NPF: THE DESIGNATED SURVIVOR

Posted in No Politics Friday on January 29th, 2010 by Ed

At some point during the State of the Union coverage every year, usually during the extended "Entering the chamber and shaking hands with everyone and his brother" sequence, the commentators will note the absent Cabinet member, aka the Designated Survivor, who will accede to the Presidency if…well…everyone dies. This practice was born of Cold War paranoia about a Soviet nuclear "decapitation strike" that would wipe out the Federal government in the blink of an eye. It's rare that the entirety of the government is located in one room and the godless Communist was simply waiting for such an opportunity to pounce. A member of the Joint Chiefs once described the overall Continuity of Operations Plan as a means of protecting the presidency, not the President. In other words, it doesn't really matter who it is. Our system is designed to operate as long as someone fills the required roles, be it a low-ranking bureaucrat or the White House janitor. Pretty inspiring stuff, our government.

Curiously, it was only recently that four members of Congress (one Senator and Representative of each party) were included. Legislative continuity apparently did not strike anyone as important, but the survival of a small group of Congressmen would be necessary to nominate new individuals (presumably themselves) to the Vice-Presidency and Presidency Pro Tempore of the Senate. Part of me thinks it would be interesting to see a pitched battle for the Vice-Presidency between Robert Byrd and Chuck Grassley in a two-man Senate. Then again, in the wake of a nuclear strike I don't think many of us would be too concerned about finding someone to inhabit the smoldering ruins of the Blair House.

This year's DS, HUD Secretary Shaun Donovan, was in for a big disappointment if a nuclear strike hit the Capitol on Wednesday night. Since Hillary Clinton was attending a conference in London she would have become President and, well, at least the new post-apocalyptic government would have HUD covered. But Madame Clinton was not in a secure location; hypothetically she too could have been killed while out and about in London. So where was Mr. Donovan? Our secure locations, interestingly enough, are most likely the same as Dick Cheney's infamously undisclosed ones.

Even after all these years it is unlikely that there's anything more secure than the NORAD Cheyenne Mountain complex. There are also some underground facilities at Offut AFB in Omaha, home of the former Strategic Air Command (intentionally located in the dead middle of the continent, hence giving our land-based air defenses ample opportunity to shoot down incoming Soviet bombers). But Designated Survivors probably stay a lot closer to home. Everyone has heard of NORAD, but the undisclosed locations of choice in recent years are less famous. "Site R", aka the Raven Rock Mountain complex located 6 miles from Camp David, remains largely classified. Its primary tenant, the Defense Threat Reduction Agency, is known to keep the facility prepared as an emergency Continuity of Government site but little information exists about the contents or other tenants of the bunker. The second option, Mount Weather in Berryville, VA, combines two facilities. The above-ground complex is the headquarters of FEMA while the underground portion remains a comparative mystery. The odds are excellent that Designated Survivors spend a few hours in one of these locations every year.

A few years ago I chuckled at a cable program that promised to count down "The greatest spies who ever lived." The greatest spy would, by definition, be someone we've never heard of. If he or she deserves the title, s/he maintained cover and was never identified. Such is the case with these "secret" facilities. If I can tell you about a place, it's not really the secret secret facility. There's probably something else out there, hidden beneath a rural mountain or hundreds of feet below some nondescript office building in Arlington. Then again in the age of satellite imaging and ground-penetrating radar it's awfully hard to keep secrets. When the Russians began digging an end-of-world superbunker to put NORAD to shame at Mount Yamantaw in the Urals, satellite data let the American intelligence community feel like it was there digging the hole. But who knows? The U.S. government can be good at keeping secrets on occasion and sites that are actually secret may exist. Only Cheney knows for sure.

LOOK! OVER THERE! GAYMOSEXUALS!

Posted in Quick Hits on January 28th, 2010 by Ed

I received some very bad news from the vet today relating to the life expectancy of my dear Bear, so I am going to keep this somewhat brief.

