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  • Department Administrator Interference in the Doctor-Patient Relationship

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    I contacted a resident doctor in Internal Medicine at a teaching hospital and asked if he would be interested in becoming my primary care physician (PCP). My note briefly described my background in health outcomes research and two of my prescription drugs. He wrote back that he would be honored to be my PCP, and came across as professional, humble, and sincere. A new doctor-patient relationship was formed, and I contacted my existing doctor’s office to arrange for my medical records to be transferred, which immediately informed that office that I must be dissatisfied and going to a new doctor. I also shared with the resident doctor confidential information from my medical records and a copy of one of my professional presentations at a health care conference.

    A department administrator then contacted me to say the resident doctors are not available every day of the week for clinic and are not even here when they do their ICU rotation. Also, the Internal Medicine department protocol would not allow the resident doctor to write me a drug prescription for off label use. Finally, she was concerned that in the past I have ordered and correctly interpreted my own blood tests. The administrator’s attitude reflects one of the chief complaints Americans have with the health care system: the system is coming at them and requiring them to get health services in some predefined structure to which the facility is accustomed but which eliminate any potential for individualized treatment according to individual patients’ needs.

    Apparently the administrator did not spend enough “careful consideration” to get her facts straight. I do not need to see my PCP daily or even monthly. My track record shows I saw my existing doctor once in a calendar year, and the prior doctor before him I saw once in a 15-month period. So the administrator based her decision on her own ignorance of the facts.

    She also misstated facts concerning off-label prescriptions for drugs by resident doctors. One of the drugs we are talking about is Clomiphene. Both a resident doctor and an attending faculty physician at the teaching hospital advised me that they would be willing to write me (off-label) prescriptions for this drug, and the attending physician did indeed phone in a prescription for one of the drugs at my request. Similarly, the Dept. of Obstetrics and Gynecology (OB-GYN) advised me that their doctors, both resident and attending, have prescribed Clomiphene to patients. Therefore, residents in Family Medicine and OB-GYN (both primary care departments) can write prescriptions for Clomiphene, but “protocol” prevents residents in Internal Medicine (also primary care) from writing off-label prescriptions. What kind of a cockamamie rule is that? What, the residents in Internal Medicine are too dumb or too naive to understand off-label benefits of medicines?

    Finally, I had planned for my resident PCP to order and interpret blood tests each time I visited him. The administrator could have learned that fact if she had bothered to call or write me before jumping to conclusions and interfering in my doctor-patient relationship. I strongly reject the Director’s paternalistic view of medicine in which she feels she has to protect resident doctors from patients who order or interpret their own blood tests. These resident doctors are young professionals who have completed their medical degrees; they don’t need paternalistic oversight from a department administrator telling them who they can and cannot invite to be patients.

    Apparently, an overwhelming number of patients who visit this teaching hospital’s doctors want to be told what to do and how to feel. I am the exact opposite; I take personal responsibility for and manage my own health, which is strongly advocated under health care reform. Having a more equal, collaborative relationship with my PCP works for me, and that seems to be the true reason for the administrator’s interference. Studies show that medical malpractice rates drop with a non-paternalistic model of health care services. That fact of reducing litigation risks is pushing more health care systems across the country to migrate to a non-paternalistic model.

    LEGAL ANALYSIS

    I. Formation of Doctor-Patient Relationship

    The first question to address is whether, based on this fact pattern, a doctor-patient relationship was formed. When I gave the Internal Medicine resident doctor confidential information on two off-label drugs that I take, that act would be analogous to a prospective client approaching a lawyer with facts about his case to see if the lawyer will assist him. Contacting a lawyer this way does not create an attorney-client relationship. However, the lawyer is under an ethical duty to protect the confidentiality of the information shared by the prospective client. Similarly, the resident doctor was under an ethical duty to keep the information I shared with him confidential.

    When a lawyer responds to a prospective client, “I agree to take your case,” or “I will be your lawyer,” or words to that effect, then an attorney-client relationship is created, and the protection afforded to the client’s information rises to the level of constitutionally protected attorney-client privilege. In this case, when the resident doctor responded that he would be honored to be my PCP, we have offer and acceptance forming a contract. The offer-acceptance could be construed as my offering to be his patient, which he accepted, or his offer to be my PCP, which I accepted.

    But offer and acceptance are only two of the three required elements to form a contract. The third essential element is exchange of consideration, expressed in Latin as the quid pro quo. In this case, there were several separate exchanges of consideration that complete the formation of a contract and thereby render it enforceable in a court of law. Consideration is defined as some act or some transfer of an item from one party to the other, for which the receiving party had no legal right to otherwise obtain that consideration. There is no requirement that the consideration have intrisinc value. For example, the transfer of a scrap piece of paper can constitute valid consideration that renders a contract binding and enforceable.

