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January 19, 2010

Comments

nato

I don't think anyone liked Coakley. She was a pretty terrible candidate who ran a weak and dirty campaign. Nate Silver's analysis is the best I've seen:
http://www.fivethirtyeight.com/2010/01/lets-play-blame-game.html

That said, I definitely think that Nathan's general analysis about the intransigence of the ruling party is more or less accurate. Basically, the Dems took forever because Obama insisted on Republican votes and the liberal wing said "no, we have a majority and we'll do it our way." In the end the Senate bill turned out to have most of what Obama was looking for, but it took a tremendously long time to do so. Meanwhile, it seemed like all the government was doing was wrngling over healthcare while the unemployment rate (especially the long-term unemployment rate) skyrocketed.

Basically, I think the Dems are just generally incompetent at politics. Nothing new, really, but it confirms my original low expectations.

Nathan Smith

I don't think Dems being "incompetent at politics" is the problem. The problem is their ideas. Given the scale of the health care reform legislation, its costs, its importance to the nation's future, its complexity, to spend a year negotiating it doesn't exactly seem excessive *per se*. If it were good legislation, it might have given time for people to understand it better and come to support it. It did give people time to understand it better. But the result was that they didn't support it.

The problem is that the set of beliefs that motivate health care reform are wrong, even silly, despite being advocated by some very intelligent people, such as Paul Krugman. (But that shouldn't surprise us, for very intelligent people often believe very silly things. Thales, the first philosopher, thought that everything was made of water.) This set of beliefs has an empirical basis-- most other industrialized nations spend less on health care and have (slightly) longer life expectancies-- but a very inadequate one, since (a) longevity depends on many factors and not primarily on health care, (b) the United States bears, directly through R&D costs and indirectly for being providing the critical mass of demand for high-end cutting-edge technologies, most of the costs of health care innovation the spillovers of which come to other nations as a windfall, (c) health care is sometimes used to provide quality, not quantity, of life. There is no theory worth mentioning to support the empirical basis. Sometimes you hear arguments at the popular level that health insurance is parasitic because health insurance companies try to select for health, but that is a mere failure to understand the concept of insurance of the most primitive kind. Economists, in rigorous and abstract ways, and all sensible people less systematically, analyze social situations and societal phenomena under the assumption, which we know by introspection as well as observation to be true, that people respond to incentives. This idea is missing from the arguments of health care reform advocates. They throw in hints of reasonable arguments but do not follow through, and dismiss as sophists those who try to refute them, on "empirical" grounds.

The truth is that health care is not expensive in America because the market, which in general promotes progress and efficiency as I suppose everyone by now knows, by some unaccountable perversity does the opposite in this one area, health care. It is expensive because Americans' lifestyles are less healthy, and because Americans consume a lot of health care, a lot of expensive treatments and tests. We pay for, and get, the best health care in the world, though not necessarily the best health in the world. That's not to say that America's health care system is an example of *laissez-faire* market efficiency; far from it. It is heavily regulated: entry to the medical profession is tightly controlled; hospital ERs have to provide for people without insurance; most health care for seniors is financed by Medicare at the public expense; and the structure of so-called "insurance" contracts-- the term is a misnomer-- insulates customers from the cost of the care they get and encourages over-consumption, an anomaly encouraged by the tax code. That said, it may well be that our health care system *is* efficient after all, in the sense that if people weren't insulated from the costs (and had higher incomes because they were not paying directly for the health care they consume) they would still buy all or most of the premium medicine they buy.

