I would not have written about it all, since the things that have been written in so many places, by people with much more authentic activist credentials than mine, and more skin in the game (i.e., feminist women), have covered so much of the territory and with such great insight, passion, and theoretical power.  But one thing kept coming back to me as I watched the situation unfold. It was this: my first, surface-level reaction to the situation was to feel that it had been somewhat overblown, that people were using it as an opportunity to grind axes or work out resentments, and that Schwyzer was so evidently a decent and well-intentioned guy that, whatever his past, the current outrage roiling around him was not only counterproductive but indicative of emotions or resentments for which the facts of the situation were only a convenient release.

I didn’t know that much about that Schwyzer, but had read some of his writing, including some of his confessions of his wilder, younger days. My impressions were that he was a skilled writer with a tendency toward romantic over-dramatization, he had a somewhat off-putting tendency to dwell on himself and his own experiences, he had a kind of clammy bourgeois perspective that he seemed ready to acknowledge but not to rise above, and that he was an insightful, well-intentioned, sincere feminist with a lot of good things to say. The slight bragging I heard in his confessions of past misbehavior was not attractive, but I also believed that he had come to terms with his past and put it behind him. It was unsettling that such confessions seemed to surface so often, and their impact never seemed to reach a final cumulative value. The “sinner’s testimony” so beloved of born-again Christians and recovering addicts (of which he is both) never seemed to end, in Schwyzer’s case, and that raised questions, but by and large he seemed to me as he seemed to many others, then and now: someone who was both knowledgeable about and deeply committed to feminism, and was also honestly grappling with its implications for himself as a man of privilege. As a feminist man with much less history of either writing or activism (or sleeping with my students, or murder), I thought of Schwyzer as being in (only) some ways what I felt I should be.

The revelation that finally touched off the current controversy – that, acting on a drug-addled emotional impulse, he had once actually made a considered effort to kill himself and his ex-girlfriend that was in fact the equivalent of an attempted murder – broke his previous record for confessions of irresponsibility, but, in light of his self-advertised past, in some way seemed just more of the same. The outrage it provoked, quickly rising to the level of personal vendetta, seemed unnecessary in response to an event thirteen years in the past, committed by someone whose current bona fides seemed believable and even admirable. I found myself taking Schweitzer’s part in some of these arguments, either in thought or even to a small degree online.

That reaction, one of sympathy and even protectiveness toward Schwyzer – was what began nagging at me in regard to this situation.  I had to ask myself why I felt so sympathetic to someone so clearly open to well-deserved criticism.  You can argue that Schwyzer had rehabilitated himself, that he had done extensive work on his own behavior and beliefs, that his current professed attitudes and his history of teaching and activism were authentic and creditable. He has many supporters who do make such arguments, and they are not unreasonable on their face. You could also argue that he still bears responsibility for his many transgressions, and some of them are of such magnitude that it will be impossible for anyone to have done sufficient penance whether or not he had truly changed the attitudes that had prompted that behavior in the past. There are also questions of the role of individuals of such great privilege in movements targeting the oppression of underprivileged groups; in that light, Schwyzer’s reprehensible past makes him particularly suspect as a figure of respect or prominence even, again, if it were acknowledged that he had rehabilitated himself. These arguments are also reasonable. It is partly a question of values or priorities which perspective – condemning acknowledged transgressions, or praising apparent enlightenment – one takes on the situation.

So I don’t think it’s impossible to believe in Schwyzer’s redemption, or to support him as a prominent or influential figure in the feminist movement. But why would anyone choose to take that perspective on the issue, in distinction to the opposite one? What should determine the degree of one’s willingness to accept professed penance as authentic or sufficient?

I began thinking about other transgressors, ones I would be much slower to forgive or to accept as peers, let alone role models. I began thinking about the terrible crimes of so many right-wing figures: their embrace of death squads, torture, and concentration camps; their economic rapaciousness, and the vast suffering it causes; their unremitting assault on personal autonomy, most especially of women and their reproductive autonomy; and on and on. I think of the names of figures associated with these campaigns of oppression and terror: Falwell, Robertson, Reagan, Bush, Cheney, Gingrich, Santorum, Perry, so many criminal lackeys of the Reagan and Bush administrations, and so many more. I would find it impossible to credit the redemption of any of these figures, even were they to espouse more reasonable attitudes and policies today. I would find it impossible to overcome the revulsion they generate in me. Even though they all are guilty of far more destruction and misery, fully reckoned, than Schwyzer, none of them to my knowledge has made a direct and deliberate attempt to kill another person by their own hand. Yet it seems natural to me to accept Schwyzer on his own terms, when I find it unimaginable to believe in the (hypothetical) redemption of any of these other figures.

