Planned Parenthood is the largest single provider of prenatal, contraceptive, and abortion care in the US. In a country in which over 85% of all counties have no abortion services provider at all, in which health insurance plans are not required to provide contraception, and in which government-provided health programs for the poor are prohibited from providing abortion or, at times, even information about abortion, Planned Parenthood is often the only reproductive health provider available in many communities, and usually the only one available at reduced cost.

This drives the anti-woman brigade screaming crazy. There has been an organized campaign against Planned Parenthood by the sex-negative right wing for years, using a combination of smear tactics, lies, distortions, and political lobbying. Attacks range across everything from Margaret Sanger’s racism (don’t believe what you hear from hypocritical liars), Planned Parenthood’s practices of murder, malpractice, and coverup (don’t believe what you hear from anti-woman liars), and the - in Malkin’s terms - “obscene profits” Planned Parenthood makes from the lucrative business of providing subsidized healthcare to uninsured patients in poor communities (don’t believe what you hear from financially illiterate liars). The reason, of course, is that Planned Parenthood is doing what they are dead set on wiping out: making reproductive autonomy real for the most vulnerable women in America.

Having failed in their campaign to ban abortion, having failed in their attempts to demonize abortion and the women who have them, having failed in their terrorism campaign against healthcare providers, that anti-choice movement has for years now concentrated on making abortion simply inaccessible, even though legal and Constititionally protected. Their tactics range from disingenuous “protective” restrictions that make it impossible for abortion clinics to operate or for women to get to them, secondary boycotts and blocades to intimidate those who fund or do business with abortion providers, and, for years now, an organized campaign of deception aimed at cutting funding to Planned Parenthood. To this end, the organized anti-choice community recycles the same discredited crap over and over, and now have one of the most visible - and visibly crazy - spouting their canned lies for them.

There’s no point quoting Malkin’s stupid, false, and ignorant nonsense about Planned Parenthood. What is important is that she has made herself a tool in a campaign of falsehood to try to cripple the only source of reproductive healthcare for many women in America. The major lie in the campaign is that Planned Parenthood is being subsidized by the government to provide abortions. (”cut the abortion subsidies”, “the tax-subsidized abortion industry”, “what market-distorting results do we get for those government incentives? 289,650 abortions in 2006″) Aside from the bizarreness of an opposition to abortion based on “market distortion”, this is all just false.

Given their wide geographic base and commitment to low-cost care, Planned Parenthood is often the service provider under government contracts for healthcare services for the poor, or for Medicaid services (not including abortion). The money they receive from government sources is not a “subsidy” for any of their activities - it reimburses direct services to patients under Title X and Medicare - the same as would be the case for any other provider, except that, in the communities Planned Parenthood serves, there often aren’t any other providers. And these services are often further subsidized by Planned Parenthood itself from donations. Federal funding is prohibited for abortion in all but a small percentage of cases. Abortion services to other Planned Parenthood patients are paid for out of other funds - they have to be, since the government money is more than used up providing non-abortion services. The claim that the government paid for “289,650 abortions in 2006″ through Planned Parenthood is simply a lie - not a mistake or even an exaggeration, but a straightforward lie. In fact, the federal government paid for virtually no abortions, and the money they did pay was less than required to provide the non-abortion services Planned Parenthood provides. But that’s just the first of the standard lies.

Malkin claims Planned Parenthood earned “$115 million in profits” last year. As a non-profit agency, that would be quite a trick. They did, in fact, receive (almost) that much in revenues beyond their total outlays, as every non-profit agency is allowed to do; like every non-profit agency, they are also required to devote excess revenues to their non-profit work under specified schedules and regulations. They can use it for expansion projects or to provide further services, and can maintain a small percentage of revenues as a “rainy-day” fund. That’s just sound fiscal management (if non-profits were required to spend every dollar every year, they’d go bankrupt the first year they had an unplanned expense), and it is standard for non-profit agencies. But excess revenues are not “profit”. By definition, profit is the property of the shareholders of a business entity; it belongs to them and can be distributed to them as dividends or recouped by them through selling shares as their price goes up. Non-profits do not have shareholders; they do not pay dividends; excess revenues are not extracted by anyone for personal benefit. It’s not a small thing - it’s the heart of the definition of “profit” and of “non-profit entity”. And you’d think that someone who tries to demonstrate what passes among conservatives as sophistication, by injecting the phrase “market distortion” into a discussion of abortion, wouldn’t immediately embarrass herself by proving she doesn’t even know the meaning of the elementary term “profit”.

She goes on to recycle a farrago of vague lies and complaints about Planned Parenthood: two patients in a 2-year period, out of over 6 million patients served and almost 21 million treatments provided in that time, filed malpractice suits against the agency (one was settled for apparently less than $100K; the other has not even come to trial; Malkin describes each patient’s complaint in lurid detail and gives no other information); Planned Parenthood provides confidential services even in cases of statutory rape (yes, and appropriately so); some racists donated money to Planned Parenthood and she thinks that’s the agency’s fault. It’s a bizarre and stupid grasping of mostly made-up straws.

But the - fully foreseen and deliberately intended - consequences of this nonsense are serious. The intent of this movement is to destroy the one agency that provides the bulk of reproductive healthcare services in this country, concentrated among poor women and teens. As the Annual Report that Malkin breathlessly (and cluelessly) cites as the source of her misinterpreted “facts” makes clear, abortion services are only 3% of their annual activity, and almost none of that is reimbursed by the federal government (a minority of states pay for abortions through state Medicaid programs, but this is still a tiny fraction of Planned Parenthood’s revenues). Malkin and her fellow misogyny-jihadists rave about abortion to whip up the red-meat right wing, but what they are really trying to do is cut off all control of pregnancy options for as many women as possible, focusing on the most vulnerable. Prohibiting Planned Parenthood from receiving federal healthcare money would have almost no effect on their provision of abortion services, and still less on abortion overall in the US - but it would cripple their ability to provide contraception (38% of their annual activity), STI/HIV screenings and treatments (29%), gynecological cancer screening (19%), and pregnancy testing, prenatal care, “midlife” care, and other women’s health services (10%). This is the goal and effect of the campaign of lies, slanders, and disinformation that has been running for years, and that Michelle Malkin has joined. It is a campaign born in hatred for women, contempt for their needs, health, and autonomy, and indifference to their deprivation or suffering. They’ve found themselves a fitting ally.

[This post cross-posted at Lean Left.]

I’ve decided to create a mechanism for reader input to the blog. I note the popularity of “open threads” on other blogs, but wanted something a little different here. I’ve also been worrying about the consistent lack of feedback or commentary on blog posts.

I know this blog is fairly low-traffic, but I also know that a good percentage of visitors are people who are knowledgeable about these issues and really interested in them. I don’t know why y’all don’t comment more. I’ve been telling myself that it’s because my posts are so thorough and comprehensive that there is just nothing more to say on any of the issues, but, I suppose, it’s possible that might not really be the answer. Another thought is that my posts may be generally interesting to readers, but not quite on-target enough to make them want to respond.

So, fine. Be that way. From now on you can do the work yourselves.

If there’s a topic you wish had been addressed here but hasn’t, or a question you’d like input on, or if you just have an opinion you want to get off your chest about something related to bioethics, you can now create your own posts and discussion topics on this blog.

Go to the top of the right-hand sidebar, in the section labeled “Ask the Ethicist!”. (See it up there? To the right - all the way near the side of your screen. Up at the top - below the words “Sufficient Scruples” but above all those lists of features and links. Got it?) Click anywhere in that box and it will take you to a permanent page with an open comments section. Use the comments section to post anything you like - a question, a proposed discussion topic, an argument on which you’d like feedback, or just an opinion. I will move that comment to the main page as a blog post, credited to you. In essence, you can be a blogger at “Sufficient Scruples”! Your comment will appear as a new post at the top of this page (so be sure it’s worded the way you want). Give your name or handle, and your e-mail or Web address if you like, so you get credit. I will give my response to your post, and other readers can then join in in the comments section. You can be sure, then, that this blog will always have something of interest to you on it - if it doesn’t, you have only yourself to blame!

So, welcome, to all my fellow bloggers! Let a thousand blog posts bloom!

NB: Your post will not appear immediately. I will have to create the new blog post from your text; it should usually take less than 24 hours. I reserve the right to delete posts that are offensive or trolls.

[This post will be back-dated for one month to keep the announcement at the top of the page. See below for other recent posts. 4/15/2008]

studentactivism.net covers current controversies involving students or colleges, as well as student organizing, activism, and rights issues. Given the high representation of the academic world in the blogosphere, and the increasing politicization of campuses and the educational experience, it’s a valuable resource for anyone interested in what’s happening with campuses today, and the generations of young citizens they are turning out. Check it out!

I’m interested in the issues surrounding animal testing. I’m certainly not a member of the PETA crowd or anything, but at the same time, I’d certainly think we should keep such testing to a minimum, using it only where it’s necessary, useful, and relevant. But I honestly don’t know what all the issues are.

Thanks for the first-ever “Ask the Ethicist” blog post!

