Commonwealth Dispatches
The West's complicated relationship with autonomy
Welcome back to Family Matters, where we are all, like Cleveland Browns QB Jameis Winston, just praying the Lord will deliver us from pick-sixes. On tap:
The Main Event: The U.K., Australia, and where autonomy fails us
Assisted Reproduction: Updates from the year 116 After Ford
It’s Me, Hi: The Scoop, webinar video, and John Shelton
Quick Slants
The Main Event
Today’s newsletter title is taken, with apologies, from my EPPC colleague ’s regular updates on his work on public theology, revivifying Evangelical ethical and political debates, and exploring the common good. The particular Commonwealth we’re discussing today happens to be the Balfour declaration variety, where in the last week we’ve seen glimpses of how letting autonomy become untethered from social contagion and cultural obligation can lead to dark places — and how its limits can be better respected in law.
We start in the United Kingdom, where lawmakers gave initial approval to a bill that would allow terminally-ill adults to by a vote of 330-275. There is still, technically, a chance for Parliament to reverse course — and it should.
The empathetic case for assisted suicide (or, as the Canadians have dubbed it, ‘medical assistance in dying’) is straight-forward enough. We picture terminally-ill adults, racked with pain and facing a prognosis of months, if not weeks, wanting some measure of control over the inevitable.
Yet uncontrollable pain is a much less common driver of the decision to opt for assisted suicide than many people believe. Managing pain more effectively, even more aggressively than would be appropriate at other stages in life, can lead to a decline in requests for assisted suicide. According to research from long-time pro-life scholar Richard Doerflinger, states that legalized assisted suicide saw their progress in administering effective palliative care slow, while those that maintain restrictions on assisted suicide have continued to advance approaches that effectively manage pain even into the late stages of palliative care.
And, just as importantly, the second-order consequences of permitting a self-imposed quietus are grave. Legalized physician-assisted suicide irrevocably changes the relationship between patient and provider, elder and descendants, and between the public weal and those who are no longer seen as economically productive. Individual choices about life and death inevitably have a spillover effect on how our culture treats those without full autonomy.
I am far from one to unthinkingly cite a medical trade group’s code of ethics, but in this case I think the American Medical Association gets it right: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Instead of engaging in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life.” Senior citizens could be forgiven for catching a sudden chill in the exam room if they knew the friendly face in scrubs had just come from deliberately administering a lethal dose of barbiturates down the hall. Introducing the prospect that your health care provider could end up prescribing death irrevocably changes the doctor-patient relationship — some bells can’t be unrung.
And, more salient for a newsletter focused on family policy, putting assisted suicide squarely on the table would introduce awful new dynamics around family members’ views of care as well. The last, interminable, awful weeks of watching a loved one fade away are difficult enough; if we give create legal structures which implicitly nudge Grandpa to consider an intentionally accelerated end, it would be ignorant of human nature to assume some family members won’t bring it up. This isn’t a hypothetical; UK tax law currently allows pensions to be inherited tax-free if a senior dies before his or her 75th birthday, creating an incentive in the hundreds of thousands of pounds to encourage Granny to get a move on with it as soon as she turns 74.
“We should allow people to end their lives on their own terms” may be an effective political slogan, but it ignores the fact that by permitting these choices, they impact the calculus that others — who may very well not wish to be hastened off this mortal coil — will end up facing. As EPPC scholar , has pointed out, the legalization of physician-assisted suicide has seemed to have led to a modest social contagion effect when states have legalized the procedure, with the change in the law changing the soft social expectations as well.
We don’t need to guess if the slope is slippery; we can see what’s happened north of the border, as Canada has Leroy Jenkinsed its way into a full-fledged assisted suicide regime. Despite advocates’ claims it would be carefully regulated and reserved for rare situations, it has become an increasingly normal part of life in Canada; in 2022, it made up 4 percent of all deaths in Canada, the fifth-highest cause of death, and that may even be an undercount. Plus, as EPPC scholar has reported, government regulators have turned a blind eye to as many as 428 possible cases where the safeguard protocols were violated.
Allowing a narrow vision of autonomy to trample over traditional respect for human dignity and the vocation of the medical field has turned Canada into a cautionary tale. Non-terminal mentally ill adults are coerced into euthanasia, cancer patients are told assisted dying would be covered but not their chemotherapy, and the chronically ill told they are 'selfish' if they don't choose to die. The U.K. still has time to avoid making the same mistake.
In other areas of our social life, an untrammeled autonomy has led to social ills that have become too obvious to ignore. In the UK’s near-antipode, Australian lawmakers have advanced a bill that would establish the minimum age for signing up for a social media account at 16. Australian MP Andrew Leigh took to the pages of Jonathan Haidt’s After Babel to lay out the case:
I am often reminded of a column by The Atlantic's Elizabeth Bruenig, in which she argued that children stick out misshapenly in a liberal democracy that prioritizes a sort of Rousseauian individualism. “Children are bundles of obligations, theirs and ours to them, and their vulnerability and needs leave little room for the sort of political freedom the imaginary liberal subject is presumed to have.” Because of this, our political debates are much more tolerant of collective action to protect kids from various threats — including, perhaps, from themselves, or at least the version of themselves they playact as online.
Recognizing the individual and social harms that occur when childhood is primarily experienced online is the first step; equipping parents to better protect their kids online is the next one. And when parents alone can’t change the societal calculus, state action is merited. The benefits of allowing 14- and 15-year-olds to create an Instagram may be real in some cases, but they are outweighed by the social costs of stunted maturity, rising rates of mental illness, lower academic performance, and on down the list. In the case of children, we can more easily recognize how individual choices can lead to long-term harms for them as well as for society, and individuals opting out aren’t enough to change a culture that treats teen social media use as anything but noteworthy. Collective action problems require collective solutions. “If you don’t want a smartphone/an phyisician-assisted suicide/an abortion, just don’t get one” falls short as a governing philosophy precisely because of the externalities that those decisions have on others.
