Contradictions and Strategies (continued from page 9)

industry. A team approach (patient, doctor, and other medical personnel) should be fostered.

Contradiction: "Informed consent" sounds like a positive step for patients' rights. But in large part it has been turned into a tool to protect hospitals and medical personnel from malpractice litigation, and drug companies from legal responsibility for the negative effects of their products. A patient's Bill of Rights may be used for little more than hospital decor.

In a landmark California Supreme Court case, Cobbs v. Grant, the Court stated: "...when a given procedure inherently involves a known risk of death or serious bodily harm, a medical doctor has a duty to disclose to his patient the potential of death or serious harm, and to explain in lay terms the complications that might possibly occur." Under this ruling, the typical hospital consent form, which makes you feel as if you have signed away all your rights, is no legal protection to the physician, because it "contains no actual explanation of the treatment or of the risks, so it conveys none of the essential information to the patient".

In California, at least, this ruling gives some legal backing to patient rights, (1) to decide what procedure shall be done, (2) to know what is proposed to be done, (3) to know potential side effects of treatment, (4) to know side effects of any drug prescribed, and (5) to know alternatives to what is being proposed. However, unless such rights are demanded, they are not likely to be forthcoming. Cases such as Cobbs v. Grant result primarily in an increase of more detailed consent forms to be signed by the patient, as well as more written explanations which spellout risks and atlernatives. Even this is a step forward. A Patients' Bill of Rights, vague, general and without enforcement mechanisms, was published by the American Hospital Association in 1972 in response to patient activism and increasing lawsuits. Tepid though the AHA document is, only 30 percent of all hospitals have adopted it. From intake to final bill payment, everything in a hospital is set up to foster patient vulnerability and passivity. Thus, many people do not realize they forfeit no legal rights or interests as consumers when they enter a hospital. Consent forms do not eliminate responsibility for negligence.

Strategy Principle: Use every means available to overcome medical dependency. This includes litigation, legislation (e.g., bills for right to access to medical records), administrative remedies (e.g., drug label hearings), and public consciousness raising. We must select issues of special concern to older women and pursue them both on our own and in conjunction with other medically oriented advocacy groups. "Informed consent" must become the patient's banner, not a professional smoke screen.

Contradiction: In our modern psychological society, any state short of bliss is too often defined as illness. But in our search for dignity and love, perhaps we are more troubled than sick, with troubles strongly based in reality. The legacy of Freud and his modern day counterparts may be potent pressures to conform, as well as a heavy load of guilt laid at the doorstep of older women.

In the Community Mental Health services in the San Francisco area (and. the figures are probably quite typical), twice as many women as men between the ages of 45 and 64 were served. It would appear that women are receiving far more than their share of such services, but the question might be asked, why did they need them? Is inental health of older women more fragile, or are they suffering from lack of job opportunity, desertion, and loss of status? If the latter, are the answers to be found on a psychiatrist's couch, or in collective actions toward social change? Women consume 70 percent of all tranquilizers

and anti-depressants, and most of these are taken by middle-aged and older women. Why do so many of us need our moods altered and does the result justify the danger of addiction? Perhaps if older women would share their problems in support and in consciousness raising groups they would find that they are not alone, that the "fault" is not theirs, and that despair can be replaced with new hope.

Strategy Principle: Most of us are in a better state of mental health (more “normal”) than we think we are. Many of our problems are very real ones which can best be addressed by mutual support and social action. Serious mental health conditions need the best of care available.

Contradiction: Holistic health care-a preventively oriented alternative which views the individual as a whole person within a social framework-is the new panacea. But is it viable in the 20th Century? What is it and where is it available?

Traditionally trained MD's have basically two things to offer a patient: drugs and surgery. Other health practitioners are now offering different therapies-biofeedback, herbal medicine, meditation, megavitamin therapy, acupuncture and acupressure, to name a few. The essential difference, however, is not technique but the underlying philosophy. From the holistic viewpoint, disease is seen as an important feedback message. It is assumed that the body knows how to heal itself and that we must learn how to deal with the stresses which prevent these processes from functioning properly. The central concept is that the individual is responsible for maintaining her/his own well-being. Holistic health is a response to frustration engendered by the growing adversary relationship between patient and doctor, with "Heal me or I'll sue you" as the most extreme symptom of rift between healer and sufferer.'

These alternative therapies have made considerable headway in "advanced" urban areas but are scarcely an available resource in most of the country. However, older women have traditionally been the storehouse of informal health care information, and their methods too are part of the wealth of practical knowledge on care of the body.

Strategy Principle: We shouldn't throw the doctor out with the bedpan. We certainly don't want to return to 17th Century medical practices, but room must be made for alternative therapies, and physicians should be put in their proper place. A holistic approach should include consideration of the social structure, including environmental influences, existing medical practices as well as alternative therapies, a unified view of body and mind, and programs for nutrition, exercise and rest, with the patient in charge. Holistic means a balanced approach.

These contradictions shouldn't daunt us, but instead should afford a method of looking at our health problems in a rounded fashion, in conjunction with others seeking a way out of the muddle. Certain threads already emerge: the special health problems of older women have been neglected-are even invisible; most aspects of current health care controversies impact strongly on older women; we need to fight for our "fair share" of what is now available while we also work to broaden the base of health care delivery, especially for chronic illness; and if we want to stay well, we will have to do a lot more for ourselves.

Footnotes:

'Lowell S. Levin, "Self-Care and Health Planning," Social Policy, Nov./Dec. 1977, p. 49.

2 Irene Oppenheim, "Third-Party Payments,' Social Policy, Nov./Dec. 1977, pp. 56-57.

'The Holistic Health Handbook, Berkeley Holistic Health Center, And/Or Press, Berkeley, 1978, p. 18.

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