    The initial disclosure of confidential information from my health history amounts to sufficient consideration. Second, the fact that both I and the doctor each began pursuing scheduling an appointment for me to see him is also consideration: neither of us had a prior legal right entitling us to that action by the other person. Third, when we continued to correspond after offer and acceptance, with additional information being shared back and forth, further consideration was exchanged. My sending the resident doctor a copy of one of my professional presentations was a fourth example of consideration. Finally, my request that my medical records be transferred to the resident doctor’s clinic constituted an obvious legal detriment based on reliance rendering the contract enforceable.

    If a lawsuit were filed for enforcement of this contract, I am confident that the plaintiff would overcome any attempt to dismiss the lawsuit by the teaching hospital’s attorneys based on the absence of a contract. Defendant might attempt to argue that no contract could be formed, because the resident doctor is not licensed. According to the website http://medical-dictionary.thefreedictionary.com/resident+physician, a “resident physician is a graduate and licensed physician receiving training in a specialty, usually in a hospital.” The resident’s licensing status would not prevent the formation of an enforceable contract, as we have in this fact pattern, for treatment in the supervised residents’ clinic.

    In court, we would pose a series of questions: 1) Is the resident a graduate of a medical school? Yes! 2) Was our conversation focused on health care treatment? Yes! 3) Does the resident see other patients (whether supervised or unsupervised) in the resident clinic? Yes! 4) Are the resident’s services billed to the U.S. government and to private insurers as the services of a doctor (not a student or a doctor’s aide)? Yes! 5) Did we both use the term PCP in describing our relationship? Yes. 6) Did the resident undertake to assist me in obtaining a medical appointment to see him? Yes! With these answers, any court of law is going to recognize if it looks like a duck, swims like a duck, and quacks like a duck, then it is a duck. Therefore, the defendant’s argument on licensing will be viewed as a red herring and will fail. In a similar vein, courts have noted “it is axiomatic that a doctor-patient relationship may arise from, briefly exist, and be limited by the unique circumstances presented in a transfer situation.” Sterling v. Johns Hopkins Hosp., 145 Md. App. 161 (Md. Ct. Spec. App. 2002). It does not matter how long the doctor has been seeing patients or how brief the contact with any given patient, a doctor-patient relationship can be formed.

    Selection of a PCP and other medical decisions are “core” private decisions. A fundamental tenet of privacy jurisprudence, as it has been applied to other types of personal matters, is that the individual most directly concerned is entitled to make and implement the protected decision autonomously and free from paternalistic government intrusion. See, e.g., Zablocki v. Redhail, 434 U.S. 374, 54 L. Ed. 2d 618, 98 S. Ct. 673 (1978) (decision to marry); Moore v. East Cleveland, 431 U.S. 494, 52 L. Ed. 2d 531, 97 S. Ct. 1932 (1977) (decision to live with extended family members); Griswold v. Connecticut, 381 U.S. 479, 14 L. Ed. 2d 510, 85 S. Ct. 1678 (1965)(reproductive choice). I would argue that the constitutional right to privacy also protects autonomy in selecting a PCP among a wide choice of available doctors, selecting which medications I want prescribed, and choosing what lab tests I want to order myself to monitor my health.

    In 2005, the Supreme Court of Arkansas provided the best statement in American jurisprudence on the elevated status of the doctor-patient relationship. The court noted the relationship of doctor-patient is unique. “The loss of this relationship, even temporarily, causes irreparable damage to the doctor and the patient. There is no adequate remedy at law because the loss is a loss of a one-time opportunity.” Baptist Health v. Murphy, 362 Ark. 506 (Ark. 2005)

    The court noted that the hospital had violated the Arkansas Department of Health rules and regulations for hospitals by failing to enforce policies that protected the doctor’s selection of patients and the patient’s choice of a physician. “We interpret this to mean that an otherwise qualified doctor must be granted access to his patient for the purpose of treating his patient, if that is what both the doctor and the patient want. Or, stated another way, a hospital cannot deny the services of a physician of the patient’s choice if the patient is already being seen by physicians at the hospital. Baptist Health v. Murphy, 362 Ark. 510-511 (Ark. 2005)

    Based on reading Baptist Health, I will now forward a copy of this article to the state Department of Health to determine whether the teaching hospital violated any of my state’s regulations requiring Tennessee-licensed medical centers to have policies or bylaws that respect the patient’s right to select his own physician. If so, then the teaching hospital is violating those regulations.

