Bioethics, healthcare policy, and related issues.
For some unclear reason, an anti-choice organization is promoting a “Day of Silence” for high school students in late October. The idea is that fetuses have been “silenced” by being aborted, so anti-choice students should be silent “out of solidarity” . . . whatever that means.
Sounds good to me. They ought to make it year-round. More silence is better from this group.
It’s odd that the promotional image shows a young person with tape over her mouth, emblazoned “Silenced”. Since they’re doing this of their own accord, they’ve hardly been silenced – they’ve just chosen, uncharacteristically, to finally shut up. That is, they’ve exercised their autonomy to make their own choice. But irony was never a strong point of the anti-choice right.
However, it occurs to me that those who favor freedom might as well make the most of this opportunity. Use October 25th (the appointed “Day of Silence”) to make an extra effort to talk up autonomy, freedom, and the importance of reproductive choice – when the anti-choicers can’t respond! Think of it as their gift to getting the pro-choice message out without interruption!
I hereby nominate the Day of Silence as “The Day to Speak Out for Choice”.
The oft-rumored scandal that has dogged the organ-transplant community since its inception – the false, but feared horror that has been denied, again and again, by those who struggle to use such a terribly limited supply of material to save such desperate patients – has finally taken place for real. What the public has often feared, and was told over and over didn’t happen and couldn’t happen, has happened. A patient on the liver-transplant waiting list at St.Vincent Hospital in Los Angeles was bumped over 50 places on the needs-ranking list to receive an organ that should have gone to another patient. The transplant-service staff then engaged in extensive falsification of medical records to hide the procedure. In the end, not only was one patient denied the organ that should have gone to them, but another patient was removed from the transplant list entirely and their identity used to hide the identity of the actual – unentitled – recipient. Naturally, the whole thing was paid for by the Saudi government: a premium fee of $340,000 to the hospital, undisclosed sums to the surgeons, and who knows what else to grease the skids.
Found at the delightful Frogs and Ravens, and at Sappho’s Breathing.
Rules:
1. Go into your archive.
2. Find your 23rd post (or closest to).
3. Find the fifth sentence (or closest to).
4. Post the text of the sentence in your blog along with these instructions.
“[Leon Kass, outgoing Chair of the President's Council on Bioethics] is, in his private capacity, openly coordinating an effort to push a conservative Congress to ban the technologies that the Council, in its official capacity, was supposedly advising and reporting on.”
Ah, yes . . . the good old days.
As previously noted, anti-choicers are beside themselves over the fact that Planned Parenthood is providing subsidized reproductive healthcare to Hurricane Katrina survivors, and have begun efforts to fund anti-choice “crisis pregnancy centers” in the disaster area to divert patients away from full healthcare options, and also to block Planned Parenthood’s funding to reduce the services available to patients through them. “CNS News” – “the Cybercast News Service”, a conservative online newspaper founded by Brent Bozell of the Parents Television Council (the group constantly plaguing the FCC with complaints about dirty words and Janet Jackson’s nipple) – recently ran an article consisting entirely of anti-choice propaganda claiming that Planned Parenthood was diverting donations made for Hurricane Katrina relief into its general-purpose fund. The ground for this claim is such a stupidly incompetent reading of two clearly labeled, completely separate sections of a donation Web page that it is impossible to imagine that the claim was an honest mistake, or that CNS’s reporter could reasonably have been confused about the matter.
There is an off-putting through-the-looking-glass quality to what passes for reasoned discussion on the anti-choice right wing. Their arguments against abortion often read as parodies of rational philosophy; today we get a glimpse of the “medical ethics” found in a “crisis pregnancy center”, and it has a similar clown-college aspect to it. The familiar themes are there: autonomy, patient preferences, informed consent – but as if read backwards.
There’s a weird meme (weirder than usual, I mean) running around the anti-choice community: that abortion clinics routinely lie to potential abortion patients and otherwise try to “force” them to have abortions they do not want. A variation is that they promote birth control as a way of generating unintended pregnancies among those sexually active hussies, in order to then get the abortion business that will result. Other versions have to do with a wave of deaths, child abuse, or sexual assault taking place in or abetted by abortion clinics, which the clinics somehow manage to hush up. The common theme is that pro-choice activists and caregivers are engaged in massive deception to deliberately increase the number of abortions given, for ideological or financial reasons.
