The Ethics of Triage: A Perspective on the World Food Conference
by Laurence Simon
Mr. Simon, a former director of the Third World Seminar at Fordham University, attended the World Food Conference in Rome. This article appeared in The Christian Century, January 1-8, 1975, pp. 12-15. Copyright by The Christian Century Foundation; used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted and Winnie Brock.
Scarcity, it would seem, is responsible for a crisis greater than any the world has recorded in its collective memory. Nearly 500 million persons, most of them children, are close to starvation. Tens of thousands will die this week. Before the crisis resolves itself, countless millions -- perhaps as many as 1 billion persons -- will perish.
Yet there is no scarcity. Food is plentiful. Whether it will be shared depends upon how successful we are in penetrating the myths of development strategies that have failed in the recent past -- and how effectively we counter the masters of triage.
On the battlefronts of war, the wounded are divided into three groupings -- those who will survive without medical help; those who will probably survive with medical help; and those who will probably not survive even with medical help. Available medical supplies are assigned accordingly. The sorting process that determines how resources are to be allocated is called triage. "Will you and I as American citizens some day have to participate in the choice of ‘Food Triage’ similar to that facing a combat surgeon in war?" asks the report "Malthus and America" (subcommittee on department operations, House Committee on Agriculture, October 1974). The report brings to our attention the inequities of global food consumption:
In the less developed countries, approximately 400 pounds of grain per year is available to the average person, nearly all of which must be consumed directly merely to meet minimal food energy needs. . . .Contrast this example to the average North American who uses nearly a ton of grain per year. Of this ton, less than 200 pounds is consumed directly as bread, pastry, and breakfast cereal. The remaining 1800 pounds plus is consumed indirectly in the form of meat, milk and eggs.
Because America produces most of the food it consumes, it is often suggested that Americans are justified in their excesses. But, as the congressional report points out, the U.S., though it has only 5 to 6 per cent of the world’s population, consumes more than 40 per cent of the world’s total food and non-food resources -- most of it imported.
Our agricultural exports have assumed, therefore, a crucial role in our balance of payments. According to figures from the U.S. Department of Agriculture, farm exports in fiscal year 1974 totaled a staggering $21.3 billion. Soybeans, wheat, feedgrains and rice alone amounted to $14.3 billion. Over 100 million tons of farm products are exported annually. Who will be the recipients of this enormous bounty? "Countries who can pay," the congressional report admits. And countries that can pay often use large quantities of grain to support their meat consumption -- the result being enormous waste. Eight pounds of grain are required to produce one pound of beef.
A. H. Boerma, director-general of the Food and Agriculture Organization of the U.N., estimates that the critical shortfall next year will run from 8 to 12 million metric tons of grain in the five most severely threatened countries: Bangladesh, India, Pakistan, Sri Lanka and Tanzania. Yet, as Dr. Boerma reminds us, the supplies do exist. America alone will have produced during 1974-75 over 212 million tons of grain. Dr. Boerma earlier warned that if help did not reach Bangladesh by Christmas 1974, 1 million persons would face imminent death. Referring to the major exporters and importers, he said: "I told them, ‘I don’t know whether you can bear the responsibility for determining who is to live and who is to die.’"
The U.S., by far the largest producer and exporter of food, provided 9 million tons of food aid to needy nations three years ago. Two years ago we committed 7.5 million tons. Last year, when U.S. commercial food exports were the largest in history, only 3.3 million tons were made available for aid. This year’s contribution is running slightly ahead of last year’s.
Explaining the U.S. government’s negative response to the urgent call from Rome for an emergency commitment of 1 million additional tons of grain to help close the 8-to-12-million-ton gap, Secretary of Agriculture Earl Butz said, "It would have a bullish effect on the market." Yet the commercial value of the 1 million tons is only $175 million. Presidential counselor Anne Armstrong, often described as a champion of women’s rights, announced the decision in Rome with the comment that "the American housewife is having a tough time meeting her own budget. American citizens are having a tough time feeding their own families." Must the American housewife accept the blame for the suffering of other mothers who watch their children starve? Are women’s rights a middle-class phenomenon? Or is the American housewife victimized by the same mechanism that has caused massive starvation elsewhere in the world? This is triage in a world of plenty.
