He’s been in the news lately for making bizarre comparisons of gay marriage to beer, a cup of tea, and a paper napkin – all predicated upon the rather obvious but undeniable point that “it is what it is. Right? You can call it whatever you want, but it doesn’t change the character of what it is”. This is a claim on which Santorum congratulates himself by describing it as “sort of metaphysical”, but might otherwise be categorized as “sort of idiotic”. Apparently it means something to him, though, because he keeps saying it – most recently in a just-posted interview on the Iowa Independent Website: “It’s like going out and saying, ‘That tree is a car.’ Well, the tree’s not a car. A tree’s a tree. Marriage is marriage.” He goes on to spew a frothy mixture of crazy in a wide arc: gay marriage “minimizes what that bond means to society” (by letting people . . . form that bond . . .); “you’re gonna undermine religious liberty in this country” (his examples consist exclusively of the liberty to prevent other people from doing things); “we’ve created something that is not what it is” (so much for the tautological metaphysics).

But there’s a particular moment in the interview I want to highlight, because it captures so perfectly the ideological dishonesty, and complete divorce from reality, of the right-wing, and particularly the anti-choice movement.

If your position on abortion prevails and abortion is prohibited, Senator, what should the penalty be for a woman who obtains an abortion or a doctor who performs one?

Santorum: I don’t think there should be criminal penalties for a woman who obtains an abortion. I see women in this case as a victim. I see the person who is performing the abortion as doing the illegal act

This is a common, but relatively recent, dodge for anti-choicers. Throughout history, in the US and many other countries, when abortion was illegal (and it was not always or universally, or even commonly, so), women who sought abortion were held guilty of a crime; a woman who successfully obtained an abortion was often jailed, and women who were injured in illegal abortions were arrested when they sought medical treatment. This was a major contributor to the death rate from illegal abortion: not only could women not find safe providers, but they were fearful of seeking treatment when their unsafe abortions went wrong. This was never, for the anti-choicers, a reason not to make abortion illegal. But it was viciously cruel, and that cruelty became part of the justification for legalizing abortion. The deadly legacy of the lack of choice has likewise been part of the motivation to keep abortion safe and women out of jail, against the misogynistic war to reverse both those developments.

Yet, there is a logic (if not a “metaphysics”) to the war on women who procure abortion: if abortion really is the horrible crime the right wing claims, it’s hard to grant impunity to people who plan, solicit, and participate in that crime. If abortion is murder, surely the one who knowingly seeks, requests, pays for, and submits to an abortion, deliberately, by choice and preference, knowing its meaning and consequences, must be a murderer, at least as much so as the medical professionals who perform the procedure (and surely more so in the case of medical abortion, in which the professional’s only role is to write or fill a prescription, but the woman’s intentional agency is just as extensive as in a surgical procedure). And the idea that someone who solicits, hires out, and participates in a serious crime – let alone “murder” – is not guilty would be a travesty of the law in the case of any real crime.

The willingness to absolve women of initiating, paying for, and participating in a crime for which the person they paid, who acted on that woman’s own body at her request, will be punished under law reflects no sensible understanding of criminal guilt. It is a purely political move intended to head off a backlash against the anti-choice movement for victimizing women legally as well as medically. It is an attempt to evade the public’s revulsion at the right wing’s treating uppity women as the criminals the wingers say that they are – and to prevent the spectacle of women languishing in jail for simply claiming their own fertility through an act that one out of three women in the US has undertaken in her lifetime. It is a deliberate decision to void their own moral judgments for political expediency – to let a category of so-called “crimes” go unprosecuted to avoid drawing scrutiny to the ways the criminalization of healthcare affects women in general, and thus maintain that oppression in broader effect. It is an all-but-explicit declaration that the ideology that they claim justifies their persecution of women is itself expendable if it would get in the way of persecuting women – that making women suffer is more important than consistently and honestly applying the ideological framework that they use to rationalize that suffering.

But beyond the craven dishonesty and political expedience of the misogynist anti-choice crowd, there is a deep contempt for reality itself. To rationalize their insistence that abortion is a crime, and simultaneous refusal to hold women accountable for their choice to commit that “crime”, they have to characterize the act as criminal but the deliberate commission of it not. Who commits criminal acts but is not a criminal? People who are mentally incompetent, or coerced. Thus: “I see women in this case as a victim”.

This is another popular trope of the misogynist right: women are incapable of agency in their own disapproved choices. The idea that women are commonly “pressured” into abortion is a staple of anti-choice activism, as is the idea that they don’t really know what they are doing. This, of course, makes no sense legally: whether or not you are “pressured”, you can’t plan, schedule, show up for, pay for, and participate in a crime – after extensive discussion, preparation, and informed consent! – and claim you were acting under duress. (It didn’t work for Patty Hearst, and she was truly coerced.) Nor can you claim, after all that, that you didn’t know what you were doing, nor – the legally important part – does that claim matter as a defense to a criminal charge. (“Ignorance of the law is no excuse.”) For women to be exculpable of crime for a crime they planned and participated in, they have to be not just unknowing, or a “victim”, but actually mentally incompetent – a mental child, lacking legal autonomy, unable to give consent for her own choices.

That is the characterization the right wing puts on women – any woman having, or even seeking, an abortion – as their out for criminalizing the act but not the actor. That is how Rick Santorum – and all his Wingnut Woman Hater’s Club fellows – describe every woman who makes a choice they disapprove of: incompetent, non-autonomous, “victimized” by choices they themselves have freely considered, endorsed, and enacted.

But these are not simply more of the crazy opinions and perverse perspectives on women and the world that the right wing wallows in. They are claims of fact – claims about what it is actually like to be a woman who wants an abortion, or simply be a woman who believes abortion is one of the tools she can use to control her own life, take care of her own body, and achieve her own goals. To be a “victim” of one’s own choices and goals, it must be true in fact that you are mentally deficient, not capable of decision-making about yourself as the owner and inhabitant of your own life and body, oppressed by circumstances to the point that you cannot, in literal fact, think straight about yourself. These are claims of psychological fact – claims about the actual mental states of women attempting to assert sexual autonomy – claims about all such women (since the get-out-of-abortion-free card is made available to all women on these grounds).

It is simply impossible that such a claim could be true. It is patently obvious that it is not, in fact, true even about most or very many of the women who choose abortion. (All such women undergo intake counseling and an informed consent discussion. Repeated studies have shown again and again that they are at least as mentally healthy after the fact as are women who have not had an abortion.) The actual facts are clear: women who choose abortion are not mentally deficient, mis-informed, or incapable of making their own decisions. The claim Santorum and his ilk rely on to absolve themselves of the consequences in public opinion of their own misogyny is simply not true. But since it was never intended to be true – only to sound like something that would help them if it were true – that has no effect on their willingness to keep saying it.

