A New Meaning of Freedom

Marie was a young woman who struggled with her weight, starting from a young age. At seven, her mother placed her on her first diet. At fifteen, they took her to an institution to be treated for bulimia. Like all chronic dieters, she suffered from a weight that yoyo-ed. Marie could never be satisfied, for she was bombarded daily with advertisements demanding she live up to our culture’s paradoxical ideal – enjoying food in overabundance, eating out often and cleaning her plate—while maintaining the slimness of models whose own waistlines were trimmed with Photoshop.

That was, until the miracle elixir came— a simple formula syrup that could be consumed with any meal. Researchers found a way to coat microvilli in the small intestine so that food would be fully processed by the body, but not truly digested. It initially was designed for people who had diseases of the intestine, but the real market was much, much bigger.

Soon ads for the Syrup were everywhere! You could eat all the food you wanted, but consume a modicum of the calories. Doctors made different varieties, some that would cover a single meal, some that would last ten years before needing to be replaced, some that would cover you for a lifetime. Health advocates hailed the Syrup as a vital invention for the modern world!

The Presidential administration in power launched new initiatives to distribute the Syrup everywhere – including for free to all school-aged children. Mrs. Obama had experimented with the Let’s Move! initiative, but it simply wasn’t working fast enough. The Syrup was seen as the only way to truly handle the obesity epidemic. With 30% of Americans overweight and another 30% obese, it seemed there was no other option. Marie became their poster child— a model of overcoming obesity through modern medicine!

Soon, insurance companies began covering the Syrup in the hopes of saving money by staving off other more expensive procedures like diabetes treatments. As more and more Americans started taking the Syrup, it became harder and harder for those who didn’t want to take it to refuse. Cultural norms are powerful, and the ability to indulge in any food with none of the consequences was enticing.

Of course, for a small number —about 20%— of imperfect users (those who forgot to take the Syrup and those who didn’t take enough), they still remained obese. And just like all treatments, it wasn’t 100% effective even for perfect users— about 3% would find themselves still obese or even gain weight. But liposuction still existed for those folks.

The only problem remained the cost. Like all medical treatments, there were different costs in different places. Though the Syrup was, by far, one of the cheapest medicines on the market, that didn’t mean much for the poor who could barely put food on the table. Folks with lower-income levels were some of those most impacted by obesity. It was considered public health priority #1 to figure out how to manufacture more affordable Syrup and to distribute it to those who needed it the most. Soon a plan emerged for the federal government to mandate that all insurance providers cover the Syrup, branding it as an essential part of the universal right to health care and oby’s (obese persons’) rights.

There were, alas, some name-sayers. The Catholic Church had consistently opposed the Syrup on the grounds that it encouraged gluttony; a few Christian groups joined them in this opposition. The progressives retorted that gluttony had always existed. The Church wondered how a technological invention only required because of our overindulgence in food could be considered a human right mandated by the federal government. The progressives complained that the Church callously invested in stopping the medicine but had no truly effective plan to help the overweight. But the religious uproar was finally enough that the Obama administration wisely decided to maintain an objection for churches— if there was an ethical religiously-based objection to providing the Syrup, churches and ministries would be exempt from the ruling. (This was deemed acceptable because most of the people working in such organizations would likely hold the same beliefs as those providing the insurance.)

But this wasn’t enough for the religious zealots. Some of them had been fanatical enough to want their ethical beliefs to play out in the workplace; they objected to the secular idea that religion should be removed from all public activity. They’d formed companies motivated by their religious principles and believed their companies—as proper expressions of their religion— should be exempt from the gluttony-promoting requirement to provide the Syrup. As their lawsuits advanced, the circuit courts were split—the 9th and 6th insisted the Syrup mandate must be upheld while the 7th argued the mandate violated religious liberty.

