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Culture War Roundup for the week of January 27, 2025

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Reuters:

Trump orders sweeping freeze for federal grants and loans

Trump order set to halt supply of HIV, malaria drugs to poor countries, sources say

Apparently based on this memo (pdf).

This seems very... crude. The question is if it's purposefully crude, if there's some structural reason it can't be better implemented, or if the person in charge is incompetent.

Also, impoundment? We'll see?

I can understand the logic of cutting off all funding first and then re-opening the spigot only to programs that reveal themselves as essential, so I will reserve judgement on this policy (if it even survives its first appearance in court) until we see how the second part is supposed to work. If it ends up taking long enough that most university and national lab research grinds to a halt and children in Africa start dying of AIDS because local workers are not allowed to hand over drugs that have been already been purchased and delivered, then I will consider it a grave blunder.

Are you counting malicious compliance in that assessment?

I mean, on other policies, we've already had pro DEI bureaucrats in the military claiming the executive order banning DEI prevents them from teaching about the Tuskegee Airmen. Pete Hegseth then told them to knock it off and keep teaching it. But it created another news cycle of "Oh my god, the Trump administration is trying to erase the Tuskegee Airmen from history!"

We saw it in Florida with the don't say gay bill, where a bunch of pro keeping pornography in schools teachers just got rid of all their books because "they were just so afraid of getting in trouble".

Arguably we've seen it repeatedly with pro-abortion doctors letting patients die, where the law clearly states that are allowed to treat them, because of abortion bans. Or maybe to be more charitable to the doctors, the patients make a lot of really dumb healthcare choices, and the press invents that story around it.

I've seen enough of it where I simply do not care. These people are going to throw temper tantrums, sociopathically let people come to harm despite the obvious reading of the order not requiring them to do, or even explicitly telling them not to, and they'll blame Trump. Every single day will be a new misleading headline characterizing every one of these bureaucratic tantrums as Trump's singular fault.

Honestly it's not all that different from when Biden pulled out of Afghanistan, and the generals did it in the shittiest most passive aggressive way possible to make him look like an idiot retard. Which... I mean we've since learned he may have been. Which I guess made the general's sabotage super effective. Supposedly that was the moment his popularity tanked and never recovered.

But that is these people's game. Malicious compliance, and crying to the media about unnecessary problems they created, which everyone spins to blame the executive who dared to give the bureaucrats a lawful order they didn't agree with. It's ok, you can tune them out. Or shoot them in the streets. I heard that's part of Project 2025.

But that is these people's game. Malicious compliance, and crying to the media about unnecessary problems they created, which everyone spins to blame the executive who dared to give the bureaucrats a lawful order they didn't agree with. It's ok, you can tune them out. Or shoot them in the streets. I heard that's part of Project 2025.

How are you sure this is malicious compliance, and not just a combination of chilling effects and most people not knowing the limits of new, unfamiliar laws?

For your teacher example, I could easily see a situation where they genuinely don't know whether books in their classroom library violate some part of the law (because, say, LGBT content wasn't among the things they screened for when buying the books in the first place), and thus found it easier to nuke the classroom library than it would be to comb through all of them and make sure they don't run afoul of the law.

And in the case of the doctors and anti-abortion laws, it really feels like you're doing the thing so many people do where they assume they live in the "most convenient world" for their worldview. Like, how convenient that anti-abortion laws would never lead to any negative outcomes ever, if not for malicious compliance on the part of doctors.

Just as police officers are not lawyers, and they deserve a little bit of charity when they misinterpret or misapply a law, doctors are not lawyers and it is not at all surprising to me that a new set of laws whose limits haven't fully been tested in the courts is leading them to fail to treat patients even when it might technically be permissible under the law. I suspect that once the dust is settled and doctors are less spooked by the threat of being charged under the new law, fewer women will die this way, but I don't think chalking it up to a "tantrum" is the most likely reading of the cases that have been making headlines.

And in the case of the doctors and anti-abortion laws, it really feels like you're doing the thing so many people do where they assume they live in the "most convenient world" for their worldview. Like, how convenient that anti-abortion laws would never lead to any negative outcomes ever, if not for malicious compliance on the part of doctors.

Am doctor. Spend a lot of time here defending doctors.

The level of overreaction and fear mongering from the relevant physicians on social media was profoundly immense, these people are grossly ideologically captured, and I could absolutely see them letting someone die because of it.