What this cashes out as, for me, is the absolute necessity to put women and women’s needs at the center of any discussion about abortion. A third of all women in this country will have an abortion in their lifetime – and that’s with the grinding barriers and hurdles the right wing has put in their way. Tens of millions of them have already had abortions – women from every part of the country, every ethnic and religious group, almost certainly every extended family. In the same way that the “I had an abortion” T-shirt makes that army of normal, everyday, free and independent women visible, and forces the misogynists to question how far they are willing to go in targeting their own friends and family members, we need to make it clear also that those women are not “victims”, nor criminals.

Unless you are willing to call some vast percentage of women in the country – family members, co-workers, the women who raised all those children, taught all those classes, earned all those college degrees, held down all those jobs, accomplished all that they have accomplished and are still doing, and in the course of it knowingly and deliberately and self-affirmingly chose to abort an unwanted pregnancy and were better off for it – mentally ill, mentally incompetent, not in control of their own lives or choices, unable to control their own lives and choices, then you cannot claim their are victims for having made those deliberate and conscious choices. You will have to confront the reality that the women who choose abortion are, in largest part, strong, self-aware, competent, autonomous, and fully responsible for their own lives, values, goals, choices, and actions. And that being anti-choice is an assault on those women and their status as independent and autonomous persons.

It’s not an unreasonable law, and I think it’s something that probably ought to be done though I have the impression that the issue is overblown from both sides. It’s also obvious that the law would most directly impact Jews (and adherents of some the other smaller faiths,  including some branches of Islam); the largest number of parents choosing circumcision in American are Christian, but they don’t make a religion out of it. (Ha! Haha!) But the debate over “male genital mutilation” – while pretty crazed at times – has mostly not had a religious focus; there are good non-religious reasons to oppose circumcision, and some non-religious reasons to favor it, and both argunents have been beaten to death by combatants on this subject without making it a religious war (other than to the extent that some people support circumcision for religious reasons).

But the group in San Diego that wrote the bill coming up for vote, and pushed the signature campaign that got it on the ballot, somehow stepped on a banana peel just recently, and threw the whole issue down a steep and bumpy flight of steps to an ugly landing (if you’ll excuse an increasingly awkward metaphor). The group has generally followed the “I mourn my penis” line in its “intactivist” crusade for prepuce justice, but for reasons that are hard to comprehend it recently came out with this:

This is a page from their “Monster Mohel” comic book, issued in support of their ballot initiative. The comic features a blond, muscular superhero – “Foreskinman” – who bursts in on a group of Orthodox Jews conducting a bris on a struggling boy. The villain – “Monster Mohel” – and his evil minyans (Ha! Haha!*) are wild-eyed, scraggly-haired, and grinning psychotically; one of them holds the child’s terrified mother by force while they cut her baby boy. Just to top off the Jews-as-freaks theme, the mohel gibbers about a “sacrifice to God” while brandishing scissors over the boy’s crotch, and also gushes praise for “the metzitzah b’peh for [sic] which I am about to partake” (the latter being a rare version of the circumcision ritual in which the mohel cleans the penis of blood by sucking it).

So: Jews as savages, religious nuts, and perverts, and their religious rites as violent and forcible; the anti-circumcision types as strong, Aryan, saviors rescuing children stolen from their mothers for bloody Jewish religious rituals. Hmmmm . . . never heard of anything like that before.

Not surprisingly, this has gotten a lot of criticism as anti-Semitic, and many commentators, especially on the right wing, have gone on from there to state categorically that the entire anti-circumcision bill is an exercise in anti-Semitism, and the “MGM” activism movement is just anti-Semitism in disguise.

That seems to me no more than another example of right-wing logical failure. (Are anti-Semites really that hung up on Jewish penises? And would they really go to the extent of funding and promoting years of agitation, and multiple state ballot initiatives, on an issue that makes them sound like cranks while affecting over 90% non-Jews? As far as I’m aware, even Nazis didn’t ban circumcision.) Through some bizarre twist of religio-political fate, the political movement that was forever railroading Jews on false charges and banning them from colleges and country clubs has in recent years decided that Jews are their special project (i.e., a convenient hammer in the Middle East to use against Muslims, and tied up in some loony way with Rapture prophecies – which also foretell the murder or forcible religious conversion of those same Jews, but that part doesn’t get mentioned). So finding an initiative they regard as left-wing that also has anti-Semitic elements is a welcome opportunity for them to paint the left wing as anti-Semitic. Between the fact that there’s nothing leftist about the “MGM” movement (except insofar as it’s anti-traditionalist and anti-religious, so clearly not rightist – but most liberals aren’t het up about foreskins and there’s nothing about them that is particularly associated with liberalism) and that tiresomely familiar hasty-generalization thing, the whole argument just makes no sense to begin with. The fact that one argument against circumcision is anti-Semitic, or even that some opponents of circumcision may be anti-Semitic, doesn’t mean that opposing circumcision is in itself anti-Semitic, especially when, again, Jews are only a tiny percentage of the people in the US who practice infant circumcision. Besides,  if we’re going to ban an entire policy because some of its supporters did something stupidly offensive, there would simply be no right-wing policies at all, so this is an argument form they really don’t want to be throwing around lightly.

But the weird thing about this is that the group forwarding the bill is not, seemingly, anti-Semitic. Their Web site is for the most part filled with the standard kinds of information and arguments about circumcision that you find among most supporters of this movement; religious issues are hardly touched upon and not, where I’ve seen, in an offensive way. The comic book is just absurdly divergent – in tone it’s completely incompatible with the rest of their work, and in content it has nothing to do with the actual substance of the group’s issue. It’s hard to believe it comes from the same group as is running the “MGM Bill” Web site. It may have been an attempt to address the strongest source of the religious-tradition argument for circumcision, that simply came out stupid-bad. Even though it’s hard to believe this sort of thing could have been dreamed up, proposed, produced, and approved without someone raising a flag, still, things do fall through the cracks. I can believe that something this messed up could emerge from a group that does not have overt or overriding anti-Jewish sentiments, in the same sense that I can believe Michael Richard didn’t intend to sound like a racist dick in his infamous comedy-club meltdown incident – sometimes you lose sight of what you’re trying to do, and . . . well, shit happens. It’s a very weak argument to claim that “they’re not anti-Semitic except for the unbelievably offensive anti-Semitic stereotypes in the major publication they just issued”, but, even so, for the reasons given above I think it’s believable in this case that this was an aberration more than a real statement of their policy.

