1.15: CHAPTER 14 EATING ANIMALS
Eating Animals
A man can live and be healthy without killing animals for food; therefore, if he eats meat, he participates in taking animal life merely for the sake of his appetite. And to act so is immoral. 1
1. Eating Animals Introduction
The British, and many other nations, have something of an odd relationship with animals. I have, for example, just returned to begin typing up this chapter after adding extra straw for my chickens — chickens that I care for on a daily basis and chickens in whose well-being I am invested. This, however, followed on from my enjoyable consumption of a chicken dinner last night, a fact that would seem to suggest I am far less invested in the well-being of chickens more generally. This oddness in terms of the relationship between myself and my chickens is not, however, peculiar to me. Few people in the UK are vegetarians — the data has consistently suggested between 2% and 3% in recent years — yet many more would claim to identify as animal lovers. 2 In this chapter, the applied ethical issue of the moral acceptability of eating animals is considered; it remains to be seen what conclusions might be drawn to be either justify or condemn some aspects of our multi-faceted behaviour and attitude towards animals.
2. Justifying Meat Eating
It seems sensible to begin by considering on what grounds the eating of meat might be morally justified. To this end, two possible justifications are considered below.
Comparative Justification
It is hard to give a proper name to this oft-cited justification for the consumption of animal meat. When questioned as to why meat-eating is morally acceptable, a fairly common reply relates to the comparison between humans as meateaters and other animals as meat-eaters.  Given that it would be odd, even for the most ardent vegetarian, for us to morally criticise the lion, the bear or the fox, then it might seem to follow that there is a moral equivalence between the actions of these different species that extends to the actions of non-vegetarian human beings, such that we too should be free from moral criticism in our consumption of meat.
However, possible weaknesses in the above response should not be too challenging to identify. For one, we do not often base our moral judgments regarding the acceptability of certain actions on the behaviours of lions, bears and foxes etc. Indeed, the fact that lions sometimes eat human beings does not suggest to us that eating other humans may be morally acceptable. In addition, those who find eating some types of meat more acceptable than eating other types of meat (chicken as more acceptable than gorilla, for example) will find limited resource in this type of justification. If there is some merit in this blunt argument for meat-eating, it will very likely need to be brought out more precisely and sharply, perhaps within the context of a wider normative ethical theory.
Dominion-Based Justification
The second justification we will consider for meat-eating may have slightly more going for it, depending on your wider outlook on the world. According to the Bible, “[…] the Lord God formed a man from the dust of the ground and breathed into his nostrils the breath of life, and the man became a living being”.
3
This verse is often interpreted as God providing man with a soul, and thus differentiating mankind from the rest of animal creation. In addition, after “the Flood”, God says that “[everything] that lives and moves about will be food for you. Just as I gave you the green plants, I now give you everything”.
4
It is therefore apparently quite clear that God has no objection to the eating of animals, although a number of Christians do opt for a vegetarian lifestyle for a variety of other factors (the fact that something is allowable does not make it necessarily desirable).
In the remainder of this chapter, however, we consider the ethical issues surrounding meat-eating from the perspective of Utilitarianism, Kantian Ethics and Aristotelian Virtue Ethics; theories in which Biblical references are not central for deciding how to act. Thus, although a religious ethic focussing on Biblical teaching may seem to provide a clear answer on the justification of eating animals, students studying for the AQA exam must be familiar with the application of the three theories mentioned above in order to be well prepared for the exam. In the next section, we begin this process of applying the normative theories as previously outlined in Chapters 1, 2 and 3. The application of metaethical theories to this applied ethical topic can be understood from Chapter 6, and the discussion of Metaethics in an applied context in Chapter 11.
3. Act Utilitarianism
Utilitarianism, as explained in Chapter 1, comes in a variety of different forms — Act, Rule and Preference Utilitarianism as suggested by Jeremy Bentham, John Stuart Mill and Peter Singer respectively. It might seem that the views of Jeremy Bentham and other act utilitarians, when it comes to the acceptability of eating animals, would be fairly simple to ascertain. The act utilitarian of a Benthamite variety simply seeks to secure the greatest amount of pleasure for the greatest number of people. Although Bentham holds to the idea of equal consideration of interests — the pleasures of a queen should count no more than the pleasures of a peasant, irrespective of their social standing and societal power — this notion of equality might be thought of as applying to human beings only. If understood in this way, the view of the act utilitarian would be clear, as the pleasure of a human being when eating a beef burger would outweigh any morally relevant pain. After all, on this version of the equal consideration of interests, any pain that might be suffered by the cow would not have any moral weight in deciding how to maximise total pleasure.
However, Bentham did not adopt this anthropocentric (human-centred) approach to the principle of equal consideration. In one of his most famous passages, he states that:
The day may come when the rest of the animal creation may acquire those rights which never could have been [withheld] from them but by the hand of tyranny. The French have already discovered that the blackness of the skin is no reason a human being should be abandoned without redress to the caprice of a tormentor. It may one day come to be recognised that the number of the legs, the villosity of the skin, or the termination of the [pelvic bone] are reasons equally insufficient for abandoning a sensitive being to the same fate […]. The question is not, ‘Can they reason?’ nor, ‘Can they talk?’ but, ‘Can they suffer?’ 5
In this passage, Bentham makes it clear that animals cannot be excluded from the calculation of total pains and total pleasures associated with a particular act just because of their inability to talk or their deficient rational capacities in comparison to human beings. On the contrary, so long as an animal does experience some suffering or pain, then this suffering or pain must be factored into the calculation determining which act will produce the greatest pleasure for the greatest number; simply put, all suffering creatures — human or not — are part of the group of morally relevant beings.
This idea of equality of consideration for animals is justified by Bentham in the initial section of the passage, where a comparison to the ethical failing of racism is drawn. Bentham says that skin colour is deemed to be a morally irrelevant feature of an individual and affords no reason to ignore their pains or pleasures. So, just as denying moral relevance based on skin colour or race is arbitrary, and just as we in the contemporary world believe that denying moral relevance based on gender is arbitrary, denying moral relevance based on species alone is also arbitrary. If what matters is pain and pleasure, then the species that acts as host to that pain and pleasure would seem to be irrelevant.
Bentham’s openness to weighing the pains and pleasures of animals in utilitarian decision-making has made him a heroic figure in animal rights and animal welfare movements. Whether you agree with Bentham or not, his views were certainly somewhat out of kilter with many of his philosophical contemporaries. For example, just a little over a century earlier, one of the most respected philosophers of all-time — René Descartes — was, according to some accounts, cutting open his wife’s pet dog after nailing the poor creature to the wall in order to study its mechanistic movements. For Descartes, there was no moral issue in this type of action, since a soulless animal such as a dog could not feel pain and only mimicked the appearance of genuine pain. Bentham, had he known of Descartes actions, would have likely recoiled at the inability to recognise the morally relevant pains of the dog.
By putting the individual pieces of his theorising together, we can come to the view that Bentham would count the pains and pleasures of animals as morally relevant when considering the acceptability of eating animals, and he would seemingly count those pains and pleasures as just as valuable as the pains and pleasures of human beings given his commitment to a principle of equality when counting pains and pleasures. Thus, if the total pain (including pain suffered by animals) associated with acts of meat-eating were to outweigh the total pleasure associated with such acts, then Bentham and Benthamite philosophers would be forced to conclude that those instances of meat-eating were morally wrong.
Before moving on, it is worth noting that the language used in the paragraph above is important. Neither Bentham nor any other relativistic utilitarian would ever comment that eating animals is absolutely right or absolutely wrong. The ideas of relativism and absolutism are explored in more detail in Chapter 1, but for now it is worth reminding ourselves that the act utilitarian is interested only in working out how to bring about the good in each individual situation. Thus, meat-eating may be morally acceptable on this view if a research scientist, close to curing cancer, needs to eat a healthy dog in order to survive long enough to pass his research on. On the other hand, eating a turkey burger produced cheaply and with much suffering to the animal may not be justifiable because the pleasure associated with consumption is so minimal. These are, of course, “cardboard cut-out” cases, some distance from real-world ethical decision making in the context of Act Utilitarianism and eating animals. However, it will be of far greater benefit for you to consider the range of cases in which Act Utilitarianism may speak against eating animals, and the range of cases in which Act Utilitarianism will speak in favour of eating animals, in order for you to form either a robust critique or defence of the application of this theory in this applied context. Does Act Utilitarianism seem to provide the right sort of decision procedure, with the right sorts of conclusions?
