Pre-Existing Conditions

[PatriotResistance]

I assume this is the proper forum for this? I just got home from a Health Care Forum sponsored by a local news station (Denver, 9news). The governor and six of Colorado's U.S. congresspeople and senators answered questions. I plan on blogging about it once I organize my notes. But there is one very specific topic I would like to hear your opinions on.

As I striving/budding Objectivist I understand that health care is not a right. One man in the audience talked about his daughter being born with issues requiring 27 surgeries, and Ed Perlmutter (Colorado Congressman) mentioned his epileptic daughter in his response. The citizen complained of not being able to get insurance for his daughter's pre-existing condition.

Here are my questions - please understand I'm not arguing for these positions, I'm asking how the Objectivist explains rights and values regarding these situations.

First, is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child? I would think the answer is no, so then those unlucky parents who don't have the means are just that - unlucky, and they just have to do the best they can? For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not? I can see part of the problem is defining which parents can and cannot afford that care. But I need much help on this issue.

Secondly, one of my favorite charities is Operation Smile. Doctors and nurses donate their time and materials to travel around the world, mostly to quite impoverished areas, and perform cleft lip and cleft palate surgery on children whose parents have no possible means to get that service. Now, my first solution to that problem is rights protected by rule of law and free-market capitalism to empower those people. But until that happens how do you justify not helping such a child left behind after Operation Smile has spent all their donations and has to return home. I assume part of the explanation is how do you define who needs what, and where does the definition of "need" end? And I can accept that. But repairing a birth defect like a cleft palate is a simple operation and many of these kids suffer unnecessarily for years. Surely that does fall under any definition of "need" that could be defined? Is it really enough to say, well they are a third world country and the rest of the world just can't fix everyone else's problems?

Bob

[jeffrey smith]

Here are my questions - please understand I'm not arguing for these positions, I'm asking how the Objectivist explains rights and values regarding these situations.

First, is it necessary for all couples who plan on having a child to be financially able to deal with all possible birth defects before giving birth to that child? I would think the answer is no, so then those unlucky parents who don't have the means are just that - unlucky, and they just have to do the best they can? For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not? I can see part of the problem is defining which parents can and cannot afford that care. But I need much help on this issue.

Secondly, one of my favorite charities is Operation Smile. Doctors and nurses donate their time and materials to travel around the world, mostly to quite impoverished areas, and perform cleft lip and cleft palate surgery on children whose parents have no possible means to get that service. Now, my first solution to that problem is rights protected by rule of law and free-market capitalism to empower those people. But until that happens how do you justify not helping such a child left behind after Operation Smile has spent all their donations and has to return home. I assume part of the explanation is how do you define who needs what, and where does the definition of "need" end? And I can accept that. But repairing a birth defect like a cleft palate is a simple operation and many of these kids suffer unnecessarily for years. Surely that does fall under any definition of "need" that could be defined? Is it really enough to say, well they are a third world country and the rest of the world just can't fix everyone else's problems?

Bob

As for the first question, let me reply with a question.

Does anyone have a "duty" to that child--even the parents? (Much less that pseudo-entity, "society".)

As for your second question, the answer is--if you think Operation Smile is worthy, donate and fundraise for it.

Jeff S.

[tjohnson]

For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not?

It depends on what kind of a society we want to live in. Do we want one where it is survival of the fittest or a benevolent society where we cooperate?

[Brant Gaede]

For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not?

It depends on what kind of a society we want to live in. Do we want one where it is survival of the fittest or a benevolent society where we cooperate?

Social Darwinism is not Objectivism. Nor is it capitalism. It is not a society based on the protection of individual rights. Social Darwinism is a bunch of theoretical crap used to attack the true benevolent society created out of human freedom.

--Brant

[Selene]

For a modern civilization like ours, with the knowledge and means to repair many birth defects, does society have a duty to heal those children? If no, why not?

It depends on what kind of a society we want to live in. Do we want one where it is survival of the fittest or a benevolent society where we cooperate?