For instance, the infamous Bernard Nathanson is now quite visible on the anti-choice lecture circuit claiming that, in the early days of NARAL, he and others knew that the commonly-cited figure of 5-10,000 deaths by illegal abortion per year was much too high – or that in fact he personally made it up – but they used it anyway because it was an effective scare tactic.
The statistics that we gave to the American public about illegal abortions annually; the statistics we fabricated regarding the number of women dying from illegal abortions annually; all of thes ematters were pure fabrication and still persist to this very day.
I confess that I knew the figures were totally false, and I suppose the others did too if they stopped to think of it. But in the “morality” of the revolution, it was a useful figure, widely accepted, so why go out of our way to correct it with honest statistics. The overriding concern was to get the laws eliminated, and anything within reason which had to be done was permissible.
[variously attributed to Nathanson's books, Aborting America or Hand of God]
And, today, there is this bizarre post from the deranged blog Extreme Truths (tagline: “Satanic sacrifices require Blood of The innocence. Every baby killed during Abortion is a Sacrifice to Satan!” [sic capitalization, spelling, and color]):
“Cindy” . . . is 15 and is 4 months pregnant. Fearing her parents disownment she sets off to get an abortion. While in the clinic she tells the counselor she has reservations and doesn’t really want an abortion. The counselor tears up the consent form. This is whaere it gets interesting and the lies start!
“……They hooked me up with a lady that was willing to do a embryo transplant and adopt my baby. However on that day I did an ultra sound and we found out the baby had died. The doctor said I should continue with the abortion procedure since it would be the fastest way to remove the baby’s body to prevent infections. For a wonderful 25min I thought my baby was going to live and be happy. Then it was dead. I was in a lot of pain after the procedure, but my boyfriend was really supportive. He took care of me and I soon recovered. Now I see cry sometimes, but I guess it was for the best. At least I know my baby is in a better place.”
[And further:]
“In my facilities, I always gave option counseling. Of course you make the abortion the most appealing. . . . The longer I was in it, the less I cared, so I really didn’t really care what my conscience said. My conscience was totally numb anyway. . . . It’s typical — I would give them an option and then shoot it down. The only option you didn’t shoot down, obviously, was abortion.”
Former clinic owner Eric Harrah quoted by Dr. Jack Willke and Brad Mattes
“I was trained by a professional marketing director in how to sell abortions over the telephone. He took every one of our receptionists, nurses, and anyone else who would deal with people over the phone through an extensive training period. The object was, when the girl called, to hook the sale so that she wouldn’t get an abortion somewhere else, or adopt out her baby, or change her mind. We were doing it for the money.”
–Nina Whitten, chief secretary at a Dallas abortion clinic under Dr. Curtis Boyd
“If a woman we were counseling expressed doubts about having an abortion, we would say whatever was necessary to persuade her to abort immediately.”
–Judy W., former office manager of the second largest abortion clinic in El Paso, Texas
“The counselor at our clinic would cry with the girls at the drop of a hat. She would find theirweakness and work on it. The women were never given any alternatives. They were told how much trouble it is to have a baby.”
–former abortion worker Debra Harry, quoted in the film “Meet the Abortion Providers” 1989
[etc.]
Apparently the above are from a long list of “outrageous” quotes circulating on the Web, mostly from a small set of magazine articles. Taking them at face value, what they amount to is a couple of dozen people involved in providing abortions over the last 20 years or so who say they violated the spirit of the informed consent procedure. (Most of the other quotes are to the effect that the providers felt uneasy about doing the work, or simply “shocking” descriptions of procedures taken from the medical literature.) This is a very serious matter, but it hardly amounts to an indictment of abortion as a practice or of the community of providers as a whole. It is hardly even very surprising that there would be some bad apples in such a large community over such a long period of time.
It has become a standard tactic of the anti-choice right to accumulate “embarrassing” stories about abortion providers as a way of discrediting the profession. Every time an abortion clinic worker gets into some kind of trouble, or a clinic fails a health inspection, anti-choicers trumpet this as evidence that the entire field is somehow sleazy. There are many Web sites “memorializing” the deaths of women following legal abortion, none of which ever note the much larger number of deaths that would be expected if all women seeking abortions were forced to carry their pregnancies to term against their will. (There is a “Blackmun Wall” site dedicated to all the women supposedly killed by Harry Blackmun as the result of the abortions he – by himself – legalized. My suggestion that they congratulate Blackmun on the thousands of net lives he saved by protecting those women from much riskier unwanted pregnancies was not received with enthusiasm.) The seemingly-obsessive Christina at Real Choice frantically notes every abortion-related adverse incident she can find and advertises their anniversaries on her blog. (How would you like your medical history and death publicly recounted in every detail by someone who disapproved of your choice of treatment?) The “lying” quotes are just part of this tactic – an accumulation of further evidence that all abortion providers are bad and all abortions are dangerous, because some ex-abortion providers said they themselves were bad, or some abortions turned out badly. But, aside from this crude and stupid inference (“enough anecdotes becomes a statistic”), it is the question of this “widespread lying” meme that interests me.
