I’m Richard Heffner, your host on The Open Mind … and it was twenty years ago that today’s guest and I recorded our first program together.

Everette Dennis was then the Executive Director of the Freedom Forum Media Study Center at Columbia University. An erstwhile newspaper reporter with a doctorate in mass communication, constitutional law and history from the University of Minnesota, he has also been Dean of the School of Journalism and Communication at the University of Oregon, Director of Graduate Studies in Journalism and Mass Communication back at the University of Minnesota, and, most recently, Chairperson of Communication and Media Management at Fordham University.

Now Ev Dennis is Dean and CEO of NU-Q … Northwestern University in Qatar in the Middle East … and I would first ask my old friend how goes it there, though perhaps the introduction to his newest report on this unique institution sums up his answer best of all. Let me read from it:

“Learning and the advancement of knowledge are at the heart of our mission,” he writes, “but so too is promoting the value of freedom of expression in our objectives and operational programs.

“We take that charge seriously,” my guest writes, “and use it as we educate the next generation of global, media and entertainment professionals—students and faculty work with a guarantee of academic freedom; students write, film and publish freely, and classrooms are alive with debate.

“No society and no school is perfect, and building a tradition of freedom of expression in an emerging region where it has not been part of the culture is an incremental process.”

And my guest concludes “We’re optimistic about that process and pleased to be a part of it.” Ev, that’s a very nice statement and I wonder, going back to my first question as I was going to put it, how goes it?

DENNIS: It goes very well. First Qatar is an amazing little country that is transforming itself from a traditional to a modern society. And there’s a lot of conflict in that process, getting there.

And our university is part of a consortium of other universities; there are six American universities sitting there with other universities from France and England, so we’re in an academic enclave in this amazing country of great change. And it’s, it’s an exciting place to be.

Nothing’s ever boring there, five steps forward and two steps back. It’s an incremental process of promoting learning, of the advancement there, building a journalism and communication program in a place where it has not been common … and yet connected so much to a global economy and the desire of that country to be a player in the media world.

HEFFNER: Why is Northwestern there?

DENNIS: Well, first because we were invited.

HEFFNER: Good reason.

DENNIS: Northwestern was invited about 2007/2008 at a time when the University was increasing its global presence and interested in the rest of the world. There was a lot of interest in the Middle East as a part of the world that they had not attended to very much before.

And the invitation came to create a journalism and media school there, and those are among the great strengths of Northwestern University … its Medill School of Journalism and its School of Communication and some liberal arts work, as well.

And so they looked at it and evaluated the situation and decided to go. And so it’s been an extremely exciting venture and step-by-step creating both instructional programs, building research that makes sense, doing the kind of outreach that leads to change in the community.

Now, it’s a remarkable enterprise.

HEFFNER: What do you mean by “change in the community”?

DENNIS: Well, change in the community is that first there have been somewhat repressive press laws. It is a country; it’s a monarchy with certain traditions. And there are a lot of, a lot of traditions that change very slowly.

So, if one’s going to be part of a knowledge-based economy, which is Qatar’s great goal. One has to be a player, and to be able to do that you need some independent media; you need transparency at institutions.

There are a lot of things that have not been part of the scene there. And we’re part of helping make that happen.

HEFFNER: Well, I told you I couldn’t avoid reading in this morning’s New York Times …

DENNIS: Yes.

HEFFNER: … we’re taping this program in December, 2013 …

DENNIS: Yes.

HEFFNER: … but who knows what the future will bring. The title of this front-page article by Tamar Lewin is “US Colleges Finding Ideals Tested Abroad.” And she talks about … this is about Wellesley College faculty reacting very strongly in terms of having made an agreement, as Northwestern has …

DENNIS: MmmHmm.

HEFFNER: … finding that their school in another country … China …

DENNIS: Yes.

HEFFNER: … in this instance, is not able to practice the freedom … the academic freedom that we’re accustomed to in this country. What happens then?

DENNIS: Well, each case, I think, is different, and each university going to various other places in the world has to determine what the bottom line is.

For Northwestern it was that the academic freedom guaranteed in the University in Evanston, Illinois, must also exist on the campus in Education City, where we are in Doha,Qatar.

And that’s true. We have full academic freedom for people to teach, to explore ideas, for our students to write and work and do many, many things.

There isn’t the same freedom outside of the campus enclave. The, larger community itself has some difficulties … there has not been a tradition of freedom of expression. And so one works with that, incrementally.

But I think having basic academic freedom is very important. At the same time, one can’t expect a developing nation to have all the same values at the same level that they might exist in the United States or Western Europe.

And you look in the United States, how I read the other day that Yale was founded in the 1700s and it took until 1930 to have academic freedom. Well, the Mideast universities elsewhere are on a different trajectory.

I think the question is one of “are you willing to go into a place and be an agent of change and not expect everything to be at a perfection level on the first day.” And it seems to me that it’s an isolationist attitude to say that unless everything is done to your satisfaction and liking, that you agree with all the policies of a government wherever it is, is really foolhardy and you wouldn’t communicate or be a global citizen anywhere … we wouldn’t go to China, we wouldn’t go to Russia in the old days, or even today …

I read only this morning in The New York Times that a person could be arrested in the beautiful city of Monte Carlo for criticizing the prince. And so, there’s imperfection everywhere and we’re trying to be a part of the change, and so far, so good.

HEFFNER: Let me ask you whether on the Northwestern campus …

DENNIS: Yes.

HEFFNER: … here in this country …

DENNIS: … MmmYmm …

HEFFNER: … whether there is opposition to the presence of the university in Qatar?

DENNIS: Not any formal opposition. I think I should mention that Northwestern’s strategic plan has to do with engaging the world, and this is a part of engaging the world. It is Northwestern’s only overseas campus. And so it’s very much a test case for the future.

There has been opposition at times to policies in Qatar, or particular international incidents, one involving a poet a year ago, when a poet was arrested and charged and eventually sentenced to life in prison and then later … the sentence later reduced to fifteen years and still very much in play.

From time to time, there is criticism. And you hear it and we respond. It seems that every time there’s an international incident in the region or the area, I hear about it. And we simply can’t be expected to be either the apologist for the government or the fixers for everything that goes on.

We often raise our voices and we do this sometimes quietly, sometimes in more effective ways, but you know, so far it’s been a very good journey for Northwestern and I think … the main thing for us is that we live by the core values of the University itself and we promote them in that particular region. And it’s been a very healthy thing.

Not just for our Journalism and Communications area and some liberal arts, but also through various other projects that Northwestern is bringing into the area … grants in the sciences, projects having to do with traffic safety and some others. So it’s a very active place. And happily, our President Morton Schapiro says now Northwestern University has three campuses … Evanston, Chicago and Doha. And we’re very proud to be part of that, to be a part of the university, it’s 12th school, but very much its overseas representative.

HEFFNER: Why are there so many other American educational institutions in this one particular, tiny spot?

DENNIS: Well, there is a vision of the country itself … to move from a … carbon-based economy to a knowledge-based economy. And so the leadership of the country, represented by the former Emir, who abdicated last summer, and his Consort Sheikha Moza bint Nasser, to create an educational enclave … second to none in the world.

And it is an amazing place to see … massive buildings on a campus that started out as 2,500 acres and has spread out … by world-class architects … and an effort to speak to the national vision of Qatar, which has to do, as I said, with a knowledge-based economy. So Cornell went there to develop a medical school. Carnegie Mellon has business and computer science there … Georgetown is there with political science, foreign service and liberal arts, and Texas A&M in engineering and other schools.

