People who need people

23 08 2012

No no no no no no no.

Just in case it wasn’t clear from my last post, I am against any and all laws seeking to limit access to abortion: Waiting periods, mandatory ultrasounds, parental notification, time limits—all of them, every damn one of them.

I come by the label Abortion Rights Militanthonestly.

I have also argued for the morality of abortion, that is, that the decision to terminate a pregnancy is, by default, a moral one, albeit of the ontological sort. In other words, because the woman is a moral actor in making decisions about her life, then the decision of whether or not to gestate a fetus into human being is inherently a moral decision.

On a practical level, however, it’s not necessarily a moral decision. If, for example, the woman feels that continuing with the pregnancy is so unfathomable that there seems no choice but to terminate, that there is no deliberation because there is nothing to deliberate, then it might be said the decision to terminate is amoral or beyond morality. It might even be immoral if, say, a woman chose to terminate in order to punish someone else, but, again, the mere fact of ending a pregnancy, of killing an embryo or fetus, is not, to me, inherently immoral.

Which brings me to Shauna Prewitt.

Huh? you say.

Shauna Prewitt got pregnant as a result of rape and decided to continue the pregnancy and raise the child (now a seven-year-old girl). She wrote An Open Letter to Rep. Akin describing that, yes, pregnancy after rape is possible, and that the belief that it is not may underlie some state laws which allow—unfuckingbelievably—the rapist custody and visitation rights to the child.

Prewitt deserves all kinds of praise for her willingness to rely on her own fraught experience in calling out morons like Akin (and a certain blue-eyed cheddarhead. . .) and for her efforts to change those unfuckingbelievable laws.

But does she deserve praise for carrying the pregnancy to term? I don’t know.

Clearly, if the choice to end a terminate can be a moral one, then the choice to continue a pregnancy can be moral.

That sounds a bit odd, doesn’t it? As if it should be so obvious that continuing a pregnancy is moral that to ‘concede’ the point seems a kind of backwards-day game? But hang with me: Prewitt continued her pregnancy because she felt attached to the fetus:

You see, to my surprise, I did not altogether hate the life growing inside of me. Instead, I felt a sort of kinship, a partnership — perhaps the kind that only develops between those who have suffered together — but, nevertheless, I felt a bond.

She goes on to note that the decision to continue the pregnancy and raise her daughter wasn’t easy, but it was the right one for her. Ontologically, she made a moral decision.

Is it a moral decision in a more day-to-day sense? Sure. Yeah, things are fucked up on this earth, but when have they not been? And while we humans may have played no small part in that fucking up, we’re not all bad; bringing in new people beats the alternative.

Anyway, note as well the role that desire played in her decision: Prewitt decided to gestate the fetus which became her daughter because she felt a bond, because she felt “enlivened” by the life inside of her. She had the baby because she wanted to.

Does action in accordance with the fulfillment of desire nullify the morality of that action? Well, the argument that passion drives reason has a long history in philosophy, but that we act on our desires, because we do what we want does not mean those doings are morally tainted. If that were the case, then morality would have no place for humans, and we would have no place for morality.

So how do we adjudge the morality of decisions shot through with desire and need and fear and hope and confusion? How do we say that this decision to do what we want is moral and that decision to do what we want is not?

I’m not  sure. This blog post has gotten way away from me—I was going to write about my sympathy for the position of those who think abortion is murder and admit of my own ambivalences—so at this point I just want (!) to bring this to a close and go to bed.

I don’t have answers. I don’t even have a way to the answers, beyond that of saying that, perhaps, the place to begin is by paying attention to what people have to say about their own lives, and how they come to live with themselves.


ETA: It’s now Thursday morning and even though I haven’t had nearly enough coffee, I’m awake enough to observe that I do, in fact, have a way to the answers (or, at least, a way to the way): that’s kinda what the whole “we might as well try” series is about.


Testing, one, two

20 02 2012

Rick Santorum got one (kinda) right.

The bottom line is that a lot of prenatal tests are done to identify deformities in utero, and the customary procedure is to encourage abortions.

That is exactly why a lot of prenatal tests are done—to identify any possible problems—and, yes, if the problems are sufficiently grave, an abortion may follow.

I’d argue about the word “encourage”—doctors are unlikely to be so explicitly directive in their discussion of test results—but I wouldn’t doubt that a fair amount of pressure is brought to bear on the woman (and her partner) to decide quickly, not least because abortions become more complicated the later in the pregnancy they’re performed.

