One Year After January 6th: A Role For Restorative Justice and Universal Health Care In America.

Posted on | January 6, 2022 | 2 Comments

Mike Magee

“We’re better than this” is the common refrain heard from many political leaders following the deadly assault on our democracy on January 6th. We hear empty appeals for blind appeasement from the likes of Kevin McCarthy in the interest of “bringing our country together.” But for those of us who study medical history, pursuing this course takes our nation in exactly the wrong direction.

Rather, the model we must follow is the model of Germany in 1945, or South Africa in 1995. In both cases, strict legal and public accountability (retributive justice) were married with fundamental expansion of universal social services to rebuild confidence and trust in their government’s ability to assure safety and security, and an equal playing field for all of their citizens (restorative justice).

In sorting through the legacy of Hitler’s regime in Germany, the Allied forces established the International Military Tribunal.  One of the series of trials, opened on November 19, 1945 in the Palace of Justice in Nuremberg, delved into egregious examples of medical criminality, including Nazi experimentation on human subjects. These trials are often cited as an example of “retributive justice.” Of 23 defendants, 7 were hanged, 7 acquitted, and the rest given sentences of from 10 years to life in prison.

These judgments were conducted under the direction of U.S. judges and prosecutors and fully compliant with U.S. standards of criminal procedure. Yet another 25 years would pass before any of the 10 agreed-upon medical ethics research standards were integrated into US trial law.

Legal scholars such as Michelle Miller at Cornell Law School attribute this lapse to the self-regarding biases of leaders within the Medical Industrial Complex. As Jay Katz, a physician and professor of law at Yale wrote in 1992 of the Nuremberg directives, “It was a good code for barbarians, but an unnecessary code for ordinary physician-scientists.” In other words, it was assumed that American medicine’s noble professionalism was adequate to ensure appropriate ethical standards.

Adding to the irony, at the very same moment that the leaders of the Medical Industrial Complex were rejecting President’s Truman’s 1946 call for a national health plan as “socialized medicine,” our military under the Marshall Plan was fast at work creating highly successful national health plans for our two main vanquished archenemies, Germany and Japan. We were willing to allocate precious taxpayer resources to assure this expression of “restorative justice.”

An analysis of the German and Japanese programs made some years later by the Rand Corporation summed up the Marshall Plan’s rationale: “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population. The health status of those living in the country has a direct impact on the nation’s construction and development, and history teaches us it can be a tool in capturing goodwill of the nation’s residents.”

A similar restorative approach was utilized in South Africa in 1995. Nelson Mandela’s Truth and Reconciliation Commission conducted over 1000 public hearings on their road to a free democracy, offering amnesty to those who publicly admitted past crimes of sectarian violence and asked for forgiveness. Less recognized, Mandela simultaneously instituted fundamental social service reform, including free primary level public health care for all in 1996 serviced in over 350 newly constructed health clinics by 1997.

Now a quarter of a century later, Mandela’s words, delivered that day, continue to resonate on our own shores.

He said: “With our freedom won, we faced the challenge of using our limited resources to provide the majority of our people with adequate housing, education and health services. These things are regarded as basic human needs anywhere in the world and yet most of our people had been denied them…

“Because there were very few hospitals and clinics, only those with money and who were healthy enough could travel the long distances to get proper medical help. This was the situation of millions of South Africans across the country.

“One of the most important steps the government has taken to deal with this crisis in our nation’s health was to introduce free universal primary health care. Since April last year, for the first time in our history, basic health-care has become available to everybody without cost. And to make that health-care easily accessible, to especially the poor, we launched the clinic-building programme so that there would be a clinic within walking distance – five kilometres – of every household.

“Primary Health Care uses measures for both prevention and cure, like immunisation, family planning and health education. But in order for these programmes to work we also need to make sure that communities have adequate shelter, employment, sanitation and clean water supply. Poverty and lack of essential services are the greatest threat to our nation’s health.”

