Tag Archives: Health care

GoFundMe(dical Expenses)

While the United States does offer some of the best health care in the world, it also offers the most expensive care. What it does not offer is the sort of medical coverage for the citizens that other Western countries provide. As such, many citizens are on their own when it comes to paying for this expensive care. As of this writing, Trumpcare has not passed, but it seems likely that the final version will be essentially a tax-cut for the wealthy with a reduction in coverage and benefits for those who are not well off. In any case, healthcare is likely to grow increasingly expensive for most Americans while they have reduced abilities to meet these expenses.

Americans are a creative and generous people, so it is not surprising that many people have turned to GoFundMe to get money to meet their medical expenses. Medical bills can be ruinous and are all too often a contributing factor in personal bankruptcy. As such, successful GoFundMe campaigns can help people pay their bills, get the care they need and avoid financial ruin. Friends of mine have been forced to undertake such campaigns and I have donated to them, as have many other people. In my own case, I am lucky—I have a job that still offers insurance coverage at a price I can afford and my modest salary allows me to easily meet the normal medical expenses for a very healthy person with no pre-existing conditions. However, I know that like most Americans, I am one bad medical disaster away from financial ruin. As such, I have followed the use of GoFundMe for medical expenses with some practical interest. I have also given it some thought from a philosophical perspective.

On the one hand, the success of certain GoFundMe campaigns to cover such expenses does suggest that people are morally decent—they are willing to expend their own resources to help other people in need. While GoFundMe does profit from such donations, their take is relatively modest for the service they provide. They are not engaged in gouging people in need and exploiting medical necessity for absurdly high profits—unlike some pharmaceutical companies.

On the other hand, there is the moral concern that in such a wealthy country replete with billionaires and millionaires, many people must resort to what amounts to begging for money to meet their medical expenses. This reality points to the excessive cost of healthcare, the relatively low earnings of many Americans, and the weakness of the nation’s safety net. While those who donate out of generosity and compassion merit moral praise, the need for such donations merits moral condemnation. In a purportedly civilized nation, people should not need to go begging for money to pay for their medical care.

To anticipate an objection, I am aware that people do use GoFundMe for frivolous things and that there are no doubt scammers using fictions of medical woe to separate the kind but uncritical from their money. Obviously enough, people are under no obligation to donate to frivolous camp and such scams are to be condemned for their wickedness. My concern is with the honest campaigns that are necessary to meet medical expenses. These are the campaigns that illustrate much that is wrong with the existing health care system.

While donating to such honest campaigns is morally laudable, there are some concerns about this method of funding. One obvious problem is that it depends on the generosity of others. It is not a systematic and dependable method of funding. As such, it is certainly problematic that some people need to rely on it.

A second obvious problem is that this method depends on an effective social media campaign to succeed. Like any other crowdfunding, success depends on getting attention and then persuading people to donate. Those who have the time, resources and skills to run effective social media campaigns (or who have such people helping them) will be far more likely to succeed than people who are lacking in these areas. This is especially concerning because people who are facing serious medical expenses are often in no condition to undertake the challenges of running such a campaign. In some cases, their efforts are being devoted to not dying. This is not to criticize or condemn people who can do this or recruit others to do it for them. Rather it, is to point out that this method is obviously no substitute for a systematic and consistent approach to funding health care.

A third obvious problem is that the success of this method depends on the appeal factor of the medical condition and the person with that condition. While a rational approach to funding would be based on merit and need, there are clearly conditions and people that are much more appealing in terms of attracting donors. For example, certain diseases and conditions can be “in vogue” and generate considerable sympathy, while others are not as appealing. In the case of people, it is evident that we are not all equal in how appealing we are to others. As with the other problems, I do not condemn or criticize people for having conditions that are in vogue or being appealing. Rather, my concern is that this method rests so heavily on these factors rather than medical and financial need. Once again, this serves to illustrate how the current system has been willfully broken and does not serve the needs of most Americans. While those who have succeeded in their GoFundMe campaigns should be lauded for their effort and ingenuity, those who run the health care system should be chastised for a state of affairs in which people have to run social media campaigns to afford their health care.

 

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Medicine & Markets

As a point of ideology, many conservatives advocate the broad application of free market principles. One key part of this ideology is the opposition of regulation, at least regulation that does not favor businesses. Since health care is regarded as a business in the United States, there is an interesting question in regards to the extent that health care pricing should be regulated by the state.

Because of the high cost of health care in the United States, there have been proposals to place limits on the cost of health care services. Some areas have implemented such proposals, but there is a general lack of such regulations on pricing. Those who oppose such regulations often contend that pricing should be set by free competition between health care providers and that consumers of health care should be savvy shoppers. The idea is that savvy health care shoppers will take their business to providers that offer better services or lower costs, which will force the competition to lower costs or improve quality.

