Monday Ethics Cool-Down, 7/27/2020: Lots of Stuff Hanging Around The Runway

I have a long night of work ahead of me, so I don’t know what time it is.

Or care.

1. Res ipsa loquitur.  Oopsie! “Health company apologizes for falsely telling 600,000 US military members they were infected with coronavirus”

Tricare apologized for a poorly worded email that implied the recipient had  been infected with the Wuhan virus.

I guess the writer was a Rutgers English major.

On the bright side, it is better to get a false positive than a false negative.

2. Schadenfreude Alert! Seattle radio host  Paul Gallant  mocked President Donald Trump last month for suggesting Seattle’s riots were violent. Then, last night, the “mostly peaceful” demonstrations got his Starbucks. HIS STARBUCKS!!!

“I feel like I need to buy a firearm, because clearly this is going to keep happening. Enough is enough,” Gallant he added.

It was enough a long time ago, you pathetic jerk.

3.  Boy, when you can’t even trust the sports reporters…ESPN tweeted a video over the weekend of players from the WNBA’s New York Liberty and the Seattle Storm leaving the court, and wrote, “As the national anthem was played, the @nyliberty and @seattlestorm walked off the floor as part of the social justice initiative.” For this display, the women were roundly criticized.

Then ESPN tweeted  “Correction: Players left the court before the national anthem was played, not during.” That’s what I call a material mistake.

Nevertheless, at last checking,  the original misleading tweet is still up.

4. This is presumably justifiable because all cops in New Jersey are racists, as proven by the fact that a non-racist cop in Minneapolis killed a black man.  Kevin Trejo, 21, of Westwood, New Jersey has been arrested for  spitting into the coffee of a police officer at Starbucks.  Police have evidence  that Trejo had done this repeatedly with officers.  Trejo claims to have only done it just once. Oh! Well that’s OK, then!

Question 1: Is this a violent offense?

Question 2: Why would any police officer chance ordering a beverage at Starbucks?

5. Gorsuch was still right, and so is the ACLU. In Bostock v. Clayton County (2020), the Civil Rights Act of 1964 extended to sexual orientation, this making discrimination against gay and transgender individuals illegal.  Since such discrimination is unethical beyond a reasonable doubt, I regard the decision as one where the Court reasonably interprets the law according to ethical and practical enlightenment over time, as it did in Brown v. Bd. of Education.

Now conservative pundits are claiming that the parade of horribles predicted by anti-LGBTQ activists in the wake of this decision is coming to pass. In Hammons v. University of Maryland Medical System (UMMS), a biological female who identifies as a transgender man, Jesse Hammons, claims St. Joseph Medical Center unlawfully discriminated against “them” by refusing to perform a hysterectomy to remove the transitioning female’s healthy uterus. The lawsuit, critics say, aims to force Catholic hospitals to violate its interpretation of the Hippocratic Oath by removing a fully-functional organ and permanently sterilizing patients.

The Ethical and Religious Directives for Catholic Health Care Services established by the U.S. Conference of Catholic Bishops directs that Catholic hospitals may not perform procedures that induce sterility unless “their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.” St. Joseph  performs hysterectomies to treat serious medical conditions. Hammons and the ACLU argue that   gender dysphoria (identifying with the gender opposite one’s birth sex) is a serious condition requiring hysterectomy, and thus the hysterectomy is a “medically necessary treatment relating to his [sic] diagnosis of gender dysphoria.” The hospital had scheduled the surgery, but canceled it after its ethics committee determined the surgery would violate the Hippocratic Oath.

Did canceling the surgery involved discrimination on the basis of sex in violation of the Fourteenth Amendment’s Equal Protection Clause and the Affordable Care Act (a.k.a. Obamacare)?  The question comes down to whether or not transgender surgery  is “medically necessary” or the infliction of harm.    Catholic teaching holds fertility to be an essential bodily function, it regards elective sterility as immoral, an attack on God’s design for the human body. Transgender activists and pro-transgender health professionals regard transgender surgery as essential to alleviate the emotional distress of gender dysphoria.