The way to bring costs down is to stop insulating people from costs, to the extent possible. It can't be done entirely: the nature of health care is that people will suddenly suffer disasters that impose costs equal to a significant part of, or even more than, their lifetime earnings. I'll put to one side for the moment my deep moral qualms about saving lives for millions of dollars when thousands could save the lives of orphans in Africa (a practice which the Catholics seem to have embraced as a dogma and yet which seems to me an expression of the inordinate modern horror of death that comes from loss of belief in the afterlife and thus quite contrary to the spirit of Christianity). So people will purchase insurance, and that will create misalignments of individual and social interests. But it needn't do so on nearly the scale that it does today. It would be good if we got accustomed to the idea of going $30K, $40K in debt because of a medical emergency as something normal. If we did, we might not have to do it for long, because we'd have the incentive to turn into entrepreneurial patients and know how to get better treatment for less, and we'd create the kind of downward pressures on cost that empowered customers have wrought in so many other industries. And the less entrepreneurial patients could imitate the more entrepreneurial ones.

Anyway, the Democrats believed vaguely that if we just took a few steps in the direction of socialized medicine costs would fall and health care would improve by magic. If that were true, the process by which they chose to pursue this end might have worked out well. Most people would find they had an interest in supporting the legislation. The few who would lose out in the short run could be bought off by transferring some of the gains of the many winners, without sacrificing the latter's support.

Instead, as the debate engaged various stakeholders, most of them were inclined to oppose it and made demands in return for their support. And since the true case that health care reform would benefit the broader population couldn't be made since it didn't exist-- Obama could only argue for the reform in a very incomplete and naive way-- public suspicion only spread and intensified. The problem is the ideas, not the process. The process, namely one in which democratic deliberation leads to popular rejection of a bad idea, seems to be working just fine.

Joyless Moralist

A couple of random, unrelated comments.

1) I don't know that Thales' theory was *so* silly, taken in context and considering certain limitations of his time. What it really is is the first known case of a monist metaphysics -- the idea that everything that exists might be made of some underlying thing. If you reworded it a bit to say that, "Everything is made of some basic underlying material, of which water is the most elemental manifestation," would that sound so ridiculous? To one who didn't know the things that we do about what water really is, anyway?

In any event, Thales certainly isn't the only one to have toyed with monist metaphysics over the centuries.

2) Your remark about Catholics makes it sound as though you think that, according to Catholic dogma, every available medical treatment must be used to save a life. That's not the case. It is permissible to refuse certain medical treatments, because of expense or for other reasons, even realizing that death will be the result. What is not permissible is a) deliberately killing patients to save money (or for any other reason), and b) denying them food or water as a means of bringing about their death. So, you can't poison them, suffocate them, starve or dehydrate them, as a means of ending their life. But you can, under some circumstances, unplug a respirator. You can take a patient off an expensive medication even knowing that they will die shortly afterwards. You can decide not to do the hundred thousand dollar surgery.

The Catholic position is not a manifestation of a modern fear of death. It is born of a respect for life, and for God's sovereignty over life and death. It seems to me that the utilitarian-type theory to which you are apparently attracted, which treats life as a commodity to be maximized and death as a tragedy to be postponed if at all possible, is a better reflection of the modern horror of death.

3) I don't have time to develop this, but I think one thing to consider in opening up health care to market forces as you want to do, is the incredible amount of stress that this would put on consumers. Given what a maze modern health care has become, the idea of navigating those waters unfettered (and yet with so much to lose potentially!) actually sounds to me like a tremendous burden. This isn't the kind of disadvantage economists normally count for much, but I think there's something to be said for streamlining people's choices somewhat, though I wouldn't want to do away with choices entirely.

I'd like to develop this thought more, but unfortunately, my narrow window of available time just elapsed. :)

nato

jm is, of course, correct. Maintaining the requisite level of information about medical treatment would be onerous and, for many people, close to impossible. This is, for example, why I'm glad we have an FDA, though I frequently don't agree with how it works.

Nathan probably has the intuition that if the government does not step in to manage information abut health or whatever and doesn't get in the way of an alternative that some private (i.e. non-governmental) analogue will arise at some point. This is what has always happened before and we can assume that it will happen again. But then, these have not necessarily been market institutions so much as institutions that had to operate within a market. I think 1) they would take a long time to eventuate, during which there would be needless suffering, death and waste and 2) I'm not sure we can assume that what would eventuate would be (on average) better than an institution we establish through the (now traditional) process of democratic government.

nato

Put another way:
The trials an travails of healthcare reform in the 2010 United States are probably best regarded as another example of natural organic evolution* of new traditions/social technologies with which history is replete.

