Hollowing out medicine (or, Leavitt is a bastard)

19 12 2008

Those fuckers have done it. Everybody knew it was coming, but it’s so egregiously bad that, somehow, I thought it might disappear into the trailing vapors of the soon-to-be-ex Bush administration.

From a story by David Stout, of the New York Times:

“Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience,” Michael O. Leavitt, the secretary of Health and Human Services, said in a statement on his department’s Web site.

The rule prohibits recipients of federal money from discriminating against doctors, nurses and health care aides who refuse to take part in procedures because of their convictions, and it bars hospitals, clinics, doctors’ office and pharmacies from forcing their employees to assist in programs and activities financed by the department.

Excellent. Never mind professional standards, fiduciary responsibility, and, oh, patient health and well-being. Nope, if you’re too wobbly, er, conscience-stricken to deal with birth control or IVF or emergency contraception or even letting a woman know that there’s this procedure known as (shhh!) abortion, and that the doctor down the hall might just be willing to provide you with one, you now have an executive-branch rule to NOT DO YOUR JOB. And still get paid, presumably.

I was never much of a fan of the so-called conscience rule (dating back to the 1970s Church amendments and to a 1996 directive), believing that if you choose to enter a particular discipline, then you agree to adhere to the standards of that discipline. This is particularly important in medicine, insofar as your primary duty is to your patient, i.e., not a theoretical construct but an actual, mortal, human being.

If you want to practice medicine, then you ought to think about what that entails. I briefly considered trying to earn a spot at the US Air Force Academy, but as my pop (who put in his own stint as an Air Force enlistee) pointed out, once you’re in, you do what you’re told. I don’t particularly like to be told to do anything, and the thought of carrying out the policies of the then-Reagan administration really didn’t work for me. My efforts ended with those stray thoughts. (For the record, I doubt I would have passed the psych tests.)

I’m not saying that all doctors have to perform abortions. However common a procedure, it’s a fairly narrow one, unlike, say, drawing blood or inserting a catheter. In other words, it’s pretty damned easy to avoid doing abortions. Not all doctors want to cut someone open, or examine children or work with old people; the appropriate response to these disinclinations, then, is to avoid surgery, pediatrics, and gerontology. That said, there may be times, however rare, when surgery, children, or old people are unavoidable: you then have a duty to care for that patient until you are able responsibly to hand that care over to another doctor. Along those same lines, then, it seems to me that knowledge of how safely to perform abortions should be a basic part of medical education—not even that every resident must induce abortion, but that each should know the process for doing so.

Still, mine is a minority opinion: the conscience clause for abortion seems pretty well set in American medical ethics. And I guess that as long as those who decline to do abortions are willing to refer a patient to a willing doctor, it is a reasonable compromise.

It is not clear to me (I’ll try to find this out) that the old conscience clause require such willingness to refer; what is clear is that new regs not only do not require this, they protect a wide variety of ‘health care providers’ from their refusal to assist in any way with procedures they find morally objectionable—including not only abortion, but also sterilization and the provision of contraception (including emergency contraception), and undefined research activities. (cf. p. 15 of the pdf doc in the above link).

I’ve only skimmed the document, so my rant is based more on impressions than a good, critical read. Key sections appear to be II. Comments on the Proposed Rule (pp. 13-  ; esp. 14-25 , 34-60, 68-77). Let’s just say that even this preliminary once-over is. . . GAH! I can’t even detail how fucking awful it is! Mealy-mouthed in its refusal fully to define or limit terms! Blandly dismissive of counter-conscience claims (and yes, Mr. Secretary, health care providers who perform abortions, prescribe contraceptives, and fill those prescriptions also have consciences!)! Condescending in its approach to patient concerns! Stupidly ignorant of how actual human beings make use of actual medical services! Derisive in its approach to informed consent and standards of medical care! And on and on and on. . . !

One more perverse invocation from an administration far more in love with its own mirrored image than the people it purports to serve.


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Here is my blood shed for thee

13 12 2008

Last thing about Ainadamar (for awhile): Did I mention that after the performance I trekked up to Corporate Bookstore and bought two books on the Spanish Civil War?