1. Revising (or at least proposing to revise) "Don't Ask, Don't Tell" is a political masterstroke by Obama. We can build a pretty substantial majority by fusing three groups: people supportive of gay rights, people completely ambivalent on the subject, and anti-gay rights people who have far more pressing things to worry about at the moment. That majority will offer a response ranging from "It's about time!" to "Grr. Whatever." and then forget about it. The demographic opposed to the proposal, however…well, let's just say they're going to make a much bigger deal out of it. I think this has the potential to distract Rick Warren for the better part of a year. Classic misdirection, well played. Whatever mileage the far right thinks they got out of "Oh no, the gays!" in the past, they're going to be sorely disappointed this time around.

2. So the ACORN pimp was arrested (with three idiot co-conspirators) in New Orleans trying to tap Mary Landrieu's office phone. Aside from breaking the R. Kelly Rule – if you're going to commit a felony, don't record it on video – these retards and their Scooby Doo-esque plot make the Watergate burglars look like Ocean's 11. Strangely enough, the gasbags on Fox who spent weeks trying to make his little ACORN pimp video an international crisis haven't said anything about his arrest. Breitbart threw them under the bus too even though Pimp Daddy is on his payroll. One of the "conspirators" is the son of the US Attorney in that district. It'll be interesting to see if these guys are prosecuted, although nothing short of execution would do if the party roles were reversed.

3. Chris Matthews' response to the SotU: "I forgot he was black tonight for an hour."

What the fuck.

DAILY DOUBLE

Posted in Rants on January 27th, 2010 by Ed

What can I say about the President's half-assed "spending freeze" proposal that hasn't already been said about AIDS? While I've never been a fan of this guy, it would take a herculean effort to get me to ponder – not accept, but at least consider – the charges of his conservative opponents in 2008. Does this guy have the slightest idea what he's doing? Are we going to try a new macroeconomic policy every six months, or are we just slap-dashing bits and pieces of different policies together and hoping that the sum will be greater than the parts? This is just the latest in a string of attempts to "govern from the center" (i.e., do nothing) and it manages to be bad economics and bad politics simultaneously. That's hard to do; I guess Obama really is special after all.

On the one hand, as Ron Paul (!!!) was astute enough to note, the odds of much spending actually being cut by the time Congress caters to the demands of each individual member are slim. On the other, it signals that Obama had the balls for all of about 6 months of governing with any sort of coherent policy of his own. Now, with 58 Democrats in the Senate and an 80-seat majority in the House, he's moved on to full-blown Republican appeasement. Time to "reign in spending" and a bunch of other shit that Republican voters aren't going to care about anyway. I mean, why stick to your guns or follow through for the people who voted for you when you can bend over trying to appease people who hate you no matter what? Maybe the problem, as his supporters are slowly discovering, is that he had no guns to begin with. As I said repeatedly during the election, he offered us nothing but four years of centrist New Democrat bullshit. And he's delivering.

Reich and Krugman have plenty to say about why the economics are fundamentally unsound. Politically, this will pretty much guarantee the Democratic base sitting out the next couple of elections while winning the President exactly zero support from the right in the process. I'm not sure what he could propose that would be a bigger insult to the people who voted for him than a freeze on all non-military spending. Obviously if it's time to start tightening out belts (to achieve deficit reduction that voters won't even know happened) we should start with everything other than Iraq and Afghanistan. Idiot.

It's not the act itself that matters; anyone with a working knowledge of Congress understands that this will result in very little reduction in spending (if any). It's the absence of principles, absence of a backbone, and willingness to cave to the slightest political pressure that augurs badly for the next couple of years. You can't beat the Republicans at being Republicans. If voters want Republicans they'll vote for them. That our political choices since 1980 have been Republican and Republican Lite says everything we need to know about our current economic predicament and the overwhelming disinterest in politics among voters to the left of Trent Lott. Of course the teabaggers are excited. You would be too if you always got what you wanted, win or lose.

DISASTER STRIKES – IS THE APPLE STORE OK?

Posted in Rants on January 26th, 2010 by Ed

Media coverage of disasters on television is formulaic. Consider hurricane coverage, for example. The cycle is well-established: start with shots of empty grocery store shelves (time to stock up!) and people boarding up windows. Throw in an interview with idiots who plan to "tough it out." Lots of cutaways to the storm-addled reporter giving important updates ("It's really windy, Bob! Back to you!") while getting pelted with 80 mph rain. After the storm serve up the oh-the-humanity destruction footage. And complete the cycle with a day of footage of and moral panic about looting. Gotta have the looting. There is no better indication of the class biases and motives of the mainstream media than its obsession with looting during times of unspeakable human tragedy.

