HYPE! HYPE, I TELL YOU!

So apparently morning-after pills don’t prevent implantation after all? (Which matters because that’s the reason abortion opponents hate them. Or say they do.)

Nurse: Oi vey! I feel like every time we open up a discussion like this, I
put on my sarcastic hat and say something like, “what, does pregnancy
begin at ovulation now, no sperm required?” and then the religious
right is like, “yes, actually, it does.” and then my head explodes and
something inside me dies.

Lawyer: That’s right. We’re all pregnant right now. In fact, we’re born with eggs,
so maybe we’re born pregnant?

Nurse: So now, if, as this article suggests, EC pills actually stop fertilization rather than stopping implantation, you’d think that would make things better, wouldn’t you? I guess my
point is that. . . well, they probably won’t. Whatever the quibble was this time, there will be something else, seemingly unthinkable, to take its place. Such is the nature of this debate. It’s not reasonable or logical.

Lawyer: True, but it’s often couched in those terms. So I think there’s value in
continuing to expose flawed logic. To protect the integrity of logic, if not to win on the actual issue.

Nurse: OK, Mr. Spock!

Lawyer: Plus, there are plenty of people out there who are swayed by logic. So, the
super-fringe will hold fast no matter what. But I have to believe there are people who will listen to reason, or reasonable-sounding things, such that that battle is worth fighting.

Nurse: In terms of the labelling, we sell all kinds of drugs that work without completely understanding the mechanism, and that is all fine and dandy and perfectly legal, right?  Also, the FDA may not really be a great source for cutting-edge science– they are the sanctioned authority, but not necessarily “right.”.

Lawyer: Agreed. What I think is really fascinating here is the power that one line
of an FDA label had. We’ve seen this fight play out a bit with the question of over-the-counter morning after pills, too — a good deal of the debate ends up being about
what’s on the label. But there seems to be a disconnect between how those things get designed and the immense ripples they can create.

Nurse: Finally, I always think it’s interesting when science may be influenced by religion and politics. Who is funding, or suppressing, research? Who knows?

Lawyer: Tell that to Secretary Sebelius.

Nurse: No, ma’am, I don’t like it!

Really, Kansas? Really?

We could barely bring ourselves to write about this.

The Kansas House has passed what would probably be the most restrictive abortion bill in the country, described here by the Huffington Post.

Lawyer: I think the two most troubling provisions (obviously?) are the ones mandating that doctors tell women certain things, and those authorizing doctors to withhold certain information. 

Nurse: Yeah. . . this seems like it completely undermines the doctor/patient relationship. You can no longer trust that your doctor is telling you what he really thinks is in your best interest. This seems a little. . . facist? I don’t know. The state doctor is going to tell you the state facts about your body now.  True? What do you mean? The state scientist said so. This is coming from the political party that wants the state to intervene less? Um. Ok. I think we really have 3 parties– democrats, fiscal conservatives, and religious right-wing nut-jobs. 

Lawyer: We can look at it both from the perspective of the rights of the patients and the rights of the doctors.  (Let’s not forget that the First Amendment not only prohibits restraining speech — but also compelling speech.)

Nurse: Good one. Plus, I didn’t even get into the fact that, um, the birth control/breast cancer link which is part of this whole argument is not what any informed person would call solid evidence. So there’s another way the state is telling doctors to lie.

Lawyer: It also raises a really thorny question about the relationship between science and law, reminiscent of the debate about teaching creationism. If a legislature deems something fact, that doesn’t make it true — but they do (and properly, I think) have some control over a curriculum. It’s harder to argue that the government has any role in dictating what can happen in the exam room with the door closed.

Nurse: Yep, that was my reaction as well– it’s similar, but worse. Private physicians behind closed doors should not have to tell patients any particular thing. Public schools. . . . more debatable. But, then, how the h-e-double-hockey-sticks are they going to enforce that law? Big brother? 