    II. Tennessee’s Tortious Interference Statute

    Tenn. Code Ann. § 47-50-109 is captioned, “Procurement of breach of contracts unlawful – Damages.” The administrator tortiously interfered in my doctor-patient relationship and prevented the resident doctor from performing his services under our contract. She therefore procured a breach of that contract. The administrator will argue that she was merely performing her duties, but that is no excuse for interfering in an existing doctor-patient relationship.

    Although Tennessee jurisprudence does not have a case on point, courts across the country have taken a dim view and expressed disapproval of employer interference in the doctor-patient relationship. For example, the U.S. Supreme Court stated, “The ethical objection has been that intervention by employer… makes a tripartite matter of the doctor-patient relation. Since the contract doctor owes his employment and looks for his pay to the employer… rather than to the patient, he serves two masters with conflicting interests.” United States v. Oregon State Medical Soc., 343 U.S. 326, 329 (U.S. 1952).

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    Source by Michael Guth

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  • Relationship Between Brother And Sister

    Relationship Between Brother And Sister

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    Sibling rivalry is the result of competitive relationship or animosity between siblings, blood related or not. It is believed that competition between siblings arises because one of the siblings gets more attention from parents.

    A brother-sister relationship is one of the most beautiful relationships of the world. One finds the best friend, second parent, silly fights, partner in crime and protector in this one relation. In short, siblings are friend and guide to each other. The friendship between siblings is similar to that which exists amongst peers. The possibility of friendship among siblings is great.

    Having a sibling is a bliss. Seriously. They maybe irritating, annoying and what not, but, be sure, if there is a problem, they are the ones who would come first in front of you to protect you. That is how the relationship should be. In a sibling relationship, you have fun and talk but not romantically. There is no sexual attraction but talk and love each other.

    There exist siblings who are friends but there also exist siblings who are separated by rivalry, fight and animosity. Since day one, they are each other’s best friend, greatest arch enemy. There are people who share more affectionate relationships with friends than with their own siblings. The possibility of developing friendship among sibling is great. There are many factors which influence this friendship such as having been born in the same family, having been grown up together, having been educated in the same or similar way. Based on their biological nature, siblings share a mutual affection that comes from years of living together.

    Siblings are simply too precious to waste. They are your longest memory bank, your shared history, the person who may know you better than anyone else. They are so deeply part of your identity that they cannot be erased even when they are not present. Many siblings become estranged and stop seeing one another altogether. That is a pity, indeed. If there is anyone who has grown apart with their siblings, please make efforts to change that situation before it is too late. Yes, it may end in failure – some rifts are too deep to heal. But if you can find a way, you will never regret it. Siblings are too precious to be forgotten because they helped to make you who you are.

    A brother-sister relationship is the most endearing relationship ever in which there is a lot of love, care and fun too. Everyone have nice memories in childhood. There is nothing stronger than the relationship between brother and sister. Brother and sister are childhood friends. Their bonding is very much strong and is never lost.

    A sister is for telling stories and making promises that will never be broken. Being sister and brother means being there for each other in the time of need. For a brother, a sister is his soul mate and the best part of him. A true sister is a friend who listens with her heart.

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    Source by Anil Prabhakar

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  • The Risk/ Reward Approach, To Better Health: 4 Scenarios

    The Risk/ Reward Approach, To Better Health: 4 Scenarios

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    Doesn’t it, make sense, to be more willing to use, more extreme approaches, possibilities, and approaches, if there is a serious, and/ or, life – threatening, treatment, than, when, this doesn’t exist? Several years ago, I remember watching a television advertisement, for a prescription drug, for treating, foot – nail fungus. This product, perhaps, effectively treated its desired ailment, yet, when the contra – indications, etc, were listed, which included causing cancer, liver ailments, etc, I wondered, why, anyone, would use this, for a seemingly, less – than, life – threatening ailment. With that, and similar issues, considered, this article will attempt to, briefly, consider, examine, review, and discuss, 4 possible scenarios, and, whether, they are warranted, using the risk/ reward approach, and mindset.

    1. Chronic ailments: Many of us, suffer, from one, or more, chronic ailments, especially, as we age. Some people learn to live, with the discomfort, and/ or, address it, by using some safe alternative remedy, and/ or approach. Others, either, are so uncomfortable, have such a low pain/ discomfort threshold, etc, they seek more aggressive treatments, and modalities. A chronic ailment, is one, which lingers, on an ongoing basis, either, consistently, or on a sporadic time – frame.