It sure didn't take the cable news networks to move beyond the human suffering frame in Haiti to get to the important question: is the property OK? Matthew L. directed me to this piece about the media's obsession with the possibility that people might be taking things for which they did not pay. It is stunning how they can't connect the stories they run from one minute to the next; they leap from food shortages and international aid not getting through to the people of Haiti to tales of civil disorder and looting. Well, if people have no food or shelter they're probably going to take whatever they can find, right? This isn't a Sunday afternoon on Long Island. It's a country that was impoverished to begin with and it is in complete ruins. A little "looting" may be understandable given the circumstances. But God forbid the media get hold of footage of looters taking non-essentials (TVs and DVDs instead of food and medicine). Their contempt becomes almost too much to bear; it takes all the strength they can muster to refrain from saying, "Typical. Just typical. Stupid nig…Whoops, we're still on the air, aren't we?" over the footage.

The linked story goes to some lengths to justify the intent of the apparent looters – maybe the man taking fabric from a demolished store needs it to shelter his family from the sun. Maybe the people taking food have starving children. That line of argument is futile for two reasons. First, we'll never know the motives of the people we are observing. Second, who gives a shit? Whether these people are taking food from the rubble or breaking into an undamaged mall to steal cell phones, looting is about 37th on the list of Haiti's most important problems at the moment. The news is now full of stories of police shooting looters on sight (implicitly condoning the idea that every crime becomes a capital offense, no trial required, during a disaster). Is this a wise allocation of resources? There were still survivors in the rubble a week ago, not to mention tens of thousands of corpses ready to rot and kill more people with disease. I can think of a few things the police could be doing other than chasing looters. How is this a priority?

It becomes a priority when the media and governments from the so-called First World impose their twisted worldview on people who have just lost everything. Americans would rather be dead than have someone (black and poor) take their stuff. Isn't that what this kind of coverage is about? A lot of our voyeuristic obsession with disaster coverage is the implicit "This could happen to me" dynamic – but in the American context, "this" refers less to the natural disaster than to the horrifying prospect of life without our shit. Ironically, projecting that materialism onto the people of the poorest country in the hemisphere makes a lot less sense than the looting we see.

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A BULL MARKET IN STUPIDITY

Posted in Rants on January 25th, 2010 by Ed

Remember the 1990s? One of the central tenets of the new, hi-tech capitalism we embraced so jubilantly after our heady victory over the forces of communism was the democratization of the stock market. Prior to the mid-1990s, buying stock was a laborious affair hamstrung by limited information (no internet meant getting daily prices from the newspaper) and formidable barriers to entry. Much like early internet users were considered to be technologically advanced people with strange, mysterious skills, pre-1990s stock owners were regarded with no small amount of awe. Few people bought and almost no one "traded."

The exclusivity of the market ended in two waves. First, the country went Mutual Fund loco in the late 1980s, allowing a wider audience to buy stocks while someone else did the work. Second, the transition of the internet from a rare technology to an omnipresent part of life gave everyone a chance to play Gordon Gekko. Along came NASDAQ, AMEX, E*Trade, Scottrade, Ameritrade, and dozens of others. We were all liberated from reliance on outmoded Second Wave institutions like Social Security or pension plans from our employers (that our employers were simultaneously liberated from the cost of providing one was just a happy coincidence). Instead we'd plot our own financial destinies in just a few minutes per day, everyone sharing equally in the munificence of The Market and becoming a fast tradin', self-made millionaire in his or her spare time.

It turns out, of course, that giving a bunch of people who know not their assholes from a hole in the ground didn't create a society of millionaires. It created millions of new investors who didn't know what the fuck they were doing. The only beneficiaries were the institutional investors who made billions off amateurs buying and selling idiotically based on the recommendations of TV and magazine "analysts." Uninformed demand was a terrific way to drive up prices; the pros enjoyed the ride, sold high, and got the hell out before John Q. Public's investment came crashing to Earth. In short, democratizing stock ownership has not and was not intended to spread wealth. That was merely a canard. The only thing it has accomplished is to make the people who were already wealthy even moreso. Massive herds of people buying what a loud guy on TV tells them to buy is a godsend for people who know better.