One thing I note about Nathanson and the people quoted in the various magazine articles is that they all attribute their duplicity to a previous time when their beliefs about abortion were the opposite of what they are now – that is, they lied or manipulated patients back when they were pro-choice, but of course they are telling the truth about that now. We are expected to take their word that they are telling the truth now, about what they said back then, when they supported the thing that they oppose now. We are supposed to believe they were lying about abortion when they were for it, but are not lying about lying about abortion now that they oppose it.
Well, clearly they were all lying at some point . . . but when?
In Nathanson’s case, we know the answer. He is, of course, the producer of the egregiously fraudulent anti-abortion film “Silent Scream”. Nathanson himself has acknowledged the film is inaccurate. So, Nathanson was certainly a liar after he became anti-abortion, and we have only his (anti-abortion) word for it that he was a liar before then. We also know that the thing he says he lied about – 5,000 or more abortion deaths per year – was not actually false. (It was, by best estimates, true 30-40 years before Roe v. Wade, though the numbers had dropped drastically by the time of that decision. So, it was certainly wrong to imply that illegal abortion deaths were that high in 1972, but not wrong that they had been within the lifetimes of women who lived then. The numbers were certainly not “pure fabrication” – they came from documented epidemiological research – or “totally false” – they were true, but the chronology was lost or distorted.) So, here, Nathanson is lying about what he claims he lied about before. Possibly he was as dishonest as a pro-choicer as he now is as an anti-choicer, but that’s hard to tell, because we know he is at least in part lying about having lied.
It is impossible to document the veracity of the claims made by the other anti-choice activists, and so it would be unfair to accuse them of lying. But we do know they have the same conflict of motives that Nathanson suffers from: they are (now) anti-choice, and by their own description are willing to lie in the service of what they believe in. Why would we possibly assume they are telling the truth now (about having lied before)?
Whether the various “outrageous” quotes going around from supposed ex-abortion-providers are true or not matters little. They are not an indictment of abortion or the abortion-services community even if true. But more than this, we know that some of the people offering these shocking confessions are, in fact, confirmed liars in their roles as anti-abortion activists. We know that the anti-choice community in general is mind-bogglingly duplicitous (establishing anti-choice “pregnancy centers” that advertise as abortion clinics; flogging the discredited film Silent Scream after its own producer has admitted its flaws; inventing bizarre or undocumented side effects of abortion such as “Post-Abortion Trauma Syndrome” and breast cancer, and so on). And we know that all the people who “confess” that they are both liars and anti-choice are . . . anti-choice liars.
I see no reason to imagine that any of this material is true, at least in the absence of corroboration. And, again, no reason to imagine that it matters whether or not corroborated. The “confessions” of anti-choice activists are simply moral ultrasounds – distracting images intended to shock us out of supporting choice, but which mean nothing to the actual issue at hand.
Sam Brownback has always been one of those fuzzy-headed dim bulbs who cannot see any issue except in terms of his own personal experience. How he regards anything is largely a matter of how it personally strikes his severely limited, and apparently uneducable, imagination. He belongs on a front porch in the Ozarks with a piece of straw in his mouth, but, sadly, he’s got a seat in The World’s Greatest Deliberative And Sometimes Folksy Drawling Body. He pulled his intuition-driven ignorance out for display in the Roberts hearings, with a heartwarming paen to mentally disabled elevator operators and fetuses, whom he (no doubt rightly) regards as cognitively equal to himself:
BROWNBACK: . . . [W]e talked a lot about the disability community, and well we should, and the protection needed for the disability community. And that’s important, because I think it really helps people that need help, but it helps the rest of us to be much more human and caring.
Senator Kennedy is helping me with a bill because a number of children never get here that have disabilities. Unborn children prenatally diagnosed with Down’s Syndrome and other disabilities — I don’t know if you know this, but there was a recent analysis, and 80 percent to 90 percent of children prenatally diagnosed with Down’s Syndrome never get here — never get here. They’re aborted in the system.
