Touching Innocence

This is a sorta kinda followup to the last post, which discussed matters of life and death, space and time, religion, law, morality, and what it is to be human. Which was a tad ambitious now that I think about it. But I request that people not add comments disagreeing with this post until you’ve read that one. This will save us both a lot of time.

Anyway, I see that some righties are upset about a British court ruling that will allow physicians to impose a “do not resuscitate” order for Baby Charlotte, a desperately ill two-year-old, against the wishes of her parents.

The rightie blogger of Stop the ACLU asks,

Is this the direction America is headed? Is this where the ACLU, and the “right to die” folks will take us?

Kim Priestap of Wizbang blames socialized medicine:

Baby Charlotte’s health is fragile normally, so she will go through health scares like this again. This will cost Britain a lot of money. Since Britain has a nationalized healthcare system, funded by taxpayer money, it’s in the state’s best interest to let her die.

What’s going on here? As a mother myself I’m very uncomfortable when government interferes with family decisions like this. I tend to think that when the family is agreed the patient should be resuscitated, the doctors should respect the decision and not involve courts. I don’t know enough about Baby Charlotte to be able to judge whether there is a compelling reason to make an exception in her case. I infer from news stories that the doctors consider her case to be hopeless and that keeping her alive is just making her suffer. And her parents see things very differently.

I argued in the last post that humans need to struggle with hard choices. When governments or other institutions swoop into our lives and make our choices for us, it makes us less human. And this is true even when we make “bad” choices (within the law, of course). Our decisions may be less important than the process we go through to make them. So in that respect I’m sympathetic to the rightie point of view.

However … the title of this post doesn’t refer to Baby Charlotte. It refers to the righties who are oh, so innocent of the facts of life and death these days.

Nearly a year ago us “culture of death” liberals took up the cause of Sun Hudson, a Texas baby whose life support was terminated against family wishes. Although their diagnoses may differ, the legal situations of Baby Sun and Baby Charlotte seem to me to be nearly identical. If anything, Sun’s case was more extreme than Charlotte’s. His mother (father unknown) wanted aggressive medical care to continue, but the law sided with physicians who decided enough had been enough. Baby Sun’s breathing tube was removed on March 15, 2005, and he died of asphyxiation within minutes.

My understanding is that Sun Hudson’s prognosis really was hopeless. But then, so was Terri Schiavo’s.

Sun Hudson died three days before Terri Schiavo’s feeding tube was removed for the last time. Some of you might recall that righties got a tad excited about the Schiavo case. However, they were mostly silent about Sun Hudson — slipped their attention, I guess. Were it not for liberal blogs I wouldn’t have heard about Sun Hudson either.

Why were righties so oblivious to the Sun Hudson case? One explanation is that the law that allowed his life to be terminated had been signed by then-Governor George W. Bush.

The federal law that President Bush signed early yesterday in an effort to prolong Terri Schiavo’s life appears to contradict a right-to-die law that he signed as Texas governor, prompting cries of hypocrisy from congressional Democrats and some bioethicists.

In 1999, then-Gov. Bush signed the Advance Directives Act, which lets a patient’s surrogate make life-ending decisions on his or her behalf. The measure also allows Texas hospitals to disconnect patients from life-sustaining systems if a physician, in consultation with a hospital bioethics committee, concludes that the patient’s condition is hopeless.

Bioethicists familiar with the Texas law said yesterday that if the Schiavo case had occurred in Texas, her husband would be the legal decision-maker and, because he and her doctors agreed that she had no hope of recovery, her feeding tube would be disconnected. [Knight Ridder]

The Sun Hudson story came out just as the VRWC media echo chamber was working overtime to promote George W. Bush as a champion of life. Faux News’s Bill O’Reilly first commented on the Sun Hudson story before he discovered the Bush angle, forcing him to flip-flop harder than a trout on a hot pier. While Terri Schiavo’s parents were depicted as noble and pure of heart, Sun Hudson’s mother became a deranged black woman who couldn’t face reality. Never fear; O’Reilly had flip-flopped back by April when he attacked the ACLU for (perhaps) being behind “infanticide for impaired babies.”

Let’s go back to the Texas Advance Directives Act of 1999, which is the law under which Sun Hudson’s life was terminated. Put very simply, the law allows a health care facility to discontinue life support against the wishes of the patient’s family. The law requires the facility to jump through a number of hoops before it can do this, which ensures there is an overwhelming medical consensus that the patient’s condition is hopeless before the plug is pulled. The family has the option of finding another medical facility willing to continue life support. But other medical facilities are unlikely to take such a patient, especially if the patient will be a drain on the budget.

In other words, if the family is wealthy enough to pay the costs of Grandma’s care and make a generous contribution to the hospital building fund, Grandma lives. If the family’s insurance is capped and they’ve already spent the second mortgage to pay her medical bills, she dies. To paraphrase (well, OK, mock) Kim Priestap of Wizbang (see above), Grandma’s care will cost hospitals a lot of money, so it’s in their best interest to let her die.

