the only necessary argument against routine infant circumcision

Although I’ve lost track of the @replies, I recall that there was significant pushback from a couple of my followers, and so I wanted to say more about the issue.

Basically the argument offered at L’Hôte is this:

“In a free society, individuals are free to make their own choices. And they should particularly be free to make their own choices about their bodies. Any adult man is fully free to go get a circumcision if he wants one. (The fact that none do, outside of the coercion involved in religious conversion in order to get married, should tell you something.) Men who were circumcised as infants are denied that right. One position in this debate increases human autonomy and human liberty, and one restricts it. To oppose routine infant circumcision, you don’t need to be convinced by the arguments against circumcision! You only need to recognize the right of the individual to make his own choice and to have sovereign control over his own body.”

Now let’s recognize at the outset that even the seemingly clear call to give individuals freedom of choice regarding what happens to their own bodies cannot have as straightforward of implications as we might like. On any reasonable moral theory, parents have duties to care for their children, and this will inevitably involve doing things to those children’s bodies well before they are capable of giving informed consent.

Where to draw the line as to which parental actions are liberty-compatible and which are liberty-violating will be tricky and controversial. But to refuse to take a middle position, however subtle, is absurd, given that the remaining options are to claim either that all parental actions towards children are morally permissible, or that none are. The former treats children as mere property, the latter treats children as adults; neither is appropriate.

Using bodily integrity as a guide to which parental actions are morally permissible gives us a way to think about concrete cases, but it doesn’t readily solve them because all of the middle ground between the extreme positions is murky. What constitutes “liberty” is contestable, and even many of the most ardent supporters of individual liberty recognize that it is not the only value worth pursuing. The criteria of bodily integrity definitely suggests, however, that we are to err on the side of leaving children’s bodies alone.

I think it best to understand the permissibility of actions like circumcision as a function of two primary factors: the invasiveness of the proposed action, and what’s at stake in performing it, or not. So, take two examples that readily arise in this context: vaccinations and ear piercing. In the case of childhood vaccinations like that against polio, what’s at stake can be whether or not a child will become immune to a life-threatening disease. There is a risk that the vaccination will have adverse effects, even death, but we can roughly compare the threat of these to the threat of the disease in order to reach a rationally defensible decision regarding the vaccinations. The vaccination is somewhat invasive, being permanent and possibly dangerous, but there is sometimes alot at stake. So vaccinations, depending on the particulars of the vaccine, disease, and child, are often justifiable. The liberty to be free from nonconsensual medical procedures doesn’t mean anything to the victims of easily preventable childhood diseases, after all.

Take now the case of ear piercing. This procedure ranks low both in terms of invasiveness and what’s at stake. Most ear piercings will heal without incident if the piercee later decides (s)he doesn’t want them, but their value is simply cosmetic. Some cosmetic procedures, such as reconstructive surgery for this kid, may stand to dramatically improve children’s current and future quality of life but ear piercing?… not so much. So I would say in this case that parents can and should err on the side of bodily integrity by refraining from piercing their children’s ears until at least such time when the children say that they want the piercings (they may later change their minds, but anyway so do adults). This implication of the bodily integrity view seems ridiculous to some, who take for granted the permissibility of ear piercing and would discount any theory prohibiting it. However, I hasten to add that since ear piercing is minimally invasive and generally reversible, parents do their children no gross wrong in having them pierced without consent.

I understand that the vast majority of parents love their children and have no interest in doing them harm. Of these parents, those who chose routine infant circumcision do so for at least comprehensible reasons: faith, culture, tradition, cleanliness, whatever. But, when bodily integrity is at stake, the bar of justification for parental action is set much higher than these reasons can reach. We do not generally accept religion or culture as properly justifying what would otherwise count as the physical abuse of children, and the procedure by many accounts lacks significant hygienic value. Bottom line: routine infant circumcision — like childhood vaccination — is invasive and irreversible, but — unlike childhood vaccination– is without equally as weighty values at stake. Considerations of religion and culture may explain why so many parents do in fact chose routine male circumcision, and they explain why so few men subjected to it feel victimized, but they do not morally justify the practice.

All this is great news! But I wonder whether the article itself displays some stigma towards HIV/AIDS sufferers. Why would I think such a thing? Because, of all the couples they could have picked to feature in the article, they chose one in which the HIV-positive partner “contracted HIV through contaminated blood products when he was a child.” As such, he is sexually innocent, having played no part in his contracting HIV. We should be glad that he is able to get married, because he didn’t do anything wrong.

