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I'm just back from vacation and trying to catch up on the war in Gaza. More on that later. But first, something I didn't have a chance to get to before the break: the Vatican's latest pronouncement on fertility technology. Apparently the men in Rome are having trouble understanding some nuances of the female reproductive system.
The pronouncement comes in the form of Dignitas Personae, an instruction from the Congregation for the Doctrine of the Faith, which articulates official Catholic positions. This document covers several interesting topics, which I hope to get to in the days ahead. But the one that calls for rebuttal right away is the section on "[n]ew forms of interception and contragestation." It says:
Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted.
This is an astute and useful set of distinctions. Unfortunately, the CDF immediately proceeds to violate them. Here's its next paragraph:
In order to promote wider use of interceptive methods [a footnote here specifies "morning-after pills"], it is sometimes stated that the way in which they function is not sufficiently understood. It is true that there is not always complete knowledge of the way that different pharmaceuticals operate, but scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used. ...
Really? Is the effect of inhibiting implantation "certainly present"? Let's review the mechanics of morning-after pills, specifically levonorgestrel, marketed as Plan B. The problem with the CDF's statement is that this "interceptive" is chemically identical to the best-known contraceptive: the pill. And the risk that this drug
will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.
So, the assertion of an anti-implantation effect is theoretically unsound. But what do the data show? Two years ago, the world's leading expert on levonorgestrel, James Trussell, co-authored an analysis of the available research in the Journal of the American Medical Association. The analysis confirmed that that anti-ovulation effects wipe out any data suggesting a possible anti-implantation effect. It concluded:
Published evidence clearly indicates that Plan B can interfere with sperm migration by altering the cervical and uterine environment, and that preovulatory use of Plan B usually suppresses the LH surge either completely or partially, which in turn either prevents ovulation or leads to the release of ova that are resistant to fertilization. Epidemiological evidence rules strongly against interruption of fallopian tube function by Plan B. Evidence that would support direct involvement of endometrial damage or luteal dysfunction in Plan B's contraceptive mechanism is either weak or lacking altogether. Both epidemiologic and clinical studies of Plan B's efficacy in relation to the timing of ovulation are inconsistent with the hypothesis that Plan B acts to prevent implantation.
In fact:
Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase the rate of successful implantation and pregnancy. That observation a priori reduces the likelihood that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation.
So, in summary:
[T]he ability of Plan B to interfere with implantation remains speculative, since virtually no evidence supports that mechanism and some evidence contradicts it. ... [T]he best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with postfertilization events.
So much for the question of effect. But what about the other part of the moral equation: intent? The Vatican document, still referring to morning-after pills, says that "anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion."
But a woman who requests a morning-after pill doesn't necessarily seek to prevent an embryo's implantation. In fact, as we just showed, it would be irrational of her to seek that effect, since no evidence supports it. In fact, given the evidence, it would make just as much sense for her to request the pill in order to prevent embryonic loss. And anyone who has ever taken a morning-after pill knows that at that moment, your actual intent is to avert pregnancy at the earliest possible stage of the process, which happens to be ovulation.
Bottom line: The perceptive analytical framework established by Dignitas Personae, combined with the best scientific evidence and analysis, clearly implies that morning-after pills are contraceptives, not interceptives. Therefore, from the standpoint of respecting embryonic life, you may take them in good conscience.
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Hey, Detroit! We have a new job for you.
Just in time to bail out the auto parts suppliers, Madeline Drexler heralds the latest cool new (or is it old?) idea: car-parts incubators. Here's her description of them in yesterday's Science Times:
The heat source is a pair of headlights. A car door alarm signals emergencies. An auto air filter and fan provide climate control. ... Unlike the notoriously high-maintenance incubators found in neonatal intensive care units in the United States, it is easily repaired, because all of its operational parts come from cars. And while incubators can cost $40,000 or more, this one can be built for less than $1,000. The creators of the car parts incubator ... say it could prevent millions of newborn deaths in the developing world.
We're so used to incubators these days that we've forgotten how radical they are. Their function, Drexler notes, is "providing a warm, clean, womblike environment in which a baby can mature." In short, they're artificial wombs. They don't replicate every function, of course. But for millions of babies who would otherwise die, they replicate enough.
They also destabilize our notions of abortion and infanticide. U.S. abortion laws are organized around viability, the idea that a fetus is entitled to protection when it can survive outside the womb. That's a technical question, and incubators, by creating a kind of womb outside the womb, influence the answer. The earlier they can sustain preemies, the further the line of viability advances.
But that's the fancy far edge of incubator technology. Drexler is talking about something simpler and more immediate: making basic incubation available and functional around the world. Who cares about the latest million-dollar American baby born at 21 weeks when you live in a country where preemies die at 35 weeks? You can't spend that kind of money. You can't even find somebody local to fix a $20,000 incubator. You need an affordable machine that works for most preemies and can be reliably maintained. That's what the car-parts incubator is designed for: babies born at 32 weeks or later.
In the transition from George W. Bush to Barack Obama, we're going to see a big shift in the politics of biotechnology. The conservative preoccupation with technological frontiers will be replaced, for the time being, by a progressive preoccupation with distributive justice. That means less debate about things like future artificial wombs and more attention to things like car-parts incubators. In some ways, it'll be more boring. But tell that to the woman in Indonesia who gets to keep her baby.
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From today's piece:
I remember the day my first child was born. He lay sleeping, swaddled, in a plastic bin at the hospital. That's when I finally understood what it meant to be a parent. "If we leave this hospital without this baby," I told my wife, "we'll be arrested."
It was a joke, but it was also true. You arrive at the hospital as two people, and you leave as three. You can't just make a baby and walk away. It's yours forever.
Unless, that is, you make a baby through in vitro fertilization. In that case, you can put the embryo away in a freezer and decide what to do about it later. Or never. ...
More here.
