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Want To See The Future of Nationalized Health Care? Look to England


John L. Rustin speaks with Dr. Marty McCaffrey, a clinical professor in neonatal and perinatal medicine at UNC Chapel Hill, and Director of the Perinatal Quality Collaborative of North Carolina. They discuss the current trends in regards to a sanctity of life ethic in medical care.

Family Policy Matters
Transcript: Want To See The Future of Nationalized Health Care? Look to England

JOHN RUSTIN: Thanks for joining us this week for Family Policy Matters. Today, we are joined by one of North Carolina’s leading medical voices calling for a return to a sanctity of life ethic in medical care. Our guest today is Dr. Marty McCaffrey, Clinical Professor in Neonatal and Perinatal Medicine at UNC Chapel Hill and Director of the Perinatal Quality Collaborative of North Carolina. Dr. McCaffrey, welcome back to Family Policy Matters. It’s great to have you on the show again.

MARTIN MCCAFFREY: John, thanks very much for having me. It’s great to be here.

JOHN RUSTIN: Dr. McCaffrey, your job involves walking with parents through some of the most difficult scenarios a parent can face, for example, a diagnosis that a child in utero is having significant difficulties or may be born with a severe medical condition or disease. Having experienced this first hand on numerous occasions, what perspective do you have on the topic of abortion as it relates to situations where a pregnancy is deemed—as some physicians like to characterize it—“incompatible with life”?

MARTIN MCCAFFREY: It’s an increasingly common situation that families are put in now, John, for a variety of reasons. We’ve gotten really quite expert at what we can do with ultrasound and with surveying babies before birth. We also have begun just a myriad of new testings that we can do on maternal blood samples, looking at the genetic makeup of babies. I think regarding the latter, we’re really in the infancy, so-to-speak, of developing the expertise necessary to really understand what these tests mean. Those tests have their challenges. But I think the notion that infants and babies who are yet to be born have conditions, which are “incompatible with life” is really a difficult one to prove. I think there absolutely are conditions, which will lead babies to have shortened lives; I think there absolutely are conditions babies have, which may make those lives measured in minutes or hours or days or weeks. But we’ve all, as physicians and providers who work in this area, offered different types of counseling for families of children with difficult prenatal diagnoses. And we’ve all thought that we’ve known pretty well what was going to happen with the child. But it’s not infrequent that we’re proven wrong. And I think what often gets lost in the scientific rush to really examine what’s going on physiologically with an unborn baby is that we oftentimes fail to realize that this is a very unique, sacred life. And you mentioned sanctity of life initially in your opening there, and I think that’s absolutely true. I think we have moved—and I would say not evolved but devolved—to a standard where we don’t look at every life as individually sacred, inherent with its own unique dignity. I think where we’ve moved is a point where things are a bit more relativistic and we feel that we have the ability to judge, not only what survivals might be, but what quality of life may be. And then, we have the temptation to go ahead and advise families based on those judgments—which are very often personal judgments for us—about what the future might hold and advise families regarding the possibility of terminating a pregnancy. I think what also gets lost in that is we fail to realize, when we’ve diagnosed a difficult prenatal condition, is that families are now confronted with several really critical elements. One, they’ve got to mourn the loss of what probably is going to be the child that they thought they were going to have and now will not have. So, whether it’s a difficult chromosomal diagnosis or a child with a difficult heart problem that might require multiple surgeries to survive, they’ve now got a very different child with very different expectations. Then, when you make the next leap—and this not infrequently happens within the same conversation, which is just inconceivable to me—to offering a family termination for a pregnancy, you’ve gone from saying, “Not only is your child not the child that you thought it might be and that the dreams that you had are not the dreams that are going to be realized.” Now you’re asking a family, a mother, to decide whether her love is conditional and whether she should end a pregnancy that she’s bonded with, with a child that she has been loving, who’s been growing inside of her, based on the fact that the child has difficulties or a prenatal condition which may cause their life to be different, shortened and may cause her at that point to make a decision that she may have to consider ending that life.

JOHN RUSTIN: Dr. McCaffrey, the Hippocratic Oath states that a doctor will “do no harm.” In your opinion, is that still the prevailing approach to medicine today or has it come to mean something else entirely within the medical community?

MARTIN MCCAFFREY: It’s interesting you bring up the Hippocratic Oath. So, “do no harm” is not actually in the Hippocratic Oath. But the Hippocratic Oath does clearly and explicitly state that you will not participate in abortion, you will not participate in euthanasia. So, if we were all taking the Hippocratic Oath and abiding by it, gosh you would hope that people would be working in a medical environment that would really appreciate and see the sanctity of individual life. What is really going on is, the Hippocratic Oath is falling out of fashion. So there was a survey done back on 2009 and they polled over 140 medical schools to see what they were using for a graduation oath. Only 11 percent were using the Hippocratic Oath. The majority were using some other variety of an oath, and there’s two to three other varieties out there that were most common. All of them de-emphasize—well they don’t even mention euthanasia or abortions specifically—and all of them de-emphasize the individual sanctity of life, and the dignity of the individual as it applicably applies across humanity. So, even the oaths have started to reflect what, sort of, is the new bioethics, which is much more relativistic and is separated from the traditional bioethics school [of thought] that really started disappearing back in the 70s. Paul Ramsey was a Christian bioethicist who really echoed the Hippocratic Oath. Obviously, Hippocrates existed long before Christianity did, but the sentiments of the Hippocratic Oath are clearly seminal to what goes on in Christianity, in terms of the sanctity of the life of the individual. And we’ve moved now to something that is much more relativistic, in terms of the commonly accepted bioethical mantras.