There are various problems with the idea of savvy health care shoppers. The first is the challenge consumers face in finding the prices that health care providers charge. While it can be difficult to predict what services a consumer might need, health care providers often have a range of prices depending on who is paying for the services. For example, insurance companies negotiate prices with providers and these differ from what consumers without insurance would pay. Health care providers, although they always have a database of billing codes and costs, are generally reluctant to provide this information. This makes savvy shopping difficult.

A second problem is that health care consumers typically lack the medical knowledge to make informed decisions about health care. While a person might have some challenge in sorting out what sort of phone or laptop they should buy, sorting out what sort of medical care they might really need is typically beyond the skill of most people. That is why people go to medical professionals. As such, being a savvy shopper is rather difficult.

A third problem is that it is something of a mistake to describe a health care consumer as a consumer; it is usually more apt to call them a patient. While this might seem to be a mere difference in labels, the difference between consumer and patient is significant.

A rather important difference is that a patient is typically in duress—they are injured or ill and thus not in a very good state to engage in savvy shopping practices. While an informed rational consumer will be looking for the best deal, a suffering patient is concerned primarily with getting better. As people say to not go grocery shopping on an empty stomach, it would be best to not shop for health care when one is not healthy—but that is exactly when one needs health care. There are also the more extreme cases. For example, a person who is badly injured in a car crash is not going to be shopping in a savvy manner for emergency rooms as they are being transported in the ambulance.

It can be countered that there are cases in which a person can engage in savvy shopping, such as elective surgeries and non-emergencies. This is a reasonable point—a person who is not in dire need can take the time to shop around and be a savvy consumer. However, this does not apply to cases in which a person is sick or injured enough to impeded such savvy shopping.

Another important difference between consumer and patient is that the consumer often has a reasonable choice between buying a good or service and doing without. In contrast, patients usually have a real need for the good or service and doing without would be a real hardship or even fatal. When one must buy the good or service and the provider knows this, it makes it much harder to be a savvy shopper. This also provides a segue into the matter of regulating prices.

While free market pricing can work when consumers can easily do without the good or service, it runs into obvious problems for the consumer when the goods or services are necessities. To the degree that the patient cannot do without the health care goods or services, the patient is at the mercy of the provider. So, while a person can easily elect to do without the latest iPhone if they cannot afford it, it is much more difficult for a person to do without their chemotherapy or AIDS medication. True, a consumer could do without liposuction or breast implants, but such elective surgery differs from non-elective treatments.

The stock counter to such concerns is that if a consumer finds the price of a good or service too high, they can go to a lower priced competitor. Assuming, of course, that there is real competition. In the case of health care, the opportunity to find a lower priced competitor can be problematic. A patient might not have the time to shop around on the way to an emergency room. In many places, there is not any local competition with lower prices. As such, this free market advice is not very helpful.

In the case of pharmaceuticals, patients often find that there is no competition. When a company has a patent on a medication, the United States’ government uses its coercive power to enforce that patent, ensuring that the company retains a monopoly on that medication. Because of this, a patient who needs the medication has two basic choices: do without or pay the price. There is no free market competition, so without regulation on the part of the state, the company can decide to charge whatever is desired—subject to the cost of bad press, of course.

This monopoly system does create something of a quandary for a principled proponent of the free market. On the one hand, without such patents a free market of drugs would make it irrational for for-profit companies to invest in costly research. This is because as soon as the drug was developed, the competition would just duplicate it and can sell it cheaper because they would not need to recoup the cost of development. A solution, which would not be very free market, would be to have the state fund the expensive research and then provide the results to companies who would then compete without monopolies for consumer dollars. Another “solution” would be to let the market remain free and hope that medications would somehow be developed.

On the other hand, if the state stepped in to regulate prices as part of the agreement for using its coercive power to protect the monopoly, then there would also be no free market competition. But, the state could see to it that the companies charged prices that allowed profits while not gouging patients.

My own view, as might be suspected, is that since patients are essentially a coerced market when it comes to health care and medication, the state should act to regulate prices. In the case of pharmaceutical companies, this should be part of the bargain with the state that allows them to maintain their monopolies. After all, if taxpayer dollars are to be used to protect monopolies, then they should get something in return—and this something should be reasonably priced medication. In the case of health care providers, while they do not usually have a monopoly, they do have a coerced market. Just as the state justly steps in to prevent price gouging during large scale natural disasters, it can justly do so in regards to personal disasters—that is, injury and illness.

I am certainly sensitive of the desire of health care providers and pharmaceutical companies to make a profit and, as such, I would certainly advocate that the regulations on pricing leave them a reasonable margin of profit. While it might be objected that a reasonable margin of profit it hard to define, my reply is that if price gouging can be recognized in other areas, it can (and is) be recognized in the realm of medicine.

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The State & Health Care

One way to argue that the state is obligated to provide health care (in some manner) to its citizens is to draw an analogy to the obligation of the state to defend its citizens from “enemies foreign and domestic.” While thinkers disagree about the obligations of the state, almost everyone except the anarchists hold that the state is required to provide military defense against foreign threats and police against domestic threats. This seems to be at least reasonable, though it can be debated. So, just as the United States is obligated to defend its citizens from the Taliban, it is also obligated to defend them against tuberculous.