*not literally!

Joyless Moralist

Yes, well, I wouldn't want to completely do away with choice, as I've said. Making ALL of one's own health decisions would be overwhelming, but I think most people do know certain things about themselves and what they want when it comes to health care, and it's nice to accommodate those to some degree. Insurance companies, in some cases, offer a good degree of choice... you have a limited number of options for providers that are fully covered, and then usually you can get some compensation even when going outside the system, but you'll have to pay more for that. And insurance companies make decisions for you about which preventative care is most important by, in many cases, covering certain things 100% (in which case people are more likely to do them -- I generally get whatever tests or preventative procedures my insurance is willing to cover fully), and others less or not at all, in which case only the determined are likely to seek them out.

I guess what I'm thinking is that it should be possible to have some level of competition, and some level of consumer choice, without asking patients to forge their own health plans from scratch, as it were.

Nathan Smith

JM writes:

"It seems to me that the utilitarian-type theory to which you are apparently attracted, which treats life as a commodity to be maximized and death as a tragedy to be postponed if at all possible, is a better reflection of the modern horror of death."

Honestly I didn't want to start another quarrel about end-of-life issues, but when I write anything about health care I just can't help running up against the big fact that so much is spent in rich countries to draw out life for a few more months when so many people die in poorer countries, in the prime of life, of preventable illnesses. Socialists and religious leaders often express disgust at the way rich people gorge themselves and dine luxuriously while people elsewhere in the world starve. But this charge is overdone, at least in our times. There isn't really a serious global scarcity of food these days, such that overeating by rich people is linked to the hunger that some poor people suffer. There are local scarcities of food, but these are generally related to security or transport or spoilage and other storage and distribution issues, and there probably wouldn't be any less hunger in Malawi or Ethiopia if all Americans gave up excess eating. By contrast, health care at the end of life really does eat up a large and growing share of the productive powers of wealthy nations, so that there *is*, to some extent now and probably much more so in the future, a trade-off between marginal life extension via astronomically expensive medical procedures, and all the things that rich countries do to help poor countries, from direct foreign aid to pushing technological frontiers to buying clothes and coffee etc. It seems to me that popes and priests and pastors ought to call people on their excess health care consumption the way they do on their excess food consumption, shaming them: how can you justify this chemotherapy or this mammogram when people in Angola or the DRC are dying for lack of bednets? Instead, they seem to be doing the opposite, exacerbating the problem; they want to compel people to accept health care that they don't even want. That said, the Catholic position as JM describes it does sound like a reasonable way of drawing the line. So maybe we don't disagree, but...

Incidentally, the quote is very odd, because JM seems to be attributing to me, and blaming me for, precisely the view that from which I was suggesting an attitude of dissent. I was not saying that death is a "tragedy to be postponed if at all possible," I was saying the exact opposite, that one sometimes *shouldn't* postpone death even if it is possible, because the resources can be put to a better use. Because the example I used involved saving lives elsewhere, maybe JM thinks that I'm trying to maximize the total human life-years lived, but I said nothing of the kind. The case where hundreds of other lives are left unsaved so that one life might be saved is just a way of making the inappropriateness of the course of action devastatingly obvious. I didn't rule out the possibility that one might rightly forgo an expensive life-saving operation for the sake of some purpose other than life extension; say, from refusal to raid the grandkids' college funds, or so as to leave a larger bequest to a church or charity, or even just from distaste at the pain and discomfort involved in the procedures or at seeing people go to so much trouble for oneself.

