Sunday, August 16, 2009

The Health Care Debate And The Reality Of Mortality

While it might be a bit odd to consider the silly "death panel" canard (changed slightly by Sen. Charles Grassley of Iows to the government deciding to pull the plug on grandma) as something indicative of a far deeper issue in the American psyche, I think it is. That a mainstream television personality, Chris Matthews on Hardball would get all bent out of shape because the current health care reform bill includes reimbursement for end-of-life counseling, not just for seniors, but for anyone ("Why would young people want this?") indicates that there is something deeply amiss in our discussions surrounding issues of life and death.

This has not been helped over the past generation by the creation of an ideology of life (for lack of a better phrase), in which life itself, the simple physical extension of the working of the organs that keep the human body functioning is seen not just as a personal or social good, but as a "right" that is not just inherent in us as enlightened, rational creatures, but a theological imperative as well. The right-to-life movement is rooted in the idea that "life begins at conception", and all sorts of tortuous arguments ensue about "beating hearts" and various fetal activities from thumb sucking to fetal masturbation. Similarly, as the Terri Schiavo ordeal showed us, the question of life for some becomes divorced from any sense of proportion or quality; even though Mrs. Schiavo was incapable of sustaining herself, that her heart was beating, her lungs and kidneys and liver were still functioning was all that was needed to insist she was, in fact, fully alive. Sustaining that life against the very personal and perfectly legal decision by her husband to terminate her care to allow her to die became a cause celebre that pushed many Americans away from the Republican Party.

While there has been little discussion on the related questions of "What is life?" and "What is death?", they are so intertwined in our current health care debate, even if they are not asked, that I think it important to address them.

While it has been popular to discuss our cultural fascination with youth as part of these intertwined questions, I think that is a far more facile expression of a more deep-seated refusal to face the difficulties that arise once we face squarely the realities that are bound up in them. While Chris Matthews may wonder why end-of-life counseling for young people is appropriate, that is linked, in many ways to the illusion that death is reserved only for the aged. We often hear people say that someone who has died at a relatively young age has died "before their time", or "is gone too soon." We bemoan the "unfairness" of the death of a child or youth. Just last night, my wife said that she could not face the death of one of our children and maintain her mental health.

As Christopher Lasch pointed out in an early section of The True and Only Heaven, this is in stark contrast to early- and mid-Victorian bourgeois scenes of death. Death was not something hidden, but in fact a multi-generational family event. Whether it was an aged grandparent, or a child, the extended family would gather around the death bed, sharing the experience of death and loss and grief. By contrast, the recent innovation of allowing terminally ill patients to return to their homes belies a long-standing idea that death is something secret, hidden away in hospital rooms and nursing homes, sanitary and overseen by medical professionals.

Yet, the hoopla over Sarah Palin's "death panel" comment shows that there is still a long way to go before we can have any kind of serious discussion about the place of death in our society. The very idea that there would be segments of our mainstream political culture that would consider some human life unworthy of care and concern is ludicrous. Yet, it is precisely because we refuse to think of death as a reality that confronts us all that such a position can be voiced at all.

As a professor of mine in seminary once quipped, the death rate is the same as it always has been, 100%. Our mortality is a reality, and death awaits us whether we are newly born or have lived a long, productive life. Death does not negate a life lived, whether a few short minutes or over 100 years. It can be a blessing to those who have suffered pain, or are no longer capable of maintaining their bodily integrity (persistent vegetative state, multiple organ failure superseded by technological innovation). It is as much a reality as recovery, and the end result of life in general, the one reality that transcends all the differences of time, space, class, and culture.

How we as a society face this reality, how we address it, and how we now have an opportunity to address our cultural denial of death through a serious discussion of health care reform might be a bit too much to ask of our superficial, occasionally crazy, public discourse. Yet, it is an opportunity we should not pass up simply because we think it too burdensome.

Death is not an enemy. It is the only constant in human life. There are no rules, no timetables, no guarantees. In the end, we will always lose our battle with death. Facing this reality in the context of reforming health care might be part of becoming a more mature society.

Virtual Tin Cup

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