Choice and Ethics: Discuss Amongst Yourselves

Frances Kissling

Opinions about the expression of ethical obligations as part of choice discourse are highly varied in the movement. Can we not rationally discuss these opposing views, fleshing out the pros and cons?

I just caught a segment of Hardball in which Chris Matthews talked with Will Saletan of Slate and Ken Blackwell of the Family Research Council about Will’s New York Times op-ed on responsibility and contraception. Will is hawking a tough message: pro-choice on abortion but heavy on the moral responsibility to avoid pregnancy when you don’t want to have a baby. It’s head and shoulders above the phony prevention message of those who are anti-abortion and can’t say the "C word" (contraception) or talk about sex, but it is difficult to make clear that abortion is a morally justifiable choice if one is pregnant and doesn’t want to or can’t have a baby, but is morally complex enough that it’s a very good idea to work really hard to prevent it.

On MSNBC’s Hardball with Chris Matthews Slate’s Will Saletan and Family Research Council’s Ken Blackwell, debate how to get past the culture wars and whether there’s an ethical responsibility to use contraception.

Will got trapped twice. Once when Matthews pushed the idea that contraception was a lesser evil to abortion, and Will agreed – I’m sure he doesn’t think contraception is anything other than an unmitigated social and moral good. And again when he fell into an ill-defined notion of discouraging abortion. I take these moments with a grain of salt; talking about morality on political talk shows is a no-win situation, but one that cannot and should not be avoided. We just need to get better at it every time. Moreover, those of us who are pro-choice feel stung whenever anyone suggests there is something we need to change and we tend to forget the tough message Will is sending to the Catholic Church and so-called progressive evangelicals like Jim Wallis. To them he is saying unequivocally: stop talking about prevention without contraception. This was the strong point of his Hardball appearance. A straightforward acceptance of sexuality as part of the human condition – and a good part.

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I’d missed Will’s Times piece on the issue but caught Jodi Jacobson’s reaction and the comments on Rewire last week.  I found the Rewire article and discussion disturbing, but decided not weigh in.  Listening to the Hardball discussion made me reconsider. Now, let me confess I am not a Chris Matthews fan and I am both a friend of Will’s and in general agreement with his position on abortion. I say generally, because unless one believes that either fetuses or women have an absolute right to life or to abortion, none of us, even within the pro-choice community, is going to agree 100%. Sometimes Will annoys me because he seems to undercut his own position with those of us who are pro-choice by using too broad a brush and coming down too hard on us. And we in turn beat him up.

Here is where I understand Will to stand on abortion. (I ran this section by him about an hour ago and he says I got it right). He is pro-choice. He believes it is a woman’s legal right to choose to end a pregnancy and that abortion can be a morally justifiable act. To say it is a morally justifiable act is not to say that every decision to have an abortion is moral (a position some in the pro-choice community seem to take) but rather to say that since it can be either moral or immoral and the lines are difficult to draw in the abstract, it is best not to legally second guess a woman’s decision to continue or end a pregnancy. This does not mean that one should be silent about moral matters or refrain from offering a vision of when and under what circumstances abortion is morally – or if you prefer the cooler word ethically – responsible sexual and reproductive behavior. On issues of moral significance, the public wants to know what movement leaders believe, what values they have. And those of us who lead the movement have an obligation to speak to these concerns.

Now, Will takes fetal life seriously, more seriously than many of us in the movement and more seriously than many ethicists and theologians do. He thinks there is something important to society about the way we collectively and individually approach and treat the fetus. He even has some queasy thoughts about destroying early embryos to create stem cells. That means that he thinks at a minimum men and women ought to try not to create embryos or fetuses that they are likely to have to terminate and that health care professionals have a serious obligation to work with people to help them understand and accomplish that (if they themselves believe that). It may be moral for women to terminate those embryos and fetuses (I would say it is very often morally justifiable), but it would be morally preferable for both the person and society if one did not face that situation.

Let us be clear. We may all not agree with Will’s position or mine, but they are respectable views that deserve to be treated seriously and civilly. They can be critiqued, analyzed, questioned, and rejected for other views. But to treat them as "insulting to women" or ill-informed is not helpful or justified. Hurling invective does not contribute to furthering the cause of choice. Our movement has suffered many losses and has experienced an erosion of public support. The President we elected holds some of these views himself and has embarked on an approach to abortion that some of us find, to be kind, confusing. To refuse to find what is useful in the approach or thinking of outsiders who are more with us than against us would be a costly error. And, to be frank, I found Jodi’s response over the top in invective and lacking in necessary balance. This is the risk of blogging. One does not read and re-read; one does not reflect, one just cries out in pain. There is a place for that, once in awhile.

Will’s central point, aimed at those of us who are pro-choice, is that we need to think about contraception, preventing unintended pregnancy, as an ethical obligation and as leaders of the reproductive health and rights movement we should not shy away from expressing that value. There are at least two reactions to this. Agreement: I find that it treats women as competent moral agents who can hear and either accept or reject moral opinion or disagreement. We are all subject to social discourse about what is right and wrong and that is a good thing. Those on Wall Street should be subject to more of it, as should our military men and women. Disagreement: It is none of our business to preach to women. Women already know what is and is not responsible.

Will contends that there is some evidence that a significant number of women do not seem to know or have not accepted that creating a fetus is a significant moral decision to be entered into consciously and with self-reflection on the consequences. He cites Guttmacher Institute data that shows that a substantial number of women were not using and did not consider using contraception in the month they became pregnant, although they knew it existed. Jodi does not directly address that data, but offers an alternative view of why women don’t use contraception, which diminishes women’s responsibility and places the blame on the structure, system, cost, opposition, pickets, etc.

Jodi was "insulted" (more than once in the piece) by Saletan’s demand that "reproductive health counselors must speak bluntly to women who are having unprotected sex." What, she asked, does he think they do? Here was another missed opportunity. Rather than going into high gear defense of counselors, one might ask why Saletan has this view. Is there any merit to it? Having been in a room with Will and 30 leaders in the abortion rights movement and heard a number of them speak out against the introduction of a stronger ethic of personal responsibility into the choice message as well as in counseling, there is some reason for Will to believe there is a lack of commitment in some segments of the movement to this kind of discourse or to personal responsibility as a value. In a follow-up piece on his column, Will made this clearer noting that counselors do indeed give medical information about pregnancy prevention, which he distinguishes from ethical guidance.

Opinions about the expression of ethical obligations as part of choice discourse are highly varied in the movement. Again, there are respectable differences of opinion and one should be no more insulted that some leaders believe we have no business expressing our moral or ethical views to patients or the public than others are insulted that some believe it is the obligation of professionals and social movement leaders to offer patients their best advice and to express their moral views. I for one want to know what my doctor believes about these issues and I want to go to a doctor who respects and seeks out my views. Yet I also understand that not all women have my power to negotiate medical care. Can we not rationally discuss these opposing views, fleshing out the pros and cons?

Rewire is a great place for these conversations to take place, but an editorial ethos that seeks light and not heat is essential to making that a reality.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.