This Woman Pays Drug Users Not To Have Kids (HBO)

[mr friendly guy]

VICE



Basically this woman runs an organisation which pays drug addicts to either use contraception or sterilisation.

Or for those who want to read it on VICE
https://news.vice.com/story/this-woman- ... -have-kids

This woman pays drug users not to have kids
This woman pays drug users not to have kids
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By Amanda Pisetzner Jul 26, 2017

For the past 20 years, Barbara Harris has been driving around the country in a branded RV, advertising her nonprofit to drug addicts and alcoholics. Her organization, Project Prevention, pays substance abusers $300 to get sterilized or put on long-term birth control like an implant or an IUD. To date, she has paid more than 7,000 people, mostly women, to basically give up their fertility.

Using cash incentives, she feels like she is stopping a societal problem in its tracks. “We’re preventing women who are strung out on drugs and alcohol from conceiving a child,” Harris says. “Nobody has a right to force-feed any child drugs and then deliver a child that may die or may have lifelong illnesses.”

It seems straightforward enough, but the ethical questions behind Harris’s program are not. VICE News caught up with Harris during her first road trip this summer, stopping where addicts or those who know them hang out and speaking to longtime critics who think Project Prevention may be contributing to the very problems Harris set out to solve two decades ago.

I will say this. If the drug addicts were able to consent for the contraceptive or sterilisation (as judged by their treating doctor) then it isn't a matter of forcing someone to do it, so there is no ethical issue in that regard. However, she shouldn't say he doesn't promote sterilisation more than contraception when she offers better rates (ie get it right away vs instalments).

There are however some social engineering issues around this which I feel is worthy of discussion.

[Zaune]

Social engineering? I'd be more worried about the undercurrent of Social Darwinism myself. I mean, the clear implication here is that this woman thinks drug addicts aren't worth trying to rehabilitate and the best thing you can do is make sure they can't breed so the problem goes away on its own: I think we all know what the final result is when we start thinking like that.

[Gandalf]

The IUD is reversible, which is good should one get clean and then want to have children. Having seen the problems caused by when drug addicts have children, I can't say I have too many problems with this.

[Joun_Lord]

I have no problem with offering long term birth control to addicts or anyone else who might be in dire straights, its pretty freaking criminal that the US doesn't already offer it (though I guess we can choke that into that towering pile of fucked up problems the US has with health care). Sterilization? Fuck nah. What this woman is doing is taking advantage of people who are in the worst way possible, preying on people who are so desperate they are willing to trade their reproductive rights away for 300 bucks. Thats essentially tricking people, tricking sick and mentally ill people with an addiction. Treating them as less then human even because they are addicts, because they are homeless, because they are mentally ill. Like Zaune said, it treats them like they aren't worth rehabilitation, aren't worth being allowed to breed.

And its just putting a band aid over the gaping would that is the problem with rampant addiction and a lack of health services for the mentally ill. It is creating a lifetime ban on reproduction for a solvable problem. The problem is not addiction, addiction is the end result of the myriad problems that lead to addiction. This.......expletive garbage person is fucking treating a symptom of the problem and creating far worse long term problems. What reason would some of these poor drunkey druggies have to get clean now, this goddamn mini-Hitler in an RV could be said to have stolen their futures. Now they can take their 300 and put it into a bottle and have no worries about children maybe giving them the motivation to clean up their act. Yeah I think it might exacerbate the problem a wee fucking bit, lets give druggies free money and take away their reproductive future, fucking brilliant, next we should solve the aids problem in Africa by preaching abstinence only and thats fucking it!!!! We R teh smarts!!!!

I'll admit this angers me so very greatly. The level of pure rage I feel towards this woman taking advantage of those that need our help the most is so high it could replace the ozone layer. This fucking sterilizing monster, this modern monument to one of the worst ideas of we've ever had during the 20th century and considering we've had some fucking doozies thats saying something.

These aren't defectives, these aren't undesirables, or degenerate or unfit or any other buzzword this lady could drop that would sound right up at home stuffed up Hitlers asshole (as in his anus, not Richard Spencer), these are people that need treated like fucking people.

