For weeks, we’ve been hearing about the Catholic Church’s objections to requiring health insurers to cover contraception, with conservative talk-radio host Rush Limbaugh calling a young law student a “slut” for her support of the requirement and Congress making noises about legislation permitting employers to deny coverage for any medical procedure they found morally objectionable.
Then came the news that Dr. Peter Goodwin, longtime advocate for the right of terminally ill patients to end their own lives and architect of Oregon’s landmark Death with Dignity Act, was himself dying. Goodwin had a rare, fatal degenerative brain disease and recently reached the point where his doctors predicted he had only six months left to live. Under the law he helped create, Goodwin requested a lethal dose of drugs and died. To top it all off, Game Change, an HBO movie about the woman who brought us the term death panels, aired last weekend.
How did choosing such deeply personal decisions as how we want to die and when we want to bear children become so politicized? These are topics of conversation that we should be able to have in private with our doctors, yet because some people and some religions deem these choices morally objectionable, they become somebody else’s business.
It seems more than a little ironic that many of the same people who are objecting to covering birth control and conversations with your doctor about end-of-life care also object when the government refuses to pay for other kinds of medical treatments. When the U.S. Preventive Services Task Force recommended against mammograms for women under the age of 50, having found that prostate-specific antigen (PSA) testing doesn’t save lives, conservatives accused the Obama Administration of using the task force to ration care.
So does government have a legitimate role in determining what kinds of medical care patients should be offered or doesn’t it? I think it does, and there is a big difference between covering PSA tests and covering birth control. One of them (birth control) has been shown to be effective; we know what the risks are, and it should be a decision made between doctor and patient. The other (PSA testing) has been shown to be either ineffective or marginally effective, and it causes a boatload of harm to men. It seems incredibly wasteful to pay for that.
Is it logically inconsistent, then, for me to think that patients should have full autonomy in their choices about what kind of contraception to use or their decision to stop suffering from a fatal disease? I don’t think so.
I write a lot about evidence-based medicine — basically, the notion that using good medical science can help us spend a lot less money on medical care that doesn’t work, and get a lot more benefit out of the treatments we have that actually do work. My reason for opposing coverage for PSA screening, mammography for younger women, vertebroplasty for back pain, Avastin for metastatic breast cancer and many other ineffective or marginally useful procedures is precisely that they don’t work. Whether or not a treatment saves lives or relieves suffering should not be up for debate: the numbers show that they do or they don’t. It seems entirely appropriate to make decisions about what we as taxpayers are willing to subsidize based on the degree to which the treatment offers patients real benefit.
By contrast, the medical issues that are now sparking debate have relatively little to do with the pure numbers or effectiveness. The controversy arises because people have different moral beliefs. In a pluralistic society, we should try to respect and even celebrate that. When it comes to decisions that are rooted in values, I don’t want anyone — be it the government, my employer or somebody else’s religious leader — coming between me and my doctor.