Inconsistent Paternalism

Matt Zeitlin makes the case that doctors refusing to give tubal ligations to women under thirty is okay because:

…everyone under 30 could use some soft paternalism, and permanent decisions of this nature ought to be extensively thought through, and then thought through some more. Doctor’s also have extensive personal and collective wisdom on this issue, so when there’s a near unanimous position- even among those doctors who work at organizations that provide abortions – against doing this surgery for women under 30, I feel that there should be stronger arguments against it than claims of agency, especially considering tubal ligation’s elective nature.

Which causes me to ask why choosing to be sterile is such an especially dangerous decision for a young person to make (and I am suspicious as to whether doctors treat vasectomies the same, but for now let’s assume we’re talking gender-neutral sterilization).

Choosing to not personally produce children is an extremely responsible choice. You can still be a parent via adoption. All you “miss out on” is the pregnancy experience and the (to many, weirdly comforting) knowledge that your genes will carry on. Meanwhile, you help avert possible Malthusian disaster. Assuming that there’s a toss up regarding whether pregnancy is empowering/marginalizing, I think gene continuity is the big issue. Which mostly makes me think people are crazy.

Why is it so important to have kids with your genes? Is it about rationalizing living vicariously through them? I will likely have a biological child one day, but if I couldn’t, I would shrug my shoulders and adopt. It would be annoying, but would in no way impact any of my core life narratives.

But so many people think that genetic continuity with future generations is so important that disagreeing is a sign you can’t be trusted to make decisions for yourself. This is ridiculous. A person’s agency shouldn’t be compromised unless there is a serious concrete harm at stake. With sterilization that harm is both minor and abstract.

In comparison, we let young people sign up for the army (I know, banal example), where it is “considered normal for the government to take control of a man’s body, to use him as a weapon, and to use him as cannon fodder,” to quote Mike Meginnis on Matt’s blog here. That seems to be a serious concrete harm, and I do wish army recruiters would advise those that come to see them that they have to wait until they’re at least 30 to make such a big decision.

6 comments to Inconsistent Paternalism

  • I think a lot of what you say is correct, but there might be a slight misunderstanding. My point wasn’t that there’s some intrinsic good in people having their own children. One could make the argument that from a Peter Singer style ethical system, you’d have to adopt children from third world countries, that having your own children is senseless prioritizing of your own genes with an oppurtunity cost of greatly improving the situations of living children.

    The central tenent of my post is that having children makes people happy. It’s something people want to do. It improves their emotional and mental well being. And in so much as medical care should be about that, it makes sense for doctors to permanently disable individuals from achieving what so many want. My concern is with the people getting the surgery and their happiness, not any specific good that comes from bearing one’s own children.

    And while you may think that wanting to have children for the sake of genetic continuity is ridiculous, the people having those children sure don’t think so.

  • Fair enough, clearly certain opinions are my own. But if the good of having your own children is based only on its popularity with a super-majority of people, it’s problematic to restrict the minority, no matter how small, from pursuing another, conflicting good. Control of ones body/life shouldn’t be impacted by what other people really like.

  • Having stumbled in by shamefully obvious means…

    …I would add my own feeling that doctors ought to be taking the first excuse they can to sterilize everybody in sight. Our planet has a serious problem with over-population looming on the horizon. I’d be pretty comfortable with using taxes or some other incentive structure to severely discourage anybody from having more than two children (thus maintaining zero population growth, more or less). Of course, the US isn’t really behind population explosions anymore anyhow.

  • My favorite population control solution come from a science fiction book — Green Mars.

    In it, a CEO-type suggest that every person be given the right to 3/4 of a child, and so be allowed to have 1.5 children as a couple. Then their would be a sort of commodity market where you could sell your extra half-share (and attain more resources to support your one child) or buy a half share, and so be able to have another baby.

    It’s creepy and in the category of “inappropriate market solutions to human problems,” but I kind of…like it.

  • One immediate problem with that solution is single mothers. If you’re a 35 year old woman who wants a child but the entire finding a husband thing is working out, how do you have one child? Where can you buy another 1/4 of a child? Would you buy 3/4, then sell 1/2 to a couple who wanted number two? If there was a consensus that some sort of radical population control was necessary and popular, something along those lines would clearly be the way to go.

  • Yeah, the exchange of fractional children would be complicated, maybe 2/3 is a better allowance. I imagine if I wanted to be a single parent I would just get a 1/4 from a friend, but then if children are rationed I imagine that would be a rather large favor to ask.

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