http://youtu.be/7WuqLJtoXyY
In the last week I have been deeply disturbed by baseless bigotry. Two stories have troubled me. First, as an avid hockey fan I was shocked when I read comments after the Boston Bruins lost game 7 and hence the series against the Washington Capitals. The man that scored the deciding goal, in over tome no less, Joel Ward, is a clutch performer. This is what I think when I see his name on the sports page. A clutch player who has a knack for scoring important goals. That is not what all fans saw. Some bigots only noticed the color of Wards skin. Seconds after he scored a torrent of racist tweets appeared, all of them vile. Worse yet, Ward was not surprised by the bigoted remarks. When I read this I thought back to a pre season exhibition game in London Ontario where a banana was thrown at Wayne Simmonds, one of the few other black men playing in the NHL. Ward and Simmons both said such bigotry is to be expected when playing a sport that is dominated by white athletes. This observation is truly sad, proof bigotry is alive and well.
The second terrible story concerns Jennifer Tyrrell in the moving talk she gave at GLAAD (Gay and Lesbian Alliance Against Defamation). Tyrrell's experience with the Boy Scouts of America did not surprise me one iota. Please watch this embedded video from beginning to end. I was deeply moved and reminded of my struggles with the Boy Scouts of America. My son, like Tyrrell's was captivated in first grade by Cub Scout activities. Much to my chagrin, after attending one Pack Night he was hooked. By extension I was hooked too as I was quickly recruited to be a Den Leader. For those that know nothing about the BSA, the organization is divided into two different groups--younger boys participate in the Cub Scouts. Cub Scouts are parent driven--parents do the organizing and choose activities for boys to participate in. When boys reach middle school they can become Boy Scouts though half usually drop out. Boy Scouts are a youth directed group, that is older boys are supposed to design, lead and choose activities with limited parental support. The point here is to emphasize the Cub Scouts and Boy Scouts are both BSA owned and operated entities but in reality are remarkably different. I have much first hand experience with the BSA. Aside from being a Den Leader and committee member of the Cub Scouts I also "advanced" with my son into the Boy Scouts. With the Boy Scouts I was an active assistant scout master. I was also the Venture Crew Leader, another group operated byt he BSA.
I learned much as a leader within the BSA. The power and weakness of the BSA is rooted in its refusal to change. We anthropologists characterize the images associated with the BSA to be symbolic demography. That is nationwide Americans have a preconceived notion of what the BSA entails. Think Norman Rockwell images. Boys camping. Boys helping a little old lady across the street. Boys taught to be honest to a fault--hence the phrase "you are such a Boy Scout". Boys who help the poor. Boys that are clean cut and do not do drugs. Boys that have a moral compass and do not bully others. This is powerful and basic. Time and time again I saw boys truly taught by parents and older boys to do the right thing. This refusal to change has a dark under belly. In celebrating the past circa 1955 Normal Rockwell imagery, in embracing the symbols associated with the roots of scouting, the BSA has failed to acknowledge much less embrace fundamental changes in American society. It is as thought the civil rights movement never existed. Women rights and the feminist movement never took place. Black people were never integrated. Cripples never escaped institutions. Churches abound and gay people are firmly and solidly in the closet. It is a very white world. People know their place. It is in short a fantasy.
The BSA is in my estimation a social tragedy. The perpetrators of this tragedy are not to be found at the grass roots level who in my experience largely do their best. Exception exist of course. The heart of the problem is the BSA is rotten at the core. The professional scouters, the national organization itself is hopelessly backward and dominated by the Mormon Church. Scouting is the official youth activity of Church of Latter day Saints. From this core come directives to ban gay men, women and boys. Atheists are targeted as well. Women fair little better. The "three Gs" are banned. It is a significant problem because in the last two decades the BSA is developing a new image--hate mongers that exclude. Hence my memories as a BSA scout leader are decidedly mixed. Some of my fondest memories of my son's childhood are associated with scouting events. But these memories are sullied by the needless bigotry we encountered. Important events held in inaccessible locations and the rigid refusal to move them in the name of tradition. I remember countless outings to scouting events on scout property without a single accessible bathroom. Again and again I was told we never had a paralyzed scout or scout leader. We never had the need to build a ramp or accessible toilet was a constant refrain. Sorry, you can just drop off your son and leave was always the solution. Inclusion? What a joke. Thus I was a bit teary eyed when I saw Tyrrell talk. I was jealous too. Few people were willing to support my efforts when involved with the scouts. I was surely never flown anywhere and given a standing ovation. This makes me wish we people with a disability were as powerful as gay rights groups that I respect and admire. And on this cold spring day I dream of a day when access is assumed and socially supported.