    2. Acute ailments: Acute ailments are those, which come on, rather suddenly, and may, come from known, or unknown causes. Known causes may include injuries, due to falls, strains, etc, while, unknown ones, often, come from something, we may not even recall happening. The smart approach is to, first, recognize, and consider, the reasons, and causes for the discomfort/ ailment/ pains/ aches, etc, and, then, evaluate the possible remedies. It is always wise, to contact, and consult, a trusted, health professional, as soon as possible, in order to ensure, nothing is overlooked! Once, more serious ailments, and/ or, causes, have been ruled out, it is often wise, to consider alternatives, which may be safe, effective approaches.

    3. Life – threatening illnesses: Obviously, if you are diagnosed with a life – threatening disease, such as cancer, etc, it makes sense to consider using a more aggressive treatment, with potential severe side – effects, than it is, for lesser ailments. If, without the treatment, your chances are somewhat poor, your risk is limited, and reward enhanced!

    4. Options/ alternatives: If you don’t pay keen attention to taking care of yourself, no one else will! Examine your true needs, medical causes of your discomfort, and your options and alternatives. The lesser, the danger of the ailment, it is wise, to take fewer risks/ chances, and vice versa!

    Take care of your health needs, by using the risk/ reward approach, and consideration! Doesn’t that make sense?

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    Source by Richard Brody

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  • A Substantive Due Process Challenge to the War on Drugs

    A Substantive Due Process Challenge to the War on Drugs

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    Substantive Due Process Analysis of the Incarceration of Drug Offenders

    A. Framework

    In Washington v. Glucksberg, Chief Justice Rehnquist described the framework for substantive due process analysis:

    Our established method of substantive-due-process analysis has two primary features: First, we have regularly observed that the Due Process Clause specially protects those fundamental rights and liberties which are, objectively, “deeply rooted in this Nation’s history and tradition,” and “implicit in the concept of ordered liberty,” such that “neither liberty nor justice would exist if they were sacrificed.” Second, we have required in substantive-due-process cases a “careful description” of the asserted fundamental liberty interest. Our Nation’s history, legal traditions, and practices thus provide the crucial “guideposts for responsible decisionmaking,” that direct and restrain our exposition of the Due Process Clause. As we stated recently in Flores, the Fourteenth Amendment “forbids the government to infringe . . . ‘fundamental’ liberty interests at all, no matter what process is provided, unless the infringement is narrowly tailored to serve a compelling state interest.”

    Applying this method, one must first examine freedom from incarceration to determine if it is a fundamental right. If so, government policies that require the incarceration of offenders, including drug offenders, must serve compelling interests and be narrowly tailored to achieve them. This article assumes for the sake of argument that drug problems give rise to compelling state interests. It then reviews the interests asserted by the government in its pursuit of its drug war policies and the results of those policies to determine whether the policy of incarcerating drug offenders is narrowly tailored to those asserted interests.

    B. The Fundamental Liberty Interest: Freedom from Incarceration

    Federal and state laws subject drug offenders to incarceration. Incarceration is a tremendous deprivation of liberty that triggers the protections of the Due Process Clause. The Supreme Court has recognized this right on a number of occasions. In DeShaney v. Winnebago County DSS for example, the court held:

    [I]t is the State’s affirmative act of restraining the individual’s freedom to act on his own behalf–through incarceration, institutionalization, or other similar restraint of personal liberty–which is the “deprivation of liberty” triggering the protections of the Due Process Clause . . . .

    Perhaps the earliest explicit recognition by the Supreme Court of freedom from incarceration as a fundamental right under substantive due process came in Allgeyer:

    The ‘liberty’ mentioned in [the fourteenth] amendment means, not only the right of the citizen to be free from the mere physical restraint of his person, as by incarceration, but the term is deemed to embrace the right of the citizen to be free in the enjoyment of all his faculties; to be free to use them in all lawful ways; to live and work where he will; to earn his livelihood by any lawful calling; to pursue any livelihood or avocation; and for that purpose to enter into all contracts which may be proper, necessary, and essential to his carrying out to a successful conclusion the purposes above mentioned.

    An 1891 law review article noted that Blackstone described “freedom from restraint of the person” as “perhaps the most important of all civil rights,” and that Lord Coke felt “the liberty of a man’s person is more precious to him than everything else that is mentioned [in the Magna Charta].” Blackstone states that “the rights of all mankind . . . may be reduced to three principal or primary articles; the right of personal security, the right of personal liberty, and the right of private property.” Indeed, the original Latin in the Magna Charta’s “law of the land” clause uses the term “imprisonetur.”