I don’t see how this case properly involved sexual discrimination at all. The hospital refuses to remove all healthy uteruses, and it doesn’t matter what the patient “identifies as,” or why. It’s not as if the hospital will remove health male uteruses. It seems obvious to me that this is a fake lawsuit, much like some of the wedding cake suits.  Hammons and the ACLU want to prevent Catholic hospitals from interpreting medical ethics through a religious lens. The appeal to Bostock is contrived and disingenuous, and I suspect it will fail.

If Hammons and the ACLU really want to win the case, they need only make the medically supportable argument that a uterus itself is a dangerous medical condition if one has no intention of conceiving. A woman having a hysterectomy reduces her chances of dying from cancer, perhaps significantly. That should be enough to get past the “do no harm” prohibition.

18 thoughts on “Monday Ethics Cool-Down, 7/27/2020: Lots of Stuff Hanging Around The Runway

  1. Jack, One of the nigardly principles states you don’t do something you know will offend someone (paraphrasing here). With all the available options why does a person choose a Catholic agency to perform an act they can reasonably foresee will result in a denial unless they are merely fishing for a lawsuit?
    This also applies to those cake bakers. Like cops that keep patronizing Starbucks it makes no sense to me that people will try to engage in some economic transaction with higher transaction costs (non- financial considerations when lower cost alternatives are readily available.

  2. 4. It’s tampering with food and drink; maybe not violence per se, but approaching it due to tricking someone into ingesting something unsanitary or otherwise non-food and not FDA-approved.

    5. I’d actually go the other way with it and try to convince Catholic authorities that by the logic of sanctifying “God’s design for the human body,” there is a whole host of maladies that they would be forbidden from treating. Therefore, it is absurd to deny a medical procedure on the grounds of idea of an inviolate perfect body design, when so many other procedures are accepted as necessary in a “sinful” world where people’s bodies are very clearly imperfect. To illustrate the absurdity, Jehovah’s Witnesses are a bit more consistent about the whole “the body is sacred” thing and refuse to accept blood transfusions. Arguably, if Catholics actually took the idea of the sanctity of the human body seriously, they’d do the same.

    (Arguably, if they took their beliefs literally they might save a lot more lives by doing wine transfusions during mass, but that’s just a cheap joke on my part. I do know enough to know that’s not how transubstantiation is supposed to work, but now that I think of it, it might actually be acceptable to Jehovah’s Witnesses if they subscribed to that belief, since apparently part of their objection to transfusions is that only the blood of Christ can save them.)

    The thing about dogma is that it’s got a mane of frayed threads around it that unravel the whole thing when pulled.

    • If you were to examine Scholastic philosophy and arguments — Thomism — you would I am sure understand and appreciate the logic and consistency of it. And that is where you will find the structural argument that supports the “God’s design” argument pertaining to reproductive fertility.

      But without that you will continue to fail to grasp well that which you critique and so your counter argument never rises be truly being an argument. Though you don’t see yourself as doing so you make a fool of yourself through a failure to grasp the logic and consistency of the ‘dogma’ you critique.

      It is not just you of course.

    • EC,

      I’m not following your logic here. Maybe you have some more specific examples in mind that you could help illustrate your point? But the general principle is that there is an objective way the human body works, and because of that, we can identify when something is going wrong with the body. We know that human beings are dimorphic, with 46 chromosomes in 23 pairs, come equipped with four limbs, ten fingers, ten toes, two eyes, one nose, and a belly button. We know that genetic abnormalities occur that are harmful to the human person. We know the breaking down of the functions of particular organs is harmful. We know that diseases are harmful. We know all these things because we know how the body ought to function. Fertility is a normal process in the body, and directly harming fertility is introducing disorder to the human body. Now, it may be the case that a procedure is necessary to remedy some other problem with the body, and that procedure may result in harm to the body’s fertility (such as needing to remove a cancerous uterus that is not responding to other treatments), and that is a legitimate course of action.

      Regarding blood transfusions, I’m even more baffled by your arguments. Jehovah’s Witnesses object to blood transfusions because of the Old Testament prohibition from consuming blood. In other words, they are extending a dietary prohibition to a medical context. Whether that is a legitimate interpretation can be argued, but it doesn’t touch on the sanctity of the body in the context we’re discussing. Consuming blood would render one ritually unclean, whereas the sanctity of the body we’re referring to is specifically about respecting the integrity of the human body, i.e. respecting the human body in how it is supposed to function. Catholics are fully consistent as regards blood transfusions, because it is an efficacious medical treatment intended to restore a wounded human body to proper function.