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We have a late-breaking frontrunner for dumbest policy idea of 2008: defunding Planned Parenthood in the name of fighting abortion.
Stephanie Simon reports the latest developments in the Wall Street Journal:
Abortion opponents are pressing state and local governments to stop sending taxpayer dollars to Planned Parenthood, arguing that the nonprofit group has plenty of cash and shouldn't be granted scarce public funds at a time of economic crisis. ...
In recent weeks, Planned Parenthood chapters have lost public funds in two states as elected officials juggled tight budgets. Fulton County, Ga., which includes Atlanta, canceled a $420,000 contract as part of statewide cuts in health care. The move ended a teen-pregnancy prevention program and prompted a local Planned Parenthood clinic to raise fees to make up lost revenue. Sarasota County, Fla., ended years of subsidizing Planned Parenthood's sex-education programs with annual grants of as much as $30,000. ... The Family Research Council is developing a kit to help grass-roots activists dig through financial reports so they can make detailed presentations to elected officials about the assets and revenue of local Planned Parenthood chapters. The council has sent letters to 1,200 state legislators describing Planned Parenthood's strong financial position and urging "a second look" at public funding.
Defunding Planned Parenthood is hardly a new idea. What's new is the fiscal-responsibility angle. And from a pure cost-cutting perspective, you can make the case that Planned Parenthood brings in plenty of private funding and doesn't need public money. I think the pure cost-cutting perspective is a mistake, given the enormous social and economic benefits of preventing unintended pregnancies. But you can make that case, if you really believe in fiscal austerity.
What's insane, however, is the real motivation behind this push. The Family Research Council doesn't really care about economics. That's why, as you might have noticed, it's called the Family Research Council. The campaign to defund Planned Parenthood is really about abortions. FRC would like to see fewer of them. So would I. And that's the crux of the idiocy: The single best thing you can spend money on to reduce the number of abortions, not just in this country but around the world, is Planned Parenthood.
I'll say that again: If you define pro-life as preventing abortions, Planned Parenthood is the most effective pro-life organization in the history of the world. No, it doesn't give teenagers the idea of having sex. That idea comes to them quite naturally, thank you very much. What Planned Parenthood does, more comprehensively than anyone else, is to distribute the means and knowledge to control your risk of getting pregnant when you don't want to be pregnant. And those two things, combined with pressure to exercise that control assiduously, are the surest way to prevent abortions. If you wait till women are already unhappily pregnant, you're too late.
If you think Planned Parenthood is sufficiently funded, fine. Write your check or award your grant to some other, smaller organization that does similar work. But don't imagine that defunding birth control will buy you fewer abortions. It will buy you more.
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David Savage, one of my favorite legal writers, has a good story in the L.A. Times about President Bush's plan to protect medical employees from punishment when they refuse to violate their consciences. The idea sounds good till you read the details: The rule bars "any entity" that gets federal money (e.g., private companies that happen to be funded in part by a grant) from disciplining any employee, including one "whose task it is to clean the instruments." Savage reports:
Proponents, including the Christian Medical Assn. and the U.S. Conference of Catholic Bishops, say the rule is not limited to abortion. It will protect doctors who do not wish to prescribe birth control or to provide artificial insemination, said Dr. David Stevens, president of CMA. "The real battle line is the morning-after pill," he said. "This prevents the embryo from implanting. This involves moral complicity. Doctors should not be required to dispense a medication they have a moral objection to."
Hey, I'm all for respecting moral objections. Doctors are entitled to their own ethical judgments, regardless of what the medical establishment says. But they're not entitled to such defiance when the judgments in question are scientific. And what Dr. Stevens says about the morning-after pill—that it "prevents the embryo from implanting"—is such a gross misrepresentation that it's amazing he's in charge of any medical association.
Let's get clear on two important points. First, "morning-after" does not mean "after-fertilization." To repeat what I wrote about this two years ago:
An egg loses its fertility within 12 to 24 hours. It takes sperm about 10 hours to reach the egg, and sperm can survive in the female reproductive tract for up to five days. If you want to get pregnant, you'd better send in the sperm before the egg shows up. But if you don't want to get pregnant, and the sperm are on their way or already there, you still have time to stop the egg.
Second, of all the ways in which a morning-after pill might block pregnancy, preventing implantation is the least plausible. Chemically, a morning-after pill is a form of oral contraception. Here are the facts:
The risk that oral contraception will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.
So what Stevens says is, at a minimum, a gross distortion. And it's a particularly evil distortion because it steers women away, not from abortion, but from the measure that is at that moment most likely to prevent them from later resorting to an abortion. If I ran a medical facility and found out one of my doctors was feeding patients that kind of propaganda, I'd fire him. And the government, particularly a government that calls itself conservative, has no business standing in my way.
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Sarah Palin spent her first days as John McCain's running mate being pounded over her daughter Bristol's out-of-wedlock pregnancy. In this predicament, critics saw Puritan hypocrisy, maternal neglect, and the predictable consequences of abstinence-only education.
There are many good grounds for criticizing Palin. This isn't one of them. The only reason we know about Bristol's pregnancy is that she's taking it to term. If she had aborted it, we'd never have known. Last month, I counted up the daughters of previous presidential and vice-presidential nominees going back to 1964. Of these, 37 were between the ages of 17 and 30 when their parents ran for national office. Based on unintended-pregnancy rates in this age group among higher-income families, I said it was almost inconceivable that "none of these young women got knocked up before their parents' nominations or elections." From the data, I inferred that at least one of them had probably had an abortion.
Readers and bloggers pounced on this inference, calling it unwarranted, perverted, and sexist. Call it whatever you want. It's now confirmed.
