Hoffman-ISSUeS cont<strong>in</strong>ued'frompg. 2In response to these consumerdemands, physicians are practic<strong>in</strong>gmore and more defensive medic<strong>in</strong>emoreand more Cesareans, morestress test<strong>in</strong>g, more sonography—creat<strong>in</strong>g newer and more complicatedtoys, driv<strong>in</strong>g the costs ofhealth care higher and higher, lessen<strong>in</strong>gaccessibility—all result<strong>in</strong>g <strong>in</strong> ak<strong>in</strong>d of "Uter<strong>in</strong>e Star Wars."Physicians are pressured tobecome even more and more Godlike—andGod help them if theydon't deliver! In New York, the malpracticerates for obstetrics havebeen driven so high by enormous settlementsthat many obstetriciansenterta<strong>in</strong> the idea and even makethe decision to give up deliver<strong>in</strong>gbabies. In an environment whereeveryone is concentrat<strong>in</strong>g on offensiveweaponry—rather than preventativeapproaches—there are losseson all sides—especially for women.It is a fact that a significantamount of the massive health caredollars spent <strong>in</strong> this country arespent for treatment of <strong>in</strong>dividuals <strong>in</strong>the last months of life. In a contextof $400 billion dollars, this is a startl<strong>in</strong>gfigure, especially when juxtaposedwith others like: In 1990, theblack <strong>in</strong>fant mortality rate will be 14per 1,000. <strong>On</strong>ly 79 percent of womenwill receive adequate prenatal care<strong>in</strong>stead of the 90 percent that hadbeen projected by the Public HealthService. Accord<strong>in</strong>g to 1985 Journalof Pediatrics statistics, the gapbetween black and white <strong>in</strong>fant mortalityseems to be widen<strong>in</strong>g <strong>in</strong> thelast three years. While Adm<strong>in</strong>istrationofficials claim there is no relationshipbetween relevant Federalprograms which have been cut andchanges <strong>in</strong> <strong>in</strong>fant mortality, a NewYork Times editorial po<strong>in</strong>ts out thatthe figures strongly suggest a l<strong>in</strong>k.Michigan, for example, has lost 25percent of its fund<strong>in</strong>g for maternaland child-health programs and theblack <strong>in</strong>fant mortality rate hasstalled at 23.1. In parts of Detroit, ithas been as high as 33 per 1,000.Ironically, every dollar spent onprenatal care for women at risk ofbear<strong>in</strong>g low-birth weight babies willsave more than $3 <strong>in</strong> specialized carelater. It has been stated and demonstratedtime and time aga<strong>in</strong> thatadequate pre-natal care will drasticallyreduce the amount of low-birthweight and problem deliveries. It hasalso been adequately demonstratedthat it is the poor women, the22m<strong>in</strong>orities, that suffer most fromthe lack of ongo<strong>in</strong>g pre-natal medicalattention. In the area of contraceptiveservices, a recent study byMargaret Terry Orr et. al. (FamilyPlann<strong>in</strong>g Perspectives, Vol. 17, #2)reveals that only half of all privatephysicians will provide contraceptiveservices to Medicaid-eligible women,fewer than one third will provideobstetric care. Our society whichuses women and sex to sell all of itsproducts offensively, expends m<strong>in</strong>imalf<strong>in</strong>ancial resources on defense.And let's take a hard look atwhat is happen<strong>in</strong>g to Americanteenagers.A recent study by the AlanGuttmacher Institute revealed thefasc<strong>in</strong>at<strong>in</strong>g comparative data thatteenage pregnancy rates <strong>in</strong> thiscountry are more than twice as highas they are <strong>in</strong> Canada, England andFrance; three times higher than theyare <strong>in</strong> Sweden and seven timeshigher than they are <strong>in</strong> the Netherlands.An analysis of the differences<strong>in</strong> the systems revealed that it wasthe availability of confidential andfree or low-cost contraceptive servicescomb<strong>in</strong>ed with realistic sex educationprograms <strong>in</strong> the schools alongwith concurrent liberalized abortionlaws that resulted <strong>in</strong> greater contraceptiveuse among teenagers. A salientpo<strong>in</strong>t by Kajsa Sundstrom-Feigenburg,a Swedish gynecologist..."We didnot th<strong>in</strong>k it was a good th<strong>in</strong>g forSwedish teenagers to beg<strong>in</strong> theirsexual lives by hav<strong>in</strong>g an abortion."Many of our country's teenagers,and we see quite a few at CHOICES,beg<strong>in</strong> their sexual lives just this way.