[A previous version of this essay was posted incomplete. This is the full version]
Dear friend, have you considered banning health care?
Several studies agree that sick people are often treated against their preferences and sometimes against their explicit requests. 51% of patients who request Do Not Resuscitate orders never get them. Among those who get them, 75% of their doctors don’t know about it. And among doctors who do know about it, 65% don’t feel a need to follow them if it conflicts with their own opinions.
So it should come as little surprise that 22% of people who sign forms saying they don’t want to be hospitalized get hospitalized and 31% of people who sign forms saying they don’t want CPR get CPR.
Or that patients who prefer to limit life-prolonging treatment get an amount of life-prolonging treatment that is statistically indistinguishable from everyone else.
Or that even though 80% of Americans say they want to avoid hospitalizations and intensive care as they are dying, in fact about 50% of Americans die in hospital and intensive care.
But in fact, the situation is far more dire than this. These studies only count people who have legally, explicitly spelled out a desire not to receive health care. What of people who sign off on all the dotted lines, but only under emotional blackmail that can hardly be called consensual?
The cancer patient who gets told she is “brave” and “a fighter” if and only if she accepts all the interventions modern medicine has to offer, but otherwise gets given “pep talks” on how she can’t “give up” on her family and friends.
The heart disease patient whose family constantly implies that if he really cares about them he’d “push on” as long as he could.
The elderly Muslim who consents to a massive and hopeless surgery only because she doesn’t want her community to remember her as a sinner who rejected God’s gift of life and who is burning in Hell for all eternity.
So although health care produces more than its share of obvious and legally binding consent violations, we have every reason to think this is only the tip of the iceberg, that countless millions of people who don’t want health care are pressured and bullied into accepting it and undergoing unnecessary suffering against their deepest wishes.
And the obvious solution, dear friend, is to ban health care. If there is no health care, no one can be coerced into receiving health care against their wishes. We tried having a health care system that operated on the principle of informed consent, it failed terribly, and now we must pass laws imprisoning anyone who provides any form of medication, surgery, or any other treatment attempting to alleviate disease or prolong life. While doctors, nurses, et cetera may be well-meaning, the real (and indeed realized) risk of nonconsensual treatment is far too dire to allow this so-called “humane” practice to continue.
Now you may think to yourself: this seems like it would be politically unpalatable. If the Republicans obstructed President Obama at every turn merely because he wanted to slightly modify the health system, what would they think of a law that would dismantle the health system entirely, and indeed threaten large fines and jail time to anyone trying to assume its functions?
This would indeed be a significant complication if not for the fact that the Republican Party must in any case very soon be eliminated forever.
Perhaps you recall the 2000 presidential election? That one with the whole rigamarole in Florida, with the hanging chads and so on? Several thousand Democrats tried to vote for Al Gore, but the ballot was confusingly designed and they ended up voting for Pat Buchanan.
Now, the right to vote is absolutely sacred, and to have your vote unfairly shifted to another candidate is an egregious violation. Imagine how those poor Miami-Dade residents – most of them elderly liberal Jews – must have felt when they were told their votes went to an uberconservative Christian often accused of anti-Semitism and Holocaust denial. Dear friend, was that fair?
No Democrat should have to go through that. Yet as long as there are non-Democrats on the ballot, inevitably some Democrat – whether through poor ballot design, poor reading comprehension, or simple bad luck – will accidentally vote for them.
Even if they say they intended to vote for a non-Democratic candidate, can we really trust them? Perhaps they come from a very conservative area, where liberals risk violence or ostracism, and in order to maintain their relationships they must vote against their deeply held beliefs. Maybe their bosses have threatened to fire them if they vote Republican. It is a very real possibility, and quite frankly our nation’s Democrats deserve better.
The only way to protect the sacred right to vote for the candidate you truly believe is best, without the threat of accidental mishap or outside pressure distorting your choice, is to remove all non-Democrat candidates from the ballot. That way, no one can force a Democrat to vote for another party’s candidates, and we can rest secure knowing that the wishes of our nation’s electorate are being respected.
Except that some people don’t like Democrats – which is why in order to ensure absolute fairness and consensuality, instead of only including Democrats, the ballot will actually just include candidates from my own party, the Ban Everything That Anyone Might Experience And Later Regret (BETA-MEALR) Party.
