In last week’s 365gay column, I looked at recent scientific advances that might soon enable same-sex couples to have their own biological children. Many, many comments have been generated by readers who feel strongly about whether this science should be used, even if available.
This week, I dig more deeply into the bioethical and legal questions that would surface, encourage debate on the subject now, and call for a debate on the value of having one’s own bio kids in the first place. Some incisive comments are already coming in.
Just a few short minutes ago, as the snow began to really pile up and the wind to howl, I hit “send” on the manuscript my seven co-authors and I have been working on for what seems like a decade. (In fact, the project began with a symposium almost two years ago; we signed with Cambridge almost a year ago; and the chapters began coming in by this Fall). I’m the editor of the volume, with all of the great and challenging tasks that position commands. So what is this book, and when will you be able to find it at a bookstore near you? Thanks for asking.
The book takes some of the most red-hot, and polarized issues on the political landscape and puts them through a public health, population-based wringer. The topics are: reproductive (abortion) rights; end of life matters; marriage equality (my chapter); the persistent connection between racism and health disparities; gun violence; domestic violence; and tort law and reform. How might these questions and issues be illuminated by looking at them from a perspective that didn’t focus so much on rights and morality, but on the health and welfare of the population? Through some cosmic stroke of good fortune, I managed to convince some of the very brightest and most thoughtful legal and public health scholars to participate, and editing the book was a special privilege (albeit an exhausting and occasionally frustrating one, as when documents wouldn’t do what they were requested, then commanded, to do. I hate Word but that’s another issue entirely.)
I’m guessing at this point that the book will be out later this year, but it’s a bit early to say for sure. But now I can say with confidence that it’s going to happen. (Now where did I put that Grand Marnier?)
I’ll be shamelessly flogging the book in the months to come. What is its title, you might wonder? Well, that’s the one thing I’m not crazy about — it has a tentative title that can still be changed. I’ve been wracking my brain, but for some reason the perfect title yet eludes me (and all of us). Any ideas, readers? Please? A valuable prize to be named later awaits whoever can bring me to my feet in an Archimedes-inspired exclamation. (Archimedes might never have actually yelled “Eureka!” — but I will.)
Here’s a fool-proof plan for spoiling an otherwise-delightful dinner with friends: Talk about the various ways one might build a family.
This I learned recently, after getting into a surprisingly heated exchange with a couple that we count among our very closest friends. I was reminded that everyone has very strong opinions, not only about how they’ve decided to create their own families, but also about how others should build theirs. In the interests of avoiding another round of unpleasantness (and of making my friends fear that every conversation with me could end up as blog-fodder), I won’t go into any specifics about my friends’ views, or their arguments in support. Instead I want to use this opportunity to make and defend a point that might go insufficiently appreciated at times:
Every method of “having” children has its own ethical issues.
Let’s start with the old-fashioned way: Having your own kids through procreation. More than a decade ago, Joy Williams blew apart any thought that simply having one’s own biological kid was a moral good, or even that it was necessarily ethically neutral. While most of her deliciously over-the-top essay took aim at the fertility industry, she didn’t spare those who conceived the ol’ fashioned way. After reminding us that there are too many people in the world, she gets specific about American babies:
The argument that western countries with their wealth and relatively low birth rate do not fuel the population crisis is, of course, fallacious….The US population is growing faster than that of eighteen other industrialized nations and, in terms of energy consumption, when an American couple stops spawning at two babies, it’s the same as an average East Indian couple stopping at sixty-six, or an Ethiopian couple drawing the line at one thousand.
Williams’s snark-attack at those women and couples who choose to go to extraordinary means to conceive recently received a substantial boost from an in-depth series in the New York Times. The issues involved in such reproductive gymnastics are well-known, and the Times reporting shone what I’d consider to be an unflattering light on extreme cases. Sometimes, there are as many as five participants (egg donor, sperm donor, gestational surrogate, adopting couple) in the birth and parenting processes and an unsavory amount of money changing hands. Other cases involve Herculean and medically ill-advised efforts at fertility.
A woman profiled in one of the stories, for example, went through the following: an in vitro procedure that resulted in a miscarriage and revealed a problem (“incompetent cervix”) that made further pregnancies fraught with danger; a second procedure that resulted in twins — one of which died in utero, and the other of which was born at twenty-four weeks (and then remained in the neonatal unit for more than 100 days, so that the hospital bills approached $1 million — all of which was eaten by the woman’s self-insured employer); and then, incredibly, another in vitro procedure that resulted in a healthy birth. Why the last one?
“I didn’t did feel our family was complete yet.”
At this point in reading, I could barely contain my anger. Not once in this story, nor in the next installment in the series, was the word “adoption” used. Yet the question fairly screamed from the page: Why not complete your family by providing a good home to one of the millions of kids, world-wide, who need one?
As regular readers of this blog know, this is the time for full disclosure: David and I are adoptive parents. So obviously I have a bias of my own, and one that I defend. Our kids are local (from Philadelphia), so we don’t have to face the question: Why not adopt a child from your own backyard? Yet one must decide during the adoption process all kinds of questions that don’t otherwise come up: Does race matter to you? What about disability? Are you willing to adopt an older child? And so on…. I won’t get into the particulars of how we answered those questions, but the moral issues they raise should be clear enough.
And then there’s international adoptions, which raise for some additional but related issues: What justifies removing kids from their community of origin? (In a sense, this question can be asked of any adoption.) Would they be better off, in some ways, remaining there? On the other hand, are we simply associating a baby with a “community” that it will never even know? In other words, does it matter where kids are from? And for gay couples, international adoptions may not even be an option unless they lie — which of course raises its own set of questions.