Partly, I think it’s because Schwyzer was first established in my mind as a positive figure.  I first knew about his feminist work, and read some of his writings on the issues, before I learned of his shady past, and long before the most recent revelations.  The newest controversies work against an established impression that I had already developed which perhaps makes it harder to weigh the two sides of the issue in a perfectly even balance.  In contrast, the murderers, torturers, and perverts of the right wing have always been perfectly visible to me in their true colors.

However, I think there may be a more personal process at work here. Although Schwyzer and I are not very much alike in personality, history, or career trajectory, there’s an obvious basis of fellow-feeling toward him. We’re both educated white men from at least moderately affluent backgrounds, with connections to academia. We both self-identify as feminists and sympathizers with the oppressed, but both obviously came to that perspective from positions of considerable privilege which we cannot renounce. We both – like almost all male feminists – had to work our way toward feminism from anti-feminist backgrounds which we had to acknowledge and overcome.  Like all feminists, we have particular perspectives on the various internal divisions and conflicts of the feminist movement, and like all male feminists must defend the particular positions we take against other (mostly female) feminists who may see our stances as not merely collegial disagreement but another form of privilege.

And so, when I see Schwyzer attacked for aspects of his pre-feminist or proto-feminist life, I can’t help feeling that those attacks are to some degree aimed at me, or could be. I wonder how other feminists would view me if I confessed all the (far less lurid) details of my past, or the things I’ve done wrong, particularly involving or against women. I want to think that the feminist movement can be not merely welcoming but in some ways forgiving of men and their imperfect pasts. And, in a way that surprises even me, when I regard Schwyzer and his difficulties, I feel a bit of the same defensiveness that I feel when my own shortcomings are called to account: I want to put it behind me; I want to say “yes, yes, I’ll do better” and let the matter drop; I hope my accusers will let me slide as long as I promise to do better, and not keep probing and publicizing my faults.

Schwyzer, whatever his guilt for his past behavior, has been admirably open in the face of the current controversy, and has indicated he will consider and likely accept the many calls for his retreat to a less prominent position within the feminist movement. I don’t know how I would behave in a similar situation (I take comfort in thinking that I will never have to explain away the kinds of behavior that Schwyzer does). And I think some of the sympathy that the situation evokes in me is in part an unexplored sense of a need to atone for myself – the fabled “liberal guilt” – and the hope that my own failures could if necessary be absolved and overlooked. I want this cup to pass away from Schwyzer because I hope that, if such a fateful day were to come, it would pass away from me as well.

It is easy for me to consign right-wing criminals to permanent condemnation. I feel nothing in common with them, and can’t imagine I would even if they repented. Hugo Schwyzer, in his best parts, is the kind of person I want to be, inescapably privileged but using the tools of privilege – intellect and learning – for good. I know that I, in my worst parts, fall short of that. If he – who has done more overt work for feminism than I have – has no place in the movement, perhaps I have none, too.

But Schwyzer’s place in the movement ought to be determined on the basis of the needs and dynamics of that movement, and his own nature and history (hopefully, if not probably, considered objectively). My reflexive willingness to absolve him is more about my needs than his, and thus less about the needs of the movement than either of those. Which is another form of distraction for male feminists (or, at least, for me), and another stumbling block to seeing clearly and acting forthrightly and effectively.

That’s the lesson I take for myself from this, and, like so many lessons learned in growth as a feminist and humanist, particularly as a man of privilege, it is not an easy one to recognize, still less absorb.

This video is great in so many ways: Taylor’s discussion of the ways society makes her life with an impairment harder or easier; her description of the psychological burden in going into a coffee shop and ordering coffee, and then having to deal with the difficulties of either trying to carry it herself or asking for help – “it’s a political protest for me to go in”; the simple and lovely depiction of two affectionate people being out together, while not pretending the issue of disability doesn’t affect them; the segment in which they go into a used-clothing store (which charges by the pound! – I love San Francisco!) and buy Taylor a warm sweater, which is both a perfectly simple and normal act, and complicated by the ways impairment affects her ability to try it on and the process of payment – ending with the store clerk’s matter-of-factly accommodating reaction. Taylor works in a useful bit of disability-theory: the distinction between “impairment” (physical limitations) and “disability” (difficulties in living caused by social context or discrimination), and the video underscores that point again and again as Taylor goes about her day and talks about how disability affects her. (I’m not sure I’d go so far as to say that she has “what the medical world has labeled as arthrogryphosis”. I’m very much sympathetic to the notion of individualized definitions of disease and health, but I don’t think that means there’s no such thing as a diagnosible condition. I see no reason to say that she doesn’t really have arthrogryphosis if she meets the diagnostic criteria for it – as, by her own description, she seems to do. Pointedly repudiating her own use of that name, as she does in the video, doesn’t seem to me to gain anything; whether she wants to call it a “disease” is another matter.) There are also brilliant moments of reflection on the nature of embodiment and what it means to live an embodied life in a social context.

