Thanks for your helpful comments Lyn and David - will chase that reference up.
I have found it interesting that nearly everyone has assumed that paying a woman not to have more children equated to this being used to fund her having an abortion or being sterilised.
That's not what I had in mind at all given our Medicare health insurance system in Australia.
I guess my comments are coloured too by the current policy in Australia to give all women who give birth to a child a $5,000 baby bonus. In this woman's case, I think one could argue that it would be in the interests of subsequent children and society if this particular woman didn't have any more children - ok, the $5,000 - I would raise it to $10,000 in circumstances such as I've described - then becomes an incentive to get herself on to effective contraception which she would have to pay for since Medicare won't cover all of those costs. Then after she reaches menopause with no more kids to her name she gets the jackpot. Given that this may mean a wait of 20 years into the future, some scheme whereby she could get a downpayment in advance of that would be necessary, to be returned (by reduction in benefits if unemployed, or a tax surcharge if she was working) if she did become pregnant.
Some have argued - and it's arguably better policy - that it would be better to get her into an effective drug rehab program. Fine if it's accessible and it works, but that alone without changing other likely drivers of her addiction, probably only has modest chances of success. Maybe both policies should be introduced. One to directly benefit her and as a spin-off society, the other to benefit society and children who would otherwise have been born.
And, if she became rehabilitated and proven to remain drug free for some years the policy could have a rider that ensured no penalty would apply if she had a subsequent child.
I have commented IN NON SHOUTING CAPITALS below on Lyn's comments.....
>>> David Zakus <[log in to unmask]> 10/04/08 1:17 PM >>>
HI...have you read the chapter on abortion in the book
"Freakonomics"...it makes for a very interesting read following from
this discussion...b est,
david zakus
On 3-Oct-08, at 10:49 PM, Lynette Reid wrote:
I think it is important for us to be able to articulate clearly why policies
like this are problematic. When we think about weighing costs in
healthcare, we can lose site of the perspective that spending money to support
human life and, hopefully, flourishing, is basically what economies are for.
AGREED
Every living human being costs their families and the state (in some
particular combination for each person) large sums of money at the
beginning of life, and often, at the end. (THE COSTS AT THE END ARE USUALLY MUCH HIGHER THAN THOSE AT THE BEGINNING) We pay for that person in our tax
dollars when the state is heavily involved in their care; we pay for that
person in the general structure of wages and price of goods (raising Paris
Hilton cost everyone who has stayed in a Hilton hotel a certain amount of
money), and by tax subsidies to families with children, when the family absorbs
more of the cost.
IN THE CASE OF CHILDREN PLACED IN OUT OF HOME CARE THE OUTLOOK IS PRETTY BLEAK FOR THEM IN TERMS OF EMOTIONAL AND PSYCHOLOGICAL WELLBEING, ACADEMIC SUCCESS AND LIFE CHANCES. SURE, RISK IS NOT DESTINY, AS IS SHOWN BY THE SUCCESSES OF SOME YOUNG PEOPLE WHO HAVE EXPERIENCED A LONG TIME IN OUT OF BIRTH-HOME CARE, BUT OVERALL THIS GROUP HAS BEEN SHOWN BY SURVEYS IN SEVERAL COUNTRIES TO BE AMONGST THE MOST UNHEALTHY IN ANY SOCIETY -NOT ONLY DURING CHILDHOOD AND ADOLESCENCE, AND INTO ADULT LIFE - THE AMERICAN ACADEMY OF PEDIATRICS HAS PRODUCED SWATHES OF DATA ON THIS.
IT SEEMS TO ME THAT WE ARE AT RISK OF BEING INCONSISTENT IN OUR APPROACH TO THESE DILEMMAS. IF BEING PLACED IN OUT OF HOME CARE HAD A BIOLOGICAL CAUSE, RATHER THAN A SOCIAL ONE, AND COULD BE PREDICTED IN ADVANCE OF BIRTH, PARENTS WOULD BE OFFERED THE OPTION OF TERMINATION IN MANY SOCIETIES - DOWN SYNDROME OR SPINA BIFIDA BEING A PRIME EXAMPLE. A JUDGEMENT IS SURELY BEING MADE IN SUCH CIRCUMSTANCES SIMILAR TO THE ONE LYN CRITICISES BELOW, NAMELY THAT THEIR LIVES ARE WORTH LESS THAN OTHER LIVES. OR MORE ACCURATELY, THE COST OF THEIR LIVES TO FAMILIES (SOCIALLY, PSYCHOLOGICALLY AND EMOTIONALLY) AND SOCIETIES (THE LIKELIHOOD OF BEING A PRODUCTIVE, FULLY INDEPENDENT HUMAN BEING IS MUCH LESS THAN IN CHILDREN WHO DON'T HAVE DOWN SYNDROME) IS SUCH THAT NOT BEING BORN IS DEEMED A BETTER OPTION.
Any reality that stands behind the idea that some people "cost
us" money and some don't is highly constructed by our particular economic
system.
In my view, any policy that encourages certain (kinds of) people not
to be born is a statement that their life is worth less than other lives. It's a
prediction that they won't be net contributors. And a valuation that
being a net economic contributor is what we care about in human life.