But to return to the main argument, it seems to me that if I understand JM rightly, the attitude I would want to adopt personally and perhaps, to a lesser extent, to encourage in others, on end-of-life issues, is not inconsistent with the Catholic position. An example may illustrate. I once met a guy, not old, he was in his late 30s or early 40s I think, who had had such horrible health problems that he said his insurance company spent $1 million keeping him alive. He seemed healthy enough when I talked to him, so that's good at least, and I certainly don't wish to judge him: probably he thought it was perfectly acceptable to exploit to the full an insurance policy which he owned to save his own life, and that is certainly a tenable view. But I would feel very uncomfortable letting such vast amounts be spent on myself. The money has to come from somewhere; and that money would come out of premiums, creating ripple effects that ultimately would impoverish the whole world, harming the quality of life for a lot of people, and more likely than not-- it's hard to figure out for sure-- ultimately costing several lives somewhere else by destroying resources which could have saved them. So if I foresaw the expenses (and of course one might have thought, over and over again, "Just another $10,000 and I'll be on my feet again," which would change the moral calculus somewhat), I would want to decline the treatment. And as far as I understand, that course of action would be consistent with the Catholic position on end-of-life issues, no? And more generally, I take it that the Catholic position would allow individuals, if they so chose, to make end-of-life medical decisions on the basis of such an altruistic calculus as I'm proposing instead of seeking to maximize life extension, provided that those decisions didn't involve deliberate euthanasia or deprivation of food and water?

JM writes:

"[The Catholic position] is born of a respect for life, and for God's sovereignty over life and death."

Now, this sounds good but I don't really know what to make of it. I mean, yes, God is the Lord, and we should strive to do His will, by all means! But that applies to *everything*, not just life and death, and to suggest that God has some sovereignty over life and death, specifically, seems to separate that issue from others as if God were not sovereign in other matters, or was somehow less sovereign. No doubt JM would deny this is what she meant; no doubt sincerely; yet I think the implication is still there, at least a little bit. And that maybe it matters. Because if we just say that God is sovereign over all things, that we ought to do His will in everything in our lives, we immediately become aware that, after all, He hasn't specified everything that we should do, that He has left much to our own choice, that we have freedom, and that His laws do not lessen that freedom, but, if we understand them and once we have grown with their aid, even increase it. In that sense to put God's will and human choice in general opposition to each other is a mistake, even if prideful self-will can alienate us from God and even from ourselves. Now if we apply this to end-of-life issues we should expect God's sovereignty to be consistent with our own efforts to do what is right in the light of our own reason, and this would very likely leave room for a person to make end-of-life medical decisions on the basis of altruistic calculation, though probably without constraining them to do so. And it sounds to me like the Catholic position does in fact, imply this. God's sovereignty does not mean that individuals don't get to choose; it constrains the choice a bit but leaves a good deal of room for individual decisions, e.g., to refuse the expensive operation. In this sense, the "God's sovereignty over life and death" phrase seems possibly a bit misleading, since why use the phrase if not to mean that God's sovereignty is somehow stronger, more exacting, in this area, leaving less room for individual choice? But perhaps that's hair-splitting.

The reason I dwell on it a bit, though, is that in the Terri Schiavo affair in particular, the whole attitude of the religious right-- and I don't use the term pejoratively; on the contrary, I am generally an admirer and fellow-traveler of the religious right-- seems to have been wrong-headed and unhealthy. First, to equate removing a feeding tube with depriving a person of food and water to kill them is implausible. A feeding tube is not "ordinary." Ordinary people can ingest food and water on their own. And from something JM said a while back I think this argument, though not the general view, is regarded as a tenable position even among Catholics. But if you're a spiritual advisor to the person with legal custody of Terri Schiavo and you advise them that it's (probably) wrong to remove the feeding tube, well, all right, it's a plausible way to resolve a difficult case. If someone draws the opposite conclusion, however, and thinks the feeding tube should be removed, and that the person would want that done, that's a judgment that must be respected even if one disagrees with it. It must be respected because it's plausible. To condemn and vilify someone for making that judgment call is to commit injustice. But it gets worse. The case turns into a national *cause celebre*, and Congress, in a turn of events that as far as I understand is a sort of mockery of constitutional due processes in the United States, tries to intervene directly in the case. What is one to conclude but that political Catholics are not content to advise their own faithful in private conduct but that they feel impelled to hijack the state for ends most of the population does not support, having little regard for democratic legitimacy? I'll gladly admit that there's nothing morbid in the Catholic position *per se*, but I'm afraid it does seem to me that the motive of the participants in the mass hysteria about Terri Schiavo was a morbid modern fear of death projected psychologically onto the helpless Terri Schiavo, under the pretext of a basically sensible but excessively legalistic Catholic position on the end of life. Is it necessary for me to argue that Catholics can distinguish private and public morality and be loyal and respectful subjects of a state that doesn't draw all the lines on social questions exactly the way the Church does down to the last iota, or do Catholics already know this and just let emotion overwhelm reason during the Terri Schiavo affair?

