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The Left Atrium
Contents
• Liberty and limitation in public health [PDF] • Documents of disconnection [PDF] • 9 months [PDF] • On pepper spray and civil disobediencet [PDF] Any country faced with spiralling health care costs has attempted to control the problem through some form of governmental involvement. As a result, interest in health law has grown over the past two decades, and so has the demand for articles and books on the subject — of which there has been no shortage, except in the field of public health. Lawrence O. Gostin's Public Health Law: Power, Duty, Restraint is the first available general text on population-based health law issues. Gostin, professor of law at Georgetown University Law Center and professor of public health and law at Johns Hopkins School of Public Health, is a well-recognized contributor to law and medical journals alike. His many articles have been geared to two topics: the legal aspects of HIV infection, and the privacy and confidentiality of health care information. Although these issues dominate his selection of examples in Public Health Law, he clearly has as his broader mission the investigation of the role of government in protecting the health and safety of populations. Of critical importance to Gostin is the question of the limitations that exist — or should exist — on the government's ability to restrict individual liberties. Gostin melds together political philosophy, politics and ethics in his discussion, widening the inquiry of the proper balance that should be achieved when we weigh the collective right to health-promoting social conditions against the individual's right to self-determination, whether in the personal or commercial realm. Goslin's multidisciplinary approach lends depth to his subject and, in fact, may broaden the audience of interested readers to members of the general public as well as public health officials, health care providers and academics. Any well-written discourse on government intervention — when it should begin and where it should stop — is of help to all of us. At nearly 500 pages, this book has breadth. However, it will not readily appeal to anyone looking for discussions pertinent to all subfields of public health. With some imagination, though, an extrapolation to other areas can yield an understanding within, for instance, occupational or environmental health. Gostin's work imparts a solid enough foundation for an understanding of population-based governmental mandates and constitutional repercussions to satisfy anyone truly interested in public health law. The book is divided into three substantive parts; these deal with the conceptual foundation of pubic health law, specific civil liberties issues and governmental regulation, and the future of public health. The more philosophical first part logically precedes the middle section's specific topics, which include immunization, the use of health-related information and tobacco control efforts. In the last section, Gostin offers his ideas on the legal standards that should guide public health in the future. The book includes creative and helpful diagrams of various kinds. For instance, a chronology of the United States Supreme Court rulings on constitutionally permitted commercial speech limitations complements his written materials (although legal scholars may take issue with his interpretation of US law on this topic). Too, historical illustrations of public health problems and state interventions remind the reader why public health regulations came into being in the first place. As in any human effort, weaknesses accompany the strengths. First, as noted earlier, the title of his work creates a false impression that the focus is purely on law. The melding of ethics and policy may lead to confusion, since on many occasions legal principles are not distinguished from statements based on, for instance, political theory. For example, in the chapter entitled "A Theory and Definition," Gostin writes that "Government ... is compelled by its role as the elected representative of the community to act affirmatively to promote the health of the people ... ." This statement is ethical, not legal, in nature. Although the legislature could mandate a governmental agency to adopt regulations, Gostin's statement implies the presence of an affirmative duty to protect public health. Sections devoted separately to policy, law and ethics would alleviate the problem. Second, the fragmentary presentation periodically causes malabsorption of the intellectual content. For example, the basic definitions of privacy and confidentiality appear almost halfway through the chapter on public health information, sandwiched between discussions of the various kinds of uses of information for public health ends. Also, following a paragraph on the deplorable Tuskagee research project in the US and the withholding of information from the men with syphilis, Gostin comments that the sub-Saharan AZT research protocol is ethically unsupportable, without mentioning the connection with nondisclosure of information or the glaring informed-consent problem with the research. Third, the recommendations in the last part of the book are logical outgrowths of the examples the author uses from his areas of interest in public health. However, the limited coverage of the public health field does not warrant his global statements about the future of public health law overall. Without the inclusion of environmental or occupational law, an eager prescription of a trajectory for the field is overzealous at best, and harmful to the public at worst. Different public health ends may in fact justify the use of different public health means. Yet these shortcomings do not eclipse the book's value. It lays a foundation for public health law discourse, and we can expect contributions and more discussion of sound standards to come more readily. For this reason, Gostin's attention to politics and ethics will generate interest in what public health law ought to be. For these reasons, Public Health Law: Power, Duty, Restraint is a welcome addition to the health law literature, and readers from any country will gain from the way in which Gostin raises and analyzes issues.
Eileen A. O'Neil Contents
• Liberty and limitation in public health [PDF] • Documents of disconnection [PDF] • 9 months [PDF] • On pepper spray and civil disobediencet [PDF] Lifeworks Documents of disconnection
This 15-year retrospective of Towell's work consists of three long-term projects on war zones in Central America (primarily El Salvador) and Palestine, and on impoverished Mennonite colonies in Mexico and Southwestern Ontario. Although the locations vary, the images are closely linked thematically and stylistically. Towell focuses his camera on people caught in extraordinarily harsh circumstances but continuing to cling to the familiar routines of daily life. In El Salvador, a mother nurses her infant in the maternity ward of a civilian hospital, apparently oblivious to the armed, camouflage-clad soldier beside her, and a young boy delights in the antics of three chicks in the rubble in front of his home, a shack in the dump. In Palestine, youths appear to play with slingshots against a background of burning tanks, black smoke and hurrying figures. In Mexico, a little girl holds a puppy up to the sun, as if introducing a newborn to the world, behind her hangs the mutilated carcass of a slaughtered hog. Towell's subjects engage in an endless cycle of birthing and burial. Children live the austere, segregated lives, and fight the endless battles, of their parents and grandparents. They live in the confines of belief systems so entrenched that they accept their struggles as normal. In Towell's pictures, the cycle of life constantly repeats itself to the point where his subjects' lives seem to unfurl independently from their environment.
