The Anarchist in the Cancer Center
From Bad News Press by Joe Peacott
There are certainly frustrations associated with being an anarchist and working as a nurse. The entire health care system, like the rest of society, is riddled with authoritarian relationships, corporate penny-pinching and profit-taking, and intrusive government regulations. The state believes that individuals are not capable of taking care of themselves so it requires licensing of healthcare providers and institutions and prevents people from purchasing most drugs without a doctor’s note. Besides restricting the number of health care providers and limiting people’s choices in seeking treatment, licensing and prescribing laws institutionalize the hierarchical relationships between doctors and nurses, nurses and patient care techs, and, perhaps most importantly, between those providing care and those receiving it.
I had evolved into an anarchist and individualist before I graduated from nursing school, so I knew what I was up against from the beginning of my career. But, 40 years later, I remain happy with my choice of an occupation. I love the work I do and enjoy my relationships with most of my patients and some of my co-workers, including physicians and even some of the administrators. Besides enjoying my day-to-day work duties and the interactions with patients, I find my areas of specialty, cancer care and infusion nursing, intellectually stimulating, as well. I get to work in a chemotherapy infusion center, a radiation oncology department and in the office of a group of gynecologic oncologists. In these various roles I do all sorts of nursing work: I educate, counsel and comfort patients; I support and educate other health care workers: and I work closely—largely collegially—with physicians, nurse practitioners and physician assistants in planning and managing patient care. This job works for me.
Over the years I have tried to live out, as well as I can within the constraints of statist health care, my individualist and anarchist values. In my relationships with my patients, this largely takes the form of making sure the people I care for are knowledgeable enough about their illness and their care options to play a role in determining their treatment. All too often patients blindly follow the orders of their physicians, simply because they are physicians. While their treatment plans are generally ones I agree with, I believe people should know why they are getting the drugs or radiation they are receiving, how the treatment works, and what the side effects or other downsides are.
Patients sign form after form declaring they are giving informed consent to this or that treatment or procedure, but most of them are ill-informed, at best. This is usually not the fault of any individual, but the result of a combination of things: physicians unable to take the time to fully explain treatments, other health care workers who are not knowledgeable enough to answer patient’s questions, and patients who are overwhelmed by their diagnosis and really do not hear or understand what they are being told. I see it as my job to make sure patients get the information they need when they are most ready to absorb it, so they can understand what is happening to them and make truly educated decisions.
I spend a lot of time explaining to people how to prevent or treat symptoms caused either by their disease or by the treatment they receive from me and others. Again, whether because they weren’t told how to respond to them or didn’t “hear” what they were told, patients often tolerate treatable conditions, including significant pain, without seeking help from their physician or other healthcare workers. Something that complicates this piece of my work are the widespread myths about pain medication and addiction, made much worse recently by the so-called “opioid epidemic” which I wrote about in this zine last year. It is not uncommon for doctors to undertreat people’s pain and for patients to avoid taking narcotic analgesics because they are afraid they will become “addicted.” This is largely because of the crap the government has been peddling for years about “dangerous” drugs, as well as the punitive laws which sometimes scare well-meaning physicians into denying their patients adequate treatment. I consider counteracting misconceptions about pain relievers to be a key part of serving my patients well.
I like to think that by encouraging patients to be active participants in treatment planning, enabling them to take charge of maintaining their own health and comfort, and prompting them to question the prevailing myths and “expert” opinions with which they are presented, I promote their independence and autonomy, even if it is only in this one area of their lives.
Nurses as Workers
The other part of my working life where I try to put at least a little anarchy into action is as a union activist. When I was a grievance officer in my chapter, I spent a fair amount of time advocating for nurses who had gotten into some form of trouble with the boss. I sat in on disciplinary meetings with nurses and managers, filed grievances as needed and helped people navigate the human resources and payroll bureaucracy when errors were made or people’s contractual rights were violated. There is a huge disparity in power between management and labor, and unions, for all their faults, add a bit of protection for workers so that some limits can be placed on the ability of managers to discipline, discharge, and generally beat up on workers. While I no longer work as an “official” grievance officer, I still take part in particularly difficult grievance cases, and continue to be on the union team during contract negotiations and related discussions. Helping folks out and standing up to the powers that be can be enjoyable.