<strong>The</strong> results of female sexuality aresurgical <strong>in</strong>vasions. Would we rather"teach them a lesson" than teachthem prevention?It is not uncommon for amother to call to make an appo<strong>in</strong>tmentfor her 12-year-old daughter'sabortion and demand that it be doneunder "local anesthesia" so that shecan "learn" from the pa<strong>in</strong> of theexperience. This concept of adversarial,<strong>in</strong>vasive condition<strong>in</strong>g—abortionto teach responsibility—does notexist only <strong>in</strong> the vacuum of maternalweaponry.It is a reflection of the largersociety (America as mother if youwill, as ultimate re<strong>in</strong>forcer) and themessages and the re<strong>in</strong>forcementsare crystal clear. <strong>The</strong> only real valuesare technology and consumerism —as def<strong>in</strong>ed and deified by the malepower establishment. Women's livesand health have become mere extensionsof this—they do not have value<strong>in</strong> and of themselves, but as consumeritems. This concept of be<strong>in</strong>ga perfect product operates not onlyfor ourselves but for our childrenas well.It thrusts us to diets, to exercise,to cosmetics and ultimately, totechnology, to achieve that elusivestate of consciousness and existenceknown as be<strong>in</strong>g "10," be<strong>in</strong>g perfect.In this sense, the women'smovement has not only been coopted,it has become part of maledom<strong>in</strong>atedma<strong>in</strong>stream th<strong>in</strong>k<strong>in</strong>g. Ak<strong>in</strong>d of th<strong>in</strong>k<strong>in</strong>g that results <strong>in</strong> moreand more consumerism, more andmore technology, and less and lesstrue (female def<strong>in</strong>ed) liberation.It is time for women tochange the climate of the debate. Itis time for us to re-def<strong>in</strong>e and reorderour national priorities.Is it right that the majority ofour health care dollars go to dy<strong>in</strong>gpatients <strong>in</strong> the last months of theirlives when children <strong>in</strong> their mother'swombs or <strong>in</strong> the first months oftheir lives are be<strong>in</strong>g neglected? Isn'tthe price for the medical boys play<strong>in</strong>gwith their toys too high? Yes,DeVries is brilliant. Yes, a perfectartificial heart down the roadsometime, somewhere may be ofmajor benefit to the few (and they<strong>in</strong>clude the research and medicalcommunities).<strong>The</strong> New York Times reportedon Friday, May 24, that the artificialheart had received a sweep<strong>in</strong>gendorsement from a committee ofexperts appo<strong>in</strong>ted to study its potentialimpact on society. <strong>The</strong> reportcalled for greatly expanded Federalresearch to develop a fully implantablepermanent artificial heart. Toquote the study, "Such devices couldprovide a significant <strong>in</strong>crease <strong>in</strong> lifespanwith an acceptable quality oflife for 17,000 to 35,000 patientsbelow age 70 annually."What does this say about ournational ethics and priorities?<strong>The</strong> benefit to the many mustbe weighed aga<strong>in</strong>st the benefit tothe few. John Stuart Mill's doctr<strong>in</strong>eof Utilitarianism demands that youtake an <strong>in</strong>dividual case and multiplyit for all the world and if it works foreveryone, it is an assumptive good.Virtue is based on utility and conductshould be directed towards promot<strong>in</strong>gthe greatest happ<strong>in</strong>ess for the
