The future that conservatives have designed for us. Project 2025 would have us all live in this awful version of America
this post was submitted on 12 Aug 2024
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I think it is interesting that southern Republican states think they are "pro-life" when they have traffic fatality rates 10x higher than countries like Switzerland, Sweden, Icelans, Japan, Korea, etc and yet they get so angry whenever progressives question their pickup size or talk about saving lives through safer road design and better urbanism.
Anyone that fights against vaccines or safer road design and smaller vehicles is NOT pro-life: they just hate women.
You're Breaking the Law: Abortion Edition
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Treating a woman during a miscarriage: ILLEGAL
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Turning a woman away at the door of the ER because you're afraid of civil liabilities: PERFECTLY FINE
The Pro-Life Party, folks.
Here's the thing. You have to look at it from the doctor's point of view.
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If the doctor gives assistance to one woman in violation of state law, he risks losing his license and his freedom. He may have helped one patient, but how many other current or future patients are now at risk for a variety of reasons because he's no longer available to help them? How is the community best served by having one less doctor to serve them? Are they willing to send their own families into personal and financial ruin when his salary vanishes and he ends up in jail? It's a classic example of Sophie's Choice.
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Given the point above, no doctor is going to put their careers on the line to hide behind a federal law that states are routinely challenging or outright ignoring, and that may very well be overturned by this Supreme Court if given the opportunity.
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Even if the doctor wanted to use the federal law as a legal defense, that is a case that would still take years to go through the court system. Not only is this extremely expensive, but it's years that the doctor will still have his license suspended, or years that he'll still be in jail for violating state law, or at the very least years that he is unable to help the women of his state. How many of his other patients would be affected in the meantime while he fights a case he isn't even guaranteed to win?
This is where the problem is. It's easy to say that the doctors can just use federal law as a legal defense so they can administer care, but the reality of the situation is so, so much more complicated than that. And this is the exact effect that the GOP wanted it to have: Make the punishment for going against the system or even trying to fight the system so untenable to doctors that they essentially force doctors into compliance out of fear, rather than having to deal with doctors willing to challenge the system in order to get the best care for their patients. And it's working.
You have to look at it from the doctor’s point of view.
Trying to explain this to a woman dying of blood lose on the floor of an emergency room.
And this is where the Sophie's Choice comes in.
Because you are absolutely right. Nobody wants to have to explain that to someone in immediate need.
But what about his other patients? What about the high risk pregnancies that he's been carefully monitoring for the past several months? Will any of them even be able to find another doctor that knows about whatever specific condition they have? What happens if you're one of the only, if not the only OB/GYN in an underserved rural area? What happens when other doctors in the area close up shop out of fear of being the next one prosecuted?
There is no good answer. That's the whole point. The doctor has to choose between saving the one vs. saving the many.
But what about his other patients?
I don't think they want to be left on the ER bleeding out either. In theory, that means coming together as a community to reject this horrific policy. In practice, it appears to be looking the other way and feeling #Blessed that you're not the one doing the suffering.
What happens if you’re one of the only, if not the only OB/GYN in an underserved rural area?
I actually heard about a surgeon out in Beaumont, TX who used to race his Lamborghini up and down I-35. That section of the road is swarming with police, but any time he got clocked the police would pull him over and politely give him a warning. That's because he had a reputation for saving lives - particularly cop lives - any time they'd get injured on the job and wheeled in to the ER.
If you're the only doctor in town who can safely deliver a baby (and you don't suck at your job) you are going to enjoy not an insignificant amount of political clout. You're absolutely the person who is in the best position to defiantly act against this kind of law, because you've got the leverage by being the person with the skills to do the job.
But if you're not willing to stand up, why on earth would you expect anyone else to do it?
There is no good answer.
The good answer is to save the life in front of you and go on from there.
I don’t think they want to be left on the ER bleeding out either. In theory, that means coming together as a community to reject this horrific policy. In practice, it appears to be looking the other way and feeling #Blessed that you’re not the one doing the suffering.
This is 100% correct and exactly what's happening. And that's because deep-red states are giving people no other options. Sure, the doctor could take a stand and say "I'm saving this woman's life because it's the right thing to do, laws be damned!". And he could very well save the life of that theoretical patient bleeding out. What you don't seem to get is that this doesn't magically lead to a situation where he keeps seeing other patients. Now, these doctors face jail time and being stripped of their licenses, denying countless women and their babies the services that they need to live as well. It ends up leading to underserved rural communities even more underserved, creating a downward spiral of problems due to a lack of even basic prenatal care because doctors don't want the legal risks that come with caring for pregnant patients.