Now most recently University College, London, has come, HEC Paris and others, and the Qatar Foundation, which is the sponsor for all this activity, is creating four or five new graduate schools that will be doctoral and Ph.D. programs.

So it will be an educational gathering place and a great collaboration between a foundation with, I think, a great deal of vision and universities that want to be a part of this.

And so, they are there and I think doing it for all the right reasons I think: to develop programs in that area … I think to be part of a changing society. And I think those are the main reasons. I really believe they are primarily idealistic and have to do with the noble cause of education rather than, say, money or soft power or other strategic issues. And, of course, Qatar is a great ally of the United States.

HEFFNER: Well, let’s, let’s talk for a moment about money and soft power …

DENNIS: Yes …sure.

HEFFNER: There are many people who say that money is at the basis of this …

DENNIS: Yes.

HEFFNER: … universal university interest in extending itself.

DENNIS: Right. Well, as you, as you recall … our colleague and friend, Fred Friendly, used to say, if it’s not about the money, it’s about the money.

And so I always am careful to say it’s not about the money, because these things cost money to … these institutions are extremely expensive. Not only their physical plants but also, funding faculty, research, housing … all these kinds of things.

The Qatar Foundation, in the case of Education City, is paying the bill for everything. So, unlike some schools, which are actually investing in international operations, there is no direct cost to … in terms of a financial burden on the home university and relatively modest management fees. So it’s … I say it’s not about the money in that … nobody’s doing this to make a big profit. In fact the management fees are less than probably any overhead on a major Federal grant.

So, it’s … I mean I think it’s a very workable operation. It’s a win-win for everybody involved. And the risk, of course, is a risk of reputation. And that, of course, is at the heart of some of the debate you referred to about international campuses themselves.

HEFFNER: There have been those also who have said, you … Ev Dennis …

HEFFNER: … without mentioning you by name …

DENNIS: … Yup … sure.

HEFFNER: … but your colleagues and you are, in a sense the American centurions …

HEFFNER: … the symbols of and the spreaders of American power. How do you respond to that, because on some level it is absolutely true.

DENNIS: On some level it is, and the difference of course is that we are not an army of occupation, we were invited there … you know, to go there … all the institutions were invited there.

It [Northwestern] went through quite a process to decide whether they wanted to go. It wasn’t an instant decision … “let’s go.”

The other part of it is that what we’re doing is not simply implanting American values, but developing a program that’s respectful of local traditions and culture.

Something that’s going to work in that environment. You could not go to many of these countries and do exactly what you do in the United States. You can deliver the same program substantively, but you have to be respectful of the Islamic faith. I think some of the issues in the community … aspects of local culture. I mean many, many things are different … modesty of people … some big issues, some very small. But I think learning about a new culture … a long and old tradition that actually had… intellectual roots back in the eighth century and, and bringing that into play in the modern era is exciting and fun and I think it has value.

And of course, does this benefit the United States … I suppose so. But many people once you get established there don’t think of you so much as an American institution … you have American names, much of our faculty come from the United States … some stay, some come and go … but I think people think of it very much as a part of the community.

And I was in a majlis, which is a gathering place of a prominent member of the Qatari community, just a couple of weeks ago, and he asked me some questions about local politics, and I said, well I beg to differ on that … or I really don’t want to deal so much in your local domestic policy … I said, “After all, we’re a guest in your house.” And he said, “No, you’re a partner.” And I thought that was a great thing that they see us as an … institution and an instrument by which their own people can be educated. In a very interesting way, in that 40 percent of our students are Qatari students from the immediate community. The rest … we have 50 passports or so and they come from the rest of the world.

When you talk to some of the leadership … it’s very important for us that we get the best students in the world to come here. We want our students to be tested against that kind of standard and we try to maintain standards as close as we can to the main campus in Evanston and we’re, and we’re doing well in that regard … getting students of quality on every measure you would imagine and putting them to the same tests they would be put to in the US.

HEFFNER: Ev, what are the difficulties?

DENNIS: Well the difficulties are, I think … first just adapting to a very different culture. Weather is a problem in Qatar, of course since …

HEFFNER: No … I’m sorry … the weather I would assume …

DENNIS: … very hot there. I think when you’re dealing with something as volatile and changing as disruptive media technologies in a country that’s wanting to be a media player … there is a tug-of-war there … at times when, we don’t get access … our students want access to certain government agencies … they want things to be more transparent. There can be dust-ups with security and police … nothing of great consequence, but it does happen. You have to work that through.

HEFFNER: Are you talking about Washington, DC?

DENNIS: Sounds like it, doesn’t it?

HEFFNER: Yes.

DENNIS: But the government has not closed yet in Qatar … it’s open for business. So, that’s the one difference … but I think that many of the criticisms of international campuses are true in many places in the world including some parts of the United States if you don’t agree with the policies of every one of the 50 states and things that happen there.

But, you know, I wouldn’t say you shouldn’t send your children to Texas because some of the policies there are also tough. So, these are things that are a part of change and kind of understanding and adapting.

HEFFNER: The American students. How are they …

DENNIS: Yes.

HEFFNER: … doing there?

DENNIS: Well, we have relatively few now, we’re getting more next fall. But they’re coming in greater numbers and they’re very interested. Some of them come because they have Middle Eastern heritage and they want to re-touch that heritage and understand it and take advantage of our Middle Eastern studies courses and our Middle Eastern media courses.

But they’re doing extremely well and, and they come with a very different context and one of the great debates between our students is that some of the Qatari and the Middle Eastern students will somehow believe that there is an absolute freedom of expression in the United States and you can do anything you want.

And the American students will tend to say, “Well, not quite. You know some things are the same everywhere in the world.” And I think that’s a … the students are doing well. They’re getting out into the community, they’re learning the Arabic language in a number of cases where that’s something they want to do.

And they’re producing wonderful documentaries, they’ve written plays, they produce articles, they have a web-based daily newspaper, The Daily Q, and it’s really quite exciting and a wonderful link back to our home campus as well, where students and faculty are coming in greater numbers to join us.

HEFFNER: I would think that one great question does come up and that is the relationship that we identify so much with the Mid-East and that is of the role of Israel …

DENNIS: Yes.

HEFFNER: … in that area. How does that impact, play a part in what you’re doing.

DENNIS: Well, it does. And, and you can’t not deal with Israel, much of the Middle East pretends that Israel doesn’t exist … that’s really not true in our classrooms in Qatar.

Again, we have conversations all the time with the students here about a two state solution and that sort of thing. That would not have been very common in that country in the past.

Qatar, unlike some of the other countries, has had some tentative relations with Israel. There have been trade delegations in the past … Israeli scholars and business leaders and others, come to Qatar for international conferences. They’ve been hired by the government for some projects, I understand. So there’s some movement back and forth. But it’s somewhat tentative, but it’s not the closed door that exists elsewhere, and typically having an Israeli passport is not a problem there.

But, of course, there are not diplomatic relations formally. One would hope that would happen at some point. But there are Jewish faculty … not from Israel at the moment … but … and students and others and so … I think we’re very open on these issues.

HEFFNER: How comfortable are the Jewish faculty and students?

DENNIS: Well, I think quite. A number have come and gone at different times and have not found that to be much of an issue. People are quite willing to talk about these matters.

We had a young Israeli professor who’s just been hired at our Evanston campus come and visit a couple of weeks ago … and he was around for a while, and I think we’ll see more of that. So … that’s also I think a very healthy development.