And in fact, prenatal testing, particularly amniocentesis — I’m not talking about general prenatal care—we’re talking about specifically prenatal testing, and specifically amniocentesis, which is a procedure that actually creates a risk of having a miscarriage when you have it, and is done for the purposes of identifying maladies in the womb. And which in many cases — in fact, most cases physicians recommend — particularly if there’s a problem — recommend abortion.

Again, this is less clear. “Non-directive counseling” is the watchword in genetics counseling, and while OB/GYN’s have not necessarily undergone such training, the mantra of let-the-patient-decide has pretty well seeped into the ethos of American medicine.

“Doctor’s orders” ain’t what they used to be: since the 1970s, patient autonomy has been elevated to one of the main principles of biomedical ethics, a principle reinforced by the legal system. Doctors may and do recommend a particular course of action, but having been imbued with the notion of respecting the ability of the patient to make her own decisions and mindful of the possibility of tort action if their recommended solution goes south, they are far more likely to dump information into the patient’s lap and say “your decision”.

Okay, that’s a bit severe, but it is the case that patients expect more information and that courts will hold a doctor liable if she withholds such information from them; failure to perform standard medical tests and inform the patient of the results can itself result in lawsuits.

This is the real dynamic behind the pressure—and oh, yes, there is pressure*—for pregnant women to undergo prenatal testing.  Blood tests and ultrasounds are routine in all pregnancies in the US, and amniocentesis is strongly recommended for high-risk pregnancies, a procedure which Santorum, correctly, notes puts the fetus at risk for miscarriage. To decline such tests is to open oneself to repeated (incredulous and/or hostile) questioning of that decision.

But here is where Santorum begins to go off track:

One of the things that you don’t know about ObamaCare in one of the mandates is they require free prenatal testing. Why? Because free prenatal testing ends up in more abortions and, therefore, less care that has to be done, because we cull the ranks of the disabled in our society. That too is part of ObamaCare — another hidden message as to what president Obama thinks of those who are less able than the elites who want to govern our country.

Let’s unpack this, shall we?

First, those who perform the test, those on whom the tests are performed, those who pay for the test,  and those who regulate insurance are not all the same person. The doctor orders the test because it is standard medical practice and because she agrees that this standard medical practice is, in fact good, insofar as it gives both her and her patient more information. The patient generally (although not always) wants this information, so she, too assents to the screenings.

Those who pay for the test do so as a result of pressure from doctors to pay for good medical care and because, yes, testing can lead to lower costs to the insurer down the road. These lower costs may result from treatments prior to birth to forestall greater problems after birth and, yes, from women deciding to terminate pregnancies which are at high risk of resulting in the birth of a child with a disability. Over 90 percent of fetuses which test positive for Trisomy 21, the chromosomal abnormality responsible for Down Syndrome, are terminated.

There was, in fact, a case in which an insurer told a couple that if they did not terminate an affected pregnancy, any medical expenses associated with the birth and the child would not be covered. The couple sued, and won. Given that many couples will chose voluntarily to end such pregnancies, however, such coercion is generally unnecessary.

Finally, there are the insurance regulators, who have to balance concerns of patients, doctors,  and insurance companies; given that there is little conflict between these different groups (although there may be with some individual patients and doctors) about the desirability of the tests themselves, encouraging or even mandating partial or full coverage of such tests is non-controversial.

This basic dynamic was set into play long before Barack Obama became president, and it is highly unlikely that the (equally highly unlikely) presidency of Rick Santorum would alter this in any way.

Oh, he might try to force insurers to drop coverage of prenatal care, but both Congress and the courts would be hostile (for a variety of reasons) to any such executive orders. The testing regime, for better and for worse, has become entrenched in American medicine.

Let us now consider the most offensive aspect of Santorum’s screed against screening: he doesn’t consider the role of the women (or couples) themselves. Once again, they are pure victims of a dark techno-liberal conspiracy, unable to make any decisions for themselves and unworthy of consideration as actors in their own lives. They must be protected from Obama, liberals, doctors, and, of course, themselves.

That is Santorum’s own not-so-hidden message to the rest of us: he doesn’t consider us able to make the most basic decisions about our own lives.

I hate the term “sheeple”, but it certainly seems as if that’s how Santorum, the would-be shepherd, views the American people.


*Questions regarding prenatal screening have long preoccupied those who work in bioethics; a good introduction to some of this work is Prenatal Testing and Disability Rights by Erik Parens and Adrienne Asch.

