Many conservative argue that instead of government programs for the needy, we should let charities and volunteer organizations provide those services. Let's support churches and local groups who operate soup kitchens and reading programs. Especially around the holidays, we see volunteer groups at their best, ringing bells outside the malls and collecting toys at high schools. It would seem that there is already a vast infrastructure of help for the poor and the sick.
The reality is that these groups are struggling and only scratch the surface of need.
The food kitchen that my dad runs is operated by a bunch of 80 year old men. They need help stocking shelves and driving the van to pick up food and toys from local schools. They need younger bodies to do the physical labor involved with the job, and they need those bodies during daylight hours. Nobody is there.
People are willing to help the needy and the sick theoretically, but they don't want to get their hands dirty. My mom is helping take care of dying woman. People who are dying and in severe pain can be extreme assholes. All of her former friends have deserted her, and only my mom remains to make sure the bills are paid and the woman gets her pain medicine.
I've often wondered why thousands attend Right to Life marchs, but there are no volunteers for special needs schools or at inner-city schools. Is it because it is easier to support a dead fetus than a 8 year old with behavior problems? Yes.
When people volunteer their time, they want some reward. They aren't expected a paycheck, but they want that warm feeling of doing a good job. A smile and a hug from a photogenic child or a kind wrinkled face grandma. It's very hard to help people who are ugly, disturbed, angry, and dirty.
We need government support, because there's a limit to charity. There are not enough people who are willing to do the dirty work of stocking shelves during inconvenient times, comforting an old woman with dementia, talking to a sad 9 year old with behavior problems. Simply writing a check for groups that do good deeds isn't enough. They need people who are willing to roll up their sleeves and do a job with no thanks. Because those people will never appear, government has to step in.
UPDATE: As part of my after school marathon, I end up spending a lot of time talking to moms of children with special needs. These kids' needs are in a whole different league than my kids' needs. Think smearing poo on the wall type of needs. Think never ever sleeping type of needs.
Because these kids are high needs, the families have very high needs. The parents are burned out, stressed, exhausted, lonely, depressed, worried, and often times, financially strung out. There is absolutely no one helping these people. No one. There are no church groups helping them. In fact, so many of these families have been run out of their churches, because the other parishioners don't want to deal with those kids. There are no neighborhood welcome wagons handing out casseroles. These women cling to each other sharing their own private hells.
Apt. 11d 
Americans give about $250 billion dollars a year to tax deductible charities, and the #1 recipient of that money is churches (about $100 billion). A large chunk of those donations are motivated by the charitable works that the churches do with their donations. Also, recipients of those donations may feel more kindly to the church, and sign up and give when they no longer need charitable services.
Imagine that you increase taxes $100 billion instead. People would have less money to give to their church, and they would feel less need to support the church’s charitable causes before the government was funding them. It’s essentially a church/state turf war over the same funds and the allegiance of the poor people and potential church goers.
LikeLike
I totally agree with you, Laura.
Re: Ragtime’s comment, when the government began to get into the welfare business, the churches raised some of these same objections. One church leader – I believe it was a Catholic – said the this shouldn’t happen, because “The poor belong to us.”
LikeLike
“I’ve often wondered why thousands attend Right to Life marchs, but there are no volunteers for special needs schools or at inner-city schools. Is it because it is easier to support a dead fetus than a 8 year old with behavior problems?”
The people who go to things like the March for Life are primarily high school and college students. If you’d like to study this, I think you will find that those students are probably more likely to be involved in volunteering than the rank and file of others their age, and that this is particularly true of those with a higher level of involvement. It would certainly be interesting to have numbers on this. My feeling is that the more likely somebody is involved in A, the more likely the same person is involved in B (if those things do not actively conflict). For instance, your dad is pro-life (right?) and also running that food bank. As my grandma says, if you want something done, ask a busy person. It’s not people who are currently doing nothing that will be most helpful if you ask them to assist you. (For a related case, think of the lefty girls who have buttons for every conceivable cause on their bags. The fact that a lefty girl is vegetarian does not reduce the chance that a lefty girl is also pro-Palestinian, pro-abortion and pro-OWS–you could probably get her to attend an event for any of those causes.)
I don’t know if you’ve noticed this, but in a larger family (which is more common among those who are strongly pro-life), there’s usually at least one kid with significant problems–a heart problem, Downs Syndrome, autism or some weird health fluke. You roll the dice more than other people by having more kids and don’t cull out the sick ones, and you’re going to have more to deal with than the normal family under your very own roof. I have an old friend who is very pro-life, but the last time I saw her, she had to carry her baby around with a little tank all the time (some sort of digestive condition), and she only had three kids at the time. And then there are people like the Deputy Headmistress who has raised 7 children, two (?) of them adopted, one of the adoptees having Down Syndrome, and now that her kids are grown, is doing a lot of the raising of two little boys with a single mother. There can be an awful lot happening just at home. And even with a completely healthy family, just the fact of always having a baby or a toddler or being pregnant or homeschooling means that a lot of outside activities aren’t feasible. And it goes without saying that having a large family and accepting imperfect children when they come to you is a very natural expression (if not the most natural expression) of pro-life sentiment.
LikeLike
Another factor which I believe influences those who volunteer is the need for all the adults in a family to be a wage earner. When ‘Dad’ worked outside the home, ‘Mom’ often had time after the children went to school to volunteer at the local charity organization. Now with both Mom and Dad and any adult children working outside the home, no one is free to do the charity work during the day.
LikeLike
“When people volunteer their time, they want some reward. They aren’t expected a paycheck, but they want that warm feeling of doing a good job. A smile and a hug from a photogenic child or a kind wrinkled face grandma. It’s very hard to help people who are ugly, disturbed, angry, and dirty.
We need government support, because there’s a limit to charity.”
Let me rewrite that.
Here’s my version:
“When people work, they want some emotional reward. They expect a paycheck, but they also want that warm feeling of doing a good job. A smile and a hug from a photogenic child or a kind wrinkled face grandma. It’s very hard to help people who are ugly, disturbed, angry, and dirty. We need more charitable effort and better oversight of state-funded facilities, because all too often, state-funded funded nursing homes and group homes for the disabled are staffed by indifferent or callous or abusive workers.”
Show of hands, who wants to go to a Medicaid-funded nursing home when they get old? Not me.
LikeLike
As Grandpa Simpson was threatened, “Then we’ll put you in a crooked home we saw in 60 minutes!”
LikeLike
Laura,
I wonder if you are looking in the wrong places, or if maybe NJ is really a hellhole of indifference. Here are two stories from my own circle of experience:
1. A mom friend of mine with two special needs children tells me that there’s a very good local dance program for disabled children who would not be able to participate in a standard dance class. Each little dancer is paired with a sorority girl volunteer throughout the class to help her do the correct moves. If you had to pay those volunteers, it would be prohibitively expensive to run those classes. (After hearing that story, I have sworn never to say anything nasty about sorority girls again.)