HEFFNER: How much … and we just have a couple of minutes left … how much of this is going on around the world in areas as the one in which you now …

DENNIS: MmmHmm.

HEFFNER: … work. In which there are such different values from our own. What’s happening to the American university system. I see …

HEFFNER: … and you mention some of the …

HEFFNER: … campuses …

DENNIS: Yup.

HEFFNER: … but I have the feeling that we’re expanding, expanding, expanding.

DENNIS: Well, I think we are. We’re, not the only country that’s developing campuses … some European universities are doing this in the Middle East and in China … India and elsewhere.

I think there’s going to be more and more of that … I think one of the great assets of the United States is its system of higher education. One of the things we have both to bring international students and to export abroad … and I think that’s one of our great assets and we ought to develop that more. But as you know, schools like NYU and Yale and many others have various enterprises out in the world and they’re not doing this because they have to … these are universities of great substance and, and stature and resources … they’re doing it for reasons other than the mighty buck.

HEFFNER: John Sexton, President of NYU, has been here quite frequently talking about what I might call the “world university.”

DENNIS: Yes.

HEFFNER: Is that your vision, too?

DENNIS: It is. I think at least everybody is going to subscribe to some kind of global understanding. And for our students, we want them to really plug into a global society … to understand the great issues. What works in one culture, does not work in another.

And we … a year and a half ago, sponsored a Good Offices Conferences with the Libyan government … the interim government of Libya … to help the Libyans to develop a Magna Carta for media … and whether it will be implemented or not, who knows.

But that was a chance to really reach out and look at something that may be 20 years down the road, and part of that was because the Libyans recognized that to be a player in the world today, you’ve got to have some kind of open independent media system and some transparency. And they’re not there, but I, I think these kinds of things are helpful and it’s one of the contributions we can make to world understanding and make sure that our students can work almost anywhere in the world. They understand that it’s a fluid place and that borders are now porous and moving, and living in different places is going to be part of the future.

And that speaks to a global university whether it’s in a physical place or it exists digitally somewhere in cyberspace.

HEFFNER: Let me ask whether there is any connection visible …

HEFFNER: … or however tenuous between what it is you’re doing and what it is the others are doing. And our government policy.

DENNIS: I think … government policy plays very, very little role. We have, really, little or no connection with the government directly. We see the American Ambassador once in a while at social events … that’s about it.

I don’t think there’s official policy anywhere that even encourages this or makes it particularly attractive for a university. I think it’s really being done by other governments, by foundations. Now it plays into US government policy in that it tends to happen in places where there are at least diplomatic relations with the government and some sense of that government wanting to have American institutions there … so I suppose in that sense it’s contiguous. But not always, and people will say to me … how can you be in a country where they’re at odds with the US government policy on this or that.

And, you know, I say to them … “Well, it’s an independent sovereign state … a little one … but it has its own mind about what it wants to do in the world … and it does seem to have very good diplomatic relations with the United States and two large military bases there. So, it doesn’t seem to be a problem for our government and yet, we hear and our students certainly are not necessarily out beating the drum for American foreign policy and don’t always approve of it. There’s, a lot of conflict and discussion about these issues.

HEFFNER: Certainly those who are not favorably disposed toward us … see this as part of the American imperium.

DENNIS: Oh, they do, indeed … yes … and the university … whether it’s in Qatar or in UAE or China, there are certainly forces in all of these countries that oppose these institutions being there at all and are highly critical. So that’s part of what you also play with. There’s criticism coming from the West about whether we ought to be there or not, there’s criticism internally about whether we ought to be there.

It turns out that at the moment in Qatar the critics are there, but they’re relatively … this is about a small faction compared to the belief that institutions—not just ours, but the others there from the US and from other countries—are playing a role that’s going to help develop that economy. And so they see it as having a very great self-interest … whether it’s in hospitals or sport and other kinds of things. And sport has played a great role, with Qatar getting the World Cup in 2022 … that’s a great driver … not only for business development and for higher education, but also for freedom of expression and media.

HEFFNER: Ev Dennis … you’re report if quite fascinating … I certainly wish you luck and I’ll be interested to know a year from now whether you feel progress has been made as you predict in “The Way Forward,” your report. Thank you for joining me today.

DENNIS: Thank you very much, it’s always great to be with you.

HEFFNER: And thanks to you in the audience, I hope you’ll join us again next time. Meanwhile, as another old friend used to say, “Good night and good luck.”

And do visit the Open Mind Website at thirteen.org/openmind to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.

The post NU-Q: Northwestern University in Qatar appeared first on Richard Heffner's Open Mind Archive.

GUEST: Daniel Jonah Goldhagen
AIR DATE: 03/29/14
VTR: 12/12/13

I’m Richard Heffner, your host on The Open Mind.

And my guest – who joined me at this table several times towards the end of the last century to discuss his brilliant study of Germans, Jews and the Holocaust titled Hitler’s Willing Executioners is political scientist, historian Daniel Jonah Goldhagen, who now has written Little Brown’s vastly disturbing The Devil That Never Dies – The Rise and Threat of Global Anti-Semitism.

My guest begins his new book: “This devil [Anti-Semitism] changes form, but it never dies.” Then, in a chilling chapter titled “Today’s Demonology”, he writes that “Global Anti-Semitism is new and distinctive.” And I would ask Daniel Jonah Goldhagen both how it is so, and how it has become so.

GOLDHAGEN: First of all, it’s a pleasure to be back with you after all this time …

HEFFNER: To have you.

GOLDHAGEN: It’s nice to see you … although unfortunately we have another unhappy topic to discuss, which is global Anti-Semitism.

HEFFNER: It’s really the same topic … isn’t it.

GOLDHAGEN: Well, it’s the same topic, but it’s new … it is not the same as before. And for, in several ways … for one thing anti-Semitism has really gone … has really gone global. Before it was confined to vast regions, but confined to certain regions of the world.

Now it can be found anywhere … in Brazil, in China, in Japan and India, not to mention the Middle East, all over Europe and of course, North America.

HEFFNER: How do you explain that?

GOLDHAGEN: Well, the … anti-Semitism always mimics or takes on the features of its age and we live in a global world. And in the global world you have information flowing all over the world, with the media blanketing the world and so notions about Jews, which were taught before by parent to child, by priest to parishioner, by community leaders to communal followers is now beamed around the world digitally, on satellite television, on the Internet and so all over the world, people are being exposed to the anti-Semitic accusations, canards …the lies about Jews the anti-Semites have been perpetrating for all these centuries, but they’ve also taken new form as well.

HEFFNER: Yes, but you know, I’m impressed by the fact you still talk about American exceptionalism. And we … lord knows … are very much involved in the new media and the spread of this material. Why are we an exception to this?

GOLDHAGEN: In several respects, and discussing anti-Semitism in the United States is a complicated thing. Because, on the one hand you say the story is a good story because it’s been declining here when it’s been rising elsewhere. It’s at much lower levels than in comparable countries such as Western European democracies, so that’s all very positive.

Jews are far more integrated into American society, as Jews … that is Jewish Americans … than they are in any other country, except, of course, Israel. So that’s all positive. At the same time, the levels are still alarming.

HEFFNER: The levels of …

GOLDHAGEN: … the levels of anti-Semitism. If you … 30 … 20 to 30 to 40% of Americans might answer “Yes” to anti-Semitic statements in surveys. Many still believe and still profess that Jews today are responsible for the death of Jesus, one of the oldest anti-Semitic canards, and most damaging perhaps prejudicial canard of all time.