And now, what about animal testing? Just to get the ball rolling, here are some relevant issues:

1. What makes using animals in labs worthwhile?

Animals are generally used for lab tests for several reasons: first, much basic biological research concerns animal biology, for which the relevant animals are obviously the best model, and it is possible to study animal subjects in the lab without endangering the wild population of the same animal; in the case of research relevant to humans, animals may still be preferred because statistical analysis requires large sample sizes, which are easier and cheaper to achieve with, say, gerbils than with humans; testing may be invasive, painful, dangerous, or fatal, which again is more convenient with animal models than with humans, unless you’re running a Nazi concentration camp or a US prison; animals can be subjected to experimental regimens, including drugs, with unknown safety or side effects; animals can be used for inevitably fatal or harmful procedures such as the development of new surgical techniques or the deliberate creation of wounds or diseases for the testing of treatments; animal models can be biologically or genetically tailored to the specific research protocol to produce a uniform test sample; animals can be reproduced in the lab to increase the population with a rare condition, making it easier to test; animals are simply easier to control and don’t inject their personalities into the test procedure.

These benefits are predicated upon two assumptions: that animals are good models, biologically, psychologically, or sociologically, for humans, and that it is permissible to do things to animals that would not be permissible in humans. If both those assumptions are true, then animal testing obviously brings great benefits. Any treatment or procedure that is not tested on animals will have to be tested on humans alone, without preliminary indications that it is safe. If the assumption that animals are good biological models for humans is not true, that undermines the value of such testing and hence its moral justification. If the assumption that it is permissible to harm animals in certain ways is not true, that would prohibit types of research involving that harm, even if it were to be beneficial to humans.

2. What problems are there in using animals in labs?

An important problem is that the animals may not always be good models for humans after all; the literature is filled with examples of drugs that passed safety and efficacy testing in animals and were useless or dangerous in humans, and there are other examples of drugs that are safe in humans but dangerous in animals, and still other cases where drugs were safe in some animals but not in others, making the question of human modelling ambiguous. This is why animal testing is a preliminary step in development of human treatments, but human testing is still required. Some have suggested that this means animal testing can be done away with entirely, since it does not definitively prove a treatment will or won’t work, and does not prevent exposing humans to uncertainty anyway.

Aside from that practical issue, the moral assumption mentioned above is the focus of this discussion. Obviously, to the extent that it’s an open question whether animal tests are morally permissible, those tests are problematic - they may be a source of moral harm (to the animals), not a means of avoiding it (for humans).

3. What controversies arise in considering moral criticisms of such use?

Is it true that it is morally permissible to use animals for procedures that it would be immoral to perform on humans? That is, do animals have some lesser claim on moral protection than humans do? Do they have no moral claims at all?

How do we determine which moral claims take priority, and how does species identity enter into that issue? Why do we accord animals any moral claims at all (such as a right not to be mistreated), and why do we not accord them the same moral claims as humans? What standard do we use to determine such questions, and why that one?

4. What are some relevant moral issues underlying these arguments?

Leaving practical considerations aside, the question at the center of this topic rests on the issue of moral standing: what entities have moral interests, or a claim to moral consideration, and why? How do we mediate conflicts between entities that each have some certain level of moral standing?

There are simplistic moral arguments favoring animals, based on assertions of religious, emotional, or otherwise idiosyncratic personal values - that is, some people simply feel an affinity for animals, hold religious beliefs prohibiting harm to animals, or somehow feel that animals are “citizens of the earth” or “living creatures” and that that fact confers moral status sufficient to prohibit harmful treatment. Others assert a moral value to the natural world, such that it is immoral to destroy part of the natural environment because of its inherent moral worth (rather than because it is useful, or valuable, or necessary for life). The problem, of course, is that these are non-starters for anyone who happens to hold different beliefs or values - and therefore non-starters as policy because our policies cannot be parochial or arbitrary and carry compulsory moral force.

Thus, the assertion of animal interests generally follows some analysis of the moral status of animals that makes harming them a morally significant act.

That can be an argument to the effect that animals are moral persons with equal claim to moral interests, compared to humans. Jeremy Bentham argued that this was an inevitable consequence of utilitarian morality over 100 years ago, and Peter Springer has resurrected that line of reasoning in a way that has been influential in the current animal-rights movement. To make this argument, you have to define the threshhold for personhood fairly leniently. For Bentham, it was merely the capacity to experience pain. (”The question is not, Can they reason? nor, Can they talk? but, Can they suffer?”) From this perspective, any creature that can consciously experience pain is a full moral person, whether or not they have any other mental functions - so birds, fish, and of course all mammals are morally equal. This is why Singer promotes vegetarianism, and why some animal-rights advocates are against pet ownership as a form of slavery.

You can also argue that animals have lesser moral status than humans, but are still due some degree of moral consideration. On this ground, it might be permissible to use animals in some ways that did not cause suffering, but perhaps not to kill them, or to do so only when a comparable benefit to humans was expected. This argument would be grounded on a definition of personhood that required capacities beyond those of most animals - for instance, the possession of a unique sense of self-identity, or perhaps some kind of higher reasoning function. If animals have some, but lesser, moral status, then at the least we must alter our animal-handling practices to ensure that they are not excessively cruel, and perhaps we might have to cut out some practices as well - but a wide variety of common behaviors toward animals would still be tolerated, possibly including farming or killing them, or conducting research on them, under specific guidelines.

Finally, you can argue that animals are not moral persons and are thus due no moral consideration at all - they can be treated as if they were inanimate objects, such that the only considerations against using or killing them would be practical ones (maintaining species diversity, stabilizing the food chain, etc.). One might also work in some sort of protections against cruelty or gratuitous pain infliction, on grounds of a general duty not to be cruel, or for moral training purposes (avoiding developing bad habits), but not on the basis of the animal’s moral interests itself. Given this perspective, almost any animal-treatment practices that are not gratuitously cruel - including raising them for food or commercial exploitation, or even conducting relatively frivolous research on them - would be allowed, since there are no countervailing interests on the part of the animals to stand against them.

Note, though, that if we do not take the extreme abolitionist position, then whatever view of animals that we do take will impose at least some limits on our behavior. If we think animals have limited moral claims, there will still be some things we cannot do to them, but, since they stand at a lesser moral plane than humans, there will always be some things we can do to them. How far those limits go in either direction is open for debate, but most people in this position would agree, for instance, that it is wrong to torture animals for fun, but not wrong to use them in medicine to save human lives. Narrowing down those extremes is what the continuing debate is about (if not torture, what about forcing them to perform under stress in rodeos?; what about performing under less stress in circuses?; what about being owned as pets?; if medical uses of animals are allowed, what about medical research?; what about cosmetics research?). Even if we hold that animals have no moral claims per se, respect for suffering as suffering ought to impose at least some check on what we can do to animals capable of experiencing pain.

So, the debate over animals incorporates the debate over the proper definition of moral personhood. It also rests heavily on empirical questions about the degree to which they can feel pain, the degree to which they exhibit emotions or consciousness, and our interpretation of their various behaviors in that regard. This debate thus parallels, and both influences and is influenced by, identical debates taking place regarding humans in the context of abortion, stem-cell research, the treatment of newborns, and end-of-life treatment. It has unique elements, too, in that animal personhood must obviously be of a different type from human personhood, and convey different privileges even if that personhood is recognized (i.e., saying that animals have moral interests does not require saying that they should be able to vote, enter contracts, marry human beings, etc.; conversely, saying that they should not or cannot do those things does not by itself imply that they are not persons).

Species is an important issue in animal-rights debates, too. Animal-rights advocates often accuse opponents of “speciesism”, meaning making arbitrary moral distinctions between living things on the basis of their membership in one or another species. However, it is seemingly impossible to articulate an argument that establishes equal moral personhood for all living things, or even just all animals, without any discrimination between species whatsoever, especially given the huge number of invertebrate or microscopic species that very obviously possess no conception of the moral life; taking that position seriously would also lead to absurdities such as claiming that it is morally wrong for obligate carnivores to eat prey. So, we must make distinctions on grounds of moral personhood, and since species identity more or less determines moral capacity, as a baseline at least, those distinctions are going to include or exclude entire species, possibly with the exception of a few borderline cases where the evidence is more ambiguous. Thus, most animal-rights activists wind up drawing a line somewhere, allowing that it is permissible to make use of species with lesser mental capacity than those at the borderline, but that there are limits regarding species with greater capacities. Many attempt to draw this line to include some ape species; some go farther to include a larger range of mammals; Singer famously draws it provisionally somewhere among the Molluscs.

5. If we are not extreme abolitionists on animal-rights issues, how do we decide what kinds of treatment are justified and which are not?

It must be recognized that the different things we do to animals have different types and degrees of consequences, and also that the different benefits we derive from our treatment of animals are likewise of differing kinds and degrees of significance. The greater the human benefit derived, the greater justification there is for the process of obtaining that benefit; the more harmful the treatment required to obtain it, however, the less justified it is. The general approach to such situations is a “balancing” test of degree of harm vs. degree of benefit.

For this reason, much animal-rights activism has - reasonably enough - focused on particularly egregious harms to animals in pursuit of seemingly trivial benefits to humans: for instance, hunting rare species only for luxury products or gourmet foods; the cruel confinement of veal calves only to produce tender meat; or the use of irritating or deadly chemicals on animals to test cosmetics or soaps. But we do not have a system for establishing absolute degrees of harm or benefit (how bad is it to be immobilized in a pen or cage? how good is it to eat plump chickens or tasty veal?), so we cannot say with authority exactly when the balance of harms and benefits tips in different cases.

