I forget which of the several great blogs I owe thanks to for pointing me to Secondhand Smoke. Good coverage of ethical issues, and over the past week there have been a few posts specifically on health care and end-of-life decisions. Look here for a brief report about how the British healthcare system rations expensive medicines. And here is an article about a family that wishes to dehydrate-to-death a family member who has become severely disabled by a stroke — of significant concern is the cost of nursing care for the patient.
I wanted to point out two issues that these articles raise:
First of all, making cost-versus-benefit decisions about medical care is normal and rational. Resources are limited, and both length and quality of life can be subject to opportunity costs. As a wife and mother, frankly I’m all about making this life’s inevitable suffering and end as frugal as possible. There are times when my family’s money is better spent on some other purpose than my medical care.
Forgive me if I shock you, but shouldn’t my money be spent on my happiness? If I find greater marginal utility in spending $10,000 on college tuition for my children, rather than on a year’s supply of a prescription drug of doubtful longterm benefit, do I not have the right to spend my money as I see fit? If it is acceptable for me to give up my life of housewife luxury in order to toil away in a fluorescent-lit cubicle farm, in order to provide some perceived good for my children, am I not also allowed to give up that same number of days of housewife luxury, for the same benefit to my children, if instead of a cube farm I find myself suffering at home, or in purgatory, doing some kind of work arguably no less valuable than whatever clerical job I might have gotten in the first case?
So what’s wrong with a nationalized health care system making rationing decisions? The same thing that would be wrong with a command economy telling me I am required to take that clerical job. These are my decisions to make. The catholic name for this principle is ‘subsidarity’. From CCC 1883:
Socialization also presents dangers. Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good.”
Any health care system that violates the principle of subsidarity — taking health care decisions out of the hands of the patient and making them subject to the preferences of the state — is not morally sound.
The second point that came to me, especially reading about the beleaguered stroke patient, is that we as a culture seem to have lost all concept of responsibility for caring for family members. Let me be the first to say that I find nursing to be icky work. There’s good reason I went into accounting and not health care. I can barely stand to change my own kids’ diapers, why would I want to change anyone else’s?
But contemporary America has decided to completely forget about the work of caring for the helpless. All those housewives who ‘don’t do anything’? They’re, um, taking care of other people.
–> Ever notice that if you don’t take care of your own children, you have to pay other people to do it? It’s because childcare is actual work. Same story with making dinner, vacumning, cleaning toilets, all that stuff. When people decry the ‘high cost of childcare’ I want to shake their shoulders. Don’t you know that the nice lady who keeps your kids for you has to feed herself and her family, too? There isn’t a ‘cheap’ method of caring for children.
And the same is true of nursing care. Fine and good if you as a family have decided that expensive hospitalization and advanced medical procedures are not how you wish to spend your money for the care of ill family member. But you can’t anymore decide that therefore *nobody* should feed the poor guy, just because you don’t want to pay someone to do it for you — anymore than you could decide that since daycare is so expensive, just leave the baby home alone and unfed while you go to work all day.
And now we’re back to subsidarity. You can’t have it both ways. Does the state have a responsibility to pay for the care of your children? Then you have given up your right to decide how that child will be treated. Does the state have a responsibility to care for your elderly, disabled, father? Than you again have turned over your rights. Because these are, fundamentally, your rights. Your rights, and your responsibilities.
We are slipping more and more from the notion that the state has a legitimate role in assisting the most weak and vulnerable among us — the orphan, the childless elderly, the abandoned and helpless — to thinking that the state has the obligation to care for all of us. It isn’t so. What the state does for those most in need, it does on our behalf — the church, or some other private group or individual, could as easily do the same. In a secular nation, it is not unreasonable that our government be a logical choice for representing us in these works of mercy.
But they are, all the same, our work. Our responsibility. We have a collective responsibility to the poor in our communities. We have an individual responsibility for our own family members. And claiming and fulfilling that responsibility is the only way we can hope to hold onto our freedom. Which I suppose makes a homeschooling housewife a rather patriotic sort of worker.