2. My daughter has gone to a special needs horse riding program for a couple of years now. Initially, she had four people working with her (one on each side to keep her from falling off, one holding the lead rope, one instructor), plus the horse. If you were paying all of those people plus paying for the upkeep of the horse, there’s no way that the program could function (literally nobody could afford to pay that much), so it is very dependent on volunteers. Also, kids who age out of the program are able to continue on as volunteers themselves, there being a lot of work to do keeping a stable running. They recently started a program for “Wounded Warriors” to be able to ride as part of their rehabilitation. The front gate of the facility has Isaiah 40:31. I eventually looked it up and it turns out to be, “But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint,” which in context, usually makes me tear up.
I note here that 1) the activities are ones that the volunteers themselves are passionate about (aside from any interest in the disabled themselves) and 2) the two programs themselves could never exist without lots of volunteers.
LikeLike
A few days ago, Dave Ramsey was awarding a cash prize to a special needs hockey program called “Triangle Special Hockey.”
http://www.trianglespecialhockey.org/about/about.aspx
My feeling is that it’s important not to just ask people to eat their vegetables, volunteering-wise. It may be more productive of a long-term relationship to ask people to volunteer doing things that they actually enjoy.
LikeLike
As I understand, actual sociological analysis shows that religious conservatives (i.e., the kind of people who go to right to life marches) are much MORE likely to do volunteer charitable work than pro-choice secular humanists. I read one liberal commenter (I don’t remember where), who in fact did work at a soup kitchen or some such, who said, “It would be wonderful if the soup kitchens and neighborhood shelters of America were staffed by volunteers from the ACLU and NARAL. But they aren’t.”
On a more practical level, has your dad reached out to a local evangelical youth group? Of course, I don’t know where the food kitchen is.
LikeLike
The need for charity will always outstrip the supply. That’s true for government charity, too.
The need will be particularly desperate very soon. We’re still adjusting to the after-effects of effective birth-control. As the ratio of working adult to retiree shifts, there will be ever fewer strong hands to do the work.
Sooner or later, you do run out of other people’s money. This is no longer theory. Greece has attained that state this week.
While European banks may or may not succeed in delaying the inevitable unwind of the Eurozone by a month or two, the European credit catastrophe is taking on a grotesque form, first in Greece, where following news that the budget deficit will soar past an unprecedented 10% of GDP, the Greek government has halted virtually all cash outflows. Ekathimerini reports that “The government has decided to stop tax returns and other obligation payments to enterprises, salary workers and pensioners.” In other words, the entire government has now virtually halted one half of its operations – the outlays – as the country reverts even more to its status as European bank debt slave, in perpetuity, or until the country breaks away from the Eurozone and reinstitutes the Drachma (which as Zero Hedge pointed out first in August, continues to trade When Issued at various desks) whichever comes first.
http://www.zerohedge.com/news/greek-budget-deficit-pass-10-gdp-country-stops-most-cash-outlays
LikeLike
The argument that one demographic/politically-inclined (say, by abortion rights perspective) group volunteers more than others is kind of ridiculous if you think about it. Given that some areas of the country are very anti-abortion and others are very pro-choice, then how does volunteering ever get done in pro-choice areas of the country? Urban areas tend to vote Democrat and tend to have pro-choice voters, yet they have some of the greatest needs for volunteers. Are you telling me the 10 pro-choice people in NYC are doing all the volunteering? Or that in the reddest county in Mississippi, the anti-abortion people never do any volunteering?
I’m not a fan of “both sides do it,” but in this thread, both sides are trying to take the moral high ground, and it’s ridiculous.
LikeLike
As the ratio of working adult to retiree shifts, there will be ever fewer strong hands to do the work.
Osteoarthritis FTW.
LikeLike
Given that some areas of the country are very anti-abortion and others are very pro-choice, then how does volunteering ever get done in pro-choice areas of the country?
This is why I think public charity will fail to grow much in this country under the present circumstances. There is no wide agreement on what is “charity” and even less on which is the first priority for charity when you have to choose.
LikeLike
Argh. I wrote: “Are you telling me the 10 pro-choice people in NYC are doing all the volunteering?”
I meant “Are you telling me the 10 anti-abortion people in NYC are doing all the volunteering?”
I’ve gone to contract on a house at the corner of Burned Out and Fried, myself.
LikeLike
“There is no wide agreement on what is “charity” and even less on which is the first priority for charity when you have to choose.”
Indeed. I remember a thread here a while back on charitable giving and I remember somebody mentioning some sort of favorite museum as where they donate. That blew me away because (although we are museum goers and subscribe to Smithsonian and Natural History and National Geographic and rarely pass by a museum gift shop), it would never occur to me that charitable giving to a museum or something like NPR counts against my family’s charitable obligations. I’m glad somebody is keeping these museums going, It just doesn’t feel like an adequate response to Matthew 25.
http://www.biblegateway.com/passage/?search=Matthew+25%3A31-46&version=NIV
Like, I could either give to Baby L’s organ transplant fund or I could send a check to PBS. Think, think. Which is it going to be?
LikeLike
As part of my after school marathon, I end up spending a lot of time talking to moms of children with special needs. These kids’ needs are in a whole different league than my kids’ needs. Think smearing poo on the wall type of needs. Think never ever sleeping type of needs. Because these kids are high needs, the families have very high needs. The parents are burned out, stressed, exhausted, lonely, depressed, worried, and often times, financially strung out. There is absolutely no one helping these people. No one. There are no church groups helping them. In fact, so many of these families have been run out of their churches, because the other parishioners don’t want to deal with those kids. There are no neighborhood welcome wagons handing out casseroles. These women cling to each other sharing their own private hells.
LikeLike
I don’t know about specific cases, but very possibly the move against institutional placement may have swung too far. If someone has to be monitored for 24 hours a day, there is likely to be no other way public or private charity can get funding for it once that person hits 18.
LikeLike
“There is absolutely no one helping these people. No one.”
Katharine Beals (of oilf.blogspot.com) has mentioned this on her blog a couple times (her son is a bright, but very mischievous high functioning autistic kid with cochlear implants). I think it may be a problem that Asperger’s and autism have been folded together, because groups may not realize that they are serving just the most easy-to-serve. I can’t find the post right now, but KB was talking about how annoying it is when people tell her about this wonderful program or that wonderful program, when those wonderful programs have already turned her son away, because he’s just on the other side of what they can deal with.
LikeLike
http://oilf.blogspot.com/2010/07/how-to-ensure-that-autism-is-tiny.html
LikeLike
Cranberry,
Thanks so much.
Here’s a paragraph from that post–it’s really worth reading the whole thing.
“A few months ago it looked like a new opportunity had opened up: the new Kinney Center for Autism Education and Support at nearby St. Joseph’s University was offering a social skills group for adolescents with autism. We called up, there was an opening, we faxed over evaluations and went through an accelerated intake. They couldn’t wait to meet J. But then they did. “He doesn’t comply with directions,” the psychologist told me after he interviewed J with my husband, “and so he doesn’t meet the requirements of our social group. We need kids who will follow directions.” He promised to let us know if some other program opened up that might be appropriate for J.”