Another approach is to forgo the analogy and argue that the basis of the obligation to provide military defense and police services also extends to providing health care. The general principle at hand is that the state is obligated to protect its citizens. Since anthrax and heart failure can kill a person just as dead as a bullet or a bomb, then the state would seem to be obligated to provide medical protection in addition to police and military protection. Otherwise, the citizens are left unguarded from a massive threat and the state would fail in its duty as a protector. While these lines of reasoning are appealing, they can certainly be countered. This could be done by arguing that there are relevant differences between providing health care and providing armed defenses.

One way to do this is to argue that the state is only obligated to protect its citizens from threats presented by humans and not from other threats to life and health, such as disease, accidents or congenital defects. So, the state is under no obligation to protect citizens from the ravages of Alzheimer’s. But, if ISIS or criminals developed a weapon that inflicted Alzheimer’s on citizens, then the state would be obligated to protect the citizens.

On the face of it, this seems odd. After all, from the standpoint of the victim it does not seem to matter whether their Alzheimer’s is “natural” or inflicted—the effect on them is the same. What seems to matter is the harm being inflicted on the citizen. To use an obvious analogy, it would be like the police being willing to stop a human from trying to kill another human, but shrugging and walking away if they see a wild animal tearing apart a human. As such, it does not matter whether the cause is a human or, for example, a virus—the state’s obligation to protect citizens would still apply.

Another approach is to argue that while the state is obligated to protect its citizens, it is only obligated to provide a certain type of defense. The psychology behind this approach can be made clear by the rhetoric those who favor strong state funding for the military and police while being against state funding for medical care. The military is spoken of in terms of its importance in “degrading and destroying” the enemy and the police are spoken of in terms of their role in imposing “law and order.” These are very aggressive roles and very manly. One can swagger while speaking about funding submarines, torpedoes, bullets and missiles.

In contrast, the rhetoric against state funding of health care speaks of “the nanny state” and how providing such support will make people “weak” and “dependent.” This is caring rather than clubbing, curing rather than killing. One cannot swagger about while speaking about funding preventative care and wellness initiatives.

What lies behind this psychology and rhetoric is the principle that the state’s role in protecting its citizens is one of force and violence, not one of caring and curing. This does provide a potential relevant difference; but the challenge is showing that this difference warrants providing armed defense while precluding providing medical care.

One way to argue against it is to use an analogy to a family. Family members are generally obligated to protect one another, but if it were claimed that this obligation was limited only to using force and not with caring for family members, then this would be rightfully regarded as absurd.

Another approach is to embrace the military and police metaphors. Just as the state should thrust its force against enemies within and without, it should use its medical might to crush foes that are literally within—within the citizens. So, the state could wage war on viruses, disease and such and thus make it more manly and less nanny. This should have some rhetorical appeal to those who love military and police spending but loath funding healthcare. Also to those who are motivated by phallic metaphors.

As far as the argument that health care should not be provided by the state because it will make people dependent and weak, the obvious reply is that providing military and police protection would have the same impact. As such, if the dependency argument works against health care, it would also work against having state military and police. If people should go it on their own in regards to health care, then they should do the same when it comes to their armed defense. If private health coverage would suffice, then citizens should just arm themselves and provide their own defense and policing. This, obviously enough, would be a return to the anarchy of the state of nature and that seems rather problematic. If accepting military and police protection from the state does not make citizens weak and dependent, then the same should also hold true for accepting health care from the state.

As a final point, an easy way to counter the obligation argument for state health care is to argue that the state is not obligated to provide military and police protection to the citizens. Rather, the military and the military, it could be argued, exists to protect and advance the interests of the elites. Since the elites have excellent health care thanks to their wealth and power, there is no need for the state to provide it to them. Other than the elites in government, like Paul Ryan and Trump, who get their health care from the state, of course. On this view, support for using public money for the military and police and not health care makes perfect sense.

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Planned Parenthood & Fetal Tissue I: Selling for Profit?

Thanks to undercover videos released by an anti-abortion group, Planned Parenthood is once again the focus of public and media attention. This situation has brought up many moral issues that are well worth considering.

One matter of concern is the claim that Planned Parenthood has engaged in selling aborted fetuses for profit. The edited videos certainly seem crafted to create the impression that Planned Parenthood was haggling over the payments it would receive for aborted fetuses to be used in research and also considering changing the methods of abortion to ensure higher quality “product.” Since clever editing can make almost anything seem rather bad, it is a good general rule of critical thinking to look beyond such video.

In this case the unedited video is also available, thus allowing people to get the context of the remarks. There is, however, still reasonable general concerns about what happened off camera as well as the impact of crafting and shaping the context of the recorded conversation. That said, even the unedited video does present what could reasonably regarded as moral awfulness. To be specific, there is certainly something horrible in casually discussing fees for human remains over wine (I will discuss the ethics of fetal tissue research later).