And so, if you look at the absolute levels, when you should say “There shouldn’t be anti-Semitism, why should people hate Jews?” … the numbers are alarming.

But when you compare the United States to other countries, it looks and it looks good in other respects. Because it’s not really part of our public culture in the way that it is even in Western Europe, let alone in the Middle East and elsewhere. You don’t have major public figures in our country espousing anti-Semitism or virulently anti … so-called anti-Israel lines, which are really just anti-Semitism in, in, in a more politicized form directed at Israel, as you do in Western European countries.

And so the public culture in this country is far better and the media culture is far better than in Western Europe and as I said, American Jews represent themselves and their interests quite openly without fear of being deemed disloyal, suspect by dint of their political positions, which is not the case for European Jewish communities.

HEFFNER: You really do insist, don’t you, that if one has serious questions about Israeli policy that this is a sign of anti-Semitism?

GOLDHAGEN: No. That’s not, that’s not the case …

HEFFNER: Sounds that way, but tell me what is the case.

GOLDHAGEN: It’s perfectly fine to have, be very critical of many of Israel’s policies, including its occupation of the West Bank and its basic orientation towards Palestinians, not to mention specific policies. One could be very, very critical. But if one is anti-Israel in the sense … against the country or says that this country has no right to exist …

HEFFNER: Ah …

GOLDHAGEN: … which is what the anti-Zionists, anti-Israel orientation is … or one says things such as “Israel is conducting a war of extermination against the Palestinians”, sounds fantastical … yet 55% of Europeans say Israel is conducting a war of extermination against Palestinians, when in fact the Palestinian population before Israel gave up Gaza doubled under Israeli occupation in the 20 year period. Hardly a war of extermination.

These are signs of anti-Semitism or the expression of anti-Semitism as opposed to a reasoned, if very harsh critical stance towards Israel’s policies.

Israel faces something that no other country in the world faces, which is an international eliminations coalition. That is a coalition of countries, organizations and peoples that are devoted to its elimination through various prospective means.

Some would love to destroy the country … literally to destroy it … others would say, “Israel should stop being a country as it is.” It should become a bi-national state, or something like that. And against no other country in the world is there such a coalition … is there a call for the extinction of a country. This is … in itself is a form of anti-Semitism … just as in the past people have called for the extinction of Jews as a people, their elimination … now it’s the state where Jews have a political home.

HEFFNER: Daniel there have been those who say that The Devil That Never Dies … is too excitable … I find it difficult to understand how one could be too excited over the question of anti-Semitism, particularly the viral anti-Semitism you describe.

But how do you respond to that, that … I know the charge was made about your first great book … how do you respond to people who are saying … “Take it easy, don’t be quite so excited about this. Don’t be quite so virulent yourself”?

GOLDHAGEN: Well, the people who say that have not pointed to anything that’s actually wrong … substantively in the book (laugh) … they don’t like the conclusions, they don’t like the raising of the alarm … but that is the case when you write about subjects that cause dis-temper in many different kinds of people, or people of many different orientations … because, in this case many … some Jews don’t like the subject because it makes them uncomfortable and makes them uncomfortable in front of their non-Jewish friends.

HEFFNER: Tell … tell me about that because I had that suspicion when we spoke all those years ago. That some Jews, perhaps many Jews, were very uncomfortable because of what you wrote.

GOLDHAGEN: Well, first … there, there are a couple of reasons … one is … things in this country are pretty good for Jews. And as they … and people are right to think that there are good relations between Jews and Christians, so they say, “Why rock the boat?” … why discuss openly the extent of anti-Semitism, which still exists among Christians, not all Christians … in fact most Christians in this country are not anti-Semitic.

And, and the long history of anti-Semitism, which goes back to Christianity causes dis-temper for Jews and for Christians. So why rock the boat? They’re very unhappy about that.

HEFFNER: But with the first book you hadn’t written about global anti-Semitism, you were writing about where it was so clear … you were writing after the Holocaust, you were writing about the Holocaust … you were writing about Germany.

GOLDHAGEN: MmmHmm.

HEFFNER: And yet there was, I believed at the time, that uneasiness among our fellow religionists.

GOLDHAGEN: There, there was a great deal of unease for many reasons, one is because the book challenged many comforting … maybe “comforting” is too strong a word, but many settled notions that people had come to terms with about the nature of the Holocaust, about what caused it.

And instead of saying it was Hitler and a few bad people who terrorized German society, it raised the lid on that and say, “No, these were ordinary people who moved by anti-Semitism, decided that it was appropriate to eliminate, in this case, to exterminate Jews”. Now this is a very disquieting notion for Jews and for non-Jews.

HEFFNER: But why for Jews?

GOLDHAGEN: Because they know there’s a lot of anti-Semitism that still exists …

HEFFNER: Ahh …

GOLDHAGEN: … and, and the linking of, the linking of these acts, these murderous, mass murderous acts to this belief, when people know that there’s such beliefs … at least in the formal terms it’s call anti-Semitism … is still, are still around … makes them unsettled, to say the least.

The notion, it’s unsettling for anyone … the notion that a person could willfully take a child and bash a child against … bash a child’s head against the wall for no reason other than, than the belief he has about the nature of this child, that the child’s a Jew… is a very disturbing notion for lots of people … Jews and non-Jews. That, that, that such deeds would be willful and done with such malice and so on.

And what they didn’t understand is that in the case of the Nazis, in the case of Germans at the time, they had a very different kind of anti-Semitism moving them from what we are more familiar with in this country … which are low level prejudices or maybe prejudices which say the Jews are, you know, are clannish or they are too powerful in business.

They actually believed at the time that Jews were devils in human form, as hard as that is to believe and that they needed to be extirpated in order for Germany and for Europe in general to survive and to prosper.

And so people confused the term “anti-Semitism” per se which covers a range of beliefs and emotions with the specific anti-Semitism that the Germans … that was the property of so many Germans and Europeans at the time that led them to kill.

And the other thing one has to say is that the book challenged the self-understanding of Germany and Germans of their own history and was very unsettling for them, so that produced a big backlash. And also all the scholars who had worked in the field for so many years, who had never investigated the killers and who had been saying things which my book showed that … which my book showed were wrong. And so there was a reaction within the scholarly community of “How can he have written such a book with all this evidence that shows that what we’re saying is wrong” … we have to push back and so on and so forth.

Now I remembered something as I was coming here … I thought back to the time we were together and I hope I remember correctly … it was in July … after the book was published in this country … before I went to Germany …

HEFFNER: Yes.

GOLDHAGEN: … the book was published in Germany and you said to me, “Are you really going to go to Germany?” or something to that effect. Given that there was such a furor that the book had unleashed even before it’s publication in Germany.

And I said to you … “I’m confident that the book will prevail, I’m going to Germany, it will get a hearing, I think Germany is different today and people will come around.

And, in fact, that’s what happened. Once they finally found out what the book said as opposed to how it was being misrepresented … the book ended up trouncing Germany and it’s changed the way Germans understand their own history.

And so I think very fondly back to this moment here …

HEFFNER: But you know I remembered thinking about what we were going to discuss here, I remembered that … I remembered particularly though the … and I went back to the transcript … of the second program in which you were rejecting, you were, you were … you wanted not to be put in a position where one was talking about guilt. And you were taking, what I considered very legalistic position … well, guilt is a matter of legal judgment.