Wait! There’s a reason for this! The libretto  included broadcasts from Radio Falange, and I wanted to know if these were the product of David Hwang’s imagination or actual transcripts. Here’s a sample (translated)

Our youth must be ready//to shed their blood generously/ for the sacred cause of Spain//Whoever is not with us/is against us//We’ll exterminate the seeds of the Revolution,/even in the wombs of their mothers//Long live death!

And later:

. . . And if we find them dead, we will kill them again. I give you permission to kill them like dogs, and your hands will be clean.

Well. I just started Anthony Beevor’s The Battle for Spain (c. 2006) so I don’t know if these are actual transcripts, but he does note, on p. 56 that the nationalist Foreign Legion, ‘Composed in large part of fugitives and criminals. . . were taught to be useful suicides  with their battle cry ‘Viva la Muerte!’‘ And, skipping ahead to p. 424, Beevor notes that ‘Ideological and religious invocations deliberately tried to make the violence abstract. . . . Carlist [nationalist] requetes were told that they would have a year less in purgatory for every red they killed, as if Christendom were still fighting the Moors.’

So much for the notion that Al Qaeda invented the (anti-)political cult of death.

In any case, I was seized by the notion of the ideological underpinnings of massacre. What makes it killing those who are not trying to kill you okay? It seemed—seems—a tremendously important issue.

But as I thought more about this, I remembered the work I did a lifetime ago in a human rights seminar in grad school. We were trying to theorize about human rights abuses, and, frankly, having a terrible time doing so. There were too many massacres, across all populated areas, from all different ethnic, religious, and ideological groups: how does one find a way through such a fog of data?

One key feature, as discussed by Leo Kuper in his book Genocide, was the dehumanization of the victims. They were a cancer, an infection, rats, insects—anything which not only removed them from their fellow humans, but which also made it a positive good to eradicate.

But the casting out of humanity of the victims is only part of the story; what of the killers? There have certainly been a number of studies of the sociology and psychology of mass killing—cf. Ervin Staub The Roots of Evil; Robert Jay Lifton’s The Nazi Doctors; Christopher Browning’s Ordinary Men, among others—but what of the specific ideological indoctrination? Robert Proctor gets at both the material and ideological aspects of Nazi scientists and doctors in Racial Hygiene, as does Benno Muller-Hill  in Murderous Science, but even these are more sociological than political-ideological.

What kind of ideology posits mass murder as a good? National Socialism was proudly genocidal, but does all fascism necessarily lead to the valorization of massacre? And Stalinism was clearly genocidal, but that seemed more cultic or psychopathic than ideological. (That said, Bolshevism wasn’t all sunshine and daisies, and Bolshevism clearly shaped Stalin. And no, I’m not one to think Lenin was somehow betrayed by Stalin: ol’ Vladimir may have been more pragmatic than Stalin, but he was a revolutionary, after all, with all the ruthlessness that implies.) The errors and crimes of Leninism and Stalinism are clear to me (if not their precise etiology), but Marxism is an ideology, if not always a practice, of liberation.

Capitalism? Certainly, in practise it has sanctioned the treatment of humans as ends rather than means, and there is plenty of violence woven into long history of the emergence from pre-capitalist economies and societies as well as colonization. And, oh yes, there were more than a few killings commited in the defense thereof during the Cold War. Yet, as with Marxism, as an ideology it pitches liberation.

Furthermore, I think it makes sense to distinguish between massacres, such as My Lai, and concerted extermination. It may make little difference to the victims of such massacres whether their deaths were the result of  a (morally, psychologically) chaotic situation or a fixed program, but as I’m trying to get at the programmatic content of mass murder, the distinction is important. In the former case it is a kind of criminal accident, a breakdown of ordinary operating procedures: Even if the soldiers or killers are not ultimately punished, the massacre itself must be explained [away] as something extrinsic to the (political, national) cause itself. In the latter case, however, massacres are intrinsic to the cause, necessary as both means and end.

Hm. I think that’s a part of it: an ideology in which death is not a mere (unfortunate) means, but a desired end. And this bifurcates: it is necessary and good to kill these others, as it is necessary and good for ourselves to die in battle against the others, and for ourselves.

So back to the ideology of death. Is this its own ideology, or a component of other ideologies? Can it be integrated into other ideologies? Does it require a belief in some kind of life [for the killers] beyond death?  And whatever its status as a freestanding or constituent part of another ideology, does the embrace of death mark the ideology as anti-political?

