On Abortion and Vaccines

At first glance, it might seem strange to combine an evaluation of abortion with vaccination, but the two are inexorably linked. At their cores, they are both rooted in the same issue: the right to bodily autonomy.

Of all rights, the right to control one’s own body seems the least controversial. If rights exist at all, then the right to make choices regarding what happens to your body should be paramount. In a way, it is from this right that all others derive—the right to free speech is the right to use your body to speak. The right to be free from physical violence is the right not to have your bodily integrity damaged by another. The right to privacy, where it exists, is to regard a person’s private space as an extension of their body. Property rights are useless without the right to use tools being implicit within the right to bodily integrity.

Before we move on, let’s address the question of whether—and how—rights exist. The religiously minded answer to the question of whether rights exist is inevitably “Yes, of course they exist. God gave them to us.” This answer is not satisfactory, and not only for the not quite trivial reason that no such beings exist, so they cannot “give” us anything. That point aside, rights are legal privileges that dictate what actions a government can and cannot take. The “right to free speech” is a legal principle that forbids a governmental body from restricting the speech of its citizens. This is a powerful principle, and much of the developed world takes it for granted, yet it is not present everywhere. There are countless people for whom speaking out against the dominant ideology would mean political suicide—or very conceivably death.

We needn’t consider such an extreme example, however, to realize that rights are not inviolable. Even the United States recognizes that “free speech” does not allow a person to say absolutely anything they desire. Even in the context of a free society, some speech must be limited for the public good. These exceptions are not immediately apparent upon hearing the phrase “free speech,” but there can be no question that the majority of the developed world, this concept is treated with great reverence. The list of examples of speech that can or should be restricted has been fleshed out over time; as it became apparent that new instances of speech were particularly troublesome, they were considered and argued by legal scholars. Thus, we see that rights are social constructs, and while they may not be “endowed by [our] Creator,” they are still very much real, and they contain just as much nuance as any other area of legal scholarship.

With the example of free speech, we see that a right is contingent upon something else to exist—rights are not self-evident. But what? The answer seems to be harm: rights apply only as long as the application of that right prevents harm. We do not allow speech that directly invites harm—we censor lies, threats, and provocations of violence and lawlessness because each of these things has a palpable risk of harm if left unchecked. We recognize that shouting “Fire!” in a crowded theater carries an immediate risk of panic (which carries an immediate risk of harm), and even though we may possess the ability to respond by shouting “There is no fire!” in return, quelling a mob is significantly harder than inciting one, and what damage has been done cannot be undone by such a counter-exclamation.

To the case of abortion, then. The arguments in favor of keeping abortion legal by and large make an appeal to the right to bodily autonomy—the principle that demands “I am the ultimate arbiter of what happens to my body.” We instinctively recognize this right in ourselves, yet some people seem to have difficulty extending the idea to others. We do not recognize the government as possessing the power to forcibly tattoo citizens. If agents of the government sought to enforce a policy of compulsory body piercings, there would be outrage. “No government can force me to pierce my nipples,” men and women alike would shout. Similarly, the government has no reasonable basis for banning the voluntary practice of navel piercing, but it does have a reasonable argument for regulating the practice—by establishing health standards, the government is justified in demanding that such procedures, when voluntarily undertaken, be done in ways guaranteed to mitigate the threat of harm. We would never abide a policy of involuntary violinist-tethering; if, however, a violinist were in dire need of an organ transplant, we do have voluntary donor programs that serve this very function!