But whatever its genesis, there’s no question that the publication, deliberately or not, is unmistakably anti-Semitic, and trades in ugly and ridiculous stereotypes. (I have to say I do like Foreskinman’s superhero logo, though: a round knob with a slit at the tip, flanked by a thin spreading collar coming up around the sides . . . use your imagination.) For an issue that has plenty of reasonable arguments on its side, including counter-arguments to religion-based adherence to tradition, this is stupid, divisive, offensive, and counterproductive. This really isn’t helping their movement – in fact, it may well kill it in California before the vote is taken – and causes real harm to many people, irrespective of their stance on the circumcision issue. Bad move, and their dismissive reaction to the first complaints made it worse. The MGM people need to start taking stock, and taking responsibility, soon.

* Yes, I stole that one.

Note that these abortion laws: forced pregnancy from the time of conception (not the beginning of pregnancy itself); limited or no exceptions for cases of rape or incest; refusal of authorities to assist in obtaining abortion even when it is legal; state coercion and withholding of truthful information to manipulate women and girls out of exercising their legal right of choice; and general hostility to choice in all its forms, and collusion of state officials to impose forced pregnancy outside the bounds of the law, with impunity – are exactly the policies promoted and supported by the religious right in the United States. In Mexico, where the Catholic Church has much greater social and political power, they have been enacted and are in force.

So if you want to know what it looks like to live in the kind of country envisioned by “pro-life” forces in the US (though with a bit less Catholicism), this is exactly what it is: 10-year-old girls raped and subject to incest held in a locked ward by the state to force them to bear the child of their rapist, with virtually no legal rights to make their own choice in the matter, and what little legal rights they do have systematically withheld from them by force and deception, by the state itself. Every aspect of this case has been managed in such a way as to ensure that this girl – note again, 10 years old – is forced to do what the religious right and the culture of patriarchy have chosen for her life and her body: bear children under force and duress, through rape and incest, while held under guard as her rights and her body itself slip away from her control. Once more, these are exactly the laws the US religious right is campaigning for; this is exactly what they want and will get.

Let me make one final point: Recall again that it is the Mexican law that prescribes forced pregnancy for child-rape victims in that country. It is the Mexican Police who are holding this girl to prevent her from exercising the limited rights the law grants her. If she had come to a US Planned Parenthood clinic needing help in this case, she could have gotten an abortion; the US religious right demands that Planned Parenthood turn her over to the police. It is one of their main complaints against PP: that they provide healthcare on demand, rather than violating confidentiality and turning rape victims over to the state – and their families, which may include the rapists themselves. PP trusts women – even girls – to know whether they are willing to be pregnant or not; the religious right demands that they do so.

For Planned Parenthood, what a rape victim deserves is the power and the right to reclaim control of her body. For the religious right, what a rape victim deserves is to bear the rapist’s child. And the younger the better, apparently. They got what they wanted in this case. And they’re coming for more.

The problem is that they were incautious enough to go on a National Geographic TV special about “taboo” lifestyles. Senator Tom Coburn saw it and has now pressured the Social Security apparatus to investigate this particular person based on his appearance on the show. His ostensible grounds for complaint are that, from what he saw on the show, he believes Thornton appears to be capable of supporting himself:

Given that Mr. Thornton is able to determine what is appropriate attire and actions in public, drive himself to complete errands, design and custom-make baby furniture to support a 350-pound adult and run an Internet support group, it is possible that he has been improperly collecting disability benefits for a period of time.

The first thing to be said about this is that Coburn seems to have a very strange idea of what “disability” consists in, or what is or is not required to hold down a job. There is nothing about being SSI-eligible that implies you cannot “determine what is appropriate attire and actions in public”, or drive a car or take care of personal needs such as performing errands. And there is a vast gulf between being able to do all or any of that and being able to support yourself in a capitalist economy (to say nothing of one in a years-long recession with close to 10% unemployment). Coburn seems to harbor both a very condescending view of what disability is, and a typically hard-hearted view of what self-reliance requires: the disabled are essentially children, mentally non-competent, cannot even choose their own clothes, and certainly cannot act independently in public, drive, or run errands unsupervised; at the same time, anyone who’s not actually bedridden ought to earn their own living or die trying. Coburn’s worldview seems to be taken from a Dickens novel: spastic lunatics chained to the walls in Bedlam, and starving cripples begging in the streets. In addition, Coburn’s apparent belief that anyone who can cobble up a chair out of 2x4s (I’ve seen pictures of Thornton’s furniture; he’s not exactly Sam Maloof) should be working as a full-time woodcrafter is rather absurd, and the idea that maintaining a Web site imputes the ability to earn a living identifies someone who is clearly struggling to grasp the nature of the intertubes.

But for all its confusion, Coburn’s statement at least seems to focus on the right issue: it’s true that Thornton is not qualified for SSI disability payments unless he is actually disabled and partly or wholly unable to support himself, and it’s not unreasonable to ask whether that is true.  Given that Thornton does offer his furniture plans for sale, and he and his friend apparently also offer a paid sleep-over service catering to other adult babies, he apparently does have some income and there may be a legitimate question about his qualifications for disability. As far as it goes, that’s not an unreasonable question to ask.

What gets me about this is that a senior US Senator took the time to pursue an inquiry against one single individual under a program that accounts for close to $13 Billion per year, or more than 20% of the entire national budget. Does he really think that is a productive use of his time? More to the point, was this really prompted by a suspicion that this one disabled guy might have some illicit sturdy-furniture income he hasn’t been reporting, and Coburn is determined to find out how much that is?

It seems obvious that Coburn focused on this case not because this SSDI recipient has made two or three pieces of exceedingly simple furniture (Coburn’s letter notes that one basic chair took him a year and a half just to design – hardly qualification for gainful employment), but because “his choice to live as an adult baby violates societal norms”, as Coburn himself puts it. In fact, although Coburn’s letter ostensibly focuses on Thornton’s possible ability to hold a job, it repeatedly mentions his lifestyle. More than that, Coburn’s official Senate Web page touts the same letter without a single reference to actual qualifications for disability; instead, it proudly notes that Coburn is “requesting an investigation of how people choosing certain lifestyles – focusing specifically on those who live their lives role-playing as ‘adult babies,’ are able to get taxpayer-funded Social Security Disability Insurance (SSDI)”. In short, Coburn is using his position as ranking Republican on the Senate Sub-Committee on Investigations to bring down the heat on “people choosing certain lifestyles” – for which the issue of possible income on the side is only a convenient pretext. And the crowing and mockery this has already generated on the usual right-wing Web sites can easily be imagined.