The reality of the matter is that nowadays few people contract HIV through contaminated blood products and most contract it instead through choices involving sex and drugs. Many individuals play russian roulette in this regard, and some lose. CNN passed up a valuable opportunity to portray the reality of the matter: that most HIV/AIDS patients are not victims of circumstances but of their own choices. However, that does not make them terrible people or undeserving of valuable relationships, it’s just the way the disease works. With the loving understanding of their partners, people who have made all kinds of mistakes in the past, even including those resulting in HIV/AIDS, can participate in successful marriages.

With the help of friends, family, and medicine, HIV/AIDS patients are now more able than ever take control of their futures and enjoy lives well worth living. This is something to be celebrated, regardless of whether the patient in question was a drug user or did not conform to rarely practiced ideals of sexuality. Let (s)he who is without sin cast the first stone.

A new study from the George Washington University School of Public Health and Health Services reports that “the Stupak/Pitts Amendment will have an industry-wide effect, eliminating coverage of medically indicated abortions over time for all women, not only those whose coverage is derived through a health insurance exchange.”

Brian at TPMDC writes:

In other words, though the immediate impact of the Stupak amendment will be limited to the millions of women initially insured through a new insurance exchange, over time, as the exchanges grow, the insurance industry will scale down their abortion coverage options until they offer none at all.

Do people not understand that abortions will remain legal and available even if this change occurs in the insurance industry? And that third-party payments for abortions have probably driven the prices up? And that if everyone who wanted an abortion were choosing her own provider and paying out of pocket, then the price of the procedure would probably drop? And maybe even it would be cheaper to just pay for an abortion than to buy a policy that covers abortions?

Just sayin’.

Will the Stupak Amendment Affect Insurance Coverage for Miscarriages? I Think So

Sadly, the author experienced a miscarriage recently. In her case, as sometimes happens, the fetus had yet to be expelled. She was put in the difficult position of either waiting for that to occur naturally, or choosing either a chemical abortion or D&C. Each had different risks and costs. The author, like many women who miscarry, chose to undergo the procedure.

Although the fetus is this sort of case is deceased, there is some question (and dispute) as to how the procedure to remove it is typically described medically, or how it is supposed to be documented. It may be described as an abortion. If so, then the Stupak Amendment (which I wrote about earlier this week) would forbid public funding of these procedures even in the case of miscarriage.

It is doubtful that even the most ardent of pro-lifers intended to limit access to post-miscarriage medical care. The mainstream feminists who claim that generous reproductive care, including abortion, is a non-negotiable when it comes to health care reform are using this unintended consequence as evidence that the government should generously fund care but stay the heck out of decisions between a woman and her doctor.

However, that position is not politically viable right now. And, I was taken aback at the naïveté of one commenter who wrote to the OP: “Your eloquent post points out the problems when legislators do not adequately consider complex issues.” The legislators are trying to consider complex issues, but no result will ever be satisfactory to everyone, and there will always be unintended consequences. If they try to write in miscarriage exceptions to Stupak, the pro-life contingency will object that such measures will be used to cover up actual abortions with miscarriage paperwork. Or, women will start trying to induce miscarriages themselves at home, so that the care afterward will be covered by their publicly funded health plans.

There will not be any no strings attached public funding of reproductive health care anytime soon. Whether you are pro-choice or pro-life, take a look at how legislative bodies have always functioned in the past, and take a guess as to whether you will be happy with how they handle bungle this one.

The National Organization for Women is very upset because the Stupak Amendment passed and is part of the health care bill that passed the house the other day. According to the NYT, the Amendment “would impose tight restrictions on abortions that could be offered through a new government-run insurance plan and through private insurance that is bought using government subsidies.” According to the LA Times,

The compromise amendment, offered Saturday by Rep. Bart Stupak (D-Mich.), in effect bans abortion coverage by all plans that are purchased using taxpayer dollars. Abortions could still be obtained by policyholders who pay their entire premiums without government assistance or by individuals receiving federal subsidies in the event of rape, incest or danger to the mother’s life.

Since the Amendment was included in the bill that was passed last night, NOW sees this as a “bill that strips millions of women of their existing access to abortion.” More from NOW:

NOW calls on the Senate to pass a health care bill that respects women’s constitutionally protected right to abortion and calls on President Obama to refuse to sign any health care bill that restricts women’s access to affordable, quality reproductive health care.

