Many of the most contentious issues of our time revolve around human sexuality. Presently the most notable of these are care of transgender persons and the legality of abortion. But whether one realizes it or not, one’s position on these issues depends on a deeper assumption of how one defines health care. We see this assumption on full display with bumper stickers that say “abortion is healthcare” and the use of the phrase “gender affirming care.”
The World Health Organization (WHO) defines “health” as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” which is all well and good. The ethical justification of elective abortions and gender affirming care rests on this definition. But note well that this definition has an inherently large component of subjectivity. Although the health of the body can be objectively gauged (to a point), mental health and social well-being are far more difficult to quantify.
However, there is another longstanding tenet of medical ethics derived from the Hippocratic Oath that often is rendered “first do no harm.” This principle indicates that it is generally unethical to alter an otherwise healthy body.
In addition to this principle, one must also consider the fundamental question of the mind/body relationship. Modern ethics seems to take its cue from Rene Descartes’ famous “I think therefore I am.” From that starting assumption (and it is an assumption), the person is viewed primarily as his or her consciousness, with the body being an afterthought whose purpose it is to serve that consciousness. The counterargument is that to be human is to have a mind and body that act as one whole, both of which are of equal importance. Many very erudite people have come down on either side of the issue.
Returning to our contentious issues of elective abortions, and surgical/pharmacological approaches to treat Gender Dysphoria, both do in fact modify or “harm” an otherwise properly functioning body under the assumption that doing so is for the sake of the broader health of the person. However, one can also see that Hippocratic Oath derived principle of “first do no harm,” along with one’s philosophical position on the mind-body problem, can lead to reasons to disagree with the claim that those procedures qualify as health care.
It is my observation that reasoning which never would pass as critical thinking for any other subject seems to be readily accepted when the issue is human sexuality (e.g., the infamous and nonsensical “pro-choice” argument). If the issues did not involve human sexuality, would we be so quick to make surgical or pharmacological alterations to the human body? Would we even consider, as in a case of Bodily Integrity Identity Disorder wherein a person has an uncontrollable desire to have a healthy body part removed, amputating a hand?
As a culture we have lost sight of the difference between “feeling” better and “being” better. Any person of maturity should know that things that are truly good for us do not necessarily make us feel better. We have gone from a nation of thinkers to a nation of emoters. The decision to alter, chemically or surgically, an otherwise physically healthy body for the sake of a highly subjective broader definition of health is a very serious one, especially when those decisions might be irreversible and have life-long consequences. It is a subject over which reasonable people can disagree is a proper act of healthcare. And, by the way, labeling those who disagree with you as “extremists” does not constitute a cogent argument.
Charles Dern is an adjunct teacher of philosophy and theology for various Catholic institutions of higher learning.
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