It’s hardly worth saying that this is ugly and mean-spirited, or that it makes little sense if taken at face value. Whether or not this person is disabled has nothing to do with how he chooses to dress or what kinds of emotional relationships he values. And the nonsense about driving, running errands, or designing furniture is pathetic as an excuse for a challenge to what is apparently a documented medical disability. Coburn has found someone whose lifestyle he disapproves, and is taking advantage of the fact that it’s unusual and off-putting to many people to harm that person while grandstanding on the issue to promote his anti-social, anti-government ideology.

It’s not like he wouldn’t have been glad to cut anybody else’s Social Security benefits (Coburn has consistently voted against virtually every aspect of Medicare, Medicaid, SCHIP, and other healthcare programs, against the SSI “lockbox”, and in favor of privatizing Social Security). But finding someone in the program he can despise, and then inviting (and getting, in spades, from the right wing) open mockery of that person’s lifestyle as a lever for attacking their health benefits, is a right-wing two-fer: hurting people who aren’t like them, while casting social welfare as unnecessary or a fraud. The message, in political or social terms, is clear enough. But the message for the disabled, and those with alternative lives, is also clear: if you’re disabled, don’t be weird, because it makes you a target; and if you’re weird, don’t expect help if you’re also disabled, because you don’t deserve it.

The percentage of women who reach the end of their fertility with zero or one live-born child almost doubled over a recent 28-year period. The fraction who had 3 or more has been cut in half. These are remarkable trends. The fact that nulligravidity has almost doubled, to nearly 20% of women, is especially striking. Forty years ago, childlessness was almost always a product of circumstances; now, for at least about 10% of women and probably far more, it is a choice (i.e., childlessness has grown by 9% in that time; the maximum rate of biological infertility in 1976 – two years before the first “test tube baby” – was 10.2%, but surely at least some of that childlessness even then was chosen; today’s rate of actual biological infertility is likely lower still, thus, most likely, well under half the current nulligravidity rate of over 19% is due to true infertility, with the rest the product of women’s active decisions not to bear children although they could).

In fact, the shift in total lifetime fertility over this period is markedly toward lower numbers at every level: the category of 4 or more children has declined by the greatest percentage, followed by the category of 3; the fraction of women with exactly 2 children has expanded markedly, but the fraction with just 1 has expanded more, and the fraction with 0 has increased most of all. Comparing the categories shows how pervasive the shift to smaller families has become: not only are more women not having children, but few are having very large families (the percentage of women with 4 or more children has plummeted, almost to the fraction of women who had none at all 40 years ago), and with 2 now being the most common choice, but 1 or 0 (combined) even more popular; essentially, most women who might have had 4 or 5 kids are now having 3 or 2, and those who might have had 3 or 2 are in many cases now having 1 or none. As has been widely reported, the overall fertility rate in the US now is about 2.0 – 2.1, which is just below the replacement rate; it has fluctuated at that level for over a decade and shows no signs of changing. (Hispanic women are the only ethnic group with higher fertility, and that is concentrated largely among recent immigrants.) This also is a choice – one that represents a remarkable shift from 100 years ago, when lifetime fertility was about 4 children per woman.

It’s interesting how sensitive to conditions the total fertility number is as well: within less than a generation, it dropped to about 2 during the Great Depression and through WWII, rose sharply to 3.7 during the Baby Boom, dropped to an all-time low well below 2 in the mid-70s, and has slowly risen to its current stable level just below replacement. Thus, average total fertility is capable of shifting, either up or down, by a factor of 2 in as little as 10 years, and has done so several times in the recent past. Women have always made choices about their fertility, but increasing economic security and more-reliable access to birth control has likely made those choices easier and more authentic. From this perspective, then, the currently stable average total fertility rate of 2 can be regarded as what economists would term a “revealed preference” – a choice women have made when they were free to make their own choices. (Another revealed preference: the percentage of women who remain in the workforce after having children has grown by a factor of almost 2 compared to 1976, and more since before then.)

This has many implications for the United States and the world, in terms of population levels, economic activity, demographic shifts affecting distributions by race, class, and age, and so on. But aside from those often-remarked consequences, what this shift, and its historical roots, tell us, is how far voluntary choices about fertility are part of people’s lives and their strategies for dealing with both reproductive and social opportunities. This shift – which parallels that in other developed countries – demonstrates that fewer children, greater control of reproduction, and greater participation in the external economy and other activities, are the life patterns that women (and their male partners) choose when circumstances allow it. (The only major upsurge in fertility in America in the last century was immediately after WWII, when young men who had been displaced by the war returned and began the reproductive lives that had been delayed for a period of years; the long-term trend has been downwards, and temporary upswings have generally been small.) And this in turn emphasizes how important that freedom is to people’s lives and the goals they hold for them.

The most obvious, and currently salient, lesson to be drawn from this, of course, has to do with the importance of effective and available family planning. Just a day after having narrowly avoided a shutdown of the entire US government over a dispute centered largely on continued funding of Title X – the nation’s only dedicated family-planning healthcare program – and the right-wing attack on reproductive healthcare in general, the recklessness of such policies, and their cost to people’s independence and well-being, can’t be overstated. But there are broader lessons as well: people care about and make active choices about their health and reproductive strategies, in huge numbers, and with surprising subtlety. The economy, demographics, and availability of equitable access to social opportunities such as jobs, education, and employment, have powerful consequences for how people live their lives and use their bodies – and the choices they make in response to circumstances demonstrate that the choices others make under other circumstances are not always free or welcome.

Average Fertility by Country

Given a chance, most women in developed countries around the world will choose to have 3 or fewer – often 2 or fewer – children in their lifetimes, and the rate drops predictably with improving conditions. Most women in non-developed countries, and even in affluent ones before the development of effective and available birth control, had many more (in most of central Africa today, it is an average of 5 – 8 liveborn children per woman, and even more total pregnancies including stillbirths; in Afghanistan it is 7). Clearly those choices were not voluntary for most of those women. They were not voluntary for most women in America less than 100 years – just a few generations – ago. Increased economic affluence and urbanization made having fewer children more desirable, but it was the development and availability of modern birth control that made it possible. To remove that access for some of the population now is not merely to endorse certain lifestyle choices or even to make them possible (women have always been perfectly free to have 4 or more children if they choose); it is to eliminate the choices others might make if they could, and constrain them by economic force to a life most of the country, and most of the world, has chosen to flee. It is to return some of the women of America to the conditions of life of 100 years ago, while the affluent continue the path to greater opportunity that was made possible by the economic and medical advances over that time.

