John is Going to Die
John is going to die and he knows it. He knows it, not in the way we all abstractly know we are going, some day, to die. John’s sun is setting not over some far horizon but a near-by hill. On this sunny summer day in Encino, death’s dark shadow is falling.
Michael Moore’s new movie SiCKO looks at the problems and frustrations of our healthcare industry and how profit has taken both the care and health from our system. He also examines the uninsured and how everyone pays for them and they still don’t get first-rate care. A classic lose-lose. Moore’s new movie opening this week is coincidental to my subject. I learned about John’s condition on Saturday when I noticed that he seemed to be in pain and asked him what was wrong.
John has cancer and needs an operation. He has insurance but they have effectively just said no to his doctor’s request for the surgery to remove the rapidly growing tumor in his abdomen.
I wonder what medical insurance is for, if not to remove cancer. The answer is that the purpose of private insurance companies is to collect premiums and withhold services in the interests’ of their shareholders.
John’s insurance company did not exactly “decline” his doctor’s request. They are “studying” it and will get back to him. They are studying the policy to death—John’s death. One immutable law of medicine is that the dead don’t need benefits.
No one disputes his diagnosis. The insurance company has recognized this by authorizing two previous cancer surgeries. But the cancer is back. John can feel it inside his body, and anyone who looks can see the tumor mass pushing his flesh out in a grotesque outline of encroaching death.
I guess the insurance company has calculated that they have spent enough on John and he is just going to die anyway. What, they must wonder, would the point be of just fighting a staying action against the inevitable?
All medicine is fighting a staying battle against inevitable death. All medicine calculates the efficacy of procedures and the issue of the quality of life.
This question of quality is at the heartless center of John’s insurer’s bad faith. Yes, John is going to die, but must he also suffer? The growth is causing terrible pain. Must his choice be between being narcotized into insensibility and missing his final days or months in a drug induced haze or being immobilized by both the pain and the fear of greater pain?
John is going to die but he’d like to be able to have a greater quality of life to his dying.
We do not, as a society, approve of euthanasia and assisted suicide. Should we not then make available a humane choice that will fund surgeries for the remediation of pain and suffering?
Often people accuse doctors of playing God. Too many decisions have been taken from our doctors and given to the accountants. People trained neither in medicine nor ethics are now routinely making the life and death decisions for us and our loved ones. They know that they will rarely pay a price for the cruelty of their calculations.
Hannah Arendt famously wrote about the banality of evil and held that it was not done by inherently monstrous people, doing self-consciously hateful things. Evil is in the ordinary calculation of money against life and in the polite legalistic language of “declining to cover,” as against saying the truth, “We do not calculate that you’re worth paying more to keep alive.”
The evil is built into the system by making each person play just a small part in the life crushing machinery of business. The accountant only dealt with numbers, not a human being. The secretary only pushed a button that caused a form to be printed and mailed. No real person looked into John’s eyes and saw the pain. No human being encountered John as a fellow human being. Each part of this machine feels no more individual moral responsibility for John’s death than the mail deliverer who puts the envelope in John’s mailbox.
John is going to die, but he is still working at being alive. He goes to work every day and limps, in painful steps, through his day. John is going to die but he would like his insurer to buy him both some time and add the value of quality to that time. No, the operation will not save his life, only extend it. Most importantly, for John, the operation would remove the growing tumor pushing against his skin, his muscles, his organs and his spinal nerves.
If we do not believe in suicide, we must believe in life. If we believe that all life is precious—even frozen fertilized human eggs—must we not also believe that human beings are due a certain level of kindness and care as we leave?
John’s insurers inform him he can appeal and helpfully offer him a form to fill out. He knows he could sue the insurer, but he also knows that with the court’s crowded calendar, status conferences and disputes over discovery, he would be long in his grave and unavailable for the trial. So do his insurers. This is part of the cruel calculation that must be made when accountants and not doctors play God.
John looks across Ventura Blvd and sees the office of his doctor. He knows that he is only feet away from hundreds of people who could help him. But private pay for cancer surgery is out of the reach of most of us—even people who believe they have insurance. John can see help across the boulevard, but it might as well be a raging river. John cannot cross against the cruel currents of ordinary business practices that strand him and turn Ventura Blvd in the river Styx.
John knows that he is going to die, and he knows that it will be slow and painful. He also knows both what his insurers are doing and why. We too should know about why John’s death will be unnecessarily painful.
John is his real name, and he is a real person. This situation could befall any of us. How congruent is this with any of our moral values—conservative or liberal? We must agree that respect for the sanctity and dignity of life, whenever it begins, is not diminished by birth.
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