Ethics, Democracy, and Teen Age Birth Control

If you don’t already know that on Wednesday night the Portland, Maine school board voted to allow prescription of birth control without parental knowledge at a middle school health clinic, you are leading a sheltered life.

What struck me in the story was the thoughtful and civil-seeming debate that occurred at the school board’s open hearing. The question elicited fervently held opinions. Reasonable people disagreed. Everyone had their say before the board voted 7-2 in favor of allowing the clinic to prescribe.

Democracy isn’t just about voting. The distinctive feature is public deliberation in which citizens can be heard. (Amy Gutmann and Dennis Thompson explicate the theory behind this perspective in their seminal 1996 book “Democracy and Deliberation.”) I hope that at least some of the Maine parents who were disappointed by the outcome felt that their perspectives were considered respectfully even though their viewpoint didn’t prevail.

By chance my posting about health care rationing on the morning of the day the school board met spoke about how we will not be able to make our health system affordable or provide coverage to all without being “able to conduct vigorous debate and accept disappointing conclusions.” The heartening story from Maine shows that with effective public leadership this can be done.

I don’t know if the Portland decision was right or wrong. That’s the whole point. Reasonable people will disagree on many decisions that health systems must make. But unless we can disagree, debate, decide, and move on, we will continue to have out of control health costs and nearly 50 million uninsured.