by Lucas Bergkamp
A hypothetical medical case involving uncertain diagnosis, prognosis, and therapy to explain the wickedness of climate change.
The Current Defective Model of Raising Support for Climate Action
President Obama’s scientifically unsupportable statements about asthma and hurricanes demonstrate that some politicians assume that people will support climate action only if they believe that climate change affects them here and now. As the first IPCC chairman suggested decades ago, “[i]f we want a good environmental policy in the future, we’ll have to have a disaster.” Thus, to garner support for climate policies, politicians may be inclined to allege that extreme weather events are becoming the ‘new normal’ and that human diseases will proliferate and spread rapidly. In so promoting their policy proposals, they may have to intentionally misrepresent the science. In their minds, they are justified in doing so because decisive climate action is urgently necessary. As now is ‘our last chance,’ such propaganda is deemed to be merely a white lie.
Will this less than completely honest strategy work? Of course, politicians will anticipate that some people are hard to fool and will attempt to expose the lies, so they also adopt strategies to “neutralize” them. These strategies can be nasty and divisive, but as long as the vast majority accept the propaganda, they do not cause major political issues. If, on the other hand, the part of the population that does not buy into the narrative becomes too large, the ‘neutralizing’ strategies lose their effectiveness and politicians have a problem on their hands. In the area of climate change, it is hard to predict whether and, if so, when, this point will be reached; once the silent majority wakes up, things may move quickly indeed. Irrespective of its effectiveness, however, the “impending catastrophe-based” climate policy sell is unsatisfactory and, arguably, unethical. A new model of soliciting public support for climate action policy is urgently needed.
The Informed Consent Model’s Advantages
For several reasons, the model of informed consent, which has been employed in the medical area with some success, is possibly a useful way of thinking about garnering public support for climate policy. Informed consent requires that an individual is provided with accurate and full information about a medical problem, its consequences, possible solutions, and their pros and cons. On that basis, this person can make an informed decision and select the therapy he or she is comfortable with. The first benefit hence is that the informed consent model does not accommodate misrepresentations and white lies, which makes it attractive as a key element of a long term relation between individual and state. Second, it is based on realistic scenarios of individual, rational decision-making. Third, because physicians, unlike politicians, have an obligation to provide objective and complete information on problems and options, irrespective of their effects on third party interests or the public interest, issues of individual concern are flashed out and can be given full recognition and consideration. Fourth, the model does not have to be limited to self-interested considerations, and can be adapted to include information relevant to third party interests, as in the case of organ donation.
Having said that by way of background, here is my attempt at using the model of informed consent to explain the uncertainty and complexity of both climate science and climate policies.
Information About Climate-Related Disease
“Mr and Mrs. Doe, please sit down, we have much to discuss. I have now reviewed all of your test results, the blood analysis, and other information relevant to your situation. On this basis, I hope to be able to provide you with a balanced picture of the disease from which you are suffering. I will also attempt to explain the possible consequences of the disease, and the pros and cons of the possible treatments. But I should emphasize up front that, unfortunately, there is much uncertainty about the disease, the possible treatments, and the prognosis, even with treatment. I know you want more certainty and clarity. I agree this is unsatisfactory and inadequate, but it is all medical science has to offer at this point. Please interrupt me if you have any questions or do not understand what I am trying to tell you.
You suffer from a syndrome called CRD, climate-related disease. The root cause is unknown, it may be due to an infectious agent, or some sort of addiction. There is no diagnostic test that can detect CRD with confidence. But there is a theory that suggests that you suffer from this disease, and one specific blood parameter is consistent with this theory and believed to be indicative of CRD. No currently known disease other than CRD is consistent with all of your symptoms. I sent your test results to an authoritative scientific advisory body, the Intergovernmental Panel on CRD (the IPC). According to some, not entirely reliable research, they represent the consensus in the medical community. The IRC has opined that CRD is a highly infectious disease and people around the world may be infected. They have expressed high confidence that you have CRD, but they also emphasize that there is some uncertainty and you may not have it after all. I should add also that other doctors disagree with the IPC. Some of these doctors claim that CRD does not exist, others believe that CRD is not serious and does not require treatment.
