Helmet laws, genetic testing, & the nature of precedent
Topics: Health, Misc
10 May 1992
From:
Tonight on 60 Minutes they had a report on the status of genetic testing
and some debate about which uses of it were ethical and which were not.
One person's view was that genetic testing and abortion of fetuses
with serious problems was moral because of the burden that society
would otherwise have to assume to pay for medical care for the
children-to-be who would have serious problems. I am sure there are
some as well who would make it mandatory.
The situation reminds me of Chau-Wen's argument that we need helmet
laws because otherwise society has to pay more to care for uninsured
riders. The logic of one is as good as the other. If we accept the
premise that people are not allowed to accept risk of their own
health (or that of their children), the conclusion is that freedom has
no value. One is not even permitted to buy out of the system, i.e. I
cannot promise to pay my own bills in exchange for being 'allowed' not
to wear my helmet nor can I (hypothetically) pay for the hospital care
for my child.
The Brave New World possibilities of just what kind of children we let
people have are staggering. I particularly want to make the point
that precedent does matter (contrary to Chau-Wen's claim that we
shouldn't let bad precedent stop 'good' laws). Helmet laws have
already broken the philosophical ground that we can control people's
behavior just because their medical costs are imposed on society
*regardless* of whether or not they need or want that support(*).
There is no reason to stop there.
Another instance came up last month when someone on MacNeil/Lehrer was
defeding Oregan's 'play or pay' health care proposal on the grounds
that the government has already forced employers to provide
unemployment insurance so why should medical insurance be any
different? Well, why not indeed? Why not homes and day care and
everything else on the liberal wish list? The precedent does matter.
Speaking of health insurance, the aforementioned 60 Minutes piece also
said that more employers were requiring genetic testing and refusing
to hire people that were susceptible to any of a long list of long
range problems (e.g. colon cancer). I asked myself why should an
employer completely forego 30 years of productive work out of fear of
losing the last 5? The answer is not that they are so worried about
the last five but that their insurance (which they'll soon be
obligated to buy) cannot 'discriminate' against people with genetic
predispositions (or any pre-existing condition in many cases). So,
they simply do not hire them instead. People with problems that
otherwise could have had a job do not get one and at the same time
companies get fewer productive employees. The 'solutions' that I hear
are all of the form of more regulation.
(*) This is a stronger and more specific argument than the general libertarian
principle of let people do what they want. In this case, the damage is
confined to the person in question (e.g. it's not like drugs presumably
inducing criminal behavior). The person is not making an irrational
decision because of unavailability of facts, e.g. one might think that
food content laws are necessary because people cannot properly evaluate
the long term damage of lose dosages of carcinongens unlike helmet laws
where you know that you are going to die if you crash without a helmet
and you have a feel for what the chances of that are. The individual
choice is not cheating someone else out of a 'fair' chance (e.g. it's
not like trying to combat racism with AA). Finally, what is at issue
here is not that we protect people from their own foolishness but that
we do not let them make plausibly rational choices just because society
redistributes the burden and then refuses to pay for it.
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