Actually, the evidence has been available for a while. It just didn't show up in Nexis, and the two best sources weren't searchable online. Fifteen years ago, Lee Edwards, who had worked on Barry Goldwater's 1964 presidential campaign, interviewed Goldwater's daughter Joanne for a biography of the senator. Based on the interview, he reported that in 1955, when Joanne, "not yet twenty and still in school, became pregnant with the child of her intended husband and told her father that she did not want to have the child, Goldwater said, ‘I'll take care of it.' He arranged for Joanne to fly back to Washington and have a then-illegal abortion."
Two years ago, Zeitgeist Films released Mr. Conservative: Goldwater on Goldwater, a documentary produced and narrated by C.C. Goldwater, the senator's granddaughter. In it, Joanne Goldwater tells the story:
I was getting engaged. ... It was actually in the Christmas of 1955. And in January, I—I found out that I was pregnant. And I had planned—I had planned this engagement party and a wedding. And—we had—we had planned to have children. We both were still in school. I was getting my degree. And I—I wasn't ready to have a child. And I got an abortion. ... And this was when it was just totally forbidden and very, very dangerous. And young girls were dying by trying it themselves. My father, being conservative, he felt that the government should not decide what women do with their bodies or anything else, you know. The government should stay out of all that. My mother started Planned Parenthood in Arizona in the '30s. And that's why I felt that it was easy to go to them and tell them. And they were very, very supportive.
Why didn't Joanne Goldwater get the Bristol Palin treatment in 1964? Because nobody knew she'd been pregnant. And the reason they didn't know is that she and her parents got rid of the problem.
The point isn't that abortion should be legal or illegal. The point is to exercise humility before accusing somebody else of bad parenting or a dysfunctional family. Was Joanne Goldwater's mom, a founder of Planned Parenthood of Arizona, a bad parent? Do you imagine that she taught her daughter abstinence-only? And how about Goldwater himself? If Palin can be judged by a daughter's pregnancy, why can't he? Shouldn't dads be held to the same standard? And shouldn't parents be held accountable for their sons, too?
You don't know how many of your friends or your friends' daughters have been pregnant. Unless they carry the baby to term or tell you about the abortion or the miscarriage, you just don't know. So before you open your mouth about the Palins, remember the Goldwaters.
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Tomorrow night, Joe Biden and Sarah Palin will meet in their only vice-presidential debate. Most of the discussion will be about economics and foreign policy. On the social issues, here are two questions moderator Gwen Ifill should ask.
1. Gov. Palin, you were asked this week whether it should be illegal for a girl to get an abortion in the case of rape or incest. Your answer was that the girl herself should not go to jail. What about the doctor? Should the doctor who performs that abortion face criminal penalties?
2. Sen. Biden, you said four weeks ago that you believe life begins at conception but that you can't impose your personal beliefs on other people. Yet you also voted for a law against gay marriage called the Defense of Marriage Act, and two years ago, you said this law expresses your view that "marriage is between a man and a woman and states must respect that." Why is it OK to impose your beliefs on gay marriage but not on abortion?
Here's all the background information Ifill will need when the candidates start fudging.
Palin's interview with Katie Couric, aired yesterday:
Couric: If a 15-year-old is raped by her father, you believe it should be illegal for her to get an abortion. Why?
Palin: I am pro-life. And I'm unapologetic about my position there on pro-life. And I understand good people on both sides of the abortion debate. In fact, good people in my own family have differing views on abortion and when it should be allowed. So ... I respect people's opinion on this. ...
Couric: But, ideally, you think it should be illegal for a girl who was raped or the victim of incest to get an abortion?
Palin: I'm saying that, personally, I would counsel the person to choose life, despite horrific, horrific circumstances that this person would find themselves in. And, um, if you're asking, though, kind of foundationally here, should anyone end up in jail for having an ... abortion, absolutely not.
Biden on Meet the Press, Sept. 7, 2008:
Biden: I'm prepared as a matter of faith to accept that life begins at the moment of conception. But that is my judgment. For me to impose that judgment on everyone else who is equally and maybe even more devout than I am seems to me is inappropriate in a pluralistic society. ...
Tom Brokaw: But if you, you believe that life begins at conception, and you've also voted for abortion rights.
Biden: No, what [I] voted against curtailing the right, criminalizing abortion. I voted against telling everyone else in the country that they have to accept my religiously based view that it's a moment of conception.
Biden's recorded vote for DOMA, Sept. 10, 1996.
Biden on Meet the Press, June 4, 2006:
We already have a law, the Defense of Marriage Act. We've all voted—not, where I've voted, and others have said, look, marriage is between a man and a woman and states must respect that. Nobody's violated that law, there's been no challenge to that law.
Biden on CNN, June 5, 2006:
We have already passed a law saying that—and the Defense of Marriage Act, defining marriage between a man and a woman.
The Biden campaign's evasive response to a same-sex marriage question on the Human Rights Campaign's 2007 survey of presidential candidates:
Senator Biden supports letting states determine how to recognize civil unions and how to define marriage. He believes that legal recognition should not be denied to same-sex couples.
Bonus peg: Biden will speak at HRC's annual dinner Saturday night.
All yours, Gwen. Go for it.
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In yesterday's post on the proposed HHS abortion "conscience" regulation, I overlooked a very important quote from Secretary Leavitt. Rob Stein of the Washington Post relates the following exchange from Leavitt's Aug. 21 conference call with reporters:
But when pressed about whether the regulation would protect health-care workers who consider birth control pills, Plan B and other forms of contraception to be equivalent to abortion, Leavitt said: "This regulation does not seek to resolve any ambiguity in that area. It focuses on abortion and focuses on physicians' conscience in relation to that."
Ambiguity is precisely what pharmacists have asserted in lawsuits demanding the right to withhold hormonal contraceptives. While framing the regulation as neutral, Leavitt is lending support to their position. And, as noted yesterday, the regulation explicitly applies to pharmacies (see page 24 of the PDF) which dispense contraceptives but do not perform surgical abortions.
