Dean's medical practice boards: setting the record straight

So we've seen Dr. Hern's letter to Dr. Dean, taking him to task for, among many other things, the proposal of medical practice boards to set statewide abortion guidelines, which he brought up during his MTP appearance in May. Just tonight, Madman in the marketplace posted another diary to hit Dean over the head one more time over the same thing. So it finally dawned on me that there's a bit of a confusion going on here. Since Madman's thread has now gone stale, and I suspect that there are a few people here who care about this business, I'm devoting this diary to try and clarify the issue. Follow me...

Okay, first let's hear Dr. Hern one more time. Says Dr. Hern to Dr. Dean:

Your idea of setting up "medical practice boards" to decide who gets late abortions was ruled unconstitutional in Doe v. Bolton in 1973. Look it up. You have no excuse for not knowing this. It is also an invitation for the anti-abortion nut case doctors to take over the process. Terrible idea. Drop it.

Cool. So let's see what Doe v. Bolton has to say about medical boards and abortion decisions:

(b) The interposition of a hospital committee on abortion, a procedure not applicable as a matter of state criminal law to other surgical situations, is unduly restrictive of the patient's rights, which are already safeguarded by her personal physician. Pp. 195-198.

Finally, let's hear what Dr. Dean said on MTP:

DR. DEAN:  You know what I'd prefer to see, frankly?  I'd prefer to see medical practice boards around the country, state by state -- because people do believe different things about this in different states.  I'd prefer to see medical practice boards around the country set ethical guidelines for abortion.  I don't have a problem with that. You know, I don't know of people who do third-term abortions without a moral reason for doing it, which is to save the health and life of the mother. So let them set some ethical guidelines. But I think this debate ought to get out of the realm of having politicians standing up and grandstanding.

Alright kids, now who's been paying attention?

• Doe v. Bolton is talking about hospital committees that get to interfere with individual abortion cases, one of many unconstitutional provisions of a Georgia law that the SCOTUS struck down in that decision.

• Dean, in contrast, proposes medical boards that set statewide ethics guidelines on abortion for physicians. Neither would these have any say in individual abortion decisions, nor would they set abortion law for the state. What they would do, as I understand it, is define a framework of guidelines meant to help doctors make their individual decisions about what is ethical in grey area scenarios (specifically, late term abortion). This is completely in line with Dean's general position that the abortion decision is between a woman and her physician. As Dean said on MTP:

I don't think it's ethical to do third-term abortions, unless-- just to save the health and the life of the mother.  I don't think that's unreasonable. Shouldn't this be a realm where doctors and women make up their minds instead of politicians? What do politicians know about practicing medicine?  Not very many of us have an MD.

It just isn't the same thing. So on this particular issue, Hern's criticism is unfair and probably based on a misunderstanding. Now, just to be clear:

• Whenever Dean as the spokesman for our party says something that lends itself to misinterpretations, that's regretable.

• I do suspect that Dean mentioned his medical practice board idea as a vehicle to be able to say (late term?) abortion should be more of a state by state issue - without actually saying that. Now, I generally like Dean's libertarian pro state rights tendencies. But right-to-privacy issues are probably the last domain where a Democrat wants to clamor for state rights. So, color me sceptical on that count.

• I'm not going to say anything about Dr. Hern's other criticisms of Dean. This diary is neither meant as a smackdown of Dr. Hern nor as a blanket defense of Dr. Dean.
  

•  any thoughts?

  Lemme know.

  by brainwave on Mon Aug 08, 2005 at 10:04:54 PM PDT

  •  i like the style in which you wrote it

    (hence 4) and appreciate the clarification.  i still hate that dean said it, and disagree with him on the substance (i'm not a doctor, but i think it's asking for ten kinds of trouble to "concede" that there's something wrong with of letting families and their family doctors decide what route to take, whether early or late in the pregnancy).

    by decafdyke on Mon Aug 08, 2005 at 11:25:02 PM PDT

    •  But that's the whole point!

