abortion

When I came out as an atheist almost 3 years ago, very few people were surprised or upset. Whether it was because I’d made efforts warn those who might take the news poorly or because I made clear that I was not trying to convert anybody to my position, I ultimately didn’t catch much flack for a decision I thought would be controversial. I imagine I’ll get a slightly different response from this note. I am coming out of the closet as a future abortion provider. On the one hand, this should not be surprising: I’m openly pro-choice, I’m an unabashed feminist, and I’ve been leaning towards a career in OB-GYN for quite some time. On the other hand, coming out as a future abortion provider increases the chances of being killed for my profession. Many providers take great pains to protect their personal safety, purchasing their homes with corporate shell companies, carrying weapons in public in response to death threats, and fighting to keep their information from being disseminated by pro-life extremists. I feel the need to come out as a “future abortion provider” however, because I fear that vacating the rhetorical battleground only strengthens those who would ban a woman’s right to choose. We have seen a radicalization of Republican politics and policies which explicitly seek to deny access to contraception, target abortion providers for pseudo-scientific and medically unnecessary reasons, and ban abortion even in cases where the life of the mother is seriously endangered. Given the sheer volume of factually inaccurate information readily available—and actively peddled by anti-choice activists—I feel compelled to at least make an attempt to spread the truth about abortion, even if doing so makes me an easier target to violent radicals. But I want to abandon the marketing and rhetorical spin that sometimes clouds these debates. I don’t care if you think I’m a terrible person, and will make no effort to convince you otherwise. I want to head off any ad hominem attacks by simply agreeing to accept any personal smears as irrelevant to the debate at hand. If it makes you feel better to call me a “baby killer” or participating in “genocide,” I’m fine with that. But know that I feel an equal and opposite open disdain for those who would make abortion illegal. Let’s just agree that personal rage is simply not a cogent argument. Although the debate around abortion often centers on the exceptions, I feel passionately that abortion is moral and should be legal at any stage before viability. Although there should absolutely be exceptions for rape, incest, and “health and life of the mother,” too many social liberals have allowed the line to be pushed to these few exceptions, and have neglected to win hearts and minds for common, elective abortions. This has led to nut jobs on the right trying to turn a blanket ban on abortions into a respectable position. Let’s start with the science. About one half of all pregnancies end in spontaneous abortions. Many women who have these abortions are not aware that they’ve even had a one. I start with this point first because I think it fairly roundly destroys the sentimental religious supposition that every embryo is endowed with a soul, and that this soul is non-transferable to a different body, should the mother choose to abort. God didn’t design a very good system for supplying souls with bodies, if he has no b-plan for when an embryo fails. If you really believe that every single embryo is divine, take it up with God before bothering me. The next important statistic is that giving birth is 14 times more dangerous to a woman than getting an abortion is (http://www.guttmacher.org/pubs/fb_induced_abortion.html ). I’m willing, but frankly not terribly interested in debating the science on this as if it were under dispute. There are any number of reasons why becoming pregnant can be very dangerous to a woman, including increasing the chance of fatal blood clots, massive blood loss, or preventing her from taking required medications like anti-epileptics because of feared possible effects on the growing fetus. Abortion also poses some health risks, including sepsis, bleeding, and perforation of the uterus (in mechanical modalities), although they are clearly far less numerous and less extreme than those commonly associated with pregnancy. If any of you are interested in or confused by anything you’ve heard about the dangers of pregnancy or abortion, shoot me a message and I’d be happy to parse it in public or private, or send you to other sources which you can trust. The obvious retort to this line or reasoning is to focus on the fetus. In 1,000,000 theoretical pregnancies, we could save 634 women by aborting all the pregnancies, but we’d be killing 1,000,000+ fetuses to do so, would we not? The fact that there’s no easy, bumper-sticker-length answer to this question is probably why public opinion on abortion has not been liberalizing in the same way that attitudes about gay rights have been doing in recent years, and that racial attitudes have been doing for decades. Before I try and explain my answer to this argument, I need to head off yet one more frequent ad hominem attack. While I believe that all life has some value and should be respected, I also strongly believe that quality of life should have equal consideration with quantity. This is not to say that I’d barter human lives for fiscal gain or genetic social hygiene a-la Nazi Germany, but I also don’t think that Nazi Germany’s manifold crimes should force us into a patently absurd sentimentality which values any and all hypothetical lives above all other considerations. To my friends who call abortion “genocide,” I would submit that you’re cheapening the term and confusing the issues. Gassing