Category Archives: Policy

Don’t You Care That I’m Dying?

Yesterday, I attended an  ethics talk on the potential issues of merging Secular and Religious healthcare organizations. It was an extremely interesting discussion and one that’s far too complex to try and detail here1.

For anyone who’s been living under a rock for the past few years, the US healthcare system is undergoing a tremendous amount of change and reorganization. Changes in treatment reimbursement and shifting regulations regarding electronic health records and such have seen many smaller hospitals consolidating into larger Accountable Care Organizations (ACO). This has inevitably resulted in religiously affiliated hospitals (primarily Catholic ones) merging with or associating with secular institutions. With these new agreements come another set of governing documents known as the Ethical and Religious Directives (ERD) which are handed down by the U.S. Conference of Catholic Bishops. These directives are an attempt to elucidate Catholic Social Teaching within the context of medicine and healthcare and provide a framework for not only reasoning about critical decisions, but also for defending existing doctrine. Of course, these documents don’t stand on their own, they are products of a current political and cultural climate and thus deal with extremely delicate topics centered around both the beginning and end of life. And it’s these stances that are proving to be problematic.

As the session opened the panelists each gave their perspective on the topic and attempted to explain the issues at stake. This is where things began to get interesting. Like any old fool, I’d originally assumed that in a discussion of both Catholic teaching and Catholic hospitals, there would be representatives from some of the respective organizations. Silly me, in fact, not only were they not in attendance, they were purposefully not invited, in order to keep the discussion focused on ‘the ethics’2.
The problem with this approach, is that catholic3 teaching is focused within a larger religious framework that makes it impossible to split off and analyze as a piece of secular health policy. Consider this section from the ERD Introduction:

The mystery of Christ casts light on every facet of Catholic health care: to see Christian love as the animating principle of health care; to see healing and compassion as a continuation of Christ’s mission; to see suffering as a participation in the redemptive power of Christ’s passion, death, and resurrection; and to see death, transformed by the resurrection, as an opportunity for a final act of communion with Christ.4.

As a religious person, I find this statement to be incredibly powerful, beautiful in its hopefulness for a world renewed, and invigorating in its extortion to us as agents of healing and change. To a non-religious individual, this statement is at best completely inaccessible, and at worst extremely offensive.

Consider Directive #61, which ends with:

… Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.

When trying to evaluate this as a piece of health policy it largely reads ‘let them suffer until the bitter end, and maybe preach at them until they pass out’.  Which brings us to the crux of the forum, the prevailing opinion is that the merging of secular and religious hospitals is unethical because Catholic teaching is inconsistent with moral care of both the dying and the soon to be born, or accurately scheduling those soon to be born.

A religious person would bristle at this statement, and rightly so, but that fact remains, this is the perception of a huge swath of the American populace.

But why is this the case?

While there are most likely a myriad of reasons, the one that stuck out to me was the fact that religious views on health and ethics are inextricably rooted in a larger religious system. The reason Catholics oppose abortion, is not some form of uterine control, but a deep understanding on the meaning and value of life. Likewise, this concern is extended to include those whose time on earth is drawing to a swift, though painful, close. Thus, when you simply strip all that away, you’re left with a series of cryptic one-liners which seem to simply regurgitate the last remnants of some medieval council.

But this misunderstanding goes even further. Consider the recent supreme court case Sibelius v. Hobby Lobby, here the court wants to know why the actions and choices of an individual must be made subject to religious doctrine. A fair question, but one that’s inherently misguided. To a religious person, the question is not about why actions may be held to account for religious teachings, but if these specific actions can be held to such a standard. Religious people understand the concept of self-surrender, whereby our wants and desires are made subject to the perfect will of God. So, while you may argue over specific cases, it makes logical sense that there would be situations in which our own wants and desires would have to be surrendered for some larger purpose5. Of course, without a theological framework to lean on, this explanation holds little to no weight.

At this point, there are probably quite a few people who would take issue with my characterization of religious doctrine, in that God’s truth extends beyond simple metaphor or liturgical ritual, it indeed resounds in the night and shines in the light of day6. This is absolutely true, and one need only take a cursory scan of places like The Public Discourse,  or First Things in order to find logical, well reasoned discussions of Christian ethics and thought within the public realm; however, these discussions seem to be relegated to the back-burner of public society and have ceased to light the way forward.

