More than a year later, it is still painful to recall the silly talking points that supporters of sexual liberation bellowed when the Supreme Court was preparing to hand down its decision in the Burwell v. Hobby Lobby case. It’s even more painful to recall their reaction after the ruling was made. According to Sandra Fluke, for example, the Hobby Lobby decision was an attempt “to limit access to comprehensive women’s health care from all directions.”
Others, echoing Justice Ginsburg’s concerns, argued that allowing closely held businesses to decline to provide certain forms of contraception and abortifacients because of a religious objection would also allow businesses to refuse to provide blood transfusions in their employee healthcare plan. Not providing the employees of Hobby Lobby with certain forms of contraceptives, they argued, was to fail to provide an essential medical service to them, just as it would be to refuse to cover the cost of blood transfusions. Fluke, once again, provides a pithy encapsulation of Ginsburg’s objection: “Why is birth control—an uncontroversial form of [health] care used by an astonishing number of women—different from blood transfusions and vaccines, which many individuals have religious objections to?”
More recently, the release of damning videos exposing Planned Parenthood’s depraved practice of selling the body parts of the unborn children they have dismembered has reminded the public that Planned Parenthood is a repugnant enterprise that profits from the killing and commodification of human beings. Yet Hillary Clinton recently warned that the Republican-led effort to defund Planned Parenthood amounts to “an attack on women’s health—nothing more, nothing less,” adding that Republicans “should be ashamed.” Senator Bernie Sanders also echoed Clinton’s remarks, averring that “the attempt by Republicans to cut off support for Planned Parenthood is an attack on women’s health.”
Such appeals to “women’s healthcare” are tired talking points. But they reveal something that is rarely, if ever, noted: that sexual liberation and its sacred cows—abortion, contraception, sex-reassignment surgery, etc.—depend crucially on a particular view of medicine and health. As it happens, this account of medicine and health is false. A sound account of medicine and health, which I defend below, reveals that abortion, contraception, and sex-reassignment surgery are not medical procedures—and, in fact, they are in most cases utterly antithetical to the practice of medicine.
A Proper Account of Health and Medicine
As Dr. Leon Kass elegantly puts it, “medicine is an art which aims at health.” And health is the proper functioning of bodily faculties.
This is simple enough to see when we consider bodily faculties in isolation: a healthy eye is one that sees well, healthy lungs are those that respire well, and healthy hearts are those that pump blood well. But one should also speak of health as not merely the proper functioning of a particular bodily faculty but the proper functioning of the human organism considered as a whole. Thus, a healthy human is one whose parts function well in unison toward the end of the bodily life of the whole. Of course, it bears noting that bodily health is necessary but not sufficient for the holistic flourishing of the human person.
In order to know what medicine is not, one needs to know what medicine is. Consider the following cases.
– A man whose eyesight has recently worsened visits an ophthalmologist to see what is the matter with his eye. The doctor identifies the problem with his eye and restores the man’s eye to its proper function.
– A physician giving his patient a routine check-up notices that, if left untreated, his patient’s cholesterol levels will kill him by way of cardiac arrest. The doctor recommends that his patient change his diet, and he prescribes cholesterol-reducing medication and physical exercise.
– A woman books an appointment with a plastic surgeon because she believes that her nose is aesthetically displeasing. There is nothing functionally wrong with her nose—she can breathe comfortably and easily detect different smells. The surgeon proceeds to remove some cartilage from her nose to mold it into a more aesthetically pleasing shape.
– A man with perfectly functioning arms desires to have one of his arms removed. In his opinion, doing so would allow him truly to “be himself” and to “be more comfortable” in his own body. Besides the desire to remove his arm, the man seems perfectly reasonable. The man books an appointment with a surgeon and the surgeon agrees to remove the man’s arm.
The first two cases seem quite clearly to be medical procedures. The third case is questionable. The fourth example certainly does not qualify as medicine.
The first two cases reveal important truths about medicine. First, medicine restores bodily faculties to their proper function. Second, medicine prevents the dysfunction of bodily faculties. Indeed, this is the account of medicine that has prevailed for thousands of years and that explains the content and spirit of the Hippocratic Oath, particularly its primum non nocere (“first, do no harm”) maxim. Call this account of medicine, then, the Hippocratic account.
Our hesitation to consider the third case a medical procedure is because the procedure is not oriented toward either the restoring of a bodily faculty to its proper function or preventing a bodily faculty’s dysfunction. Likewise, in the fourth case, rather than being oriented toward the restoring of a faculty to its proper function or preventing its dysfunction, the procedure intentionally frustrates and damages the proper operation of bodily faculties. Because of this, we can say something much stronger about the fourth case: it is contrary to the aims of medicine.
Contraception and Sterilization
If we accept this account of the nature and purpose of medicine, what conclusions follow?
Consider contraception. Broadly speaking, a contraceptive is a device, chemical, or surgical procedure that prevents the proper functioning of sexual faculties in order to prevent pregnancy, either temporarily or permanently. Contraception includes familiar examples such as condoms, hormonal contraceptives, and IUDs, as well as surgeries such as vasectomies and tubal ligation.