Am lawyer. Spend a lot of time here defending lawyers.

One of the things I've always told clients asking for advice on specific actions is that you don't be the one who finds out where the line is. Yes, you may have a strong argument that your actions are legal, but you don't want to put yourself in a position where you have to make that argument and hope that someone with your liberty and livelihood in your hands agrees with it. People on this sub who were responding that these women's cases were obviously covered by the exception were woefully misinformed on how these things actually work. First, unless you're a doctor, and I mean an OB/GYN with 30 years of experience and a CV as long as your arm, AND you have access to the patient's medical records and anything else that could be used as evidence in the case, you're not qualified to offer an opinion on what treatment was appropriate.

Second, I remember a lot of arguments along the lines of "If you can get a hundred doctors to say the treatment was reasonable..."; well, no, that's not how it works. Maybe you can get a hundred doctors to say so, in which case you can ask them to write letters to the DA asking him not to prosecute. At trial, you get one. You'll have your expert, the prosecution will have theirs, and you have to hope the jury believes yours. And you have to keep in mind that the prosecution expert is going to be just as qualified as your guy and sound just as reasonable to a lay audience as your guy, even if you know the guy is a witch doctor who is full of shit.

And then you have to consider the political elements at play. This is a new law passed by parties who are strongly ideologically motivated. The case in question, IIRC, involved a woman with a nonviable pregnancy who was forced to wait until she miscarried before they would remove the fetus, and in the meantime she became septic. The Texas legislature has been under pressure to amend the law to specifically allow for termination of nonviable pregnancies, but has steadfastly refused to do so. So now the doctors have to rely on the much vaguer "risk of death or serious bodily injury" standard. Was there some extenuating circumstance that made this particular woman's risk of infection substantially greater than that of the average woman with a nonviable pregnancy? Unless there was, by terminating this woman's pregnancy they would effectively be instituting a policy that all nonviable pregnancies are covered under the exception. Since the legislature explicitly refused to carve out that exception, the prosecutor is likely to view the policy as pretext to perform prohibited abortions, and will be under pressure to prosecute to reassert that the exception does not exist.

Arguing something on the internet where you can press enter and not have to worry about any consequences is one thing. Making a decision that could result in a lengthy prison sentence, substantial fines, and loss of your license in quite another. Regardless of how ideologically captured they may be, their actions are reasonable. I know that if I were advising any of these doctors, I'd tell them not to perform any abortions at all unless they were on the right side of a bright line or the woman was on her death bed. If it comes down to an argument about increased risk or relies on some reasonableness standard, I'm not touching it with a ten foot pole.

I think their is some truth to this but I also saw a lot of people saying things that amounted to "well if I can't provide abortions than I'll just leave the state and leave their mothers/babies to die" which suggests their is some mean spirited and political aspects to the whole thing.

Although, in support of your point (incoming vagueness because OPSEC) I was talking to a prominent medical ethicist a few months ago and he was telling a story about how he was doing something in two different states with mutually incompatible laws, and reached out to the state AGs for both to ask which situation took precedence (ex: when the patient calls the doctor from one place but the doctor is in a different state). Shocking both of them said "our rules!"

Nobody knows what would actually happen unless you run afoul of something and it actually goes to court, but actually following the rules is at times inadvisable and awkwardly at times outright impossible.

One of the things I've always told clients asking for advice on specific actions is that you don't be the one who finds out where the line is. Yes, you may have a strong argument that your actions are legal, but you don't want to put yourself in a position where you have to make that argument and hope that someone with your liberty and livelihood in your hands agrees with it.

Right, this is why you only ask a lawyer about something like that if you want a "no". If you want to be able to do anything at all without risking losing your life, liberty, and/or property to government action, you need true anarchy.

Nevertheless, it doesn't apply in some of the situations promoted in the press, because respecting a 200-mile zone around the abortion law's actual strictures would and did force the hospitals and doctors into non-compliance with other laws and regulations. Unless discharging patients with life-threatening conditions like sepsis is somehow black-letter legal?

respecting a 200-mile zone around the abortion law's actual strictures would and did force the hospitals and doctors into non-compliance with other laws and regulations. Unless discharging patients with life-threatening conditions like sepsis is somehow black-letter legal?