One thing Laura doesn’t mention in support of her argument is that you really can’t walk off the street and be much help to the poop smearing/never sleeping kid. I’ve read quite a bit on autism issues and yet I was really over my head last fall when I was babysitting a verbally delayed 4-year-old who came my way because his public school kept expelling him for behavior (i.e., the stuff they’re supposed to be helping him with). He was really a strong kid, and since he was verbally delayed, his response to any disagreement (like, it’s time for a snack or the potty or to leave the zoo or the children’s museum) was to try to punch me hard in the face. If I’d had any more time with him, I would have been well advised to study hard and figure out what the official protocols are for getting a nonverbal kid to stop trying to punch you in the face (on reflection, maybe I could hand him an M&M as I was announcing it was time for the potty). But, as I said, he was being repeatedly expelled from public school, so at the time, the public system was also at their wit’s end. (Things have since improved, I’m told.)
LikeLike
“KB was talking about how annoying it is when people tell her about this wonderful program or that wonderful program, when those wonderful programs have already turned her son away, because he’s just on the other side of what they can deal with.”
I misremembered–that was one of Katharine Beals’ commentors who had encountered the same problem.
LikeLike
But that’s part of Laura’s point. The significant disabilities are poorly suited to aid by volunteering. Quadraplegocs on feeding tubes and kids who are significantly delayed need trained help, not well-meaning neighbors with caseroles.
In the olden days, this kind of person died or was institutionalized (whi h, frankly, was abandonment, too).
LikeLike
“But that’s part of Laura’s point.”
Yes, she just forgot to make it. She discusses the lack of volunteers, rather than talking about the skills and no-how that volunteers would need to deal with the seriously disabled. (Unfortunately, those skills are not universally present in the public sector.)
That said, with all of the chaos, I bet a lot of families would take the casseroles. (I had a boeuf bourguignon and a lentil curry come my way earlier this fall, and it was a very welcome gesture of support.)
LikeLike
Actually, bj, The families would be happy to take the casseroles, but nobody is offering. They would need trained help, but casseroles are good for the spirit. Too bad that these poor women don’t get either.
LikeLike
Yes, I did think of that after posting. But, I think I understand why(well part of why) there are no casseroles in the offing — casseroles are for temporary assistance, and the women have chronic needs.
I think part of what I think is that volunteer help seems to work when it’s short tem and somewhat reciprocal (not on a tit for tat basis, but in the long term, and with pass it forward). I don’t think it works in addressing chronic needs, and I think the big difference in modern society is that people with chronic needs don’t just disappear from our communities, by, say, dying or other means.
LikeLike
I think there are several issues being conflated here. Special needs children certainly need and deserve more and better services than we currently offer, including education, respite care, and trained support. But Laura, it sounds like what also is striking you about these women is that they seem to lack support systems, the networks of family and friends that would bring over a casserole or do other “good for the spirit” tasks. That’s an entirely different need, and not one that government is well suited to provide.
Also, I agree with carosgram that there’s a smaller population of adults who are home during the day and can do the kind of volunteering you’re talking about in your father’s soup kitchen. The adults I know who do that much volunteering are stay-at-home moms whose kids are all in school–how many of those are there, these days?
LikeLike
I was actually thinking about this issue the other day. When I was growing up, my mom was a SAHM but she was also “a doctor’s wife.” As such, she participated in something called the Medical Auxiliary where she drove lonely women without families to chemotherapy, raised money for the Cancer Society and did a heck of a lot of good for the community. At some point, the Medical Auxiliary went through an identity crisis — namely because a lot of the new members were men who were married to women doctors. It limped a long for a few years and finally died. I was thinking that this is probably equally true with organizations like: wives of firemen, wives of policemen, etc. Generally, every so-called “community helper” also contributed a spouse to the pool of volunteer labor in the community — until the professions became coed and families became two career families. I was thinking about the fact that this HUGE pool of volunteer labor essentially dried up and was never replaced. I think it’s part of Robert Putnam’s thesis regarding ‘bowling alone’ — how these community organizations like Lions, Jaycees, etc. are much less strong and popular these days and how they leave a hole in tthe community.
LikeLike
I should have mentioned that my chum who sent the boeuf bourguignon and lentil curry is the mother of a little boy who is blind in one eye and partially deaf (in this particularly case, help arrived right after I’d had a brief hospitalization this fall). So that matches both what bj says about short term help and what Laura said about the help these women have being from peers.
There’s also the issue of the death of cooking. When my friend heard about my bad news, she was immediately able to tap her freezer stash of lentil curry. Not everybody would be so well-prepared.
LikeLike
how these community organizations like Lions, Jaycees, etc. are much less strong and popular these days and how they leave a hole in tthe community
I keep meaning to join the Knights or the Hibernians. I wonder if there are many under 50 in them?
LikeLike
There are college-based organizations Knights of Columbus groups, but then you’d be the old guy. When we lived in DC near a very active college chapter, my husband was involved with the Knights. He hasn’t done anything with the K of C since we moved to Texas, but he may someday. And of course our life insurance is through the Knights.
In your case, you’ll turn 50 eventually.
LikeLike
it would never occur to me that charitable giving to a museum or something like NPR counts against my family’s charitable obligations. I’m glad somebody is keeping these museums going, It just doesn’t feel like an adequate response to Matthew 25.
There are other needs. I remember a local children’s museum closed during my college years. If you don’t support the local nonprofits, they die. I consider the great works of art and thought to be part of the common human heritage.
LikeLike
So we have the decline of housewives, the decline of men’s groups like the K of C (which my grandfather belonged to and was seriously involved in), the death of cooking–couldn’t we add the drop in believers in organized religion? If numbers of people who belong to churches declines, I think there’s probably a correlating drop in the number of people participating in church-sponsored charity/community work.
I’m still not convinced government can/should step in to fill these gaps, and I am an urban-dwelling feminist liberal progressive tree-loving hippie who strongly supports the role of government in our public sphere.
LikeLike
It’s come to this. The Masons are advertising: http://www.youtube.com/watch?v=Wv0UuRbKJr0&feature=mfu_in_order&list=UL.
I’m certain our hostess is not arguing for the reinstatement of state hospitals for the disabled. Closing the state hospitals does impose severe burdens on families. Placing children with severe conditions into institutional care was one way to solve this problem.
Children grow into adults. A relative has an adult child who is cared for in a group home for much of the year. The child, with a mental age of 3 or 4, is now larger and stronger than her aging mother, who has her own health problems. It is hard to find nurses to help keep everyone safe during the times the child is sent home to her mother. There are not many people who are willing to do that sort of work for the rest of their lives, not for any amount of money.
LikeLike
“I think there are several issues being conflated here. Special needs children certainly need and deserve more and better services than we currently offer, including education, respite care, and trained support. But Laura, it sounds like what also is striking you about these women is that they seem to lack support systems, the networks of family and friends that would bring over a casserole or do other “good for the spirit” tasks.”
