Personal Autonomy – Page 19

Recognizing Reality

The Supreme Court has finally stepped in to say “enough” to the oh-so-clever politicians trying to mask their disdain for women’s autonomy by pretending a concern for women’s health.

The Texas law that triggered the lawsuit was one of a number of similar efforts to cloak anti-choice measures in excessive and onerous “medical” regulations. It required doctors performing abortions to have admitting privileges at nearby hospitals, and imposed a number of physical requirements on clinics, making them meet the standards of ambulatory surgical centers.

Although Texas argued that the measures were aimed at protecting women’s health, Rick Perry was among the political figures who were more forthright about the law’s actual motive, describing it as one step toward an “ideal world” in which there would be no abortion.

Motive aside, as Justice Breyer wrote for the majority, neither of the provisions imposed by Texas “offers medical benefits sufficient to justify the burdens upon access that each imposes.” Justice Ginsberg was more blunt, noting that “It is beyond rational belief” that those provisions actually protected women’s health.

As numerous medical experts have pointed out, abortion is one of the safest of medical procedures. (Colonoscopies and tonsillectomies are riskier, but political figures expressing concern about those operations are non-existent.)

What participants in the ongoing battles over reproductive choice, same-sex marriage, and other “culture war” issues that roil American public debate miss is the actual legal question at the heart of these conflicts. The issue is not whether a woman should terminate a pregnancy or carry it to term; the question is: who should decide what she should do?

Too many Americans fail to understand the purpose of the Bill of Rights, which was to protect individual autonomy—a person’s right to self-government—against government infringement. The Bill of Rights, as I tell my students, is a list of things that government is prohibited from doing. Government cannot tell you what to say, or what to believe, no matter how ugly your speech or deluded your belief. Government cannot tell you whether or how to pray, who to marry, how many children to have, or what career to follow.

Government can’t do these things even if a majority of its citizens wants it to. Just as your neighbors cannot vote to make you an Episcopalian or a Baptist, popular majorities cannot use government to restrict the individual liberties protected by the Bill of Rights.

In short, government cannot tell you how to live your life—how to make what the Court has called your most “intimate decisions.” The rest of us don’t have to agree with the decisions you make, but you get to make them.

The Texas law was one of several transparent efforts by lawmakers trying to do an “end run” around a woman’s right to make decisions with which they disagree.

Fortunately, the Court saw through the dishonesty of that effort.

Comments

Killing for Life…

Well, evidently, failed Presidential contender Ted Cruz had a “pro life” adviser who wants to execute abortion providers. (“Pro life” folks like these always remind me of that Cold War-era Second City skit: “Kill a Commie for Christ.”)

Abortion is a very thorny issue. Unlike so much of the culture war agenda, there is a genuine argument to be made by those who see abortion as equivalent to murder. They tend to start from very different premises than those of us who defend a woman’s right to control her own autonomy–they see a human being from the moment of conception, and believe that the interests of that potential human should be given priority over the rights of the woman who is carrying it.

Pro-choice defenders have many responses to that viewpoint, both moral and practical, but we can–and mostly do– respect the legitimacy of that perspective, and the sincerity of many people who hold it.

Unfortunately for the conduct of the “abortion wars,” however, the loudest voices claiming the “pro-life” label are anything but legitimately pro-life. Their ranks are filled with fundamentalist culture warriors fanatically opposed both to women’s autonomy and to our equality. Their concern for “life” rather pointedly excludes the life of the woman, and it extends to the fetus only until it is born. These are the dishonest “filmmakers” who doctor surreptitious videos, the “pro life” legislators unwilling to spend money to feed or house or properly educate poor children once they are born, the opponents of birth control…Well, you all know the drill.

But the worst of the worst are the men (and they’re almost always men) who advocate killing in the service of “life.” The men who murder abortion doctors, the political opportunists who argue that women should carry their rapist’s baby to term, the un-self-aware pontificators who advocate prison or even execution for those who help desperate women avoid back-alley abortions.

Let’s get real.

As my friends in Planned Parenthood point out, women didn’t start getting abortions after Roe v. Wade. They just stopped dying from them. But theirs are clearly not the lives that matter to the sanctimonious “pro life” culture warriors like Cruz and his “advisor.”

There’s a reason that so many observers considered Ted Cruz even more dangerous than Donald Trump. Although–as Lindsay Graham memorably put it–choosing between the two of them would be like choosing between death by gun or by poison….

