They Shoot Horses, Don't They?
and them what don't, won't
and what he don't take
the undertaker takes as you exit
--Them That Has, Gets,
The Andrew Sisters
The dice was loaded from the start
-Romeo and Juliet, Dire Straits
Maybe it's just the whole world
is like central casting.
They got it all rigged before you ever show up
--They Shoot Horses, Don't They? (1969)
We’ll never be sick a day in our lives my love
simply because we can’t afford to be
--Mink River, Brian Doyle
__________________
Sunday Homily: The Fallacy of Christian Emotionalism.
Mr. Doyle's characters live on the edge, as do the one of six Americans at or below the poverty line. Their willing health is romantic, but life doesn't deal out romance. Hard facts dictate limited resources, and everyone doesn't get everything.
Thing is, we know it. That is why everyone is afraid to make a move regarding actual health care reformation. We are all very grateful for the drugs we get and the five minutes of the doctor's time. None of us wants to be thrown on the ash heap too soon, and somewhere along the way someone instilled the idea that we have a purpose for roaming this earth (even though for many, that seems to be little beyond patronizing Costcos to lay up 128 oz. bags of artificially-colored chips.)
If we would look at our existence rationally, there are only so many resources, and they are not apportioned equally. You and I both know that we do not get Cadillac health care. We accept something middling if we are fortunate to have some sort of coverage. If we choose to show compassion, we feel for those unfortunate enough to never have been at the receiving end of the bennie chute and so must trudge along with bad teeth and pulling ramps from the side of the road in the hopes of building concoctions to keep them going.
Instead of fearing "death panels", Ranger would welcome them, both at the state and federal levels -- death panels based upon medical realities, based in logical thinking, shucked of the emotionalism and false Christian ideas which swirl about any current efforts to address the thing.
We will not spend much time deconstructing the religious hypocrisy, but if one were to live by The Word, one would not lay up material things and would be buried in a pine box or incinerated (ashes to ashes, dust to dust). How is it the deceased enters the natural flow when hermetically sealed in a locked vault? Jesus does not speak of prolonging life in perpetuity on this physical plane. The Lazaruses and Methuselahs are few and far between. So, perpetuation of life beyond reasonable means is not a part of scripture.
Mercy, compassion and love are, however. The question is, how best to show those qualities? Is it always shown through keeping the organism alive through superhuman means, even when the sentience (soul?) has left the building (=body)? That may be interpreted as a selfish cruelty on the behalf of those who cannot let go.
The system bears a heavy burden during the final days, weeks, months and even years prior to the expiration of a critically ill person. Most Medicare costs are seen then. We prolong life that will benefit naught, except to line some health executive's pockets, and we do it unquestioningly, meeting any opposition with fierce and unthinking opposition.
"All life is sacred", is it not? If so, then we needs define "life", and perhaps differentiate that from existence in extremis. If mercy is the prime objective, that would seem mandatory.
As it stands, emotion and prejudice rule what should be the most rational of decisions. This is not a question of choosing who lives and dies; this IS a question of applying a medical protocol to determine what intervention are not merely heroic, but in fact, futile, and which may bring benefit.
It seems most of us would prefer to reach a reasonable end, knowing that death and taxes are the only sure thing, without extreme measures to extend our lives when there will be no further quality to be wrung from extending the quantity. Death panels could help revitalize our medical system by prioritizing and categorizing states of being and allocating resources in an equable manner. This would be a step in reining in the health care behemoth.
The NYT's Paul Krugman calls us out this week:
"A serious fiscal plan for America would address the long-run drivers of spending, above all health care costs, and it would almost certainly include some kind of tax increase. But we’re not serious: any talk of using Medicare funds effectively is met with shrieks of “death panels,” and the official G.O.P. position — barely challenged by Democrats — appears to be that nobody should ever pay higher taxes" (The Austerity Delusion).
Krugman concludes, "The confidence fairy (= hope) won’t save us from the consequences of our folly." So we languish in a head lock we won't get out of because who will let granny die, or the hydroencephalocele baby who is doomed to die anyway, but who will undergo extravagant outlays of medical resources and funds during its brief existence? Because somewhere in the arcana, Christianity demands that hydroencephalocele's keep breathing until superhuman efforts fail to continue to enable that possibility.
Meanwhile, Ranger has an associate who is caught up in the folly of a poorly administrated health care system of limited resources. She is medically disabled but fairly young and in fairly good health. A recently FDA-approved drug might provide the help she has been seeking to become a more productive member of society.
However, that drug is caught up in a precious Big Pharma + drug manufacturer monopoly: It is not covered by her plan's formulary, and must be ordered by the doctor from the manufacturer (even though FDA-approved.) Someone stands to benefit from this Rube Goldberg distribution scheme, and it is not her. It will cost hundreds of dollars per month, and she will probably not be able to afford this. Yet we choose to afford to allow people like her -- prospective contributing members of society -- to limp along with the minimal resources currently provided.
We live in a country where medical caravans visit the most under-served parts of our country a few times a year and must turn away hundreds each time for the most basic of health care. Ranger contends that precious medical resources like health care professionals should not be providing frivolous services like nose and boob jobs and penis implants. What a revolution THAT would be, if we trained our attention on things that actually mattered.
