February 20, 2017

The Doctor-Politician-Patient Relationship

What is it with politicians, that they simply can't seem to keep themselves from getting in the way of things that really should be up to individuals to decide?

We've heard for years about how the government doesn't belong in the middle of the doctor-patient relationship, at least not as far as anything related to the Affordable Care Act is concerned, right? Except, of course, when we need the government to get in the way, we're led to believe.

We've gone through the battle on paying for contraception, even making legitimate allowances for actual religious organizations such as churches and their affiliates to not have to directly provide and pay for contraception, but leaving that up to insurance companies. And that hasn't been good enough.

And we've had the fight to make sure that companies that sell picture frames and baskets and similar decorative items also don't have to provide the full array of contraceptive methods to their employees because, well, because Republicans. And because corporations are people too, of course. We mustn't forget that.

The reason we have had the latter battles, the ones over contraception, are clear. Well, kind of,  Then-Representative (now House Speaker). Paul Ryan said back in 2012 that, when it comes to Catholics at least, what's constitutional is not up for discussion by mere mortals in the executive, legislative and judicial branches of our government - someone else owns that decision. Here's Ryan talking about covering contraception under the Affordable Care Act,after the religious opt-out was implemented:
The question is, can the government mandate that people violate their religious teaching, their conscience, their freedom of religion. Look, I can tell you as a Catholic the charities, and the hospitals, they don't enforce doctrine, they don't interpret it. It's the bishops and they're very clear in saying this is a violation of our constitutional rights. So it's an issue of constitutional rights and the government having the kind of power to trump them.
Seems we need the government to get in the way when the religious leaders tell us to, I guess, to help us understand what our constitution means. Except, of course, when the religious leaders say things that the politicians don't like, then all bets are off.

We've had the battle over paying for discussions about end-of-life care decisions - you know, health care proxies, DNRs, living wills, and MOLST and POLST forms, and things like that. We've learned how those critical documents, designed to ensure that a person has the right to define their own wishes and courses of treatment - and that others must honor those wishes - became death panels.

And we need a government to insert itself between patient and doctor in other cases too, such as keeping a person on life support - or taking them off - against medical advice or against patient and family wishes.

In this post from January 2014, we have both sides of that coin. On the one hand, we have a woman who was kept on life support against her wishes, because she was pregnant and in Texas. Because in Texas, where everything is bigger including their smaller government, it's illegal to remove life support from a pregnant woman, no matter the circumstances. The courts eventually ordered life support to end, after what I would only describe as eight weeks of torture for the family. I later found out that it's not just Texas where this type of 'pregnancy' exclusion applies.

On the other hand, we have a teenager who suffered complications during surgery to help relieve her sleep apnea, and was declared dead with no brain activity. In this case, the family believed their child was not dead, even though a host of medical professionals hired by the hospital, the family and the courts concluded she was. The court eventually allowed the family to move their daughter to a facility in another state where she could be 'treated', if that's the right word. Today, she is still 'alive' on machines. Legal actions drag on.

And now, it seems, we need a government to interject itself between the doctor and patient again, specifically when we're talking about a different type of end-of-life care.

Washington DC passed a bill allowing assisted suicide, the Death with Dignity Act. Under the rules, Congress has 30 days to overturn anything DC passes, but it was unable to get the overturn votes and a Trump signature in time. The DC bill survives -- for now -- as do bills in a handful of states that have made assisted suicide legal, allowing patients to truly and finally control their own destiny.

I can't help thinking we won't have to wait long belong before the next time the politicians will come into the examining room with us again. Because, as I noted above, they simply can't help themselves.