Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Thursday, August 6, 2009

Another reader's thoughts on a right to health care

This from an MOJ reader, in response to the "health care as a right" question:

My first thought is a criticism of those who claim that health care is a right.  It seems that the argument for health-care (which would be significantly subsidized, somehow, by the state) is based upon the contingencies of history rather than on a universalizing principle of human-ness.   In this regard, I think I bypass the argument as to whether it is a positive or negative right (and possibly a legal or moral right) because certain historical and economic characteristics have to be in place for this discussion to even make sense.  For example, two hundred years ago, I have not heard of any person argue for a right to health care, precisely because the materialistic conditions for it to be a possibility were not in evidence.

However, there were discussions about rights in religion, speech, conscience etc. I believe that these rights discussions were about how we define ourselves as human, while health care, while an undeniable good, is not fundamental to our ontology.  Health care, or the lack thereof, does not detract from us as humans.  Furthermore, these fundamental rights appear to be able to be universal, appealing across time and space to our consciences.  Yet, discussing the right of (say) Nigerians to healthcare seems somewhat backwards when their basic, fundamental rights of religion and conscience is not defended by the state.  Additionally, they do not have the economic nor technological skill to have the same level of health care as we enjoy in North America.  Essentially, the material conditions have to be met before universal health care can be even concieved of, while the more foundational liberties do not.

Relatedly, as a Canadian, I wonder at the distortion of the meaning of health care when we celebrate our wealth by the wholesale slaughter of our children through embryonic stem cell research and abortion.  Is the entrenchment of these practices and state support for them something that we, as Catholics, can support?  Is the greater evil having universal coverage if these profound injustices persist under our medical plans and in our names? 

The reader's observations about historical contingencies and material conditions confirm, in my view, my sense that it is better to think about the health-care debate in terms of the moral obligations of (and practical challenges that confront) a political community than in terms of "rights."  I take it (and I am confident that Michael P. agrees) that, given all the current givens, political communities (in the developed West) ought to take the steps necessary (and prudent) to secure access to cost-effective, reasonably high-quality, basic health care.  This is the smart, and right, thing to do, but the *reason* it is the right thing to do might not be because there is a human right, possessed by individuals, invokable against governments, to such health care.  The moral case for policies that secure the kind of access just described, and the moral responsibility of a decent political community to pursue them, does not depend, it seems to me, on their being a "right" to that access.

Tuesday, August 4, 2009

George on marriage, courts, and the culture wars

If the Supreme Court imposes same-sex marriage, it will exacerbate, not heal, "culture wars" and divisions, writes Robert George in The Wall Street Journal:

We are in the midst of a showdown over the legal definition of marriage. Though some state courts have interfered, the battle is mainly being fought in referenda around the country, where “same-sex marriage” has uniformly been rejected, and in legislatures, where some states have adopted it. It’s a raucous battle, but democracy is working.

Now the fight may head to the U.S. Supreme Court. Following California’s Proposition 8, which restored the historic definition of marriage in that state as the union of husband and wife, a federal lawsuit has been filed to invalidate traditional marriage laws.

It would be disastrous for the justices to do so. They would repeat the error in Roe v. Wade: namely, trying to remove a morally charged policy issue from the forums of democratic deliberation and resolve it according to their personal lights. . .

As it happens, our own Michael Perry has argued in a new book that, while federal judges usually should defer to political actors' judgments on the subjects of moral controversy, they should, in the case of same-sex marriage, rule that it is unconstitutional to refuse to recognize same-sex marriage. 

Michael, do you have any reactions to Prof. George's WSJ piece?

The bishops on health-care proposals and abortion

Following up on Richard's and Michael P.'s recent posts on the current health-care debate:  Here is a piece about Cardinal Rigali's recent letter to the members of the relevant House committee.  He says, among other things:

In this particular letter I am writing specifically about our fundamental requirement that health care legislation respect human life and rights of conscience. Much-needed reform must not become a vehicle for promoting an “abortion rights” agenda or reversing longstanding current policies against federal abortion mandates and funding. In this sense we urge you to make this legislation “abortion neutral” by preserving longstanding federal policies that prevent government promotion of abortion and respect conscience rights.. . .

As long-time supporters of genuine health care reform, the United States Conference of Catholic Bishops is working to ensure that needed health reform is not undermined by abandoning longstanding and widely supported policies against abortion funding and mandates and in favor of conscience protection.

Farr on the Administration and religious liberty abroad

Thomas Farr is a veteran diplomat and a crucial voice in the struggle for religious liberty, here and abroad.  (Read his book!)  Courtesy of the American Principles Project, here (and here) are some of his thoughts on the Administration's plans and policies regarding religious freedom around the world.  He emphasizes, among other things, that "the United States should move its policy of advancing international religious freedom into the mainstream. It is not a 'nice to have' humanitarian issue to be shoved aside when more 'strategic' imperatives (the environment and trade) loom. Religious liberty is intimately connected to all human affairs, including the defeat of those who, in the President's well-crafted words,  'would murder innocents.' It should be treated as such."