Finally, the case came before the Supreme Court. Lawyers for the government argued that the overwhelming public interest in preventing obesity, the critical value of the Syrup as medicine, and the necessity of eating to our very humanity trumped over the desire of individuals to think consciously about their decisions and avoid taking actions which would unethically promote a culture of wastefulness and indiscriminate consumption.  The ruling was split solidly down partisan lines. Though the religious fanatics won this round, Ginsberg, Sotomayor, Kagan, and Breyer stood up for essential oby’s rights. The four justices argued that an employer’s refusal to cover the Syrup would “deny legions of [people] who do not hold their employers’ beliefs access” to this vital medical innovation, the relative cheapness of that innovation notwithstanding. After all, it is no violation of rights to require every person to pay for morally questionable services for others; the real violation of rights comes when you choose to not pay for another person’s syrup. Because to 4/9ths of the Supreme Court and to many in America today, freedom means you demand from others the oil to polish your shackles.

 

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  • http://menliketreeswalking.blogspot.com/ Matthew Loftus

    The main problem with this analogy is that a great number of otherwise thoughtful, orthodox Christians think that The Pill is non-abortifacient and has morally lawful uses beyond treating illness (for married couples who wish to have children every 2-3 years or married women who don’t have a gynecological disorder but do have a different medical condition for which pregnancy would be harmful, for example.)

    • Jordan Ashley Monge

      I agree it’s an imperfect analogy; no analogy can ever be perfect. But it is mind-boggling to say that contraception (in general – let alone abortifacient methods) is an “essential part” of women’s health requiring coverage; it implies two fundamentally falsehoods: 1. That sex is almost always something beyond our control – a god to whom we are slaves – which must be mastered by technology rather than by discipline. Because if a woman wants to avoid pregnancy, her only recourse is birth control and not to abstinence. 2. That, for “legions of women,” their fertility is dangerous to their overall health and well being. That is, their bodies, by virtue of their very design, are dangerous to them. The fact that contraception is now viewed as vital to health should be a signal to us that our society is significantly warped so as to deny our very human nature. I’m not sure what I think about the ethics of contraception in general (it’s a question I’m wrestling with) but I do know this: never will I demand from others the “right” to less-risky sex.

      • http://menliketreeswalking.blogspot.com/ Matthew Loftus

        Thanks for responding. I completely agree that our culture as a whole has deified sexual gratification. However, while this may form a significant part of the argument for contraception for some people, our opposition to it shouldn’t be the basis of our opposition to artificial contraception.

        Your point #1 is a non sequitur; as I mentioned, there are frequently occurring morally licit reasons to avoid pregnancy. Your point #2 does not take into account the fact that, yes, in general, being pregnant carries a number of health risks with it. Just as aspirin is an “essential part” of most older people’s health because taking it decreases the natural risks incurred by aging (even though it comes with side effects!), artificial contraception can be an “essential part” of women’s health because taking it decreases the natural risks incurred by pregnancy.

        • Jordan Ashley Monge

          I think you might be misunderstanding my argument; the moral licitness of contraception is irrelevant. The question is whether the government should require companies to provide it. (It’s morally licit to drink wine, but pretty sure both sides would be up in arms if Obama required companies to provide it to their employees, especially on the job…)

          That is why #1 is not a non-sequitur. There is a cheap and nearly universally accessible way to prevent pregnancy: don’t have sex. (This, of course, does not cover the case of rape.) If you still want to have sex but don’t want to take on as high a risk of pregnancy*, then you can provide for the birth control yourself. Sex is a privilege, not an entitlement. Even if we believe that contraception is morally licit, that doesn’t mean it is required for preventative care – abstinence (or NFP) is always a cheaper preventative option.

          As for number 2 – I don’t think a health risk is sufficient to decide whether something qualifies as legally mandated preventative care. When we think about preventative care, we generally try to prevent things which are diseases and not simply natural risks. Aspirin is considered essential to health because it helps prevent heart disease. Viagra is considered important because it helps prevent early impotence. But pregnancy is not a disease; it is how the body normally functions.

