Choice in Health Care

This is a really big topic, and the center of a lot of debate at the moment.

When I was pregnant with my son, we spent a lot of time looking over all of the information about the different tests and things that were available to us. We decided not to do any tests that we could not do anything about. What that means is that if the result of a test would tell us something, but we could not do anything to change the outcome then there is no point. One of these tests would tell us that our child would likely have down syndrome. Because there would be no way to lessen the probability following the test, we decided not to do it. Additionally the risks associated with the test were far more likely to cause problems than the likelihood that it would find anything. I have worked with down syndrome kids and we knew that if anything were to happen we would deal with it.

That said I was seeing many different doctors within the practice so that I would have met any of the ones who might end up delivering the baby. One of these doctors (luckily they were no longer employed there by the time I went into labor) was very indignant that we opted not to do this test. I understand that doctors have their own personal beliefs, and that they are supposed to do no harm. We were very upset that she refused to respect our choice, especially since that choice, according to the statistics, the science, was the less damaging. The doctor agreed that there was nothing that could be done about the results, and understood our risk/benefit analysis. Unfortunately the doctor’s personal preference to know took precedence and made us very uncomfortable.

This is something that is the patient’s choice. It has no effect on anyone else’s life. Us knowing in advance would change nothing except potentially adding problems because of the test.

Some people choose to have the test because if the child is more than likely going to have down syndrome, they would terminate the pregnancy. This would be considered a medical reason and is subject to different rules than if the parents chose abortion for a healthy child. I respect that choice. Having children is a huge responsibility, children with special needs more than doubly so. Although I do believe that every person has worth I know that many people would not be able to handle the care that these children require.

Abortion is a choice that does affect other’s lives, mostly the parents and the child’s. That choice should be about what is best for those people. If the parents, specifically the mother, know that the child would not be well off growing up in that household or situation, they have the options of adoption or abortion. It is the responsibility of those involved to make the decision about what is best. Just being alive is not always the better option. I used to say that having a child would end my life, not in a literal sense, but in a figurative one. When I was younger I would not be able to devote the time to improving my situation if I were to care for a child. The child would come first, and unfortunately would not be able to be brought up in the way I would like if I did not have a job and an education.

So what about the other big debate right now? Vaccines. I believe in free choice. I do not like it when the government imposes things we have to do. As far as I am concerned wearing a seat belt should be a personal choice. The statistics are out there, it is undoubtedly safer with a seat belt, but the only life lost would be your own, yes other lives are affected by this as well. In a perfect society I would say that people need to take that into consideration as they weigh the risks and benefits (?) of not wearing a seat-belt. I know however that people tend to be self-centered and not consider that others would be affected by their passing.

What does this have to with vaccines? I believe that people should be allowed to make their own choices. However people are not very good at weighing the data, or considering others. I really feel silly for repeating some of this, but the original study used to back the argument that vaccines cause autism has been retracted, and the author discredited. The other risks that are often cited are concerns about the inefficacy or side effects of the vaccines themselves. If the vaccine is ineffective, you are no worse off than if you did not have it, so I believe there is no more to be said about that. As far as side effects, these are usually minimal, a little soreness, but come on, you stuck a needle there, why wouldn’t it be sore? Yes, some people are allergic to certain elements of the vaccines. The chances of this are extremely remote. Those who are too young, do have a bad reaction, or find that the vaccine is ineffective are those who have to count on herd immunity. As a culture we have had this type of immunity for long enough that some people forget what the risks really are, which makes a real risk/reward analysis skewed. It can also allow people to forget that their decisions can affect others.

This is an article about a child who was exposed to measles. And this is the response from an anti-vaccine advocate. One of the points made in the response is that the man who carried the infection had been vaccinated. This means that he is just as much of a victim of the shrinking herd immunity as the child. Yes, I have problems with the pharmaceutical industry, but that is about them charging too much for things. They have something of value and a monopoly on it. They are taking advantage, and not realizing who that might hurt, but I do not believe they are evil. If you look at some of her links you can see that the evidence does not all fit. The risks associated with the vaccine are stated, but it is clearly stated that those risks apply to the people who should be counting on herd immunity. Her link about the court case has a headline reading “Merck Whistleblower Suit A Boon to Vaccine Foes Even As It Stresses Importance of Vaccines”.

I do believe in free choice, but I am an idealist and think that people should have the ability to make informed decisions when they are given the information. I have a problem when what I believe should be the case is not the case. In the case of vaccines, I am tempted to say that the government should take away people’s right to choose, for other’s protection. But if I do that, am I any different than those who want to take away women’s right to make decisions about abortion? Am I any different than those who advocate taking guns away because some might be used to kill? Am I any different than those who are trying to take away our right to choose our leaders? If I choose to limit people’s right to spread misinformation I am not different than anyone who tries to limit my speech against corporations or governments. These are rights I believe in, and I refuse to participate in setting a precedent that would assist taking away these rights, and others. I can only hope that giving people the information and teaching them how to use it (including reforming our current school system) is the best way. I am not willing to risk the future of our democracy in order to combat one ill-informed decision. A functional democracy depends on having an informed populace. That is what we need.

