March 4, 2008 | Commentary on Health Care
There are moral costs in socialized medicine
Anyone who considers Canada's health system a role model for the U.S. should consider the case of Samuel Golubchuk. His case shows the inevitable collision course between government-controlled health care and the rights of private conscience.
Golubchuk is an 84-year old patient at Grace General Hospital in Winnipeg, Manitoba. He is believed to be cognitively disabled. I say "believed" because two months after his admission to the hospital -- when his children had to rush his case into court to prevent what they saw as government-assisted homicide -- he still hadn't been examined by a neurologist or had diagnostic tests, which in the United States would be standard procedure almost immediately.
Golubchuk is on a respirator and is fed by a tube. The doctor wants to remove the tube and unplug the respirator.
The family objects, citing their Orthodox Jewish beliefs. "It is our belief that life is paramount and one should do everything possible to maintain life and sustain it, as it is a sin to do anything to hasten death," wrote son Percy Golubchuk in a court document.
Here is the ethical conflict. The doctor believes that he cannot "ethically participate in the administration of this treatment any longer." He thinks the machines only prolong Golubchuk's suffering. So he wants to unplug them. British common law, the foundation of Canadian law, requires a physician to provide care only as long as he thinks it benefits the patient. The Golubchuks believe it would be intrinsically evil to unplug the machines.
The Canadian government controls what happens in the health care system, not individuals and families. If your values place you in opposition to the government's values . . . well, tough.
Because of the government's overriding control over health care, this is potentially every Canadian family's story. And if the U.S. adopts a government-controlled health care system, it is potentially every American family's story as well.
In Canada's "single payer" system, each province is responsible for funding all of its own health care. Which procedures are covered varies by province. But, with few exceptions, a Canadian cannot go outside the system to purchase medical services the government already provides -- unless they go to the United States and foot the bill themselves.
In the case of Golubchuk, we have a microcosm of what's wrong with a government-controlled health care system, including substandard care and an unconscionably long wait to use proper diagnostic tools. But the bigger problem is the lack of practical alternatives for patients and their families. Suppose Golubchuk's family could find a hospital with a standard of care satisfactory to the family (say, a hospital that followed orthodox Jewish or Catholic principles), and the space to take him for whatever they could pay, even pro bono? Wouldn't it solve the problem for the family to transfer Golubchuk to that hospital?
That was precisely the solution Dr. Peter A. Singer, a prominent Toronto ethicist, proposed in Canada's National Post: "The family of Mr. Golubchuk should be given a period of time to find a health care team and hospital who share their belief that the treatment being provided is worthwhile."
Yes, that would solve the problem. Golubchuk's children could be satisfied that they were not being forced to violate their religious convictions. At another hospital, they could arrange for the tube feedings to be kosher, and the family could be at peace.
But in Canada this solution is fraught with difficulties. The government determines what care you get and don't get, and it finances that care under a government budget and under government rules.
The lesson here is simple. Any national health system is inevitably on a collision course with private conscience. The only way conscience can ever be given primacy is in an environment of personal freedom. That means personal choice -- if a family can choose a doctor, hospital or health plan with similar moral values. This is most urgently the case in matters concerning the quality of care, and the standard of care, before birth or before death.
In the United States, we will face similar problems. Insurance companies and government officials often make decisions about the kind of care we get, what we pay for, and what the fine print is in medical treatments and procedures. Individuals and patients often have little or no direct control, for example, over the kind of health care plan they have, or what's in that health care plan. They get what the employers, managed care executives or government officials give them.
There is a better idea. Individuals and families should be able to get the kind of health care they want, not just what big third-party players says they can and cannot have. Americans need the freedom to choose the health care they trust. Where are the companies that offer health coverage that is morally acceptable to practicing Catholics or Orthodox Jews, or Evangelical Christians?
Many faith-based fraternities sell life insurance, but they don't offer health insurance. It's time that they did. And Congress and state officials should change federal and state laws to enable that to happen.
The need for more freedom in the American health care system has never been greater. And the reform should begin with allowing people to own their own health insurance without either the outdated tax or the onerous regulatory penalties that plague the system today.
As for Samuel Golubchuk: Fortunately, Canada still has an independent judiciary, and his case went before a judge who issued a temporary injunction forbidding the hospital from killing him, at least as of this writing.
May his case be a lesson to those of us south of the 49th parallel.
Distributed nationally on the McClatchy Tribune wire