Health Risks of Punishment

When someone commits a criminal offence we punish them. If the offence is serious enough we incarcerate them. How long they are imprisoned depends on the severity of the crime. As the saying goes- “The punishment should fit the crime”.

Different justifications are offered for punishment- deterrence, rehabilitation and retribution are popular answers that are often given to justify punishment. Justifying punishment in theory is of course very different from justifying it in practice. That is, justifying the actual institutions of punishment, as they are practiced in our own societies, raises many non-ideal considerations that might not come to the fore when our attention is focused exclusively in the abstract. For example, considerations about discrimination in the criminal justice system will muddy the waters in terms of how our actual institutions fare with respect to the theory of punishment. And these kinds of non-ideal considerations should themselves inform the theory of punishment.

The New England Journal of Medicine published a very important study in the Jan. 11th 2007 issue on the rate of the risk of death for former prison inmates (see here). Here is the abstract:

Release from Prison — A High Risk of Death for Former Inmates
Ingrid A. Binswanger et. al.

ABSTRACT
Background
The U.S. population of former prison inmates is large and growing. The period immediately after release may be challenging for former inmates and may involve substantial health risks. We studied the risk of death among former inmates soon after their release from Washington State prisons.

Methods
We conducted a retrospective cohort study of all inmates released from the Washington State Department of Corrections from July 1999 through December 2003. Prison records were linked to the National Death Index. Data for comparison with Washington State residents were obtained from the Wide-ranging OnLine Data for Epidemiologic Research system of the Centers for Disease Control and Prevention. Mortality rates among former inmates were compared with those among other state residents with the use of indirect standardization and adjustment for age, sex, and race.

Results
Of 30,237 released inmates, 443 died during a mean follow-up period of 1.9 years. The overall mortality rate was 777 deaths per 100,000 person-years. The adjusted risk of death among former inmates was 3.5 times that among other state residents (95% confidence interval [CI], 3.2 to 3.8). During the first 2 weeks after release, the risk of death among former inmates was 12.7 (95% CI, 9.2 to 17.4) times that among other state residents, with a markedly elevated relative risk of death from drug overdose (129; 95% CI, 89 to 186). The leading causes of death among former inmates were drug overdose, cardiovascular disease, homicide, and suicide.

Conclusions
Former prison inmates were at high risk for death after release from prison, particularly during the first 2 weeks. Interventions are necessary to reduce the risk of death after release from prison.

This kind of empirical information is important for it shows how complex the challenge of linking theory to practice really is. We may feel society is justified in incarcerating a criminal so that a retributive principle is satisfied. But if the punishment also imposes unexpected burdens, like an increase in the risk of death after release, this will have very important implications for determining what constitutes proportionality in this context.

So the slogan “The punishment must fit the crime” needs to be informed not only by considerations of the harm of the crime, but also by the realities of the burdens punishment, as it is currently practiced, imposes on a criminal’s life prospects. Otherwise we risk jeopardizing the sense of proportionality that underlies retributive principles of justice.

Cheers,
Colin

Greatest Philosopher Contest

BBC Radio 4 ran a very interesting contest to see who should be granted the title "The Greatest Philosopher". 34 000 votes were cast and the list of candidates included a very impressive and diverse list of thinkers.


So who came in #1, with 28% of the vote?

Karl Marx. You can listen to the results on the contest web site (which has an interesting discussion of Marx).

I myself think Marx is one of the greatest philosophers of all time (see my thoughts here). Is he THE greatest? That is a more difficult question. No doubt our close temporal proximity to Marx might make us a bit more partial to him than some more distant historical greats. I would certainly put Marx in my top 5 list, but not at #1.

My list of the three greatest philosophers of all time (who all edge out Marx by a significant margin) consist of philosophers who all lived over 2000 years ago! All three made the BBC's top 10 list. And my overall #1 gives Marx a run for his money on the longest beard competition.