When it comes to conscience rights, I'm a libertarian. As a pharmacist, you have every right to refuse to fill contraceptive prescriptions. But your customers have every right to boycott your store, and your employer has every right to fire you. If you don't like your employer's policy, open your own pharmacy.
The HHS regulation is not neutral. It uses government leverage to prevent employers from insisting that their employees honor consumer choice. In the name of one freedom, it suppresses another. And in the name of ambiguity, it lends official support to lawsuits that would extend this government intervention from abortion to contraception.
You can add your own views, pro or con, at consciencecomment@hhs.gov.
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HHS Secretary Michael Leavitt has issued a final version of his proposed regulation to protect medical conscience (PDF). As predicted, he has dropped the sentence that originally defined abortion as "any of the various procedures—including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action—that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation."
Leavitt has also chosen to leave open the possibility that the regulation will be applied that way. In that case, it would protect a provider's right to withhold oral contraception, which theoretically could prevent implantation of an embryo. Pharmacists and Catholic hospitals are already waging legal battles to assert this right.
The proposed regulation is 42 pages long. I'm embarrassed to tell you that I read it last week during my vacation. I was looking for a definition of abortion. I'll save you the trouble: There is none. The regulation draws no distinction between abortion and contraception.
In his blog, Leavitt has twice addressed the contraception question. On Aug. 7, he said his intent was to protect the right of conscience, not to define contraceptives as abortion. This left open the obvious next question: Intent aside, does the right of conscience protected by the regulation include the right to withhold hormonal contraception on the grounds asserted by pharmacist litigants: that it might be abortifacient? Two weeks ago, I invited Leavitt to answer that question. He has ignored it.
He has, however, answered a similar challenge from Mary Jane Gallagher, the president of the National Family Planning and Reproductive Health Association. In an Aug. 11 blog post, Leavitt quoted and rebutted her:
"Who's going to provide access to contraceptives services if the administration provides this large loophole to deny services?" [said Gallagher.] CQ reported Ms. Gallagher continued: "Providers are ‘given an oath—now they get to pick and choose what they want to do' if a regulation is issued, she said."
So, according to Ms. Gallagher's ideology, if a person goes to medical school they lose their right of conscience. ... There is something I'd like to point out to Ms Gallagher and the people she represents. It is currently a violation of three separate federal laws to compel medical practitioners to perform a procedure that violates their conscience.
Gallagher is explicitly talking about contraception. And Leavitt's response is to invoke conscience rights.
Last week, Leavitt said some practitioners might "press the definition" in the final HHS regulation and argue that hormonal contraception is abortion. They certainly will. Pharmacists for Life International is already on the case. So is the Christian Legal Society. Concerned Women for America says the equation of hormonal contraception with abortion, explicit in the original draft of the regulation, was right all along.
And when these litigants argue that the regulation implicitly covers contraception, they'll have lots of help from Leavitt. They can cite his response to Gallagher. They can also point out that the regulation explicitly lists pharmacies as a category of "affected entities." (See Page 24.) Last time I checked, pharmacies didn't do surgical abortions.
The argument on the other side will be that Leavitt has said he's not targeting birth control. "This regulation is not about contraception," he said in a conference call last week. "It's about abortion and conscience." But Leavitt has said the same thing about abortion itself. "This is not a discussion about the rights of a woman to get an abortion," he wrote in his blog. "This is about the right of a doctor to not participate if he or she chooses for reasons they consider a matter of conscience." Leavitt's point, in other words, is that the regulation doesn't ban anything; it just protects the right not to facilitate it. As he put it in the conference call, "There is nothing in this rule that would in any way change a patient's right to a legal procedure." But in asserting this right of refusal, the rule doesn't distinguish between surgical abortion and theoretically abortifacient drugs.
The rule is open to public comments until Sept. 20. You can submit your comments to consciencecomment@hhs.gov. Here's mine: Mr. Secretary, if this rule doesn't extend the right of refusal to hormonal contraception, say so.
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Last Tuesday, I wrote about a draft regulation, circulated by the Department of Health and Human Services, that would protect the right of private employees to refuse to facilitate any abortifacient chemical or activity. The draft rule defined abortion as "any of the various procedures—including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action—that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation." It would thereby encompass the right to withhold oral contraception, which theoretically could prevent implantation of an embryo.
On Friday, HHS Secretary Mike Leavitt wrote a blog post about the draft rule. According to the Washington Post, Leavitt "denied that [the] draft regulation would redefine common birth control methods as abortion and protect the rights of doctors and other health-care workers who refuse to provide them."
Really? Where's the denial?
Here's the relevant part of Leavitt's post:
An early draft of the regulations found its way into public circulation before it had reached my review. It contained words that lead some to conclude my intent is to deal with the subject of contraceptives, somehow defining them as abortion. Not true.
The Bush Administration has consistently supported the unborn. However, the issue I asked to be addressed in this regulation is not abortion or contraceptives, but the legal right medical practitioners have to practice according to their conscience and patients should be able to choose a doctor who has beliefs like his or hers.
The Department is still contemplating if it will issue a regulation or not. If it does, it will be directly focused on the protection of practitioner conscience.
Leavitt's post says his intent is to protect the right of conscience, not to define contraceptives as abortion. It doesn't deny that the final version of the rule will have the effect of treating some contraceptives as abortion. And there's every reason to believe it will do just that.
Leavitt writes as though conscience protection is a separate issue from the blurring of abortion with contraception. It isn't. A rule that guarantees the pro-life conscience rights of doctors, pharmacists, and other private employees is limited only by what those employees believe. And what many of them believe, as the Post's Rob Stein has documented, is that oral contraceptives are wrong because they can prevent implantation.
If you think Leavitt won't extend conscience protections that far, you haven't met his boss. Nine years ago, when George W. Bush was running for president, Tim Russert asked him: "Do you believe life begins at conception?" Bush replied: "I do." Two years later, as he prohibited federal funding of embryo-destructive stem-cell research, Bush repeated, "I think life begins at conception." Referring to pre-implantation embryos, Bush wrote that "it is unethical to end life," even to save the lives of others.