      Further regarding the matters of operations to make a biological male look like a women, or a biological woman to look like a male, there is sufficient evidence that these procedures, many of which introduce irrevocable changes (like amputation), do no alleviate the pyschological distress of many who engage in them, and a significant subset of people who undergo these transition surgeries regret them after 10-15 years. It shouldn’t be an appeal to Catholic doctrines but common sense that would have any doctor exercise the Hippocratic Oath and deny removing perfectly healthy organs.

      • I’ll defer to you on what Jehovah’s Witnesses actually believe.

        My only real point was that if a person’s body starts destroying itself, who are we mere mortals to say that’s not its “normal” functioning? Each human has a natural lifespan, and if we accept that as ordained by a higher power, then why would we attempt to cure diseases which arise from a person’s own body? Why would we attempt to help a person live longer if their natural body, given to them by a deity that never makes mistakes, is clearly shutting itself down of its own accord?

        I suspect there’s a ready answer to this in Catholicism; I just don’t know what it is yet. My own answer is that I reject the assumptions on which the question is based.

        • EC,

          Well, WordPress rejected my reply yesterday, so we’ll see if my shorter, revamped version will take.

          Your questions really touch on two of the classic discussions, namely the problem of evil and the problem of free will versus predestination. The quick and dirty on the Catholic position on these is that an omnipotent, omniscient, omnibenevolent God can still permit evils to exist, and one of those reasons is that he could draw a greater good from that evil. Thus God can design the perfect human body, but allow individual humans to suffer from imperfections and defects. On the second problem, God’s specifying the length of our days does not preclude our free choices in the matter. Rather he incorporates our free choices into that. So, God might decree that my life comes to an end in 2033, but if I end up with cancer in 2025, my decision to treat that cancer is probably what will ensure I make it to my expiration date.

          Why would we attempt to help a person live longer? There are myriad reasons. First and foremost, because we respect the dignity of a human person. Second, because we want good for people. Now, the ultimate good is God himself, but that does not preclude willing lesser goods for people, such as health. Though heaven is our intended destination, and there we will have perfect happiness and, in the resurrection, glorified bodies that will never diminish, this life is still good. More time in this life can mean more time spent for the good of others. Third, seeking to help other people is good for us because it nurtures love in our own lives. Fourth, ministering to other people is itself a participation in the divine life. God doesn’t need us. He could take care of everything himself. But he makes room for us in his divine prerogatives, and that is for our benefit.

          I’m just throwing these points out as is. Each one deserves an entire treatise. Let me know if there are any of them you’d like me to explain further.

          The problem I have with the issue of people suing the Catholic Hospital for refusing to remove a healthy uterus is that we shouldn’t need recourse to any religious viewpoint. There are ample reasons to reject such surgeries that are not religious. The evidence that most people with gender dysphoria eventually grow out of it should be the number one reason right there. The evidence that there’s growing crowd of people who have undergone these permanent, life-altering transition surgeries who deeply regret them and are having to cope with how badly they have wrecked their lives is another. But we seem to live in a time when rational arguments must perforce give way to purely emotional demands.

  3. I got one of those emails, I had to get tested before getting surgery and was clear, got surgery and then the email. Assholes.

  4. I will continue to have reservations against anti-discrimination laws that extend to private persons and businesses.
    Anti-discrimination laws are simply an infringement on people’s rights to personal liberty and association and they do more harm than good for civilised society. People should be able to decide who they wish to or do not wish to interact or associate with for WHATEVER reason and it is not the place of government to force social assimilation between different groups or classes of people.
    A person should be understood as being justified in refusing to associate with someone for whatever reason whatsoever including the person’s race, sexuality, age, etc. Good intentions cannot justify an infringement on people’s rights.
    These laws A majority of the problems we experience today is just one more stage in the slippery slope of anti-discrimination legislation that have become the norm. We will still slide down into worse situations if these are not addressed.

    PS: I’m a gay person that lives in one of the most oppressive anti-LGBT societies in the world. But it it ever comes down to it, I will oppose anti-discrimination legislations on matter of principle.

