Bioethics, healthcare policy, and related issues.
I attended a bioethics conference last week at which a featured speaker was Dr. Ron Cranford, the most prominent consulting neurologist in the Schiavo case. His presentation was interesting, not so much for its technical content (which was not new to most of us present) but for the general thrust of his remarks.
I’m getting my act together and taking it on the road - both to a bioethics conference and some personal vacation with friends and family.
Blogging will be light for the next two weeks, but I’ll do what I can.
Watch this space!
(In the meantime, call this an open thread . . . )
The Schiavo autopsy results all but certainly substantiated the interpretation of her clinical situation made by every competent and responsible professional involved in her case. But that is by no means a majority of the whole group of people who were, in one way or another, and with or without invitation, involved. For purposes of reference, and to put these meddling buffoons on record, let’s take a look at some of the players and their “professional” opinions, rendered before termination of Terri Schiavo’s feeding tube.
The full autopsy report on Terri Schiavo was released today. Preliminary news reports on the press briefing held by the Pinellas County Coroner indicate that the results were much as had been expected by those who understood the facts of the case: Schiavo had suffered severe, irreversible brain damage, showed no signs of physical abuse, and was incapable of taking food or water by mouth.
The nomination of Dr. Lester Crawford, Acting Commissioner of the FDA, for permanent appointment is scheduled for today. This also makes possible the activation of threatened “holds” on his nomination by 3 Senators. There is a great deal of concern over his willingness to act responsibly on women’s health and contraception, and over his refusal to do so so far.
I am floored by this article in today’s New York Times: a sensitive profile of an episode I had never heard of, and one that calls a lot of feelings about medical ethics into mind.
For over 40 years, during a period - 1903 - 1940s - when care of premature infants in the US lagged far behind that in Europe and facilities were extremely limited, a crusading doctor provided free incubator care to over 8,000 preemies in New York, saving over 6,500 lives . . . by putting them on display in the carnival sideshows of Coney Island.
The Center for Reproductive Rights has a set of statements and briefing papers on the FDA’s religiously-dictated refusal to certify “Plan B” emergency contraception for over-the-counter sale. They also show running clocks counting up the time since the original petition for OTC status was filed, and the number of unplanned pregnances in the US that are estimated to have resulted since (1,580 days as of today, and 13 million unplanned pregnancies, respectively).
Women’s lives, health, and liberty hang in the balance as this shame continues.
Rana, of Frogs and Ravens, is one pissed-off frog:
Do these things sound familiar?
“You lefties just don’t get it . . .”
“Why are you offended by this? It’s no big deal, and we have more important things to talk about . . .”
“It’s not like Roe v. Wade is going to overturned — and maybe if it is, that’d be a good thing . . .”
She puts the “feminist issues are not second-class” argument as well as it ever was:
AJOB has a good editorial on the inflated claims that are sometimes made for the therapeutic benefits of early-stage research, particularly, lately, regarding embryonic stem cells:
Those of us who support embryonic stem cell research often cringe when the claims in favor of that research are embellished. During the Presidential election, of course, that reached its apex with arguments by a number of folks including Sen. Kerry himself to the effect that Christopher Reeve might have been cured has stem cell research been funded sooner. Today, dozens of children and others who argue - like us - for stem cell research are held up as potential recipients of embryonic stem cell-derived therapy, as though the big worry is that they will not receive their embryo pills next year and will suffer as a result. You don’t have to have a long memory to see how dangerous these views can be. Just think back to gene therapy, and the clamor of folks to enroll in early, non-therapeutic trials because of the perceived magic of anything genetic.
The latest twist comes from an unnamed “Scientist in Irvine [California]”, . . .
who writes the San Francisco Chronicle to let us know that among the victims of unenlightened stem cell research are the soldiers in Iraq, who won’t get their stem cell therapies and will die as a result.
It’s true that stem cell research has been over-hyped, which both misleads the public and hands ammunition to opponents of science. It is dishonest and unfair to promise immediate benefits from research that faces so many technical hurdles before even earliest clinical trials can begin for most of its potential applications.
Part of the problem comes from the criminal debasement of our political discourse. No issue - no matter how momentous - gets debated at any level more sophisticated than the sound bite and the grandstanding photo op. When opponents of stem cell research trot out their own children and absurdly label them “Former Embryo“, or poignantly ask a Congressional committee “which of my twin daughters should be sacrificed” for stem cell research, it is hardly surprising for proponents of that research to counter with Christopher Reeve. But those who are in the right on this issue owe it to themselves and their own commitment to ethics to behave responsibly even where the political climate is not conducive. There is no point in promoting the truth if we do not believe the truth has both value and power.