It's already happening in Idaho. It ends up being a net negative to everybody. This is what doctors have to consider; save the one, or save the many?
What happens if you’re one of the only, if not the only OB/GYN in an underserved rural area?
I actually heard about a surgeon out in Beaumont, TX who used to race his Lamborghini up and down I-35. That section of the road is swarming with police, but any time he got clocked the police would pull him over and politely give him a warning. That’s because he had a reputation for saving lives - particularly cop lives - any time they’d get injured on the job and wheeled in to the ER.
If you’re the only doctor in town who can safely deliver a baby (and you don’t suck at your job) you are going to enjoy not an insignificant amount of political clout. You’re absolutely the person who is in the best position to defiantly act against this kind of law, because you’ve got the leverage by being the person with the skills to do the job.
Again, this is already happening in Idaho, and the results that are being reported contradict your example. Doctors are leaving in droves because of the restrictive laws in the state. The ones that remain aren't being given preferential treatment because of the services they provide. The government of Idaho is actively trying to run the ones that are remaining out of the state as well.
Heck, did you see how abortion providers were treated in red states before Roe was tossed out? They don't get treated with some kind of preferential treatment. No, they're under constant death threats and are barely protected by a government that actively wanted them gone in the first place. They've always been about as welcome in those states as a Nazi in a synagogue.
But if you’re not willing to stand up, why on earth would you expect anyone else to do it?
You don't think they would if they could? You again continue to ignore the costs associated with making that choice.
There is no good answer.
The good answer is to save the life in front of you and go on from there.
Tell that to the family of every woman that suffers as a result of not getting the care they need once he's gone.
And for the record -- at no point are you wrong. In fact, I'd be making some of the exact same arguments you're making right now if our positions were reversed. That's the whole point I've been trying to make. There are no good options. The government and the Supreme Court has put doctors and patients in a position where no matter what they pick, everybody loses. Whether or not they make the 'right' choice is up for debate, but you can't blame doctors for understanding the reality of the situation and trying to minimize the losses in the long run as much as possible. It may be awkward for him to have to explain that to one patient now, but if he doesn't, several other doctors will have to give that explanation to patients who are affected by him being gone later.
It's an age old thought experiment, being played out in real time, with real people. Do you sacrifice the one to save the many?
You don’t think they would if they could?
I think they would rather avoid an immediate conflict with their own managers and the more zealous members of the community than to take any amount of personal risk to their careers. And, as a result, they are leaving an uncountable number of people to suffer and die, because they no longer have any confidence in the American medical system.
the costs associated with making that choice
The costs associated with not making the choice rack up every time good people refuse to act.
Tell that to the family of every woman that suffers as a result of not getting the care
If we're serious about delivering care to every woman that needs it, we can expand Medicaid to cover everyone without insurance and have the DOJ step in to provide legal aid to any doctor caught in the legal crossfire.
This isn't just a problem of doctors. Its a political problem as well. But the doctors are the people on the front lines. If they are too terrified to even make the attempt to deliver services to people in need, no woman is safe and the volume of untreated patients will continue to balloon.
It’s an age old thought experiment
So much so that its practically a joke.
But the solution to the trolley problem is to stop the trolley, not to console yourself by driving down a track where you can't see as many people.
You're agreeing that this is a political problem, but you're still putting the impetus and responsibility on the physician in that situation. If we're using the trolley problem as an example, the person holding the switch to choose between the 5 people in harm's way, or actively switching it to one person who currently isn't in harm's way....the switch just changes the track direction. That person doesn't have access to brakes, or a "derail" option. The physician in that situation has to choose between actively leaving one person in harm's way, or allowing many people to suffer down the line.
Personally, I don't have kids, I'm not going to have kids, and it's just me and my husband. I don't have a whole family of lives to ruin by getting into legal trouble by running afoul of this, but I don't blame the physicians who do have a lot to lose. Also, I know enough about the legal system and how medical documentation and coding work to make it tough for the hypothetical prosecutor to pin things on me. Hell, I'm still a student and I'm thinking up ways to play this horrible game they've set up, and I think some of my solutions will be pretty clever if I ever have to use them. I will not be sharing any of those ideas, but I have quite a few of them.