There are two issues to be addressed here, both involving rightie inability to face reality. The first is regarding health care and how it is paid for. Just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system. The exception is the United States. In a recent Newsweek column, Jane Bryant Quinn (hardly a socialist) said that America’s health-care system is turning into a lottery.

The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.

Years ago there was a joke in circulation that said a conservative is a liberal who got mugged. The new joke is that a liberal is a conservative who’s lost his health insurance.

The point is that all the evil, inhumane things going on in Other Countries That Have Socialized Medicine are happening here, too. Righties just refuse to acknowledge them. Among those Other Countries, Britain is a good “bad example” because they’ve underfunded their system for years. Meanwhile, we in the U.S. spend far more per capita than other nations (see this report in PDF format; note especially Figure 1 on page 3) but we’re getting worse results (see Table 1, page 4). By some measures we’re getting even worse results than those cheapskate Brits.

And the moral is, people whose health care system is a broken down mess shouldn’t be pointing fingers at other peoples’ health care systems.

The other issue I see here is the touching innocence of righties regarding hopelessly terminal patients. Physicians have made decisions not to aggressively treat hopeless patients, especially suffering hopeless patients, since Hippocrates. Generally they’ve done it quietly and without drawing attention to themselves, but they’ve done it. For example, since the 19th century physicians have prescribed larger and larger doses of opiates to ease the pain of dying patients, knowing that eventually the dosage will be fatal. And as far as the family ever knew, it was the cancer that killed Grandpa, not that last dose of morphine.

Just about any health care professional will confirm this. I’m sure such decisions are being made all over America even as you read this.

The reason we’re hearing about such cases these days is, IMO, multifold. First, in the past medicine wasn’t all that effective. It was easy for doctors to make a show of “doing all we can” because in truth there wasn’t a whole hell of a lot they could do. But now we can do so much more. We have medical technology that will retain life in a body even when the person that body once sustained has long since dissipated, as in Terri Schiavo’s case. The line between life and death itself has blurred.

Second, because of the technology, more and more families refuse to accept a hopeless prognosis. I understand even anencephalic babies are sometimes put on life support these days, even though those babies have no hope of survival. In earlier times, the only choice offered parents would have been whether they wanted to hold the baby while it died, or not.

And third, mass media and our “reality TV” culture make sure the more controversial decisions get global publicity. In earlier times, these matters wouldn’t have been been discussed outside the family. Today, people with less than a half-assed idea of the facts can plaster their uninformed opinions all over the Web.

As individuals, as a nation, as a society, as a species, we’ve got hard choices to make. These choices involve ourselves and our loved ones. We need to make some mature, non-politicized judgments about how to pay for health care. We must think rationally about how much of our health-care resources should be spent on futile care. We need non-hysterical discussion about if, or when, governments should intervene in family decisions. These are all complex issues. Reasonable people will disagree on many points. But we’re going to get nowhere until we’re able to face some hard realities.

Which means we’re going to get nowhere as long as righties dominate the discussion.

16 thoughts on “Touching Innocence

  1. I saw a sign of a protester last week in Vermont’s largest daily newspaper, the Burlington Free Press (which is owned by the right-wing Gannett, BTW). The sign said, I am paraphrasing, “I broke both my wrists and it cost me $14,000 out-of-pocket to get it treated because I had no insurance. If I had Blue Cross it would have cost me $16,000 in premiums and deductibles.”

    In Vermont having insurance is MORE expensive than the treatment alone.

    I have no insurance, I have had insurance for 2 years of the last 20. My children are not insured, and they won’t be any time soon. I don’t have a full-time job, so I can’t get a group rate, I have to apply as an individual. When I called the insurer, the rate for me, my wife, and two kids was a mere $860 per month. That would add over $10,000 to my annual expenses, and that, the cheapest policy, had a $5000 deductible.

    So after paying $10,320 for one year’s worth of insurance, if I were ever to want to actually use it, I would have to pay another $5000!

    What is the point? Why have insurance at all? Well this is why the GOP and some Dems, like Joe Biden (D-MBNA), passed the bankruptcy-ending law. So that hospitals and insurers can continue to gouge the poor and then garner their Wal-Mart wages if they get ill in any way.

    Oh, sure, corporate citizens can still file bankruptcy as a way to force their employees to give back 40% of their pay while the Executives vote themselves payraises, like the airline industry has been doing. But the actual citizens are now on the hook for the hugely bloated hospital bills that they accrue.

    I took one of my kids to a hospital because she couldn’t stop throwing up last winter. We saw a doctor for 5 minutes, and he said take her home and don’t come back unless this goes on for another 2 days. We got three bills from different departments, who each have their own gigantic beauracarcies for $225. Even if I had insurance I would still have to pay that because of the $5000 deductible!

    Health care in this country is so backwards, yet to even mention that is to make yourself a target of extermination of the right-wing bigots that are your neighbors…

  2. I was shocked few months ago to learn that Israel has universal health care. How can we afford to give them billions each year in aid if we can’t afford their level of health care? They should be giving us aid.

