We talk about freedom as if we knew what it is, but it’s a tricky business.
Issues relating to health are a constant source of dispute, so they dramatize some of the problems. Medical freedom is the right to make one’s own medical decisions. But it can be hard to pin down what that means, since it’s not always clear which decisions are medical, why medical situations are different from others, and which decisions are truly one’s own.
For example, does suicide when depressed or terminally ill count as a medical decision? “Gender confirmation” surgery? Killing one’s baby before birth? Sixty years ago, hardly anyone would have said so. It would have been like saying injecting heroin, female genital mutilation, and producing castrati for church choirs are medical decisions.
Today, politicians, activists, and professional associations say the former are medical decisions and should be protected as such. If a teen-aged girl wants to get her breasts removed, and her doctor will do it, that’s her right and her parents can’t be allowed to stand in the way.
But life, pregnancy, and normal sexual development are not diseases, so why is ending them a medical decision? For that matter, what health benefit is conferred by birth control pills, which are designed to disrupt normal bodily functioning for the sake of other goals?
The participation of medical professionals is thought to make such matters medical decisions that are properly left up to the patient and his doctor. But why do white coats make such a difference? If they are signs of special knowledge and standards, the same argument should apply to sports doctors who prescribe anabolic steroids. And how about doctors whose medical knowledge and loyalty to the Hippocratic Oath lead them to refuse participation in abortion? There’s a growing tendency to say that kind of professional judgment doesn’t count.
It seems clear that it’s not medical considerations that provide the answers to such questions but considerations that fall outside doctors’ professional expertise and have to do with the nature of man and human life. Such considerations are accessible to us all, and too important to be left up to the health-care industry.
The phrase “one’s own decision” raises even more questions. Abortion is again an obvious case. It is said to be an “intensely personal” decision for the mother, and that is often so. But many intensely personal decisions—marriage, for example—involve more than one person, so they cannot be left to the discretion of a single individual. The mother is not the unborn child, and the father, whose involvement is also intensely personal, will be equally responsible if the mother lets the baby live. So why is the decision so uniquely hers?
In fact, the question of who decides for whom arises in almost all medical situations. As assisted suicide becomes routine, it seems inevitable that the actual decision will often be made not by the patient but by a doctor, guardian, or someone holding a health care proxy. More generally, medical problems usually create problems for other people. COVID-19 vaccines provide an example—a great many people are prepared to force a novel semi-effective vaccine with serious and largely unknown side-effects on everyone, on the theory that doing so will help suppress a pandemic and thereby increase most people’s well-being and effective freedom.
But it’s not just medicine. Concerns regarding effects on others arise everywhere, because our choices depend on those around us and how they choose to live. A friend told me that his Italian grandmother visited when he was young and complained about the lack of freedom in America. He expressed surprise, and she pointed out that in Italy she was free to go out and buy a loaf of bread whenever she wanted, before or after dark. In 1970s America, as a lone woman without an automobile in suburban New York City, she was not.
In the absence of a way of life that worked for her, she found American freedom hollow. Similar points have been made in other settings, notably in the case of people who don’t have the money to exercise freedoms that are theoretically theirs.
The problem pops up everywhere. Gay “marriage” and easy divorce mean that more relationships qualify as marriages, and people can easily escape abusive ones. But depriving marriage of social definition, support, and specific function makes it much harder to enter a marriage worthy of the name. That’s bad for men, women, and especially children. So which freedom is more important, the freedom of each individual to define marriage for himself, or the freedom to have an actual marriage?
It can be hard to deal with that kind of problem. Socialism takes some of these issues very seriously, but its emphasis on system leaves no room for the individual. That is why economic inefficiency killed it, at least for a time. Fitting people into a perfect system is impossible without turning them into passive drones, and passive drones aren’t good for much.
In non-economic settings that problem is still with us. As sensitivities have developed, for example, cancel culture, political correctness, and the tyranny of health are determining more and more of what we are allowed to do, say, and think. When was the last time you heard someone say “it’s a free country”?
Even so, those who support the growing tendency to supervise and control everything believe it increases freedom. Bigots and unvaccinated people restrict what other people can do, they say, and that’s oppressive. It’s the “Karens” and judgmental people, the white middle-class cisheteronormative types who expect everyone to live like them, who are the enemies of freedom and need to be crushed.
All sides can make these arguments. Freedom can’t be maximized as such. When we can’t rely on others for basic things, because they are free to do as they wish, our own freedom is restricted. But what are those basic things?
Everyone wants a way of life that he finds good or at least tolerable, but a way of life depends on the cooperation of other people. So freedom that means anything must be ordered freedom, with sensible standards for what goes and what does not. But people differ on what those things are. The result is that everyone wants to infringe on what other people think is their freedom, in order to fit them into the system he finds most sensible.
Liberalism originally wanted to solve that problem by letting everyone decide on his own way of life. As we see all around us, it didn’t work. All we can do is try to find practical ways of living together, while making the freedoms that seem most valuable more secure and generally available.
That is difficult to do, since people are hard to manage. And we can’t begin to deal with the problem without some basic decisions about how it makes sense to live. But how can such decisions, which depend on a common understanding of human nature and the public good, be made?
We live in a technocratic age with democratic ideals, so people want to let experts or democratic politics decide. But such understandings are too basic to decide that way. They give expertise its mission and define the limits of legitimate political decision, so how can they be decided by experts or politicians?
In the past, such issues have been decided through the development of traditions that reflect the experience of the whole people, or else through divine revelation. That makes a great deal of sense, but technological society destroys tradition, the coherence of peoples, and public acceptance of revelation.
So now what? It’s a very difficult problem. To me, a Catholic society seems the only principled solution. Catholicism is the most reasonable way of understanding man and the world, and it supports natural law—ordering society in accordance with human nature. But that solution is practically very distant. For now it seems we have to bump along with various unprincipled arrangements, and do what we can to bring about something better. How that turns out we shall see.
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