Anyone from another industrialized country might wonder what is going on with America’s health care system. It’s ironic that we have some of the most advanced medical research programs and forms of treatment anywhere in the world and many of the world’s best-known drugs were researched, invented and manufactured here. Yet we are dealing with some very difficult medical/social issues.
We have, at present, a dramatic increase in the number of cases of measles, despite vaccination programs that have come close to eliminating what used to be a common, though not insignificant, childhood disease. We have a major opiate addiction problem in many parts of the country, urban and rural.
The cost of providing health care has increased so much that many small, rural hospitals are being forced to close at a rate of 30 per year, according to the American Hospital Association. This means that patients from these areas have to depend on traveling to distant clinics or using telemedicine. These may be adequate for non-urgent care but do not provide comfort and bonding with a regular provider, which is fundamental to good care.
A recent (May 9, 2019) article in the New York Times about maternal death during pregnancy, birth, and post-partum, states that the U.S. has the highest level of death in these categories and also the highest perinatal infant mortality level in the top 13 similarly industrialized countries. These are not statistics to be proud of.
These real issues can be solved by education, research, and the intelligent, focused investment of resources.
There is a more significant issue impacting health care, which strikes at the heart of providing equitable care to all. The intrusion of the personal ethics of care providers into their relationship with patients is an issue that goes back centuries. The recent announcement of the expansion of the “conscience rule” that protects health care workers who oppose certain procedures on religious or moral grounds, can have a profound effect on health care accessibility. This can impact patients who are looking for help with reproductive health care and the LGBTQ community who are seeking general health care and more major care, such as gender reassignment surgery. To be plain, this rule affects mostly women and the gay community but also those looking for end of life care and assisted suicide. The new expansion of the conscience rule includes not only protection for the actual providers of care but anyone working in such institutions, including receptionists and other clerical staff, and even the board members of hospitals.
Women over the centuries and in many countries have known about religious discrimination in health care. It wasn’t until 1951 that the Catholic church, in an address by Pope Pius XII, gave permission to midwives and other health providers to alleviate “the pains which, after original sin, a mother has to suffer to give birth.” (This refers to the Bible, Genesis Ch.3 v.16.) This papal blessing allowed the use of breathing and relaxation techniques (Lamaze method) in labor and delivery, and also some analgesic drugs. A hundred years prior to this Papal action, in 1853, Queen Victoria, the head of the Church of England which also followed the same doctrine about original sin, had already demanded the personal use of chloroform in delivery after having had seven children without! The plight of the many Irish women who suffered the social consequences of an illegitimate pregnancy by being ostracized to work in laundries run by religious orders has been documented in books, articles, and movies over recent years, as has the fate of their illegitimate babies.
In today’s world, we should be more aware of the psychological needs of patients confronting difficult and painful health issues such as a painful miscarriage, an unplanned, unwanted, or assault induced pregnancy. To blame women for these situations is ignorant and cruel. Contraception for women is expensive; many men do not realize the cost and inconvenience of dealing with this part of life.
Gender reassignment involves both physical, hormonal and psychological changes deserving of support from all medical personnel. It is not supportive to have a receptionist refuse to interact with such a client or merely refuse to offer the name of an alternative provider. Applying guilt is not a recommended treatment for any medical condition.
The central core of the Hippocratic school on which medical education is based is, "Practice two things in your dealings with disease: either help or do not harm the patient". The phrase, “Primum non nocere,” first, do no harm, is often used to summarize that concept. As any adult knows, especially those in a professional environment, there are many forms of harm; verbal rejection, implied blame and deliberate superiority are as cruel as a knife. I wonder why any physician, nurse or medical assistant would choose to work in an environment where conflict with their ethical or religious beliefs will be a constant issue taking precedence over using their skills to heal.
Health care is a personal issue but it is also a national issue. There are many aspects of health care that need improvement but the most important is cost and availability. We do not need to add to those problems by restricting access and denying care for religious reasons. That time is long past!