(By Andrew MacKie-Mason)
The critique against the secular dogma of contraception as essential to healthcare is not religious or normative but conceptual. “Health” is a scientific term that refers to the proper functioning of the human body and mind, and “healthcare” refers to the use of the medical arts to heal, cure or alleviate the effects of some disease, pathology, or physiological malady that impairs the health of the individual.
The letter [his post was a response to a letter by other academics] simply assumes that contraception constitutes “healthcare” without showing this to be the case. For this assumption to be valid, however, one must regard pregnancy as a disease that should be prevented or “cured” once this condition ensues – a “cure” addressed by the abortifacient drugs also prescribed by the mandate.
I responded (in part) that "Health isn't about bringing everyone up to some objective universal standard of 'proper functioning.' It contains a highly subjective element of what each person sees as the proper functioning of their own body as an integral aspect of their self...it's *unwanted* pregnancy that's seen as a health problem: that is, someone's body (an integral part of the self) operating in a way which they do not want."
Breen wrote
a long response available here, and I'm going to use this forum to respond since Mirror of Justice has a bad track record with long comments. I'll also add a few thoughts at the end in response to
this posted reply by John O'Callaghan, since he takes issue with my argument (to the extent that it seems he considers the subjective understanding of 'health' "manifestly absurd"). I apologize to those not interested in the back and forth; please feel free to ignore this post.
Dear John,
First, I'd like to point out a mischaracterization in your latest post. I did not call your view a "fuzzy teleological objectivism," because you defended it more clearly than that. I used that in reply to Matt Bowman, another commenter on the original thread, who flatly rejected the notion that "health" can be anything but objective, while providing absolutely no reasoning behind his claim.
You also seem to object to the conclusory tone I used in my original comment. I don't think it was out of line, given the forum and the fact that I was responding to a similarly conclusory claim in your original post. I also don't quite understand why you feel it's necessary to point out that I "should be prepared to follow your argument where it leads." Of course I should, or I should be prepared to revise my views when serious discourse leads me to new conclusions. But anyways, on to the substance.
One of the themes in your argument is that a subjective definition of health leads to bad things being classified as health. For instance, you argue:
Thus, if “health” is a subjective determination – a matter of personal autonomy – then you should be prepared to require physicians and hospitals (i.e. “healthcare providers”) to engage in assisted suicide – whether the person is young, old, or middle-aged; suffering from a debilitating, terminal illness or “the picture of health.”
And:
What is more, if autonomy is the touchstone of “health” then you should be prepared to require physicians and hospitals to perform “voluntary amputations”
There's a missing link in your argument, though. Just because something falls under the definition of "health" does not mean that physicians or hospitals should be forced, or even necessarily allowed, to perform it. There are other values besides health that doctors must answer to, and some things (i.e. assisted suicide) might be impermissible even if they qualify as healthcare. (To be clear, I'm not acknowledging that assisted suicide is necessarily healthcare — more on that below.)
Another major thread in your argument focuses on what we can at least temporarily call "mental illness." You seem to be circling around a claim that my subjective conception of health doesn't allow me to acknowledge the existence of mental illness, at least when the patient (as so often happens) doesn't acknowledge that there's anything wrong. I agree that the way I originally framed my point suggests the conclusion you're reaching, and I'm grateful for the opportunity to clarify.
My argument, like most that rely on personal autonomy, appeals to that human capacity which we can call "reason." For a choice to be autonomous, and thus to come under my understanding of health, it must be rational. I realize that I must hasten to clarify how this isn't just slipping some new teleology in under a different name. The difference, it seems to me, is that while a teleological objectivism of the kind you're relying on argues that there is a correct end for each kind of thing. A requirement of rationality, on the other hand, simply says that the autonomous actor must be processing information, have goals and values, and make decisions aimed at achieving those goals and values. (I'll leave the difficult task of providing a more detailed definition of rationality to others more skilled than I.)
When someone has lost (either entirely or with respect to a certain decision) their ability to think rationally, we no longer think of their decisions as autonomous and those decisions no longer affect what we think of as healthcare for that individual. In those circumstances, one goal of healthcare is to restore rationality, so that the person can once again be an autonomous agent. Failing that, we try to decide what their wishes would be if they were thinking rationally — hence why people put in a position to make health decisions for an incapable individual try to respect what that person's wishes would have been.
