More health care stuff

Here’s a statement from the Catholic Medical Association. Odds are pretty high they have a more thorough take on stuff than anything you’ll read here while I noodle the matter in my spare time.

That said, however, it is my blog and basically what I do is noodle ideas, so here’s an interesting conversation I had with a very thoughtful reader whose husband is a doctor:

Hi Mark,

I’m a lurker–love your blog.

Don’t know if you get time to answer reader email and your combox seemed overwhelming–but

About the right to a liver transplant.

This seems really problematic, because in asserting that someone has a right to a liver transplant you are also asserting that they have a right to another person’s body.

Do you see this as a problem or no?

To be clear: I don’t doubt that organ transplant is an ethically permissible and even a holy transaction and gift of self.

But.

A RIGHT to someone else’s organ?

How this complicated transaction is addressed leads to a cascade of other complications in defining what is meant by a “right” to “healthcare”–but I was curious, since you are so clear thinking how you would address the complication in asserting that someone has a “right’ to an organ transplant?

I have in view *only* a normal situation (i.e, there is a liver available for transplant due to the death of the previous owner). Obviously I’m not saying “I have a right to take your liver by force.” I’m simply saying “When somebody is dying and we have the means to save them, profit does not trump human life.”

She replies:

LOL Monty Python has a hilarious sketch about taking a liver by force. “We’ve come for your liver.” “But I’m still using it!”

Hmm. I see what you mean, but the question also points to extraordinary measures which is also a complex issue–is an organ transplant an extraordinary measure? which services are ours by “right” and which services/treatments, are an option but not necessarily an entitlement? Do you see what I mean?

Is the “right” to health care only reserved for life saving procedures? do people have a right to things like allergy shots? do they have a right to laser eye surgery?

or is the right to healthcare the right to the labor, services, and materials of those in the healthcare industry apply to all “gold standard” treatments?

It’s often neglected that in saying that we have a right to healthcare we are saying that we have a right to the labor of another human being–in fact a whole team of human beings–and then we are in conflict with two different points of Catholic social teaching. I’m not saying I know what the solution is I’m wondering if you have thoughts on that.

Thanks for indulging me. I have no answers myself, I just think Catholic teaching is not exactly black and white–or even clearly in focus–when it comes to healthcare.

“Extraordinary measures” typically refers to life-prolonging treatments which attempt to stave off the inevitable at the end of a normal life. Heart transplants for a 90 year old. Heart-lung machines for brain dead victims. Basically, stuff beyond food and water.

I’m talking about, say, a teenage girl who needs a kidney, has a donor and a competent surgery staff, but is denied it solely due to cost. *Any* system that is set up that way is evil and needs to be fixed so that the good of the person is not subordinate to lesser goods like profit. Nothing wrong with profit. But it’s a lesser good and must yield to the good of the person. We can create a system where both goods are respected in their proper order.

The goal is a system ordered toward the full flourishing of the human person. I would guess the goal is not to start with Minimum Daily Adult thinking (“What’s the least we can do to give primacy to the good of the person and still make as much money as possible?”) and instead ask “How can we maximize the good of the person and still make as much money as possible?”
She replies:

Thanks this makes sense. Then the question becomes if the state is really the best one to be making these determinations and valuing the costs and labor of the surgeons involved. Perhpas its a right that faith-based organizations should be intervening in to fill the gap between what is needed for the good of the person when it is counter to the right of a laborer to the fruits of his labor. We don’t tend to think of surgeons as laborer because in our culture we think of them as a privileged and moneyed elite, but they are skilled-laborers, who went to great emotional and physical lengths and great costs to obtain those skills. Same for the nurses, etc. So I’m still not sure how to escape the trap of healthcare rights and rights to the labor of the surgeons, janitorial staff, nursing staff, and adminstrators involved.

But thanks for your thoughts and sorry I grossed you out with the Monty Python sketch. 🙂

Thanks for your calm and sensible approach. Very refreshing.

I’m feeling my way through this myself. My concern is primarly with trying to figure out first principles. What bugged me was noticing that the firstest of the first principles was being categorically denied by lots of people on the Right with the categorically wrong claim that health care is not a right. I get doubly suspicious when people say I am “twisting” or misinterpreting those denials to mean something contrary to Catholic teaching. My response is “Uh? How?” The Church says it is a right. These people I have linked to (thousands of hits from Google from people saying “Health care is not a right” and even “The bishops are wrong”) do not appear to me to be agreeing with the Church on the fundamental question of whether it is a right.” One gets the sense that somebody feels very threatened by the fact that their Tribe might be in dissent from the Church and they are struggling with cognitive dissonance since they have lived by the narrative that is only the Bad Tribe that dissents from the Church.