[Broomstick]

I agree, this service is targeting the desperate and the poor, people who will do literally anything for sufficient money for their next fix. I question just how "voluntary" this is. It's like encouraging suicide in the depressed instead of treatment because it's their "choice" to die.

[Raw Shark]

Speaking straight out of the orphanage, I can get behind this. Sure, it means I wouldn't exist, but my genetic mother probably could've used three hundred bucks more than a slap on the ass and a, "See you around." The first planned industrial city in the Western hemisphere is not a kind place.

[Soontir C'boath]

I would not have a problem with this if it was just putting in a reversible birth control device like an IUD, but to offer sterilization as an option to receive money is rather abhorrent. It is a permanent decision to make that should not be taken lightly especially in a demographic where their decision making can be dictated by their addiction.

[Raw Shark]

I'm not saying that it should be taken lightly. But I am an addict, many times. There are a full room of things to consider here.

[Lord Revan]

I'd say that Broomstick's depression comparison is quite good and as someone who still suffers from chronic long term depression and in the past had to to deal with suicidal thoughts I can say that "it's your choice to kill yourself" is the biggest BS I've heard in a long time, no it's not a choice it's sickness that needs to understood and properly treated, because for us the idea of just giving up and blaming ourselves for all the wrongs of the world (and I mean all even things that we had no way of effecting either in a positive or negative way) is something we have to struggle with daily.

From what I've gathered addiction isn't much different, where not giving in to the "demon within"(obviously not a literal demon but you get the point) is a daily struggle that no-one wants and would do things they would regret later just to get rid of it.

That's why something like this must be done with massive care lest it become a form of getting rid of the "undesirebles".

[Formless]

Fuck this woman, and fuck anyone who thinks she is doing the right thing.

We cannot give informed consent when we are very young or very ill, mentally impaired, demented or unconscious, or merely frail or confused. Often people cannot give informed consent to emergency treatment. Even in the maturity of our faculties we may find it quite taxing to give informed consent to complex medical treatment when feeling lousy.

[...]

A second limitation of informed consent procedures in medicine is that they are useless for selecting public health policies. Public policies, including public health policies, have to be uniform for populations. We cannot adjust water purity levels or food safety requirements to individual choice, or seek informed consent for health and safety legislation or quarantine restrictions.

[...]

A fourth limitation of informed consent emerges when people with adequate competence to consent are under duress or constraint, so less able to refuse others' demands. Prisoners and soldiers, the vulnerable, and dependent often have ordinary capacities to consent but cannot refuse, so undermining any “consent” they offer. These cases have traditionally been seen as problematic in recruiting subjects for experiments; they are no less problematic in obtaining informed consent to medical treatment.

My commentary will focus primarily on the issues of undue inducement and fair compensation. It is important to recognize the technical difference between coercion and undue inducement. Coercion involves a threat to harm, whereas undue inducement involves a gratuitously large, and therefore distorting, offer of benefit. Coercion is a threat to make someone worse off unless they comply with a given demand. In the context of research ethics, coercion is actually quite rare. One example of coercion in research would be where a physician threatened to stop providing care to a patient unless they joined a clinic trial. Undue inducement, by comparison, occurs when the reward offered to potential research participants is so great that it undermines the participants’ ability to rationally weight up the costs and benefits of research participation. Debate about undue inducement in research is comparatively common.

There is considerable confusion regarding the ethical appropriateness of using incentives in research with human subjects. Previous work on determining whether incentives are unethical considers them as a form of undue influence or coercive offer. We understand the ethical issue of undue influence as an issue, not of coercion, but of corruption of judgment. By doing so we find that, for the most part, the use of incentives to recruit and retain research subjects is innocuous. But there are some instances where it is not. Specifically, incentives become problematic when conjoined with the following factors, singly or in combination with one another: where the subject is in a dependency relationship with the researcher, where the risks are particularly high, where the research is degrading, where the participant will only consent if the incentive is relatively large because the participant’s aversion to the study is strong, and where the aversion is a principled one. The factors we have identified and the kinds of judgments they require differ substantially from those considered crucial in most previous discussions of the ethics of employing incentives in research with human subjects.