4. Challenges to Bentham
One challenge to Bentham’s act utilitarian view may be based upon the idea that the making of a moral distinction between animals and human beings is far from arbitrary and that there is a difference between such a “
speciesist
” (Peter Singer made this term famous) distinction and discriminatory thoughtprocesses such as racism and sexism. Perhaps it is the case that the pleasures and pains of human beings are worth more, in virtue of our intellect or our capacity for higher-order thinking and experience.
However, we should be cautious when responding to Bentham in this way. Consider an elderly human being who is suffering from dementia, or a twomonth-old baby, or a patient in a Persistent Vegetative State (as discussed in Chapter 7). All three of these individuals would seem to be lacking in rational capacity to fairly serious levels. To this end, in the portion of text removed from original Bentham quote, Bentham says that a “full-grown horse or dog is beyond comparison a more rational, as well as a more conversable animal, than an infant of a day or a week or even a month, old”.6 Thus, those who seek to draw a line in the sand in terms of rationality, a line that separates human beings from animals, a line that might justify eating those below the line but not those above the line, are faced with a seemingly insurmountable dilemma — either rationality is morally relevant and so some humans lack moral standing, or rationality is not morally relevant and this attempt to separate humans from animals is a failure.
In order to overcome this problem, a
potentiality argument
may be put forward. Since babies of two months have the potential to become more rational than they currently are, and since this applies to dementia patients and PVS patients also if successful treatment could be discovered and administered, then the morally relevant line in the sand between humans and animals may be redrawn on the basis that all humans have potentially higher rational skills that any non-human animal has.
However, Singer has a clever response to this potentiality suggestion, which is clear if we consider the powers of Prince Charles. Whilst he is a
potential king
, Prince Charles is currently only a prince. This means that, at the moment, he has only the rights of a prince, not a king. He will not earn kingly rights until he actually becomes a king.  Therefore, any attempt to morally separate animals and humans on grounds of rationality or intellect is again seemingly confronted by the dilemma as stated in the previous paragraph.
5. Utilitarian Reasons for Eating Animals
The previous two sections should make clear that for utilitarians such as Bentham and Singer, there will be times when it is morally wrong to eat animals; when the pain associated with eating animals outweighs any corresponding pleasure. It is worth noting, however, that Singer is very clear that eating animals can be entirely morally justifiable, and not just in extremely unlikely situations. It is true that Singer is scornful of the moral acceptability of eating factory-farmed foods, as the following quote suggests:
These arguments [relating to the moral relevance of pains afflicting animals] apply to animals who have been reared in factory farms — which means that we should not eat chicken, pork or veal, unless we know that the meat we are eating was not produced by factory farm methods. 7
Singer also objects to the consumption of eggs that are not sourced from freerange chickens; the same would presumably apply to the eating of the chicken itself. However, this type of objection to the eating of particular animals, in particular conditions, does point us towards the situations in which meateating may be morally acceptable to a preference utilitarian such as Singer.
If chickens, for example, are allowed to roam freely, before being painlessly killed (something that seems entirely possible, even if this is not what is always achieved in reality), then the balance of preference satisfaction may swing in favour of the hungry family seeking a healthy diet and away from the continued existence of the chicken itself — chickens, as those who deal with them will know, are unlikely to have the mental capacity to have long running future preferences that will go unfulfilled if their lives are cut short.
Indeed, even Bentham himself supported the idea of eating animals, despite all that was suggested earlier. Animals farmed and killed, thought Bentham, may suffer far less pain than animals left to die in the harsh reality of the unmanaged wilderness. Well-managed and quickly administered slaughter may lead to less pain than starvation, disease or violent death after the attack of a predator.
In an ever changing world, where the practices associated with animal slaughter vary from company to company and culture to culture, the utilitarian cannot provide a clear-cut answer on the general acceptability of eating animals. Singer sums this up when he says that:
[…] the important question is not whether animal flesh could be produced without suffering, but whether the flesh we are considering buying was produced without suffering. Unless we can be confident that it was, the principle of equal consideration of interests implies that it was wrong to sacrifice important interests of the animal in order to satisfy less important interests of our own; consequently we should boycott the end result of this process. 8
The various criticisms applied to Utilitarianism in Chapter 1 — objections based on demandingness, or based on issues of calculation of pleasures or preferences, for example — are not irrelevant in this chapter. However, for the sake of avoiding repetition, you should consider the application of these criticisms yourself when coming to your view regarding the potential success of utilitarian (act and preference) responses to eating animals.
Given the previous comments, it may be suggested that the lack of discussion of Mill and Rule Utilitarianism, as well as a discussion of higher and lower pleasures, is a critical omission from this chapter. In a sense, we agree. However, once the issues regarding the application of Utilitarianism to the act of eating animals have been set out as above, then applying ruleutilitarian-style thinking should be a far easier task. For now, the following issues are suggested for consideration.
- Is meat-eating a higher or lower pleasure? Does it make a difference if lamb is consumed in a greasy-spoon café, or if it is prepared by a world-renowned chef? Should the moral acceptability of eating an animal turn on the way in which an animal is prepared for consumption?
- Are animals worth less than humans because they cannot access higher pleasures?
- Would an outright ban on factory farming be a rule that, if universalised, would lead to the greatest good for the greatest number? What other rules might be advocated by a rule utilitarian in this applied ethical setting?
Answering these questions, in the light of the discussion in both this chapter and Chapter 1, should provide a solid grasp of utilitarian thinking in this area.
6. Kantian Ethics and Eating Animals
According to Immanuel Kant, a human being is “[…] a being altogether different in rank and dignity from things, such as irrational animals, with which one may deal and dispose at one’s discretion”.
9
Of course, the idea that humans have no responsibility to animals, and therefore may seemingly consume them at will, is open to the same objections as outlined in section 4. However, putting those concerns to one side, it may then seem as though Kant has given us a usefully clear statement of his ethical thinking as it may be applied in this context.
Kant is clear that we have no Direct Duties towards animals because the eating of animals does not fall foul of the two formulations of the Categorical Imperative as explored in Chapter 2. The eating of animals can become a universal law, as there is no issue with either conceiving this action as being universalised or willing the universalising of this action. In addition, eating animals does not itself entail the treating of another person merely as a means to an end (and Kant is clear that animals exist themselves only as a mean to an end
10
). Of course, we may treat a person merely as a means to an end in seeking to secure food, but there is nothing necessary about this taking place when animals are consumed. Thus, eating animals will generally be permissible and will only be impermissible when we act wrongly towards a fellow human being in securing our food — the animal itself is not relevant to the assessment of our duty.
Yet, for all of the above, Kant does encourage us to treat animals with care and concern rather than with no consideration at all, despite our lack of a direct duty to care for them. Kant says of a person that “[if] he is not to stifle his human feelings, he must practice kindness towards animals, for he who is cruel to animals becomes hard also in his dealings with men”.
11
Those who are needlessly cruel to animals, who kill wantonly or who treat animals with scant regard for their suffering, become familiar with this approach to life and will be, as a result, less likely to act in accordance with duty in their dealings with other human beings. Our duty to animals, says Kant, is therefore indirect rather than direct — it exists only in so far as it pays out in our dealings with our fellow humans.
In terms of applying this line of thought to eating animals, Kant would have no objection so long as we were not cruel or unkind in our approach. Perhaps it is the case that the eating of factory-farmed foods could be considered an act, or an endorsement of, cruelty. In any case, it seems that, rather ironically, Singer and Kant end up in much the same position when it comes to advice regarding how to act in the sphere of eating animals.
It is worthwhile noting, finally, that contemporary Kantians such as
Christine Korsgaard
(1952–) have objected to Kant’s own disregarding of the notion of Direct Duties towards animals. Korsgaard does not accept that it is permissible or acceptable to treat a pain-experiencing creature merely as a means to an end, since “[…] it is a pain to be in pain. And that is not a trivial fact”.12 It therefore may be an open question whether Kantians should allow for Direct Duties to animals, even if Kant himself did not.