adult gypsies is a far cry from allowing a woman to not carry to term a fetus which has less than a 50% chance of survival anyway. It’s mostly because of this that I don’t see the definition of human life as being the ultimate trump card in the abortion debate. Fine. I’ll admit—even if only for the sake of argument—that a zygote is a full human being. That still doesn’t mean, however, that a pregnant woman can’t morally and ethically decide that she doesn’t want to carry that full human being to full term. Imagine a woman who finds out at the 20-week scan that her child has gross physical deformities which will prevent it from living more than a few days past birth. Should she carry that child another 20 weeks so that the child can experience life for 72 hours? What if those hours are miserable? What if those additional 20 weeks greatly jeopardize that mother’s life? What is the rubric to determine just how much value that child’s life will have, and how do we decide whether it’s worth the costs and risks? I picked a deliberately difficult case to illustrate the point that this IS NOT an easy question with a pat answer, even if we start with the supposition that a 20-week fetus is as human as you or I. Some women in that case would surely want to carry the fetus to term. Others might choose to abort. Yet others might decide to carry the fetus, and then reconsider if a major health concern like preeclampsia came to bear later in the pregnancy. As a society, we have the ability to pass laws and regulations. When faced with the difficult question of abortions, the first question is rather broad: do we allow women to make her own decision about whether she wants to incur the risks and costs of continuing a pregnancy, or do we intervene and restrict or mandate her decision for her. In analyzing (and in talking with a woman in this exact) situation, I am personally uncomfortable with making any decision FOR her. I’d be loath to deny her an abortion if she decided that it would be immoral to force that baby to endure 72 hours of misery. And I can’t imagine being forced to perform an abortion on her if she decided that she wanted to keep her pregnancy. While I can see the theoretical ethical arguments for all cases, I ultimately conclude that it’s beyond my pay grade to make a personal, ethical decision for any woman in this case, because it ultimately has nothing to do with me. And this brings up my ultimate bias—that of being a future physician. Abortion is only one of many ethical questions that I face daily in learning to practice medicine. And, while society occasionally debates these questions in a public forum, medicine already has its guiding principles laid down in our profession. These are: beneficence, non-malfeasance (“first do no harm”), respect for autonomy, and justice. In my view, refusing an abortion to a woman who wants it violates at least the first three of these without question, and the fourth is a debatable point. Given that pregnancy is more dangerous than an abortion would be, I feel it’s a gross violation of medical ethics to force a woman to accept risk to her health against her will. While there are a few points of clarification I’ll get to in my next paragraphs, my point with bringing up the Hippocratic Oath is merely to make the argument that no doctor should consider themself a doctor if they are violating these standards. I feel it should thus be illegal for a physician to refuse a patient an abortion (or a referral to a competent provider). Where the law sometimes provides cover for physicians to refuse, I would submit that these doctors should have their licenses revoked, just as they would be if they violated medical ethics in other situations. There are two arguments I’ve heard repeatedly as assaults on this ethical stand: that the life of the child outweighs any non-mortal costs the mother might have to pay, and that the child is innocent of its conception, and thus has moral standing to demand the costs the mother might pay. The first claim is roundly defeated by medical tradition and laws currently in place. We could easily save hundreds of people today by mandating that every person donate blood or a kidney. Although transplantation medicine is complicated, odds are very good that if we took a kidney from you right now, that it could be implanted into someone with failing kidneys and extend their life for decades. Aside from the cost of the surgery and recovery, it’s likely that your life would not be significantly reduced. And yet we have no such laws. We value your freedom to not undergo forced surgery as being more important than a person with kidney failure’s life. The risk to your life—and the violation of your autonomy—is more important than the guaranteed life of someone else. If only 634 people out of 1,000,000 kidney donors would die in saving 1,000,000 children in need of kidneys, would it be kosher to pass a law mandating it? The second is related to the first, but demands that in some circumstances, that you would owe it to someone else to undergo that surgery. But where is that line? Let’s imagine that you purposely stabbed a family member in the back (literally) and destroyed both of their kidneys. Would it then be moral to forcibly take one of your kidneys and give to that family member? What about if you accidentally got into car accident with them and their kidneys were destroyed? These are tough questions. I’m not sure I have good answers for them. But neither am I convinced that they have any place in our laws or traditions anywhere. The opposite of this ethical claim, however, does have a large precedent. Where else do we refuse to treat a patient if they “deserve” the outcome of their mistakes? When we find someone unconscious on