That last question, at least, I can answer: Yes. Politics is about the world, a particular kind of being-in-the-world which is predicated on human life (yep, Arendt again). To disdain such life is to disdain politics.

I’m not saying anything particularly shocking here: What violent dictator hasn’t asserted his triumph over politics? And while I think there is a political (i.e., worldly) agenda of Al Qaeda, from what I’ve read of bin Laden or Mullah Omar’s speeches, ideologically, they’re all about wiping out politics.

Sigh. Don’t know how much this helps me with the whole exterminationist-ideology thing, tho’.

Anyway, I did at least discover that one line from the opera is authentic. It is the response of the fascist Ramon Ruiz Alonso, to the question of the crimes of Lorca:

He has done more damage with his pen,/than others have with their pistols.



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Get offa my cloud

6 12 2008

Getting bogged in the blog.

I have in mind a couple of pieces (about abortion, morality and politics) in which I lay out a comprehensive argument, with arrows running hither and yon, connecting outliers to the center, blah blah, so as to capture as fully as possible the phenomenon under investigation.

Hah.

Bit by bit, I know. Still, I used to be able to pull my thoughts together for more than a paragraph or two, so my current impatience-slash-laziness (hm, what is the connection between impatience and laziness? I’ll have to blog on that. . . .), both feeds that distraction and increases my sense that I should do. . . something.

Anyway, a coupla’ good pieces on abortion and conscience clauses from Slate:

Dahlia Lithwick notes that so-called conscience clauses only run one way, that is, those who oppose abortion (and anything contra-conceptual) may opt out of their fiduciary responsibilities to their patients any procedures or conversations related to these matters, but those who do provide abortions have to read from scripts with which they disagree and know to be medically misleadling.

And William Saletan has more on the obsfucations surrounding the morning-after pill, involving, unsurprisingly, the substitution of religious for medical definitions. My take? Hey, if you want to make a religious argument about the status of the embryo or fetus, go right ahead. But don’t misrepresent that position as the scientific or medical definition.

Shite. Now I’ll have to blog on the relationships between science, medicine, and morality. And, oh, hell, let’s throw in politics.

Okay, one last thing: the William Ayers op-ed in the New York Times, and Obama’s interactions with Ayers. There’s a lot that’s provocative in this piece, but I want to pull back and consider the larger question of conversations/arguments in the public square.

I gotta go to work, but I want to argue that it is precisely in public that one is able to meet or even consort with those with whom one disagrees, or even finds distasteful. (Remember, I’m an argue-and-eat-pie kinda gal.) I wouldn’t invite a fascist into my home, but I’d certainly talk with her outside of my house.

Shit, this could all get quite complicated quite quickly, and I really do have to go. Would it make sense to say that the public is a more a space of freedom and the home more a place of judgement or discernment?

Nah, I didn’t think so. More on this. Eventually.

Hah.


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Sandra at the beach

6 11 2008

My expectations are few:

Guantanamo: close. Torture: stop.

That’s it. More? Yeah, more would be nice, more would be more than nice, but if an Obama administration cannot accomplish these two very basic acts—no matter what else it does—it will have failed.

As for other happenings on Nov 4:

Prop 8 passed. Hey, gays and lesbians, bisexuals and the transgendered: You/we don’t count! (Oh, feel free to keep being, y’know, gay and all that, but please keep it to yourselves. Do that, and you get domestic partnership laws! That’s good enough, doncha think?)

And all you/us straight folk out there who think anti-gay laws and referenda have nothing to do with you: check out the Arkansas ballot measure which prohibits any unmarried couple from fostering or adopting children. The measure—which passed, natch—was explicitly aimed at prohibiting gays and lesbians from taking care of children. To get around an Arkansas Supreme Court decision which prohibited Arkansas’s Child Welfare Agency Review Board from, mm, discriminating against gays and lesbians, ballot proponents widened the prohibition to include all unmarried couples (ie, ‘individuals cohabiting with a sexual partner outside of marriage’).

I tried to find out if Arkansas allows single people to foster or adopt children (although the statute states that ‘It is the public policy of the state to favor marriage. . . over unmarried cohabitation with regard to adoption and foster care’), but was unable to do so.