Saturday, April 28, 2012
Wednesday, April 18, 2012
Better off Dead Than Disabled
In the last week a few people have asked if I am going to comment on a day time TV show Dr. Phil. After my experience with Dr. OZ months ago I am gun shy to say the least about weighing in any topic discussed on day time TV. I do not get the allure of day time TV. The only time I would think of turning on the TV during the day would be to follow a breaking national news story or local weather alerts. I cannot imagine siting down in the middle of the day and watching a TV program. So with some trepidation I am going to make some general observations about Dr. Phil and how he recently advocated for the "mercy killing" of people with disabilities. I will not provide the link to his show. It is simply too offensive. Dr. Phil had a mother, Annette Corriveau, on his show who wanted to euthanasia her children. Yes, she wanted the right to kill her children. Is that putting it too harshly? I think not. Who else was on the show? The lawyer Geoffrey Fleiger who defended Jack Kevorkian. So much for balance. What the show was all about was pulling on viewers heart strings. Corriveau's children have Sanfilippo Syndrome. It was not clear what type they have. It was not clear the level of their cognition. It was not clear whether they were in pain. It was not clear what their daily life is like. It was not clear whether they could see or hear. It was not clear how much they are able to communicate. Inconvenient facts such as these only get in the way of the gut wrenching emotion TV programs thrive on.
No hard questions were asked. No one who actually spends time with Corriveau's children were interviewed. No one asked what their daily lives are like. No one asked why they have not left the institution they reside in for over two decades. No one asked Corriveau how she determined her children are suffering--a hard to access fact when she seems them infrequently. Apparently simply visiting her children is too upsetting. Yet Corriveau does the have the time to go on the Dr. Phil show and be interviewed on Canadian TV with Robert Latimer, a man who was convicted of murdering his disabled daughter. Corriveau is setting herself up to be the expert on when it is acceptable for a parent to kill their children. Worse yet, Canadians seem to be rewriting history as it pertains to Latimer. He is not identified as a convicted murder but as an expert on children and disability. What shocks me is the social support parents receive when they express a desire to kill their children with a disability. Oh, how horrible it must be to raise a special needs child. Oh, how you must suffer. Only these parents know what such a miserable existence parenting a child can entail. I am not exaggerating. When Dr. Phil asked for a show of hands as to who supports Corriveau virtually the entire audience raised their hand. I just hung my head.
I do not know if it is the weak economy, the health care reform debate, or that the divide between rich and poor is expanding daily but these are hard times for people with a disability and by extension anyone else that does not fit into society. I have never truly believed people thought I was better off dead as the disability rights slogan mockingly proclaims. That belief has been shattered in the last two years. I have no doubt people with a disability are perceived to be suffering and those people that have no experience with disability think we should be put out of our misery. I am not being mellow dramatic. I was offered assisted suicide in an underhanded way in 2010. Next week a paper will be put on line in advance of publication detailing my experience. The point, here is we are well on our way down a slippery slope if the masses are listening and watching people like Dr. Phil and Dr. Oz. Killing people with a disability is not seen as inherently wrong but rather an act of compassion, mercy even. Great for day time emotional tear jerking TV shows but way short of facts and devoid of reality. The fact is people with a disability lead rich and full lives. I am one of many. But I am one of many at risk. And that thought keeps me up at night and fearful of accessing the health care system that is hostile to my existence.
No hard questions were asked. No one who actually spends time with Corriveau's children were interviewed. No one asked what their daily lives are like. No one asked why they have not left the institution they reside in for over two decades. No one asked Corriveau how she determined her children are suffering--a hard to access fact when she seems them infrequently. Apparently simply visiting her children is too upsetting. Yet Corriveau does the have the time to go on the Dr. Phil show and be interviewed on Canadian TV with Robert Latimer, a man who was convicted of murdering his disabled daughter. Corriveau is setting herself up to be the expert on when it is acceptable for a parent to kill their children. Worse yet, Canadians seem to be rewriting history as it pertains to Latimer. He is not identified as a convicted murder but as an expert on children and disability. What shocks me is the social support parents receive when they express a desire to kill their children with a disability. Oh, how horrible it must be to raise a special needs child. Oh, how you must suffer. Only these parents know what such a miserable existence parenting a child can entail. I am not exaggerating. When Dr. Phil asked for a show of hands as to who supports Corriveau virtually the entire audience raised their hand. I just hung my head.