It's a real shame philosophy peaked such a long time ago. I guess some acts truly are too tough to follow.

Cheers,
Colin

The Brain, Emotions and Morality

Moral philosophers often focus on examples like the famous Trolley Problem to test our intuitions concerning utilitiarian versus deontological ethical theories. Is it permissible (indeed obligatory) to sacrifice one person's life to save a greater number of lives? People have different reactions to these kinds of scenarios.

The latest issue of Nature has two interesting pieces which address this issue. In "Damage to the prefrontal cortex increases utilitarian moral judgements" Michael Koenigs et. al. examine how damage to the brain can cause a utilitiarian response to certain kinds of moral dilemmas. Here is the abstract:

The psychological and neurobiological processes underlying moral judgement have been the focus of many recent empirical studies1. Of central interest is whether emotions play a causal role in moral judgement, and, in parallel, how emotion-related areas of the brain contribute to moral judgement. Here we show that six patients with focal bilateral damage to the ventromedial prefrontal cortex (VMPC), a brain region necessary for the normal generation of emotions and, in particular, social emotions, produce an abnormally 'utilitarian' pattern of judgements on moral dilemmas that pit compelling considerations of aggregate welfare against highly emotionally aversive behaviours (for example, having to sacrifice one person's life to save a number of other lives). In contrast, the VMPC patients' judgements were normal in other classes of moral dilemmas. These findings indicate that, for a selective set of moral dilemmas, the VMPC is critical for normal judgements of right and wrong. The findings support a necessary role for emotion in the generation of those judgements.

And in "Neurobiology: Feeling right about doing right" Deborah Talmi and Chris Frith offer further reflections on these findings. They argue:

....This result engenders a paradox. On the one hand, believing that emotion is the enemy of reason, our society still goes to great lengths to prevent emotional considerations from influencing important decisions, in particular moral decisions. Intriguingly, the result reported by Koenigs and colleagues seems to show that damage to the VMPFC does not impair moral decision-making, but rather improves it through eliminating the effects of emotion. On the other hand, there is abundant evidence that decision-making in other spheres is severely impaired in these patients.

....The challenge, then, is for decision-makers to cultivate an intelligent use of their emotional responses by integrating them with a reflective reasoning process, sensitive to the context and goals of the moral dilemmas they face. If decision-makers meet this challenge, they may be better able to decide when to rely upon their emotions, and when to regulate them. Indeed, such cultivation is already occurring in the legal system.

Cheers,
Colin

Discovery of Genetic "Self-Destruct" Switch

Today's Telegraph.co.uk reports (here) about the discovery of switch p53, a genetic "self-destruct" switch. Turning this switch off during a stroke and heart failure could potentially reduce the risk of death and severe disability. Here is an excerpt from the story:

When patients suffer a stroke or heart failure, parts of the brain and heart continue to deteriorate after the initial illness. It is believed that temporarily switching off the mechanism can limit the destruction of vital organs and help speed recovery.

Scientists at Cambridge University say they have identified a way to turn it on and off. They hope to find new drug treatments that can be administered during a heart attack or stroke.

....The self-destruct activity of p53 is thought to be triggered when the body feels threatened. During a heart attack the heart and brain are starved of oxygen by blockages in blood vessels, causing the gene to damage tissue in the organs.

The brain damage suffered by stroke victims can leave them needing prolonged physiotherapy. Treating stroke patients is estimated to cost the NHS more than £2.8 billion a year. Drug companies are already developing cancer treatments that target the p53 gene.

Cheers,
Colin

Egalitarian Motives

The theme of human nature has long dominated debates in political theory. Are human beings, as a species, primarily motivated by self-interest or altruism? The answer one gives to that question will have a great influence on what one thinks it is possible for human societies to achieve and the kinds of institutions (e.g. economic, political, etc.) we should implement.

The latest issue of the journal Nature has an interesting piece entitled "Egalitarian Motives in Humans". Here is the abstract.

