You May Be A Bad Person, But Not For These Reasons

I arrive at the same conclusions as White Coat Underground.  Female contraception is important and should be covered as part of basic health care.  However – importantly – this is not because I feel that any political opinions with irreconcilable differences are somehow inherently invalid. WCU discounting the legitimacy of opposed political arguments seems far too over-zealous, to the point of actually being inaccurate.

The political is odd, in that it seems patently fringe . . . If the argument is, ‘don’t use my taxes for stuff I don’t like,’ then what they really are saying is, ‘taxation is illegitimate.’

No doubt some people really feel that way, but at a more moderate level, that argument is actually perfectly valid. The essential point of any representative government is that we agree to pool our resources for expenditures we cannot individually meet. The US goes further and allows people to designate where their tax dollars go. There is nothing “fringe” about someone accustomed to this wanting their money going to uses they approve of. WCU would probably not object to someone protesting that their tax dollars, in the Kissinger years, went to funding some third-world dictator; the core idea that we are on some level responsible for what our tax dollars do is the same.  We must allow that conservatives as well as liberals may feel guilt over what their dollars do.

If the Church, through one of its institutions in the US decides to provide health insurance (a morally laudable practice) they cannot discriminate based on sex. That’s against the law, and not morally laudable. If they are truly serious about removing all hints of support for contraception, they must eliminate all insurance coverage.

Discrimination “on the basis of sex” uses “sex” in the meaning of the biological component of gender (gender encompassing various cultural aspects.) It does not literally mean on the basis of having sex, but I suspect WCU knows this and is being deliberately obtuse.

Treatment has never been all-or-none, and any implication that it must be is ludicrous. Would we say that a Jehovah’s Witness who refuses a blood transplant should be denied other forms of medical care, because he is making things difficult by choosing not to engage in treatment that his religious authorities have deemed blasphemous? No? Would we understand if a Jehovah’s Witness church declines to have a fundraiser for blood transfusions?  Then why is it morally permissible for them to pick and choose treatments on religious grounds, but not the Catholic church?  Further, if withholding service at any time is bad, why is it morally acceptable for observant Jews who are doctors to avoid working on Saturdays? Cultural and religious nuances have always existed.  They certainly make things a lot harder on those providing care, but unless you are wildly at odds with the medical establishment, you probably try your best to accommodate those with religious views even if those views are incomprehensible to you.

Again, with another example: suppose a friend of mine goes to a hospital for a minor burn he got while we were grilling burgers.  I feel bad because it was my grill, and pay for the bill.  Suppose it is discovered at the hospital that he also has some major issues threatening to kill him, and he needs emergency surgery.  I decline to pay for that.  Is it reasonable to expect that if I pay for some of his treatments, I must pay for all of them?

I understand, of course, that if a provider is the only provider in the area (or the only one available), then they ought to be compelled to provide the full gamut of medical services – anything else would constitute a de facto abrogation of the patient’s right to choose. If a health care provider is the only available provider of coverage, the same standard should apply.  But in a city where dozens of alternatives exist, why is it an issue if one place chooses not to provide certain medical services?

For that matter, is it in any way unethical or illegal to only provide some medical services because you don’t have the machines or trained personnel needed for others? I have read accounts by physicians who were not able to go through with things like emergency thoracotomy surgeries for knife wounds, because they were not trained specialists in chest surgery.  As no one else was available in time, the patient died in at least one of these cases.  Yet despite that, this was not considered unethical or illegal.  Can we not consider the religious “inability” of certain people to do things along similar grounds?

Political convictions aside, there are many practical reasons to prescribe hormones that have little to do with actual contraception, and it is the myopic conflation of the two that is the biggest threat to informed public discussion here. (Ideological mud-slinging is perhaps a close second.)  I suggest that the public is poorly educated about medicine and equates all uses of birth control pills with birth control, as the flap about contraception in the UK shows.  (I assume that the UK public is not substantially less educated than the American public on this topic, and will be delighted to be proven wrong.)