What, what are your thoughts now about Germany and the Jews?

GOLDHAGEN: About Germany and the Jews today? Or …

HEFFNER: No, Germany and the Jews then.

GOLDHAGEN: Well, my views haven’t changed … ahmm, and the book was not about guilt or innocence …

HEFFNER: I know …

GOLDHAGEN: … in that respect … it was in … it was a social scientific attempt to explain what had happened and why it happened. I …since … in the meantime I wrote a book that deals with these moral issues, called A Moral Reckoning, which is precisely about those issues. And I tried to, to put forward a more nuanced way of thinking about blameworthiness and guilt and so on and so forth.

And I still maintain that people are guilty only for their individual acts and deeds. Not by dint of membership in a group. Because the issue really was, in Germany at the time … of Hitler’s Willing Executioners … the issue really was collective guilt which they said I was charging Germany with … and I …

HEFFNER: Right.

GOLDHAGEN: … decidedly wasn’t, I wrote at the time I wasn’t, I’ve never said … I’ve always been, perhaps, the most vocal and harshest critic of the notion of collective guilt.

You’re not guilty by dint of your membership in a group, you’re only guilty for your deeds or acts and you may be deemed blameworthy for your beliefs and for what you support morally and emotionally, but that doesn’t make you guilty.

And yes, I still take a more legalistic account … or approach to the notion of guilt, as you put it.

HEFFNER: Where do you see this ending, if that’s the proper word … The Devil That Never Dies …

GOLDHAGEN: Well, I’m quite pessimistic about the state of anti-Semitism today because it’s become even more endemic to the world than it was even during the Nazi period. Because of it’s spread all around the world, because of digital technology … I mean it’s really frightening … you type the word “Jew” into Google or Bing … a child or an adult who wants to learn about Jews and the third or fourth or second site depending on what day it is … it comes up as a site called “Jew Watch” or “Jew Watch News”.

And it’s an emporium, a supermarket of hatred, well-organized, seemingly sensible … if you don’t already know it’s not, with a claimed 1.5 billion pages, who knows how many pages there really are … but organized by categories … Jewish Hate Hoaxes, Jewish genocide, Jewish … Jewish manipulators, Jewish mind control, Jewish criminals, etc., etc., etc. and what is someone supposed to think who goes there, who doesn’t really know, who’s looking for information. This stuff is everywhere on the web.

Not to mention it being really and so pervasive in Arab and Islamic countries today where the surveys that we have show that the anti-Semitism is the property of 95%, 97% of the people in these countries, not to mention Europe, where 50% of Europeans hold absolutely anti-Semitic views of Jews and where Jews are fleeing the continent because, because they’re physically endangered. They’re afraid to show visible signs of Jewishness on the street for fear of being attacked. And they … and many say there’s no future for Jews in Europe.

So if you look around the world … you have vast numbers of anti-Semites around the world, more than ever. They’re everywhere in the world … it’s available at every moment, anywhere with a click or two of the mouse. And the demonology is as bad as ever in the Arab and Islamic world … as Nazified as it was during the Nazi period. In fact more openly blood-thirsty, more openly exterminationist than, than even the Nazis were in their public pronouncements. Not in their deeds, but in their public pronouncements.

So for all these reasons, it’s hard to see how anti-Semitism is going to eradicated, forget about eradicated, but even, even decline in its reach, in its scope, in its numbers and in its power. It’s getting worse, really in the last two decades … it’s gotten much worse and I see the trend lines continuing in a bad, not in a good direction.

HEFFNER: Now, you say all this … you write it so well in The Devil That Never Dies … what’s been the reaction in the Jewish community to this book, as contrasted to the reaction that we’ve just discussed to the first book.

GOLDHAGEN: Well, you know, my, my sample, my sample is not … is not one that allows me to speak with the Jewish community … broadly speaking I can say …

HEFFNER: You’re getting legalistic again.

GOLDHAGEN: (Laugh) I can say two things, in Jewish … in Jewish publications the response, the response has been very … extremely positive. Those who deal with these issues say this is important, they, they present the message, they say “people need to pay attention” to this … and so on.

When I speak before Jewish audiences, they’re immensely appreciative, they want to know more, they’re thankful that I’m … that I’m speaking plainly and directly … which is my habit … to be as direct and plain as possible and not to pull punches, not to think about the fine sensibilities of people, but in fact to take my vocation seriously, which is to do my best to tell the truth as I understand it.

And to do it in the … in as forceful and as direct a manner. And so they’ve been very appreciative. So that’s about as much as I can say. So far things … the response has been very positive and more and more people are in the … are aware of how bad anti-Semitism is out there, even if it doesn’t touch them so much here in the United States in their own communities. And they’ve been searching to try to understand what the nature of this new … of this global anti-Semitism is. And that’s what The Devil That Never Dies … at least proposes an answer to.

HEFFNER: Your response to my question about that focused on the viral network, focused on the means by which we can transmit these canards at, at, at this time. But that can’t be all … or maybe you think it is … maybe you think it is the ease of communications that has led to this spread of this new life, expanded life of anti-Semitism.

GOLDHAGEN: Well, there, there are variety … a number of different issues. One is that there was a several decade period where anti-Semitism was suppressed after the Holocaust in …

HEFFNER: Suppressed?

GOLDHAGEN: … suppressed, it was really suppressed … the public spheres of Western countries became denuded of anti-Semitism, overnight practically. But the, but the repression of anti-Semitism was artificial because it was just out of the … continued to exist within people’s communities and in families and so on.

And then, with end of the East/West conflict where the world was reshuffled … politics, society and so on … suddenly anti-Semitism … the tablets were broken and they came to the fore and that’s why in the last couple of decades there’s been this resurgence.

But took, but took most experts by surprise. Because it had, because there had been so little public anti-Semitism for several decades. So it was, it was for a variety of reasons, for a variety of reasons … it came back to the fore an it was something that a lot of people from the Left and the Right and not just the Left and Right could, could settle upon as being a way for them to express their antagonisms towards Jews by focusing on Israel, by focusing on American Jews as being powerful and manipulating the United States, as a way for them to make sense of the world and to find outlets for their own passions.

Then you have in the Arab and Islamic world the activation of ancient …of, of chronic anti-Semitism in the context of the Middle East conflict and, and an absolute demonization of Israel, which then was merged with the Western, the European anti-Semitism to bring together a, a … these two streams in a political, in a politicized form of anti-Semitism that is different from before.

Anti-Semitism today is so much more politically oriented, as our global role is more politically oriented. And you now have something that you never had before … which is anti-Semitism and it’s not just with regard to Jews, but with regard to any prejudice that I can think of … you have a … you have anti-Semitism … a prejudice being part of the foreign policy orientations of countries … to spread it, to act upon it, to make alliances around it, this is something that is unprecedented in history and they’ve captured international institutions such as the UN and other international institutions and so you have a completely different constellation for anti-Semitism today than before.

HEFFNER: What do you mean “captured” the UN.

GOLDHAGEN: Well, you take the Human Rights Council, which has produced more, more resolutions and censures against Israel than against all Arab countries combined … than against Sudan … Sudan is carrying out a genocide during the last 10 years against the people in Darfur and elsewhere and there are more … there are more resolutions and more, more motions of censure against Israel than again Sudan.