A politics that prizes human dignity will need to push back against the myth of fully autonomous individual making choices that only affect him- or herself. As Ramesh Ponnuru wrote in the Washington Post, assisted suicide advocates assume the subject of their legislative efforts will be a “willful, competent, self-actualizing, independent person, [placing] too little weight on the interests of those who exemplify other aspects of the human condition: vulnerability, limitation, dependence.” Recognizing the limits of autonomy will be difficult for a West that prioritizes individuals rights. But it will become essential for a politics that prioritizes those who are not fully self-contained, self-sufficient individuals — as we are all, especially at the beginning and often the end of our natural lives.
Assisted Reproduction
"Joy," the Netflix bio-drama about the invention of IVF, has gotten respectful if not especially stellar reviews, with Bill Nighy, Thomasin McKenzie and James Norton depicting the trio of researchers whose work ended up creating the technology that led to the first “test-tube baby,” Louise Brown and the suite of assisted reproductive technologies (ART) that followed.
Prior to the Alabama case that held IVF clinics responsible for the inadvertent destruction of frozen embryos, there had been a quiet drumbeat of articles in the popular press about the excesses, problems, and difficulties in the ART industry. They fell out of fashion for a while, but two feature pieces raise new questions about the U.S. preference for light- or no-touch regulation around this most intimate sector of the economy — they come from in The Free Press, and Susan Dominus for the New York Times Magazine:
In the December 2024 issue of First Things, Michael Hanby offers a maximalist argument against these technologies:
“Infertile couples who have recourse to assisted reproductive technologies obviously do not intend to bring about the brave new world. They only want a child, and their desperation blinds them to the incalculable gravity of the technological means for having one…
“[But] those implicated in the industry of baby production live in a world of questions that can scarcely be posed, let alone answered. What do you say to the teenager who asks why it was he who was selected from among his five embryonic siblings? That he was a boy? That he had the best genetic profile? What do you tell the child who spent five years in cryopreservation so that his embryonic twins could be born first? What do you tell the son of a single professional woman, conceived with donor sperm, when he asks about his father? What do you say to the girl with “two dads,” born from an egg donor and a gestational surrogate who was paid to disappear, when she asks who her mother is?”
I don’t think these structural arguments are likely to change much in the way of the broad public support for most ARTs. But the deeper questions he raises feed into the very real concerns about exploitation and lack of accountability that better regulations of ARTs could ameliorate but never full solve. As the new Congress considers legislation that could expand or regulate the field of assisted reproduction, it should weight heartwarming Netflix dramas less, and the slew of stories that show the industry should not be given a blank check and blanket immunity without having to address the ethical concerns it can create alongside the very real sources of joy welcomed by new parents.
It’s Me, Hi
I was interviewed by Ann McElhinney and Phelim McAleer on their podcast The Scoop on the role of educational polarization in the 2024 election, and the disconnect between D.C. policymakers and working-class voters.
Our webinar on pro-family policy in 2025 with Joseph Zeballos-Roig, John Shelton, Leah Sargeant, and Autumn Christensen is now available online:
My gentle skepticism towards the effectiveness of the Family Policymaking Assessment received a response at the IFS blog by Advancing American Freedom’s John Shelton.
I am quoted in Chabeli Carrazana’s review of where Child Tax Credit efforts stand heading into the new year for The 19th:
“In a post-Dobbs, low birth rate, high deficit environment, a baby bonus will give the biggest political and cultural bang for the buck, and thus should be prioritized accordingly,” wrote Patrick T. Brown, a fellow at the conservative think tank the Ethics and Public Policy Center.
Quick Slants
Lance Morrow (1939-2024) was a long-time journalist at Time magazine, a two-time winner of the National Magazine Award, and, since 2017, a senior fellow at EPPC. R.I.P.
Laurie DeRose, a sociologist at the Catholic University of America, argues that "pronatalists need to purposefully distance ourselves from misogynists and racists” (Family Studies)
Rachel Cohrs Zhang reports that former FDA chief Scott Gottlieb is marshaling a quiet effort to convince Republican senators with concerns about Robert F. Kennedy Jr.'s views on vaccines and abortion to oppose his nomination (Stat News)
Pascal-Emmanuel Gobry offers his gloss on what a conservative quality-of-life agenda could look like, building off the discontent with progressive management of U.S. cities referenced in a previous Family Matters post (PolicySphere)
Ariel Gilreath reports on a new threat to small child care providers - rising insurance rates (Hechinger Report)
The anonymous Substacker wrote against the too-facile ideal of “The Village”, pointing out that while many parents say they want close-knit social networks, they often opt for more contingent relationships; this parallels the uneasy truth that the decline in social capital is because we've become rich enough to buy our way out of community involvement and inter-dependence (Slate)
Joe Waters, Caroline Cassidy, and Elliot Haspel offer some suggestions for a new consensus around family policy - the emphasis on breaking down siloed programs into approaches that holistically support the heterogenous preferences of families (and, intriguingly, communities) seems like fertile ground for both left and right to explore (Capita)
Jeremy Peters covers the quiet reconsideration of confrontational tactics among transgender activists (New York Times)
Comments and criticism both welcome, albeit not quite equally; send me a postcard, drop me a line, and then sign up for more content and analysis from EPPC scholars.