Notice, in this discussion, that there is no clear moral distinction between the use of animals in medical testing and their use in other ways - and so I have broadened your question to include all forms of use of animals. The “balancing” approach described above merely asks how much benefit - not of what kind, and likewise how much harm - not why it is inflicted. To most moral philosophers, there is nothing inherently “better” about research to save lives than research to invent cosmetics, except that the one outcome is obviously more significant in the lives of, and more highly valued by, the people benefiting; similar remarks apply to the different kinds of harms inflicted upon animals. Because medical care is so important, medical research on animals is most likely easier to justify than less-vital uses of them, but only for that reason. There may be medical treatments whose benefits do not justify the toll taken on animals to develop them (in light of the fact that most candidate drugs or procedures do not successfully emerge from development, and the few that do still require extensive human testing, it may be that almost no new medical discoveries truly justify the many thousands of animal deaths required to produce them - if we place a sufficiently high value on animal suffering). Then again, there may be less-important non-medical benefits that are justified, if the role of animals in producing them was minimal enough. So, in considering “testing”, we have to remind ourselves that animal use involves much more than the development of new and important medical procedures; it involves a vast amount of unsuccessful medical research and even more non-clinical basic-science research, developmental testing of consumer products (most of which are not exactly in the cure-for-cancer category), and the use of animals to test products and procedures for the farming or treatment of animals themselves. In addition, there are non-testing uses of animals such as for the production of industrial products and materials, hunting, entertainment, and pet-keeping, and the vast animal-based food industry, that must be taken into account.

These remarks may help outline the scope of the problem. You’ll notice no answers are given! But thanks for a great and timely question. The ball is now in the readers’ court!

Resources:

Animal Liberation, by Peter Singer
The theoretical Bible, and foundational text, of the animal-rights movement.

Animal Rights: Current Debates and New Directions, by Cass Sunstein and Martha Nussbaum
A new treatise by two well-respected academics.

Should Trees Have Standing? And Other Essays on Law, Morals, and the Environment, by Christopher Stone
The issue of moral and legal rights for non-person entities, from a legal perspective.

The Omnivore’s Dilemma: A Natural History of Four Meals, by Michael Pollan
A review of the entire US food-production industry, including problems with animal-based foods.

“Animal Rights“, “Animal Welfare” and “Animal Liberation Movement“, Wikipedia
Decent surveys of the distinct concepts and their histories, with lots of links and references.

“Animal Rights: An E-mail Debate between Peter Singer and Richard Posner“, at Slate
An epistolary debate between Singer and a well-known conservative US Federal judge.

But that can take many forms, one of which is mocking, in appropriately childish fashion, PETA’s own tactic for pressuring corporate chicken-torturers [sic]. They have a Web sign-generator site in which they encourage people to post comments about Kentucky Fried Chicken’s practice of, as they put it “tortur[ing] chickens for profit”. Whatever the hell that’s about, it interests me far less than the fact that PETA, as a group, is offensive and abusive to real people, whom I care about far more than the animal fetish-objects that are their sole obsession. So if we’re going to make little signs about cruelty and inappropriate moral priorities, well, let’s get our inappropriate priorities straight, first:

Make your own!

But, as important as the issue is, and as vital as it is to re-assess and reform our justice and prison systems overall, I think viewing this as merely an aspect of the mis-management of prisons is a mistake. Systemic sexual abuse occurs not merely in prisons but in the military, among the “contractors” of KBR in Iraq, between priests and congregants, in the workplace, and throughout society. As feminist critics of violence against women have long been saying, the problem is not one of sex in itself, but of the use and abuse of power in general. It is just one manifestation of an issue that pervades the authoritative control of human beings by other human beings.

In saying that, I don’t mean to minimize the irresponsibility of organizations that create situations that allow for abuse, or the impact of poor training, poor leadership, racism, sexism, and similar contributing factors. These are all egregious faults, they are characteristic of the abusive institutions and attitudes that govern prisons, the military, youth homes, workplaces, and the like, and they are the conditions that give rise to the abuses that result. But there is a deeper issue at play.

It has been shown time and again that humans with absolute power over other humans will abuse them in the most shocking ways, no matter what other circumstantial factors are in place. Practical experience demonstrates this in our sad history of ethnic violence, pogroms and genocide, and slavery; it has been demonstrated in the laboratory as well, in Milgram’s classic works on willingness to inflict pain to helpless victims on command, and Zimabardo’s prison simulation using ordinary college students, which degenerated into psychotic physical abuse within a matter of days; it manifests itself in almost exactly parallel ways in such cases as police beatings and killings, Abu Ghraib, Guantanamo Bay, and the longstanding use of torture against political prisoners. It takes place not only among organizations with a belligerent and abusive mindset, like the police and prisons, but among those with a nominally professional mindset and an explicit code of law and ethics governing the use of force, as with the military; it arises even between ordinary individuals almost literally as soon as any hierarchical distinction is made between them, as, again, in the case of the Zimbardo experiment.

This inherent tendency needs to be recognized for what it is. For whatever reason, it appears to be a feature of the behavior of humans in groups. We need not posit any dubious “evolutionary psychology” Just-So story about why, or speculate as to what purpose it serves. It may be an innate human impulse, selected-for for some sort of competitive advantage it brings, it may be a secondary effect of other, more benign, psychological processes, or it may merely be an exercise in opportunistic self-interest, like filching money from an open purse or telling lies to evade punishment - the sort of thing many people would do even if they like to think of themselves as better than that. Whatever its source, its manifestation is real, and too ubiquitous to go unnoticed.

What we know is this: when you give some human beings almost unlimited physical power over other human beings, and don’t monitor or control them carefully, they will physically abuse those under their control. They will do other bad things as well - mocking and humiliating their charges (recall Abu Ghraib again), taking advantage of their helplessness to extract benefits from them (coercing them for money or services, and enslaving them to extract labor), and engaging in constant petty abuses to maintain the power distinction. And the forms of abuse employed will take various guises, depending upon circumstances and the people involved: it may be cultural or religious humiliation, where the powerful and powerless groups are of different backgrounds; it may be political indoctrination, where they are ideologically opposed; it may take any of the many forms of racist violence where race is a factor, and it will invariably involve sexual abuse where women are the powerless group. But what is constant in such scenarios is simply that one person has the power to treat another as they choose, with impunity; given that one, simple, empowering condition, the result is almost always that how they choose to treat those under them is by way of abuse, often violent.

We recognize and plan for other forms of ubiquitous human perfidy: we do not leave our money lying around, not because everyone around us is a career criminal, but because we know many people around us will become criminals if they have the chance and think they can get away with it; we do not simply take people’s word for the information we need from them, not because very many people are congenital liars but because most people will be opportunistic liars if given a reason to be. We do not expect terrible moral abuses from most of our fellows most of the time, but we live almost every aspect of our lives taking basic precautions against such abuses, and trying to minimize the temptation to engage in them. Almost everything we own (house, car, computer, purse, desk, etc. . . .) has a lock on it. Almost every important statement we make (tax returns, legal testimony, our age when buying beer, . . .) requires corroborating evidence. We know that people will take advantage of circumstances to steal or lie if they think they can, even if those people are generally reliable within a reasonable framework of control. We take precautions to limit their temptation and to provide the oversight that will keep them from feeling that they can violate the rules. (It is often said that the flimsy locks on desk drawers are only there to keep out honest people.) We must recognize that the temptation to abuse and violence is another human characteristic that we need to anticipate and plan for.

The use of power to abuse others is one of the features of human behavior - like opportunistic lying or stealing - that simply must be guarded against as a standard precaution. We must build abuse monitoring and prevention mechanisms into our lives and institutions in just the way we put locks on all our doors and demand evidence to back up factual statements. We must assume that abuse will be likely when we do not take precautions against it, just as we assume people will get robbed if they leave their valuables unattended, and be lied to if they take everything they are told at face value. Again, why this is so is a deeper question, but it appears, on extensive empirical evidence, to be a commonplace emergent feature of certain types of human interactions.

Understanding and planning for the social problems we have to manage to maintain a decent society requires understanding that some of those problems are characteristic, not of specific circumstances, attitudes, ethnic or religious groups, or what have you, but of humans, in general, in group interactions. More broadly, this means we must think about morality from a more empirical perspective, acknowledging that there are certain stereotypical immoral practices that humans slip into if not otherwise motivated (violence against the weak being just one of them), and that these must be guarded against as standard practice. It means we must not expect moral behavior in group situations as a baseline assumption; we must assume certain types of abuses will occur unless specifically guarded against, and build institutions and practices that incorporate those precautions. At the very least we must stop imagining that the repeated incidents of violence or abusive behavior we keep discovering are the result of “a few bad apples”, or of some mere failure of discipline in an isolated case. They are the result of humans being human, in all that that, unfortunately, implies.
These thoughts are the result of some vague thinking I’ve been doing lately about the empirical nature of human moral behavior. Where exactly they’re leading I’m not sure. These considerations are far too preliminary to attempt to read any simplistic policy recommendations out of them. And I am aware that they can be used to support reactionary programs like a police state or universal monitoring, or the conservative notion of “moral depravity” that justifies any possible intrusions on individual liberty. I hope and believe that the empirical foundation of human moral behavior is compatible with the traditional notions of moral liberty and the public/private distinction. It is at the least closely linked to the empirical observations forming the basis of classical social contract theory, which is certainly compatible with a fairly robust liberalism (if not radical libertarianism). But all that remains to be worked out. For now, I merely wish to make the point that we need to stop being surprised by tales of systematic torture, abuse, or rape in out social institutions; we’ve seen that enough now to recognize it is the norm, not the exception.