[This will be a recurring feature at Sufficient Scruples: a weekly roundup of bioethics-related blog posts from notable sources. (Feel free to drop me a line alerting me to your blog or your posts, if I haven’t got you blogrolled yet.) Use this feature to keep abreast of issues or commentary that you may not have gotten to over the week.]
The Well-Timed Period gives us this trenchant “shorter Pope”: “If those Africans could just deal with the horrific threats posed by divorce, abortion, and a contraceptive mentality [threats on par with human trafficking], think how much more safe and serene the fabric of their life would be.”
Ophelia Payne at XX notes yet another study showing children raised by gay parents are doing just fine, thank you, and concludes: “Either we do our best to integrate families of all shades and kinds into mainstream culture, or we shame them for the audacity to do the best for their children.”
Reproductive Rights Blog notes the almost unbelievable, contemptuous (and beyond contemptible) viciousness of Louisiana’s anti-abortion waiting-period and mandatory-counseling laws designed to coerce women to carry unwanted pregnancies to term - and which are applied to victims of rape and incest as well as all other women.
And more . . .! (more…)
[Note: A consensus is growing that, because the young man mentioned below is still a minor and is in a very vulnerable position, bloggers should remove direct links to his blog or uses of his name. I have removed them below and made minor revisions to the text to avoid using his name. I can say, though, that I have seen his blog and it appears to me to be authentic.]
Lindsay at Majikthise alerts us to this appalling story:
[Name deleted] is a very courageous 16-year-old guy from Tennessee who recently come out to his parents. He’s also a damn good writer who has been blogging about their hateful anti-Christian reaction.
[His] parents have decided to ship him off to a self-professed “Safe Place” known as Refuge–a Christianist residential program that promises to turn kids straight.
When did miscegenation become OK?
There are the high-profile examples, of course: in the late 50s, Sammy Davis, Jr., enjoyed a series of public relationships with various blond bombshells that netted him a lifetime of harassment and death threats, while still commanding the loyalty of legions of black and white fans; later there was Clarence Thomas’s wife, who struck a blow for women’s independence in 1991 when she declared that Anita Hill was a psychotic who “was probably in love with” the man she claimed had sexually harassed her. And, in 1967, “Guess Who’s Coming to Dinner?” was released as a serious social drama, in which dreamboat black man Sidney Poitier is judged barely acceptable by liberal white parents willing to stretch their own principles to the point of martyrdom; in 2005 it was remade as a comedy in which Ashton Kutcher is adjudged an imbecile by every living person in the United States including Bernie Mac.
So, I guess we can say that some time between the late 50s and now, something changed. Popular, wealthy, and privileged blacks went from a point where they could satisfy their jungle desires for relationships with whites if they were willing to risk their careers and their lives, to a point where they could publicly reject whites as not measuring up to their standards. And, between the late 60s and the early 90s, where once it was barely imaginable that a black man would be an acceptable in-law in the eyes of “enlightened” society, it became possible for white women married to black men to dictate to black women how they should let black men treat them - and be applauded by white Republicans for doing so. It appears, then, that at some point in the 70s or 80s, it became possible in US society for inter-racial couples to present themselves as standing inside the accepted social picture of what married couples were supposed to look like.
But there’s more.
The latest wrinkle in the emergency contraception “conscience clause” business is a nurse at Eastern Illinois University who applied for a job that involved dispensing EC, stated in the job interview she would not perform that duty, and then sued when she didn’t get the job.
Archaeopteryx notes some Kiwi wingnuttery about sex education (I’m sorry to hear it’s taking root down there, too). In response to the wonderfully-named program to encourage safe sex - “No Rubba, No Hubba Bubba” - the local wingers had their usual complaints about the failure of the program to include their particular brand of social conditioning:
Sex without a sense of morality is like a car without brakes
- to which Archaeopteryx has the definitive reply:
That’s not what I heard. I think a better analogy is “Abstinence-only without real knowledge is like a society full of willfully ignorant parents with an STI epidemic among youths.”
That’s sayin’ it.
Ms. Magazine has an interesting news blurb about a feminist-leaning, pro-choice hotline service in Oakland set up to allow women to “talk freely about their experience with abortion, without judgment.” The service is now expanding to nation-wide operation. The service “operates with respect for the social, cultural, and religious beliefs of all of our callers – this is the unique cornerstone of our service and philosophy”. While I’d hardly call that “unique” - most service providers in the abortion community try hard to be accepting of all aspects of their patients’ backgrounds - it’s obviously admirable.