And people just say: Look, this child’s got difficulties. And we even have waiting lists in America of people, today, willing to adopt children with Down’s Syndrome. And we will protect that child — as well we should, under the Americans with Disabilities Act and other issues — when they get here.
But so much of the time, and with our increased ability of genetic testing, they don’t get here. Diagnosed in the womb, system that encourages this child to be destroyed at that stage — and this is all in the records.
And we are the poorer for it as a society.
All the members of this body know a young man with Down’s Syndrome named Jimmy. Maybe you’ve met him, even. He runs the elevator that takes the senators up and down on the Senate floors. His warm smile welcomes us every day. We’re a better body for him. . . .
And Jimmy said to me the other day after he hugged me; he said “Shhh, don’t tell my supervisor. They’re telling me I’m hugging too many people.”
And, yet, we’re ennobled by him and what he does and how he lifts up our humanity and 80 to 90 percent of the kids in this country like Jimmy never get here.
What does that do to us? What does that say about us. And I would just ask you, Judge Roberts, to consider — and probably you can’t answer here today, whether the individuals with disabilities have the same constitutional rights that you and I share while they’re in the womb.
ROBERTS: Well, Senator, I appreciate your thoughts on the subject very much [blah, blah, evasion, evasion, . . .]
This is idiocy at its finest.
Let’s take another look at the money quote:
“individuals with disabilities have the same constitutional rights that you and I share while they’re in the womb.”
Disabled fetuses have the same constitutional rights as Sam Brownback or even citizens of normal intelligence?
A brief digression: Here we know Roberts is jerking the Senate around, because there’s a clear and unambiguous answer to the question: “No.” Fetuses do not have the same constitutional rights as citizens because they are not persons in either the philosophical or the legal sense. There is, of course, a multi-prong movement underway to write fetuses into the law as if they were persons, in every place possible, in the apparent hope that enough saying so will make it true – but there is as yet no definitive law to change the unbroken historical precedent that they are not legal persons. The fact that Roberts could not bring himself to speak this simple truth shows how much pandering he’s doing.
But that Brownback could – apparently in all seriousness – ask this question shows how clueless he is. Obviously, Brownback is maneuvering to create legal personhood for fetuses. But I am tempted to take him at his word when he says that what motivated him on the issue is the plight of disabled fetuses (if it makes sense to talk about mental disability in an organism with no organized cognitive processes). He seems to really believe that it constitutes some sort of discrimination not to give birth to a disabled child. This makes sense only if you believe the fetus is a person (otherwise there’s no one to discriminate against), but it’s not clear whether Brownback means all fetuses are persons, or only disabled ones are – a particularly bizarre turn of the imagination. More to the point, he just seems to be so confused he doesn’t know what to think, and can’t work through the issue by himself. (Snarky thought: I wonder if Brownback holds up little notes to his aides that say “I may need to ask a question about bioethics”?)
The implications of Brownback’s stumbling intuitions are particularly offensive: not only that women have some sort of obligation to gestate an unwanted fetus, but that they have an even greater obligation if that fetus has some sort of diagnosable “disability”. And presumably this “argument” extends to more severe, non-cognitive disabilities as well (at least, we agree that live-born, independent persons with disabilities have fully equal moral standing with all other persons, so, if we are going to grant moral standing to disabled fetuses, there are no obvious grounds for distinguishing between them on the basis of degree of disability). Thus, women are, by his lights, morally obligated to gestate, against their will, even hopelessly doomed, or at the very least horribly compromised, fetuses. In other words, Brownback’s heartwarming affection for Jimmy the huggable elevator operator turns women’s medical necessity on its head: no longer is severe deformity or even unviability a justification for terminating a pregnancy, but it is now a kind of civil rights argument forcing the woman to carry a pregnancy against her will. The worst cases would then be the ones that most greatly erode women’s autonomy. And, of course, if you are required to carry a pregnancy that is essentially hopeless, out of regard for poor little Jimmy, obviously you would be required to carry one that could potentially result in a healthy infant.
Someone smarter than Brownback could be accused of being crazy like a fox – stumbling his way to reducing women to breeding machines for both healthy babies and anencephalic monsters alike. In fact, he’s probably just too dumb to understand the meaning of what comes out of his own mouth, but the end result would be the same if anyone took him seriously.