Just a beautiful, sweet film with surprisingly profound content, visually and verbally. I can’t wait to see the rest of this series.

Taylor:     When do you still count as a human?

Butler:     My sense is that what’s at stake here is really rethinking the human as a site of interdependency.

. . .

Butler:     [When] you ask for the coffee, or indeed even ask for some assistance with the coffee, you’re basically posing the question “Do we or do we not help each other with basic needs?”

HT: sexgenderbody

Jill righteously calls him out for it (as did many others):

The deflecting from legitimate concerns, and the fact that the OWS “public” includes a lot of men who think it’s ok to treat women at a protest like we’re there for their visual fulfillment, troubles me. No one is saying, “Don’t find women attractive.” . . . No one is objecting to the fact that straight men are attracted to some women (fun fact: straight women are also attracted to some men! So really, no one is pissed about attraction, I promise). What people are pissed about is what Rebecca Traister says:

“The larger, simpler argument, outside of consent or permission, is: This video is sexist. It’s an example of women participating in public life — political, professional, social — and having their participation reduced to sexual objectification. That’s what happened here, nothing more, nothing less.” . . .

Emphasis mine. . . . [C]reating a blog and a video dedicated to showing women at a protest with the sole purpose of reminding dudes that women at the protest are hot? That does reduce women to objects of male attention. It’s another reminder, for women, that how seriously we’re taken and how valuable we are depends on how sexually attractive we’re deemed.

Read the whole thing; she’s got good things to say. But the part that really triggered something for me was this:

Frankly, the kinds of dudes who would come to the OWS protests because they heard there are hot chicks there? Are not the kinds of dudes I want to be protesting with. I would hope they’re not the kinds of dudes that most progressives would want to be protesting with — but judging by the lefty-dude reaction to Steven Greenstreet (hi Matt Zoller Seitz, looking at you!), that’s not the case. It’s disappointing.

To say the least. And far too common, from way back. It’s no secret that supposedly “progressive” groups have always been rife with sexism and sexual pressuring, and it doesn’t seem to be getting better. Progressives have never been immune to human failings, including stereotyping and bigotry of the kind that they supposedly abhor but sometimes don’t recognize in themselves; the long fight for acceptance in progressive movements of gays and transexuals is one case in point, and the difficulty many white (and especially male heterosexual) liberals have in recognizing and acknowledging their own privilege is another. But the LGBTQ community, people of color, and other marginalized groups, though still embattled, have by now to a considerable degree been granted by progressives the one thing many persist in denying to women: recognition of the fact that they have real interests, problems, and worth that must be taken seriously. The situation is far from perfect, and not everybody agrees on how the tensions between different progressive constituencies should be resolved, but in most cases they are acknowledged, and the human pain and human interests that lie at their heart are given due deference. Except in the case of women.

To be sure, progressives are not right-wingers. They don’t overtly hate women. They don’t gleefully consign them to death by deliberate neglect at the hands of sniffy sex-negative religious bigots. They don’t dishonestly and cynically strain moral concepts – often ones introduced and championed by progressives – such as “informed consent” to create barriers to the very autonomy they are intended to protect. They don’t penalize the fact of women’s having sexual natures – just the opposite! But in too many cases they don’t grant them the respect and freedom needed to act on their own natures and seek their own good. Just as with conservatives, women exist for far too many progressive men for the purpose of their gratification – an impersonal usage that erases those women as persons themselves.

Which leads me, finally, to the question that came up for me on surveying this latest stupid and distasteful incident: how, exactly, are these dipshit “progressive” men progressives? What goes through their heads, what process takes place in their heads, such that they wind up thinking things like “let’s go to the OWS protest and photograph women’s breasts!”? How, when they are called out for that, do they expend so much energy defending their childishness and sexism? Why do they not care about offending or humiliating their supposed fellow activists – about derailing or undermining the movement they claim to support – about embarrassing that movement by acting in a regressive manner and then elevating their own bad behavior into the limelight? More particularly, what is it that allows progressives to empathize with everyone but women, even women in their own movement? What allows them to hear everyone else’s protests at mistreatment, and dismiss those of women out of hand?

In a way, I suppose it has something in common with the denial and self-absorption that allowed Southern slave-holders to rationalize their own crimes. Patriarchy is its own form of slavery, more complex and less overt, but very real, and it is very hard to acknowledge you are doing wrong when your entire lifestyle, all its comforts and conveniences and pleasures, derives so much from others’ service to your needs. It is easy to protest obvious wrongs that don’t require you to change your own life to amend. But progressive men, in many cases, are no better than the privileged classes of the Confederacy, of apartheid South Africa, of Wall Street itself, at admitting that their own satisfaction depends on bending others to their desires, against their will and at the denial of their basic human personhood.