The defenders of Planned Parenthood have pointed out that while the organization does receive fees to cover the costs associated with the fetal tissue (or human remains, if one prefers) it does not make a profit from this and it does not sell the tissue. As such, the charge that Planned Parenthood sells fetal tissue for a profit seems to be false. Interestingly, making a profit off something that is immoral strikes some as morally worse than doing something wrong that fails to make a profit (which is a reversal of the usual notion that making a profit is generally laudable).

It could be replied that this is a matter of mere semantics that misses the real point. The claim that the organization does not make a profit would seem to be a matter of saying that what it receives in income for fetal tissue does not exceed its claimed expenses for this process. What really matters, one might argue, is not whether it is rocking the free market with its tissue sales, but that it is engaged in selling what should not be sold. This leads to the second matter, which is whether or not Planned Parenthood is selling fetal tissue.

As with the matter of profit, it could be contended that the organization’s claim that it is receiving fees to cover expenses and is not selling fetal tissues is semantic trickery. To use an analogy, a drug dealer might claim that he is not selling drugs. Rather, he is receiving fees to cover his expenses for providing the drugs. To use another analogy, a slaver might claim that she is not selling human beings. Rather, she is receiving fees to cover her transportation and manacle expenses.

This argument has considerable appeal, but can be responded to. One plausible response is that there can be a real moral distinction between covering expenses and selling something. This is similar to the distinction between hiring a person and covering her expenses. To use an example, if I am being paid to move a person, then I have been hired to move her. But, if I help a friend move and she covers the cost of the gas I use in transporting her stuff, I have not been hired. There does seem to be a meaningful distinction here. If I agree to help a friend move and then give her a moving bill covering my expenses and my hourly pay for moving, then I seem to be doing something rather different than if I just asked her to cover the cost of gas.

To use a selling sort of example, if I pick up a pizza for the guys and they pay what the pizza cost me to get (minus my share), then I have not sold them a pizza. They have merely covered the cost of the pizza. If I charge them extra for the pizza (that is, beyond what it cost me), then I would seem to be doing something meaningfully different—I have sold them a pizza.

Returning to the Planned Parenthood situation, a similar argument can be advanced: the organization is not selling the fetal tissue, it is merely having its expenses covered. This does seem to matter morally. I suspect that one worry people have about tissue selling is that the selling would seem to provide an incentive to engage in morally problematic behavior to acquire more tissue to sell. To be specific, if the expense of providing the tissue for research is being covered, then there is no financial incentive to increase the amount of “product” via morally dubious means. After all, if one is merely “breaking even” there is no financial incentive to do more of that. But, if the tissue is being sold, then there would be a financial motive to get more “product” to sell—which would incentivize pushing abortions.

Going with the moving analogy, if I am selling moving services, then I want to sell as much as I can. I might even engage in dubious behavior to get more business.  If I am just getting my gas covered, I have no financial incentive to engage in more moves. In fact, the hassle of moving would give me a disincentive to seek more moving opportunities.

This, obviously enough, might be regarded by some as merely more semantic trickery. Whether it is mere semantics or not does rest on whether or not there is a meaningful distinction between selling something and having the expenses for something covered, which seems to come down to one’s intuitions about the matter. Naturally, intuitions tend to vary greatly based on the specific issue—those who dislike Planned Parenthood will tend to think that there is no distinction in this case. Those same people are quite likely to “see” the distinction as meaningful in cases in which the entity receiving fees is one they like. Obviously, a comparable bias of intuitions applies to supporters of Planned Parenthood.

Even if one agrees that there is a moral distinction between selling and having one’s expenses covered, there are still at least two moral issues remaining. One is whether or not it is morally acceptable to provide fetal tissues for research (whether one is selling them or merely having expenses covered). The second is whether or not it is morally acceptable to engage in fetal tissue research. These issues will be covered in the next essay.

 

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Medbots, Autodocs & Telemedicine


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In science fiction stories, movies and games automated medical services are quite common. Some take the form of autodocs—essentially an autonomous robotic pod that treats the patient within its confines. Medbots, as distinct from the autodoc, are robots that do not enclose the patient, but do their work in a way similar to a traditional doctor or medic. There are also non-robotic options using remote-controlled machines—this would be an advanced form of telemedicine in which the patient can actually be treated remotely. Naturally, robots can be built that can be switched from robotic (autonomous) to remote controlled mode. For example, a medbot might gather data about the patient and then a human doctor might take control to diagnose and treat the patient.

One of the main and morally commendable reasons to create medical robots and telemedicine capabilities is to provide treatment to people in areas that do not have enough human medical professionals. For example, a medical specialist who lives in the United States could diagnose and treat patients in a remote part of the world using a suitable machine. With such machines, a patient could (in theory) have access to any medical professional in the world and this would certainly change medicine. True medical robots would obviously change medicine—after all, a medical robot would never get tired and such robots could, in theory, be sent all over the world to provide medical care. There is, of course, the usual concern about the impact of technology on jobs—if a robot can replace medical personnel and do so in a way that increases profits, that will certainly happen. While robots would certainly excel at programmable surgery and similar tasks, it will certainly be quite some time before robots are advanced enough to replace human medical professionals on a large scale

Another excellent reason to create medical robots and telemedicine capabilities has been made clear by the Ebola outbreak: medical personnel, paramedics and body handlers can be infected. While protective gear and protocols do exist, the gear is cumbersome, flawed and hot and people often fail to properly follow the protocols. While many people are moral heroes and put themselves at risk to treat the ill and bury the dead, there are no doubt people who are deterred by the very real possibility of a horrible death. Medical robots and telemedicine seem ideal for handling such cases.