Egalitarian motives in humans
By Christopher T. Dawes, James H. Fowler, Tim Johnson, Richard McElreath & Oleg Smirnov

Participants in laboratory games are often willing to alter others' incomes at a cost to themselves, and this behaviour has the effect of promoting cooperation. What motivates this action is unclear: punishment and reward aimed at promoting cooperation cannot be distinguished from attempts to produce equality. To understand costly taking and costly giving, we create an experimental game that isolates egalitarian motives. The results show that subjects reduce and augment others' incomes, at a personal cost, even when there is no cooperative behaviour to be reinforced. Furthermore, the size and frequency of income alterations are strongly influenced by inequality. Emotions towards top earners become increasingly negative as inequality increases, and those who express these emotions spend more to reduce above-average earners' incomes and to increase below-average earners' incomes. The results suggest that egalitarian motives affect income-altering behaviours, and may therefore be an important factor underlying the evolution of strong reciprocity and, hence, cooperation in humans.

Cheers,
Colin

Smoking, Genes and Public Health

According to the World Health Organization tobacco is a public health priority and is responsible for killing approximately 1 in 10 adults worldwide (5 000 000 deaths each year). Tobacco is the fourth most common risk factor for disease worldwide and the harmful effects of smoking impact not only the lives of the smokers who develop disease, but also their families and society-at-large (e.g. economic costs).

The Pharmacogenomics Journal has an interesting (free online) piece entitled “Overview of the Pharmacogenomics of Cigarette Smoking” which examines how a better understanding of the genetic influences on different smoking stages and phenotypes can help us better tackle the problem of tobacco smoking. Here is a sample:

Cigarette smoking is a complex behavior that includes a number of stages such as initiation, experimentation, regular use, dependence, cessation and relapse. Although environmental factors such as the influence of family members, peers and culture undoubtedly affects one's smoking behaviors at these stages, genetics also has a substantial role. Numerous twin, adoption and family studies have been performed and large variations in the estimation of heritability of 'ever' smoking have been reported in ranges of 11–78%. This may be due, at least in part, to the broadness of this phenotype which encompasses those who have only tried cigarettes once to regular heavy smokers. Once smoking is initiated, the heritability for persistence to regular smoking has been estimated at 28–84%, for number of cigarettes smoked at 45–86% and for diagnosed ND at 31–75%. A genetic influence on nicotine withdrawal symptoms and smoking cessation has also been identified with heritability estimated at 26–48 and 50–58%, respectively. Taken together, these studies suggest a substantial genetic contribution to most aspects of smoking. It should be noted that genetic risk factors for different aspects of smoking (such as initiation and persistence) only partially overlap, suggesting some genes will be specific to one smoking phenotype whereas others may influence multiple aspects of smoking. Further, the proportion of genetic versus environmental influences on the different smoking stages vary by gender, with genetics appearing to have a larger role on initiation compared to persistence in women, whereas the opposite is observed in men.

While heritability studies can demonstrate a genetic influence in smoking behaviors, advances in our understanding of the human genome have allowed for the localization of specific genes involved. Genome-wide linkage analysis is used to locate areas in the genome with high linkage disequilibrium for a specific phenotype such as ND. The impact of variation in genes found in these loci can then be examined in candidate gene association studies. Candidate gene association studies have focused primarily on targets identified in linkage studies and on genes selected for their biological relevance. Current research has focused mainly on genes involved in neurotransmitter pathways of the brain reward system and nicotine metabolism. It should be noted that like other complex disorders, it is likely that multiple interacting genetic factors underlie ND with each gene contributing a small effect. This review will provide a brief overview of the data from linkage scans and candidate gene association studies, and discuss some of the observed discrepancies in the literature. An examination of how genetic variation may be associated with differential outcomes to nicotine cessation pharmacotherapies will also be described. A better understanding of the genetic influences on the different smoking stages and phenotypes can provide a rationale for prevention strategies, can be used to optimize current treatments and provide novel targets for the development of new treatments.