  5. Correction: “the problems you experience in your society today are just different stages in the slippery slope caused by a normalisation of anti-discrimination legislation that extend to private individuals. You will still slide down into worse situations if those laws are not scrapped.*

  6. 5. An elective hysterectomy (generally and in this case) may be viewed as violating the Hippocratic Oath with no need for a religious lens.

    Doctors routinely refuse or decline testing or treatments that are not in a patient’s best interests. Generally an attempt is made to arrive at a shared decision (between physician and patient), but that isn’t always possible.

    In this case, I would find it fairly easy to argue that the risks of hysterectomy (any imaginable complication of a pelvic surgery) outweigh the benefits. Obviously, different practitioners may disagree, and that’s exactly why a rational person would just seek a second opinion.

  7. 5. GDD (Gender Dysphoria Disorder) nests in the DSM near BDD, (Body Dismorphia Disorder), I think when talking about patients with GDD, it pays to take a step back and talk like they had BDD, because the disorders are very parallel, and BDD doesn’t have a metric ton of political baggage.

    BDD is, in very simplified terms, the belief that certain parts of your body aren’t actually parts of your body. That your body doesn’t conform to the ideal that you have pictured in your head, or that parts of your body do not belong to you. (It’s an uncommon disorder, but a common symptom is the belief that your arm is not your arm) The disorder causes serious stress and depression among patients, who often seek to surgically correct (remove) the offending appendage. There is no cure for BDD, but there is an ethical conversation happening around it.

    From the Good Therapy Blog:

    “People with the condition may desperately want to have a limb amputated, raising issues of personal autonomy and informed consent. Amputating a perfectly functioning limb is a troubling proposition to many medical professionals, but some have questioned whether it is in fact harmful to refuse a person a potentially helpful treatment that may lead to an increased quality of life.

    Another concern is that those who undertake to amputate their own limbs or attempt to find someone who will perform the procedure for them may face serious complications, even death, due to unsafe and unlicensed surgeries. A man died in 1998 of complications following surgery, after the desire to remove his leg led him to allow a surgeon who had lost his license to perform the amputation.”

    But while the ethics are still being debated, the treatment is a little more clean cut:

    “This condition is troubling partially because there is little information about it and no cure. Treatments such as cognitive behavioral therapy and selective serotonin reuptake inhibitors (SSRIs) can often reduce the distress and depression associated with the disorder, and some clinicians find treating the symptoms exhibited by those with obsessions and compulsions can help reduce symptoms. Some people with the disorder experience an unrelenting desire to become an amputee even after years of psychological treatment, which leads some doctors to wonder if perhaps treatments are not effective because they are not specifically meant to treat this particular condition. Still, debates about effective treatment, as well as the ethics of amputating healthy limbs, continue.

    Most surgeons will not perform a medically unnecessary amputation, so while some individuals are able to able to alleviate their desire for amputation to some degree—often using canes and prosthetics to simulate an amputated limb—other individuals may attempt self-amputation or damage the limb they wish removed until amputation becomes necessary.

    Further, amputation has only been shown to have a 70% success rate of resolving the symptoms of BIID. Thus, when surgeons do agree to amputate, they do not often do so until all other treatments have failed. Increased awareness of this condition is needed, both to support those who have been diagnosed and so that more effective treatments, and possibly a cure, may be developed.”

    Basically, the ethical question is: BDD has no cure, it causes genuine distress. Is the correct path to amputate the offending (yet completely healthy, and obviously actually the patient’s) limb? So far, the general consensus is no. Both because it’s ineffective, and because it seems to some that it violates the Hippocratic oath.

    I actually don’t know what the answer to the above question is. I really don’t. I’m glad I don’t have to make it, and glad I don’t have to live with it. I think it’s the kind of problem that well intentioned, intelligent people could have a heated argument about. I think that conversation would be made poorer by injecting politics and religion into the conversation.

    And then, to circle back to GDD… I’m not certain why the two disorders are treated so differently. I’m trying to explain it in a way that isn’t cravenly political…. Maybe it has something to do with the relative size of the populations, maybe it has something to do with how there is a biological component to some cases of GDD (Kleinfelter’s or Turner’s or hormone imbalances), or maybe it has to do with how BDD amputations always leave someone less physically able, where GDD transitions leave patients relatively healthy, if sterile.