You can’t be progressive just for causes you aren’t invested in, at the expense of people you don’t like. Being progressive means wanting to live in a better world – not just wanting to take down the most guilty in this one and then carry on regardless. Being progressive means checking your privilege, living the dream you envision, being part of the solution – all slogans that have at their heart the basic truth that you have to be as critical of yourself as you are of others, or more so, since you can only really change yourself.

You aren’t a progressive if you mistreat women. You aren’t a progressive if you think progressivism is defined as rallies, protests, and events, rather than a mindset that is grounded on a world in which people are treated with respect, by everyone, starting with yourself. You aren’t a progressive if you go to events but don’t treat the people there with regard. You aren’t a progressive if you revel in your own privileges at the expense of the pain and diminishment of others, then feel hurt because you’ve decided that whatever superficial support you feel for “the cause” entitles you to use others for your pleasure and then resent it when they object.

If you’re not a progressive for any of these reasons, you’re little better than a reactionary even if you vote the right way. You’re pro-choice? Great. You don’t think being pro-choice encompasses the choice to control, and present, your own sexuality on your own terms? You’re not a progressive, and you’re a pain and an embarrassment to those who sincerely try to be.

What got me onto this is that there’s just so much cool stuff in this post and the comments thread. I don’t have anything to say about the basic question of natural transitioning, but I want to point out several things that come up in the discussion.

First, it’s interesting that this post arose on a skeptic (i.e., atheist, anti-paranormal) site in the first place. Transexuality isn’t inherently an issue for skeptics, but the questioner identified as a skeptic and was apparently feeling vulnerable as both a transexual and a skeptic, so sought out a welcoming community. He found the right place: DebGod happens to be gender-queer, and is knowledgeable about transexuality and a former bodybuilder, and the community of readers was supportive. From some of the comments, it appears that many perceive the skeptical community as not uniformly welcoming for LGBTQ people – something I hadn’t known or expected. This post included some interesting discussion of LGBTQ issues among skeptics, and raises questions that – especially in light of the recent conflict over misogyny among skeptics (notably involving another prominent Skepchick poster) – I hope the skeptical community will take the opportunity to address.

More importantly, DebGod’s response is a model of careful and helpful analysis. She gives her own background, with appropriate disclaimers, then lays out the issues clearly and concisely. She notes red flags with the claims being made (no professional credentials, buzzwords, trademarked terminology, skeptical responses from people directly affected). She then reviews the suggested procedure, notes that it relies heavily on biochemical supplements, comments intelligently on their purity and efficacy, and discusses the vague distinction between “natural” and “non-natural” that the promoters take advantage of. She seeks information from a more knowledgeable source. Shen then concludes by running down all the issues this analysis raises, categorically, giving pros and cons for each and pointing out dangers. This is a really well-done, intelligent, well-argued analysis, at least as good as that commonly seen from Quackwatch or prominent skeptics like PZ Myers.

What I really like about DebGod’s analysis is that she is carefully value-neutral in all of this. Though it’s clear that there is much to be worried about in this suggested regimen, she never takes it on herself to make other people’s decisions for them. Her final statement is a clear and balanced sketch of the relationship between all the competing factors – health, personal goals, available support, and insurance or income – that influence a decision among the many different options for transitioning; she doesn’t declare any of them right or wrong for any individual, but makes it clear that each may be better or worse under different conditions. She includes just a single sentence offering her opinion that the “natural” process is too risky and low-benefit, but clearly identifies it as her own perspective and doesn’t insist that anyone else has to adopt it. She really gets her role as guide and analyst, as opposed to parent, judge, or dictator – something that so many culture-critic blowhards, and even many licensed professionals, can’t accept.

As she notes:

When it comes to gender identity and transsexualism, where you want to go, who you want to be, and how you want to do it is up to you, of course.

- a message that needs to be heard more widely, and not just regarding transexualism.

That leads to another issue that comes up obliquely, but importantly, in the comments. The medical community’s response to transexualism has been mixed, in ways that have generated a lot of resentment in the T/Q community even when the doctors and psychologists thought they were being helpful. For many years, transexuals seeking medical treatment in the US were commonly required to conform to the so-called “Harry Benjamin Standards of Care” (now the “World Professional Association for Transgender Health Standards of Care”), requiring extensive counseling and explicit authorization from multiple psychologists, and a set period of pre-treatment life in the transitioned gender, before professionals would agree to provide the requested treatment. Those standards have been eased but still exist. Many critics have pointed out that this is not only paternalistic but unnecessary – transexual patients have a higher level of success and satisfaction with their treatment than patients of many other conditions, including cosmetic procedures, that do not involve such heavy-handed gatekeeping. The professional societies – starting in the 1950s, when this work was extremely controversial – saw themselves as protecting patients and preventing harmful mistakes, while also going to lengths to provide treatments that more conservative caregivers would have prohibited in the first place. Patients, however, saw it as condescending, offensive, and wasteful of time and money. (Note that in other parts of the world, clinical standards for transexual therapy are much looser or non-existent; there is no known epidemic of regretful genderflippers.)

