Sunday, November 24, 2019

The streets of ... name-your-town

The series of tents on the sidewalks was no carnival but the crude shelters that the homeless have put up for themselves.

It saddens me to no end.

It angers me that this is the reality in one of the richest and most powerful country that humanity has ever known.

This is not merely an Eugene story, but all across the country.  Therefore, it pisses me off that the federal government could not be bothered about it.  As I wrote here a few years ago:
I pay taxes. I expect the government to use the revenue to take care of my fellow humans in this country. Instead of doing that, my government spends gazillions on the military in order to bomb the shit out of countries and send them back to the stone age. A gazillion for defense, but ask for a couple of millions for some homeless program and they cry poverty. And I am forced to then deal with this reality on a windy and rainy night at the grocery store parking lot. Pox on the war-mongering demagogues!
The President one-ups every one who was in the White House before him; the President directed aides to figure out “how the hell we can get these people off the streets" because he views that the homeless are living on the “best highways, our best streets, our best entrances to buildings . . . where people in those buildings pay tremendous taxes, where they went to those locations because of the prestige.”  The madman can only think about real estate and dollars, and 63 million people, including the "true" believers of Jesus, applaud his views!

My personal consolation is that my work does not require me to personally interact with the homeless.  Because, given my empathetic wimpiness, I would be paralyzed into inaction.

Consider, on the other hand, this lengthy note in the NY Times' Ethicist column:
I’m a doctor in an urban emergency room in California, and I’m struggling with two classes of patients who are becoming more common in our E.R: patients experiencing homelessness, and patients with chronic pain requiring opiate therapy. 
By law, E.R.s are required to medically screen and stabilize all patients. What this means is that any person can come to the emergency room with any medical complaint and be given a warm place to stay until said medical complaint is evaluated. While this law is being used appropriately by the vast majority of patients, a small subset of patients (often the most vulnerable) take advantage of it. They know that if they present to the E.R. with a medical complaint — real or imagined — they will be guaranteed a bed for a few hours and a meal (per California law). We will often see the same handful of people once or twice a day. We know that they often have no other access to food or shelter, and we want to be helpful. The problem is that the E.R. is not meant for shelter and food. First, it is a very costly use of resources. Second, these patients often divert scant resources such as ambulances and beds from others who have acute medical needs. We often have to weigh whether to provide the desired food, shelter or clothing or deny those resources in hopes that the patients are helped elsewhere.
Similarly, we have seen an uptick in chronic-pain patients abandoned by primary-care clinics that no longer administer opiates due to the unclear crackdown on opiate prescribing, even legitimate opiate prescribing. Patients often come in desperate because of their ongoing pain, or because of the withdrawal from medicines taken safely for years. Some will even threaten to start using heroin if we don’t prescribe opiates, which we know is a real possibility. And again, while we want to help, we cannot have the E.R. become the default place for people to get pain medicine when others won’t help.
I struggle with these questions daily. The reality is that it is costing the health care system $200-$300 to provide a patient with a cold turkey sandwich. How do I, as a physician, proceed? Name Withheld
The Ethicist, Kwame Appiah, who is one of my favorite contemporary public intellectuals, reminds us in his response that this is not the doctor's problem, but our collective problem.  Appiah wraps it up with this:
But at the moment, you have good reason to complain: That we still haven’t addressed these problems adequately makes it harder for people like you to do your job.

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