The failures of this nation’s health care system have been well documented, and now include the mismanagement of the Covid-19 pandemic, certain to claim more than a million American lives. As with Germany in 1945, and South Africa in 1995, creation of reliable health access for all would assist our troubled nation in her efforts to address racism, disinformation, and the current erosion of public trust – problems that are egregious and deep-seated.

Criminal investigations of the January 6^th insurrectionists are well underway and appropriate expressions of retributive justice. No one is above the law. At the same time, movement toward universal health care in America, as an expression of restorative justice, and a means to begin to address societal financial, educational and health inequities, would be a logical next step if we truly wish to “bring our nation together.”

A 2022 New Year Message – With Help From The Lamont’s.

Posted on | December 31, 2021 | 2 Comments

On December 31, 2021, our family received a Holiday Card from Ned and Annie Lamont and their family. Its message so capsulized our own feelings that I wanted to share the message with you. Here is their wish – and ours as well.

For Sarah Weddington (1945-2021), RIP = Rest In Power.

Posted on | December 30, 2021 | 2 Comments

Mike Magee

“I am sure when my obituary is written, the lead paragraph will be about Roe v. Wade. I thought, over a period of time, that the right of a woman to make a decision about what she would do in a particular pregnancy would be accepted, that by this time, the 30th anniversary of Roe v. Wade, the controversy over abortion would have gradually faded away like the closing scenes of a movie and we could go on to other issues. I was wrong.”  Sarah Weddington, 2003.

_______________________________________________________

Sarah Catherine Ragle Weddington died in her home in Austin, Texas on December 27, 2021. She was 76. She was born in Abilene, Texas on February 5, 1945, the daughter of a Methodist minister father and a college business professor mother.

Bright and inquisitive, she graduated from small Methodist McMurry College magna cum laude at the age of 19, and enrolled at the University of Texas at Austin Law School. She was one of 40 women in a school of 1,600 students. Her course work was briefly interrupted in her final year, at age 22, by an unwanted pregnancy. With her soon to be law student husband, Ron Weddington, she traveled to Mexico for what she later described in a 1992 autobiography as a “safe abortion.” She later remembered her last thoughts as they administered her anesthesia, “I hope I don’t die, and I pray that no one ever finds out about this.”

After passing the Texas bar, she hung out a shingle in Austin, Texas where she supported herself by writing wills, and resolving uncontested divorces. She had no trial experience, but was fascinated by women’s rights issues, and with several other women in the area, advised college women which doctors in the area might be willing to perform abortions, currently illegal in the state unless to save the life of the mother.

At the time, she was asked by one student whether she could be prosecuted for helping a friend receive an abortion. Not knowing the answer, she turned to a more experienced former fellow student and friend, Linda Coffee, who was clerking for a federal district judge in Dallas. At the same time, Coffee was advising a pregnant woman named Norma McCorvey, who had already had two children given up to adoption, and was pursuing an illegal abortion as a solution to a third unwanted pregnancy.

In December 1969, Coffee wrote Weddington, “Would you consider being co-counsel in the event that a suit is actually filed? I have always found that it is a great deal more fun to work with someone on a lawsuit of this nature.” Two months later, the new legal team met in a pizza shop with McCorvey, soon to be retitled Jane Roe, and a challenge to the Texas anti-abortion law, and to Dallas District Attorney, Henry Wade, was born.

In December 1971, when Sarah Weddington, age 26, stood before the Justices of the Supreme Court to argue Roe v. Wade, she had never tried a legal case. The lawyer’s lounge at the Court didn’t even have a women’s rest room. She felt the full weight of responsibility on her young shoulders. She later recalled, “I cared so much about the result. I was the only person that would be allowed to speak to the Court for the plaintiffs, asking them to overturn the restrictive Texas law. So it was fear-invoking, awe-inspiring, and something you just want so much to win you can taste it.” In October 1972, she was back again to field the all male Court’s questions.

One year later, her name would be forever recorded in legal history, and the case itself would be one of the most cited precedents ever to appear in American legal annals. The 7-2 majority decision leaned heavily of the First, Fourth, Ninth and Fourteenth Amendments, and resulted in a cascading reversal of existing state laws outlawing abortion in the years that followed.

