Monday, December 27, 2010

Health care and the lack thereof

I'm a regular reader of Get Religion, a blog by and for journalists who cover religious issues. It's often the place I find out about news I would otherwise have missed, as in this article which led me to the New York Times article that reveals Obama's plan to reinstate "'voluntary advance care planning' to discuss end-of-life treatment," which was famously (whether accurately or not) called "death panels."

Now, let's be honest. Economics is part of life and part of health care decisions. It doesn't matter how much I need a particular medicine or treatment; if it's not available, I'm not going to get it. If it's outrageously expensive, then the only way I'll get it is by sacrificing some other good.

Moreover, our obligation is not to prolong life at any cost whatsoever. Our obligation is to make every reasonable effort to provide healing and care.

But economics is far from the only issue involved. And I very much distrust any advice that reduces "Quality of Life" to a merely economic factor in a purely economic decision.

So, while I don't mind talking with my doctor about the pros and cons of various options for treating a terminal disease or for treatment of my advancing age, I do mind the government butting in to give its own advice. I particularly object to the government providing financial incentive for my doctor to follow their advice.

So, by all means, make plans for future contingencies. Medical advance directives and durable powers of attorney are important tools, especially in a climate where doctors are pressured to ignore both their own moral compass and that of their patients. But make sure your legal documents genuinely protect your freedom and your faith.

As an addendum, here is the Catechism on end-of-life issues:
2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.

2277 Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick, or dying persons. It is morally unacceptable.

Thus an act or omission which, of itself or by intention, causes death in order to eliminate suffering constitutes a murder gravely contrary to the dignity of the human person and to the respect due to the living God, his Creator. The error of judgment into which one can fall in good faith does not change the nature of this murderous act, which must always be forbidden and excluded.

2278 Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable Palliative care is a special form of disinterested charity. As such it should be encouraged.

[... snip ...]

2288 Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good.

Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance.

2289 If morality requires respect for the life of the body, it does not make it an absolute value. It rejects a neo-pagan notion that tends to promote the cult of the body, to sacrifice everything for it's sake, to idolize physical perfection and success at sports. By its selective preference of the strong over the weak, such a conception can lead to the perversion of human relationships.

2290 The virtue of temperance disposes us to avoid every kind of excess: the abuse of food, alcohol, tobacco, or medicine. Those incur grave guilt who, by drunkenness or a love of speed, endanger their own and others' safety on the road, at sea, or in the air.

2291 The use of drugs inflicts very grave damage on human health and life. Their use, except on strictly therapeutic grounds, is a grave offense. Clandestine production of and trafficking in drugs are scandalous practices. They constitute direct co-operation in evil, since they encourage people to practices gravely contrary to the moral law.

2292 Scientific, medical, or psychological experiments on human individuals or groups can contribute to healing the sick and the advancement of public health.

2293 Basic scientific research, as well as applied research, is a significant expression of man's dominion over creation. Science and technology are precious resources when placed at the service of man and promote his integral development for the benefit of all. By themselves however they cannot disclose the meaning of existence and of human progress. Science and technology are ordered to man, from whom they take their origin and development; hence they find in the person and in his moral values both evidence of their purpose and awareness of their limits.

2294 It is an illusion to claim moral neutrality in scientific research and its applications. On the other hand, guiding principles cannot be inferred from simple technical efficiency, or from the usefulness accruing to some at the expense of others or, even worse, from prevailing ideologies. Science and technology by their very nature require unconditional respect for fundamental moral criteria. They must be at the service of the human person, of his inalienable rights, of his true and integral good, in conformity with the plan and the will of God.

2295 Research or experimentation on the human being cannot legitimate acts that are in themselves contrary to the dignity of persons and to the moral law. The subjects' potential consent does not justify such acts. Experimentation on human beings is not morally legitimate if it exposes the subject's life or physical and psychological integrity to disproportionate or avoidable risks. Experimentation on human beings does not conform to the dignity of the person if it takes place without the informed consent of the subject or those who legitimately speak for him.

2296 Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.

Thursday, December 2, 2010

Punishing children for their parents' immigration?

Mark Shea, writing about the DREAM act, says the following:
This seems to me to be simple justice. Sure, secure the borders. Do what you can to stop more illegal immigration. Fine by me. But, in the meantime, while "failure to fill out paperwork" is certainly a problem, depriving workers of their wages is a sin that cries out to heaven for vengeance in our tradition. Since we have long ago agreed to integrate these people into our nation in order to exploit them, we owe it in justice to, at the very least, not screw their kids. One might even hope that a time will come that we won't screw the parents either.
This seems very sane and sensible to me. In some instances we are debating sending home the adult children of those who came here illegally, when those children have been here since the ages of one, two, or three years old, don't remember their home country, speak English as well or better as their parents' native tongue, and have no roots anywhere but here. To punish them for the illegal entry of their parents seems like an injustice, and one we can easily remedy.