But again, why is this the case?

I would hold that the fault lies not with the secular world, but with those of us who profess to hold such believes. We have failed. We have failed to translate the spiritual to the physical, not only in our explanations of truth, but in the way we model and reveal the glory of God in this world. We have become a Church defined by what we’re against, not what we’re for. A Church in which ‘not as you are’, has replaced ‘what you will become’. Is it any wonder people are pushing back against us? If the Church was really what they perceived it to be, would you want to be a part of it?

This is what I hear people rebelling against. Not our forms of worship, or our personal moral codes, but our perceived abandonment of mercy and compassion. The Church is seen not as a field hospital for those cast about by the waves of post-modernity, but as a wall with which to break upon. In discussions such as these, I hear less the mocking laugh of atheism, then the heartbroken pleas of those left behind. And while the Church’s truth on death and dying may hold together from a logical perspective, it seems a cold comfort to those on death’s door, without any hope of what lies beyond.

In the end, this is not a doctrinal issue, it’s a language issue, it’s a relational issue. Perhaps it’s an issue that will never be solved, perhaps the chasm is just too great, but if the Church ever hopes to regain its place in the public sphere, it needs to shift is language7, it needs declare its support for those in life’s most vulnerable states. It needs to show (through words and actions) how it values all people and that the truths it extols are, in fact, those most consistent with human flourishing. Only then, will people begin to understand the crux of the religious arguments, which are built upon the idea of a loving savior, and a world broken but longing to be renewed. Until then, we’ll all just be talking past each other and we’ll keep running down this same road, and I find it highly unlikely that things will simply work themselves out over time.

Today, I don’t really have any good answers, like everyone else, I’m still trying to figure out what it means to be a Christian in 2014, living in the community I’ve found myself in. I’m trying to figure out how my faith and beliefs work themselves out in the public life I live. And, like everyone else in that room yesterday, I’m trying to work towards alleviating the pain and suffering from those in this world who seem to have too much of both. But while I don’t have any direct answers, I do know one thing for sure. The way things are right now, does not bode well for the future of religion and American Christianity. Living in Seattle we find ourselves not in a post-Christian world but a post-post-Christian one, one in which the the forms and frameworks of religion have faded quietly into the past. Unless we change the way we communicate hope and truth people won’t understand. And unless we change the way we live out that truth in the world, they won’t listen.


  1. The tax issues alone require at least a month to go through, but that’s probably because everyone would be falling asleep with regularity. 

  2. In case you’re worried that this would cause a slant in the dialogue, fear not, the ACLU provided all the necessary expertise. 

  3. Notice the small C spelling, from here on out I’m going to use Catholic doctrine as a model, but I think the issues are largely transferable between faiths and denominations. 

  4. Ethical and Religious Directives for Catholic Health Care Services, 5th Edition (2009). 

  5. Some questions will, naturally, be raised as to what type of freedom we’re promoting, but I would dodge that whole debate by simply stating ‘positive freedom’. Yes it’s a simplistic response, but it leaves a little something for next time. 

  6. I love that UW’s motto is Lux sit ‘Let there be light’ 

  7. notice I said language, not doctrine. 

On Net Neutrality

With all the hubbub around the recent Court opinion on Net Neutrality, I thought I’d way in with my two cents. It’s important to point out that I am in no way a lawyer, nor do I have expansive experience in legal analysis. The following thoughts are simply my reflections and understandings from reading the Opinion. Take them as you well.

 

Did the court kill Net Neutrality?

No.

 

What, yes they did!!

No, what they did was vacate 2 provisions of the FCC’s Open Internet Order, specifically the anti-blocking and anti-discrimination provisions, which prevent Internet Service Providers (ISPs) from blocking or throttling content on their networks. All, while leaving the disclosure rules intact.

 

Dude, I think you’re full of it, that sounds like killing to me.

Yup, that seems to be the prevailing opinion (see what I did there), but in reality, the court didn’t really comment on the content of the rule, only the FCC’s statutory authority to implement said rule. The issue of neutrality is very much alive.