Let’s discuss the possible consequences of CRD. The IPC believes that this disease is easily transmitted within families and beyond, in other words, your children will also suffer from it, unless it is effectively treated. They expect it will result in adverse consequences in the long term, say, 50 to 100 years, but your children or their children may suffer serious symptoms early on in their lives. The IPC cannot tell you when symptoms will occur and how serious they will be, and they emphasize that there is substantial natural variability. In the worst case, you or your children may become progressively disabled, and at some point even unable to eat. There is a small risk that CRD will kill you, but if you are lucky, you may remain free of the most serious symptoms. Other doctors do not think that CRD is likely to result in any serious symptoms, and some even believe that CRD may be beneficial to you, but they seem to represent a minority opinion, although this is not known with any precision. In other words, assuming CRD is real, there is some probability that you will suffer severe symptoms at some point in the future. Based on current knowledge, neither this probability not the timing of the onset of symptoms can be reliably quantified.
Now we need to go over possible treatments, which is the most complicated and uncertain part. According to the IPC, the best therapy is a complete change of life style. They recommend that you go on a life-long diet, move into communal housing, and give up some of the pleasures of life, such as travel for fun. Your children may have to do the same, but maybe to a lesser degree. The therapy is demanding and painful, although it may turn out to be bearable for you as you get accustomed to it. Some doctors, however, believe that this therapy will not be effective, or that no therapy is required as the natural course of the disease will cause it to abate or completely disappear. Other doctors believe that a new drug or other treatment will be discovered before the symptoms of CRD become serious. These doctors are believed to be a minority, and they are underrepresented in the IPC. Whether another proven therapy will become available before you will suffer from CRD-related symptoms, depends on the rate of innovation in drug and other medical research, which is unknown. In any event, the IPC assumes, but cannot prove, there will be no new discoveries or other innovation that will help to remedy CRD.
There is another tricky problem associated with the therapy recommended by the IPC. The therapy will work only if the vast majority of patients agrees to undergo it. It is like herd immunity, of which you may have heard in relation to vaccination. So even if you consent to the IPC therapy and you stick to the demanding regimen, it may not help at all if the majority refuses to comply with it. To address this problem, the IPC has organized an international advocacy group to put pressure on patients worldwide to accept the therapy recommended by them. If patients hesitate or refuse, they offer them money to get them to change their mind and accept the therapy. Whether this campaign will be effective remains to be seen. If the campaign is ineffective, the IRC therapy is useless. You should know, however, that there are also symptomatic therapies available that do not fight CRD itself, but they do substantially alleviate the most serious symptoms of CRD. These therapies depend to a much lesser extent on what other patients decide to do.
I have told you all I know. CRD is wicked disease, much is unknown, unclear and uncertain in terms of the cause and progression of the disease, as well as possible therapies. With respect to the IRC-endorsed therapy, as I explained, your decision is also a function of what other patients will decide; for other symptomatic therapies, their effect depends much less on what other patients do and, thus, they are a “safer bet.”
So, Mr. and Mrs. Doe, what do you want to do? If you need to think about all of this some more, that is perfectly fine, you have time, the decision is not urgent. If you ask me what I would do, in all honesty, I could only say I would think long and hard, maybe consent to some therapy now, and postpone my decision on the CRD-recommended therapy until more is known about both the disease and possible therapies. But that is only my thinking, which reflects my values and interests. Of course, you may disagree and make a very different assessment. Let’s schedule a further appointment, once you have had a chance to think the situation through. Please take this information sheet, and call when you are ready to make a decision. And do not hesitate to contact me should any questions arise. ”
JC comment: As with all guest posts, please keep your comments civil and relevant.Filed under: Policy