Illness & Dying in the United States
Facing Terminal Illness
I think that it is true that in spite of what we undeniably know none of us believe we are going to die, which is what Morrie tells his former student Mitch in the book Tuesdays with Morrie. I also believe that none of us believe we are going to grow old. No wonder we are uncomfortable about facing terminal illness. We have to deal with observing the worst thing that can happen while not admitting to ourselves that death could happen to us but knowing that it will. In the book Morrie and Mitch find a way to deal with Morrie’s dying in a positive way by having Morrie give Mitch his lessons for living and Mitch give Morrie a kind of immortality by writing a book. When Morrie says, “The truth is…once you learn how to die, you learn how to live,” he is telling Mitch that it is important for all of us to accept the idea of our own death so we can realize all the gifts we have just by the fact of being alive. We must take advantage of these available gifts and value them so that we will not have a lot of regrets when it is our time to die.
For Beth, whose husband was dying of cancer, the way she helped him, herself, and her family face his dying was by displaying his paintings in order to celebrate his life as an artist. She also displayed photographs of his family to show him and everyone helping him or visiting him that he had had a fulfilled life. This was her way of helping him die, valuing all that had been important in his life so that he would not have regrets.
Isolation
Unlike Morrie in Tuesdays with Morrie and Beth’s real life husband, who both are able to die at home, many elderly people die in hospitals or nursing homes. For those who do not have family members to visit, the experience must be incredibly isolating. According to an intervention study called Quality of life in nursing-home residents, “The prevalence of depression among residents of nursing homes is 30-75%. In spite of good care, residents may feel like inmates and function as isolated individuals.” Now that people are living so much longer, it makes sense that more and more of them will end up in nursing homes because they will not be able to take care of themselves or have family members be able to keep taking care of them. According to an article in the Washington Post called The New Retirement: Getting Old Ain’t What it Used to Be by Douglas J. Besharov and Keith W. Smilt (august 1, 1999), after age 80, many people have trouble performing the ADLs (activities of daily living), which are “eating, bathing, dressing, toileting and getting out of bed.” About 50% of people need help with ADLs after age 85. Also, nearly 20% of people over 85 have problems of dementia, brain damage, or mental retardation.
For people who are ill or dying, they can be made to feel isolated by the rejection of younger and healthier people, who are not comfortable with them. In his work Stigma, the sociologist Erving Goffman talks about all types of people who feel stigmatized by “normals,” and these can include cripples and other handicapped or disfigured people, and members of ethnic and every kind of minority group. He says that interactions between “normals” and the stigmatized are “usually accompanied by one or more of the familiar discomforts and stickiness: the guarded references, the common everyday words suddenly made taboo, the fixed stare elsewhere, the artificial levity, the compulsive loquaciousness, the awkward solemnity.” All of these reactions are ones that are common to have when visiting a dying person: avoiding talking about the future or even next month plans (“the guarded references”), avoiding saying the words death or dying (“the common everyday words suddenly made taboo), not being able to look the dying person in the eye for long (“the fixed stare elsewhere”), having mouths fixed in smiles or laughing in an embarrassed way (the artificial levity), talking on and on just to keep conversation going (the compulsive loquaciousness); acting stiff and serious (the awkward solemnity). In other words the unnatural behavior of others toward sick or dying or elderly people can make them feel extremely isolated.
Paying for Medical Care
According to Sick by Jonathan Cohn, the first insurance company in the U.S. was started by Benjamin Franklin to protect Philadelphia momes from being destroyed by fire. Health insurance to help protect people from the risk of illness did not start until the 20th century. In the 1920s and 1930s many Americans could not afford the cost of health care because doctors expected to be paid a lot for their expensive training and equipment. Hospitals exanded the the 1920s during the boom economy, but then in the 30s when there was the depression there were not enough patients who could pay. In other industrial countries the goverments supported health care, which was becoming “a right, rather than a privilege.” In the U.S. corporations and doctors were against the government handling health care, corporations becaues they wanted a private economy they could control and doctors because they thought the government would pay them less and try to control them. Non-profit health insurance organizations started out collecting contributions from groups of people like employees and then give them hospital care when they needed it. The first one helped Baylor Hospital in Dallas, Texas in 1929 by getting teachers to contribute for hospital care. Then companies started offering health insurance instead of raised during World War II, and they were given tax breads so the whole U.S. system became based on businesses and employers providing health insurance. Unemployed people and elderly people were left out of the system.
In 1965 President Lynden Johnson started Medicare to help the elderly which as paid for out of taxes during the time they worked. He also started Medicaid to help poor people. Medicaid is paid for by the Federal and State governments. Without these programs many people would have become ill and died and still would become ill and die. In 1985 the Consolidated Omnibus Budget Reconciliation Act (COBRA) was enacted so that people who lost their jobs or retired people could keep their health insurance. In 1997 the State Children’sHealth Insurance Program (SCHIP) was enacted for children “at or below 200% of the Fenderal poverty line. Then in 2010 President Obama enacted the Patient Protection and Affordable Care Act to reform U.S. health care by making insurance companies unable to drop people with pre-existing conditions or find other excuses not to pay, and also to have insurance companies charge standard amounts at three different levels so that people can have choices they can afford. There would also be subsidies so that poor people could afford insurance.