Let's see do we want our tortellini pesto with a lethal dose of arsenic or do we want my tortellini pesto with the best wine that enhances the meal.

Hmmm damn decisions decisions..

How about we have a society where intelligent individuals like yourself GS could ask questions which are objective on an Objectivist Living forum?

Adam

smiling subjectively

Edited October 18, 2009 by Selene

[Christopher]

I love these questions, they are very good.

What is the Objective position towards helping children who are orphaned in a society?

Objectivism recognizes that children are not in a position to take care of themselves. Surely we as individuals living in a society may find justification to offer some services. After all, we offer incarcerated people services when they break the law, we don't just drop them off cliffs. Does Rand expound on her views of child support when the parent is deemed unsuitable to raise the child?

[Selene]

Chris:

Good questions. Who, pray tell, should do the "deeming" as to the unsuitability of the parent Chris?

Adam

[Christopher]

We're both up pretty late tonight, I see.

I have hazy recollections of reading how Rand would argue that a parent had a duty to educate a child to some degree (although I might just have read it on an OL forum many months ago). Parents can't starve children, beat children, hold children in isolation for long periods of time. Rather than sort out the exact borders right now, I think we can agree that borders do exist.

Who should decide the borders? Well now, that is perhaps something we need to decide en masse (I know, what the hell am I saying!). Philosophy can only give us so much resolution on social services, and then at some point we really do need to come together as a collective and sort out the gray areas. When is a fetus living, how much nutritional information should be provided on food labels, at what point of word overlap should copyright violations be enforced?... tonight I will pray on the answers and see if God has anything to say. Until then, I'd love to hear your thoughts on that ever-good "who" question.

[Alfonso Jones]

Some statements about this:

1) The fact that a child is born cannot generate obligations on the part of someone who didn't make a choice involving that birth. That is, the ONLY PEOPLE who might have an obligation wrt the child are the parents. If you affirm otherwise, consider whether your same logic is going to lead to "rights" to so-called free health care, to a good job, to a good house, etc... Which notions are nonsense.

2) I strongly suggest that those with a desire that such children receive support cooperate in providing that support. I myself have certainly provided support for people who were in situations where they were unable to provide fully for themselves. But I would reject the notion that I or "society" have any unchosen obligation/duty to do so.

3) I will further say that I'm happier to live in a society where there are those who do show compassion to those in such need. And that I see NOTHING in Objectivism inconsistent with that.

Regards,

Bill P

Edited October 18, 2009 by Bill P

[tjohnson]

I wouldn't use the word 'duty' in this respect. No we don't have "a duty" to look after the disabled and disenfranchised but we would be wise to do so. Humans are not commodities to be disposed of when we deem them unfit because at some point in time WE may be consider useless (perhaps when we get old?). We don't know a priori what potential for contribution any given individual has at any point in their life and so we should assume the best but be prepared for the worst.

[Christopher]

I agree with what you're saying Bill. But it still is a bit inconclusive because:

A. Objectivism asserts individuals do not have a duty to take care of other individuals

B. Objectivism recognizes that children cannot take care of themselves (and their social rights should be limited - no voting, etc.)

C. Objectivism understands that not all parents will take responsibility to raise their children appropriately

Do we accept that children are dependents, build a system on which life is the core value, and then make it near-impossible for certain groups to survive in this system? Do we lawfully limit children's rights as less than an adult, thereby forcing them to be dependent upon the goodwill of others without means of survival otherwise? That sounds a bit risky and unfair. As I mentioned with prisoners and along what GS is saying, I believe there is a point where it makes more sense from a societal standpoint to offer some level of services (just as we do with criminals in the very least!).

But as you also point out, this is not the healthiest argument either. For one, this argument could be used to support public education. Perhaps this argument could be eventually extended to support universal health care.

[Selene]

I wouldn't use the word 'duty' in this respect. No we don't have "a duty" to look after the disabled and disenfranchised but we would be wise to do so. Humans are not commodities to be disposed of when we deem them unfit because at some point in time WE may be consider useless (perhaps when we get old?). We don't know a priori what potential for contribution any given individual has at any point in their life and so we should assume the best but be prepared for the worst.

