The five women gathered in the living room of Ina Bliss' Irvine apartment had perused the questionnaire on ethical health care issues and were in the process of picking out items for discussion.
It was the outset of a California Health Decisions-Orange County Project small-group meeting, one of dozens of such meetings being held throughout Orange County to elicit the public's opinions and concerns for future recommendations to health care providers and policy makers.
The suggested health care discussion issues range from the right of patients to refuse life-prolonging medical treatment to whether everyone who needs expensive life-saving procedures (such as organ transplants and open heart surgery) should have an equal chance at having them.
As is typical at the small-group gatherings, it didn't take long for the meeting to evolve into a lively dialogue.
"We are one of the few (industrialized) countries that doesn't take care of its citizens, and I think it's a disgrace," said Molly Lyon of Newport Beach.
"I think this is all very nice," said Anne Campbell of South Laguna, scanning the questionnaire, "but I don't see how in the world any government could provide artificial hearts and new kidneys for anybody in the United States who wished it. There simply isn't enough money to pay for things like that for everybody."
"Oh, I agree," said Lyon, "and I'm not talking about that. I'm talking about when people on Social Security get sick. . . . There has to be a base (of health care), I guess."
"We just have to give up 'Star Wars,' and we have to give up arming to the teeth," observed Lois Shea of Newport Beach.
"Is that an adequate statement for a group such as this?" Irmeli Desenberg of Balboa asked.
"What I think I'm hearing you say," said group leader Bliss, "is that three of you so far are saying your very top resource priority is social services, which in this case is emphasis on health. . . ."
And so it went for the next 90 minutes, with the discussion veering off into numerous areas, including quality of life for the elderly, the right to die and whether all pregnant women should have access to prenatal care.
By the end of the meeting, which was leavened with occasional dashes of humor, anger and poignant personal observations from dealing with ill or dying relatives, the five women had come up with three recommendations:
- Resources should be made available for primary, or base-line, health care for everyone in the United States.
- Given that there is always $2 worth of needs for every $1 in resources, priority should be given to the elderly and newborns, but medical care should be appropriate to a patient's health status: Rather than using costly intensive care units, for example, it may be more appropriate for terminally ill patients to spend their final days in an ordinary hospital bed or at home.
- Individuals should make their own decisions on their right to die, not the government, and doctors should not be held liable for whatever direction the patient's decision takes.
These recommendations, along with those arrived at in the other small-group meetings, will help form the agenda for further discussion of ethical health care issues at larger town-hall meetings to be held throughout the county beginning in February.
For real estate agent Bliss, who is a member of the California Health Decisions Advisory Board, this was the first of three small-group meetings she will be facilitating. And she was pleased with the way it had gone.
Speaking Their Minds
"It went very well, but I would hardly expect it to be any different with this kind of group," she said, noting that the participants at this particular meeting happen to be friends of hers and that they either are, or have been, politically active and are used to speaking their minds.
Bliss observed that the meeting could have been more structured or focused but, she said with a smile, "part of the fun with being with women like this is sort of the intellectual cartwheels that everybody does. I'm not sure my other two (meetings) will be as stimulating; they'll just be quite different."
"The thing I like about this whole concept today," Molly Lyon observed toward the end of the meeting, "is citizens are taking it upon themselves to be involved before laws are made that affect us that we don't like. This is what I am for on every level of our society, not just on health decisions. And if this is a trend--God, I hope it continues and grows."
That, of course, is the goal of California Health Decisions-Orange County Project, an ambitious countywide effort being co-sponsored by the Orange County Health Planning Council and the Center for Bioethics at St. Joseph Health System in Orange.
"I think we do have the best health care system in the world and there are many things we do very well, but there are some things that need fixing," said project director Ellen Severoni in an interview.