What she is doing is a violation of medical and research ethics. Period. She is exploiting people who have their ability to think through the long term consequences of their actions compromised by the very drugs that make them eligible, all because of her sense of self-righteousness and delusion that a drug addiction is a social problem and not a public health problem, and the all too common perception that drug addiction is for life when proper treatment regimes do in fact exist. In a country where treatment is all too uncommon due to the war on drugs, no less. I should also point out that there is no promise that someone like her would keep information truly private; the potential for coercion is there as well. From even the limited training in research ethics you get with a bachelors degree, you would automatically know that this kind of thing would never get beyond an ethics committee. And if you went and did it anyway it would be the end of your career as a doctor or a psychologist.

This person is simply a turd in human skin.

[The Romulan Republic]

Social engineering? I'd be more worried about the undercurrent of Social Darwinism myself. I mean, the clear implication here is that this woman thinks drug addicts aren't worth trying to rehabilitate and the best thing you can do is make sure they can't breed so the problem goes away on its own: I think we all know what the final result is when we start thinking like that.

Plus its not as though becoming an addict is necessarily hereditary anyway. I can at least see an argument in terms of it being undesirable for addicts to have children, because addicts tend to be shitty parents, but the historical context of sterilizing "undesirables" makes this deeply creepy, even if its not forced.

Eugenics is back.

[Zaune]

Quite. If she really wanted to break the cycle and prevent the children of addicts and other "undesirables" from growing up to wind up in the gutter like their parents she might try a charity offering free trade school places or life-skills classes, or lobby school boards to have every 7th grade English class do a module on Irvine Welsh's Trainspotting.

[Joun_Lord]

even if its not forced.

Is it though? Even if Ms Nazi wannabe is not physically forcing these people to sign away their reproductive rights, she is still getting people who at best are under the addictive influence of a mind altering drug that even sober their will not be in a rational state of mind. Plus alot of addicts are that way thanks to existing mentally illness.

So she's having people not really capable of consenting signing this shite. It would be the same if a court had some drunk sign legal documents or someone had a mentally ill person signing some shit. Legally it would never had a leg to stand on, it would be shown that those people could not legally consent to anything.

Anyway it goes its definitely underhanded as all fuck, like a repeat of when "feeble minded" women were sent to institutions to be sterilized or the mentally ill and mentally disabled underwent forced sterilization.

[The Romulan Republic]

That's a very good point. Not forced, perhaps, but definitely coercive.

[Lord Revan]

In many ways this is akin to saying to suicidally depressed person that all their worries would go away if they offed themselves, while there is a hint of truth there as it's kind of hard to be depressed when you're dead it's very much a case of the cure being worse the illness and who ever proposed the "cure" was simply abusing the desperation of the depressed person.

same deal essentially here just replace "depression" with "addiction" and "off yourself" with "sterilization"

[Zaune]

In many ways this is akin to saying to suicidally depressed person that all their worries would go away if they offed themselves, while there is a hint of truth there as it's kind of hard to be depressed when you're dead it's very much a case of the cure being worse the illness and who ever proposed the "cure" was simply abusing the desperation of the depressed person.

Saves a bit of money, though, doesn't it? Counselling, medication, probably disability benefits... it all adds up, and for what some people would probably see as questionable return on the investment.

I spend way too much time thinking about that sort of thing.

[mr friendly guy]

Things to keep in mind.

1. Her organisation isn't the one doing the procedures. They just pay for it, which means the doctors have to make the judgement that the patient is able to give consent. If that many doctors are approving the procedures (and patients are not able to consent), it suggests another underlying problem rather than woman offering contraception. Presumably patients consent when they are not high.

2. Sterilisation is a big issue, and I can see a lot of people are happy with IUDs because they are reversible. Keep in mind that as a general rule, sterilisation is not offered unless you already have children. I wonder how many of these offered sterilisation already have kids.

3. Formless brings up a good point about the difference between coercion and undue inducement. There doesn't appear to be coercion in the segments shown on the video. The question becomes is what $300 undue inducement?

[Formless]

What makes you think the doctors know what is going on when these people come through her? Or for that matter that the doctors themselves aren't dicks who see addicts as undesirables too? Medical ethics exist precisely because doctors tend to be fucknuggets in this country. Especially to poor people. I'm not even kidding, there are studies showing that they tend to be more brusque and uncommunicative towards patients from lower SES backgrounds, and patients from those backgrounds tend to view the healthcare profession in a more ambivalent light as a result.

