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Liberals in their own words

Warning:  this is a long post about disability and abortion and end-of-life care.  By “long” I mean “about three thousand words.” To all of you who came looking for the puppies and dolphins, or who were simply hoping to be this blog’s millionth visitor, hah.  This blog will never write about puppies and dolphins.

Eric Cohen’s recent Weekly Standard essay, “How Liberalism Failed Terri Schiavo,” is probably the best of its genre: while opposing the removal of Ms. Schiavo’s feeding tube, it acknowledges the moral complexity of the case, does not fudge the medical details, and keeps the vilification of Michael Schiavo to a bare minimum.  (The contrast with Nat Hentoff’s work on the subject is stark, and not flattering to Mr. Hentoff.)

But it purchases its thoughtfulness about the case, so to speak, by means of a misunderstanding of liberalism so severe as to amount to a form of ideological ventriloquism.  The pivotal passage comes in the middle of Cohen’s biting but plausible reading of the Florida court’s rationale for supporting Michael Schiavo:

Part of the problem was simply judicial incompetence—especially the court’s decision, in direct violation of Florida law, to act as Terri Schiavo’s guardian at key moments of the case rather than appoint an independent guardian to represent her interests, separate from the interests of her husband and her parents. But the problem went deeper than incompetence: It also had to do with ideology—with a set of assumptions about what makes life worth living and thus worth protecting. Procedural liberalism (discerning and respecting the prior wishes of the incompetent person; preserving life when such wishes are not clear) gave way to ideological liberalism (treating incompetence itself as reasonable grounds for assuming that life is not worth living). When the district court’s decision to allow Michael Schiavo to remove the feeding tube was challenged, a Florida appeals court framed the question before it as follows:

[W]hether Theresa Marie Schindler Schiavo, not after a few weeks in a coma, but after ten years in a persistent vegetative state that has robbed her of most of her cerebrum and all but the most instinctive of neurological functions, with no hope of a medical cure but with sufficient money and strength of body to live indefinitely, would choose to continue the constant nursing care and the supporting tubes in hopes that a miracle would somehow recreate her missing brain tissue, or whether she would wish to permit a natural death process to take its course and for her family members and loved ones to be free to continue their lives.  (emphasis added)

Now, one could surely read this as an effort to get inside Terri’s once competent mind. But more likely, it expresses the court’s own view of Terri’s now incompetent and incapacitated existence as a meaningless burden, a barrier to her husband’s freedom. The court’s obligation to discern objectively what Terri’s wishes were and whether they were clear – a question of fact – morphed into an inquiry as to whether she could ever get better, with the subjective assumption that life in her present condition was not meaningful life.

(My emphasis added in the passages in boldface.)

I call Cohen’s reading “biting but plausible” because it does seem that the court is phrasing its decision as a means of letting Michael Schiavo be all that he can be.  But it’s also a crabbed and ungenerous reading, on Cohen’s part, of what spouses like Michael Schiavo – or Rose Wendland, to take someone who cannot possibly be subjected to the same kind of faux moralism that infects Schiavo’s critics – go through in the course of their decisions about end-of-life care.  It’s noteworthy that both Wendland and Schiavo agreed to feeding tubes – and much, much more – for some years after their spouses’ injuries, but gradually decided that their spouses’ “lives” were little more than a legal fiction.  And it’s noteworthy that commentators – even commentators so sober and restrained as Cohen – give short shrift to the moral considerations weighed by those spouses, and construe them as people who simply want to give up and get back to their lives.  Surely this involves treating Mr. Schiavo, or Ms. Wendland, with something less than the human dignity to which they, too, are entitled.

But that’s an ancillary issue here. The real problem lies with Cohen’s identification of the real problem: his definition of “ideological liberalism” as “treating incompetence itself as reasonable grounds for assuming that life is not worth living.” This line will resonate with some disability rights activists, who already have good reason to believe, as Mary Johnson’s essay of last year put it, that liberals just don’t get it when it comes to disability.  I was interviewed for that essay, and I was pretty harsh on liberals myself, for their reluctance to see disability rights as central to civil rights.  But this time, I’ve got to come to liberalism’s defense.

Here’s why.  Cohen’s distinction between procedural and ideological liberalism leads him to the following conclusion:

A true adherence to procedural liberalism – respecting a person’s clear wishes when they can be discovered, erring on the side of life when they cannot – would have led to a much better outcome in this case. It would have led the court to preserve Terri Schiavo’s life and deny Michael Schiavo’s request to let her die. But as we have learned, the descent from procedural liberalism’s respect for a person’s wishes to ideological liberalism’s lack of respect for incapacitated persons is relatively swift. Treating autonomy as an absolute makes a person’s dignity turn entirely on his or her capacity to act autonomously. It leads to the view that only those with the ability to express their will possess any dignity at all – everyone else is “life unworthy of life.”

This is what ideological liberalism now seems to believe – whether in regard to early human embryos, or late-stage dementia patients, or fetuses with Down syndrome. And in the end, the Schiavo case is just one more act in modern liberalism’s betrayal of the vulnerable people it once claimed to speak for. Instead of sympathizing with Terri Schiavo – a disabled woman, abandoned by her husband, seen by many as a burden on society – modern liberalism now sympathizes with Michael Schiavo, a healthy man seeking freedom from the burden of his disabled wife and self-fulfillment in the arms of another.

Again, the gratuitous “in the arms of another,” as if Cohen or any of his compatriots would be more sympathetic to Michael Schiavo if he had joined the priesthood.  But never mind Schiavo for a moment.  What are fetuses with Down syndrome doing here?

I know, it would be more politically efficient for me to ask why “early human embryos” are refashioned here as “vulnerable people.” But the assumption that liberalism will advocate the termination of pregnancies involving fetuses with Down syndrome goes to the heart of the matter, and I know a thing or two about fetuses with Down syndrome.

So let me hit the ball back into Cohen’s court: this is what ideological conservatism now seems to believe – whether in regard to the earliest or latest stages of life: that decisions should be made not by individuals or families, but by those who have decided that their moral judgments about such matters are objectively correct, and who have made those judgments enforceable by means of the power of the state.

Cohen has a point about the insufficiency of autonomy; in fact, it’s a point that Janet and I agree with, in part, in our Boston Globe essay on the subject.  But doing away with autonomy altogether leads to truly monstrous conclusions, which are no less monstrous for being expressed tenderly and eloquently:

But the autonomy regime, even at its best, is deeply inadequate. It is based on a failure to recognize that the human condition involves both giving and needing care, and not always being morally free to decide our own fate.

In the end, the only alternative is a renewed understanding of both the family and human equality – two things ideological liberalism has now abandoned and modern conservatism now defends. Living in a family means accepting the burdens of caring for those bound to us in ties of fidelity – whether parent for child, child for parent, or spouse for spouse. The human answer to our dependency is not living wills but loving surrogates. And for those who believe in human equality, this means treating even the profoundly disabled – people like Terri Schiavo, who are not dead and are not dying – as deserving of at least basic care, so long as the care itself is not the cause of additional suffering. Of course, this does not mean that keeping our loved ones alive is our only goal. But neither can we treat a person’s life as a disease in need of a cure, or aim at death as a means of ending suffering – even if a loved one asks us to do so.

(My emphasis added in the passages in italics.)

Read those italicized passages again, folks. That’s right, even if you yourselves ask your life partner to refuse medical treatment on your behalf if you are severely and profoundly incapacitated, Cohen and his “modern conservatives” will overrule you.  Indeed, in the name of championing “loving surrogates” over “living wills” (a euphonic but horrific line), Cohen will treat you as if you are morally incapacitated and thus ineligible to decide your own fate.