But the real tragedy of it is this. Think of all the energy that was spent during the Terri Schiavo affair. Now imagine if all that energy were poured into a movement to cut Medicare spending and divert the money into foreign aid to fight malaria and AIDS in Africa. How many orders of magnitude greater is the number of lives that might be saved? And not just the number but the quality of the lives. Perhaps it will seem incorrect or offensive to take the quality of lives into account, or to say that, say, an able-bodied young Malawian mother's life is worth more than Terri Schiavo's. I would agree that the able-bodied young mother *herself* is not worth more than Terri Schiavo; or at least, that it is not for us to judge; because the chief worth of each is her immortal soul. But to say that their *lives* are of equal worth is to reduce life to the mere fact of consciousness. Life is movement; is working and singing and dancing and running and walking and talking and laughing and bearing children and being of use to one's neighbor; and by that standard, yes, the life of an able-bodied young Malawian mother is worth more, and more worth saving, than Terri Schiavo's. Surely this is not contrary to the Catholic position, yet during the Terri Schiavo affair the Catholic position *seemed* to insist on valuing a life in total and permanent disability equally with any other life; and that's what made it seem morbid and nihilistic and filled other Americans with horror.

Joyless Moralist

Well, the Sciavo case was complex, and I think there were many details of it that contributed to the general outrage. There was the fact that her parents, who had been caring for her for years, wished to continue doing so, but her husband, who had already moved on and had another family with children, insisted that her tube be removed. Technically he was her next of kin, so he won the day, but taken in context that seemed somewhat unfair. Then there was the way that it ended, with Gov. Bush literally ordering the state militia to forcibly prevent the nurses from administering care to Schiavo as she starved/dehydrated to death. Altogether, I would give the protesters (many of whom were Evangelical, by the way; it wasn't only the Catholics who were concerned) the benefit of the doubt and assume that it wasn't just horror of death per se that motivated them; rather, it was a general horror of the culture of death, which sees the elimination of inconvenient people as fine, and even obligatory.

And, incidentally, I think it's important to note that much of the rhetoric used to defend (husband) Schiavo emphasized, not the better uses to which the relevant resources could be put, but rather the idea that Schiavo *would be better off dead* than in a vegetative state. *That* is an offensive position. Personally I don't think it right to remove the feeding tube, but I agree that this decision is more defensible than many, and much more so than the case made for abortions, which are happening by the thousands all over the world. So there is a sense in which the tragedy of Terri Schiavo is comparatively little compared to others that are going on all the time; at the same time, I don't think the religious right was wrong to see the Schiavo case as being in many ways of a piece with other aspects of the "culture of death."

As for refusing treatment on the grounds that it's too costly or too wasteful of resources -- yes, I think the Catholic position does certainly allow for this in general, though of course it may be the wrong thing to do in given cases. I do agree with you that there are cases in which a person *ought* to refuse treatment, for themselves or even for their dependents, if it really is exorbitantly expensive and thus costly to others. On the other hand, a utilitarian life-maximization calculus is not consistent with a Catholic perspective, so I'd need to get a better sense for your position before rendering an opinion on whether your general view is consistent with the Catholic one or not.

Finally, I do think there's a sense in which God has more absolute sovereignty over life and death than over many other things. But unfortunately, I don't have time to explain further right now, so I'll have to leave it at that for the moment.