IUDs can come out, but not without risk of complication. Sometimes those fuckers can cause inflammation and other problems, which may not be evident until you try to remove it. Compared to a lot of other nations (particularly in Asia) IUDs are actually one of the less popular birth control options in the US despite their effectiveness. Birth control pills are simply perceived as easier to back out of, even if IUDs aren't technically irreversible. If they are perceived that way, patients may just not consider going back on their decision.

$300 is far more money than most experimenters/researchers are ever allowed to offer, and we have to justify our research on human subjects by either harmlessness or the benefits the research itself will bring the participants. It might be a one time payment, but we have to remember that undue inducement is relative to the socioeconomic status of the group. $300 dollars wouldn't be worth half a minute of Bill Gates' time, but for someone on foodstamps? That money might mean being able to eat something that isn't garbage for a month! Or, you know, being able to buy a week's worth of cocaine. These are drug addicts we are talking about. Whether the organization is actually doing them a favor by giving them money is completely relevant here.

[mr friendly guy]

What makes you think the doctors know what is going on when these people come through her? Or for that matter that the doctors themselves aren't dicks who see addicts as undesirables too? Medical ethics exist precisely because doctors tend to be fucknuggets in this country. Especially to poor people. I'm not even kidding, there are studies showing that they tend to be more brusque and uncommunicative towards patients from lower SES backgrounds, and patients from those backgrounds tend to view the healthcare profession in a more ambivalent light as a result.

1. The possibility did occur to me that the doctors could be the problem, although I can't say how bad they are in the US. I will say the probability decreases given the fact that the procedures are done by different doctors in different states. It becomes less plausible to me that all the doctors just happen to be unscrupulous, although it occurred to me there is a fair chance that some of them are.

2. I doubt the doctors know that these women are being paid to have an IUD, but how much will that affect the ethics from the doctor's POV? The questions they should ask are
a. is the patient of sound mind - yes, no, not sure
b. is the procedure for a medical reason- yes all the time
c. is there a contraindication to such a procedure - yes , no

3. I think $300 is very tempting for a drug addict. I am just not sure how high the offer needs to be to seriously impair judgement.

[Simon_Jester]

"Friendly Guy," there are drug addicts who will commit serious crimes for a few hundred dollars. They're making what is, objectively, a very poor life choice that has a high risk of haunting them for the rest of their lives. By the standards of a rational outside observer, their actions do not make logical sense. Surely, it would be 'more rational' to quit their drug habit or otherwise find a way to do without the few hundred dollars.

And yet, people don't do this.

This is empirical evidence that the offer of a few hundred dollars IS enough to seriously impair the judgment of at least some drug addicts. Or, that the drug addiction has already impaired their judgment so badly that they aren't capable of rationally evaluating the offer. In which case you cannot assume that the addict's "judgment" actually means anything, any more than you could give weight to the "judgment" of a toddler who agrees to give up their right arm in exchange for free candy forever.

The decision is a terrible one by objective outside standards; it only looks appealing to people who are under severe emotional pressure and suffering from impaired thinking. It's completely pointless to even worry about "well, but they DID agree to it, so it can't be THAT bad an offer!"

I'm not saying that it should be taken lightly. But I am an addict, many times. There are a full room of things to consider here.

Suffice to say that if someone tells me "Raw Shark, and everyone else in the world born under similar circumstances, should never have existed and paying people pocket change to be sterilized so that such people cannot come into existence is okay..."

I am going to tell them to go play hopscotch in a minefield.

[Lord Revan]

The main problem with this whole thing is the idea that some people are "less worthy" then others (and pretty sure this program ignores the wealthy drug addicts and focuses solely on the poor ones).

[Raw Shark]

I'm not saying that it should be taken lightly. But I am an addict, many times. There are a full room of things to consider here.

Suffice to say that if someone tells me "Raw Shark, and everyone else in the world born under similar circumstances, should never have existed and paying people pocket change to be sterilized so that such people cannot come into existence is okay..."

I am going to tell them to go play hopscotch in a minefield.

