7 Quick Takes Friday #10?!

Those of you who may have checked out the above site last week will have discovered that the Jennifer had taken the week off as part of fast from the Internet.  I’m not about to try anything that crazy just yet.  Suffer on.

I hope that I’m not the only person who is something far shy of surprised that the little boy floating away in a weather balloon thingy that apparently dominated the media yesterday may not have been the innocent accident it was initially reported as by the family.   Just Googling the family name should have turned up enough half-baked YouTube clips and other media endeavors to warrant some further probing into the event. 

That being said, the remaining posts for this week all center around various aspects of health care and the law here in the United States.  Some of you may remember this ancient news story from last week about the conviction of a Wisconsin couple who prayed rather than seek medical attention for their sick daughter, resulting in her death.

The article really doesn’t do justice to the murkiness of the law at the crossroads of religion and health.  And it is interesting to note that lawmakers are resolving to solve this situation by removing religious exemptions for cases of neglect and abuse.  What the heck does that mean?  If you don’t take your child to the doctor at the first sniffle, are you opening yourself up for a case of neglect and abuse?  How about attempting to better define when failure to seek medical care ceases to become a matter of ignorance or simply poor judgment, and becomes something prosecutable, like neglect or abuse?  Who gets to make that call on when that line is crossed, and what legal codification is going to simplify this any? 

None that I can think of.  Fortunately, who would think to argue that the death of their child was as much an issue of innocent ignorance as it was a religiously motivated decision?

This couple.

I find it interesting how the reporter leads off with the weight of the child, as though that is indicative of some sort of abuse or neglect.  A two-year old boy that weighs 32 pounds is certainly nothing abnormal, and perhaps even on the larger side of the scale. 

I also find it interesting that the entire story almost is taken up with the religious aspect of the case, when the parents aren’t even attempting to defend themselves on religious grounds.  Rather, they’re arguing that they thought their child just had a cold, and therefore didn’t see a reason to seek medical assistance.  The judge states that “Your child needed medical care.  As parents, that what your duty is, and that’s why you are here in court today.”  The article doesn’t mention whether or not the parents have other, older children.  I certainly know that we were a lot more paranoid about colds with our firstborn than with our younger children.  And as parents, you’re responsible for best knowing your child and attempting to provide for their needs on that basis.  Sometimes a doctor can be helpful in that process.  Sometimes not. 

I believe that the parents should have taken the child to the doctor, especially if religion was not a compelling factor in their decision not to.  Especially if (and it’s unclear if they tried this) they tried to deal with the cold through aspirin or other over-the-counter options.  But if the child showed improvements and then relapsed?  That’s a tough call.  And no mention was made of the family’s situation in terms of finances or health insurance.  For many folks, the idea of an expensive doctor’s appointment or an interminable wait in ER would be enough to keep them searching for quicker, less expensive solutions.

I found this editorial by the CEO of the Coca-Cola company to be rather interesting.  It appeared in the Wall Street Journal last week.   At one level, his argument has merit – there are plenty of factors in the growing obesity problem in the United States.  On the other hand, I felt his blatant appeal to economics and utilitarianism in the final paragraph to be out of place.  I’m sure that cigarette companies employed a lot of people before they fell under the legislative hammer.  Clearly, when people’s lives are at stake, arguing about employment figures is really a moot issue.

Who ultimately should have the power to make health decisions?  Is this a personal decision, or a communal one?  This is a great, short piece by the Christian Science Monitor discussing the ratcheting up of rhetoric regarding the H1N1 threat. 

Should individual liberty place a community – even a nation – at risk?  Should the interests of the community take precedent over an individual’s freedom of body?  I’m sure that if arguments were being made that abortions had to be eliminated because they were a threat to our greater community, there would be a holy terror of shrieks of outrage regarding the sanctity of decision-making authority that every woman has over her body – regardless of the potential impact on anyone else (like the father, or the unborn baby, to name just a few). 