    Regarding babies Charlotte and Sun–universal health care requires that limits be placed on care. The state has an interest not in requiring the child to die, but in simply telling the parents that they will have to pay for any additional care at this point, because as a self-insured group we have agreed that we will not waste money on hopeless cases. Compound fractures are always addressed, but we’re not going to finance another liver replacement for a raging alcoholic. We can’t afford it. (and my family is full of dead or dying alcoholics).

    Terri Schiavo is a different case, in that the husband was seeking to terminate the care that kept her husk of a body alive. It was right wing insanity on full display, including Dr. Frist’s absurd pronouncements. Remember the eye-rolling Terri Schiavo shots shown over and over again on Fox News and emphasized by right wing media outlets while the woman’s brain was liquified? Insane.

  3. I like the way you think. My wife recently died. She was doing fine until having a breast removed at age 74 and going through chemo. She lost her feminity and then her will to live. She couldn’t eat and lost weight so quickly I could do nothing to help her. I knew she was dieing and then in six weeks she was gone. I don’t think I’ve have had a day without crying since.

    Perhaps these children and the Terri Shiavo’s you write about cannot speak for themselves but I am convinced they are speaking through those that care for them and are saying the quality of their life is not what they desire and it’s time to move on. They are not trophies to be admired like do-good badges on a Boy Scout’s sash.

    Thank you for your comments.

  4. limits be placed on care.

    Of course we’re placing such limits on care now; we’re just not being honest with ourselves about it. That’s why rightie hysteria over Baby Charlotte is so hypocritical.

  5. Wasn’t there another case in Texas (I believe) of a terminally ill woman who was taken off life support AGAINST HER OWN FULLY CONSCIOUS WISHES because she could no longer pay for her care? She just wanted to stay alive long enough for her mother to be there when she died but they pulled the plug anyway. The righties missed that one, too.

  6. Thirty one years ago my mother’s life was ended by a doctor who had the compassion, the wisdom, and the respect for the wishes of the family to honor our request that her suffering without hope be ended. I still hold gratitute for that doctor’s mercy in not refusing to prolong the inevitable. In my mother’s case, death was a merciful release from tremendous suffering.

    I often think, when I think of my mother, what a shame it is that some crusaders pushed so hard to convict Dr. Jack Kevorian in his efforts to relieve the suffering of the terminally ill. Death is a part of life.

  7. Lynne, you’re thinking of the case of Tirhas Habtegiris. Perhaps the righties missed it because she was a woman of color, and a legal immigrant to the U.S. from Africa.

    I love Steve Nichols’ comment about U.S. aid to Israel, which has universal health care when we don’t. It’s all about the priorities.

  8. Howard, that was difficult for me to read. I cannot imagine living it. Peace and love to you.
    Maha, I’m going to use that line about a Liberal is someone who lost their health insurance. Hah. That’s a good one.
    In 1992 my father suffered several health issues at once. But mostly the fact that this very intelligent man had gone almost catatonic, we all, my mother and my brothers and sisters (7 of us) knew that he would not want to live this way. Yeah, medical science could have probably kept him alive for quite a while, but what was the point? All we did was mention this to his doctor and nothing was done to prolong his life. We didn’t sign anything, lawyers were not brought in. It was simply done. I wonder if that would have been done today. How comfortable are doctors doing that in today’s climate? My husband has health issues right now. He’s 65. Will I have a legal issue on my hands if I suggest that nothing be done to prolong his life after something catastophic happens. Knowing my husband would not want extrodinary measures be taken to keep him alive if there isn’t really any hope that he will be a normally functioning human being again? I think I’ll have him work on a living will this week.

  9. I wonder how much of the health care dollar goes for insurance, and how much for actual treatment? The American system is outrageous. It is immoral to profit from people’s suffering. The only people who are entitled to make any money from health care are the physicians, nurses, techs, and other workers directly involved in providing care. Not investors and insurance CEOs.

  10. Somehow, someday….we will have the perspective to realize that the business model [ ‘bottom line’ having automatic god-like priority] is a poor conceptual framework to use in designing programs which address our shared non-material needs and values.

    In areas such as health care, environmental quality, and education, the business model itself becomes a destructive tool because, by its nature, it focuses on siphoning profits rather than serving needs The needs of the people who are the front-line providers [educators, health professionals, government servants at EPA, etc] and the needs of the general public who are to receive essential services become secondary to profits.

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  13. We are so stupid about health care in this country. We rail about “socialized medicine” and how if we had “socialized medicine” people would abuse it, going to the doctor for every bunion and hang nail. The result is that only the very wealthy and people with jobs that offer healthcare insurance can afford medical care. Which means that those without insurance or money end up when very ill in the emergency room. Which is the most expensive care of all. And they can’t pay.

    Tell me again why our medical care is so expensive? If we had single payer national health care, we’d end up paying less and getting better care. But noooooo — cain’t have that socialized medicine!

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