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Choice devours itself--end of life, abortion, and contraception edition

I have three items to add to the "choice devours itself" list. To review, for those to whom this is relatively new: I coined this phrase not, as one might think, to refer to the totalitarianism of the left toward anyone who won't toe their line (as in cases of Christian bakers who are punished for not baking cakes for homosexual weddings, etc.) but rather to refer to the tendency to start forcing the supposed beneficiaries of various favored leftist "freedoms" to accept these "freedoms" even when they don't want them. These instances usually revolve around death and sex. I'll let the more Freudian sociologists make of that what they will. The leftist program starts by saying that it's so important to be free to do X (commit suicide, have an abortion, sell one's body, be promiscuous, etc.) and ends up pressuring, coercing, or outright forcing people to do these things, or looking the other way when they are unable meaningfully to consent or have refused their consent. I put into the "choice devours itself" basket the leftist spin surrounding forced abortion in China, for example.

The idea often ends up being that, if this person doesn't want X, he (or often, she) should want X. For example, if a woman doesn't want to abort her child conceived out of wedlock, she is being irrational, so it's okay to pressure her to abort, because that is allegedly the more rational decision. If a woman in a poor country with a "population problem," doesn't want an IUD inserted, she should, so heavy-handed programs to "encourage" the "choice" of such methods are a great idea.

Or, at a minimum, the presumption is supposed to be in favor of X and in favor of the conclusion that X (e.g., suicide) is freely chosen and that interfering or not cooperating would do more harm than good. Choice devours itself because the presumption in law and policy is switched to favor, e.g., death rather than life. For example, because the priority is not to prevent anybody from dying who "should" be free to die, the presumption should be that someone would want to die rather than that he would want to live. And so forth.

End-of-life cases are especially thick on the ground as examples. I discussed in detail in this post the way that the pro-death thought processes lead to advocating killing people who never asked to die, with special reference to the philosopher Ronald Dworkin. There I discussed Dworkin's "endorsement" principle, which says that people must "endorse their lives" and that it is paternalistic not to allow them to die if they do not "endorse their lives." I pointed out that such a principle almost seems tailor-made to permit lethal injection or other forms of killing carried out on people who have not explicitly asked to die but who, one hypothesizes, would not "endorse their lives" in their current circumstances.

A case like that has arisen in England. A mother is "minimally conscious" (meaning she can track with her eyes, for example), but her daughter says she would not have wanted to go on living in her present situation because her appearance was so important to her. Hence, she would be embarrassed by her current lack of "dignity." The court has agreed with the daughter's petition to withdraw food and hydration from the mother until she dies. (This process of being dehydrated to death usually takes between one and two weeks, depending on how healthy or unhealthy the person was to begin with.)

This is the daughter's report of her mother's deepest commitments:

“My mum’s immaculate appearance, the importance she placed on maintaining her dignity and how she lived her life to its fullest is what formed her belief system; it’s what she lived for,” said the daughter, who is not named in reports. “All of that is gone now and very sadly my mum has suffered profound humiliation and indignity for so many years.”

So, let's get this straight: The mother no longer has an immaculate appearance. The daughter thinks her life would seem undignified to her and not worth living because of her loss of external appearance. Hence, she is to be dehydrated to death. Hardly, for what it's worth, a pretty death, but no doubt the daughter would pick something more in line with her mother's desire for an "immaculate appearance" if it were available.

The judge himself calls his decision an "evolution in case law," evidently because the patient's degree of consciousness in this case is greater than that in previous cases. This evidently doesn't make the judge bat an eyelash. Perhaps he likes to think of himself as being at the forefront of history.

And here's an interesting note about this history-making case:

The woman's interests were represented by the Office of the Official Solicitor, which provides legal help to mentally ill people.

Lawyers instructed by the Official Solicitor initially said the judge should conclude that there was a 'strong presumption in favour of the benefits of continuing life'.

But they altered their view after hearing evidence and said they had decided to support the application.

Let that sink in a minute. England has an office whose job it is to represent the interests of mentally disabled people. In this case, lawyers from this office were appointed to represent the woman whose daughter was seeking to have her dehydrated to death. At first they took the position that there should be a strong presumption in favor of life, but then they changed their position. Why? Well, it sounds like all the daughter had to offer as an argument was talk of her mother's deep commitment to her own immaculate appearance and further talk of the currently ugly and undignified nature of her mother's life. And that was all it took to alter the opinion of the lawyers representing the interests of the helpless mother so that they, too, supported the position that she should be dehydrated to death. In the end, says the story, there was no disagreement. How convenient. The one who actually will be dehydrated to death, of course, can't be asked.