Time magazine (November 11, 1974), concluding its special report on the world food crisis, explains its support of triage:
In the West, there is increasing talk of triage. . . .If the U.S. decides that the grant would simply go down the drain as a mere palliative because the recipient country was doing little to improve its food distribution or start a population control program, no help would be sent. This may be a brutal policy, but it is perhaps the only kind that can have any long-range impact. A triage approach could also demand political concessions. . . . Washington may feel no obligation to help countries that consistently and strongly oppose it. As Earl Butz told TIME: "Food is a weapon. It is now one of the principal tools in our negotiating kit."
Food, however, is not the weapon. The denial of food -- famine -- is the weapon. Under the terms of Public Law 480, the Food for Peace Program, food is given away only after all our commercial commitments are met. Only surplus food will find its way to those nations unable to compete in the market. But not even this paltry sum has been directed to the areas most in need. The Sahelian countries of Africa, where 100,000 persons were felled by famine last year, received relatively little of this surplus food. The decision as to where the food is shipped is based on cold war politics. Last year nearly half of our food aid went to South Vietnam and Cambodia. Our "defense perimeter" certainly did not include Chile under Salvador Allende. Three days before the military coup d’état, the U.S. turned down a request to sell wheat to Chile for cash. Yet one month after the junta’s putsch, with Allende dead, the U.S. granted the new regime eight times the total credit ever offered to Allende to purchase wheat. Food for Peace has been handled as an adjunct of our military assistance programs.
Further, the U.S. has consistently opposed the creation of internationally held grain reserves. The virtual depletion of world food stocks prompted the U.N. meeting in Rome; yet the U.S. government maintains that the private sector is best able to build reserves. In 1972, when the world suffered an exceptionally poor harvest, there were 209 million metric tons of grain, or 66 days’ worth, in world reserve. Last year saw record grain crops worldwide, yet the reserve was reduced to 25 million metric tons, or 37 days. This year there is estimated to be a 27-day reserve after exceptionally large grain harvests.
Writes George McGovern, chairman of the Senate Committee on Human Nutrition and Needs, in the preface to the committee’s "Report on Nutrition and the International Situation": "Private traders are in business to turn investments into profit as rapidly as possible. . . . In reality a reserve in private hands is no reserve at all. It is indeed precisely the same market mechanism which has produced the situation we face today." The mechanism of the marketplace is geared to scarcity, not to reserve. If prices begin to decline, produce is withheld to create an artificial scarcity and inflate prices. If prices increase, produce is withheld to force prices still higher. Furthermore, there is no accurate and mandatory grain-reserve reporting system maintained by the USDA. We may think there is scarcity; only the corporate traders know for certain.
One person who agrees with Senator McGovern is James McHale, an energetic farmer appointed by Governor Milton Shapp as Pennsylvania’s secretary of agriculture. McHale, who led the delegation from Pennsylvania (the only state in the Union to send one) to Rome to lobby the official U.S. delegation for a sane food policy, charged that 95 per cent of all grain reserves in the world are under the control of six multinational agribusiness corporations (Cargill Grain Company, Continental Grain Company, Cook Industries Inc., Dreyfus, Bunge Company and Archer-Daniel Midland -- all of them American-based companies).
These corporate middlemen have as much power over the small farmers of America as they do over sovereign nations in the market to purchase grain. The prices paid in the supermarket are determined to a large extent by these giants. The five top corporations are presently involved in class-action suits brought by wheat farmers in Oklahoma and Texas who accuse them of rigging grain prices.
Multinational agribusiness, primarily U.S.-based, controls more than the markets of world agriculture, as Jean Pierre Laviec of the International Union of Food Workers said in a statement released in Rome:
They decide the quantities of vital inputs to be produced, the quantities of agricultural products to be bought, where plants will be built and investments made. The growth rate of agribusiness has risen during the last ten years and . . . has been directly proportional to the increase of hunger and scarcity.