I do not know if it is the weak economy, the health care reform debate, or that the divide between rich and poor is expanding daily but these are hard times for people with a disability and by extension anyone else that does not fit into society. I have never truly believed people thought I was better off dead as the disability rights slogan mockingly proclaims. That belief has been shattered in the last two years. I have no doubt people with a disability are perceived to be suffering and those people that have no experience with disability think we should be put out of our misery. I am not being mellow dramatic. I was offered assisted suicide in an underhanded way in 2010. Next week a paper will be put on line in advance of publication detailing my experience. The point, here is we are well on our way down a slippery slope if the masses are listening and watching people like Dr. Phil and Dr. Oz. Killing people with a disability is not seen as inherently wrong but rather an act of compassion, mercy even. Great for day time emotional tear jerking TV shows but way short of facts and devoid of reality. The fact is people with a disability lead rich and full lives. I am one of many. But I am one of many at risk. And that thought keeps me up at night and fearful of accessing the health care system that is hostile to my existence.
Monday, April 16, 2012
TEDMED: Abysmal Transportation at a Great Conference
While I could wax poetic about the facilities and speakers there was one glaring flaw--transportation in the form of buses from my hotel to events all over Washington DC was problematic at best. And here I am being far too polite. Transportation was a disgrace, totally unacceptable. Prior to attending the conference I inquired multiple times about accessible transportation. The first reply was typical. Of course we have accessible transportation. When I inquired as to what that accessible transportation entails I was informed "some buses" have wheelchair lifts. At any other conference I would have interpreted "some buses" to mean you are on your own. We have an accessible bus but have not seen it since the Nixon Administration. However, given the conference was a TEDMED event I had higher hopes and expectations. I will say this about the buses. I was able to get to every event. That is as far as my praise can go. By itself this is an indictment of just how bad bus service is in America for people with a disability.
What I was told before I left for Washington DC was correct. Some buses were accessible. Not many, but some. If each and every bus that had a lift operated and the driver knew how to use the lift I would have experienced minor inconvenience. But as most people that use a wheelchair know just because a bus has a lift does not mean it works. I would estimate half the wheelchair lifts on "some buses" were not operational. This transformed my transportation experience from being a minor inconvenience to a major problem.
What problems did I encounter? The usual excuses abounded: "the lift is broken", "the key is missing", "I don't know how to use it", "the tie downs are gone", "I don't know how to use the tie downs" etc. At any other conference or tour of the city this would be expected. But we are not talking about any other conference or city tour. Major funding goes into the TEDMED conference. It is a spectacular conference, speakers uniformly superb, polished even, and all other events were extremely accessible. The Kennedy Center was a delight, bathrooms abounded, staff helpful and professional.
By the end of the second day I realized two things. One, at least two buses and as many as six would pass me by before I could get on. Some accessible buses became a lonely singular bus. I lost a great deal of time simply waiting and watching other delegates get on and off bus after bus after bus. This did not seem to bother any delegate or employees. Second, the transportation supervisor lied to me and was willing to say anything to get me to stop complaining. After watching many buses pass me by I confronted her and told her each and every bus with a lift had to be tested before it was put in service; and be tested by the driver. She said of course we do that. The next bus arrived and the driver told me he had never used a lift a before and had no idea how to operate it. I quickly learned the transportation supervisor was worthless. The actual drivers were the one's to know. In the end I was able to manage and did not miss any event. However, if I had trouble at a prestigious conference such as TEDMED what takes place at an ordinary conference? What happens to the average tourist with a disability who tries to use a trolly bus? These question make me think back to 2004 when my son and I tried to visit the new Air and Space Museum outside Dulles Airport. Just like I experienced at the TEDMED conference, the bus had a lift but it did not work. Eight years later it appears not much if anything has changed. Lip service is paid to accessible transportation. Try and use those pesky lifts and a new harsher reality emerges.