    No court has invalidated a criminal statute through the application of substantive due process analysis to the fundamental right of freedom from incarceration. At the same time, no court has ruled to the contrary. The Supreme Court avoided the question in Reno v. Flores:

    The “freedom from physical restraint” invoked by respondents is not at issue in this case. Surely not in the sense of shackles, chains, or barred cells, given the Juvenile Care Agreement. Nor even in the sense of a right to come and go at will, since, as we have said elsewhere, “juveniles, unlike adults, are always in some form of custody,” and where the custody of the parent or legal guardian fails, the government may (indeed, we have said must) either exercise custody itself or appoint someone else to do so.

    This analysis would not apply to adult drug offenders. The Fourth Circuit also avoided addressing freedom from incarceration as a fundamental right in Hawkins v. Freeman:

    Hawkins’s rhetorical reference to the right as being “freedom from unjust incarceration,” and that of amicus, American Civil Liberties Union of North Carolina, as the “right to be free from arbitrary incarceration,” are issue-begging generalizations that cannot serve the inquiry. A properly precise description can, however, be found in the facts and legal authorities relied upon by Hawkins in support of his claim. From these, we deduce that the precise right asserted is that of a prisoner to remain free on erroneously granted parole so long as he did not contribute to or know of the error and has for an appreciable time remained on good behavior to the point that his expectations for continued freedom from incarceration have “crystallized.”

    Hawkins is distinguishable because it deals with an inmate whose parole was revoked. In any event, the casual dismissal as an “issue-begging generalization” flies in the face of nearly 800 years of common law tradition and over a century of Supreme Court decisions recognizing freedom from incarceration as a fundamental right. Indeed the language of the Supreme Court’s Ingraham decision supports the application of substantive due process proposed in this paper:

    While the contours of this historic liberty interest in the context of our federal system of government have not been defined precisely, they always have been thought to encompass freedom from bodily restraint and punishment. It is fundamental that the state cannot hold and physically punish an individual except in accordance with due process of law.

    The Court also stressed this fundamental liberty interest in Foucha v. Louisiana, a case involving the confinement of a person found not guilty by reason of insanity:

    Freedom from bodily restraint has always been at the core of the liberty protected by the Due Process Clause from arbitrary governmental action. “It is clear that commitment for any purpose constitutes a significant deprivation of liberty that requires due process protection.” We have always been careful not to “minimize the importance and fundamental nature” of the individual’s right to liberty.

    While the Foucha Court indicated that “a State may imprison convicted criminals for the purposes of deterrence and retribution,” the remark was dicta and did not involve any discussion of substantive limits on the police power. In Meachum v. Fano the Court made a similar remark in the context of a case dealing with prison conditions: “[G]iven a valid conviction, the criminal defendant has been constitutionally deprived of his liberty to the extent that the State may confine him.” Again there was no discussion of substantive limits on the police power. Indeed the previous sentence noted: “The Due Process Clause by its own force forbids the State from convicting any person of crime and depriving him of his liberty without complying fully with the requirements of the Clause.”

    Recently in Zadvydas v. Davis, the Court noted:

    The Fifth Amendment’s Due Process Clause forbids the Government to “depriv[e]” any “person … of … liberty … without due process of law.” Freedom from imprisonment–from government custody, detention, or other forms of physical restraint–lies at the heart of the liberty that Clause protects.

    Freedom from incarceration is not just a fundamental right. It is the one of the most fundamental of rights.

    C. Identifying the State’s Interests

    Governmental drug policy interests identified in federal statutes include “demand reduction,” “supply reduction,” and “reducing drug abuse and the consequences of drug abuse in the United States, by limiting the availability of and reducing the demand for illegal drugs.”

    Federal law sets specific goals for the National Drug Control Strategy. These include:

    “Reduction of unlawful drug use to 3 percent of the population”;

    “Reduction of adolescent unlawful drug use to 3 percent of the adolescent population”;

    “Reduction of the availability of cocaine, heroin, marijuana, and methamphetamine”;

    “Reduction of the respective nationwide average street purity levels for cocaine, heroin, marijuana, and methamphetamine”; and

    “Reduction of drug-related crime.”

    Goals are also set forth with regard to drug-related crime:

    (i) reduction of State and Federal unlawful drug trafficking and distribution; (ii) reduction of State and Federal crimes committed by persons under the influence of unlawful drugs; (iii) reduction of State and Federal crimes committed for the purpose of obtaining unlawful drugs or obtaining property that is intended to be used for the purchase of unlawful drugs; and (iv) reduction of drug-related emergency room incidents . . . .