Initially widely praised and supported by both medical and religious organizations, within five years, the reversal of Roe v. Wade became the rallying call and fundraising organizing tool of a new evangelical political movement self-titled, the Moral Majority. As it rose, so did the number and seriousness of death threats to the young lawyer.

What became of Sarah Weddington? She was Texan through and through, part of a group of notable women achievers of the time, sometimes referred to as the “Great Austin Matriarchy”which included Barbara Jordan, Sissy Farenthold, Ann Richards, Molly Ivins, and Liz Carpenter. In 1972, while awaiting the epic decision, she ran for a seat in the 150-member Texas House of Representatives and won, serving three successive terms. Her legislative aide at the time was none other than the future Texas Governor, Ann Richards. Three years later, she was labeled “the hardest working member of the house.” Over the years that followed, she served in President Jimmy Carter’s administration on women’s issues, helped advance the movement to approve the Equal Rights Amendment, and ultimately settled in as the first female director of Federal Government Relations for the state of Texas.

Of hiding her own abortion, she later said, “For a lot of years, that was exactly the way I felt. Now there’s a major push to encourage women to tell their stories so people will realize that it is not a shameful thing. One out of every five women will have an abortion.”

Four years ago, she was asked to predict the staying power of the Roe v. Wade decision. She said at the time, “If Gorsuch’s nomination is approved, will abortion be illegal the next day? No. One new judge won’t necessarily make much difference. But two or three might.”

Up to her death, she was known for advocacy. Sherrilyn Ifill, president of the NAACP Legal Defense and Educational Fund, marked her loss with three simple words: “Rest in power.”

Santa’s Message on Health – 2021

Posted on | December 20, 2021 | 4 Comments

Mike Magee

When I first posted “Santa’s Letter” four years ago, these three of our ten grandchildren were believers, Trump was in power, and immigrant children were literally dying in cages on our southern border. The words written then, by our youngest of four children and her husband, were much needed reassurance.

Our challenges in 2021 are different but no less significant and disorienting. The ongoing pandemic, a climate crisis now visible enough to be difficult to deny, and real threats to our form of government coming from within rather than from outside our borders simply head the list.

And yet – there is still a Santa Claus for true believers. And as he says above, believing in magic, family, laughter, yourself – these are not “luxuries,” but rather essentials to a healthy human existence. Read along with me:

“Dear Quinn, Luca and Charlotte,
Thank you for believing in my magic. I hope you will always believe in magic. 
Believe in the magic of family. There are times you will stumble, but your family will always be by your side. 
Believe in the magic of laughter. It will keep you whole. 
Believe in yourselves because I believe in you. 
Take care of each other.
Love always,
Santa”

This coming year will be a critical challenge for all Americans. How will the American family respond? How do we make America healthy again? I cling to Santa’s final words – “Take care of each other.”

Here is what that means to me as a health professional.

Eisenhower to Biden on Health Care: “Enlarge the Problem.”

Posted on | December 16, 2021 | 2 Comments

Mike Magee

My good friend, Kim Bellard, in a piece published in Medium titled “The Eisenhower Principle”, shines a light on this genuine American hero’s seminal military, political and management insight – “If a problem cannot be solved, enlarge it.”

In Kim’s astute health care analysis, he notes “We’ve learned only half of Eisenhower’s adage: we’ve got the letting the problem get bigger part down, but we’ve forgotten the part about how/when to come up with solutions.”

In the spirit of uncovering solutions, it is worthwhile to retrace Eisenhower’s steps, supported by his own commentary, in the decade that followed WW II.

Section 1: The Chance For Peace.