It’s from the Sierra Club’s new ad campaign “to remind our representatives who they are actually hurting when they attack the EPA.” I’m entirely in agreement with the goal of the campaign, and even with the message of this ad (“gutting emissions regulations results in greater release of toxins, which can do their worst damage during fetal development”). But I have reservations about its methods.

The obvious function of the ad, of course, is that it plays to the right-wing’s proclaimed concern for fetuses to the exclusion of all other health issues (including, of course, pre-natal care, gynecology, infant and child care, and other such irrelevancies). And the fact that the imagery plays so obviously and shamelessly off of the right wing’s fetish for pregnant bellies – in this case to prod them to do something to improve people’s health, rather than take away their rights to healthcare, is an amusing irony. But it’s just those points that leave me uncomfortable.

First, there’s something in a way defeatist, or at least pessimistic, about the focus of the campaign: because the GOP only cares about unborn fetuses, we have to couch every issue in terms of its impact on fetuses. (“Wear your seatbelt – so your fetus doesn’t get hurt!” “Support solar power – so your fetus will use less oil!” “Don’t spread deadly poisons in the environment – because it might hurt some of the fetuses of the less than 1% of the population that’s pregnant at any given time!”) But surrendering every issue to the religious right’s fetus-fetish takes everyone else in the population out of the picture. Mercury, dioxin, and other poisons in the environment hurt everyone. It matters that young children who have grown out of the right’s preferred age for adulation (i.e., they’ve been born already) are also vulnerable to developmental delays and all the other effects of environmental toxins; it matters that adults are crippled and killed by heavy metal poisoning; it matters that the women who are carrying these favored fetuses are also affected by the poisons they ingest – in addition to the fetuses that are the focus of concern in this campaign: these are the people who are hurt when the right wing attackes the EPA – why can’t the Sierra Club, of all people, say so? It may be true that the right only cares about fetuses (and then largely as tools for hurting women, who are their real obsession), but allowing them to forget everyone else is to forfeit the major part of the fight to them without contest. When progressives’ campaigns have the same focus, same tactics, and same blind spots as the reactionaries they are campaigning against, much is lost even if those campaigns succeed.

The second, and perhaps more striking, issue that arises for me from this ad is the imagery that is used. When I said it leaves everyone but the fetus out of the picture, I meant it literally. This ad replays in every detail one of the most common, and most offensive, tropes of anti-choice misogyny: the faceless pregnant woman reduced to nothing but her belly. (Can’t say “uterus“, you know!) You see it everywhere (and, as @ClinicEscort points out, particularly in stories about abortion): a woman’s body reduced to nothing but swollen boobs and swollen belly, or often just the belly – the face is always cut off, just out of the frame. The effect – and unquestionably the purpose – is to erase the woman from her own pregnancy. It’s fetus porn, with the woman dehumanized just as badly as, and in some ways even more fully than, in sexual porn (where at least you can often see the face). It’s the kind of misogynist metonymy that at least has come to be recognized (if not eliminated) in product advertising, but apparently still goes unremarked in issue or values advertising – even though its major function is to promote the value of dehumanizing women. That it does reflect and promote the right-wing vision of women goes without saying: women as pregnant vessels who are not even named or acknowledged, and certainly have no interests or needs that deserve to be addressed in their own right, could hardly be better illustrated than by photographs of them as exactly that, used in campaigns aimed at denigrating women’s interests in favor of the “interests” of an unborn fetus.

It’s infuriating to see progressive groups use such images and tactics. This goes beyond simply bowing to the reality of the  right’s indifference to women by finding another “hook” for an issue; this actively embraces and endorses its dehumanizing methods in order to use them for that other issue – exactly what the right wants. What I want is something better than this from nominal allies.

The child at the center of this case is an infant born with an unspecified “neurodegenerative disease” that has rendered him ventilator-dependent and in a “vegetative state”. (No press source I have seen has used the term “persistent vegetative state”, which has an exact clinical definition, and no doctor has been quoted on the patient’s actual condition, so it is not entirely clear what his status is.) It seems to be agreed that the condition is terminal. The family has had one child with a similar condition, who was brought home from hospital and died six months later. They are requesting to do the same with this child, but his vent status complicates this.

Here is a reasonably clear explanation of the background of the case:

The hospital precipitated the standoff last month when it sought the family’s permission to remove Joseph from his ventilator. This would have led to suffocation due to his progressive neurodegenerative disease, which his doctors say is fatal anyway.

The Maraachlis want to bring Joseph home to die, but to do so he must be removed from his ventilator and given a tracheostomy.

The hospital has refused to do a tracheostomy, insisting “it is not a palliative procedure. It is an invasive procedure in which a device is installed in a hole cut in the throat.”

For its part, the family refused permission to disconnect, then went public over it, then viral, with a save-baby-joseph Facebook page, a petition site by the same name and YouTube videos showing the baby, who the hospital claimed was vegetative, responding to tickling.

The story crossed the border when a Detroit hospital initially agreed to examine Joseph but then reneged. Fox News jumped on the story anyway, and in the resulting furor the staff at London Health Sciences Centre was subjected to death threats and accusations of murder and euthanasia.

The hospital has secured favorable rulings from both a judge and the Ontario Consent and Capacity Board, but the family has nonetheless gotten the hospital to hold off. Now the latter is insisting it was always willing to let Joseph go home — without a tracheostomy.

The hospital also offered to assist with a transfer to another facility willing to accommodate the family, but none could be found. Every hospital contacted, or which agreed to look into the case, refused to accept the transfer – a situation that is common in cases in which families demand medically futile care.

Today, a Catholic group known for grandstanding on end-of-life cases has apparently arranged a transfer to a US facility; Fox News helpfully inflames the issue with its usual journalistic integrity:

The baby who was hours from being pulled off life support at his Canadian hospital has been rescued by the national director of Priests for Life and taken to the U.S. for treatment.

Thirteen-month-old Joseph Maraachli, who is currently kept alive by a respirator and was recently denied a transfer to a Michigan hospital to undergo a tracheotomy, arrived in the U.S. early Monday morning with Fr. Frank Pavone and other Priests for Life staff.

“Priests for Life staff toiled through the night for many nights, working in concert with dozens of people to make this possible,” Father Pavone said in a statement. “Now that we have won the battle against the medical bureaucracy in Canada, the real work of saving Baby Joseph can begin.” . . .

“The medical board overseeing his case is apparently convinced that giving proper care to ‘Baby Joseph’ is futile,” the [Priests for Life] website reads. “They don’t mean that the medical care won’t help him. They mean his life in its current condition isn’t worth the trouble.”