The service’s Web site explains:
Exhale offers a free, After-Abortion Talkline that provides emotional support, resources and information. The talkline is available to women and girls who have had abortions and to their partners, friends, allies and family members. All calls are completely confidential and counselors are non-judgmental. . . .
Women and men of all backgrounds call the Exhale talkline. Some people feel relief that the abortion is finally over and they just want to tell someone. Others feel a sense of loss and are looking for ways to work through their grief. Parents, friends and partners want to learn how they can best provide support. Women may call the day of their abortion, a month after or years later.
At Exhale, we believe there is no “right” way to feel after an abortion. We also know that feelings of happiness, sadness, empowerment, anxiety, grief, relief or guilt are common. Abortion can be hard to talk about and finding the right person to talk with can be even harder. Exhale provides the opportunity to talk with someone that supports and respects you, in a safe and confidential environment.
The Ms. article notes that the Oakland service has received about 1,500 calls since 2000 - which is less than one a day. Still, there appears to be a demand for the service, and it sounds like an excellent idea.
I think this kind of service reflects a growing willingness to acknowledge the complexity of the abortion decision within the pro-choice community. The nonsense from the anti-choice community - ranging from simply fraudulent claims of a “Post-Abortion Syndrome” and flat lies about the health consequences of abortion, to continual insinuations that abortion somehow damages women - have made any admission that abortion can be regrettable a risky thing for those who support choice - it plays too much into an ongoing line of assault - however false - from the right wing. But that reluctance has been a mistake. To be sure, many people in the pro-choice community have long acknowledged the ambivalence women may feel about abortion, and the range of possible responses women may have to it. But I also think it’s fair to say that post-abortion counseling has not been a priority for supporters of abortion rights or for abortion providers - which is too bad, because it is a part of the fullness of care for abortion patients, and of an honest and thorough understanding of their experiences.
Services like this hotline, and the Pittsburgh “November Gang” of abortion clinic operators who offer in-clinic counseling services, fill a gap in dealing with abortion holistically, and possibly expand the dialogue about abortion among pro-choicers. Both, I think, are good things, and signs of growth in the abortion-rights and abortion-services communities.
The Bush Adminsitration has sicced the Department of Homeland Security on a new class of - as they see it - legally invisible non-persons: transsexual immigrant spouses of US citizens.
Many blogs have noted that yesterday was the 40th anniversary of the landmark Supreme Court decision in Girswold v. Connecticut - the case that established the right of married couples to use birth control. The timeline of consequences of that case deserves to be filled in.
The New York Times reports today on a “lacktivist” protest outside the studio of ABC’s morning show “The View” - breastfeeding mothers blockaded the sidewalk with a wall of mammaries after Barbara Walters (who I really thought was more together than this) made a remark on the show that she was “uncomfortable” seeing a woman breastfeeding her infant on a plane.
This absurd reaction keeps popping up, a product of our culture’s pathologically perverse reaction to women’s bodies and reproductive biology. The story remarks on the “sexualization of the breast”, which is certainly part of the problem - the inability to see normal biology as other than sexual - but only part. Seeing breasts as sexual - or even simultaneoulsy as sexual and as . . . um, feeding stations - would not be a problem if there weren’t so many people in our society who are so phobic about sex - to the point not only that they are nearly hysterical at seeing a fraction of a second’s worth of part of one of Janet Jackson’s nipples, but that they can’t bring themselves even to be in proximity to a breast being used for its natural function! That squeamishness has resulted in women being harassed or thrown out of public venues around the country - but gradually a counterwave is building.
The religious-right’s war on America has become increasingly aggressive and decreasingly covert over the period of Bush’s tenure in office. Their agenda has not changed, but the increased confidence they have gained has made them less circumspect and even, more and more, outrightly triumphal in their pursuit of their aims. Right-wing politicians have gone from coded shout-outs to their extremist base (like Bush’s pointed appearances at Bob Jones University, or his references to Dred Scott in a debate question about abortion - sound-biting a current talking point that claims embryos are being held in “slavery”) to a kind of taunting defiance of the separation of church and state, and of the interests of those who have not signed on to their doctrinal Crusade.
Governor Rick Perry of Texas has rung in with a gratuitious, symbolic insult added to his signing-away of young Texas women’s rights over their own bodies - not only did he sign an abortion-restriction bill, but went out of his way to do so in an evangelical church on Sunday, then put his signature on a state Constitutional amendment - which does not require a governor’s signature - banning gay marriage, in the same venue. He even managed to get in a little dig at the Jews.
On the bright side, though he’s a flaming asshole, as Molly Ivins points out he has excellent hair.
George Bush waxed philosophical in a recent interview regarding the moral question of the utilitarian value of torture.
