BETA-MEALRs
Several studies agree that sick people are often treated against their preferences and sometimes against their explicit requests. 51% of patients who request Do Not Resuscitate orders never get them. Among those who get them, 75% of their doctors don’t know about it. And among doctors who do know about it, 65% don’t feel a need to follow them if it conflicts with their own opinions.
So it should come as little surprise that 22% of people who sign forms saying they don’t want to be hospitalized get hospitalized and 31% of people who sign forms saying they don’t want CPR get CPR.
Or that patients who prefer to limit life-prolonging treatment get an amount of life-prolonging treatment that is statistically indistinguishable from everyone else.
Or that even though 80% of Americans say they want to avoid hospitalizations and intensive care as they are dying, in fact about 50% of Americans die in hospital and intensive care.
But in fact, the situation is far more dire than this. These studies only count people who have legally, explicitly spelled out a desire not to receive health care. What of people who sign off on all the dotted lines, but only under emotional blackmail that can hardly be called consensual?
The cancer patient who gets told she is “brave” and “a fighter” if and only if she accepts all the interventions modern medicine has to offer, but otherwise gets given “pep talks” on how she can’t “give up” on her family and friends.
The heart disease patient whose family constantly implies that if he really cares about them he’d “push on” as long as he could.
The elderly Muslim who consents to a massive and hopeless surgery only because she doesn’t want her community to remember her as a sinner who rejected God’s gift of life and who is burning in Hell for all eternity.
So although health care produces more than its share of obvious and legally binding consent violations, we have every reason to think this is only the tip of the iceberg, that countless millions of people who don’t want health care are pressured and bullied into accepting it and undergoing unnecessary suffering against their deepest wishes.
And the obvious solution, dear friend, is to ban health care. If there is no health care, no one can be coerced into receiving health care against their wishes. We tried having a health care system that operated on the principle of informed consent, it failed terribly, and now we must pass laws imprisoning anyone who provides any form of medication, surgery, or any other treatment attempting to alleviate disease or prolong life. While doctors, nurses, et cetera may be well-meaning, the real (and indeed realized) risk of nonconsensual treatment is far too dire to allow this so-called “humane” practice to continue.
Now you may think to yourself: this seems like it would be politically unpalatable. If the Republicans obstructed President Obama at every turn merely because he wanted to slightly modify the health system, what would they think of a law that would dismantle the health system entirely, and indeed threaten large fines and jail time to anyone trying to assume its functions?
This would indeed be a significant complication if not for the fact that the Republican Party must in any case very soon be eliminated forever. (...)
Yes, we want to ban health care, but we’re about so much more than that! We also oppose gay marriage, and straight marriage to boot. We are against prostitution but also all other forms of employment and all other sex (but especially BDSM). Also religion, vasectomies, all social gatherings, gender roles and breaking out of gender roles, gift-giving, telephones…(...)
II.
Even though most people dislike libertarians, their basic insight – that you can get a lot of the way to morality by saying things that people consent to are okay and things people don’t consent to are bad – holds a pretty eminent place in moral discourse, especially on the Left. This is with good reason. In a country where no one really agrees on what exactly morality is, consent is a useful semi-neutral principle that allows everyone to go off and do their own thing.
I’ve written a bit before about fake consequentialism, where people who have nonconsequentialist reasons for what they believe make up consequentialist ones so they can appeal to the general populace. I don’t think anyone has ever been convinced gay marriage is wrong because of sincere concern about the fate of children adopted by gay couples, but that argument keeps getting trotted out again and again because it’s one of the few anti-gay-marriage arguments that sounds remotely consequentialist. Or people who dislike porn claiming it will encourage viewers to rape people, even though as far as anyone can tell exactly the opposite is true.
And where there is fake consequentialism, not far behind you will find fake consensualism. Suppose there’s something you don’t like, but every time you argue against it, people say “Well, it’s all consensual and it doesn’t harm anyone except the people who have agreed to it, so mind your own business.” You can come back with “Yes, but how can we be sure the people involved in it really consented? Deep down? I bet they didn’t!” Or even “I bet this would lead to something nonconsensual happening somewhere else down the line!” Consensual BDSM? Just going to glorify abuse and lead to more nonconsensual abusing, right?
I used to automatically steelman BETA-MEALRs (ed. Ban Everything That Anyone Might Experience And Later Regret) into proper utilitarian arguments. “Well, euthanasia produces a gain of utility, by allowing people who want to die to do so. But it also produces a loss in utility, because it might unfortunately result in some people who didn’t want to die doing so. Who could possibly ever know which of these would be greater? So I guess all we can do is play it safe, right?”
But at some point, I started wondering how likely it was – even in cases where we genuinely have good reasons to worry about mistakes or pressure – that allowing people to choose whatever they preferred would result in fewer people getting what they want than banning all choices except one.
I mean, okay. You say we have to ban euthanasia, because if it’s not banned, some people who don’t want to die might have to. Okay. I come back and say “But if we ban euthanasia, some people who don’t want to live might have to. Except wait, no, not some people. All people. And not might have to. Definitely will have to. Required by law.” You say “Get the hell out of my office.” (...)
III.
According to Philip Tetlock’s dichotomy, a sacred value is a value in Far Mode, one that has big flashing signs saying “MORALITY!” around it. A secular value is one that is nice but not morally important, like saving money or increasing productivity.
A taboo tradeoff is when someone asks you to trade a secular value off against a sacred value, and tends to get people morally up in arms.
by Scott Alexander, Slate Star Codex | Read more:
[ed. Seems widely applicable - from 'culture war' eruptions to abortion. See also: Policy Debates Should Not Appear One-Sided (Less Wrong).]