If you fancy yourself an investor – and I do, albeit a long term buy-and-hold one – you can probably anticipate where I'm headed here. Anyone seen the price of gold lately?

Although gold predates the stock market as a mode of investment by several centuries, it is only recently that Americans have been swept with the paranoid, frenzied, Galt-goin', Paul-votin' urge to physically hoard gold (and silver). With the general public egged on by shameless shills who stand to make a fortune from herds of new buyers, precious metals are no longer the exclusive province of survivalists. Every patriot worth his salt is burying some gold in the yard ahead of the inevitable collapse of the worthless fiat dollar. That Glenn Beck is paid by retail gold outlet Goldline International to hawk gold on the air is no cause for suspicion. That prices have quadrupled in a decade matters not a bit. That anyone buying at these prices stands to lose a fantastic amount of money is irrelevant. When money ceases to exist and gold is the only currency with any value, Uncle Larry and his buried treasure will have the last laugh!

Someone once gave me a useful piece of financial advice: if your cabdriver is talking about the wisdom of a particular investment opportunity, it's time to short it. Fads become bubbles and bubbles become crashes. The only people who win are the ones who got in before the hysteria and are sharp enough to sell high. It may be inconceivable that anyone would be stupid enough to buy at $1,200/ounce, but something tells me the average teabagger rally has more than enough candidates who qualify. The guise of democratization – "Finally, a chance for the Everyman to own gold!" – is as cynical as it is effective.

NPF: CHEATING

Posted in No Politics Friday on January 22nd, 2010 by Ed

You don't need experience teaching at the college level to figure out that students don't go to office hours until immediately before (as in, the day of) and after exams. This phenomenon gives rise to one of my favorite awkward/terrible moments in academia. In the last hour before an exam a parade of frenetic students pass through the office to deliver unintelligible bursts of words at a mile-a-minute, pupils unnaturally dilated and extremities restlessly twitching. Let's just say the studying to Exam Day Adderall Abuse ratio is lopsided in favor of the latter.

Adderall is amphetamine combined with Dexedrine, the wonder drug that brought you such hits as Charles Whitman in a bell tower. That its effects are so similar to methamphetamine should not be surprising. As any high school or college student can tell you, it's a pretty potent performance enhancer that makes focus and concentration easier (at low doses). Not only is it readily available from peers but doctors give it out like candy irrespective of the fact that it's basically speed. There isn't a lot of careful drug-seeking behavior necessary; I'm pretty sure people between the ages of 13 and 21 just have to say "I have trouble concentrating in school" and they'll be full of uppers in no time.

Is taking Adderall or Ritalin or whatever before an exam cheating? Well, it's performance enhancing. It's not "natural." So inasmuch as you think Barry Bonds, Marion Jones, or Floyd Landis are cheaters, I guess the students are too. We get a lot of mileage out of belittling high-profile steroid cheaters like Mark McGwire, but we have little trouble ignoring other kinds of drug-related cheating.

Admit it, when the Atlantic blew the lid off the drug-addled world of classical music (seriously, your average violinist or cellist pops beta blockers like Pez before auditions and performances) you didn't get indignant and label them all cheaters. It seemed kinda funny, right? The idea of performance-enhancement for playing the tuba was just too silly to serve as the basis for moral outrage. Don't hold your breath waiting for Congress to grill the Boston Pops in the name of fairness and setting a good example for our youngsters.

We really do have a problem in this society with the win-at-all-costs mentality and subjective morality; like all drugs, Americans are willing to do some significant rationalization for the ones upper-middle class people use. Mr. McGwire's media moment last week cast our hypocrisy in high relief. Like many Americans I believe he and the other glandular freaks of baseball are cheaters, but perhaps we should enforce a little consistency in applying that label.

(Recommended reading/viewing: The Cheating Culture by David Callahan and the 2008 documentary Bigger, Stronger, Faster*)

THE CULTURAL DIVIDE

Posted in Rants on January 21st, 2010 by Ed

It may have taken five months, but I had my first "Holy crap I live in the deep south" moment today.

