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Does physical disability make a parent less fit?



There’s been a lot of discussion in the blog community this past week about the rights of disabled parents to care for their own children.


The Chicago Tribune has been following the story of Kaney O’Neill, a 31-year-old woman with quadriplegia who’s being sued by her ex-boyfriend and the father of their son Aidan, five months, for full custody, charging that her disability “greatly limits her ability to care for the minor.”

O’Neill – who has no use of her legs and limited use of her arms – worked with rehab staff for months before Aidan was born to build her physical strength and put adaptive baby equipment in place. She’s never alone with her son and has the assistance of a full-time attendant, her live-in brother, a mother who helps on weekends, and a trained service dog. A good overview of the case can be found at the New York Times’ Motherlode blog.

Still, headlines asked: Can a quadriplegic woman be a good parent?

It reminded me of a column by a single mom with cerebral palsy we ran in BLOOM eight years ago. Lisa Jones, then a health planner, was raising two daughters aged four and 10 (see photo above). She used a power wheelchair and had minimal use of her hands – perhaps not unlike O'Neill's level of physical function. This made it challenging to lift her daughters when they were babies, to support them as they began to walk, or to push a stroller. 

How did she do it? I wondered.

Lisa addressed the practical challenges of caring for her daughters' physical needs in this piece below, which I think is as relevant today.

‘I know that I’m raising really good girls’
By Lisa Jones

My philosophy is that even if I wasn’t disabled – and maybe because I am – it takes a whole village to raise a child.

My name is Lisa Jones and I’m raising two girls – Laural, 10, and Emily Grace, 4 – on my own. I think my role as a parent is to guide my daughters and help them along, but my family and friends also play a huge part. When parenting with a disability, I think it’s important to embrace the fact that we are all interdependent and we each have different skills to contribute in raising happy, healthy children.

I have cerebral palsy and work as a health planner. I use a power wheelchair and have limited use of my hands.

When I was growing up, I always knew I wanted to have children. I knew I had a lot of stuff to pass on to a child and that I could help a little person become a really good individual. I wasn’t exposed to the common stereotypes that suggest a person with a disability is somehow less of a parent, so it came as quite a shock when some of my relatives expressed these sentiments after I became pregnant with my first child.

In spite of this opposition, I believed in myself, and since my children were born, I’ve rarely dealt with attitudinal barriers. The greatest challenges I’ve faced involved caring for my girls physically during their early years. Because I have poor fine motor skills, I couldn’t easily lift my children when they were babies, support them as they began to toddle about, or push a stroller.

I met each of these challenges through problem-solving, trial and error and the fervent belief that I would be able to work something out. Many of the adaptations I came up with were based on simple ideas. For example, when Laural was born, my father built a crib with a side that slid away so that I could wheel right up to the crib. The crib was at a perfect height so that I could feed and change her there.

In order to lift Laurel, I would roll her up in a receiving blanket, then grasp the sides of the blanket and pull her onto my lap.

I couldn’t push a stroller, so in order for us to go for a walk, I figured out a way to carry Laural – who was then seven months – on my lap while I pushed my wheelchair. I made a padded apron that I would wear, and which Laural could lean against. It included a fabric strap that fit around Laural’s chest. Then I had my wheelchair repair store make an extra long seat belt that fit around Laural and me.

When Laural was first walking, I took her out wearing a harness with a long strap that I held. I would take her to enclosed playgrounds so that she could run freely without any danger of running away.

What I have found, over the years, is that my daughters are incredibly resourceful, adaptable and safety-conscious because they know that I can’t rescue them like other parents can. I’ve noticed that able-bodied parents are very protective of their children. I can’t be, so my children have become very good at self-managing. They understand – at a level far beyond any other child – that if they take a physical risk, they’re on their own. I support them by giving them the confidence that they can figure out situations and by allowing them to participate in decision-making.

For example, I remember when Laural was about 18 months, she climbed up on the back of our couch and began inching along the narrow top. I said “You better be careful, because Mom can’t get you down, and if you fall, you’ll really hurt yourself.” I couldn’t scoop her up like other parents, all I could do was sit beside the couch and talk her through it. I could see her reasoning it out, figuring out whether she could move a little further, then deciding it was a bit too scary. She pulled her legs back over the front and was able to fall safely onto the couch.