First, human diseases cannot infect machines: a robot cannot get Ebola. So, a doctor using telemedicine to treat Ebola patients would be at not risk. This lack of risk would presumably increase the number of people willing to treat such diseases and also lower the impact of such diseases on medical professionals. That is, far fewer would die trying to treat people.

Second, while a machine can be contaminated, decontaminating a properly designed medical robot or telemedicine machine would be much easier than disinfecting a human being. After all, a sealed machine could be completely hosed down by another machine without concerns about it being poisoned, etc. While numerous patients might be exposed to a machine, machines do not go home—so a contaminated machine would not spread a disease like an infected or contaminated human would.

Third, medical machines could be sent, even air-dropped, into remote and isolated areas that lack doctors yet are often the starting points of diseases. This would allow a rapid response that would help the people there and also help stop a disease before it makes its way into heavily populated areas. While some doctors and medical professionals are willing to be dropped into isolated areas, there are no doubt many more who would be willing to remotely operate a medical machine that has been dropped into a remote area suffering from a deadly disease.

There are, of course, some concerns about the medical machines, be they medbots, autodocs or telemedicine devices.

One is that such medical machines might be so expensive that it would be cost prohibitive to use them in situations in which they would be ideal (namely in isolated or impoverished areas). While politicians and pundits often talk about human life being priceless, human life is rather often given a price and one that is quite low. So, the challenge would be to develop medical machines that are effective yet inexpensive enough that they would be deployed where they would be needed.

Another is that there might be a psychological impact on the patient. When patients who have been treated by medical personal in hazard suits speak about their experiences, they often remark on the lack of human contact. If a machine is treating the patient, even one remotely operated by a person, there will be a lack of human contact. But, the harm done to the patient would presumably be outweighed by the vastly lowered risk of the disease spreading. Also, machines could be designed to provide more in the way of human interaction—for example, a telemedicine machine could have a screen that allows the patient to see the doctor’s face and talk to her.

A third concern is that such machines could malfunction or be intentionally interfered with. For example, someone might “hack” into a telemedicine device as an act of terrorism. While it might be wondered why someone would do this, it seems to be a general rule that if someone can do something evil, then someone will do something evil. As such, these devices would need to be safeguarded. While no device will be perfect, it would certainly be wise to consider possible problems ahead of time—although the usual process is to have something horrible occur and then fix it. Or at least talk about fixing it.

In sum, the recent Ebola outbreak has shown the importance of developing effective medical machines that can enable treatment while taking medical and other personnel out of harm’s way.

 

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Contraception, Again…

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It seems a bit odd arguing about contraception in 2012. After all, the matter seemed to have been large resolved some time ago.  While it is tempting to say that Contraception 2012 is a manufactured conflict, there do seem to be some points worth addressing in this context.

One talking point that has been presented by some folks, such as mainstream American media personality Rush Limbaugh, is that insurance coverage of contraception is the same thing as paying someone to have sex.

In the case of people who are prescribed contraceptives because of medical conditions (such as ovarian cysts), this is obviously not the case. In cases in which the person is simply using the contraception as contraception, she is still not being paid to have sex any more than the coverage of Viagra and comparable medicine for men is paying men to have sex. At most, what is being paid for is the means to have sex (Viagra) and the means to avoid getting pregnant (contraception). True, these are connected to sex, but covering either is not the same thing as paying people to have sex.

Another common talking point is that the plan to cover contraception will be “using people’s money” to pay for something they do not approve of.

One obvious reply to this is that for most folks insurance coverage is either paid for by the individual or as part of a benefit package for a job. Either way, the person is earning her coverage. To use an analogy, my insurance covered my quadriceps tendon repair (mostly). This was not using some other people’s money since I pay for my insurance. Likewise, if a woman get contraception covered by her insurance, she is paying for that (either directly or by getting benefits as part of her compensation).

It might be countered that some women get coverage from the state, so tax dollars could go to pay for birth control. Since some folks are against contraception or do not want to pay for it, this should not be done.

The stock reply to this is that our tax dollars are routinely used to pay for things that we might not want to pay for or that we might even oppose. For example, I’d rather not have my tax dollars pay for subsidies to corporations and I certainly don’t want to be paying for other dudes’ Viagra.  This is the way democracy works-provided that the spending is set up through due process, by agreeing to the legitimacy of the state we also give our consent to the spending-even for things we would rather not contribute to.