Lawyer: It’s also just really gross.

Nurse: AMEN, SISTER.

Ping-Pong Post: Sotomayor Nomination

President Obama’s nomination of Sonia Sotomayor for the Supreme Court raises several nurse-and-lawyer issues:

1. Abortion.

Lawyer: We don’t know what she thinks. We have a little bit of evidence (upholding the Bush administration’s right to restrict federal funds to overseas agencies that perform or promote abortion, granting asylum to Chinese women (and their husbands) who would either be forced to abort or charged with a crime for allowing a pregnant woman to escape forced abortion) but neither of these rulings gives us much of a glimmer about a Roe challenge, which hinges on an implicit right to privacy as part of substantive due process.   As the Times says, objecting to forced abortion is hardly a radical stance — and it doesn’t really come down on either side of the choice debate as we know it in this country.

Nurse: Abortion is clearly a health issue, and a major one– and frequently kind of a litmus test (but we’ll get into that later). I think if a judge had NOT objected to forced abortion, it would be a huge, major red flag– whether or not we were looking Roe v. Wade in the future. I think that in the abortion issue, having another woman on the court– liberal or conservative– is a good thing. It’s hard to have a conversation about somethig which is so clearly a women’s issue without any women.

Lawyer: That’s a really good point, and one that I think is underplayed in the discussion. Gotta love the idea of a room full of men deciding things about women’s bodies. But that’s how it’s been.
2. Gun control.
Lawyer: SCOTUS ruled last year  that the FEDERAL government cannot make a law prohibiting guns to be kept in the home for self defense, and that played out in DC, which exists under federal laws — Judge Sotomayor sat on a panel that decided that a state CAN make such a law, and that’s  headed for the supreme court this summer (Maloney v. Cuomo.) She would almost surely recuse herself from this case, having already ruled on it, but there are others coming along on which she could rule.
Nurse: Violence is also a health issue– and some people don’t think so, but as a health care professional, I do. It’s good practice to ask about guns in the home when doing a health interview. I feel that law that regulate where guns can be have the potential to be really good– but like any laws, they need to be done well
Lawyer: I also think this issue is an interesting test of a judge’s judicial philosophy, as the Second Amendment, more than much of the rest of the constitution, seems a little anachronistic.  It was written to address a specific type of situation that no longer occurs, but other related situations do occur. So looking at how a judge interprets a question like this can give us a good sense of how much she wants to be living in the eighteenth century and how much she is willing to view the Constitution as a living document, a question that becomes more and more important as our society changes ever faster.
3. Gay marriage:
Lawyer: It’s already in the works. She has a history of siding with victims of discrimination — but that’s no sure bet.
Nurse: Again, in terms of health, we talked about gay marriage and the right to make healthcare decisions– this IS discrimination, no question. The law should protect people from discrimination.
Lawyer: I’m curious about where civil unions come into this discussion. Theoretically, a couple who was civilly united would have all those same visitation rights — right? I’m not condoning it — but in a way, that option being available makes the marriage fight harder to fight, because the discrrimination isn’t as blatant as it seems like it might be.
General thoughts:
Lawyer: The bigger question, from where I sit: to what degee is it right to look for a sure bet? We’re choosing a judge, not a congressman —  the President and Senate are not supposed to choose based on a stated platform. But at the same time, the President and the Senate need to make sure they choose someone who will protect our fundamental rights under the Constitution (though we differ on what those may be). It’s a fine line to walk.
Nurse: No, I don’t think we should look for a “sure bet.” We shouldn’t be picking judges on their positions on laws and issues, but rather on their process and their views on the law and the constitution, no? Healthcare is an area that needs law, and it needs it badly, so these are good questions to ask– but we need to remember in what context we’re asking them.
Lawyer: Either way, barring some revelation of a major ethical transgression, she’s almost certain to be confirmed. And I feel good about that.
Nurse: Me too.  :)