the ground, should we look around for clues as to whether they deserved what they got, before starting CPR (did they look both ways before crossing the street)? If someone has a heart attack because they are obese, should we require an exercise log to determine if they deserved the heart attack, before beginning treatment? What if someone gets a sexually transmitted infection? Chances are pretty nearly 100% that they would not have gotten that infection had they properly used a condom, yet we regularly treat these infections. Indeed, I think the notion of refusing treatment for a patient based on a moral judgment is a path we do not quickly want to go down. While society could clearly mandate more laws to punish people by refusing certain medical treatments (no removal of gangrenous feet due to uncontrolled diabetes), a physician’s perspective chafes wildly at being a form of executioner for the moral majority. It’s one thing for society to not pay to correct the mistakes of others, but it’s entirely different for society to ban treatment because it believes that illness is a just punishment from God. Society does ultimately pay for the mistakes of its citizens, whether in lost productivity or expenses on its balance sheet. We can and should aim to correct and provide incentives to citizens to act responsibly. But forcing them to suffer for their sins when a remedy is available is a virulent form of Christian theology that should not be allowed to gain purchase as public policy. If you want to scourge yourself for your carnal sins, go right ahead. If you want to pass a law that forces us all to do the same, don’t regulate that I have to do the whipping for you. I’ve done dozens of hours of research over the years on abortion statistics and controversy. While I’ll happily parse the statistical nuances of any study you find convincing, it wouldn’t be influential or useful to throw endless statistics at you and expect them to be persuasive. Part of the problem is that both sides of this debate have their own facts and statistics, and the debate about which side is trustworthy quickly eclipses the debate on the issues. So we’ll start with a few (hopefully) non-controversial statements: Making abortion legal and available increases the number of legal abortions. When medical abortion is not legal, some women will seek other ways to end their pregnancy. In both of these sets of women—those who have babies they would prefer to abort, and those who abort using coat hangers—fatalities for the women will be higher than they are where abortion is legal (and thus safe). I thus conclude that laws which prevent abortion will always kill women. For this reason, I chafe at the term “pro-life” for those who oppose legalized abortion. Yes, you’re pro-fetal-life, but that necessarily connotes the deaths of some number of unwilling women. As a future abortion provider and medical practitioner, I’m very much aware that I’m aiding in ending the lives of many fetuses. I’m not the one deciding to kill them, however, so I consider myself free of any sin. Those who support abortion bans are at least partly to blame for forcing women to die as a result of them. So how do we mediate this conundrum? How many fetuses equal one pregnant woman? If you’re passing a law dictating how I do my job, what is the threshold for the health of a woman which dictates when an abortion would be acceptable? Is a ten percent chance that the woman will die enough to justify your blessing to allow an abortion? Fifty? Perhaps such questions are unfair. I sure as hell can’t answer them. As a self-professed libertarian, I don’t think these are questions any government should answer for a woman. Radical as it sounds, I believe that a woman should be the only person who decides what is best for her medically. I’ll be happy to advise her and give her the information she needs, but I deem the “pro-life” laws to be nanny-state government at its worst. To any “conservative” who supports banning abortion, know that you violate the conservatism and the small-government rhetoric you espouse in the worst possible way. I don’t really expect that I’m going to convert anybody to accepting that abortion should be legal. I was religious for long enough to know that reason and logic have no power to dislodge any belief that was arrived at through non-logical means. I do hope, however, that starting this conversation will help people to gain a more nuanced view of the difficult questions which abortion laws address. Far too often I get “I don’t believe in abortion because it’s against my religion” as if that were an answer. Fine. Your religion bans abortion. That is a great argument that your religion is a horrible institution which needlessly endangers women and seeks to enforce its precepts with the force of law, but not a very good argument about why YOU support banning abortion even in cases of rape or incest (or why you’d vote for a congressperson who does the same). I have quite a few friends who are vegetarian and vegan. While I have nothing but respect for their views, I personally think it’s appropriate and even enjoyable to eat meat. I’ve never felt threatened, however, that vegetarians would rise up and pass laws against eating meat, much less that they’d try to close down slaughterhouses, bomb butcher’s shops, or kill producers of veal while they’re in church. If you’re opposed to abortion, do your best to convince people that abortion is wrong. Pass out Bibles in front of clinics. Talk your daughters in to keeping their illegitimate children. But please don’t ban it for everybody else. Don’t pass laws which arbitrarily make abortions harder to get or needlessly expensive. Or at the very least, don’t ask me to respect you when you do.