Yes, we want to ban health care, but we’re about so much more than that! We also oppose gay marriage, and straight marriage to boot. We are against prostitution but also all other forms of employment and all other sex (but especially BDSM). Also religion, vasectomies, all social gatherings, gender roles and breaking out of gender roles, gift-giving, telephones…
…what is that? You say this fundamentally misunderstands consent, that it tramples the delicate balance between “freedom to” and “freedom from”? What balderdash! And here I thought you were my dear friend! How could you…oh, I believe I know what your problem is. You are being pressured to say this; some force not your own has pushed you to criticize my remarkably astute policy proposals despite a clear hidden preference against doing so. Do not worry, dear friend! I will save you! Once we get elected, criticizing our policies will be forbidden on pain of death, giving everyone complete freedom to avoid outside interference and express their honest positive opinion of us at last!
BETA-MEALR 2016: because your preferences can only be violated if you were allowed to have them in the first place!
Even though most people dislike libertarians, their basic insight – that you can get a lot of the way to morality by saying things that people consent to are okay and things people don’t consent to are bad – holds a pretty eminent place in moral discourse, especially on the Left. This is with good reason. In a country where no one really agrees on what exactly morality is, consent is a useful semi-neutral principle that allows everyone to go off and do their own thing.
I’ve written a bit before about fake consequentialism, where people who have nonconsequentialist reasons for what they believe make up consequentialist ones so they can appeal to the general populace. I don’t think anyone has ever been convinced gay marriage is wrong because of sincere concern about the fate of children adopted by gay couples, but that argument keeps getting trotted out again and again because it’s one of the few anti-gay-marriage arguments that sounds remotely consequentialist. Or people who dislike porn claiming it will encourage viewers to rape people, even though as far as anyone can tell exactly the opposite is true.
And where there is fake consequentialism, not far behind you will find fake consensualism. Suppose there’s something you don’t like, but every time you argue against it, people say “Well, it’s all consensual and it doesn’t harm anyone except the people who have agreed to it, so mind your own business.” You can come back with “Yes, but how can we be sure the people involved in it really consented? Deep down? I bet they didn’t!” Or even “I bet this would lead to something nonconsensual happening somewhere else down the line!” Consensual BDSM? Just going to glorify abuse and lead to more nonconsensual abusing, right?
I used to automatically steelman BETA-MEALRs into proper utilitarian arguments. “Well, euthanasia produces a gain of utility, by allowing people who want to die to do so. But it also produces a loss in utility, because it might unfortunately result in some people who didn’t want to die doing so. Who could possibly ever know which of these would be greater? So I guess all we can do is play it safe, right?”
But at some point, I started wondering how likely it was – even in cases where we genuinely have good reasons to worry about mistakes or pressure – that allowing people to choose whatever they preferred would result in fewer people getting what they want than banning all choices except one.
I mean, okay. You say we have to ban euthanasia, because if it’s not banned, some people who don’t want to die might have to. Okay. I come back and say “But if we ban euthanasia, some people who don’t want to live might have to. Except wait, no, not some people. All people. And not might have to. Definitely will have to. Required by law.” You say “Get the hell out of my office.”
And I tried to steelman even this. Well, I told myself, there are more people who don’t want euthanasia than who do want euthanasia. And it would be a really, really big loss in utility if we killed people who didn’t want to die. Maybe the numbers still check out.
Except when I tried to check the numbers, it was immediately apparent that they didn’t. There are loads of good data from the Netherlands we can use to estimate how nonconsensual and slippery-slopey real world euthanasia is, and the answer is statistically indistinguishable from zero.
(you may have heard the usual suspects claim that “studies show 92.7% of Dutch males die by being seized by goons and euthanized against their will” or something. This is based on extremely creative readings of the data, but proving this is a job for another blog post.)
I no longer try to steelman BETA-MEALR arguments as utilitarian. When I do, I just end up yelling at my interlocutor, asking how she could possibly get her calculations so wrong, only for her to reasonably protest that she wasn’t making any calculations and what am I even talking about?
And yet without the utilitarian angle, this whole argument falls apart on exactly the “proving too much” grounds pushed by our hypothetical politician above. If you want to ban euthanasia, why not ban health care? If you want to ban prostitution, why not McJobs? If you want to ban BDSM, why not all consensual sex? If you don’t have a good quantitative argument ready, you sure can’t support it on qualitative grounds alone.
According to Philip Tetlock’s dichotomy, a sacred value is a value in Far Mode, one that has big flashing signs saying “MORALITY!” around it. A secular value is one that is nice but not morally important, like saving money or increasing productivity.
A taboo tradeoff is when someone asks you to trade a secular value off against a sacred value, and tends to get people morally up in arms.
For example, suppose I asked you whether the government should spend a recent windfall of ten million dollars on a public education campaign about avoiding dangerous chemicals which is projected to reduce the incidence of cancer by 300 cases per year, or on a renovation of Yellowstone National Park. Different people would have different opinions, and no one would think it was an especially odd question.