Me: I’ve given up on tribes. My question is “What are the first principles the Church gives us here?” If a tribe supports the principle (i.e. “health care is a right), I support the tribe insofar as it does so. If the subsidiary principles are rejected by one tribe and supported by another (“justice requires a fair wage”), I support the tribe that groks the subsidiary principle, but reject that tribe where it is disordered in the heirarchy of goods (i.e., when it denies that health care is a right). So, for instance, those who on the Right who say “justice requires a fair wage, therefore there is no right to health care”) are right about the wage, but wrong about the right to health. They’ve got the heirarchy of goods in the wrong order, since the good of person means there *is* a right to health care. In the same way, those on the Left who say, “Health care is a right, therefore those who profit from it should be punished” or “Health care is a right, therefore abortion should be free and compulsory for all practicing physicians to perform” or “Health care is a right, therefore to give more of Fit, a piece of the pie, we should eliminate the weak, sick and old so that the Pepsi Generation and Democratic members of Congress can always enjoy the full benefits of American medical technology” all these arguments betray certain weakness owing to various inversions in the hierarchy of goods as well.

This frank disinterest in tribal loyalties and tendency to ask, “What does the Church prioritize” explains my (to an astonishing number of readers) “inexplicable” rejection of both abortion and torture and my (seeming) in-the-tankness for “conservative” or “liberal” parties, depending on the ideological zealot who is complaining about me. In fact, I have no party allegiance and regard political mechanisms as clumsy tools we are forced to work with in order to enact Catholic social teaching. I will work with and support anybody from the anywhere on the political spectrum insofar as they support some aspect of CST. Similarly, I will oppose anybody from any part of the spectrum who contradicts CST.

That’s the entire mystery of my political opinions that have so baffled so many of my readers for so long. With health care, I reject right wing agitprop that denies a right to health care exists. I also reject any attempt the left may make to pit the right to health care diametrically against lesser goods like profit, or to pit the weak, sick, and old against so-called Lives Worthy of Life. It’s not either/or but an ordered both/and: the hierarchy of goods. I will vehemently oppose any attempt to subordinate the good of persons to systems which urge the murder, whether by neglect (the preferred GOP “support the status quo/block health care reform and propose nothing substantial instead” method) or euthanasia and abortion (the preferred Lefty method) of the costly for the sake of cost-cutting. Both parties are, in their own ways, about power. Only the Church’s teaching is actually ordered toward the primacy of the person and the family. So I’m trying to think with that.

God bless you for trying to do it too!
She replies:

Ah, Mark, I find you so very refreshing as well.

I’ve been talking (it seems until I am blue) about the way Catholic media has “heated” up (as in McLuhan’s “hot” media) in the Internet and enmeshed itself with the conservative party line. Its an understandable affinity but reductive and disrespectful to the Magisterium as both a teaching body and a complex theological collage that requires consistency and carefulness (which punditry may as well stand as the contrapositive to). It also completely keeps Catholicism in a clique-y ghetto and fails to engage the culture as a whole. I affirm and applaud your ability to cross-party lines with fluency when our theology demands it.

I’ve been blogging under several banners for awhile and I’ve finally come to the realization that Catholic teaching is implicit and not explicit in my writing—as a way of escaping this “hot” media environment and clique-ishness that I’ve seen developing as an electronic ghetto. I also avoid social and political topics overtly for this reason–my background is in the humanities so I stick to technology, pop culture and the arts. What I have found now, is that a suprisingly diverse readership has emerged that are actually affirming and identifying with Catholic teaching without even knowing it.

Sorry for the self-referential tangent, but point being, when I was blogging under explicitly Catholic banners, I was attracting all sorts of Catholic conservative wing-nuts (and I also don’t subscribe to either political designation for the very reasons you cite, though I tend toward the libertarian Right) who arrived their merely to affirm themselves in what they already thought, and sought out increasingly like-minded people. What results from that is an incestuous sort of Catholic hair-splitting, in which we create increasingly false dichotomies (like profit vs. human good) and wield the power of Church authority as if it were ours to do so in the first place, each of us trying to out-Catholic the other. I saw some abysmal behavior in that regard and felt like I couldn’t breathe for all the people
that sought each other out because they think exactly as they do. (Chesterton has written very well on this clique mentality and I’m reminded of it all the time).

This is precisely the reason I enjoy your blog (which was introduced to me by Sean Dailey from The Blue Boar, btw) because you seem very at ease with defying knee-jerk ideology.

