Life, Philosophy, and Policy

A while back (in Unpersons) I mentioned an approach to the abortion question that, while maybe not a consensus among folks on the left, at least seems to be fairly common, if not always articulated: namely, that the question of whether or not abortion is acceptable hinges on questions of social personhood and not biological life.

In some ways this is a deeply philosophical point and when it comes to public life perfect intellectual consistency usually isn't the order of the day. Consider the Children's Health Insurance Program (CHIP), government-financed health insurance primarily for kids who don't quality for Medicaid. Both Medicaid and CHIP have special (higher) eligibility thresholds for pregnant woman. Since 2002 states have also been allowed to exercise a so-called "unborn child option" that allows them to consider a fetus as a "targeted low-income child" for CHIP coverage. Currently, 15 states do this: Arkansas, California, Illinois, Louisiana, Massachusetts, Michigan, Minnesota, Nebraska, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington, and Wisconsin.

Of course, it's not really possible to disentangle providing care to a pregnant woman from providing it to an unborn child so what exactly you call it is sort of academic. Is it a special benefit for a pregnant woman (a vulnerable member of society) or is it a benefit for an unborn child, implicitly acknowledging that fetus as a member of society? Whatever. But it does have philosophical ramifications because, at least ostensibly, that defines how you're thinking about it. And it would seem that designating a fetus--what I previously called an unperson--as a child, a person eligible for social benefits is a firm pronouncement that the unborn are not just biological lives but persons. And persons, presumably, are subject to societal protection, not just from ill health (thanks, CHIP!) but from termination.

So why have these states decided to exercise the unborn child option? Is it a bold philosophical statement about the ontological status of the unborn? In general, no, probably not. You see, unborn children don't have a citizenship status. Thus if you choose to provide care to them, you can do so without worrying about the citizenship or residency requirements that characterize public assistance programs. And, like I said, in a practical sense you can't really disentangle providing care to a pregnant woman from providing it to an unborn child. So states can use the unborn child option to provide CHIP health care benefits (in this case, prenatal care) to otherwise ineligible pregnant illegal immigrants* by (*wink*) targeting it at their unborn child.

So an ostensibly key piece of the philosophical puzzle here turns out to be a policy tool to get around some practical political constraints. Pragmatism might arguably have desirable outcomes but it doesn't do much for producing a cohesive philosophical view of the universe.

*These woman would be eligible for emergency coverage of labor and delivery but not the full package of prenatal care before that.