Thursday, July 30, 2009

Two new blogs of interest

I learned the other day about a new group blog, run by a group of in-formation (not-yet-ordained) Jesuits, called "Whosoeverdesires".  Check it out.  Lots of interesting stuff.  I also discovered that one of these young Jesuits has a blog of his own, called "Under a Chindolea".  (Walker Percy fans -- and aren't we all Walker Percy fans -- might catch the reference.)  Again, well worth reading.

Wednesday, July 29, 2009

More on Saletan's "pragmatism" on abortion

It has been suggested -- at Slate, at Commonweal, and elsewhere -- that opposition to (or even, it seems, doubts about) the Preventing Unintended Pregnancies, Reducing the Need for Abortion, and Supporting Parents Act makes one a "militant" (boo!) rather than a "pragmatist" (yay!).  The Catholic blogger Blackadder (formerly of Vox Nova and now at American Catholic) expresses well the implausibility of this suggestion.

To be clear:  I have said many times that, given all the givens, I would and do accept the inevitability of some "compromise" on abortion.  For example, while I suspect that many of the "abortion reduction" proposals that are floated in the conversation are really just re-branded calls for increased social-welfare-spending programs that might not actually do much to reduce abortion and might have significant policy downsides, I would be more enthusiastic about a compromise proposal that including increases in such spending *if* the the pro-abortion-rights side were actually compromising.  But -- and I realize I've harped on this point before, so apologies -- that side is, generally speaking, not giving anything up.  Indeed, they are asking pro-lifers to agree that it is "compromise" to accept the roll-back of the gains they have secured. 

What is happening, instead, is that many of us who are pro-life are being asked to accept a legal -- indeed, a constitutional -- regime in which citizens are disabled from meaningfully regulating (as opposed to financially disincentivizing) abortion, a regime whose premises are that unborn children are not in fact morally entitled to the protection of the laws and that those who think otherwise are required by the norms of good citizenship to cease trying to persuade, and a policy landscape in which public funds are being used not only to subsidize pro-abortion-rights activity (no, Mr. Saletan, not just contraception, but abortion-rights-advocacy, here and abroad) but abortions themselves.

To have doubts about the attractiveness of this faux-compromise is not to be a "radical", or a misguided "prophet."  A real compromise -- one that actually reflected the views of the broad center of the American public -- would involve acceptance of reasonable regulations (and, in some cases, prohibition) of abortion; it would include the various (and popular) laws that structure and slow down the choice for abortion (waiting-periods, etc.); it would include agreement that public funds should not be used for elective abortions; it would include free-speech protections for (peaceful) pro-life expression and protest.  It would also involve -- I am happy to agree -- increased social-welfare spending aimed at helping low-income women avoid the temptation to abortion and at helping low-income families raise and care for their children.  (It would probably also involve various reasonable programs aimed at discouraging so-called unwanted pregnancies.)  If Mr. Saletan were to endorse such a compromise, his scolding of pro-lifers might be warranted.  At present, though, I don't think it is.

Now, one might say, "but why should pro-lifers insist on real compromise if the proposed faux-compromise still reduces the number of abortions?"  A few (restatements of earlier) responses:  First, overall, all things considered, the policy agenda of the current Administration and congressional majority cannot plausibly be regarded as one that will reduce abortions.  Dramatic increases in the subsidization of an activity, combined with calls for the removal of all restrictions on that activity, are not well designed for reducing that activity.  Next, the concern of pro-lifers is, but is not only, with the number of deaths (if it were, then calls for a 25 mph speed limit would have to be regarded as "pro life" moves).  It is with a distorted constitutional and jurisprudential framework that excludes entirely from the protection of the law an entire class of human beings and that disrespects democracy by removing from the political arena (i.e., the arena of "dialogue" and "compromise") a question about the role of the law in expressing and protecting human dignity.

I'm ready for a pragmatic compromise, Mr. Saletan.  No radicalism here.  Debate and dialogue welcome.  What about you?  

UPDATE:  Douglas Johnson's response to Saletan's essay is devastating.  It is a must-read.

UPDATE:  Saletan responds to me (and others) here.

MOJ among the "stickiest" law blogs

According to uber-law-blogger Paul Caron, Mirror of Justice is the sixth (!) "stickiest" law blog; that is, our visitors spend, relatively speaking, much more time at our blog than do the visitors to most law blogs.  I choose to chalk this up to our readers' well-developed attention spans and desire for intellectual engagement, rather than to the density or impenetrability of our bloggers' writing.

Tuesday, July 28, 2009

The possibility of "vigorous debate" on abortion

Many of us very much want to be reasonable and realistic when it comes to difficult and divisive questions regarding the use of law to promote and protect moral goods.  The perfect should not, this side of Heaven, be seen as the enemy of the good, compromise in politics and policy should not be regarded as unprincipled selling-out, etc.  And, particularly for those of us in the academy, the appeal of "dialogue" and "debate" is undeniable.

