ON THE SURVIVAL OF PEOPLE AND NATIONS
Ernest Partridge
May 26, 1980
This paper is
derived from a response to T. R. Girill's Colloquium
paper, "International Food Triage: A Conceptual
Clarification," both presented at the Annual Meeting
of the Pacific Division of the American
Philosophical Association, San Francisco, March 29,
1980. This version is an adaptation of the APA
paper, presented to the faculty of the
Department of Agricultural Economics, Texas A & M
University, May 26, 1980.
The focus of my analysis will be the concept of
"International Food Triage" as presented by William and Paul
Paddock in 1967. Both the concept of "Triage" and the Paddock's
book are, of course, dated (as is immediately evident by the
title of their book, Famine 1975!). And yet, the "triage"
controversy is both close enough to us in time to invite
adherents and to provoke discussion, and at the same time far
enough removed in time to permit some critical perspective on
the debate. I will pay particular attention to the Paddock's
analogical method of argument and attempt to draw some lessons
from it. We will also find that events that have taken place in
the thirteen years since publication of their book will give
special insight into the pitfalls of analogical reasoning of
this type.
The concept of "triage" is concisely explicated by the
Paddocks in the penultimate chapter of their book. A full page
of their text will entirely suffice to introduce the concept and
the use to which they put it. The Paddocks write:
"Triage" is a term used in military medicine. It is
defined as the assigning of priority of treatment to the
wounded brought to a battlefield hospital in a time of
mass casualties and limited medical facilities. The
wounded are divided on the basis of three
classifications:
(1) Those so seriously wounded they cannot survive
regardless of the treatment given them; call these the
"can't-be-saved."
(2) Those who can survive without treatment
regardless of the pain they may be suffering; call these
the "walking wounded."
(3) Those who can be saved by immediate medical care.
The practice of triage is put into effect when the
flow of wounded fills the tents of the battlefield
hospitals and when it becomes impossible for the
available medical staff to give even rudimentary care to
all. Furthermore, the number allowed to be sorted into
the third group for immediate treatment must be limited
by the number of doctors available. The marginal cases
must then also be selected out into the other two
groups.
It is a terrible chore for the doctors to classify
the helpless wounded in this fashion, but it is the only
way to save the maximum number of lives. To spend time
with the less seriously wounded or with the dying would
mean that many of those who might have lived will die.
It would be a misuse of the available medical help.
Call triage cold-blooded, but it is derived from the
hard experience of medical humaneness during a crisis.
In fact, if there is time before the battle starts, the
medical staff prepares in advance the facilities to sort
out these three groups.
President Johnson has proposed "that the United
States lead the world in a war against hunger." On the
battlefields of this forthcoming war the practice of
triage will be vital because choices must be made as to
which wounded countries will receive our food.
The leadership in Washington comprises the medical
staff. The stricken ones in need of medical attention
(American food aid) are the hungry nations. To provide
maximum effective treatment the medical staff must
divide them into the three classifications of triage:
As is immediately apparent, the concept of "international
food triage" is based upon an analogy. Accordingly, we are led
directly to the fundamental challenge faced by all analogy
arguments: How similar are the cases (viz: battle
casualties and nations). Or, to put it negatively, are the
disanalogies between the exemplar case and the analogue
sufficient to disallow strong inference from the exemplar to the
analogue? I suspect that this is in fact the case when one
attempts to draw strong inferences from medical triage to food
relief. Furthermore, I suggest that while the concept of
"medical triage" might serve to illustrate the dilemmas
of international food assistance, further attempts to draw
inferences from combat medicine to famine relief poses grave
dangers of over-simplification and misconception of the moral
requirements and practical responses that are appropriate to the
international food emergency.
The gravest difficulties of the triage analogy reside at the
very core -- with the concepts of "patient" and "survival" Let
us consider these concepts in turn, as they variously apply to
combat medicine and food assistance.
In the case of medical triage, we clearly know what a
"patient" is. It is an individual human being -- a biological
organism. But what is the "patient" in the case of international
food triage? The Paddocks identify "hungry nations" as the
"casualties" (p. 207), But what, in fact, is a "nation?" Is it a
territory? Is it a culture? Cultures persist through centuries,
as if independent of the bearers thereof. One does not "feed"
cultures. Is the "patient-Nation" a government, then? Hardly.