The  “Chance For Peace” speech was delivered on April 16, 1953, shortly after Stalin’s unexpected death. In the speech, Eisenhower stated:

“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed…This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter with a half-million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people…This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”

For those who actively criticized President Biden’s unilateral disengagement from Afghanistan, consider the anti-war stance of our nation’s most decorated general. As President, in foreign affairs, he demonstrated enormous restraint, even as his supporters questioned his decisions. For example, he did not take any advantage when Stalin died unexpectedly in 1953, and he resisted being drawn into Indochina in 1954 when the French departed, electing to “wage peace” rather than engage in another war. Similarly, in 1956, when Hungry was invaded by the Soviets, he chose (at least publicly) to stand down. In the midst of the Cold War, he envisioned a negotiated truce with the Soviets on nuclear weapons, a long range goal that was eventually scuttled near the end of his second term by the shooting down of an American U-2 spy plane over Soviet territory. He did take definitive action on two occasions, in 1955 and 1956, when he believed American interests were at risk. In the first case, when Communist Chinese appeared ready to attack Taiwan, he seeked and gained Congressional approval to use force “if necessary to assure the security” of Taiwan. The Chinese backed off. A year later, when the United Arab Republic seized the Suez Canal, and Israel invaded Egypt, American allies, Britain and France, were ready to enter the fray, which would likely ignite a broader conflagration. Eisenhower immediately involved the UN and all parties were forced to stand-down. Crisis averted.

Section 2: The Pivot.

While Communism and the Cold War must be managed, Eisenhower had strong ambitions for his domestic agenda which he labeled “the middle way” to domestic prosperity. This included balancing the budget, building up America’s highway infrastructure, and continuing the New Deal commitments – a decision that more than raised the eyebrows of the Republican Old Guard. He extended insurance coverage through Social Security and bumped the minimum wage from .75 cents an hour to 1$ an hour. For passage he relied on Democrats to support key legislation.

Believing “what was good for business was good for the nation”, he stacked his Cabinet with successful millionaire businessmen including Secretary of Defense Charles E. Wilson (General Motors CEO), Secretary of the Treasury George M. Humphrey (M.A. Hanna Steel Company), and Secretary of the Air Force Harold E. Talbott (a director in both TWA and Douglas Aircraft Company). He saw this as simply a common sense, pragmatic approach. Would Americans rather he choose “some failure…or a successful businessman,” he asked.  Clearly the new president intended to be activist in the domestic arena, and signaled this early to the business community with corporate tax cuts. Prosperity and expansion of the middle class were his key objectives.

Seven months before his heart attack, on January 31, 1955, Eisenhower delivered his “Special Message To Congress Recommending A Health Program.” This needs to be appreciated in the context of what had occurred over the past twenty years in the health insurance arena. When FDR declined to use political capital required to pass Social Security legislation to advance health insurance in 1937, opposition was abundant. The American Medical Association was fully engaged and pulled out all the stops. This included an FDR lunch with famous neurosurgeon Harvey Cushing, Roosevelt’s son’s father-in-law, the day before FDR’s announced decision to delay action. Into the resultant void came the non-profit Blue Cross and Blue Shield plans.  For-profit companies watched from afar through the 1930s. Once profitability was clear, they streamed in behind the Blues, so that by the time the country was prepared for post World War II expansion, the private insurance infrastructure was firmly in place.

In the early years of the war, the economy super-heated and caps were placed on employee salaries to prevent inflation. Employers, competing for scarce workers, began to layer on benefits, including health insurance. By 1949, the government ruled that benefits were part of the negotiated wage package, and five years later, the IRS exempted employer-provided health benefits from income tax. Coincident with this, labor and management dueled over the issue. In 1949, the United Auto Workers Toledo local began a drive to create a regional pension plan that would spread risk across many auto industry suppliers. The reasoning was that even if your particular company went bankrupt, your benefits would be safe because they came from a regional pool, not directly from your employer. Business owners and large employers disagreed with the concept. They felt that collectivization threatened the free market and business owners’ autonomy. In the United States a year later, Eisenhower’s future Secretary of Defense, Charlie Wilson, then president of General Motors, began offering GM workers health care benefits and a pension. The offer was more defensive than beneficent. In the single decade between 1940 and 1950, the number of Americans covered by employer-sponsored health care increased from 21 million to 142 million.

The opening paragraph of Eisenhower’s 1955 Special Message on Health Care reads, “ Because the strength of our nation is in its people, their good health is a proper national concern; healthy Americans live more rewarding, more productive and happier lives.”

