Archive for June, 2010

Managed Care. By Force

June 2, 2010

In the rush to try and provide care to everyone, we might wish to pause and consider the ramifications of forcing care on people .

Theologically, how do we sort through a situation like this?  How do we balance out the equation of individual free-will and seeking to best care for God’s creation – in this case human beings?  I’ve been grappling with this for the past week or so, off and on, and am still uncertain of the best way to proceed.
It might seem somewhat straightforward – if you can save a life you ought to.  The questions come into play as to how we define “saving a life”.  Is there a difference between “saving a life” (curing) and “potentially extending a life” (delaying death for some arbitrarily defined adequate amount of time) that would merit forcing someone to have a treatment they did not want?  What about free will and the rights of the individual?  Does our right as Americans to the “pursuit of happiness” mean that we define happiness arbitrarily, or can someone dictate what happiness is and that people are not only allowed to pursue it, they must pursue it?  Is the refusal to receive care tantamount to suicide?  
In this particular article the issue is blurred because the patient in question has been diagnosed as having cognitive problems.  She has been deemed as somewhat unable to make these sorts of decisions for herself, and therefore others have the responsibility to act in her behalf.  But who has that right?  Does the state?  Do neighbors?  Family members?  I think it’s interesting that the woman is definitely an adult (55 years old), who appears to live on her own or without assisted care.  No mention is made of family or others who would be in a better position to make decisions for or with this woman.  
Biblically we are mandated to love our neighbor as ourselves (Matthew 22:38-40).  Does this mean that we force our neighbor to do things we deem are in their best interest just because we would do them ourselves if the situation was reversed?  Christians certainly to find this warranted on other hot-button issues.  Does the Golden Rule apply here, or is it misapplied?  Nothing is said about this woman’s theological beliefs, only that she has a fear of hospitals.  Given the fact that hospitals are not exactly the safest places in the world, I can’t blame her.  
As Christians, are we required to avail ourselves of every possible means of extending our lives?  Is a refusal of treatment that will likely extend our lives tantamount to suicide or euthanasia?  What level of treatment would be considered reasonable to reject then, and what level would be unrejectable?  
Biblical Christians value the unique, God-given created quality of every human being.  We are not to draw distinctions in life – we are not to choose or define what sort of life is worth living and what is not.  We are not to create arbitrary standards that would take life from someone because of criteria that deems their live not worthy of living.  But we also acknowledge that this life is not all we have, and while it is a precious gift from God, it is not necessarily even the most important aspect of our life in sum.  Our earthly existence affords us the blessing and opportunity to come to know our Creator and how He is redeeming not only our own life, but all of creation from the mire and mess we see and experience around us and within us.  
But while death is an enemy, it is a defeated enemy, and we needn’t fear it.  Our battle is not against death, so that we must save life at all costs and under any circumstances – even against the will of the person we seek to save.  So long as the person is not acting with the intention of ending life themselves, we have freedom to dictate the type of treatment we wish to have, based on how it will affect our life.  Humanism and other non-theistic philosophies tend to view death as the ultimate enemy who must be staved off as long as possible, because once we succumb to death we are no more.  Christians declare that this is not so.  Death is a vestigial barrier that causes us pain and loss and suffering for now, but beyond which we can and will live on in a recognizable but different manner, either in joy or in sorrow.  None of us escape the portal of death, and so how we approach it becomes infinitely more important than (though not completely separate from) how we seek to avoid it as long as possible.  
I eagerly expect and hope that I will in no way be ashamed, but will have sufficient courage so that now as always Christ will be exalted in my body, whether by life or by death.  For to me, to live is Christ and to die is gain.  If I am to go on living in the body, this will mean fruitful labor for me.  Yet what shall I choose?  I do not know!  I am torn between the two:  I desire to depart and be with Christ, which is better by far; but it is more necessary for you that I remain in the body.  
– St. Paul, Philippians 1:20-24 –