This article by Timothy Egan is a real gem. He gets past the “death panel” and “they’re gonna take your Medicaid!” rhetoric and discusses how end-of-life care should really look. And he emphasizes that while many (or even most) people wish to die at home with their pain managed, the current U.S. health care establishment pushes hospitalization and costly life-preserving treatments.
With his mother’s death in 2005, Kitzhaber lived the absurdities of the present system. Medicare would pay hundreds of thousands of dollars for endless hospital procedures and tests but would not pay $18 an hour for a non-hospice care giver to come into Annabel’s home and help her through her final days.
“The fundamental problem is that one percent of the population accounts for 35 percent of health care spending,” he said. “So the big question is not how we pay for health care, but what are we buying.”
While conservatives love to use the rhetoric of “life” to promote their social policies, there isn’t much discussion in the United States about what we do when life is coming to an end. Many of us care for our aging parents and grandparents quietly; we worry about what will happen when we have to make tough decisions for them. When my grandmother was dying, I had long conversations with my mother about what she wants when she gets older; it was painful, but necessary. What was striking about those conversations was her insistence that she didn’t want to be a burden on my sister or I; she also didn’t want to spend the end of her life hooked up to machines or only partially conscious. I told her a hundred times that she would never be a burden, but she knew differently — she had just spent years trying to balance a full-time job with caring for her own elderly mother. Her two sisters also helped out, with one flying up from California regularly; her brother offered money, but not time. My other aging grandparent — my dad’s mom — is in relatively good health but recently had to move in with her daughter, after years of living alone.
That, to me, tells a story which is borne out by statistics: Care work for the elderly is done primarily by women, and health care is a women’s issue.
Female family members often take on a disproportionate amount of the care work for aging relatives. Nursing home employees and hospice workers are disproportionately female. Now that more women are working, middle and upper-class women often have less time to care for elderly relatives than they might have a generation ago; instead of sharing that work with male partners, it gets put on lower-income women who do care work professionally. At the same time, the medical and insurance industries push a version of “care” that emphasizes treatment instead of management, length of life over quality of life, and the political morality of the day over individual patient wishes.
So patients have fewer choices. Hospice and care workers are relegated to the lowest rung of the medical totem pole — underpaid, overworked and undervalued. And taxpayers and families spend exhorbitant sums on medical treatments they may not want, simply for lack of other options.
I also can’t help but see the parallels to childbirth and women’s health care — the medicalization of the birthing and dying processes, the pushing out and under-valuing of in-home (largely female) care-givers, the shrill black-and-white morality of those who wield terms like “life” and “death” as rhetorical swords instead of addressing life, death and the in-between with the respect, nuance and complexity they demand.
How we’re born and how we birth are obvious feminist issues. But it’s time we expand that list to include how we pass on, and how we treat the aging and dying among us.