7. Virtue Ethics and Eating Animals
Being an agent-centred moral theory, it would be a misunderstanding of Virtue Ethics to expect absolute moral answers on the ethical acceptability of eating animals. Rather than attempting to make ethical judgments on the morality of specific instances of eating animals, Virtue Ethics instead opts to discuss the dispositions and character traits associated with virtuous people, who then may provide guidance when it comes to whether or not the virtuous person would eat no animals at all, just some animals, or all animals on offer.
From the explanation of Virtue Ethics offered in Chapter 3, we should draw the following important lesson from the outset. It is not possible that vegetarianism could be a virtue in and of itself, since vegetarianism is a way of life rather than a character trait or a disposition. Rather, if we are to follow virtue-ethical thinking, we should ask in what circumstances and at what times would a disposition to refrain from eating meat be virtuous, and when such a disposition might be labelled as a vice of excess or deficiency.
Rosalind Hursthouse draws interesting comparisons between the arguments of Singer in this area and the approach of the virtue ethicist.
13
Hursthouse suggests that Singer, in arguing against cruelty to animals from his preference utilitarian perspective, provides evidence in favour of the view that the eating of animals will often reflect a vice-like character trait rather than a virtuous character trait. Given that many of us are aware, when we purchase our meat, that the animal in question may have led a rather unpleasant existence, our willingness to ignore this information hardly coheres neatly with exercising the virtuous mean of compassion in the sphere of life of shopping or making dietary decisions; wilful ignorance may be viewed as vice of deficiency.
The example above of shopping in the value aisle for our food puts the issue of eating animals into a particular setting, perhaps the choice of cheap chicken for dinner rather than a more expensive and less attractive vegetarian alternative. However, it is not difficult to conceive of a situation in which meat-eating might be considered to be the result of a virtuous characteristic, such as the eating of an animal in order to promote the health of your children when other options are unavailable (perhaps through economic factors). In this setting, a stubborn commitment to vegetarianism over and above a clearheaded recognition of the needs of your children may represent an action based on a vice of excess. (Roger Scruton is one virtue ethicist who speaks of the virtue of meat-eating; his ideas are worth exploring for a slightly different virtue-ethical response to this issue).
14
Of course, rather than the specific study of virtuous responses in two outlined cases, it would be useful to have more general guidance. Again, focussing on promoting compassionate rather than cruel decision-making when it comes to choosing whether or not to eat animals, Hursthouse says:
[…] we need a substantial change in our outlook to get any further — in virtue ethicists’ terms, a clearly seen and effective recognition of the fact that human beings, and thereby human lives, are not only interwoven with each other but with the rest of nature. Then, and only then, will we apply virtue ethics correctly to what we are doing. 15
Aristotle was more concerned with the application of the virtues as they pertained to human conduct, but human flourishing is supposed to be a whole-life process and it is therefore not without motivation to focus on our dispositions towards animals as Hursthouse does. Whether this guidance is an accurate interpretation of Aristotelian ideas, or whether it is an independently advantageous extension of Aristotelian ideas, is something that is worth reflecting on in the context of the virtues as actually outlined by Aristotle, and provided in Chapter 3. A key question to answer is whether or not Hursthouse’s reasoning is in line with core Aristotelian thinking, or has she created a rival version of Virtue Ethics?
Of the criticisms that might be applied to Virtue Ethics, the objection from unclear guidance may seem highly troubling, even in spite of the ideas above. Considering the following three issues may help you to clarify your thoughts as to the practical usefulness of Virtue Ethics for deciding how to act in this setting.
- Who are the virtuous role models from whom we can learn when it comes to eating animals? TV chefs, who speak of “doing justice to the animal” when cooking it? Vegetarian campaigners? Peter Singer?
- TV presenters such as Bear Grylls and Ed Stafford are often dropped into inhospitable locations for our entertainment, and can only survive by killing animals for food. Does their killing reflect a virtue, or a vice?
- Angela is a vegetarian who is eating with a friend at a highly expensive restaurant. Angela’s friend has paid for dinner, and has chosen the courses to eat. One dish involves the eating of carefully prepared duck. Would it be virtuous for Angela to eat the duck, or to stand by her beliefs even in an extreme situation? (It is worth researching Singer’s idea of the “Paris Exemption” to develop your answer.)
If you can answer these questions, you should feel more confident in terms of your ability to apply virtue ethical thinking to the issue of eating animals.
8. Cora Diamond
To conclude this chapter, we will briefly reflect on the ideas of Cora Diamond, who offers a perspective on the ethical acceptability of eating animals that stands apart from the normative ethical theory-based views hitherto discussed (AQA also recommend reading Diamond’s article).
16
Much of the focus in this chapter has been on the question of whether animals are morally relevant, or whether they have rights to the same degree as humans when it comes to considering the ethical acceptability of consuming them. Diamond objects to this approach entirely and does not seek to criticise the morality of eating animals via talk of moral rights; she has a different kind of criticism altogether.
For Diamond, the notion of “moral rights” for animals is irrelevant when it comes to explaining the moral acceptability of eating animals, because we make decisions in other spheres of life that eating certain entities is unacceptable without any associated talk of rights. Specifically, Diamond suggests that our aversion to eating the human dead is not based on the moral right of the dead body not to be eaten, but because we feel uncomfortable at the very mention of the possibility of consuming human dead bodies, or amputated human limbs. This uncomfortableness is explained not by talk of rights, but by the idea that “a person is not something to eat”. This is a thought that comes about because of the nature of our interactions with human beings and human body parts in our lives.
17
Extending this line of thinking to the issue of eating animals, Diamond takes issue with the following line of argument:
If
You would not eat human beings
and
You would not eat your pets
then
You should not eat other animals (at least higher primates, perhaps) because there is no meaningful difference between such animals and things that you would not eat.
For Diamond, such an argument is extremely unpersuasive. This is because it misses, in its cold and logical form, the fact that pets, like dead human bodies and amputated human limbs, are also not things to be eaten. As Diamond says, pets are given names, we let them into our houses and we interact with them in ways that we do not with wild animals. Wild animals may be things to eat, just as a chicken on display in a supermarket is something for me to eat whereas my own chickens in the garden are not.
This approach may be appealing to a non-cognitivist, anti-realist interpretation of moral thought and moral talk (these theories are explained in Chapter 6). We might wonder if the cries of the campaigner regarding the moral status of certain animals as “things not to eat” are designed to pick up on genuinely existing moral properties in the world as the cognitivist or realist would like, or whether these calls reflect a non-cognitivist, perhaps an emotivist-style, attitude.
However, Diamond herself holds a vegetarian position that she thinks can be advanced, not by cold and logical arguments as previously identified, and not by talk of moral rights, but by reshaping our relationship with animals to add to the list of things not to be eaten. To this end, Diamond offers a Jane Legge poem,
Learning to be a Dutiful Carnivore
, as an exemplar of tactics that may be far more effective for securing movements towards vegetarianism:
Dogs and cats and goats and cows,
Ducks and chickens, sheep and sows
Woven into tales for tots,
Pictured on their walls and pots.
Time for dinner!
One day ham from Percy Porker
(In the comics he’s a corker),
Then the breast from Mrs Cluck
Or the wing from Donald Duck.
Liver next from Clara Cow
(No, it doesn’t hurt her now).
Yes, that leg’s from Peter Rabbit
Chew it well; make that a habit.
Eat the creatures killed for sale,
But never pull the pussy’s tail.
Eat the flesh from “filthy hogs”
But never be unkind to dogs.
Grow up into double-think
Kiss the hamster; skin the mink.
Never think of slaughter, dear,
That’s why animals are here.
They only come on earth to die,
So eat your meat, and don’t ask why.
18
This poem, says Diamond, does not preach a form of behaviour, but instead challenges assumed beliefs regarding which animals are acceptable sources of food and which are not. If we view animals as fellow creatures rather than as objects for consumption, then we may change our relationship with them such that killing and eating them will seem as out of bounds as consuming a dead human being. Cannibalism is not always viewed as being morally wrong, of course, as difficult situations will change our perspective; most of the time, however, we recoil at this possible act without the need for formal utilitarian or Kantian justifications.