Why should unmarried straight folks care? Well, in addition to reasons of principle (equality, dignity, and all those other silly et ceteras), it’s clear that those transfixed by same sex attraction have no problem flattening singles on their way to buttress the married.

As the commenter on Rod Dreher’s Crunchy Con website put it:

S
November 5, 2008 8:36 PM

I’m not gay and I don’t have any particular dog in the race over gay marriage. I’m not particularly for it, but given the tax subsidies and other benefits given to “married” people, I can see why a seriously-committed gay couple would want to participate.

What is really starting to gripe me is the whole focus on “marriage” is the foundation of our civil society, yada yada yada.

Well, I’m a heterosexual single. I’d like to feel like I have some contributing role to play in the betterment of society even though I’m not married.

There’s a pretty huge demographic of unmarried, never-married heterosexual adults. We matter, too.

It’d be nice to think so, wouldn’t it?

I let loose of fair number of words disclaiming any kum-by-ya sentiments, and am not bothered by the combative aspect of politics.

But, underneath it all, I hold to the basic belief that there is no us-and-them, there is only us. To strip away the dignity of the despised among us to strip away our dignity.

Grumblegrumblegrumble.

Okay, how I square this with understanding of difference and pluralism and the Other, well, that’s going to have to wait for another post. For now, let’s just say that this ‘us’ is a mixed bag. . . .


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At last

5 11 2008

Perhaps I should wait until January, when he officially becomes the 44th president of the United States, but I’ll probably be all cranky and same-shit-different-day-ish by then.

So, for a day or two, I’ll enjoy.

(from HuffingtonPost)


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Waiting for the great leap forward

29 10 2008

So I heard there’s going to be an election next week. Something about the presidency. . . ?

Yeah, I’ve been markedly blase this election season, and not just because ‘election season’ started shortly after the dinosaurs were killed off. I don’t like Bush, have little respect for the Democratic Party (tho’ much respect for individual Dems—go Russ Feingold!), and tend to think that the machinations in the nation’s Capitol are more likely to grind up citizens than ennoble them.

(Ennoble. I know, too much to ask for, but not too much to demand.)

Anyway, long before the major parties settled on their candidates, I knew I’d vote Dem. I’m not a Democrat—it’s a capitalist party, and I’m not a capitalist—but I often move to the right to vote for them. I don’t expect much (anymore), but thought Hey, if the Dem would close Guantanamo and stop torture, the vote would be worth it. That ought not be too much to ask for, and if I get more (sane HHS policies regarding women’s health and contraception, say, or an understanding that diplomacy is required in dealing with one’s adversaries, not friends), all the better.

So I registered with the nice woman in a Bed-Stuy park and asked for time off from Job1 to make sure I’d have time to get to the polls and listened to the conventions and speeches and urged my students to register and vote and listen to the conventions and speeches and listened to political coverage on WNYC  and read and read and read and. . . thought, Whatever.

It’s not that I’m blase about a McCain presidency. Given his apparent lack of interest in domestic policy, I feared that he would appoint ideologues to key positions in HHS, Education, and Justice as a bone to the rightists in his party (this was before the selection of Palin as his running mate). And while I agree with some conservatives that political questions ought to be dealt with politically and not juridically, I’m not looking forward to the judges a President McCain would appoint. Oh, and that whole Iraq thing. . . .

Still, as a pinko in the US, I’m used to the political despair of life under running capitalist dogs! in opposition. It’s not that hard, really. Try not to be OUTRAGED! every time someone says or does something with which you disagree—too exhausting. Don’t think that every person on the other side of you is fatally compromised as a human being—you will end up drinking alone. Oh, and have a drink every now and then, with friends to bitch, and with friends to spar. Yell, if you need to, then eat pie.

This is the one saving grace of the remoteness of federal politics from the ordinary lives of citizens: losing isn’t that much different from winning. Things may be slightly better or slightly worse, but you’ll get to bitch about it, regardless.

More to the point, you’ll get to bitch about it and forget it. That matters, more than any unhappy words (traitor! hater!) that some fool hurls at you. It used to. . . well, it still does irritate me when people foam that a Bush (or Obama) presidency means the end of life, liberty, and the pursuit of happiness. Whatever the flaws of the US, this ain’t Russia or Saudi Arabia or Myanmar: when you levee vos skinny fists comme antennae to heaven!, you will most likely be ignored, not imprisoned, disappeared, or murdered.