Well, thanks for that, but a: $300 is not pocket change to a guy like me, it's food for a month, and b: if I could track down my genetic mother and give her $300, I would. She deserves at least that much. She squeezed this little son of a gun out of her vagina, after all. I owe her for that. I like to think that I've done some good in this bad old world. I've saved three lives. I'll never call her Mom, but she has some measure of gratitude.

[Ralin]

This is empirical evidence that the offer of a few hundred dollars IS enough to seriously impair the judgment of at least some drug addicts. Or, that the drug addiction has already impaired their judgment so badly that they aren't capable of rationally evaluating the offer. In which case you cannot assume that the addict's "judgment" actually means anything, any more than you could give weight to the "judgment" of a toddler who agrees to give up their right arm in exchange for free candy forever.

I keep seeing people say this, and not just in this particular case. If these people's judgment is so compromised that they can't make decisions like why the hell are those criminally liable when they rob a house or whatever for three hundred bucks?

[Formless]

I don't think you understand what we mean when we say that their judgement is "corrupted". We don't mean that they cannot be held accountable, because they are partly responsible for being addicted to a substance in the first place. We mean that they are HIGHLY unlikely to refuse such an offer regardless of the risks or long term consequences for precisely the same reason that some drug addicts commit robbery. They don't care about consequences anymore, just the "reward" of getting another hit of whatever they are addicted to. Offering them money is not helping them, especially when it comes with strings attached that could have negative consequences for themselves in the long run. What they need is treatment for their addiction.

And again, money by itself can unduly motivate people to ignore risks even when they aren't addicted to something. That's why $300 is too much to offer a demographic that is largely poor.

Your confusion is that you are equating responsibility and accountability when they are actually very different concepts that the English language unfortunately delineates with the same word 90% of the time. When you treat them as the same you end up with a paradox called "moral luck" where no one can be held responsible for anything because there are always circumstantial factors beyond their control. But if you separate accountability from responsibility there is no problem. One is responsible when one can make the connection between their actions to the risks and consequences. On the other hand, accountability is merely society forcing irresponsible people to reform or be punished for harms that they had a hand in causing, even if it sometimes means rejecting certain categories of "luck" as an excuse. Many criminals were born into bad homes and had no say in it, but society still cannot tolerate their behavior.

So there is nothing inconsistent with saying that these drug addicts are being exploited by a bitch who does not understand how informed consent rules work while also saying that a drug addict who burglarizes a house should be held accountable. Both statements stem from literally the exact same source: the drugs that impair the capacity of drug addicts to be responsible. This is also why I say that they need treatment, and its a reason to decriminalize many drugs. Punishment doesn't help solve the problem of drug addiction. But of course, the idea that paying addicts to stop having kids or even get sterilized will also solve the drug problem can be summed up in one emote:

[Simon_Jester]

I like to think that I've done some good in this bad old world. I've saved three lives. I'll never call her Mom, but she has some measure of gratitude.

See, there you go.

Well, thanks for that, but a: $300 is not pocket change to a guy like me, it's food for a month

Yeah, I'm getting rhetorical about this, but you get the point...

It's like, $300 isn't literal pocket change unless you're a millionaire, but compared to anything that gets multiplied out over anyone's whole lifetime, it's pocket change. Divide $300 by twenty years, and it's a little more than four cents a day, in other words.

Nobody would make a rational decision to give up anything they value for four cents a day. If you heard someone say they'd made a rational decision to give up something most people value for four cents a day, you'd wonder about their sanity.

As to people who need the $300 now dammit because they have to eat? That still entitles me to make a judgment on the approach of the woman doing this.

To explain my stance, I'm going to quote a piece by G. K. Chesterton:

[Mr. Pond] stood up before the astonished official, who had no apparent alternative but to follow him as he passed swiftly across the café. Some vivacious and talkative young men were taking leave of M. Louis, who courteously invited the newcomers to the empty chairs, saying something about “my young friends often enliven my solitude with their rather Socialistic views.”

"I should not agree with your young friends," said Marcus curtly, "I am so old-fashioned as to believe in free contract."