I think that’s right. You could probably break needs down in various ways, but here’s a try:
1. basic survival (physical care)
2. extracurriculars (like the special needs ballet or riding I talked about)
3. oversight (to make sure the nursing home is OK, the utility bills are paid, the hired caregiver or live-in relative isn’t stealing too much)
4. showing concern and ongoing interest
Category 1 is probably the area where government programs are most effective, with the usual caveats about the quality of care–government care is always a last resort. I’m very impressed by the quantity and performance of volunteers in category 2 (although, as we’ve discussed, there are no programs for the most difficult cases). 3 is an area that I think the government really struggles with (for instance in child protective cases), because it requires so much individualized, personal attention and actual caring. The CASA or guardian ad litem system is a good hybrid, I think. 4 is private more or less by definition. We can’t federalize hugs and casseroles and sympathetic emails.
LikeLike
An enlightening read on the challenges is “Boy in the Moon” by Ian Brown. There is another world of exhausted parents of special needs kids, like Laura says, that is so much more than “my kid has add” or “boy that dyslexia tutor is expensive”.
No time for a long post but you already know that u am an advocate for government support for all sorts of services beyond volunteers and the for profit sector.
LikeLike
Just want to make clear… I don’t have extreme needs. My kid is doing fine, and so are we. This isn’t a cry for help or anything. I come across these families in the waiting room of the speech therapist or at the swimming pool. They need to vent, so I hear all the stories.
Extended families are supportive in some cases, not in others. It’s really a mixed bag. Some family members are freaked out by severely affected kids. The grandparents are too old to handle the behaviors. Everyone is busy. But I’ve also heard about grandparents who drive from Queens to pick up a kid from school in New Jersey. That’s huge.
Since these people have no one to rely on them, government has to step in. There are respite programs for parents. Nurses come in, so parents can go see a movie. There’s a year long waiting list for those services. Need more of that. Also, so much of the grief that these family have comes just from battling their school districts to get basic services. Maybe if gov’t wasn’t such an asshole, these women would have better lives.
LikeLike
As Alvy Singer (Woody Allen) once said, “The food here is terrible, and the portions are too small!”
Laura gives us the modern liberal corollary: “Government is such an asshole, and we need it to step in more often!” I am a modern liberal too, but I acknowledge that the Republican talking point (“Government is the problem — let’s cut and defund it.”) is at least theoretically more consistent (even if the Republicans never actually practice what they preach).
So, not a criticism exactly, but more of a starting point. Personally, I like the idea of grants to private, secular organizations that can show better results than the current governmental structure. (But, then again, I also like school vouchers, which puts me at odds with most Democrats.) I think governments do better jobs overseeing other organizations (that it can threaten to defund) rather than doing things itself.
LikeLike
It sounds wonderful, the idea of skilled social workers visiting families of autistic children, but all government social service programs turn into gold-plated giveaways for social workers. The City of New York spends $8 billion every year–that’s $1000 for every man, woman and child in the City–on pension contributions. How many autistic children would that money care for? That isn’t what my tax dollars are used for, it isn’t what they’re going to be used for, and I’m annoyed by having my money constantly poured down the drain.
I think liberals should have enough intellectual honesty to admit where tax dollars actually go, rather than draping themselves in the mantle of suffering children. Put another way, why don’t liberals fix the government we have, before they start making up more things for it to do?
LikeLike
“Personally, I like the idea of grants to private, secular organizations that can show better results than the current governmental structure.”
Yeah, I’ve noticed that the monopoly structure of special education does seem to be a recurring thread in these posts (although we haven’t discussed it in those terms before). You go to them, hat in hand, and you get what they give you or you sue (perhaps unsuccessfully, perhaps you win and your kid has grown so much it’s a moot point) or you spend tens or hundreds of thousands of dollars to move. If that’s free appropriate public education, I am Maria of Romania.
It might be impractical, but maybe the money should be an explicit part of the IEP discussion. The school could say, we have $5k (or $15k or $50k) allotted to spend on your child this year. What is the best use of that money? Maybe you’d like respite care, not more speech therapy? Or maybe you’d like summer school and after care rather than an aide. In the current structure, if I understand it correctly, the parents’ incentives are to fight for as much as possible, even if what they wind up with isn’t really what the child needs, but if the amount of money is static, there might actually be a reduction in the use of certain services that were accepted just a consolation prize. Also, is it the case that the parent is appealing to multiple different agencies? If so, it might make sense to work with a single pile of money that can be divvied up according to the child’s needs. There would continue to be a big fight over the dollar value that the child needed, but I think it’s better to be fighting over a large scale issue like that, rather than duking it out over micro-issues like hours of therapy. Also, as Ragtime says, it should be possible to spend the money on approved services elsewhere than at the school. Ragtime says “secular,” I’d say anywhere. Who cares if there’s a crucifix hanging in the office or other paraphernalia if the therapist is competent and competitively priced?
Now, I understand that there are goofy parents out there who would want to spend the whole pile on aromatherapy, gluten-free diets, and “cleansing,” but I don’t think that the desperate mothers that Laura is talking about would do that.
LikeLike
“That isn’t what my tax dollars are used for, it isn’t what they’re going to be used for, and I’m annoyed by having my money constantly poured down the drain.”
If your tax dollars don’t go into pensions, they’re going to have to go into Medicare and Medicaid to take care of people in their old age. I don’t get why “pensions” are seen as such an evil thing. They are ways for people to retire without having to eat dog food.
LikeLike
“[I]t would never occur to me that charitable giving to a museum or something like NPR counts against my family’s charitable obligations.”
Don’t get me started on the animal lovers. One acquaintance once told me that she only donates to causes that help animals, since humans can control what happens to them and animals can’t. This applies to tax expenditures, too — I have no idea what programs will be reduced if the pressure groups have their way and convert Austin’s municipal pound into a “no-kill shelter”.
LikeLike
Wendy, I used to work for the state, and believe me, government retirees don’t eat dog food and don’t depend on Medicaid. Also, Medicare is a federally funded program for every eligible person over 65; its costs have nothing to do with the recipient’s city pension income. Stick to the facts and actual programmatic details and defend the pension system of New York City as it actually exists.
LikeLike
“I used to work for the state, and believe me, government retirees don’t eat dog food and don’t depend on Medicaid.”
Because they have pensions?
LikeLike
I oontribute to public radio and Wikipedia and MoMA and the Vancouver art museum because those are services I like to have around and realized about 5 years ago that I am now the “They” I always counted on to support those things.
I do not consider those contributions to be charitable giving like food banks, . . . .
I do think there is less community support now, but not necessarily for the parents of severely disabled children — I think the general expectation for a “normal” family would have been to institutionalize the child and relieve everyone in the family, grandparent, siblings, . . of providing that support.
LikeLike
I do not consider those contributions to be charitable giving like food banks, . . . .
Yes. There’s charity-charity for actual need and UMC-guilt-charity because the robber barons didn’t endow everything useful.
LikeLike
“…but not necessarily for the parents of severely disabled children — I think the general expectation for a “normal” family would have been to institutionalize the child and relieve everyone in the family, grandparent, siblings, . . of providing that support.”
Right.
LikeLike
“I’ve often wondered why thousands attend Right to Life marchs, but there are no volunteers for special needs schools or at inner-city schools. Is it because it is easier to support a dead fetus than a 8 year old with behavior problems?”
