.  His life, as much as anyone’s, was a singularity – and like the outer space version of such, it has left a black hole behind.  I wonder at this feeling of loss, this presence-of-an-absence, that some people leave behind.  It’s the converse of the bright flare of joy such people bring to our lives, and I’m going to try and le that shine on in my memory, as much as possible.  He really was the funniest person I’ve ever seen, and I see in my mind’s eye, him being punched for being TOO good a mime, with an astonished Jimmy Wales looking on, heading out to change the world in another way.  And you can read all about one due to the vision of the other.

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Filed under Comedy, Decision Making, End of Life Care, Philosophy

Trust and Behavior – Personal, Professional, and Political

Personal

My wife and I are placing significant trust in two young people we’ve never met before tonight.  We’re going to dinner together and leaving our boys — ages 11, 8, and 8 — with two strangers we’ve only met on the phone.  We’re even doing so in a place we’ve never been before.  Hopefully, we won’t be arrested for parental negligence, like a Florida mom was for allowing her 7 year old to walk to the park.

In addition to the trust we’re placing in these two young women strangers, we’re placing a significant amount of trust in our young boys, especially our eldest son.  He’s a smart 11 year old kid, with reasonable judgment, generally cautious, but with bouts of immaturity. We’ve gone through contingencies, he has a phone to contact us, and he wants to be more “grown up”.  He’s done well given appropriate leeway in the past.  Unfortunately, as Nicholas Nassim Taleb and others point out, successful past performance isn’t always a reliable guide to future success – a problem when large consequences are at stake. Our 8 year-old twins are rambunctious boys, one is very risk-averse and the other is risk-seeking; both are argumentative.  All of this was relayed to the babysitters.  They seemed perplexed that we were telling them all of this – apparently recognizing the extreme risk-aversion in the parents as more important than that of the kids.

The paradox of trust is that it involves a judgment of people in the face of insufficient evidence and lots of uncertainty.  Human beings make choices, and past action in similar circumstances is no guarantee of similar future action.  Even more difficult is predicting how people will behave in brand new circumstances. Trust when applied to human beings requires a judgement about character – that their virtues/values will guide their actions in a consistent, life-affirming way.  But there is no guarantee.  And mistakes are brutal in their consequences.  And yet, the greatest rewards flow to those who take the biggest risks.  As someone who studies decision making in a medical context, I’m hyper-aware of all of these issues.

Professional

I spend much of my professional life as a physician counseling people on risk.  As a physician caring for older patients with cancer, I’m constantly trying to provide my best advice for patient to balance the risks of having cancer with the risks of being treated for cancer.  One of my personal practice patterns is not only to tell patients and families what I think they should do, but to explain at some length WHY I suggest this.  Most appreciate knowing this additional information, although some find it overwhelming and confusing.

Over time, many of my patients have come to trust my judgment, even to the point of insisting that other doctors contact me before they allow a procedure or a treatment to take place.  I believe this trust comes from three sources: my willingness to explain the uncertain trade-offs they face, my constant reassurance that their quality of life is my highest goal, and my willingness to support whatever decision they ultimately make.  Also, my track-record is pretty good, in telling people what to expect, which tends to inspire trust.  The investment of extra time in clinic is worth the improved outcomes down the road.

Political  

I often marvel at the willingness of politicians to make definitive statements about uncertain events involving many people.  Having to act on issues that affect millions, or even billions, of people in the face of such uncertainty would be virtually impossible for most people, and certainly for me.  Yet we ask our presidents to do this on a nearly daily basis.  Today, I read in the news that we’ve decided to use military force, in the face of rising violence by terrorists, in the form of bombs, in Iraq.  Having supported our on-going troop withdrawl from that country, I’m unsure this is a good idea or not.  Hopefully, it will help the beleaguered people in the north of the country being brutally killed by the terrorists.  On the other hand, it might lead to escalation of violence in the country, increasing the overall violence in the area, to little effect.  Even worse, it appears to be a concession that our current policies in Iraq specifically, and the Middle East general, are failing.  I’m not sure whether this is a good thing to do, and I do not trust our government to choose wisely.  In the face of all this uncertainty, I truly don’t understand how to feel any trust.  As Ronald Reagan reminded us, when it comes to the politics of foreign policy, “Trust, but verify.”

