By Ezio Di Nucci
Last night I was running with my public health colleagues (the token philosopher ended up being faster than our Head of Department from Biostat, by the way – which sure must have a symbolic meaning in the modern academy).
After the race, conversation turned to my forthcoming vasectomy (anecdotally, this might well be because I am told that after a vasectomy you are not allowed to run for a week or so, the patriarchy’s bag of tricks being sure deep).
Then a surprising thing happened: my colleagues – all women – started trying to talk me out of getting a vasectomy – mentioning, for example, evidence pointing to the fact that vasectomies increase prostate cancer risk by 15% (parochialism disclaimer: the study comes from the very same country where the conversation was taking place, Denmark).
It might be worth reflecting on the difference between my female colleagues’ arguments and the reaction I have had from male friends and colleagues, which tended to be different versions of the following two considerations:
- What if you meet someone else and want to have kids with this new partner?
- What if one of your kids dies, you might then want another one.
Neither of these two considerations made much sense to me, but as they are existential more than philosophical in nature, in what follows I will focus on the argument used by my female colleagues after the race, which throws up a fascinating question at the intersection of reproductive health, feminist bioethics and the philosophy of medicine:
given patriarchal structures of oppression, how should we evaluate a 15% increase in the risk of prostate cancer?
For the sake of this argument, we will assume the validity of the study (because otherwise there would also be a lot to say about overmedicalization and prostate cancer screenings in particular).
The rest of this short comment will try to answer the above question: the basic argument will be that the patriarchy silences a 15% increase in the risk of prostate cancer (and probably more… what about 50%, for example?), because the relevant medical considerations here are trumped by feminist ones. And that therefore such data ought to be irrelevant, morally and politically speaking, to my decision-making about getting a vasectomy.
What is philosophically interesting, here, is the commensurability of, on the one hand, a medical data point – increase in cancer risk – and, on the other hand, the ethical and political issue of how the “burdens” of prevention should be distributed within a society still soaked in patriarchal prejudices, which has recently gone back even on abortion. But before dealing with the complex issue of whether medical considerations are commensurable with feminist ones (social, political, ethical), we mustn’t forget that contraceptives for women carry their own risks.
The first dilemma, then, is whether or not those medical and ethical/political issues are commensurable; but that’s an easy dilemma to solve. Given scarcity of resources, we are always weighing medical considerations against non-medical considerations within the healthcare system and society at large (just think of COVID-19), so nothing new here.
The more challenging question is according to what principles should we weigh medical and non-medical (ethical and political) considerations against each other, once we have accepted that those are – must be – commensurable.
And here a 15% increase – especially in the risk of a kind of cancer that many consider paradigmatic of overdiagnosis anyway – seems like a small price to pay; and maybe even a price that men ought to pay. As in, a duty to get a vasectomy in the face of patriarchal structures of oppression. Is that going too far? This might indeed depend on other features of one’s life situation, both locally and globally: already having three kids, for example, can hardly be expected to be irrelevant to such an assessment. As is climate change.
A full defence of a duty to get a vasectomy – under a clearly defined set of circumstances likely to involve both one’s family situation and climate considerations – is beyond the scope of this short commentary; it is rather a methodological move meant at raising the larger issue of whether liberal principles of opportunity and availability are enough to challenge powerful oppressive structures, be that the patriarchy or climate change. In a slogan: is democracy enough? But this BIG question is clearly beyond the scope of this short comment.
And this problem – can I even say it? – is particularly worrying if it happens to be women themselves who, in “caring” for their partners or colleagues, appeal to “objective” medical considerations in preventing change. Men might have a duty to get cut, but women certainly don’t have a duty to save them.
About the Author
Ezio Di Nucci is a philosophy professor at the University of Copenhagen, with special responsibilities in bioethics.
Competing interests: None declared