Diamond’s paper is worth your careful attention, and she responds to a challenge that her line of argument opposing unethical treatment of animals might create unfortunate analogies with ways in which we should oppose sexism and racism. In cases of sexism and racism, we might hope that moral rights justify fair and equal treatment, rather than the mere fact that we might happen to see people as fellow creatures (a fact that appears to depend on us, and not the person who should have the moral right). We might suggest that our recoiling at racial discrimination follows from the moral right a person has, not that our recoiling is what makes such discrimination morally wrong. Whether you find Diamond’s approach compelling or not matters more, in all likelihood, than whether you agree with her conclusions; if her method is sound, then does this show a weakness in the approaches of the normative theories based on reference to rights or duties?
SUMMARY
| Few moral theorists will claim that eating animals is absolutely and completely acceptable in all circumstances and at all times. Even Kant recoiled at the idea of cruelty to animals in spite of his expressed denial that humans possess any duty towards animals. This fact suggests that conclusions regarding the ethical acceptability of eating animals may often be determined by empirical and real-world data regarding the preferences, pains or pleasures of animals and the impact of the processes of rearing and then slaughtering animals for human consumption. The real-world situation is constantly in flux, but this chapter should provide you with the moral framework into which real-world research can be plugged, in order to explain the different key theories, as well as coming to your own viewpoint. |
COMMON STUDENT MISTAKES
- Over-simplifying Kant’s position on animals — no Direct Duties does not mean no duties at all towards animals.
- Completely avoiding metaethical issues that may be relevant to criticising moral positions — such as the Open Question Argument against a naturalistic utilitarian who associates goodness with pleasure (see Chapter 6).
- Claiming that the issue of eating animals must turn on the issue of equal consideration of interests and the rights of animals, without considering the argument of Diamond.
- Failing to give due consideration to Emotivism and/or Prescriptivism as non-cognitive ways of interpreting this debate.
- Falling into the total vegetarianism versus total meat-eating narrative without drawing deeper distinctions as to when meat-eating might be acceptable and when it might not be.
ISSUES TO CONSIDER
Some questions are provided at the ends of sections 5 and 7.
- Moral statements regarding the acceptability of eating animals are often emotional. Does this mean the emotivist explanation is the best explanation?
- Do all animals deserve equal consideration of interests? Do only some animals? Which ones?
- Should we expect clear moral answers when it comes to the acceptability of eating animals?
- Does moral disagreement in this applied ethical area lend support to Anti-Realism?
- How much of this moral issue turns on empirical data regarding the treatment of animals before slaughter?
- Should you apply your favoured normative moral theory in order to find the correct conclusion in this ethical area, or should you check you favoured normative moral theory to see if it gets it right in this ethical area?
KEY TERMINOLOGY
Speciesism
Equal consideration of interests
Direct Duties
Indirect Duties
References
Bentham, Jeremy, An Introduction to the Principles of Morals and Legislation, freely available at http://www.econlib.org/library/Bentham/bnthPML18.html
Bible, New International Version, freely available at https://www.biblegateway.com/
Diamond, Cora, ‘Eating Meat and Eating People’, Philosophy, 53.206 (1978): 465–79, https://doi.org/10.1017/s0031819100026334 ; freely available at http://www.laurentillinghast.com/Dia...EatingMeat.pdf
Hursthouse, Rosalind, ‘Applying Virtue Ethics to Our Treatment of the Other Animals’, in The Practice of Virtue: Classic and Contemporary Readings in Virtue Ethics, ed. by Jennifer Welchman (Indianapolis: Hackett Publishing, 2006), pp. 136–55, freely available at http://www.hackettpublishing.com/pdf...ouse_Essay.pdf
Kant, Immanuel, ‘We Have No Duties to Animals’, in Ethical Theory, ed. by Russ Shafer-Landau (Oxford: Blackwell Publishing, 2007), pp. 395–96.
―, Lectures on Anthropology, ed. by Allen Wood and Robert Loudon (Cambridge: Cambridge University Press, 2012).
Korsgaard, Christine, The Sources of Normativity (Cambridge: Cambridge University Press, 1996), https://doi.org/10.1017/cbo9780511554476
Scruton, Roger, ‘Eat Animals! It’s for Their Own Good’, Los Angeles Times (25 July 1991), freely available at http://articles.latimes.com/1991-07-..._animal-rights
Singer, Peter, ‘Equality for Animals?’, in Ethics, Humans and Other Animals: An Introduction with Readings, ed. by Rosalind Hursthouse (London: Routledge, 2000), pp. 169–79.
Tolstoy, Leo, Writings on Civil Disobedience and Non-Violence (Philadelphia: New Society Publishers, 1988).
|
1 L. Tolstoy, Writings on Civil Disobedience and Non-Violence . 2 Data available at https://www.vegsoc.org/sslpage.aspx?pid=753 3 Genesis 2:7, New International Version, https://www.biblegateway.com/passage/?search=Genesis+ 2%3A7&version=NIV 4 Genesis 9:3, New International Version, https://www.biblegateway.com/passage/?search=Genesis+ 9:3&version=NIV 5 J. Bentham, An Introduction to the Principles of Morals and Legislation , http://www.econlib.org/library/ Bentham/bnthPML18.html 6 Ibid . 7 P. Singer, ‘Equality for Animals?’, p. 174. 8 Ibid ., p. 175. 9 I. Kant, Lectures on Anthropology . 10 I. Kant, ‘We Have no Duties to Animals’, p. 395. 11 Ibid . 12 C. Korsgaard, The Sources of Normativity , p. 154. 13 R. Hursthouse, ‘Applying Virtue Ethics to Our Treatment of the Other Animals’, http://www.hackettpublishing.com/pdf...ouse_Essay.pdf 14 R. Scruton, ‘Eat Animals! It’s for Their Own Good’, http://articles.latimes.com/1991-07-..._animal-rights 15 R. Hursthouse, ‘Applying Virtue Ethics to Our Treatment of the Other Animals’, p. 154, http://www.hackettpublishing.com/pdf...ouse_Essay.pdf 16 C. Diamond, ‘Eating Meat and Eating People’, http://www.laurentillinghast.com/DiamondEatingMeat . pdf 17 Ibid ., p. 468. 18 Ibid ., pp. 472–73. |


4.6: Is the capability approach too individualistic?
At the beginning of this century, an often-heard critique at academic meetings on the capability approach was that “the capability approach is too individualistic”. This critique has been especially widespread among those who endorse communitarian philosophies, or social scientists who argue that neoclassical economics is too individualistic, and believe that the same applies to the capability approach (e.g. Gore 1997; Evans 2002; Deneulin and Stewart 2002; Stewart 2005). The main claim would be that any theory should regard individuals as part of their social environment, and hence agents should be recognised as socially embedded and connected to others, and not as atomised individuals. Very few scholars have directly argued that the capability approach is too individualistic, but a few have stated it explicitly. Séverine Deneulin and Frances Stewart (2002, 66) write that “the [capability] approach is an example of methodological individualism” and also add “the individualism of the [capability] approach leads us […] to a belief that there are autonomous individuals whose choices are somehow independent of the society in which they live”. But is this critique correct? What are we to make of the argument that the capability approach is “too individualistic”? 6
4.6.1 Different forms of individualism
To scrutinise the allegedly individualistic character of the capability approach, we should distinguish between ethical or normative individualism on the one hand and methodological and ontological individualism on the other. As we already saw in section 2.6.8, ethical individualism , or normative individualism , makes a claim about who or what should count in our evaluative exercises and decisions. It postulates that individuals, and only individuals, are the units of ultimate moral concern. In other words, when evaluating different states of affairs, we are only interested in the (direct and indirect) effects of those states on individuals. Methodological and ontological individualism are somewhat more difficult to describe, as the debate on methodological individualism has suffered from confusion and much obscurity. Nevertheless, at its core is the claim that “all social phenomena are to be explained wholly and exclusively in terms of individuals and their properties” (Bhargava 1992, 19). It is a doctrine that includes semantic, ontological and explanatory individualism. The last is probably the most important of these doctrines, and this can also explain why many people reduce methodological individualism to explanatory individualism. Ontological individualism states that only individuals and their properties exist, and that all social entities and properties can be identified by reducing them to individuals and their properties. Ontological individualism hence makes a claim about the nature of human beings, about the way they live their lives and about their relation to society. In this view, society is built up from individuals only, and hence is nothing more than the sum of individuals and their properties. Similarly, explanatory individualism is the doctrine that all social phenomena can in principle be explained in terms of individuals and their properties.
