Yoshie,
I'm going to respond to some things line by line then give a summary at the bottom. sorry this is long, but I couldn't see anyway else to fully address the points you raise.
Yoshie Furuhashi wrote:
If only a grave threat to a person's life or health is to be a criterion to
determine what counts as medicine, many "medical" decisions can't be called
medical. What is the criterion for "medical necessity" of flu shots,
they often prevent the death of old people - preventative medicine is what they call it
eyeglasses,
this is a correction for sight which is a medical issue
massages to ease back pains,
this is treatment for a medical condition
orthodontic
people have cavities, they must be corrected or your teeth rot and then you lose the ability to eat
well-balanced diets,
very few doctors I know of are up on nutrition - this is generally something we learn on our own anyway, isn't it?
assisted living, etc.,
to my knowledge people pay for this option themselves and it is not generally under the umbrella of medicine, though some health care insurers are getting into offering it as a long term care option (more on this below)
given such a
criterion? Most of us _can_ manage to "live" without them, can we, but
lives without them aren't the same as lives with them, as
institutionalization is not the same as assisted living. I think that you
may be equating "medical" with "medically necessary to prevent death or
gravely ill health" in the above remarks of yours.
No, I am speaking of abortions that are not connected to the medical health of a woman. Abortion clinics do not give women appointments with the doctor before hand - though a counselor may be made available if she feels like she needs to talk to someone about her decision. She generally does not see a medical professional until the actual abortion itself unless she is having medical symptoms, like bleeding or severe cramps, etc. So in most cases, she and her doctor are not making a medical decision, she is making a personal decision about her own body. It is her decision independent of a doctor's evaluation. Though when she chooses abortion, she will submit to a medical procedure. I am certainly not saying that abortion, regardless of reason, still should not be made available - but I do think there are draw backs to medicalizing women's reproduction processes (more on this below)
Given the current attacks on access to health care, we might have to be
careful not to narrow the scope of what counts as medical decisions. This
question of definition has repercussions beyond reproductive health and
concerns health in general and who pays for it. It is tragic that what is
said to be "merely desirable" -- a matter of "choice" -- has to be not
socially but individually paid for. In the context of privatization &
deregulation, we individually assume risks, do "comparison shopping," watch
out for "waste," and become efficient & effective "consumers" of medical
services. What should be a matter of medical decision-making becomes a
"consumer" decision in rhetoric, an object of statistical cost-benefit
analysis for HMOs, insurance companies, etc. in fact. Therefore, we might
endeavor to give a more holistic account of what counts as medicine and
health; otherwise, why not make disabled persons individually pay for home
care & assisted living -- it's a matter of "choice," calculated against the
"choices" of institutionalization & care by family members & friends?
Individuals do find that they mostly pay for it on their own, unless they are impoverished and can qualify for Medicaid or have a medical model version - like nurses sent to the home - through Medicare or some private insurance company -- but policies vary, and many fall between the cracks on this one, so its a mixed bag as to how much this has been medicalized in order to fit within the packaging required to get services. Many are institutionalized because personal assistance services or family assistance are not available to them.
Under capitalism, we have either an "individual choice" or "medical
necessity" -- we have _by definition_ no "social decision," for capitalism
doesn't allow "social decisions" to exist (except for the purpose of social
control).
The medical model does not exist independently of social control mechanisms either.
So, the contraction of "medical necessity" usually translates
into the expansion of "individual choice," which means "personal
responsibility" in effect. And that's bad for all of us.
I long for the day when abortion, as well as a host of other services such
as assisted living, will become generally regarded as a _socially
beneficial_ service to be made use of _individually_, but such a day has
yet to come.
Childcare exists as a free social service under capitalism in the Social democratic countries in Europe. Childcare could have been medicalized too -- the medical profession could have been put in power to determine if it was in the best interest of the parents' mental health to have childcare available outside the family unit.
While I understand your caution about privatization and consumerism and HMO business practices opportunistically severing some services if they aren't called medical, it is also important to recognize that the medical profession has commodified "patient hood." Patients are consumers of medical services. And it has established TOO much control over peoples lives. Having a baby, for example, has been converted into a medical event. Some feminists in Europe (Maria Mies, silvia Kontos, I would especially recommend Theresia Degener's "Female Self-Determination between Feminist Claims and 'Voluntary' eugenics, between 'Rights' and Ethics" Issues in Reproductive and Genetic Engineering, vol. 3, No. 2, pp 87-99, 1990) ) are alarmed by this reality. The power of a woman giving birth has been handed over to physicians. Women think they are in charge but they aren't. Their pregnant bodies have been commodified by the medical profession just as disabled people's whole lives have been. The need for an attendant, for example, has been made into a medical issue when it is a functional issue. It is often deemed a medical task for trained nurses to perform, when all it is about is having someone help you get out of bed and do some minor tasks that don't require a nurse's training. The whole of society is conditioned to think that we need nurses because the medical profession has so dominated our thinking. This domination has benefited the medical professionals more than people with disabilities. I think some services now under the umbrella of medicine do need to be converted to a social model, rather than preserve the status quo and those services should be fought for as the social dems fought for childcare, free public education, etc.
best, Marta