My second case is of a surrogate mother, pregnant with triplets, being strongly pressured by a lawyer to abort one of them because the man who hired her services didn't really want three babies. He was, apparently, assuming that at least one of the three embryos would spontaneously fail to implant.

Here's a snippet from the charming letter the surrogate got from the lawyer:

“As you know, his remedies where you refuse to abide by the terms of the agreement, are immense [and] include, but are not limited to, loss of all benefits under the agreement, damages in relation to future care of the children [and] medical costs associated with any extraordinary care the children may need,” the lawyer warned.

Triplets, of course, often do need special care after birth because they are usually small when born.

Digression: I have to wonder how insurance companies work this out. Presumably the surrogate mother has medical insurance of her own. How does the biological father force her insurance company to be liable for the children's care after birth? Or how, alternatively, would he be held liable for their care?

In any event, the surrogate evidently believes that she can be financially ruined by medical expenses if she won't schedule the killing of one of the babies.

As of the 25th, when the story was posted, she was wavering and considering agreeing to the demand that she schedule an abortion for one of the babies, now at 17 weeks' gestation. Says the surrogate, "I have to reduce. I'm scared."

So much for choice.

My third example concerns contraception. Back when a study came out allegedly showing that contraception "availability" reduces abortion rates, I got hold of the study in question and wrote up a long post on it. One of my points at the time was the aggressive sales techniques used to induce the women to use the LARC methods (as they are called). I said,

Unless we are willing to envisage a program under which American women generally receive a high-pressure sales pitch for having an IUD or implant inserted, we shouldn't be too quick to imagine any straightforward generalization of this study's methods...

Later, The Federalist asked me to write about a second, similar study. I raised similar concerns about that study as well.

Oregon has now made the high-pressure nature of all of this quite clear with its "One Key Question" initiative. The "one key question," to be asked to all women accessing public assistance for all kinds of services in Oregon, including dental services and WIC, is, "Would you like to become pregnant in the next year?" Apparently any woman who does not say that she definitely would like to become pregnant in the next year will receive contraception "counseling." This includes women who say they are "unsure or okay either way." Distributors of public funds will receive direct financial incentives to meet goals of women who are using contraception. Naturally, the distributors will have to be able to document their claims, which means tracking the women. Here is a quote from Oregon Public Health concerning the "effective contraceptive use" metric as an "incentive metric" for state Medicaid distributors:

The ECU metric is focused on women ages 15-50 who are not currently pregnant and who adopted or continued use of one of the most effective or moderately effective contraceptives.

OHA will be measuring and reporting on adolescent and adult women separately, by ages 15-17 and ages 18-50; only the adult rate (18-50) will be tied to the CCO’s incentive payments.

Denominator: All women ages 15-50 who were continuously enrolled in a CCO for the 12-month measurement period. Women who are not capable of becoming pregnant and women who were pregnant during the measurement year are excluded from the metric.

Numerator: All women in the denominator with evidence of one of the following methods of contraception during the measurement period: sterilization, IUD / IUS, implants, contraceptive injection, contraceptive pills, patch, ring, or diaphragm. Evidence includes having a pharmacy claim for one of these methods of contraception or a claim that includes procedure or diagnosis codes that indicate the provider assessed current use of effective contraception or that the client adopted a new effective method. For women using long-acting or permanent methods, evidence must be documented in claims each year in order to be counted towards the metric.

So doctors who give out treatment under Medicaid will be told to keep records on their female patients that tracks their use of contraception in order to show the State that they are meeting their goals, in order for their medical conglomerate to get "incentive" money from the state. Privacy, what's that?

Here is a feminist chortling about women's being badgered to use contraception in an unexpected venue:

Stranger Hunter said that Jackson and Josephine counties would soon implement One Key Question “throughout the healthcare delivery system.” She said, “It will be at every point of service, whether you are a private practitioner, a public health program, a human service program, or a dentist. I got to love this – dentist,” said Stranger Hunter.

As the Public Discourse points out,

But the government-imposed questioning doesn’t stop at the woman’s doctor’s office. In July 2014, it was reported that the One Key Question initiative was being integrated into home visiting programs in the state. As a result, women will not be able to escape this NARAL Pro-Choice Oregon-inspired questioning, even in the privacy of their own homes. The One Key Question initiative is also being integrated as part of WIC screening by some WIC providers in the state. This is the program that provides women with essential food supplementation to help feed their children.