There are some very interesting comments from “natalie1984″ noting that the sex-reassignment gatekeeping system has been eroded in recent years, and along with it the stereotyped view of what it means to “really” be transexual or gender-dysphoric in the first place. Not only has therapy become more accessible, but what kind of therapy and what therapeutic endpoint the patient seeks have also been thrown open. As she notes: “Now we’re all able to simply work out for ourselves who we are and what we want from transition, and what will make us feel happiest”. She speaks with understanding of why many healthcare professionals are not current on T/Q issues, and simply encourages patients to find caregivers they are comfortable with. There’s also an interesting exchange further down the thread between her and one of the promoters of the natural therapy. She comes across as uncompromising but smart, thoughtful, and understanding.

There’s more, including the politics of gendered pronouns, but even just this adds up to a rich and complex discussion, with intersections between skepticism, healthcare autonomy, gender issues, and, vaguely, perhaps some philosophy-of-science stuff. What this post brings up for me is the deeply connected ways in which such issues always do surface in any similar debates over the proper application of facts to values – that is, the use of science or medicine to achieve chosen goals in human lives, and the conflicts that arise between those who control the science and those whose goals are at stake. It is common in ethics and philosophy of science to emphasize the “fact/value distinction”, but real cases often dredge up facts – and perceived facts – from many aspects of our lives, and competing values that arise from very different lived perspectives.

In this one issue, the skeptical community provides a useful mindset for analyzing clinical claims, but has also been charged with hostility to the LGBTQ community in whose interests those questions are asked. The “natural health” community offers the autonomy and self-direction that many patients want, but also harbors liars and scammers. The doctors who invented the sex-assignment gatekeeping system that so many transexual people hate did so as a way to make it possible for those patients to get care than had never previously been available. It is impossible for anyone to assert an exclusive claim to the moral or epistemological high ground here.

This stuff is hard, and, like so many progressive programs, requires a dedication to working through all the implications of a given position, and to striving to make one’s positions more defensible, more responsive, and more accepting. Every one of these communities – the skeptics, the healthcare professionals, the alternative-health promoters, and to some degree the LGBTQ population as well – have work to do in that way. Some of it has been done, though, and some of it is being done now, over at Skepchick. Good start.

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.

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.

A gun-rights-advocacy group sued Mayor Michael R. Bloomberg on Tuesday, claiming that the city fee for obtaining a home-handgun permit was so excessive that it impinged on the Second Amendment.

The group, the Second Amendment Foundation, based in Bellevue, Wash., is focusing on New York’s fees because, according to the group, the city is one of the few places in the country that requires people to obtain permits to keep guns in their homes.

The city’s fee is $340, plus a $94.25 charge for a fingerprint check. The fee in most other places in the state is $10, according to the foundation. Mr. Bloomberg has long been a staunch supporter of gun control and has made efforts to reduce the traffic in guns into the city through sting operations, lawsuits against gun dealers and other antigun measures.

The city’s fee for obtaining a home gun permit has long been in place.

The suit, filed in federal court, claims that the city’s fee is so exorbitant that it “impermissibly burdens the Second Amendment right to keep and bear arms,” and the suit argues that because city residents are forced to pay more than others, the fee also violates the 14th Amendment’s equal-protection clause.

(Just to be clear: New York City, separate from New York State, requires a permit just to have a gun in one’s own home; the process of obtaining one is deliberately made as burdensome as possible, including high fees and an extensive application and testing process designed to make you fail, as a form of indirect gun control. A completely different and vastly more difficult process is required to obtain a concealed carry license, which is rare in NYC.)

What’s interesting to me about this is not the gun-control issue itself, but the legal approach in this suit: they are claiming that the fact that the state (or the city, acting under authority from the state) has erected restrictive procedures that make it significantly difficult to exercise a right that in fact exists under law should constitutionally invalidate those restrictive procedures. And presumably they’re going to argue that the rationalizations the state offers – that they must review applications for reasons of public safety, that this incurs administrative expenses that must be covered, that the city has the authority to act on its official perception of the public interest against the wishes of the people actually affected, etc. – are obviously disingenuous or at any rate insignificant in view of the basic right of people to exercise freedoms that otherwise exist under law.

