A CASE FOR EQUAL ACCESS TO HEALTH CARE
Richard J. Pitch
Equal access to health care is a basic human right. It is not a privilege that must be earned by being productive in society, or by inheriting gifts of intelligence, beauty, wealth, race, or social class. When resources are limited, however (and they usually are), health care is delivered according to a priority list. Those who write that list generally place people who are mentally retarded near the bottom. I believe they do so not maliciously, but because they have little experience with people who are mentally retarded. With a long history of being hidden in closets (literally) and stowed away in institutions, people with mental retardation are among the most misunderstood of people.
The following discussion, which is based on an actual recent case, 1 illustrates some of the difficulties involved in maintaining equal access when a bureaucracy as large as an academic medical institution subscribes to the myth that people who are mentally retarded are less valuable than others.
Mr. R. was a 58-year-old man with moderate mental retardation who lived in a staffed community residence. Although nonverbal, he could make his needs known through sounds and gestures; in fact, he expressed a well-developed sense of humor. His receptive language skills were very good. Mr. R. was employed part-time doing table-top tasks at a sheltered workshop, and he helped prepare meals at home. He also enjoyed a number of social activities and had numerous friends. Mr. R. had no family contacts since he had been brought to a state institution when he was very young, and family members did not visit him. He moved to his community home when he was 47 years old.