And yet in the arena of vaccinations, it seems perfectly legitimate to argue that for our own good, or for the good of our society, we ought to be compelled to receive a vaccination or any other procedure that poses very real – if difficult to predict – damage to our bodies.  If people are compelled to take vaccinations by the government, should the government promise to compensate them and their families if anything goes wrong after the vaccination? 

If I enlist in the military, I voluntarily place myself in harm’s way.  I acknowledge that I am willing (if not thrilled) to lay down my life as necessary.  Totally voluntary (at least when the draft isn’t in effect).  Yet if I were to be killed in the line of duty, my family is compensated for my death to the tune of $100,000.  Why don’t we have similar policies in effect for those who might be compelled to receive a medical treatment such as a vaccination, only to find that they suffer from debilitating side effects? 

To place all this in a historical context, you might also be interested in viewing this little video clip from 60 Minutes which originally aired over 30 years ago. 

Chemical castration.  A process suggested for use with serial sex offenders (either voluntarily on their part or mandated by the state in light of certain crimes or repetitions of crimes) whereby the sex drive of the offender is lowered through the mandatory intake of drugs designed to reduce the sex drive of the recipient.  Some countries (such as France) already offer this option to certain offenders who volunteer for it.  In Poland, it is mandatory for certain crimes

In general, the p
rocess is reversible (once the drugs are no longer taken), and does not result in sterility.  And yet this issue raises some fierce debate, even as it’s considered in more and more places (South Korea and Russia, to name two).  Is this a viable option here in the United States?  Why or why not? 

The last and most recent item of note is a recent recommendation that dementia be considered – in and of itself – a terminal disease.  At stake appears to be the issue of how dementia conditions are discussed with the patient and/or relatives and others who need to decide care options for the patient.  A new study claims that dementia should not be noted as a side-effect or some lesser disorder, but deserves to be recognized in and of itself as a terminal illness.  The study actually wishes to switch the stated cause of death for many sufferers of dementia.  Rather than attributing death to pneumonia, a fever-related episode, or eating problems, the researchers think that the dementia ought to be credited as the actual killer.

I think this is a dangerous step.  First off, it seems a dangerous confusion of attendant symptoms or concerns with core health issues.  If a person dies from pneumonia, does it matter if they are functioning normally intellectually?  If complications from a severe fever kill a person, do we blame this in some respect on the fact that they have lost their short term memory?  How is it that the mental condition of the patient supersedes actual, physical causes of death?  Does the fact that many dementia patients die from some of these things mean that dementia causes these things?  By that logic, wouldn’t old age itself become a new terminal disease, with the patients more prone to die from cardiac arrest, or a stroke, or some other specific, physical situation or condition?

It seems that the goal of this report is to encourage a change in how care options are presented to those making medical decisions for a dementia patient.  “Patients with health care proxies who have an understanding of the prognosis and clinical course are likely to receive less aggressive care near the end of life.” 

5 Responses to “7 Quick Takes Friday #10?!”

  1. Marie Says:

    The diabetes and religious stuff comes up a lot.I think what the deal is is that there are come folks who, for religious or other reasons, try to limit their dependence on medical professionals and procedures and chemicals. I think this has a lot of benefits for many.What happens with diabetes is that when a kid has it and no one knows, it can look like a regular illness or even not that until it suddenly doesn’t and then there is a very rapid tailspin that is sometimes irreversible.My kid was two when she was diagnosed. We had a good doctor. Still, I spent about five months going in over and over because I knew something was wrong, but no one else thought so. As far as they could see, she was just cranky, spoiled, wanting to nurse all the time and be held all the time. She lost weight, four pounds over five months, but since she was so demanding about nursing it wasn’t as dramatic as it would have been if she’d been older and eating solids like cereals. Our nurse was checking her urine for a UTI when she stumbled on the sugar in it. We were told that most kids this young, the diabetes doesn’t get caught until the kid is in diabetic ketoacidosis and being airlifted to the nearest big city. Our story is very, very common, if you get together with families of diabetic kids you’ll see the diagnosis is very, very frequently missed. There are innumerable stories of moms being sent home and told they are making things up, essentially, and then coming back with kids near death. Dying from diabetes is an awful thing, it is a suffering disease, I won’t give you details, and any parent who allows that for selfish reasons should be imprisoned for life. But I’d take these news stories more seriously if they ever pointed out how many kids die of diabetes every year not because the parents thought it was a flu and didn’t treat, but because a doctor thought it was a flu and didn’t treat. I’d like to see one of these prosecuters just once put a doctor in jail for ignoring the pleas of a mom and allowing misery or death to come to a diabetic child.