He begins with a standard myth that, for reasons that entirely escape me, has become some sort of cri du combat among forced-pregnancy activists:

In the summer of 1992, as Bill Clinton solidified his control over the Democratic Party, Robert P. Casey Sr. . . . was banned from speaking to the Democratic convention for the heresy of being pro-life. The elder Casey (now deceased) was then the governor of Pennsylvania — one of the most prominent elected Democrats in the country. He was an economic progressive in the Roosevelt tradition. But his Irish Catholic conscience led him to oppose abortion. So the Clintons chose to humiliate him.

I simply don’t know why this story keeps coming up, or why anyone cares. It hardly makes sense even if you don’t know the facts - it’s not like a prime-time speaking slot at a political campaign is some sort of birthright that Casey was cheated out of - and it’s an unusually weird motivation for stripping women of their bodily integrity (”We must eliminate reproductive autonomy to avenge the memory of Robert P. ‘Who?’ Casey!”). But it’s also false.

At the time of the 1992 convention (unlike now), the Democratic nomination was already sewn up. Clinton was the official nominee, and he was running on an explicitly pro-choice platform; the official Democratic party platform was also explicitly pro-choice. Casey had refused to endorse Clinton for President even after he sealed the nomination, and had indicated he wanted to get a speaking slot at the convention to speak against reproductive freedom. So he wasn’t invited to. That’s the whole story: shockingly, the Democratic party did not grant prime-time speaking time at their official convention to a speaker who opposed their official platform, stated that he would use his speaking time to undermine the platform, disagreed with the nominee on a major political issue, and refused to endorse the nominee. It’s beyond bizarre, it’s simply stupid dishonesty to pretend there’s anything scandalous, underhanded, or unfair in that - still less that it was retaliation for his being anti-choice; no fewer than 8 prominent anti-choice Democrats spoke at the convention, they just didn’t use their opportunity to explicitly renounce their candidate’s and party’s platform. The party was engaged in an election campaign and they carefully coordinated their convention to promote their platform and support their nominee - that’s what parties are for. Casey openly intended to do exactly the opposite, and so he wasn’t given space on the official convention program to play his loose-cannon tricks. Anybody who isn’t now saying “No shit, Sherlock” is an idiot. And for Gerson to pretend that was some kind of “humiliation” of Casey (he uses the word twice - never once mentioning that Casey was the one not playing ball) is beyond idiotic; Casey explicitly intended to embarrass his party and its nominee at their own convention, and announced as much - and was then not invited to do so. He had only himself to blame.

But it goes on.

After re-raising the banner of Robert P. “Who?” Casey’s self-wounded honor, Gerson declares Obama to be “extreme” in his attitudes toward abortion because, apparently, of three positions he took that Gerson somehow cannot fathorm.

Obama’s record on abortion is extreme. He opposed the ban on partial-birth abortion — a practice a fellow Democrat, the late Daniel Patrick Moynihan, once called “too close to infanticide.” Obama strongly criticized the Supreme Court decision upholding the partial-birth ban. In the Illinois state Senate, he opposed a bill similar to the Born-Alive Infants Protection Act, which prevents the killing of infants mistakenly left alive by abortion. And now Obama has oddly claimed that he would not want his daughters to be “punished with a baby” because of a crisis pregnancy — hardly a welcoming attitude toward new life.

What is it that, to Gerson is beyond the pale? What is so “extreme” that it unfits Obama for the presidency?

Intact dilation and extraction (”IDX”) is a clinical procedure used in some cases of very late-term abortion - reportedly about 5,000 cases per year at most, which was well under 1/2 of 1% of all abortions performed at that time. It was termed “partial-birth” abortion as a propaganda tactic, and as a means of crafting bans supposedly aimed at a specific procedure (intact dilation and extraction, which does have a specific medical definition) that, by vagueness of terminology (”partial birth” has no medical definition) could be extended to cover a wide range of third-trimester abortions. IDX is the procedure of choice when aborting a large fetus because it allows for lesser dilation of the woman’s cervix than a regular delivery, but does not involve complete disarticulation of fetal limbs inside the uterus; it is thus safer for the woman than any alternative at that stage of pregnancy, particularly for very young and undeveloped women. Note that the “partial-birth” abortion ban contains no exceptions for threats to the woman’s health - the GOP explicitly demanded that they be removed from the bill; it also contains no limits on gestational age (meaning that it applies throughout the pregnancy, not just in cases of the last weeks of viability that its supporters invariably harped on). Note particularly that it does not, in fact, ban abortion at any time; it only bans one (vaguely-described) type of procedure used in abortion. In other words, the effect of the so-called partial-birth abortion ban is, exclusively, to force women to use a more-dangerous procedure for late-term abortion when a safer one is available, while explicitly denying the woman’s health as a mitigating factor in choosing the safer procedure.

For Gerson, it is “extreme” not to ban a woman’s choice of the safest option for surgical procedures that themselves are not banned, and to admit that women’s health and safety is a factor in decisionmaking about women’s healthcare. That is the Republican approach to women’s health, and that is what Obama opposed.

Regarding the post-viability abortion bill, the basic requirement was that doctors must provide medical care for fetuses that survive an abortion procedure. This cuts at the distinction between a right to control one’s own body by expelling an unwanted fetus and the right to demand the actual death of that fetus - a distinction that in fact was common in many of the “classic” ethics papers on abortion (Thomson, Warren, etc.). Most pro-choice activists were not opposed to that requirement in itself, but many were wary of the bills promoting it because - as noted above - virtually all legislation supported by anti-choice forces is actually crafted as a stalking horse for a complete repeal of women’s rights. That appears to have been the case in this bill, too.

The oddest thing about the post-viability bills that appeared at both the federal and state levels is that, like much anti-choice legislation, they did not simply state their goals and specify the means to achieve them. Instead, they insisted on introducing wholly unnecessary ideological language that seemed intended to lay the groundwork for a challenge to abortion rights in toto. The most egregious example of this was in the case of the federal “Unborn Victims of Crime” bill, which stipulated that the death of the fetus in an assault on a pregnant woman was to be charged as a separate crime of murder, and included language about “life beginning at conception”, in an obvious attempt to establish legal personhood for the fetus as an attack on abortion rights. Senator Dianne Feinstein offered an amendment that restated the exact terms of the original bill in every particular, with the exception of not defining the fetus as a separate victim with rights under the law. The right wing was beside itself in reaction to the Feinstein amendment - which, again, was precisely identical in effect to the bill they were originally pushing. They did everything to block it (and eventually prevailed by one vote), thereby demonstrating that their only concern was fetal personhood - which was the only thing Feinstein objected to - and not the putative substance of their own bill - which Feinstein endorsed in its entirety. This by itself gave good reason to beware any right-wing bills having to do with the treatment of the fetus. And the post-viability abortion bills were particularly suspect, because they contained even more explicit personhood language than that in the disingenuous, anti-choice fetal-murder bills. It would have been straightforward to simply declare that any fetus born alive should be given medical treatment, as Illinois law had already required for 20 years; instead, they went out of their way to stipulate that any fetus born alive after an abortion was to be considered a person under the law, and then require treatment for them by way of that unnecessary reason. There is obviously a hidden motivation for a law that both duplicates existing requirements and circumambulates its own objectives so deviously - and obviously, also, good reason to be suspicious of that law and its backers.

Obama’s specifically-stated objection to the version of the bill that was offered in Illinois was on those grounds - that he thought it was an attack on abortion rights, and that it appeared to contradict the protection of pregnant women’s rights in the pre-viability period as well. As with the fetal homicide bills, the post-viability bill only had the effect of introducing inflammatory language into an issue that could be, and in this case already had been, easily settled under the law. Obama thus opposed the bill the first two (of three) years it appeared before the IL State Senate (as did the Illinois State Medical Society). In the third year, there was an attempt to modify the bill to meet that objection (in which Obama was not alone), by revising the suspect section to match the similar federal bill, which had wide bipartisan support. And here, there seems to be some confusion about what happened, in part because the state legislature’s own Web site appears to be mistaken on the issue. Terence Jeffrey has a helpful, and refreshingly honest, post at Townhall in which he explains the confusion. Many people have claimed, using the Web site as their source, that Obama used his position as committee chair to pigeonhole the amended bill. But Jeffrey quotes Republican Senators saying their records show the bill did in fact come out of committee, where Obama then voted against it and it failed to pass. I have not found a statement from Obama explicitly addressing his reasons for the vote against the bill in its third, revised, form. The votes against the first two, with their explicit personhood language and ambiguous timeline, are easy to understand. Why Obama voted against it the third time I don’t know, but there were clearly reasons to be suspicious of the bill, and he was with the majority in opposing it.

Those who object to Obama’s actions toward that bill ought to explain why the existing law requiring treatment for viable fetuses had to be superseded by language about personhood. They should also explain what difference in medical practice this bill would have caused, given that the treatment it stipulates is already required under the law. And they should explain if they believe that the state medical societies, civil rights groups, and the majority of the state legislature who also opposed the bill are all as “extreme” as Obama is claimed to be. From here, it looks as if his actions (a) defeated a covert attack on abortion rights, (b) protected the factual and moral definition of personhood from irrational abuse, and (c) left intact an existing provision of law requiring treatment for living infants, identical in effect to that nominally sought by this law’s supporters. Hardly sounds “extreme” to me.

Regarding Obama’s “extreme” support for his daughter, in the interests of brevity I merely refer to to my man Brooklynite’s post on that very topic; he said much what I would say, though I want to emphasize that the fact that not ruining women’s lives - let alone your own daughter’s - with forced pregnancy should be regarded as “extreme” speaks volumes about Gerson’s, and the right’s, heartless indifference to anything in any way relating to women’s lives and autonomy.