Monday, April 9, 2012
TEDMED
I am leaving early tomorrow morning for Washington DC. I will be attending the TEDMED conference. Thanks to the Hastings Center I received a full scholarship to attend. Without this support attending the conference would not have been possible. I am going as a delegate and scholar. Sounds impressive. I eagerly await this conference as I often watch the TED Talks. If you are not familiar with them check out You Tube or Netflix. The talks are uniformly engaging. I hope to get some good photos that I will try and post. I am somewhat nervous about transportation. Washington DC and accessible transportation has been problematic at best. There is a stark dichotomy between what is supposed to be accessible and what is actually accessible. I have been assured I will not encounter any problems. Gee, some how I think I have heard this before. Always get worried when I am told not to worry, it is a recipe for disaster.
Thursday, April 5, 2012
Growth Attenuation: A Cultural Mess
I consider myself to be a disenfranchised individual. I will never fit into mainstream society. I will never be accepted. My presence always open to question. My humanity will be subject to public debate. My ability doubted and belittled. Bigots abound. They love to accost me in the name of "safety", "concern" and have my best interests at heart. This is an old story. I don't like it and have railed against social injustice for decades. What sobers me is that I am lucky, very lucky. I can defend myself and am quite good at it. I also know the bigotry I encounter is minimal when compared to people, humans, with a cognitive and physical disability. No other population in American receives less support and services. No other population is as stigmatized. This is outrageous. Much can be learned from those who care about people with profound cognitive and physical disabilities. Thus I deeply admire the scholarship of a people like Eva Kittay and Allison C. Carey. I urge you to read Kittay's recent edited volume Cognitive Disability and its Challenge to Moral Philosophy and Carey's wonderful book On the Margins of Citizenship. This provides the academic context but cannot replace touching thought provoking blogs such as Life With a Severely Disabled Daughter and Single Dad, Disabled Daughter that detail what it is like to parent a person with a profound cognitive and physically disability. This bring me to why I am posting today.
Within the past 48 hours I have read two posts on growth attenuation no doubt in part inspired by the articles in the Guardian (see my posts on March 15 and 16). Both writers are adamantly opposed to growth attenuation. Both are passionate about their opposition. Single Dad Disabled Daughter writes that he considers growth attenuation to be "immoral mutilation". The words mutilation were used when growth attenuation exploded in the news but its usage has waned as has the moral outrage. I do not know if the lack of moral condemnation is good or bad or somewhere in between. I do know that in spite of the efforts of the Seattle Working Group and the publication of their paper in the Hastings Center report on growth attenuation it firmly remains a polarizing issue. It also highlights how poorly understood disability is from a cultural standpoint. Equality and an inclusive society is not to be found in blue wheelchair logos, ramps, elevators, and wheelchair lifts. Obviously our physical environment is far more accessible and the law is firmly in our favor. But this only gets people with a disability so far. Utterly absent is cultural acceptance and a social mandate to protect the rights of people with a disability--any disability.
In referring to his severely disabled daughter Single Dad writes: "We don’t need just physical accessibility. Nowadays there is a lot of that. But when was the last time you saw an adult changing table anywhere other than my house? Even “family bathrooms” (and I just learned what they are) may have infant changing tables, useless to us. Where is there a quiet place, if needed, anywhere for the disabled? Pearlsky loves IKEA and Home Depot and the symphony, but sometimes it becomes a bit much. How fast can we get back to our van? There is no other place to escape to. If I could just pick her up … We need either mental accessibility, growth attenuation, or … what we have now."
Sorry but no. Just no. No! Mental accessibility is decades away. By this I suspect Single Dad means cultural acceptance and inclusion I referred to above. He cannot find a changing table for an adult because there is no social mandate for it to exist. He cannot find a quiet place because people do want those with a cognitive and physical disability to be in their mix. He cannot get on a plane because the airline industry has been hostile people with a disability for decades. This is not a question of architecture but rather a society deciding the best way to cope with people like his daughter is to exclude them. Shunt them off to group homes or resource rooms in schools, transport them on short buses. The message is very clear. Segregation is socially accepted. People with a disability, especially those with a cognitive disability, are different, not equal.