How can Leavitt fail to extend conscience protections to a pharmacist who refuses to fill a birth-control prescription because, like Bush, he believes that life begins at conception? If that belief is good enough to bar funding of stem-cell research, why isn't it good enough for the pharmacist?
If Leavitt really wants to clarify this question, he can do so by writing one more post in which he stipulates that the HHS rule, if issued, will not extend to drugs or procedures that act prior to implantation. I'm betting a month's supply of birth-control pills that he won't.
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Starting this week, under orders from the state attorney general and the U.S. Court of Appeals for the 8th Circuit, medical providers in South Dakota must present a scripted statement to women who seek abortions. The script, dictated by the legislature three years ago, declares that any abortion "will terminate the life of a whole, separate, unique, living human being."
Until now, I wasn't aware that the fetus—a term that, according to the South Dakota law, includes "the implanted embryo"—was a whole, separate, living human being. I thought it was ... you know ... implanted. I mean, I'm just a guy, not really an expert or anything. But, um, placenta? Umbilical cord? Do those terms ring a bell? And that's not even getting to the tricky stuff, like the role of maternal RNA in directing embryonic growth or all the work done by the womb to facilitate the embryo's attachment and nourishment.
I have to say, it's a relief to learn that the embryo is so complete and independent. I mean, it solves the whole problem. Here's this woman who just wants to be separated from her embryo. And lo and behold, it's already separate! No need to agonize. Just detach it and let it grow. It's separate, it's whole, it's living. Cancel the abortion. Perform a separation instead.
Sure, some cranky district attorney might take you to court, claiming your separation was really an abortion. Make sure you countersue for legal costs, because you've got a slam-dunk case. The law under which you're being prosecuted doesn't just declare that embryos and fetuses are separate. It also defines abortion as "the use of any means to intentionally terminate the pregnancy of a woman known to be pregnant with knowledge that the termination with those means will, with reasonable likelihood, cause the death of the fetus."
How can South Dakota claim that you should know separation will kill the fetus, when South Dakota has insisted on informing you, prior to the procedure, that the fetus is already whole and separate?
Don't give me some medical-school mumbo jumbo about obstetrics. The legislature mooted all that blather when it superimposed its judgment. Fetuses are whole and separate. Therefore, being a law-abiding citizen, you have no reason to believe that separation will cause fetal death. Therefore, under the law's terms, separation is not abortion. No need to bother with the onerous paperwork and liability threats the legislature has assigned exclusively to abortion. You're not in the abortion business anymore.
Look, I don't like abortions. Fortunately, neither do the women who ask for them. Most abortions happen because women get pregnant when they're not ready. Prevent the pregnancy, and you prevent the abortion. So, here's a word of advice to legislators like those in South Dakota: Stop withholding birth control and stop lying to women about their bodies. You can't even keep your lies straight. That's how you ended up telling doctors to tell women that separation will kill a separate human being. See you in court.
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Look who's flirting with animal rights.
In recent days, the New York Times has published two in-house commentaries on Spain's move to legislate rights for apes. "We like to think of these as absolutes: that there are distinct lines between humans and animals," Donald McNeil, Jr., wrote Sunday. "But we're kidding ourselves." Yesterday, Adam Cohen added that "showing respect for apes would elevate humans."
I agree with my human colleagues. But that agreement is the beginning of a huge mess.
The mess starts when we abandon an old religious idea. "Ten years ago, I stood in a clearing in the Cameroonian jungle, asking a hunter to hold up for my camera half the baby gorilla he had split and butterflied for smoking," McNeil recalls. He remembers the words his guide spoke at the time: "A gorilla is still meat. It has no soul." This, McNeil notes, is the position of Spain's Catholic bishops: Humans have souls; animals don't.
Secular humanists reject this dogma. We understand that there's something wonderful and uniquely worthy of respect in the power, richness, and subtlety of the human mind. But to us, the soul doesn't explain these wonders. It describes them. That's one reason why the destruction of human embryos doesn't torment us the way it torments pro-lifers. We don't believe in ensoulment at conception. We believe in the gradual development of mental capacities.
This puts us in an awkward position. We call ourselves egalitarians, yet we deny the equality of conceived humans. We believe that a woman deserves more respect than a fetus. A 26-week fetus deserves more respect than a 12-week fetus. A 12-week fetus deserves more consideration than a zygote. We discriminate according to ability.
This is also why ape rights appeals to us. It's not a claim of equality among all animals. It's a claim that apes resemble us in ways that insects don't. It's a kind of discrimination. Cohen observes that Peter Singer, the philosopher behind the ape rights movement, believes that "species should be evaluated on a case-by-case basis." And McNeil reports:
In an interview, Mr. Singer described just such calculations behind the Great Ape Project: he left out lesser apes like gibbons because scientific evidence of human qualities is weaker, and he demanded only rights that he felt all humans were usually offered, such as freedom from torture -- rather than, say, rights to education or medical care.
This multi-tiered approach to species and rights isn't just Singer's position. It's your government's position. As Cohen points out, chimps get special protection under the Chimpanzee Health Improvement, Maintenance and Protection Act. McNeil adds:
Even animal cruelty laws have a bias toward big mammals like us. For example, in a slaughterhouse, chickens are sent alive and squawking into the throat-slitting machine and the scalding bath. But under the federal Humane Slaughter Act, a cow must be knocked senseless as painlessly as possible before the first cut can be made.
In other words, as the pigs of Animal Farm put it, some animals are more equal than others. And if that principle applies to other animals -- discriminating among them based on humanlike capacities -- does it also apply to us? Are some humans more equal than others?
