Trade Offs: Time Zones and Medical Morality
Wednesday, August 20th, 2008I just got back from Japan.
Jet lag always gives me time to contemplate, and the near 180 degree nature of Tokyo/Toronto time zones usually guarantees at least two day/night reversals on either side of my trip. This very early August morning proves mornings are indeed shortening, at least until that wondrous day in October when “Fall back” gives a brief reprieve from wake-up darkness. Due to my recent travels, my contemplations turned to a discussion that I once had in a Japanese class around a newspaper article that proposed the introduction of “daylight savings” to Japan (”sunny time” as the article tagged the North American phenomena).
“People in Japan would never agree to ’sunny time’ because we work long enough as it is,” came my teacher’s summary. What on earth is the link between moving dawn until after 5AM and working even longer hours? After diligent effort and multiple paraphrasing to erase any doubt of a missed nuance, I grasped the link: There is an understanding in the Japanese workforce that you cannot leave work before dark. Darkness is by no means an indication that you can go home (or, more commonly, out for beers with your co-workers), but sunlight is not to be encountered on your homeward commute. My notion of “end of day” may also have slid because many of my “foreigner-friendly” jobs (i.e. teaching English, translating to English, etc.) had mid-morning start times.
That this conversation took place in a language class made it natural for me to suspect I was actually misunderstanding, which made me genuinely open to really understanding the core issue. I am not sure I would probed to the same extent had the conversation taken place in English (or had my Japanese been better!). What we had was a fundamental difference in beliefs. For me, daylight savings time could mean getting in a full-round of golf after work, or bike riding with the kids after dinner. To my Japanese teacher, and potentially to Japan’s average working Taro, the clock change was like watching the “fall back” time change while working the night shift… but for everyday of the summer!
Fundamental differences don’t fall easily, and that is exactly why daylight savings time will never be implemented in Japan. But given the absence of evidence the change breeds the promised energy efficiency, is Japan really worse off?
Fundamental differences are at the heart of the proposal to limit a physicians rights to exercise moral judgement in delivering medical care. Some life and death issues (beginning and end) cannot be driven by science and rationality, but instead fall prey to fundamental beliefs (aka: morals) that may conflict with legislation. When this is the case, and when operating within the laws of the land, it is most realistic to have patients find doctors who share (or at least don’t oppose) the fundamental belief in question. The trade off should be seeing that doctor OR getting the medical treatment in question.
NOTE: The case may be different in rural areas where the supply and demand dynamics are different.
If you really like daylight savings time, you shouldn’t live in Japan. Conversely, if you really like Japan, you had better be flexible about Springing ahead and Falling back. No one can have both. Patients are not different.