How high a level of awareness is there among average people without high need individuals in their own families? My guess is that as a rule, either 1) people don’t have the awareness or experience or 2) they do have the awareness and experience and are neck deep in dealing with stuff at home 3) they are already professionally employed in the field or some combination of 2) and 3).
Plus, there’s always the possibility that people aren’t doing stuff simply because nobody asked them. I suspect that a major driver of different levels of volunteer activity is that if you have certain affiliations, people will ask you to do stuff. As we all know, if you have kids in school, there will automatically be lots of requests coming your way to drive, bring something in, contribute $3 for this, $5 for that, etc. The same thing happens at church, to a varying degree depending on the personality of the flock. It’s a snowball effect, where the more involved you are, the more involved you will be, because people automatically think of you when they need something done. (My kids’ school is doing a crackdown on service hours after they realized that 90% of the volunteer work was being done by 10% of the parents.)
LikeLike
Amy P, good comments on this thread.
Alright, I’m moving on. It’s so wonderfully warm and damp around here that I”m nesting big time. It’s time for some homey posts.
LikeLike
Thanks!
LikeLike
Ragtime says “secular,” I’d say anywhere. Who cares if there’s a crucifix hanging in the office or other paraphernalia if the therapist is competent and competitively priced?
I have no problem with religious organizations being involved, as long as they don’t ask for religious exemptions from generally applicable standards. But that never happens. I find the conversation usually goes:
State: We’ll give the money to secular organizations.
Church: That’s not fair! That’s discriminating against religion unless you treat us exactly the same as everyone else!
State: Okay, we’ll include you too. Here are the list of standards.
Church: These standards say we have to teach evolution and sex education and provide birth control pills and tell people where they can get abortions and stuff.
State: Yes. That’s what the standards say.
Church: That’s not fair! That’s violation of the separation of church and state! We demand a religious exemption! It’s religious discrimination unless you treat us differently from everyone else!
State: FML.
As long as there is up-front agreement that the religious provider isn’t allowed to ignore “best practices” and substitute “church approved practices,” I don’t have any particular problem with the money going to religious organizations. But that’s never the case.
LikeLike
Ragtime,
I’m not clear on what sex ed and evolution and birth control pills have to do with speech therapy or child psychology or occupational therapy or physical therapy or feeding therapy or ABA. Those are pretty much totally different planets.
Also, it’s my understanding that the goofiest, most dangerous quack therapies are (as a rule) “secular.”
http://en.wikipedia.org/wiki/Andrew_Wakefield
LikeLike
Well, we don’t know now because they’re not eligible for funding, so they haven’t tried to come up with “prayer therapy” or whatever. Who knows what sort of crap they’ll come up with once they become entitled to federal funding. I can just imagine a church recommending “the systematic use of “the rod to teach young children to submit to authority” for autistic kids.
http://news.yahoo.com/blogs/lookout/pastor-corporal-punishment-advice-scrutinized-child-deaths-160004793.html
Like I said, if they agree in advance not to restrict what they do for religious reasons, or do some extra crap because of religious reasons, I have no problem with it. I just don’t think the religious groups will sign on to that in advance.
LikeLike
“Well, we don’t know now because they’re not eligible for funding, so they haven’t tried to come up with “prayer therapy” or whatever.”
I feel like I have to mention an odd and interesting thing that happened this spring. My oldest child is 9.5 and on the autistic spectrum and has been seeing a child psychologist for the past three years and has done a variety of different therapies as well as going to a super-duper intellectual Protestant school with a small class size for the past 4.5 years. When she was 6 and 7, there were some very scary times, but that has largely faded out with time and therapy in a trajectory very similar to the one Drama Mama talks about in the archives at likeashark.blogspot.com. We delayed her first confession and first communion about a year, but when she finally did first confession this spring, there was a definite uptick in behavior and conscientiousness. Even after two years of therapy, going to confession gave her a very noticeable moral boost. You could see very clearly that she was thinking more and was really wanting to do the right thing, in a way that had never previously been the case.
Although we don’t normally talk in those terms, there really is a big moral and spiritual dimension to autism (and indeed, how could there not be?), because autism affects an individual’s ability to see themselves, to see other people, and to understand the relationship between themselves and other people. In my daughter’s bad days, she couldn’t see other people and she couldn’t differentiate herself from her environment. In the old days, if she were angry (and the rages would go on and on and on), she’d tell you it was because other people were making her mad. I can’t put my finger on where the turning point came (it was some time in the past two years), but eventually the rages stopped, and she stopped talking as if other people were 100% responsible for her negative emotions. At this point, I think she really does see (and often understand) other people. I really identify with this post by Drama Mama (which incidentally contains a plug for a very good book):
http://likeashark.blogspot.com/2010/02/gravity-pulls-you-in-why-not-sit-spell.html
Anyway, my general philosophy about therapy is that 1) what isn’t harmful is helpful 2) more is better 3) it’s often only in retrospect that you realize what was therapeutic. So, I would heartily recommend to anybody religious that they take full advantage of their tradition, because you never know what may move you along in the direction you need to go.
LikeLike
Here’s a somewhat related story that has been important to me.
Our old pastor has mentioned in his sermons that he was an extraordinarily difficult and angry child. He was one of 7 children in a family of moderate means, so his parents must have been at their wits’ end. He too would tell his family that they were making him angry when he lost his temper. Eventually, his parents told him, how is it possible that we are responsible for making you angry when no matter what anybody in the house does, none of us can calm you down?
Fast forward 40 years, and Fr. T. is a very level-headed, compassionate and prudent pastor, with occasional flashes of temper, but the best judgment of anybody I know.
LikeLike
Religious guidance is very helpful to many people. I have never seen its benefits firsthand, but I am sure it helps many people. It is nice that some people can get it. I just don’t want my tax dollars paying for it, if they are not open to everyone.
I read this morning that “most of the Catholic Charities affiliates in Illinois are closing down rather than comply with a new requirement that says they can no longer receive state money if they turn away same-sex couples as potential foster care and adoptive parents.”
It is part of an “escalating campaign by the government to trample on their religious freedom while expanding the rights of gay people.”
“In the name of tolerance, we’re not being tolerated,” said Bishop Thomas J. Paprocki
Do we really have to wait for the New York Times expose before we find out what the church-affiliated government-funded child psychologist is saying to the autistic boy whose lesbian parents bring him in for counseling?
LikeLike
I was thinking of adoption and foster care earlier. The thing is, a lot of birth mothers who want to find homes for their babies would prefer that a married heterosexual churchgoing couple raise their child, which is exactly why they themselves are not undertaking the raising of their own babies. Isn’t it right that those mothers’ interests be represented and their desires be respected, even if those interests and desires are not ones that you yourself share? Choosing a family for a child is by the nature of things a discriminatory business (consider how race and ethnicity is handled in the adoption process). We don’t just hand people babies because it’s “fair.”
“Do we really have to wait for the New York Times expose before we find out what the church-affiliated government-funded child psychologist is saying to the autistic boy whose lesbian parents bring him in for counseling?”
