Essay: A Non-Capitalist Approach to Biomedical Consent

Ask anybody about bioethics in the old days, like forty years ago, and they’ll talk all about autonomy and consent. It was all about how people didn’t have to do what you thought was good for them and how you couldn’t touch patients, even to help them, without it being some kind of battery or something. Everybody talked about all these famous examples where people were treated without wanting to, but most people only go to the doctor when they want and need to get treated. Most people these days only refuse treatment because they can’t afford it.

I’m sure a lot of them can’t afford the treatment but also don’t need it. It’s hard to argue with a doctor about that, though. If you want to feel better, stay healthy, live longer, or whatever; you’re going to listen to the doctor. You are paying the doctor to know more about it than you do. And the doctor may or may not be making money off every service you buy. It’d be good to know who makes money off what, wouldn’t it? It would also be good to know in advance exactly what everything would cost. It would be even better to be able to prepare costs.

In the early days of bioethics, it wasn’t all about costs, because most people could afford their healthcare bills. Money was a concern, of course, but people didn’t panic from fear that their life savings would be wiped out anytime they got sick. It wasn’t at the front of everyone’s mind, so when someone refused treatment, it was because they didn’t want to live longer, didn’t think the treatment worked, or something like that.

But now it’s all about costs. Can a doctor ethically prescribe you treatment knowing you can’t afford it? Can a doctor ethically not tell you about treatments you can’t afford? Should doctors help patients set up Go Fund Me accounts? How can anyone just stand by and let people die because they can’t afford insulin?

In the past, we didn’t notice how much autonomy and consent were tangled up in financial concerns. Most patients didn’t know doctors received so much money from industry. Most patients trusted their doctors, hospitals, and so on to have their best interests in mind, not to be focused on profit front and center. But things have changed, and bioethics can’t afford to have many debates that don’t deal with patients’ ability to access needed care.

So, if you are dealing with public health ethics and planning for pandemics, you might want to consider how many patients will walk around shedding viruses simply because they can’t pay for a visit to the hospital. And if people are forced into quarantine at hospitals, you might want to consider who will get the bill for that. It’s the same with vaccines. At least some people are opposed to vaccines because they think, right or wrong, that they are just being made to create more profit for pharmacy companies, clinics, and doctors. It’s just another way, they think, to get in people’s pockets.

I’m not saying that no one writing in bioethics is dealing with these topics. Great work is being done. What I’m saying is that all work in bioethics must include a discussion of economics and an expressed concern for how access to medicine can be guaranteed for everyone who needs it. You can have lots of detailed and technical disagreements over how much medicine is actually needed and what are the best ways to deliver needed medicine without bankrupting an entire country, but the focus should be on creating a society of healthy, financially secure people. That’s all anyone wants, I think, and anyone who doesn’t want it isn’t really worth my trouble.

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Baptist Primer: Backsliding Versus Non-Practicing

A non-practicing Catholic, I guess, is someone born into the Catholic faith who no longer adheres to any of it’s prescribed behaviours or rituals, and I would suppose some people don’t feel they need to practice it once they know how to do it. Practicing Catholicism must be for newbies.

But Baptists are a different beast all together. Technically, if you follow the letter of Baptist convention, no one is born into the Baptist faith. No one, no matter the circumstances of birth, can become a Baptist without actively choosing to do so, though the age of consent for such a choice is surprisingly low. This is why you see so many Baptist preachers dunking little kids in the water—it shows those children have chosen of their own free will to live their lives for Jesus. And if you check the news of late, you’ll find some preachers seem a little confused about what other things children are or are not able to consent to, under the laws constructed by good old human beings.

Once your accepted in the fold, you are saved, and there’s not much you can do to get kicked out, and you don’t have to practice, either. If you don’t keep up your Godly work by staying clean and pure and avoiding all the temptations the earth has to offer, you’re only human and no one should throw stones at you (according to New Testament law).

If you’ve slipped a little, you’re officially a backslider. Baptists believe that a truly saved person can’t genuinely fall out of favor with God. If you actively reject God and all God’s work, you are not a backslider but a reprobate, and God will surely turn against you, because when you said you wanted to devote your life to Jesus when you were six, you must have been a lying little demon.