 

Hmm, explain.

I’ll do my best. But first, a little history. In 1996 the Telecommunications Act (Pub. L. No. 104-104, 110 Stat. 56 ) was passed which broke telecommunications providers (telcos) into 2 classes, those who provided basic services (such as phone lines), from those who provide more enhanced information services (such as America Online, when that was a thing (sorry Tim Armstrong)). Then, in 2000 the FCC classified all cable broadband providers as ‘single, integrated information service’ providers, which was subsequently upheld by the Supreme Court (National Cable & Telecommunications Ass’n v. Brand X Internet Services, 545 U.S. 967 (2005)).

 

So what?

So, the last time this issue came up, it was in 2008 for Comcast blocking peer-to-peer networking apps (for a refresher on the gems people were torrenting in 2008). The court held that the FCC did not have the authority to regulate the network practices of Comcast, since it had classified them as ‘enhanced providers’ (600 F.3d (2008)). So, the FCC, instead of changing the rules and reclassifying Comcast and its ilk as ‘basic providers’ they instead opted to issue the Open Internet Order (25 F.C.C.R. 17905) which Verizon challenged.

 

Still not clear, maybe you’re not so good at this.

Probably not, but still, I press on. The FCC’s argument is based on a simple assertion: We (the FCC) have the duty (and regulatory authority) to promote internet access nationwide. We take the stand that an open internet is critical to said access, and thus we have the authority to enforce a certain minimum standard that all ISPs must provide, because we have the authorization to regulate telcos as ‘common carriers’ and thus enforce minimum standards.

 

Verizon’s response: I thought we weren’t telcos.

 

FCC: ….

 

What’s a common carrier?

The term “common carrier” or “carrier” means any person engaged as a common carrier for hire, in interstate or foreign communication by wire or radio or interstate or foreign radio transmission of energy, except where reference is made to common carriers not subject to this chapter; but a person engaged in radio broadcasting shall not, insofar as such person is so engaged, be deemed a common carrier.

– 47 U.S.C. § 153(11) 

 

Basically, it’s phone companies. The courts have consistently (FCC v. Midwest Video Corp., 440 U.S. 689; Cellco, 700 F.3d (2012)) upheld that cable (video cable) and mobile data providers are not subject to common carrier rules (for a variety of reasons). And remember, the FCC took the stance that ISPs were distinctly different from traditional ‘basic service’ providers.

 

I feel like you’re building towards something. I don’t like being strung along.

You’re right, here’s the kicker. The court ruled that the FCC, by forcing the ISPs to provide service indiscriminately (e.g. to any weirdo with a WordPress blog) then they are in fact forcing them into ‘common carriage’ status.

And that, faithful readers, is the primary reason why the court vacated the Open Internet provisions. Not because they were bad per se, but because they overstepped the statutory authority granted to the FCC.

 

Cool story bro, so what happens now?

Well, Verizon has already stated that would be exploring pray-for-priority arrangements, if it wasn’t for the Open Internet restrictions (Oral Arg. Tr. 31), so that could happen. Comcast, due to its merger with NBC,  is prohibited from any such action until 2016. AT&T has stated that they will continue to abide by the Open Internet rules, for now.

 

So is the FCC going to be relegated to the dustbin of federal agencies?

No. At least, not until they allow cellphones in flight.

 

Will Verizon stop providing internet to rural areas? Because I’m so over having only EDGE at my grandma’s house, it makes holidays akin to Dante’s 2nd circle.

What do you think?

 

No….?

Correct. The Court reaffirmed section 706 of the Telecommunications Act, which is what governs broadband rollout and other such matters (47 U.S.C. § 1302(a). Section 706(b)). To be clear, it was never overtly challenged, but the court still reiterated that the FCC has a property role in the internet in general. In fact, a primary argument by Verizon is that infrastructure is expensive, and they need more capital in order to continue expanding and improving their services.

 

Do you actually believe that?

No, but it’s now in oral testimony, so somebody should hold them to that.

 

Did the Court simply roll over and let Verizon walk all over them?