Nathan Smith

Well, maybe JM's right about the protestors' motivations in the Schiavo case. I suppose if you were following it closely those details would motivate the emotional response. I didn't hear those, and I didn't actually pay much attention to it at the time, thinking it didn't really warrant attention, but I guess it made an impression on me so that I still think about it when these issues come up. I'm hardly an authority, but I do think the impression it made on the broader public was unfortunate. Maybe part of the problem is the highly tendentious and propagandistic phrase "culture of death." That's a little bit like calling America's consumer culture the "culture of trash," on the grounds that a side-effect of buying lots of stuff is that you produce a lot of trash, or calling America's law-and-order system a "culture of incarceration," on the grounds that our success in keeping crime down has involved a large expansion of prison populations. Such terms would be tendentious because trash and incarceration are not goals but *side-effects* of consumer capitalism and law and order, and even if it's plausible that we are too accepting of these side-effects, it is unfair to name the culture after these side-effects. Likewise, though some of the activists for abortion and euthanasia do seem creepy, the typical citizen who doesn't like thinking about abortion and euthanasia but thinks they should be allowed favors ease or pleasure or economy, not death *per se*, even if he recognizes that death is a side-effect, and in the case of abortion I think many or most pro-choice people don't think the fetus is a person so they don't think the death of persons is even a side-effect of their preferred policies. I suppose they would still admit that the death of a fetus is a death, but if we're going to include the deaths of non-persons then the ones who really have a right to use the phrase "culture of death" are the vegetarians. Indeed they should be much more entitled to use the phrase, since those of us who savor chicken and beef really are enjoying the deaths of animals in a way that women who get abortions or people who opt for euthanasia are not enjoying the deaths of fetuses or of themselves. The other group who would have a right to use the phrase are pacifists; I'll gladly admit that in my hawkish moods I am much more willing to entertain policies that directly cause death (though they may indirectly save net lives) than your average pacifist. The Catholic Church is more pacifist than I have sometimes been but is ultimately neither pacifist nor vegetarian. So for this non-pacifist non-vegetarian organization which once upon a time sponsored the Crusades and used to burn people at the stake for their beliefs and celebrates proudly the gory deaths of its martyrs, whose very symbol, indeed, is an instrument of torture and execution, suddenly to come along and (after reversing its long-held position to become an opponent of the death penalty) start blaming modern-minded tolerant urban professionals for their "culture of death" on the ground that they use contraceptives and condone occasional abortion and euthanasia for the sake of the ease and pleasures of life seems insolent to the point of absurdity. I agree, at least mostly and maybe almost completely, with the Catholic position in substance, but the term seems quite unfair and I think even more counter-productive. Indeed, I wonder how many people who were following the controversy only at a distance got the impression that the phrase "culture of death" was a reference to the 20% or whatever of the population that had nothing better to do than think obsessively about the death of one obscure Terri Schiavo. In this respect the terminology of the abortion debate is better. Both terms, "pro-life" and "pro-choice," are tendentious, but in opposite directions; each side is called by the term that it prefers. Perhaps we could label the sides on euthanasia "culture of life" vs. "culture of convenience" or "culture of comfort?"