The crucial issue here is that a commitment to normative individualism is not incompatible with an ontology that recognises the connections between people, their social relations, and their social embedment. Similarly, a social policy focussing on and targeting certain groups or communities can be perfectly compatible with normative individualism.
As I argued in section 2.6.8, the capability approach embraces normative individualism — and this is, for reasons given there, a desirable property. However, it also follows from the discussion on the importance of structural constraints (section 2.7.5) that the capability approach does not rely on ontological individualism.
Clearly, scholars have divergent (implicit) social theories, and hence some attach more importance to social structures than others do. Nevertheless, I fail to see how the capability approach can be understood to be methodologically or ontologically individualistic, especially since Sen himself has analysed some processes that are profoundly collective, such as his analysis of households as sites of cooperative conflict (1990a). In later work too, he acknowledged persons as socially embedded, as the following quote from his joint work illustrates:
The [capability] approach used in this study is much concerned with the opportunities that people have to improve the quality of their lives. It is essentially a ‘people-centered’ approach, which puts human agency (rather than organizations such as markets or governments) at the centre of the stage. The crucial role of social opportunities is to expand the realm of human agency and freedom, both as an end in itself and as a means of further expansion of freedom. The word ‘social’ in the expression ‘social opportunity’ […] is a useful reminder not to view individuals and their opportunities in isolated terms. The options that a person has depend greatly on relations with others and on what the state and other institutions do. We shall be particularly concerned with those opportunities that are strongly influenced by social circumstances and public policy […]. (Drèze and Sen 2002: 6)
Of course, the critique is not only (and also not primarily) about Sen’s work, but about the capability approach in general, or about capability theories. But the work done by other scholars similarly doesn’t meet the criteria for being plausibly considered to be methodologically or ontologically individualistic. In general, we can say that the capability approach acknowledges some non-individual structures, and for the various more specific capability theories, the degree to which they move away from methodological or ontological individualism depends on the choices made in modules B and C. But whatever those choices are, there are already some features in module A that prevent capability theories from being methodologically or ontologically individualistic.
4.6.2 Does the capability approach pay sufficient attention to groups?
The critique that the capability approach should focus more on groups is often related to the critique that the focus of the capability approach is too individualistic, but it is nevertheless a distinct critique. A clear example can be found in the work of Frances Stewart (2005), who argues that in order to understand processes that affect the lives of people, such as violent conflict, one has to look at group capabilities — which she defines as the average of the individual capabilities of all the individuals in the selected group. The reason we need to focus on these ‘group capabilities’ is because they are a central source of group conflict. They are thus crucial to understand processes such as violent conflict.
We will return to Stewart’s specific complaint below, but first unpack the general critique that the capability approach doesn’t pay enough attention to groups. To properly judge the critique that the capability approach does not pay sufficient attention to groups, we need to distinguish between a weaker and a stronger version of that claim.
A stronger version of that claim would be that the capability approach cannot pay sufficient attention to groups — that there is something in the conceptual apparatus of the capability approach that makes it impossible for the capability approach to pay attention to groups. But that claim is obviously false, because there exists a large literature of research analysing the average capabilities of one group compared to another, e.g. women and men (Kynch and Sen 1983; Nussbaum 2000; Robeyns 2003, 2006a) or the disabled versus those without disabilities (Kuklys 2005; Zaidi and Burchardt 2005). Capability theorists have also written on the importance of groups for people’s wellbeing, like Nussbaum’s discussion of women’s collectives in India. Several lists of capabilities that have been proposed in the literature include capabilities related to community membership: Nussbaum stresses affiliation as an architectonic capability, Alkire (2002) discusses relationships and participation, and in earlier work I have included social relationships (Robeyns 2003). The UNDP (1995, 2004) has produced Human Development Reports on both gender and culture, thus policy reports based on the capability approach focus on groups.
The weaker claim states that the present state of the literature on the capability approach does not pay sufficient attention to groups. I agree that contemporary mainstream economics is very badly equipped to account for group membership on people’s wellbeing. But is this also the case for the capability approach? While some capability theorists have a great faith in people’s abilities to be rational and to resist social and moral pressure stemming from groups (e.g. Sen 1999b, 2009b), other writers on the capability approach pay much more attention to the influence of social norms and other group-based processes on our choices and, ultimately, on our wellbeing (e.g. Alkire 2002; Nussbaum 2000; Iversen 2003; Robeyns 2003a). There is thus no reason why the capability approach would not be able to take the normative and constitutive importance of groups fully into account. Admittedly, however, this is a theoretical choice that needs to be made when making scholarly decisions in modules B3, B5 and C1, hence we may not agree with the assumptions about groups in each and every capability theory.
If we return to the reasons Stewart gave for a focus on group capabilities, we notice that the main reason stated is that analysis of group capabilities is needed to understand outcomes. Yet that is precisely what the just mentioned capability applications do (since they do not only measure group inequalities in capabilities but also try to understand them). Those applications also investigate how group identities constrain groups to different degrees, or which privileges they ensure for certain groups. In my reading of the literature, many capability scholars do precisely this kind of work, and to the extent that they do not do so, one important reason is that they are engaging in documenting and measuring inequalities, rather than in explaining them. The complaint should then be that capability analysis should be less concerned with documenting and measuring inequalities, and should spend more time on understanding how inequalities emerge, are sustained, and can be decreased — but that is another complaint.
Still, I do think that a consideration of the role of groups in the capability approach gives us a warning. To fully understand the importance of groups, capability theories should engage more intensively in a dialogue with disciplines such as sociology, anthropology, history, and gender and cultural studies. This will make the choices of the account of human diversity (module B3), the account of structural constraints (module B5), and of ontological and explanatory theories (module C1) more accurate. Disciplinary boundaries and structures make these kinds of dialogues difficult, but there is no inherent reason why this could not be done.
4.6.3 Social structures, norms and institutions in the capability approach
The critique that the capability approach is too individualistic is sometimes also put in another way, namely that the capability approach should pay more attention to collective features, such as social structures, social norms, and institutions. How can the capability approach account for such collective aspects of human living?
At the theoretical level, the capability approach does account for social relations and the constraints and opportunities of societal structures and institutions on individuals in two ways. First, by recognising the social and environmental factors which influence the conversions of commodities into functionings. For example, suppose that Jaap and Joseph both have the same individual conversion factors and possess the same commodities. But Jaap is living in a town with cycle lanes and low criminality rates, whereas Joseph is living in a city with poor infrastructure for cyclists, and with high levels of criminality and theft. Whereas Jaap can use his bike to cycle anywhere he wants, at any moment of the day, Joseph will be faced with a much higher chance that his bike will be stolen. Hence, the same commodity (a bike) leads to different levels of the functioning ‘to transport oneself safely’, due to characteristics of the society in which one lives (its public infrastructure, crime levels etc).
The second way in which the capability approach accounts for societal structures and constraints is by theoretically distinguishing functionings from capabilities. More precisely, moving from capabilities to achieved functionings requires an act of choice. Now, it is perfectly possible to take into account the influence of societal structures and constraints on those choices, by choosing a nuanced and rich account of agency (module B4 — account of agency) and of societal structures (module B5 — account of structural constraints). For example, suppose Sarah and Sigal both have the same intellectual capacities and human capital at the age of six, and live in a country where education is free and children from poorer families receive scholarships. Sarah was born in a class in which little attention was paid to intellectual achievement and studying, whereas Sigal’s parents are both graduates pursuing intellectual careers. The social environment in which Sarah and Sigal live will greatly influence and shape their preferences for studying. In other words, while initially Sarah and Sigal have the same capability set, the social structures and constraints that influence and shape their preferences will influence the choice they will make to pick one bundle of functionings. The capability approach allows us to take those structures and constraints on choices into account, but whether a particular capability theory will take that into account depends on the choices made in the various modules, especially modules B4 and B5. Yet it is clear that the choices made in modules B and C will have ultimately far reaching consequences for our capabilitarian evaluations.
