Today I’m going to continue yesterday‘s discussion see: Conflict Resolution
In the news today there was a discussion of there being many state laws against treating people under 18 for transgender issues.
I’m going to use that issue along with abortion and the prescribing of opiates to speak more about the conflict between law and medicine.
Yesterday I framed or spoke about how we can look at systems as being essential or elemental and pointed out yet another way of speaking about them was the humanist or cooperative versus the normative or rule-based way of looking at things.
Another issue raises its head concerning these three issues and that is the moral stance, the view of morality that each community has on these issues of being transgender, using opiates, and abortion.
Medicine tries to stand apart from the legal and the moral deriving its actions from an ethic that’s been developed over centuries that in some ways is expressed in the phrase “do no harm”. This phrase turns out to be complicated, but we will leave those complications for now. Here I am just using it as a marker for saying that in the main medicine is applied on a case-by-case basis and it involves all of humanity and thus goes away from being culturally specific. For example, and I don’t know when this started, but doctors treat all wounded no matter what side they are on, or what religious or political position they take. This is the ideal that is remarkably upheld most of the time. I should mention that medicine also has had its very dark side as with all human endeavors it can be corrupted as we note with the Nazi experiments and Mengele or the Tuskegee tuberculosis experiments.
That said, medicine has come to stand, in many ways, outside society. It’s ruled by practicality and science. What works to alleviate suffering in this particular patient is the focus.
This has not always been the case because medicine was part and parcel of the culture, organic to a given culture.
There has been this transition where such things as abortion, transgender issues, and the treatment of pain have become more divorced from the culture and gone towards the more objective and scientific evaluation of each of these issues. That is before they were never a problem as they were part and parcel of the culture. There have always been transgender people and they’ve been dealt with in various ways in various cultures. There has always been abortion and birth control. And there’s always been some attempt at pain control albeit for most of history you couldn’t do much about it or do anything about it.
They are more of a problem now because medicine now, like technology, science, and popular culture tends to invade and take over other aspects of culture such as religiosity and particular ethical systems, and ancient tribal beliefs. So there are multiple complex conflicts.
The law reflects many of these belief systems and tries to codify them. Simply saying this is the way we should live our lives and saying it be damned whatever science and medicine are telling us. There are rules and we can’t break them. Emphasizing the elemental over the essential or humanistic.
That does not mean that the law does not change but it changes slowly and that’s one of the main problems of bringing law and medicine together. Someone once said that the law is like looking in the rearview mirror. The law is always almost 100 years behind a given culture and its technology. it’s elemental and normative in its approach. Medicine by its nature is humanistic, expensive, and democratic in the search for truth.
That is not to say that questions about transgender treatment are not legitimate. People can rightly worry that this is moving too fast and that people under 18 should not be treated. It makes sense that they are not psychologically stable enough, or just mature enough, to make such a choice.
One theme that runs through a lot of what I write is that it is doubly complicated because that’s kind of the point, that the mind and body are becoming, we are becoming to see, that the mind and body are so integrated that you can’t treat sexuality, mental health, and other aspects of being alive separately when you get down to it. Sexuality is integral go to your mental health.
Science and medicine have outpaced much of traditional culture and have caught up with what is going on with the human as seen essentially and holistically. We need to go slow but we also need to leave it to the family and the children. Over and over again you can’t legislate these things because you don’t set medicine in stone, it is always a moving target.
I won’t say much about abortion. We all are aware of the different arguments for and against. I will say that all these issues have recently come to the fore again in all their complexity due to the Dobbs decision.
Abortions are going to take place. A punitive approach never makes things better. Education is essential. We don’t want to go back to self-induced abortions yet that is where we are headed and assuredly where some are. Any serious person against abortion needs to think deeply and resolve these conflicts in their own mind. Essentially, we now see that advances in medicine have, again, outpaced culture. We simply did not have so many instances of fetal and maternal complications before. Corrections we had all the complications but we couldn’t do anything about them. The law is not nuanced enough or fast enough to keep up.
