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.

 

Strengths & Weaknesses

I was in the Gifted Program in school, I was lucky. My mother was a teacher and advocated for me. What this meant was that I was able to receive extra instruction. In elementary school this might mean an art, Spanish or guitar class during a time that my class was reviewing things I already knew. In third grade I spent one hour a week in a sixth grade class while they did science. I was also permitted to get ahead of the other kids in my class. I remember in first grade practicing counting money on my own (including dollars) while the class was still learning what each coin stood for. In fourth, fifth, and sixth grade I was in a pair of classes that worked together. One teacher taught language arts, while the other taught math. This allowed the students to divide up by ability level instead of grade level. But by sixth grade I had covered the main math information that they taught to the rest of the classes, so I spent the year doing more self-directed studies.

I am very thankful that I was able to do things like this. It allowed me to not be super bored in my classes and move at my own pace to a certain extent. However there are many problems with this system.

First and foremost: Not every child has access to it. This type of program is not set up in every state, those that do have it vary widely in implementation, even between districts. Within a district some schools support it, some do not, just like any special education program. The middle school that I went to did not have a gifted program, but I went there because that is where my mother taught. Because she knew the teachers, she was able to get me in the best classes for me, even though I had to go outside the established ‘team’ structure the school used at the time.

Even if a child is lucky enough to live in the right place to be able to take advantage of the system, their parents might not know to get them involved, and their teachers might not advise them to do so.

Secondly: Tailored education for all. I do not write this post to tell you how smart I am. I used to think that I was better than other, normal, people and I apologize for that.  I now know that everyone has strengths, and everyone has weaknesses. Because my family was full of teachers, and traditional education was such a focus of my upbringing, I thought that it was the most important thing, and that since I was good at that, I was some kind of super-genius.

I now do not support the use of the IQ test. I do not support a system that puts a single set of abilities over another. I believe that it is very damaging. The first thing you may think of when I say that is the people who are told that they are not smart by such a system, and that is a huge part of what I mean. But because that is so obvious, I am not going to go into it. I will tell you why it is not good for the above average kids as well.

As I grew up and I saw the strengths of my friends, I thought that because I was ‘Gifted’ that I should be better at everything than people who did not receive the same label. This is probably part of why I have dabbled in so many different things. It’s not just that I get bored with it, or that I like to be a Jack-of-all-Trades, but that I felt the requirement to beat others at their own strengths. Obviously this is an unrealistic expectation. Through a long and arduous journey I have discovered a long list of things that I am not very good at. And every time that I try these things again, I find the realization again. And every time I have to get over the disappointment again. I have to fail over and over again, and waste my time repeatedly just to re-learn the same lesson I did not learn when I was young. No-one is good at everything.

For a long time I assumed that the people that I made friends with were also in the Gifted Program, because they were smart. I would later find out that most were not. Some were actually in the lower levels of Special Education. Some had failed grades in school. This surprised me. Yes, if a child has dyslexia, that needs to be addressed, but they should also be addressing the things they are good at.

I believe everyone should be allowed to pursue the things that they excel at. This does not mean they should ignore the things they struggle in. Everyone needs to understand trying to learn something outside of their strength. I do believe that there are some skills that should be universal, but these are extremely basic compared to the requirements for school today. (I also understand that these concepts are outside the realm of possibility for some people.) People do not all think in the same way, and as a society we should use each-other’s strengths to grow, rather than requiring everyone to maintain roughly the same experience from which to grow.

Third: Labels. The Gifted Program is part of the Special Education program. As we all know, there is a stigma that goes along with being a Special Ed kid. (When I first got into the program, I did not know that and bragged about being special ed. I was very confused as to why people were not in awe of my awesomeness.)

Referring to my previous point, everyone should be able to get the tailored education that the gifted program is supposed to provide. There should not be a need to label someone as unusual in any way in order to give them what they need. We all are different, we cannot expect everyone to be good at the same things or to learn at the same pace.

In my time in school, the Gifted program offered me the opportunity to explore many things. But unfortunately I found that the extra classes that I was able to take did not make sense for me. These were the first classes I ever struggled in. Because school was so easy for me I expected everything to come just as easily. I know that these classes were supposed to challenge me. I understand that intention now, but at the time, it just seemed too hard. During my time as a substitute teacher, I saw students struggling with the core concepts of math so much they cried. This gave me an insight as to how much strength and weakness really affect our learning. (As well as the problems with expecting too much of students too soon.) I gave up many of these extra classes before trying very hard. This means that from my experience in school I have no way of knowing if I could have been good at them if I gave them a chance. Having tried again later more doggedly I have come to the conclusion that these were not my strengths. It seems odd that because I was good at one thing, I should be given the opportunity to pursue things that I was not good at, while other students were denied the opportunity to pursue something that they might have excelled at because they struggled with something completely unrelated.