Seek and ye shall find.

I know it's indulgent of me to post again, especially not only given how much I have to do, but also because I take such pains to complain about how much I have to do, but I got such a lovely response to my birthday post that I convinced myself to get out of bed early to get something down.

American's Elect is trying to establish a 3-party system in America. Unless we change to a parliamentary system where the president is chosen by congress, however, this is an awful, awful idea. In the current system, moderates--and by that I mean anybody who would be willing to vote for either or a Republican or a Democrat depending on the circumstances--have all the power. When the Democrats choose an overly-ideological or inept candidate (I didn't live through Jimmy Carter's presidency, but I still use him as my example for this. He may have been a good person, but he was doing a rubbish job of fixing inflation) for office, the middle of the electorate deserts him or her and throws their votes behind another choice. It's not that Reagan was necessarily the moderate's first choice (and many Reagan democrats were surely annoyed at how badly Reagan plunged America into debt), but they still found him superior to their practical alternative. Americans elect (and other moderately-minded voters) would do well to focus on their efforts to bring the Republican and Democratic candidate to the middle, rather than trying to select a 3rd option. This is especially true when a large section of the country is extremist in its views. Obama may be less market-friendly than I would hope, for example, but if throwing my support to Gary Johnson (my actual first choice among those running) were to allow a far-right candidate like Santorum to win the presidency, my vote would have helped select someone even further from my ideal than before. Primaries will likely have to change in the future if the two major parties want to select candidates who can actually win the general election. The current Republican contest is going a long way to re-electing Obama by pushing Romney to the right and highlighting the very worst side of what the Republican party has to offer. If my choice were to vote for Mitt Romney from 1994 or Barack Obama from 2012, I'd probably actually select Romney. If my choice is the born-again Romney who is fashioning himself into a red-meat-loving George W. Bush clone, however, suddenly Obama is a centrist who has my vote.

But I didn't just want to talk about moderate politics in a concrete sense. The same rigid and ideological thinking that leads people to become life-long Republicans or Democrats unfortunately spreads into the world of ideas as well. I am convinced that many people pick their ideas in the same way that they pick a favorite sports team--for social and practical reasons, rather than on what is true. In the world of sports, such arbitrariness is not a problem (and "truth" does not exist in the same way). The economics of sports demands that someone sticks by even bad teams, and there's no denying that there's a certain joy from cheering for the losers (I like the Cubs, Tigers, and Bills). It also makes sense to choose sports preferences on where you're from; I would be able to connect with random people on the street much better if I were a Bears fan here in Chicago. I can also cheer for the Bills without having to claim that they are somehow more talented or athletically superior to the teams they compete against.

A few events in recent days have highlighted the problem with ideological and dishonest thinking for me. First off, I had a brief argument with a FB friend about abortion and infanticide. Although I think it's an interesting debate and one with much room for honest disagreement, it only took a few back-and-forths to conclusively prove that my friend hadn't read, much less understood the argument he had originally commented on. Although I think we still salvaged an entertaining discussion, I'm still flummoxed by his move to post a link to an argument he couldn't hope to understand (not because he's incapable, but rather because he was unwilling to take the time to understand it). Furthermore, his argument COULD only make sense to those who were equally ignorant of the posted arguments, since his position had literally no bearing to what it was he ostensibly want to talk about in the first place.