(The patient was not “denied a transfer” by his current hospital – a hospital in Michigan was contacted, reviewed the case, and refused to initiate futile treatment, just as the current hospital has done. And note that nobody is going to “save” this patient – he is dying, and even his family recognizes that. Note also that “the medical bureaucracy in Canada” are the ones who have kept the patient’s body alive this far, and were still doing so at least as of last night. And, finally, note that nobody has said, and surely nobody believes, that caring for this patient “isn’t worth the trouble”; what they mean is in fact precisely that the requested care – a debilitating intervention prolonging a hopeless case for an unconscious patient – “won’t help him“. The loathsome Pavone is deliberately inflaming the issue to grind his personal axes regarding termination of treatment and universal healthcare. As in every case of futility, the problem here is that the further treatment the family is demanding won’t do any good, but doing no good is pretty much Pavone’s mission in life, so it was inevitable he’d insert himself and start shooting his mouth off.)

The case is, sadly, another familiar example of a fairly common clinical tragedy, in which a family, for emotional or religious reasons, wants an outcome that may not be possible or optimal, and right-wing ghouls descend to distort the facts and make use of the family’s tragedy for their own religious and political ends. Predictably, Michael Schiavo Bobby Schindler has gotten aboard, still complaining about the case of his sister Terri Schiavo and making wild accusations, and the usual range of suspects is also clamoring for attention.

Before moving on to the larger implications of this otherwise ordinary case, however, it’s worth giving some thought to what is actually going on here, and trying to understand the interplay of interests and moral principles that are relevant.

Reasons for Refusal of Treatment

Almost the only information available about the case has come from the family, their lawyer, and the media-hungry agitators who are making it a political issue, so it is very hard to know what the actual facts are. But the case does seem unmistakably to be one of medical futility: the patient has no hope of recovery, further treatment will offer no change in his clinical condition, and the treatment demanded imposes costs and burdens without hope of changing the overall clinical course. Under these circumstances, the hospital recommended termination of treatment, and when the family refused the hospital waited a certain period and then moved to terminate treatment under a futility doctrine. I don’t know the exact terms of such policies in Canada (or whether they fall under national, local, or the hospital’s own authority), but in broad brush this is a familiar course of events.

The reasons for termination of futile treatment should be obvious, but are worth rehearsing again: Inevitably in such cases, there are accusations that the hospital is doing this “for the money”. (This is especially popular among American right-wingers when the hospital operates under a governmental single-payer system, as in this case. But of course US hospitals, for-profit or otherwise, are equally budget-driven, and nobody ever stops to mention the millions of Americans who never get into this situation because they simply have no access to care in the first place. But if red herrings were outlawed, there wouldn’t be a right wing at all . . .) Certainly financial resources are an important consideration – every dollar spent doing no good in a hopeless case is a dollar not spent helping a patient who could benefit. But conflicts over futility are not necessarily, or even mostly, triggered by financial considerations primarily; other resources can be equally or more important: a vent-dependent patient is taking up a ventilator, which is an expensive piece of equipment in limited supply, as well as an enhanced-care or ICU bed, nursing staff, and a part-time respiratory technician, all of which are likewise expensive and stretched thin in most hospitals. Regardless of financial issues, all this represents resources that other patients may need, and which at busy times may mean the difference between life and death for someone who could benefit in a tangible way from resources being used to provide no tangible clinical benefit to a vegetative patient. In some cases, families demand literally unlimited care for patients who can experience no benefit at all. In addition, if a given treatment is literally futile, continuing to impose that treatment may be a harm to the patient (since almost all treatments cause some degree of disruption or discomfort, and in the case of futile treatments this is not justified by any expected benefits). Clearly, limits have to be set; it seems just obvious that limiting treatments that are actually futile would be the first and least objectionable place to start.

In this case, the family does seem resigned to the fact that the patient’s case is terminal. What they are asking for is – apparently – not a miracle cure but the opportunity to care for the patient at home for as long as possible before he dies. This is more realistic than in some of these cases, and you can sympathize with the family’s desires. It’s reasonable to ask why the hospital objects, since the intervention needed to facilitate this request is not difficult to perform, and the patient would then no longer be taking up a hospital bed. Because the case has been so poorly reported, it is not clear exactly what the hospital is thinking, or why they oppose a terminal discharge to the patient’s family’s home. But it appears to me there are two issues at hand:

First, although the patient would be leaving the hospital, he would still require extensive outpatient services. The news stories do not bother to mention this, but he cannot “just” get a tracheotomy and go home – since he’s vent-dependent now, he’s not going to develop spontaneous respiration just because he’s got a hole in his throat. The tracheotomy is preparatory to placing him on a portable ventilator, which he will remain on until he finally dies. It’s easier to manage a home ventilator with a trache than with an endotracheal airway, but he’s still going to be vent-dependent for the rest of his life. As such, he will also need nursing and respiratory care, and physician oversight. Some of this can be managed by the family, but the patient will still need considerable resources from the local health authorities. It is possible that the hospital regarded this – equally clinically futile – care as an unwise use of resources, whether or not the patient was still hospitalized. Second, as the hospital notes, a tracheotomy is an invasive procedure that does significant damage to the patient’s airway, and in this case will provide no overt clinical benefit. Although this might allow the patient to go home, and that seems on its face to be a good thing, it’s important to remember that the patient himself is not going to experience any benefit from that. If this patient is truly vegetative, he is not going to be consciously aware of anything that happens, including whether he is at home or in a hospital. Sending the patient home – as natural as that seems – is purely for the family’s benefit in terms of any conscious experience any of them might gain from this. It seems to me that the hospital might be taking the line that the trache procedure cannot be justified on these grounds because it is not for the patient’s own personal benefit; the family, however well-intentioned, is clearly asking for a surgical procedure for this patient for reasons of their own – a request that directly violates the most basic accepted principles of decision-making for non-autonomous patients (i.e., that the decision-maker must act for the patient’s benefit alone, and especially not for their own benefit). This second consideration looms large: because this is a congenitally neurologically damaged infant, there can be no question in this case of “what the patient wants”, or even “what the patient would have wanted” (since the patient in this case has never, and apparently would not ever have, wanted anything). And given that the patient has no conscious experiences, good or bad, anything done in this case can only be to gratify other parties’ wishes (the family’s, and increasingly those of the growing crowd of right-wing religious agitators who continually turn these cases into fodder for their cultural jihad).