Summing up, one could, plausibly, complain that a certain capability theory doesn’t pay sufficient attention to social structures or collective features of human life. This may well be a very valid critique of a particular capability theory in which the additional theories of human diversity, social structures, and other social theories more generally, are very minimal (that is, the explanatory and ontological theories added in C1 do not properly account for many collective features of life). But I have argued that it is not a valid critique against the capability approach in general.
6 Amartya Sen has responded to their critique by stating that “I fear I do not see at all the basis of their diagnosis” (Sen 2002b, 80). As my arguments in this section will show, I think Sen is right, because Deneulin’s and Stewart’s critique fails to distinguish properly between different types of individualism, including methodological individualism (which the capability approach is not) and normative individualism (which the capability approach meets, and, as I have argued in section 2.6.8, should meet).


8: Chemical Equilibrium
Chemical equilibrium is the state in which both reactants and products are present in concentrations which have no further tendency to change with time. This results when the forward reaction proceeds at the same rate as the reverse reaction. Thus, no net changes in the concentrations of the reactant(s) and product(s) are observed. This is known as dynamic equilibrium
-
- 8.1: The Nature of Chemical Equilibrium
- At equilibrium, the forward and reverse reactions of a system proceed at equal rates. Chemical equilibrium is a dynamic process consisting of forward and reverse reactions that proceed at equal rates. At equilibrium, the composition of the system no longer changes with time. The composition of an equilibrium mixture is independent of the direction from which equilibrium is approached.
-
- 8.2: The Empirical Law of Mass Action
- The law of mass action describes a system at equilibrium in terms of the concentrations of the products and the reactants. For a system involving one or more gases, either the molar concentrations of the gases or their partial pressures can be used. The equilibrium constant can be defined in terms of forward and reverse rate constants: \(K=k_f/k_r\). The equilibrium constant expression (law of mass action): \[K=\dfrac{[C]^c[D]^d}{[A]^a[B]^b} \]
-
- 8.3: Thermodynamic Description of the Equilibrium State
- In this unit we introduce a new thermodynamic function, the free energy, which turns out to be the single most useful criterion for predicting the direction of a chemical reaction and the composition of the system at equilibrium. As we will explain near the bottom of this page, the term "free energy", although still widely used, is rather misleading, so we will often refer to it as "Gibbs energy."
-
- 8.4: The Law of Mass Action for Related and Simultaneous Equilibria
- Chemists frequently need to know the equilibrium constant for a reaction that has not been previously studied. In such cases, the desired reaction can often be written as the sum of other reactions for which the equilibrium constants are known. The equilibrium constant for the unknown reaction can then be calculated from the tabulated values for the other reactions.
-
- 8.6: The Direction of Change in Chemical Reactions- Empirical Description
- Systems at equilibrium can be disturbed by changes to temperature, concentration, and, in some cases, volume and pressure; volume and pressure changes will disturb equilibrium if the number of moles of gas is different on the reactant and product sides of the reaction. The system's response to these disturbances is described by Le Châtelier's principle: The system will respond in a way that counteracts the disturbance. Not all changes to the system result in a disturbance of the equilibrium.
-
- 8.7: The Direction of Change in Chemical Reactions - Thermodynamic Explanation
- A negative value for ΔG indicates a spontaneous process; a positive ΔG indicates a nonspontaneous process; and a ΔG of zero indicates that the system is at equilibrium. A number of approaches to the computation of free energy changes are possible.
-
- 8.8: Distribution between Immiscible Phases - Extraction and Separation Processes
- A partitioning of a compound exist between a mixture of two immiscible phases at equilibrium, which is a measure of the difference in solubility of the compound in these two phases. If one of the solvents is a gas and the other a liquid, the "gas/liquid partition coefficient" is the same as the dimensionless form of the Henry's law constant. A solute can partition when one or both solvents is a solid (e.g., solid solution).


5.4: Emergency Room
Day: 0
Time: 11h15
Place: Emergency Triage
Nurse Jackie thinks to herself, Wow, I finally get to sit for a minute. This flu season has been brutal. Fifteen patients before 10:30 in the morning . She completes a number of stats forms behind the triage desk and adds some names to the whiteboard to keep track of where patients and staff are located.
Turning back to the desk, Jackie looks up to see two well-dressed, middle-aged women approaching, one in a wheelchair.
“I bet this is another flu case,” Jackie says to herself.
“Good morning, can I help you?”
Dorothy pulls the wheelchair up to the triage desk. “That is why we are here, for you to help us or more specifically help Meryl!!”
Jackie looks at both women and attempts a smile. Ok, this could be challenging , she thinks.
“What seems to be the problem or what can I help with?”
“My name is Dorothy and this is my wife, Meryl, who happened to pass out at Safeway this morning while we were shopping.”
“My name is Jackie and I am the triage nurse or the nurse that looks at you first to consider how serious your problem is. Ok, so you passed out? Did you lose conscious or did you become dizzy and just sink to the floor?”
Meryl looks over at both of them. “I think a little of both. I just remember coming to, sitting cross legged on the floor.”
“Ok, seems you are a bit short of breath?”
Meryl tries to take a deep breath that only results in a weak cough. “Yes, getting over the flu. Thought I was over it.”
Jackie steps out from behind the triage desk and brings the vital sign machine with her.
Hooking Meryl up to the blood pressure cuff and the pulse and temperature, she presses a button to initiate the machine to take Meryl’s vital signs.
| Day: 0 | Pulse Rate | Blood Pressure | Respiratory Rate | Temperature | O 2 Saturation |
| Time: 11h20 | 106 | 95/60 | 20 | 36.5°C | 95% |
Nurse Jackie looks over the results and sees the temperature is not elevated, but the blood pressure (BP) is down and the heart rate (HR) is up. “Doesn’t look like it’s the flu for you, but maybe something else. Ok, let’s get you to wait over there and I will see if we can get someone to see you shortly. It’s not too busy so it should not be long.”
Dorothy shakes her head. “Wonderful — our health system at work. Ok Meryl, we get to sit and wait.”
Meryl looks up at Dorothy. “I am ok to wait.”
“You might be but I am not.” Dorothy directs the chair over to where Jackie indicated.
Time: 11h30
Nurse Jackie approaches Meryl and Dorothy. “I need to take some more information and then we can get you seen by the doctor.”
Jackie takes a full health history from Meryl asking her about past history, medication, allergies, and contact information.
“So you have a heart murmur that didn’t go away after your last pregnancy?”
“Yes, they told me not to worry too much about it.”
“Did they tell you anything more?”
“No, I haven’t worried about it till now. Today my chest just feels different and I am short of breath.”
“Ok, thank you. I am going to talk with Dr. Smythe and we will move you to another area here so we can explore more fully what is going on.”
Jackie walks away to find Dr. Smythe.
Time: 12h15
Just as Jackie is finishing recording her findings, Dr. Smythe approaches the bedside.
“Hello, my name is Dr. Edward Smythe. I am one of the Emergency physicians and Jackie asked me to take a look at you.”
Both Meryl and Dorothy look up and smile at Dr. Smythe and nod their heads together.
Dr. Smythe begins to assess Meryl, turning her head back and forth looking at her neck. He then checks her fingers and then looks at her ankles and gives them a bit of a squeeze. “I need to listen to your heart and lungs.”
Meryl adjusts her blouse to allow Dr. Smthye to access her chest. Dr. Smythe listens carefully to heart and breath sounds.
After completing his assessment, he steps back and looks at both Meryl and Dorothy. “I don’t think it’s the flu.  I believe I am also hearing an extra heart sound. Now this could be nothing or it could be serious so I would like to do some blood work, and a chest X-ray. I am also going to ask for a pregnancy test since the heart murmur appeared with your last pregnancy.”
Dorothy laughs. “Doctor Smythe, I don’t think she is pregnant!”
“Still it did happen and we need to rule it out.”
Dr. Smythe turns to Jill. “Please place her on the monitor and take vital signs q 15 minutes for the next hour then q1h. I will order a CBC, lytes, BUN, creatinine, trops, 12 Lead, and a portable chest X-ray.” Also, glucose, urinalysis, and a pregnancy screen. For the time being you’re on bed rest, and I will ask Cardiology to come see you.”