Those who oppose abortion have traditionally adopted a stance of moral indignation, suggesting that a woman’s pregnancy has rights that exceed the woman’s right to autonomy. This approach, enduring though it may be, is utterly baseless. We do not grant rights equally to an adult, a child, a dog, a statue, and a box of paints. We recognize that each item in that list has fewer rights than the item preceding it. The paints have the potential to become a portrait, but we would never dream of hanging them on our wall. The statue may have all the same external physical characteristics of a person, but it gets no rights afforded to human beings because it isn’t a person. We recognize that the dog has some rights due to being a living, thinking creature. We see that dogs feel pain, thus they should not be subjected to needless torture; however, we do not seriously discuss a dog’s right to free speech or to the freedom of doggy-religion. Because children are capable of speaking, reasoning, and feeling pain, they are entitled to more rights than the family pet, but by virtue of their inability to engage in higher reasoning and to understand the consequences of their actions, we do not grant them the full rights and privileges of an adult. With these factors in mind, it seems we must conclude that rights—including the right to bodily autonomy—are contingent upon and proportional to one’s ability to feel, to plan, and to reason. Due to their reduced capacity for these things, the child’s and the dog’s rights to autonomy are consequently entrusted, at least partially, to their respective caretakers for as long as (and to the degree that) they lack the ability to do these things. Inescapably, then, a fetus can have no rights of its own because it has no more ability to engage in these higher-level activities than the statue or the box of paints.

Some anti-abortion activists suggest that because an embryo has the potential to become a person, it is entitled to the rights of a person, but this is absurd. A thing’s value is not determined by what it might one day become but rather what it is. If this were not the case, we would punish the amateur artist with prison for destroying a canvas’s ability to become the next The Starry Night when they fail to produce anything more moving than a painful self-portrait. An embryo’s ability to become a person is contingent upon an exhaustive list of conditions that are not guaranteed to occur, just like how any given blank canvas has the ability to become the Mona Lisa. It is incoherent and frankly offensive to insist on the treatment of potential as the equivalent of reality. To regard a cluster of cells that has the potential to become a person as having all the same rights as an actual person, is to fundamentally misunderstand the entire spheres of morality, legality, and biology.

But even this obscene false equivalence of potentiality to actuality is not what the anti-abortion crowd advocates. Instead, they would rank the well-being of this potential life above the woman’s by denying her the right to bodily autonomy. I don’t think there is any contention over whether children have the “right to life”—they certainly do! (Although I would stress that a “fetus” is not a “child.”) Children, however, do not have the right to be raised by their biological parents: we are free to give our children up for adoption, as abortion opponents just love to remind us. In the same sense, even if an embryo had any right to life, it would not have the right to impinge upon another’s right to bodily integrity. If such a right existed at all, I would insist that it exercise that right in someone else’s womb—someone who actually wants it there.

Yet we should always remember that rights are conditional. Just as the right to free speech does not guard against harmful speech, we must consider the potential harms of abortion. Does an abortion harm the fetus? There may be reasons to answer this question with a yes, but we cannot simplify rights to a false dichotomy of “harm exists” and “harm does not exist” because such a binary standard would be functionally unworkable. Instead, we have to look at a sliding scale, acknowledging that some actions are more harmful than others, and conceding that there is a certain threshold at which harm becomes inexcusable.

How do we draw this line? I don’t claim to have the perfect answer, but a good first guess would seem to be to use pain as a standard. A shoe does not feel pain. An amoeba does not suffer. A tree does not weep. These kinds of discomfort require neural activity—not just that, they require a sufficiently developed nervous system. Pain is a mental state, so things that are not capable of mental states cannot experience it. This is why we feel no remorse for killing and eating carrots. Most aborted fetuses lack this capacity. If it comes down to a choice between a pregnant woman’s bodily autonomy and the fetus, which is incapable of suffering, only someone with no moral compass could choose the latter, just as a choice between the rights of a woman and a park bench is easily decided in the woman’s favor. Where, approximately, is the line separating an acceptable imposition of pain from an unacceptable one?