Is growth attenuation needed? In a word, no. Could it in exceedingly rare instances after all other avenues of care have been exhausted be appropriate? This is possible. I am not willing to put an outright ban on growth attenuation as such absolutes make me uncomfortable. I will not deny growth attenuation will make caring for a person with a profound cognitive and physical disability physically easier but is that really the answer? I think not. How about appropriate social services or even better comprehensive services. What about providing not just some but all needed adaptive equipment that would make care giving easier. How about community support. How about home modifications designed to meet the needs of the person in their home. None of this is available without a fight. Some simply is a pipe dream--the comprehensive services for instance. Again, this is a social problem.
What we have now in terms of growth attenuation? Again, no. Growth attenuation has gone underground. It is being done in secret and privately. Doctors are avoiding ethic committees, ethical oversight and skirting the law. This is frightening. It is exactly what the Seattle Working Group did not want to happen. If growth attenuation is performed we must study the long range implications. Are children subjected to growth attenuation getting strange cancers as they age like some women have whose growth was attenuated in the 1950s? We can only learn how effective growth attenuation is if it is studied in earnest. Only then can we address if it is truly an effective treatment.
Growth attenuation is a radical treatment. Whether opposed or in favor, there is something deeply unsettling when doctors are removing healthy organs from children. I question whether we are targeting a specific population of people, treating them as a class apart. No one would ever suggest attenuating the growth of a child with typical cognition. The idea is repugnant. But it is a solution for children with profound physical and cognitive disabilities? Worse yet, we willing remove healthy organs yet deny the very same people with cognitive and physical deficits organ transplants as a life saving treatment. To me a very powerful social message is being sent. People with cognitive and physical disabilities are not fully human, they do not have the same human rights. We have been down this road before in America and elsewhere. One example should suffice. Eugenic sterilization. We look back in horror at what took place. Read Edwin Black's searing work, War Against the Weak and be ashamed. But dig deeper and think about one state, North Carolina. Long after eugenic sterilization was discontinued 7600 people were sterilized against their will some as young as 14 years old.
I do not maintain growth attenuation is akin to eugenics. But some of the lessons learned from this dark chapter in American history are worth consideration. Will we look back aghast that we attenuated the growth of children with profound cognitive and physical disabilities? Will the Ashley Treatment be seen in the same light as we now regard to the famed Oliver Wendell Holmes statement about three generations of imbeciles is enough when deciding Buck v. Bell?
I rarely if ever close a post with a quote. Long ago I was taught not to do this. The idea being leave the reader with your own words. But I lack the passion and experience a parent of a child that has a profound cognitive and physical disability. So I end with Claire Roy's forceful words at Life with a Severely Disabled Daughter that I hope will sting readers to the core. I know this is how they affected me.
"We are a stupid people, loathe to study and learn from our collective history. We have burned the witches, strung up the niggers, gassed the kykes, lobotomized the crazies, beat up the faggots all in the name of what was right and good. We look back now, in horror at our primitive ancestors’ sins, failing to remove the mote in our own eyes. Disability rights…especially the rights of those most severely affected…are the final frontier of civil rights action. Sadly, I suspect a few more generations of dehumanization of our most vulnerable will pass before any sort of serious political action will take place to bring about real change.
And mark my words, the day will come when we see growth attenuation for the misguided barbarism that it is. On that day, be I the age of Methuselah, I will stand up and point my finger vigorously and without qualms say “I told you so.”
Within the past 48 hours I have read two posts on growth attenuation no doubt in part inspired by the articles in the Guardian (see my posts on March 15 and 16). Both writers are adamantly opposed to growth attenuation. Both are passionate about their opposition. Single Dad Disabled Daughter writes that he considers growth attenuation to be "immoral mutilation". The words mutilation were used when growth attenuation exploded in the news but its usage has waned as has the moral outrage. I do not know if the lack of moral condemnation is good or bad or somewhere in between. I do know that in spite of the efforts of the Seattle Working Group and the publication of their paper in the Hastings Center report on growth attenuation it firmly remains a polarizing issue. It also highlights how poorly understood disability is from a cultural standpoint. Equality and an inclusive society is not to be found in blue wheelchair logos, ramps, elevators, and wheelchair lifts. Obviously our physical environment is far more accessible and the law is firmly in our favor. But this only gets people with a disability so far. Utterly absent is cultural acceptance and a social mandate to protect the rights of people with a disability--any disability.