You label the services appropriately and people seek out the providers of their choice (Catholic-friendly, LGBT-friendly, LGBT/Catholic-friendly, Muslim-friendly, Jewish-friendly, Jewish/LGBT-friendly, Muslim/LGBT-friendly, redneck friendly, specializing in gifted/autistic/ADHD kids, specializing in low-functioning autistic kids, specializing in home/school liaison work, etc.), with perhaps an online reviewing system where clients evaluate the service providers and the accuracy of the label the provider operates under.
The question of what is and what is not “best practices” with regard to therapy is, I think, a lot murkier than you might imagine, even in an area more conducive to “science” like physical or occupational therapy. But I feel that if the state is paying for XYZ, the state shouldn’t mind if the provider produces XYZ (with ABC thrown in for good measure), if the service recipient is informed and on board with the mix going in and ABC is not obviously risky or harmful (as an example of risky and harmful, see Wakefield’s totally secular colonoscopies and “lumbar punches” on little kids).
The line is going to be in different places for different specialties, but public services can’t simply ignore religious sensibilities. We are not 300 million totally fungible widgets. Some years back, I was friends and neighbors with an educated Muslim woman. She was expecting a baby. It was very important to her that during her labor and delivery, she not have some male personnel barging into her hospital room, and I believe she was able to work something out in advance (this was at Georgetown University Hospital, a Catholic-affiliated hospital). It seems to me that it’s not a gross abuse of public funds to accommodate that sort of request in the public sector. In fact, it would arguably be very dangerous (in fact, a public health disaster) if accommodations were not made in the public sector and low-income Muslim mothers started en masse having unattended home births in order to avoid male hospital personnel.
Less dramatically, quite a few Catholic women (and others) practice family planning through fertility awareness and have ethical or personal qualms about conventional birth control (hormonal contraception, condoms, sterilization, etc.). If one of those women walks into a publicly funded doctor’s office with a pile of carefully filled-out fertility charts (potentially a goldmine of medical information), she deserves a respectful hearing and a doctor who can give her well-informed advice that she will be able to work with. If there’s no intersection between what a doctor is saying and what the patient believes to be ethical or suited to her situation, the doctor-patient relationship is not going to be a success.
A lot of this stuff boils down to cultural sensitivity. A provider has to think, who am I treating? How can I best serve this individual today?
LikeLike
You label the services appropriately and people seek out the providers of their choice
That’s fine for me. I live less than 20 minutes from Philadelphia, and have no problem with any of that — we are at a level where we can go through lists of available pediatricians, and make sure we pick ones with admitting rights at CHOP (Children’s Hospital of Philadelphia). We would never go to a Catholic Hospital, and know people who would only go one. Fine.
The good folks who lives 20 minutes outside of the metropolis of Pierre, South Dakota (population 14K) don’t have that luxury. Many small places don’t have the population base to support your hypothetical 8 treatment centers for gay Jewish transsexuals. They only support one, and I’d rather have the Catholic woman drive 8 hours to Minneapolis to find a private Catholic service who will make sure her child is raised by heterosexuals, then make the gay couple who wants birth control do the same.
Again, the question is not whether a Catholic treatment center should be allowed to exist, but whether we taxpayers should fund it. And even if you want to make it about “choice,” it is only people in urban areas who will get it.
LikeLike
“we are at a level where we can go through lists of available pediatricians, and make sure we pick ones with admitting rights at CHOP (Children’s Hospital of Philadelphia). ”
Ugh, you’re reminding me of when I was pregnant when I lived in central Maine. I very diligently picked out the best midwife. She was wonderful, shared all my values, etc. And then a few weeks before I gave birth I told her we’d decided my husband would get a vasectomy a few months after I gave birth, but if something happened and I had to have a c-section, they should feel free to tie my tubes as long as they were in there. She stared at me. “Wendy, this is St. Mary’s.” *facepalm*
I had only two hospitals to choose from in town. At least I had two choices, I guess. I just chose the wrong one. It still never occurs to me that medical “professionals” can pick and choose which procedures to do and which medicines to prescribe.
LikeLike
As far as I know, most “professionals” get to pick and choose what kinds of work they do. It would be hard to exercise the independent judgment and autonomy which characterize professional services doing something you despised. So if an architect doesn’t want to design prisons, or a doctor doesn’t want to perform abortions, or a lawyer doesn’t want to represent cigarette companies, they don’t have to.
LikeLike
The good folks who lives 20 minutes outside of the metropolis of Pierre, South Dakota (population 14K) don’t have that luxury.
Most places 20 minutes outside of Pierre (in fact, most places in SD, ND, and NE outside of the very east most sliver), SD have no medical specialists at all. Most places that have any specialists at all have a single surgeon. You have to drive for any medical problem that can’t be handled by a GP.
LikeLike
And, indeed, Catholic Charities will not have to provide services that they don’t want to provide.
In addition, although a doctor can choose not to provide pregnancy terminations, they are on shakier ground if, say they choose only to provide terminations for Asian women, or if the baby is not a girl. CC was happy to provide the service — but wanted to limit the people they would provide the service to ( the children — who would now be prevented from access to a category of parent, the birth parent, and to the prospective a-parents).
So, in order to receive government funding, they are spinning off the services.
How do doctors react when women describe fertility monitoring as a form of pregnancy planning? I certainly believe a doctor should provide accurate medical feedback — and stay out of the religious motivation.
LikeLike
y81 — Again, it is not about the kind of work that a professional can choose not to do. It is about what they can choose not to do, while still receiving governmental funding and support. Schools were free to exclude the armed forces from on-campus recruiting due to their (former) anti-gay discrimination, and the government was free to say that if they did so, they wouldn’t be eligible to receive government funds.
A lawyer in New Jersey may, for example, be assigned to defend a man at a parole revocation hearing who hit his ex-girlfriend despite a restraining order put in place while he was in prison. That Jersey lawyer might (hypothetically speaking, of course) have preferred to not defend that particular man and let him just go back to prison, but was obligated to, as a condition of being licensed in the state. (That lawyer would have won the case, by the way. Yey?)
It is two distinct question — what should professionals have the right to do, and who should governments choose to fund. I prefer that the government only fund entities that are willing to follow secular guidelines on best practices. That means no religion, no withholding of legal treatments, and no adding unproven techniques that are church approved. They are free to attract whomever they can, but it is a bad use of government money — especially if it crowds out secular options.
LikeLike
The point I was making is that even an informed customer such as myself ended up in a situation where what I think of as a normal procedure (tube-tying) was not allowed because of religious reasons.
I just went to the website of the hospital where I had E and found their Patients’ Rights page:
http://www.stmarysmaine.com/Patient-Guide/Patient-Centered-Care/
Interestingly, they allow people to choose “not to be kept alive,” but they wouldn’t tie my goddamned tubes when I asked.
