Health & Health Care Feed

What 'pro-life' really means

Today I was looking for something else and came across this old column I wrote for the Oklahoma Gazette when I was a newspaper columnist.  Seems rather relevant still in 2022.  Maybe even more relevant?  

This was the draft I submitted, but not the final published draft.  Sadly, my columns don't appear anymore on the Gazette website.  I do know that the editor didn't let me publish the phrase "state sponsored rape bill."

 

What “Pro-Life” Really Means

By Scott Jones

 

What we should really be afraid of is those who support governmental control of our bodies.  Don’t be fooled, because that’s what many of the falsely called “pro-life” members of our legislature are after.  It is their ideology that government can dictate to a person what they can and cannot do in matters of their own health.  

Last year’s Senate Bill 1878 made the ideology abundantly clear.  It is affectionately called the “state sponsored rape bill” by many because it forces women to undergo a medically unnecessary, invasive procedure where a vaginal instrument is inserted in order to perform an ultrasound, even it is against her wish and not recommended by her physician.

I’m sure many of you are tired of the demagoguery on this issue, which has now lasted for decades.  Particularly when the language used diverts from the real issue of creating a healthy civil society.

A healthy civil society is one in which people are free to make their own health decisions, not have them dictated by the government.  Genuine freedom also includes access to health care and the education to make healthy decisions.  These are areas in which central Oklahoma is seriously lacking.

The 2007 Vital Signs published by the United Way of Central Oklahoma highlights in its “trends to watch” the poor educational achievements of new mothers in Oklahoma County, measured by the percentage with a high school diploma.  26.7% of new mothers in the county do not have a high school diploma, which is over nine percentage points worse than the national average.  Vital Signs calls this measurement “one of the most important predictors of positive outcomes for children.”

Oklahoma ranks 44th in the nation for health care and 21% of Oklahoma County residents are uninsured.  In a wide array of measurements on health and access to health care, we rank low and trends are not improving.  Nor do most of our public schools offer comprehensive sex education.

The report states that 50.39% of live births in Oklahoma were the result of unintended pregnancies.  It is reasonable to conclude that the incredibly high incidence of unintended pregnancies partially results from the combination of poor access to both health care and comprehensive health and sex education?  

As even The Christian Century reported in 2005, the societies with the lowest abortion rates are precisely those with wider access to health care, comprehensive health and sex education, and greater resources for child care.  The societies with the highest actual abortion rates are those with the most legal restrictions.  In other words, you are either for legal or illegal abortion, there is no such thing as a society with no abortion.

If our legislature really valued life as anything more than an empty political slogan, then they would work diligently to improve access to health care, provide comprehensive sex education, and improve various social services.

The evidence is clear – a society that empowers individuals to make their own health decisions is a society which values life.  What we so often have here in Oklahoma is the exact opposite – an ideology of governmental control of our bodies which would rob us of our freedoms and our health.  That’s truly frightening.

Jones, who holds a Ph. D. in philosophy from the University of Oklahoma, is pastor of the Cathedral of Hope United Church of Christ in Oklahoma City.

 


Reconciling Ourselves: On Consolation, Part 7

"The Good Death" is the title of Ignatieff's final chapter, focusing on the hospice pioneer Cicely Saunders.  Ignatieff argues that in her creation of hospice care, Saunders "helped create a new secular practice of consolation, crafted from nursing, psychology, pain management, and therapy."  One might also had chaplaincy.

Her key insight was "What the dying needed was to talk about their lives, to make sense of them, to forgive themselves and others, to reconcile themselves to the ending of it all."

In the Epilogue he writes about dealing with his own parent's deaths.  This was when he first learned consolation.  And what he learned is that it is "both a conscious process by which we seek meaning for our losses and at the same time a deeply unconscious undertaking, in the recesses of our souls, in which we recover hope.  It is the most arduous but also the most rewarding work we do, and we cannot escape it."