WCU’s medical authority is clear, but I fail to see that the reductionist interpretation of opposing views presented is anything but deliberately putting words in their mouths.  Personally, I’m all for basic health care including reproductive health care because not everyone lives in a city with access to lots of different providers, and because many women need reproductive health care for basic life concerns like ovarian cysts, very irregular periods that could threaten their health, and so forth.  I’m certainly not for it because I can’t see the legitimacy of people arguing they should have some say over where their money goes.

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  1. I have three issues here, one being arguing based on what your tax dollars do, and the others being different types of inability and the rights of health care providers versus insurance companies versus patients.

    As for the first one, it is quite simply the wrong way around. You can’t just argue that you don’t want your tax dollars to go to X, so X should not be done, that’s ridiculous. “X is bad, so I don’t want my tax dollars to go to it” makes sense, but the other way around is just a slightly obtuse form of “X is iffy, so X is bad”. “I don’t wanna” is nearly never a very good argument on its own. (Also, that’s putting aside the part where tax dollars do not come into this at any point, ever. This is insurance, not taxes.)

    Concerning religious “inability” versus lack of skill, I can’t see how these are comparable at all. If someone needs your help, desperately, and you cannot help because you lack the skill required, but you still try or at least try to find someone who can or are at least willing to, in general, that is commendable. If someone needs your help, desperately, and you refuse to because you are scared, or because you do not like that person, or again simply because you do not wish to, then that is – at least most of the time – not exactly despicable, but certainly not laudable either, and a different thing.

    The third is a more annoying beast. In the end, it works out to who should be allowed to decide what health care you get, and “your insurance company” and “your employer” (which is what “your insurance company” works out to, practically) is most assuredly the wrong answer. The reason for this is the immense power differential between single insurees and employees (the former cannot just decide to switch insurance companies when they need it, the latter cannot usually just quit).

    The people who _should_ decide such things are exactly the patient and the health care provider. It is acceptable for a doctor to, in general, not do certain procedures based on not wanting to do them (unless no one else is available), it is acceptable for a patient to refuse treatment, it is utterly inacceptable for an insurance company to refuse a neccesary treatment or neccesary medication to a patient.

    If you do not wish to use contraceptives, or heart rate stabilizing medicine, or get an MRI, or a blood transfusion, that is fine – do not do that, then. If you wish to deny people who want to get these – and who cannot just seek out alternative ways of getting them – these things, that is not. Framing the issue as poor, poor people being _forced_ to pay for things they do not want to pay for is ridiculous. You’d have more of a moral foothold arguing that you do not want to pay for an overweight persons bypass or a smokers respiratory treatment: Unlike “being biologically female”, these things can be your own fault. (It would still be ridiculous – slightly less so, but only very slightly.)

    You can “not want to” pay for these things all you want, in the end, not paying for them is wrong, and part of living in a civilized social democratic society is paying for things even if you do not like them because a nation isn’t burger king and you can’t always have it your way, and you know that not paying that would be wrong.

    • You characterize the entire thing as a matter of arbitrary choice, but consider: from the perspective of a religious fundamentalist, there is little moral difference between funding abortions and funding war. As absurd as that sentence may sound to you, if we acknowledge that people have the right – in fact, the moral obligation – to ensure that their money does not go towards unethical causes, then we must accept that they have their own view of what constitutes unethical causes. This problem is really irreducible; anything else amounts to “screw what you think; you’re forced to contribute to this thing because society as a whole has a different idea of morality and ethics than you.”

      From the point of view of a religious fundamentalist, trying to avoid money going to abortions is as laudable as not buying blood diamonds, or choosing not to patronize a Swiss bank that laundered Nazi gold. Obviously, it differs in that at the other end here is a woman trying to get basic health care, and not some tyrant bent on conquest or decrepit arms merchant getting rich, but that is the consequence of the situation, not necessarily the ethics of the situation (unless you are a strict consequentialist.) The parallels to accepted activist situations are real and we do a disservice to the issue by pretending to ignore them.