This reflects is a seemingly simple principle – people have a right to exercise their rights – that actually has considerable legal repercussions. For the most part, the Supreme Court has not recognized that the government has a positive obligation to ensure that people can act on their legal negative rights (i.e., a right that merely specifies freedoms that other people may not ban), but has not usually gotten into the question whether regulatory procedures that constrain but do not entirely vacate a given legal right are for that reason illegal. It’s a difficult problem; obviously, some regulatory restrictions are necessary in many cases, and equally obviously, that regulatory authority can be used to create insuperable practical barriers in cases where the law does not allow outright bans. But, to my knowledge, the Supreme Court has not held that the mere existence of a barrier is the equivalent of an unconstitutional ban. In fact, the Court has often gone out of its way to give deference to government regulations even when their burden on citizens’ rights is grave: the standard test for Constitutionality of a law is that it must show a “rational basis” for its existence, which the Court interprets to mean literally any rationale – however stupid or obviously dishonest – that is not literally logically impossible; the Court also usually rejects “substantive due process” and “equity” arguments, which ask for the application of general principles of law or morality outside the strict “black letter law” of statutes and case precedents. Thus, laws and regulations are typically upheld as written, on the presumption that legislations have wide latitude to act as they choose, and the laws they write are therefore prima facie in keeping with the principles of representative democracy regardless of how burdensome, unfair, or duplicitous they may be.

There are few exceptions to the “rational basis” doctrine, all having to do with Constitutional-level civil rights. The Supreme Court has held that laws directly impinging “fundamental” Constitutional rights, or imposing ethnicity-based restrictions on freedoms guaranteed by the Constitution, must meet the test of “strict scrutiny” – that is, they must not merely have a nominal “rational basis”, but must “advance a compelling state interest”, be “narrowly tailored” to that interest alone, and use the “least restrictive means” to achieve it. Arbitrary distinctions between groups also come in for strict scrutiny, under the 14th Amendment’s “privileges and immunities”/”due process”/”equal protection” clauses. In other civil rights cases, the Court has imposed a doctrine of “intermediate” or “heightened” scrutiny, under which the laws must demonstrate a weaker but still compelling rationale for their restrictions. (Almost all sex- and gender-related discrimination receives only heightened scrutiny, because, you know . . . teh uterus . . . .) In the case of abortion, the Supreme Court has struck down some, but not all, anti-choice laws and regulations that were clearly intended to impose, in its words, an “undue burden” on women’s exercise of their rights; however, others were permitted under heightened scrutiny if the anti-choice state could articulate even a moderately plausible-sounding (as opposed to barely “rational”) reason for the law, even when those laws were obviously intended only as burdens on women, and even when they arose as part and parcel of laws that were otherwise rejected for that reason. So, in general, the Court has not taken the step of saying “this law is obviously intended to void a legal right, and you can’t do that”; it merely subjects burdensome laws to various levels of analysis as to how well they disguise that intention.

What’s interesting about this gun-control case is that the legal theory it relies on (as reported in this short article – hard to tell if this is true) attempts to raise burdensome but otherwise normal administrative regulations to the level of Constitutional infringement – that is, it appears to claim that having to pay ordinary but high fees, and jump through ordinary but complicated procedural hoops, is as much an infringement on Constitutional rights as are poll taxes or racial segregation, or at least as gender-based restrictions on employment. “Unduly burdensome” regulations may be unconstitutional, it’s true, but in this case the regulations are not unusual, even if the fees are high: every jurisdiction (other than a couple of whacko states that have no gun permit laws at all) processes paperwork, assesses fees, and in general requires some kind of procedural rigmarole for getting a gun permit. New York City is an outlier, in that their licensing process is unusually difficult (they make you take a test that includes trick questions), lengthy (it commonly takes months), and expensive (as much as 40 times what other jurisdictions – even in New York State itself – charge). But that is only a matter of degree, which it seems can easily be explained given the City’s political determination that they want to make the process stringent. (The fees, I suspect, are an estimate of the fully-loaded cost of staff time and expenses to process the fingerprints, application, and background check, and are probably slightly, but not hugely, inflated. That’s a bullshit way to calculate fees for a job the government actually exists to perform in the first place, but that’s a different matter.) So the issue here is whether a normal and appropriate government function – processing applications and assessing fees – which nobody suggests is unconstitutional in its typical form, becomes unconstitutional when that function gets so out of hand that it essentially becomes a tool for prohibition of what is otherwise a legal right.

This has obvious implications for the constant barrage of dishonest and hostile regulatory encroachments on fundamental Constitutional rights that have become the favorite tactic of the anti-choice brigades. Unnecessary waiting times, intrusive and unnecessary medical procedures, explicit ideological harassment deliberately intended to discourage people from the decisions they have made, technical regulations intended only to delicense or bankrupt clinics – all these and much more have been commonplace tactics in the anti-woman crusade for years, and they are getting more brazen and more offensive almost literally day by day.