“If you’re in my shoes, and you thought Abu Farraj al-Libbi had planned an attack on America, would you use any means necessary to get the information from him?” Bush asked. “The decision I have made is ‘No, we will not.’ And let’s just pray he doesn’t have that information. And when I told the American people we’re not torturing, we’re not torturing.
“But try that on for an interesting ethical dilemma as the President of the United States,” he added.
Leave aside the continuing scandal of the US’s use of torture in its prisons and concentration camps, and the weak amusement afforded by the thought of George Bush pondering ethical dilemmas with serious intent, leave aside even the factual falsity of Bush’s statement (as only casual attention to recent news makes heartbreakingly clear, we are torturing; we were torturing, and very likely at his impetus, at the time Bush said we were not, and, to all appearances, we are continuing to torture to this day). It is a new infuriation that this administration - infatuated by torture as it has been through its highest levels - still seems to regard the worst abuses of the most inhumane regimes as mere policy options for this once-great nation. Under George Bush, “we’re [supposedly] not torturing” not because it violates the most fundamental principles of international law, not because it violates treaties and charters the US itself helped write and are still (Attorney General Albert “Torture Boy” Gonzales notwithstanding) legally in effect, not because it’s grossly immoral (even granting highly dubious “ticking time-bomb” scenarios that have never actually been encountered in real life), not even because it’s ineffective - but merely because Bush himself decided we won’t, for now. Torture is something he decided we wouldn’t do - after thinking about it - a decison he regards with apparent wistfulness.
There’s a buzz a’growin’ over today’s Boston Globe story, summarizing an upcoming National Review profile (not yet online) of Mitt Romney, Governor of Massachusetts. Romney is a prominent conservative, most recently in the news for vehemently opposing a state stem-cell-research initiative on grounds of zygotic personhood (no word on whether he wore a “Former Embryo” sign on his chest). Romney had previously pledged to support abortion rights in his gubernatorial campaign - a necessity in pro-choice Massachusetts - but has since been quietly drifting rightward.
Romney ran for US Senate in 1994 pledging to keep abortion ‘’safe and legal in this country.” As a 2002 candidate for governor, Romney said he would not change the state’s abortion laws. But in recent months, he has described himself as ‘’personally prolife” to out-of-town political audiences. And last month, he told USA Today that he is in a ‘’different place” on abortion than when he ran in 1994 against US Senator Edward M. Kennedy. A Romney spokeswoman said he had ‘’evolved over time,” but would not elaborate.
The kicker in the article is a statement by one of Romney’s top campaign advisers that Romney had been “faking” his pro-choice stance:
‘’He’s been a pro-life Mormon faking it as a pro-choice friendly,” Romney adviser Michael Murphy told the National Review in a cover story hitting newstands today titled ‘’Matinee Mitt.”
That caused an uproar over whether Romney had campaigned on false pretences, and whether he had been presenting himself since as being more moderate on reproductive issues than he actually is. It’s clear his position is much more conservative than it had been, and the simple semantic difference between his Senatorial promise and his gubernatorial promise should have been all the clue anyone needed even three years ago. But the issue today seems to be not whether he is in fact personally anti-choice, but whether he deliberately created a false impression of his position in the campaign and later.
Murphy started back-pedalling his own remarks immediately:
Murphy, a prominent Republican consultant, issued a statement of regret yesterday afternoon after a prepublication copy of the article circulated among political strategists and reporters and threatened to overshadow the positive exposure Romney was getting from appearing on the cover of two conservative magazines this week.
‘’The quote in the National Review article was not what I meant to communicate,” Murphy’s statement said. ‘’I was discussing a characterization the governor’s critics use. I regret the quote and any confusion it might have caused.”
However, nobody seems to believe that.
Kathryn Lopez, at the NRO Corner (NR’s blog), holds that Romney really only promised not to change abortion laws in Massachusetts, not that he supported them. Lopez thus undercuts both Murphy’s claim that he never made the “faking it” comment and the argument that Romney really is pro-choice - seeking to defend him only from the charge of lying about his position. This echoes Romney’s own staff in the BoGlob article:
Romney’s press staff yesterday insisted that the governor has kept his campaign promise to leave the abortion laws of Massachusetts untouched. ‘’When the governor ran for office in 2002, he promised he would not change the abortion laws of the Commonwealth, and he has kept that promise,” said his press secretary, Julie Teer.
For myself, I am not very concerned about his possibly lying about his position (I never understood why they elected him in the first place, and was not surprised at his anti-research stance, so it would be a minimal surprise if he now launched an assault on abortion also). What is interesting to me is what this portends for Romney’s open thirsting for the presidency - not what it says about his now-past state campaign.