The "survival" of Idi Amin's government was a disaster and its
downfall a triumph. Perhaps the best we can do is to identify a
"nation" as the population residing within a territory
administered by one or another government. (Thus the "nation"
may endure, though governments come and go). But this definition
scarcely solves the problem of identifying the "patient," for
"nations," so defined, may not be in need of aid though
some inhabitants thereof may be in desperate straits. Perhaps
some victims of famine maybe better identified as members of an
ethnic group within a national boundary (e.g., the Ibo of
Nigeria), or an identifiable group among various
countries (e.g., the Kurds or the Armenians) or even an
identifiable population without a state (e.g. the
Palestinians today or, ironically, the Israelis before 1948).
How are such groups to be "targeted" for relief? How can these
"patients" be "treated" except through national entities? But
"the nation" doesn't need aid, the distinct groups within
or among nations need aid. (This distinction is
tragically exemplified today in Cambodia).
Consider still another problem residing in the concept of
"the nation" as a "triage patient." Battle casualties are, of
course, biologically discrete, individual human beings. The
treatment of one human patient does not directly affect another.
Physical boundaries between such patients are separate and
impermeable. In contrast, the boundaries between nations are not impermeable, and the "patient-nations" can
not be
treated as discrete entities. The Paddocks give a vivid, if
inadvertent, illustration of the point. In 1967 they proposed
that Pakistan might qualify to receive aid (triage group C) but
that India was beyond help (triage group A). Consider the
implications of this pronouncement, as the Paddocks apparently
did not. Are we to suppose that the Indians, one the opposite
side of their thousand-mile common border (and with their
primitive, dirty nuclear bomb), will quietly resign themselves
to their dreadful fate, while American freighters unload their
grain on the docks of Karachi, some 150 miles away? Not with the
simplicity and finality of the unfortunate battle casualty
assigned to group A by the triage officer.
Consider another problem, tied to the concept of "the nation
as patient." In the triage scheme, the separation of "casualties
must be made early and, as just noted, the decision can not be
open for appeal. The crush of the emergency does not allow for
second guessing. This necessary finality is applied by the
Paddocks as they describe the "hopeless case among nations:
(These are) nations in which the population growth
trend has already passed the agricultural potential.
This combined with inadequate leadership and other
divisive factors make catastrophic disasters inevitable.
These nations form the "can-be-saved" group. To send
food to them is to throw sand in the ocean. (207)
But what is it that "makes(s) catastrophic disasters
inevitable"? First, say the Paddocks, a "population growth
trend ... (passing) the agricultural potential." But this sounds
like a careless extension of "carrying capacity" from ecology to
international political economy. As several commentators have
noted, a nation's "carrying capacity" can be significantly
expanded through the development and exportation of domestic
natural resources (e.g. Libya) or the training and utilization
of human resources (e.g., the Netherlands and Japan). (I will
grant, however, that the "carrying capacity" concept has
application to human population on the world-wide level).
But when we turn to the other factors alleged to "make
disaster inevitable," the Paddock's case is even worse. These
other factors, we will recall, are "inadequate leadership and
other factors." (Note the vagueness here). Inevitable
Disaster? Only if the continuation of "inadequate leadership and
other divisive factors" is "inevitable." But this I submit, is
never the case with nations. To illustrate this point, one can
do no better than to note the changes, for better or for worse,
since the publication of the Paddock's book in 1967. Let the
Paddocks speak their own refutation:
-
(In Egypt) Nasser consistently, year after year, does
all in his power to abort American policies in the Middle
East, The Congo and elsewhere through deliberate acts of
subversive plots, alleged attempted assassinations of
neighboring leaders friendly to the United State and open,
active support of anti-American regimes throughout the area.
-
(In Pakistan): "Officials who were fearful, suspicious,
or jealous of (Norman Borlaug and colleagues) ... have been
converted or transferred. Other roadblocks will continue to
be laid down by minor bureaucrats and local scientists, but
the overall progress is assured.