      I happen to personally believe that government funds should go to abortions, due to the benefit to society, but that is a utilitarian argument, which obviously does not have any bearing on the moral calculus of anyone who rejects the utilitarian worldview. We should not ask people to be morally courageous and then balk when their morals happen to differ from ours. We are not, after all, in the business of promoting a single state religion.

      • Religion is as close you can get to being a choice as possible without actually being in entirely-chosen territory, so naturally, “religiously motivated” should always weighed less than, well, the health of a human being. If a religions beliefs demand that people who never had anything to do with that religion die, then that religion is bad and needs to adapt or go away. (And this is exactly the situation here: Estrogen pills have prevented over 100000 cancer deaths since their introduction in the 50s [1])

        Also, yes, we’re certainly not in the business of promoting a state religion. We’re in the business of promoting no religion in politics, separation of church and state. We’re in the business of making political decisions based on weighing evidence and on considering the implications they have on peoples lives.

        (Random unrelated musing: I wonder if any insurance company at all would actually not pay for the pill, in the long run, considering that it saves them bucketloads of money in not having to pay for cancer treatment or for pregnancy treatment… saaa.)

        [1] http://www.cancer.gov/cancertopics/prevention/ovarian/oral-contraceptives

      • “Naturally, “religiously motivated” should always weighed less than, well, the health of a human being.”

        Then from the start, you aren’t putting other peoples’ beliefs (their moral priorities) on equal weight with your own set of priorities. You conceptually can’t enter into this discussion, because you state flat-out you don’t believe in any ideal which outweighs the value of human life, and moreover, you don’t believe in letting other people make that choice of priorities.

        Yours is a fine set of beliefs to have. It just so happens that you are insistent that everyone else follow your beliefs because you can’t see any other way of being moral. This gives you more in common with many religious fundamentalists than I suspect you would be comfortable with.

        (Bonus points if your first reaction is that ‘obviously’ anyone who disagrees with your moral priorities as espoused above is acting immorally, or somehow morally suspect.)

      • I’m not sure I can acknowledge the right to ensure that my money doesn’t fund things I find objectionable. The setup of a representative democracy is such that the representatives decide what tax money is used for. I have the right to petition my representative, group up with people to protest and draw attention to the issue, and if fed up enough to try to vote my representative out of office, but I cannot just withhold my check to the IRS or take out a portion that I deem to be spent on things that I don’t like. I find it odd, but not surprising that the Republicans found it necessary to use the religious freedom argument, but fail to argue for exemptions for Hindus and beef subsidies, Quakers and the military, or Christians and the death penalty.

        I understand the bind the Catholic Church finds itself, but this was the problem they created by entering into the public sector by creating hospitals, adoption agencies, universities, and other services for the general public. Purely religious institutions like churches are exempt from the mandate; it’s only when the Church enters the public arena and affects people that are not adherents to their religion that they may not impose their beliefs on others.

        I think the Obama compromise is a good solution for the most part. In most cases, the Church’s is not directly offering or funding a service it objects to. Previously even if the Church didn’t offer contraceptive services, the insurance premiums may have paid for services like abortion and contraceptives indirectly; that’s just how a large pool of money works. The situations where this falls apart are when the Church organization self-funds its health plan. In this case, I don’t have a good solution.

        In that case, we’d have to do an analysis. On the one hand, we have a Church that believes that contraceptives are against its religion. On the other, we have a compelling case that contraceptives are a legitimate health necessity and in fact most of the adherents of the Catholic Church break its mandates against contraception (I don’t know the numbers, but a vast majority of Catholic women use contraception). Given there’s a general acceptance among the U.S. public that contraception is a health issue more than a religious issue, then I’m willing to force these organizations to provide contraceptive care. If they don’t like it, they can always try to elect representatives and convince the public to overturn the rule or they can withdraw from the public sector if they find providing contraceptive coverage to be that egregious of a mandate.

      • Joran – No one is saying they are allowed to not pay, but just as pacifists may specify that their contributions should go to non-military spending, so too it should be possible for Catholics to direct that their funds not be used for abortions.