You’ll have to excuse me for being bitter. My midwife was wonderful, but she’d had a baby 3 months prior to me and was still on leave when I gave birth (so I won’t blame her). 3 days after I gave birth, when I was back home, I woke up one night and couldn’t walk; it hurt too badly. When I called the office at St. Mary’s, the nurse who answered asked me if I had a fever. When I told her no, she said, “Well, call us back if you have a fever.” And people wonder why I had postpartum depression….
LikeLike
It is about what they can choose not to do, while still receiving governmental funding and support.
You mean the Hyde Amendment?
LikeLike
“They only support one, and I’d rather have the Catholic woman drive 8 hours to Minneapolis to find a private Catholic service who will make sure her child is raised by heterosexuals, then make the gay couple who wants birth control do the same.”
Whoa–the gay couple wants birth control? (Sorry, I know what you mean, but it was really funny.)
“Most places 20 minutes outside of Pierre (in fact, most places in SD, ND, and NE outside of the very east most sliver), SD have no medical specialists at all. Most places that have any specialists at all have a single surgeon. You have to drive for any medical problem that can’t be handled by a GP.”
Indeed. When my mom was in labor with me, my parents drove right by our small town hospital to the next hospital over (60 miles away) in a small city. She did the same thing for the next two babies. She just didn’t have a lot of confidence in the small town hospital. When you live in a rural area, you drive for EVERYTHING. Years later, my mom was commuting the same 60 miles for her chemotherapy and oncology appointments. All of my small town relatives sometimes see local doctors for routine or urgent care, but all of their specialists that I know of are at least 60+ miles away, and occasionally you’ll wind up four hours away in the Seattle area (like my sister’s FIL did when he had a stroke). My grandma has lost confidence in her old local dentist, and she’d like to see somebody 60 miles away (that’s partly local politics, though–she doesn’t want to offend her old dentist, who is an old friend of the family). Distance from quality medical care (or medical care, period) is the main rap against living in a rural area. It really makes me queasy thinking about having a stroke or a heart take a half an hour drive from the nearest hospital of any kind, which is the situation my parents are in. (My home town ER is supposed to be pretty good for dealing with trauma (i.e. chainsaw accidents).) On the bright side, all those long-distance doctor trips provide a good reason to go to Costco for quality produce.
“That Jersey lawyer might (hypothetically speaking, of course) have preferred to not defend that particular man and let him just go back to prison, but was obligated to, as a condition of being licensed in the state.”
I don’t know about you, but I would never accept any lawyer (even a free one) that wasn’t enthusiastic about my defense.
“I woke up one night and couldn’t walk; it hurt too badly. When I called the office at St. Mary’s, the nurse who answered asked me if I had a fever. When I told her no, she said, “Well, call us back if you have a fever.””
You might have just been too stoical on the phone. I’ve been on the phone with nurses a number of times this fall and had similar issues a couple times–you can be giving 100% factually accurate information, but if there isn’t severe distress in your voice, they won’t think it’s a big deal, especially if there’s no fever. (At least that’s what my husband thinks happened–his nationality is prone to turn any illness into Shakespearean drama.)
“How do doctors react when women describe fertility monitoring as a form of pregnancy planning? I certainly believe a doctor should provide accurate medical feedback — and stay out of the religious motivation.”
This is going to be way more information about me then I ever intended to share, but it is highly relevant, so here we go.
Over the years, I’ve had a number of different OB/GYNs. They ask about birth control use and I say “Natural Family Planning” and nobody makes a federal case out of it. However, I am a 36-year-old woman, married 13 years with two big kids, and obviously not re-enacting the “Every Sperm is Sacred” scene from Monty Python, so my doctors probably figure I’m doing just fine. I suspect (actually, I know) that women with larger families often get different treatment, even when they haven’t asked for birth control or sterilization advice.
My current OB/GYN is a specialist on birth control. However, she is also very compassionate, with excellent people sense. I can’t evaluate her professional skills, but I know that she really listens to me, I’ve seen her performance under difficult circumstances, and I have a lot of confidence in her. She’ll occasionally suggest something that I feel is unethical, but our relationship is very good, and I’ve lately been bringing in my charts to be able to answer questions and ask her questions. When I see her, I bring all current medications, my charts, and a list of questions. I try to be a good patient. Now, ideally, I’d like to have a doctor with the same interpersonal talents who knew more about fertility awareness, but I seem to be doing OK at the moment with what I’ve got. Perimenopause looms ahead, though.
I should note here that while fertility awareness is a niche, it’s a huge niche, especially since so many women do charting to achieve pregnancy. While the Kippley’s “Art of Natural Family Planning” (a Catholic-oriented book) has 80 some reviews on Amazon, Weschler’s “Taking Charge of Your Fertility (a feminist book I think–I haven’t read it myself) has 400 some. (Of course, a lot of Weschler’s readers probably just use her book for achieving pregnancy, but her ideas are definitely in the water.)
I was at a graduate Christmas party a couple weeks ago. There were several moms at the table and one young married but childless woman who was getting the hard sell for having a baby. There was a Protestant science teacher at the table who was zealously evangelizing for charting. The other Catholic mom and I didn’t say anything, just looked at each other and smiled just a little bit.
LikeLike
I lost a big comment–not sure how exactly. I may try again later, but for the moment, I’ll just note that doctors do sometimes misbehave toward patients that the doctors believe have had enough kids already. One of my mom’s obstetricians eventually got into trouble because a nurse blew the whistle on him after he performed a non-requested sterilization on a Hispanic woman who was having her 7th child (I think–it’s been a while). I wonder if that was really the first time the doctor did that.
LikeLike
So that big comment did go through.
Here’s the “Every Sperm is Sacred” song from Monty Python’s Meaning of Life.
(Note: this is humor, rather than rigorous theology.)
LikeLike
I don’t know about you, but I would never accept any lawyer (even a free one) that wasn’t enthusiastic about my defense.
One does not express one’s lack of enthusiasm, other that on anonymous blog comments. One simply acts like a professional and does one’s job. In this case, it would involve asking for the prosecutor’s files, identifying that the records did not indicate legal service of the restraining order on the incarcerated client (irrespective of whether there was actual service), pointing that out to the prosecutor, upon which she dropped her case. Boom.
As Wendy identifies, a patient should not need to study the tenets of Catholicism in order to decide which hospital to visit — especially if one is unconscious and being rushed to the emergency room. Or, even if you are conscious, should you have to decide, while you are pregnant and hemorrhaging, “I don’t know what’s going on yet, but should I have the ambulance drive an extra 10 minutes to take me to the second closest hospital because St. Mary’s will treat my second trimester fetus as of equal value to me, and so will not harm a viable fetus to save my life?”
http://www.usatoday.com/news/religion/2010-12-21-phoenix-catholic-hospital_N.htm
Choice in the free market of hospitals is fine for me. I got to chose where to live, and what hospital to chose from a long list. Government intervention is most needed for those who don’t have those choices, and default rules matter a lot.
LikeLike
If I may tell another story…
In 1957, my grandmother (already a mother of 4) was pregnant and at some point during delivery showed signs of serious distress. The doctor told my grandfather that if it came down to choosing between the fetus and my grandmother, he would save the fetus. My grandfather, who was bipolar and an alcoholic but still seemed to have some sense, said, Um, no. And he got another doctor. That doctor focused on saving my grandmother, not the fetus. Both survived (it was a pulmonary embolism–in the 90s we discovered that there is a strain of Factor V Leiden in the family).
