The Anarchist in the Cancer Center

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.

Promoting Autonomy

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.

Until Then

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.

The Body Count in the War on Drugs Continues to Rise

We are told daily that there is an epidemic of opioid-related deaths in the united states. Those to blame, according to our would-be masters and their loyal servants in the news media, are the usual suspects: unethical drug dealers, greedy pharmaceutical manufacturers, reckless doctors, and careless patients.  The approved script is that the drug companies market narcotics too aggressively, physicians and other healthcare providers prescribe too casually, and the recipients then become habituated to and dependent on these drugs and/or allow the medications to fall into the hands of friends and relatives who do not have a medical need for them.  Once hooked, the “addicts” then turn to illegal sources to feed their habit where they risk injury and death from using drugs whose contents they are unable to verify, mixtures which often include drugs like fentanyl, which is more easily to cause an accidental overdose than heroin.

Assigning Blame

While there is some truth to this story, it is far from a complete explanation of how the current state of affairs came to be.  The increase in medical prescriptions for narcotics over time was primarily a result of a needed change in the approach to pain management among medical and nursing health care providers.  Sure, Pharma marketed their products heavily, but it was to a willing audience who were free to prescribe such drugs or not.  Instead of demonizing opioids, providers came to see them as largely safe and effective tools to control pain, especially in the setting of chronic and cancer-related pain.  Narcotics can be used with minimal risk of harm and great benefit in those experiencing pain, but since they create a pleasurable experience for some, they are also commonly used by people not in pain to get high.  And that is the rub.  The government—and all too many people in general—believe it is OK for people in pain to use these drugs but not OK for those who simply want the rush. That is why there is a war on drugs. And the commanders and soldiers in that war bear a large portion of the blame for the deaths we are now seeing among narcotics users.

Of course, the ultimate responsibility for any harm suffered lies with the users of opioids.  While the conventional wisdom is that these users are addicts, compelled by their “disease” to use opioids at any cost, there are many, including this writer, who reject out-of-hand the medical model of drug use.  While it is pretty clear that some people are more prone to using these drugs unsafely, there is no reason to believe they have an illness, or that their drug use is out of their control.  Sustained use of narcotics produces tolerance and dependence, so that increasing doses are sometimes needed to maintain a desired effect, and weaning off them is necessary to prevent withdrawal effects. But they do not take over one’s mind and body and compel the user to consume more and more.  People make choices, often bad ones, but they are still choices.

Primum non nocere

Even though the numbers of people using, and dying from the effects of, narcotics have been steadily increasing, it is also just as true that narcotics are essential to providing relief to the large numbers of people with chronic pain, including many people with cancer.  So any ethical attempts to reduce the harm caused by narcotics must at the same time ensure that those in pain are not deprived of an effective remedy.  And the statist approach of more regulation of the prescription of opioids, suing drug companies, and criminalizing non-medical users of narcotics is not only unethical, but counter-productive.

The government is trying to restrict the legal supply of narcotics by scrutinizing the practices of medical and nursing providers and frightening them into prescribing fewer opioids.  The result is that more people in pain are suffering.  In addition, less than ideal medications, such as those that include acetaminophen as well as a narcotic, are being used in situations where a pure opioid is more appropriate because the combination product limits the total safe daily dose of the combination drug, even though this results in inadequate pain control. These drugs are also less lucrative when sold on the black market, which delights the drug warriors.  Pain management strategies are now often driven by the desire to avoid the notice of the DEA, instead of the goal of optimizing the relief of suffering while minimizing adverse effects.  When it comes to medical treatment of people in pain, instead of “first, do no harm,” the new operating principle for doctors and nurses is “first, cover your arse.”

The statist approach to the illegal market is just as flawed—and destructive.  Dealers and users will always find a way to get opioids of one sort or another. Restricting the flow of pharmaceutical grade drugs simply promotes the use of black market concoctions made up of unpredictable ingredients and with unknown potency.  This is why people are dying.  By criminalizing the non-medical drug market, the government prevents people from openly testing drugs for contents and strength so that users can make an informed decision.  Instead, consumers of illegal opioids are forced to take the word of the supplier, who in a non-competitive and illegal trade has less incentive to deal honestly with customers than they would in an open and transparent market.

A New Anti-war Movement

The anarchist solution to the opioid “crisis” is simple.  Stop the drug war.  Keep the state out of the business of regulating medication prescription and use. Eliminate the DEA and police drug squads.  Let people to purchase any drug they like on an open market.  Such an approach is not popular, largely because people have believed the lies about addiction and narcotics that have been spread by the state and the medical authorities for so long.  But opioids are just another chemical, like alcohol or caffeine or marijuana or nicotine.  They are not uniquely demonic.  Marijuana was, until recently, considered as nefarious as heroin, but I can now buy it openly at my local herb shop.  That took a sea-change in public opinion to bring about, and was the result of years and years of agitation to show that pot could be used safely and that the reefer madness which drove the campaign against cannabis was nonsense based on junk science. The similar lies that drive the current attack on opioid users need to be confronted and similarly demolished.

I have been a nurse for 40 years, and an oncology nurse for half of them.  I have personally seen the havoc that has been wrought by the drug war.  I have cared for people whose bodies were ruined by using illegal drugs.  I have seen unintentional overdoses.  I provide services to people infected with HIV and hepatitis C from sharing needles and syringes.  I constantly speak with people with cancer-related pain and other chronic pain symptoms who struggle to live full lives because the government has kept the appropriate pain medications out of their hands.  Politicians and regulators have taken it upon themselves to be our overseers and determine who can have narcotics and who cannot, and under what circumstances.  This is an unacceptable infringement of people’s freedom to control their own bodies and what they wish to put into them.

