History > 2014 > USA > Health (II)

Mass Imprisonment

and Public Health

By THE EDITORIAL BOARD

NOV. 26, 2014

The Opinion Pages | Editorial

When public health authorities talk about an epidemic, they are referring to a disease that can spread rapidly throughout a population, like the flu or tuberculosis.

But researchers are increasingly finding the term useful in understanding another destructive, and distinctly American, phenomenon — mass incarceration. This four-decade binge poses one of the greatest public health challenges of modern times, concludes a new report released last week by the Vera Institute of Justice.

For many obvious reasons, people in prison are among the unhealthiest members of society. Most come from impoverished communities where chronic and infectious diseases, drug abuse and other physical and mental stressors are present at much higher rates than in the general population. Health care in those communities also tends to be poor or nonexistent.

The experience of being locked up — which often involves dangerous overcrowding and inconsistent or inadequate health care — exacerbates these problems, or creates new ones. Worse, the criminal justice system has to absorb more of the mentally ill and the addicted. The collapse of institutional psychiatric care and the surge of punitive drug laws have sent millions of people to prison, where they rarely if ever get the care they need. Severe mental illness is two to four times as common in prison as on the outside, while more than two-thirds of inmates have a substance abuse problem, compared with about 9 percent of the general public.

Common prison-management tactics can also turn even relatively healthy inmates against themselves. Studies have found that people held in solitary confinement are up to seven times more likely than other inmates to harm themselves or attempt suicide.

The report also highlights the “contagious” health effects of incarceration on the already unstable communities most of the 700,000 inmates released each year will return to. When swaths of young, mostly minority men are put behind bars, families are ripped apart, children grow up fatherless, and poverty and homelessness increase. Today 2.7 million children have a parent in prison, which increases their own risk of incarceration down the road.

If this epidemic is going to be stopped, the report finds, public health and criminal justice systems must communicate effectively with one another. That requires comprehensive electronic health records that can be shared among agencies, increasing the likelihood that those who leave prison with health problems will not fall through the cracks.

Better health outcomes also depend on giving newly released inmates a real chance to find jobs and housing. The report calls for the end of laws that keep punishing people after they have been released from prison, like denying public housing and food stamps to those with drug felony convictions.

Finally, the Affordable Care Act — which provides more coverage for mental illness and substance abuse, and expanded Medicaid for childless adults — is a big step in the right direction.

Like any epidemic, mass incarceration must be tackled at many different levels. It is an opportune time for such an approach, as states around the country are thinking more broadly, pulling back on harsh sentencing laws and focusing more on alternatives to incarceration. But the moment may not last long. Public health professionals should seize a unique opportunity to help guide criminal justice reform while they have the chance.


A version of this editorial appears in print on November 27, 2014, on page A34 of the New York edition with the headline: Mass Imprisonment and Public Health.

    Mass Imprisonment and Public Health, NYT, 26.11.2014,
    http://www.nytimes.com/2014/11/27/opinion/
    mass-imprisonment-and-public-health.html

Health Care Reform Imperiled

 

NOV. 7, 2014

The New York Times

The Opinion Pages | Editorial

By THE EDITORIAL BOARD

Will five Supreme Court justices eliminate essential health care subsidies for more than four million lower-income Americans, based on a contorted reading of four words?

It sounds inconceivable, but that would be the effect of a ruling in favor of the latest legal challenge to the Affordable Care Act. On Friday, the justices announced that they would hear that case, King v. Burwell, a dispute over the meaning of a single phrase — “established by the State” — in the 900-page health-care reform law.

The law, which has been under constant assault since its 2010 passage, has made health-care coverage newly available for between 8 and 11 million people this year alone.

This unprecedented achievement in social policy has improved, and surely saved, many lives. But, to the law’s implacable opponents, it represents nothing more than an oppressive big-government program that must be stomped out.

The opponents lost before the Supreme Court in 2012 in an effort to kill the law on constitutional grounds. Now they are taking aim at the tax-credit subsidies that are central to the success of health reform.

Because one subsection of the law says these subsidies are available on an exchange “established by the State,” the plaintiffs claim there can be no subsidies for anyone living in the 36 states where the federal government established a health exchange after state officials did not.

It is a superficially simple argument, which most federal judges who have considered the claim have rejected. That is because it runs counter to the explicit purpose and structure of the Affordable Care Act. As everyone involved in the law’s creation understood at the time, its success depends on making coverage both required and available to as many people as possible. As a Senate staff member told Vox.com recently, “We certainly wanted every individual in every state, regardless of their federal or state exchange status, to receive the same subsidies.”

In cases where there is a dispute over statutory wording, a well-established legal principle requires courts to defer to a government agency’s reasonable interpretation of the language at issue. In fact, the plaintiffs concede that their strained reading of the law could render several other provisions nonsensical.

The Supreme Court itself has said repeatedly that when construing laws, “we must not be guided by a single sentence or member of a sentence, but look to the provisions of the whole law, and to its object and policy.”

The Affordable Care Act’s challengers have taken the opposite approach and spent years scouring each sentence of the law for any and all possible lines of attack. Their persistence is impressive, but it does not make them right.