  2. It’s not a matter of forcing a provider to provide services. Physicians have no ethical obligation to provide care they think is out of their scope of practice, nor to provide care to anyone. Physicians may arbitrarily decide who and who not to treat.

    What they cannot do is lie, either by commission or omission. Telling a patient that, for instance, Plan B is dangerous or useless is a lie. Failing to tell them that it can be helpful when they ask is also a lie.

    From an ethical standpoint, if you are a GYN and you don’t want to provide abortions, you have to be willing to refer to a provider who does.

    If you cannot provide basic services you cannot be a doctor. It is pretty much black and white.

    • Thanks for your reply.

      I argue above that they have the right or even the moral obligation to decline to personally perform actions they find immoral, as long as the patient has access to alternatives. I argue that nothing is “fringe” about it, and since you basically say that this is the status quo in medicine, that confirms my argument.

      Beyond that, my point is that many of the arguments being advanced are legitimate conclusions, given the premises that religious fundamentalists are working with. If we accept that they have the right to these beliefs, and that for moral reasons people can do things I listed above (to ensure their money doesn’t go towards war, etc.) then we don’t have any right to deny them the ability to act similarly on the strength of their own convictions (again, assuming that alternatives are accessible and it doesn’t prevent the patient from getting care.)

      Your original post doesn’t mention anything like whether Plan B can be lied about (which I have no interest in defending, as that is a very obvious breach of ethics.)

  3. “Then from the start, you aren’t putting other peoples’ beliefs (their moral priorities) on equal weight with your own set of priorities. You conceptually can’t enter into this discussion…”
    What a straw-man! Of course he can enter the discussion, and your comment comes off as quite hypocritical. In any case, the separation of church and state totally allows for the enforcement of equality. Maybe you should re-read the original blog that clearly outlines why- since this religious organization has entered the public sector is not immune to what is basically an OLD law enforcing equal rights. Contraceptives are PREVENTATIVE CARE, and as such must be given in a plan that covers PREVENTATIVE CARE!

    “If we accept that they have the right to these beliefs, and that for moral reasons people can do things I listed above …then we don’t have any right to deny them the ability to act similarly on the strength of their own convictions” Again, this is a false dichotomy. Their right to those beliefs belongs from the swing of their arm but ends just before another man’s nose. Or if this is unclear: they can believe what they want, but, again, once they become involved in the public sector, they are not immune to granting equality. You did not misquote the original blog (“If the Church, through one of its institutions… they must eliminate all insurance coverage”), but you did leave out an important part (the immediate sentences before it that explained that the plan covers *preventative care* and the whole part that describes how contraceptives are ***preventative***) when you quoted it and your conclusion of it is, again, somewhat hypocritical.
    “Discrimination “on the basis of sex” uses “sex” in the meaning of the biological component of gender (gender encompassing various cultural aspects.) It does not literally mean on the basis of having sex, but I suspect WCU knows this and is being deliberately obtuse.” Again- you come off as deliberately obtuse because it REALLY IS DISCRIMINATION ON THE BASIS OF GENDER- again: contraceptives are PREVENTATIVE AND THE PLAN IS FOR PREVENTATIVE CARE.

    Again; to summarize: where the church is involved with the PUBLIC SECTOR, and offers a plan that has PREVENTATIVE CARE, it must FOLLOW THE LAW and provide such care EQUALLY, DESPITE ANY CONVICTIONS THAT IT MAY HAVE AGAINST SUCH EQUAL CARE. There is no room for religious freedom when it inhibits the rights of an individual. This is what it means for a separation of church and state.

    Furthermore, the argument is STILL invalid when one complains about ‘tax dollars spent’ because (AS WAS STATED IN THE ORIGINAL BLOG that you either did not read carefully or are just “being deliberately obtuse” about) tax dollars are NOT spent on these contraceptives. This is a (deliberately?) propagated lie being churned out by the spin machine.

    Please re-read the blog if you still fail to understand any of these points.

    • You seem to be under the impression that I am arguing legal permissibility as opposed to moral permissibility.