Ahh. you mean like Cass Sunstein and Ezekiel Emanuel.

Adam

[Alexander]

A positive right, a right that states that another person HAS to do something, is effectually taking away their rights. Example: Stating that a child has the right to have a surgery means that a doctors work is no longer his own, that his freedom is no longer applicable, that his lift is not his own. Taxation to support something like this is simply thinning out the injustice over more people. But a right TO something is a right to TAKE IT from somebody else.

Negative rights, such as the right to life, to freedom, and to your earned property, demand nothing of others, except that they NOT strip you of your rights. Your rights do not conflict with others.

Duty implies that a person is not an end in themselves, having the right to exist for their own sake, but that they must do something for others to justify their own existence.

Private charity? No moral problems there, and probably less fraud.

[PatriotResistance]

Some statements about this:

1) The fact that a child is born cannot generate obligations on the part of someone who didn't make a choice involving that birth. That is, the ONLY PEOPLE who might have an obligation wrt the child are the parents. If you affirm otherwise, consider whether your same logic is going to lead to "rights" to so-called free health care, to a good job, to a good house, etc... Which notions are nonsense.

I understand. This is why I mentioned the difficulty in defining just what is a "need", it is a slippery slope with no bottom. I also understand that, for an example, if a poor population somewhere makes a habit of six or more children per family they would be forcing an undue burden on those elsewhere in the world who are more responsible. But that is an extreme example. What about the poor couple who do have the means to take care for the one or two children they have, but are unlucky in that one is born with a cleft palate. Can you really stand in front of that six year old child, who should have had the operation as an infant, and say, "Maybe next year." I realize the pat answer is, 'if you care so much then you are free to donate'. But then when donations aren't enough we say, 'sorry, the world is not obligated to help you'?

Now to explore it from the other side, imagine if we DID create some definition of minimal "rights" that all humans are to be provided with. Perhaps the minimum standard of guaranteed housing would be a 4-foot by 6-foot plywood shack. I believe such a thing would belittle what it means to be human by removing any incentive to provide for oneself. In other words, we should rather teach our children that they have a duty to themselves to exercise their own self-interest in providing for themselves. But you can't say that to a newborn with a cleft palate - that operation should be performed soon after birth. So what I'm saying is that birth defects seem to me to be something that could be defined, in a medically advanced society, as a right that is not allowed to slide down the slippery slope to anything else.

But I do have a major problem in defining when the parents are "unable" to provide that need and society should step in, or when the parents have been negligent in having too many children or whatever. Can't come up with ANY equitable means of defining that, so maybe THAT is why it's not a good idea.

2) I strongly suggest that those with a desire that such children receive support cooperate in providing that support. I myself have certainly provided support for people who were in situations where they were unable to provide fully for themselves. But I would reject the notion that I or "society" have any unchosen obligation/duty to do so.

In spite of what I wrote above I do understand that. But my problem with birth defects is that the child did nothing wrong. I wonder if anyone has every looked into what the costs of fixing birth defects are worldwide. What if society fixed birth defects where the parents were unable, but then required the parents to repay in some fashion? I'm reaching, I know, I'm just having trouble with innocent children suffering when the technology to fix that suffering exists, whether the parents are responsible or complete cads or dead.

3) I will further say that I'm happier to live in a society where there are those who do show compassion to those in such need. And that I see NOTHING in Objectivism inconsistent with that.

Absolutely. As a fundamental tenet of Objectivism is that noone is forced to donate, I wish Objectivists would make more of a point that Objectivism does not "object" to compassion in any way.

Bob

[PatriotResistance]

As for the first question, let me reply with a question.

Does anyone have a "duty" to that child--even the parents? (Much less that pseudo-entity, "society".)

The parents have a duty to the child.

So now their child is born with a serious heart defect, or conjoined twins. Their country does not have a hospital capable of dealing with that, and though they are middle-class in their community they have no means to cover this expense. Your solution?