A version of this editorial appears in print on November 8, 2014, on page A20 of the New York edition with the headline: Health Care Reform Imperiled.

    Health Care Reform Imperiled, NYT, 7.11.2014,
    http://www.nytimes.com/2014/11/08/opinion/health-care-reform-imperiled.html

Brittany Maynard,

‘Death With Dignity’ Ally,

Dies at 29

NOV. 3, 2014

The New York Times

By DANIEL E. SLOTNIK

Brittany Maynard, who became a public face for the “death with dignity” movement in the United States after she was found to have terminal brain cancer, ended her life on Saturday at her home in Portland, Ore. She was 29.

Her death, from barbiturates, was confirmed by her husband, Daniel Diaz, who noted that in accordance with Oregon law her death certificate listed a brain tumor as the cause.

Ms. Maynard learned she had brain cancer on New Year’s Day this year. Her doctors told her at first that she could live for several years, but after further tests they revised the prognosis in April, saying she had only about six months.

“After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left,” Ms. Maynard wrote in a post on CNN’s website.

Ms. Maynard decided that when her condition became unbearable she would end her life with medication. She had to uproot her family from her home in Alamo, Calif., and move to Oregon to receive the barbiturates legally.

“Brittany’s take on this issue was that it just seems ridiculous that we couldn’t live out her final months comfortably in our own home,” Mr. Diaz said in an interview on Monday.

Ms. Maynard contacted Compassion & Choices, an end-of-life rights advocacy group, which helped promote a video she posted on YouTube in early October and a second released a few days ago. The videos have been viewed more than 13 million times, and she was interviewed for an article by People magazine. Her story drew international news coverage.

So-called “death with dignity” laws have been passed in five states but are opposed by many political and religious organizations. Many people publicly asked Ms. Maynard to reconsider her decision, including one woman also dying of cancer.

Ms. Maynard defended her right to decide.

“I would not tell anyone else that he or she should choose death with dignity,” she wrote on the CNN website. “My question is: Who has the right to tell me that I don’t deserve this choice?”

Brittany Lauren Maynard was born on Nov. 19, 1984, in Anaheim, Calif. She received a bachelor’s degree in psychology from the University of California, Berkeley, in 2006 and a master’s in education from the University of California, Irvine, in 2010.

She married Mr. Diaz in Sonoma, Calif., in 2012 and taught school in Danville, Calif. An ardent traveler, she had explored Southeast Asia and parts of Central and South America.

Besides her husband, she is survived by her mother, Deborah Ziegler, and her stepfather, Gary Holmes.

Ms. Maynard continued traveling during her last months, visiting Alaska, Yellowstone National Park and the Grand Canyon. Being able to choose when to die, she said, allowed her to live.

“It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty and pain,” she wrote.

Correction: November 5, 2014

An obituary on Tuesday about Brittany Maynard, who became a public face for the “death with dignity” movement in the United States after she was found to have terminal brain cancer, referred incorrectly to a woman who asked Ms. Maynard to reconsider her decision to end her own life. That woman is dying from breast cancer that has metastasized — not from “the same cancer” as Ms. Maynard.

A version of this article appears in print on November 4, 2014, on page B16 of the New York edition with the headline: Brittany Maynard, 29, Right-to-Die Advocate.

    Brittany Maynard, ‘Death With Dignity’ Ally, Dies at 29, NYT, 3.11.2014,
    http://www.nytimes.com/2014/11/04/us/
    brittany-maynard-death-with-dignity-ally-dies-at-29.html

A Right Like Any Other

New Judicial Approaches to Abortion Right

6 August 2014

The New York Times

The Opinion Pages | Contributing Op-Ed Writer

Linda Greenhouse

Listening to politicians talk about abortion, watching state legislatures put up ever more daunting obstacles, reading the opinions of judges who give the states a free pass, it’s abundantly clear to me that some constitutional rights are more equal than others. Or to put it another way, there are constitutional rights and then there is abortion — a right, increasingly, in name only, treated as something separate and apart, vulnerable in its isolation from the mainstream of those rights the Constitution actually protects.

And then, forcefully to the contrary, came this week’s opinion by a federal district judge in Alabama, Myron H. Thompson, who declared unconstitutional the state’s Women’s Health and Safety Act, which required doctors who performed abortions to have admitting privileges at a nearby hospital. The law would have shut down three of Alabama’s five remaining abortion clinics.

There is so much to say about this remarkable 172-page opinion that it’s hard to know where to begin. So I’ll start with where Judge Thompson ended his opinion in Planned Parenthood Southeast v. Strange and it’s a point that has gone unsaid in too many quarters for too many years: the right to an abortion is a constitutional right like any other.

Just suppose, Judge Thompson wrote, that the justices were to recognize an individual right to keep a gun at home for self-defense. (As of course the court did, six years ago in the Second Amendment case, District of Columbia v. Heller.) Then suppose that sellers of firearms and ammunition were regulated by the state to such an extent that there were only two vendors left. “The defenders of this law would be called upon to do a heck of a lot of explaining,” Judge Thompson said, adding, “and rightly so in the face of an effect so severe.”