It was on the torture issue that I found my way to your blog in the first place, and it was like being given a meal after an extraordinary fast. I’d become sick at heart and mind reading all the right-wing punditry, much of it Catholic or at least Christian, that had a Bush-Cheney right or wrong attitude and continue to bless torture as the right of the morally superior West. (The same people who also support the death penalty, usually.)

On the health-care issue–full disclosure my husband is a physician. We live in Taxachussetts–and he cannot run a practice here because the state forces him to take a certain number of state sponsored health-care patients and it is impossible for a primary care physician (IMPOSSIBLE) to make a profit. Notably these patients often don’t show up to appointments at the highest rate of any other type of patients (there is no financial penalty and we do not esteem what is given too easily) and this takes up monstrous amounts of time that could go to paying patients. The solution has been to work as an employee to a hospital who hires the primary care physician at a loss in order to keep the system alive. Our hospital the only one serving the area is bankrupt and doctors are leaving en masse leaving behind a crisis in healthcare of epic proportions.

We do alright, for sure, but the amount of effort, study, and stress the physicians have to endure should be remunerated fairly. The amount of study required to keep up credentialling alone is unbelievable. The amount of stress on the families of these physicians is also enormous. Speaking from experience.

To experience such stress–worrying every day day in and day out whether or not your last decision may have killed someone, if you may have actually worsened a patient’s health instead of improving it, whether or not your wrote the proper dosage on a prescription pad–and realize that you don’t even receive as remuneration doctors received 20 years ago, is an incredibly disheartening prospect. And the practice of medicine is now not even an intellectual or service oriented pleasure as the insurance companies dictate every move in a horrifyingly inadequate algorithm. A doctor of creativity or innovative thought can in no way apply those skills to the practice of his patients. So now the primary care physician works as slave to the state and to the insurance company monstrosity and cannot even feel equipped to
care for his patients in the way he feels is best. It is soul-killing really.

Sorry for the ramble and thanks for taking so much time to talk with me–it’s a pleasure. Nice to “meet” you.

I’m sorry for the suffering you and your family have had to endure. It really is a disastrously destructive system in so many ways–and not just for patients as you make clear. I’m remind of Zippy Catholic’s memorable dictum: “System do not do what you want them to do. They do what you design them to do.” We want a system that respects the good of the person, both doctor and patient, and which delivers excellent treatment to the sick while providing a living wage for their caregivers. We have *designed* a system that places corporate profit and state power over the good of persons.

The heartening thing for me, in this discussion, has been seeing how many of my readers *get* that persons are the primary good in the heirarchy of goods. Sure, a couple of people have responded with knee jerk boilerplate accusing me of being “in the tank” for Obama. And yes, it seems to take a while for the fog to clear for some folk so that they realize that I’m really not secretly saying “Send the National Guard to Rush Limbaugh’s house, confiscate his fortune and force the medical establishment into indentured servitude or, better yet, chattel slavery now!” But it is a mark of how muddy our approach to Catholic teaching is that it takes so very long to establish a bare minimum statement like “Health care is a right” as an obvious fact and starting point for the conversation, even among Catholics. Saying such things aloud *marks* you as suspect among tribalists on the Catholic Right, just as saying “I’m not persuaded Obamacare is going to do what we want it to do, but what we will design it to do” marks you as suspect among tribalists on the Catholic Left. So we get the bizarre spectacle of attack goons from the Right declaring that my saying health care is a right means “Support Obamacare or go to hell” while we also get the attack goons of the Left, such as Morning’s Minion, telling a Catholic (whose friend died of cancer at 32, who is acutely aware of and supportive of the fact that health care is a right, but who is, like me, very concerned about erecting a system that murder the costly) that his *real* reason is that he is in the tank for corporate profit and the GOP, etc.

What strikes me about so much of this way of thinking is, again and again, how it replaces consideration of the person with mere perception of tribal membership. Indeed, the spectacle of Morning’s Minion’s contemptuous mockery of a person in obvious anguish over the death of a friend, and his robotic (and remarkably Karl Rove-like insistence on remaining attack mode to destroy his perceived tribal enemy) makes clear that tribalism is by no means an illness confined to conservative politics. And the generally thoughtful responses I’ve gotten to raising the issue last week suggests to me that being out of power may, in the long run have a salutary effect on the Right, while the dementia that seems to afflict fallen man whenever he has the power to get what he wants will now be something the Left will have to contend with. Turns out the doctrine of the Fall and Original Sin is a pretty good diagnostic tool.

Anyway, thanks for your thoughtful conversation!