    D. Defining “Narrow Tailoring” in the Context of Substantive Due Process

    Assuming that the governmental interests are compelling, we must determine whether the incarceration of drug offenders is narrowly tailored to achieving them. The government must show that its policy passes strict scrutiny. The concept of narrow tailoring is not well defined in the context of substantive due process, but has been fairly well defined in regard to the First Amendment and Equal Protection. Equal Protection cases also arise out of the Fourteenth Amendment. In Wygant v. Jackson Bd. of Education the Supreme Court held: “Under strict scrutiny the means chosen to accomplish the State’s asserted purpose must be specifically and narrowly framed to accomplish that purpose.” In a footnote, the Court described narrow tailoring in even further detail:

    The term “narrowly tailored,” so frequently used in our cases, has acquired a secondary meaning. More specifically, as commentators have indicated, the term may be used to require consideration of whether lawful alternative and less restrictive means could have been used. Or, as Professor Ely has noted, the classification at issue must “fit” with greater precision than any alternative means. “[Courts] should give particularly intense scrutiny to whether a nonracial approach or a more narrowly-tailored racial classification could promote the substantial interest about as well and at tolerable administrative expense.”

    It is important to note here that a policy that does not advance the government’s interests violates substantive due process regardless of how it compares with the alternatives. If it does not accomplish its purpose, logic dictates it cannot be specifically and narrowly framed to accomplish its purpose.

    E. Advancing Governmental Interests

    Congress has identified certain tools for assessing the national drug control strategy. The National Household Survey is the measure for “unlawful drug use.” Similarly, “adolescent unlawful drug use” is to be measured “by the Monitoring the Future Survey of the University of Michigan or the National PRIDE Survey conducted by the National Parents’ Resource Institute for Drug Education.” On these measures, the goals are not being reached.

    The measure of adolescent drug use that was specifically identified by Congress, illicit drug use in the past 30 days, worsened in 2001. More than 25% of US twelfth graders reported using illicit drugs in the past 30 days. That is nearly double the figure for 1992 and more than eight times the stated goal of 3%. Over 40% of 12th graders tried an illicit drug in the past year.

    The PRIDE Survey and National Household Survey show similar results.

    The drug war has also failed in its other goals. The Monitoring the Future Survey tracks how twelfth graders perceive the availability of drugs. Reducing availability is an explicit goal of the drug war. The perceived availability of marijuana in 2001 was slightly higher than in 1975. The figures for harder drugs are more disturbing. From 1975 to 1986, roughly 20% of twelfth graders said heroin was easy to get. That number shot up in the late 1980s and has remained consistently higher than 30%. Cocaine remains widely available to our youth, with nearly 50% of twelfth graders saying it is easy to get. The survey began measuring the availability of ecstasy in 1989, when only 22% of twelfth graders felt it was easy to get. In 2001, that number went over 61%, having jumped from 51% the year before.

    Drug war policies are not achieving the stated drug war goals. They cannot be “specifically and narrowly framed to accomplish their purpose” because they are not accomplishing their purpose. Drug use has not been reduced in any significant way, and levels of drug use are far above the stated goals. Our children have easy access to drugs. We can’t even keep drugs out of jails. The drug war and the incarceration of drug offenders have also failed to achieve secondary goals regarding supply, demand, purity, drug-related health problems and drug-related crime. The policy of incarcerating drug offenders does not “directly advance[] the governmental interest asserted.” The War on Drugs is not working.

    F. Alternative Means

    Even if a court is persuaded that incarceration advances the government’s interests, the government must also show that its policy choice fits better than the alternatives. Critics of the drug war encompass a broad spectrum of backgrounds, and the range of “solutions” is just as wide. Libertarians and others favor outright legalization of drugs. The legalization of marijuana is a somewhat popular variation of overall legalization, and there are other variations such as the legalization of marijuana for medical purposes and decriminalization of drugs or marijuana. Another leading approach, known as harm reduction, looks at drugs from a public health perspective.

    The effectiveness of some of these alternatives is difficult to assess. Even so, certain comparisons can be made. Advocates of treatment point to studies showing that treatment is much more effective than incarceration. Spencer notes:

    The recidivism rate for first time Dade County drug offenders was sixty percent, but for those who successfully completed the Dade County Drug Court treatment programs, the recidivism rate reported by Dade County officials was only seven percent. Drug court treatment programs are also cost effective. It costs Florida only $2,000 to put a drug offender through a drug court program, as compared to $17,000 per drug offender for incarceration. As a result, other drug court programs are being established throughout the country.