But suppose I asked you whether the government should spend a recent windfall of ten million dollars paying for years of extremely expensive hospital care for an impoverished nine-year-old girl who is critically ill with cancer – or, again on the renovation of Yellowstone? Obviously you HAVE to do the former and to do the latter would be inhuman.
The inhumanity here is not in making a spectacularly bad choice. After all, the choice in the first case was even starker than in the second – saving 300 cancer patients is clearly better than maybe saving just one cancer patient. Yet the first choice offers to trade one secular value against another, while the second choice offers to trade a sacred value (life) against a secular value (national parks).
BETA-MEALR arguments offer taboo tradeoffs. BDSM opponents don’t care if a ban prevents one billion people who really really wanted to do BDSM from getting to do that. It’s wrong to have even one person be pressured into something they will later decide felt like abuse.
(Three hundred people? No problem, that’s just a statistic! But one person? SACRED VALUE SACRED VALUE SACRED VALUE.)
The same is true of euthanasia. It’s not that there’s any difference at all between the argument that would ban euthanasia and the argument that would ban health care. It’s just that not allowing even the tiniest possibility of a person involuntarily being euthanized is a sacred value, but not allowing even the tiniest possibility of a person involuntarily getting health care isn’t.
Now, I don’t like the idea of sacred values much, but other people do, and merely saying “You’re treating life as a sacred value!” isn’t going to make people start crying and protesting “I’m sorry! I didn’t mean to!” Mostly they’ll just say “Yeah, life is a sacred value to me.” Okay, fine.
What bothers me is when they do this and they pretend they’re making a value-free statement about respecting the rights of others. “Oh, well, we’re a liberal democracy and people should be able to do whatever they like with their own bodies, but I’m just worried about people being euthanized against their will, and that would be a violation of consent, and a good liberal democracy like us wouldn’t want to violate consent, no sirree!”
No. You do not care how many people are kept alive without their consent, just like you do not care how many people work McJobs without their consent, or how many people feel pressured into going to social gatherings they don’t want to attend. You care about consent solely when it serves the purpose of your sacred values. You would gladly violate the consent of a billion people on some unrelated issue rather than risk a single consent violation of your own personal pet project.
When you start preferring that every single Republican be disenfranchised rather than risk the disenfranchisement of a single Democrat, you can no longer credibly claim to be standing for the sanctity of the electoral system. You’re standing up for the Democratic Party, plain and simple, and “sanctity of electoral system” is your convenient excuse to people who would otherwise have a dim view of “let’s disenfranchise all Republicans because Democrats are better”.
Likewise, when you start preferring that every single person who desires euthanasia be thwarted rather than risk thwarting a single person who wants to live, you can no longer claim to be standing for the principle of concern for people’s preferences. You’re standing up for your religion, or your personal revulsion at seeing people die, or whatever else, plain and simple. Concern for people who might get forcibly euthanized is your convenient excuse to people who would otherwise have a dim view of “let’s force everyone to abide by my religion’s views.”
One possible counterargument: “But people dying by accident is so much worse than people living by accident!” Well, says your value system. I actually happen to feel the opposite (the reasons why are complicated, but this comic is a pretty good start). Which of us is right? I don’t know, but “I can use my value system when deciding about my own life, you can use your value system when deciding about yours” seems a heck of a lot less horrifying than a lot of the alternatives. I happen to think voting for a Republican by mistake is far more horrifying than voting for a Democrat by mistake, but insofar as we’re a democracy that choice is for each of us to make without interference.
Certainly people being pressured or dragged into something that on the surface appears consensual is a genuine problem. When people have good suggestions for how to increase the certainty that consent is genuine – like the sex-positivity community’s friendly reminders not to have sex with really drunk people – I am all in favor of this. And the one intervention that would go further than any other into ensuring all acts of consent are genuine – giving people a Basic Income Guarantee so that no one gets forced to consent to any unpleasant job or relationship out of fear of starving to death – well, I’m in favor of that too.
But when people start saying we should ban the thing entirely because they can never be totally sure it will be utilized 100% consensually, or won’t cause a slippery slope that leads to consent violations in some vague and hypothetical future – well, I support a moratorium on using that argument. The very rare cases where it might be true don’t seem worth the extreme latitude it gives everyone to declare that they are outraged at consent violations that might conceivably occur if we don’t support their pet project to abolish all possibility of consent on a certain topic. At the very least, anyone so arguing should be required to meet an extraordinarily high burden of proof, like having numbers that aren’t made up.