SHAPING DECISIONS IN HEALTH CARE POLICY.
What happens in the courtroom, in the state legislature and in Congress affects what happens at the bedside, within families and between patients and their doctors. Philosopher, attorney and psychoanalyst Bill Winslade knows that. Holding dual appointments at the Institute for the Medical Humanities and the University of Houston's Health Law and Policy Institute, he uses the insights offered by the humanities to illuminate the issues that arise as our society tries to craft a health care system that balances access with available resources, technological progress with human values.
“One role of the medical humanities is to mediate among all of the different interest groups to make better laws, establish better public policy and protect the rights of individuals,” Winslade says. In addition to teaching graduate, medical and law students and serving on UTMB's Ethics Consultation Service, he collaborates with political leaders, government agencies and grassroots organizations to propose and evaluate new and better ways of preventing injury and illness and providing better care.
One area that has caught Winslade's attention is traumatic brain injury. Brain damage resulting from traffic accidents, falls, sports injuries and violence is the fourth greatest cause of death in the developed world; and the annual cost of treating and maintaining those disabled by such trauma runs in the billions in the United States alone. With the help of the Rockefeller Foundation, Winslade organized an international conference on permanently unconscious patients in Bellagio, Italy, in 1994. Hearing participants from Europe, Asia and North America discuss their countries' treatment policies strengthened Winslade's conviction that resources need to be shifted from patients who can't be helped to those who can: brain-trauma victims who, with proper rehabilitation, have a chance of recovering at least some ability to care for themselves and to interact with others.
“In this country, we're willing to spend money on rescuing people from the brink of death and even keeping them alive,” Winslade points out. “What we're not so great at is investing in restoring them to independence.”
Winslade argued this case persuasively in his third book, Confronting Traumatic Brain Injury, published in 1998 by Yale University Press. And he went further, maintaining that society has an obligation to enact policies that curtail this waste of human life and potential. In his book and in frequent guest columns for newspapers including the Houston Chronicle and the New York Times, he recommends banning boxing (“the only sport in which the goal is to inflict brain injury on your opponent”), enacting bicycle and motorcycle helmet laws for adults as well as children, raising the driving age to at least 19 and requiring annual driving tests of everyone 65 and over.
His suggestions aren't always popular, but years of serving as an expert witness in court cases have taught Winslade to hold his ground.
“The overall goal of taking the medical humanities out beyond the ivy-covered walls is to educate the public on matters important to their health,” he explains. “We are experts who should be witnesses to the community. Our job is to help people find new ways of seeing, new ways of relating—to each other and to the challenges we all face.”