DATE POSTED: November 13, 2023.
“The body is given meaning and wholly constituted by discourse. The body vanishes as a biological entity and becomes instead a socially constituted product which is infinitely malleable and highly unstable.”
– Michel Foucault
“Whether an honest performer wishes to convey the truth or whether a dishonest performer wishes to convey a falsehood, both must take care to enliven their performances with appropriate expressions, exclude from their performances expressions that might discredit the impression being fostered, and take care lest the audience impute unintended meanings.”
– Erving Goffman
On September 14, 2023, members of RIM attended the Select Subcommittee on the Coronavirus Pandemic hearing titled, “Oh Doctor Where Art Thou? Pandemic Erosion of the Doctor-Patient Relationship.” Sebastian Sirais watched the recording afterward. This hearing included another four “witnesses,” clinicians from various parts of the United States, whose written testimonies can be found here. It is the third such hearing that Rituals in the Making researchers have attended – see our dispatches on the May 14, 2023 and July 27, 2023 hearings.
Focused on the so-called sacred doctor-patient relationship, this particular hearing showed both literally and figuratively the politics of misinformation and the contestations it fuels. The setting, performance, and discourse displayed how public health policy-related misinformation is debated on the political stage and how elected officials and figures of authority and expertise such as doctors framed the “fight for their patients’ rights” and the issue of government intervention into individual healthcare choices. Both Democrats and Republicans had much to say on the matter, specifically in terms of the government’s involvement in—or intrusion into—in the public’s health.
The following key quotations are pulled directly from the subcommittee hearing. We juxtapose them, Majority (Republican) and Minority (Democratic) members’ statements, one with the other, to illustrate the often diametrically opposed meanings ascribed to the same phrase.
Bodily Autonomy and Practitioner Autonomy
“…the autonomy of physicians has been eroded in recent decades. Government interference in medicine has continually crept in and taken advantage of in times of crisis. Bureaucratic red tape and administrative burden forces physicians to spend less time treating patients… we must ensure that physicians have the autonomy to treat patients without undue interference.”
– Representative Brad Wenstrup (Chairman, R-OH) [min 17:44]
“When government agencies ‘recommend’ things, it oftentimes becomes a de facto mandate, either because of the government agency being a source of funding, or maybe having regulatory oversight that could be detrimental. I jokingly say that when the CDC recommends something, it’s like when Tony Soprano recommends something.”
– Jeffrey Singer, M.D. [min 1:54:48]
“I take this relationship very seriously. My father is a doctor. He raised many of the concerns about having insurance companies interfere with his doctor patient relationships. This is not an unfamiliar topic to me. But having this discussion, while simultaneously advancing an extreme agenda to undercut reproductive health care, and insist that elected officials know better than doctors and patients is really rich. It appears that some of my colleagues support government encroachment on America’s privacy and health as long as it aligns with their goals of dismantling access to reproductive care.”
– Representative Deborah Ross (D-NC) [min 35:24]
“Now to use their own words, this hearing is about a ‘one size fits all protocols promoted by politicians that eliminate the decision-making power of patients and physicians.’ Now we know that abortion bans have deprived women and 22 states have access to abortion, and criminalized doctors seeking to provide the highest quality care to their patients.”
– Representative Robert Garcia, Democratic member (D-CA) [min 1:44:21]
Regardless of the subcommittee hearing’s focus, both Democratic and Representative parties were equally advocating for less government interference on physician practices. It was the site of that interference that differed significantly. The excerpt from Rep. Garcia is from his time questioning the witnesses and his quick exploration of recent government regulations on bodily autonomy and reproductive rights. He dedicated his five minutes to criticizing the hypocrisy of his Republican colleagues in seeking sanctions against the U.S. government for infringing on personal freedoms by mandating vaccines, while they simultaneously enact strict regulations on reproductive rights. Three Democratic representatives during this subcommittee hearing (Representatives Ross (D-NC), Garcia (D-CA), and Tokuda (D-HI)), re-centered their questions away from vaccine mandates, and towards bodily autonomy in the context of reproductive rights. In contrast, the quotation from Chairman Wenstrup is from his opening statement, in which he cites the recent degradation of independent decision-making by physicians when practicing medicine. The sentiment of Wenstrup’s words and the logic of his overall argument could easily be transposed onto criticism of the U.S. government’s approach to abortions commonly made by his Democratic colleagues.
We saw similar clashes of meaning around the characterization of doctor-patient relationships and terms like consensus and censorship:
Sacredness of the Doctor-Patient Relationship
“Ruth Bader Ginsburg wrote in her 2007 dissent in Gonzales vs. Carhart, ‘Legal challenges to unroot, undue restrictions on abortion procedures do not seek to vindicate some generalized notion of privacy. Rather, they center on a woman’s autonomy to determine her life’s course and thus enjoy equal citizenship stature… and when the government controls the decision for her, she’s being treated as less than a fully adult human responsible for her own choices. If my colleagues on the other side of the aisle genuinely believe that vaccine requirements constitute government overreach, then they must acknowledge that across this country are evidence of an even greater overreach and violate the relationship that we have with doctors.”