Section 3: Tipping His Hat To Truman.

By now, President Eisenhower clearly had determined that health care deserved to be at the center of his domestic agenda.  His second paragraph in the 1955 State of The Union address focused on chronic disease. “Deaths from infectious diseases have diminished. During the past year, important progress has been made in dealing with such diseases as rheumatic fever, high blood pressure, poliomyelitis and tuberculosis. Intensified research has produced more knowledge than ever before about the scourges of heart disease and cancer.”

Two paragraphs later, he highlighted President Truman’s accomplishments noting the 1947 Hospital Survey and Construction Act (known also as the Hill-Burton Act) as a critical achievement that had greatly expanded America’s caring capacity. It provided federal funding in support of communities advancing local hospital construction to expand access throughout the country to 4.5 hospital beds per 1000 citizens. In return for the grants, hospitals had to commit to non discriminatory behavior based on race, creed, color or national origin; agree to provide a “reasonable volume” of free care to needy residents (though “reasonable volume” was not defined for another twenty years); and the community had to demonstrate the long term economic viability of the hospital construction that was to be funded.

Eisenhower then acknowledged the 83rd Congress’s expansion of this law saying, “The 1954 amendments to the Hospital Survey and Construction Act opened another new chapter in the national drive for better health. Under these amendments, further provision was made to help build health care facilities for the chronically ill; to aid in the construction of nursing and convalescent homes; to provide for more diagnostic and treatment centers for patients who do not need hospital care; and to help make centers available for the rehabilitation of the disabled.”

And yet,  Eisenhower said clearly in 1955, we can do more. In his words, “These achievements represent a major gain for the immediate and future welfare of countless Americans – in the health of both mind and body. Recent advances do not, however, represent our full capacity to wage war on illness and disability throughout the land. As a nation, we are doing less than now lies within our power to reduce the impact of disease. Many of our fellow Americans cannot afford to pay the costs of medical care when it is needed, and they are not protected by adequate health insurance. Too frequently the local hospitals, clinics, or nursing homes required for the prevention, diagnosis and treatment of disease either do not exist or are badly out of date. Finally, there are critical shortages of the trained personnel required to study, prevent, treat and control disease.”

Section 4: The Solutions.

Eisenhower then laid out a long list of recommendations that read remarkably progressive for it’s day. It includes:

Lower the Cost of Care: Expanding the numbers covered by health insurance and the scope of benefits with a special focus on protection against catastrophic costs, coverage for the disabled and those in rural areas, and coverage for low income Americans.

Health Facility Construction: Improved access to funding mechanisms with federally backed support for privately funded construction loans to health care facilities.

Health Manpower: Grants to support expanded training of nurses and public health specialists including those focused on mental health.

Expansion of Public Health Programming: Expanded grants for the Public Health service, the Children’s Bureau of the Social Security Administration, and the Food and Drug Administration.

Environmental Health: Expanded research on air pollution control, and water purity.

Mental Health: Increased funding for training of mental health professionals, expansion and improvement of mental health facilities, and strategies to manage mental health in the community rather than in large institutional settings.

International Health: Stronger support of the World Health Organization (WHO). His positioning for support was new for the day. As he said, “For half of mankind, disease and disability are a normal condition of life. This incalculable burden not only causes poverty and distress, and impedes economic development, but provides a fertile field for the spread of communism.”

These were not simply words for Eisenhower, they were backed up by organizational action that he had taken in 1953.

On April 11, 1953, the president provided his signature of approval and HEW was created. Within its’ umbrella were sheltered Social Security providing 70 million Americans with $4 billion annually on the back of proceeds from a $19 billion dollar trust fund; the Public Health Service and its’ new National Institute of Health (NIH) and National Cancer Institute (NCI); the Office of Education overseeing national education policy; the Food and Drug Administration; The Office of Vocational Rehabilitation; the Children’s Bureau; the American Printing House for the Blind; the Columbia Institute for the Deaf; and St. Elizabeth’s Hospital for the Mentally Ill.

