Solving the Too Many People Problem: Contraception vs. No More Practice of Medicine? Take Your Pick
Dr. Erich Loewy, a physician-ethicist, who has written to this blog in the past, wrote the following to a bioethics listserv regarding considerations for control of the progression of current and further over-population of our planet. He gave me permission to post his comment here.
I personally would claim that what has caused a large number of our problems both in the US as, and especially, in developing nations is that there are simply too many of us. China used to have a severe famine every few years. No doubt there are many causes as to why the Chinese no longer have these famines but one of the chief ones is that the birth rate was too high. Their one child policy has effectively given a chance to their people's ability not to have to face famine every few years. The argument will be made (and there is, of course, something to it) that this is an incursion in people's autonomy and "rights"--that is they have a claim to speak to a question and how it affects others and the community. However in my viewpoint it is a rather weak claim. The fact that the world is overpopulated is hardly a figment of the imagination and it undoubtedly is one of the main causes why millions of deaths per year, occur; not only in China but in large parts of the so-called developing world as well as in the industrialized west and especially in the US where 25% of the people are hungry a large part of the year, the average income of a worker is $8.50/hour (which makes it very difficult for one person and impossible for a family) to do more than fulfill its most basic needs--and often not even these. I know that this is against the avowed principles of many churches more interested to produce many babies than worrying about what to do with them after birth--sort of a "let them be baptized and starve to death" attitude. I know that this is not politically correct--an idea which has made a virtue of disassembling.
In various dictatorships of the past century the desire to have children was made into a virtue. Those who have studied this era will remember the "Lebensborn"--institutions in which blond, tall and blue-eyed Aryans could sacrifice themselves to their Führer by going to bed with blond, blue eyed and tall SS men who likewise were performing a patriotic act for their Führer.
It is deeply ingrained in us that being pregnant is a cause for congratulations. In Nazi Germany with the murder of about six-million Jews, millions of Germans and citizens of other nations it is true that a large percentage of the pre-Hitler population had died. It is one way of handling the bath-tub problem: a problem which say that when the outflow from the bath-tub equals the inflow the amount of water remains the same. If the outflow (modern medicine) is decreased at the same time (fewer deaths, longer life) that the inflow is increased the bath-tub will overflow. It is then that we shall have wars, pestilence and other natural disasters. Does decreasing the number of children by fiat violate personal autonomy? Yes, of course it does. Does allowing people to have as many children as they want violate the survival and flourishing of the community? Yes, of course it does.
Having an increasing number of people is dangerous both for those who can and cannot afford it. Is it a basic violation of autonomy and an invasion of human rights---yes, it undoubtedly is. But if the community fails to flourish and eventually perishes, there is no possibility to speak of individual autonomy--there will be few left.
If we continue to hold every fertilized egg or implantation of such an egg co-equal with a happy carpenter or college student we are comparing some very different things. In early and probably until the mid-second trimester the developing fetus is not self-aware. How do I know this? Well in a future function that lacks a substrate and is, therefore, without the possibility of self-awareness, it seems almost ridiculous to hold it co-equal with a happy, functioning human being. We have the choice: (1) encourage more people not to use contraceptives and continuing the production of ever-increasing humans many of whom will starve to death or lead terrible lives; or (2) do all that is necessary to decrease our enormous birth rate.
Do I not respect the right of religions to do all they can not to use contraception? Yes, you are right, I do not respect any institution which makes a virtue out of producing babies fated to live miserably and cause their community to fail.
We are told by experts in the field of world populations that we cannot currently feed the world if we do not become vegetarians (which I would applaud but is another matter) and that even if we do we shall be unable to do so entirely. We have only two reasonable choices: (1) give up the practice of medicine except perhaps for palliation or (2) Decrease the world population even should that interfere with people's personal morality.
Dr Erich H. Loewy
Professor of Medicine and Founding Chair of Bioethics (emeritus)
Associate in Philosophy
University of California, Davis
It may be necessary for some to rethink the moral harm of contraception and balance it against the moral harm of the suffering of starving populations and all the other consequences of over-population of this planet. On the other hand.. as Dr. Loewy suggests, give up treating disease and thereby allowing nature to reduce the population. I don't think we want to go back to the Nazi method of population reduction. What is your thoughts on this subject? Can those of you who find contraception immoral, rethink your view or suggest some other way? ..Maurice.
GRAPHIC-Photograph from CorpoAlert, modified.
posted by Maurice Bernstein, M.D. @ 8:04:00 PM
3 comments
3 Comments:
According to economist Amartya Sen, famines have been caused not by a lack of food, but from inequalities in food distribution, even within a given country or region; often there is ample food to feed everyone even during famine. I've read Sen's work and would like to evaluate the other experts' data and not just take them at their word. If the true cause of famine is overpopulation, then why historically have we had famines? (Natural disasters and weather conditions are more likely culprits, and again, the lack of food.)
For environmental and other reasons I favor contraception and we had only two children (replacement). It's trendy these days to have many children. More education about the environmental and consumer impact might help, but such efforts must be voluntary rather than compulsory, without criticism of the offspring of those who choose to have more for existing. More education will cause more to have zero or one or two children.
How can people say that China's program is a success since it removes bodily autonomy? Women in both Romania and China have experienced the trauma of forced abortions or actually had additional children and abandoned them in orphanages. The "greater good," as John Stuart Mill pointed out, leaves many people disenfranchised, often a significant minority (as with women or black people or people with disabilities).
What could very well result is the systematic sexual and medical abuse of women by the medical establishment in the name of population control. There is no perfect solution to overpopulation, but education seems best. Education easily becomes propaganda and worse, though.