In referring to his severely disabled daughter Single Dad writes: "We don’t need just physical accessibility. Nowadays there is a lot of that. But when was the last time you saw an adult changing table anywhere other than my house? Even “family bathrooms” (and I just learned what they are) may have infant changing tables, useless to us. Where is there a quiet place, if needed, anywhere for the disabled? Pearlsky loves IKEA and Home Depot and the symphony, but sometimes it becomes a bit much. How fast can we get back to our van? There is no other place to escape to. If I could just pick her up … We need either mental accessibility, growth attenuation, or … what we have now."
Sorry but no. Just no. No! Mental accessibility is decades away. By this I suspect Single Dad means cultural acceptance and inclusion I referred to above. He cannot find a changing table for an adult because there is no social mandate for it to exist. He cannot find a quiet place because people do want those with a cognitive and physical disability to be in their mix. He cannot get on a plane because the airline industry has been hostile people with a disability for decades. This is not a question of architecture but rather a society deciding the best way to cope with people like his daughter is to exclude them. Shunt them off to group homes or resource rooms in schools, transport them on short buses. The message is very clear. Segregation is socially accepted. People with a disability, especially those with a cognitive disability, are different, not equal.
Is growth attenuation needed? In a word, no. Could it in exceedingly rare instances after all other avenues of care have been exhausted be appropriate? This is possible. I am not willing to put an outright ban on growth attenuation as such absolutes make me uncomfortable. I will not deny growth attenuation will make caring for a person with a profound cognitive and physical disability physically easier but is that really the answer? I think not. How about appropriate social services or even better comprehensive services. What about providing not just some but all needed adaptive equipment that would make care giving easier. How about community support. How about home modifications designed to meet the needs of the person in their home. None of this is available without a fight. Some simply is a pipe dream--the comprehensive services for instance. Again, this is a social problem.
What we have now in terms of growth attenuation? Again, no. Growth attenuation has gone underground. It is being done in secret and privately. Doctors are avoiding ethic committees, ethical oversight and skirting the law. This is frightening. It is exactly what the Seattle Working Group did not want to happen. If growth attenuation is performed we must study the long range implications. Are children subjected to growth attenuation getting strange cancers as they age like some women have whose growth was attenuated in the 1950s? We can only learn how effective growth attenuation is if it is studied in earnest. Only then can we address if it is truly an effective treatment.
Growth attenuation is a radical treatment. Whether opposed or in favor, there is something deeply unsettling when doctors are removing healthy organs from children. I question whether we are targeting a specific population of people, treating them as a class apart. No one would ever suggest attenuating the growth of a child with typical cognition. The idea is repugnant. But it is a solution for children with profound physical and cognitive disabilities? Worse yet, we willing remove healthy organs yet deny the very same people with cognitive and physical deficits organ transplants as a life saving treatment. To me a very powerful social message is being sent. People with cognitive and physical disabilities are not fully human, they do not have the same human rights. We have been down this road before in America and elsewhere. One example should suffice. Eugenic sterilization. We look back in horror at what took place. Read Edwin Black's searing work, War Against the Weak and be ashamed. But dig deeper and think about one state, North Carolina. Long after eugenic sterilization was discontinued 7600 people were sterilized against their will some as young as 14 years old.
I do not maintain growth attenuation is akin to eugenics. But some of the lessons learned from this dark chapter in American history are worth consideration. Will we look back aghast that we attenuated the growth of children with profound cognitive and physical disabilities? Will the Ashley Treatment be seen in the same light as we now regard to the famed Oliver Wendell Holmes statement about three generations of imbeciles is enough when deciding Buck v. Bell?
I rarely if ever close a post with a quote. Long ago I was taught not to do this. The idea being leave the reader with your own words. But I lack the passion and experience a parent of a child that has a profound cognitive and physical disability. So I end with Claire Roy's forceful words at Life with a Severely Disabled Daughter that I hope will sting readers to the core. I know this is how they affected me.
"We are a stupid people, loathe to study and learn from our collective history. We have burned the witches, strung up the niggers, gassed the kykes, lobotomized the crazies, beat up the faggots all in the name of what was right and good. We look back now, in horror at our primitive ancestors’ sins, failing to remove the mote in our own eyes. Disability rights…especially the rights of those most severely affected…are the final frontier of civil rights action. Sadly, I suspect a few more generations of dehumanization of our most vulnerable will pass before any sort of serious political action will take place to bring about real change.
And mark my words, the day will come when we see growth attenuation for the misguided barbarism that it is. On that day, be I the age of Methuselah, I will stand up and point my finger vigorously and without qualms say “I told you so.”
