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Is Health Care Supposed to Be Compassionate?

Posted Sep 07 2008 8:10pm
I have always had an interest in the liberal arts and philosophy in particular. I never got the formal training, but as a perennial dilettante, articles such as this (courtesy of aldaily ) tend catch my interest.

It is a brief and digestible history of the idea of compassion. It made me consider how the religious right views the morality of health care as a kind of theological experience of salvation through pity. It is truly opposed to (may I say positivist?) humanist notions that arose during the enlightenment. It is interesting to me, although perhaps unsurprising, that the origins of both liberal and conservative American political discourse lie in the Enlightenment. Smith and Rousseau are cut of the same material, albeit opposite surfaces of it.

The idea of health care as a right seems to be based on pure sentiment as a moral center, pushing a political process to assuage the suffering of those people for whom we feel sorry. The natural objection would be "Hey, what about me. I've worked hard. I've made all the right moves. These people are suffering because they screwed up. They have no right to anything I didn't have when I made my choices."

Naturally the truth is likely to fall somewhere in between these two positions. Helping people for whom we feel sorry tends not to help them. Conservative thought reveals that some programs create a tendency to dependency which should offend any liberal. But the doctrine of personal responsibility is a sham because it assumes that every choice is made from the same perspective, with the same natural abilities and skills and assume the same opportunities. Once the playing field is leveled in terms of genetics and the psychological, social and economic background of upbringing and then we can talk about personal repsonsibility as a political ethic.

What else have I learned? I have been using the term "enlightened self-interest" without understanding its pedigree traced back to Rousseau. Montesquieu's adherence to the idea that commerce increases "humanity" is close to my heart and sounds a little like compassionate conservatism without the religious wingnut contribution prevalent in American political thought.

Rousseau's attachment to equality is cloying. Nobody really believe is equality any more, do they? Given equal opportunities, no two people will ever produce the same value or achieve the same success, irrespective of the perspectives by which we judge success. It is often difficult to feel compassion for people whose own worst enemies are themselves. Ask any doctor who has ever seen a dysfunctional human being as a patient.

On the other hand, Rousseau's criticism of amour-propre is, in my eyes, an unerringly accruate criticism of America's vomitous middle class self-adulation: the best reason to deny health care to the poor is that I didn't have that advantage growing up and now I am rich and they are not. It discounts the central role of luck and chance and the Grace of God in determining success.

I do not understand the relationship of "modern moral realism" to the neo-con realpolitik of the 20th century. It is difficult to think of paralels between Rousseau and Donald Rumsfeld in the same chapter of political ethics. Rousseau's addition of sentiment to "enlightened self-interest" diminishes its value while the neoconservative denial of it simply darkens it.

Tocqueville's obesrvations should resonate to those readers that have recognized the degree of alienation and isolation in which we live. To find democracy partly responsible for any part of our modern angst is a mind-bending and sadening thought. But perhaps there is something to the fact that people who are more or less equal have little need for compassion as they go about their business.

Nietzche, like Ayn Rand, I still find sickening in that they both propagate this modern sense that the world is there to be controlled. It is the prime message of the serenity prayer to indicate that control is an illusion, yet the 21st century is filled with the drive to control and the anxiety which follows the failure toi control the uncontrollable. Resources, such as money, friends and power, come naturally to those who are best capable of managing and stewarding resources. That does not mean they come to those most willing to nakedly seek them.

So health care is a resource and an intermediate end to the well-being of others. It is an intermediate end because the final end is well-being itself. One cannot be well if one is not healthy but one can be healthy and decidedly unwell; from a philosophical, social and spiritual perspective. health is not just about CT scans and MRI's. Many have argued that health care is a waste of societal resources given the impact it has on the well-being of populations. I respectfully disagree, in that we still cannot measure neither health nor the contribution of physicians and other health care workers.

At the end of the day compassion as a sentiment will probably fail as a justification for health care and reform. On the other hand, a purely utilitarian approach suffers form the lack of empirical method and data. This article, strange as it seems, serves as a stepping stone in the evolution of my thinking about the purpose of health care and health care systems.
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