Author: Haruka Sakamoto
Have you ever thought about how long we should continue with medical intervention? Should we set conditions on whether patients get treatment or not? One of my experiences made me realize that we should think about these questions to keep proper medical service.
“Have you ever heard about Charley Guard*?” This was the first question our teacher asked us at a seminar on euthanasia.
In 2017, I attended a summer school program in the Netherlands on the topic of global health as a Japanese medical student studying medicine in the Czech Republic. Some participants were from European countries, some came from Latin American countries such as Mexico, Colombia, and Brazil, and the others came from Indonesia and Africa.
At day 8 of the program, we had a lecture about euthanasia. In the Netherlands, euthanasia is allowed not just for adults but also for children. We learned the current situation, and then divided into small groups and discussed euthanasia of children.
During the discussion, an idea crossed my mind, which was that medical ethics differ according to a person’s origin. I noticed that people from poor or developing countries tend to have practical ways of thinking, whereas people from wealthy and developed countries tend to consider feeling and equality. My thoughts became clearer when we talked about whether an infant with a serious disease that has a low cure rate is worth curing. What impressed me most about the discussion was the following.
A Ukrainian woman said, “In my country, when an infant or fetus has a low cure rate such as 3%, parents most often choose euthanasia or abortion. Three percent is just an example, but this percentage is enough to give up.” She continued telling us about her background. “There are not enough medical resources in Ukraine so we cannot afford saving the life of an infant who has a disease with a low cure rate. If parents want to save their child and if they have money, then they can treat him or her in another country such as Germany.”
After that, a Slovakian woman who studied medicine in the UK argued that it is not fair that rich people can receive treatment while poor people cannot. The Ukrainian woman just said, “That is life.” I was hit by the cruel reality. Equality is important as everyone says, but things do not always work like that. Talk about equality sounds nice, but that is all.
After the small group discussion, we gathered and shared what we discussed. At that time, I was especially impressed by two questions the teacher asked us.
1. Some countries with high technology are trying to find treatments for incurable diseases that are normally not treated. Some people have the opportunity to receive advanced treatment while other people do not. What can we do to solve this inequality?
2. When deciding on treatment, people tend to choose according to their feelings. However, how we feel differs with every single individual. How can we decide the level of suffering of disease?
I thought about many things. To what extent should medical care intervene with us? What are the conditions of getting treatment? How can we decide on conditions? Is it possible to achieve equality in medical service? What I learned through the workshop about euthanasia is that finding answers to these questions is difficult.
I think such questions are not only related to euthanasia but also to medical services for elderly people as well.
Even though differences exist in each country, many European countries have universal health care like Japan, which means that developed countries supply equal access to medical service. This situation looks very ideal but it causes some problems such as increased medical fees.
In Japan, continuously increasing medical fees are a big problem. In the Czech Republic, people are dealing with the same problem. There are three main reasons for this situation: easy access to hospitals due to universal health care, improvement of medical technology, and an aging society.
More elderly people will mean more medical fees. University Hospital Olomouc, where I study medicine, opened its geriatrics department this year. In addition, the aging population** is about 18% in European countries, while in Japan it is 25%. Therefore, the acceleration of aging societies in developed countries is obvious.
Given this situation, countries with universal health care should change the system, otherwise it will collapse in the near future. Since Japan has lower taxes than those of European countries, I think collapse is more likely to happen sooner in Japan (e.g., Japan’s tax rate is 8%***, but the Czech Republic’s normal tax rate is 21% and its reduced tax rate is 15%).
I faced differing ways of thinking between people from developing and developed countries. From my experience during the summer program, it seems that developed countries have become stuck under the name of equality. Because medical technology will continuously improve, I suggest that we should think about conditions for receiving treatment or stopping medical intervention to keep proper medical service.
*** It will be 10% from 1.10.2019