19 August 2009

Catholics and health-care reform

I'm asked rather frequently these days how faithful Catholics should be thinking about health-care reform. We seem to be in a tight bind between the Catholic imperative to care for others and the equally Catholic imperative to respect individual conscience and freedom.

Here's the very basic question I ask when evaluating any reform of the health-care system: what are the moral principles that stand under the proposed system and drive its inevitably tough choices?

Given the answer to this question, I ask another: what system of laws, regulations, incentives, etc. will be used to implement these moral principles?

In the current debate it seems to me that the proposals under review are based on a highly objectionable utilitarianism; that is, the reforms proposed rely on a variety of cost-benefit analyses that require those making medical decisions to commodify human life. If those making the decisions are not the ones who will suffer the consequences of the decisions made, then the utilitarianism in use becomes nothing short of immoral.

If, as a 95 year old Dominican friar, I decide to forego cancer treatment that will cost my province $150,000, that's my right as a person. However, having this decision made by a government accountant is simply wrong. I may use cost-benefit analysis to determine whether or not I will receive medical treatment. The government cannot. If the argument is made that the government will be paying for the treatment, therefore the government gets to decide on the treatment's value for my life, then I would retort: get the government out of the health-care business!

My fundamental worry is this: I simply do not trust the government to do the right thing, meaning I do think that the government is the proper body for deciding on the relative value of medical treatments. In order to be fair, such decisions would have to be made on objective criteria. We can't have the government deciding life and death issues based on circumstance and intention. This breeds injustice and inequality. Given this, it falls to bureaucrats to establish objective guidelines for decision-making, guidelines that ignore everything that makes me a person created in the image and likeness of God by placing a monetary value on my life. I am reduced to the value of my life expectancy and weighed against monetary costs of extending my life beyond a pre-determined point.

At some point between now (at 45 years old) and my expected age for death, I reach a tipping-point and become an potentially expensive liability to the public treasury. And the only thing that seems to matter is my age. Wholly ignored as irrevelant in the decision-making process is my potential to create something of value after a certain age; and worst of all, my inherent value as a person created by God to flourish is never even considered. Under a utilitarian cost-benefit analysis this inherent worth has no monetary value whatsoever.

So, do the proposals currently under debate respect the inherent worth of the individual person created and sustained by a loving God? Are the proposed medical decision-making processes grounded in the notion that patients have the freedom of conscience inherent to being persons? Will these processes reduce the person to a monetary value or treat persons as inherently valuable?

I don't think so.


10 comments:

  1. Here is something I read:

    "Cardinal Justin Rigali, the archbishop of Philadelphia and the President of the United States Conference of Catholic Bishops (USCCB), said in a letter to Congressmen the main 'health care' bill under consideration in the House of Representatives is unacceptable because it would: (1) allow the Secretary of Health and Human Services (HHS), who is currently very much in favor of abortion funding, to require all health plans to cover abortion and contraception; (2) provide direct federal funding of abortions; (3) allow courts or the HHS to invalidate all state laws governing abortion, including parental notification and informed consent laws; and (4) fail to protect the conscience rights of pro-life doctors and other medical care workers who object to being involved in abortions, artificial contraception or sterilization, a group that should include all Catholics in the field."

    ReplyDelete
  2. As anything involving the state, it's utilitarian to the masses, but discriminating to the powerful. Make no mistake, a 45 year-old friar is less likely to get an expensive treatment than a 75 year-old senator (assuming that congressmen would get the same public health care insurance, which they won't).

    But in a recent argument with colleagues I just asked one question: if the poor can get care from charitable hospitals have they been doing anything to support them? If not, why are they so willing to fork money to the state when they cannot care to fork it right now?

    ReplyDelete
  3. Augustine...good points! The problem with charitable hospitals is that they tend to be ideologically impure, i.e. refuse to sterilize women and perform abortions. Can't have that! We must all be forced to celebrate the sacrament of abortion!

    ReplyDelete
  4. Social Justice Review ran an interesting article in 2003, Universal Health Care: Justice or Charity?

    Because this article discusses a raft of errors in current popular assumptions, it will appear in full in the next issue of Truth Be Told - the newsletter of the laity of the Province of the Holy Name of Jesus.

    I've made it available (see link above) early because it is so timely; it is reprinted with permission from SJR.

    ReplyDelete
  5. Flambeaux3:53 PM

    Can anything good come out of a publication titled Social Justice Review?

    ReplyDelete
  6. I have been giving this issue a great deal of thought. I was a student taking a course in Justice and CST at a Dominican institution. I was part of a group project looking at this exact issue. As an individualist, I find the Catholic principle that moral decisions should be made by the invdividual through formation of the person's conscience very appeal. It places the responsiblity where it belongs, with the individual. The healthcare plans I've heard put forth by Catholic moral theologians to destroy that. I also see that the plans ignore some very basic economic truths about "Healthcare", namely that it is a collection of scarce resources. As such, no Socialist or collectivist plan will morally distribute those resources.

    ReplyDelete
  7. A former professor told us the following story about when she was living in Paris (her husband is a diplomat). She was 42 at the time and became pregnant. When she went to the doctor, she was told that, because of her age, she had to submit to a series of tests to ensure that the baby did not have Down Syndrome or other defects. If any defects were discovered, she would have to abort the baby. She balked and asked if there were any options and was told that she could go see a judge to state her opposition. If the baby had any developmental or health problems, they would be banned for life from the public health system. Is that where Obama is leading us?

    ReplyDelete
  8. Right now our healthcare is in the hands of multi-billion dollar corporations. Are you expecting them to look out for the benefit of all?

    Your objections against trusting the government work even better against the current system.

    Having lived in other countries with socialized healthcare and enjoyed those benefits immensely, I almost keeled over when I returned to this great land three months ago to find out what a disaster the health care is here. The care in S. Korea is head and shoulders above ours.

    Finally, what sense does it make to say health care is an individual thing? It's only an individual thing if you're covered by your employer and/or you're rich enough to pay the absurd prices.

    The US Health Care system is such a disaster... and it sounds like you folks prefer just to leave it as is.

    ReplyDelete
  9. I live in Canada. If we lived in the States we would either be so far in debt we wouldn't be able to see the end of it or we would not be as healthy as we are. We have four kids, my husband is a farmer and I have worked up to 3 part time jobs at a time while I went to school. We are not lazy nor stupid, but there is no way we could have afforded the health care insurance fees my father and brothers pay in the States. In addition to the four births (one of which was a high risk birth requiring longer than normal hospitalization)and regular doctor visits, members of our family have been hospitalized 5 times for medical treatment or surgeries and usually these hospitalizations lasted for a week or more. Our youngest is currently in the hospital. If we had had to pay cash for these hospitalizations we would have had to sell the farm and we'd probably still be in debt.

    I suggest you read this article and then pray that these people will soon have the kind of access to medical care we enjoy in Canada.

    http://www.commondreams.org/headline/2009/08/15

    ReplyDelete
  10. Joseph,

    The "Oppose BO's Reform = You Don't Want Reform" is a DNC talking point.

    I am very much in favor of reforming the system. BO's way is not The Only Way.

    There are any number of things we can do to improve insurance provision, but well over 75% of Americans are happy with their insurance as it is.

    Given the choice btw trusting the obvious greed of the profit motive and the murky agendas of left-wing community organizers, I'll take the devil I know.

    ReplyDelete