What has made the difference in my ability to raise my daughters has been the support of my family and friends. Transportation is a big issue, as I don’t drive. One of the ways my parents help out is to drive my children to school and to other activities. One of my friends picks my kids up after school and that’s her contribution to my “little village.” I do things for my girlfriend’s children in exchange, such as helping with French homework. It’s that interdependence with other people that is so essential in raising children. Everyone has different skills, but we share what we can give.

During Emily Grace’s first year, I received five hours of attendant services each day. Today, I receive two on weekdays and three to four on the weekend. Our attendants primarily meet my personal care, grocery and cooking needs, although they do help the girls with small things like braiding their hair. When the girls were young, the attendants spent more time helping them with bathing and dressing.

When Laural was a baby, it used to bother me that I couldn’t do everything for her. I missed the feeling of being able to lift my baby up easily to my shoulder, or of being able to dress her when she was tiny. What I’ve learned is not to sweat those things. I focus on what I am able to do, and I do it as often and fully as I can. I know my kids won’t grow up with a complex because I didn’t wash their hair when they were three months old, or because someone else tied their shoes. Regardless of who’s braiding their hair, they know that I’m their mother. They come to me when they’re hurt, when they want direction or when they want a hug.

I’ve always been open and honest with my daughters about my disability and talked about why I do things differently. In turn, I’ve also given them the licence to do things in their own way.

I think my disability has given my children the ability to be hugely independent, adaptable and able to reason for themselves. It’s also given them a strong sense of social justice. Laural and Emily Grace don’t see disability or diversity because they just accept that everyone does things differently.

As a parent, I’ve gained a real sense of peace, fulfillment and purpose. I know that I’m raising really good girls – not in terms of them being well-behaved, but in terms of them being good people at their core. I hope that in hearing my story, parents of children with disabilities will see that their child can have a full, rich life – one that might even include children.

Is life with disability half as good as life without?

Every time I see an article written by bioethicist Peter Singer, my chest gets a knot in it.

Last weekend, his piece Why we must ration health care appeared in the New York Times Magazine, along with this description: A utilitarian philosopher's argument for placing a dollar value on human life.

The article is about why health care, as a finite resource, needs to be rationed in the U.S. It's about setting limits on what we're prepared to spend to save a human life or to reduce pain, so we get value for our money. Okay, that I get.

In order to compare treatments, we need a common unit to measure their benefits and Singer uses the “quality-adjusted life year (QALY).”

The QALY is a composite of the number of years saved by a procedure or drug (for example, saving the life of a teenager is equivalent to saving the lives of 14 85-year-olds, he says, because a teenager could live for 70 more years vs. the 85-year-old living for five) and the quality of those extra years. The idea, according to Pinning down the money value of a person's life, is that “a year in perfect health is worth more – both to the patient and to society – than a year spent in pain, depression or a wheelchair.”

Singer doesn’t clearly define what he means by quality of life, but implies it is synonymous with "an active life," and is diminished by medical conditions that limit function.

In order to compare how we might allocate resources, Singer suggests we consider how “most people” would rate life with a severe disability like quadriplegia, with life without. Would the average person have a hard time deciding whether they’d prefer five years of able-bodied life or 10 years with paralysis? If so, he says, what they're really saying is that life with quadriplegia is half as good as nondisabled life.

In this scenario, the QALY would rate a procedure that saves the lives of nondisabled people at twice the value of one that extends, for the same time, the lives of quadriplegics.

Looked at in a different way, the value of saving one able-bodied life would be equal to restoring function in two people with quadriplegia.

I have problems with this on two fronts.

First, the premise that reduced physical ability always translates into a less satisfying or happy life flies in the face of facts. A number of studies show that people with quadriplegia rate their quality of life as average or above average, and that they value their lives highly.