Israel is a permanent … is a permanent agenda item … the only country which is a permanent agenda item on the Human Rights Council … when, when by any reasonable stretch, even of the most critical view of Israeli policy you can’t, couldn’t possibly say that Israel is, is so much worse than all these mass murderous countries. I mean Sudan, after all, committed the mass murder of hundreds of thousands of people … expelled millions more, so that Israel should be the object of such a fixation and obsession on the part of the UN … on the Human Rights Council and the UN in general.

HEFFNER: Because Israel is supposed to be better than everyone else.

GOLDHAGEN: Well, it’s not because it’s supposed to better … because there’s powerful international block of Islamic and, and Arab countries, which, which have made attacking Israel and going along with the censuring of Israel a sine qua non of support.

HEFFNER: Where is Germany now in all of this?

GOLDHAGEN: Germany has a complicated position. In some ways, in some ways Germany has been a good friend of Israel and more, and more supportive of Israel than other European countries, which by and large …you know, it’s easier to go along against Israel than to support Israel, it must makes life easier to go, to go along with the countries that are censuring Israel and also there are large domestic anti-Semitic constituencies in their country.

But Germany in some way has, has been better. But still when you know that 55% or 57%, I think the number is, of Germans say that Israel is conducting a war of extermination against Palestinians … you think, how, how, in Germany of all places, where they know what a war of extermination is … were, were they, not the people today alive necessarily …

HEFFNER: MmmHmm.

GOLDHAGEN: … but their fathers or parents and grandparents actually conducted a war of extermination against the Jews and against many others as well, but specifically against the Jews … that they could have such a fantastical view of Jews and of Israel, to say something as absurd as that. This is one of the hallmarks of anti-Semitism … that differentiates it also from many other prejudices, which is how unmoored from reality it is.

I mean this is just a, this is just an out-of-this world kind of accusation and yet, sober, 21st century Germans who have a lot of access to information … actually believe this. And not just Germans, but Europeans.

HEFFNER: In the very short time that we have left … a little over a minute. Fantastical … you use it in the book, you’ve used it here. What do you mean?

GOLDHAGEN: When people believe as they have historically that Jews are minions of the devil, are in league with the devil, or devils in human form, that has nothing to do with reality. It’s a fan … it’s a phantasm … it’s … one might even say it’s hallucinatory … you look at a human being and you see a devil …

HEFFNER: You mean … nothing to do …

GOLDHAGEN: That was the common sense of the middle Ages. And during the Nazi period they looked at Jews and they didn’t see human beings, they saw devils, secularized devils in human form. And today, Jews and Israel, as incarnation of Jews, the political incarnation are depicted and seen by hundreds of millions of people around the world as also secular devils in human form. Or in some … the eyes of some religions … devils and so on.

This has nothing to do with reality. The charges against us have nothing to do with realty. Most anti-Semites have never met Jews, all they know are the figments of their imagination, what their public cultures or political cultures have taught them, which have nothing to do with reality.

This also distinguishes anti-Semities from many, many other prejudices … the fantasical quality which makes it that much harder to combat because it’s so deeply rooted, so divorced from reality that if you tell people the facts, it doesn’t matter.

HEFFNER: The Devil That Never Dies … The Rise and Threat of Global Anti-Semitism, I’m sure it’s a book that when read is going to make everyone’s hair stand on end. And Mr. Goldhagen, thank you for coming back, I hope another 20 years go by … 16, 17, 20 years go by … you’re able to write a book that isn’t as disturbing as the ones we’ve discussed. Thank you.

GOLDHAGEN: I hope you’re right. Thank you.

HEFFNER: And thanks to you in the audience. I hope you join us again next time.

Meanwhile, as an old friend used to say, “Good night and good luck”.

And do visit the Open Mind Website at thirteen.org/openmind to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.

The post The Devil That Never Dies appeared first on Richard Heffner's Open Mind Archive.

GUEST: Mark Zauderer
AIR DATE: 2/22/2014
VTR: 12/12/13

I’m Richard Heffner, your host on The Open Mind, which I began way back in 1956, when still a young man … a statistic that may make it somewhat unseemly that today, nearly sixty years later, though quite so long in the tooth myself, I insist on discussing the folly of rigid mandatory retirement requirements set generations and generations ago when average life expectancy was so much shorter than it is today.

Specifically, I’d like to discuss such retirement requirements as imposed upon the judiciary, where surely skilled and experienced judges are so much needed.

And my guest, appropriately enough, is once again my distinguished attorney friend Mark Zauderer, who a few years back, when he was President of the Federal Bar Council here in New York, joined me then on Open Mind as Chair of the State Bar Association’s Special Committee on Age Discrimination in the Legal Profession.

At the time, we talked about my guest’s Bar Committee’s having urged private law firms “Not to Force Retirements”, as a New York Times headline read.

Now, I gather, Mark Zauderer has fought – however unsuccessfully – for New York State’s recent effort at the ballot box to ease age restrictions on judicial service. And I would ask him why?: why he fought and why he lost. Mark?

ZAUDERER: Well, I think trial lawyers always like to win … not lose, but they’re always, always willing to fight for something that they think is important.

I think to put some perspective on, on the topic again for some who may not have thought about it.

There are some major trends in society that make this an important issue. For one thing the Baby Boom generation in great numbers is hitting what is thought of as the traditional retirement age.

So we have an enormous explosion of the population in that age group. And the other factor, of which we’re all aware … is that we’re simply living longer, healthier lives.

The age retirement for judges in New York, for example, was set in the mid-nineteenth century when age 70, which is the nominal retirement for judges in New York was an age to which many people didn’t live. Most people didn’t live. It was a very academic notion.

And what we have today, of course, is which was true with lawyers, is we have large numbers of people entering that age segment who are willing to work, who … in many cases … need to work because of the expected lengthy lifetime … but I think in the case of judges, what’s particularly important, not only for their personal reasons, they ought to be allowed to work, but for the reasons that society benefits enormously from the contributions that come along with age, wisdom, experience that people can, can make and particularly judges.

And we’ve had in New York and I’m sure it’s true elsewhere numerous instances where distinguished judges have been forced to retire from New York’s high court at age 70, unlike the lower courts … that’s it … you can’t get extended.

In the lower courts when you reach age 70 as a judge, subject to good health and vigor, your term can be extended for up to three two year terms to a maximum of 76.

But we know from experience, not only in our own system, but in the US Supreme Court, for example, we’ve had distinguished jurists serving … not only into their seventies, but eighties, nineties and, and in one case in the Federal judiciary, someone beyond that.

But on the Supreme Court we have today people who would, in New York and many states … not all … would be mandatorially retired and the society would not be able to benefit from their long experience and, in fact, wisdom.

HEFFNER: It’s interesting to me, Mark, that somewhere along the lines of a, a the materials to study for this … one finds reference to the notion that many state judges did not take up their participation on the bench until after a rather successful career in the legal profession.

So that they, indeed, need that time to make their greatest contributions and they cut off too quickly.

ZAUDERER: Well, that’s an excellent point. It’s something we all intuitively understand … that many judges … and something we expect will become judges only after they’ve had that experience. Why is that?

Because we want those who sit in judgment in very important matters of, of life to have had that kind of experience.

You know, this is not necessarily true in other professions. There are other, extremely capable, successful people in the financial world, for example, on Wall Street who retire at age 40 or 45 … and, and think … apart from the fact that they may be able financially to do so, they’ve achieved their peak, so to speak earlier.

In the legal world, which involves not only knowledge, but the responsibility of making important judgments in grey areas where people’s lives and fortunes are at stake … we value as a society the maturity, the ability to make judgments that can only be made with significant experience.