It is the most human of all questions: What constitutes a life? It is our contention that being brain dead and on life support is not living.
--Lisa and Jim
Labels: big pharma, fda, health care, life choices, religion, religious hypocrisy
11 Comments:
human beings are sometimes "blessed" with medically-inspired conditions we wouldn't allow a veterinary to inflict on an animal (i was going to shy away from this one. it is intense. but bracket the sexual overtones and imagine medical objectification of life.. really, be warned... nine inch nails~closer)
1st the kulaks.
G.D.,
You make an excellent point. The animality of the lyrics speaks to the debased nature of the human (if we wish to say being "animal" is debased.)
Surely, if we admit the equivalence, we cannot with a straight-face maintain our high-falutin' God myths (unless we are willing to bring the whole herd in on it.) And if animal, then what makes a human life so worthy of superhuman efforts to prolong it in the face of gross abnormality?
what, indeed, is the more fully human and compassionate way to proceed with end-of-life issues? legalistic, technical? or with attention to spiritual dignity and respect for natural processes? Which approach truly jettisons the concept of God and gratitude for the divine spark.
there is the issue of transhumanism as well... technologically, dealing with mortality in an ethical and moral way is not going to get easier.
G.D. says,
"Which approach truly jettisons the concept of God and gratitude for the divine spark."
Precisely. If the pro-lifers-at-any-cost reconcile themselves with religion, they must face that question. God has not put it in the rule book what to do in the event of such dire medical events.
Transhumanism is an interesting topic, as it seems that is precisely what is being chased after when such interventions are attempted. While I cannot argue against reasonable interventions, such things do disallow the weeding out via natural selection of many negative traits.
GD,
I oppose the hypocrisy of not allowing assisted end of life, which we continue to call suicide.
We need a new word for this concept.
jim
And the aspect of medical costs we don't like to talk about (because we don't want to die!) is that a HUGE proportion of the increased cost of health care comes in the last 6 months or so of your life.
We spend an assload of money to keep ourselves alive one more day, one more week; sick, hurt, dazed...all sorts of fucked up. Rather than bite the bullet, scoop up the morphine syrettes, wrap up in our poncho, and deal with it.
Sad to say, I don't know how you change this. People aren't going to just suddenly develop a stoic acceptance of Fate, especially here in the Land of Opportunity, where everything tells us that even Death can be bought off, spun, or spoofed with bullshit.
G.D.,
In line with "Closer", another thought I've had is that the medical behemoth, aside from padding its pockets, gets some
fiendish benefit by trifling with maladies which literally should be "closers". They scoop us out, irradiate us and everything else in a culturally-sanctioned experimentation.
We'd howl at the moon if some of this stuff were wrought upon prisoners or the mentally unwell.
FDC,
Exactly -- that is when the costs balloon, in trying to stave off the inevitable. If we could just do what we need to do, say what we need to say, we could go in peace.
Who does that?
Chief:
HUGE proportion of the increased cost of health care comes in the last 6 months or so of your life.
Much of which can be mollified if we had a decent and effective of regular medical care throughout our lives.
Like folk just about anywhere else other than the Greatest Country on God's Green Earth.
bb
basil: True, to a point. We tend to live longer just because we're (on average) wealthier than much of the rest of the world. But you're right that a lot of us get relatively shitty medical care when we're NOT ill (by First World standards) AND we're on the whole sedentary, and we eat crap.
But...dying is dying, and we die harder than most of the rest of the world, both because we can "afford" it (i.e. we put it on the insurance tab and pass it on to someone else) and because we expect it. I think this is a relatively new thing, and I'll tell you a story to illustrate it.
My Scots grandfather was a Christian in the true sense; a Salvation Army officer, the U.S. Sally Ann national commissioner (i.e. the top guy in the SA in this country) for much of WW2 and the Forties, he hob-nobbed with FDR and Truman and the political heavies of his day. But he lived in a small apartment on the Lower East Side of NYC.
In the Sixties his doctors found a cancer in his lungs. It had spread widely, and they told him that he could undergo several months of painful treatments which might extend his life another several months, as much as a year.
He discussed the treatment, including the cost (which was enormous for the time), told them politely no, and went home. About a month later he went into the hospital one last time (since there was no such thing as hospice care, but that's what it was) and died, in as little pain as the morphine could grant him.
Most of his contemporaries were like that, too.
But we've developed this idea that medicine will work miracles. We just don't want to give up. And sometimes it does. But miracles are expensive, and most of them fail. And all of us end up paying for them...
FDC,
Your grandfather sounds like quite a man, and must have shared some wonderful stories of his life.
His decision, as you say, was very typical. It was stoic, and in line with his faith.
Today, I believe the loudest Bible-thumpers lack the faith. They seek the medical "miracles" and the "magic bullet", but even the words belie the impossibility. I believe the body is capable of great things -- miraculous things vis-a vis our small medical tool kit. But miracles can't be bought.
The end comes for us all. All reasonable efforts should be applied, with palliative care, and then, the end. Why must we rail insanely against the inevitable?
My father decided years ago his body would go to medicine when he dies; mom wishes cremation.
It's the end; meanwhile, do some good :)
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