Viewed from these two perspectives – that continued intensive home care for a terminal, vegetative patient is equally as futile as continued hospital care; and that the family’s request for a surgical intervention in order to take the patient home with them is motivated by their own emotional needs, not an anticipated benefit to the patient -  the refusal of the family’s request not only makes more sense, but would in fact have to be regarded as correct, barring other factors that haven’t been made clear.

[Note: there are some factors of the case that aren't clear, and make it harder to figure out what all is going on here. First, the article at top says the hospital did, late in the game, state that the patient could go home without a tracheotomy. This doesn't change the fact that continued intervention is futile, but it weakens the objection regarding non-beneficial treatment (the tracheotomy). Futility doctrine has not generally been taken to the point of forcing families to terminate treatment if an alternative could be found; it's not clear why, if they could discharge the patient without surgery, they didn't do so. At the same time, today's intervention - transferring the patient to another hospital in a different country - also does not accomplish the family's goal of taking him home with them. It may be that they decided they would rather seek continued life support in a hospital setting if they could not get the home-care option they preferred, but that makes the case a more typical futility scenario of a family demanding open-ended treatment that produces no clinical benefit, rather than one of them just seeking help in finding a more congenial terminal setting. Interestingly, both of these developments minimize the significance of the tracheotomy as the sticking point in the case (unless he's going to get a tracheotomy in the US, and then go back to Canada to die, which would create a complicated administrative conflict - are Canadian providers obligated to pay for after-care for procedures in foreign countries that they had previously refused to authorize at home?). With so much unexplained about the case, it's hard to know how or why any of this is happening.]

Alternative Considerations

For the same reason that the tracheotomy will not benefit this patient, however, it should be noted that it will not severely harm him either. Ventilator dependency is uncomfortable, and a tracheotomy generally destroys the patient’s larynx, making it impossible for them to talk. But, since this patient – if he is truly irreversibly vegetative – cannot feel or speak anyway, those are not major issues. The patient is not going to experience any conditions, at home on a vent, worse than he currently experiences in a hospital on a vent (which is to say, nothing at all). This suggests – again extrapolating from the vague descriptions in newspaper stories, mostly from very biased sources – that the objection to the tracheotomy, though properly based on considerations of preventing the imposition of unbeneficial harmful procedures on the patient, may be overstated; this procedure may be futile, but it would not be a harm that the patient was actually conscious of.

Given that observation, the objection that the family is acting out of their own interests is likewise well-taken but perhaps rather formalistic: they are not acting strictly in the patient’s interests, but the patient has no (consciously felt) interests and can (consciously) experience no harms, so what is gained by insisting on strict adherence to that principle here?

At this point it is also meet to introduce the question of subjective benefits of treatment. Throughout the discussion above, I have been careful to focus on “clinical changes” from treatment, and “conscious experience” of benefits and harms. These are the objective consequences of treatment: actual changes in the patient’s clinical condition as determinable by examination, and the actual experience of and reaction to events by the patient themselves as consciously felt by them. I have been careful not to specify what clinical changes actually constitute a benefit, and I have avoided the question of subjective benefits that might conceivably accrue even to an unconscious or vegetative patient. But it’s fair to acknowledge that some people might regard clinically futile treatments – treatments that do not produce a significant change in the patient’s clinical condition – as beneficial, if they serve non-clinical interests the patient may have. Some patients have a personal or religious desire to live as long as possible, regardless of clinical condition; this is valid where it represents an authentic desire of the patient. (It is in no way mandatory, still less anything that religious reactionaries can be allowed to impose against a patient’s will, as in the Schiavo case and so many others. And of course the mere existence of that desire does not constitute an obligation on anyone else to provide the resources to fulfill it.) Some patients may want to die at home rather than in a hospital; some may want to meet specific goals in life (live to see a meaningful event in their lives, spend time with their family before the end, wait to have final meetings with friends or family members, etc.). And some may have religious beliefs about the right way or right time to die. All these may require continued treatment in otherwise clinically hopeless cases, and they are certainly valid interests of some patients that can be met through continued treatment. It is important to remember that all treatment – whatever its clinical consequences – is valuable only because it serves some interest of the patient; the clinical impact of any treatment – however great or minimal – means nothing except in the light of what the patient themselves wants. And so, clinical treatments can only truly be considered futile if they fail to serve the goals of the patient in seeking treatment, not simply because they do or don’t produce a cure or any other particular clinical outcome. This consideration is meliorated in the Baby Joseph case by the fact that the patient himself, as noted above, holds no such desires. But we should remember that it’s too simplistic to treat “futility” as simply a matter of clinical efficacy in a technical sense.

Summing Up

Given the considerations above, and reading between the lines of the news reports a bit, the situation seems sad and confounding, but far from a scandal. That hasn’t kept the vultures from whipping up their usual “death panels” frenzy, of course, but we don’t have to play along.

The family wants to bring their child home to be with them; possibly also they want to prolong his life as far as possible regardless of his condition, but that part’s less clear. Either way, it’s easy to understand, and perhaps sympathize with, their wishes. But we must also realize that this is their desire, arising from their own needs and interests; it cannot be an individual desire on the part of the actual patient. This is not to accuse the family of being uncaring or manipulative; no doubt their desire is to care for their son the best way they can, which means as closely a part of their family as they can manage. It’s just that, in the nature of things in this case, that desire cannot arise from or be shared by the son himself, and so the family’s sincere desire to provide the best possible treatment runs up against the facts that this patient cannot expect any overt clinical benefit from prolonged treatment, and cannot form or hold any personal, subjective values or goals that would be served by continued treatment. Thus, the family’s plans do not actually serve the patient’s own, personal good, no matter how sincerely they intend to do so. (Note particularly that the religious value some place on prolongation of life cannot be an issue in this case, since the child has no religious – or any other kind of – beliefs of his own.)

The hospital wants to minimize the expenditure of clinical and financial resources without benefit (on an inpatient, and possibly also an outpatient basis); in this case continued treatment of this patient will produce no clinical benefit other than prolonged stasis in a vegetative state. The hospital also apparently objects to performing an invasive procedure on a non-consenting patient with no hope of clinical benefit, in response to a third party’s wishes – though here also their precise reasoning is less clear. Since the patient has no personal desires to be accommodated, the issue of possible subjective benefits from clinically futile treatment does not arise. Thus, the hospital is acting in keeping with obviously reasonable priorities and well-recognized principles of patient autonomy, and is not acting contrary to the desires or interests of the patient himself.