HEFFNER: Well, last month in fact … we’re taping this program in December, 2013, but in election day last month, here in New York State, the voters rejected a Constitutional amendment that would have enabled judges to serve longer. Why do you think that was true?

ZAUDERER: I think there was a confluence of factors. And one thing as our, our Governor pointed out, I think correctly …the Bill was … as a compromise … was, was somewhat flawed. It was imperfect because it created extended tenure only for certain judges and not others.

So there was confusion over that, and some of the opposition understandably pointed that out. But I think as an overarching point there’s a, a, a general reluctance among the population to extend the terms of elected or appointed people.

Hence the controversy over terms limits. I think that played a role. In addition, I think the fact that the economy is still not in great shape and many people are disaffected.

I think when one reads a description of the Bill, which is all many voters would actually see, they’re not … they don’t have the opportunity to study the background of it … that when they see that they’re in effect extending tenure to people, when either they or people in their families, you know, are themselves, without jobs, is not something that’s likely to, you know, inspire good feeling in the voter.

Finally, and this, of course, is just speculation … I think notwithstanding their good works, there are many people that just gratuitously would not want to feel a debt of gratitude toward judges in our society.

So, that’s my speculation that all of these factors combined to make it such that the, the proposition did not pass.

HEFFNER: Was there any research done on the voters coming out of the ballot … ah … place.

ZAUDERER: I haven’t seen that research. And I would also say that to the extent that one would want to understand that … to renew this effort, there may be an uphill fight, particularly in the political world. Because, remember for this proposition to have been on the ballot, it had to have been passed by the Legislature more than once.

HEFFNER: What’s your prediction …

ZAUDERER: So …

HEFFNER: … will it be back?

ZAUDERER: … well, if you were a politician today and you saw that it was the only amendment that did not pass … the proposition did not pass … you might hesitate to be in vanguard of those promoting it.

But, I’m … I have a … some optimism about it. I think that as one of the things that perhaps was not done successfully was for those who were backing this amendment to educate the public about the value of it.

I’ll give you an example. I heard somebody comment when this debate was going on … “Well, we have to make room for newer, younger judges.”

Well the fact is by having extended retirement age, you have more judges in the system because in New York, when a judge reaches the retirement age of 70, that position opens up and is filled so you, in effect, have a supernumerary … you have an extra judge. And boy we need all the judge time we can get in our system.

We have our, our Criminal courts, our Family courts, our courts that handle civil cases for ordinary people. They’re having difficulty particularly in a time of budget constraints, keeping up with the cases.

So any proposition that allows there to be more judges hearing more cases, has to be thought of as healthy feature.

HEFFNER: Let me just switch a bit from the matter of extending the tenure of judges, in terms at least of their age, to the selection of judges.

This battle over whether judges should be elected or selected … has been going on for some time. What’s your fix on this?

ZAUDERER: Yes. Well, “for some time” is really right on point. In fact, our system which was inherited from the British reflected appointments, by the Crown … initially and later by the Legislature or our Governor’s appointment of judicial officials.

And what happened, really, in the middle of the nineteenth century throughout the United States, in part reflecting the Jeffersonian and then the Jacksonian tradition of putting confidence or faith in the people … many states switched to elective systems.

The problem with elective systems, while superficially appealing because it seems consistent with the notion that in a democracy the people picked their public officials … but it’s, it’s beset with problems.

For one thing, the public in voting for judges really does not have the, the tools to judge. Who has the tools to judge whether somebody should be a judge? The competing system which you alluded to, which has gained favor throughout the United States in many states … some in the High Court, some in the lower court … some in both levels of courts … is an appointive system.

Well, the argument is made that in an appointive system, you just switch the politics from the voters to someone else … whoever the appointers are.

But in practice some of these systems are, are really quite ingenious … you have screening bodies such as we, we have for the High Court of New York and some courts … some states do it for other courts … where the bodies themselves are selected at different times by different Governors or different people so you have a diversity on the group that’s making the recommendations. But perhaps …

HEFFNER: You mean a committee …

ZAUDERER: … a committee that recommends … in some cases, for example in New York’s High Court there’s a Commission which has appointees from different political figures over time … they will recommend between four and seven people for the New York Court of Appeals and the Governor must then select from one of those people who are proposed or nominated.

And all these committees in whatever form they’re set up, have the resources to make these judgments because they have the applicants submit extensive questionnaires, answers to questions, their writings … extensive polling is done of lawyers or judges who have worked with the judge-candidates in their professor as lawyers in the courtroom or whatever their, their field of endeavor is.

And for sitting judges they’re reviewed for, for re-appointment … their, their decisions are studied. So these bodies are really in a position, unlike the electorate to make informed choices.

But I think probably the strongest argument for the elective or rather the appointive system … rather than the elective system … ah … is that a judge unlike another kind of public official is not supposed to be playing to a particular crowd … is not supposed to be making promises the way a politician legitimately can.

I mean somebody comes and runs for public office and says, “Look, if you elect me I’m going to do A, B, C or D and you can hold me to it”. A judge cannot and should not do that. We don’t want that of our judges. We want our judges to be judges. And not simply carrying out a particular agenda.

And the system is further complicated by the fact that not only can’t judges speak to a particular platform … therefore the voters have no basis of judging … based on that … but now, and particularly with the Supreme Court giving free license to political contributions by corporations, we have, throughout the United States … a view of many … an unhealthy situation where heavy contributions to judges’ races are affecting both openly and subliminally … the results that judges reach in cases.

Particularly on the High Appellate Courts. You know originally there was much written in the press that trial lawyers, representing personal injury plaintiffs or class action plaintiff played a disproportionate role in the selection of the judiciary because they made heavy political contributions.

But ever since the Supreme Court’s decision in the Citizens United case which basically has blessed corporate contributions …other segments of the community have contributed very heavily to elections of judges, particularly the business community.

Now whether that’s balanced … what has been said … the plaintiffs … or whether it’s … whether the scale is tipped too far that way, who knows. But in either case, do we want a system in which political contributions can influence the decisions, the very important decisions that our High Courts make on basic issues of policy.

HEFFNER: I gather in reading many stories in the last couple of years … many items in the press … that just this thing has happened … at least accusations have been made that judges on the High Court of a state have ruled in favor of people who have made substantial contributions to them. Or to people related to corporations that have made substantial contributions to them.

ZAUDERER: There certainly has been a lot in the press about that. And there have been some instances where some judges have either been removed or have resigned from office because of disclosure of relationships that apparently have affected the decisions. Fortunately, they’re rare, but they have occurred.

HEFFNER: Mark, you’re still a youngish man … have you noticed in the course of your legal career any shift or changes in the quality of judges?

ZAUDERER: Well, let me premise what I say to start with what the notion that by and large … both then and now … judges are good.

They have a very difficult job to do … under very difficult circumstances often with limited resources.

But I have noticed a shift which I and others, I think, have found somewhat disturbing.

One is that with the disparity of income that’s grown between private practitioners and judges …

HEFFNER: MmmmHmm.

ZAUDERER: … the pool from which judges are chosen has, has somewhat shrunk. Ahh …

HEFFNER: You mean in a, in a sense because they’re paid so little.

ZAUDERER: Because they’re paid so little. Ahemm … I think I … when I was a law clerk to a Federal judge … I think I made $10,000 a year and the Federal judge made $40,000 a year. So the judge made four times as much as the starting lawyer. Today, you’ve got lawyers who make $60,000 or more with bonuses to start out and the judges are, you know, are making $150,000 and the practitioners are making, you know, many times that.