American idiot

16 02 2012

This just passed the Virginia House of Delegates by a vote of 66-32:

HOUSE BILL NO. 1 Offered January 11, 2012Prefiled November 21, 2011A BILL to construe the word “person” under Virginia law, including but not limited to § 8.01-50 of the Code of Virginia, to include unborn children.

———-Patrons– Marshall, R.G. and Cline; Senators: Colgan and Garrett———-Referred to Committee for Courts of Justice———-Be it enacted by the General Assembly of Virginia:

1.  § 1. The life of each human being begins at conception.

§ 2. Unborn children have protectable interests in life, health, and well-being.

§ 3. The natural parents of unborn children have protectable interests in the life, health, and well-being of their unborn child.

§ 4. The laws of this Commonwealth shall be interpreted and construed to acknowledge on behalf of the unborn child at every stage of development all the rights, privileges, and immunities available to other persons, citizens, and residents of this Commonwealth, subject only to the Constitution of the United States and decisional interpretations thereof by the United States Supreme Court and specific provisions to the contrary in the statutes and constitution of this Commonwealth.

§ 5. As used in this section, the term “unborn children” or “unborn child” shall include any unborn child or children or the offspring of human beings from the moment of conception until birth at every stage of biological development.

§ 6. Nothing in this section shall be interpreted as creating a cause of action against a woman for indirectly harming her unborn child by failing to properly care for herself or by failing to follow any particular program of prenatal care.

§ 7. Nothing in this section shall be interpreted as affecting lawful assisted conception.

§ 8. Nothing in this section shall be interpreted as affecting lawful contraception.

That’s right: the proposed amendment protecting contraception was stripped out of the final bill.

As for “affecting lawful assisted conception”, does Delegate Robert G. Marshall know that the process of culturing, testing, freezing, and thawing embryos carries the non-negligible risk of embryo death? Or that this bill would require those who created the embryos in vitro either to transfer said embryos to a willing woman or to keep them in a deep freeze forever?

Does he know that as of 2009 Virginia contained 12 fertility clinics, which performed over 2000 cycles using fresh non-donor eggs? Is he aware that many, many more than 2000 fertilized eggs were transferred which never took? Is he aware that during these IVF cycles that many eggs were fertilized that never developed beyond a few cleavage stages—that is, that these eggs died in the dish?

Maybe he does, and he just doesn’t care.

But no, let’s not give him the benefit of the doubt—especially since he couldn’t be bothered to agree to the contraception-protection amendment—and let’s denounce his double-idiocy. Why double?

1. He does not understand conception.

To begin with, fertilization is a process, not a single event. The zygote is not formed until the last stage of fertilization, that is, after the sperm has penetrated into the ooplasm it takes some time before the 23 pairs of chromosomes are sorted and arranged. Furthermore, the early pregnancy factor protein—the presence of which in the first 10 days after fertilization indicates a pregnancy—is not secreted into the woman’s bloodstream until 24-48 hours post-fertilization.

And of course, pregnancy is not considered to have begun until 6 days or so post-fertilization, when the blastocyst attaches itself to the endometrium epithelium of the uterine wall.

Given that neither Marshall nor any of the rest of the 65 delegates could be bothered even to define what is “conception”—is it that magic moment when a single sperm pushes its way through the zona pellucida surrounded the ooplasm? after the formation of the two pronuclei? the fusion of said pronuclei?—-it’s easy to conclude they don’t give a damn about biological reality.

Which matters because it is the biological reality that 60-80 percent of all fertilized eggs will never result in a live birth, which in turn would indicate that “nature” or “biology” doesn’t give a damn about Marshall’s definition of personhood.

2. This biological reality also matters because these majority of failed fertilizations could potential open a woman up to legal liability.

Yes, the bill states that “Nothing in this section shall be interpreted as creating a cause of action against a woman for indirectly harming her unborn child by failing to properly care for herself or by failing to follow any particular program of prenatal care” —but it doesn’t prevent such creation, either. In other words, the legislators, in attempting to get around the legal reality that it would be impossible to investigate every single instance of failed fertilization, nonetheless leave open the possibility (via § 4) that a woman could be held liable.

Admittedly, I could be reaching here, but it does seem as if sections 4 and 6 are in potential conflict with one another, and it is by no means certain how a court would resolve such a conflict.

More to the point, this is a piece of bullshit boilerplate designed both to get the state off the hook for not providing adequate prenatal care to poor and uninsured women and to reinforce the notion that women aren’t responsible enough to make decisions about their own health.