Follow-up

Throughout the night, several people asked us, “What did you do with the kids? You didn’t leave them alone, did you?”  We received several text messages from the kids, including pictures of them having fun at the amusement park.  We had a fun, relaxing time, even seeing a celebrity from a favorite TV show, proving that Black Swan events aren’t always negative events.  We returned home from our event to find that the kids had a great time — and to our surprise, so did the sitters!   The kids spent many hours playing on the beach and riding rides, playing games, and eating ice cream.  The sitters had many delighted stories to tell. A win all around – we were right to trust the young ladies.  Professionally, my clinic continues to grow, enough that I need more time and space to see everyone we need to see.  Referrals continue to pour in.   Politically, unfortunately, I see no end to the problems, which continue to grow as we  drop some more bombs on Iraq.

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Filed under Decision Making, Philosophy, Risk, Trust

Reflections on the Anniversary of the Flight of the Enola Gay

Walking on the Old Orchard Beach in Maine with my kids, enjoying a break from the challenges of work, preparing to attend a wedding, a plane flew over.  I was reminded that today is a poignant day in history involving a plane.

On this day (Aug 6) in 1945, the Enola Gay, on behalf of the US government, dropped the first atomic bomb in world history on the Empire of Japan.  It is estimated that 50,000 people instantly lost their lives, with many more dying in the coming months directly from the radiation effects.  The instantaneous loss of human life is staggering.

I recently visited Singapore for a medical conference on geriatric-oncology.  Across the street from where we were staying, there was an austere Memorial, a towering, four-sided white spire.  It commemorates the massacre of 50,000 Singaporeans, most of Chinese descent, by the invading Japanese during WWII.  It is a powerful symbol of human tragedy.  Standing there, I was stunned to realize I had no idea about this event, wondering how many other similar examples had been hidden from my awareness. The toll from this war became even more staggering to consider.

Both of these events from WWII are mind-bogglingly sad to reflect upon.  The equivalent of a football-stadium full of people, the majority of which were non-combatants, destroyed in a few moments or a few days.  Considered out of context, it appears to be two more instances of the mental instability of humanity.  So many individual lives wiped out, with us never to know what greatness may have lurked within some of those lost forever. The awfulness of war seems ridiculous when considering these events.

Yet, it is difficult to argue against our countries’ involvement in that terrible war and our efforts to end it as swiftly as possible. The moral worthiness of fighting against the genocidal Hitler and the appropriateness of responding to the bombing of Pearl Harbor seem reasonable responses to irrationality.  If anything, the consequences of failing to respond appear worse than what ultimately occurred.  Considered in this wider context, doling out a utilitarian, Realpolitik calculus of abstract lives lost, individual events like the dropping of The Bomb to end further bloodshed seem justified, strategically. But what about morally?

How are these two views – the unjustifiable loss of largely innocent life from total warfare and the justified use of force to achieve pragmatic ends – to be reconciled?

I’ve long been uncomfortable with utilitarian justifications for actions; it’s too easy in this few to reduce individual human beings to interchangeable, expendable parts.  My original juxtaposition of the Japanese civilian deaths due to the atomic bomb with the Singaporean deaths due to conquering armies hints at such a justification.  In truth, this obscures the tragedy of the lives snuffed out on both sides. It also personifies countries, of nationalistic fervor, as if the loss of a part of a country, a certain number of citizens, is a legitimate “trade” for a similar loss of life by another country.  This way of thinking can’t be right.

More concretely, we too often fail to consider what an individual life is about.  How people are more than interchangeable parts whose further existence is justifiable in the name of “national goals”.  That people like Adolf Hitler can consider certain people, due to happenstance of birth, is an extreme example.  But a similar version allowed the Emperor of Japan to consider those living in Singapore to be extinguished on similar lines.  Whether our use of the atomic bomb to help end the war with Japan was strategically justified, we should not forget the individual lives snuffed out with the effort.

We now exist in a world full of philosophies that too easily think of people as members of specific groups, that those in other groups are “inferior” enemies to be destroyed, rather than as individuals living out their lives as best they can.

Finishing the walk with my kids, I spent an extra few minutes to talk about their individual plans for life, to better understand what makes them each individually happy, and to think about how to better encourage us all to avoid being overly utilitarian regarding others.  My hope is that their future will involve less “trade-offs”, especially at the level national governments, of some abstract lives for other abstract lives – with the consequent loss of too many individual lives unlived.

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Filed under History, Philosophy, Utilitarianism