And this is just the weird stuff. Again and again, Obama’s “extreme” positions amount to nothing more than regarding women’s autonomy - not to say health and safety - as important. If feminism is the proposition that women are neither prostitutes nor doormats, Gerson tells us what “extreme” feminism is: the proposition that women should neither die nor suffer for being sexually autonomous. That as much as anything tells us what Gerson and his contsituency are about, and what is at stake (yet again) in this election.

The rest is just a farrago of lies and distortions, many of them so old that ignorance of the truth cannot be an excuse.

Perhaps [Gerson’s inaccurate diagnosis of changes in attitudes toward abortion] reflects the continuing revolution of ultrasound technology — what might be called the “Juno” effect. In the delightful movie by that name, the protagonist, a pregnant teen seeking an abortion, is confronted by a classmate who informs her that the unborn child already has fingernails — which causes second thoughts. A worthless part of its mother’s body — a clump of protoplasmic rubbish — doesn’t have fingernails.

The anti-choice platform in a nutshell: emotional manipulation through irrelevant images and pseudo-scientific factoids, and the imputation of wholly imaginary arguments to pro-choice positions they clearly don’t understand (I can’t count how many times I’ve heard “worthless clump of cells” or the like from anti-choicers who think they’re offering an unanswerable sneer at the heart of the pro-choice stance, but I can count how many times I’ve heard it from serious, informed pro-choice proponents: zero).

Democrats of a past generation — the generation of Hubert Humphrey and Martin Luther King Jr. — spoke about building a beloved community that cared especially for the elderly, the weak, the disadvantaged and the young.

Sounds like a good idea - why don’t you ask Obama about it:

• Provide Americans with disabilities with . . . educational opportunities
• End discrimination and promote equal opportunity
• Increase the employment rate of workers with disabilities
• Support independent, community-based living for Americans with disabilities
• Provide a Living Wage
• Expand the Earned Income Tax Credit
• Expand Paid Sick Days
• Expand the Family and Medical Leave Act
• Encourage States to Adopt Paid Leave
• Expand High-Quality Afterschool Opportunities
• Expand the Child and Dependent Care Tax Credit
• Protect Against Caregiver Discrimination
• Expand Flexible Work Arrangements
• Expand Early Childhood Education
• Reform and Fund No Child Left Behind
• Make College More Affordable
• Provide Universal Health Care and Lower Health Costs
• Create a Universal Mortgage Credit
• Support Parents with Young Children
• Create Automatic Workplace Pensions
• Expand Retirement Savings Incentives for Working Families
• Prevent Age Discrimination
• Provide Cheaper Prescription Drugs
• Protect and Strengthen Medicare
• Provide Transparency to Medicare Prescription Drug Plans
• Strengthen Long-Term Care Options
• Ensure Heating Assistance
• Support Senior Volunteer Efforts
• and on, and on, and on . . .

For Gerson, and the rest of the anti-choice horde, “community” has nothing to do with the disabled, the elderly, the young, or the disadvantaged. It specifically doesn’t include women at all. “Family” means nothing more than patriarchy and forced pregnancy - it also doesn’t include women, and the process of bearing children does not include women in any capacity other than as vessels and incubators, surely not as decisionmakers or interested moral persons in their own right. And naturally, whether a candidate is committed to “community” or the public welfare consists only and entirely of whether that candidate is committed to stripping women of their control of their own bodies, and forcing them - including the candidate’s own 9-year-old daughter - the undergo unwanted pregnancies against their will. (Remember when Dan Quayle showed a weak moment of almost-human affection, and stated that if his teenage daughter became pregnant he would “support her on whatever decision she made” - and then was forced to recant by his own wife, and insist they would force the 13-year-old girl to carry the pregnancy to term, less than 24 hours later?)

But who is a part of Gerson’s “community”?

The advance of pro-choice policies imported a different ideology into the Democratic Party — the absolute triumph of individualism. The rights and choices of adults have become paramount, even at the expense of other, voiceless members of the community.

Fetuses.

And here again, anti-choice misogyny in a nutshell. Only an anti-choicer can sneer that contemptuously at “the rights and choices of adults”, like that was some sort of suspect moral category. But undeveloped fetuses are now “members of the community”. And his confusion about his own creepy anti-person stance is similarly evident: whatever you may think about abortion rights, it has nothing to do with “individualism” vs. “the community”. This is merely another wrongheaded meme, very much akin to the shibboleth “relativism”, which right-wingers inject to make themselves sound sophisticated when talking rot about other people’s moral interests.

Rights and personhood begin with, and inhere in, the individual. There is nowhere else for them to do so. Even the strongest traditional defense of self-denial in favor of group survival - contract theory - is grounded entirely in the notion of rights adhering in the individual. (There was a reason - which I’m sure Gerson, the Bush speechwriter who coined the phrase “axis of evil”, could never explain no matter how much babbling you were willing to endure - that Hobbes’s masterly elucidation of contract theory was named Leviathan. That word was Hobbes’s name for the aggregative power of the king, deriving from the personal sovereignty of each and every individual citizen independently - because there was no other source of such power. His commissioned frontispiece for the work - a drawing of a king, regnant over all the land, urban, rural, and ecclesiastical, whose body was composed of thousands of tiny figures of individuals from all walks of life, but with a single head - illustrates it beautifully.) There is a recent body of work re-asserting “communitarianism” as a locus of rights, but it isn’t well worked out and it has very little to do with the abortion debate. Whether abortion is or isn’t justifiable has nothing to do with communitarianism, another concept I’m sure Gerson couldn’t explain (since it’s proponents largely can’t, either). Abortion is not an attack on the community, and asserting community interests has nothing to do with denying women’s interests in their own bodies. (Thomson’s famous defense of abortion rights even assuming the fetus is a person works just as well if you assume communitarianism, too; simply acknowledging competing interests - of the fetus, or of the community - does not lead to the conclusion that women’s interests in themselves are impotent.) And Gerson himself offers no community-based attack on women’s autonomy; he merely asserts the personhood of the fetus, once again setting women’s interests at nought in favor of his particular moral fetish-object.

Gerson clearly has no idea what he’s talking about, and seems incapable of making an argument on the issues at hand. He merely identifies aspects of Obama’s outlook that don’t sit well with him, and labels them “extremist”. Aside from personal values or moral positions, he’s willing to do so with statistical facts as well.

Obama could take the wise counsel of evangelical Democrats such as Amy Sullivan and come out strongly for policies that would reduce the number of abortions — support for pregnant women, abstinence education, the responsible promotion of birth control. An organization called Democrats for Life has proposed the creation of a “95-10 Initiative” in which states and the federal government would work toward the reduction of abortion rates by 95 percent within 10 years.

Please. After enduring years of heckling by moral buffoons like Gerson and Alan Keyes, the last thing Obama - or anyone - needs is a dose of Amy Sullivan. But, besides that, Gerson here again seems to have no idea about, and no interest in, what he’s actually saying. He’s merely mouthing disingenuous anti-choice tropes with an implication that anyone who doesn’t acquiesce in his false or misleading claims is “extremist”. But the policies he claims to support are either ones that reasonable people have been clamoring for against Republican opposition - prenatal care and birth control - and that Obama explicitly endorses and has detailed plans for, or nonsensical frauds that are worse than doing nothing at all (like abstinence education, which actually increases the rate of STIs and unwanted pregnancies among teenagers, and has been used as an excuse to block AIDS prevention campaigns in Africa). The idiotic “95-10″ plan seriously intends to reduce 95% of abortions? How? By reducing 95% of unwanted pregnancies? Since almost no birth-control methods have >95% effectiveness in use, and the people who are promoting this “Initiative” are the same clowns who oppose birth control, it’s obvious that’s not what they have in mind. (The organization Gerson touts admits they are not in agreement on any pro-contraception program - “because of ethical, religious or personal reasons” - and have not endorsed any bill in Congress to promote it.) That leaves blocking abortion outright as the only path available. They do talk about providing support for women who want to carry a pregnancy to term and “feel that abortion is their only option” for financial reasons, but there’s no evidence how large a part of the abortion rate that is (just getting an abortion is hard enough in most of the country that hundreds of thousands of women seeking them are forced into childbirth they cannot afford; being “forced” into abortion to avoid that fate is hardly the problem). And of course the group offers no support for women who are determined not to become unwilling parents, and who face financial or other barriers to the abortions they want: like all “pro-life” organizations, Democrats for Life is supportive of women’s choices only when they are the choices the organization has already decided they should make.

This bullshit makes me tired. Gerson is a typical anti-choice hack: self-contradictory, ignorant, and deeply anti-woman. The positions he declares are “extreme” are no more than acknowledging that women have some interest in controlling their own fates. The positions he favors are either, paradoxically, ones Obama has not only endorsed but planned for in detail, which Gerson has no knowledge of, or counterproductive and cynically manipulative. He repeats long-since falsified myths and anti-choice campfire stories, slings around philosophical terms he has no comprehension of, and attempts to package it all as some sort of common-sensical stance against an “extremism” that he invented and inflated with his own hot air.

