Wednesday, May 30, 2018

Medical Bias? Oppose It

This is the fourth in a five-part series contrasting the ways our society could handle end-of-life care moving forward.

Medical bias is real, and it could affect anyone. What happens when medical bias is paired with a seemingly cheap and simple solution: doctor-prescribed suicide or euthanasia?

In a perfect world, a doctor examines a patient, finds the underlying cause of the problem, and uses the best treatment available for that particular patient. However, our world is not even close to perfect.

Every patient is different. Every individual has their own unique health circumstances, and they come from different races, cultures, sexes, classes, etc. Not only do each of those groups have their own unique health concerns, but our medical system has been proven to treat them differently, often without being aware of it. Medicine is not like building a car in a factory with a set of unchanging instructions; personal interaction between patients and caregivers often determines whether a health problem is even identified.

Some health problems are not well-understood, and some remain essentially mysteries. Sometimes an underlying health problem may be misunderstood or ignored, leading to a wrong diagnosis or no diagnosis at all.

The best treatment is not always obvious. Individuals may respond differently to the same treatment.

When you add culture, the human body, and flawed and unique individuals together, you get an extremely complex situation. The opportunities for even subtle bias from well-meaning physicians to effect outcomes is large. Unlike cases of employment or housing, mistakes due to bias in medicine costs lives.

We can't fix such a complex system overnight. We can strive to be aware of medical bias and to work to fix it the best we can. The one thing we shouldn't do is ignore or even exacerbate medical bias. Doctor-prescribed suicide and euthanasia make medial bias harder to confront, and even provide an excuse to ignore or embrace it.

We must face several critical questions if we accept taking life as an acceptable practice of medicine. In dealing with a patient a doctor or nurse explicitly or implicitly sees as unworthy of their effort or perhaps even life itself, it's tempting to just shut the patient's file and encourage cheap, lethal drugs as the easy choice.

Studies show minority patients often have worse health outcomes. When deciding if a patient should be recommended for suicide, will our medical system treat patients of each race equally? Will patients feel confident that they can trust their caregivers when taking their life becomes a legal option? Women also have poorer health outcomes, will they be able to confidently trust their caregivers as well?

Women attempt suicide more often than men. Men have much higher rates of successful suicide. Will doctors be cognizant of the complex nature of suicide risk and be aware that many requests for suicide stem from depression or despair, or will they just encourage every patient to get it over with? Will they nudge a person from the brink of despair into the abyss, because it's easier than solving a complex problem? Based on how few people in states with legalized doctor-prescribed suicide receive counseling before receiving lethal doses of drugs, we can be confident about the answer to these questions.
Will poor patients have insurance companies in their corner for expensive treatments, or will they be refused care and offered the cheapest treatment as the only alternative? Will wealthy patients be pressured into suicide by their family members, especially if those family members will financially gain from a quick death?

We already know the disabled are marginalized by a society that often sees them as life unworthy of life. When ending their life becomes a viable option, their level of care will continue to suffer.

Nobody should feel safe from medical bias. Treating difficult cases asks the most of our medical system, while encouraging suicide via lethal doses of drugs is a cheap and easy shortcut. Which way helps us confront medical bias?