 

Intelligence

What is intelligence? I know I have touched on this before. Traditionally we define intelligence as IQ, or Intelligence Quotient. This is something inherent to us that does not change within our lifetime, or at least that is how it is thought of. IQ is a way that we are all assigned a number that puts us on a line from less intelligent to more intelligent. There is no second dimension to it. More or Less, that is all.

But I believe that there is more than that. Think of it as the difference between plotting a point on a one dimensional number line and plotting a point in three dimensional space, except that I want more planes than even that and adding time (as a fourth dimension) would allow. There are so many different ways that people (and animals) can be intelligent. This is how we generally think of animal intelligence.

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But not only do they probably think the same of us, but what if they are the smart ones? All it takes is a small perspective shift. They have figured out a way to let us do the work while they reap the rewards. Pretty smart.

In my opinion, intelligence is made up of many things, including some that cannot be tested for. I don’t really see the point of testing for it anyway. As I see it the point of testing is to see who is superior, and I would argue that no-one is. Everyone has their own strengths, and beyond finding a way to discover those, testing is superfluous.

Children are a perfect example of this. People often laugh at children because they believe the things they say are stupid. When I was young I put together the fact that I saw the world as flat and the fact that I knew there was another side of it and imagined that the world was a cube. Obviously my conclusion was incorrect, but you cannot fault the logic. I had used the information available to me to come to a more accurate representation of the world than man had for centuries. Intelligence, in this case, is about taking pieces of information and putting them together.

My son still has a very limited vocabulary, but he is figuring out ways to tell a story. Sometimes he will say ‘hot’ and ‘mom’ while pointing to the kitchen. It is pretty clear at that point that he wants a meal. He is communicating not only that he is hungry, but he wants hot food, or a meal. One time I came home and he said ‘eye’ and ‘ear’ and pointed at a wall. I was a bit confused, until my husband told me that they had been pointing out the eyes and ears of the girl in a picture on the wall. My 18 month old was telling me what they did while I was at work.

I know that may not sound like much, but one of the smartest things about kids, and this applies double to babies, is that they soak up information all the time. Learning itself is a part of what intelligence is. And, as many parents have discovered, they don’t only learn what you try to teach them. Many parents find to their dismay that the kid has picked up curse words. This is for the same reason that many babies first word is ‘no’. Kids say what they hear.

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These type of images are all over the internet, and people laugh at the dumb little kids. Really though that is a very smart kid. He knows that he is hungry, and food comes from boobs. He is just missing some information that led him to a false conclusion.

All the time kids fall down because they are still learning physics. If a kid learns to walk in a room with a perfectly flat floor and nothing on it, they will stumble when he gets on a ramp or a hill. But the younger they are, the quicker they are able to learn to compensate.

Another group that is often mocked for low intelligence is older people. When someone with Parkinson’s shakes and drops something they are called ‘retarded’. (We will address that in a minute.) The person’s mind can be as sharp as ever, but if the motor function starts to drop off, the labels fly off the shelf. In many cultures, and I am sad that mine is not one, older people are respected for their wisdom.

I completely understand that it can be very frustrating to try to teach someone who did not grow up using a computer how to do something that my generation regards as basic. But all it means is that the person’s mind is less malleable. They have more information stored in their brains than we do. Their intelligence is generally called ‘wisdom’ and it comes from the build up of all of the information that they have accrued in life.

Even people with what most people would consider ‘diminished mental capacity’ are intelligent in their own way. Today Einstein would probably be diagnosed with half a dozen learning disabilities. The reason that we think in terms of higher and lower intelligence is because we are giving the fish and the birds the same test as the monkeys and the elephants.

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This image has been used as a mockery of our current educational system, and it is. But the problem goes deeper than that. While many kids can excel at reading, teaching a dyslexic student in the same way can be disheartening, and make them wary of not only books, but the information contained in them. While trying to teach an autistic child to read can be completely futile. (And yes, under No Child Left Behind they are held to the same standards of ‘proficiency’ as anyone else in their grade).

That same autistic child might be a savant at something else. For some it might be advanced mathematics, another might be just obsessed with trains. While some teachers might try to use that obsession to motivate the child, (nothing wrong with that) I would suggest going even further and trying to figure out what it is about trains that they love so much. It might be that she is interested in creating the path for them because in their mind they can instantly see the most efficient route, or maybe it is the idea of multiple things following in the exact same path.

Sensory Processing Disorder is diagnosed when people’s sensory perception is abnormal. It is often described in terms related to ‘broken’ but what if some of them feel the need to re-confirm the solidity of objects because they somehow subconsciously know that atoms are mostly empty space? When Earnest Rutherford first discovered that fact, he is reported to have been afraid to get out of bed in the morning because he did not want to fall through the floor.

I am not presenting any of these ideas as fact, but as a thought exercise, a reminder that things are not always how we perceive them. Something that we see as stupid can, in fact, be signs of intelligence. It just means that we not see something in the same way as someone else. Rather than judging in the moment, we should give some time to consider how they came to that conclusion. It might just be that our own understanding of the situation is missing some information, or that they understand something better than we do.