Wednesday, April 4, 2012
Rationing Health Care: A Policy Approach
Health care is back in the news in a big way. Yesterday President Obama characterized the GOP budget as a thinly veiled form of social Darwinism. Strong rhetoric for sure but also accurate. Republicans are slashing budgets and hurting the people with the least amount of power--people such as the elderly and disabled. Through Paul Ryan the Republicans are waging an all out war against people that are dependent upon Medicare. Republicans want to partially privatize Medicare into a voucher system. Many Americans rely on Medicare, Medicaid and Social Security Disability payments. By rely I mean use this to help pay for prescription medication and wheelchairs. We are not talking about luxuries but rather people's life and ability to function. People like Ryan are playing a dangerous game. The Social safety net is too expensive and poorly run by Washington he cries. Let the states handle it via a voucher system. What Ryan is not stating is that many states are broke. Moreover states can use the money any way they want.
After I read the President's speech I came across an article by Daniel Callahan, "Must We Ration Health Care for the Elderly" in the Journal of Law, Medicine and Ethics. Bear with me as I will get to the connection. Callahan is a major figure in bioethics. He helped found the Hastings Center and is a prolific author. He is also a kind and generous man as I have been fortunate enough to meet him. I have read much of his work and cannot make heads or tails of what he wants. Sometimes I shake my head in wonder and think he wants me and other people with a disability to be dead. We are a serious drain on the economy. Yet, there are other times when he is spot on and I agree with much of what he writes. For instance his views on technology in medicine are thought provoking and I agree with much of what he wrote in his book Taming the Beast. No doubt the health care system is overly reliant on expensive technology. For example, I think we can surely pass on expensive exoskeletons and invest heavily in wheelchair technology.
So what did Callahan have to say about rationing and the elderly? First he considers rationing to be "an organized effort by a public or private institutions (e.g., Medicare or a private insurer) to equitably limit the availability of some desired or needed medical treatments in the name of preserving the economic sustainability of the institution as a whole or equitably distributing a scarce resource." Obviously the key word here is "equitably". Callahan goes on to state:
"First, rationing should be done by policy, not by individual doctors and patients at the bedside. There would otherwise be too much variation in decision making, discrepancies between doctor and patient values, and the possibility of physician bias. Rationing must, that is, be removed from the ordinary doctor-patient relationship and shifted to the policy level. Second, policy must be set by democratic process (which could be accomplished by Congress delegating responsibility to a federal agency). Third, the policy must be carried out in a transparent way. Fourth, there should always be a provision for appeal."
I agree with his first point. I have been subjected to physician bias and it is not only wrong but dangerous. I depart from Callahan on his other points. For example, point two. The democratic process is far from equitable and people with a disability are not part of the discussion that takes place in congress. With regard to points three and four, at a theoretical level I agree. But I do not live in a world of theories. I do not believe any policy will be transparent--well maybe to law makers and lawyers but not to your average person and especially not your average person with a disability. As for appeals, great. Let me just ask how long and involved will they be? Let's say you are turned down for a high end wheelchair cushion and need to use a cheaper alternative that was considered to be adequate. You get a skin breakdown, a bad one. The skin that heals will never be the same. Never.
Callahan also advocates the use of QALY used in Britain. Quality Adjusted Life Years are economically proven to save money. Callahan stated QALY "is a leading means of assessing the cost effectiveness of a treatment. Its use requires careful evidence-based research, which in the U.S. could be provided by a federal agency. Instead of contending as I did in my book that an age would have to be specified for setting limits, I would now use QALYs to determine (but not solely) what they would be, thus using a methodological tool applicable to all age groups." Great but using QALY would establish my life has far less value than a person that can walk. Yes, my life is not as valuable as a person my age who can walk. So who gets treated? Not my crippled ass.
Ryan and Callahan are thinking at a national level. I am not such a thinker or politician. I am a grass roots sort of person. I study culture and how it affects people's every day life. From this microcosm I make observations about the lives of the people I study and where they fit in culturally. There is no doubt in my mind if Ryan's GOP budget is enacted the elderly and disabled will suffer. I am equally certain if we follow Callahan's suggestion on rationing I fear what will happen to the elderly and disabled. Most troubling is Callahan's desire to use QALY. Yes QALY will save a significant amount of money. No doubt about the savings. But at what cost are we saving? I for one do not accept the fact my life has less value than a person who is not paralyzed. Why there is even a law that states this--that pesky legislation know as the ADA. Ryan and Callahan make me shake my head in wonder. What ever happened to equality?