And, of course, this bill leaves the status of in vitro-created zygotes in limbo: what happens if they don’t develop? Could clinicians be held liable?

Who knows. Answers to these questions would require some recognition of the messiness and complexity of human life, something which these reality-challenged delegates are clearly unable to do.

The bill now goes to the Senate.

Mayan Campaign Mashup 2012: Santorum’s choices

8 01 2012

In 1996, Rick Santorum’s wife Karen had a difficult pregnancy.

The health of the fetus severely compromised, she decided to undergo surgery to correct the problems; this surgery led to a life-threatening infection, which in turn led to a course of antibiotics which had the (known) effect of starting labor. Doctors then gave her a drug to bring the labor along, resulting in the early delivery of a 20-week old fetus the Santorums named Gabriel.

Prior to the surgery, Karen Santorum was adamant that she wanted doctors to do everything possible to try to save the pregnancy; even after she agreed to take the antibiotics, she and her husband hoped that the fetus could be saved, to the point that Santorum initially refused the Pitocin which sped up labor. However, Santorum admitted that had labor not resulted, she would—reluctantly—have agreed to an abortion to save her life.

The fetus, named Gabriel, lived for two hours. After his death, the Santorums took him home to their then-three (they now have seven) children so that they could  “absorb and understand that they had a brother.”

Karen Santorum later wrote on book on the experience, Letters to Gabriel, and the experience apparently reinforced her husband’s views against abortion.

Three points:

1. It is good that Karen Santorum had the choice to decide how to deal with a difficult pregnancy, including the choice to risk her own life.

The person who has to live with the consequences of any decision ought to be the one to make that decision.

2. It is a dicey matter to criticize how people mourn. Eugene Robinson and Alan Colmes have come in for a great deal of criticism for mocking the Santorums for bringing the dead fetus home. While both Robinson and Colmes seem more weirded out by rather than contemptuous of the Santorums, they both imply that Santorum’s action reflects poorly on his ability to lead.

I have nothing good to say about Santorum, not one damned thing, but I also strongly believe in judging public officials by their public actions. Even shitty politicians get to have a personal life, whatever the shape of that personal life may be.

And as an aside, I don’t know how weird it is to bring a loved one’s corpse home. In most cases, of course, this isn’t an option, but into the 20th century in the US many of us dealt with our own dead. Perhaps there were those in the community who were called upon to help wash and prepare the body, but death in the home was not uncommon.

And in some sense both the right-to-die and the hospice movements (which are usually in political opposition) have reacted against the depersonalization of death in their efforts to allow people a decent death at home. I am among those who would prefer to bring death home, to see death as the end of life, not separate from it. Whatever my view of the status of the fetus, I don’t know that the urge of the Santorums to bring what they considered their son’s body home is really all that strange.

It seems quite human.

3. Anything goes, winning is the only thing, whatever you can get away with—I don’t take back a word of it. While I might think it politically dicey to bring up Santorum’s actions in this matter, I don’t think it’s out of bounds, mainly because I don’t think anything is out of bounds. My own personal beliefs on the respect for privacy have nothing to do with observations on political tactics, and in political campaigns, anything that can be used, will be used.

This is even more the case when you refer to your personal life in order to score political points. If, like Santorum, you use you and your wife’s ordeal to buttress your political attacks on abortion, then you transform that ordeal into political fodder, fodder which may now legitimately raked over and flung back at you.

There’s a big foggy territory between the personal and public for politicians. Yes, their minor children (and grandchildren) are used in photo ops and they may make occasional jokey references to something that their kids said or heard, but such uses are stylistic tropes, and are generally ignored, as are generic references to family in order to humanize oneself. When the politician goes deep into, say, a family tragedy, whether we see the person as been courageous and honest or cynical and conniving, and how the story can be used politically, likely depends on our views of the politician in the first place.

This is where the the “can be used/will be used” meets the “whatever works”: Will going after your opponent’s personal life help or hurt your campaign? If bringing up his personal life helps you, you do it; if it is likely to spark a backlash and hurt you, you don’t. That’s it.

It is noteworthy that those who criticized the Santorums’ decision are pundits, not anyone connected to any campaigns. The other candidates or their strategists might also think this is (further) evidence for his unfitness, but they will keep their lips zipped because there is nothing to be gained and too much to lose. That calculus is what regulates their behavior—period.

The point is to win.