OK, now while that’s sinking in, let me explain what liberalism really believes about those fetuses with Down syndrome.  In chapter two of Life As We Know It, after a long discussion of prenatal screening, I argue the following, and I aim the argument primarily at genetics counselors – among whom, I am happy to say, I have often found a sympathetic ear:

Obviously I can’t and don’t advocate abortion of fetuses with Down syndrome; indeed, the only argument I have is that such decisions should not be automatic.  A fetal diagnosis of Down syndrome should not be understood, either by medical personnel or by parents, as a finding to which abortion is the most logical response.  I believe this not only on humanitarian grounds but also as a matter of practicality:  unlike Tay-Sachs or trisomy 13, say, Down syndrome is a disability whose effects are too various to predict and often too mild to justify abortion on “quality of life” considerations for the parents and child.

Nonetheless, although this is my belief, it is only my belief.  I would not want to see it become something more than belief – something more like a coercive social expectation.  There are already plenty of social forces out there telling pregnant women that they may have an abortion only if they agree to be consumed with guilt about it, and I want to do nothing to reinforce those pressures.  I believe that no good is achieved by making some forms of childbearing mandatory, even in a matter so close to my heart as this.  But by the same token, just as I would deny that I have the right to make other parents feel guilty for aborting a fetus with Down syndrome, so too would I deny that other parents have the right to make Janet and me feel guilty for having Jamie.  This is not a “relativist” position:  it is based on the ideal of reciprocity.  I will not claim right of access to certain areas of your life, so long as you do not claim right of access to equivalent areas of mine.  If I do not want to interfere with other people’s most intimate decisions, I also want it understood that those of us who do have “disabled” children are not selfish: we are not a corporate liability, we are not a drain on health care resources, we are not siphoning money away from soup kitchens, environmental protection, or job training and day care for single mothers.

In what one might conceivably call a “hostile” review of my book (in the pages of Books and Culture: A Christian Review), Jean Bethke Elshtain not only literally put words in my mouth (quoting me but interpolating, in brackets, a passage that was entirely her own, suggesting that Janet and I would have aborted Jamie in utero had we known that he had Down syndrome, and deliberately overlooking the fact that our decision to forego amniocentesis was based precisely on our determination to go ahead with the pregnancy regardless of whether the fetus had Down syndrome), but also accused me of “subtly but inexorably blowing out the moral lights among us, as Lincoln said of Douglas’s defense of popular sovereignty in the matter of slavery.” (The review, I have since learned, was awarded first place in the “Critical Review category” by the 1999 Evangelical Press Association Meeting.  To which all I can say is, wow.) Here’s the relevant passage (I’d provide the url to the review, but Christianity Today will make you pay at least $7.95 to read the whole thing):

In his words: “If you had told me in August 1991 – or, for that matter, after an amniocentesis in April 1991 – that I’d have to feed my infant by dipping a small plastic tube in K-Y jelly and slipping it into his nose and down his pharynx into his teeny tummy, I’d have told you that I wasn’t capable of caring for such a child. [In other words, had they had amniocentesis, they would likely have opted for abortion.] But by mid-October, I felt as if I had grown new limbs and new areas of the brain to direct them.” He learned that “[y]ou can do this. You can cope with practically everything.” Many parents of children with disabilities make similar discoveries.

But, of course, my point was precisely that parents of children with disabilities make similar discoveries, and that prospective parents should be advised, by medical personnel and genetics counselors, of this fact.  Elshtain’s interpolated words – in a sentence that begins “in his words,” no less – are simply dishonest, for two reasons.  First, because few neonates with Down syndrome require this kind of care; amniocentesis would not have “told” us that we would need to feed Jamie with a gavage tube.  More important, the bracketed sentence allows Elshtain to ignore my discussion of prenatal care information about disabilities, and the reason that’s important, in turn, is that I was trying to persuade ob/gyn practitioners and genetic counselors not to think of the detection of trisomy-21 as a search-and-destroy operation.  I criticized the high abortion rate for fetuses with Down syndrome, but unlike those who rely on various invocations of divine authority to dictate the terms of life to others, I would rather decrease the abortion rate by means of persuasion than by means of state coercion.

And that’s what constitutes “blowing out the moral lights among us,” for certain moral theorists. You don’t even have to disagree with their decisions about pregnancy or end-of-life care; you simply have to point out that other people, for their own plausible reasons, might so disagree.  In the case of fetuses with Down syndrome, then, it is not enough to bring the pregnancy to term, love the child unconditionally, and encourage others to do likewise in similar circumstances; in order to be properly “moral,” one has to insist that one’s own decision should have the status of a universal law.  As a principle, this is clear enough, and for some it will be compelling.  But there should be no mystery why liberals would regard it with skepticism, and liberals who do so are not, I repeat not, betraying their best intellectual traditions.

In the course of reading (and reviewing) Rayna Rapp’s fine book, Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America, I learned that people believe all kinds of strange things about pregnancy and disability, and that they frequently make what I would consider poor decisions, or good decisions for poor reasons, largely because they do not think the way I do.  At one point in my review, I wrote:

in a more morally nebulous zone are those prospective parents who believe, as one woman puts it, that “having a ‘tard, that’s a bummer for life” or that if the baby “can’t grow up to have a shot at becoming the president, we don’t want him.” Such beliefs are qualitatively different from the belief that a fetus can “acquire” mental retardation from contact with developmentally delayed adults, since they do not involve actual misstatements of fact; but they too are based heavily on misinformation and intellectual parochialism, and they make up a crucial part of the terrain any genetic counselor must traverse.  And then, yet again, there’s the question of how we should understand the administrative secretary who tells Rapp, “I don’t think I really believe in chromosomes, I mean, I could see the pictures, but I can’t believe everything is in the chromosomes.”

As ignorant (or as spiritually obvious) as this last remark may sound, the funny thing is that as a description of amniocentesis it’s actually quite right – and it points out the limits of the practical rigor and the hegemonic claims of this particular technoscientific practice.  Amniocentesis will not detect autism, or cerebral palsy, or deafness; it will not protect newborns from polio, rubella, diabetes, or farm machinery.  Of all the frailties to which human flesh is heir, amniocentesis can identify only Down syndrome – which “accounts for about 50 percent of the chromosome problems detected” – and a mere 800 “much rarer, arcane genetic disabilities.” Amniocentesis, in other words, sees only a tiny fraction of what can go wrong between conception and death.  Genes can code for disabilities, but not all disabilities are genetic; not everything is in the chromosomes, after all.

In both the deontological and utilitarian traditions, I believe that prospective parents who say “having a ‘tard, that’s a bummer for life” or “if he can’t grow up to have a shot at becoming the president, we don’t want him” are technically known as “assholes.” And forgive me, all you mullahs and moralists out there, if to this day I remain unpersuaded of the transcendent virtue of compelling such people to bear children with disabilities.  (For those of you interested in a more careful and patient response to this question, I recommend this book).

Liberals do not believe, pace Cohen, in treating incompetence itself as reasonable grounds for assuming that life is not worth living.  But we do believe in granting others a zone of privacy from state scrutiny in order to allow other people to make intimate decisions about pregnancy or end-of-life care, and we believe that we are bound to honor those decisions even when we ourselves regard them as uninformed or mistaken.  Those of us who are familiar with disability issues know that many of our fellow citizens – on the left and on the right – will regard incompetence as reasonable grounds for assuming that life is not worth living.  While we may regret this, we do not take our regret as license to override the “living wills” of persons determining for themselves the degree of medical care they wish to receive or refuse.  We do not believe that autonomy is the only or the highest good, but we do believe that the refusal to recognize the autonomy of others does violence to their human dignity.  And we believe in our own autonomy just enough to resent it deeply when our ideological adversaries try to ventriloquize us in order to misrepresent us.

Posted by on 04/06 at 10:58 AM
  1. You had me at word 2500.

    A couple thoughts:

    (Quoting Cohen) A true adherence to procedural liberalism – respecting a person’s clear wishes when they can be discovered, erring on the side of life when they cannot – would have led to a much better outcome in this case.

    So long Roe v. Wade.