In the move Sicko, Michael Moore states that the U.S. health care system costs nearly $7,000 per person a year and that in Cuba the cost is $251 per person. According to the National Health Expenditure Date in 2005, the cost of health care per person in 2005 was $6,697 and according to the 2006 United Nations Development Report, the annual cost in Cuba was $251 per person so Michael Moore was right. Other industrial countries also pay much less per person for health care than the U.S. with a universal health care system. One scene in the movie that stands out is when Michael Moore is interviewing the National Health Service in England and the people there cannot relate to his questions about cost because they only think about providing health care.
In Mountains Beyond Mountains by Tracy Kidder, Paul Farmer also greatly admires Cuba for using its poor resources well enough to have excellent health care and fight the spread of AIDS successfully. He believes that a for profit health system is an unjust system. He says, “ I remember signing the oath to assist the patient and do him no harm. I don’t really remember signing that I would do it in a cost-effective way.” Republicans think that the government cannot run the health care system well because it does not run anything as well as private companies can and it wastes money. Since it is many of the private insurance companies that have been cheating and charging the government millions of dollars illegally for Medicare services, and since the government has run many national programs well like Medicare, Social Security, Clean Water and Clean Air Programs ("The Forgotten Achievements of Governments," by Douglass J. Amy, Professor of Politics at Mount Holyoke College), the Republicans don’t know what they are talking about.
The Process of Dying
Near Death is a documentary filmed in black and white with no narration about doctors, staff, and patients in the intensive care unit of Beth Israel Hospital. From the clips of the movie shown in class, one segment that was as hard to watch as nails on chalkboard are to hear is when a female nurse tries to explain to her elderly male patient the choices he has about dying. “Your lungs are about as bad as they can get,” she says. When she calmly attempts to explain the dying man’s situation to him, he does not answer her and talks about his family instead in a failed attempt to swerve the conversation away from him. The nurse is incredibly persistent in her questions which rattle the old man and seem to confuse him. At one point she says, “I don’t want to keep you alive unless you like living.” The casualness of many of the doctors was also a little unnerving. In one quick scene a doctor checks the patient’s pulse and mouth and when he detects no sign of life, pronounces the patient dead, announces the exact time of death, and then just walks out of the room.
What is happening in this movie is interesting in the context of what Sharon R Kaufman, a medical anthropologist, writes about in the book A Time To Die. Many patients say that under no circumstances do they want to be placed on life support when they enter the hospital. The problem is that when those patients are in a crisis and life support is the only way to keep them alive, relatives and even the patients if they are capable of knowing what is going on will often be so indecisive that the patients end up on life support. When placed in this situation, are the people involved sustaining life or prolonging dying? I heard a reporter say on the National Public Radio morning news a few weeks ago that there are three ways that all of us can prepare for our death:
- Have a Living Will in which we say wheter we want to go on life support
- Designate a particular person to make decisions for us
- Agree to be an organ donor to help save someone else’s life
It seems to me that doing these three things would avoid a lot of the unnecessary cost and torment regarding life support decisions and that deciding to be an organ donor gives a certain value to the death that it would not otherwise have.
Our guest speaker Beth, I believe, gave the best possible care to her husband once she knew he was dying by keeping him at home so he could have a dignified death without any question of putting him on temporary life support to prolong his dying.
Being Sick
Being sick in this country is too tied to health insurance. Last year my brother was in a college basketball game, and an opponent’s elbow came down hard on the top of his gead. There was a big gash, and he was taken to a Boston hospital for stitches. He called my parents for out health insurance information, which he said was needed before he could get any attention even though he was covered in blood. Later my parents received a bill, Since they pay $1,000 a month for health insurance and any emergency that is taken care of in 24 hours issupposed to be covered, they questioned the bil. Then they received a call from the insurance company asking how the injury happened. They explained that their son was hurt in a college basketball game. “And why was he playing basketball? they asked. This situation contrasts with the time when I was in France playing sports and became sick. A doctor drove to come see me in my room late on a Sunday night, gave me a shot, made a call to open up the nearest pharmacy, gave me medicine to keep taking, and charged me nothing.
Another time my soccer team was practicing on the grounds of a monestary on Long Island near the water. We noticed a body floating face down near the shore. One parent who was a foot doctor and my dad pulled him out, pushed the water out of him, and gave him mouth to mouth resusitation. All of us called 911 on our cell phones. When the ambulance came, the medical people said that he had had a massive heart attack and was barely alive. We found out that he was a visiting monk from the Ukraine. The foot doctor parent called the hospital in Hicksville the next morning to find out how the man was doing. He was told that the hospital released him because he had no insurance. The monestary put him on a plane to go home, and he died a week later. This experience made our whole team feel outrage about our health care system. If this poor man had had a heart attack in any other industrialized country, he would have been treated for free.
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