I have to say, too, that he does no favors to the disabled community with this drivel, either. For a group of full moral persons fighting for acceptance on equal terms with other such persons, it is not an advance to be lumped with undeveloped fetuses. I know there are disability-rights groups who object to the abortion of fetuses with diagnosed disabilities because they think it erodes the position of, or our respect for, full persons with similar conditions, but even so, to claim that disabled fetuses have a right against abortion because they are just the same as disabled persons makes those persons indistinquishable from the fetuses. (Talk about infantalizing the disabled! Brownback is fetalizing them!)
Hat tip: Uncle Sam’s Cabin
Hospice Blog has a good post on the”Will to Live” document which is being promoted by the “National Right to Life Committee” as an alternative to living wills. The document is essentially an advance directive that demands the most aggressive treatment possible in all cases. It has apparently been getting big play in conservative Catholic circles, although its tenets go beyond official Catholic teachings; it is also causing some concern among hospice providers. Close examination demonstrates it is not merely “pro-life” but bizarrely extremist, misleading, and deliberately manipulative.
I’ve been thinking about the obligations that attend taking responsibility for others’ health care, and how they dovetail with the moral obligations we all bear to one another.
Hurricane Katrina has brought that issue sadly to the fore in stories of the abandonment of patients to their deaths by nursing home administrators who failed to take action to evacuate, of terminal sedation/euthanasia of doomed patients – possibly at risk to their careers or liberty – by caregivers who had no other options; and, more heartwarmingly, of intense devotion to others, beyond duty, in the face of crisis. These stories are not necessarily better or worse than others we hear from that disaster zone, but that they feature the acts of healthcare workers who had accepted – or in some cases voluntarily took on, during the disaster – responsibility for others, and either met or failed the obligations they thereby entailed, makes these stories particularly salient for our concerns.
The [UK] Mail is reporting that dying patients in some New Orleans hospitals were given terminal sedation prior to evacuating the hospital wards after Hurricane Katrina, because the staff were convinced they could not live through an evacuation.
It has just been announced that Dr. Edmund Pellegrino will replace Leon Kass as Chair of the President’s Council on Bioethics. This is very welcome news.
Dr. Pellegrino is a conservative Catholic with very much “old school” views: that medicine possesses an “internal ethic” that defines the doctor’s role independently of other ethical considerations (his most-quoted article is undoubtedly “Doctors Must Not Kill”, arguing against physician-assisted suicide but not necessarily assisted euthanasia in all circumstances); that natural law defines some of the appropriate goals of healthcare; that abortion is impermissible under almost all circumstances, and so on. His arguments for his positions are often more intuitive than rigorous. But he brings a towering personal decency and incisive intelligence to his work, and is respectful of other views. (Full disclosure: I had the great privilege of direct study under Dr. Pellegrino early in my graduate education, and came away with a lasting affection and respect for someone I was happy to acknowledge as a great man and a great scholar – though I abhorred almost all his ethical views.)
I am confident that we can expect much more professional and intellectually grounded proceedings from the President’s Council from now on. Given that we’re not going to see decent healthcare policy-making from this administration no matter what happens, it will be interesting to see in what direction Dr. Pellegrino takes the Council. It will surely continue to be a conservative body, but likely one with more room for dissenting views and a more scholarly product. Conceivably, this move could earn some respect for conservative bioethics, which has been sinking ever further into cranky, idiosyncratic and religious-fanatic laughing-stock status under Kass and the religious right. Whatever happens, this represents an almost-immeasurable leap forward in respectability and professionalism.
Hat tip: AJOB/bioethics.net
There has been much commentary on the left about the right’s apoplexy over Planned Parenthood’s contribution to disaster relief: providing free or subsidized services to survivors, and shipping contraceptives into the disaster zone for those who lost theirs. I have little to add to the basic point: right-wing dumbasses simply can’t understand (a) why access to contraception and reproductive healthcare matters, and (b) why Planned Parenthood is supplying its resources and expertise to the relief effort, as opposed to, say, resources and expertise it doesn’t actually have. (Dawn Eden: “Is Planned Parenthood offering evacuees food? No! Water? No! Shelter? No! First aid? No!”) The stupidity, and the insensitive hostility to sex-related needs, speak for themselves.
