Dr. Peter Pronovost is a distinguished physician known for his efforts to decrease the frequency of deadly hospital-borne infections. His remedy to the problem is surprisingly simple: a checklist of ICU protocols that directs physician sanitary practices (e.g. hand-washing). Hospitals that have put Pronovost’s checklist into practice have had immediate success, reducing hospital-infection rates somewhere between (estimates vary) well over a third to a whopping two-thirds within the first few months of its adoption. Yet as the story goes, many physicians have rejected this solution and Pronovost has struggled to persuade hospitals to adopt his reform.
The Centers for Disease Control and Prevention estimates that nearly 100,000 American deaths are caused or contributed to by hospital-borne infections. Blood clots following surgery or illness are the leading cause of avertable hospital deaths in the U.S., which by the most liberal estimates might contribute t o the death of almost 200,000 patients annually. Given such a hideous fact, why exactly does a doctor need to travel about and emphatically seek to persuade other medical institutions to adopt, in effect, a cost-free idea that could save so many lives?
How is that an industry which stridently decries the high cost of liability insurance or the absolute injustice of our tort system(which does need reform) need such petitioning to embrace such a simple technique to save thousands of lives? Moreover, in the United States it is not unheard of for a whole business to shut down due a single illness from some suspicious food—yet, we tolerate the killing-via-negligence on such a grand scale in our hospitals? Medical mistakes and institutional carelessness do not qualify as some must-be-accepted inevitability.
This reality has been almost entirely been neglected in the discourse on health care reform. Beyond the structure and financing troubles of our medical system, the institutional practice and governance of hospitals are in need of severe criticism. For example, in what alternate dimension does the peculiar scheduling of hospital work shifts in any way benefit the patient? A few weeks at the hospitals virtually guarantees a never-ending string of new personnel assigned to one patient’s care. If this can be avoided, should it not? It seems quite reasonable to presume that passing patients off from doctor to doctor, or nurse to nurse, might increase the chance of someone making a mistake? The effect of changing such a seemingly small problem could be huge. Or, take for example, the “sanitary” environment of hospitals in general, which contribute to the nearly 100,000 annual American deaths. Anyone who has ever worked in “corporate America” or in a large building in general might note that the trash is picked up once daily. Is it any different in a hospital? It takes some sort intellectual schizophrenia to insist on ICU sterility in a building if one has not the slightest care over how many times trash (never mind what is in it) is picked up in a day.
Any array of complaints about institutional malpractice must lead to the inevitable question: how is it that the most technologically advanced medical institutions in the industrialized world miss out on a just as modern, just as recent, revolution of quality control and customer-service that has pervaded every other consumer-based industry? The answer to this question is telling. →']);" class="more-link">Continue reading
Health care reform has been at the forefront of the American political discourse in the past few months. One of the most difficult tasks in this debate is to discern an authentically Catholic approach to reform efforts. The Catholic Church takes no official position as to how a health care system ought to be structured, but rather presents enduring moral principles that must be present in public policy.
Adhering to the richness of Catholic social teaching, the ultimate goal for Catholics must be to establish a system that is capable of universal access and coverage for all American citizens, one way or another. Any number of schemes might achieve universal health insurance and preferences will differ based on political philosophy, but the end result seems to be a Catholic moral obligation. In this sense, no Catholic ought to oppose universal health care, if it means achieving coverage for all Americans citizens either through market schemes, government assistance, “third sector” non-profit organizations, co-operatives efforts (co-ops), or some combination of these depending on the social need, the ethical principles at stake, and the resources each solution offers.
Catholic social teaching treats health care as a profound social interest and essential for the common good. Health care, because of this, ought not to be viewed as a mere commodity. The poor and vulnerable, by default, are immediately disadvantaged as health care costs increase. The United States, we are told, has the most technologically advanced and best quality medical care. But, one must inquire: at what cost? Other consumer “goods” are not essential safeguards to the indispensable good of human life in the same way as medical care.
Health care markets that are laissez-faire, an inherently utilitarian mechanism, do not necessarily yield nor are they ordered toward natural justice. Natural law theory is alien to such a mechanism— it is not intrinsic to it, neither is solidarity or preferential option for the poor, though these things are not necessarily excluded by it.
It is self-evident that different spheres of society appropriately employ different standards of distribution. College professors assign grades based on merits of achievement; athletic competition employs the same principle. Parents might distribute slices of cake at a birthday party to strict equality. In the same way, numerical equality governs votes in a democratic society. Food, clothing, shelter, electronic goods, clothing, automobiles, jewelry, etc, receive unequal distribution by market mechanisms—sometimes justly, sometimes not.
Need is one of those principles of distribution (and one of those things often argued about) recognized in some spheres, but not others. Need is terrible for distributing grades, but the proper principle for distributing emergency food supplies. Need, arguably, is a proper principle for the distribution of health care. Health is necessary for a community’s proper functioning. Justice, in terms of health care, will require a redeveloped way of distributing health care based on personal responsibility, collective interest, and legitimate need—the weakest and most vulnerable among us first and foremost.
Many important areas of life must resist “commodification,” at least in the same sense as dispensable goods. This could not be more evident than by the fact that people are becoming commodities to other people. Children are the prime example of this, from abortion to assisted reproduction. Fundamentally, justice demands that we re-examine our consumerism for it is the heart of the issue and I believe, the life-source of the “Culture of Death.” →']);" class="more-link">Continue reading