We've already established that you accept this principle if, like me, you discriminate among preborn humans based on degree of development. And if you accept that humans and apes gradually evolved from common ancestors, then you'd also probably discriminate among born humans based on degree of evolution. As McNeil observes, the archaeological record of human bones "suggests that some of our ancestors exited this world as stew." Were the ancestors who gnawed those bones truly human?
We don't like to face such questions. Like creationists, we ridicule anyone who lumps us together with other primates. Cohen says animal rights activists "come off as loopy" when they say things like, "I am an ape." But according to the U.S. government, that statement isn't loopy. It's fact. All of us are great apes.
If preborn and prehistoric humans are less worthy of respect, what about born, living humans who seem functionally subhuman? McNeil says we're kidding ourselves when we imagine that "certain ‘human' rights are unalienable." He mentions a terrorist who beheaded a reporter. Is it possible, he asks, to forfeit your human rights for subhuman behavior?
On the other hand, if we deem some people less human than others, does it lead us back to the bad old days of racism? McNeil raises this question in the context of his African guide's comment about the butchered gorilla: that it was just "meat" because it had "no soul." The comment, he writes,
was an interesting observation for a West African to make. He looked much like the guy on the famous engraving adopted as a coat of arms by British abolitionists: a slave in shackles, kneeling to either beg or pray. Below it the motto: Am I Not a Man, and a Brother? Whether or not Africans had souls -- whether they were human in God's eyes, capable of salvation -- underlay much of the colonial debate about slavery.
To say the least, that's a controversial analogy. People for the Ethical Treatment of Animals made a similar comparison three years ago and was charged with racism. "They're comparing chickens to black people?" an NAACP spokesman protested at the time. Cohen offers the same objection, faulting PETA for "boneheaded moves, like the ad it ran juxtaposing photos of penned-up animals with starving Jews in concentration camps." He doesn't mention his own paper's juxtaposition of gorillas with Africans a day earlier.
Not that I should be throwing stones. I've got my own contradictions to sort out: that it's wrong to eat animals but not meat; that it's wrong to compare mistreatment of blacks to mistreatment of animals; that it's wrong to "predict the criminal propensity of unborn children based on the color of their skin"; that we should "prepare for the possibility that equality of intelligence, in the sense of racial averages on tests, will turn out not to be true"; and that it's pernicious "to group people by race and compare averages."
I'm still working my way through the puzzle of equality as we learn more about human and animal biology. So are McNeil, Cohen, and others. It's a communal dialogue between morals and science. Where it will lead, I can't say. But what strikes me at this point in the conversation is that equality and discrimination are intricately related. What we often call equality -- sorting creatures into biological groups and treating each group member as identical to the others, but different from members of other groups -- is also discriminatory. That's the paradox of "human rights."
Each of us mixes the two in our own way. Spain extends its "community of equals" to gorillas but not gibbons. Catholic bishops demand rights for zygotes but not chimps. PETA equates racial with interspecies equality. The NAACP discriminates between discriminations.
For my part, I've come to suspect that the first problem to deal with isn't inequality. It's indiscriminateness. Discrimination in the best sense means seeing each individual as she is. It takes effort. You have to look past the surface of things. It's easier to assign individuals to groups and judge them that way. But it's also, to the same extent, unfair. The unfairness arises not from inequality, but from how we organize it. Inequality, at the biological level, is mostly nature's fault. Indiscriminateness is ours.
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The movement to stamp out birth control appears to have taken an ominous turn. Until now, women with contraceptive prescriptions were just being turned down by individual pharmacists. Now they're being turned down by whole pharmacies. Refusals from individuals behind the counter have "resulted in pharmacists being fired, fined or reprimanded," reports Rob Stein in Monday's Washington Post. "In response, some pharmacists have stopped carrying the products or have opened pharmacies that do not stock any." Pharmacists for Life International names seven pharmacies that have signed a "pro-life" pledge and says others are doing the same.
It's not clear how many of these proprietors object to birth control per se and how many are abstaining because they think emergency contraception is abortion. Stein points out that in some states, the only legal way to refuse a prescription for emergency contraception is to abstain from offering contraceptives generally.
What's the reaction from pro-choicers and bioethicists? Here are excerpts from the Post story:
1) "I'm very, very troubled by this," said Marcia Greenberger of the National Women's Law Center, a Washington advocacy group. "Contraception is essential for women's health. A pharmacy like this is walling off an essential part of health care. That could endanger women's health."
2) "Why do you care about the sexual health of men but not women?" asked Anita L. Nelson, a professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA. "If he gets his Viagra, why can't she get her contraception?"
3) "If you are a health-care professional, you are bound by professional obligations," said Nancy Berlinger, deputy director of the Hastings Center, a bioethics think tank in Garrison, N.Y. "You can't say you won't do part of that profession."
4) Critics also worry that women might unsuspectingly seek contraceptives at such a store and be humiliated, or that women needing the morning-after pill, which is most effective when used quickly, may waste precious time. "Rape victims could end up in a pharmacy not understanding this pharmacy will not meet their needs," Greenberger said.
5) "We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications," said R. Alta Charo, a University of Wisconsin lawyer and bioethicist. "We're talking about creating a separate universe of pharmacies that puts women at a disadvantage."
Let's take these objections one at a time.
First: "Walling off" women's health care? Beware dramatic metaphors from lawyers. There is no wall. You bring your scrip to the pharmacy, and the guy at the counter says, "Sorry, we don't stock contraceptives." That's annoying and, in my view, stupid. But nobody's walling you in. Your burden consists of finding another pharmacy.
Second: Why Viagra and not contraception? Because some pro-lifers view hormonal contraception as potentially lethal. I don't share their anxiety about this theoretical risk to an early embryo, particularly when the alternative, in the event of pregnancy, is a high likelihood of fetal killing. But you can't blow off the argument by assuming that contraception should be covered because it's more important than Viagra. The whole point of the argument is that you're looking at it backward: The fact that contraception is more consequential than Viagra is a reason to be more wary, not less, of distributing it.