By the way, in what sense is it offensive to say that Schiavo would be better off dead, aside from, perhaps, the rudeness of the language if JM is quoting directly? I'm not denying that it is, just wondering why. I believe it has often been customary to shoot crippled horses, "to put them out of their misery." In other words, the shooter of crippled horses believes the horse would be better off dead. Is that offensive? Of course I recognize there's a moral difference between animals and people. But the difference is that it is generally and presumptively, unless some important factor renders it justified, wrong to kill a person, as it is not wrong to kill an animal. So it is wrong, at least usually and maybe always, to *act on* the belief that a person would be better off dead. But is it wrong to hold the *opinion* that they would be? But how can a Christian claim that it is, if we believe that at least some people dwell in beatific glory beyond the grave? When the martyrs went to their deaths singing, perhaps the main reason was that they saw an opportunity to glorify God, but did they not also expect to win crowns, to be, so to speak, better off, happier, after they were dead? At the end of C.S. Lewis's *The Last Battle*, the characters are killed in various fashions (a train wreck on Earth; a battle in Narnia) and find themselves in a paradisical country beyond the grave. Is C.S. Lewis wrong to suggest that Peter, Edmund, Lucy, Eustace, Jill, and King Tirian are better off dead? If we divide this into two questions: (a) "Is it true that people can be better off dead?" and (b) "Even if it is false, is it acceptable for someone to express the opposite view if they believe otherwise?", wouldn't a Christian have to answer Yes even to (a), let alone (b)? Or even if we answer No to (a), surely we can accept that someone might sincerely and plausibly believe that some living states are worse than death, and that to spare people such states is an application of the Golden Rule, even if, we believe, a wrong one?

Joyless Moralist

One might think that a person was better of after death if one believed that they were enjoying a glorious afterlife, though there are still reasons not to kill them (as you know, I take issue with your "presumptively okay/presumptively not okay way of thinking about it, but never mind that for now). But the glorious afterlife argument didn't appear much in defenders of Schiavo's death. The idea was more that such a life was in itself an evil, not only not worth anything, but actually better not lived. A similar argument is often employed to justify aborting Down Syndrome children, or children with disabilities.

You say, "Yes, but it's okay, because these people think such lives are worse than death." Well, sure, but the question is, what kind of person would think that? Ignoring your anti-Catholic ranting (which is even more irrelevant than usual here), the question we should ask ourselves is: does our culture embrace an ethic that holds life cheaply, valuing superficial commodities to excess and tolerating moral atrocities as a result? If so, the phrase "culture of death" might be objectively fair, whether or not people think of themselves as embracing death.

Suppose, as an example, that a queen was in the habit of sending subjects to do very hazardous things just on a whim, for no very good reason. "It's all right," she might say when they die horribly. "They're just peasants, and their lives are worse than death." She may believe that; she might herself prefer death to peasanthood; but objectively speaking, she's got a gravely deficient understanding of life and its worth, and her actions are no less monstrous because she is incapable of appreciating them.

Similarly here. Certainly proponents of abortion, say, wouldn't describe themselves as pro-death, but their inability or refusal to recognize the horror of their crimes is its own indictment. The phrase "culture of death" was coined by JPII to describe the trends seen in the Western world, embracing abortion, euthanasia, etc, in what he saw as a steady progression towards the position that only the healthy/beautiful/useful/pleasing deserve to live. It's not so much intended as an apologetic phrase for the unconvinced; rather, it gives those who see and recognize this trend a way to refer to this phenomenon that they all see. But I think it's an apt description, and helps explain what the defenders of Terri Sciavo's right to live thought they were fighting.

Nathan Smith

JM seems to have misunderstood me. In what I think she calls "anti-Catholic rhetoric" I meant to be taken as voicing not my own view, but that of a typical representative of the so-called "culture of death," i.e., a mildly hedonistic, somewhat affluent professional, in everyday matters honest and decent and amiable, who thinks that people in painful terminal illness should be able to choose to die when they want to, and who thinks it's OK to terminate an unwanted pregnancy. On the Inquisition, though I meant to attribute the words to such a hypothetical person, my own view is the same: the Inquisition was utterly evil and anti-Christian, and to understand why it cannot be condoned is the *sine qua non* of political conscience. But I would tend to be, if anything, a bit of an apologist for the Crusades, and obviously I don't think the use of the cross as a Christian symbol is morbid. However, I can see how a reasonable person would.