      I really don't think Dean is saying the decision should not be between women and their doctors. What I'm trying to get across here is, the ethics commissions Dean is talking about would not in fact have any say in abortion decisions! That's not their function.

      by brainwave on Tue Aug 09, 2005 at 06:42:16 AM PDT

      •  What we THINK Dean is saying

        isn't very important, is it?

        I actually like Dean very much. What I don't like is how he's being squeezed.

        No one is saying an ethics committee would decide individual cases. I only wish that is all such a board, by definition, would be empowered to do.

        How much do you know about TRAP law?

        by moiv on Tue Aug 09, 2005 at 07:31:09 AM PDT

        •  Zilch. Zero. Nada. Nuthin.

          I don't have a clue what TRAP laws are. Enlighten me, please! And yes, I believe it DOES matter what we think Dean's intentions were. I saw comments in your diary and Madman's to the effect that Dean caved on abortion, etc. The whole point of Madman's diary was to paint Dean as basically the next Joe Lieberman, at least as far as the abortion issue goes. And I think nothing could be further from the truth. And this kind of thinking would most definitely influence people's attitudes towards Dean, the DNC, DFA, and who knows what else. That's why I thought it worth my while to set the record straight.

          by brainwave on Tue Aug 09, 2005 at 08:55:08 AM PDT

          •  I haven't said he 'caved'

            and I'm not sure that he has. My point here is that advocating state "ethics" boards and the "woman and her doctor" philosophy at the same time are mutually contradictory positions.

            TRAP (Targeted Regulation of Abortion Providers) laws are what states--and in many areas, like mine, state medical boards as well--do to restrict (or even completely bar) women's access to abortion, by enacting both laws and state regulations that affect only doctors who perform abortions. The effect is to make the provision of abortion so terribly problematic and downright risky (some TRAP laws, like one here in Texas, carry criminal charges) that doctors just stop doing them.

            This is what happens when you institute state level controls, and I assure you that Dr. Dean knows that. He's in the pressure cooker, just trying to hold it together, and I wish him luck. he's going to need it.

            by moiv on Tue Aug 09, 2005 at 01:10:37 PM PDT

            •  Thx for the info

              The problem with this whole discussion is that you're assuming a certain interpretation of what state ethics boards and their functions would be. You're saying they would be like this or do that, etc. But none of this is in Dean's remarks. Dean's position is contradictory only under your intepretations, which aren't in fact backed up by Dean's own words. I've sketched an interpretation in my diary under which state ethics boards and "the woman and her doctor" philosophy are perfectly compatible. Under this interpretation, the ethics boards have no legislative or judicial power whatsoever - they simply give doctors guidelines which they can choose to follow or to ignore. Now can you prove that that wasn't what Dean intended? Of course not. Now if you simply don't trust Dean and aren't willing to give him the benefit of the doubt that's your call, but maybe you should say so?

              by brainwave on Tue Aug 09, 2005 at 01:58:13 PM PDT

              •  Not my position at all

                I'm saying that Dean was squeezed into making that proposal in the first place, and if the states become free to set their own definitions of "ethics" that apply only to the practice of abortion, there is no reason at all to suppose that Dr. Dean's own interpretation would be taken into account--and since the point of these postulated boards is to leave states free to set their own standards, there is every reason in the world to believe that they would not be.

                It isn't Howard Dean that I have a problem with.  It's antiabortion politics, and how they affect the lives of women. I don't know where you are located, but in states like mine, lives are even now being trainwrecked by the power the state already has to deny women access to abortion.

                This what I do; I see it five days a week. As a clinic administrator, I write policy and protocol for licensed facilities to conform with existing state standards, so this is not only what I think could happen, but what I know to be happening already. Any increase in the ability of the individual states to bar women's access to abortion is a recipe for even more suppression of women's control over their own reproduction.

                by moiv on Tue Aug 09, 2005 at 07:42:37 PM PDT

•  IMO, still the same thing

  It is also an invitation for the anti-abortion nut case doctors to take over the process.

  One doesn't have to be either a doctor or a politician to know that this is true.