All of Towell's work is characterized by disconnection. He is naturally attracted to subjects that are ironic, or inherently contradictory — their different elements mirroring the ironies of human life. He reinforces his subject matter through aesthetic devices — skewed points of view, internal divisions of the image with architectural elements and rays of light, truncated body parts, absence of eye contact between individuals. These devices create a disequilibrium within the photographs, a sense of dislocation, a feeling of rootlessness — which in essence is Towell's intent. Towell has stated that his work is about landlessness, what happens to people who have lost their land, or on a psychological level, their sense of being anchored to their surroundings. The brilliance of his work is that he manages to capture both the story and the emotion. His photographs speak of misery, tragedy, irony, the entire range of emotions — but primarily about humanity — in all its tenacity and its imperfection. While he obviously sympathizes with the underclasses, Towell neither idealizes nor judges them. He watches and records — then filters his observations through his understanding that human experience includes human folly. Towell's own shadow appears in the foreground of a 1994 photograph from the Mennonite series, La Batea Colony, Zacatecas, Mexico. For once unpeopled, it is an agricultural scene of a barn, a towering haystack, a whirring flock of crows suspended momentarily, and for all time, in the sky overhead. In this photograph, Towell stakes his own claim on this harsh, dry landscape, but he also claims it in homage to the people he documents. This is picture-making of the highest order.
Vivian Tors Contents
• Liberty and limitation in public health [PDF] • Documents of disconnection [PDF] • 9 months [PDF] • On pepper spray and civil disobediencet [PDF]
Contents
• Liberty and limitation in public health [PDF] • Documents of disconnection [PDF] • 9 months [PDF] • On pepper spray and civil disobediencet [PDF] Room for a view On pepper spray and civil disobedience
The ancient city of Madurai in the state of Tamil Nadu, India, has two main attractions that contrast starkly in atmosphere and effect. The extravagant Sri Meenakshi Temple, in the heart of the old city, houses a vibrant bazaar of colours, fragrances and sounds, more reminiscent of a carnival than of a temple. Entering, you are simultaneously greeted by vendors, blessed by elephants and adorned by the nimble fingers of sweet women who lace strings of jasmine through your hair; these tickle your neck and swish perfume each time you turn your head to take in the confectionary of multicoloured statues that decorate every nook and cranny of the festive building. In contrast, the Gandhi museum, located on the outskirts of the city, a fair taxi ride away in the tranquil palace of Rani Mangammal, is more reminiscent of a temple than of a museum, offering solitude and instilling reverence. It houses an account of India's struggle for independence and exhibits Mahatma Gandhi's contributions to this effort, culminating with a display of the garment he was wearing when assassinated and a transcript of his utterance to God in that moment when he realized that his fate, and India's, were sealed.
Gandhi's peaceful approach to civil disobedience, satyagraha, combined a demonstration of truth (satya) with firmness (agraha). The strength of satyagraha was soulful, not brutal, and its weapons — humility, patience and purity — resided in the individual and were expressed through self-control. Through satyagraha one vindicated the truth by inflicting suffering not on one's opponent but on oneself; fasting was the most extreme act of nonviolence. It was Gandhi's hope and belief that through the dissident's patience and sympathy the opponent might be weaned from error and catch a glimpse of truth.
To lose sight either of one's objective or of one's opponent during an act of civil disobedience reduces the effectiveness of this act. As articulated in a manual on civil disobedience posted on the Web by ACT UP (AIDS Coalition to Unleash Power),1 the aim of nonviolent civil disobedience is communication. To effectively practise peaceful protest, the protestor must believe that his or her objectives are fair and must be in a position to communicate this directly to the opposing individual. It is important during this communication that the protestor maintain eye contact with the front-line opponent as much as possible in an attempt to engage his soul rather than his brute.
This is difficult to do when the opponent is hidden beneath riot gear (or suited behind wire fencing) and when pepper and tear gas are being sprayed into one's face — which is probably why these agents are used as often as they are to squelch social protest. The active ingredient in pepper spray is oleoresin capsicum, an oily extract of hot peppers that targets pain receptors and causes neurogenic inflammation, short-term pain, erythema, blepharospasm, tearing and blurred vision — most of which resolves within one hour after exposure. When administered in an experimental setting, the effects are fairly benign. Among 47 law-enforcement officers who willingly subjected themselves to pepper spray, 21% experienced punctate epithelial erosions, but none suffered corneal abrasions.2 These results differ from those of a retrospective study of 100 patients who presented to a jail ward emergency area after pepper spray exposure. Seven cases of corneal abrasion were identified among these patients,3 which suggests that corneal abrasion is not a rare outcome when pepper spray is administered outside the confines of a study protocol.
For the most part the antiglobalization protestors who attended the Summit of the Americas in Quebec City in April anticipated the assault of pepper spray, tear gas and what-not and protected themselves. Determined that we not lose sight of occupational health standards and environmental protection issues as the political leaders of the Americas extolled the economic benefits of free trade, the protestors draped their faces with vinegar-soaked kerchiefs and donned swim goggles and sunglasses to keep lines of communication, and their eyes, open. They succeeded in drawing international media attention and in communicating civilian concerns to our political leaders. Yet, in the aftermath of the excitement it appears that any change of vision experienced by either side as a result of the Summit protest has been little more than transitory. Normal vision has been restored, an outcome consistent with the nature and design of agents of crowd control.
Erica Weir References
Copyright 2001 Canadian Medical Association or its licensors |