I mean, I'm not sure what you're talking about. First, none of the Texas cases at issue involved patients who were discharged, but lets forget that for a minute because it doesn't mean that future cases won't. What is it about exercising extreme caution that requires the hospital to discharge a septic patient? In one of the cases the septic woman was being monitored in the hospital the entire time, so this is obviously the preferred course of action. Third, even if the hospital did discharge a septic patient, well, I'm unaware of any laws that prohibit that, black letter or otherwise. the closest laws I'm aware of are those that prohibit hospitals with EDs from turning away patients with emergency medical conditions due to inability to pay.

So doctors and hospitals realistically have two options:

  1. Perform the abortion, which creates a potential criminal liability, the consequences of which are up to 99 years in prison, substantial fines, loss of license, and various other administrative penalties. If this liability is pursued I have a good defense.

  2. Don't perform the abortion and treat the patient using other means. This MAY create a civil liability IF the patient actually suffers adverse consequences, which they may not. In the event that happens, the civil liability is limited to money damages the doctor and hospital are insured against it. The doctor and hospital have a good defense here as well, as they can argue that they reasonably assumed that the abortion would have been illegal under Texas law.

the defenses cancel each other out. So what you have here is a fully mature criminal liability with severe consequences that can't be indemnified, vs. a potential civil liability with mild to moderate consequences that already are indemnified. What doctor in his right mind would select option 1?

The other interesting thing I would point out about this is that, for all the guarantees I've seen here and elsewhere that the doctor's actions in any of these deaths would have totally been covered by the exception, they've been curiously absent coming from anyone who actually matters. I haven't heard Ken Paxton or anyone else from the AG's office saying that performing an abortion in those circumstances would not be criminal, nor have I heard it from the governor. I haven't heard any state legislator suggest that those circumstances were of the type the exception was intended to cover. The Supreme Court declared that the law wasn't vague and declined to offer any further guidance. The only Texas politician who has done so was Ted Cruz, but he's in no position to actually make determinations about these things. It's easy to say what we think would have happened because we know that the woman ended up dying. But if she lives, it's a different story. We now have a perfectly healthy woman and a dead baby and the Terri Schaivo crowd who is behind limiting these exceptions would claim that there's no way we can know that the baby wouldn't have been perfectly healthy had it not been killed in the womb. There have been no prosecutions thus far, and as such we have no idea what to expect. Any doctor who decides to perform an abortion he can't absolutely, 100% say is necessary to prevent death or permanent impairment, not simply a reasonable precaution against an increased risk, is taking a 99 year gamble. You'd better believe he's not getting within 200 miles of that law.

I mean, I'm not sure what you're talking about. First, none of the Texas cases at issue involved patients who were discharged, but lets forget that for a minute because it doesn't mean that future cases won't. What is it about exercising extreme caution that requires the hospital to discharge a septic patient?

Nevaeh Crain

The first hospital diagnosed her with strep throat without investigating her sharp abdominal cramps. At the second, she screened positive for sepsis, a life-threatening and fast-moving reaction to an infection, medical records show. But doctors said her six-month fetus had a heartbeat and that Crain was fine to leave.

Neither of these have anything to do with over-reaction, even justified over-reaction, to the heartbeat law. Nor do they demonstrate a precautionary attitude in the first place.

She went to a third hospital where care was supposedly delayed two hours because they needed two ultrasounds (it doesn't take two hours to get two ultrasounds if your hospital is at all competent) to confirm fetal death. But that doesn't explain the first two hospitals.

The other interesting thing I would point out about this is that, for all the guarantees I've seen here and elsewhere that the doctor's actions in any of these deaths would have totally been covered by the exception, they've been curiously absent coming from anyone who actually matters. I haven't heard Ken Paxton or anyone else from the AG's office saying that performing an abortion in those circumstances would not be criminal, nor have I heard it from the governor. I haven't heard any state legislator suggest that those circumstances were of the type the exception was intended to cover. The Supreme Court declared that the law wasn't vague and declined to offer any further guidance.

The Supreme Court:

A physician who tells a patient, “Your life is threatened by a complication that has arisen during your pregnancy, and you may die, or there is a serious risk you will suffer substantial physical impairment unless an abortion is performed,” and in the same breath states “but the law won’t allow me to provide an abortion in these circumstances” is simply wrong in that legal assessment.

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