Last month I offered a philosophical argument showing why contraception isn’t medicine. This month, I will treat some questions and clarify some difficult points.
Q. Your theory is neat, but it doesn’t match reality. Doctors commonly treat certain diseases with hormonal contraceptives. Therefore, aren’t we correct to regard such contraceptives as medicine?
A. The real question is whether contraceptive acts can be medical acts. Sometimes our way of speaking obscures this. A particular arrangement of chemicals, e.g., in the form of a pill, is not to be considered “medicine” or “contraception” wholly apart from the way it is used—wholly apart from its place as a tool or instrument in human acts. Of course, this or that chemical may have properties and qualities that make it apt to be used as a tool in a whole range of human acts. But when we name some physical thing a “contraceptive,” we do so because it is an apt tool for the sake of contraceptive acts.
For example, a scalpel is a medical tool. But, its sharpness also makes it an apt tool for other uses, like cutting an orange. Clearly, it would be wrong to conclude from these facts that cutting oranges with scalpels is a medical act. In the same way, when people say that “contraceptives” are put to medical use, they are engaging in a subtle equivocation on the name “contraception.” A drug or device is called “contraceptive” insofar as it is part of an act ordered to a contraceptive end or purpose, and in certain cases it may not be so ordered. Some physical object that has a medicinal use can also have a contraceptive use, but that doesn’t show that a contraceptive act has become a medical act.
Q. These Aristotelian analyses of arts and acts are irrelevant. The ancients were wrong about medicine, so why should we trust them? Isn’t modern medical science vastly superior to that of the ancients?
A. Contemporary medical science is excellent at helping us to achieve the ends for which we use it; but it cannot, by itself, tell us what those ends should be. A technical discipline simply assumes the end to which we direct it; it aims at producing the effects we desire. But it is not sufficient for determining its own end. For that, some sort of philosophical analysis is necessary and unavaoidable.
Q. Isn’t it misleading to say that the controversy over the HHS mandate is really about religious liberty, when women clearly see it as a matter of women’s rights?
A. How we frame the debate is important. Many news articles and media reports have suggested that this debate is primarily about health care and women’s rights. The cultural “meme” here is that there is a “war on women.” This critique presupposes that contraception is a part of women’s health care. This shows that determining whether contraception is health care is logically prior to judging whether opposition to the HHS mandate is part of a “war on women.”
A recent poll shows that fifty-seven percent of Americans support exceptions to the HHS mandate for religious employers. What’s interesting about this poll is how the internal numbers break down. People who consider this debate more about women’s rights and health care support mandatory coverage of contraception by a large margin. On the other hand, among those who consider the debate more about religious freedom, a majority say that all employers should be able to opt out.
This points to something crucial: the judgments of our speculative intellect influence the judgments of our practical intellect. To put it more plainly, what we think about the nature of contraception (e.g., whether it is properly described as medicine) determines our practical views on whether to implement things like the HHS mandate. It makes sense that people who think contraception is health care also tend to support its mandatory coverage.
The various media reports are wrong, then, to characterize opposition to the HHS mandate as a “war on women.” This kind of language presupposes that contraception is health care and that, therefore, those who oppose its mandatory coverage are denying women a “right.” But I suggest that what is at issue is precisely whether contraception is health care. Only philosophical arguments can adjudicate this question, and so it is not idle to appeal to philosophical terms and categories in this debate.
Q: What is the controversy really about, then?
A: Those who judge that contraception is not medicine will be more likely to see it for what it is: a matter of lifestyle, not health care. If contraception is truly health care, then the controversy can plausibly be framed in terms of women’s rights. But if it is not health care, then the debate is really about personal lifestyle. And it makes eminent sense that my freedom of conscience ought not to be violated to accommodate another person’s lifestyle.
Image: Domenico di Bartolo, Care of the Sick (This fifteenth-century fresco was painted for the Pilgrim’s Hall of the Hospital of St. Mary of the Staircase in Siena. On the right, a rotund Dominican friar hears a sick man’s confession.)