To answer that question, let’s turn to the topic of vaccination. There can be no question that a government mandate requiring a person to be vaccinated is a suspension of their bodily autonomy, but we’ve already seen that rights can be suspended, so this alone is not a worthwhile question. Instead, let’s ask whether it is an acceptable violation. Violating the right to free speech is judged permissible when doing so prevents larger harms. For the most part, forbidding people from speaking freely in public can be seen to have very negative repercussions on that society in, for example, being subjected to official sanctions for actions that do not cause harm (as does sometimes happen). Thus, there must be some nuance to interpreting the acceptability of constraining rights. Let’s turn to cost-benefit analyses to better understand this.

In a cost-benefit analysis of forbidding “blasphemy,” we see the following:
Cost: People go to prison for disagreeing with religious claims.
Benefit: Religious believers don’t have to endure the inconvenience of hearing someone disagree with them about their religion.
Conclusion: Having the occasional person disagree with you is significantly less damaging than being imprisoned over disagreeing with someone. That cost does not justify the harm.

How about forbidding calls to violence?
Cost: People can go to jail for saying things like, “Hey everyone, let’s go firebomb that building!”
Benefit: Fewer buildings get firebombed.
Conclusion: If enforced, this leads to a very plausible deterrent effect, strongly suggesting a more stable society as a result of having less crime. This fairly convincingly outweighs the inconvenience of having to express yourself without asking people to commit themselves to violent actions.

What about vaccination, then? Well, contrary to popular urban legend, vaccines do not cause autism. There are recorded instances of vaccines having unfortunate side effects, but these have been largely corrected for through the wonders of modern medical science, wherein scientists identify the mechanisms that cause sickness and address those mechanisms—you know, instead of just hoping really hard. (There is actually a lot of misinformation about vaccines that is constantly spread around by anti-vax ideologues with no grasp over science.) On to the cost-benefit analysis, then:
Cost: In the case of the MMR vaccine, a less than one in one million chance of severe side effects.
Benefit: A breathtakingly effective way to avoid the harms of diseases that ravaged preceding generations for hundreds or thousands of years.
Conclusion: When you calculate the difference, you see that the risk of harm from the disease is over ten times greater than the risk from the vaccine.

With these cost-benefit analyses in mind, why should we compare abortion to vaccination? At first glance, the issue of whether or not we can legislate abortion seems to need the same answer as whether or not we can legislate vaccination—if bodily integrity requires that abortion be legal, then mandatory vaccination must also be illegal, right? Or, conversely, if mandatory vaccination can be legal, then we should be able to declare abortions illegal on the same reasoning, right?

No.

In the case of mandating vaccination, the benefits demonstrably exceed the costs. The temporary violation of the individual’s right to bodily autonomy is offset by the drastic improvement in that same individual’s quality of life. Also, by contributing to herd immunity, that individual’s vaccination also improves the well-being of every other member of society. What are the benefits to outlawing abortion? Doing this would endow a fetus—a potential human, rather than an actual human—with rights more powerful than the woman’s own right to bodily integrity. At best, the result of this is that a new, unwanted child enters the world. But this interpretation is a white-washing of the normal physical and psychological effects pregnancy has on a woman’s body, the potentially very serious complications of pregnancy, and the increased trauma of being forced to bear a child against her will, which has been likened rather convincingly to forced organ donation.

In my eyes, this is an open-and-shut case. Government mandated vaccinations are low-risk inconveniences akin to, well, being forced to go to the doctor’s office. At the worst, they bring a slight risk of harm well below that brought on by the diseases they prevent.* Government mandated child-bearing, on the other hand, introduces a guaranteed substantial investment of time and energy. This forces a woman to undergo a torrent of physiological changes that will very likely result in permanent and unwanted changes to her body. This is a guaranteed harm. If we are going to permit the temporary suspension of the right to bodily autonomy, which I contend we must, let it be only in cases where doing so is overwhelmingly beneficial to the person whose rights are being overridden. Demanding that women relinquish their right to bodily integrity to carry out a policy of mandatory pregnancy would be nothing short of the abrogation of moral reasoning.