In a bipartisan slight of hand, Eisenhower appointed Democratic Texan, Oveta Culp Hobby, as HEW’s first Secretary. She had been a strong Eisenhower supporter in 1952. He backed her up by appointing Nelson Rockefeller the under-secretary. Rockefeller accepted the role against the advice of his handlers who felt it was beneath him to be the number two. But as he stated, “I’m responsible for creating this baby. I have a responsibility for seeing to it that it succeeds.”

Section 5: In Summary – Eisenhower Gets The Final Word.

In his contemporary review, Kim Bellard reflects, “Yet still the outlines of a solution continue to elude us. It seems there is no health problem so big that we can’t turn it into a political issue, not even a pandemic.”

But in shining a light on this remarkable American, Bellard reminds us that Biden is on the right path in promoting peace time oriented spending priorities, confronting the enemies of truth, and believing that the health of Americans is the critical determinant in the economic and political future of our American democracy.

Eisenhower had no second thoughts about the wisdom of such investment. As health care expenditures hit $4.1 trillion this week, controlling 1/5 of our GDP, Eisenhower would likely advise President Biden to “lean in” to the problem, expose the liars and haters, and do the right thing.

Our former President gets the final word:  “I believe that the social gains achieved by the people of the United States, whether they were enacted by a Republican or a Democratic administration, are not only here to stay but are to be improved and expanded…Anyone who says it is my purpose to cut down Social Security, unemployment insurance, to leave the ill and aged destitute, is lying. Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history.”

The Terri Schiavo Case: A Cautionary Tale For Justices Who Want to Play Doctor.

Posted on | December 12, 2021 | 2 Comments

Mike Magee

For the Justices on the Supreme Court considering allowing the government to “muscle out” the patient-physician relationship in the Mississippi abortion case (Dobbs v. Jackson Women’s Health Organization), the question each should be asking is, “What possibly could go wrong if we remove doctors from delicate life and death decisions?”

For historic precedent and an answer to this question, they need only review the Terri Schiavo case. For those interested in a full summary, it was provided as part of my Fall, 2021 course, “The Right to Health Care and the U.S. Constitution” at the President’s College of the University of Hartford.

Here’s a quick summary and timeline of the case:

•Theresa Marie Schindler was born in a Philadelphia suburb on December 3, 1963. She and her bother Richard and sister Suzanne attended local schools. Terri struggled with weight and had an eating disorder.

•Terri married her husband, Michael in 1984 and moved to Florida to be close to her parents. Terri apparently continued to struggle with her eating disorder, a condition left undiscovered when she sought evaluation for infertility.

•On February 25, 1990, she collapsed in the lobby of their apartment in St. Petersburg, Florida. She was 26 years old. She was resuscitated, and taken to the local hospital, Humana Northside, where she was determined to have had a cardiac arrest brought on by a cardiac arrhythmia caused by hypokalemia with a blood potassium of 2.0 mEq’L (normal 3.5 – 5.0 mEq/L).

•Michael received a court order on June 18, 1990 making him legal guardian and director of future medical decisions related to his wife. Two physicians independently declared her in a “permanent vegetative state.” A gastric feeding tube was surgically placed to provide regular nutritional feedings.

•When she developed a urinary tract infection in mid-1993, he signed a Do Not Resuscitate (DNR) order on her behalf.

•In May, 1998, Michael filed a petition to remove the feeding tube, providing some evidence that his wife would not have wanted to continue to live this way. He refused her parents request that he divorce his wife and hand over decisions, and money garnered from a successful malpractice suit for ongoing care of Terri.

•The parents challenged the removal of the feeding tube that her doctors supported. The case went to Court and a decision to remove the tube was upheld in Florida Second District Court of Appeal in February 2000. After multiple legal maneuvers, the tube was finally removed on April 24, 2001. Terri was now 37 years old.

•The Schindler’s charged Michael Schiavo with perjury, and a judge ordered the tube reinserted 2 days later.

•Claims and counter-claims ate up two more years. On September 17, 2003, as Terri approached her 40th birthday, a frustrated presiding Judge George Greer declared the actions of the Schindler parents was “an attempt to re-litigate the entire case”, and ordered the feeding tube to be removed for a second time, which it was on October 15, 2003.