You’re agreeing that this is a political problem, but you’re still putting the impetus and responsibility on the physician in that situation.
The physician who engages with these laws becomes a political actor. Medical centers don't have a political commissar sitting around enforcing the party line, they've got civilian staff and administration. The choice they make in enacting or ignoring these laws is a political one.
The physician in that situation has to choose between actively leaving one person in harm’s way, or allowing many people to suffer down the line.
The physician makes the choice of who to save in the moment, and then private administrators, local law enforcement, and courts decide how many people suffer down the line.
I will not be sharing any of those ideas, but I have quite a few of them.
More power to you. But whatever you do (or refuse to do) is as political a decision as anything your bosses and local government enact above you.
Well, time to Godwin's Law this discussion I guess.
What you're suggesting is an expectation for physicians to do something akin to actively defying the Nazi regime to hide/evacuate/personally protect vulnerable people who the Nazis are trying to round up. The people in Nazi Germany who put their lives and livelihoods on the line to help shield people from the concentration camps are unequivocally heroes in every sense of the word.
It is unreasonable to expect, much less demand true heroism from people who are trying to live their lives. Right now, the penalties for performing an illegal abortion in Texas are loss of your medical license and a minimum of 5 years' imprisonment, and maximum of 99 years' imprisonment, as well as a $100,000 fine per instance. (They are very generous though, in that if the fetus miraculously survives, it's only a second degree felony that carries a mandatory sentence of 2 to 20 years).
You are effectively insisting that physicians put in this position must put their entire profession, career, livelihood, and potentially even their life on the line in the hopes that the politically selected prosecutor elects to not pursue charges. That's a hell of a gamble without even beginning to consider the impact of the loss of a physician would have on their community.
This is a political problem with a political solution, but despite my own intentions and moral convictions, I would never presume to insist that another physician puts everything on the line to stand up to the modern Nazi party. (because, let's be honest, that's what the GOP is now.)
That's horrible and unjust. But it doesn't invalidate everything else. That poor woman is understandably looking at it from her perspective, which doesn't give a damn about what comes next. Part of medicine and medical policy is making difficult decisions. Let's look the other direction where what the government has done isnt evil.
The opioid epidemic has been devastating. Recently, they've restricted prescribing of opioid to surgeons and pain specialists instead of everyday physicians. When my back goes out and I can't make it to the toilet do you think I care about the big picture? I've never had issues with opiod abuse and use them just as pain killers to get me through the worst of it. I always need up with most of my prescription expiring.
But my individual suffering is less than the societal cost of easy access to opioids.
With this insane abortion law, it's clear the state is in the wrong, but the doctors have to look at the impact of their decisions. The doctors want to help that poor woman. It's the easy, satisfying thing to do in the moment. But if the outcome is fewer people receiving medical treatment is it a net positive.
Maybe?
It really depends on the rate at which this is happening and whether the doctors would actually win at court.
That's the security guard's problem
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Republicans doing their best to make life a living hell for women. Job well done.
The political party that can't even decide what a woman is.
What a bunch of weirdos.
Although the state law says termination of ectopic pregnancies is not considered abortion, the draconian penalties scare Texas doctors from treating those patients
This. The same thing is happening in Poland. Doctors don't want to risk going to jail, so you might die, because politicians decided to make decisions for the doctors to appeal to the "Taliban".
Then they are surprised the population is on decline and people are afraid to have kids.
If they really wanted to solve the demographic problem, they should stop stalking from the citizens and do everything to help middle class to prosper. People won't have kids, if they can barely survive themselves and now they can even die.
As you can check by my comments history I'm not an usual US hater. But here, I must admit this country is a professional shitshow.
When a state used to have maternal outcomes similar to a developing nation's, then passed some new laws and it got worse, I'd say shitshow is too mild.
This is what happens when a political party decides it knows more than doctors. Really pisses me off
You're giving them way too much credit. They're not playing doctor, they're playing "Christian Autocrat" and near-death pregnancies are just the price of doing business.
So prolife, really, killing and terrifying pregnant women who are bleeding.
Each day we move closer to Texas being in play.
Could have codified Roe, but keeping the filibuster intact was and will always be Senate Democrats' highest priority.
Given that every Republican was against codification, it only takes having a few Democrats against it to block such a move. Even as a majority of Democrats were in favor, at no time was a majority of the Senate
Then you make them vote and you primary the fuck out of them.
Funny how everyone in the senate seems to forget how to politic when it suits them.
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