A family consisting of two adults and one child walk stairs with their backs to the camera.

Lessons from One Child Nation for Health Policy

By Katherine Drabiak

The acclaimed One Child Nation, streaming on Amazon Prime, provides a haunting look at the reasoning, implementation, and consequences behind China’s (now revised) One Child Policy. Director Nanfu Wang expertly weaves together interviews from population health officials, medical professionals, and family members to describe how government policy strictly enforced population control measures through propaganda, forced sterilization, abortion, steep fines, and infanticide.

At first blush, it seems convenient to contextualize these gross violations of human rights as a product of a vastly different system of law and government than the U.S., but this is an oversimplification. Like the U.S., China also has a Constitution that enshrines central principles, such as deriving authority by the power of the people, equality under the law, preservation of human rights, freedom of the human person, freedom of speech and press, and certain freedoms of family life.  Unlike the U.S., a co-existing provision grants broad power to the government to promote responsible family planning.  Among key differences, One Child Nation illustrates the danger of interpreting rights through a prism that elevates social goals, public order, and government defined community interests above individual rights.

Rights and protection from government abuse or overreach become meaningless if the system of law views them as secondary to the public good, suspended when addressing a pressing threat, or most dangerous – not applicable at all based on a person’s status.

In any system of government, rights of the people – even when exalted in the nation’s Constitution – are tenuous and must be vigilantly protected; particularly against seemingly beneficial attempts by government to subtly chip away at bright lines, and assert these rights are conditional.  In the U.S., our legal system has wrestled with the difficulties of defining how to simultaneously protect both individual rights and the public good, learning from historical missteps along the way.  The times when our legal system did justify conditional rights in the name of public good, such as involuntary sterilization, internment, and torture, we not only corrupted justice, but sacrificed small bits of our own humanity.

More recently in the U.S., we have struggled to define rights related to highly charged topics that intersect safety, privacy, and healthcare.  Just this past year, New York became the testing ground for restrictions on carrying firearms, southern states rose up to vocally challenge Roe v. Wade, and families in Texas asserted the unconstitutionality of Texas’s futility law.  Each of these issues involves complex trade-offs of how to define the scope of individual rights and determining when these rights unduly impinge on others.

There are several lessons that emerge from the film that are applicable to approaching generalized health policy questions in the U.S.:

  1. “The worst thing a nation can have is no memory.” – Lanfu Wang. Censorship and surveillance obscures the truth and facilitates the perilous practice of digital incineration.

Democracy requires that citizens challenge the law and perceived abuses of power through a systematic and transparent process.  Wang’s multiple interviews with population health officials, medical professionals, and family members revealed the common response that they had “no choice” to comply with and enforce the policy, which appeared not only as a suppression of their political power, but more fundamentally their thoughts.

Surveillance and social policing, such as in China’s emerging social credit system effectively preclude checks on power by exacting compliance.  Technological censorship as on a substantial scale in China and alleged to a far lesser degree in the U.S. can distort our perception of truth and reality.  Perhaps this is why technology’s increasing surveillance should rightly be a topic of thoughtful consideration, and we have a duty to speak out for ethical limits on technology.  To strengthen our society while respecting every person’s inherent equal value, we must have the freedom to engage in these contentious social and political debates.

  1. We must distinguish health policy problem solving from propaganda.

As Wang portrays, propaganda defines a threat: in China, it was a war on population growth that would worsen food scarcity and bring despair.  Propaganda exalted the One Child Policy as a necessary and effective solution to avoid the dire outcome.  Neat packaging obfuscates the horrific aspects of what enforcing family planning entailed: women dragged from their homes and tied to boards for sterilization, involuntary late term abortions, infanticide, child abandonment, and a lost population of females.  Propaganda insidiously shapes society’s entire frame of determining what constitutes the problem, how to solve it, and relies on coercion to demand unyielding acceptance of its proclaimed infallible reasoning.

Health policy debates should recognize there are often multiple causes of a problem and acknowledge that different solutions rely on concessions and implicit value judgments.  Aggressively labeling a problem as a public health issue affecting the greater good and requiring the sacrifice of individual Constitutional rights glosses over alternatives and ignores the full scope of questions required to arrive at an ethical and sustainable solution.

  1. How we view infants – and the unborn – signifies the hierarchy of our social values and whether we genuinely believe every person has inherent and unconditional dignity.

In China, strong social and political conditioning created the perception that stability and progress requires meticulous family planning, where medical providers discarded full term fetuses into trash heaps as medical waste, and families abandoned infants to die.  Despite equality under the law in China’s Constitution, certain lives were more equal.

As a society in the U.S., we will likely not agree on the value of the unborn.  But polarizing the debate using the premise that full term fetuses have no moral value has exerted troubling consequences for how we treat vulnerable pregnant women by giving little media attention to the grotesque and criminal acts of physicians providing abortions such as Dr. Kermit Gosnell and Dr. Ulrich Klopfer.  Fear of undermining abortion access sets the climate for harm to women as collateral damage.  It’s narrowed the definition of reproductive choice into an unwinnable and violent war of women against their future offspring.  Moreover, it has blurred the line of holding women accountable when they cause the death of their newborn infant by abusing drugs.  A moral society must enforce norms of behavior and sanction egregious and harmful conduct by setting limits on what actions are not tolerable.

History, along with these powerful messages in One Child Nation reminds us that using coercion and subverting individual rights in the name of the public good constitutes a dangerous proposition.  In the U.S., we have a duty to preserve Constitutional principles and engage our democratic system to work through thorny health policy questions that test our commitment to upholding the unconditional value of each person.

Katherine Drabiak

Katherine Drabiak, JD, is an Associate Professor at the University of South Florida College of Public Health and College of Medicine. She is also Co-Director of the Law and Medicine Scholarly Concentration Program at USF’s Morsani College of Medicine. Drabiak’s teaching and research is focused in health law, public health law and medical ethics. Drabiak has authored numerous law review articles and her scholarship has appeared in a variety of other journals including the Journal of Law, Medicine, and Ethics; Bioethics; and popular media outlets. She has experience consulting in both research ethics and clinical ethics to develop guidance policies and best practices. She is currently a member of Advent Health’s Medical Ethics Committee and has worked with the Florida State Bar Association, the Hillsborough County Bar Association, the 13th Judicial Circuit, and the Florida Department of Health. http://katherinedrabiakjd.com/

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