  2. Paul Nelson Says:

    Thanks for sharing, Marie.  I had no idea that diabetes in children was so difficult to diagnose – or, more accurately, something that they don’t think to check for very often.  Kind of amazing to me that if a simple urine test for a UTI could detect the sugars, that isn’t something that’s more commonly done, especially in a situation where there have been ongoing complaints.You bring up an interesting point in terms of how we choose to hold people accountable or not – particularly doctors.  While I have a respect for doctors, I also don’t trust them much more than I trust mechanics, plumbers, and anyone else that is trained to do a particular job (pastors included!).  In other words, they’re human.  They make mistakes.  They overlook things.  And while I can switch plumbers or mechanics as necessary, I may not have that chance with a doctor.  I’m the first to argue against frivolous lawsuits of any kind, yet how do we hold health care workers to a level of accountability?  It’s all too easy to just say that we missed something, and expect that it should be the end of the discussion.  I’d be fine with that – but then there’s little excuse in my book for prosecuting parents why say the same thing.  What sorts of double standards are we perpetuating?I’m not suggesting that we treat parents as doctors, and assume that they know as much as they need to about their child’s health condition.  But they also have some innate sense that an outside party isn’t privy to, that can tell them when their child is suffering even when the doctor insists there’s nothing wrong.  And it can similarly tell the parent that there’s no need for a doctor, even if in hindsight it’s easy to say yes there was.  I worry that the role of the parent continues to be marginalized, hemmed in, under assault from ‘experts of every stripe whether medical or educational or a form of social services.  These services exist to serve the parent, to provide resources and rebuke if necessary.  But the flat out assumption that these experts know better than a parent automatically isn’t very realistic.  I dislike the air of infallibility that seems to permeate many hospitals and doctors offices – in spite of well documented evidence such as yours, not to mention some very frightening statistics.  Too often, the patient is ruled out as having any meaningful or useful information to contribute, beyond what their bodies reveal through exams.  That’s one of the things that worries me about national health care – that it’s only going to further reinforce the idea that we somehow exist to serve doctors, rather than the other way around.  I don’t think that’s healthy (pardon the pun) in any type of profession. 

  3. Marie Says:

    I give my peds office a lot of credit, our kid was diagnosed early in the game (blood sugar was 400 or so on the day of diagnosis, some kids go in over 1000)because they were both smart enough to know how to test things and compassionate enough to let me keep bringing her in even though her symptoms were basically “she won’t let me put her down, she nurses continually, she’s cranky and can’t sleep”. At 18 months, many doctors would have sweetly told me to just let her cry it out, it’s time to wean, whatever. This doctor figured it out only because she was willing to take the time with a parent that she probably honestly thought had it wrong. I’ve now had way more experience with doctors than I’d want. I do think the good ones are extraordinary people, I’ll fully credit them. The mediocre ones are useful if you use your own sense, too. The bad ones are downright homicidal. I have a friend that you could call a victim of a serial doctor. Her mom died of cancer after being diagnosed too late — lung cancer, and she was a smoker. She stayed with that doctor out of a sense of not wanting to make him feel bad? Years later, he misdiagnosed a 16 pound cyst in her abdomen as “women over 30 just have a harder time losing weight in their abdomen”. That was removed. About five years later, he diagnosed a stomach bug — she died within a month from retroperitineal cancer. She was 42.I thank God for the doctors and nurses who have helped me keep my baby alive. But I don’t blindly trust anyone anymore because they are employed as a medical professional.

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