Freedom is Obedience by Steve Vaughn MD, PhD


Freedom is obedience. Orwell, writing in a more heavy-handed time, wrote that freedom is slavery. Perhaps that was a time for using hard-edged words that clearly mean what they say. Nowadays, it goes down smoother to use more politically suave words that do not run the risk of awakening the reader’s attention too much.

The American College of Physicians has leaped onto the bandwagon well after it began to be underway. The Annals of Internal Medicine published a Position Statement on 12 May 2015, about a month before the Supreme Court’s OBERGEFELL v. HODGES was issued, regarding “Lesbian, Gay, Bisexual, and Transgender Health Disparities…” A quick review of the case before the Supreme Court showed the submission of about thirty briefs of amicus curiae by various parties. Unlike Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders, The Organization of American Historians, “54 International and Comparative Law Experts from 27 Countries” and many others, the ACP did not lend its voice to the case when the question was actually on the line.

We learn several things from the ACP’s brave publication in its own journal to its paying subscribers. First, we are in a post-existentialist time; individuals matter only so much as a label can be placed upon them, and they can be manipulated solely by virtue of their label. (Post-existentialist means the disappearance of the awareness of irony.) Persons assembled into a sympathy class need no longer be treated as individuals. If one has a patient who is Iraqi or female or transgender or Black, or upon whom any label can be attached, one dares not treat them as a person first. One must seek recourse to the spokesperson for their identified Group, and determine the correctness of the approach to the patient.

This causes me much confusion about why we should get all in a lather about tearing the Confederate Battle Flag down, when we race towards treating people as things who possess labels, rather than individuals first and foremost. Perhaps, like Orwell, we are skittish about being too obvious about our beliefs?

Approaching medicine as Martin Buber approached philosophy is terribly unregulated, and can lead to all sorts of differing approaches – none of which can be pre-determined to be Best Practices. He discussed relating to others as one and whole, possessed of the life and love of God, first and only; any particulars were just that, particulars. His philosophy was very harsh towards bigotry and prejudice; it is reassuring to see that so few people follow his principles in modern medicine.

The remedies for disparity proposed by the ACP are mostly increasing the internal structure and regulation of medical service delivery. Apparently, care of persons who are LGBTI cannot take place without sufficient rules and policies. Here are a few.

The American College of Physicians supports data collection and research into understanding the demographics of the LGBT population, potential causes of LGBT health disparities, and best practices in reducing these disparities.

These gentle people are largely unknown to Us, and we must send a gender-identity Dian Fossey to study Them in the mist. The thought that we may already know enough about Them – that they may be suffering humans just like Us – is ridiculous, and even worse, un-fundable by Government agencies. We cannot know more about Them by simply talking to each as a one-to-one, human-to-human encounter. They should be conceptually rounded up into camps of some sort for further study.

The American College of Physicians encourages all hospitals and medical facilities to allow all patients to determine who may visit and who may act on their behalf during their stay, regardless of their sexual orientation, gender identity, or marital status, and ensure visitation policies are consistent with the Centers for Medicare & Medicaid Services Conditions of Participation and The Joint Commission standards for Medicare-funded hospitals and critical-access hospitals.

The ACP comes down bravely on the side that hospitals and medical facilities should after all follow the law that underlies equity and common sense. Perhaps in the old days we could rely on decency and dignity to bring forth compassion. Now that these concepts are foreign to us, we must assert our pro-following-the-law position. After all, we have assured ourselves that Law and Policy are without blemish – it is only the taint of the individual hand that spreads inequity – in spite of confused individuals such as Obergefell and Goodridge.

The American College of Physicians recommends that gender identity, independent and fundamentally different from sexual orientation, be included as part of nondiscrimination and antiharassment policies. The College encourages medical schools, hospitals, physicians’ offices, and other medical facilities to adopt gender identity as part of their nondiscrimination and antiharassment policies.

Unlike Martin Buber’s heretical thoughts – and that other Martin fellow, the preacher – we have decided that injustice is not a state of sin, of hardening one’s heart against one’s fellow human. It is rather a natural attitude that must be washed away seriatim, by explicit listing of the sorts of bigotry which are not tolerated, rather than covering them all under the traditional methods.

Before computer technology, a fellow once said, after a preceding rule about theology, “YOU SHALL LOVE YOUR NEIGHBOR AS YOURSELF. On these two commandments depend the whole Law and the Prophets.”

Perhaps that was good enough for then, and perhaps he did not wish any of his chroniclers to suffer writer’s cramp. Nowadays, we can enumerate people undeserving of bigotry – “Mennonites, men who have sex with men, Mesopotamians, metrosexuals…Rotarians, riparians, recently-divorced persons, Republicans, reticulated individuals….” The list can be endless.

So kudos to the ACP for finding the same solution to our world’s problems – insufficient study and insufficient rules. There’s no shame to racing onto the battlefield once the enemy has surrendered – such combatants have been self-proclaimed heroes throughout the history of strife. We are rapidly expanding the categories of “land of the free, home of the brave” to more inclusive definitions of “free” and “brave.” Good for us!

71970cookie-checkFreedom is Obedience by Steve Vaughn MD, PhD