Prohibition has never been an effective approach to preventing the use of chemicals that people enjoy taking.  In the case of the war on opioids, it promotes dangerous behavior among both dealers and consumers in the illegal market and deprives others of an effective means of mitigating their suffering.  And besides the awful results in the united states, the international drug war, driven largely by the american government, creates suffering worldwide.  Because of a misplaced concern about “addiction,” poor people in much of africa commonly have little or no access to narcotics to ease the pain of cancer and injury, while opium produced in afghanistan and elsewhere, which could easily and cheaply fill their and others’ need for relief, is either destroyed by the united states military and its allies or funneled into the lucrative illegal trade.  It is outrageous that people stand by and cheer while the drug warriors deprive others of access to cheap narcotics in the name of their (remarkably ineffective) fight against addiction.

The only beneficiaries of the drug war are those in government who have made careers out of regulating and policing opium use, and those who have made fortunes in the illegal markets created by drug laws. They are far outnumbered by the victims: those who accidentally overdose, people with unrelieved cancer pain, people murdered by the governments of many countries for the non-violent use or sale of narcotics, those killed daily in latin america by participants in the illegal drug trade—a trade that exists only because of prohibitory drug laws.

As an anarchist I oppose any intervention by the state in my life or that of others.  But that is clearly a minority opinion.  Drug laws, like so many other statist interventions, promise protection from harm at the expense of personal freedom.  And even though these laws actually cause more harm than good, while severely restricting individual liberty, most people appear to believe the hype and kowtow to the authorities.  They are unwilling to think and act for themselves and would rather just accept the information fed to them by the government and its supporters without question.  Unless people reject the authority of the state and start taking responsibility for themselves we will never see the end of the drug war and the bodies will continue to pile up.

Josiah Warren: A Communitarian Individualist

The goal of every anarchist is the elimination of the state and all other forms of authority.  From this common starting point, however, libertarians then take off in many different directions.  Ideas about how people should or could interact with each other socially, economically, sexually or in any other way vary tremendously from person to person and from group to group.  Continue reading

Not My Presidents

It has been entertaining to watch all the demonstrations and actions by anarchists and leftists since the election of Donald Trump.  These have largely been prophylactic interventions since Trump had not yet actually done much but talk and insult people, having failed to implement very many real changes.  It was unclear what the point of some of these marches was other than support for all good things and opposition to bad ones, presumably all of which were caused by Trump.  A recurring image has been a sign that reads “Not My President.”  Anarchists, one would hope, have never had a president but some of them seem to feel it is more important to point this out at present than it was under the regime of Obama. Continue reading

Identity Fraud

The word anarchist has long been used to label various people and movements that often are and have been quite different from each other in their approaches, ideas and goals.  People who have called themselves or been described by others as libertarians include individuals as diverse as Bakunin, Warren, Armand, Kropotkin, Michel, Stirner, Goldman, Mackay, Durruti, Arrigoni, Dolgoff, and Rothbard.  What made all of these folks anarchists was their opposition to the state, to governments of all kinds.  They all believed that the state was a pernicious force which crushed individual freedom and stood in the way of cooperation and mutual aid among equals.  But their ideas about how to destroy or circumvent the state and their actions intended to accomplish their goals varied tremendously.  Continue reading

The Drug War is Hell

Legalization of possession and use of marijuana is spreading gradually from state to state, but this should not be taken as a sign that the drug warriors have declared a truce in their murderous attempts to control what people smoke, ingest or inject. They have simply conceded one battle in this war, one that was becoming harder and harder to justify to the people of this country whose extorted tax payments fund this misguided adventure. Just as re-legalization of alcohol after prohibition was repealed did not lead to deregulation and free individual choice in when, where, and how people were allowed to imbibe, now-legal marijuana use is and will be regulated, controlled, limited, and taxed by those who feel it is their responsibility—no, right—to tell the rest of us how to live. Continue reading

Unsettling Science

“In science, theories are always hypothetical and provisional and are a convenient method of grouping and linking known facts, as well as a useful instrument for research, for the discovery and interpretation of new facts; but they are not the truth.”

“The scientist makes use of hypotheses to work on, that is to say he makes certain assumptions which serve him as a guide and as a spur in his research, but he is not a victim of his imagination, nor does he allow familiarity with his assumptions to be hardened into a demonstrated truth, raising to a law, with arbitrary induction, every individual fact which serves his thesis.”

These quotations, taken from two articles written by Errico Malatesta in the journals Umanità Nova and Pensiero e Volontà in 1922 and 1924, respectively, resonate strongly with me when I consider what passes for science today. Continue reading

To Market, To Market

In a review of anchorage anarchy in a recent edition of Anarchy, A Journal of Desire Armed, I am described by the author as a “non-anti-capitalist anarchist.” Around the same time I read this article, I also received a letter from a contributor to aa in which I was called to task for my use of the word market to describe the sort of economic relations I think would best serve free people.   While the Anarchy writer did not elaborate on why he chose the description he did, my correspondent did go on to say that he thinks “free people would determine the means of exchange/sharing/distribution that is most suitable for them & it would tend to be disorganized and fluid, where market implies a more structured approach.” Continue reading

Heroes and Villains: A Review of Kontrrazvedka by Vyacheslav Azarov

Anarchists can’t seem to give up their heroes, no matter how badly they are shown to have behaved. When anarchists rule or kill or silence or tax others there is always some justification for these actions. Often the excuse is wartime conditions, but in other cases the misdeeds are seen as simple mistakes by well-intended class warriors. Apparently anarchists, especially anarchist leaders, are not to be held to the same standards as mere mortals or the “class enemy.” Continue reading