greatest number of persons. Accord<strong>in</strong>gto that criteria, artificial heartswould fall very low on the scale. Notevery person needs one and <strong>in</strong>deed,not everyone who may need one willwant one. But, on the other end ofthe spectrum, there are millions ofmothers and would-be mothers whoneed adequate prenatal care andeducation. <strong>The</strong>re are millions of teenagerswho need, <strong>in</strong>deed, require<strong>in</strong><strong>format</strong>ion and help to equip themselvesfor sexual survival <strong>in</strong> theonslaught of the culture and themedia. This is where the moneyshould be spent. We cannot, <strong>in</strong> fact,allow a military mentality to dom<strong>in</strong>ateour medical establishment. <strong>The</strong>offensive arsenal does not have to bepurely technological. Unlike the military<strong>in</strong>dustrial complex, the medicalestablishment does not have an "evilempire" to blame for the massiveexpenditure of dollars. <strong>The</strong>y are, <strong>in</strong>fact, not elected and do not directlyanswer to any constituency.Women who are concernedabout power, who are <strong>in</strong> positions ofpower, must go beyond their ownself-<strong>in</strong>terest to see that their hav<strong>in</strong>ga perfect baby, their be<strong>in</strong>g superwomenwith careers and families, isnot the ultimate positive result ofthe revolution! Just as the notion ofpower <strong>in</strong> the women's movementmust be one of the universal collectiverather than the <strong>in</strong>dividual personal,"Patient Power" must beg<strong>in</strong> tomove from the <strong>in</strong>dividual patient'srelationship with her physician to abroader, more active political andclass consciousness. <strong>The</strong> power ofwomen as patients, and as medicalconsumers, cannot exist only with<strong>in</strong>the limited conf<strong>in</strong>es of family or thehome.Women are the primary constituencyof the medical establishmentand must understand that until theyhave a major voice <strong>in</strong> how the moneyis be<strong>in</strong>g spent, how the research isbe<strong>in</strong>g directed, what technologicalpriorities are be<strong>in</strong>g established, anduntil all women (those who wouldbe, and those who would choose notto be mothers) and their children aregiven the <strong>in</strong><strong>format</strong>ion they needfrom various sources, the preventativecare they need from physiciansand a government that acknowledgesthem as a priority—and a commitmentof DOLLARS—women maybe less than second class citizens..they are victims.PATIENT POWERIn the early 1970s, Merle Hoffman,founder/president of CHOICES,developed the concept of Patient Power,based on the pr<strong>in</strong>ciple that patients(ma<strong>in</strong>ly women) are consumers of medicaltreatment rather than passive (andoften victimized) recipients. As such,J1. Patient Power is the right to questionyour doctor.2. Patient Power is not be<strong>in</strong>g <strong>in</strong>timidatedby the medical establishment.3. Patient Power is mak<strong>in</strong>g medic<strong>in</strong>ework for you.4. Patient Power is knowledge of thepower of your own will to health.5. Patient Power is awareness of availablemedical choices.6. Patient Power is assertive question<strong>in</strong>gof the medical system.cr, 7 Athey are entitled to get what they payfor, know what they're gett<strong>in</strong>g, andunderstand all their options for treatment.<strong>The</strong> follow<strong>in</strong>g "12 Tenets ofPatient Power" will help you understandthis philosophy and ultimately practiceit <strong>in</strong> your own medical care.7. Patient Power is know<strong>in</strong>g all youroptions.8. Patient Power is be<strong>in</strong>g <strong>in</strong>formed ofyour rights and responsibilities.9. Patient Power is comparison shopp<strong>in</strong>gfor doctors and drugs.10. Patient Power is be<strong>in</strong>g an <strong>in</strong>formedconsumer.11. Patient Power is <strong>in</strong>tegrity andresponsiblity.12. Patient Power is a discipl<strong>in</strong>e of selfawareness.Now, listen carefully and take notes/. ©ketchup ISQ vegetable.@Highmilitary Spend<strong>in</strong>g reduces the naticna/ ,.^{%hereisNOunemp)oyment<strong>in</strong> America '