To return to the beginning of this post: The friends with whom we were arguing had the benefit of a particular experience that colors their view of one of these options. Another couple we know had a somewhat-similar experience, but the difference may be in the “somewhat,” as their view of this same option is diametrically opposed.
So maybe we can’t do any better than this aphorism, attributed by a member of this second couple to an unidentified friend:
Apparently, my kidneys are manufacturing stones like cheap Chinese toys. Last night, I found myself back in the ER with another stabbing pain. This is now what I look for in home sale ads: “Charming Victorian house in diverse neighborhood. Walking distance to emergency room. Must see!”
This time, I thought that a CT scan did make sense, but that wasn’t going to happen for several hours, because all of the CT staff was out sick. So, doped up on morphine, I walked home in the sticky dawn. I then took advantage of my pain-free state to sleep for several hours, but now I’m awake and uncomfortable. Hence, this post.
I’m now in favor of some kind of “cap and trade” program for kidney stones. I’m also in favor of major changes to the health care system. Today’s lesson is that the pieces don’t move especially well together. ER docs, my doc on call, the urologist I’m supposed to see next week — my experience suggests that they won’t check each other’s notes thoroughly enough (if at all), and that there are lost efficiencies all over the place.
But don’t take my word for it: Here’s what some academic physicians had to say about the cost issue in a recent op-ed piece in the NY Times. Their many useful suggestions include reconsidering the “fee for service” model, which encourages overutilization of procedures. In a given year, for example, the number of CT scans done exceeds .2 per capita (62 million for 300 million people).
In a recent interview on NPR’s Fresh Air, Lisa Sanders, who writes the fascinating (to me and other worry warts) “Diagnosis” column for the Times, picked up on related point with her pithy insight that doctors are reimbursed for “doing” — not for “thinking.” One morning, she explained, she had some twelve patients, who represented the mine run of what internists encounter on a typical day: colds; bronchitis; flu symptoms; pain. Her final patient needed an ingrown toenail removed. Doing that brought Dr. Sanders more reimbursement from the insurance companies than everything else she’d done all morning, combined. Fee for service combined with heavy compensation for procedures, rather than diagnosis, may explain a good part of our current mess.
You may have heard that the evident need for some kind of health care reform hasn’t exactly resulted in universal acclaim for President Obama’s initiative. To an extent, the responsibility rests with the White House for failing to engage and to make clear exactly what’s being proposed, what would happen as a result, and so on.
Obama’s Town Hall Meetings have been a belated corrective to the more vitriolic incarnations of the format that have caught many people, including me, by surprise. Listen in and you’ll hear comments that are only sometimes about health care itself. In this story, one woman complains broadly and emotionally about the death of American exceptionalism. It seems to me that Kai Wright, senior writer for the Root who was interviewed for the story, is exactly right in saying that health care has provided a convenient flash point for broader anger and anxiety: “What is my place in a vastly changing culture and a vastly changing economy?” is the question he suggests underlies whatever is actually spoken.
Wright also blames right-wing flame-fanners — especially Glenn Beck — for provoking this anger. In the chain of distribution, Beck is the wholesaler, and people like John Stahl, President of the Berks County, PA Tea Party Patriots, are the distributors who work on the local level. Reading about Stahl’s criticisms of “Obamacare” at Arlen Specter’s noisy town hall meeting, I did the only sensible thing: I called the guy. (His phone number is on his organization’s website.)
Stahl, who’s about to turn 65, doesn’t plan to turn down Medicare. This would be an easy but unfair ground for calling him on hypocrisy; as he pointed out, Medicare is a contract on which people (presumably including “John Stahl”) have relied upon. But it’s broke, he says, and so is the whole system. He doesn’t exempt insurance companies from blame for what he acknowledges is a problem with our health care system but puts the lion’s share of blame on lawyers and med mal suits, illegal aliens (and legal ones, too!) using the system, and the insufficient number of doc being graduated from medical school.
A staunch libertarian (but one who critizes Obama and his staff for being “ideologues”), Stahl favors the free market solution (which I’m convinced won’t work in the case of health care insurance), opposes any kind of “counseling” of people about their legal options regarding end of life care (not the role of government, he says), and even put on a retro, Steve Forbes wig to call for the “flat tax, ” an idea that no one will ever be able to drive a stake through. The flat tax should fix the problem, he says, along with an unspecified dose of tort and immigration “reform.”
Stahl’s positions aren’t radical, and he stressed the need for civility in debate. But his idea of civility is broad enough to include even Claire McCaskill’s notorious Town Hall Meeting, which he defended. See what you think:
At the risk of engaging in amateur social psychology, Stahl seems to me very much to fit within Wright’s questioning classes. Laid off from his job in his mid-sixties, a conservative Christian seeing his world changing at a vertiginous pace, Wright has seized on an issue in which he’d seem to have little personal stake, using it as a prism through which his deeper concerns can be reflected. Obama is “not a good person.” He’s “not to be trusted,” based on his “background.” He and his ideologues are using the public option as a kind of Trojan horse, to get to their ultimate goal of complete government takeover of health care.
Is this code for a kind of racism? That’s much too simple, because Obama’s race may itself be a surrogate, for some, for what’s making them uncomfortable with change, more broadly. The world is caving in on John Stahl, and it’s not fair.