To JM's question, "does our culture embrace an ethic that holds life cheaply?" the answer is a resounding NO. Many people in our culture *do* hold different views than the Catholic Church about where life (or that of a human person) begins, hence the disagreement about abortion. But on what we do agree in regarding as human life, we place very high value. That, in a way, is the whole idea of the welfare state: that human life has such a high value that providing everyone with insurance against starvation is more important than respecting rights to property. A high valuation of human life was strikingly evident in Clinton's foreign policy: the only goal seemed to be to stop genocides and other mass killing; whether people were free from totalitarianism was at best a secondary consideration; and moreover, Clinton refused to risk American lives for that end, withdrawing from Mogadishu when 19 soldiers were killed, and then waging the war in Kosovo in such a manner that *not a single American* died for the cause. Again, when 3,000 were killed in the WTC terrorist attacks-- 1/100,000th of the US population-- the entire foreign policy of the world's most powerful nation was transformed at a cost of trillions of dollars.

A "culture of death" is the opposite of the problem we have. Ours is a culture of whatever-you-do-never-think-about-death, a culture of faux-immortality, a culture that worships youth because it carries no traces of the approach of death, marginalizing the old in nursing homes and regarding the process of aging as vaguely shameful. Christianity is in some ways more of a culture of death, and I mean that in a good way: it regards death as an evil of course; indeed it regards death in general, the dissolution of the fusion of soul and body that ought not to be dissolved, the exile of the soul into the senselessness and chaos and darkness of Hades, as horrible and disgusting, and it rejoices in the Resurrection of Christ and the promise that "death is slain" and that all men may be resurrected someday; but it doesn't necessarily regard every particular death as a great evil. On the contrary, "precious in the sight of the Lord is the death of His saints." It rejoices in its martyrs, and it is not above rejoicing in non-martyric but heroic deaths of fighting men in battle for just causes. And it encourages its members, at least sometimes, to think about death, so as to stir them to greater vigor and vigilance in living so as to secure their eternal happiness even at the expense, if need be, of much earthly toil and humiliation and sorrow and sacrifice. Death is not a taboo subject for Christians as it often seems to be for liberals. Certainly it is not the ultimate evil. (The fallen nature of man that brings death into the world is, perhaps, the ultimate evil, but not the particular deaths of individuals in today's world.)

Which brings me back to my opinion that the "culture of death" is a singularly unfortunate phrase. It's unfair and inapt, because contemporary liberal culture actually does place great value on human life, even in a way too much, and the disagreements between Catholics and liberals concern either questions about facts (Is the fetus a person?) or questions about who gets to make decisions (Do individuals or external rules get to make end-of-life decisions?). On the specific questions of abortion and euthanasia the Catholics do happen to be pro-life, but that's accidental and not a general characteristic of a Catholic worldview: with respect to vegetarians, or pacifists, or when advising a person how to respond to a demand to trample on the cross or be shot, the Catholic position is pro-death. Possibly on the question of whether a person ought to accept astronomically expensive medical treatments to extend life a couple of years at a time when there is so much poverty in the world, the Catholic position should also be pro-death. The "culture of life"/"culture of death" rhetoric obscures this. Worse, it tends to ratify, at least by suggestion, precisely that excessive fear of death and sense of entitlement to the absolute maximum of life that is medically feasible which is a great vice of liberal culture. This conflation of Catholicism with welfare-statism may contribute to a certain kind of popular appeal, but I think it tends to distort and misdirect the efforts of the religious in the public square. It makes socially conservative suburbanites feel like saints, when they shouldn't.

Nathan Smith

By the way, I mean no disrespect to John Paul II in any of this. Just because I don't like the way he framed this issue doesn't mean he wasn't a good and wise man in general, worthy of admiration.

nato

Kat and I have discussed with each other that we would be revolted at the idea of lingering after the destruction of almost our entire personality, and my grandfather has over and over demanded that we allow him to do what he sees fit if he becomes subject to irremediable Alzheimer's, of which he has a visceral horror. It would seem that we all regard the ruined mind as a negation of our selves, and a burden on both the emotions and the finances of our loved ones. I would never want some shambling remnant of my body and brain to persist after my substantive death, mocking my erstwhile life.

I don't know how Sciavo felt about it, but if Kat was in her place, I believe would feel a deep and relatively unconflicted duty to follow her wishes. I hope she would do the same for me.

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