Health Care – What is it?

 

Question-Mark-820x1024One of the goals of the Affordable Care Act was to expand access to regular and affordable health care for Americans. Underpinning this goal was a hard-to-argue-with notion that the nation, individually and collectively, is better off when its citizens are healthy.

Is that the same as saying that that all Americans have a right to health care? Even those who instinctively nod “yes” might qualify their answer, depending on how you define health care. Some types of health care are critical to good health, while others seem of marginal benefit.  Under the best of circumstances, the boundaries are far from clear.  And most types of health care are in limited supply, based on the availability of equipment, medical staff, facilities and drug supplies.  We can’t all have everything.

A starting point for the discussion might be the definitions given by the President’s Council on Bioethics in 2003:

    • Therapy: treatment of “known diseases, disabilities or impairments in an effort to restore a normal state of health or fitness.”  Included in this category are things like repair of broken bones, antibiotics for infections, surgical removal of tumors, pacemakers, and chemotherapy or radiation for cancers.
    • Enhancement: treatment “to alter the ‘normal’ functions of the human body or psyche so as to augment or improve native capacities and performances.” In this category are such things as discretionary plastic surgery, botox injections to remove wrinkles, or steroids to improve athletic performance.

This simple model, however, leaves many questions unanswered.

    • How do we classify vaccinations, annual visits to the dentist for cleaning, or periodic screenings for breast or prostate cancer? What about vitamins and exercise regimens, or anti-smoking campaigns. None of these quite fit the definition therapy or enhancement, but they are included in what is now called Preventive Medicine, a set of strategies to maintain health rather than cure illness.
    • Another challenge to this binary model is Palliative Care, which covers the spectrum of physical, emotional, spiritual, and social suffering that often accompanies illness.  Drugs and medical treatments are considered palliative if they relieve symptoms without having any beneficial or therapeutic effect on the underlying disease or illness.  Examples would be dialysis for kidney failure or Aricept for early-stage Alzheimer’s, both of which make life more manageable for a time, but do nothing to cure or reverse the underlying problem.
    • Yet another complication comes with Long Term Care, particularly for the elderly.  While everyday tasks like feeding, bathing and dosing out medications do not ordinarily constitute medical care, their absence leaves those with chronic illnesses and/or limited mobility prone to accidents or malnutrition.  These in turn lead to diseases or illness that may require acute or chronic medical care.

It seems reasonable, at first glance, to make therapeutic medical care available to all Americans. But should I have a right to any and all therapeutic treatments, regardless of my ability to pay?  Should I have the right to any and all procedures—a kidney transplant, for example—if I already suffer from multiple or chronic illnesses from which I will never recover?  Should I have the right to any and all procedures even if I am responsible—alcohol or drug additions, for example—for my condition? And should the standard of “normal” be the same for a 40-year-old as for an 85-year-old?

If your answer to any of these questions is “no,” you are left with even harder questions.  What types of procedures should be restricted or prohibited … and under what circumstances? Who should decide? Based on what criteria?

Similar questions apply to things that fall into the category of enhancement, preventive care, palliative, or long-term care.  Most would agree that pain-medication is a palliative treatment that should be available to anyone who needs it.  But what about Viagra, when it is used to offset a “normal” decline in physical function, but may help to restore emotional health.

What do you think?  Should health care be a universal right, regardless of the ability to pay?  Regardless of other health conditions?  If so, how would you propose to pay for the rapidly increasing costs associated with the aging baby boomers?  If not, what criteria would you use to decide who gets what?

Health Care and You

 

 

images-1Greetings!  I have returned after an extended and not-entirely intentional absence from the world of blogging. A significant factor has been the time required to prepare for a university level course, entitled “Comparative Religion,” that I began co-teaching as of September, 2015.

Readers of my blog could be forgiven for asking what qualifies me—a confirmed agnostic and an ex-Wall Street maven—to teach a course on religion. The answer is that a key element of the course is the recurring collision between modern health care and many religious traditions. My contribution is less on theology and more on bioethics—the many different ways in which religious beliefs affect health care, and particularly people’s end-of-life decisions.

As I noted in a blog last November, my interest in bioethics and health care was provoked by the prolonged and painful deaths suffered by both of my parents.  My father, bedridden with the complications of diabetes at age 54, repeatedly asked to be allowed to die. Sadly, four of the five time his heart failed, his doctor took extraordinary measures to get it pumping again. Even as a devout Catholic, he had the moral right to be allowed to die a year earlier, but he did not have the stamina to overcome his doctor’s refusal to let nature take its course.

By contrast, my mother romped through eight decades with élan. At age 70, while still of sound mind, she handed my brother and me detailed instructions from the Hemlock Society (now Compassion & Choices) for facilitating her death if she was no longer able to manage day-to-day life on her own.  Her advance directive, however, contemplated a stroke or terminal cancer rather than dementia. When Alzheimer’s unexpectedly stole away both her mental and physical capacities, there was little we could do.  No longer of sound mind, she did not meet the requirements for physician-assisted suicide in even the most liberal of states.

In my blog last fall, I initiated a discussion of several health care themes that seemed particularly relevant to the baby boom generation. Going forward, my focus will be broader, to include a host of issues that fall under the general heading of bioethics, and address health care issues faced by all age groups. Health care issues to be explored include the challenges posed by modern drugs and medical technology, as well as the challenges that many religious traditions face in this environment and the insights that they still have to offer.

Early health care topics will include:

  • How did we get to a place where aging has become a disease, something to be repaired and reversed … a place where we no longer seem to know what it means to let nature take its course?
  • Should health care be a universal right … and if so, what kind of health care?  If not, what criteria do we as a society use to decide what health care is necessary and appropriate?
  • Who should decide what kind of medical care we receive … whether to initiate or terminate treatment … based on what criteria?
  • What are your rights when medical treatment is deemed futile?  Can you … should you … override your doctor’s recommendation?  If so, under what circumstances.
  • What are the economic, financial and/or legal implications of the medical choices many of us will have to face … for ourselves and our families … for society as a whole?
  • Is there a “right to die” at a time and under conditions of our own choosing?  If so, does that imply a right to commit suicide … to have someone assist us with suicide?
  • What are the ethical implications of clinical research trials?
  • What are the pros and cons of “controversial” medical procedures: physician assisted suicide … clinical trials for new drugs and treatments … stem cell research … in vitro fertilization … organ transplants … designer babies?

As in the past, my goal is not to promote a particular point of view, but to prompt a vigorous discussion of the complex issues facing us all … not just the aging baby boomers, but the generations who come behind us, and must live with the consequences of the decisions we make—or perhaps even worse, the decisions we don’t make.

I hope you will join me — and bring your friends — on this journey.