So if a low-income Oregon woman is on Medicaid, her health-care provider will ask about her pregnancy intentions. If a home-visiting nurse comes to her home, the nurse will ask about her pregnancy intentions. If she needs WIC food supplements and lives within certain counties, the WIC provider will ask her about her pregnancy intentions.

It may be argued that these women are not strictly being coerced to use contraception. But that objection would be a form of prevarication. When a low-income woman is badgered at every turn to use contraception whenever trying to obtain welfare or other public benefits, it's not hard for her to take a hint. Indeed, I have no particular reason to believe that healthcare providers who step over the line and falsely tell a woman that she must use contraception in order to receive benefits will be detected or punished. And it would help them meet those quotas and get that incentive money for their medical network, wouldn't it? Such programs, with quotas for distributors, are eerily reminiscent of sterilization quota programs in third-world countries such as India, the chief difference being that America's healthcare system is better, so women who have surgical interventions are less likely actually to die or develop infections.

Unfortunately some Republicans and even some libertarians (ironically) have suggested that women accessing welfare should be forced to use long-term contraception. It's difficult for me even to call such proposals "well-intentioned." My reaction, rather, is like that of G.K. Chesterton concerning a sterilization requirement for blind men and women receiving public assistance who wished to marry: "This is slavery, no more and no less." ("An Attack from the Altars" collected in Brave New Family, pp. 220-21)

Oregon hasn't gone quite to that point, but its Nanny State, with the incessant dropping of water on stone, its nagging "one key question" at every point of service, is doing the nearest bureaucratic equivalent while maintaining a fig leaf of plausible deniability.

The ACLU, which has rightly written against the literal requirement of contraceptive use for receipt of public benefits, hasn't that I know of said anything to criticize the new Oregon program, and I doubt they will ever get around to it. In general, the left is thoroughly taken in when choice devours itself, so long as some patina of choice is left in the picture. Old Mom surely would have wanted to die, and these women receiving public benefits are just being asked a simple question. What could be wrong with that?

The surrogate mother, on the other hand, is receiving a flat-out demand to stand and deliver. Or, as the case may be, not deliver, one of the babies. To deliver it over to the slayer. Jennifer Lahl's organization, the Center for Bioethics and Culture, is seeking legal help for her. We can hope and pray that she will stand firm. She is under the impression that she cannot get an abortion in California after 20 weeks. While such alleged bans can be circumvented under "health of the mother" exceptions (required by the Supreme Court), if that perception aids this mother in resisting the pressure, if she holds out for three more weeks, all the better.

Meanwhile, one waits in vain for the left-wing outcry.

Death and eros are jealous gods, and when they are made gods, they become demons.

Comments (9)

Human beings choices must be limited. De Maistre deduced this from both the fact that we are social creatures and intrinsically flawed. This requires authoritarianism to rule us.

My second case is of a surrogate mother, pregnant with triplets, being strongly pressured by a lawyer to abort one of them because the man who hired her services didn't really want three babies. He was, apparently, assuming that at least one of the three embryos would spontaneously fail to implant.

Here's a snippet from the charming letter the surrogate got from the lawyer:

“As you know, his remedies where you refuse to abide by the terms of the agreement, are immense [and] include, but are not limited to, loss of all benefits under the agreement, damages in relation to future care of the children [and] medical costs associated with any extraordinary care the children may need,” the lawyer warned.

Actually, it's even worse. (A) This woman has already borne triplets (and 2 others). So all parties know she is capable of bearing 3. (B) The man apparently consented to the doctor implanting 3 embryos, so he is not without responsibility for the conditions leading to her _carrying_ all 3. (C) The contract explicitly provides that she gets $33,000 for the first baby, and $6,000 for "each additional" baby. Oh, and (D) she "has bonded" with all 3 and doesn't want to abort any of them.

It sounds to me like a terribly written contract. The lawyer probably ought to be sued for malpractice. Whatever they thought was likely to happen, they should have EXPLICITLY COVERED what would happen if she carried more than 2 babies, including who gets to decide what, and she shouldn't have signed a contract if it said the contract-father could tell her to abort a baby if she doesn't like doing that. I mean, she has already carried 5 children, including trips, she knew darn well that she bonds during pregnancy. But a contract that says pseudo-Dad gets to decide she has to abort 1 or more babies EVEN WHILE providing that she gets $6,000 for "each additional" kid is a conflicted contract, regardless of what else is the case.