So, dear reader, does this sound like a reasonable interpretation of these two issues? Why or why not? I welcome your feedback.**

*I guess you also have those incessant spurious pseudoscientific claims that endure in spite of being regularly debunked by the scientifically literate. Some might say that that’s a pretty big drawback, but it certainly doesn’t outweigh the health benefits of immunization.
**If any of this didn’t make sense, I blame the fact that I faced a constant stream of interruptions while writing this. Feel free to point out any indecipherable bits.

Why the “Moral Objection” Fails

This notion of the Affordable Care Act (ACA, a.k.a. Obamacare) as a violation of a person’s religious liberty persists because it sounds like a convincing argument. It isn’t, of course, or the law wouldn’t have been ruled constitutional by the (majority Catholic) US Supreme Court. There are two main reasons why this argument does not hold water:

  1. It is a red herring.
  2. It is not sound policy.

It is a red herring because it mischaracterizes the way the law works. That the Supreme Court has ruled that the law is constitutional in its entirety (including this contraception mandate) should be sufficient to illustrate why this objection is irrelevant, but I’ll elaborate further for the sake of being comprehensive.

The religious “moral objection” issue seeks to erroneously portray the law (savvy readers might recognize this terminology as indicative of a straw man) by claiming that the law requires employers to provide contraception for their employees. This is false. So what does this law do? It does three things:

  1. It mandates that people carry health insurance.
  2. It mandates that employers of a certain size (50+ employees) offer health insurance.
  3. It regulates the insurance industry.

At the abstract level, that’s “all” it does.

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Situational Values (a.k.a. Religion)

At the risk of further abusing a decayed and desiccated equestrian cadaver, I’ve had it up to here (crap—you can’t see my gestures through text. Bah, just imagine it) with the “contraceptive coverage violates my religious liberties” argument. Here’s the latest one, courtesy of Speaker of the House John Boehner’s twitter feed:

The Obamacare HHS mandate takes effect today that requires Americans to violate their religious beliefs to implement the president’s health care law. The mandate compels religious employers to pay for and refer women for abortion-causing drugs, birth control, contraception and sterilizations.”

Let’s ignore, for a moment, the absurdity of the notion of an “abortion-causing drug” and—oh nevermind, let’s not. This one’s so stupid, it needs its own paragraph. What is an abortion?

a·bor·tion   /əˈbɔrʃən/
noun
1. Also called voluntary abortion. the removal of an embryo or fetus from the uterus in order to end a pregnancy.
2. any of various surgical methods for terminating a pregnancy, especially during the first six months.

And contraception?

con·tra·cep·tion   /ˌkɒntrəˈsɛpʃən/
noun
the deliberate prevention of conception or impregnation by any of various drugs, techniques, or devices; birth control.

Abortion is an intervention, either surgical or medical (85% and 15%, respectively, per the CDC), to terminate a pregnancy. Contraception, by definition, cannot be abortion because abortion can only occur after impregnation. An abortion can be done, realistically, at any point in a woman’s pregnancy, all the way up to the final (ninth-ish) month of pregnancy, although third trimester abortions are exceedingly rare (91% occur in the first trimester, and most of that remaining 9% in the second). Contrast this with the notion of “abortion-causing drugs,” by which the author is presumably referring to ella, a “Plan C” pill that a woman can take up to five days after sex to prevent pregnancy (it also triggered a good deal of outrage in the wingnut lobby). It should be obvious—but apparently it isn’t—that swallowing a pill is radically different from undergoing an invasive surgical procedure. One cannot merely swallow a pill six months into her pregnancy and consider the whole ordeal over. The implication that these drugs are fundamentally equivalent to a surgical procedure is at best a gross misrepresentation of the facts (and is more likely a deliberate distortion intended to compel people with more emotion than sense to yell vociferously). Comparing abortion to contraception serves only to demonstrate an unwillingness to engage in rational discussion. It is a red herring, meant only for deception.

