“It is rather for us to be here dedicated to the great task remaining before us—that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion—that we here highly resolve that these dead shall not have died in vain—that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.” Lincoln, Gettysburg, November 19, 1863.
But we, the people, have delegated governance to the money-politics-politics-money cycle. We have abdicated our duty of oversight.
And like tyrants, we don’t spend time caring about the pain and suffering that causes.
I’m 70 years old and in excellent health, take no meds, have no active diagnoses, and avoid doctors as much as possible. I think about how I’d like to die, and it’s the same as how I live: one day at a time. My wife is several years younger, and I don’t want to burden her as my caregiver. If I get cancer, I’d prefer to take one shot at treatment, and if unsuccessful, join hospice and die one day at a time. We only die once, so might as well enjoy it! But hospice is mainly for cancer patients, so what if I have dementia or Parkinson’s?
Our fee-for-medically-necessary-service paradigm has had unintended consequences. A 2001 study showed that a fourth of Medicare spending is for care in the last year of life, and that had not changed in 20 years (and probably hasn’t changed since then). What’s wrong with that? For one thing, the most likely reason for the spending is that they are sick: heart disease, cancer, stroke, COPD, pneumonia/flu, dementia. Sick people don’t feel well; it’s money spent prolonging a poor quality of life.
“Death squads,” you’re thinking. In this country, our “health care system offers little support for end-of-life care other than through traditional acute care providers.” Meaning expensive specialists using expensive diagnostic tools, expensive hospitals, and expensive pharmaceuticals. So many wealthy corporations making so much money off sick Americans. So many treatments that are painful, stressful, or plain miserable, with long-term cure unlikely. Who will stand up and say, “Stop”? Not the corporations, and not our heavily lobbied delegates. Yes, I can understand you might hear “death squads”.
But we are using expensive sick-care tools to fight a battle that was lost long ago. I remember being taught that all diseases are pediatric: look again at the list. All are self-inflicted from early in life. They are strongly correlated with overeating (obesity), smoking, and lack of exercise. Contrast France, the healthiest nation in the world, where most people are still skinny (also written in 2001, when only 20% of us were obese), and are taught to live that way from birth. Who will teach Americans to give up fast food?
American primary care doctors are dispirited, quitting the practice of medicine as soon as possible, and advising their children and friends not to enter the profession. They are powerless to halt the pitiful effects of the American sickcare system on their fellow Americans.
To me, healthcare is a spiritual matter, and the first step of the 12-step spiritual programs is to admit defeat: “We admitted we were powerless over [something], that our lives had become unmanageable.” It’s paradoxical: we must surrender to win.
Honesty with ourselves is essential. In a sense, as of today, they died in vain. We still have a chance, but we need to get honest. It’s our fault.
I asked a good friend today whether he would rather die at home or in a hospital. He has morbid obesity and diabetes. He said, “Well, I don’t know. Home would be nice, but hospital might be where I should be to get the care I need.”
“So you have abdicated,” I said. He didn’t answer my question, leaving someone in authority to decide what he wants. Of course he probably thinks he has the right of consent, but it usually doesn’t work that way. Doctors feel a duty to explain so the patient will comply, and he is a compliant person.
Ask yourself, in that scenario, whether our medical system will address his fears of unnecessary misery, pain, or death, even if he denies he has them. Will it provide counseling to help resolve his feelings about losing his life, and his wife’s feelings about losing him? What about his stuffed anger at the food industry; can we be honest here?
Is our medical system tyrannical? Will it focus instead on evidence-based standard-of-care diagnosis and treatment, while ignoring possible spiritual harm to him and his family?
Are we responsible?