Jill records all this to make sure nothing gets missed.
Dr. Smythe turns back to the two women. “Meryl, you are going to be spending the better part of the day with us, so I am going to admit you to the Emergency and after we have all the tests results back, I will come and discuss these with you and what our next steps are.”
“Thank you, Dr. Smythe.”
Time: 12h45
The phone rings beside Jill as she is charting another episode of atrial fib, “Hello, this is Jill.”
“Hi Jill. This is Gurpreet in Radiology. I have a requisition for a chest X-ray on a Mrs. Meryl Smith. Can she come to the department?”
“I am thinking not as I have her on the monitor, and she was admitted with a complaint of loss of consciousness. I am a bit concerned that if she goes out, something may happen. I or another nurse will need to go with her.”
“Ok Jill, I thought that might be the case but I thought I would ask. I’ll be down in a couple of minutes and will do her X-ray with the portable in Emergency.”
“Thanks.” Jill hangs up the phone, finishes scotch taping the rhythm change to the patient’s chart and moves to Meryl’s bedside.
“Hi, Mrs. Smith. They’re coming down to do a chest X-ray so I would like to help get you setup so you’re ready for it when Gurpreet arrives with the machine.”
Jill then helps Meryl sit up straight, moves the ECG leads off her chest, and explains the X-ray to both Dorothy and Meryl.
Just as she is finishing, Gurpreet comes around the corner pushing the portable x-ray.
“Man, these things never get any lighter! Even with the power drive they’re a challenge to move around without running on toes. Is this Mrs. Meryl Smith?”
Jill smiles and looks at Gurpreet, “Yes it is, and that was quick. Do I need to check the wheels for any toes?”
“No, heard a couple of screams but nothing else as I drove here. Thank you for getting everything setup for me.”
“No problem.”
Gurpreet moves to the bedside, and checks Meryl’s position. “My name is Gurpreet. I just need to double check who you are and then I’m going to place a very hard board behind your back and take a picture of your chest.”
Meryl nods her consent.
Gurpreet looks at the requisition, and compares the information to the ID band on Meryl’s left wrist. “Can you tell me your birth date?”
“Yes it is June 6, 19xx.”
“Ok, we are good to go.”
Gurpreet returns to the portable X-ray and withdraws from the rear hidden compartment, a large board. Slipping the board into a special plastic bag, she returns to the bedside. With Jill’s assistance they both lean Meryl forward and place the X-ray board behind her back.
“Oh, that is so uncomfortable.”
“Its only for a couple of minutes. Relax against the board and try not to move.”
Gurpreet maneuvers the X-ray machine into position at the end of the stretcher. She turns on a light on the camera head and adjusts the aperture for Meryl’s chest size. Using the built-in tape measure, Gurpreet checks to make sure the X-ray is the proper distance away. Satisfied that everything is correct, Gurpreet nods to Jill and grabs a lead apron from the stanchion of the X-ray machine.
“X-ray ready in Bed 4.
“Stand clear, X-ray exposing Bed 4!” Gurpreet then presses a button which starts a whirring sound, ending with a dull click.
“Ok, all done Mrs. Smith.” Gurpreet hangs up the lead apron on the stanchion and moves to the bedside to help Jill remove the board and reposition Meryl into a more comfortable position.
Gurpreet backs the portable X-ray machine out.
Dorothy returns at the same time from grabbing coffees for her and Meryl. “Hey, what did I miss?”
Jill turns and says “First of many tests we have to complete. That was the X-ray and I’m hoping the lab person will be by shortly as well for the other tests.”
Time: 12h59
Alexa looks at the list of requisitions that have come into the lab. “Alright, there is a bunch from Emergency and two from the Family Birthing Unit. I can do the Emergency ones quickly. I should see if someone can do the FBU ones.”
Looking up, she sees Harry at the desk. “Hey Harry, can you do me a favour? I am a bit swamped with reqs from Emergency and there are two from the FBU that I can’t do as quickly as they would like. Do you mind?”
Harry smiles, “For you Alexa, anything, but it will cost you a coffee.”
“A coffee I can handle, thank you.”
Alexa grabs her lab cart and heads out the door to the Emergency Department. While waiting in the elevator she, looks over the reqs for Emergency. Ok , she thinks. Nothing special. Appears to be more routine with no stats. Let’s start with the oldest time stamp and work my way to the recents .
Time: 13h14
Alexa: “Good day, are you Mrs. Meryl Smith?”
“Yes, why do you ask?”
“My name is Alexa and the Emergency physician ordered some lab work for you.”
“Ok.”
Alexa looks at the requisition, compares this to the labels and then attaches the labels to the appropriate tubes. That done, she approaches Meryl’s bedside. “I need to ask you some questions to ensure that I have the right patient and the right lab work ordered.” Alexa sees Meryl nod. “Ok, can you tell me your full legal name?”
“Meryl May Smith. My birth date is June 6, 19xx.”
“Oh, you have been practicing.”
“Not really, everyone seems to ask me the same questions.”
“True, we need to make sure we have the right patient and the right tests. We try to avoid making an error as much as possible.”
Alexa, prepares for the venipuncture by gathering all the correct equipment. She then wraps a tourniquet around Meryl’s left arm. Carefully examining her ACF she finds a large prominent vein. “You may feel a bit of a pinch.”
Alexa then slips the vacu-container needle quickly into the vein and seeing a flashback of blood pushes the first tube down into the vacu-container. She repeats this three more times to fill all four collection tubes.
“Ok, Mrs. Smith, please hold here.” Meryl does as requested. Alexa rechecks the labels against the requisition and then places the tubes in their racks for processing .
“Now, lets put a bit of a band-aid on that and then I will leave you be. I hope everything turns out ok for you, Mrs. Smith.” Alexa then pushes her cart out into the main part of the Emergency Department. Ok, that’s all the patients , she notes . I’ll take these samples back for processing and then see if anyone needs help.
Time: 13h20
Jill approaches Meryl’s bedside just as the ECG technician arrives. “Is this Mrs. Meryl Smith?”
Jill looks up and sees the 12 lead cart. “Yes it is.”
“Ok, thanks, it has been a bit hectic. Sorry, I’m running a bit late.”
Jill shrugs and checks the monitor and writes down the vital signs.
| Day: 0 | Pulse Rate | Blood Pressure | Respiratory Rate | Temperature | O 2 Saturation |
| Time: 13h20 | 104 | 98/60 | 22 | 36.5°C | 95% |
“Hi Mrs. Smith, I’m Denis and I am going to place some wires on your chest, legs and arms. This will then give us a better view of your heart electrical function.”
“Ok, I guess.”
Denis pulls the curtains closed to give Meryl some privacy and then requests she lift her shirt up a bit so that he can place the wires on the left side of her chest. Efficiently he quickly places the leads on Meryl’s chest, legs, and arms. About a minute later the machines is printing out a 12 lead ECG.
“Now that you have all those squiggly lines on pink paper, who looks at it and what does it all mean?” asks Meryl.
Denis smiles, “Well I give one copy here to Jill for your chart and another copy goes with me for the heart doctor to look at. Whoever the heart doctor is, will then dictate a report that goes on your chart.”
“When will I know what it says?”
“I would guess pretty soon, but that is up to Jill and the Emergency doctor.”
Meryl sighs and lays back.
Denis pulls the curtains back and passes the 12 lead to Jill.
“Ok, Jill, here you go. I’ll let you discuss it with the Emergency doctors. I need to get up to the fifth floor for a stat.”
“Thanks Denis.”
Time: 14h30
Jill finds Dr. Smythe reviewing the chest X-ray, labs, and 12 lead of Meryl.
“What do you think, Dr. Smythe?”
“Well, it’s not great. Mrs. Smith has some congestion in her lungs, but has no fever, a little rise in WBC, and no signs of infection so I think the congestion is cardiac in nature. When I look at her 12 lead, I see some left ventricle enlargement. Her lab work is interesting as she has decreased kidney function according to her GFR and creatinine, plus, she has an elevated BNP. All other cardiac markers are normal. So, it appears she has exacerbation of heart failure.”
“Wow, she is very young to have HF.”
“Yes, but the valve issues she had when she was pregnant have not gotten better and it appears may have worsened over time. Is her wife here? I would like both of them to hear this.”