OK, my second. The first was seeing an advertisement for an Uncle Remus museum. OK, third. There was also that time at Hartsfield Airport when an old white woman got off a shuttle bus and handed her luggage to the first black guy she saw irrespective of the fact that he was a fellow passenger and not a luggage porter.

I digress. The following is my first HCILitDS moment in the classroom. Yes, that should hold.

It turns out that all of the jokes up north about the way the American Civil War is taught in southern schools are…well, not jokes. My students, almost all of whom are from Georgia, South Carolina (First in Secession, Last in Everything Else!tm) or Tennessee, informed me that the Civil War was not caused by slavery. It was caused by economic differences between the North and South. And states' rights. And a principled debate about state sovereignty. And the inherent tension resulting from the cultural differences between North and South.

Fortunately this was in an honors class. Most of the students are able, regardless of ideology, to understand that they had been on the receiving end of a comically awkward attempt at historical revisionism. But not all of them. One student earnestly pressed me, noting that he had been taught that "slavery" is a facile and incomplete answer to a complicated social-political conflict. I noted that this was an outstanding question, and in fact the sharpest students are inevitably those who refuse to accept superficial answers and insist on digging deeper. It warms my heart to see undergraduates exercising critical thinking skills and questioning The Man.

That said, the Civil War was caused by slavery.

Yes, states' rights was an issue. Namely states' right to maintain slavery. Yes, there were contentious economic differences between North and South, such as the fact that the entire Southern economy depended on cotton which in turn depended on slavery. Yes, there were dramatic cultural differences between North and South that made the Union a strained marriage. For example, in the South some people owned other people. That was a pretty big difference.

I rarely find myself arguing against intellectual subtlety, but the way this is taught in southern schools appears to go several steps beyond self-parody. This simply isn't a puzzling historical dilemma. Charles Sumner (who survived the infamous cane-beating on the Senate floor at the hands of South Carolina Senator Preston Brooks in 1856 because of his fierce anti-South rhetoric) said it best 150 years ago:

There are two apparent rudiments to this war. One is Slavery and the other is State Rights. But the latter is only a cover for the former. If Slavery were out of the way there would be no trouble from State Rights. The war, then, is for Slavery, and nothing else. It is an insane attempt to vindicate by arms the lordship which had been already asserted in debate.

Indeed, Chuck. Indeed. I assumed this to be common knowledge and my image of how the War is taught in the South was nothing but partisan Yankee humor. But now I understand quite clearly that the War of Northern Aggression is a peculiar issue down here. Quite fitting, given the Peculiar Institution that precipitated it.

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THE GOOD NEWS

Posted in Election 2010 on January 20th, 2010 by Ed

If you're a veteran reader you've heard this before, but special elections always get blown far out of proportion. Elections are ratings events for the political media and it takes very little prodding to get them to cover whatever is at hand like it's some combination of the Super Bowl and presidential election. That said, what happened in Massachusetts yesterday was bad, bad news for the Democratic Party. If they had enough sense to learn anything from what happened, it probably wouldn't have happened in the first place.

The Democrats lost Ted Kennedy's Senate seat. The good news? There is no good news, unless you're a Republican.

The Democrats in Massachusetts nominated a horrendous candidate who proceeded to run a somnolent campaign (or non-campaign) that presumed victory and excited exactly no one. The Republicans were highly motivated even though Scott Brown is far from great shakes himself. So we're back to the pre-2008 electoral dynamics: Republicans vote, Democrats don't. And why would they? What kind of rallying cry could Coakley have used? "Get out to vote! Protect that watered-down embarrassment of a health care 'reform' bill! You know, the one we let the insurance companies write!" Something tells me that would not have worked. It is plainly obvious that Democratic candidates can't expect success without the voters who showed up in 2008, and they're not going to show up unless they're highly motivated by distaste for the GOP (which they aren't at the moment, given the results from 2006-08) or enthusiasm for the Congressional agenda. What we're seeing is not a schizophrenic electorate giving the GOP eight years to screw things up and expecting the Democrats to fix it all in nine months. We're seeing that nine months is more than enough time for the modern Democratic Party to disgust most of its base.