    Similarly, a Rand study found treatment to be seven times more cost-effective than current supply-control policy in reducing cocaine consumption.

    G. The Incarceration of Drug Offenders is Not Narrowly Tailored

    Incarceration involves a far greater infringement of fundamental rights than alternatives which are both more effective and less intrusive. The incarceration of offenders is not advancing the state’s asserted interests. The drug war is not narrowly tailored, failing the Supreme Court’s “established method of substantive-due-process analysis” as described by Chief Justice Rehnquist. The laws requiring the incarceration of drug offenders are therefore unconstitutional, if substantive due process analysis is applied.

    IV. CONCLUSION

    It is true that the approach suggested in this paper would limit the police power. Constitutional protection of individual rights exists for that very purpose. We face coercive government action, carried out in a corrupt and racist manner, with military and paramilitary assaults on our homes, leading to mass incarceration and innocent deaths. We can never forget the tyranny of a government unrestrained by an independent judiciary. Our courts must end the War on Drugs.

    For the full article, with endnotes, see: http://www.redlichlaw.com/crim/substantive-due-process-drug-war.pdf

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    Source by Warren Redlich

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  • How To Make Your Rebellious Wife a Submissive Wife

    How To Make Your Rebellious Wife a Submissive Wife

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    All too frequently in the regular or secular world exist the battle and the discussion about women who ought to submit to men. Do an Internet search on “rebellious wives” or “rebellious women” and you will find this is no small concern, nor is there a shortage of opinions. There are Rebellious Magazine For Women, Rebellious Thoughts of A Woman, videos of men chastising women to submit, etc. Christians carry a greater volume of the discussion since in books of the Bible like Ephesians, Colossians, and 1 Peter clearly says that “…submit yourselves to your own husbands” (NIV).

    Even government and political issues have no protection from this culturally unsettling thought as presidential candidate Michele Bachman was asked if she is a “submissive wife” in an Iowa GOP debate.

    Well, while we are in the mood of celebrating “Fathers Day” I want to bring an answer and the solution to men and likely fathers who are being shredded emotionally by this psychological think-tank we have created around this issue. Regardless of my position as an author, speaker, and more for family legacy issues, I deliver this more from a man and father who has a willingly submissive wife. Yet my wife is a mother, career woman, independently strong, and opinionated. However there is no conflict in her submission. Why, you ask?

    The way to make rebellious wife a submissive wife is to:

    1) Be a considerate husband – Have knowledgeable and intelligent understanding of your wife. Be a student of your wife at all levels of intimacy and not just pertaining to sexuality. Give her honor which is more from your ready preparation to endure the price of deep suffering for her. This is the same price that is meant by the readiness to die protecting your wife and children.

    2) Acknowledge her as the weaker vessel – Remember that a vessel is very rarely ever interpreted as something abstract; rather there is always tangibility to the context of its use. As such the expression of weaker is clearly addressing a physical aspect of the woman or your wife, and not mental (intelligence), psychological, or emotional. Our society has abused this expression greatly.

    3) Realize your equality with your wife – This speaks of yours and your wife’s level of importance. Between the two of you there is none favored; you are absolutely equals in the essence of your relationship. So does the Bible contradict itself by repeatedly stating “wives must submit”? No, the Bible’s call is strictly based on the roles we must play as a husband and wife.

    4) Intercede on her behalf in purity – Your purity of heart, actions, and thoughts carry a great importance and is the determinant your consistency or inconsistency in attitude towards her. More importantly your purity is critical to your prayers for her and your children before God.

    If you can authentically demonstrate, personify, and exemplify these four components within the nature of your relationship to your wife, I promise you a rebellious wife will fast become a submissive wife to and for you. The truth is your wife is design to be incapable of not submitting. In honesty, she does not have a problem submitting to a man. She simply has a problem submitting to you as a man. Sadly, you are the only one she is truly designed/created to submit to. The great news…it can be fixed.

    By the way, here is the source of my wisdom:

    1 Peter 3:7 (AMP)

    In the same way you married men should live considerately with [your wives], with an[c]intelligent recognition [of the marriage relation], honoring the woman as [physically] the weaker, but [realizing that you] are joint heirs of the grace (God’s unmerited favor) of life, in order that your prayers may not be hindered and cut off. [Otherwise you cannot pray effectively.]