He wrote the book because he drew consolation from people who had themselves wrestled with suffering.  The examples of others reveal ways for us to keep going.

He closes with a meditation on Czeslaw Milosz from whom he experienced that "to feel consoled, to be reconciled to one's losses, to have come to terms with one's shame and regrets, and to feel, despite everything, alive to the beauty of life."  And this is not work we do once and are done.  It is "the work of a lifetime."

I hope after these dark years we've all experienced, you've found some consolation in my detailed exploration of this book, which I intentionally read here at the beginning of my sabbatical.  There is much to heal, learn, and grow from in what we've all experienced, and in what I've experienced in my personal life.  I hope to use this sacred time away as a chance to really focus on the future and the possibilities ahead, to be alive to what comes next.


The Weariness of the Self

The Weariness of the Self: Diagnosing the History of Depression in the Contemporary AgeThe Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age by Alain Ehrenberg
My rating: 4 of 5 stars

Why in the last fifty years has depression become such a widespread illness? Ehrenberg explores that question. While much of the book details changing understandings in psychiatry and psychoanalysis, particularly with the advent of anti-depressants, his question is much broader. He determines that the rise of depression is a result in a changed understanding of the self. We have emerged from traditional societies where our roles were often defined for us. Now we have almost complete freedom to create our own lives. He argues this has caused the rise in depression, as many struggle with that freedom and the social impulse to keep up. Depression results from feeling of inadequacy and leads to an inability to function.

This book was referenced in a book I read in December, and I was so intrigued by these ideas that I ordered this to read for myself. I found it illuminating and thought provoking. I feel it advanced my understanding of some of the people in my life and myself.

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The Body Keeps the Score

The Body Keeps the Score: Brain, Mind, and Body in the Healing of TraumaThe Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk
My rating: 5 of 5 stars

In one week back in January three different people in three different settings referenced this book. So I decided I needed to read it as part of my Season of Grieving, Healing, and Growth. It did not disappoint. In fact, it exceeded expectations.

There is much wisdom and much to learn in the book. Enough that I'll need to use it as a resource to return to. I can see it being helpful both personally and professionally for me. And I know I will recommend it to many people.

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Deaths of Despair

Deaths of Despair and the Future of CapitalismDeaths of Despair and the Future of Capitalism by Anne Case
My rating: 2 of 5 stars

Case & Deaton were alarmed by numbers related to the opioid epidemic and further researched showed a rise in white middle class mortality in the United States after a century of decline and with no corresponding rise in comparable nations. What to explain this?

They conclude a loss of a way-of-life that brought meaning and economic stability.

And for them the primary cause is neither globalization or inequality, though those are both part of the narrative, but the American health care system.

The book concludes with their ideas on what we need to do.

The analysis is interesting and persuasive. I scored the book lower because it's not really an enjoyable read. It also seemed longer than necessary.

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Apollo's Arrow

Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We LiveApollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live by Nicholas A. Christakis
My rating: 4 of 5 stars

In one volume Christakis helps to make sense of the year we have all just endured, approaching from many angles. Here is a review of the medical science and our quickly developing understanding of the virus. He also presents the history of the outbreak beginning last fall in Wuhan and spreading around the world. He sets this virus within the broader historical setting of other plagues and pandemics. He reviews the various kinds of public health measures, evaluating their use this year and their justifications. And he also discusses the wider social and moral impacts, how the virus has impacted mental health, economics, education, racial disparities, etc. He shows how plagues are accompanied by epidemics of grief, fear, and lies. He also shows how our species has evolved critical tools to respond to plagues and how we have marshalled these tools this year in ways that will bring the pandemic to an end. In the final chapter he discusses the difference between the medical and social ends of the pandemic.

I found this an important read for drawing together in one place so much of the disparate information and impacts of this pandemic.

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Pandemic Philosophy

Cross posted from my church column.

