I have seen the light...

As I’m sure you’re aware, and have probably been told adnauseam, we live in an astonishing age. We yawn at developments that were undreamed of by our grandparents. We somehow think the limits of these developments are bound only by the laws of physics and our imagination, but I suggest that, in the final analysis, limits are circumscribed by the much smaller vision of culture, society and religion.

Last summer the right-to-die issue was one of the major stories in North America as family, lawyers and religious “experts” debated the rights of a Florida woman who had lain in a coma for 15 years. Prior to that, Dr. Jack Kevorkian brought the issue to centre stage in a different way and was jailed for 10 to 25 years for seconddegree homicide. In America, re-fighting the Rowe vs. Wade abortion debate has replaced re-fighting the Civil War.

Debate on both these issues do not occupy Canadians in the same way, but serve to show how it’s hard to make a complex decision and stick to it. Each occupy both brackets of the human condition – the beginning of life and the end of life, but we will soon be occupied with an issue that affects some Canadians in mid-life. Merck has developed a vaccine for the human papilloma virus, the leading cause of cervical cancer; it is pending FDA approval in the US and Canadian approval is expected shortly thereafter. Where this becomes an ethical dilemma is that the vaccine has to be administered before exposure to the virus, which is a sexually transmitted disease. The idea is to vaccinate girls between the ages of 11 and 12, a decision which would obviously have to be made by the parents.

Many of you will recall the debate about birth control pills in the ‘60s where women’s groups squared off against religious groups; even the Vatican weighed in. This might overshadow the Harper governments pre-occupation with same sex marriage in the moral and ethical department, as cervical cancer actually kills people while, to date, gay marriage hasn’t.

Canadians also wrestle with the issue of smoking-related cancer and its treatment. The public is starting to see this as a lifestyle choice where increasingly the argument is presented as “you made this lifestyle choice, you brought this upon yourself, why should the public purse have to pay for your mistakes?” That argument has been presented about AIDS, which is largely considered a homosexual issue in North America. I even heard a variation of that put forth after a speech by Stephen Lewis, the United Nations Special Envoy for HIV/AIDS in Africa. He pointed out that where AIDS is in the heterosexual community, “why should the West be “guilted” out of billions of dollars for something that, if you’d kept your pants and zipper up, wouldn’t be a problem?”

Increasingly, the decisions are based not on ‘can we do it’ but ‘can we afford to do it?’ Even though we don’t appear to be in a recession or depression, money is a scarce resource and the scraping for it and what it provides has entered the public realm. Canadians born here who live in areas with high immigrant populations argue that ‘my father (mother, etc.) worked and contributed their entire life. Why should they have to wait 18 months for a hip (or knee) replacement, with the same priority as a senior who came over under the family reunification program? They never contributed a nickel to the system and never will, yet they have the same entitlements as someone who did.’

I predict this argument will also soon be heard over availability and placement in senior and long term care facilities, where budgets are always tight and money never seems to be forthcoming. It falls into the category of ‘prior entitlement’ and can be argued from the standpoint of ‘are all citizens equal under a democracy?’ – but a quick look at Indian and Northern Affairs’ budget shows that the argument goes back a long way.

I think Canadians have the impression that their tax money goes into some big bank account and hospitals and services will be there when they’re ready to ‘draw it out.’ I frequently hear people say ‘our tax money and fundraising built that hospital, why shouldn’t those facilities be there when we need them?’ Woe be unto any politician that tries to explain the reality of the situation to the tax paying public.

As a society we have to make some serious, informed decisions on ethical issues and this extends beyond stem cell research and gene therapy. I and people in the senior and long term care business have a responsibility to bring these issues and decisions to the attention of a public that currently seems to be more interested in hearing Ben Mulroney blathering on about Angelina Jolie and Brad Pit’s new baby.

These issues and decisions not only affect the lifespan and quality of life of those in our care, but ultimately each one of us as well. Americans march on the Mall, they burn cars in France but in Canada we grumble into our cup o’ Tims. We have to change that.

I have seen the light at the end of the tunnel – and it’s the headlight of a freight train speeding towards us; I suggest we get moving.