After I read the President's speech I came across an article by Daniel Callahan, "Must We Ration Health Care for the Elderly" in the Journal of Law, Medicine and Ethics. Bear with me as I will get to the connection. Callahan is a major figure in bioethics. He helped found the Hastings Center and is a prolific author. He is also a kind and generous man as I have been fortunate enough to meet him. I have read much of his work and cannot make heads or tails of what he wants. Sometimes I shake my head in wonder and think he wants me and other people with a disability to be dead. We are a serious drain on the economy. Yet, there are other times when he is spot on and I agree with much of what he writes. For instance his views on technology in medicine are thought provoking and I agree with much of what he wrote in his book Taming the Beast. No doubt the health care system is overly reliant on expensive technology. For example, I think we can surely pass on expensive exoskeletons and invest heavily in wheelchair technology.
So what did Callahan have to say about rationing and the elderly? First he considers rationing to be "an organized effort by a public or private institutions (e.g., Medicare or a private insurer) to equitably limit the availability of some desired or needed medical treatments in the name of preserving the economic sustainability of the institution as a whole or equitably distributing a scarce resource." Obviously the key word here is "equitably". Callahan goes on to state:
"First, rationing should be done by policy, not by individual doctors and patients at the bedside. There would otherwise be too much variation in decision making, discrepancies between doctor and patient values, and the possibility of physician bias. Rationing must, that is, be removed from the ordinary doctor-patient relationship and shifted to the policy level. Second, policy must be set by democratic process (which could be accomplished by Congress delegating responsibility to a federal agency). Third, the policy must be carried out in a transparent way. Fourth, there should always be a provision for appeal."
I agree with his first point. I have been subjected to physician bias and it is not only wrong but dangerous. I depart from Callahan on his other points. For example, point two. The democratic process is far from equitable and people with a disability are not part of the discussion that takes place in congress. With regard to points three and four, at a theoretical level I agree. But I do not live in a world of theories. I do not believe any policy will be transparent--well maybe to law makers and lawyers but not to your average person and especially not your average person with a disability. As for appeals, great. Let me just ask how long and involved will they be? Let's say you are turned down for a high end wheelchair cushion and need to use a cheaper alternative that was considered to be adequate. You get a skin breakdown, a bad one. The skin that heals will never be the same. Never.
Callahan also advocates the use of QALY used in Britain. Quality Adjusted Life Years are economically proven to save money. Callahan stated QALY "is a leading means of assessing the cost effectiveness of a treatment. Its use requires careful evidence-based research, which in the U.S. could be provided by a federal agency. Instead of contending as I did in my book that an age would have to be specified for setting limits, I would now use QALYs to determine (but not solely) what they would be, thus using a methodological tool applicable to all age groups." Great but using QALY would establish my life has far less value than a person that can walk. Yes, my life is not as valuable as a person my age who can walk. So who gets treated? Not my crippled ass.
Ryan and Callahan are thinking at a national level. I am not such a thinker or politician. I am a grass roots sort of person. I study culture and how it affects people's every day life. From this microcosm I make observations about the lives of the people I study and where they fit in culturally. There is no doubt in my mind if Ryan's GOP budget is enacted the elderly and disabled will suffer. I am equally certain if we follow Callahan's suggestion on rationing I fear what will happen to the elderly and disabled. Most troubling is Callahan's desire to use QALY. Yes QALY will save a significant amount of money. No doubt about the savings. But at what cost are we saving? I for one do not accept the fact my life has less value than a person who is not paralyzed. Why there is even a law that states this--that pesky legislation know as the ADA. Ryan and Callahan make me shake my head in wonder. What ever happened to equality?
A Small but Important Change
This morning I was reading A Girl with a Cane, a blog I like very much. I noted she added a widget to her blog Odiogo. I down loaded this and hope it solves a long standing problem with my blog. Specifically, some people who are blind have struggled to read the content of my blog. So go ahead and click on Odiogo. Yes you can now listen to a computer generated voice read my blog via itunes. Very cool and I sincerely hope this will solve problems a few blind readers have encountered.
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