•With encouragement from Republican operatives in Florida, the Schindler’s joined by their son, Bobby, engaged anti-abortion Operation Rescue/Right to Life extremist Randall Terry in a very public campaign with daily demonstrations at the care facility.

•The Florida legislature in emergency session granted then Gov. Jeb Bush (filled with Presidential aspirations), the authority to intervene in the case. Citing the new “Terri’s Law”, Bush ordered the feeding tube surgically reinserted for the third time.

• In the meantime the ACLU lined up with Terri’s husband. On May 5, 2004, “Terri’s Law” was declared unconstitutional.

•Senator Mel Martinez’s (R-FL) political career was damaged irreparably when he called for federal government intervention in the case. His top aide, Brian Darling’s memo went public. Commenting on the case, it read, “This is an important moral issue, and the pro-life base will be excited…This is a great political issue, because Senator Nelson of Florida has already refused to become a co-sponsor and this is a tough issue for Democrats.”

•A second Republican casualty was the future political career of doctor turned politician, Senator Bill Frist, who had Presidential aspirations but couldn’t resist weighing in as a physician. Breaking an unspoken code of ethics for the medical profession, without every seeing the patient, he challenged the decision to remove Terri’s feeding tube, proclaiming on the floor of the Senate on March 17, 2005,  “I question it based on a review of the video footage which I spent an hour or so looking at last night in my office.”

•The United States Congress held hearings on the case, and then President George W. Bush brokered a compromise transferring the case to Federal Courts. The Federal Court agreed with prior State Court Appeals.

•Terri Schiavo’s feeding tube was removed a final time on March 24, 2005. She died at a Pinellas Park hospice on March 31, 2005.

_____________________________________________________________

The case spanned 15 years, and was rejected by the Supreme Court for a hearing four times. Hijacked from doctors and patients by political opportunists and Right-to-Life activists, it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned.

Note To AMA: Reversing Roe v. Wade Threatens the Patient-Physician Relationship and Societal Trust in Doctors.

Posted on | December 9, 2021 | 1 Comment

Mike Magee

“Should anyone present know of any reason that this couple should not be joined in holy matrimony, speak now or forever hold your peace.”

The admonition above first appeared in the marriage liturgy section of the Book of Common Prayer in 1549 that laid out Church of England guidelines for worship leaders at the time.

Three hundred years later, Charles Dickens said his piece in the opening lines of the Tale of Two Cities. “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, …”

Dickens was exposing an unhappy union on a grand scale – the contrasting realities and uneasy coexistence of human prosperity and despair, class warfare where joy and hope seem incapable of overcoming suffering and anguish.

A century and half after Dickens shined a light on two cities – London and Paris – and dipped into themes like income inequality and political chaos, our own nation served up its own Dickenesque character in the form of a plucky 44 year old self-promoter, born in 1964 in Sandpoint, Idaho. Her name was Sarah Palin.

Her unlikely rise from Mayor of Wasilla, Alaska (population 11,562) to John McCain’s choice for Vice President of the United States on August 29, 2008, has been well documented elsewhere. What has been less well recognized is that the behaviors and tactics she exhibited helped inform Trump and whet his appetite for politics years before he threw his hat into the Presidential ring.

Palin was crude, flamboyant, and lied with ease. She was unfazed when lampooned, calm and supremely confident as she displayed instincts for the political jugular. Most important, even in the face of withering criticism, she never ever backed down, and her people (soon to be Trump’s) loved her for that.

Let’s take just one example – Palin’s “death panels.”

Sarah Palin invented “death panels” out of thin air, much as Trump invented “The Big Lie” of voter fraud. At the time her claim first appeared in a Facebook post in August, 2009, many of us were busy promoting “Living Wills”, “Advanced Directives” and end-of -life discussions, and never thought she would be taken seriously, even though there was a past history to this distortion.

We thought her laughable antics would fall flat. They were totally and wildly inaccurate.  Her claims that elders across America had much to fear were panned and exposed for what they were – a pack of lies.

