Why we must restigmatize the institution of illegitimacy.

Author:Lamm, Richard D.
Position:Out-of-wedlock births - Creative Controversy - Column

In keeping with the policy of The Humanist to consider the diverse social, political, and philosophical viewpoints of its readers, this occasional feature allows for the expression of alternative and dissenting views on issues of importance to the humanist community.

No snowflake in an avalanche

ever feels responsible.

--Stanislaw Jerzy Lec

I have come to the painful conclusion that public policy must look at the total impact of a program, not its impact on isolated individuals; public policy must look at the big picture. Take the area of health care. We have made a grave mistake trying to build a health care system an individual at a time. There is a divergence between what is good for the individual and what is good for the total population.

When you wonder why the United States ranks twenty-second in infant mortality and eleventh in maternal mortality, and has such poor life expectancy rates for both men and women compared to other developed countries, you can see that we have focused too much on the individual. No one asks what policies produce the most healthy people in a society. We fly newborn children--born to some of the 600,000 American women last year who did not have adequate prenatal care--in helicopters to million dollar neonatal care units, where we put them on million dollar machines. The fastest growing use of kidney dialysis is for people over the age of eighty five; yet 41.2 million Americans do not have basic health insurance. We have no sense of proportion or priorities.

Individually, it might be morally difficult to say to an eighty seven year old with Alzheimer's that he or she can not have a heart bypass operation. But in the context of the society that has a myriad of other unmet needs, it is totally justifiable.

Sometimes it makes for bad press. In Oregon, it was decided not to pay for any soft tissue transplants until all women received prenatal care. The first person needing a transplant was a seven year old boy named Colby Howard (who was probably fatally ill regardless of a transplant). He did not get a transplant and he died on the front page of newspapers across America. Lost in the bad publicity was the fact that Oregon was actually adopting a policy which would save more people, and that it was not a cruel policy but actually a kind policy. About the same time, California decided to pay for transplants. Then, one week later, it knocked 270,000 low income women off Medi-Cal.

Which state killed the most...

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