Back in March the Italian philosopher, Giorgio Agamben criticized the approach to the virus then taking hold.  He wrote,

The first thing that the wave of panic that has paralyzed the country obviously shows is that our society no longer believes in anything but bare life. It is obvious that Italians are disposed to sacrifice practically everything — the normal conditions of life, social relationships, work, even friendships, affections, and religious and political convictions — to the danger of getting sick. Bare life — and the danger of losing it — is not something that unites people, but blinds and separates them.

His was one of the first philosophical writings on the pandemic, but since then philosophers have been very busy commenting on the metaphysical, epistemological, and ethical implications of this crisis.  Some have also been involved practically—for example a group of philosophical ethicists in Sweden helped to devise that nation’s triage criteria for ventilators. 

Let me draw attention to three of the ethical writings I’ve found provocative and worthy of consideration as we all do our best to think well and wisely during this crisis.

First is an article from May by Dalia Nassar, Senior Lecturer in Philosophy at the University of Sydney, that developed Agamben’s ideas and responded to some of his many critics.  Nassar points out that

the COVID-19 shutdown infringes on every aspect of our selves: not only our biological lives, but also our psychological or emotional lives, our social and political lives, our intellectual lives, and so on. That the shutdown affects every aspect of our lives should mean that every aspect of our lives should be taken into consideration when decisions about restrictions or easing restrictions are being made. It means, in other words, that ethicists, psychologists, sociologists, political scientists, economists, philosophers and theologians should be part of the decision-making process concerning the right response to the crisis.

I agree with Nassar that trying to reduce the human person to biological health is wrong and that the full richness of the human person and human life must be weighed when we are making individual and communal decisions during this crisis.  She goes on to encourage democratic processes of decision-making:

The ideal response to a crisis must be capacious, context sensitive and democratic. It must take account of the complexity and many-sidedness of life and of the concrete lives of all living beings. It must consider differences across regions and cultures. Only in this way can we develop an adequate response to the . . . crisis: one that aims not to neglect, leave out, or put in harm’s way any of the beings that share this planet.

In June I read “Surging Solidarity: Reorienting Ethics for Pandemics” by Jordan Pascoe & Mitch Stripling, in which they argued that our ethical frameworks must be revised in response to the pandemic.  They offered their alternative:

We develop a pandemic ethics framework rooted in uBuntu and care ethics that makes visible the underlying multidimensional structural inequities of the pandemic, attending to the problems of resource scarcity and inequities in mortality while insisting on a response that surges existing and emergent forms of solidarity.

I thought their paper provided the most robust, interesting ethical analysis I’ve read.  They emphasized relational approaches rooted in the South African concept of Ubuntu and feminist care ethics.  I liked this claim, “Our framework understands disasters as producing networks of interlinked people who need care and are giving it; the ethics we propose will help to surge and sustain that entire network, not force us to break it apart and choose between the pieces.” 

They too were advocating a more holistic approach to the human person, not settling for reductionist accounts.  And by doing so were able to explain in one theory the importance of public health measures while also criticizing how they violate core aspects of our humanity:

The tragedy of our dangerously overwhelmed health care system is not only that there are not enough ventilators to go around. It is also that people must suffer alone, must die alone, must give birth alone; it is that our system is so broken that even a basic right to human company must be surrendered (Goldstein and Weiser 2020). Many of us fear not just getting sick, not just dying, but dying alone. Many who are grieving are grieving because they could not be present for a person essential to them, for birth or for death or for suffering. We are grieving not just the inevitable moral failures that will come from lack of resources, but from the lack of humanness, of being human with and through one another. These, too, are moral failures.

Yes.  That people were not able to be with their sick and dying loved ones was one of the most cruel and inhumane aspects of this year.  Which should compel us to imagine and develop different approaches in the future so that such inhumane burdens can be prevented.