These attacks on abortion rights go much further than New York City’s procedural hurdles for a gun permit. In New York, if you pass the test and pay the fee, they will give you a license (for home possession, at least). The administrative procedures are clearly intended as a bottleneck, and the fee is unfair, but the procedure is straightforward and involves nothing that is not common in the administration of similar governmental functions across the country. Anti-choice regulations, in contrast, commonly apply only to abortion procedures, impose burdens that serve no reasonable purpose or are inflated absurdly beyond what is necessary for their ostensible purpose, or distort ordinary procedures in ways that are intended solely to make abortion unobtainable, unaffordable, or discouragingly unpleasant. Examples include requiring multiple trips on different days to a clinic that is often a vast distance from a woman’s home; applying hospital licensing standards to outpatient clinics for abortion only; requiring medically unnecessary ultrasounds at a cost of hundreds of dollars; requiring scripted and false speeches to deliberately upset patients before a procedure – all of them extraordinary burdens that have nothing to do with the ordinary process of licensing and regulating medical clinics, or ensuring informed consent (which, in every other medical discipline, is intended to help patients get what they want and need).

The gun-rights people do have a point about New York City’s regulations: although those regs are not that unusual on their face, the details of their implementation make the legal right of gun ownership essentially unexercisable by many citizens who lack the money, time, or persistence to overcome a burden that is not actually required by the legitimate government function it purports to arise from. But if that difficulty rises to the level of a Constitutional infringement in the case of gun permits, how can the GOP’s outright and unashamed assault on women’s rights to legal and vital healthcare not be seen in the same light?

This puts the right wing, of society and the Supreme Court, in a pickle. If they agree that burdensome and hostile regulations intended to discourage the exercise of a Constitutional right are impermissible even when those regulations are normal and proper other than in the degree of the burden they impose, then they would have to agree that far more invasive regulations serving no ordinary purpose and deliberately intended to actually void a Constitutional right entirely, and even in cases of life-threatening consequences, are that much more obviously impermissible. On the other hand, if they want to continue their assault on women with any degree of logical consistency, it would seem they would have to throw gun lovers under the bus along with them. It will be interesting to see this play out.

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.

Overeating is a behavioral problem, not a surgical one

This may seem to be a statement of the obvious, but the solution to a behavioral problem is not surgery. Overeating is not a surgical problem — it is a behavioral one. The problem is not because the stomach is too big and needs to be made smaller. It is a function of how much food is put into the stomach. Surgical “solutions” should be the absolute last resort measure.

The letter – from an Australian physician who touts himself on the Web as a “DIY health” guru – goes on to make a number of good points about bariatric surgery (mostly stomach-banding), couched in terms of clinical efficacy and relative risk: it does not work for everyone; the campaign to expand the qualifying criteria may include patients who have marginal need or expected benefit; there are known side effects and long-term safety is unknown; the promoters are compromised by conflicts of interest. These are all relevant considerations. But the overall tone in the letter, and even more so the comments, is both judgmental and dismissive. (From commenters: “People are obese simply because of their own behavioral inability to control their diet . . . the solution still lies FIRST in the individual admitting his/her 100% responsibility in the problem weight.” “Obesity results solely from laziness and apathy, which consequently are the same traits that are leading to the devolution of our species.”)

The giveaway here is the headline: yes, overeating is of course a “behavioral problem”, not a surgical one, because in this context “behavioral problem” clearly refers to the etiology of a pathological condition (obesity), while “surgical [problem]” clearly refers to the preferred mode of treatment for that condition. The writer conflates the two categories, and then draws an inference from a logical contradiction of his own making: it’s true that the  etiology of this condition is not its treatment, but that’s true in every case, so that hardly tells against that treatment considered in and of itself. We can reinterpret the sentence to make sense, but only by making it obviously absurd: either “Overeating is a behavioral treatment, not a surgical treatment” or “Overeating, not surgery, is the cause of obesity”. There is a vacuity of clinical concepts here that suggests something else is at work in the writer’s animosity to certain kinds of treatments.

What the writer is really trying to say is this: “Obesity is caused by behavior, and should not be treated by surgery”. And the logical implication of that statement, and the letter and comments that follow, is this: “Obesity is caused by behavior, and therefore should not be treated by surgery”. The clinical counter-indications for surgery (and medical treatments for obesity – he’s against pills, too) that the writer details do not really seem to be the issue in his mind. Instead, certain treatments are ruled in or out categorically, on the basis of criteria of appropriateness that seem to hinge on his view of what health and medicine are fundamentally about, or how they are fundamentally related. There is a sense that diet is better than medical treatment because it is lower-risk, but also a sense that people who brought their conditions upon themselves behaviorally should be expected to work out their own salvation without clinical intervention. There is a clear implication that the writer would still object to bariatric surgery even if it were safer and more effective, simply because it’s not the kind of treatment he thinks this condition should get, in some essential sense (“obvious[ly] . . . the solution to a behavioral problem is not surgery”). Because the condition is behavioral, the treatment should be behavioral: QED.