Third: "Professional obligations" to provide all health care? Actually, doctors and hospitals draw moral lines around their practices all the time. This doctor won't pull the plug; that one won't do abortions; this other one can't in good conscience collaborate in your faith-based treatment plan.
Fourth: Humiliation? Sorry, but part of true equality is brushing off people who don't respect you. If the guy behind the counter won't sell birth control, he's the one who should be embarrassed, not you. Walk out, and don't come back.
Fifth: Whole regions where pharmacies won't stock contraceptives? Come on. Only seven have even signed the "pro-life" pledge. It's true that abortions have been driven out of rural counties. But politically, the resistance to birth control is nothing like the resistance to abortion. A pharmacy that won't stock contraceptives looks pretty silly.
Greenberger does make a good point about wasting women's time when, as in the case of morning-after pills, speed is essential. And Stein's reporting suggests the abstaining pharmacies aren't making their policies clear enough. If they won't do this voluntarily—by posting them, for instance—the law should make them do it. If I were writing the regulations, I'd draw up a big, fat, standardized "We don't stock birth control" notice, complete with a 24-hour toll-free number that will direct you to the nearest pharmacy that has what you need.
But I wouldn't force pharmacies to sell birth control if they don't want to. In particular, I dread Charo's suggestion that providers should be compelled to offer "legal" drugs. One of this country's greatest achievements is its separation of legality from morality, so that individuals can hold themselves to a higher standard, as they see it, without forcing it on everyone else. This is the principle many pro-lifers have rejected as they press for abortion bans to "teach" the immorality of killing fetuses. Happily, some have shifted their energy from attacking abortion clinics to setting up "alternative" pregnancy centers. It's a shift from violence and harassment to exhortation and, at worst, deceit.
So, please, don't tell moralists they have to do or sell whatever's legal. If you do, you won't like what happens to the law.
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A lot of people in China are angry. The earthquake that struck there two weeks ago has destroyed their entire stock of the country's most strictly rationed item: children.
Here's the background from the New York Times:
Thousands of parents have openly challenged the government over why so many schools collapsed during the earthquake. An estimated 10,000 students are believed to have died. The anguish of parents and grandparents has been compounded by the one-child policy, which was introduced in 1979 to control population growth.
Imagine being one of these parents. The government has restricted you to one child, and now that child is dead. You've lost your whole family in one stroke.
But wait: The government has come up with a solution. You can replace your defunct child with a new one. The Associated Press explains the offer:
Chinese officials said Monday that the country's one-child policy exempts families with a child killed, severely injured or disabled in the country's devastating earthquake. Those families can obtain a certificate to have another child, the Chengdu Population and Family Planning Committee in the capital of hard-hit Sichuan province said. ... Chinese couples who have more than one child are commonly punished by fines. The announcement says that if a child born illegally was killed in the quake, the parents will no longer have to pay fines for that child-but the previously paid fines won't be refunded. If the couple's legally born child is killed and the couple is left with an illegally born child under the age of 18, that child can be registered as the legal child-an important move that gives the child previously denied rights including free nine years of compulsory education.
Got that? If your child is broken, you can apply for a certificate to get a replacement child. Or you can substitute a used child and transfer the license from your previous child, with all the attendant financial rights. However, there will be no refunds.
It reads like a warranty or a software agreement. Except we're not talking about consumer electronics. We're talking about children. This is what happens when you ration people like commodities.
A few years ago, I lambasted the one-child policy as a forced-abortion machine. Then, a couple of weeks ago, I was talking with a friend about global warming, and it occurred to me that the single most effective thing anybody has done to slow that process over the last 30 years is probably the one-child policy. I still think it's a colossal offense against human rights. And in the present context, it's a case study in the regulation of human beings as a kind of property. If you lose your quota through no fault of your own, you can get a coupon to refill it. Half of me is grateful to the Chinese government for giving these bereft couples a second chance. The other half is revolted that the government controls such things.
If you're going to replace children like broken toasters, one per customer, then you'd better standardize the warranty. When I looked for the earthquake exemption report on Xinhua, the state news agency, I couldn't find it. Then I realized why. It was granted by the authorities in Chengdu. It's a local exemption. The last thing the national government wants is to broadcast it in other provinces, where people are still being held to the one-child policy.
Sorry, but that won't do. Why should the warranty apply only to this earthquake? What about the floods of 1991 and 1998? What about the drought of 1988? How many couples lost their only kids in those calamities? Where's their compensation?
Forget it. You can't replace children like toasters. You shouldn't ration them like toasters, either.
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If you're tired of reading about how dead Hillary Clinton is or how long it'll take her to admit it, fly with me across the Atlantic for a couple of minutes. A monumental debate is going on in the British House of Commons over the Human Fertilisation and Embryology Bill, which will influence how governments around the world regulate family and reproductive issues in the next century.
Everything's on the table in this free-for-all: late-term abortions, human-animal hybrids, and IVF for lesbians and unmarried women.
The liberals are steamrolling the conservatives. None of the proposed restrictions has passed. But what's really intriguing is the difference in vote counts among the various issues. It tells us something about which values people care about most. Is it life? Sex? Human dignity?
Here's how many members of Parliament voted for each proposed restriction:
A. Ban abortions after 22 weeks instead of the current 24 weeks: 233.
B. Require clinics to consider the "need for a father" in approving women for IVF: 217.
C. Ban abortions after 20 weeks: 190.
D. Ban the use of gutted animal eggs to make human embryos for research: 176.
E. Ban genetic testing of embryos to choose (for implantation and birth) those that could grow tissue for transplant to an already-born sibling: 163.
F. Ban abortions after 16 weeks: 84.
So the most popular restriction was on late-term abortions. Chalk one up for life.