Is it accurate to say that this is a referendum on Obama? No, although you will hear plenty of that anyway. Is it a referendum on the Congressional leadership? Absolutely. I've never seen a group of elected officials so talented at getting voters to simply not give a fuck who wins or loses. Can you listen to Harry Reid for five minutes without completely losing interest in anything political? It is problematic to make the following claim – that the Democrats inevitably lose their grip on power because they fail to be liberal enough – because we often mock the GOP for making the same excuse in the wake of defeat. In the case of the GOP, however, the argument is patently silly. Their leadership is very conservative and not at all shy about ramming their agenda through Congress. When the Democrats are in power, only Glenn Beck and hysterical teabaggers would describe their agenda as "liberal." America gets a heaping serving of Republican Lite, tons of pointless commitments to pursue "bipartisanship" and therefore get nothing accomplished, and the powerful leadership skills of Steny Hoyer and Harry Reid. Enthralling.

Midterm elections are rarely good for incumbent presidents and 2010 will be no different. That said, the GOP is likely to get carried away with hyperbolic predictions of picking up 15 Senate and 100 House seats in November. The slow trickle of faint but positive economic signs will cushion the downside for the majority party, especially if the employment numbers pick up (which is no sure thing). In the end, however, Obama will get exactly what he deserves. He took office with all the enthusiasm in the world behind him and he proceeded to govern like an Eisenhower Republican. Like Clinton, Obama will probably survive re-election in 2012 because of his personal appeal and the pitiful field of challengers. But his brief window of opportunity to seize the initiative and take control of the Congressional agenda has passed. The partisan balance in the general public favors the Democrats, but the same can't be said among people who can be counted upon to vote regularly. The Democrats have only themselves to blame for the disparity between the two.

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TRIAGE

Posted in Uncategorized on January 19th, 2010 by Ed

I need you to set aside about 30-40 minutes and read this. When I first saw it back in August I felt like I'd been punched in the stomach by the end. A second reading months later, inspired by the chaos in Haiti, had much the same effect. If you're in a hurry it is a lengthy New York Times piece about Memorial Hospital in New Orleans in the wake of Hurricane Katrina. It raises ethical issues complex enough to make abortion and the death penalty look like kindergarten topics in comparison.

Several hospital employees, particularly one doctor named Anna Pou, were charged with second-degree murder (and conspiracy to) for allegedly causing the death of a number of non-ambulatory patients with morphine and other sedatives after everyone involved had been trapped in the hospital for four days. A grand jury chosen from a community sympathetic to the doctor ("They did what they had to do! It was a tough situation!") refused to indict, and as the story stands it appears unlikely that any of them will be convicted of a crime. The reality of what happened appears to be a lot more troubling.

Triage is a pretty basic concept in emergency medicine and it originated on Europe's battlefields more than two centuries ago. It is necessary whenever the means to provide care are overwhelmed by the number of people who need it. We see that problem today in Haiti and four years ago in New Orleans. It seems like a very basic concept – do the most good with the limited resources available. But what does that mean? Does it mean treating the most severely injured, who may have little hope for survival? Treating the greatest possible number of patients? The ones with the best chance to survive? (and in whose judgment?) The youngest? The first to arrive? It's not so simple.

After the Hurricane, Memorial Hospital was without electricity or water, filling with backed-up sewage, and in a neighborhood in which gunshots were ringing out with alarming frequency. With dwindling resources (and the need to manually respire patients on ventilators) the doctors did an unorganized triage – there was no official policy in place – to make everything last until the government rescue that they soon learned was not coming. Evacuating patients to a helipad required carrying them down 7 or 8 flights of stairs in the dark, passing them through a 3'x3' hole in a concrete wall, and then carrying them up 5 more to the roof of the parking deck. This presented an obvious challenge to a staff – many of whom were older people who could add little to the manual labor effort – working on no sleep in appalling conditions. Compounding the problem was the apparent hopelessness of several of the patients; it is not hard to see how a 92 year old cancer patient with less than a week to live would seem like a wasted effort under such circumstances.

What resulted was a decision by a few doctors, given that no one seemed to be in charge, to euthanize several patients who were either nearly dead or simply too large to move. In one case that directly led to the second-degree murder charge, an otherwise healthy 350 pound patient who could not walk was euthanized for no reason other than that the doctors did not think he could be moved. Not all of the physicians agreed with these actions; several protested and others left rather than be involved.