    I’m by no means an expert in disability issues, but it astonishes me that I haven’t heard principled, disability-rights-based objections to the Not Dead Yet argument equating PVS with all other disabilities.  Seems to me that a person with a spinal injury, or hearing impairment, or dyslexia or cerebral palsy or Downs or whatever might rightly take offense at being equated with someone with no possibility of ever regaining cognitive function. As I understand it, the Principia of the modern disability rights movement can be pretty much boiled down to:

    1) All people have a basic right to take part in human society regardless of their physical, mental, or emotional attributes;

    2) All people have a basic right to enjoy life and personal freedom to the maximum degree possible regardless of above-said attributes.

    I find it hard to see how either of the above applies to someone in an irremediable vegetative state.

    Is the Not Dead Yet position colored by conflicting information about Schiavo’s (former) medical condition, or am I missing something?

    Posted by Chris Clarke  on  04/06  at  12:46 PM
  2. Ah yes, Jean Bethke Elshtain, the mark of quality in any conservative review. I’m amazed that anybody, you know, publishes anything she writes, since her nonsense is perceptible from the surface of the moon.

    Posted by Scott Paeth  on  04/06  at  01:34 PM
  3. My apologies for essentially changing the subject, but regarding the execrable Nat Hentoff, I concluded that he is simply lying when he describes himself as an “atheist”, and that he is a closet convert to a particularly reactionary form of Roman Catholicism. In the late 1980s he made feeble attempts to deny that he adhered to the “seamless garment” conceit, but he now aggresssively embraces it.

    Posted by  on  04/06  at  02:02 PM
  4. Tsk, tsk. That should be “...I concluded years ago that he is...”

    Posted by  on  04/06  at  02:05 PM
  5. Wow. No wonder you’re widely referred to as “the most valuable person in the Democratic party.” Surely that endowed chair with scores of nubile RAs to fetch your Chai can’t be far behind.

    I’d like to particularly thank you for mentioning the evolving perspective of those who deal with disability. We really can’t predict what life with disability will look like to us, and while the right use this as an argument to erode the importance of autonomy it seems to me to be a call to (a) enhance education regarding the influence (or lack thereof) of various disabilites on quality of life, and (b) make sure it’s clear just who is supposed to exercise substituted judgment for each of us in case we can’t communicate our desires directly.

    Posted by  on  04/06  at  02:07 PM
  6. Well, go after Jean Bethke Elshtain.  Not just on your website.  Check with the law school to see if falsification of your work could constitute libel.

    Posted by  on  04/06  at  02:09 PM
  7. Michael mentioned Nat Hentoff’s recent work about Schiavo. I haven’t read it, because I’ve stopped reading Hentoff. Once upon a time, even when I disagreed with him I found him thoughtful and provocative, if a bit limited and naive. But now? Man, this dude has gone off the deep end.

    I was told by a reliable source that he voted for Bush in November, and I believe it. His columns on the controversy involving alleged anti-Semitism at Columbia have been insane, especially when compared to Scott Sherman’s recent piece on the subject in the Nation, which was appropriately skeptical and had far more depth.

    It also strikes me as very weird that back in the 90s he was vociferously defending “academic freedom” and “freedom of speech” when the accused were professors defending themselves against charges of sexual harassment.

    But he’s done a total 180, now that the accused are professors who are defending themselves against charges of being anti-Israel and anti-Semitic. He’s trying to have it both ways, and it’s not a pretty sight. Plus, he’s long had a weakness for wingnut Christians. I’ve completely lost whatever little respect I’d had for him.

    Posted by  on  04/06  at  02:13 PM
  8. I just read the other comment about Hentoff and yes, I wouldn’t be surprised if he’s a Catholic convert. Someone who knows him told me his wife is some kind of wingnut Christian who for years has been deeply involved in anti-abortion politics. So yeah, that would make sense.

    Posted by  on  04/06  at  02:17 PM
  9. Hang on.

    (Quoting Cohen): A true adherence to procedural liberalism – respecting a person’s clear wishes when they can be discovered, erring on the side of life when they cannot – would have led to a much better outcome in this case.

    True adherence to “procedural liberalism” WAS observed in the Schiavo case. The person’s wishes were the subject of and were determined in a trial on the evidence. Multiple witnesses were called. Multiple appeals all resulted in the upholding of the original trier-of-fact’s conclusion. Her wishes were discovered, fer cryin’ out loud.

    Posted by Kathy  on  04/06  at  02:27 PM
  10. Books and Culture: Things We’re Agin’

    Posted by Alex  on  04/06  at  03:18 PM
  11. I would have to agree with Cohen about the ideological problem with the Schiavo case but would put the shoe on the other foot. Procedural Conservatism (where the government would stay out of the private ethical and moral decisions tht citizens face) has given way to Ideological Conservatism (where the country is going to hell in a hand basket because of liberal values and the government must step in and make these decisions).

    Posted by  on  04/06  at  03:38 PM
  12. Yes, I wanted to echo Kathy’s point that this case adhered pretty much completely to ‘procedural liberalism.’ Because of that I think it was actually a pretty easy case.

    There are other situations that are not so clear for me.  What if we are faced with an individual who indicated a desire to stay alive at all costs and whose family demands that the state must pay for it.  On the one hand, I’m uncomfortable with the purely utilitarian argument (how many children could get vaccinated with $100,000?), but on the other hand I’m not really sure that what Terri Schiavo had was life.  It isn’t clear to me that our duty as citizens requires us to support what I view as a moral failing, a narcissistic inability to confront the reality of death.

    There is yet another case where I think taking autonomy too far gets one into trouble.  I would have thought that state laws preventing suicide by otherwise healthy people were generally accepted as reasonable, but I’ve seen people argue on blogs for an unmitigated right to die.  I, for one, have no problem with the state pumping the stomach of a severely depressed person who tries to commit suicide.  I think the value of the human life is worth more than that individual is able to see at the fateful moment, and I have faith that for most of those people adequate treatment can make that decision one the individual would regret.

    Insane people, in my view, have only limited rights to exercise their own autonomy.  I know that’s very controversial, but when one ceases to be able to function and winds up on the street in the exercise of “autonomy”, then autonomy becomes pretty meaningless --if indeed the self that is acting is indeed one’s true self.

    Posted by  on  04/06  at  04:06 PM
  13. Cohen’s essay fails to convince because he refusees to see the corporate conservative viewpoint behind the Court’s language. He doesn’t understand how the Texas law then Gov. Bush signed which allows a patient’s feeding tubes to be removed by a hospital committee even where the family of the patient is united that the person wanted to continue living.

    The money issue is the implicit issue behind the Court’s language, and last time I checked, money is what most capitalists value more than anything else.  That’s not liberals, since Cohen and his friends at the Weekly Standard know we’re “softhearted socialists.”

    This issue can be twisted to “liberal,” “conservative,” “right” or “left” or Libertarian (I’d love to hear two Libertarians who disagree on the Schiavo case make their case with Libertarian “doctrine"). 

    The fact that made this case tough was that the parents and the husband disagreed and did so in the most profound way.  Somebody had to decide it and the Courts were the logical place when the people couldn’t decide among themselves in an informal manner.  I might well have ruled differently than Judge Greer in the mid-1990s and would definitely have ordered a PET Scan and other testing than an MRI at the time.  But I guess that’s my “procedural” liberalism talking, which Cohen supposedly champions.

    As Michael points out, even Cohen fails to realize that his embrace of “autonomy” and “procedural liberalism” crashes into a “paternalist” standpoint by the time he reaches his ultimate conclusion.