In light of this balance of interests and principles, the hospital’s objections to continued or increased treatments in this case are not unreasonable. Even so, given that the patient cannot suffer conscious harms by more-aggressive intervention, it may seem that the hospital is being unnecessarily nit-picky. It may seem reasonable that, even though the patient cannot benefit overtly and has no desires regarding possible subjective benefits, it might be reasonable to “give the family the benefit of the doubt” and let them do what they want. The problem with this is multi-fold: (i) it establishes a principle whereby unconscious patients without advance directives can be treated whatever way someone else wants, for the other party’s benefit – thus voiding the established consensus on substituted judgment; (ii) it elevates parents’ religious or personal beliefs above patient interests for minor patients – an already-contentious issue in decision-making for children by parents; (iii) it would essentially void the entire concept of medical futility by making virtually any articulated desire by family members (or other third parties) a sufficient ground for prolongation of treatment no matter how hopeless (and it is easy to suspect that this is in fact the goal of the right-wing interlopers who have jumped on this case). Even if we are tempted to void ethical principles in this case, where it seems there are few or no direct interests of the patient at stake and the patient has not expressed any prior preferences that might be violated by continuing treatment, and even if we are willing to disregard any questions of competing priorities or limitations on resources (which the hospital understandably is not), agreeing that principles can be voided, and resource limitations should be overlooked, is a dangerous step when so many such cases arise, and especially in the face of a coordinated movement to hijack patient-centered care for religious and political reasons.

Further Observations

One feature of this case that does call out for sympathy is the obvious concern of the family for their son. And this is common in many such cases, not only involving children but dependent adults, elders, and others. It is understandable that in these cases the family’s interest in soothing their own feelings is not distinct from, but to a large degree indistinguishable from, their love for the patient and their desire to do the best for that patient themselves. It seems cold to insist – even if technically true – that taking a family member home to die does not serve that patient’s own interests (because, as cognitively diminished, they may have none). I am tempted to speculate about a possible limited exception to the rule of substituted judgment in the patient’s interest: in cases where the patient has literally no countervailing interests of their own, is it reasonable to allow decision-makers (specifically, family members) to act for their own interests in relation to the patient, by bringing them home to die or maintaining life support for non-suffering patients even when there is no hope of cure? The dangers seem to me significant, and the possibility that such exceptions would be further misused by political interests almost inevitable. Still, it’s worth thinking about in cases like that of Baby Joseph: where the family is clearly acting out of love for the patient, but not in the patient’s interests, would it be wrong to indulge their desires if it at least doesn’t harm the patient?

Worth discussing, perhaps.

UPDATE: Fixed mistake in the name of Terri Schiavo’s brother, Bobby Schindler. Thanks to Barry in comments.

Happy Fetus

Feto Incognito

Adam Lambert Embryo

The purveyor of the site insists that “Feti is just for fun, no political statements being made here.” I’m tempted to believe that in her case, but the thing still strikes me as weird,  and indicative of a mindset that is worth noting.

The vendor suggests these are intended as gifts for expectant parents, as appropriate additions to the “Baby’s First _____” category of remembrances. (Exactly how, I’m not sure: “Baby’s First Disembodied Hanging on a Christmas Tree”?) In that vein, they play off the very common and understandable practice of many expectant parents in personifying their fetus as it develops – talking to it, playing music, naming it before it is born, and so on. They also seem to accept as a cultural commonplace the fetishizing – literally, in this case! – and personifying of the fetus that is a mainstay of anti-choice propaganda. (Anti-choicers often wear gold-plated fetal-footprint jewelry, and they are forever trying to force abortion patients to look at pictures or sonograms of the fetus.)

I don’t know if the anti-choice movement has so far succeeded in turning the fetus into a fetish object that you can now literally market them to the general public as holiday ornaments, or if the common desire to see fetuses as sort of reverse-extensions of babies simply makes this a natural marketing move, like Cabbage Patch dolls or those weird Anne Geddes photographs of babies in flower petals, and the right wing has merely piggybacked off that common emotional trope for their own purposes. The former would scare me a bit, the latter is merely infuriating. Either way, this sort of thing leaves me with a creepy feeling.

I’m happy for people to be happy about their pregnancies, and to embue their future offspring with emotional valence or even a somewhat overgrandiose sense of promise or accomplishment. In the same way that all parents think their kids are smart and talented, and I wouldn’t quarrel with that, expectant parents can and should go ga-ga over the cute little buns in their respective ovens. There is no point, in the case of people’s emotional experience of the events in their lives, to go around insisting to them “you know it has no functional higher nervous system, right?” . . . “that’s not a ‘person’ you’re carrying, in any meaningful sense of the term – just wanted to let you know” . . . “don’t get too close to it – there’s about a 1-in-12 chance you’ll lose the pregnancy”. But when it comes to law and policy-making, clear distinctions do have to be made – and at that point, the conflict between stark reality and parents’ expectations may be uncomfortable.

Regardless of parental beliefs, not all kids are smart or talented, and thus some won’t make it into selective academic or sports or art programs. And regardless of the fervent, desperately dishonest myth-making of the anti-choice right, the early fetus is not a person and does not make moral claims on a woman’s body and life sufficient to override her autonomy. It is unfortunate to have to disappoint people emotionally invested in believing otherwise, but it is far worse to make policy based on wishful thinking in defiance of the truth.

By all means, have yourself a merry little Christmas, and hang a smiling Adam Lambert Jewish punk fetus upon the highest bough. But let’s keep the “personified fetus” myth firmly in its place when we go to making important decisions about real issues in real people’s lives.

It is.

Thanks, Penn.

(See here for a similar observation from an equally-surprising source.)

I just thought I can’t do this anymore, and it was just like a flash that hit me and I thought that’s it,” said Jonhson. . . .

Johnson said she was told to bring in more women who wanted [icky procedures], something the Episcopalian church goer recently became convicted about.

“I feel so pure in heart (since leaving). I don’t have this guilt, I don’t have this burden on me anymore that’s how I know this conversion was a spiritual conversion.”

Johnson reports that she is likewise convicted about gall bladder removals, most forms of cancer surgery, and liposuction, although she does not criticize the decisions several of her friends have made to have such procedures, because “that’s different”. She is semi-convicted about breast implants, believing they are the work of the Whore of Babylon but also something you could understand that a woman needs sometimes. She justifies these distinctions with random Bible quotes and references to her own idiosyncratic feelings, which she cannot coherently articulate but is happy to impose on others by law.

This otherwise trivial story about one small-town individual’s weird religious hangups was trumpeted by the religious right as a stunning victory over the right of other people to make healthcare choices they don’t like, claiming other people’s healthcare was now “in meltdown mode” and “total disarray”. Every healthcare clinic in the country, including the one that has now hired a new director, went about its business as usual.