Here’s a sampling collected and published by American Medical News at the time :

End-of-life discussions are useful
“In truth, there are no “death panels” in the proposed legislation to overhaul the health care system. HR 3200, the main proposal in the U.S. House, makes periodic, voluntary end-of-life discussions with your doctor a covered expense under Medicare (Sec. 1233). In truth, Republicans supported such discussions in Medicare proposals when George W. Bush was president. That’s it. No euthanasia, no arbitrary decisions about who should live or die, no mandatory anything.” Miami Herald, Aug. 20, 2009

Distortions doom end-of-life counseling
“This is not a proud moment in American politics. Financing beneficiaries’ optional consultations about a range of end-of-life care is a good idea. Families need it. Patients benefit. But a well-orchestrated rumor campaign ensured this element of the plan could not survive.” Seattle Times, Aug. 16, 2009

Stop distortion: There’s no “death panel”
“End-of-life care is a difficult issue, but one Americans should discuss — with family members, attorneys and doctors. Especially doctors. They will likely be involved in end-of-life care, if it becomes necessary. They should be compensated for consulting with patients on the issue. That is what the House legislation strives to allow: consultation. It’s not about death panels. It’s about planning, which is important for individual patients and the health-care system as a whole.”
Des Moines (Iowa) Register, Aug. 14, 2009

In truth, health professionals made a huge mistake in believing that logic, knowledge, and well-established professional practice would easily counteract Palin’s irresponsible actions. Their collective voice was weak. They largely “held their peace” in order to keep the peace.

A simple check of top Google searches at the time (with “death panels” beating all comers) should have forecast what happened next. The fact that the bill wouldn’t require patients to receive counseling sessions, nor would it require a doctor to offer one didn’t matter. Nor that it simply modified Section 1861(s) of the Social Security Act, defining what services Medicare will pay for and allowing a patient receiving an end of life counseling session from a doctor or health care practitioner, to have Medicare pay for it.  No matter it earned Politifact’s “Lie of the Year.” Within weeks, the proposed coverage was gone.

Palin’s intrusion into well-established medical terrain did not receive an adequate and sustained counter-punch from health professionals and their societies around the country. And once the public endorsed Palin’s lie, it was difficult to reverse.

The 2012 lackluster performance of traditional Republicans Mitt Romney and Paul Ryan provided the ideal foil for the full-blown high octane “Palinesque” takeover of the party in 2016. Trump had been toying and experimenting and learning the game of politics as part of a Brand-extension strategy. In 2011, during a Conservative Political Action Committee address when he first admitted to considering a run for President, he tried out the Obama “birther” claim.  To John McCain’s campaign director, Steve Schmidt, his choice of Palin for VP had unleashed Trumpism. As he said of Palin in 2020, “She is the first of a generation of politicians who live in a post-truth environment. She was, and there’s no polite way to say it, but a serial liar.”

What Trump understood in 2011 was that Palin’s only mistake was being a woman and not lying enough.

A quick examination of the map of our United States, color coded for regressive legislation and tactics to disenfranchise women and children, people of color, the poor and the vulnerable, well illustrates that we too are a tale of two cities.

Attacks on women’s rights are the underpinning of current and future assaults on democracy. With women’s rights comes trust in physicians (and the patient-physician relationship) to help negotiate the individual and complex choices that come with child bearing.

On September 21, 2021, the AMA with 25 other medical organizations filed an amicus brief in opposition to the restrictive Mississippi abortion law, Dobbs v. Jackson Women’s Health Organization.  On  October 12, 2021, 19 medical societies, with the AMA in the lead, filed  an amicus brief in U.S. v. Texas, the abortion vigilante law signed by Gov. Greg Abbott. But in the court of public opinion, there has been minimal investment of time and resources by these same medical associations over the past two months considering all that is at stake in the upcoming Supreme Court decision.

As the Supreme Court deliberates the future of Roe v. Wade, health professionals and their societies should not make the same mistake they did in 2009 on “death panels.”

“Speak now or forever hold your peace.”

 

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