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Where You’re Going Matters

Would you tell me, please, which way I ought to go from here?”

That depends a good deal on where you want to get to,” said the Cat.

I don’t much care where—” said Alice.

Then it doesn’t matter which way you go,” said the Cat.

It was early 2022, Russia had just invaded Ukraine, and stories of refugees in desperate need were plentiful. Hearts were touched at the church this man attended. One of the ladies knew a woman who was chairperson of the local Democratic party. Upon reaching out, she found shared interest in this issue.  Concerned church members were invited to a rally that very weekend, which they gladly accepted.


As they gathered to hold signs publicizing the plight of families displaced from their homes, church members talked among themselves how they might help. Methods to provide housing, clothing, food, and transportation were contemplated. But when this lady spoke of her ideas to her chairperson friend, she was stunned to find no interest to participate.


“We assumed that because we shared a cause, we shared a goal”, this man reflected. “We didn’t.  Those from the church saw the need through the lens of vulnerable people and a problem to solve. For those coming from the political perspective, this issue itself was the goal. How they could use it to advocate for their party.”


As I listened to this man I met while on vacation last week express his bewilderment, I thought of Evergreen’s experience during Covid. I first assumed public health, OHA, and our community partners, facing a common threat, shared the same goals. It quickly became evident we did not. There existed a political class and media that benefitted from hysteria.


When some of us disagreed with vaccine mandates, the value of masking or the 6 foot social distancing rule, the need to close schools and lockdown communities, the threat of Covid to  healthy individuals, the protection offered from acquired immunity, potential risk of Covid vaccines to children or pregnant women, the efficacy over time of the vaccines to prevent disease or transmission, or the value of various antivirals co marketed by big pharma and the government – we were threatened and attacked. Threatened repeatedly by the Oregon Medical Board. Attacked in the press and in a letter signed by many of our colleagues in the community, most of whom never treated Covid.


When health care providers face compelled adherence to an orthodoxy generated by government institutions and corporate self-interests, truth is the first casualty. It is not providers who are the victims, rather our patients who are owed that truth.


As with the man I met last week, I was stunned and frightened by what I saw. I realized the American democracy is much more delicate than I was willing to admit. I always knew there was a power-hungry ruling class. But I didn’t allow myself to see how many people would be willing to kneel in front of it. This gift of freedom we have been given can be lost.


Recently, I was made aware of a proposed change in the ethics rule from the Oregon Medical Board. At issue is not just making the use of “microaggressions” a cause to discipline doctors but also making reporting such transgressions mandatory for all doctors.


Terms ranging from “melting pot” to phrases like “pulling oneself up by your own bootstraps” have been declared racist. “Everyone can succeed if they just work hard enough” is used as an example of a microaggression. Under the new ethics rule proposed by the Oregon Medical Board, “unprofessional conduct” (over which a doctor can lose his or her license) will include microaggressions.


Two years ago, I wrote a series of blogs focusing on medical ethics. I spoke of four main ethical principles: beneficence, nonmaleficence, autonomy and justice. I then applied those principles to practical issues we face in medicine. I followed that with a sequence of blogs of how philosophy drives medical ethics. It is not enough to know what constitutes ethical behavior. It is critical to understand why we believe that to be so.


The rules being considered by the Oregon Medical Board have nothing to do with any of these principles or goals. This is simply compelled speech, a form of thought control, with approval at the whims of current social fads and self-appointed monitors.


What I have learned is that it is extremely dangerous, even disastrous, to assume that because people are in positions of responsibility, they are therefore behaving responsibly.  Our freedom to practice medicine according to traditional ethics is at risk. We find ourselves, like Alice, asking where to go from here. Well, we better know where we want to get to.


The son had moved out for a few years ago to begin his life with his own family. One day he returned home to speak with his father.  “Life is hard. I’m struggling financially. The job isn’t what I hoped. There is tension in my marriage, the kids are sick ……… It’s just hard. Do you have any advice?”


His dad said nothing as he moved into the kitchen where he filled three pots with water and brought each to a boil. Into the first pot, he placed a potato, in the second, an egg and in the third coarse coffee grounds. He let the silence build until finally he spoke to his son.


“Life is hard. It will get hot. How you respond reveals your character. Each of these items were exposed to the same environmental stress.”


“The potato went in hard. Tough, Now, its soft and mushy. The egg was brittle on the outside and soft on the inside. It still has a brittle exterior but now is hard on the inside. But the coffee did something totally different. It changed the water around it. It transformed its environment into something better.”


The challenge for Evergreen will be to never forget who we are and what our goals are. We must never allow anybody else to define that for us. We will need to stand together as we stand apart. Because I expect it to get hot. We will be changed. For our patients, for our community, for our own integrity, I want us to use the heat to transform our realm of influence into something better. One we are all proud to belong to.


Tim Powell MD

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