    I’d like to say to Cohen:  Cut the crappy politicizing of a tough legal battle.  If you want to find out how liberals really feel, let’s talk about changing that Texas law.  Then, we’ll also see a whole bunch of Weekly Standard and National Review writers going, “Well, if they don’t have the money to keep up the feeding tube, why should taxpayers pay?” Ah, the compassion of a conservative…

    Posted by  on  04/06  at  04:55 PM
  14. Chris, from what I’ve been reading and hearing from generally reasonable people about the Schiavo mess, I’d suspect that some combination of controversy and misinformation might indeed color NDY’s stated views. I’m flabbergasted at how much carrying-on and opining is being done by people who pretend to be experts—and I’m including the <Daffy>despicable quacks</Daffy> that have circled the case—and how trustingly people seem to have swallowed that slagbrew of ill-informed opinion. Just for example: people do seem to believe, contrary to what the public court records have indicated, that Michael Schiavo prevented any attempt at therapy for Terri, was in a position to inherit lots of money if she died, and/or forbade her parents from visiting—in spite of all that footage of them with her. It’s an interesting exercise, referring such people to the solid evidence available, the court records and (for visual impact, if not expert reading) that CAT scan photo. I seriously doubt the statement by “a top Catholic priest”—a vague handwave of a phrase that, IIRC, occurred in a Catholic publication, which ought to know better—thet he got an actual response out of Terri when he visited her a few days before her official death. But he said confidently, in public, that he had, and people are acting as if that made it true. He did not, as far as I know, deign to give specifics.

    And, Michael, that distillation of the problem, that statement that Cohen (et, presumably, alii) would treat a physically incapacitated person as an also morally incapicated person, is devastating and spot-on.

    I keep wanting to ask the disability-rights folks who’ve hollered about this if they’ve thought their own positions through. They’ve been sounding a bit like those women who tell me we’re “the weaker sex” and should “let our husbands lead us” and all that tripe—and why should I listen to someone who’s telling me that she’s intellectually or morally second-class, even or especially when she’s telling me I am, too?

    Posted by Ron Sullivan  on  04/06  at  05:09 PM
  15. Am I the millionth visitor?

    Posted by  on  04/06  at  05:23 PM
  16. Great post! And Freedman is absolutely right, it is all about the money. Not only the law the Great Moron signed in Texas, but the cuts in Medicaid, and the recent “reforms” pushed in Tort and Bankruptcy Laws, which will make it more difficult to keep people alive if they can’t come up with the scratch.

    Posted by  on  04/06  at  05:29 PM
  17. This person with multiple disabilities says thank you.  Pfft! As if we all had to reach the hight of some “autonomy” placard in Life’s Amusment Park, *and remain there for seventy straight years* smile

    Wonderful column.

    Posted by imfunnytoo  on  04/06  at  06:22 PM
  18. That’s first rate, Michael, and I thank you.

    Our current leadership and its supporters are control freaks of the worst kind:  they seek control of others without accepting any control themselves.  They are most destructive of the controls and limits imposed by the Constitution. 

    P.S.  This is the first time I’ve checked in since you’ve redesigned the site.  It’s great!

    Posted by PW  on  04/06  at  06:31 PM
  19. Whew—and here I thought I was going to put up a long post and take the rest of the week off.  Ron, Chris, I can’t (of course) speak for Not Dead Yet.  But I’ve read their amicus briefs in the case, and my sense is this:  they place PVS on a par with myriad other disabilities partly out of a skepticism about the very diagnosis of PVS itself, and partly out of a pragmatic desire to prevent any form of slippery-slope arguments (first we pull the plug on PVS, then incompetence in general, then communications disorders, then the whole eugenic horror show begins again).  I think this argument is mistaken (or I wouldn’t be arguing against it), and I believe it involves its own form of the slippery-slope mechanism, but I do not believe it is unreflective or undertheorized.  The NDY briefs rightly cite the history of eugenics and the contemporary work of Peter Singer, who is, after all, a complete loon (albeit a complete utilitarian loon, which is a rare bird indeed) on the subject of disability.  As far as they’re concerned, they have good reason to be afraid, and to circle the legal wagons when it comes to cases like Cruzan, Martin, Wendland, and Schiavo.

    But I do think it’s worth calling attention to arguments—no matter who makes them—that would deny individuals the right to determine their level of medical care.  As for the question of how impaired individuals are to be represented by surrogates, let’s foreground (for a change) not people of sound mind and able body who suffer severe illnesses or accidents, but people with intellectual disabilities who can never attain the level of autonomy we expect of a “reasonable” person.  I hope it will surprise no one if I fail to sign on with a political movement that would deny to me and my wife the right to determine if and when to refuse medical treatment of our younger son, who, even when he reaches adulthood, will not be able to deliberate these questions on his own behalf.

    Abby brings up an excruciatingly difficult question, one that was debated at some length at my 2000 MLA panel on “Disability and Democracy.” Let me respond in the form of a conundrum:  is it acceptable to compel a mentally ill person to take medication which, when taken, will allow her to function autonomously?  This is not a Philosophy 306 exercise; it’s a real live ethical dilemma for anyone who has treated so-called “schizophrenics” who strongly refuse medication, whose wishes are ignored, and who then thank their physicians and counselors for having ignored their stated wishes and having acted in their real best interests.  The history of lobotomy and shock therapy and other tortures notwithstanding, there are times when the wishes of individuals who are not of sound mind (as, arguably, a suicidally depressed person might be) should not be honored.  Again, though, it would be mistake to take this caveat and use it, as Cohen does with regard to advance directives, to argue against the principle of autonomy in toto.

    Mitchell, thank you as always for a very thorough analysis.  And thanks especially for mentioning PET (positron emission tomography) scans, which I too would have ordered in Schiavo’s case.

    Bill, I won’t sue Elshtain.  Hell, I won’t even sue Horowitz for claiming that I’ve spent all my time since 9/11 working to get terrorists off the hook, and that‘s a far more incendiary claim.  I’m content to point out that her review played fast and loose with the rules governing citation and paraphrase.  And Tinman, thanks so much for the kind words, but I already have an endowed chair, and have been sitting in it these past four years.  I don’t have any research assistants, however, nubile or otherwise.  I did have some research assistance from the brilliant and resourceful Stacie Colwell, an M.D./Ph.D. candidate at Illinois who assisted me with the medical research for Life As We Know It, but that was ten years ago.  It’s been a lonely research haul since then.

    Posted by Michael  on  04/06  at  06:34 PM
  20. I appreciate the willingness to engage in this discussion, posting this essay and allowing the above articulate and well reasoned responses.  Thank you Michael.  I want to cite an example that is supported by what Mitchell said, i think, and involves the state security system(as you called it) to make numerous decisions about persons who suffer from intellectual function disabilities.  During my years in academia beginning as an undergrad, through grad school, into the teaching roles, etc.  i spent my summers working for the State of California as a Lifeguard.  In CA, State Lifeguards are peace officers as well as lifeguards, charged with maintaining law and order while protecting, rescuing, and serving the public using the State Beaches, as well as other aquatic parks. 

    CA has Penal Code statute 5150--that can be used at the discretion of the officer to detain a person, who exhibits behaviors that demonstrate that person’s inability to care for themselves.  Over many years and many legislative reviews and court rulings, but most importantly appropriations legislation and funding of services, 5150 classified persons are detained in public, or privately contracted, facilities for a period of 72 hours for evaluation and observation.  Republican governors and legislatures felt that the majority of persons who would be deemed 5150 would include those who had been released from facilities under the rubric that they would be no threat or danger to themselves or others if they took their medications.  For a few years my duty station included 33 miles of coastline of parks and beaches that backed up to a range of “mountains” behind which was the SoCal state mental health facility.  I spent hours processing and reprocessing 5150’s who were released by the state, for almost always economic reasons, given prescriptions for meds, and told they would be fine.  The state, representing in the interests of what Mitchell so aptly described as the corporate conservatives, felt it was easier to leave the intellectually and cognitively disabled on their own, without so much as anything other than the clothes they wore and the meds in their pockets, to wonder free in the parks of CA and the local cities/towns, etc.  Our passion we feel for those like Terri is in some ways misdirected--it needs to extend towards the hundreds of thousands of people out in our nation, whose sole contact with support and care and attention is constituted with peace officers, 72 hours observations, and releases with meds.  Whether we espouse a liberal position regarding the intimate intrusion by the state in the private affairs of those with these types of disabilities and diseases, or not, we owe it to ourselves to support deeper pockets of economic investments in the care and attention for these others. 
    sorry about the length of the rant.

    Posted by  on  04/06  at  07:02 PM
  21. I just printed your post out. Lemme give this a think before I run my pixels off at the keyboard.