      Of course the Church is compelled to follow the law – as is everyone. But that has no bearing on the morality of this or any other situation, unless you labor under the impression that law somehow implies morality. Do you?

      I specifically brought up analogous situations of moral dissent from the law to remind readers that there are times when people flout the law, but we accept that because their morality requires it.

      As for halcy’s preconceptions and inability to get outside his own moral framework, I may have chosen my words imprecisely when firing off my reply. Technically he can enter into the discussion; it’s just that any attempt to communicate is doomed from the start to be fruitless if he is not willing to assign any gravity to other peoples’ morality. Do note that I am entirely willing to say that the majority of people on the conservative side make this mistake of applying their own morality as universal law. I just think it’s pointless to be against this and then make the very same mistake yourself.

      • I think the unstated point that you are trying to make is that the morality of one group trumps the separation of church and state. Or perhaps you are arguing that the moral stance that contraception is inherently wrong is a more moral standpoint than basic health care?

        I think the larger point is that the rights for one group ends in their group, and they cannot impose their ‘morality’ on others. This, again, is in the original blog post.

        Do YOU think it is right for one group to impose beliefs on another? That is how you come off. The women who want BC in their plan are NOT forcing this issue on workers IN the church itself, only for those who work in the public sectors owned by the church.
        I still don’t understand how your reply to me, or your original reply to the first blog is relevant or logical.

        Are you just making a moral argument? You don’t directly defend that argument, and your statement: “I just think it’s pointless to be against this and then make the very same mistake yourself,” seems to imply that one’s personal beliefs are valid enough to deny basic healthcare to another. Maybe this is what you are arguing. I am not saying you are wrong, but I guess it is pointless for me to try an argue an opinion. Epically since it is not really based in logic as the key point you are talking about seems to be morality but then that somehow implies that one person’s beliefs trumps another’s right to basic care.

        Also: in your reply to me, you still never addressed the fact that the “don’t spend my tax money” argument is irrelevant because this whole issue is NOT ABOUT TAX MONEY. The original blog laments the right’s use of this argument because it is specious and a flat out lie. It is lies like that that that make people like that “bad” people. Yet, even you use that argument and then try to spin it further. Doesn’t that make YOU an AMORAL person? Again, it seems that either you have not carefully read the original blog or are just another spinner.

      • To be clear – the original blog post I reply to argues that even if the Catholics find birth control or abortion morally reprehensible, they must administer it. The author responds in the comments by noting that this isn’t true on an individual level, but doesn’t say that it isn’t true at the organizational level – because that is the very substance of the argument. He or she believes that Catholics as an organization should be made to support and provide birth control, in contravention of their beliefs.

        I do not support that conclusion and find it more extreme than my own position that birth control is a basic health care service. As long as a patient is able to get care, why make the Catholics do things they believe are the equivalent of murder?

        Everything else is an elaboration on various parallels, to try to draw out the unfairness of singling out one religious group among others which have been accommodated.

  4. Just FYI, to help you out: The Catholic church RECEIVES money FROM the US government. So can I argue that I don’t want MY taxes going to an organization that I support?
    Furthermore, no one is forcing women to take contraceptives. In fact, 98% of Catholic women are on contraceptives. Now, the real issue is really that the employees of the church (not the ones in the church, even, but the employees of hospitals, schools, etc.) who ARE NOT Catholic shouldn’t be imposed upon by Catholic doctrine, am I right?

    This is basically my problem with your reasoning: No one is imposing anything on Catholics because they took GOVERNMENT FUNDNIG, AFTER AGREEING TO THE RULES ABOUT TAKING THAT FUNDNG, and are now NOT FOLLOWING THOSE RULES. It is, in fact, Catholic heads that are trying to impose their beliefs on things OUT OF THEIR JURISDICTION. Why is it out of their jurisdiction? Because the money is given to them under a condition. If they didn’t want to follow that rule then they should have not taken the money.

    I don’t really know where your stance on morality lies on this, it seems to equate to: “their view is correct because they believe it is correct”

    • It equates to “Their view is correct, to them.” No more, no less. Similarly, the assertion that, say, international arms dealing is immoral is correct within the moral framework of those who decry it, no more, no less. It is not a universal physical truth like gravity.