It is questionable whether genuine solutions to hunger and scarcity can be generated by private organizations whose first and last aim is to maximize profits. Technical solutions rely on multinational corporations for their design and implementation. Short of genocide -- or triage -- technical solutions, to the extent that they will be applied and at the cost of their purchase, will not work. For hunger, like no other issue, goes right to the heart of global injustice. Any "solution" that does not encompass structural change toward a just society is part of the problem.
Multinational agribusiness has clearly not been concerned with such change. Most Third World nations, even after they achieved political independence, continued to be economically determined by foreign corporations. These Western economic interests established symbiotic relationships with the ruling elites of the poor nations. Colonial structures of land tenure and exploitation of natural resources were carried over, with the elite accumulating economic and political fortunes at the expense of the impoverished masses.
Technical solutions for hunger do not attack poverty or its preconditions in exploitation. So long as Third World nations and the masses of the poor are seen solely as cheap sources of raw materials and labor and receptive markets for industrial products, poverty and hunger will continue to grow. Large capital investments in the Third World on the part of multinational business will increasingly require political commitments from the host nation -- and such commitments are most easily secured in such rightist dictatorships as Brazil and Chile. The impoverished world is politically volatile, and civil unrest may soon follow spreading famine. Only the most secure areas or those vital to our interests will continue to enjoy "development." The "Fourth World" of nations, devoid of purchasing power, political stability or personal hope, will implode under the enormous pressures of overpopulation and despair.
Jay W. Forrester, professor of management at MIT whose sophisticated computer modeling of social and environmental issues led to the Club of Rome report on "The Limits of Growth," sees the political and economic stresses in the world as caused by the necessary transition from worldwide growth to equilibrium. Speaking at the prestigious Franklin Institute in Philadelphia (October 15, 1974), Dr. Forrester suggested that
the interrelationships become, for the first time, very tight between technology, economics, politics and even ethics. . . . If we grow more food, to reduce hunger, this may simply lead to more people and the continuation of the same control in the system which is the same percentage of the population hungry. More food leads to more population, not to less average hunger.
Recognizing that "the industrialized countries are living on the flow of energy and materials from all over the world," Forrester believes that the "threat of the whole concept of limits is much greater to the industrialized countries." He predicts that as these stresses make themselves felt in the industrial sector, our ethics of affluence will shift into an ethics of triage.
The editorial columns of ordinary newspapers in the United States are now using the word triage relative to the food situation. This is a measure of the changing nature of the situation; our ethics are very much tied up with technology and economics.
Probing the ethical implications of triage before the program board of the National Council of Churches’ Division of Overseas Ministries, Forrester maintained that
a vast new set of ethical and moral dilemmas now faces man as humanity begins to encroach on the physical limits of the world. . . . In the teaching of the church is often the implication that right is absolute, that it knows no compromise, that it is independent of the future time toward which one looks. These are fallacies. Generally, a system policy that is desirable in the short run is detrimental in the long run and vice versa. . . . The church has taken an overly simplistic view of right and ethics. As a consequence, it contributes to the goal conflicts between present and future [Zygon, Journal of Religion and Science, September 1972].
System-dynamics, developed largely by private corporations to solve management problems, may play a valuable role in the transition to the "technological steady-state," as other scientists call it. But multiloop diagrams and computer print-outs are fundamentally lacking if they are not infused with political vision. For what is equilibrium if it is not a new world order?
To stop the holocaust in the underdeveloped world, important moral choices have to be made in ours. The purveyors of triage do not challenge the economics of scarcity. Scientists can accept the verdict of management experts or can proceed on their quest and revolutionize the world with limitless, clean sources of solar and fusion energy. The ecological-industrial equilibrium can be built, like some island paradise, on the calcified remains of a billion beings or, beyond vested interest, on justice and mercy. "There is no way out for man," H. G. Wells observed, "but steeply up or steeply down." It’s gravity or grace, Simone Weil would say. And by her life and death we may glimpse the clue: "Belief in the existence of other human beings as such is love."