Guns and abortion? That’s a pairing no previous judicial opinion has made. “At its core, each protected right is held by the individual,” the judge explained. “However, neither right can be fully exercised without the assistance of someone else. The right to abortion cannot be exercised without a medical professional, and the right to keep and bear arms means little if there is no one from whom to acquire the handgun or ammunition.”

Do I have to point out how delicious this analogy is? Of course, it’s unthinkable that Alabama would regulate firearms dealers to the point of extinction. But recall the June day 22 years ago when the Supreme Court, to the surprise of nearly everyone, reaffirmed the right to abortion in Planned Parenthood v. Casey. It was unthinkable then that nearly a generation later, states would flagrantly be regulating the practice of abortion (in the name of women’s health and safety, no less) out of business — a goal that Texas, enabled by the United States Court of Appeals for the Fifth Circuit is close to achieving.

(In his opinion, Judge Thompson referred to “the one justice” who was in the majority in both the Heller and Casey decisions. This unnamed justice is Anthony M. Kennedy, on whom, as Judge Thompson and everyone else knows, the next chapter in this saga most likely depends.)
Continue reading the main story

By pairing gun rights and abortion rights, Judge Thompson was not just indulging in shock value. He was making a profound point: that a right — any right — without the infrastructure and the social conditions that enable its exercise is no right at all.

In the abortion context, he pointed out, there is an additional, even deeper point. In the years immediately after its 1973 decision in Roe v. Wade, the Supreme Court was confronted with the question of whether the government was obliged to pay for abortions, as it paid for other medical services, for women who couldn’t afford them. The court’s eventual answer, in a 1980 case, Harris v. McRae, was no. The case is often invoked by states and others who argue that since the government’s refusal to subsidize abortion doesn’t violate the right to abortion, then surely women have no entitlement to a clinic within convenient driving distance, and so the government doesn’t infringe on the right to abortion by imposing regulations that force particular clinics to close.

But this reasoning results from a category error, Judge Thompson suggested. In the public funding case, the government didn’t create, and wasn’t required to remedy, a woman’s inability to pay for an abortion. The obstacle was poverty. But the admitting-privilege requirement — which Judge Thompson’s opinion persuasively demonstrates is medically unnecessary and can’t be met, because of the desire of hospitals in Alabama to have nothing to do with abortion — is something else entirely. The obstacle is the government itself, through a regulation that threatens to dismantle an existing infrastructure that for years has made abortions available in Birmingham, Mobile, and Montgomery — three major cities that would lose their only clinics. The government-created burden on women seeking abortions would be severe, Judge Thompson concluded, while the state’s rationale for the regulation was “by no means sufficiently robust to justify the obstacles that the requirement would impose.”

Days before the Alabama decision, a Fifth Circuit panel voted 2-to-1 to invalidate Mississippi’s admitting-privilege requirement, which would have shut down the state’s sole abortion clinic. As did Judge Thompson, the two judges in the majority (E. Grady Jolly, one of the circuit’s most senior judges, appointed by President Ronald Reagan in 1982, and Stephen E. Higginson, one of its most junior, appointed by President Obama in 2011) looked beyond abortion jurisprudence for sources of law to illuminate the issues.

They found such a source in an early civil rights case, State of Missouri ex rel. Gaines v. Canada from 1938. In that case, rather than accept a black man into its whites-only law school, the state offered to subsidize his attendance at a law school in a neighboring state. The would-be law student, Lloyd Gaines, rejected the offer, sued, and won in the Supreme Court, which held that the 14th Amendment’s equal protection guarantee imposed an obligation “the burden of which cannot be cast by one state upon another, and no state can be excused from performance by what another state may do or fail to do.”
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So in the recent Mississippi case, as in the Alabama case, federal judges have demonstrated a new willingness to treat the abortion right as a right among others. (“Gaines has never been cited in the abortion context,” Judge Jolly wrote in his majority opinion, but added: “We think the principle of Gaines resolves this appeal.” The old case, he said. “simply and plainly holds that a state cannot lean on its sovereign neighbors to provide protection of its citizens’ federal constitutional rights.”)

The Mississippi opinion, Jackson Women’s Health Organization v. Currier, is not necessarily a slam-dunk win for abortion rights. It’s hard to imagine a more drastic situation than the forced closure of a state’s sole remaining clinic. What if there were two left, or —as in Alabama — three? It’s not clear to me how the panel would have ruled in that instance.

Still, judges’ willingness to step outside the abortion frame and to weigh, from that broad perspective, whether the abortion right has become unduly burdened is something new and potentially of great value in the struggle to preserve women’s reproductive freedom. Even in the face of cynical and unrelenting political attack, the right to abortion can become stronger the more tightly it is stitched into the constitutional fabric, the more that smart and gutsy judges are willing to treat it as what it is, a right like any other.

    A Right Like Any Other, NYT, 6.8.2014,
    http://www.nytimes.com/2014/08/07/opinion/
    new-judicial-approaches-to-abortion-rights.html