If the Obama administration is to be believed, such things are not merely optional gadgets and procedures that indirectly, if at all, relate to healthcare and medicine—such things are rather essential medicines, indispensable to healthcare.
Is the Obama administration right? Clearly not. Given what has been said about medicine and health, it is easy to see why: insofar as contraception is oriented toward preventing bodily faculties from functioning as they should, such things are not medicine. In particular, sterilization is utterly contrary to medicine: it involves the mutilation of reproductive organs to prevent them from ever functioning properly. Thus, the Obama administration’s argument that the Little Sisters of the Poor should be forced to provide contraceptives vis-à-vis its HHS mandate on the grounds that contraception is medicine or “healthcare” is mistaken at best and tyrannical at worst.
Abortion and Abortifacients
If contraception is not medicine, then abortion is all the more clearly not medicine. Abortion, after all, is the intentional killing of an unborn human being. First-trimester abortions typically involve the destruction of the unborn through the use of a powerful suction device, which tears apart the unborn and removes him from the womb. Second-trimester abortions likewise typically involve the dismembering of the child with pincer-like tools and removal of his body parts from the womb. Third trimester abortions often involve placing the unborn child in the headfirst position, bringing him mostly out of the birth canal, and then crushing his skull and suctioning out his brain.
I mention these grisly details because they are relevant to understanding that abortion is not a medical procedure: it involves the intentional and catastrophic destruction of the bodily faculties of the unborn child with the purpose of killing him. Such a thing is utterly contrary to medicine on two counts: not only does it intentionally destroy the bodily faculties of the unborn, but it also prevents the proper functioning of the pregnant woman’s bodily faculties, which are ordered toward the nourishment, growth, and eventual delivery of a healthy child.
Abortifacients, insofar as they prevent the proper functioning of a woman’s reproductive process with the aim of preventing the implantation of an embryo, cannot be considered medicine either. And yet there is no end to the claim, from Nancy Pelosi, Elizabeth Warren, Hilary Clinton, and other abortion apologists, that abortion is “healthcare.”
Repeated attempts to force those with perfectly reasonable objections to abortion to refer for or personally perform abortions in the name of “medicine” or “healthcare” are, then, not only unjust but also nonsensical because such procedures are not even medicine in the first place. Here, too, is a perfectly good argument for why Planned Parenthood ought not receive even a dime from taxpayers: the “services” they offer vis-à-vis contraception, abortion, etc., are not medicine and are in fact utterly contrary to it.
“Sex-Reassignment Surgery” and “Conversion Therapy”
As others and I have recently argued here at Public Discourse, transgenderism and “sex-reassignment surgery” are, to say the least, fraught with many problems. Insofar as medicine is the enterprise of restoring bodily faculties to their proper function and/or preventing their dysfunction, “sex-reassignment surgery” cannot be considered a medical procedure, insofar as it involves the intentional damaging of otherwise healthy bodily faculties.
Pejoratively labeled “conversion therapy”—attempts by physicians and psychologists to restore a patient’s understanding of his gender identity to accord with his physical sex—is, on the other hand, a perfectly proper procedure of medicine (despite attempts to ban it) insofar as it involves the restoring of a patient’s mental faculties to their proper function.
This particular argument can be buttressed by Christopher Tollefsen’s insightful account of sex and gender: if one’s sex is the particular reproductive function that one’s body is fit for participating in coitus qua male or qua female, then it is perfective of one’s truth-apprehending mental faculties to correctly recognize what sex one is. And surely, because marriage and the common good to which it tends are of crucial importance, there is strong normative reason to communicate truths (and avoid communicating falsehoods) about one’s sex vis-à-vis one’s gender persona, which undergirds the social norms that make the institution of marriage possible.
The fact that procedures such as these are so commonplace, coupled with the fact that we allow public persons such as Hilary Clinton, Nancy Pelosi, Elizabeth Warren, and Bernie Sanders to get away with calling such things healthcare without challenging them, tells us that we have, to our fault, lost a grasp of what medicine is and what it aims toward. Despite all the marvelous technological advances that have in many ways greatly benefited the enterprise of medicine, a perilous rot has set into its philosophical foundations that is threatening to turn medicine, as it already has in part, from a noble art to an efficient servant of murder and mutilation.
Medicine, in other words, is sickly, shambling, and begging to be treated. This is largely because we have for many decades neglected to care for it and allowed it to be treated as an instrument for sexual liberation and other political causes. It is a grave mistake, however—one that millions of aborted children and hundreds of mutilated persons can attest to—to pervert medicine for political goals. Like the noble and ongoing campaign to restore a true and good understanding of marriage and motherhood, we too must invest in the project of restoring a proper understanding of medicine and the noble aim to which it tends: healthy and flourishing human bodies. For as Dr. Leon Kass warns, “there will be an end to medicine unless there remains an end for medicine.” We would be fools not to heed his warning.