I personally think we have more responsibility to those already here than those who (with or without contraception) may or may not be born, so I am in favour of contraception over withdrawal of medical care, tough I do believe that withdrawal of medical care is appropriate in futile cases (particularly where this preference has been stated by the patient ahead of time).
If you live in the US, it is evident that your access to contraception and abortion has been reduced significantly in the last eight years. Instead of the Chinese violations of personal autonomy, you have quite the opposite, and this is problematic to me in a world where we have more people than we can support ecologically. Adequate contraceptives for men would help in our battle against current overpopulation, because double protection is better than none at all. Many of the methods in development for men do not require hormones (heat or internal barrier), and so would be safer than many of those for women.
Should we force contraception on anyone? Absolutely not. Should we lower the barriers as close to nil as possible (including more methods, male methods, proper education of our children starting at an age early enough to catch them before they have sex, low or no cost, limited medical barriers)? Absolutely.
--PG
The following commentary titled "How Best to Temper Population Growth" was written to me by ethicist Dr. Stanislaus J. Dundon who teaches philosophy at California State University, Sacramento, California. I publish the commentary here with his permission. ..Maurice.
"How Best to Temper Population Growth"
As some of you know, my real entry into bioethics was through my concern with world hunger issues which were severe in Africa in the 1970's. Over the next decade I became on of the few full-time agricultural ethicists in the country. My work in Congress as a AAAS Congressional Science Fellow during that time was focused on international agricultural development and I have published a number of long pieces on the topic.
It is difficult to address Dr. Loewy's compassionate concerns. He is an intelligent person with a passionate interest in human well-being. At least indirectly his alertness to the fact that any physician assisted suicide (PAS) legislation in this state would lead inexorably to pressure put on the sick poor to choose death over expensive treatment played a pivotal role in the defeat of PAS laws in California. This is a perceptive person, gifted with a solid social justice conscience.
In this issue of large regions suffering hunger, however, all concerned contributions and contributors to the solution the problem need to do a lot of home work. I am currently teaching so I have not enough time to make an adequate response, especially to a man of Dr. Loewy's calibre. I will lay out some fairly strong counter-points, in the style of Food First's frequent publications of "Myths" (Remember Frances Moore Lappe' ?)
Dictators Cause Babies: Dr. Joseph Opio-Odongo (Uganda) did an interesting (published)study of regional severe weather related food shortages in Africa which demonstrated that the ability of states to avoid actual starvation was directly related to the degree of democracy in the state. Dictators caused death, not babies. (As an aside, how is it that Africa is regarded as over-populated?)
Over-population Causes Poverty: Destitute people cannot buy food, no matter how dense the population is. If there are no destitute people, no matter how dense the population, no one thinks of hunger as a problem at all, and only cranky people will call the place over populated. Notice how the fuel prices are causing people to move back into the "over-crowded cities." Starvation occurs mostly in rural places where over-population is rarely the case. Poverty, on the other hand, often causes poor but stable rural families to choose larger family sizes as a defense against infant mortality and as a social network in old age. Students of "demographic transition" have repeatedly warned that under-population is a far greater danger in stable middle class societies. A mere prediction in the 1970's, it is now a menacing reality in Western European states. Birth-Control in those counties is likely to destroy those populations. People advocating more birth-control are usually referring to somebody else's family, whose family-size choices (assuming stable governments and peace) are rational and in their best interests. Paradoxically, it is crushingly obvious, and supported by many studies, that poverty causes overpopulation, not vice-versa.
[Many studies have shown that as infant mortality rates decline so do family sizes.]
Modern Medicine Causes Over-Population : Saving large numbers of lives, meaning hundreds of thousands, is rarely the product of sophisticated medicine. Clean water, good sewage, small amounts of meat and adequate caloric intake take most of the credit for a healthy population, although rapid delivery of medicines during an epidemic deserves some credit as does the spread of simple re-hydration techniques. This assignment of blame to medicine (the bath-tub analogy) is paradoxical in another direction. To the extent that fairly simple medicines are available to keep children alive, to that extent poor families will choose a smaller family. Commentators on this issue need to be wary of class-based discrimination--namely that poor people are stupid. But a further oddity exists in the bath-tub metaphor. If we can't get enough food out to people in some region, how is it that life-saving medical intervention is getting there?
Government Enforced Family Size Policies are Needed: As the demographic transition studies show this has not been the case in most stable societies where there is adequate social infrastructure. China and India's programs are fraught with problems. What impact on world history will millions of testosterone laden Chinese men who cannot find wives have? In India, the chances of a girl baby making it to birth whose sex was detected in utero are 1/8000.
Dundon's Final Wisdom (hopefully not a myth) Social policies advocating prudent family-size choice are necessarily predicated on a stable and peaceful environment. Such policies, if they are advocating a smaller family, need to be family-oriented true. I.E. it must be true that this family will be better off with a smaller family than a larger family. If you cannot make that case by truthful education, then either you are assuming your audience is stupid, or you are willing to resort to violence, violence of the worst sort, namely trying to stop births on their way. An extremely interesting, occasionally humorous and brief book on this subject is Mahmood Mamdani's(also Uganda) The Myth of Population Control where he does a retrospective philosophy of science critique of the 10 year Harvard -Rockefeller Population Control project in the Punjab. For me one of his most interesting discoveries was that some neighboring "control" viliages" (where no explicit birth control work was done) achieved equal or superior reduction in family sizes because a government Small Farms program introduced yield improving techniques which made keeping marriage aged daughters on the farm an average of two additional years to help with farmwork. Normally these girls would move to the city, marry and have babies immediately. Statistically, keeping these girls out of the marriage market for two years reduces their total fertility by 24%! (Babies come quick with 18 year olds.) And that showed up in the village stats.
I hope this helps.
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