But I notice another trend piggy-backing on these outbursts: not only are the wingers incensed that some disaster victims will retain control over their reproductive health in these desperate times, through the efforts of pro-freedom health organizations, but they’re delighted that other organizations are working equally hard to distort or close down reproductive health options under exactly the same circumstances. Specifically, a number of (almost always religiously-motivated) “crisis pregnancy centers” – which offer “support” to women in problem pregnancies but in fact pressure them to make only the choices the center approves, and often advertise themselves fraudulently as pro-choice – are scrambling for support to restart operations in the disaster zone.
Dawn Eden seems oblivious to her own double standard:
Planned Parenthood . . . is shamelessly milking Americans’ compassion for Katrina victims . . .
If those refugees have nowhere else to turn but Planned Parenthood, they’re really in trouble.
Please, pray for the victims, and donate to organizations that are providing them with real relief—including crisis-pregnancy centers.
Your values regarding your reproductive health are not OK. Dawn Eden’s values regarding your reproductive health are OK.
Jill Stanek has a similar set of priorities:
Louisiana and Mississippi pregnancy resource centers are in desperate need of our help. . . .
The good news is that five of eight Louisiana abortion clinics were also destroyed. . . .
Dorothy Wallis, director of Caring to Love Ministries in Baton Rouge, told me that Planned Parenthood was on the ground within 72 hours, handing out morning-after-pills at the shelters.
The only things standing in the way of spreading God’s truth and love to these abortion-vulnerable familes are money and hands. Please help.
This is quite odd. Apparently some of these centers are handing out baby formula and other child-care resources – which is an excellent thing, but one that can easily be handled by any relief agency or aid station. What “pregnancy resource centers” actually do is simply try to pressure people not to have abortions. Since it is always available not to have an abortion simply by . . . not having an abortion . . . it’s not clear what they think they’re doing down there. They’re not providing a unique service; their entire stock in trade is to not provide certain services.
What they are trying to do, of course, is establish a kind of alternative aid pipeline that will be sure to carefully exclude certain options – including emergency contraception and abortion, and in most cases regular contraception – that might otherwise be available at non-judgmental service providers. In other words, they’re trying to entice some victims into aid locations where they will not be allowed to have, and certainly not informed about, some of their options, and thereby block those options for that group of people, while simulataneously “spreading God’s truth and love” – i.e., engaging in religious proselytizing to disaster victims who come to them in need. They are setting themselves up as part of the disaster relief effort, hoping to capture some part of the flow of victims through aid agencies, for the specific purpose of blocking those victims’ access to information and services these centers disapprove of for religious reasons, and then religiously proselytizing the victims as part of their manipulative services.
This by itself is disgusting, but the casual hypocrisy of their winger supporters is startling as well. The same people who accuse Planned Parenthood of “shamelessly” providing a full range of reproductive health services, and of requesting donations to support their doing so, are, on the same page, openly shilling for “crisis pregnancy centers” for the purpose of deliberately blocking patients’ health options and imposing religious beliefs and proselytizing on them, while soliciting donations to support their doing so. How is providing more services and more options taking advantage of “vulnerable” patients (vulnerable, that is, to making a choice Jill Stanek doesn’t like), while deliberately blocking access to services is “real relief” (or as much of it as Dawn Eden thinks you need)? No explanation necessary: in the winger world, dictating to other people what their values and priorities should be is a self-justifying act.
I haven’t blogged on the developing furor over the New Hampshire physician now being sued by a former patient for telling her – rather brusquely, it seems – to lose weight. But the longer this goes on, the more it seems to me the real problem is being missed.
The facts of this particular case aren’t clear, but apparently the doctor told the patient that if she didn’t lose weight she would suffer consequences to her health and her social life. The New Hampshire Union Leader explains:
Dr. Terry Bennett, who practices in Rochester, said he has “an obesity lecture for women” that is a stark litany designed to get the attention of obese female patients.
He said he tells obese women they most likely will outlive an obese spouse and will have a difficult time establishing a new relationship because studies show most males are completely negative to obese women.
Bennett said he tells them their obesity will lead to high blood pressure, diabetes, heart disease, gastroesophageal reflux and stroke.
My reaction has always been that this is rather out of line, and a patient is not amiss in taking offense. If the doctor actually is making hard-and-fast predictions of this kind, he is going beyond the facts to simply scare his patients into losing weight – not giving them information to make decisions, but deliberately pushing emotional buttons to get them to make the decision he wants, and doing so on the basis of predictions of future consequences he cannot know will be true for each patient. That’s not good doctoring, and it may certainly be offensive – lapses for which the doctor should be held accountable. But this is not what catches my attention about this case.