A final essay from July with the very academic title “Virus interruptus: An Arendtian exploration of political world‐building in pandemic times” by Rita A. Gardner and Katy Fulfer develops from the philosophy of the ever-more-essential Hannah Arendt.  In their abstract they describe their project:

We explore the ways in which we can engage in political world‐building during pandemic times through the work of Hannah Arendt. Following Arendt’s notion of the world as the space for human togetherness, we ask: how can we respond to COVID‐19’s interruptions to the familiarity of daily life and our relationship to public space? By extending relational accounts of public health and organizational ethics, we critique a narrow view of solidarity that focuses on individual compliance with public health directives. Instead, we argue that solidarity involves addressing structural inequities, both within public health and our wider community. Finally, we suggest possibilities for political world‐building by considering how new forms of human togetherness might emerge as we forge a collective ‘new normal’.

Their discussion focuses on togetherness as essential for responding to a crisis and yet the paradox of our traditional modes of togetherness being impossible.  They are critical of judging those who are non-compliant with public health measures, arguing that individual compliance is not the true crisis of solidarity revealed this year, but rather the larger systemic inequities.  Our frustration and anger should be directed at those concerns.  One reason they resist too much judgment of individual behavior is that the only way out of this crisis is to develop greater trust in one another:

Indeed, it seems as if many societies are at a serious juncture where we have the potential for making new choices about how we want to live together. The COVID‐19 crisis has also shown us that we too have a choice in that we can live our lives in fear and isolation, or we can start to trust one another again as we move back to our public spaces. Establishing trust will be important in helping people learn to adapt to the new normal in organizational spaces and other public places.

They conclude that the virus creates an opportunity to rethink human social and political relationships and to address the inequities and lack of trust we’ve seen: “An Arendtian politics is concerned with how we share the world in such a way that it becomes a place of belonging, not just for a few, but for humanity.”

These essays all share a robust vision of the human person which leads to an emphasis on relationships of solidarity, care, and trust and the opportunity to create new and better institutions and systems. 

This crisis does compel us into deep, visionary, and careful thinking as we use our best judgment to make wise and good decisions for ourselves, our families, our institutions, and our society.  We don’t want “bare life;” we want to belong to a flourishing humanity.


The Basic Question of the Moment

I feel as if the most basic question of our worldwide moment remains unclear.  And how one answers that basic question implies radically different behaviors.

That basic question is:  Is the coronavirus an infection we should all/most anticipate getting at some point or is it an infection that can be avoided?

Back in February I read that Atlantic article that said option A, which has been my underlying assumption all along.  But it became obvious in April that many people were under the impression that number two was true.  In recent weeks I've seen very little that clarifies this basic question, and even the public health experts I've asked have largely been unable to answer it satisfactorily.

Let's call Option A the one where everyone or most everyone can expect to be infected.  That means this is largely an event in the natural history of our species that we have to get through.  Five percent of humanity may die.  A significant number will be seriously ill, some with lasting lifetime effects.  While a large percentage (according to the best data currently available) will have no or few symptoms.

Back in the first quarter of the year you read and heard debate about two approaches to Option A--either spike early and get it over with or flatten the curve so the medical system doesn't crash and has time to prepare.  Most nations chose the latter public health approach.

On Option A the purpose of the public health measures is to manage the crisis.  Manage it so we can prepare.  Or so health systems don't crash.  Or to try to delay most infections until a time we have a better treatment or better yet develop a vaccine.  Or try to manage so that the most vulnerable aren't impacted unjustly. 

On Option A  the recent lockdowns could be understood as temporary measures in order to prepare the health care system for the inevitable and are not justified once those preparations are in place.  Or another version of Option A is that they are justified until treatment is available.  But a common feature of Option A is the measures must be weighed significantly with other factors.

On Option B the purpose of the public health measures is to avoid getting the virus all together.  So the lockdowns would be justified in being longer.

A goal of Option B would be to keep as many people alive a possible.  That might also be a goal of Option A, but with the larger goal of maintaining a social order that can see us through a horrible event.