NOW is so into universal health care, but then they act all surprised and indignant when the political processes which govern the birth of any such scheme return a result which — surprise! — reflects the preferences of the sizable pro-life constituency in this country. Just imagine: If you (or your constituents) thought that abortion was murder and therefore the very antithesis of health care, you would vote to minimize directly or indirectly state-funded abortions, too.

Furthermore, it’s unwise for NOW to keep pressing the point that the Amendment keeps women from using “their own money” to access abortion care. It’s not clear whether NOW is counting federal assistance as “their own money” (I think they are). But, even if they’re not, it’s important to remember that this hugely expensive (don’t even try to deny it) plan does lots and lots of things with money that belongs to other people. So while women seeking abortions may be prevented from spending their money in that way, there are tons and tons of taxpayers who are also prevented from spending their money in ways of their choosing. The “their own money” point does not support opposition to this particular bill, it supports opposition to expanding the government’s role in health care in the first place.

Finally, obviously this Bill is not itself an amendment to the constitution and it does not abridge the right to have an abortion. True, it would not in theory respect a right to have an abortion on the government’s tab, and thereby on the tab of pro-choicers, but no such right exists. The Stupak Amendment seems to be the logical extension of the Hyde Amendment, which has long prohibited the funding of abortion using federal Health & Human Services monies. Since now a more expansive health care program is on the table, a more expansive abortion funding policy is needed.

(Of course, I am still ardently pro-choice, and always will be. But nothing regarding positions on the state funding of abortions follows merely from that).

Editing to add: Megan McArdle has some cogents thoughts on this matter in this post: The Health of the Nation

Recently, I saw the above video on Facebook. Basically, it illustrates the argument that a public option in health care would compete against private insurers to the benefit of those covered under both kinds of plans. This argument seems like it is supposed to appeal to the market-minded among us, who are into competition amongst businesses. And “competition is as American as apple pie,” quoth MoveOn.org

Now, I’m going to take the liberty of guessing that alot of people who are in favor of the public option also oppose school choice (in my experience, this is true, but feel free to take issue with this assumption in your comments). To the extent that their arguments for the public option are really about competition, their opposing school choice — which promotes competition amongst schools — is inconsistent with their position on health care.

Alternatively, perhaps this just exposes the fact that the proponents of the public option really don’t care about competition much at all, that it was just a strategic argument aimed at pro-business types, and that really they favor something about the state provision of important goods and services, like health care and education.

Thoughts anyone? I’m particularly interested in hearing from people who favor the public option but oppose school choice. Please explain to me your real position on competition, as I am confused. Thanks in advance.

The author offers two pieces of information that she seems to believe are contradictory.

1. A quote by Michele Bachmann:

“That’s why people need to continue to go to the town halls, continue to melt the phone lines of their liberal members of Congress, and let them know, under no certain circumstances will I give the government control over my body and my health care decisions.“

2. A video of Michele Bachmann speaking. Basically, she calls for the government to quit funding Planned Parenthood, which provides alot of abortions.

Now, I understand how this is a weird picture if you add a further piece of information:

3. Michele Bachmann is quite radically pro-choice (and that is why she wants Planned Parenthood defunded)

But in the absence of 3, there is no contradiction, and so I don’t really understand the shock value of the original post as presented.

I guess it comes down to this:

If you oppose state control of health care (and thereby abortion), and you think that “control” consists in, or is promoted by, many-strings-attached state funding, then definitely retracting federal funding from Planned Parenthood is the right thing to do.

But I can only assume from the post that the Feministe author thinks that state control of health care amounts to the state refusing to help provide those services promoting reproductive choice for women — i.e., abortion. (Remember, the Bachmann speech wasn’t about outlawing abortion, even if she actually wants to, but merely about defunding it).

Which seems like a better way of understanding “state control of health care/abortion” to you? Or am I totally missing something here?

Edited to add: A very similar story also appeared over at Feministing.  Someone, please explain this to me? I don’t get it.

Just as background, let me say that I am both pro-choice and a feminist (in some sense, but that is a topic for another time). But, I am against universal health care, for complicated reasons including, but not limited to, that health care is a need and not a right, that it would stifle medical innovation, that it would violate doctors’ right to contract freely, that it would not be able to control costs, and that it is morally worse for the government to engage in care rationing than for a private insurance company one has voluntarily hired to do so (but, this too is a topic for another time).

