Friday, February 1, 2013

Christian Personalism in Medicine

Being the medical ethics nerd that I am, I happily ate Victoria Sweet's God's Hotel up. This awesome book taught me a lot and gave me a lot of food for thought from a medical ethicist point of view.

Just so's you know, this book is part memoir, part manifesto. She mainly writes about her experiences working for the last almshouse in the US, Laguna Honda, in San Francisco. Her experiences at the hospital informs her studies of pre-modern medicine, particularly the recently declared Doctor of the Church St. Hildegard of Bingen. And her studies of Hildegard makes a big impact on her treatment of her patients.

St. Hildegard of Bingen

 There is a significant religious overtone to the entire book, although she rarely invokes explicitly Christian doctrine. She talks often about the anima, the life-force, that she believes is the main difference between the living and the dead. She does not speculate what happens to the anima after death. Her pilgrimage, the Compostela, seems to have a big spiritual impact on her as it teaches her that she has no real control over life, she just needs to roll with the punches.

But that's not what I'm here to principally write about, I'm here to write about the ethics of it all. She covers several diverse topics in ethics:

- The treatment of the poor
- The treatment of the mentally ill
- The treatment of the elderly
- The relationship between administration, the doctors, and the nurses
- Medical efficiency

An overall critique that she has is that the medical establishment does not really pay attention to patients anymore. I remember hearing once that in an appointment with your doctor, you only have your doctor's attention for maybe 5 minutes and you need to get out all of your concerns early. The doctor is under a lot of pressure from insurance companies and their own superiors to get you examined and treated quickly and move on to the next patient. This pressure leads to major abuses in the treatment of the poor and the treatment of the elderly.

She is concerned that there are many elderly people who are getting the label of "dementia" or "Alzheimer's" that do not have it. There are many different reasons for the symptoms of dementia and they need to be considered before giving someone the diagnosis. I agree with her concern. Elderly patients are often written off because, well, "They're old." Working in nursing homes, I saw time and again my residents not getting the level of medical care from their doctors that they deserve because the medical establishment would rather spend that money and energy on the young. Just because someone is old, doesn't mean that you can neglect them.


The same logic sometimes goes to the poor. In the book, Dr. Sweet gives numerous examples of poor people coming under her care who are in horrible shape. She discovers that what is ailing them is actually something very treatable that the other doctors just didn't notice. She argues that the other doctors would have discovered it if they had only sat down with the patient and spent some time with them instead of rushing from bed to bed.

She gave me a lot to think about in regards to the mentally ill. I am definitely not for re-opening the mental institutions. However, she makes a compelling case that there cannot be sweeping laws that apply to all of the handicapped. For example, they all have the right to refuse their meds. Now, for the patient that still has his reason, this law makes sense and it empowers them. But for the patient that no longer has their wits about them, in their refusal to take their meds they are not only hurting themselves but perhaps endangering those around them. Similarly, the idea that all mentally ill people have the right to live out in the community. It certainly sounds good, but Dr. Sweet argues that it is not always a practical idea for all patients. Certainly, the mental institutions cannot run like they used to, but, she argues, they shouldn't be completely closed, either, because some people cannot live out in the community. And, she points out repeatedly, that sometimes the closing of the mental institutions caused more problems than it solved because, while some of the patients got to move into the "real world," many if not most of them were moved into nursing homes and other long-term care facilities.


I have always been for the closing down of the mental institutions. I have always been for giving the mentally ill all of these rights that she talks about in the book. But she gave very good arguments against my long-held beliefs. Maybe, just maybe, in exceptional cases, institutions should stay open, but they would have to undergo a "culture change" like what is currently happening in nursing homes all over the country. I think I would be comfortable with that. It would be better than having them in prison or homeless on the streets like what frequently happens to the severely mentally ill in our society.

The most interesting sub-plot in the whole book IMHO is the fights with Dr. Stein. I cannot remember Dr. Stein's official title, but suffice to say he was a big shot in the local, governmental medical hierarchy. He was in charge of the public hospitals. He was apparently used to always getting his way, so when Laguna Honda told him "no," they were on his hit list from there on. It was fascinating to me to read about all of the politics and infighting going on between, mainly, the doctors and administration. I would have to agree with Dr. Sweet, that healthcare decisions are best left to the doctors and patients and economics should have little, if anything, to do with it. But, that's not the way the healthcare system in the US works and that is a shame.

We do seem to sacrifice efficiency for care in this country. It's easier to go to the doctor and get a pill then wait to find out what is really wrong and go through whatever arduous process we need to in order to bring about true healing. Health is about much more than just pills. We have pills for everything and some of them are very good and life saving, but I think we all could probably afford to discontinue some. We want quick fixes and easy answers, but what we really need most of the time is to sit down, watch and listen.

Taken from here.

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