That is the best I can do for a brief summary. Two things.

It is easy for us to revel in hindsight bias – we know that they were rescued after the fourth day – and make judgments based on information unavailable to the participants at the time. It's also easy to neglect the context. Before you come to a decision about the morality of their actions, close up the windows, turn the heat up to 90, and stay awake for three days manually pumping a ventilator bag, running from floor to floor in the dark, and caring for 100 dying people. To say that the doctors and nurses involved were not of a mindset to make good decisions is an understatement, especially in light of the paucity of information and outside help coming in.

Then again, their argument falls flat on my ears. It is essentially this: The hospital was being evacuated after several days in horrendous conditions. We could not leave these patients and we could not feasibly move them. What else could we do? It is easy for me to say, not having been present, but my answer is simple: suck it up. That's what you do. You have a moral obligation to provide health care to people regardless of the circumstances. If you have to stand there and manually ventilate people for days on end, do it. If it takes 15 people a full day to get a 350 pound man down the stairs in the dark, so be it. Spend that time suffering and thinking of the six-figure book deal and White House photo op you'll get for telling your heroic story.

The final issue, and the one most commonly ignored, is the prevalence of this kind of "passive euthanasia" in palliative care. All of the opiates they pump into terminal and elderly patients when they are near death…come on. Who is naive enough to see that as anything but what it really is? It is ostensibly about patient comfort, and to some extent it is. But it is really about convenience – about getting on with the inevitable so time and resources can be devoted to patients with some chance to survive. Even in non-emergency situations this mentality prevails. And who can blame medical professionals for that? The staff of Memorial Hospital were right to wonder why in the hell the hospital had a floor full of people in their nineties hooked up to ventilators and heart-lung machines. That is, to all but the bleedingest of hearts, a complete waste.

We comfort ourselves with advanced care directives, living wills, powers of attorney, and codes of medical ethics, believing strongly that these things will govern our end-of-life decisions. And they do, except when reality intervenes and removes us from the world in which resources are limited only by what we and our insurer will bear financially. When the capacity to provide care becomes a zero-sum game it is only natural that "turkeys" with no long-term prospects for survival will go to the bottom of the priority list. But whether triage decisions should account for doctors' convenience or their impressions, made under duress, of what is feasible is a much more troubling question.

EXTINCTION

Posted in Rants on January 18th, 2010 by Ed

Congress recognized Martin Luther King Day as a Federal holiday in 1983. As most of you are well aware, this was not done without opposition. In the House, 90 members voted against it, as did 22 Senators. The following is the coalition of 18 Republicans and 4 Democrats from hillbilly states who opposed it in the Senate:

Reagan was opposed to it, of course, but relented when he saw the Act pass with veto-override majorities in both houses. He signed it and then tried to pass himself off as Friend of the Civil Rights Movement. But the GOP was not united in attempting to obstruct the holiday. While Jesse Helms led the anti-King faction (and made the farcical claim that an extra holiday would cost the government $12 billion) one of its most ardent supporters in the Senate was none other than Bob Dole. Arlen Specter also publicly condemned Helms' witch hunt, calling MLK "a Herculean figure in the American scene" and a "stabilizing influence" on the at-times violent conflict over civil rights. Dole argued on the Senate floor, "To those who would worry about cost, I would suggest they hurry back to their pocket calculators and estimate the cost of 300 years of slavery, followed by a century or more of economic, political and social exclusion and discrimination."

Can you imagine a single Senate Republican who would fill that role today? Can you imagine what Limbaugh and Beck would do to him or her? Those who would support the bill would keep quiet about it, and they'd certainly lack the balls to call out their colleagues like Helms on the Senate floor. Even that wouldn't be enough to protect them from the pitchforks-and-torches mob that the GOP base has become.

A lot has changed in a relatively short time. While the Democratic Party still has its share of knee-jerk conservatives who cater to the baser desires of the electorate – especially in the House – the GOP has systematically purged its more moderate members over the intervening years. They have the ideological diversity of a Patrick Henry College classroom.

While it can be beyond infuriating to deal with the obstructionism and attention-seeking of people like Lieberman, Ben Nelson, Bart Stupak, and Heath Shuler, I suppose it beats forming a lynch mob to go after anyone who deviates from The Way.