– Representative Deborah Ross (D-NC) [38:43]
(at the time of this quotation, Rep. Ross was the only woman in the room)
“As a physician, obviously, it’s important that this subcommittee held today’s hearing to better understand the sacred doctor patient relationship, and the effects of the interaction of the government getting involved with that relationship. And I think that we can have a better path forward in the future, if we really listen to what has taken place, and do better going into the future. We as doctors, we know the importance of holding a patient’s hand and patting them on the back to let them know that we’re there. And that we care for them. And when you’re told you have to go get a shot in your arm, regardless of what it is, and no conversation with the physician that you know and trust. And you get it at the pharmacy or you get it from the National Guard… let there be at least the opportunity for a discussion with your physician. We can’t let ideology replace medical science. To me it’s a new twist on government overreach.”
– Representative Brad Wenstrup (Chairman, R-OH) [min 2:27:45]
Consensus and Censorship among Medical Practitioners
“I was censored, and I had a scientific/medical opinion. That turned out to be right, by the way, but that’s inconsequential. The fact is, the government got to tell me what was right and wrong. Government officials who hadn’t seen a patient in decades, or at all, people who didn’t have an MD, who had never seen a person in the ER, who’d never treated a virus in their life, got to censor me. And some people even threatened to take away my license because I disagree with them.”
– Representative Rich McCormick (R-GA) [min 31:03]
“Never before have we had governors threaten the medical licenses of individuals if, through their interactions and their medical knowledge, they were to prescribe a certain type of medication. Or boards of pharmacies to be told that those certificates would be removed. I was, and am still appalled by the multitude of COVID-19 mandates imposed by federal, state and local governments for exactly this reason.”
– Representative Mariannette Miller-Meeks (R-IA) [min 1:27:23]
“Over the course of the pandemic, public health officials worked with limited and constantly evolving and changing information to keep Americans safe, and implemented policies to help our nation overcome the virus. We talk about off-label use of medications: as a physician, that’s something we do. But we also do it with caution. And we do it in respect of science, in search of the evidence to determine whether it’s a sham, or whether it’s a real medication that has proof… With caution, we said, ‘be careful, let’s do more research’. And then as the research developed, then there would be some recommendations, and the medical societies… our colleagues… put certain parameters based on that research to give us a sort of ‘gold standard’ of research that we can abide by.”
– Representative Raul Ruiz (D-CA) [min 1:13:54]
“It is truly hypocritical that my Republican colleagues are convening a hearing on government overreach into the doctor-patient relationship, when their party is literally writing the playbook across the country on how to do exactly that – all while endangering the lives of twenty-five million women across the country by denying them access to abortions, and forcing doctors to break their Hippocratic oath to ‘do no harm’ when the government denies them the ability to provide their patients with the care they need… Extreme Republican lawmakers have been tripping over themselves to pass dangerous bans and restrictions, denying the will of the majority of Americans. According to the American College of Obstetricians and Gynecologists – and it’s over 57,000 members – abortion is an essential component of women’s healthcare.”
– Representative Jill Tokuda (D-HI) [min 1:56:24]
The Republican members of the committee focused on the narrative that doctors were censored for their beliefs and practices – that physicians who recommended alternative treatments to COVID were threatened, mocked, or silenced by government officials. This sentiment was repeated by Rep. McCormick (an ER physician) and by the witnesses present, including Dr. Jerry Williams and Dr. Azadeh Khatibi. On the one hand, the Democrat members refuted these claims, stating that the guidelines put in place by entities such as the CDC and the FDA were meant to promote caution, not conformity. On the other hand, Democrats such as Reps. Ross and Tokuda continued to apply the counter-narrative that claims of government overreach by Republicans were hypocritical given the party’s efforts to restrict abortion rights to women throughout the United States, against the recommendations of thousands of medical practitioners.
As we’ve come to expect from these hearings, disagreements about the terms of debate often manifest themselves in heated exchanges, such as when Rep. Marjorie Taylor Greene (R-GA) repeatedly interrupted Rep. Tokuda (D-HI) during her allotted five minutes of questioning:
“According to the American College of Obstetricians and Gynecologists, and it’s over 57,000 members, abortion is an essential component of women’s healthcare. Abortion is healthcare. When we criminalize … [Rep. Greene attempts to speak over Rep. Tokuda, “[inaudible] unborn babies”] Excuse me, Mr. Chair, I would like some the ability to answer my question like when we criminalize health care undermine a patient’s ability…”
Chairman Wenstrup interjected, “We’ll have order, and I will expect it. Ms. Tokuda has her right to make her comments.” [min 2:27:45] In his closing remarks, he apologized for “some of the things that happened here today,” including that the hearing “got so off topic.” There was little, if any consensus in the hearing about the very terms of the debate – from whose autonomy mattered to what constitutes censorship and the optimal conditions for the doctor-patient relationship.