The two options suggest different behaviors as well, at least for some.  For example, if you can avoid the virus all together (Option B), and particularly if you are vulnerable, then you should minimize your risk. 

But, if you can't avoid the virus and will eventually get it no matter what you do unless you live permanently as a hermit (Option A), then you might engage in more risk.  Some might go so far as to try to get it and get past the crisis, some of those because they are taking the chance of being in the large percentage that is asymptomatic and some for other reasons.   Some might conclude that if they have a good chance of getting sick and dying, then they will want to enjoy their life and not be stuck at home.  I've had a 95 year old say as much to me acknowledging that they don't have that much longer to live regardless.

In some of the classic pandemic literature you see that the worse the crisis became that  some people began to live more openly, enjoying life precisely because the times were grim and there was risk that they would not survive.

Of course, even on Option A, some will try to hold off on running the risks of being exposed till a better treatment is available. 

Note: John Rawls developed the veil of ignorance to be a thought experiment, but here we are in a real life version.

On Option B many normal social functions would be curtailed for a longer period of time.  On Option A they would not, as they would be needed to help through the crisis.  On Option A  you will want more social solidarity in order to help with the care and grieving.  For example, I think of my institution--the church.  If a great deal of illness and death is inevitable, then you will want the church engaging in all of its functions of care and support and performing its rituals of grief and consolation.  

Another example, some of the leading choral music organizations last week recommended that choral singing largely be avoided until this is a vaccine in order to minimize infection.  But that approach only makes sense if you are confident that Option B is correct.  If Option A is correct, then singing together will be an important part of human solidarity helping the grieving through the crisis.

On Option A you will want to do your best to try to minimize the other traumas and disruptions (including but not only economic) brought about by the virus.  Whereas on Option B you will tolerate more disruption to society.

On Option B you would trade even some long term damages to society, the economy, child development, mental health, other health factors, etc. in order to minimize the death toll.  Whereas on Option A you would want to minimize all those long term damages in order to help humanity to more quickly recover from the horror of the crisis.

So, it really seems that this most basic question is the uncertainty we most need to figure out if we are to know collectively what we are to do and individually what risks we should take.


Philosophical Follow Ups

A couple of new links to follow-up on previous posts about the pandemic and philosophy.

Last Sunday I posted Alex Broadbent's article "Thinking Rationally About Coronavirus COVID-19," which generated some vigorous discussion on my Facebook timeline.  He's out with two more articles, becoming something of an indispensable voice in this crisis (he is a "philosopher of epidemiology").  The article "Why a one-size-fits-all approach to COVID-19 could have lethal consequences" discusses why the measures taken in other parts of the world might have a higher mortality rate than the virus if they were taken in Africa. 

His other new post in a broader article at Daily Nous entitled "The Role of Philosophy & Philosophers In The Coronavirus Pandemic."  I particularly liked the final paragraph labeled as "Call to arms:"

The skill of philosophers, and the value in philosophy, does not lie in our knowledge of debates that we have had with each other. It lies in our ability to think fruitfully about the unfamiliar, the disturbing, the challenging, and even the abhorrent. The coronavirus pandemic is all these things. Let’s get stuck in.

One of the commentors, a Tom Cochrane, writes about how aesthetics intersects with the pandemic:

Aesthetics won’t help to combat the disease, but it will point out that there is considerable final value to be found in simply observing what is happening, for its own sake. Whatever else it is, the coronavirus is incredibly interesting. A great big rock has been dropped into the pool of human society and we are witnessing a million different effects that even the best fiction writers would have found hard to anticipate (who would have anticipated the creative response of putting different song lyrics to hand-washing instructions? and also how this is now *so* last week?)

So all I’m saying is that, like everything else, there is intense drama, and beauty, and sublimity and tragedy and comedy in this event. And it will no doubt stimulate the creative responses of human beings for years to come. And perhaps in recognizing- and embracing this, we can be less fearful or depressed.