    Posted by  on  04/06  at  07:24 PM
  22. Diretamente d´O Biscoito, venho parabeniza-lo pelo milhão de leitores. Lamentavelmente não tive oportunidade de aprender o idioma inglês, o que me impossibilita de ler os seus ensaios. Soube de vc através do Idelber, que visito sempre que posso. Grande abraço paulistano,

    Posted by  on  04/06  at  08:05 PM
  23. It was gracious of you to stop by and offer congrats, Giulia.  My Portuguese is limited to taxi-speak and ordering in restaurants, but obrigada all the same.

    And spyder, don’t apologize for a thing.  This is a critical point.  The history of state institutionalization of mental patients is a horrific one; in 1967, Niels Erik Bank-Mikkelsen, director of Danish national services for mental retardation, visited Sonoma State Hospital and reported, “I couldn’t believe my eyes.  It was worse than any institution I have seen in visits to a dozen foreign countries. . . .  In our country, we would not be allowed to treat cattle like that.” And yet, as you know, subsequent policies of “deinstitutionalization” amounted basically to “deinstitutionalization without community support or funding.” These days, I honestly don’t see the religious right lining up behind—or blocking traffic for—better mental health services and more nuanced and personalized rehabilitation counseling and long-term disability assistance.  But if we’re talking the language of obligations to others no matter what our other political beliefs, your phrase, “we owe it to ourselves to support deeper pockets of economic investments in the care and attention for these others” strikes me as exactly right.

    Posted by Michael  on  04/06  at  08:33 PM
  24. The main problem with medication for schizophrenic disorders is that, in many cases, the cure is worse than the disease. If you do any studying on the side effects of the medication, you’ll see that while the medications may give the outward impression that the subject is “functioning”, they may not feel so. And the side effects in themselves can be very harsh.

    Think of it as someone refusing chemotherapy. It’s someone’s right, isn’t it? Yet, I understand that in the case of severe mental illness we don’t just pass on but live on with whatever illness we have. It’s a terrible choice. Schizophrenia isn’t always seen as “bad” to the person who lives with it. Not all aspects anyways.

    Where I live, in Washington State, we have basically “outpatient institutions” where the level of care is abysmal, the social workers have hundreds of cases and can’t possibly give anyone the attention we deserve and in many cases (for myself anyway) I don’t *want* the attention they try to give me. It is almost always more harmful to me what they try to do than what I know is best for me: a place to live, enough food to eat, enough money to pay my bills. None of which the state does a very good job of providing.

    Some may say it’s not the state’s problem, but I’m part of the state. I lived a somewhat productive life even though I struggled with my illness. As it progresses (I’m not schizophrenic, but paranoid psychotic) I find it harder and harder to co-exist with other people which is harmful to me because I so desperately need people in my life. Caring, decent people. Something I’ve been denied all my life. And probably never will experience.

    Even if I hadn’t been able to contribute, I don’t think it’s right that we just throw people in the dumpster for not being able pull our weight. I can’t make a compelling argument why. I just don’t feel it’s right. Maybe it’s just the moral thing to do.

    I’m sorry if this doesn’t make much sense. I try to express what goes on in my head and can’t ever fully do so. Ron, I am very curious about your last paragraph. I don’t know how to explain it, but in a way we are both wanting autonomy but unable to care for ourselves. I know that presents a difficult problem for people, especially when there are people who manage to have productive lives while living with disabilities, but for some people that is not always the case. Not everyone can be saved. That’s my perspective and it may be skewed and wrong, but that’s what I see. It’s an anomaly, but that’s part of the difficulty of being sick. I don’t mean to pick on you and I hope this doesn’t sound like it is. I’m just trying to understand. Maybe I won’t ever because I don’t have that perspective of someone who has overcome my disabilities. With my most beloved therapist we came to the conclusion that every day I survived was a success, just as much as someone winning the lottery or starting their own business or snowboarding for the first time. That may seem like a ridiculously low set of goals, but they’re the only ones I can manage. And every day I only get sicker and it is harder and harder to achieve that goal.

    I don’t want someone else making my decisions for me, but I’m not able to do so myself. I don’t know what to do with that. I don’t have any answers. The Aging and Disability Services social worker asks me every time we meet if I’ve signed over power of attorney to someone else, but I don’t have anyone I can trust with it. It’s a never-ending cycle spinning down and down and down.

    I hope this makes sense. I think it’s wrong to force people to take medications.



    (p.s. This is such an important article and the comments are so smart and valuable. Thank you, everyone.)

    Posted by Hanna  on  04/06  at  09:11 PM
  25. Whoa italics have taken over the entire web page!

    Posted by Jon  on  04/06  at  09:18 PM
  26. I find it frustrating that a conversation about what liberalism (or conservatism)is or isn’t doesn’t bother mentioning the mundane facts of who- in this actually existing society- fund, sponsor and promote disability rights. Does Cohen think these sorts of political/economic practices have no bearing on these sorts of issues. I don’t deny the importance of dialogues about the philosophical underpinnings of modern liberalism. But to neglect who actually fights for the tax dollars and the social structures that help people live well with disabilities is disingenuous, at best.

    Posted by Dale  on  04/06  at  09:34 PM
  27. Hanna,

    Of course the individuals who suffer from these illnesses deserve the best care imaginable, and there should be no scrimping on the choice of drugs, because side-effects are very real.

    I spent a lot of time worrying whether my mother would burn the house down, because she was going to leave the gas on or watching her get taken in by hucksters, and there was nothing any of us could do about it.

    It also left me to fend for myself and my sister when I was growing up, and I don’t think that having the state put us into protective services wold have been a good idea. 

    Luckily, my grandmother had money to send us to boarding school, but the situation was far from ideal, and my mother’s brain deteriorated no end so that now--even though she takes medicines and has nearly bankrupted herself--her brain does not work as well as it might have.

    Posted by  on  04/06  at  09:47 PM
  28. Sorry about that, Jon.  I was going back over the post and trying to distinguish Cohen’s citational emphases from mine.  Not an easy task.

    Posted by  on  04/06  at  10:07 PM
  29. This was truly an extraordinary and moving post, and needless to say more than convincing.  Well. done.

    Posted by  on  04/06  at  10:31 PM
  30. It’s a sad commentary that this is the best we can expect from the “culture of life” types:  a refusal to coat the medical facts of the case with syrup of cherry while still weaving the circle of holy dread around Michael Schiavo personally and Satan’s own leftist minions.  It’s a result of thirty-five years of simplistic public debate that has never forced the “pro-life” forces to defend the full implications of their absolutist bumper-sticker arguments.  It’s a result of them talking only to themselves. 

    As Kathy noted, Terri Schiavo’s wishes were discovered.  If we wish to talk about ideological liberalism let’s at least note that the Schillers were granted at least three opportunities to contest the ruling despite the fact that they had no real claim other than an emotional one.  And that was nothing more than judicial activism in action.

    Posted by Doghouse Riley  on  04/06  at  10:38 PM
  31. Idelber sent me here ‘cause he said that you have a good blog. It’s true, but I really ‘d love to read about puppies and dolphins… Congratulations!

    Posted by Donizetti  on  04/06  at  10:47 PM
  32. I’ve read this post several times today, and keep thinking about it.  And the comments, too.  I think it’s one of the best things I’ve read on the subject.  Thanks.

    Posted by bitchphd  on  04/06  at  11:08 PM
  33. Hanna, what I was alluding to (if opaquely) in the last paragraph follows from Michael’s statement (with which I agree) that the people who want to substitute “loving surrogates” for “living wills” are acting as if the physically incapacitated are therefore morally incapacitated and not capable (or deserving?) of autonomy in life-and-death decisions. That’s what I’m asking, rhetorically, if the NDY folks have thought through to.