Finally trying stop drug use and the medical use of pain medicine.
It is well-documented, but not well-publicized, that prescription drugs for pain have diminished over the last six years but overdoses have gone up. So there has to be something wrong with the way we are doing it. It is now indisputable that prescription drugs were never a big part of overdoses. Just one point is that when overdoses involve prescription drugs, they almost always involve some other drug or drugs that are illegal. 80-85% of overdoses are due to street drugs or some other form of intoxication. The essential or humanistic approach is to look at the entire society and what is driving people to use drugs. Not to put drug users in jail. Not to put doctors in jail. Not to look at the elements and make individual acts illegal.
Another example of being punitive not working is that I listened to a discussion the other day about the secondary consequences of the drug problem. Much of the discussion was about drug users having children and the children being either taken away from them or the drug user dying. Part of the discussion was a statistical analysis of how effective punitive measures were in controlling the situation. No surprise to me that the more punitive measures such as arresting and putting mothers in jail only served to have worse outcomes for the children and for the drug user.
How do we resolve all these conflicts? We just start someplace. We start discussions. We speak about them, and we progress.
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Interesting post Brian. I wish that law could be more about the individual person than the population because everyone's situation is different. I am not anti-trans but I would like to explore another theory with you, a theory related to affect psychology. We are experiencing a cultural phenomenon with the transgender movement. Do you think that some of it could be related to the images of the idealized female and male bodies constantly flashing in front of children via phones, tablets, computers, and TV? Pornography is everywhere. I have been with teens, female and male, who agonize about their bodies, and 9 times out of 10 they have a steady diet of social media.
I have spoken to adolescents, both biological males and females, who struggle with shame because they feel that they are not considered attractive. A stocky female with hirsutism, PCOS, does not feel pretty, how can they be a female when a female looks like a perfect thin naked woman with perky breasts and smooth tan skin? Children in past generations did not grow up with constant artificially doctored images.
The world tells children that they are fat, ugly, undesirable, they are not beautiful women or handsome men. People both children and adults compare themselves, to the idealized images of male and female in their cultures. Rather than having a culture that accepts all types of women/females, both feminine and masculine, or all types of men, there is complex gender identity, that creates more divisions. Why couldn't we have a welcoming whole where we can just be people, male and female as we have been over hundreds of thousands of years, but different kinds of females and different kinds of males.
I am sensitive to transgender children and adults, but the research is not strong in support of sex changes for minor youth. https://www.medscape.com/viewarticle/958742?icd=login_success_email_match_norm
I am interested in understanding how shame moderates' transgender identity. The feminist movement is losing women who might have been the more outspoken women's rights activists, masculine types--the feminist pioneers, many of them, were more masculine in their appearance. If they had become men, where would women be today?
We are losing these strong, smart, outspoken biological women to the transgender movement, and to the male identity. Surely the female identity should be a large enough spectrum to hold different types of biological females.
Lastly, consider that the effects of the transgender biological sex changes are no different than the goal of the eugenics movement. Honestly, this seems like human engineering to me. I don't know if this movement is as humanistic as it seems to be on the surface... I like to look deeper, because I care about the most vulnerable.
What organizations, billionaires, movements, want less desirable biological males and females to lose the ability to procreate, to be sterilized, and prevented from having offspring? If you find out, you might discover the orchestrators of our American cultural phenomenon....
As a healthcare provider, my priority is caring for children and families, and supporting their mental health and welfare, which may conflict with my personal concerns or beliefs. All kinds of people, all kinds of biological males and females, I love them all, no matter what. It is important to express positive affect, while also doing due diligence in a holistic assessment, and asking the right questions, to help them decide what is best for them. Ultimately the patient/family are the captains of their ship, and we just make sure they can understand the map, including where the rocks are.
Farah