Naturally, it can be argued that we should not be required to pay for anything we oppose and this has considerable appeal (see Thoreau’s arguments about civil disobedience for an interesting look at this matter). However, if we adopt this principle for contraception, it must also apply across the board. So, for example, folks who are against war can insist that war should not be paid for using tax dollars and so on. It seems likely that for every proposed spending there will be a person who opposes it-thus the state should not spend money on anything. While this would solve the deficit problem, it would seem a rather absurd solution.

A third talking point is that contraception should not be covered because it does not treat a condition. This is most often brought up when defending the coverage of Viagra (which restores a natural function).

The easy reply to this is that some forms of contraception are used to treat medical conditions (such as ovarian cysts). As such, this use should be covered. But, of course, this would not warrant the coverage of contraception as contraception.

One reply worth considering is that the framing of the debate begs the question against women. After all, the claim is that anything that is covered must treat or prevent a harmful condition and this would exclude contraception (except in cases in which a women would be medically harmed by being pregnant). However, this framing tends to be simply assumed rather than being argued for, which is rather unfair to women in this regard. After all, the matter of pregnancy seems to be unique (and limited to women) and hence it seems questionable to insist that it must automatically fall under the framing in question. It can, of course, be argued that it does-but an argument is wanted here to show that is the case.

While some might be tempted to cast pregnancy as the harmful medical  condition that is being prevented by contraception, the idea of casting pregnancy as a harmful medical condition has rather limited appeal. After all, while pregnancy puts considerable strain on the woman, it seems rather difficult to cast it as an illness that needs to be prevented or treated as if it were comparable to measles or cancer.

A more fruitful line of approach is to argue that contraception provides medical control over a woman’s quality of life. That is, it enables her to chose whether to be pregnant or not. Doing this clearly falls under the domain of medicine and women do seem to have a legitimate claim to this right. After all, much of medicine deals with maintaining a desired quality of life and women would seem to have as much right to that as men.

Naturally, it might be countered that I am treating pregnancy as a disease (which would be some major rhetorical points against me). But this is not the case. All I am claiming is that given that pregnancy can be rather challenging for a woman and, of course, a child is a major consumer of resources a women has a legitimate right to use medical means to maintain her desired quality of life-just as a man has a legitimate right to use Viagra and its ilk to maintain his desired quality of life. Just as Viaga is covered as a quality of life drug, so should contraception.

A fourth, somewhat uncommon,  talking point is that contraception is on par with abortion, so covering contraception is covering abortion.

One stock reply is the obvious fact that contraception lowers the number of unwanted pregnancies and this lowers the number of abortions. As such, folks who are worried about abortion would seem to have a good reason to favor covering contraception.

Of course, some folks contend that contraception is like abortion in that it prevents a possible person from becoming an actual person. While this does have some philosophical interest, it would seem to entail that every moment I am not out and about impregnating women, I am engaged in acts comparable to abortion. After all, by not impregnating as many women as possible, I am preventing some possible people from becoming actual people. Put a bit less absurdly, if I am practicing abstinence, then I am effectively engaged in abortion since all those possible people will never become actualized.

It could be countered that this only applies to cases in which I am actually having sex (and presumably that I should only be having sex with a woman I am married to). That is, every time I have sex, there should be a roll of the dice to see whether or not the woman gets pregnant. Presumably if either of use chooses to use any method that lowers the probability of pregnancy, then this would be on par with attempting an abortion.  As such, the only acceptable family planning would be to decide to have sex only when one plans on a pregnancy since intentionally preventing it would be unacceptable. I would be interested in seeing some arguments for this that do not involve an appeal to theology.

 

 

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Abortion is a matter of seemingly endless moral and political debate. In the latest round, the Republican controlled House has passed the Protect Life Act. Two of the main aspects of the act include preventing federal money from being used in health care plans that cover abortion and to allow health care workers to refuse to perform abortions. This includes cases in which an abortion is medically necessary to save a woman’s life.

The first aspect of the act seems to be at least partially a solution in search of a problem. The Affordable Care Act (known by the dysphemism “Obamacare”) already prevents public money separate from private insurance payments covering abortion. However, the is a common misconception (intentionally fueled) that “Obamacare” pays for abortions.

The act goes beyond this in an attempt to restrict coverage of abortion. The bill, if made into a law, would forbid women from buying private insurance plans including abortion coverage. This is, of course, limited to purchases made through a state health care exchange.

The main justification for this aspect of the bill is that the Republican backers claim that taxpayer dollars should not go to abortions. Of course, the bill goes beyond that and attempts to restrict women’s choices.

On the face of it, the justification has a certain appeal. After all, in a democratic (or republican) system, the taxpayers have a right to decide where their tax dollars are spent (and also to have a role in decisions in general-if only via representatives). As such, if the majority of Americans are opposed to having tax dollars go to abortion, then it would be presumably correct to not provide such funding. Majority rule and all that would serve as the moral justification. This would, of course, entail that the same principle should apply uniformly. So, for example, if the citizens did not want subsidies going to corporations or did not want to fun capital punishment, then such things should not be allowed.