    You’re right, I skipped a few steps in the logic dance there. But if disability removes autonomous moral capability, what are these disabled folks implying about themselves? Do they wish to yield their decision-making power to someone else if they make certain decisions, which they’re deciding ahead of time would be wrong? I cited the woman-as-moral-child thing partly to say where I got my own impatience with that line of reasoning. Yes, I have been told that by other women, that we’re secondary. I was raised Catholic.

    Oh—the “you’ll change your mind” argument is familiar, too. Several women I know have had difficulty getting docs to do tubal ligations for them because of that assumption. (I was luckier getting mine, probably because of the times—1976 or so—and because I could truthfully say I was broke at the time. All I had to do was talk some hapless social worker into the ground, and that wasn’t hard, poor kid.)

    I should probably interject here, in case this was more confusing than clarifying, that “Ron” is a heavily pruned “Veronica.” I’m a woman who wears her name short.

    From Michael’s comment, I’m concluding that that probably isn’t the basic problem the NDY folks have with Schiavo though. And I can empathize with a lot of their apprehensions; I spent some time 30-some years ago working with state hospital inhabitants and a consortium including folks from Number Nine and the Mental Patients’ Liberation Front and others, at the start of that deinstitutionalization movement. I’m still a tad bitter about what happened to that.

    I’m soooo ollld in this um struggle that I’ve met a couple of lobotomized individuals, by the way. Not confidence-inspiring; nor was much of what I saw of doctor-patient interactions then.

    But I’m also a used nurse, and nurses have an old joke about having “DNR” or “No Code” tattooed on our sternums. And fates like Terri Schiavo’s are why. I’d give my left nipple to have a long frank talk with a few of the current hospice nurses in Pinellas Park.

    I’ve dealt with a few of the problems regarding medical care (including sex-related care, which is seriously touchy) for people judged mentally or psychologically incompetent. I do think things are made more difficult than they have to be, partly because of the need (or insistence) to apply one broad rule for all, to doubt everyone’s best intentions but the agents’ of the State, and then to doubt those. And I see the need to do that last thing too. Sometimes it seems that every damned thing we do in this society is like trying to shampoo a herd of porcupines.

    Hanna, your dilemma is one of the hardest I’ve seen. I don’t know what I’d do either, except it might involve flipping a coin. I do not say that in light jest.

    Posted by Ron Sullivan  on  04/06  at  11:13 PM
  34. Should sex selection be viewed the same way?  There is a debate on this subject happening on AWID’s listserve right now.  Most responders think sex selection should be made illegal, but a few responders worry about how this fits with a philosophy of reproductive rights.  Anyway, great blog post and article.

    Posted by J  on  04/07  at  12:40 AM
  35. Michael: Not knowing much about the complex issues involved in disability studies, but of course following things from a distance and getting increasingly worried about what the rightwing machinery is able to accomplish by taking up cases like Schiavo’s, I keep getting reminded of something that’s probably not on your mind right now.

    Remember when (in 1986-1997, let us say) orthodox Marxists like Terry Eagleton used to attack pomo-deconstructive-cult-studies-influenced types like yourself or, a few years later, myself, because our allegiance to a poststructuralist “critique of the sovereign subject” was supposed to be bad for the Left? Remember when orthodox Marxists kept attacking folks like yourself or, in a much smaller and more regional setting, myself, because problematizing the unity of the human being that makes a choice was, in their eyes, a suspicious way of undoing the subject of social change? And we kept telling them that that theoretical work was needed, but they really never listened to us?

    Well, isn’t it ironic that today it is the Far Right apparatus that insists on the myth of a free subject making a free choice, even when we’re basically taking about a vegetative human being making guttural utterances later reconstructed to mean whatever that apparatus finds suitable and useful? Isn’t it ironic for Eagleton that the Far Right is working, in the Schiavo case, basically with the same conception of the subject that orthodox Marxists hammered us with in the 1980s and 90s? Isn’t it ironic that the Marxists who chastised us for not being “political enough” still cannot see how political our critique of the sovereign subject was? Even as they hold, in the aftermath of the Schiavo case, a concept of human choice fundamentally identical to the one held by the Far Right?

    Posted by Idelber  on  04/07  at  01:03 AM
  36. Michael,
    You are not the first person who has refused to sue someone for libel b/c of idealism.  With all due respect, that is a noble mistake.  The right-wing gets away with its attacks upon the left b/c of such attitudes.  You already have tenure and you must have some friends on the Penn State law school faculty.  You are in good shape to respond. 
    I also believe that Kerry should sue the swift boat liars, although the potential of the discovery process in that case makes it a more important possibilty than your situation.

    Posted by  on  04/07  at  01:16 AM
  37. I don’t know if it’s the passion, the depth, the integrity, but your post is most amazing because of the layer upon layer of angles it elicits, from free will to responsible caring, from social obligations to private sovereignty; in fact, a whole Seminar would be necessary to discuss all these different aspects. Luckily, however, your comments section IS a “whole Seminar” - a remarkable forum of first-class thinking! As a shrink (the Lacanian kind), when someone above mentioned “control” I thought of Foucault and how the whole notion of mental illness – and disability in general – is linked to the social and political mores, how it is so easy to dismiss or manipulate those that make us uncomfortable (nowadays the “dismissal” sometimes is done through Ritalin and so many other drugs that make people more tame…). How unfortunate that these most subtle of decisions, as your post so amply shows, become the fodder of crazed fanatics whose narcissism is as rabid as their obscurantism.
    Thank you Michael for being the host and catalyst to this great discussion. (By the way, I’m also a Brazilian, but I didn’t come here through Idelber, on the contrary, I found his site thanks to you).

    Posted by  on  04/07  at  10:02 AM
  38. MB,

    Good post, and I quite agree with you on all counts. I didn’t read every word in this comments thread, so I don’t know if anyone’s pointed this out yet, but: if the opposition equates abortion or euthanasia with murder, the ideological gulf between the two sides appears quite impassable. It’s quite true, as you say, that

    [liberals] do believe in granting others a zone of privacy from state scrutiny in order to allow other people to make decisions about pregnancy or end-of-life care

    But we wouldn’t grant individuals the same privacy to make decisions about ending a healthy adult’s life (i.e. murder) without that adult’s consent. That’s an example of a clear ethical boundary that most people would feel morally enjoined to enforce--thus, if you believe that an embryo or an incompetent person is equivalent to an independent individual, you’re just as enjoined to oppose abortion and euthanasia on the basis of a morality superordinate to private discretion.

    Funny thing though--your quote above reminds me of Barry Goldwater’s stance on segregation, viz. that morality cannot be legislated. As stated, his assertion is patently ridiculous, but it does illustrate that we all decide which moral positions necessitate legislation and which don’t, and that our decisions thereabouts aren’t necessarily based upon defensible logic.

    Posted by  on  04/07  at  10:54 AM
  39. Good point, DGF.  But nothing in the history of liberalism from Mill to Rawls requires liberals to honor all the desires of their fellow citizens:  we do not, for instance (to take an analogy much belabored by the pro-life side), honor another’s desires to own slaves or to engage in torture.  The zone of privacy has to be limited to specific acts and desires which we want to exempt from state scrutiny, as opposed to other acts and desires we (collectively) want to designate as illegitimate.  So, then, you’re quite right about that ideological gulf:  for those who consider a nine-day embryo to have the same moral status as a living, breathing person, there is no problem summoning the power of the state to prevent the destruction of either; no contradiction is involved.  Similarly, I was confronted in a Q-and-A after a disability studies talk some years ago by someone who insisted that democratic means of deliberation should not be considered the greatest good when it comes to abortion.  All I could do in response was to turn to the rest of the audience and say, “OK, now you know why postmodernism puts so much weight on the incommensurability of language games.  Sure, we’re sometimes a little too eager to declare something an incommensurability and go home, but this here is a real incommensurability.”

    Posted by Michael  on  04/07  at  01:00 PM
  40. Michael,

    In your comment 19, you mention the MLA discussion of “Disability and Democracy,” concerning the refusal of medication by schizophrenics. Would there be a transcript of this available anywhere? I’m going through this exact scenario with a family member and would be highly interested in reading it. Thanks.