      I have not addressed your (now increasingly hysterical) points about “forcing other people to do X” because from the start of this article, I have never supported or defended any coercion. I don’t know if you stopped reading before the sixth paragraph:

      “I understand, of course, that if a provider is the only provider in the area (or the only one available), then they ought to be compelled to provide the full gamut of medical services – anything else would constitute a de facto abrogation of the patient’s right to choose. If a health care provider is the only available provider of coverage, the same standard should apply. But in a city where dozens of alternatives exist, why is it an issue if one place chooses not to provide certain medical services?”

      It should be pretty clear that I’m for everyone‘s right to choose – the patient should choose what services he or she wants and the doctor should choose what services he or she is comfortable giving. The health care company should also be able to choose what services they as an organization are morally comfortable with giving, but only if that doesn’t interfere with the preceding rights (and structured in a way that it isn’t just flat-out cost cutting.)

      If you would stop attributing things to me that I did not say, maybe we can have a discussion. If not, then it’s going to be impossible to have a meaningful conversation.

      FYI: “So can I argue that I don’t want MY taxes going to an organization that I support?”

      I believe you can already just state your preferences about where you want your money to go. Whether the IRS cares enough to listen is another issue.

  5. I don’t want to throw a wrench in the gearbox, but I’m still waiting on the man pill. If for some reason I had a church-issued medical care plan and they didn’t buy me my man pills, I’d probably understand, or go ahead and challenge it through the law, because the church is not outside the law, at least in theory. If a court rules that is discrimination, then so be it, but I don’t think the general case is clear-cut. And since, man pills do not exist, I am sad and leaving a trivial comment.

    We do not live in a world of absolutes, but absolutely, no man pill exists. What a conundrum.

    • A “man pill” would indeed be a wonderful case where sex discrimination laws would apply. Biology, however, does not conform to our paltry human ideas of symmetry in this case. :P

      I understand that Russell Marker, who discovered how to make synthetic progesterone out of yams, was interested in giving guys the option, but the biology was too different and it wasn’t like he could just whip up an analogue. There have been attempts to make it ever since, some supposedly close to fruition.

  6. I find the “religious inability” argument to be irrelevant.

    There are several precedents in the Bible (and in the Gospels, no less), where Jesus healed people on the Sabbath. He even asked the Pharisees about this issue one time when a sick person was brought to him. The strangest thing is that they could not answer him, or if they did, it was not deemed to be important enough to be recorded. (Luke 14:1-6)

    It’s possibly tenuous to extend this to this issue (and it probably is), but I don’t see a problem with religious organizations providing contraception for workers, regardless of sexual promiscuity.

    As followers of Christ, we are to help people. This is not some sort of nambypamby option, it is an ironclad rule. Just as salvation is open to everyone without discrimination, so then should be our love for people. If that extends to paying for their contraception despite knowing that more than half of the group does not want kids or has an active sex life, then by damn well I am going to provide healthcare insurance, contraception and all.

    (The irony of arguing female healthcare insurance from a theological position is that I’m going hella off-tangent on the argument. Though in my head, it all boils down to two things: Do they love God and do they love people? Both are inseparable from each other to the follow of Christ. Other religions need not ask the first question; only the second will suffice.)

    Also, pregnant females are hot. And now I must douse myself with napalm for saying that.

    • I believe the implication was that he confounded them, because they felt bad about saying that their rules were more important than healing a sick man, right in front of the sick man.

      The thing with contraception comes where some religious hardliners decide that the act of contraception being used itself is immoral – as opposed to having, say, extramarital sex. I believe this does go further than the Bible, but I will leave that for Biblical scholars to discuss. Note that in the early 1970s, the Catholic Church was all for contraception, as it would benefit the poor, but then hardline cardinals decided it was “unnatural.”

      Regardless, the important question is: does a man with a wildly unpopular belief have the same right to cling to his belief (and act accordingly) as a man with a popular belief?


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