-
The Philippines is Asia's freest democracy ... The
present administration of Ferdinand Marcos is far above the
caliber of its predecessor ..."
In sum, it will not do to treat "national leadership" as a
constant upon which an early but irrevocable decision is to be
made concerning food assistance. If we are uncritically beguiled
by the battlefield analogy, and regard nations as "patients," we
may likewise assume that, as "patients," nations are passive
receivers of aid. But it is far more appropriate to monitor
and react to the responses of recipient nation-states to
food aid. For the sake of these states, the leaders
therein should respond to assistance with positive programs
leading toward population stability and economic
self-sufficiency. To this end, it may even be necessary to say,
in effect, "If you wish to believe that God brings you your
children, that's your business. But you must take your pick:
leave it to God to regulate your population, or let us help you
feed your population while you do God's and control births. But
you can't have it both ways.
In short: In the battlefield, the triage officer must make
crucial and final diagnoses and prognoses, after which the
patient is "sorted," with little chance for "appeal" or a
"second opinion." On the other hand, food assistance decisions
must constantly be monitored -- open to review and
reconsideration. A nation's failure to implement population
control may indicate a need for "resorting." Conversely, the
overthrow of a reactionary theocracy may open possibilities for
effective family planning policies. And so, if it is not
the case that "inadequate leadership and other factors make
disaster inevitable" and, I would add, "irredeemable," then
there are, in principle, no nations in the Paddock's
"can't be saved" category. It is a null class.
If there are difficulties to be found in the attempt to apply
the concept of "patient" to both casualties and nations, the
problems are even more severe as one attempts to apply the
concept of "survival" to both cases. Indeed, I submit that the
differences are sufficient to tear the analogy asunder.
At the field hospital the meaning of "survive" is clear
enough: it means, simply, not dying in the immediate
future as a result of one's wounds. But what does it mean for a
"nation" to "survive." Does it mean that the government or the
political system is preserved, or that the same land area
continues to be administered by a single political
administration (of whatever kind)? Surely not, since by this
definition many "developed" nations fail to "survive."
Furthermore, as noted earlier, "Failure to Survive" in the
political sense can be regarded as a moral gain (cf. the case of
Uganda).
"Survival" can not mean that no member whatever of a
country's population dies as a result of lack of food, for if that
is the test, no country on earth is "surviving." But
neither can "failure to survive" mean that every
member
of a country will perish from malnutrition, for that would
describe an empty set. All nations fall within these
extremes. Furthermore, and more significantly, we have described
here two extremes, the difference between which admit only
of degrees -- a continuum between the extremes. This
gradation of differences is compounded when we add to this
analysis, as we must, the obvious consideration that
malnutrition and undernourishment, in each individual case,
admits to degrees. And yet we are asked to treat these complexes
of continua as analogues to the stark dichotomy of life and
death in the case of the battle casualty.
What, then, are we to make of all this? The triage analogy is
illustrative of the desperate moral crisis that must now be
faced by those nations possessing food surpluses -- most
significantly, of course, the United States. It is all too clear
that there will soon be, if there are not already, far more
human beings in need of food aid than there is food available
for distribution. With need far in excess of resources for
relief, some criteria of "sorting" among potential
recipients is necessary. Thus is the hungry Earth like a battle
hospital. Beyond this, the triage analogy is not helpful, and a
determination to draw moral inferences there from is likely only
to confound us. The recipients of the aid (the nations) are not
the "patients" -- those for whom the aid is not "national
survival." Instead, the objective, in part, is the
optimum survival of individual human beings, in a manner that
is, first of all, not productive of future victims of famine,
and secondly, conducive to eventual health, self-sufficiency and
well-being. Such, I say, is the objective "in part" of
international food aid. The other "parts" of the objective,
namely the enhancement of international political stability and
peace, the extension of the rule of law, the preservation and
restoration of ecological integrity, etc., are all, of course,
morally significant. And all these additional considerations
further display the disanalogy between medical triage and
international food assistance.
We will ignore these disanalogies at the peril of causing
severe injustice and injury to the intended beneficiaries of our
unavailing good intentions.