Cheers,
Colin

Anniversary of Charter

The Globe and Mail is running a Charter of Rights 25th anniversary series. And Monday’s article was a very interesting piece on the Supreme Court’s tendency to show more deference to Parliament and the legislatures when fiscal consequences that impact the public purse are at stake.


Is such deference good or bad? I think that is an excellent question, one that cuts across standard “left/right” ideological lines. I myself think such deference is a good thing. And as I am just reading the final proofs for my new book where I argue in favour of such deference, I feel compelled to offer some thoughts here on why I believe this development is a healthy one for Canadian democracy.

Since the publication of John Rawls’s A Theory of Justice in 1971, philosophical debates about distributive justice have been dominated by “rights-oriented” accounts of social justice. Rawls was critical of utilitarianism because it was a moral theory that did not accord sufficient weight to the protection of the basic liberties of all citizens. Justice, argued Rawls, denies that the loss of freedom for some is made right by a greater good shared by others. And so a generation of liberal political philosophers championed the idea that rights are inviolable. The list of rights to be protected grew and grew, and at the same time an appreciation of the importance of democratic practices and institutions shrunk smaller and smaller.

In the 35 years since A Theory of Justice there has been an explosion of “rights-talk” as various laudable aspirations have been couched in the language of rights– these range from rights to healthcare, education, decent housing, minimum income, safe working conditions, minority rights, animal rights, the right to be loved, etc., etc., etc. Many of these causes are causes I myself am very passionate about and believe should receive greater attention and public support. However, I think it is a mistake to couch all such aspirations in the language of rights-talk. Or, perhaps more accurately, the mistake is to fail to see how limited (and potentially impoverished) the rights discourse often is.

The problems with the rights discourse are many-fold. Firstly, while saying that X is a right conveys the sensible point that X should be taken seriously, it does not tell us how important X is relative to other pressing aims that compete for finite public resources. So the rights discourse is typically a cost-blind discourse, one that ignores the reality that tradeoffs must be made.

Unfortunately many who invoke the rights discourse take the view that rights are absolute, that they cannot be compromised (that is what it means to say that X is a “right”!). But this then leads us to the state-of-affairs where the proponents of these laudable causes jump from the well-founded claim that “X is important” to the problematic prescription that “X is a right and should be enforced by the Courts”. And so judicial activism is then championed as a (perhaps the) major instrument for promoting social change and upholding justice. This is most evident in proposals to entrench social rights (like a right to decent housing, healthcare, etc.,) in the Constitution. Such proposals, while well-intended, are, I believe, ill conceived.

I agree that the judiciary has an important role to play in terms of ensuring that a reasonable balance is struck between constitutional principles and public policies. But when it comes to decisions that have significant budgetary implications, I think judicial deference is warranted. Such humility shows respect for the important challenges which executives and legislatures face. In particular, the complex challenge of determining how finite public resources should be distributed.

The reality is that legally enforcing any right, whether it be a so-called “negative” or “positive” right, will have costs. If we pump greater amounts of public money into promoting causes X and Y then we must divert funds from somewhere else (and/or raise more revenue). An excellent book on this issue is Holmes and Sunstein’s The Cost of Rights.

It is imperative that we recognise the budgetary implications of rights protection. Once we consider the budgetary implications of legally enforcing rights we realise that all rights are in fact positive rights. Thus we cannot ignore the fiscal realities of rights protection. So one of the central prescriptions of the version of liberalism I defend, what I call “civic liberalism”, is that we need to take a purposeful and fiscally responsive approach to rights.

Once we commit ourselves to taking a fiscally responsive approach to rights we realise that the really important question is not: Can we characterise X as an interest worthy of being called “a right”? Rather, the real important and difficult questions are: where does X figure in the larger picture of the pressing demands we have to take seriously? How vigorously, and at what cost, should we pursue the promotion of X? And who is best placed to make these decisions?