JOHN RUSTIN: Let’s talk about a very special situation that many of our listeners, I’m sure, have heard about, and that is the situation with young Charlie Gard, an 11-month-old baby whose parents have been thwarted by the government in England in their attempts to switch medical providers, in order to gain access to things like experimental treatment. Talk a little bit about this case and how do you interpret what’s going on in England with respect to Charlie Gard?

MARTIN MCCAFFREY: What’s going on in England with Charlie Gard really should be critical to all of us here in the states and certainly around the world. What you’re seeing in action in England is the fruits of a national health service, which has been in place since the 1940s. So, England has been laboring under the burden of a nationalized healthcare system for heading on 70-some odd years now at this point. And I just recently returned from a trip to England. I was over there speaking at a Trisomy 18 conference that was held and sponsored by a grandmother of a child that I’ve been working with over in the U.K. for the past two years. (Editors note: Trisomy means a child has an extra chromosome in some or all cells.) This little girl is an amazing, beautiful little girl who has some significant airway issues—obstructive airway issues—but also has Trisomy 18, which is commonly referred to as “lethal” or “incompatible with life,” which is really not the case at all if one looks at the current literature. But this little girl, with a lot of work on the part of this family and advocacy from family and other groups over in England, was actually able to get a tracheostomy. And this little girl is the first child with Trisomy 18 to get a tracheostomy in the U.K. I went over there and did a talk over there and I had a disheartening and terrifying little view into the world of the NHS (National Health Service). When I spoke over there, the physicians and the doctors and many of the healthcare providers who are taking care of this little girl attended the lectures. And it was two of us from the States who were lecturing over there. And prior to my lecture, one of the physicians came up and spoke with me. He’s a senior doctor at the hospital there, very well respected senior physician. And he actually had been in charge of this child’s care for a number of months and had initially been resistant to the thought of a tracheostomy, but ultimately it was his support that allowed it to go forward. And he came forward to me and he said, “You know, I have to talk to you about this case.” I said, “Sure, let’s have a conversation.” He started the conversation with this, John: “You know, I like the little…” I thought that was a shocking way to open, and I said, “I hope you would. She’s beautiful and her family’s wonderful and she’s your patient.” He said, “Yes, yes, all that. But she’s got a very difficult problem and we were trying to go along and…” And I looked at him and said, “…assuming she was going to die, right?” And he said, “Well, we were trying to go along, but you know the family would not give up. And we were doing lots of things for airway support but I knew none of them was going to work and that she needed a tracheostomy. But ultimately, what forced the hand was the knowledge that this family was going to bring us to court. And if they brought us to court, they were going to fly this doctor over from America who’d been working with them and we’d lose in court.” And I said, “Well, why would you lose?” He said, “Because it was the right thing to do.” John, at that point he looked at me. I was looking into his eyes. I felt like I was looking into the eyes of a battered spouse. He said “Marty, you’ve got to understand, we don’t have any more money. We have no money. We are being forced to be gatekeepers for expenses in this healthcare system and we’re forced to think about quality adjusted life years and what the impact is going to be potentially on the rest of the people in the system and what it’s going to mean for children down the road, when now, I have children with airway obstruction with Trisomy who want to get a tracheostomy and long-term care.” He said, “How do you afford it in your country?” I said, “Well, it gets paid for. It’s paid for, at this point, by Medicaid or it’s paid for by private insurers if we deem it the reasonable thing to do. But honestly, we haven’t been laboring under a single-provider healthcare system for 75 years. And you guys are absolutely broke now. Margaret Thatcher was right and you’re seeing the end results of that and this is the corner that you’re forced into.” We’re not quite there yet, although we are, in many ways, we’re well down the road to a single-payer system. But we’re not a single-provider system, and there’s a distinction to be made there, John. Single-payer “Obamacare” takes us well down that road. I’m not sure any of the political parties, at this point, really have the courage to try to change that necessarily, but we’re not a single-provider system. So in the U.K., the government calls the shots—the NHS (National Health Service) calls the shots for everything: how much doctors are paid; what nurses are paid—everything is unionized; what staffing looks like; where hospitals will be built; where they will not be built. And so this is a very different system. So single-payer, the movement down the road towards an Obamacare-type system, is really the next step down the road to a single-provider system, which is really, I think, the goal of some who see it as Nirvana. Having spent a very short amount of time in this hospital—for a day-and-a-half over in the U.K. about a week-and-a-half ago—and looking into the eyes of those providers, I can tell you it is not Nirvana. It’s not Nirvana for the providers and it’s not Nirvana for the patients.

JOHN RUSTIN: You’ve been listening to part one of a discussion with Dr. Marty McCaffrey, Director of the Perinatal Quality Collaborative of North Carolina. I encourage you to tune into Family Policy Matters next week for part two of this engaging discussion. Thank you for listening..

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