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First Impressions That Last (#fiction)

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People overstate the importance of first impressions. It’s possible to change your impressions of someone, for better or worse, on second or third impressions. It is even possible to change your mind about someone after 25 years. I’m sure of all that, but some people sure do make memorable first impressions.

Sharon pretty much introduced herself to me by saying, “Well, I’m a Black bisexual woman who just wants to make trouble and maybe help make a better world.” Some people would say that for shock effect, but I don’t think she really cared about that. She just liked to vet new friends. It’s sort of like those signs that say, “You must be this tall to get on this ride.” If you were bothered by her introduction, then she didn’t need to waste any more time on you.

As far as I could tell, she loved life. She loved men and women. She loved humanity. Somehow, the world can’t accommodate people like that, though. Some of us just never find a safe place. One day she would talk about all the drama women cause. The next day she would lament all the baggage Black men bring on dates with them. What’s the difference between anger, fear, grief, or love?

Blame the structure of the world. Blame biology. Blame the devil. Do what you want, but it is hard for some of us to feel connected to anything. It’s like that Jimmy Cliff line about how loneliness would never leave him alone. You know, we’re all in this together—it’s just that we seem unable to share the burden of that, so we’re all seekers.

So, anyway, at her funeral, her aunt gets up and tells all the family and other busy bodies that no one knows where Sharon is now but Sharon and God, and no one else even needs to worry about it, so just shut your mouth and show a little respect. I guess some people think Heaven is a hotel that rejects people who couldn’t find safe shelter on Earth. Some people believe in a God that locks the door for his most sensitive children.

I guess that’s just our nature. We all want to feel we’re blessed. We want to feel protected in the end. We’re not like the others, somehow. Flannery O’Connor’s Mrs. Turpin had this vision of good Christian folks like herself having their virtue “being burned away” as they descended into Hell while her inferiors sang and praised their way into Heaven. Some of us find out we are like the others before it is too late. Some of us don’t.

Randall Horton

On an Emergent Awareness of Impending Death (#fiction #prose #essay)

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Sometimes life just smacks you in the face. You’re just minding your own business and out of nowhere comes a big punch to the gut, or, yeah, a slap to the face or whatever. This mostly happens when you’re young. By the time you reach a certain age, if you are so lucky to live that long, you’ll be punch drunk enough, trust me.

Anyway, that’s why she couldn’t believe her rabbit was dying. No, she wasn’t pregnant or anything—her pet rabbit was riddled with tumors and needed to be put down. She’d never lost anyone that close before, and the tears came in waves. She was inconsolable, as you are when you lose something precious.

So she called her mother for comfort, which is a pretty reasonable thing to do, even for someone who is technically grown up and fully adult. Relying on mothers for comfort is a habit many of us never break until fate forces our hand on the matter. She called her mother and told her the devastating news, but her mother wasn’t really as sympathetic as she had expected, so she was a little crestfallen for a minute.

Her mother listened for a minute or two to the tears and lamentations before saying, “You go on like this for your rabbit when you know I have cancer, too?”

It was true that her mother had cancer and she definitely knew about it, but she was still naïve enough to believe doctors could save lives. She had heard of people surviving cancer, so she assumed her mother would be one of those, not one of the unlucky people you hear about in other families. We’re always pretty sure the worst things won’t happen to us, aren’t we?

She would be sadder and wiser soon enough, and maybe the rabbit served as a kind of omen or preparation for what was to come. Maybe it would help her get through the days, months, and years ahead. When you look back on things, it’s hard to say what helped or didn’t as you can’t imagine how bad things might have been otherwise. Trauma and grief can be pretty all consuming, you know, and your imagination for other possible worlds disappears.

You’re just sort of stuck, boxed in, and frozen.

Anyway, that’s how it all started. Tests, promising results, surgeries, promising outcomes, more tests, different doctors, different hospitals, different promises, and different prognoses were all to follow. Sure, the best of us indulge in magical thinking or just wishful thinking, anything to not indulge in despair, even when despair is rationally the correct choice. You pretend that rabbit cancer is categorically different from human cancer. You pretend doctors are magicians. You just get on with it.