From this perspective, the choice of treatments for a given condition depends on some sort of criteria of categorical appropriateness – a determination of what kinds of treatments are appropriate to any given condition, only after which do questions of safety and efficacy come into play. (This becomes more obvious in the letter above when the writer airily dismisses the notorious psychological difficulties of dieting with remarks about “responsibility for one’s actions”.) And this is the question that really got my attention about this issue. The concept of “appropriate” treatment is one that gets to the heart of healthcare as a practice, and of the ethical dimensions of such seemingly scientific concepts as the definition of disease, relative risk, and clinical indications for treatment.

To define clinical indications in some way other than in terms of clinical efficacy establishes medicine as a categorically defined practice: a praxis incorporating certain beliefs or techniques that are “just right”, and eschewing others as “just wrong”. The old ethic of “doctor knows best” exemplifies this idea to some extent (in regard of the roles of patient and physician: the doctor prescribes; the patient complies). More broadly, medical ethics based on a perception of distinctly medical virtues and traditions (Pellegrino’s “internal ethic of medicine”) makes all of medicine categorical; more than that, it moves the locus of medical ethics entirely inside the profession, such that what is right or wrong for a given patient is what is or is not in keeping with the behavioral standards applicable to the doctor. Even more modern theories of medical ethics do the same to the extent that they perceive specific types of treatments as right or wrong in and of themselves.

The movement toward patient autonomy and patient-centered care challenges this ethos at a basic level: the whole idea that patients may determine their own interests for themselves necessarily implies that healthcare is defined as serving those interests (or else we get a macabre dissociation between what patients need and what healthcare is for). The patient-centered ethic has fundamentally reformed healthcare practice in many areas, most notably refusal and termination of unwanted treatments, and more indirectly through the rise of cosmetic, nutritional, sports- or adventure-oriented, assisted reproductive, and other forms of “aspirational” (rather than pathology-driven) healthcare. The idea that what patients need is not determined by the pursuit and maintenance of “normal species functioning” – never exceeding its bounds and normal range, either positively or negatively – throws open a potentially unlimited range of possible treatments for any given condition, and indeed a potentially unlimited range of praxis under any conditions, whether or not defined in terms of disease and treatment. (The body modification movement blows the doors off the disease/treatment model, and increasingly off of any old-fashioned notions of normal species functioning.)

From this perspective, it is impossible even to formulate a declaration of the form: Because the condition is ________, the treatment should be ________. Radically patient-centered care does not require a “condition” to authorize a “treatment”, and takes it as fundamental that some patients may deny that an otherwise-recognized “condition” even exists (as in the case of the “fat acceptance” movement), while others may perceive, personally, a pathology in what would previously have been perceived categorically as normal (as with gender identity disorder). In addition, the particular best treatment for any given patient, whatever their circumstances, will be the one that best meets that patient’s interests as they themselves understand them – which may well be a riskier surgical procedure rather than a more burdensome lifestyle change, or vice versa, as they themselves perceive is best for them.

The significance of this non-categorical, patient-centered, situationally-responsive understanding of healthcare praxis is enormous. Aside from the overt impact on practical healthcare that the patient-autonomy movement continues to have, embracing a truly patient-centered ethic of care guides thinking about how to understand patient needs and how to meet them. In particular, it rules out categorical thinking of the type that prohibits providing certain treatments (with due consideration of cost, risk, and expected benefit) for a given patient or category of patient because they do not conform to some generic standard of appropriateness, and it requires that the patient’s own understanding of their goals, priorities, and risk-tolerance, be the determinative factors. Clearly the message hasn’t reached all corners yet.

That’s just a fraction of the total, even considering murderers alone. Almost no suspects have ever even been named in the over 200 arsons and bombings, or close to 100 other attempted arsons and bombings, or the literally thousands of vandalisms and chemical attacks committed at health clinics across the US, not to mention the many attempted murders, public “targeting” of chosen victims (some of them later murdered), personal harassment and threats to healthcare providers, and uncountable incidents of on-site harassment and violence directed at clinic staff and patients, that are the stock in trade of Christian anti-choice terrorism.

No person loses their life in an abortion. But here you can see just some of the people who would be alive today if the terrorists above, and others like them, had been aborted before they murdered them. If we’re counting up the possible impact on society, well, there’s only one Obama, but there’s plenty of these shitheads. So, all things considered . . .

[NB: Of course the entire line of reasoning is nonsense. The fact that some unpredictable thing could occur sometime in the future is no reason to force anyone to bring about circumstances that might randomly, but not foreseeably, result in that outcome, even ignoring the fact that it is their decision whether they want to do so. The same reasoning would not only justify mandatory childbirth, but mandatory pregnancy, and in fact mandatory maximum reproduction regardless of risk or cost - since one of those unwanted children might do enough good to offset all the suffering required to produce it. That this is in fact the official policy of the Catholic Church makes it no less insane or misogynist. It's also illogical: there's no guarantee that any child - still less an unlimited number of unwanted children imposed by force - will do more harm than good, so the proposition that there's a harm to society in aborting them is no more provable than that there's a good to society in doing so, as the above images demonstrate.]