Patient-Physician Relationship Finds Itself At High Noon On Fifth Avenue.

Posted on | June 7, 2023 | Comments Off on Patient-Physician Relationship Finds Itself At High Noon On Fifth Avenue.

Mike Magee

If there is a silver lining to the Trump assault on decency and civility, it is our majority response to this “stress test” of our Democracy, and the sturdiness (thus far) of our Founders’ vision. And right in the center of this battle is the patient-physician relationship.

It was, after all, a long shot when Alexander Hamilton, under the pen name Publius, published Federalist No. 1 on October 27, 1787, writing: “It has been frequently remarked that it seems to have been reserved to the people of this country, by their conduct and example, to decide the important question, whether societies of men are really capable or not of establishing good government from reflection and choice, or whether they are forever destined to depend for their political constitutions on accident and force.”

Two weeks before the Iowa caucus in 2016, Trump himself sided with “force” and signaled a rocky road ahead when he stated in Sioux City, Iowa, that “I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters, OK? It’s, like, incredible.”

In so doing, he was taking on medieval jurist, Henry de Bracton, who wrote in On the Laws and Customs of England in 1260 that “The king should be under no man, but under God and the law.”

Of course, Trump, while representing our Executive branch, was not acting alone. He was supported by members of our Legislative branch as they successfully stacked the Judicial branch with religious conservatives. The net impact was this past year’s overturning of Roe v. Wade, and a Christian Evangelical legislative windfall (and subsequent political backlash) in multiple Red States across the union.

This too was foreseen by our Founders. In 1799, Thomas Jefferson, in a letter to James Madison, warned that “The executive in our governments is not the sole, it is scarcely the principal object of my jealousy. The tyranny of the legislatures is the most formidable dread at present, and will be for long years. That of the executive will come in its turn, but it will be a remote period.”

Without the law, there is no society. President Teddy Roosevelt made this clear in his 1903 State of the Union address when he said. “No man is above the law and no man is below it; nor do we ask any man’s permission when we require him to obey it. Obedience to the law is demanded as a right; not asked as a favor.”

In the current assault on Roe v. Wade lies buried an assault not only on Democracy, but also on women’s rights, their autonomy, and on the integrity of the patient-physician relationship. In pushing patriarchy, and MAGA Republican dominance, a fringe minority is willing to bend the law to their favor, and undermine the health of our nation.

On June 24, 2022, Roe v. Wade was overturned. Only 5 months later, Indianapolis physician Dr. Caitlin Bernard was hauled into court to face a judge in response to a complaint filed by Indiana Attorney General Todd Rokita that the doctor had violated state law requiring notification of police and child welfare officials in cases of child abuse.

The 10-year old child involved had been raped by a 27-year old Ohio man who was under arrest. Ohio’s 6-week “fetal heart beat” abortion ban (which took affect after Roe v. Wade was eliminated) resulted in the child’s parents being forced to cross state lines and seek help in nearby Indiana. After the 3-day required waiting period, Dr. Bernard provided care necessary for a medical abortion. As her attorney stated, “Dr. Bernard is a skilled and competent doctor, and I would submit that she is exactly the doctor that people would want their children to see under these circumstances.”

She, and her fellow doctors across the nation, provide compassion, understanding, and partnership to Americans from “sea to shining sea.” But less well recognized is their function in providing health to our Democracy in three ways. First, they process the nation’s fear and worry on a daily basis, which might otherwise rise to destabilizing effect. Second, they reinforce linkages between individuals, families, and their communities, pointing those in need to resources that might help. Third, they reinforce a sense of hopefulness. If not a cure today, perhaps one just around the corner.

Extreme MAGA Republicans have inadvertently awakened deeply buried and historic fears and resentment. As historian Lawrence Friedman put it, “The American Revolution, whatever else was at issue, fed on resentment against English oppression….Criminal laws are one of the levers the government uses to exercise its power over the individual, over the ordinary citizen…the British had abused criminal justice, and were impairing the rights of the colonists….The leaders of the Revolutionary generation felt strongly that there had to be safeguards against abuse of criminal justice, or the use of criminal process to crush political dissent – the offenses King George was blamed for.”

Trump, no doubt, remains anxious to test out his theory with a last stand “in the middle of Fifth Avenue.” But in the process, he has fast-walked his followers into a position of state government over-reach, which places low-level bureaucrats at the patient’s bedside, criminalizes doctors and nurses, and leads the former “Sons of Liberty” into King George’s (or Donald’s) waiting arms. How hard will the AMA Federation push back?