And these kinds of stupid situations gives states all the reason they need to take control of surrogacy contract law and put a clamp on it. Yes, it ought to be outlawed altogether, as being a form of slavery or prostitution, but they don't have to even go that far to outlaw some of the just plain stupid stuff, like this situation. (1) the prospective parents (and it should always be two) should have to go through adoption protocols just like anyone else taking a kid from its natural mother. (2) The couple should have to post a bond for health insurance for pregnancy and immediate post-delivery issues for the babies, NO MATTER WHAT. (3) There should be no possible mandate by the prospective parents to abort - remember "choice", liberals? If the mother doesn't want to abort, and the contract-parents don't want "that baby" for whatever reason, the mother will just get that baby. End of dispute. (4) Either there should be no possibility of the birth mother profiting (this is the better option, so there is no commodifying her body), or the gain she gets from the contract should be constrained within narrow limits. There should be no prospect of popular or famous women getting 100 times as much for a baby as a plain jane woman, that will look (and be) too much like simple, out and out "buying a better baby".

It will also be interesting to see how the different states react to the terms of the contract being written to specify the contract shall be construed under the laws of CA, OR, or wherever. I could easily see the state of residence of the birth mother simply saying "she's here physically, we don't care what the contract says, surrogacy of a resident falls under our law." Shades of Dred Scott all over again.

Unfortunately some Republicans and even some libertarians (ironically) have suggested that women accessing welfare should be forced to use long-term contraception. It's difficult for me even to call such proposals "well-intentioned."

The libertarian side only even acquiesces to the welfare provision at all out of political expediency. The republican side is just too cowardly to be forthright about the moral and policy issues involved. That's just par for the course for them. These are the people who are shocked that Trump has trounced all of the establishment candidates by boldly saying what is on the minds of much of the Republican base and even many moderates.

This is the reality of life for much of the lower classes. The reason welfare reform worked was that it struck right at the heart of the issue, which was in the wallet. Live like a mooch, be prepared to be cut off. Forced contraception won't work and it's morally messy. You have to go directly at the heart of the issue. Once someone has had 3 or more kids outside of a licensed or common law marriage, send them to prison and make them register as a sex offender. Heaven knows they're more of a sex offender at that point than the majority of people who are on there for having sex with a boy/girlfriend in high school or pissing in the bushes.

A similar situation occurs in relation to single women who, having become pregnant, wish to continue the pregnancy. Previously they were, of course, pressured into relinquishing the child and ordinarily had no further contact with him or her.

Then came a new, liberal approach. Relinquishing mothers can retain contact with the child. And mothers are supported if they opt to keep the child - supported in some countries by social welfare payments.

And now social workers and similar seek to push women into keeping their children and to refuse the idea of adoption. They argue, correctly, that adoption is an imperfect solution, neglecting to point out the comparative difficulties of becoming a single mother.

In other areas also, as with gays or liturgical innovations, the discourse has been modified to be more inclusive. Those opposing gay mores are now to be prosecuted for hate speech, those worshipping in the old manner are to be ostracised. They point out that they are saying what people have said for millennia but in vain.

While people talk about increasing available options, the reality is that there will be a normative approach and the new option becomes the new orthodoxy.

Just so it's understood on this blog: I'm not always entirely sure why we let Mike T. stay around, given that he is such a loose cannon, but my silence in response to his weird comments does not ever indicate consent or approval. It's just that I have to apportion my time, and responding to him (and then wrangling with him about whether he's going to shut up, editing his comments, etc.) isn't always worth my time.

This has been a public service announcement.

And, no, Mike T., this isn't an invitation to reiterate or argue for your most recent public policy proposals. At all.

Do the sounds of departing footsteps echo in an echo chamber?

"These instances usually revolve around death and sex. I'll let the more Freudian sociologists make of that what they will."

I'm neither a Freudian nor a sociologist, but I'll have a go:

It seems to me the fundamental good in secularist thought is autonomy: fundamental in the sense that every other good is made sense of and/or contextualized by it. Piety, for instance, in pre-modern societies is universally recognized as a good (however much debate there is about what constitutes true as opposed to false piety). But the very word sounds queer to modern ears. There is still, however, at least among some, a respect for "being a spiritual person", and, among most, a profound commitment to religious liberty (as they would define it). Both these goods are made sense of in the context of the more fundamental good of autonomy: in matters that powerfully affect a person's life as a whole, that determine what kind of person they are, what kind of life they lead, they must be free to choose for themselves. That is the great fundamental right, and the only fundamental duty (other duties may exist, but aren't fundamental) toward others is not to violate their right to the same autonomy. Since spirituality (which for some takes the form of being religious) is evidently, for most people, an important part of who they are, for it clearly functions powerfully in people's lives to give them meaning and an overarching purpose, it follows that spirituality and even religiousness can be recognized as a good by the secular modern person. (So 'secular' is not a perfectly apt word for the Zeitgeist, but it is mostly apt.) Even more important, though, is religious liberty, for that is just one facet, and quite an important one, of the liberty to choose one's own lifestyle and self-definition. Hence, just as your right to swing your arm stops at my face, your right to practice your religious beliefs stops the moment it impinges on my right to choose my own lifestyle, for your right to your religion rests on nothing other than my right to my lifestyle-choice.