“Yes, Dorothy is with Meryl now.”
Jill leads Dr. Smythe to Meryl’s bedside.
Dr. Smythe looks at both women. It just never gets easy to give bad news; I so wish there was another way, he thinks.
“Ok, Mrs. Smith, I believe I know what is wrong with you and why you are not feeling well. I have reviewed all your lab tests and it points to a diagnosis of heart failure.”
“What, what is that, am I going to die?”
“Heart failure is a broad diagnosis indicating that your heart is not pumping as well as it should. For you, it is related to the valve issues you had when you were pregnant. The valve is not closing as well as it should and this is putting strain on your heart to meet your body’s need. No, you are not going to die right now. This is a serious diagnosis and needs to be managed well by you and a cardiologist.”
Dorothy begins to cry quietly at the bedside. Meryl reaches over and holds her hand. “Ok, Doctor, what happens now?”
“I am going to contact the cardiology team. I would like to admit you under their care so that they can get you on the right meds, provide some teaching for you and your spouse, and get you involved with some support groups to help you cope with this. I know it’s a lot to take in, but with proper management you should be ok.”
Meryl, looking overwhelmed, looks back at Dorothy then at Dr. Smythe and Jill. “I’ll do what ever you ask.”
Dr. Smythe backs away from the bedside and walks toward the main nursing station to call the cardiology team. Jill approaches both Meryl and Dorothy. “Do you have any questions?”
“No. Can you leaves us alone for a little bit?”
“I certainly can. I’ll draw the curtains to give you a bit of privacy. I’ll come back in 15 minutes and get you ready to go upstairs to the fifth floor.”
Time: 15h30
Jill looks up at Meryl’s monitor and sees that her oxygen saturation is decreasing, now reading 88% on room air.
| Day: 0 | Pulse Rate | Blood Pressure | Respiratory Rate | Temperature | O 2 Saturation |
| Time: 15:30 | 106 | 96/60 | 22 | 36.5°C | 88% |
“Hi Meryl, are you feeling ok?” she asks.
“No, I feel short of breath, can’t catch my breath. Feels like I have been running.”
Jill notes that Meryl’s heart rate is also increasing but still sinus.
“Ok, I think I am going to have to put some oxygen on you.” Jill frees a set of nasal prongs from their plastic bag and plugs one end into the oxygen flowmeter. She wraps the other end around Meryl’s ears and places the prongs gently in her nose. Jill adjusts the oxygen flow to 4 LPM.
“Ok, Mrs. Smith.
Meryl takes a half dozen breaths as instructed and Jill notes the sats improve to 93% and the heart rate beginning to decrease to 95 to 100 beats per minute.
“Thank you, I feel a bit better but not normal. Am I getting worse?”
“Maybe, but it is too early to tell. Let’s just say you need a bit of oxygen, but nothing else has changed.”
“All right.”
Jill leaves Meryl alone and goes to find Dr. Smythe
She finds Dr. Smythe coming out of the dictation room with a cup of tea in his hand.
“Dr. Smythe, Mrs Meryl Smith is now requiring oxygen and she is stating she is not feeling quite right and is short of breath.”
“I thought this might happen. Ok, I am going to order a transthoracic echo and I will call Cardiology to take her as soon as a bed is available. They said they are discharging eight patients today so there should be space for her.”
Jill watches Dr. Smythe fill out the stat requisition for a cardiac ultrasound.
Time: 16h00
Charlie reviews the requisitions on the computer screen. What is this: stat echo in Emergency? he wonders.
Reading the information on the echo requisition, he notes that a consult to Cardiology has also been requested.
Grabbing the phone, Charlie calls Emergency and asks for the nurse caring for Mrs. Meryl Smith.
“Hello this is Jill.”
“Hi Jill this is Charlie in Echo. I have a stat req for Mrs. Smith. Can she come to the department?”
“I am not comfortable sending her to you. She is on oxygen and is monitored. She is now experiencing shortness of breath and is not feeling quite right. This is her first experience with heart failure and we’re not sure how she is responding right now.”
“Ok, I will bring a portable machine down. It won’t be ideal, but I can help add to the information on the patient. Most likely she will need a second echo in the department to get better pictures, but I will leave that up to Cardiology. I will be there in about 10 minutes.”
“Thanks Charlie.”
 Slightly out of breath from having to push the machine and avoid all the activity in the Emergency Department, he maneuvers the machine close to Meryl’s stretcher.
“Hi Mrs. Smith, my name is Charlie and I am an echo cardiology technician. I’m going to take some moving pictures of your heart. It won’t hurt, but may be a little cold as I have to use some gel.”
“I remember having one of these when I was pregnant.”
“Meryl, I’m going to step out and update the family while Charlie does his test thingy. There’s not much room for me and his machine. I will come back.” Dorothy moves around the echo machine and heads to the waiting area to make some phone calls.
Charlie pulls the curtains around Meryl’s bedside and turns off the lights by the bed so it’s a bit darker and easier to see the echo machine’s screen.
“Ok, Mrs. Smith. You are going to need to pull your gown up a bit so I can see the left side of your chest.”
Meryl exposes the left side of her chest and Charlie adjusts the gown to cover most of Meryl’s breast.
“The gel is warm, but not really warm so it may feel a bit cold to you. I’m going to squirt some on your chest and on the probe. This helps us get a better picture.”
Meryl shudders a bit as the gel is placed on her chest and then relaxes as Charlie places the probe over her tricuspid area.
“Ok, Mrs. Smith, I am done with the echo.”
Charlie takes a towel and carefully removes as much of the gel as possible and then helps Meryl readjust her gown.
“What did you see? It looks like it was all shadows to me.”
“I can tell that your heart is not pumping as well as it should and that you have a problem with one of your valves on the left side of your heart. Anything more will be up to the doctors as I cannot tell anymore than that.”
“Not sure I needed this test as you just said the same thing as Dr. Smythe.”
Charlie smiles, “Yeah? Well it confirms what he told you then.”
Pulling back the curtains, Charlie navigates the ultrasound machine out of the space and waves goodbye to both Jill and Meryl.
Time: 16h30
Jill sees that Dr. Smythe is talking with Charlie and walks closer to hear what they are saying.
“Ok, Charlie tell me again what you saw on the ultrasound?”
“Right. The ejection fraction is estimated at about 30%. Her LV looks a bit dilated. The mitral valve is graded a moderate regurg. On the plus side, I did not see any vegetation.”
Dr. Smythe looks over at Jill. “This is much worse than I expected. I am quite surprised she was managing so well in the community and this is her first time admitted with HF.”
Jill nods, “There’s a bed available for her on the fifth floor. They told me I could move her after 4pm.”
“Well, given everything we know, that is the best place for her. Thanks Charlie. Say hello to your dad for me and tell him, when he wants another bowling lesson, I’m available.”
“Thanks Dr. Smythe. I’m pretty sure my dad is still recovering from that perfect game you threw the last time you were out together. He may not want a lesson for awhile.”
Charlie smiles at both Dr. Smythe and Jill and with a wave moves off to grab his ultrasound machine.
“Ok, Jill, I don’t think I need to speak to Mrs. Smith again. Let’s get her upstairs and let Cardiology manage her. That would be best. I’ll finish writing the progress note and her orders to date. Cardiology will need to add their specific treatment.”
“Right. I will phone up report to the fifth floor and then take her up after 4pm. Thanks, Dr. Smythe.”
Time: 17h15
“Ok, Mrs. Smith,” Jill says, “They are ready for you on the fifth floor and they have a real bed in an actual room for you. Dorothy can come with us. I’m going to attach your leads to a portable system and have Glen the porter help me with your stretcher.”
Both Dorothy and Meryl look relieved that there is a real bed ready.
Jill grabs the portable monitor system and places it at the end of the bed. She then pulls out of the main monitor the cartridge with all of Meryl’s leads and information, and slides it into the portable system. Looking at the smaller screen, Jill makes some adjustments and nods satisfactorily that everything looks good.
Jill calls the front desk and asks for Glen the porter to help her with Mrs. Smith.
Glen arrives a few minutes later and together, with Dorothy’s help, they get Meryl up to her room on the fifth floor.