It seems to me this development leaves Romney in a tight spot, but not about the alleged lying. He has been courting the right wing for some time, while moving away from his own previous pro-choice stance. His current position, and the embryo fixation he professed in the stem-cell debate, make it clear the pro-choice community has nothing to expect from him. What he has to explain to the right wing is why he hasn’t been a stronger champion for them - why he would agree to a cease-fire on abortion, given that he was so het-up about stem cells, and why he would go to such lengths to make himself seem pro-choice (the last thing a real anti-choicer wants even if it’s not true).
Part of Romney’s answer, of course, is that no other position is tenable in Massachusetts, and that by agreeing not to make a scene over abortion long enough to get elected, he got the chance to (unsuccessfully) make a scene over stem cells later. But I think, for the truly rabid core that drives the GOP, there will remain the whiff of tolerance about Romney that will always worry them. To placate that group, he has to come out as really vigorously anti-choice, which would then give credence to the claim that he was deliberately “disassembling” (that means to not tell the truth) by not attacking abortion as governor. Contrariwise, claiming - as he is now doing - that he really wasn’t lying in his election campaign means claiming that he really was comfortable with not doing anything to prevent abortion during his term - making him look too soft to challenge Frist or the Santorum/Delay cabal. It’s not the fact of lying, per se, that’s going to get him into trouble, but the way he deals with the charge of lying - by endorsing either an even harder-line stance on abortion (thus proving the charge of lying) or by re-endorsing his previous see-no-evil stance (proving he is not committed enough for the hard core).
Well, this is the bed he made. Let’s see how it fits him.
Apropos of the issue of the definitional power of euphemistic language, the NY Times today has an article on a growing movement among opponents of abortion rights and embryo research to “adopt” unused embryos left over from IVF procedures (i.e., to arrange to transfer them to women who are not the ovum donors, who will gestate them in order to prevent them being discarded or used in research). While the practice itself is not necessarily problematic, the organized movement in favor of such transfers is rife with manipulative language and demonstrative grandstanding. President Bush’s recent awkward baby-kissing was staged among a group of “adopted-embryo” children, and apparently such displays have become popular among right-wing politicians.
Ms. Magazine’s “Feminist Wire” reports that a federal district judge today overturned a Mississippi law requiring all second-trimester abortions to be performed in a hospital, on grounds that it imposed an unconstitutional “undue burden” on women’s ability to exercise their right to abortion. The law was explicitly aimed at making such procedures impossibly expensive to get, and Governer Haley Barbour had campaigned for it as a measure intended to make it impossible for the state’s only second-trimester abortion provider clinic to remain in business.
The “undue burden” test cooked up by Justice O’Connor has been unworkably restrictive from the beginning. Seemingly a compromise between women’s rights and states’ authority to impose limits on them, in practice almost anything has been held by the Supreme Court to be not an “undue burden”, including restrictions that double or triple the cost of abortion or impose waiting periods that make it impossible for women from out of town to schedule abortion procedures (a terrible problem in the over-80% of US counties - many of them large and rural - that have no local abortion provider). The Court has repeatedly pretended that restrictions which, in practical effect, actually prevent women from exercising their right to abortion at all are not “undue burdens” - notwithstanding that actual prohibition would seem to be as great a burden as it is possible to imagine. So it is welcoming to find some burden, imposed deliberately to prevent women from exercising their right to abortion, finally recognized as constitutionally “undue”. It is much too soon to imagine that the “undue burden” test itself will be recognized for what it is - a wink-and-a-nod invitation to anti-choicers to impose whatever burdens they can think of and then contrive to slip under that invitingly high constitutional bar. But if “undue burden” has been a failure as a compromise, there are at least some judges who recognize it is not meaningless entirely.
AJOB’s blog has an outstanding article today on Tom Delay’s manipulative use of language in describing stem cell harvesting from embryos as “dismemberment” - citing similar abuses by President’s Council member William Hurlbut, and Chair Leon Kass. It goes on to link this to similarly heated language used against intact-dilation-and-extraction procedures.
The article is a sweeping indictment of misuse of scientific-sounding language on both sides of these debates, though acknowledging that the abuses by conservative figures have been more extreme and more calculated. In particular, the article notes, there is a tendency to employ outmoded or suspicious scientific language with a pretended authority that attempts to pre-empt opposition with terms like “without a doubt”. There is also a strange tendency for conservatives to insist that their neologisms and declarative nomenclature are “clear language”, while accusing opponents of euphemism.
The issue is rich, and the short article linked above covers a lot of ground. Go read the whole thing.