What is interesting is that the case has been discussed in the media almost entirely as a dilemma pitting the doctor’s responsibility against the patient’s negative reactions, or against the doctor’s liability for offending the patient. The harshest comments have taken the familiar “frivolous lawsuit” tack, while others have asked “how can doctors do their jobs?” if they cannot speak their minds to patients. (The “fat acceptance” community has had a different perspective, but one that has – predictably – been treated as freakish in its own right by the many commentators.)
This response assumes that bugging patients about their health is a doctor’s job. And, isn’t it? I’m not sure that’s so.
The move to the “shared decisionmaking” model of the provider-patient relationship, along with the decisive authority granted to the patient by the law and the autonomy movement, makes “the doctor’s job description” a much more malleable thing than in the past. Patients may simply choose not to address certain issues that are, arguably, unhealthy by some sort of “normal species functioning” physiological standard, but which the patient does not regard as incompatible with their own sense of health, or the curing of which is incompatible with the patient’s other goals. A doctor who insists on harping on some issue the doctor thinks should be an important part of the patient’s healthcare, but which the patient does not want to address, is overriding the patient’s goals for treatment and the treatment relationship – which under the current model of that relationship, the doctor may not do. What doctors are entitled to do is what patients authorize them to do, either explicitly or implicitly. Absent some contrary request, it is probably appropriate for doctors to raise “normal functioning”-type questions with patients when they meet those patients for the first time; there is a presumption in the “standard” treatment relationship, that is, that physiological issues are fair game for doctors, whom patients seek out, after all, because they are trained on precisely those issues. But when the patient has clearly indicated their goals and preferences for treatment – either at first meeting or over the course of an ongoing relationship – the “high autonomy” model requires that the doctor accept the patient’s goals for treatment and focus their efforts accordingly.
The question to be asked is not whether nagging (or insulting) patients is within the bounds of a doctor’s appropriate efforts to get the patient to act in a healthy manner – the question is whether “getting the patient to act in a healthy manner” is appropriately the doctor’s goal or responsibility. That is, the question is whether the treatment relationship and its content are defined by the doctor’s understanding of the health needs of the patient, or by the patient’s own preferences and goals regarding their own health – whether we endorse the “doctor knows best” model or the “high autonomy” model of healthcare goal-setting.
To that question, my answer is an unequivocal endorsement of autonomy. My argument for this position will have to wait (hopefully, for my dissertation, and, hopefully, in the foreseeable future), but the general argument for autonomy is well-known by now. And from this perspective, doctors not only may not attempt to force or cajole the patient into health goals the patient does not value, but doctors also should not attempt to scare, manipulate, or trick patients into health goals – even, arguably, physiologically beneficial ones – that the patient has not endorsed, on the assumption that the patient would endorse them if asked.
All it would have taken for this doctor in New Hampshire to have avoided the whole problem was to have asked the patient “You know your body weight is above average – is that something you want to work on?” Instead, he worked up an entire (almost literal) song and dance predicated upon his patient’s presumed resistance to an issue that he also presumed they would want to address – if only they could make themselves act on the values he assumed they shared with him. All he had to do was ask.
Echoing the “conscience clause” refusals of pharmacists to fill prescriptions for birth control, judges in many states are now refusing to issue rulings in cases of minors requesting “judicial bypass” authorization for abortion. This leaves all such cases to fall onto the remaining judges who are still willing to perform their duties, or, in counties with only one or a few judges, onto no one at all.
A pregnant teenager went to the grand and imposing county courthouse here early in the summer, saying she wanted an abortion. The circuit court judge refused to hear the case, and he announced that he would recuse himself from any others like it.
“Taking the life of an innocent human being is contrary to the moral order,” the judge, John R. McCarroll of Shelby County Circuit Court, wrote in June. “I could not in good conscience make a finding that would allow the minor to proceed with the abortion.”. . .
Judges, however, are starting to opt out. Other judges of the Shelby Circuit Court have recused themselves like Judge McCarroll, and now, according to one judge, only four of the nine judges on the court hear such abortion applications.
Judges in Alabama and Pennsylvania have also said they will not take such cases.
