‘Today it seems appropriate to look beyond our National Health Service to envisage a World Health Service.’ Photo: by Bermix Studio on Unsplash
A picture of health: Wendy Pattinson takes a hard look at medical provision
‘The egalitarian principles expressed in the founding of the NHS break down if we look beyond our national borders.’
Our individual lives on Earth are limited by mortality. But we aspire to be part of the eternal, and the most fundamental expression of this is the hope that future generations will be able to live good lives.
The National Health Service was set up in 1948 in order to give everyone access to medical care, paid from the public purse, and so sustain life. It was ‘Nye’ Bevan’s hope that the cost would fall as people’s health improved. Instead, the NHS grew, and continues to grow, exponentially, and has become a revered institution, providing ‘cradle-to-grave’ care.
Medicine has changed a lot since 1948, as have social attitudes. We now expect every ailment to be diagnosed and treated. Many diseases that would have been fatal in 1948 can now be addressed, and often cured. There’s rarely nothing that can be done, and we expect some sort of care even when the prognosis is poor. In fact, we expect every treatment that may extend life to be available, even if that extension is only a few weeks; death is deferred. In the first wave of the pandemic we praised and gave thanks to the NHS. But we pay tribute while expecting that we and our loved ones will be saved.
Advances in medicine have been made possible by the funding that has been put into healthcare in rich countries. Whether through insurance schemes or taxation, this funding also provides for research and development. The ailments affecting the world’s wealthiest people have received most attention, while diseases endemic in poorer countries have received less. Life expectancy in different parts of the world varies accordingly (from 84.3 in Japan to 50.3 in Lesotho), although factors other than healthcare are significant too.
Let’s consider what happens if we have the privilege of living into old age. The cells that make up all the tissues of our bodies steadily deteriorate, so that the function of our organs declines. Various medications and treatments can help to mitigate symptoms but, as the aging process proceeds, it becomes an increasingly-complex balancing act, requiring cocktails of drugs. The older we get the more likely we are to experience disease due to slow-growing tumours, too. We need many hospital and other appointments. As aging proceeds we need increasing levels of support to live. Many of us will develop dementia, pressure-sores and incontinence, and will be moved to a care or nursing home where strangers will deliver the most intimate care. Some of us will develop disturbed behaviours and will fight our carers. By the time we die, many of us will no longer be in our own minds, and relatives will have grown weary.
‘Are you able to contemplate your death and the death of those closest to you? Accepting the fact of death, we are freed to live more fully. In bereavement, give yourself time to grieve. When others mourn, let your love embrace them’ (Advices & queries 30).
When I consider my own death, as we are thus encouraged to do, I hope that I’ll be ill for a month or two, so will know that my end is near. I hope that I’ll have family and friends near me during that time. I’ve tried to live simply and sustainably, and would not want to draw heavily on human and material resources during a prolonged decline. If I become frail with age and develop pneumonia, I hope I’ll be allowed to slip away, rather than being dosed with antibiotics. Of course, if I’m offered a choice at such a time, my instinct to survive will probably override this intention. Likewise, my intention to end my life should I develop a degenerative disease may wane if that comes to pass. I should therefore prefer it if criteria for when to offer or withhold treatment were set collectively, and practiced with compassion.
The current practice of keeping people alive by medical means, instead of allowing their lives to come to a close more naturally, seems cruel and degrading. It’s also unsustainable, in terms of the many single-use products (such as incontinence pads and carers’ PPE), healthcare services, care staff, and transport of patients, relatives and carers etc.
It’s only possible to fund the NHS so well because our economy has grown so much in the last few decades. This growth has been underpinned by exploiting fossil fuels and other natural resources, along with our favourable (post-colonial) trading conditions in a global economy. The egalitarian principles expressed in the founding of the NHS break down if we look beyond our national borders. Today it seems appropriate to look beyond our National Health Service to envisage a World Health Service, in which everyone around the world would have good basic healthcare, paid for by world taxes. We would take less so that others might have more. Our life expectancy would decrease a little, while that in poorer countries would increase, probably converging a little above the current world average of 72.8 years. A first step towards such a vision would be to set limits on our own healthcare, relieving some of the pressure for continued economic growth.
Good religion acts as a guide to living good lives and connecting us with eternity. The NHS, with doctrines that few of us question, revered and offering prolonged lives, has become like a poor religion, since it is unsustainable and so frays our link to eternity. Could it be that religious groups, including us Quakers, need to play a pivotal role in conversations about healthcare and our relationship with death? What should and shouldn’t we be asking of our health service?
If we don’t change our expectations and set limits on the NHS then it will fail to meet basic needs in a chaotic way, as is already happening in some local surgeries and emergency departments. We are consumers of healthcare and need to set limits on our consumerism, for the sake of our planet and future generations: for all life on Earth.