In the case of abortion, most Americans hold that it should be legal. While this does not entail that they want to fund abortions, it would seem to indicate that abortion rights are accepted by the majority of Americans. As such, attempting to restrict these rights under the guise of keeping taxpayer money from funding abortion would seem to be somewhat deceptive. After all, it is one thing to prevent public money from being used and it is quite another to forbid women from buying private insurance with their own money. It is especially ironic given the Republican mantras about the free market and individual choice.

Also, if most Americans favor the legality of abortion and the Republican backers of the bill are claiming that they are right to impose restrictions based on the fact that some people are morally opposed to abortion, then it would seem to follow that anything that is morally opposed should not be funded. This would include capital punishment, war, the drug war and so on. In fact, it seems likely that very little would be left with public funding. Naturally, it could be argued that the moral opposition would need to be significant, but even under that condition capital punishment and many other things could no longer be funded with public money. Perhaps this would be a good thing-but I am reasonable sure that neither the Democrats nor the Republicans would be willing to accept this a general principle.

Perhaps the most controversial component of the bill is that health care workers who morally oppose abortion will have the legal right to refuse to perform abortions-even when doing so is medically necessary to prevent the death of the woman. Currently hospitals are legally required to perform abortions when doing so is medically necessary to saving the life of the woman.  Some Catholic hospitals have been breaking the existing law for years.

On the one hand, a strong case can be made for allowing health care workers to decline performing an abortion on moral grounds. After all, a law that compels people to perform what they regard as an immoral action (such as fighting in war or paying taxes to support a war or what they regard as an unjust system) would seem to be well worth both moral and legal scrutiny. This matter has, of course, been addressed in regards to civil disobedience and the question of what a person should do when his/her conscience conflicts with the laws of the state.

In the case of non-emergency procedures, I am certainly sympathetic to the view that health care workers with strong moral beliefs should not be forced to engage in what they regard as an immoral action (most likely murder). Likewise, I am sympathetic to people who refuse to fight in war or support the state on the grounds that they regard the killing  (or murder) of human beings as immoral.

On the other hand, a strong case can be made that professionals are obligated to perform their jobs even when doing so goes against their conscience. For example, a nurse who is opposed to drug use would not seem to have the right to refuse to treat a victim of a self-inflicted drug overdose of illegal drugs. As another example, a police officer who thinks that homosexuality is an abomination would not seem to have the right to refuse to protect a homosexual who is being beaten to death.

In the case of emergency procedures, a very strong case can be made that such procedures should be performed. On utilitarian grounds, performing such procedures would seem to be right. After all, the most likely result of not performing the procedure is that the woman and the fetus both die. The procedure would at least save the life of one person, which would presumably be a good action. To use an analogy, imagine that a child has been rigged with a terrorist bomb and is running at a woman. The bomb cannot be removed in time and will detonate in seconds. A soldier or police officer is nearby and can stop the child-but only by shooting her. The woman can, of course, scream to the soldier/officer that she would rather die with her child. However, it would not seem wicked of the soldier or officer to take the shot if the woman did not forbid it.

It can, of course, be argued that this is not a utilitarian matter but a matter of the action itself being right or wrong. If it is assumed that abortion is wrong because it is killing, it would seem to follow that not helping the woman would also be wrong-after all, this would cause her death.

At this point it is natural to bring up the stock distinction between killing and letting die. In the case of the woman, the medical care provider would be letting her die rather than killing the other being (which may or may not be a person). In general, our moral intuitions tend to indicate that killing is worse than letting die, which could be taken as a point in favor of allowing health care providers to let women die rather than perform an abortion. However, since the being will also die anyway (in most cases) it would seem that refusing to save the woman would (as noted above) merely double the number of deaths rather than do something that would be morally commendable. This could even be argued on the same moral basis as triage. In this case, the act could be seen not as killing the being, but saving the mother rather than allowing two patients to die. To use an analogy, if a mother and child were brought to a hospital and both were dying and the doctor knew that her choice was between saving the mother or letting both die while she worked to futilely save the child, then the right thing to do would seem to be to save the mother. Expending pointless effort on a child that could not be saved while letting the mother die would not be noble or good. Rather it would be a wrongful decision that would kill the mother.  As such, this provision is clearly immoral.

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The Case for Death Panels

Rembrandt turns an autopsy into a masterpiece:...
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In the United States, Obama’s call for national health care reform has ignited a firestorm of controversy. One rather interesting result of the furor has been the accusation that Obama plans to create death panels. While the accounts vary, the general idea is that these alleged panels are intended to review cases and decide whether care (and the patient) should be terminated or not. Not surprisingly, this accusation is not true-there is nothing in the actual proposals about such death panels.

As I do every semester, I am teaching an ethics class in which the students have to write an essay on a moral issue. When the students ask what position they should take, I generally suggest that the argue for what they believe (rather than vainly trying to guess my view in the hopes of getting a better grade). But, I also suggest that they consider writing an argument against what they actually believe. Since I am against death panels, I thought I’d try my hand at my own suggestion and make a case for them. When reading, please keep in mind that what follows is not my actual view. Hence, there is no cause to accuse me of Nazi (or even socialist) leanings.