          Is there any other example where impairing the body’s natural function is considered preferable as a way of avoiding the small risk that an otherwise healthy body malfunctions in the normal process of nature? I’ve been wracking my brain and I can’t think of any. Even if there is, I don’t think that example would stand up against the fact that, for the most part, individuals choose to engage in sex. It’s not simply a question of avoiding risk, it’s a question of the method by which we avoid risk.

          This is, in fact, the very point of the above essay. I’m guessing that many Christians would praise the use of the Syrup – they would notice that it decreases the natural risks associated with obesity. In many cases, it would probably be beneficial for health. But I hope that it should still be obvious that even if the Syrup was beneficial, that would not merit its coverage being legally mandated.

          But maybe I’m wrong. If you truly think that artificial contraception is an “essential part” of women’s health because taking it decreases the natural risks incurred by pregnancy, then at least *be consistent* in saying that a syrup which stopped natural digestion to reduce the risks incurred by obesity should also be an “essential part” of health. I myself am moderately overweight. For my part, I will never demand another woman to pay for my lack of self-control when it comes to food and am instead trying to get better at exercising and portion control. I suspect most people would say the same.

          *I would also add that even with birth control, there is not 100% way of avoiding pregnancy except through the removal of one’s ovaries. Perfectly practiced symptothermal NFP has failure rates similar to perfectly practiced use of the pill (0.4% vs. 0.3%). Contraceptive Technology (which publishes these statistics) does not have data on typical use of NFP, but reports that the pill on typical use has a 9% failure rate. NFP data is highly variable (ranging from 1%-24% failure rate) but I suspect that has more to do with the lack of quality research subjects and funding. [By which, I mean, it’s not fair to compare the rhythm method with the symptothermal method, and its hard to find a large study of users dedicated to NFP, especially in the US.]

          • http://menliketreeswalking.blogspot.com/ Matthew Loftus

            Jordan,
            I don’t think that the government should compel corporations to pay for hormonal contraception that it finds morally repugnant. What I object to is the concept that taking the pill = lack of self-control & consequences (taking a pill every day is quite a discipline, I can assure you!) For some couples, the choice to use birth control may represent a prudent decision and in general, having ready access to birth control allows couples to make those decisions if they need to. Simply because abstinence is always available to people and is cost-free doesn’t mean it’s the wisest option.

            Aspirin is actually a great example because it impairs the body’s normal clotting functions in order to prevent those clots from happening in places where you don’t want them. But of course it depends on what you mean by “natural.” Vaccines are another example wherein we circumvent the body’s normal processes for the purposes of artificially preventing something. Simply because pregnancy is “how the body normally functions” doesn’t mean it is universally a good thing; for example, shorter intergestational intervals will increase the risk of preterm birth dramatically, making child spacing a matter of caring for your preborn child by harmonizing yourself with the natural process.

            I would certainly be in favor of greater access to NFP teaching (I think they should teach it in all high schools if we’re going to talk about “comprehensive” sex ed); I try to offer it as an option to my patients whenever they will listen.

            I think that your emphasis on self-control and individual effort, while certainly understandable, is part and parcel of the relentless atomization of human decision-making that has helped get us into this mess; human decisions are rarely the results of fully autonomous individuals weighing the risks & benefits of all course of action. Obesity and STDs are indeed the results of individual decisions but are influenced by a wide variety of other factors; there is little evidence to suggest that people make more reckless sexual decisions when they are given a full range of birth control options which leads me to think that those of us who are concerned for promulgating a vigorous Christian sexual ethics have bigger fish to fry. Furthermore, it makes me concerned that we would continue publicly harping on individuals deciding their own sexual destiny with more abstinence when we’ve been doing that for a few decades now and it doesn’t seem to be achieving our goal of helping people understand the joy of sex as part of God’s good creation that reflects timeless truths about who He has created us to be as male & female.

          • Jordan Ashley Monge

            Taking the pill every day is absolutely a discipline! (I have enough trouble remembering to take my temperature everyday…).