  I do suspect that Dean mentioned his medical practice board idea as a vehicle to be able to say (late term?) abortion should be more of a state by state issue - without actually saying that.

  Then that is what he should have said. But he knows that those ethical guidelines for late abortion are already in place.

  What could state boards do besides restrict and even remove existing abortion rights, when laws in all 50 states already forbid late abortion except when the woman's health or life hangs in the balance, or when severe fetal anomalies are present?

  Shouldn't this be a realm where doctors and women make up their minds instead of politicians? What do politicians know about practicing medicine?  Not very many of us have an MD.

  A very good reason to leave the politicians the hell out of it. And if state boards are set up, it is politicians who will be making the appointments to those boards, not the local chapter of the ACOG. It would be astonishingly naive to suppose otherwise, since other state medical boards are composed of political appointees.

  And the court's objection to a "hospital committee on abortion" wasn't based upon the location of the building in which it met. Such a committee's unconstitutionality was based on its function.
   

  by moiv on Tue Aug 09, 2005 at 12:09:13 AM PDT

  •  Not the same thing AT ALL!

    I agree with everything you're saying minus the subject line. It's not remotely the same thing! To have boards set general ethics guidelines for doctors is not remotely the same thing as to have them meddle in individual abortion cases. How can you say something like that?

    by brainwave on Tue Aug 09, 2005 at 06:49:59 AM PDT

    •   Simple

      The locally-based boards interfered with a small set of doctors and their patients at a time. The statewide setup would be designed to do the same thing on a much more massive scale. If you want to restrict abortion, one is just much more efficient than the other, that's all.

      Again, it all goes back to function and intent. And what they call it doesn't change what it is.

      by moiv on Tue Aug 09, 2005 at 07:26:51 AM PDT

      •  But aren't you ignoring the point

        that Dean emphasizes that abortion decisions, even in the case of late term abortion, should be between women and their doctors?

        I mean, I guess we have to distinguish between Dean's intention, as far as we can tell from the text of the interview, and the possible consequences if his idea were to become reality. If you're saying ethics boards are a bad idea b/c they could be instrumentalized to curtail abortion, no contest, you may well be right, and it's not my purpose here to argue about the merits of Dean's idea. My point was simply that he didn't suggest what Dr. Hern seemed to have thought (and certainly what Madman in the marketplace thought) he suggested.

        by brainwave on Tue Aug 09, 2005 at 08:49:06 AM PDT

  •  yeah

    I think you're exactly right on, especially "politicians...will be making the appointments to those boards." David Hager and his ilk are the model. Indeed, Dean's conceit, whether as a rhetorical ploy or through outright naivete, supposes a regime of neutral experts dealing with technical policy questions. Of course that ship has sailed; right wingers want to politicize everything. Even if we win the next two elections, they're not going away, they won't stop the assault on reason. How do we deal with this pervasive twisting of the truth? is a central question. The modern right wing in this country has always relied on insurgent logic: we have to win 100% of the time, they only need to win once.

    Still, the central logic behind Dean's proposal, putting aside strict constitutionality, makes sense to me: creating practice guidelines through a transparent process divorced from the intervention of political elites and which reflect community values. It is an admirable goal. I think it's valuable to find a way to create it, even if this specific proposal seems a non-starter.

    I think, too, that it's not out of the realm of possiblity that in a short time we may well be wishing for practice boards to be in place as a bulwark against state intrusion on the free practice of medicine. That may well be on Dr. Dean's mind as well...

    by KevStar on Tue Aug 09, 2005 at 07:20:33 AM PDT

•  thanks

  great diary...now everyone get off Dean's back.

  by astronautagogo on Tue Aug 09, 2005 at 12:43:53 AM PDT

•  thanks

  I've had the opportunity to see Dean in person a few times, and he impresses me every time with his intelligence and basic horse sense. Pretty impressive for a guy from such an elite background.

  Thanks for clarifying this. Too bad facts and a calm presentation don't get as much attention as shouting.

  by shirah on Tue Aug 09, 2005 at 04:54:27 AM PDT