I’m told that the new doctor he chose eventually became my mom’s ob-gyn and delivered me 9 years later.
LikeLike
“One does not express one’s lack of enthusiasm, other that on anonymous blog comments. One simply acts like a professional and does one’s job.”
Unless one works at King & Spalding, of course. It might be a good idea if professionals worked the way Ragtime says, and it might even be very noble, but it is not in fact the way the legal profession works.
LikeLike
“”Or, even if you are conscious, should you have to decide, while you are pregnant and hemorrhaging, ‘I don’t know what’s going on yet, but should I have the ambulance drive an extra 10 minutes to take me to the second closest hospital because St. Mary’s will treat my second trimester fetus as of equal value to me, and so will not harm a viable fetus to save my life?'”
I’m not a doctor, but it’s my understanding that if a pregnant woman is hemorrhaging heavily, her baby is likely already dead.
Here’s my husband (the Catholic ethicist):
“While a Catholic hospital should not do anything directly intended to kill a fetus, by the Principle of Double Effect (here is a reputable secular account), it can perform procedures whose aim is the saving of the mother’s life and which as an unintended side-effect result in the child dying sooner than he or she otherwise would. For instance, it is permissible to remove a cancerous uterus that presents an imminent threat to a woman’s life–even if the woman is pregnant and the removal results in the child’s death. The crucial condition is that the child’s death cannot be the means by which the mother’s life is saved, since by intending the end one would be intending the means. In practice, there are probably extremely few cases where the only way to save the mother is by intentionally killing the child. But, yes, in such cases a Catholic hospital should refrain from intentionally killing one patient to save another, just as it should refrain from transplanting a heart from one living patient–even one who ‘was going to die anyway’ (aren’t we all?)–to save another. For the Phoenix case, a lot depends on nitty-gritty details of the medical procedures that I am not privy to.”
LikeLike
I’m not a doctor, but it’s my understanding that if a pregnant woman is hemorrhaging heavily, her baby is likely already dead.
In my college philosophy classes, this is what the professor would call “fighting the hypothetical.” Recognizing that we rarely act with full information, let us say, then, that you are not a medical profession, there is pain and some blood, and you don’t know what is going on.
In practice, there are probably extremely few cases where the only way to save the mother is by intentionally killing the child. But, yes, in such cases a Catholic hospital should refrain from intentionally killing one patient to save another,
And the point is that without knowing what is going on inside of a hypothetical uterus, a woman should not have to wait to dig into the “nitty-gritty” details to determine whether her doctor acted properly in letting her die. And a world in which these “hospitals” get my tax dollars, is a world in which it becomes more and more likely that women will die because religion has gotten between the doctor/ patient relationship.
LikeLike
“In my college philosophy classes, this is what the professor would call “fighting the hypothetical.””
Not really. I’ve recently read a lot of women’s stories of their miscarriages (as well as stories of scares that turned out OK), and my layman’s impression from that reading is that by the time there’s profuse bleeding, one has to make peace with the fact that the baby is probably already dead. I wouldn’t hold out false hope to anybody in that situation. A lot of women have a little spotting now and then and have successful pregnancies, but profuse bleeding is different.
I’m open to correction by any readers who are doctors or labor and delivery nurses.
Also, here’s a short primer on standard Catholic treatment of ectopic pregnancies, which is presumably what you’re talking about. The more ethically conservative approach to ectopic pregnancy does damage the woman’s fertility (by removing the damaged fallopian tube rather than attacking the fetus itself), but does not endanger her life:
http://www.catholiceducation.org/articles/medical_ethics/me0140.htm
The key thing to remember is that the Catholic approach does not boil down simply to “baby first” or “mother and baby are of equal importance,” but consists in the application of ethical principles to particular cases. Namely, it is legitimate to save the mother by using medical methods that will lead to the death of the child, if the death of the child is not aimed at and if the death of the child is not the means used. Hence, one needs a lot of particular medical detail to figure out if a particular medical intervention is acceptable.
“And the point is that without knowing what is going on inside of a hypothetical uterus, a woman should not have to wait to dig into the “nitty-gritty” details to determine whether her doctor acted properly in letting her die. And a world in which these “hospitals” get my tax dollars, is a world in which it becomes more and more likely that women will die because religion has gotten between the doctor/ patient relationship.”
Every hospital applies some sort of ethics which affects the doctor/patient relationship. Having an ethical code is not unique to Catholic hospitals. Also, whatever this ethical code is, it will not be scientific or shared by 100% of the public. It could easily happen that a pregnant patient in your hypotheticals winds up at a non-Catholic hospital, is in severe medical distress and undergoes emergency treatment that she later believes to be unethical and that that belief adds to the trauma she experiences. This is a two-way street. (This sort of situation does pop up among the questions posted at Catholic Answers Forum, where after having some emergency, women worry if the treatment they received was ethical, and if there wasn’t something more they could have done under the circumstances.)
This discussion seems oddly unempirical. Shouldn’t you be able to prove that there is a higher maternal death rate at Catholic hospitals? It would be hard to analyze because of differences in demographics served by different hospitals, but if Catholic hospitals are the death trap for women that you imagine, there should be a statistically significant difference in outcomes. In our litigious society, if Catholic hospitals were unusually dangerous for women, the lawsuits would be financially crippling.
I’ll turn this over to my husband again:
“Of course, hypotheticals are relevant to ethics, but statistics tend to be what is rather more relevant to policy questions. Alas, a quick PubMed search didn’t turn up relevant statistics.”
LikeLike
Personally, I find “Catholic Ethics” to be ethically bereft. (And yes, I understand that it is not merely a Catholic concept, with the same or similar lines of reasoning being called ‘Jesuitical’ and ‘Talmudical’, often with good reason, and also, among deontologists, not even used for religious purposes at all.)
You begin with the generally (although not completely) non-controversial rule that intent matters — that killing is worse than letting die — and then perform some mental gymnastics so that you can change your “intent” and then achieve an identical result.
The case of the ectopic pregnancy is even worse, because you are, in fact, achieving the same result for the fetus and an admittedly worse result for the woman (both lowering fertility unnecessarily, and having a surgical rather than merely medical intervention) for the sole purpose of contorting the treatment so that the doctor can feel like he acted “morally.”
You cannot simply go from “letting die is morally permitted” to “I will intentionally change the situation from killing to letting die, and then I will not be morally bad.” Intent matters, but not if you start with a choice of intents.
LikeLike
“In our litigious society, if Catholic hospitals were unusually dangerous for women, the lawsuits would be financially crippling.”
I don’t know about that. C-sections seem to be unusually dangerous for women, but most people just laugh it off whenever I mention it.
And the maternal death rate is on the rise: http://www.usatoday.com/news/health/2007-08-24-maternal-death-rate_N.htm
So we do have some empirical data that the rate is rising. The data just needs further analysis.
LikeLike