Once we ask this latter question we realise that legislatures and executives, rather than the judiciary, are much better placed to answer these questions. Why? The answer lies in the details of the kind of deliberative bodies these different branches of government are. Unlike politically insulated and unaccountable judges, legislatures and executives are better placed to get an accurate sense of the “big picture” of the competing claims that arise at any given time because they are elected and accountable to the public. Furthermore, our institutional system is such that, in terms of the scale and scope of these institutions, the judiciary only sees a small sample of the pressing issues that arise at any given time and simply lacks the capacity to do the job entrusted to executives and legislatures. So we need to recognise how complex and enormous the task of determining what constitutes a reasonable trade off between the laudable aims that compete for finite public resources really is. And how poorly equipped the judicial branch of government is to tackle these challenges.

Critics of democracy of course see democracy as a dangerous force that must be limited and contained for fear of “tyranny of the majority”. I agree that democracy has potential dangers, and that appropriate checks and balances must be put in place. And judicial review is an important part of this process. So I champion the “dialogical model” of judicial review, a model that prescribes we strive for the mean between judicial and legislative supremacy.

The best form of government is (hands down) liberal democracy. There really are no other serious contenders in play. But much work still needs to be done and the political philosopher can help us fine-tune what this ideal is. A liberal polity that takes a fiscally responsive approach to rights protection is, I believe, a more healthy polity because it gives due respect to the democratic process and democratic lawmaking. No doubt the critic will feel uneasy about placing the fate of rights in the hands of the demos. But I think John Stuart Mill was way ahead of his time (as he was with many other things) when he insightfully noted, almost 150 years ago, that if you let a person have nothing to do for their country, they will not care for it (Representative Government). Lasting and meaningful societal change only occurs when we, the people, remain committed and determined to make these changes. Unfortunately the advocates of liberal democracy often forget the importance of the democratic component of liberal democracy. But it is encouraging to see that Canadian Supreme Court Justices are savvy enough to appreciate the important stakes involved in these issues.

Cheers,
Colin

Exercise and Your Brain

When we think of things that help keep our brain fit we might be tempted to focus on obvious mental exercises- reading, writing, memory exercises, etc. All good stuff. But it is important to recognize that our physical and mental health are intimately connected. So physical exercise is not only good for your heart, but also for your brain!

This recent study in Journal of Gerontology: Medical Sciences examines the impact aerobic exercise has on the brain volume of aging humans. Here is a sample:

Beginning in the third decade of life the human brain shows structural decline, which is disproportionately large in the frontal, parietal, and temporal lobes of the brain. This decline is contemporaneously associated with deterioration in a broad array of cognitive processes. Given the projected increase in the number of adults surviving to advanced age, and the staggering costs of caring for older individuals who suffer from neurological decline, identifying mechanisms to offset or reverse these declines has become increasingly important.


....In this study, we randomly assigned older adult participants to either an aerobic exercise group or a nonaerobic exercise control group for 6 months and then examined whether participation in an aerobic exercise regimen would alter brain volume in an aged cohort. In short, we found that participation in an aerobic exercise program increased volume in both gray and white matter primarily located in prefrontal and temporal cortices—those same regions that are often reported to show substantial age-related deterioration. The current findings are the first, to our knowledge, to confirm benefits of exercise training on brain volume in aging humans.

....We report the novel and intriguing finding that only 6 months of regular aerobic exercise not only spares brain volume but also increases brain volume in an aged cohort. These effects cannot be driven by methodological limitations because neither of the control groups (the older nonaerobic exercise participants or the younger control group) showed significant changes in brain volume over 6 months. Our results suggest that brain volume loss is not an inevitable effect of advancing age and that relatively minor interventions can go a long way in offsetting and minimizing brain volume loss. Future studies should replicate these effects using a larger sample size and a more extensive neuropsychological battery to examine the relationship between brain volume changes and cognitive changes.

Cheers,
Colin