But wait: The number of votes to prevent lesbian parenthood beat out the number of votes to prevent abortions after 20 weeks. From this, you could make a pretty good argument that feminists are right: Some supporters of abortion restrictions care more about regulating sex and family structure than about protecting life.
Personally, I'm sure of this. The proof is that most people who support abortion bans also support exceptions for rape and incest, where the life considerations are the same, but the sex and family-structure considerations are different.
Now look at the vote count on banning human-animal hybrids. The hybrids in question aren't equal mixtures of human and animal. They're fully human cell nuclei cloned inside eviscerated animal eggs, for lack of available human eggs. In other words, the animal contribution is minimal, almost inconsequential. Furthermore, the embryos are just for research and cell derivation, not for procreation. I'm not saying this is unobjectionable. I'm just pointing out that the degree of mixture is trivial.
Nevertheless, the number of votes to ban it is more than double the number of votes to ban abortions after 16 weeks. To that extent, "human dignity" beats out life. It seems that keeping our DNA separate from that of animals is more important than saving those second-trimester babies.
But that's still not the headline, in my book. The headline is that restrictions on lesbian IVF and trivial species mixture outpolled restriction of genetic testing to choose embryos for tissue harvesting. The common term for this practice is "savior siblings." Here's the prototypical situation: Your daughter has a serious disease. She needs compatible bone marrow. The best way to get it is for you and your spouse to make another baby and transplant its bone marrow to her. But not all your offspring will have tissue that matches hers. To guarantee a match, you need to make a batch of embryos, implant one that matches, and forget about the rest.
The happy ending is that your daughter is saved, and you've made another child to love. But you've also crossed a line. You've made a bunch of human embryos and then flushed them not because of anything wrong with them, but because they weren't useful. And if there's no tissue match, you've crossed that line for nothing.
In my view, the rise of this mentality -- the reconceptualization of human beings as medical tools and resources -- is way more dangerous than gender upheaval, species-mixing, or even abortion. Abortions, no matter what you think of them, are defensive. Tissue harvesting, on the other hand, carries an affirmative mandate. It entitles you, and arguably obliges you, to deliberately create new human life, which will then live or die based on its utility to others.
Contrary to pro-life rhetoric, there's no broad incentive to increase the number of abortions. But there's plenty of incentive to increase the number of sibling saviors. That's why sibling saviors scored so well in the House of Commons. This is one thing I've learned from covering biotechnology: Bad things don't happen because they're bad. They happen because they're good.
Keep an eye on this utilitarian mindset as we continue to take ourselves apart. As the British debate illustrates, it'll be hard to stop.
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Wow. Chastity belts.
Here's the report from Indonesia, courtesy of Paul Watson in Sunday's L.A. Times:
In a bid to prevent any hanky-panky between masseuses and their clients, several massage parlors ... are insisting that the women wear padlocks across the zippers of their work pants. ... [The instigating parlor owner] settled on black pants that zip up at the side, where a padlock is slipped through two cloth loops and snapped shut each time a masseuse meets a client. ... He stores the padlocks and keys in a special box at the cashier's counter. When a customer arrives for a massage, given in a private room behind a curtain, the "cashier calls one masseuse, asks her to prepare things and locks her pants," ... [and] "when the client is done, the masseuse comes to the cashier, and the cashier opens the padlock."
Several other parlor owners have supposedly decided to adopt similar locks. A local official says, "We expect this policy to be enacted as city legislation."
Any time somebody tries to take society back a few centuries, I like to know why. The instigating owner, Franky Setiawan, says he resorted to the belts because men "bombarded" his masseuses with sexual demands, and he wanted the women to feel safe. He says he and other owners have been looking for ways "to handle some naughty guests."
Ah. The old feminine-protection rationale.
The idea isn't crazy. To say that men often behave like pigs is to insult pigs. Boorishness, harassment, and sexual coercion are real problems. But let's think this through.
To begin with, there's the small problem of excretion. What the man thinks of as his—or some other guy's—way into the woman happens to be, rather more importantly, her way out. That's why, as Setiawan mentions, the masseuse "usually pees" before the cashier locks her pants. So, we're starting with a glaring engineering mistake: inconveniencing the victim more than the perpetrator.
Next, there's the political context. "In recent years, conservative Islamic values have gained influence" in Indonesia, Watson reports. "Last month, Indonesia's parliament passed a bill that makes it a crime to look at violent or pornographic material on the Internet. The penalty is up to three years in prison." So when Setiawan talks about how the chastity outfits will improve his industry's public image, you can see how workplace protection serves as a fig leaf for his awkward mix of puritanism and financial self-interest.
Finally, there's the telltale language of sexual paternalism. The problem with the some of the industry's male clients, according to Setiawan, is that "they try over and over and over again, persuading our workers with their dangerously sweet words."
Persuasion? Sweet words? This is the crisis? Words are intolerably coercive, but chastity belts aren't?
You can see how easy it is, as a paternalist, to talk yourself into absurdity. Once you get it into your head that motive is more important than method, you and your excellent motives are on the way to dystopia.
Before you deride the Indonesians, look at what's happening in the United States. Legislatures are passing laws right and left to mandate provision of ultrasound images to women seeking abortions. I support the idea of viewing an ultrasound before you make the decision. But when legislators add doctor scripts, patient viewing mandates, waiting periods, and other heavy-handed paternalist garbage, count me out.
Now comes a ballot initiative in Missouri that would hold doctors liable for "medical negligence" unless, prior to any abortion, they administer a formal psychological evaluation to ascertain whether the woman has been pressured into it. The measure's sponsors propose that women be asked: "Is someone else encouraging you to have this abortion? Do you want this abortion to satisfy your own needs or are you looking to do this to please someone else?" These questions are necessary because, as all paternalists know, women don't really want what they came to the clinic for. "The sad reality is that many abortion providers simply do abortions on r