First, a big "Willkommen" to my new German readers. Apparently my Pope post was picked up by a German blog, and some of those folks have been nice enough to come by and leave some comments. I often wonder if the war created a clearer message for the German post-war generation than it did for others. Even among Americans who have heard of the Holocaust, few seem to understand its historical context.
Next, go get a cup of coffee and read today's post at Respectful Insolence. It addresses questions raised in a New York Times article last weekend, important questions about research ethics and how they mesh with the discovery of new, promising chemotherapy drugs.
Finally, there is a horrid little letter circulating on facebook. According to Snopes, it was published as a letter to the editor in a Mississippi newspaper last year. I present it here as further evidence that a certain subset of Americans are immoral, clueless, shitbags (Hey, Deutschlanders, check this out.)
Why Pay for the Care of the Careless?
During my last shift in the ER, I had the pleasure of evaluating a
patient with a shiny new gold tooth, multiple elaborate tattoos and a
new cellular telephone equipped with her favorite R&B tune for a
Glancing over the chart, one could not help noticing her payer
She smokes a costly pack of cigarettes every day and, somehow, still
has money to buy beer.
And our president expects me to pay for this woman’s health care?
Our nation’s health care crisis is not a shortage of quality hospitals,
doctors or nurses. It is a crisis of culture — a culture in which it is
perfectly acceptable to spend money on vices while refusing to take
care of one’s self or, heaven forbid, purchase health insurance.
Life is really not that hard. Most of us reap what we sow.
ROGER STARNER JONES, MD
First, let's be clear who he is writing about. This doctor uses very clear dog whistles that imply that the patient is African American (gold tooth, R&B ring tone). This immediately sets a specific tone: the patient is poor, Black, and therefore beneath being treated with basic human dignity.
But even pretending for a moment that this isn't an obvious racist screed, there are even more flaws with Dr. Jones's "analysis". This doctor objects to the government spending money on health care for someone with "bad habits" and who isn't, in the doctor's estimation, sufficiently frugal.
He uses this example to show how Medicaid (government medical assistance for the poor) is a waste of resources since poor (and presumably Black) people don't conform to a certain set of behavioral standards. (Medicaid, by the way, primarily targets children and their parents, rather than childless adults.)
Physicians are, of course entitled to their own political beliefs, so let's assume that the obvious tone of disdain for his patient was absent from the letter. The question then becomes, should public assistance (for health care, food stamps, etc.) be tied to specific behavioral goals? If so, why? And how?
It is impossible to set behavioral goals for public assistance. Do we really want to be in a position to punish people for being dependent on nicotine? Do we want a panel to judge if a particular purchase made by a welfare recipient was non-frugal enough to cut off their assistance check?
Some people would like to do just that, or more likely, they would like to eliminate any form of government assistance. This is a view born out of an inability to empathize in any way with the suffering of others. This and his punitive desires are clear in his letter when he suggests that a poor person purchase insurance, and when he states that life isn't hard and we should reap what we sow.
This point of view is objectionable in the way it dehumanizes the poor, the way it demands certain behaviors from the poor in exchange for basic human services. As the letter shows, certain behaviors---those associated with minorities---are particularly despised.
While Dr. Jones's political views reveal him to be a crappy human being, they also show him to be lacking in the basic empathy necessary to be a good doctor. "Why pay for the care of the careless?" Because we are "careless" from time to time, and because it's the right thing to do.
As physicians, we are daily in grave danger of rendering unhelpful judgments on our patients based on behaviors which we consider "bad". It is our calling, our responsibility, not to render judgment but to help them change in whatever way they can.
As physicians we must continually ask ourselves, "is what I am doing or planning in the best interest of this patient, or am I doing it more to please myself?"
In Jones's case, the answer is obvious.