Nope, in fact, they were pretty unconvinced by the majority of their arguments (see most of Part II), so I think in future cases telcos will have their work cut out for them.

 

What if I like my Net Neutrality? Can I keep it?

If you like your Net Neutrality, you can keep your Net Neutrality. Sort of. The FCC laid out a couple of options.

 

  1. The FCC could reclassify ISPs as ‘basic providers’ and thus be subject to ‘common carrier’ regulation. [Actually, I’m a little shaky on this, it seems that this is possible, but the ruling in Midwest II seems to make things tricky. It seems the Court is suggesting that ISPs could be considered common carriers with respect to third-party content providers. I would love some clarification on this.]. Nevertheless, the Court remanded the case back to the FCC, so the ball’s in their court (Part IV, 63).
  2. Congress could pass a law that places ISPs directly under common carrier rules, after all, they didn’t write a statute that prohibits them from doing so (Part III, 53).

 

Ugh, I hate Congress!

You and 86% of your peers.

 

What else can we do, while Congress is debating how much bathroom tile to embargo from Iran?

A few thoughts.

 

  • It seems to me that this is an incredibly fertile ground for some good-old-fashioned anti-trust litigation, especially once Comcast gets into the game. Since many of the ISPs are moving into the content production realm, I could see some seriously angry third-parties camping out in front of the FTC’s office.
  • Going along with that, just because a corporation is allowed to engage in contract negotiation and variable pricing (like most businesses), doesn’t mean that they’re allowed to do whatever they want, whenever they want, to whomever they want (like most businesses). They still have to abide by fair practice laws, and now with the eyes of the world upon them (or at least, all the eyes that can be spared from the latest Vine stream), it should only be a matter of time before something happens. Remember, see something, say something.
  • We as consumers do have some abilities to influence markets. While it’s true most people only have 1-2 options for internet access, that doesn’t mean that all forms of civic action are simply out the window (remember the Comcast data caps?). If the ISPs do start charging places like Netflix more and more money, it’s likely so they can drive people to their alternative service offerings. Services that people don’t have to accept, or embrace.
  • I find the assertion that ISPs will limit access to news sources a bit incredible, that seems like a huge violation of Freedom of the Press, and the courts have shown a pretty substantial reluctance towards doing anything that would impede their ability to disseminate information. So, while most blogs (including this one) would hardly count as news, there’s still a pretty good argument for Comcast not doing this.
  • Can we do a Kickstarter ISP?

 

Ok, but I still think ISPs should be required to carry all types of content.

You’re probably right, here’s a good piece by my friend Nick DeBoer talking about it in more detail, along with an incredibly convoluted opening metaphor.

It really comes down to a simple question. What is the Internet? Is it a public utility (like power, water, etc)? Is it a public good (like food, or healthcare)? Or is it a commercial business (like YouTube, or Best Buy)? How you answer that question is largely going to determine whether the Court’s decision angers your, or relieves you.

 

What do you think?

I haven’t decided yet. I think there are very strong arguments for a concept of the Open Internet, I’m a strong believer in freedom of information, and I think the Internet is a tremendous tool for justice and equal rights. That being said, there are substantial commercial interests involved, and I think the public utility arguments are both 1) not quite applicable to the dynamics of internet economics, and 2) not a great model for us to follow in general (do we really want our internet to look like our power grid?); however, when you phrase the argument around a freedom of speech issue, and when you basically apply a status-quo (as opposed to a highly regulated model) to the current system, the arguments get much stronger in favor of openness. That being said, I really don’t think this does a whole lot (either way) to address the root issue of ISP cost and quality. We still have a long way to go before things get measurably ‘good’.

 

Well, this wasn’t a total waste of my time, is there anything else I should know?

Yes, I would like point out that the court did use the example of a ‘video of a cat’ (Part I, 6) in their opinion, a strong point in their favor as actually ‘getting the internet’. Also, they took the time to point out that even federal agencies are entitled to a little pride (Part II (A), 20).

 

That’s funny, where can I read that?

Here

 

Whoa! That’s like 80 pages!

Yup, gotta love Administration Law.

 

Forget that, I’m going to go troll Buzzfeed.

Enjoy it while it lasts.