Or sometimes you don’t. You decompensate. You look for comfort in anonymous sex, “mood altering” substances, or purely defiant denial. And you’re done for. Death keeps coming, and you find out you’re strong enough to face it down. I know, some people aren’t strong enough to face it down, but anyone reading this has been strong enough so far, so you’ve been strong for a long time.

Keep it up.

Don’t bother saving the world

In the grand scheme of things, worlds, suns, and other fabulous celestial bodies come and go all the time, so the loss of one more wouldn’t really make any difference at all, so you can relax. And, the Earth isn’t really under any serious existential threat at the moment, anyway. I mean, it’s getting warmer, but planets do that from time to time. It quite literally is not the end of the world. Hear George Carlin explain here.

The world will go on for some time, I would imagine, unless it collides with something or some other heretofore unimagined accident occurs. I mean, I guess it is possible the Earth will spontaneously break up into tiny particles and become another ring around Saturn, but the chances of that seem infinitesimally small.

But you’re still worried about the state of the world (aren’t you?) because you’re selfish. Only you don’t think you’re being selfish. You’re just worried about all the pretty flowers, the coral reefs, the poor people in other countries, and the cute animals that will disappear, severely affecting your enjoyment of travel documentaries. To be fair, if the plants and animals on the Earth are capable of wishing anything about you at all, I’m sure they do wish you would either go away or at least clean up your mess, so the anti-litter campaign is probably well received by the non-human inhabitants of the planet.

Somewhere deep down, you must fear that if the world ends, or even just changes slightly, you might also end and leave the world to fight for itself, which it could certainly do better without you, anyway. So, let’s face it, you’re really just fighting for your own survival. Don’t worry, you’ve got this. Humans always seem to find a solution to every problem.

Most inhabitants of the Earth are congregated near large bodies of water such as oceans. If the sea levels rise, you’re thinking you may have to move further inland. It might help a little. The folks who already live inland will most likely welcome you with open arms and give you plenty of food and fresh water as most people have already proven to be extremely concerned about the plight of immigrants and refugees.

Your arrival in the new place isn’t likely to cause too much disruption. They may have to expand the hospital a little, but it shouldn’t take too long. Tax revenue is sure to be increasing, so building more roads, schools, power plants, water processing centers, and so on will be easy enough.

As people like yourself travel around, you will carry germs with you. Things you may have become accustomed to may or may not cause problems for your new neighbors. It’s possible everyone will stay healthy. Of course, animals will also be moving and changing their migration patterns, but that should be all right. It’s not like anyone has ever gotten a serious disease from animals. I mean, whoever heard of bird flu or pig flu or anything like that? It’s absurd.

And no one worries about plagues, anymore, because they haven’t happened in a long time. The viruses that caused great epidemics in the past are long dormant. Who could imagine them being reintroduced into human society as a result of thawing ice or something? Preposterous. New bacteria aren’t likely to emerge, either, as we’ve already dealt with them. Scientists these days develop vaccines and new antibiotics at the drop of a hat. Infectious diseases are simply no longer a matter of concern. It’s hard to imagine a pandemic wiping out billions of people, certainly. That kind of thing doesn’t happen where you’ll be living.

As you travel, you may meet fellow travelers moving away from wildfires, drought, inland flooding, failed crops, and so on. Everyone will be understanding and work together to divide the available food as equitably as possible. The police and military might be called in to help smooth over any disagreements. You may see a few skirmishes crossing borders and so forth, but new drones and fortified structures will offer substantial protection to the good immigrants, like yourself. The people who die in conflict should have been more careful.

It’s possible extreme conditions could lead to occasional power failures, which might impact travel and communication. Some flights may be grounded. Some traffic signals might not work as expected. I guess there is a slight chance it will affect rail transportation. Navigation might be a little difficult. If you have a good signal, you can upload a funny meme about it. I mean, really, global warming shouldn’t affect satellite communication, should it? It’s not like airport runways could get too hot for planes to land, rail could warp under extreme heat, or roads could become impassable from melting or buckling. That kind of thing only happens in movies.

So don’t worry about the old Earth. She’ll keep spinning as long as she is destined to, with or without you. And don’t be too concerned about yourself, either. You’ve survived this far. Surely your good luck will continue. It’s a shame about the animals going extinct, though, and the poor people who have lost their homes. And you’ll always have your memories of how things were.