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Today’s Legal News

United States readers will likely know that today is the day that the Supreme Court has chosen to release their Opinion(s) on the Affordable Care Act, also known as Obamacare. The only consensus about today’s decision is that no one is certain how they’ll rule, and this event has more or less singlehandedly occupied my thoughts today. I’m eagerly awaiting the official announcement, scheduled to come down in approximately 45 minutes soon (rulings will begin coming out, at 10:00 am, but the Obamacare one will probably be the last one announced). I intend to follow the development as it happens, but I don’t know if I’ll actually write anything about it here. If I do address it, it will probably be to aggregate other writings by more capable legal scholars. When the furor over it has died down a bit, I might get around to writing a post before tomorrow, but I’m not actively planning to do so. We’ll see.

If you want to follow it as it unfolds, SCOTUSblog is liveblogging it here.

Needless to say, regardless of the outcome, this will be touted as an event with deep political significance by all pundits who want to be seen as relevant. In other words, we probably won’t hear about anything else until Monday. Joy.

There are other important things coming out from the Supreme Court today, but all I’ve seen from the media is ACA gossip. Hum. I wonder if that could have something to do with the politicization of that particular case.

Update, from SCOTUSblog:

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

This was a 5-to-4 vote entirely upholding the Constitutionality of the ACA. The thing that most surprises me here is neither of these facts, but the fact that the fifth vote was that of Chief Justice Roberts. Kennedy swung with the conservatives, and all four of them apparently believe that the ACA should have been struck down entirely. Yikes. Glad the good guys won.

Want to read the Opinion? It’s online.

The SCOTUS also dealt with two other cases today, and you can see a summary of those here.

Debating Morality

Today’s post was rather short because instead of coming up with a topic to blog about, I got much of my writing fix in by conversing with a pair of delightful believers. In both cases, the discussion ended up veering into “objective morality” territory, so I was happy to have written my piece on that. I expect to have more to say here tomorrow. (I’d take requests, but I doubt anyone’ll make any.)

To make up for my quietness, here’s a consolation explanation of Obamacare! (Click to expand.)

Obamacare, explained as if to a five-year-old.

Another Religious Attack on Freedom

I’ve already written at some length about why Catholic hospitals trying to exempt themselves from the laws that apply to all hospitals is completely fucking unacceptable. I have many more vitriolic things to say about this, but I’m a bit too incensed at the moment. (Yes, I’m too angry to rant. Goodie.)

So instead of a long-winded rant, I’d like to just offer this sentiment: Fuck you, Catholic Health Association. Not any kind of mundane single-position borefuck, no, but a delightfully sodomy-filled hatesex romp, preferably with a number of participants (there are surely a number of people who’d like to take out their frustration with this sort of thing on you, after all). I’m talking a “go through an entire economy-sized box of condoms” thing here (but only because you don’t believe in birth control). Once that’s all said and done, and after you’ve had a shower (maybe a nice nap too), see your way right out of the healthcare business. Sell (or donate) your hospitals to organizations that actually give a shit about their employees and clients, and never ever come back. The measure of your worth as a healthcare provider isn’t how good you feel about your hallucinatory relationship with your invisible sky daddy—it’s how well you provide for real human beings. If you want to be a church, be a church. If you want to be a hospital, be a hospital. You cannot possibly do both without completely screwing up at least one of them.

And, just in case it wasn’t clear, fuck you.

You Got Your Jesus in my Medicine!

Well, my people who need to be fired list has just gotten longer.

Dr Richard Scott is alleged to have told the “psychologically troubled” 24-year-old he was not going to offer him any medication but he did have a cure for the patient’s ills, the General Medical Council (GMC) heard.

“If he did not turn to Jesus and hand him his suffering he would suffer for the rest of his life.”

There should be an update on Thursday. I sure can’t wait.

 

Edit: Update! The GP got … a warning. Yep. Serious business, those warnings. I’m sure he’s learned his lesson. Consider me somewhat less than satisfied.