On to the Feministe article. It’s on the topic of some other work by Chris Korzen about abortion and health care reform. To be honest, I haven’t been following the news on health care reform in the legislature too well, because my gag reflex is a little weak. Even so, it is apparent that the position taken in the Feministe article is philosophically shallow. It is a great example of why I can’t get on board with many mainstream feminists regarding reproductive issues, even though I am pro-choice. Here are the highlights:

“That last part [of the Capps Amendment] strikes me as particularly stupid — what’s the point of requiring that one plan in each region not cover a specific procedure?”

Here, the author fails to take seriously the fact that many of those with serious moral objections to most or all abortions have a very strong desire not to be associated with any abortion-promoting or permitting group in any way, shape, or form. It is not true that under universal health care no one will be forced away from their current plan. In fact, many employers would have a financial incentive to dump their employees into the so-called public option. If you are one of these employees, and your current plan doesn’t cover abortion but the public option will, this may be very upsetting to you. Hence the need for one plan in each region that will not cover abortion, which is not just a “procedure” to pro-lifers, but a moral abomination. Furthermore, even if your current employer-based plan does cover abortion and you are ok with accepting the coverage, you might think that there is something especially bad about the government footing the bill for abortions, as opposed to your private employer. At least you are working for your employer voluntarily, and could quit at any time. But you can’t quit the government, if they start to encourage abortions or whatever.

At the end of the day, many pro-life people simply don’t want their tax dollars to pay for coverage for themselves or anyone else to have an abortion. If you think that abortion violates human rights, it will not be satisfactory for a pro-choice person to note that Obama/democrats/the general population is pro-choice and they make the rules, because human rights are not the sort of thing that a majority can vote away. And since being pro-life is about not having abortions, the best you can do within your own private life to be actively pro-life is to not have abortions, organize to combat abortion, and clean your hands, so to speak, of affiliation with or support of pro-choice people and groups. That will obviously include your health care. Pointing out that lots of people object to things that their tax dollars fund (biological weapons research, public school, etc) is not fruitful, because a person can just agree that the whole class of expenditures is indeed unjust. So, I basically can’t believe that any reasonably well-informed person interested in abortion debate could fail to realize why there might be a push for public option health care plans that do not fund what many consider to be murder.

“I happen to think that the common ground message is a good one, but that’s mostly because it sheds light on the fact that anti-choice groups are doing absolutely nothing to try to decrease the abortion rate. “Common ground” on abortion, to most people, means making abortion less necessary, or finding ways for pro-choice and “pro-life” groups to work together to make abortions less common.”

The alleged “common ground” of making abortion less necessary or common is a common ground only to pro-choice people and those pro-lifers who do not also believe that contraceptives are morally on a par with abortion. Since I personally don’t think there is anything independently morally unacceptable about contraceptives, I share many feminists’ frustration that some or even many pro-lifers oppose contraceptives as well as abortion. That kind of pro-life position usually amounts to abstinence only until marriage, at which point women should begin turning out babies as the lord sees fit. But if feminists are really interested in finding common ground on the abortion debate, and some of the parties at the bargaining table have moral qualms with contraceptives, then they’ll have to keep looking for that common ground in places other than pushing the Pill. I should mention here that I do not think any common ground exists between these groups, as their members often have diametrically opposed worldviews, and that the divisiveness and hopelessness for moral compromise when it comes to state-provided goods and services such as health care or education is a strong reason against their provision in the first place.

“I understand that some Americans — even many Americans — don’t want their tax dollars subsidizing abortion. But at the end of the day, abortion is one of the most common surgical procedures in the country. It’s a procedure that one in three women will have in their lives. The fact that such a common surgical procedure is already not covered by Medicaid in most states is abhorrent. The fact that we’re arguing about whether a universal health care program should cover basic reproductive care is embarassing [sic].”

Ok, this is just silly. Pro-lifers do not accept the prevalence of abortions as evidence that it a legitimate medical procedure. On the contrary, they think it’s evidence of moral decay/that judgment is coming/that people have become desensitized to the sanctity of life/that women who have abortions are coerced into doing so/etc. By the same token, they also do not accept that abortions are “basic reproductive care.” Indeed, when pro-life groups provide their version of reproductive care, it is often in the form of clinics (“crisis pregnancy centers”) which provide counseling or prenatal care but no abortions. They think that it is the provision, and not the denial, of abortions that is abhorrent. So the author’s point here is unconvincing to those who stand in need of convincing, the pro-lifers.

Altogether, it was just another dissatisfying feminist article on reproductive issues. Sometime in the future, I’ll try to find a similar example with which to illustrate my problems with the party line on health care conscience clauses.