            I would argue a blood clot and a disease (preventable by a vaccine) are still significantly different than pregnancy. I suspect when we think about health or nature, we should come back to the purpose of the thing. The purpose of blood is not to clot. The purpose of the immune system is to protect against disease. Blot clots and immune systems are failures of the body to live up to its purpose; pregnancy is not.

            I’m not 100% sure how I feel about a couple intelligently using birth control for otherwise prudent purposes. But the reason I wrote this as such is because what we’re really talking about is the sort of cultural change and bizarre approaches to thinking about “rights” that arise in a culture of rampant contraception. I think you’re right – we don’t make decisions as autonomous individuals fully weighing the risks and benefits of all actions. That’s precisely why something that seems initially so beneficial (like a syrup that would reduce obesity) may prove to have negative consequences like reducing an entire society to depend on that technology for (what it perceives to be) its basic function.

          • http://menliketreeswalking.blogspot.com/ Matthew Loftus

            Okay, it looks like we’re getting a little Aristotelian here… one of the purposes of blood *is* clotting– when you’re cut. Sometimes blood clots inside your heart vessels, though, and that’s not good. Similarly, the purpose of a woman’s ovaries & uterus are to gestate, but (as I mentioned before) oftentimes when children are conceived back-to-back, the second child is born preterm due to the very natural stressors of pregnancy. Or something else goes wrong, necessitating a very unnatural emergency c-section to preserve life. (We got into this in a recent Mere Fidelity podcast if you’re interested: http://mereorthodoxy.com/mere-fidelity-end-nature/)

            All of this is to say that we can’t be sloppy in applying the standard of “nature as measure,” nor can very prescient concerns about public health be wholly subservient to our ideals when the government is in the business of saving money and protecting its citizens. While I certainly agree that corporations shouldn’t be compelled to act against their consciences, I think that the government has a different agenda and a different set of guiding principles than any principled corporation would.

          • Adrian Urias

            Why would you have to take your temperature every day?

      • Adrian Urias

        I’m in the middle of Alexander Pruss’ book One Body. Pretty thorough stuff. I recommend it if you’re wrestling with the issue.

  • Adrian Urias

    Oh, I’m pretty sure the Catholic Church can do MUCH better than that.

    • Jordan Ashley Monge

      What do you mean, Adrian?

      • Adrian Urias

        “The Catholic Church had consistently opposed the Syrup on the grounds that it encouraged gluttony;” I predict the Catholic church would faithfully employ natural law, and while it may put forth your reason, that wouldn’t be the ground upon which it stands. We can do much better than that 😛

        • Jordan Ashley Monge

          Touché. I specifically chose digestion since it’s clear that the whole process has a purpose, with natural law sort of in mind. I was just trying to not get too caught up in the details – there were so many hilarious references that could have been made, but then it’d be too long to read.

          • Adrian Urias

            Other than that, this gave me some nice chuckles

  • Laura

    Jordan, as always I appreciate your well-considered views.

    If I read correctly, I see you presume that medical treatment should serve largely at the pleasure of a “correct” interpretation of morality and personal/social discipline. Medicine has always been, and always will be, a practice in the art of balancing pragmatism and human dignity, given finite resources. Setting aside our bizarre American configuration where employment and healthcare are linked, why shouldn’t preventative/primary care medicine take economic as well as moral considerations in stride? Aren’t we already as a society demanding that of medicine assuming your argument for “personal discipline” against sex/unwanted pregnancies? Who is assuming the labor of maintaining a culture of standards by which “personal discipline” is a legitimate “contraceptive”? Who is willing to unwind the profound economic conditions and cultural considerations that drive much decision making (or lack thereof) around sex, family planning, and abortion?

    I appreciate your argument that we’ve backed ourselves into strange semantics when we call certain types of medicine “healthcare” “rights,” but a morally bounded argument that fails to address the acute needs of the people it purportedly intends to serve (save?) isn’t very helpful. The Catholic Church has always been orthodox in its stance on contraceptives – but should we call this an unmitigated moral success in a broader scope? I hope not.