Comments

Right to Die

Those of us who listen to public radio are familiar with Diane Rehm, the raspy-voiced hostess of a respected public affairs program. Recently–in the wake of her husband’s terminal illness–Rehm has become a spokesperson for an individual’s right to decide how and when he will die.

Rehm said she decided to write the book because she was frustrated by the way her husband died.

“People need to talk about this issue,” she said. “Doctors need to be taught about this issue. The whole idea of doctors being taught about helping to keep people alive, but not being taught how to listen to those who are ready to die — that seems to me sad and misguided.”

One doctor who has come to agree with Rehm is my cousin, Morton Tavel, a cardiologist whom I often quote on this blog. He recently analyzed the issue thusly:

As a physician, I originally supported the dictum that death should be prevented at all costs. But more recently, I have come to realize that perhaps we should also consider suffering as well as dying.

These thoughts have directed my attention to the so-called “aid in dying” laws that are in force in the U.S. states of Oregon, Washington, Montana, Vermont, and California. They are sometimes referred to as “Physician-Assisted Suicide”. These examples often require that a patient’s death be expected within six months, and they compassionately offer a voluntary, self administered end to suffering at an individual’s own preferred time. Since 2014, aid-in-dying bills have been introduced in Washington, D.C. and several states. Canada is also considering such a bill. Other countries, including Switzerland and Belgium, allow aid in dying for people who are not even terminally ill. All these laws provide freedom for a physician to prescribe a lethal drug to a patient for self administration. At present, such a practice is unlawful in 46 states, including Indiana..

In the example of Oregon, which has had such a law in effect since 1997, subsequent study has uncovered no abuses, and, interestingly, about a third of patients who receive medication to end their lives never actually use it, meaning that many are likely reassured by the simple knowledge that they will be able to end their lives at any time of their choosing.

What people want, often, is knowledge that they can control their own lives and deaths.

Tavel recognizes the potential for abuse, and the need to ensure that people do not terminate their lives because they are depressed, or in pain that could be alleviated with proper medical intervention, but he insists that such issues can be addressed.

Laws addressing such issues should be clearly defined. First, I believe a specific time for life expectancy need not be spelled out, for misery without hope doesn’t necessarily conform to a distinct number of days or months. For instance, someone suffering from a severe progressive neurologic disease such as Lou Gehrig’s disease (ALS) can continue suffering for many months prior to death. On a personal level, I witnessed the suffering and death of a patient/friend of mine from a similar neurologic disorder called progressive supranuclear palsy (PSP), a disease that claimed the life of actor Dudley Moore, which is an uncommon progressive fatal brain disorder that affects movement, control of walking (gait), balance, speech, and many others.Given the choice, and if it were legal, he would have gladly opted to end his life by assisted suicide. Even various terminal cancers can behave for variable durations, but also cause prolonged pain and suffering.

In Oregon, for example,the attending physician and a consulting physician have to confirm the patient’s diagnosis and prognosis and determine whether the patient is capable of making and communicating health care decisions for him/herself. If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder (such as depression), the patient must be referred for a psychological examination.

If this and the other safeguards of the Oregon law are satisfied, the prescription may be written.

In most cases, the drug used for this purpose belongs to a group of so-called “barbiturates”, commonly used in lower doses for the induction of normal sleep. In large doses, however, death is painless, peaceful, and will occur within a matter of minutes to hours.

A death in this fashion is usually far better than other, less desirable, alternatives. Thus I might conclude with a simple question: Isn’t it more humane to deal with one’s own species in a manner at least as appropriate as the smooth and painless exit we provide to our beloved animal pets?

What is the justification for over-riding individual autonomy, and insisting that a terminally-ill person suffer?

Comments

Your Religion, My Body–Happy Mother’s Day

It’s Mother’s Day–an appropriate time to think about human reproduction.

So…let me suggest a science fiction scenario.

We’re 25 years into the future. In reaction to massive population growth, NoNo, a religion encouraging ritual sterilization, has become the majority religion in the U.S. Practitioners believe (sincerely and devoutly) that God wants humans to avoid reproduction. (This religion’s conception of Diety is noncommittal on sex–it’s just making babies She is discouraging.)

As this religious community has grown, it has come to control the majority of the nation’s hospitals; well over 60% of them have become part of a national network of medical facilities run by and faithful to NoNo principles.