"I, being older, perhaps believe in it even more," answered M. Louis smiling. "But surely it is a very old principle of law that a leonine contract is not a free contract. And it is hypocrisy to pretend that a bargain between a starving man and a man with all the food is anything but a leonine contract." He glanced up at the fire-escape, a ladder leading up to the balcony of a very high attic above. "I live in that garret; or rather on that balcony. If I fell off the balcony and hung on a spike, so far from the steps that somebody with a ladder could offer to rescue me if I gave him a hundred million francs, I should be quite morally justified in using his ladder and then telling him to go to hell for his hundred million. Hell, indeed, is not out of the picture; for it is a sin of injustice to force an advantage against the desperate."

In common law, the word for a contract that is grossly unfair in favor of the more powerful party is literally the word "unconscionable."

The state regulates what kind of deals can be made, because it is ultimately the state's responsibility to enforce agreements involving deals. A deal where one party gives up something extremely value due to short-term desperation or short-term thinking is, well... unconscionable.

This is empirical evidence that the offer of a few hundred dollars IS enough to seriously impair the judgment of at least some drug addicts. Or, that the drug addiction has already impaired their judgment so badly that they aren't capable of rationally evaluating the offer. In which case you cannot assume that the addict's "judgment" actually means anything, any more than you could give weight to the "judgment" of a toddler who agrees to give up their right arm in exchange for free candy forever.

I keep seeing people say this, and not just in this particular case. If these people's judgment is so compromised that they can't make decisions like why the hell are those criminally liable when they rob a house or whatever for three hundred bucks?

Honestly you can make a case that severe drug addiction is, in effect, a form of severe mental illness, which is precisely why I would argue in favor of focusing on rehabilitation for drug addicts who are convicted of crimes.

A basically rational person, even a fairly stupid one, can be deterred by the threat of long term punishment. "Do as we say or you will go to jail" is a good argument to use on anyone who is capable of reasoning about short term versus long term benefits in a semi-competent way.

But the same argument is useless on a schizophrenic person, who may not even comprehend what jail is or IF jail is, or may not even know whether or not the action they're undertaking violates the rules they describe. Likewise, a person with the mental competence of a five year old- at most they know that jail is VERY BAD, but they may well think all kinds of stuff is VERY BAD, and if they have the perspective of a five year old they won't be able to make the decision rationally.

...

And this is why we make such people wards of the state, or put them in mental hospitals if they can't function on their own. Because no useful purpose is served by trying to threaten them with pure punishment. They cannot react correctly to punishment, because punishment is based on long term planning and a sane risk/reward structure. There's no point in punishing them; all you can do is try to train them, repair their damaged minds, or otherwise turn them back into people capable of coping in a society where so much of our system is based on long-term reward/punishment calculations.

Hard drugs do basically the same thing: they hopelessly fuck up your risk/reward structure with addiction. There is no point in trying to punish a person like that into submission, because unless they display literal war-hero levels of grim determination and manage to quit cold turkey, they're not going to be capable of responding correctly to the punishments or threat thereof. Sooner or later, the addict will run into a situation where the choice is "do something incredibly, ridiculously fucking stupid, or go without meth for a week," and they'll choose to have meth because meth makes them feel just that good.

It's not a rational calculation in the normal sense of the word 'rational,' just because there's no coercion.

...

Now to tie this into what Formless is saying, it's entirely reasonable to hold people who make bad decisions that hurt people accountable,even if they are not 100% responsible for the circumstances that led them to make such a bad decision. The key is to combine 'accountability' with practical goals like 'actually solve the underlying problem and make sure it doesn't happen again.'

Just holding people accountable for their actions is 'good enough' when you're dealing with people who are even vaguely socialized to function among other humans. One of the things our caveman ancestors had to evolve to do was to evolve the instinct to not fuck up by violating the behavioral norms of the tribe. So we have pretty good mental wiring for learning what those norms are and obeying them, or at least balancing the risks of getting caught breaking them against the reward for doing so.

But this wiring is only, say, 95% reliable. The problem with that is, we're USED to it always working in other people, so when we encounter someone in whom it doesn't work, we tend to assume they're just evil or stupid, deliberately breaking our rules despite the risk/reward structure that stops most people from doing so. And we tend to not understand what's going on with the other 5%.

For the other 5%, 'accountability' still works, but only if we recognize that the first building block of accountability is to make sure the individual has the mental and physical capacity to make meaningful decisions. So a person who lacks that capability can only be held onto and helped medically or educationally, until such time as they can.