From an intuitive moral standpoint, private citizens are rather restricted in regards to when they can ethically end the life of another person. In general, such killing is restricted to clear cases of self defense. For example, if someone pulls a gun on me while I am out for a run and demands my fancy GPS watch, it would be morally acceptable for me to kill him on the spot. After all, he presents a clear and present threat to my survival (as Locke would say, I have no reason to think that someone who would rob me of my property would not take the next step and try to rob me of my life).

In the case of the death panel matter, it does not seem that this sort of individual right can be used as a justification. After all, a patient who is in need of critical and expensive care is not likely to be a clear and present threat to my survival.

Of course, it could be argued that such a person would be a threat because he is using resources that could save my life. However, killing an innocent person because they happen to have resources that could save my life does not seem to be morally defensible. For example, if am in a ship wreck and at risk of drowning, I have no right to kill another passenger and strip her of her life vest. As such, there seems to be little support for death panels here.

Perhaps, however, the matter changes when the focus is expanded to include society as a whole. After all, actions that would be blatantly immoral for an individual can often be transformed, by the “magic” of the collective, into acceptable actions. For example, what would be murder on the individual level becomes transformed to acceptable killing in the context of war (although, obviously, not everyone buys this).

In many cases, the moral transformation is brought about by an appeal to the general good (essentially an appeal to utilitarian considerations). For example, killing folks in war can be morally justified by appealing to the advantages of the war to “national security” or “national interest.” Not surprisingly, more cynical folks might point out that “national interest” is often the interest of a select few and it might be contended that such actions are no better than those of any organized gang of criminals.

Now, if such things as war can be morally justified, then justifying death panels should be easy enough on the same sort of grounds.

In the case of war, killing folks is most often justified on utilitarian grounds. For example, some folks must be killed (including the inevitable innocent bystanders) in order for the collective good (national security, for example) to be served. Now, let us turn to applying this sort of approach to the death panels.

While the United States and other Western countries have significant medical resources (enough so that certain folks, such as Michael Jackson, can have their own personal doctors) these resources are not unlimited. In fact, it can be contended that the resources are not sufficient to provide adequate health care to everyone.

Now, it is obvious that people who are in need of critical care use far more resources than other folks. It is also obvious that the elderly have more health issues than younger folks. Now, looking at the matter by the numbers, it seems likely that the resources used to maintain a critically ill person or an elderly person could be used to provide health care to a significant number of folks with less serious conditions. Typically, these would often be younger folks as well-folks who also still have years to contribute to the good of the state.

Looked at in terms of the general utility, it would seem to make practical and moral sense to allocate medical resources so that they do the most good for the general populace. As such, it would seem to be acceptable to terminate the care of the critical ill in favor of the less ill. It could also, on similar grounds, be argued that the focus of health care should be on the younger folks rather than the harder to maintain elderly folks. To use a car analogy, it makes more sense to spend less on maintaining a new car than to pour large sums of money in order to keep an old clunker going.

Since the United States is supposed to have a free market economy, the critical ill and the elderly who have the funds to purchase the medical care they need should be allowed to do so. After all, they are paying for the resources they are consuming and hence are not creating an undue burden on the health care system. Naturally, folks who are lacking in such funds would be imposing burdens on the system by consuming beyond what they can afford to pay for. As such, they would be robbing society of valuable resources.

Naturally, it might be pointed out that some critically ill people or elderly folks might have made valuable contributions that justify their being treated at the public expense. There might also be such folks who are making ongoing contributions or who can be expected to make such contributions in the future. For example, a medical student who is badly hurt in a accident may be expensive to treat, but it is likely that she will be able to contribute more than he treatment would cost.

This is, of course, where the death panels come in. These panels would serve to assess the relative worth of each patient and decide who will receive the medical resources and who will not. For those who balk at such an approach, the obvious reply is that this sort of thing is done in the case of triage. In this case, it is a triage of a different sort but would still seem to be justifiable on similar grounds. In this case, the person’s place in the medical queue is based not on her likelihood of survival but based on the value of her survival to the national good.

Of course, some folks might contend that the idea of having folks decide who lives and who dies is a horrific idea. It might also be wondered where people could be found with the adequate experience to make such calls. Fortunately, the United States has plenty of people who have experience in such things. For example, Governors in states that have the death penalty already serve on death panels. As another example, the folks who make decisions about going to war already are on a death panel as well. After all, they have an active role in deciding who will live and who will die. As a final example, folks in insurance companies sometimes make decisions that deny care to people. Since such decisions about life and death are fairly routine, there should be little problem finding people to serve on such panels.

So, death panels seem like a great idea and the United States should hope that Obama makes the rumors a reality. Obviously, philosophers and runners should get an automatic exemption from being reviewed by death panels. This is so obvious that there is no need to even argue.