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  • Dr. Felix Tudela Cabrera

Making autonomous decisions

Autonomy can be defined as the capacity to decide for oneself. As a physician, we are taught to respect a patient’s autonomy with shared decision making.

A patient and I might discuss the risks and benefits of treatment options A, B or C and then we decide together. Often some options have major downstream risks that are abstract and very difficult to describe. Risks hidden by false securities. When this occurs my patients often say “I’m not sure doc. I’ll trust whatever you suggest.” One response could be, “Well, if I found myself in your shoes, I think I would choose A over B, because of what I value. Option C looks good initially but the risks are just not worth the perceived benefit. Risks I personally cannot afford to take.”

In this example my patient has ultimately chosen to delegate the decision back to me. That choice in itself was them exercising their autonomy. Autonomy can also be defined as the state of being self-governed, as is our democracy.

With this we delegate much of our individual autonomy to our elected officials by the power invested in our vote of confidence in them.

Similar to how a doctor earns a patient’s trust. We expect our elected officials to help protect us from dangers, hardships, and catastrophic events.

Most especially the events that we as the lay public may be in a poor position to fully calculate or appreciate. Speaker Tina Muna-Barnes, who introduced Bill 30-35, and the other senators who already support this bill, clearly understand the protective nature of this type of legislation for GovGuam employees, dependents and retirees.

It ultimately would require that any GovGuam insurance bid must include GRMC in-network. Healthcare can be very complicated. Add the intricacies of navigating a health insurance plan and the complexities multiply exponentially.

However, there are some fundamental values we share to guide us. If an unexpected health crisis occurs, we all want the best odds of recovery using services of the most value available, all while avoiding a parallel financial crisis.

Today, this can very likely mean getting care only available at GRMC for a life-threatening issue. All with the securities of in-network coverage.

Allowing any insurance option that excludes GRMC, is equal to the high-risk treatment option C described earlier.

Currently over 1,600 TakeCare members already have had to face this financial burden personally after having been cared for by GRMC. Just like physicians, elected-officials have a duty to make choices that keep such high-risk options off the table. Furthermore, we must reject any notion of a “buy-up” option being pushed by TakeCare.

This is the illusion of individual autonomy via the guise of a choice to buy-up the inclusion of GRMC at the individual level, rather than the plan automatically including GRMC with terms negotiated on a level playing field like SelectCare, Netcare and StayWell already do.

If we agree on our values, we would ensure that important standards are kept equal in order to promote quality competition. Apples vs. apples, not pugua vs. niyok.

We cannot accurately predict when we will need GRMC services the most. But we do know that the most common causes of death on Guam are related to heart attacks and strokes, both of which GRMC provides the best odds we have to survive such an event.

This is what we should entrust in our insurance carrier to cover. Trust similar to what patients give their doctors, or that constituents give their elected officials.

This is why Bill 30-35 must be passed. Many people’s lives and livelihoods literally depend on it.

Dr. Felix Tudela Cabrera is an internal medicine physician and the Chief Medical Officer for Guam Regional Medical City.

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