    Posted by  on  04/07  at  01:43 PM
  41. It’s good to see a conservative magazine publish something on the Schiavo case that at least seems honest and thoughtful, even if as Michael devestatingly shows its key claim contridicts itself. Reading the post brings me to an observation that might be of interest to some of you. Michael frames his intervention in terms of Cohen’s misconstrual of liberalism. Or, if you will, his misconstrual of “liberalism.” This is a misconstrual, in Cohen’s case, that takes place at a high intellectual level. But other such misconstruals take place with numbing regularity up and down the food chain, from the most sophisticated like this, down to the most numbskull, like the freeper who in a debate in which I said I was a proud liberal asked me if I was proud of Pol Pot’s killing fields.

    More and more I am realizing that misconstruing “liberalism” is a REALLY important part of what conservatism is. Not disagree with liberals or liberalism, but the construction and maintenance (sometimes intention, sometimes not, sometimes willfull, sometimes innocently) of a body of misconceptions about “liberalism.”

    It seems like an obvious point, but this is where I think it gets intereresting. Just about the only time I manage to “win” a debate with a conservative--get them to fly the white flag, and maybe even express a little shame--is when I catch them short by demonstrating to them that something they believe deep, deep down about what “liberals” believe is demosntrably false. That is, they think they’re arguing with someone who believes “X,” where “X” stands for some deeply ingrained fantasy about what liberals believe. When I say, No, actually I believe “Not X,” often they are shocked at a prospect they hadn’t even considered: that liberals, as actual human beings, might not correspond to the picture of liberals they hold in their heads. This can be strangely traumatic for them. They’re like, “Really? I didn’t know that about liberals?” and are like, “Oh. My bad.” A lot of them have never really talked to a liberal (that’s one of the reasons I continue to engage in these debates, for that instant of recognition of the humanity of an actual living, breathing liberal).

    My point as it relates to this Weekly Standard essay: it’s conceivable, as hard as it is to fathom, that this Cohen ACTUALLY believes in good faith that liberals hold in their heads as an affirmative principle that a “disabled” life is not worth living.

    I have a hunch Michael has the same intuition as me, which is why he engaged Cohen’s argument so respectfully and at such great length. And why there’s hope he might actually change someone like Cohen’s mind, or at least give him that instant of recognition that he might not know as much about “liberals” as he thinks he does.

    So many conservatives think they know everything there is to know about liberalism, and that there couldn’t possibly be anything else to know. Breaking that spell can be a very effective thing to do.

    Posted by  on  04/07  at  01:47 PM
  42. Interesting point, Rick. If I read your comment (#41) correctly, you’re suggesting that the misconstrual of liberalism by relatively sophisticated authors like Cohen is a special case of a more general phenomenon that is, at its root, very unsophisticated, viz. the conservative misconstrual of liberalism.

    In fact, this misconstrual has a more sophisticated pedigree than you imply. I’m thinking of the generation of political and social theorists in the late 1940s and 1950s (most on the right, some on the left, many of them European emigres) who embraced the notion that totalitarianism was either a direct result of liberalism, or was, at the very least, a close cousin. Obviously this was the position of (conservatives) like Eric Voegelin and Leo Strauss, but also of thinkers on the left like many associated with the Frankfurt School, as well, to a certain extent, Arendt (though Voegelin criticized Origins of Totalitarianism for failing to point out how much “liberals and totalitarians have in common").  Echoes of these ideas can even be seen in some liberal thinkers like Reinhold Niebuhr (in his criticisms of the foolish “children of light") and Arthur Schlesinger, Jr. (in his effort to purge “progressives”—whose most recent manifestation was the Henry Wallace movement, but whose roots went back into American history, and whom Schlesinger saw totalitarian in certain ways—from the legacy of the New Deal).

    At any rate, while we might like to blame the “if you’re a liberal, you must like Pol Pot” meme on wingnuts past (Robert Welch) and present (David Horowitz), it actually has more sophisticated intellectual roots.

    Posted by  on  04/07  at  02:24 PM
  43. Cohen at least anticipates Kathy’s argument at the level of his claim that Florida law stipulated that a judge should have appointed an “indpendent guardian” for Terri Schiavo. I have no idea if he’s right or not, but, to be fair, he’s not just saying “their should have been a procedure and there wasn’t a procedure.” He’s saying the procedure was not legally defensible. Of course, if such a guardian and had been appointed and came to the “wrong” outcome, no doubt Cohen would base his argument about something else. Because, fundamentally, conservatives are indifferent to procedure. Except as a tactic.

    Vulture, on the other hand, speculates brilliantly. I love vulture.

    Posted by  on  04/07  at  02:52 PM
  44. Ben, we could dish for hours on the question of the intellectual geneology you refer to, a specialty of mine, especially the liberal-consensualist, Schlesinger side you refer to. Read my book “Before the Storm”; look up “Hofstadeter” in the index. Although I think the last word on that is Garry Wills’ unmatched chapter on Schlesinger in “Nixon Agonistes.” If you read that chapter and still respect Schlesinger as a political thinker, you may well be illiterate.

    Briefly, I’d put the onus of the “liberals like Pol Pot” legacy more on Hayek than anyone else. Take a left turn at Surfdom Street, and the road leads to Skulls…

    A couple of interesting points in this regard. David Brooks’ nutty recent column about what great readers of “philosophy” conservatives are relates to this--their ability to convert all material political questions into abstractions, then argue in the realm of abstraction to return dishonestly back to material political points (did “liberals” like Pol Pot? It doesn’t matter. Liberal “philosophy” can be demonstrated to entail a slippery slope acceptance of unchecked state action, so any unchecked state action is “liberal").

    On another tip, there was a fascinating discussion on a usually stupid listserve, H-HOAC (historians of communism and anti-communism) in which real-life Stalinists and Hoover Institute fellows debate the Katyn Woods Massacre and Whittaker Chambers’ typewriter, on the “authoritarian personality” model and its migration to America. Some fascinating and half-convincing points were made, if in reckless fashion, by one of the Hoover Institute guys, pointing out how the Frankfurt School’s development of the theory linked to, if you will, Stalinist “talking points” of long standing. (He charged conspiracy, of course--the Institute for Social Research was really a secret Moscow cell! or some bullshit; though I would just chalk up the discursive homology to the vagaries of cultural transmission.)

    Posted by  on  04/07  at  03:13 PM
  45. Take a left turn at Surfdom Street, and the road leads to Skulls…

    If everybody had an slave wage
    Across the USA
    Then everybody’d be serfin’
    Blacks, honkies and Nisei
    You’d see ‘em sewing those baggies
    huarache sandals too
    saluting all the blonde hair dudes
    Serfing USA!

    You’d catch ‘em serfing for K-Mart
    the Martha Stewart line
    At McDonalds and WalMart
    And unpaid overtime
    All over Manhattan
    And out in East LA
    Everybody’s gone serfing
    Serfing USA!

    Posted by Chris Clarke  on  04/07  at  03:26 PM
  46. Rick, interesting points.  I totally agree about Hayek as a key figure here.  Also agree re: Schlesinger and Wills’ take on him (I’m a huge _Nixon Agonistes_ fan; for my take on Schlesinger in his _Vital Center_ phase, check out the last chapter of my book).  I’ll try to dig up that H-HOAC discussion (I’m on a number of h-net lists which I rarely read, but this one I’m not even on).  The discussion you recount is part of a genre onto itself of debates involving Stalinists and former Stalinists (eventually these folks will all be gone and there’ll only be the memories).  Years ago I went to a panel at the Socialist Scholars Conference at BMCC about leaving the CP.  It included a very distinguished group of former Communists who’d left the party at various times, from the 1930s on up to the post-Soviet Committees of Correspondence split. During the question period, an elderly fellow stood up and roundly denounced everyone on the stage for not sticking with Stalin.  “If it hadn’t been for Stalin, the USSR wouldn’t have been a _workers’_ state, it would have been a _kulak_ state.” This was, of course, someone _actually_ repeating Stalinist talking points, but long after they’d expired.  Individual human commitment to ideologies—even awful and discredited ideologies—is often much more powerful than shadowy conspiracies.