This is not to say that as long as we’re not being terrorized by our government all is well. Even as beaten-down a politics as exists in the US gives us some space in which to think and to act. Although I’ve moved from wide-eyed activist to squint-eyed theorist, I’m not willing to write off the possibility of something. . . good coming out of elections.

And thus my reconsideration of the coming election. I retain my squint, but I have to admit there is a humming within me at the prospect of an Obama presidency: Maybe we will get something more! Finally, an African-American president! Oh, the possibilities. . . !

It is a faint hum, but it’s there. Oh, the possibilities.


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Why I sing the blues

22 10 2008

No, not another disquisition on depression—although the real topic, presidential politics, is depressing enough.

Multiple posts on toleration, respect, religion, agnosticism, but only a few quick hits on politics.

What the hell? Aren’t I a political theorist, after all? Aren’t I the one who, in 2004, moved from a city I loved in another country back to the US in order to participate in politics? Who dragged her ass out of bed on Saturday mornings to ride a bus to another state for the privilege of knocking on doors and asking those granite folk who they were likely to vote for? Who had her dad drive her to NOW meetings (until she got her license)? Who remembers raising her first-grade fingers in a ‘peace’ sign every time the school bus driver/town mayor halted at the railroad tracks?

Jesus Christ, politics has been in my conscious life as long almost as long as I’ve been conscious of life. And yet my response to this campaign has been: Eh.

Yeah, yeah, I’ll vote, and I really am looking forward to an African-American family in the White House, but, honestly, I simply think Obama will do less damage (to this country, the rest of the world) than would McCain.

I’m not a moderate (I’m a ‘hard-core leftist: run for your lives!’), and my vote for Obama is not reluctant. I just doubt it’s going to matter all that much.

Sigh. It will matter, on some crucial issues: judges, executive power, Guantanamo, torture, access to contraception, the Lily Ledbetter pay act, diplomacy. These are not small things, so in saying I doubt how much the presidential race matters, I’m not saying it doesn’t matter at all. It does. That’s why I’m voting.

And Iraq? I truly don’t know how much leeway the next president will have to do anything momentous. From what I’ve been reading, the Iraqis want the US out sooner rather than later (tho’, preferably, not right this instant), and while the surge has brought a kind of peace to many areas of the country, it’s pretty clear that the force levels required for the surge are unsustainable. I’m guessin’ that whoever the next president is, the next stage of Operation Iraqi Freedom is ‘Iraqi-zation’.

Afghanistan? Unclear that either has a workable plan. That said, Obama seems far more practical (i.e., willing to adapt to exigencies) than does McCain.

So the vote matters: who do you want as captain of the ship?

And this is where I sigh and say, Eh, and sigh again, a bit more angrily, and say I don’t want a fucking captain and I’m not a goddamned ship’s passenger. I’m a citizen in a democratic republic who’d like there to be at least some connection between the peoples’ representatives and the people, who’d like to be addressed as something other than ‘constituent’ or ‘taxpayer’ or ‘prospective voter’. I don’t want to be wooed or massaged or have my pain felt up by some suck-up in a suit who’s going to tottle off to Washington or Albany (or City Hall) and do all that he or she can to cut the citizenry out of politics.

No, I’m not talking about enacting or blocking favored social programs (tho’ I would dearly love universal health care), but about legislators doing what they can to deepen democracy, to involve us further in our own governance. I’m thinkin’: New Deal. Or, more recently, efforts by people in the gulf region post-Katrina to rebuild their cities, physically and politically (and getting at best little help and at worst obstruction from govt officials). This isn’t just about self-help, but about acting in concert with one’s fellows and fully conscious of the political implications of such solidarity.

There’s so much more to say, and I think this really does matter, deeply and broadly, to us as citizens. To presidents, senators, representatives, governors, mayors, and city council members: we’re not you’re goddamned pets. Quit throwing us bones.

And to the rest of us: quit begging for those bones. Stand up already.

*Update*

Here’s the link to the lyrics to BB King’s ‘Why I sing the blues’

Or better yet, get Aretha Franklin’s ‘Spirit in the Dark’ cd and listen to her version. Fantastic.


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They’re not stopping!

15 10 2008

Forty more minutes of this.