I THINK THIS IS OVERLY SIMPLISTIC FOR REASONS TOUCHED ON IN MY EARLIER COMMENT ABOUT DOWN SYNDROME. IT'S NOT ONLY THAT WESTERN SOCIETIES TEND TO VALUE MORE HIGHLY THOSE WHO ARE LIKELY TO BE NET ECONOMIC CONTRIBUTORS (WHICH IS WHY MANY WESTERN GOVERNMENTS ARE NOW INVESTING MUCH MORE IN THE EARLY YEARS OF LIFE), BUT ALSO THOSE WHO CAUSE US - PARENTS AND THE GENERAL SOCIETY - LESS PAIN PSYCHOLOGICALLY AND SOCIALLY ARE MORE HIGHLY VALUED. AND HOW DO CHILDREN BORN INTO A LIFE WHERE THE PROSPECTS OF THRIVING ARE NOT GOOD, WHERE BEING EXPOSED TO VIOLENCE IS A DAILY OCCURRENCE, WHERE SCHOOL FAILURE IS ALMOST INEVITABLE, FEEL ABOUT LIFE WHEN THEY SEE THE DIFFERENCE BETWEEN THEIR LIFE CHANCES AND THOSE WHO HAVE BEEN BORN INTO MORE FORTUNATE ENVIRONMENTS?
I think Melissa is right that such policies are coercive. The idea
that a person's current addicted life situation is a good moment in which
to make a permanent decision about fertility is bizarre. I WAS NOT IMPLYING STERILISATION. Paying someone to make a major medical decision at exactly the wrong moment in their life sounds coercive to me. I'M NOT SURE WHAT MOMENT YOU ARE REFERRING TO. BEING OFFERED A CHANCE OF DOING SOMETHING TO PREVENT THE EIGHTH CHILD BEING TAKEN INTO CARE BY NOT HAVING IT MIGHT ACTUALLY BE SEEN AS A GOOD CHOICE. AND HOW DOES THE PRINCIPLE HERE DIFFER FROM THE ONE INVOLVED IN OFFERING TERMINATION TO PARENTS WHOSE CHILD HAS A LIFE-ALTERING GENETIC ABNORMALITY?
PERSONALLY I HAVE LESS DIFFICULTY ETHICALLY WITH WHAT I''M FLOATING THAN ONE THAT OFFERS TERMINATION AS THE BEST OPTION IN A VERY DIFFICULT SITUATION.
I THINK THESE ARE VERY IMPORTANT ISSUES. GIVEN THAT COMPELLING PARENTS TO SURRENDER THEIR CHILD FOR ADOPTION IS AN ALTERNATIVE POLICY PROPOSAL TO DEAL WITH THESE KIND OF ISSUES I WONDER IF THAT IS NOT EVEN MORE COERCIVE THAN WHAT I'VE FLOATED?
GRAHAM
-Lynette
>
> -------
> Lynette Reid, PhD
> Assistant Professor
> Department of Bioethics
> Dalhousie University
> 5849 University Ave.
> Halifax NS B3H 4H7
> 902-494-1842
> fax: 902-494-3865
> [log in to unmask]
> -----Original Message-----
> From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf
> Of
> Melissa Wieland
> Sent: October 1, 2008 3:08 PM
> To: [log in to unmask]
> Subject: Re: [SDOH] Social Determinants of Procreation??
>
> Granted, this woman is irresponsible, but shouldn't the focus be on
> counseling and providing this procedure at no cost to her, if she
> chooses?
> In this economy, particularly, there is no way to get around the
> fact that
> this proposed legislation is a cohersive tactic.
>
> -----Original Message-----
> From: Social Determinants of Health [mailto:[log in to unmask]]On Behalf Of
> Graham Vimpani
> Sent: Wednesday, October 01, 2008 5:56 AM
> To: [log in to unmask]
> Subject: Re: [SDOH] Social Determinants of Procreation??
>
>
> what do you do when you are confronted by a woman who has a major
> drug and
> alcohol problem, and who has had 7 children already taken into state
> care?
> isn't there a case then for actually paying her not to have more
> children?
> especially when her children are already costing the state several
> million
> dollars per annum as a result of their need for care and their
> associated
> mental health and schooling problems?
> Graham
>
> Professor Graham Vimpani AM
> Clinical Chair
> Kaleidoscope in Greater Newcastle
> Hunter Children's Health Network
> Locked Bag 1
> Hunter Region Mail Centre
> NSW. 2310
> Australia
> Head of the Discipline of Paediatrics and Child Health
> University of Newcastle
>
> Phone +612 4921 3673
> Fax +612 4921 3599
> mobile 0408 484 427
> [log in to unmask]
>>>> Angeline Ferdinand <[log in to unmask]> 10/01/08 11:23 AM >>>
> I've seen a lot about this nonsense, and the conclusion I've come to
> is
> this:
>
> Yes, it's horrifying that there are people who think like this, and
> that
> there are people who will vote people who think like this into
> office. But
> the reality is, this is just some crackpot idea that a legislator
> has come
> up with. He hasn't actually proposed the legislation yet (as far as I
> know), and even if he did, there's not any chance of it passing. In
> short,
> I think that this is (yet another) opportunity to be all fired up and
> horrified about something that is ultimately fairly meaningless.
>
>
>
> On Tue, Sep 30, 2008 at 11:26 PM, Michael MacDonald <
> [log in to unmask]> wrote:
>
>> SDOH Readers,
>>
>> I was amazed when I read this, so I thought I'd share with you all:
>>
>> http://www.wwltv.com/topstories/stories/wwl092408cblabruzzo.a931c79f.html
>>
>> This politician has actually proposed sterilization of women in
>> poverty,
>> and adds men as a side-note.
>>
>> Michael
>
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David Zakus, BSc MES MSc PhD
Director, Centre for International Health
Associate Professor, Dalla Lana School of Public Health
Associate Professor, Department of Health Policy, Management and
Evaulation
Faculty of Medicine, University of Toronto, Canada
tel: +1 416-978-1458; fax: +1 416-946-7910
http://intlhealth.med.utoronto.ca
Immediate Past-President, Global Health Education Consortium (GHEC)
www.globalhealth-ec.org
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