    Posted by  on  04/07  at  03:37 PM
  47. This may be extremely simplistic, but I wonder what Cohen et. al. would have said and/or done if all of Terri’s family members had agreed to remove the feeding tube ... woudl he still have advocated state intrusion? We already know what would have happened if Terri had been poor and black, and resided in Texas ...

    And reading Cohen’s arguments, I feel as if all our definitions of “conservative” and “liberal” have become utterly meaningless. Cohen’s argument implies that it is now liberals who would practice Social Darwinism, when the exact opposite is consistently true.

    Finally, I’m curious as to where the medical definition of death fits in all of this. I always thought it was defined as the absence of brain activity; am I wrong?

    Posted by  on  04/07  at  04:12 PM
  48. Damn you’re good Michael.  And I’m proud to say I live only 20 minutes away from you down the road toward Interstate 80.  If I ever see you at the mall or walking on campus I’ll surely corral you down to a semi-fine College Avenue eatery and buy you anything on the menu under ten dollars.

    No need to fear me.  Bambi and bass don’t fear me in this rural Pennsylvania NRA haven in which we live so you don’t have to either.

    I’ll be the one wearing the “Born again Democrat” t-shirt.

    God speed, mon ami.

    Posted by  on  04/07  at  05:54 PM
  49. As I understood the case (and I have not read the court transcripts), Michael Schiavo and others provided evidence that Terri clearly expressed wishes about what she wanted in case she was incapacitaed and could not speak for herself. The court decided that she had clearly expressed such wishes and further decided that her wishes would be that the feeding tube should be removed.

    When you have a living will, whether written or oral, one question is whether your current condition corresponds to the situations you have contemplated and given instructions for. (This is far from easy, because words are few and medical conditions are many.)

    As I read the portion of the FL Appeals court decision, it seems to me they are framing the question with the intention of comparing her codition with her expressed desires (and that her expressed desires included not being a burden to her family), not, at least not necessarily, that the court was saying on its own that not being a burden was the key issue.

    So I am not sure that Cohen is fairly representing the opinion and arguments of the court.

    (Also, the same or other appeals courts decided that the judge was correct is assigning to himself the role as Terri’s guardian. Cohen calls this “incompetance ... in direct violation of FL law”. I am always wary of someone arguing that what the courts—all relevant courts—have approved is nontheless “in violation of the law”, but in any case, what would yet another participant have brought to the party? It he arguing that the judge was biased on Michael S’s behalf?)

    Posted by  on  04/07  at  06:11 PM
  50. I forwarded this entire post and thread to friends at the Center for Cognitive Liberty and Ethics.  They deal with issues of forced medicating of persons with disabilities, including the current proposals of testing and medicating all children in Title One funded schools. 

    I don’t know what part of Washington Hanna resides in; i live in the eastern part.  One of the aspects of this issue i have noticed quite clearly is that here the population is surprisingly cooperative and “mellow” with persons who exhibit mental impairments.  This is very different from California.  Whatever the causality, it needs to be honored and rewarded, and maybe studied. Such positive feedback and openness reduces the stresses that force the 5150 issues in CA.  One of the central clinics for daily treatments is along my usual bus route, and i have had lots of opportunities to observe the relationship between the general population and those with “disabilities” and “handicaps.” I have been pleasantly surprised by the consistency of the positive feedback across economic, social, and racial spectrums.

    Posted by  on  04/07  at  07:59 PM
  51. Terrific piece.

    One thing that struck is it appears you’ve been treated rudely (at best) by some unthinking and uncaring “liberals” regarding your son. 

    Two words, Michael: Fuck ‘em.

    Posted by  on  04/07  at  08:22 PM
  52. I’ve read this post here several times now. I keep coming back to it.

    But, I’ve been feeling guilty for not commenting on it because the only thing I have to add is “great piece.” It is.

    Posted by Roxanne  on  04/07  at  10:00 PM
  53. me, too.  Great post, Michael.

    Posted by Laura  on  04/07  at  10:08 PM
  54. Yes, yes. All well and good. But admit it, Michael: it would have been really funny if, just for today, you had replaced your photo on the home page with an adorable picture of a puppy!

    And I dare say that it would not have been a cheap laugh, either. Coming from you, it would have been an absolute rib-buster! I’m still giggling everytime I think about your “magical dolphins” line.

    Posted by  on  04/08  at  03:03 AM
  55. Excellent piece.

    Posted by  on  04/08  at  12:50 PM
  56. This is such a wise piece, that I feel guilty for not commenting either.  I would simply like to say that, although I certainly understand ambivalence about seeing autonomy, and more generally, the quest for human perfectability, as a value unto itself that overrides all other human values, the more I live the more I understand how taking autonomy away can be, and often is, an assault on basic human dignity.  My overall feeling is, it should be taken away only under extreme conditions that evoke clear moral consensus.  This includes forced medication, forced childbirth (that’s what it is, no matter how hard you try to keep the focus on the fetus), and forced medical care. 

    I don’t say it lightly.  I spent my high school years in a household headed by a mentally ill parent who stopped taking medications every time the most acute symptoms had been alleviated, I once walked out of an emergency room in despair when my sister refused to stay voluntarily for treatment of her psychosis.  And I have been in the prenatal testing hotseat not once but twice.  And through all that, I still believe that most of the time, society is better off when pregnant woman, however distraught, and most mentally ill people, whatever the diagnosis, and those facing intractably negative prognosis, are masters of their own fate. 

    Perhaps if we were a more nurturing society generally I would adapt my views at the margins.  But it is utterly ridiculous for someone to contest the value of autonomy in a vacuum without acknowledging that the culture around us values autonomy at what is sometimes an exorbitantly high price.  Indeed, so much of the rhetoric in favor of “life” (in particular) is in favor of life only if the burden in spirit, cost, inconvenience and shattered lives is borne by someone else. That is, once the values police have taken away your autonomy so that you must have a baby or you must keep your spouse alive, you are on your own, a free agent, to figure out how to deal with the consequences.  And God help the mentally ill—to be forced into a setting in which treatment can be ill-directed, poor or nonexistent.

    Posted by  on  04/08  at  01:09 PM
  57. Very interesting article; I hope you consider publishing a version of it in print somewhere. 

    Our blogs are very different.  You have a large readership and attack issues like this academically, while my readership is much smaller (about 600 readers/week) and I mainly use anecdotes and journal-style writings.

    Still, we sometimes come around to saying the same things, especially with regard to prenatal testing, abortion, Down syndrome, and disability rights.  I am a pro-choice liberal and have a daughter with Down syndrome.  I did have a maternal serum screen, level II ultrasound, and amniocentesis when I was pregnant.  I knew about the Down syndrome and her (now repaired) heart defect in time to terminate, had I chosen to do so.

    I think that many liberals have a blind spot the size of a barn when it comes to disability rights, but I also think that most people who advocate terminating fetuses suspected of having disabilities (whether the disability is Down syndrome or simply having two X chromosomes) are not truly liberals.

    Posted by Sarahlynn  on  04/09  at  02:16 PM
  58. I know it’s only April, I want to go ahead and nominate this post for a Koufax Award. This has to be the best blog defense of the liberal approach to “the culture of life” that I have ever read. Thank you for it.

    Posted by Chris  on  04/09  at  05:54 PM
  59. I’m deeply flattered, Chris—and thanks to everyone who wrote in to contribute to this thread.  And Sarahlynn, best wishes to Ellie.  Don’t worry just yet about her friends—I thought Jamie wouldn’t have any friends when he was a year old, but his peers were exceptionally kind and understanding with him right through fifth grade, and he was included in plenty of games and parties.  Middle school is tougher, it’s true.  But I bet Ellie will get plenty of invitations to birthday parties for years to come, and surely she’ll throw a bunch of good ones of her own. . . .

    Posted by Michael  on  04/10  at  11:02 PM





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