How often do we hear children say “that’s not fair!” How many times have you asked why you or someone you consider a ‘good’ person was dealt the worst hand in this game called life? The truth is…. life isn’t fair. There’s little justice. It just is.
Today’s reflection takes the cardinal virtue of justice – or it just is – as its theme. Buckle up, this could be interesting/thought-provoking/nonsense. Read and decide for yourselves.
Justice: Noun – just behaviour or treatment; the quality of being fair and reasonable.
Cancer doesn’t discriminate, it will happily strike the fittest, slimmest, most health conscious people if they’re genetically predisposed or exposed to certain environmental factors. The process of this disease is extremely complex. Justice plays no part in cancer development, treatment or the long-term outlook. It just is and whichever hand we’re dealt, we have to make the best of it. I could witter on about it forever; instead I’ll draw your attention to three points for contemplation – treatment, employment and family/friends.
Treatment: We have a National Health Service in England. You might think it’s free; it isn’t. It’s partially funded by National Insurance contributions deducted from salaries at source. Most people also pay for prescription medicines, dental treatment, opticians and anything to do with hearing. Cancer patients are exempt from prescription charges which seems fair and reasonable however we have to pay for dental work, sight and hearing aids in spite of the fact that some cancer treatments affect eyesight, damage hearing and teeth.
Another common misconception is that the NHS prescribes the most effective drugs, e.g. to manage side-effects. This is a fallacy. The NHS prescribes on affordability; it often means cheap substitute drugs. NHS administrators balancing the books assume this is OK because substitutes are designed to do broadly the same thing as their more effective (and expensive) counterparts. However, cancer patients and medics will tell you substitute drugs don’t always work as well. They often cause unnecessary suffering and avoidable hospital admissions (that prove more costly than the more effective drugs), it’s more stressful for the patient and adds to the workload of our overstretched doctors and nurses.
Look at the words – unnecessary, avoidable, suffering, stressful and overstretched. Now associate them with the justice – the quality of being fair and reasonable. It doesn’t make much sense does it?
In the US things are more confusing. I’d love £1 for every post I’ve read from someone fighting an insurer over the scans, medicines and follow-ups covered by their policy. The words fair and reasonable come to mind until I remember the mantra life isn’t fair. I used to work in insurance; insurance companies want to make money, they don’t care that my US friends are fighting for their lives and need the best treatment to enable their survival (or provide a comfortable journey to the end of life). Those without insurance are in an even more difficult situation; the most needy people treated in the poorest way by a civilised society. Justice? No. It just is.
In low-resource countries the situation is desperate. Fatality rates are highest in these countries because most have resource constraints that limit the capacity for detection, diagnosis and treatment. In these countries women most commonly present with node positive locally advanced breast cancers; chemotherapy is required to treat them and often the underlying resources/infrastructure are absent. When chemotherapy isn’t available these people only receive palliative care. Once again the poorest people are dealt the worst hand in the game. It doesn’t have to be this way; it just is.
Employment: Scorchy over at The Sarcastic Boob wrote an excellent piece titled Professional Identity in Crisis. Times have changed; for many women their careers are an integral part of their life so exclusion from the workplace for any reason (could be employer incompetence, failure to understand or appreciate what a person with cancer wants/needs during treatment, the effects of treatment itself or issues created by metastasis) can have devastating consequences. Continued social interaction during cancer treatment and the survival benefits of support networks at home, at work and in the community are well documented. Eating healthily, avoiding processed foods and buying organic where possible is significantly more expensive than supermarket own brands. Purchasing drugs that aren’t provided by the NHS or an insurer is very costly. Work is important to the cancer patient for many reasons. Ultimately it’s important in a practical sense; cancer patients need money to live. Putting them on the bread-line or into the benefits system (where one exists) makes survival a thousand times more difficult. Inducing stress by causing unnecessary worry is a proven route to metastasis!
Sadly too few employers understand cancer, too few seek to establish what the cancer patient wants to do and too few make adjustments that would enable the individual to balance work, treatment and the benefits that stable employment and sustained social contact can bring. Too few employers think about the real issue a cancer patient is facing.
The real issue is life or death and I defy anyone facing the uncertainty of death to deny that compassion, just behaviour and treatment matters to them. It’s one of the only things that matter when everything else is sliding out of reach.
Family and Friends: Justice, family and friends is a conundrum. Cancer is tough. It’s tough on the patient but it’s equally tough on family and friends. They don’t have to go through treatment or side-effects but they share many of the same worries. Will the treatment work? Will the cancer come back? Will s/he die? As with all traumatic life events some of us are better equipped for them others. It doesn’t mean some people are good while others are bad, we just have different approaches to difficult situations.
What many cancer patients need more than anything is a sense of certainty. Cancer throws everything up in the air and makes life very uncertain. Family and friends are well-placed to generate certainty by remaining present, offering support, listening and providing a shoulder to cry on. As the family or friend of a cancer patient, this can be difficult; fear isn’t reserved for the patient alone. Patients have no choice, they have to find a way around, over or through their fears. Family and friends have more choices; they can choose to overcome their fears and be staunch supporters of the patient. Or they can be consumed by fear and chose to hide away. I understand the second choice, fear and flight go hand-in-hand but I couldn’t do it myself. I couldn’t abandon a family member or friend in need. I understand some things look too hard, too painful and too frightening to endure and that might be true – but you don’t know for sure unless you try.
When family or friends decide it’s all too much, cancer patients have a variety of reactions. Sometimes they blame themselves for the impact they have on other people when dealing with a disease they didn’t ask for and have very little control over. On occasion they may get angry and ask ‘how could s/he disappear at a time like this?’ Often they just get sad; the absence of dear ones who’ve been ever-present until cancer came a-calling is an emotional blow.
Fortunately I haven’t had this experience but many of my friends have and it’s hurt them deeply, far more deeply that the cancer itself.
Justice, treatment, employment, family and friends. It’s not for me to tell other people how to behave but I pose a question – to health providers, insurers, administrators, employers, family members and friends….
Imagine you’ve been diagnosed with cancer. Today, as you hear the words “you have cancer,” your whole world begins to fall apart. Everything you thought you knew, all the plans you had, your hopes and dreams, they’ve all dissolved in front of your eyes. You’ll feel this way tomorrow and the next day and the day after that.
It just is and you’re going to have to make the best of the hand you’ve been dealt.…. somehow.
So ask yourself how you’ll assess justice, the quality of being fair and reasonable, when you can’t get the treatment/drugs you need, when your employer fails to understand the importance of your career or your need to work. If that’s not enough, some of the people you hold so close to your heart just disappeared from your life in a flash.
Are you wondering what just happened to you? And what they hell you’re going to do about it?
Justice: a nice concept crying out for the practice of being fair and reasonable.
It just is.
- Study ties drug shortage to poorer cancer survival (business.inquirer.net)
- In Every Sorrow There Is Profit (rogerpassman.wordpress.com)
- Stress fuels metastasis to bone (ScienceDaily.com)
- Heavenly graces, cardinal virtues, cancer and Christmas. (fecthis.wordpress.com)
- O’Hanlon v. HM Revenue and Customs
- Jewel settles disability discrimination lawsuit for $3.2 million
- PSNI pay inspector £55k over post-cancer discrimination