    But the cynic in me believes that it has to do with mandate creep from gay rights issues. The differentiation is that the common symptomatic organs for BDD are the arms, legs and eyes, while the common symptomatic organ for GDD is the penis or vagina, and gay rights activists, fresh off a whole lot of success, saw this as the new frontier for the expansion of rights, without really having a whole lot of understanding of the issues.

    • All that said, Jack nailed it with:

      “If Hammons and the ACLU really want to win the case, they need only make the medically supportable argument that a uterus itself is a dangerous medical condition if one has no intention of conceiving. A woman having a hysterectomy reduces her chances of dying from cancer, perhaps significantly. That should be enough to get past the “do no harm” prohibition.”

      That’s almost word for word the most common justification for circumcision. And again, while good intentioned and intelligent people could argue the ethics and merits of circumcision, I am 100% confident that the hospital performs them.

    • I suppose I shouldn’t be too surprised by the idea that BDD can continue after the “offending” limb has been amputated. I have to know, though: how do they determine that? If a person has BDD even after losing the limb they were upset about, does it really count as BDD, or is it just generalized depression? Or does it redirect itself towards their remaining limbs?

      While doing research on this, I stumbled on an article that reminded me of Psycho-Cybernetics by Maxwell Maltz. https://en.wikipedia.org/wiki/Psycho-Cybernetics From the Wikipedia article: “Maltz found that his plastic surgery patients often had expectations that were not satisfied by the surgery, so he pursued a means of helping them set the goal of a positive outcome through visualization of that positive outcome.” He realized people were not addressing the real problem that they had with themselves. I’m not sure that’s how BDD works but if it continues even after surgery, that indicates then I think the disorder is disguising its true nature.

      • My take on it is that there just isn’t enough research on the disorder to make concrete statements. I browsed a couple of studies and there’s some wildly different takes on the disorder. This is an excerpt from one that asserted that most post-op BDD amputees actually saw marked improvements in quality of life:

        “Amputation of one or more limbs was preferred by 30 (55.6%) “I can feel exactly the line where my leg should end and my stump should begin. Sometimes this line hurts or feels numb.” Twenty-four (44.4%) wished to be disabled in another way than limb amputation. Of those most (23/24) wished to have a form of paralysis and one preferred to have club-feet (Table 1). Upon qualitatively screening the results the two groups did not indicated an important difference on any item. Fifteen subjects (27.8%) described their preferred body part had changed overtime: (e.g. 5 went from leg amputation to spinal cord paralysation).

        It’s possible, even if counter-intuitive, that if amputation actually does improve quality of life, that it might be the right thing to do. Like I said earlier, I don’t know the answer, I just think having a conversation about BDD is more thought provoking and less politically charged, while dealing with many of the same issues present in GDD. Maybe gender reassignment surgery is the right thing to do too. I don’t necessarily buy in to a lot of baked in conclusions that come with that, but from a quality of life standpoint for someone suffering from dysphoria, it wouldn’t even surprise me if it does help some.

    • I would caution against confusing Body Dysmorphic Disorder (BDD) and Body Identity Integrity Disorder (BIID). Even in your quotes from the GoodTherapy blog, the 2 different terms were used.

      BDD is listed in the DSM. The cardinal symptom is the perception of physical flaws. In the vast majority of cases it is towards mundane things like complexion, hair, weight, etc. The typical patient would seek (“usual”) reconstructive plastic surgery or engage in (potentially dangerous) diets or exercise regimens. In BDD, patients generally do NOT improve after surgery because their mental illness redirects them to perceive a continued flaw or new flaws. I think this is different from GDD, where gender reassignment surgery DOES address the underlying issue (being “born the wrong gender” or however you wish to frame it).

      BIID is NOT listed in the DSM, but some recognise it and draw parallels between it and BDD. It is in BIID that sufferers allegedly do not believe body parts belong to them and/or desire to be amputees.

  8. #4: Q1: In the 2020 World of Wuhan where everyone is presumed to be carrying the virus–thus the mandates for wearing masks, which primarily protect others from the wearer and not the other way around–infecting a drink intended for another’s consumption with bodily fluids could be considered attempted murder.

    Q2: Hey, if that’s your favorite kind of coffee, that’s what you’ll drink. People can get downright religious about this stuff.*

    –Dwayne

    * Full Disclosure: I am not, and have never been, a coffee drinker. ICK . . . nasty stuff.

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