This is consistent with research in the world of child disability. For example, a 2007 study of 500 European children with cerebral palsy published in The Lancet found that eight-to-12-year-olds rated their quality of life no differently than children without disabilities. A similar 2007 study of 200 Canadian teenagers with cerebral palsy found participants' self-reported quality of life was not linked to their abilities or degree of disability.

“Is it surprising that subjective quality of life of children with cerebral palsy is similar to that of the general population?” The Lancet researchers asked. “Possibly, from the perspective of a non-disabled adult imagining what it would be like to be disabled, but probably not from the perspective of a child whose sense of self from birth incorporates their impairment and who embraces growth, development and living with the same excitement as most children.”

This leads to my second problem. Instead of relying on science to measure real quality of life, the QALY comes up with a score based on surveys of how "most people" predict they'd experience quadriplegia – without having lived it.

We know from recent "happiness" research that people are notoriously bad at predicting what will make them happy. In Stumbling on Happiness, Harvard psychologist Daniel Gilbert describes common blind spots in how we imagine the future. These include a lack of empathy that would allow us to imagine an experience different than our own and a tendency to overestimate the negative impact of an event and underestimate our resilience. This helps explain a study that showed sighted people will pay more to avoid going blind than blind people will pay to regain their sight. It also explains why most people assume they couldn’t be paralyzed and happy, even though surveys of people with quadriplegia show the opposite.

If someone had told me before my son was born that he would never speak, I would have assumed this was incompatible with a good life. Speaking is one of my great loves. “My son can’t handle it,” I would have thought, and, perhaps, more tellingly, “I can’t handle it.”

Imagine my surprise the first time I sat in a room with people who communicated effortlessly and richly with only their hands. There was great beauty in that silence, beauty I never would have experienced if I'd remained trapped in my narrow mindset. And because – before he learned sign language – I was forced to look deep into my son’s eyes to read what he was thinking, I discovered how much I missed in my old life, when I had to stuff every silence with words, because I was too afraid of what I'd find if I didn’t. Disability can stretch us.

Gilbert, in Stumbling on Happiness, shows that people are remarkably good at making the best of bad situations – by changing their views of the world in order to feel better about the world they find themselves in.

But for some reason we lack this insight into ourselves, he says, and don’t factor it into our predictions: we don’t believe we can adapt to something life-changing.

Given that many people with disabilities rate their quality of life highly, and given what science tells us about the mistakes we make when trying to imagine what will make us happy, why would we rely on the uninformed judgments of the average person to assess the value of a disabled person’s life?

And even if a happy life was determined solely by physical ability, does that mean the value or worth of a person’s life is diminished?

Should twice as many medical dollars be expended to save the life of an elite athlete over that of a couch potato?

What about a child with above-average physical function but a developmental disability?

Does reduced cognitive function lessen the value of a person’s life in Singer’s model?

If we asked “most people” whether living with a low IQ was as “good” as life with average intelligence, what would they say?

I bet “most people” haven’t had a close relationship with someone with a developmental disability – so they wouldn’t have direct experience to go on. Instead, they’d fall back on popular stereotypes. Singer himself equates human dignity with intellectual capacity in A convenient truth, an earlier article in the Times about the Ashley treatment. “... I find 3-month-old babies adorable, but not dignified. Nor do I believe that getting bigger and older, while remaining at the same mental level, would do anything to change that.”

Does this mean we should put fewer dollars into life-saving treatment for people with developmental disabilities?

People with disabilities face so many misconceptions about their experience. The QALY measure only perpetuates them by relying on a simplistic measure of “perfect” health. Being paralyzed or using a wheelchair doesn’t preclude being healthy or living a full life.

Physical function may contribute to a good life, but it’s only one of a myriad of factors. What about social conditions that can marginalize people? Perhaps Singer would like to survey people on whether they'd prefer to live five years white or 10 years black in the U.S.; five years rich or 10 years poor; five years as a man or 10 years as a woman.

Can a person's value be determined by race, income or gender, anymore than it can be determined by physical ability?

The QALY keeps things clean and simple and easy to calculate for economists by reducing quality of life to physical function – at the expense of people with disabilities.

I think Singer’s recipe for health-care rationing has sinister implications.