But there are also problems with traditional trade unions. For one thing the contract we sign with the hospital enshrines management rights and the power differential between those who own and run the hospital and the rest of us. The union is left in the position of just making sure that the boss doesn’t go too far. We can never challenge, at least through contractual means, the hospital’s power to manage and give orders to the people who do the real work.
Perhaps the biggest problem is that few members actually take part in the life of the union. A few of us do all the work and negotiating and phone calls, while most people never do any more than vote for officers or participate in contract ratification, if they do even that. Unions, even traditional AFL-CIO organizations, often have relatively democratic structures, at least on the local level, and have the potential to be a means to fight hierarchical organization and increase the power of individual workers, but they never seem to actually achieve this. Just as in other institutions and organizations in society at large, there are those in the unions who seek to wield power and influence over others while fattening off the (often mandatory) dues of members, and those who are unwilling or unable to speak truth to power and stand up for themselves. Corrupt union officials and passive, apathetic members are both to blame for the sorry, hierarchical internal state of most unions.
And finally, the relationship between union and management is regulated extensively by the government, so both sides can appeal to the state to settle disputes when they can’t come to an agreement on their own. Sometimes the resolution favors the hospital and sometimes it works to the advantage of the union, but in either case it serves to reinforce the control of the process by government, something that is anathema to this anarchist.
What I Would Change?
Inasmuch as I think that the philosophy and scientific basis of allopathic medicine are largely valid, I would hope that much of the work I do would still be done in some form in a free society. People will still get cancer and require treatment, and, however ineffective allopathic therapies are at times, there is no system of healing that works better. Of course, preventing illness in the first place works even better at preserving health, but that requires effort on the part of individuals. While I like to think that free people might take more responsibility for their own well-being and live more healthily in order to stay well and avoid having to deal with physicians and nurses, I’ll believe it only when I see it.
What must change, however is the hierarchical way in which this care is provided. That will require getting rid of professional licensure and other barriers to entering the healing occupations. Eliminating licensing by the state and regulation of practice by government boards would do away with the enforced doctor‑nurse-technician-patient hierarchy and allow consumers and providers of health care to contract for services however, wherever, whenever and with whomever they like. It would also allow providers to team up and practice jointly without one or some giving orders and others simply obeying.
We also have to eliminate the prescription system which keeps individuals from choosing and using the treatments they would like. This system forces patient to see state-licensed providers for even the simplest and safest medications, driving up costs and bolstering the image of the physician or other provider as parent or priest. People should be free to ingest, inject or smoke whatever they like without having to get the approval of a state-appointed expert before doing so. This would include all drugs, including narcotics, stimulants, hallucinogens and other medications which are and have been irrationally demonized by the state, the news media and much of the medical establishment. Besides freeing up access to medicines in this way, we should also do away with laws granting patent protection and other intellectual “property” rights. These statutes allow drug manufacturers to charge exorbitant fees for the medicines they produce, an expense which is a key driver in the ever-increasing cost of health care.
Labor laws should be abolished, as well, so that in situations where there are bosses and bossed, the bossed would not be prevented by the government and its police from really taking on the powers that be. This society and its laws have institutionalized the concept that some people involved in a business should have the legal right to own it and run it, while everyone else is relegated to the status of mere employees who can be dismissed at will. This idea that some stake-holders in an enterprise should have powers and privileges that are denied to others, including the ones who do the actual work and bring in the money which the bosses pocket disproportionately, is widely believed in this society. This belief needs to be challenged by anarchists so that people begin to question and reject it. Once people have come to see the injustice of capitalist ownership and management, the legal framework and enforcement mechanisms which uphold and defend this economic system can be confronted and defeated by those who are its victims.
I have laid out above a few basic components of a strategy for changing the current model of health care in the united states into one more suited to free, autonomous individuals, whether they are receiving or providing care. I recognize that it is unlikely any or all of these changes could take place without a more widespread, revolutionary, change in the rest of society. Abolishing government, and with it the hierarchy and inequality it enforces, is the only way I can see any real, sustainable change taking place. Meanwhile, I intend to keep on caring for and empowering my patients and their families, and doing my best to make people think about how health care could be provided in a more humane, respectful, and libertarian way.