As for your second question, the answer is--if you think Operation Smile is worthy, donate and fundraise for it.

I do.

Yet still this year hundreds of children who should have had the operation as an infant still cannot get the procedure and they will have to suffer for yet another year at least. Assume you have helped out the doctors somewhere in South America this year. Your group is packing to leave but there is still a line of children hoping to be treated. As an Objectivist, what do you say to them to explain why they will not helped?

Bob

[PatriotResistance]

A positive right, a right that states that another person HAS to do something, is effectually taking away their rights. Example: Stating that a child has the right to have a surgery means that a doctors work is no longer his own, that his freedom is no longer applicable, that his lift is not his own. Taxation to support something like this is simply thinning out the injustice over more people. But a right TO something is a right to TAKE IT from somebody else.

Negative rights, such as the right to life, to freedom, and to your earned property, demand nothing of others, except that they NOT strip you of your rights. Your rights do not conflict with others.

Duty implies that a person is not an end in themselves, having the right to exist for their own sake, but that they must do something for others to justify their own existence.

Private charity? No moral problems there, and probably less fraud.

Well, thank you for the excellent exposition of the Objectivist position. I'm having a problem, though, that when private charity is inadequate we say - too bad, so sad?

But I have a more important question for you. Image that Objectivist values have become a fundamental part of society in general and of everyone's education. Would that "fix" things in that there would then be adequate private charity? In other words, when almost everyone is an Objectivist and need is no longer forced on anyone, then most people are more able to care for birth defects, and everyone feels more free and able to exercise compassion and all charities become overfunded? Is that the Objectivist solution to ensuring that no child suffers unnecessarily from a birth defect?

Bob

[Selene]

Bob, Bill and Alex:

Good exposition of the issue. I emotionally and personally identify with Bob's feelings on the issue.

I can remember an NBI "Intro to objectivism" course where during the question and answer period the question from a student, who clearly cared about people, asked Ayn in one of those hesitant, halting ways of questioning the position of their "guruess" [< new word ?] as to whether, if there was one drugstore in this rural town and the man needed his prescription filled to save his child's life, and the drugest refused to come and open the pharmacy, would the man be justified in forcing the drugest at the point of a gun to save his child's life?

Her answer was cruel, as I saw it on that night in the Empire State Building.

Is this resolvable because it is a stance that clearly is not in anyone's comfort zone that I know.

Adam

[John Day]

I can remember an NBI "Intro to objectivism" course where during the question and answer period the question from a student, who clearly cared about people, asked Ayn in one of those hesitant, halting ways of questioning the position of their "guruess" [< new word ?] as to whether, if there was one drugstore in this rural town and the man needed his prescription filled to save his child's life, and the drugest refused to come and open the pharmacy, would the man be justified in forcing the drugest at the point of a gun to save his child's life?

Her answer was cruel, as I saw it on that night in the Empire State Building.

Is this resolvable because it is a stance that clearly is not in anyone's comfort zone that I know.

"Morality ends where a gun begins." Once someone initiates force against another, that person has lost his claim to moral authority.

[Brant Gaede]

I can remember an NBI "Intro to objectivism" course where during the question and answer period the question from a student, who clearly cared about people, asked Ayn in one of those hesitant, halting ways of questioning the position of their "guruess" [< new word ?] as to whether, if there was one drugstore in this rural town and the man needed his prescription filled to save his child's life, and the drugest refused to come and open the pharmacy, would the man be justified in forcing the drugest at the point of a gun to save his child's life?

Her answer was cruel, as I saw it on that night in the Empire State Building.

Is this resolvable because it is a stance that clearly is not in anyone's comfort zone that I know.

"Morality ends where a gun begins." Once someone initiates force against another, that person has lost his claim to moral authority.

Thank God for WalMart!

--Brant

haven't shot a druggist in 15 years

Edited October 25, 2009 by Brant Gaede

[PatriotResistance]

I've been gone dealing with a death in the family. I had time to think about this issue quite a bit while driving and have come up with the following reasoning to explain why I was wrong.