But this is all radically different from how piety was formerly understood, i.e., as an obligation that falls to us from realities above and independent of ourselves, an obligation we did not choose but were born to, a human need and duty to conform ourselves to something that stands as a constant reminder of our limitedness, our dependence on that which we have received, and our inability to make ourselves whatever we wish, our need to be thankful and to honor our fathers and our fathers' God, a large part of which is being obedient to his precepts, regardless of what we might wish to choose ourselves. So that's just an example of the way a traditional virtue is recontextualized by the fundamental good of autonomy in secularist thought.

Death and reproduction are intractable problems to this ideology. At the beginning of life we are unavoidably dependent, and to a huge extent the character of our life is (intolerably to the secular mind) a result of the "accident of birth". In a physical way, our nature (natura) makes it impossible to undermine this with more than slight success. In the midst of life, our reproductive behavior has the natural result of entangling us in relationships that undermine our autonomy. The obligation of parents to their children is really not something we can get entirely away from, try as we might, and those obligations are of a character that they prevent us not just from this or that passing desire, but from "choosing our own life". They in effect tell us that our life is not our own. Something similar can be said of the duties that logically follow from (but chronologically precede) parental duties, namely those of husband and wife to each other. And then our duties to our families, those horrid duties we were born to and didn't choose, crop up again at the end of life, as parents find themselves once again in a state of neediness and a flat-out physical inability to make themselves what they wish, and adult children find themselves with pressing lifestyle-impinging obligations that they did not choose.

Sex and death are of such a hard-edged nature that like nothing else they force the secularists' "choice" to devour itself, lest it become impossible to keep up the illusion that is the great foundation of their ideology.

I think you are onto something there, Christopher, and for much the same reason it has often been pointed out that the doctrinaire, full-bore, ideological libertarian (and I do intend those qualifiers) has no place in his theory for children. The idea that everyone should choose what is most important to themselves becomes absurd when applied to a two-year-old.

Similarly, Dworkin's principle that people must "endorse their lives" simply does not apply *in any way, shape, or form* to the infant or to the person who is born radically mentally disabled. Such a person not only cannot "endorse his life" right now, he has never had any opportunity to do so in the past or to tell us, as a free, rational, autonomous being, what he "would want" under this or that future circumstances.

At one point I was debating some of these matters with a Facebook friend whose thesis is that at least many of the horrible consequences of liberalism in ethics are contrary to the principles of liberalism itself and hence can be counteracted just by pressuring them to be more consistent with their own principles. He was _insistent_ that Dworkin's principles would rule out killing without consent, as in Belgium. In the course of the discussion, I found myself pointing out again and again that, when you are mentally helpless, someone else _has to_ make decisions for you. There is literally no way around it. There is no way that human beings can autonomously direct the details of their lives at every stage in their lives. Thus, principles of autonomy literally cannot tell us what to do in all medical circumstances for helpless, non-autonomous human beings.

I extended this argument in one of the earlier posts that I linked to and pointed out that, for a person who cannot make his own decisions (because he is unconscious, for example), there seem to be only two types of approaches to making decisions for him. (And one can mix and match these as well. One doesn't have to use only one at every moment.) One can use the "best interests" approach--deciding what would in fact, as far as one can tell, be best for this person. Or one can use the "substituted judgement" approach--trying to decide what this person "would want."

Any attempt to apply "substituted judgement" to infants or others who have _never_ been autonomous beings is absurd on its face. What "would" this baby want? C'mon. For them, you have to use "best interests."

The "substituted judgement" approach for people who _have been_ rational at some point in their lives seems closest to the spirit of Dworkin's autonomy principle. At least I'm _trying_ to take their autonomous wishes into account.

But of course it is also quite obvious there that you can end up killing people who never asked to die. You just throw over it the claim of, "This is what they would have wanted."

So an autonomy principle is entirely consistent, at multiple points, with killing innocent people.

$5 says that if someone told Dworkin that 9/11 is no big deal because none of the victims had positively endorsed their lives before the planes hit he would say they're insane.

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