Public Health

Public Health and the Tyranny of the Common Good

Mississippi's proposed "personhood" amendment extends progressivism to the uterus.

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By tonight, Mississippi likely will become the first state to stipulate that individual personhood begins at the moment of conception. Liberals see this as a right-wing triumph. But it's just as fair to say it simply extends progressivism to the uterus.

Mississippi's ballot measure has implications that reach beyond the abortion debate, writes Jessica Valenti, founder of the Feministing blog, in The Washington Post. She cites cases in which pregnant women intent on giving birth have been forced to undergo C-sections or bed rest against their will for the good of their unborn children. Granting personhood from the moment of conception, Valenti suggests, could end up pitting the rights of women against the rights of their potential offspring more frequently.

Pro-choice advocates generally dispute the notion that someone who has sex implicitly accepts a set of moral obligations toward any "product of conception," at least while it remains in utero. The fetus has no claim on the mother's resources, they contend, and she should not be required to provide any.

Once the baby is born, however, progressives say not only that the parents have obligations toward the child—but that so does everyone else. Through no choice of their own, people thousands of miles away are suddenly on the hook to make sure the child gets adequate food, decent housing, and a good education. The implied social contract that did not bind a mother to her baby suddenly binds complete strangers to it.

What's more, the scope of that contract has been expanding. Merely providing resources is no longer enough. See, for example, health care: To provide the uninsured with medical care, it does not suffice simply to pay taxes that fund social-welfare programs. Under the Romney/Obama individual mandate, everyone must buy health insurance for the sake of the common good.

The same rationale undergirds much of the campaign against obesity—which, some say, costs society $270 billion a year. Part of that total comes from direct expenses such as medical care for diabetics. An additional $73 billion allegedly comes from lost productivity due to poor health—at least according to a rather inexact study funded (surprise!) by Allergan, the maker of a gastric-band system for obesity surgery.

The social cost of lost productivity is an interesting concept. It implies not only that you have a duty to avoid becoming a burden to others, but also that you have an affirmative duty to produce resources for others. (Because otherwise, society has "lost" something that, in truth, it never had in the first place: your future exertions.)

Employers that offer bonuses for joining wellness programs have bought into the notion. Since they're the ones paying the tab for workers' pay and insurance, they're entitled. But as the government takeover of health care proceeds, even the self-employed and non-employed could soon find themselves (a) mandated to buy insurance, and then (b) required to shape up.

Or consider Gardasil. Five years ago a federal panel recommended that all girls receive the vaccine against the human papilloma virus (HPV), whose most common effect is cervical cancer. Twenty states enacted legislation to mandate the vaccine for girls. Now the Advisory Committee on Immunization Practices has recommended that boys receive the vaccination as well. Part of the rationale: HPV can cause genital warts and cancer of the throat and anus, which afflict roughly 7,000 men per year. Immunizing boys is "for their own good," as The New York Times put it.

But there is another rationale—namely, that rates of HPV immunization among girls have not lived up to expectations. As the Los Angeles Times argued last week, "the reasons for broadening the vaccine's use are much bigger" than HPV's effect on boys: "Just as contraception and family planning should be seen as societal health issues rather than solely 'women's issues,' so should the medical battle against a form of cancer that was diagnosed in about 12,000 American women in 2007. . . . Yet (to date) the full series of three doses has been given to only about one-third of the age-appropriate girls."

In other words, young boys should be vaccinated against a sexually transmitted virus not just for their own good, but for the good of others. From a public-health perspective this makes excellent sense. From an ethical perspective, though, it raises the same questions as the obesity debate does. What obligations do private individuals have to cede control of their bodies—their persons—to others for the sake of the collective good?

"The slippery slope is getting slicker and slicker," Valenti writes. She notes that guidelines from the CDC "tell all women of childbearing years to treat themselves as pre-pregnant—taking folic acid, refraining from smoking and maintaining a healthy weight. How long will it be before pregnant women are arrested for not taking their … vitamins or for not exercising enough—or too much?"

How long will it be before all of us are?

A. Barton Hinkle is a columnist at the Richmond Times-Dispatch, where this article originally appeared.