Our protagonist is not a NoNo, but she lives in a small town with only one hospital, and it is part of the NoNo network. She suddenly becomes ill. She is taken to the hospital in her area, where she is diagnosed with a treatable condition that will require minor surgery–and she’s told that, according to the tenets of NoNo, she will also be sterilized during the procedure. She objects–she’s only twenty, has never had children and desperately wants to be a mother–but her objections are deemed irrelevant. She is deprived of her control over her own body and any chance of having biological children.

Far fetched? Not if you switch the text.

The California Medical Association is seeking to join the ACLU of Northern California in its lawsuit against a Catholic hospital system over one of its facilities’ refusal on religious grounds to allow a doctor to perform a tubal ligation after a planned Cesarean section….

The suit stems from a case at Mercy Medical Center in Redding, one of Dignity Health’s 29 hospitals across the state. Mercy Medical says its refusal to perform the procedure was based on the Ethical and Religious Directives for Catholic Health Care Services, written by the U.S. Conference of Catholic Bishops. The Directives – followed by all of California’s 35 Catholic hospitals – prohibit birth control, abortion and, in most cases, sterilization.

The California Medical Association says hospitals should make decisions that are medically appropriate–and should not make medical decisions that are contrary to best practices for reasons of religious dogma, especially when the patient does not accept that dogma.

Civil libertarians–in this case, the ACLU–say individuals should not have to cede control over their bodies and beliefs in order to receive medical care.

Over the past quarter-century or so, Catholic hospitals have assumed control of a significant percentage of the nation’s hospitals. What the courts need to decide is whether the merger of these hospitals entitles the Church to dictate medical decisions that would at best be considered “non-standard” or at worse would constitute malpractice.

Because God.

Suddenly, my “science fiction” scenario doesn’t look so far-fetched. As I’ve said before–a government with the power to prohibit abortion (or birth control) is a government with the power to require it. As a friend used to put it, poison gas is a great weapon until the wind shifts.

Unless the courts rule otherwise, hospitals with a monopoly on medical care can impose their own rules. Based upon their religious beliefs. No matter which way medical science’s winds blow.

Comments

Losing the Wedge

Oh Ted! I hate to break it to you, but tapping a female culture warrior as your VP–even one who manages to be nearly as repulsive as you– isn’t going to get you the nomination.

Not even close.

There have been a number of signs during this unending primary season that the GOP’s “old reliable” tactic of focusing on social issues is no longer the sure-fire bet it was when George W. Bush won his second term with the help of fear of/hate for “the gays.” Part of the reason is demographic: fear of LGBT folks, hatred of immigrants, belief that women should stay in the kitchen (barefoot and most definitely pregnant), even racism are all attitudes more plentiful among older, whiter Americans–and they’re dying out.

Partly, of course, the lack of focus on social issues this time around is the flip side of the 24/7 focus on the strange orange candidate. Donald Trump doesn’t fixate on social issues. Or any issues, actually–he mostly focuses on himself, and his YUGE business ability. And large “hands.”

Actually, Trump is preferable to Cruz, in much the same way that a merciful death is preferable to an agonizing one….At any rate, according to the Boston Globe, Cruz is counting on a re-invigorated appeal to social conservatives in Indiana and elsewhere:

Over the past month, as the primary wove through Wisconsin, New York, and the socially moderate states that voted on Tuesday, the GOP candidates focused on issues like trade, jobs, and the economy. But the next contests on the calendar are in Indiana, West Virginia, and Nebraska, where evangelical voters make up more of the Republican electorate. That trend might even continue in California, which awards most of its large number of delegates by congressional district, some of which are very conservative.

It’s the first time social issues — such as abortion, gay marriage, and transgender rights — could take center stage in the primary since early March, when a swath of Southern states voted in the primary. That’s mostly good news for Cruz, who has already touted his social conservative credentials on the stump in Indiana, which holds its primary on Tuesday.

I may be wrong (wouldn’t be the first time!), but I think it’s too late for “fear of God” wedge issues. America has had same-sex marriage for a year now, and the apocalypse hasn’t occurred. Young people are more irate about their student loans than about who’s peeing in the next stall. The population keeps moving into cities, where there tend to be gay people and black people and brown people, and women in executive positions, and Americans have gotten used to the idea that the diversity is sort of nice.

Cruz isn’t going to win Indianapolis, for sure (and if he thinks Carly on the ticket is a great idea, he’s even nuttier than I previously thought), but he may win Indiana. In our more rural precincts, culture war wedge issues can still be pretty salient. And he is running against the Donald.

If Cruz does win the state, however, I really, really, REALLY need to move.

Comments