The Healthcare Debate

I've been following with great interest the current debate over healthcare in the United States. I don't claim to have read the bill (1000+ pages of legislation is daunting to say the least), but I'm going to comment on the situation anyway.

What I've read (from mainstream and fringe media, right, left and center) suggests that the system Obama is proposing is very, very similar to the current Canadian model. And that scares me. Americans deserve much, much better. I'm not even going to comment on the concerns that the proposed plan will fund abortions (as already happens in Canada) or that it will lead to rationing of healthcare (it does in Canada) or that it will lead to a utilitarian system where the disabled and elderly are not cared for because its too expensive (also a problem in Canada) because I think you all know where I stand on that issue.

Instead, I want to comment on this notion that free government healthcare is a good idea. I live the Canadian experience, and all I can say is thank God I'm healthy. The whole time I was going to university, I didn't have a doctor- I wasn't sick and didn't think I needed one. Now that I've settled into my career, I thought I'd find a doctor (my family and friends think that yearly physicals are a good idea, and apparently going 10 years without one is too long). So, I called every clinic in the area I'm now living in, and not one of them is accepting new patients.

Huh. I thought that under our universal medical care system, I could recieve medical care anywhere in the country. Apparently not. When I asked the clinics what I should do, they suggested I go to the ER for any problems.

Yeah, right.

I'm going to go to the ER for a physical.

And even if I did, and they would do it (which I'm sure they won't) what a waste of a) taxpayer money and b) ER resources. If the ER is busy dealing with people who should be seeing their GP, how can they help those who really need ER care? Our ER has essentially turned into a glorified walk- in clinic. Its a little ridiculous.

I also came across this story the other day. Apparently, this hospital has closed its maternity ward because there are no doctors to deliver babies in the city. Instead, expectant mothers are being told to go an hour away to deliver. This was supposed to be a temporary measure, but its been 6 months! Two women have already delivered en route to the hospital in the ambulance.

I don't know what the best solution is- the city can't seem to attract any doctors, but the patients are suffering. What happens when a women has a difficult or dangerous pregnancy/labour? Does a mother or child have to die before this situation is remedied? (I don't even want to think about the liability issues in this situation).

Anyway, my point is that the Canadian system is far from perfect. It is not something that other countries should try to emulate. Improve upon? Learn from? Sure- that's great, but this is not the route Americans want to take. Trust me.

The only "good" thing about Canadian healthcare is that its equal- rich or poor if you want treatment under the universal healthcare system, you will have wait equal lengths of time.

All I can say is, thank God for my health.

Pray for our neighbors to the south.

Do no harm

With the success of I-1000 on the Washington state ballot, two states have now legalized assisted suicide, but both of those states recognize doctor assisted suicide. In these systems a doctor either prescribes a lethal dose of medication, or helps to administer the medication. This fact chills me almost more than the whole concept of euthanasia and assisted suicide in general, because I believe it irreparably damages the doctor's relationship with their patients.

The Hippocratic Oath, which pre-dates the birth of Christ, tells doctors and physicians to "do no harm." The oath says "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect." So, any doctor who prescribes assisted suicide is violating that oath, or, as is more common, they are simply not taking the oath in the first place. But this worries me, because it seems we are taking a step back to the dark ages; the pre-Hippocrates times. Hippocrates created the oath in recognition of the fact that going to a doctor was dangerous business- you had to hope you paid the doctor more to heal you than you enemy paid him to kill you. Hippocrates didn't like this- he thought people should be free to seek treatment and know that the physician ministering to them would do everything he could to help them. Thus, the Hippocratic Oath- an oath taken by doctors for over 2000 years was born. It was created so people could feel safe visiting a doctor.

Physician assisted suicide threatens this, because you don't know that your doctor will actually work in your best interest. You don't know that he or she won't give you a deadly drug, or make subtle and not so subtle suggestions that you take it. You don't know that your doctor won't have spoken to your children or caregivers and have been convinced by them that you are "better off dead." If doctors continue to administer lethal prescriptions, patients cannot trust their doctors.

For this reason, it is so important that everyone talk with their doctors; just like you would a lawyer. Find out where they stand on palliative care and assisted suicide, or other medical ethical questions, and make sure they know you position as well. Communication is key, and if your doctor doesn't have the same pro-life values as you do, it is time to find another doctor. Another thing you should ask is if they took the Hippocratic Oath; increasingly medical schools are not requiring grads to take the Oath.

It's a scary world when we can't trust the people who are supposed to heal us to actually do no harm.

Health Care Directive

In Health Law, we've been working on advanced directives- the things you sign to talk about the medical decisions you want made on your behalf if you become unable to consent to treatments, or lose capacity to give instructions, and we had to draft our own. It was very tough- trying to put Church teachings on end of life care into words- I don't know that I succeeded in mine- I'm not signing it until I think about it some more, but it's really important. (Once I figure out how to draft mine, I will post it)

The first thing I want to say is be very, very, very careful as to how you word these. The second thing I want to say is make sure you ask your lawyer (if you are using one) what he uses to make them up. If he says the firm uses a precedent, you need to be very careful in the instructions you give, and ensure that you read over it and ask LOTS of questions about what it entails. Why? Because many directives do not follow the teachings of the Church regarding end of life care.

When you are coming up with your instructions, take time to think it through. Talk to a priest you trust. Do not let anyone (the lawyer, the home care facility, the hospital) rush you, because it is important. The following are my thoughts on what you should include, but please don't consider this exhaustive advice- it is merely information you need to consider. If you already have an advanced directive (also known as a health care directive) please review it.

As Catholics, we need to ensure that we don't allow our health care directives to permit passive assisted suicide (which is legal in most countries, including Canada and the US). Passive assisted suicide is removing or withholding treatments and allowing someone to die. Those treatments can include basic things like food and water. If that is removed, you starve/dehydrate to death. This is an inhumane practice, but is allowed.

For women, you want to include a clause regarding what you want done if you are pregnant.

When you appoint a proxy (a person who will make decisions in the event you cannot), make sure you choose someone who will make decisions in line with church teachings. If you want, you can explicitly state that they have to make decisions based on Church teachings.

Do you want to donate your tissues for therapeutic purposes? For medical research?

This is not a long list, but just some of the things I am considering for mine. As a final plug, I want to advise everyone to ensure they have a will, power of attorney and a healthcare directive, and advise you to get them drafted by a lawyer to ensure they meet all the legal requirements. Don't think that just because you are young, you don't need one. None of us know when we will be called home to God, and I ask you prepare your affairs so your family (who will be grieving) doesn't have to think about these things.

In the case of all of them, if you don't plan ahead, the courts can make the decisions for you, and that should scare you more than anything else I can say. J Also- please discuss these issues with your family- they NEED to know what your wishes are in advance.

Finally, if you envision you health care directive being needed sooner rather than later (or you have family who might need it) let them know that EMS personal are trained to look on the fridge for a plastic pouch containing the directive. If you've got questions, don't hesitate to ask.