Ayn Rand (and many others I'm sure) said that when one is having trouble to always check your premises. My original premise was that since we are such an advanced civilization with the medical ability to heal many birth defects that we have an obligation to do so. My idea that we are an advanced civilization I now believe is the source of my problem.

We may have the means (medical ability) but we do not possess the method (universal political/social/cultural facilities and will), and so we are not as "advanced" as I presumed. A similar example is hunger. While there is enough food produced to feed everyone on the planet some still go hungry. The problem is not the availability of food or the desire to help. It's governments and bandits who prevent it's distribution. My original premise assumed some type of perfect world in which our "advanced" society operates, but that does not exist yet. Within the free-er and more technologically advanced areas of the planet children's cleft palates ARE routinely repaired during infancy, for example.

The standard response that many provided, 'if you care so much then donate', also felt lacking to me. But once again, in a "perfect world" where capitalism and the virtue of selfishness is universally practiced it's easy to imagine that those who choose to donate their time and money would easily be able to handle any such need. And again, within a smaller venue such as the United States we see that is already the case, even though the U.S. is not yet close to that ideal.

I had argued that birth defects are somehow different from other needs, and so those forced donations are justified. I still believe birth defects are quite unique compared to other "needs" such as clean water, housing, education, etc. but that cannot justify force. Rather, for me, birth defects then are one of the most important reasons for promoting real solutions. So the lesson for me is that even though I realize my meager donations cannot fix this problem today I cannot let my despair lead to an error in judgment about premises, causes and effects. The problem is not insufficient donations. And more importantly the problem can never be fixed by forcing "donations" from everyone. There isn't a single problem or solution to universally repairing all birth defects or any other problem or need for that matter. And there may never be a "perfect" world. But in a world where rights are protected, free trade is practiced and personal responsibility is the norm, it may feel like it.

[shadesofgrey]

My idea that we are an advanced civilization I now believe is the source of my problem.

We may have the means (medical ability) but we do not possess the method (universal political/social/cultural facilities and will), and so we are not as "advanced" as I presumed. A similar example is hunger. While there is enough food produced to feed everyone on the planet some still go hungry. The problem is not the availability of food or the desire to help. It's governments and bandits who prevent it's distribution. My original premise assumed some type of perfect world in which our "advanced" society operates, but that does not exist yet. Within the free-er and more technologically advanced areas of the planet children's cleft palates ARE routinely repaired during infancy, for example.

Well put. Whether or not someone is an objectivist probably isn't going to influence their decision to donate to something like Operation Smile. 9 our of 10 people who do donate do so because they want to. The same goes for a lot of charities. In the end it doesn't matter anyway because the money is still going to a place it's needed and it's not getting there by force.

You bring up a good argument with birth defects, but although you may see it as a big issue personally, it's just another in a myriad of issues of lifestyle like clean water, food, etc. As far as the bigger healthcare debate goes, healthcare itself is not a right. ACCESS to affordable healthcare is. This is because if you do not provide access, you effectively block someone from it as if by force. Poverty used a weapon instead of a consequence. Healthcare differs from a lot of other industries/products in that if you don't have access to Corn Flakes for instance, you're probably not going to die. The accessibility of healthcare is more important to physical well-being than the accessibility to a lot of other industries, so those people who assert that healthcare is simply another product or service are short-sighted and in my opinion, naieve.

The issue is not black and white by any means. Cleft palate is not a fatal condition, but it has a significant quality of life impact and is relatively cheap to fix, making it one of the more efficient healthcare problems to solve. This still does not presuppose any sense of duty, but when considering asset allocation, factors such as relative ease of treatment need to be considered. The best example I can think of for this is insulin-dependent diabetes. Before bacterial recombinant DNA technology, diabetes had a 100% mortality rate. The first synthesized hormone in existence was insulin because it was determined that with the ability to do so, the most number of people had the most to gain if diabetes was treated first. It becomes a relative value judgement. Society weighs in with various cause support-groups (breast cancer, autism, alzheimer's, etc) and the medical establishment has its own recommendations. They usually meet somewhere in the middle.