Medical tourism reflects flaws in U.S. society

HLB_Summer2013_CoverDrawing attention to the rapidly growing phenomenon of medical tourism and I. Glenn Cohen’s intriguing work is unquestionably valuable [Summer 2013, “Patients without Borders”]. As a physician who has witnessed my own patients travel abroad for both therapeutic and cosmetic procedures, I think it is important to emphasize that, in various ways, this trend reflects deep shortcomings within our own society. Renal patients would not need to fly to the Philippines for kidney transplants if we adopted the mandatory choice or default donation models used for organ allocation in other developed nations. The terminally ill would not have to seek aid-in-dying in Swiss clinics if we afforded them a right to end their own lives in the United States. And the financially strapped women I treat in my clinic would not want to travel to Latin America for face-lifts and rhinoplasties if they were valued on the content of their characters rather than the appearance of their features. Medical tourism is far more a mirror than a window. If we look closely, we may not like what we see.

The lunchbox redux

Holmes ca. 1903, toward the beginning of his 29 years on the Supreme Court

Credit: ©HLS Historical & Special Collections Holmes ca. 1903, toward the beginning of his 29 years on the Supreme Court

Editor’s Note: The article on the Oliver Wendell Holmes Digital Suite, “Navigating the Path of a Life,  in the Summer issue, elicited this recollection:

As a fledgling lawyer in Boston, I was assigned to assist in settling the estate of Mary Stacy Holmes and incidentally going through the large house in Topsfield, Mass.

I had read enough of the Holmes literature to know that the property of the justice would very likely be in the house [Mary Stacy Holmes had been the wife of Justice Holmes’ nephew]. After quite a search, I located the property in the attic: the justice’s stand-up desk, his Civil War uniform and buttons, the lunchbox, and other treasures. With the help of a senior partner, we persuaded the family to donate the items to Harvard Law. We were able to confirm the provenance of the materials by comparing the photos then in the possession of [HLS] Professor Mark DeWolfe Howe, who was at work on an authorized biography of the justice.

The caption on the lunchbox [in your story] needs editing: The justice never carried the box himself to the Court. Mrs. Holmes would not hear of such a thing (particularly in her later years, when Justice Brandeis always stopped by to walk downtown with the justice). The box was sent down in the afternoon by a house servant (and presumably retrieved the same way). Good article!

CopyrightX’s social value

I have read the article on the amazing course CopyrightX Professor Fisher provided for us [Summer 2013, “The ‘X’ Factor”]. I was one of the participants and loved it very much! I am writing this email to reflect my views on an important point.

Would offering a free online course devalue the on-campus course? No, the question is so narrow. This project’s social value way overcame its economic value. We really need to think about the word “value’’ in a broader sense. My personal opinion is: Professor Fisher is not robbing a few privileged kids’ money or jobs to give to the poor due to pity; that concept totally demeans what is happening here. Professor Fisher is a visionary! We are leading a global revolution, a revolution that is trying to eliminate discrimination in all possible ways, including economic bias. And this behavior goes along perfectly with Harvard’s mission statement:

“Harvard seeks to identify and to remove restraints on students’ full participation, so that individuals may explore their capabilities and interests and may develop their full intellectual and human potential.”

I myself admire Professor Fisher’s bold decision very much, because finally I can be judged by the nature of my character and personal competence rather than the depth of my father’s pockets. Professor Fisher called on me and led me all the way through the course like a lighthouse. When I look at the chart of the students selected from all over the world, I feel so proud to be among these exceptional human beings! Thank you, Professor Fisher, and thank you, Harvard!

A view from the bench

The Summer 2013 edition contains a report on an April HLS conference about Gideon v. Wainwright with a keynote speech by Professor Gene Nichol of the University of North Carolina School of Law. You quote him as averring that Gideon “mainly … mocks us” and bemoaning “its marginalization on the criminal side and its brutal rejection on the civil side,” concluding that Gideon has been two-thirds “unsatisfied,” which “says more than any other stark reality about what sort of people we actually have become.”

The professor’s stunning condemnation of the result of Gideon and his implicit jeremiad about entitlement in all cases to a free lawyer paid by taxpayers are unjustified. I practiced both criminal and civil trial law for 45 years and enjoyed approximately 10 years as a Superior Court judge, presiding over mostly criminal and some civil matters. Believe me, the teaching of Gideon, that an impecunious criminal defendant merits a court-appointed lawyer in the form usually of a public defender, pervades California’s trial courts.

Theoretically, such a defendant must show inability to pay a private lawyer based upon a simple financial ability form, checked later (after appointment of counsel) by a clerk’s office functionary. In practice, almost every criminal defendant obtains appointment of a public defender or other lawyer at arraignment. Verification of entitlement is mainly a myth. Obtaining taxpayer reimbursement from a defendant with financial ability to pay for counsel is even more of a myth. Extending free legal service to civil cases represents yet another brick in the wall of societal entitlement, except perhaps if a civil-action party is ordered to show cause why he/she should not be held in criminal contempt of court. Most lawyers perform their “share” of pro bono public service to indigent parties in civil cases. The professor’s condemnation of Gideon’s effect constitutes academic rubbish, undeserving of audience from my law school.