The second example of this form of "thinking" is the current kerfuffle over birth control, especially Rush Limbaugh's horrible, classless attacks on a Georgetown law student. Again, Rush's arguments (and many of those from FOX) can ONLY make sense within the confines of a willful misunderstanding of what birth control is, how it functions, and why it may or may not be useful in certain circumstances. Although I have strong opinions about what the law should be, I'm willing to entertain a debate on the issue, and even compromise on my position in certain circumstances (I can see both sides and am willing to let laws and democracy arbitrate on the debatable points). What is happening instead, however, is that birth control opponents like Rush Limbaugh START with their conclusion, and then re-write the facts to suit their foregone conclusion.

I'm not quite sure how I should navigate an intellectual marketplace of ideas where popular, widely-held positions are not really debated or even debatable, since those who hold them are incapable or unwilling to understand the positions they so strongly hold. A further complication of this is that there seems to me to be a strong positive correlation between ignorance and stridency, with the most ignorant voices (Rush Limbaugh) are simultaneously the most vitriolic and loudest voices. When millions upon millions of people them willingly give their time to fill their brains with the ignorant drivel that spews from that man's awful mouth, It doesn't exactly make me hopeful that we as Americans will be able to come to a shared, mutually-acceptable compromise. In fact, I think I'm stuck concluding that Rush Limbaugh, as well as many of the people who listen to him, are the willfully-ignorant masses on the poles of American politics--those who would vote Democrat or Republican no matter who the contest was between. While I feel no intrinsic antipathy towards such ideologues, I'm hoping that there exists a middle arbiter between them, and I want to be part of that group.

So as not to end on such a sour note, or to merely shoot fish in a barrel, I'll post something that I think is a step in the right direction:

http://pressthink.org/2012/02/npr-tries-to-get-its-pressthink-right/

Bravo, npr. I'll be sending you a check soon. Unless you start calling civilians sluts, that is.

The big three-oh

Every year I get myself the same thing for my birthday--I take the time to write a blog post recapping my last year. Whereas almost all of my blog posts end up not getting finished for one reason or another, I always at least post once a year on my birthday.

I suppose this birthday should be even more special. I'm 30 this year. Blah, blah, blah. . . new decade. . . end of my 20's. . . time to reflect. . . whatever. I'm one year older than I was last year and a day older than I was yesterday. Maybe I'll feel sentimental about it later, but for now the line seems pretty arbitrary.

I'm rather surprised to say that this last year hasn't seemed as busy as it's probably been. I finally put the finishing touches on my master's degree (Neurobiology and Physiology from Northwestern) and graduated from that program, I kept up in my classes at med school, and I worked for the Princeton Review teaching undergrads how to prepare for MCAT biology. Even with all of that, the highlights of this year for me have been social activities, rather than work or educational ones. Even with work and school going on I managed to have a game night almost every week in the last year; some of my best friends in Chicago moved up to my neighborhood so it's been pretty easy to convince them to stop by for an impromptu dinner party or a few board games. Amanda and I bought an Xbox 360 last summer and played through some pretty great games (Portal 2, Fallout 3, Lego Harry Potter, among others). I cooked a dozen different flavors of gelato and have been thoroughly pleased with the results (although I still haven't put on any weight, despite years of hearing that my metabolism would slow down after I got married, after I hit 25, or when I started eating gelato every day).

Perhaps the single most important thing I've done differently as I've gotten older is grow less patient with stupidity. Although I still engaged in a handful of spirited debates in the past 12 months, It's been becoming increasingly clear to me that most people, even many people I love dearly, simply don't want to understand the world better. Rather than get stressed out when people claim, for example, that the morning after pill is equivalent to an abortion (it actually delays ovulation, preventing fertilization but allowing implantation if fertilization has already taken place), I try and assess whether they want to understand the issue (some do) and, if not, simply dust off my feet on them and move on. I'll sometimes post their idiocy on my facebook wall for my like-minded friends to mock, but for the most part I'm no longer bothered by even the most brazen of self-imposed ignorance. People who think that the jury is still out about whether climate change is real, whether vaccines cause autism, or whether the Earth is more than 6000 years old are worthy of mockery, but not worth getting angry about. I find I'm much, much happier laughing at fools than worrying that their foolishness will destroy the world (or that it's somehow my job to correct them).