So, when presented with an individual who expresses an abnormal desire (voluntary amputation, assisted suicide, bulimia, excessive plastic surgery) if we want to know what "healthcare" is we need to try to discern whether that person is thinking rationally and autonomously. There's a possibility that they are, though our intuitions may suggest that in most cases they aren't. If the desire is rational,
and no other values override health, then we ought to respect it.
Moving on, you take issue with my argument that vaccines don't fix a deficiency or malady in the body. You're correct that they have the potential to prevent the body from being injured in the future, but that doesn't seem to fit with the narrow teleology that you're advancing. At the time of administration, a vaccine is an interference with a perfectly normally functioning immune system. There is nothing wrong with the body before the vaccine is given; rather, the vaccine introduces a problem in order to train the body how to overcome potential (more serious) problems in the future. We administer vaccines because we choose to reorder the priorities of our immune system to address problems which reason (and research) tell us are more likely to occur. We are, in fact, interfering with the "nature" of the body in order to have it behave as we want it to behave.
A subsidiary point: how can the nature of a vaccine as "healthcare" depend on the potential for a future infection which the vaccine helps to prevent? What if that potentiality never occurs (someone has a polio vaccine, say, but is never exposed to polio)? And if we open the door to things which might potentially prevent problems in the future, where do you draw an
objective line between vaccines (which might prevent problems if there's later exposure to the virus) and contraception (which might prevent problems if the pregnancy that would have occurred had complications)?
In regard to my point that we would not consider vaccine administration "healthcare" if it were performed against the moral or religious objections of the patient, you suggest that the vaccine itself is objectively healthcare, even if we shouldn't give it for one reason or another. But the vaccine itself cannot be "healthcare;" only the act of administering it can be. (How can an object, removed from action, be "care" of any kind?) Would you argue that a doctor who administered a vaccine to an unwilling patient is providing healthcare? (Even if you would also say that the doctor ought not provide that specific healthcare because of conflict with other values.)
I believe I've responded to all the points you raised, though of course I may have missed some or responded to others unsatisfactorily. I look forward to the continuation of this dialogue.
Sincerely,
Andrew MacKie-Mason
Dear Mr. O'Callaghan,
In your letter to Mr. Breen posted by Rick Garnett, you make a few surprising claims. The most surprising of them is that a subjective understanding of the nature of "health" would somehow render meaningless all healthcare laws. Specifically, you wrote:
If the meaning of “health” and “healthcare” really are subjective determinations of the autonomy of private individuals, the state in mandating any sort of legislation concerning “healthcare” is quite literally legislating nothing. Any apparent law involving the terms “health” and “healthcare” are really schema with place markers or variables in them like “X” and “Y”, which of course means that they are not laws at all. Thus the incoherence--the law is not a law.
I'm not quite sure I understand your point here. First of all, it's undeniable that words may have a different meaning in legislation than they carry in ordinary parlance. Even if we agree that the word "health" (and all the baggage it carries with it in moral/philosophical/policy discussion) ought to refer to the subjective determination of rational individuals with regard to their own bodies, we needn't accept that it has the same meaning every time it's used in the U.S. Code.
And even if it did carry that same meaning in law, it's not true that all laws using the word "healthcare" would become meaningless. For instance, a law providing that "the decisions of all individuals with regard to their own healthcare shall be respected in certain circumstances" would remain perfectly coherent.
Your point here might be clarified if you provided some specific examples of laws which would be rendered meaningless under what I argue is the common conception of "healthcare."
You also argue that laws whose exact application depends on the decisions of private individuals are unjust because they make individuals into legislators in pursuit of their own ends:
The sort of self-legislation envisaged here by the autonomous-semanticist is quite different since it determines the very character of the law that binds, creating it, as it were, ex nihilo. And here it is a law that does not bind the autonomous individual; no it is a law that binds everyone else to the self-determination of the individual, and uses the coercive power of the state to so bind them.
But one might have thought that it was fundamentally unjust for a private individual to use the coercive power of the state to enslave the lives of others to his or her private interests. Political theorists have a very specific word for such coercion.
However, the exact application of the law often depends on the desires of private individuals, in ways which potentially "enslave the lives of others to his or her private interests." This is often uncontroversial: laws which require employers to provide accommodations for employees religious beliefs is a great example. If you feel that there's a difference here, examples of such laws might again be very helpful in evaluating your argument.
Sincerely,
Andrew MacKie-Mason