Each minute a nail in my melting head. You’d think that [melting] would make the pounding [of nails] hurt less.

And yet it doesn’t.


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Make them stop. Please. Make them stop.

15 10 2008

Oh my god. The debate.

The horror! The horror!

Be glad I’m stifling the urge to blog line by line. This is less out of self-discipline than self-preservation: I fear my head would deliquesce.

I will forbear, and listen. But must. stop. writing. . . now.


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Yesterday, once more

7 10 2008

Lucretia, as usual, is forcing me to sharpen my thoughts in response to her own perspicacious observations.

So: the varieties of tolerance. I’ve been focussing on political tolerance, tolerance among citizens, and tolerance among strangers. The first might be a kind of structural or constitutional tolerance; the second, for those who move within a particular political or constitutional tolerance; and the third, for those about whom one knows little, and for which no relationship of even the minimal constitutional type is necessarily defined.

I haven’t said much about this third type, mainly because I’ve been preoccupied with the political and there’s nothing particularly political about this. Still a brief: A certain defensive wariness may be apt when among this last group, insofar as the encounters may happen ‘outside of the law’ (e.g., a deserted street or minimally populated area, with no obvious authority present), as it were. That these encounters may be ‘lawless’, however, doesn’t mean they have to be violent or aggressive or even threatening: One may wish only to move through or around strangers, and however much the strangers may eye one another, each nonetheless decides to leave the other alone. (This might be considered a literal ‘toleration of existence’, and a necessary precondition for politics.)

Perhaps somewhere in there should be tolerance of acquaintances (feel free to offer a better term): These are the people we work with or see regularly or engage in genial conversation, even if we wouldn’t invite them into our home and they wouldn’t invite us into their home. We might like one another ‘well enough’ or find each other ‘interesting’ or ‘worth talking to’, but wouldn’t, really, call a friend. Someone you know, kinda, and are satisfied with that.

Anyway, what poked at me from Lucretia’s comment was about the personal side of toleration. I noted that I wouldn’t be friends with someone who merely tolerated me, but Lucretia adds some shading to this statement:

As for wanting more than tolerance from my friends – maybe. I’m finding as I get older that I am more tolerant than I thought I could be. I can be friends with someone even if there are one or two things about them I really don’t like or even actively disapprove of, because they have other qualities that shine brighter, and because everyone has faults and blind spots, including me. But I agree, that if a person only tolerates something that I feel is the very core of my being, it’s going to be much harder to feel close to that person, and trust them.

I was getting at more the ‘very core of my being’ aspect, as opposed to the ‘I’ll put up with’ or ‘I’ll overlook this’ aspect of tolerance. My sense of not wanting to be friends with someone who merely tolerated me arises both out of a desire for dignity and from not wanting to feed my occasionally raging neuroses. Why hang out with someone who doesn’t think you’re, basically, okay to hang out with? Why do that to yourself?

But Lucretia’s right: Ain’t none of us perfect, so even dear friends are going to irritate us (and vice versa). What then to do? Nothin’. Let it pass. Be glad for the friendship, be glad the other person is as flawed as you, be glad you don’t have to be perfect to have a friend or be a friend.

When I was younger I used to say ‘I don’t judge.’ Hah! I judged all the time, but since I didn’t want to be judgmental, I wasn’t honest about it. As a result, I was never able to reflect on those judgments; they were unconsidered. Now I know I judge all the time, but I also let a hell of a lot more judgments go. So X is always late and Y never calls, but I know that, and I still want to be around them. So I set aside time for X and I’m the one who calls Y. At some point, I decided not to moralize these behaviors. Yeah, it’d be nice if X were prompt and Y could pick up the phone, but so what: the people matter more than the irks. (And I’m glad that goes both ways.)

Yeah, sometimes the irks overwhelm the people, and it becomes difficult to remain friends. And sometimes things just change so radically you have to reconsider everything. (I’m thinking of my friendship with someone who moved her Christian faith from the periphery to the center of her life. Another post, perhaps.) But at that point I think the issue is less a matter of tolerance and more a matter of compatibility.

Huh. Perhaps the distinction should be between tolerance of persons (which is not somethings friends do to one another) and tolerance of acts (which friends, citizens, and strangers may allow).

Does this help, or am I just fucking it all up again?


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