This is not to say that I think scientific illiteracy is harmless. The world of factual-relativism that conservatives in particular are building for themselves will inevitably have real-world consequences should these lunatics gain power. I am enheartened, however, with the fact that the Democratic Party has not yet engaged in the same anti-science drivel, alternate-reality, and systematic historical-revisionism that has made up the Republican primaries. Sure, many left-wingers don't vaccinate their children, engage in historical revisionism, and accept laughable theories like the 9/11 "truther" movement, but the malignancy has not spread into official Democratic platforms (as it has in recent years with the Republicans); perhaps there's still hope that moderate Republicans will kick the young-earth-creationists out of the party and become a pragmatic, technocratic party in the future? I"m keeping my fingers crossed.

I've probably already gone too far and offended some of you. I had no intention of turning my birthday post into a partisan snipe, I just needed to explain why I have so belligerent and curt with some of you (mostly with your facebook friends, actually) this year (my friends Andy and John both pointed it out and asked me why this was the case). The short answer is that it's a litmus test for deciding when a discussion is worth my time. If someone doesn't believe that Australia exists, for example, why should I believe that that person has anything worthwhile to tell me about tax policy? Surely these are different topics, and I may be missing out on a valuable viewpoint by using a litmus test, but I've found through trial and error that someone who stridently claims falsehoods in one area is intellectually lazy in many other areas as well. I simply have no interest in debunking endless lists of googleable facts (or "facts" that aren't intended as factual statements). The reason I'm as aggressive as I am about evolution is that I actually understand it and can relatively quickly spot someone who is making up their facts on the fly. It isn't that someone has to know about evolution before I'll listen to them, but when they assert a flagrant lie about evolution I can pick it out and know that they're willing to lie in order to win a debate (whereas in other areas I might not spot the lie as easily). Put better: http://www.skepticblog.org/2012/02/07/russells-hedgehog/

I'm realizing that I'm already bored of recapping my year's events. Since I've been better this year about using facebook, writing and responding to e-mails, and even calling to catch up with some of you, I think I can probably skip the thorough explanation of everything that's gone on. Although it's been far too long since I've talked with some of you, I don't think that any major changes have happened in my life since I've called or written, so I hereby put the burden back on you to call me if you've had a dozen children since we last spoke or if you've been elected to Congress without telling me.

Thanks in advance for the b-day wishes. I'll post again in a year, perhaps sooner.

Please vote

I need my friends to help me settle a debate I'm having about how I define myself politically. Please read through this quick list of my positions and vote on how you think I should introduce myself to others (left, center-left, center/moderate, center-right, right). Thank you!

Social issues:
-Gays should have equal rights as heterosexuals (govt. should offer civil unions for all people and stay out of marriage entirely, since marriage is a religious sacrament like unto baptism)
-drugs should be legal (esp. marijuana, although others could also be legalized with restrictions) and taxed
-abortion should be completely legal; waiting periods, ultra-sounds, or excessive regulations which are designed to dissuade or badger women into alternatives should be illegal. There is room, however, for reasonable regulation such as ensuring that women understand their options (as long as such does not entail obvious fear-mongering or pseudo-science).

Environment:
-global warming exists and is man-made. Programs (like cap and trade) meant to stop global warming, however, are simply not worth the cost; they raise energy prices and hurt efficiency without actually stopping warming.
-government should invest significantly into basic science research, particularly in technology like fusion which may reduce the cost of clean energy below that of fossil fuels.
-organic foods are a scam.
-bio-fuels are merely an excuse for government giveaways and don't help the environment.
-"green jobs" are a boondoggle and a waste of tax-payer money. Solyndra is the most extreme example, but is a typical illustration of the waste that such subsidies represent.

Economics:
-income-inequality is not intrinsically a problem.
-America's falling social mobility, however, is a major problem.
-market-capitalism, properly-regulated, is the best economic model.
-America's tax code is shamefully complex and inefficient.
-social security needs to be phased out and replaced with a means-tested alternative.

Military:
-the war in Iraq was the stupidest, most wasteful decision America has made since it invaded Vietnam.
-pre-emptive war is never justified, and will ensure that America is constantly at war and less safe because of it.
-the military is far too large.
-military benefits need to become more generous, but given to a FAR smaller force.

Religion:
-God does not exist, at least in the versions He/She/It is understood by the world's major religions.
-there should be a separation between church and state.