Thursday, December 07, 2006

Mandatorily Mine

[posted by dinah]

My title is a take-off on ClinkShrink's title. I was thinking of commenting on her post, and decided I wanted one of my own.

So Clink talks about the idea of legislation as it effects how health care is delivered. We've already talked about the NHS Blog post on proposed legislation in the UK to mandate psychiatric evaluation (or screening?) of all those entering hospice care. Clink goes on to talk about legislation mandating screening for post-partum depression in New Jersey, and her feelings about legislating health care relationships. See Mandatorily Yours below.

I think the whole world is nuts.

Okay, let me explain. Basically, I believe you live until you die, and that there are only a handful of things that one can control. The biggest, obvious causes of unnecessary premature preventable death are obvious: Smoking and Car Accidents seem to cause a lot of preventable mortality. People, however, want autonomy, and want to make their own choices: no matter how you dice it, smokers want the choice to kill themselves. And while I don't smoke, I do drive, and while I don't drive drunk and I'm reasonably careful, even good, careful, law-abiding drivers are susceptible to death. Last I checked, it's illegal to drive while intoxicated, but this mostly seems to be an unenforceable law.

So what can we control, and should we? What do we, as a society, choose to legislate, and does it make sense? Over forty years after the Surgeon General's warning about the dangers of smoking, we're finally making it illegal in public places. You may be legal to drive after a drink or two, but if you're on your death bike (oops, I meant motorcycle), you may be required to stick a helmet on your head --so much for the wind ruffling through that gel-held hair-- and to buckle your seat belt. Should we go further? Why should you be allowed to stroke out - should we mandate yearly blood pressure screening? Should we make junk food illegal? Please say no! But wait, in New York City, they've passed a law banning trans fats in restaurants ! So you can smoke then have a couple of drinks (keep that level under 0.8) and jump in your car (don't forget to buckle up), but I can't eat a donut?


NeoNurseChic said...

Ah but the Governor of New Jersey's wife had PPD (or somebody important's wife in NJ - I can't really remember), so now we have this lovely law. Or at least talk of it. It definitely comes from famous political New Jersey person's wife having had post-partum depression and now making that her personal cause. Sure, I'm all for causes - have plenty of them myself, but I don't think anybody should be forced into therapy or psych evals. I do think that it's probably a good idea to hand out information pamphlets on post-partum depression as part of the whole post-partum info packet. Is that going too far? I hope not... Sure, some people could read it and then decide they have that - but that happens with anything. I think it would be helpful for those who really don't understand the feelings they are experiencing.

Anyway - that NJ law effects me and mine. Since most of my fellow employees are New Jersey peeps and not PA people. Also, we get a lot of transfers in from hospitals in NJ, so I'd be curious to hear what sort of education/intervention these new mothers have had. And given that those transfers are then all mother's of NICU babies - no matter how long/short the stay, I'd imagine they are much more emotionally fragile than most. Sure, talking to somebody might be helpful, but if they end up being required to go through some kind of screening, I imagine that this particular population might be easily mistaken for having PPD when in fact, they are just very stressed and scared about having a baby in the NICU.

Sorry this is jumbly and not coherent. Tired and usual.

Take care,
Carrie :)

ClinkShrink said...

At least smoking and drinking and trans-fat consumption laws don't have anything to do with telling doctors what to do with their patients. Why not have laws mandating how often Pap smears should be given? Or requiring doctors to give HPV vaccinations to all women of childbearing age? (Note to policy wonks: these are not serious suggestions!) It just seems so arbitrary that certain medical practices are required by law and others are not. Separate from infectious diseases which could affect entire populations quickly, government should stay out of medical practice guidelines. We have enough disagreement amongst ourselves about how things ought to be done.

Personally, I'm voting for mandatory colonoscopies for all newly elected public officials over the age of 40. Talk about running for public office...

Dinah said...

I am absolutely in favor of screening new mothers for depression. Even in New Jersey (I grew up there so I'm allowed to make fun of the state). Actually, I'm in favor of screening everybody for mental illness during the course of routine history & physicals. What I'm not in favor of is Legislating it.

Sarebear said...

What about a law against hot McDonald's coffee? Cause some people are too stupid to know it's hot, thus suing.

I don't drink coffee, but it's the principle of the thing.

It doesn't seem too far a road to becoming a "thought-police" state, when it starts to become a "everybody must conform to what we say", state. I mean rigid narrow things, like that trans fat law.

Wait, I gotta go now, the thought-police are at my door . . . .

hee hee.

NeoNurseChic said...

That should say - if they end up being forced into treatment based on a positive screening when in reality their emotionally labile state or depressed state may be due to a reaction of having their baby in the NICU. We see such a wide variety of reactions to this very stressful circumstance - anywhere from withdrawing, to being very emotional and extreme, to being flat and unemotional. Some of it has to do with the personality already present before, but other parts of it have to do with a person's reaction to shock and stress, mixed with pregnancy hormones.

Midwife with a Knife said...

Ah... postpartum depression doesn't really exist anyway. Just ask Tom Cruise. Those docs are just trying to screw people over. :P

(I think I got up on the anti-scientology side of the bed today)