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    Source by Ezechiel Bambolo, Jr

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  • New Book Removes Fear From Sales With Practical, Easy-To-Implement Techniques

    New Book Removes Fear From Sales With Practical, Easy-To-Implement Techniques

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    As a small business owner, I found Greg Andersen's Small Business Sales, WTF (Without the Fear) full of practical advice, new ideas, and down-to-earth common sense to help me rethink my sales approaches. Andersen has been in sales for many years in the printing business, but the advice he offers is applicable to anyone in sales, especially small business owners who may be wearing all the hats themselves or unable to focus on sales because they're too busy looking after everything else.

    Small Business Sales, WTF is divided into two sections: Pre-Sales Planning, in which Andersen discusses products, going to market with products, creating a sales environment, and then The Sales Process, in which he explores how to find customers, make contact , get the opportunity to sell to the customer, execute the sale, and then follow up with and retain the customer long-term. Andersen walks readers through each step of the sales process, providing practical and personal examples of what has worked for him that readers can easily model or put their own spins on.

    Andersen writes in a humorous but tell-it-like-it-is style to dismiss myths about the sales process and cut through sales jargon to get to what the reader really needs to know. For example, early in the book, he has a list of "Words / Phrases you will not hear in my book." Among the phrases included is "Belly-to-Belly" to which he responds, "Gross. How about face-to-face." Another phrase is "Low Hanging Fruit," which he says does not really exist, and still another is "Hook," which he finds insulting because it assumes customers are suckers or fish. Instead, Andersen prefers to treat his customers like human beings and rather than "close the sale" come to an "agreement" between two parties who trust and respect each other.

    For most people, sales can have a bad name. No one likes being sold to, and people who reluctantly take on a sales role are aware of that and often fearful of selling. Andersen teaches readers how to remove the fear of sales by rethinking what sales really is. Most people dread the "cold call," so Andersen talks about instead viewing sales as "demand generation." It's about looking for where there is a demand for your services and then providing the product or service to fulfill that demand. It's also about listening to customers.

    Andersen states: "When all is said and done, only a few methods of outreach will really get you in contact with a prospective new customer-the phone, letter writing, a trade show, and email. What really counts is the technique you employ . " He then provides creative examples of how to handle sales through each of these approaches, as well as discussing social media as a sales strategy. His examples are drawn from personal experiences, from his days as a shoe salesman at Nordstrom to his current sales role in the printing industry. Best of all, he even includes copies of letters he has sent to clients. His techniques are simple and straightforward, so anyone, no matter how scared of sales, can implement them.

    Of course, there will be difficult clients or people who don't want to hear how you can help them. Andersen provides strategies for getting past the gatekeepers to the decision makers. He reveals his research techniques, which are quite clever and even include looking at prospective customers' job postings to determine who in a company is or will be in a buyer position for his product.

    When facing resistance from a potential client, Andersen realizes it's not always about him, his approach, or his product. I loved the following invaluable point he made: "Another way I like to approach these challenging situations is to remind myself that all these excuses mean the customer is probably protecting his current vendor. If he is being loyal to his current vendor, some day he will be loyal to me. Stay positive. " Personally, I know this is true as a business owner. If I have a vendor providing me with a good service at a good price, I feel loyal to that vendor and am not willing to change. Such clients may be resistant to change, but they are the ones you want because they are loyal. Andersen shows how persistence pays off in these situations. Sometimes he makes contact with customers who are not in need of his services right then, but years later, he secures business with them, and even if at first he doesn't get the level of business he wants, they often will give him some business as a trial and then he can work his way in to larger sales with them.

    Perhaps what I liked most about Andersen's approaches is that he truly believes in being responsive to clients. I cannot stress enough how frustrated I feel when I send an email to someone who does not reply to me for several days. I am personally always very responsive to my clients and usually reply within hours if not minutes. Andersen points out that even if you don't have an answer to a client's problem or you can't take the time to respond to a question at that moment, a simple response like, "I'm on it," lets clients know you will get back to them and then they can quit worrying about their problem and go on to the next item on their to-do list until you do get back to them. In other words, Andersen is always in favor of reassuring the client that you will do what you say and provide reliable and quality service.

    Altogether, Small Business Sales, WTF does take a lot of the fear and stress out of sales. I believe most readers will be pleasantly surprised by this book; they'll read Andersen's stories and examples and say to themselves, "I can do that," and even find ideas of their own popping into their heads as they build off of Andersen's advice. Whether you are a small business owner with absolutely no sales experience, are just starting out in sales, or have been in sales for years, there are plenty of nuggets of advice here that can make your sales process easier, more lucrative, and all around more enjoyable.

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    Source by Tyler Tichelaar

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