College women are specifically targeted by these charlatans - sometimes with official support from the colleges themselves. Shockingly, not only does Georgetown University - a Catholic school - refuse to provide any form of contraception or abortion referral through its campus healthcare center or hospital, they apparently have also been blanketing the campus with anti-abortion stickers whose only pregnancy-care referral number is to a CPC, not a real health clinic. (Full disclosure: I have an MA from GU, from the early 90s, and their behavior in this regard was even more reprehensible then.) UNC Chapel Hill students have had to create their own sex-ed programs for fellow students, who mostly come from local high schools with “abstinence only” programs and literally don’t know anything about reproductive health, and then are targeted for lurid propaganda by a CPC located just off campus. Students at other schools have had to do the same.

CPCs are a threat to the larger patient population as well. Vicki Saporta of the National Abortion Federation documents many of the problems they represent, including their deceptive tactics, medical fraud, and the support they receive from the anti-choice right (including over $30 million in taxpayers’ money from the Bush administration, and more from state legislatures). Allyson Kirk reports her experience with a CPC that had deliberately located itself along the entranceway to a real health clinic; after receiving an appointment at the real clinic, she mistakenly entered the wrong door, deliberately made up to look like a pro-choice facility, and was treated as if she was the expected patient, then subjected to invasive questioning and fraudulent misinformation.

This kind of behavior would be criminal in a real health clinic. CPCs present themselves in a deliberately fraudulent manner, impersonating real clinics with trained personnel (almost invariably, nobody at a CPC is a licensed healthcare practitioner) offering appropriate healthcare services, for the deliberate purpose of manipulating patients’ decisions and foreclosing their options; they then defend themselves legally by denying that they are subject to the professional obligations of real healthcare providers. The more this is known, and the more their tactics are exposed, the safer women will be.

I don’t usually write link-only posts, but this is worthwhile and the stories some contributors have to share are appalling. Go take a look.

As most people will be aware, the right wing has been Swift-boating Barack Obama for the past few weeks over controversial statements made at various times over several decades by the pastor of the black-identified Baptist church Obama attends in Chicago. Yeserday Obama responded with a speech on the history and role of race and racial discrimination in America - a speech that will stand within the highest ranks of American political oratory, and, I am convinced, be seen in the future as the watershed moment in race relations in this country (certainly so if Obama wins the presidency; likely so even if he does not). There is almost nothing in the speech about healthcare, and only a little about the particular statements of the Rev. Jeremiah Wright that the right wing has picked out to whip up into controversy. Rightly, Obama placed the entire controversy in the larger context of racial history; many conservative commentators, angry at seeing their manufactured controversy dismissed in favor of more important and more substantive issues, responded with criticisms that Obama did not explicitly repudiate Wright and specific statements he had made, as they had demanded. Michael Gerson, in particular, focuses on Wright’s endorsement of the far-fetched conspiracy theory about AIDS that has been circulating in the black community.

Obama’s excellent and important speech on race in America did little to address his strange tolerance for the anti-Americanism of his spiritual mentor.

Take an issue that Obama did not specifically confront yesterday. In a 2003 sermon, Wright claimed, “The government lied about inventing the HIV virus as a means of genocide against people of color.”

This accusation does not make Wright, as Obama would have it, an “occasionally fierce critic of American domestic and foreign policy.” It makes Wright a dangerous man. He has casually accused America of one of the most monstrous crimes in history, perpetrated by a conspiracy of medical Mengeles. If Wright believes what he said, he should urge the overthrow of the U.S. government, which he views as guilty of unspeakable evil. If I believed Wright were correct, I would join him in that cause.

But Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America. And his pastoral teaching may put lives at risk because the virus that causes AIDS spreads more readily in an atmosphere of denial, quack science and conspiracy theories.

Obama’s speech implied that these toxic views are somehow parallel to the stereotyping of black men by Obama’s grandmother, which Obama said made him “cringe” — both are the foibles of family. But while Grandma may have had some issues to work through, Wright is accusing the American government of trying to kill every member of a race. There is a difference.

Gerson regards holding such an opinion as beyond the pale - and anyone who would believe such things as deranged. (”This accusation . . . makes Wright a dangerous man. . . . Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America . . . .”) Gerson is obviously grossly ignorant of the history and substance of these rumors, and the historical context in which they arise. And - like other conservatives dismissive of blacks’ reactions to America’s racial history - he seems to have no sense of what that context means to the people it most closely affects.

First, as a look at the links given above will demonstrate the AIDS conspiracy Wright endorses did not originate with, and is not limited to, African-Americans. White conspiracy theorists have been throwing around wild rumors about HIV/AIDS and germ warfare for a long time, and have developed them into intricate and extensive - and often bizarre - criticisms of both the received history of the AIDS epidemic and the scientific grounding of HIV research. Peter Duesberg, the most infamous of this crowd, is white, and has solid scientific credentials (which is not to say he’s not crazy); it was Duesberg who advised Thabo Mbeki of South Africa, and lent credence to Mbeki’s crazed ravings, resulting in the destruction of that country’s public health system and uncountable deaths. Kary Mullis, also white and an infamous eccentric even before he won a Nobel Prize and went nuts, has likewise thrown his hat into that ring, lending still further credence to charges that are at best irrational and at worst irresponsibly dishonest or just crazy. Many of the other rumor-mongers are white as well.

So Jeremiah Wright is by no means acting alone in promoting such wild theories, nor are such theories evidence of “black nationalism” or “racial anger”. But they do have a particular resonance in the black-American community, and for reasons that make such beliefs, especially in that community, seem almost defensible.

The unconscionable history of abuse and mistreatment - by medical means among others - of black Americans makes it quite simply impossible to dismiss any further story of abuse as unlikely or unbelievable. The shocking reality of slavery alone - that an entire group of human beings would be degraded to subhuman status and treated as property, and not merely as such, but subject to unspeakable mistreatment and bodily abuse at the same time - would be unbelievable if it were not so mundanely true. After America did that to its own citizens, what else is not believable? What else is not possible? In the minds of very, very many black Americans, there is nothing they do not expect America could or will do to them - and on grounds of simple historical fact, they are far from wrong.

That suspicion and resentment find a distinct focus in the area of healthcare. The abuse of black Americans’ bodies by white America is a story that begins with slavery and extends to the modern day. In addition to the horrible abuses of slavery itself, the quasi-medical mistreatment of blacks it entailed stands as its own story. Black slaves were literally bred as stock, and their children sold out of their families, by slaveholders; they were systematically raped, openly, by their white oppressors for that purpose, as well as for simple pleasure. Their health was treated as an economic question - what care they got, and whether they got any, for their illnesses while in captivity was dependent upon its implications for their future profitable labor. In some parts of the South, it was simply cheaper to let slaves die of malaria (and replace them with slaves from more malaria-tolerant African sub-groups) than to treat them. But black slaves and ex-slaves played another role in American medical history.

Southern medical schools in the 19th century openly advertised for slaves or other black patients for students to practice on, and blacks were also often the source of cadavers for medical school dissections, and the subjects of medical experimentation, often against their will. Long before rumors of AIDS or other forms of medical mistreatment, there were long-standing fears in the black community of body-snatching and even vivisection in white medical schools. In some cases, ambitious doctors “borrowed” sickly slaves from white slaveholders, or or purchased them outright, for the purpose of performing experiments, usually (in keeping with the standards of the day) crude, unscientific, and painful or dangerous. James Marion Sims and his protege, Nathan Bozeman, perfected the surgical repair of vaginal fistula by performing a harrowing series of operations on black female slaves before the Civil War; some women underwent up to 30 operations before being cured. After developing a workable procedure on these slave women, Sims turned to operating on white women for profit for the rest of his career. (Ironically, today the procedure is used almost entirely on women of color, usually in the 3rd world, where the cause of these fistulas - tearing of the vagina in childbirth by teenage mothers - is concentrated.) Sims is today honored as “the father of gynecological surgery” with not one but two statues in New York City alone.

These practices continued into the 20th century. It is increasingly-widely known that many medical treatments, having been optimized on white male research populations, do not work as effectively on women and blacks. Again and again it has been shown that aggressive interventions - including basic procedures such as an immediate aspiring for suspected heart attack - are overlooked or under-prescribed for black patients (among other sub-groups). Blacks are vastly less likely to have health insurance in America, less likely to have insurance that covers their actual needs, and more likely to be denied coverage for recommended procedures. They are consistently more likely to remain undiagnosed for life-threatening illnesses, to remain untreated or undertreated for them, and to die of them, than white patients. And those are merely the everyday, systematic injustices that occur. The real scandals are even more shocking.

It has only recently been revealed that, after WWII, the US government conducted extensive experiments involving exposure of human subjects to dangerous levels of radiation, sometimes without their knowledge; almost all of the subjects were black. There have been many publicized scandals involving research on prison inmantes; what is often overlooked is that the subjects of those studies are not jsut prisoners but most often entirely or mainly black prisoners. Many white people today have heard of the infamous Tuskegee Syphilis Study; almost all adult blacks have heard (at least some form of) the story. To whites, the story seems disorienting, unbelievable - to blacks it is all too familiar. That story is illustrative here, in another way: among the black community, the already-horrible facts about the Syphilis Study are often exaggerated to make the story worse than was actually true. Instead of a program to monitor untreated syphilis among already-infected patients, it is widely believed by black Americans to have involved actually infecting healthy patients with the disease. Instead of a limited program that grew out of a well-intended public health effort (scaled back to passive monitoring when the Depression hit and funding dried up), it is often believed to have been a calculated and planned program of genocide. But the actual facts are staggering enough - and these exaggerations are logical extensions of what did in fact occur; in principle and in effect (if not in literal fact) they are not even exaggerations.