In this (I think) clear-eyed and provocative essay at Public Discourse, Patrick Lee writes:

In his commencement address at the University of Notre Dame, President Obama suggested that he valued debate about the issue of abortion. He congratulated Notre Dame’s president, Father Jenkins, for his “courageous commitment to honest, thoughtful dialogue,” and spoke approvingly of “citizens of a vibrant and varied democracy” engaging in “vigorous debate.”

However, for "vigorous debate" to actually happen, Lee notes, "[the President's] own position must be clarified. The picture that emerges is not a flattering one."

Obama has chosen to fund abortion overseas, clearly favors funding abortions here, and has reversed the limitations on funding of embryo-destructive stem cell research  Given these facts, it is fair to ask: what is his position on the beginning of human life and when human life has or acquires inherent dignity? What position on the beginning of human life could he possibly hold?

After considering six alternatives, Lee concludes:

So, which is it? Does Obama just not care whether what is killed in abortion and embryo-destructive research is a human person or not? If he does care, what does he think occurs in abortion or embryo-destructive research? Each of the positions that might justify his actions has insuperable logical and/or philosophical difficulties. It is time to have some of that vigorous debate Obama claims to favor.

Read the whole thing.  And recall how often it has been charged, in recent years, that pro-lifers don't really believe what they say they believe about unborn children (because if they did, they would be engaging in armed revolution, killing abortionists, etc.).  It seems fair to ask of the President, "given what he has actually done, and believes should be done, with respect to abortion, what must he actually believe about human dignity, equal justice, and so on?"

Brooks on children, the future, and hope

It has struck me as a shame that David Brooks's columns are not more often as good as yesterday's, "The Power of Posterity."  Although Pope Benedict is not mentioned, the column reveals the author's (perhaps unconscious) appreciation for the fact that authentic human development and community are not easily separable from the embrace of children.  (The Pope emphasized this connection in the recent encyclicals; many of those who regard encyclicals as occasions for cherry-picking snippets for use in public-policy debates missed it.)  Here's a bit:

What would happen if a freak solar event sterilized the people on the half of the earth that happened to be facing the sun? . . .

Without posterity, there are no grand designs. There are no high ambitions. Politics becomes insignificant. Even words like justice lose meaning because everything gets reduced to the narrow qualities of the here and now.

If people knew that their nation, group and family were doomed to perish, they would build no lasting buildings. They would not strive to start new companies. They wouldn’t concern themselves with the preservation of the environment. They wouldn’t save or invest.

There would be a radical increase in individual autonomy. Not sacrificing for their own society’s children, people would themselves become children, basing their lives on pleasure and ease instead of meanings to be fulfilled. . . .

Monday, July 27, 2009

"Affordable Health Choices Act" and the End of Life

It's often been observed that one of the challenges facing our (and other developed countries') health-care systems is the increasing percentage of health-care spending that goes to those who are very near death.  It has also been observed that one of the reasons to be alarmed by the movement -- misleadingly cast in terms of "dignity" -- for doctor-assisted suicide is the likelihood that the legalization of assisting-suicide will be followed by its normalization and, perhaps, its prioritization.  That is, once we say it is alright to help Grandma kill herself, we might well find ourselves saying that she *ought* to let us help her kill herself.

I was thinking about these two observations as I read this piece, from Forbes, about the end-of-life-related provisions that have been (fairly) quietly inserted into the Bill That No One Dares Read In Its Entirety:

In a post entitled "The Democratic Culture of Death is Absolutely Terrifying." one blogger wrote "First they came for our light bulbs, then they came for our SUVs. Now, they are coming for our senior citizens," Other commentators have made a connection between the bill and the Terry Schiavo episode, in which a woman on life support in Florida starved to death after a feeding tube was removed when her husband prevailed in a prolonged legal battle.

In fact, the bill says nothing about death with dignity or any other code words for euthanasia. It also does not make these counseling sessions in any way mandatory--it just says that Medicare will start reimbursing for them.

Still, some activist groups that are not necessarily opposed to ObamaCare are concerned about the end-of-life proposals in the bill. Marilyn Golden, of the Disability Rights Education and Defense Fund in Berkeley, Calif., has been active in opposing physician-assisted suicide at the state level. Many disabled people worry legalizing suicide would lead to euthanasia.

Golden points out that many doctors, when counseling patients, push for do-not-resuscitate orders or have them sign boilerplate documents that can lead to the premature denial of lifesaving medical care. "I don't want to say we're opposed to the language in the bill," she says. "But there are legitimate concerns about how advanced directives are administered."

"There is reason to be concerned," says Diane Coleman, of Not Dead Yet, a group in Rochester, N.Y., that opposes physician-assisted suicide and what it calls medical killing. "The disability community," she says, "often experiences pressure to sign treatment-withholding orders."