This goes beyond pharmacists’ refusal to do their jobs. Traditionally, retail providers such as pharmacists were free to decline customers; there was no perceived duty to provide service to all, as in an emergency room. (The problem with allowing healthcare to be dispensed on this basis – and under a government monopoly license – has become obvious, but that’s another issue.) Judges, however, embody the state’s obligation – and exclusive authority – to dispense justice to the citizens. For judges to simply declare that they will not uphold, or even act on, laws they personally disapprove is the grossest misuse of their office. It seems to me an obviously impeachable distortion of justice. However, forcing them to act on laws they don’t support may only encourage them to issue unjust rulings obfuscated with disingenuous language. This puts legal-ethics watchdogs in a bind:
Judge McCarroll’s decision prompted 12 experts on judicial ethics to write to the Tennessee Supreme Court in late August. The experts called his action lawless and said they feared that his approach could spread around the nation and to subjects like the death penalty, medical marijuana, flag burning and even divorce.
“Unwillingness to follow the law,” the letter said, “is not a legitimate ground for recusal.”
Helena Silverstein, who teaches government and law at Lafayette College in Easton, Pa., and has studied how parental-consent laws work, said those experts might be right in the abstract. But Professor Silverstein wondered about the consequences of forcing judges to act.
“If you require judges to hear these cases when they are morally and, maybe, religiously opposed to abortion,” she said, “they are likely to impose their views on the minor. And that happens.”
I keep wondering how much of our civilization we are going to cede to right-wing religious extremists. They have declared that they will not serve you in their – state-sanctioned – professions if they don’t approve of the choices you make in your life; now they declare that they will withhold justice under the law if they don’t approve of the rights you seek to exercise. And we have seen the long litany of similar invasions: censorship of the airwaves, mandatory religious performances and state-sanctioned religious displays, health clinic terrorism, murder of doctors, increasing restrictions of reproductive privacy, selective enforcement of laws to harass women exercising their rights, pervasive sex panic, censorship and distortion of educational materials, and increasingly the demonization of science and fact that conflicts with their religious beliefs. Our society – the possibility of a life of freedom in the communities we built for that purpose – is being torn apart bit by bit, with no sense of obligation to fellow citizens, no sense of tolerance or community, no respect for the rights and interests of others who seek to live their own lives by their own values. And they’re getting away with it.
Why does no one object? Why do we not defend the rights that once meant so much to us? How is it we take seriously a huge body of primitives in our midst who openly scorn the civil liberties that keep us all safe – and we do not regard them as enemies of civilization? Why do we grant so much deference, in fact immunity to oppositon or even criticism, to a religion of grinding oppression – whatever lip service it pays to higher values – that openly seeks the destruction of the community of tolerance and liberality we once extolled, and of the lives we hoped to live within it?
They have made it as clear as they can: they will openly scorn the law if it prevents their oppressing others with their restrictive values. Is this not a declaration of war upon civilization itself? Obviously any judge who declares openly they will not uphold laws they disapprove of should be impeached. That perhaps invites religious-extremist judges to distort their rulings as a subterfuge, and that too must be guarded against – but an open refusal to uphold the law is the grossest crime a judge can commit. And, beyond acting on those cases, we must call out and forever reject the oppression that part of our society has dedicated itself to imposing on the rest. With the law itself now set at nought by that portion of society that trumpets its hatred for our society, the crisis has come to a head. We must make sure our self-declared enemies, and the self-declared enemies of tolerance itself, have no influence in the society they hate, and we love.
Hat tip: Majikthise.
A Sound of Thunder, a liberally-screwed-up adaptation of the classic, and poignant, Ray Bradbury short story of the same name, hit theaters this weekend. Owing to some sort of mixup, I went to the fillums tonight hoping to see something else that wasn’t playing, and opted for this instead. Mistake.
Still, it has often been said that, if you really love films, you like even bad films. This one offers a few things to think about in the midst of its multivalent badness.
The Web site of the Ludwig von Mises Institute – devoted to promoting right-wing politics and the laissez-faire economics of von Mises, Fred Hayek, and their ilk (what is it about these right-wing economics cults, anyway?; Ayn Rand was only the most flamboyant) – has now delved into neurobiology in an apparent attempt to prove either that people who aren’t laissez-faire right-wingers aren’t using their brains right, or that the way they use their brains has nothing to do with how they think, or something. At any rate, they are hosting a critical piece by “Lucretius” – a self-described neurobiologist who for some reason can’t give his real name – attacking recent fMRI studies characterizing brain processes associated with moral reasoning. Lucretius is embarrassed to be caught doing his thinking with his old, unevolved monkey-brain, and protests at length and much too loudly that the size of your neocortex doesn’t matter after all.