It is difficult for those who have not had experience in the area to understand the pervasiveness of distrust this history - particularly Tuskegee, but the rest of it as well - has engendered in the black community. Teaching healthcare ethics in inner-city colleges, I have never once had a class with more than a few black students in it in which it was not the case that at least some - usually almost all - of the black students had heard of the Tuskegee scandal; not one of my white students has ever known of it before entering the class. Working in a major university healthcare center in a majority-black city, I once discovered it was literally impossible to get any black patients to even answer a simple questionnaire or listen to explanatory information about advanced directives for healthcare (being approached on the subject by a white man in a white coat probably didn’t help). I heard more than one whisper to a companion, as I walked away, that this mechanism - the foremost tool for promoting patient autonomy and individual rights in healthcare - was a plot by whites to kill blacks by turning off their life support. To a person who does not share a familial or cultural history of abuse and mistreatment of the kind detailed above, these fears and obsessions seem almost crazy. Why is an entire cultural subgroup fixated upon one regrettable, but aberrational, scandal from decades ago? Why would they fear the system that, almost alone in modern society, still embodies a truly altruistic ethos and agonizes over its own failure to adequately serve its underserved client populations? How crazy do you have to be to think your doctor is trying to kill you?

Not crazy at all, if you’re black. It has been done. That is the bottom line - the inescapable truth that comes back again and again in any context which puts black Americans under the influence of the healthcare system. That system - particularly, and mostly, mainline medicine as practiced by white male physicians - has turned itself to the organized and systematic abuse of black patients and research subjects, not in one or a few isolated incidents, but again and again, in the most varied settings and through the most bizarre and abusive practices. It is not crazy - it does not even require any great stretch of the imagination - to think that medical doctors, or the government, would have created a disease to decimate the black population. They have allowed diseases to spread through that population while active working to prevent their cure. They have exposed blacks to diseases and toxic conditions, and invented birth control regimens marketed primarily to black populations, that had the effect of systematically diminishing, sterilizing, and to at least some degree eradicating black Americans as a group. They have connived at the importation of addictive drugs that have primarily affected the black community, in epidemic proportions. The Reagan administration did ignore AIDS for years, at a time when the most good could have been done to head off the eventual epidemic, out of its repugnance at the pimary victim populations of gays and non-whites.

If the government had actually anticipated that AIDS would particularly affect the black community, and stood aside to allow it to happen, that would be nothing more than an absolutely literal recreation of its behavior in regard to other diseases in the past. The step from there to the idea that the government might actually have created that disease is a small one, and hardly far-fetched in light of other things the government and medical researchers really have done. Now, it appears in fact that the US government did not invent AIDS, or deliberately encourage its spread through the black community - although they did stand by and watch for years as it happened in front of them. But with all this history behind, who would not suspect the government might have played an active, and not just a passive, role in creating the epidemic? If you were a member of a group condemned generation after generation to the kinds of treatment detailed above*, and then witnessed the history of AIDS - its prevalence closely tracked by government researchers who somehow could never quite find anything useful to offer as it destroyed the most vulnerable and downtrodden subgroups of American society - how could you not at least suspect that there was more to the story than met the eye? Given what actually has been done, time and again, generation by generation right up to the present, on what grounds can it be asserted that there is anything the government, or the medical community, might not do if they took it into their heads? What story possibly could be too far-fetched to believe in, given the range and number of seemingly unbelievable stories of medical abuse of blacks that are actually true, documented, and admitted?

Gerson, however - and I would guess at least 90% of white America - cannot grasp this. He really thinks it is unthinkable to imagine the things Jeremiah Wright imagines. In fact, he thinks such beliefs are so far gone that they - the beliefs themselves, and not the history that gives rise to them - are unAmerican:

[Believing that the US government created AIDS and unleashed it on black Americans] makes Wright a dangerous man. He has casually accused America of one of the most monstrous crimes in history, perpetrated by a conspiracy of medical Mengeles. If Wright believes what he said, he should urge the overthrow of the U.S. government, which he views as guilty of unspeakable evil.

This reaction is in a way darkly humorous. Gerson finds it literally unbelievable that black Americans would believe that America is guilty of “monstrous crimes . . . perpetrated by a conspiracy of medical Mengeles”, and of “unspeakable evil”. The joke is that, not only do many blacks believe the things he thinks are unbelievable, but those things are, in fact, true. Leaving aside the question of AIDS, what was the 40-year Tuskegee Study but “a conspiracy of medical Mengeles”? Does not the unending history of research abuses, disdain for autonomy or consent, torturous experiments on helpless slaves and prisoners, and systematic mistreatment and undertreatment of black patients constitute “unspeakable evil”? And even if the AIDS story were true, it pales, in timespan, prevalence, death toll, and sheer moral degeneracy, beside the 400 250-year history of chattel slavery, and 400 years of systematic oppression, that America openly and deliberately imposed on its black citizens. Is that not “one of the most monstrous crimes in history”? Since America, and its doctors, did in fact do all this and more, how is it unthinkable that it should have committed just one further such abuse, in the case of AIDS? That belief appears in fact to be mistaken, but in light of history it’s hardly irrational. And if Wright, knowing what he knows, and believing (mistakenly) what he believes, does not actually urge the overthrow of the US government, is it not at least understandable he should cry out to God to damn the government?

But Wright’s accusation is batty, reflecting a sputtering, incoherent hatred for America.

This is nonsense. Wright’s accusation is perfectly rational, although false. I have no idea whether Wright holds a “sputtering, incoherent hatred for America” (though he appears to me to be in no way incoherent). But the belief in the AIDS conspiracy reflects nothing more than the established historical facts of the syphilis conspiracy, the Holmesburg prison dermatology conspiracy, the Norplant (semi-)conspiracy, the nuclear radiation conspiracy, the conspiracy to promote research on slaves, the conspiracy to steal black bodies for medical school dissection, and many more over many years. The widespread black suspicion regarding the medical profession is grounded on facts Gerson has obviously never heard of. It is far more rational, and in content far more true, than Gerson’s offhanded dismissal of such suspicions as “batty”, false, or inexplicable.

Obama’s speech implied that these toxic views are somehow parallel to the stereotyping of black men by Obama’s grandmother, which Obama said made him “cringe” — both are the foibles of family. But while Grandma may have had some issues to work through, Wright is accusing the American government of trying to kill every member of a race. There is a difference.

Here I think Gerson is just suffering from the traditional Conservative Reading-Comprehension Disorder. Obama did not state any equivalence between the views of these parties - he said that he cannot eject either of them from his life for the same reason - that they are family. (And why would he? If he loves his grandmother in spite of her unconscious prejudices regarding blacks, why would he not love Wright in spite of his factual error regarding AIDS?) And again, as for Wright’s accusations about AIDS, he may be wrong but there is no ground for regarding those views as extremist, outrageous, or inexplicable. If Obama’s exposure to his grandmother’s unreconstructed ideas made him “cringe”, how could Wright’s knowledge of the very real history of medical abuse of US citizens not take the form of a much stronger reaction?

The fact that that reaction is forthcoming, and resonates so strongly, as I am sure it does, with so many black Americans, is a reflection not of their “hatred of America”, but of their acute awareness of America’s treatment of their families and others like them, and of their perception that that history has not fully run its course. In light of that history, the calls of oblivious whites for a “post-racist” or “colorblind” society are not just stupid, but morally offensive. Too many whites are like Gerson - simply uncomprehending that blacks can really believe that America would continue to treat them, today, the way America has always treated them in the past, right up to today. The first step in reconciling these two visions of America - a credulous vision of universal beneficence maintained by exhaustive ignorance of black history, and a corrosively suspicious vision grounded on pervasive historical reality - is to wake whites up to the historical grounds for, and justification for, black grievance and suspicion. That grounding of historical fact goes far beyond slavery and Jim Crow (as if those weren’t proof enough of the darkest suspicions imaginable); it is a factor of literally every generation, every family, in some way every life that makes up the black community in the United States down through the years, and it invades every aspect of such lives, including, shamefully and grievously, their encounters with the “healing professions”.

Obama - with perhaps too much sense of balance - brought forth the tiniest, least threatening glimpse of that history in his speech, and put it in the context of white grievances over “reverse discrimination”. (Talk about inappropriate parallels!) Even that was obviously too much for Gerson and whites like him. It spun his head, boggled him with aromas of “sputtering, incoherent hatred”. Until that reality sinks in with all its awful force - clearly too much for defensive whites to grapple with even at this date - Obama, and we all, may be doomed to continue living out that cancerous, Faulknerian past that is not past, within sight but not within grasp of what might have been.

UPDATE: As others have noted, slavery did not persist for 400 years in America; it is generally agreed that the first known slave was brought to the colonies in 1619, and slavery ended with the end of the Civil War in 1865, not quite 250 years later. It has been almost 400 years that black Americans have lived as the de facto, and for most of that time de jure, underclass. The description in the text above elided the distinction between the two; it has been corrected.

UPDATE: As Tgirsch notes in comments, Obama’s church is not affiliated with the Baptists. 
* And much, much more. A heartbreaking, infuriating, but very necessary review of the medical mistreatment of black Americans can be found in the indispensable volume Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, by Harriet Washington. As Washington herself notes, its 400+ pages only skim the surface of experimental abuse of blacks, and leave therapeutic mistreatment almost untouched. This legacy is truly evil, and poisonous in ways that can only be dimly sketched.

The most entrenched redoubt of medical power (though least well-grounded in research and knowledge) was psychiatry. Not only did the head-shrinkers lay claim to the most occult knowledge of human functioning and health, but they stood against a patient population that was inherently and societally almost unable to defend itself. Members of, possibly, the most severely and unsympathetically stigmatized stratum of society, mental patients were given no credence, and often had no recognized legal standing, to assert their own values and choices in treatment. And it is true that in many cases, patients with mental illness could not in fact act for their own interests or competently manage their own treatment and caretaking. But the presumption that no such patient could have a valid opinion about their own care, coupled with the prejudice that they were unfit for “normal” society, and likely dangerous, meant that virtually anything could be done to anyone, if advocated by a doctor armed with a diagnosis of mental illness. The things that were done were in many cases almost unthinkable.

Howard Dully spent over 40 years thinking about what was done to him. It took him a full life of hardship and failure to finally understand his own fate, and to come to terms with it. That anyone could have survived, let alone found peace and stability, after having lived his story, is an amazement in itself.

Dully is the author (with a professional co-writer) of My Lobotomy: A Memoir. The subject of the book is exactly what the title suggests. The story it contains is heartbreaking.

Dully’s life is difficult to summarize, except to say that it was unremittingly harsh almost from birth. Dully was born in California in 1948; his father was a hard and unemotional man who was driven to work excruciating hours, sometimes at as many as 4 or 5 low-skill physical labor jobs at the same time, partly by the need to support his family, partly by his own obsessive work ethic. Howard grew up a big kid (he’s now 6′7″, 350 lbs) who picked on his younger brother; when he was 4 his mother died after giving birth to a baby brother with a severe neurological deformation - the baby was placed with relatives and never spoken of again within the family. Howard and his family bounced around various friends’ and relatives’ homes as his father struggled to earn a living, and Howard suffered constantly both from missing his mother and from the severe discipline he suffered in some of these homes. Things really got bad when his father married again, to a woman with two sons of her own. Dully claims that she simply resented and hated him; from reading both his own stories of his home life, and some of his doctors’ notes, it is easy to believe he is correct. Howard, in the meantime, was legitimately a handful for any parent: he was apparently flightly and unreliable to an extreme degree, was aversive to school work, discipline, and hygiene, and often fought with his brothers, though they had a generally good relationship. As he got older he began doing stupid kid pranks - shoplifting and stealing items from cars, and playing hooky. As a huge and growing boy, he was constantly hungry, but was not allowed to eat between meals and was beaten for taking snacks. His step-mother also had some sort of obsession with her furniture and household trinkets, and would beat Howard for touching anything in the house, sitting on the parlor furniture, or using the front door. His step-mother would beat him for any infraction, and for things that weren’t infractions; later his brothers confirmed that she did indeed beat him for things she did not mind when done by her own sons, and would rave at him for no reason at all. When his father got home, he would get another beating - his father made him choose a piece of firewood to be beaten with, and Howard developed the skill of picking ones that were flexible enough to hurt less but strong enough not to break (which would encourage his father to continue the beating with his bare hand). Between his actual behavioral problems, his pre-adolescent awkwardness, the fact that his step-mother did seem to truly want him dead, and his father’s absence and emotionally and physically violent treatment, Howard seemed doomed to a life of misery no matter what might have happened. What actually did happen is unbelievable.

Howard’s step-mother apparently conceived the idea that she could get rid of Howard if she got the weight of professional opinion on her side. She began visiting a series of psychiatrists to complain about her son’s behavior, but none of them would agree he had to be institutionalized or removed from the home. Several wrote consulting notes to the effect that they were convinced her harsh treatment was the problem and that she should moderate her behavior toward the boy. She moved from doctor to doctor trying to find one that would agree with her. Finally she stumbled onto Dr. Walter Freeman.

Freeman was the pioneer, in the US, of the new treatment of psycho-surgery. He actually coined the word “lobotomy”, and popularized the use of that treatment in this country. He was the first US physician to see the procedure, after it was developed in Europe just before WWII; Freeman brought it back to the States and traveled the country in specially-modified vans or station wagons that he called his “Lobotomobiles”, giving demonstrations of both electro-convulsive therapy (using a machine he built himself; when it broke down, he simply held the bare wires against the patient’s head for as long as he felt was appropriate, with no mechanism for monitoring voltage or current) and lobotomy. According to the Dully, relating reports of academic researchers who studied Freeman’s career, Freeman was a constant self-promoter and showman: he would perform several lobotomies in a day, every day, in front of medical audiences, liked to demonstrate how easy it was by sometimes using ordinary household implements rather than surgical tools, and developed a signature two-handed bilateral technique in which he would insert “leucotomes” (the lobtomy knife) into both lobes of a patient’s brain and then simultaneously jerk them both through the tissue with a flourish. At times, his death rate ranged upward of 20%. Nobody seemed to think this was cause for alarm. Patients were operated on without their own knowledge or consent, and authorization was freely obtained from courts or patient guardians after reassurances from Freeman that the procedure would solve all the patients’ problems. Often, no precise psychiatric diagnosis was attempted before the lobotomy was performed; lobotomies were used for conditions ranging from headaches to schizophrenia. More than a few were performed on minors, even pre-teens; there were questions about such cases, but little organized opposition. Freeman was profiled in popular magazines, and sometimes hailed as a god, delivering sufferers from their misery. There were many detractors in the medical community, but the great benefit of lobotomy was that it often made patients docile enough to live with their families without monitoring, meaning they could be discharged from the large state mental institutions that were commonplace then. This made the procedure wildly popular with the managers of those institutions, whose patients had no effective representation to oppose the treatment plans made for them by others.

After a few years, Freeman heard about, and again pioneered, a variation of the lobotomy procedure called “trans-orbital lobotomy”, often referred to as “ice-pick lobotomy”. In that procedure, a long, sharp, thin instrument was pushed along the eyeball parallel to the nose, and through the back of the eye socket (”orbit”) into the skull, and into the frontal lobe of the brain. The instrument could then be levered back and forth, and up and down, to tear through the frontal lobes and disrupt their neural circuitry. There was no method for visualizing the exact placement of the instrument in the brain, or the location, depth, or extent of the lesions created; the method was simply to stick the metal rod in through the eye socket and wiggle it back and forth to tear the brain tissue randomly. The effect was almost as dramatic as an open-skull lobotomy, but there was no external wound, and it could be performed under mild anaesthesia. The procedure could be done in an ordinary doctor’s office, and took about ten minutes. In many cases, the surgical instrument used was, in fact, an ice pick. (Freeman’s personal lobotomy instrument was labled “Uline Ice Company”.) Patients were sometimes sent home afterward in a taxi cab.

Freeman began popularizing the trans-orbital lobotomy, sometimes performing as many as two dozen procedures a day on patients in mental institutions and hospitals. In some cases, patients were operated on against their consent; after the procedure, they lacked the drive and wherewithal to sue. After some years traveling the country in his Lobotomobile, he finally settled in the South San Francisco Bay Area, near where Howard Dully’s family were living. Eventually, Dully’s step-mother asked to see him.

Freeman met with her a number of times over a period of two months, duly recording her wild stories of Howard’s unmanageable behavior (some of which later turned out to be pure fabrications - such as the story that he had beaten his brain-damaged baby brother almost to death). From the beginning the step-mother openly solicited some kind of dramatic professional intervention. Freeman hesitated at first, insisting he would have to meet the patient and interview the other family members before coming to any conclusion. (What seems incredible is that he began formulating treatment plans with the mother for weeks before ever once meeting Howard.) He interviewed Howard’s father one time; the father gave a much more balanced report of Howard’s behavior, but Freeman didn’t pick up on the clue. He began to meet with Howard himself, and found him reasonably normal though somewhat uncommunicative (who wouldn’t be?). But he kept meeting with Howard’s step-mother, who still filled him with tales of how afraid she was of Howard, how her other sons were afraid of him and were constantly beaten up by him (they deny this), and finally how Howard had beaten up his baby brother in infancy (his entire family denies this - and note that the step-mother was not part of the family at that time). Freeman seems to have accepted everything she said, and viewed Howard’s truancy and other bad behavior through this fictionalized and delusional lens. After four meetings with the step-mother, only one meeting (ever) with Howard’s father, and four visits with Howard himself, Freeman recommended that they should attempt to “change his personality” with a trans-orbital lobotomy. Howard’s step-mother immediately agreed, and took the papers home for his father to sign, which he did without ever speaking to the doctor again. Freeman cautioned the parents not to tell Howard what would happen - only that he would be admitted to the hospital for “tests”. Howard excitedly looked forward to his night in the hospital, because he had heard they gave you Jell-O there. And they did. It was two weeks after his 12th birthday.

Freeman lobotomized Howard the next day. Howard has no memory of any of the events of that day. He contracted a fever and an apparent infection (Freeman was infamous for not sterilizing his instruments before surgery; you can see, in the actual photograph of Howard’s procedure, [see photo at end, below the jump] that he is not wearing gloves), but recovered soon enough.

The rest of his life was a disaster.

To make a long story short, the lobotomy did not placate Howard’s step-mother. She continued to persecute him, and to complain to Dr. Freeman about Howard’s behavior. Freeman claimed that Howard was improved after the surgery. His step-mother began demanding that he leave the house - at the age of 12 - and so he was sent around to a variety of relatives and foster-home settings. He found one family he liked, and who doted on him, but who were very religious. His father objected to their religion, and took him from the home. He continued to get into trouble at school, and was eventually sent to a lo