So, I think that that disparity in income reduces the pool of talented people. This was observed by the former Chief Justice of the United States Rehnquist … in one of his year-end State of the Judiciary speeches in which he also bemoaned the fact that fewer from private practice are joining the Federal judiciary.

And that basically more and more people are coming from the government. Now they’re very fine lawyers but does that produce the balance that we want on the courts? We want people who may have had government experience, people who’ve had life experience representing clients, who have been in private practice. So I think that disparity in income has produced changes like that.

HEFFNER: Since the Chief Justice made that point … is it your impression that the trend continues in that direction?

ZAUDERER: Ahhh, I think it continues and I think there’s another factor at play as well. And this is not the fault of the judges. I think that the public in, in part the elected political …the politicians bear responsibility for this.

Judges have often been convenient punching bags for problems in society. And just as all professionals at one time were held, I think, in higher esteem than today … doctors, lawyer, judges … there’s a cynicism today that didn’t exist. So that the position of judge may be less appealing to some.

Because many people make a financial sacrifice to become a judge, too, it’s not just those who don’t want to apply, but some who apply and become judges, do so not only because of the public service involved, but a, a fulfilling sense of public responsibility.

Well, you know, one of the currencies that, that somebody enjoys is, is the public respect and if the public does not hold them in the esteem they, they deserve, that reduces the appeal of the office … it would for, for anybody.

HEFFNER: Are judges, in your estimation, to your knowledge, I should say … are they held in public esteem or not held high in public esteem in terms of different regions of the country?

ZAUDERER: I think so very much. I think as you, as you get outside of urban areas, I think … just as many traditions have remained less changed than in urban areas … I think there is … ahh … in general a greater respect.

You know the judge in a small community is likely to be integrated in the community … they, they know the judge like they know the doctor or they know the, the preacher. And the position is one that is fairly universally treated with, with respect.

You know, here in New York City, for example, the judges get jostled on the subway train with everybody else. So, you know, it’s a more impersonal environment.

And I think in that kind of setting it’s natural that the esteem or respect that they deserve … can be somewhat (laugh) diminished.

HEFFNER: Is there any indication … going back a step …

ZAUDERER: Yeah.

HEFFNER: … that the Congress now will do anything about the Federal judiciary’s pay? Is there any movement?

ZAUDERER: That’s been an on-going battle and it’s a really sad story. Because it’s gotten so twisted with politics. The, the attempt to raise judicial salaries … I mean there have been cost of living adjustments, but they’re really, really lagging quite badly.

And on that point and my, my previous point if I might add … the political community has not been publicly supportive of judges. I said they’re convenient punching bags.

You know how often have we seen some commentator on television say something like, ‘”Oh, did you hear about that judge in Nebraska or, or Vermont that let that criminal go on low bail”, knowing nothing about the facts of the case. Or whether the judge was actually following the law.

You know, or a former President who slipped and fell and made some remark about … oh, I was wearing my tasseled loafers … or some other reference to something that may be associated with lawyers … is not good for … is not good for society … it’s not good for the public.

And I think politicians who help educate the public to the important role that judges play do a service rather than a disservice.

HEFFNER: The, the … we talked about the Federal judiciary, if I’m not wrong … here in New York State we’re just as bad in terms of meeting the financial needs of people who serve in the judiciary.

ZAUDERER: Absolutely. Salaries have lagged and another factor that affects the quality of justice is with the budget constraints the courts are operating under.

There’s been a reduction in staff, you know, and it finds it’s way into the justice in insidious ways. Decisions get delayed, the time that can be spent reviewing and giving judges support on particular cases is reduced.

HEFFNER: So the caseload of each judge has gone up.

ZAUDERER: The caseload goes up and the time spent on each case … reduced.

HEFFNER: Do we still have more justice in this country …do you think … than you find other places in the civilized world?

ZAUDERER: Definitely so. Definitely so. I’ve watched proceedings in Great Britain from time to time. On the one hand they’re impressive … the bar is articulate, the, the judges are articulate … the people generally … in the system … the judges are of, of high quality … but, but we have in America a culture and a lot … much of it is written into our Constitution that we value very highly.

Our Bill of Rights, for example, I think our judges are always alert to preserving those rights. We see cases all the time in which these Constitutional rights are implicated, or we have a clash of Constitutional rights … freedom of speech … freedom of the press … the right of … we had a case recently in the, in the news about the New York Court of Appeals came down with a decision that was very supportive of, of reporters confidentiality … protecting their sources, that didn’t have to respond to a subpoena in another state to produce notes of, of interviews.

But the point is that the courts are very conscious of these important bedrocks, you know, of our society. More so I think than we find in other countries.

HEFFNER: Mark Zauderer, I’m always pleased to talk with you here on The Open Mind and clearly the judiciary provides us with a lot of space and food for thought. Thank you for joining me again today.

ZAUDERER: My pleasure.

HEFFNER: And thanks, too, to you in the audience. I hope you join us again next time. Meanwhile, as another old friend used to say, “Good night and good luck.”

And do visit the Open Mind Website at thirteen.org/openmind to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.

The post Mandatory retirement… an age-old, or just an old-age problem? appeared first on Richard Heffner's Open Mind Archive.

I’m Richard Heffner, your host on The Open Mind. And this is the second of two programs with Dr. Diane Meier, Director of the Center to Advance Palliative Care, a national organization devoted to increasing the number and quality of palliative care programs in the United States. Indeed, under her leadership such programs have more than tripled in US hospitals in the last decade.

Dr. Meier is also Professor of Geriatrics and Palliative Medicine and Gaisman Professor of Medical Ethics at Mount Sinai Hospital’s Ichan School of Medicine here in New York.

My guest has received a MacArthur Foundation “genius award” as well as the American Cancer Society’s Medal of Honor in recognition of her pioneering role in bringing palliative care into mainstream American medicine.

All of which led me last time to ask my guest briefly to define or explain palliative medicine for those who may not be familiar with it … and to answer a question to which I hoped she wouldn’t take exception: why, indeed, has putting palliative care front and center in American medicine been such a struggle?

Well, this time I would ask if she is satisfied with the degree to which mainstream medicine now embraces palliative care. We’ll get back to where we ended up last time, Dr. Meier, but … are you satisfied with that general proposition?

MEIER: Of course I’m not satisfied … no. I, I will not be satisfied until … to put it in three short words … there’s palliative care everywhere.

That is wherever there is a seriously ill child. Or newborn. Or young adult. Or middle aged person. Or older person.

Whether they’re in their doctor’s office, whether they’re at home … in school … in a nursing home … in a hospital … in a cancer center. Receiving care at home.

All of … all healthcare for people with serious, challenging illness, should be informed by fundamental principles of palliative care. Asking what matters most to the patient and family. Developing a care plan around what matters most to the patient and family. Listening to what keeps them awake at night, what causes them pain … stress … suffering of any kind and addressing it.

All of healthcare should be informed by these principles and we are a long way off from that.

So, unfortunately, I’m not done and I’m not satisfied with where we’ve gotten to … in terms of scaling palliative care to inform the practice of medicine and healthcare delivery in all settings in the United States.

We’ve come a long way in hospitals … but we’re just now beginning to start spreading this model of care outside of hospitals. And after all, most people with serious illness spend 99.9% of their time at home. Not in hospitals. So we really need to bring the care into the community.

HEFFNER: But, of course, that leads me to ask something that’s puzzling me. You said in the last program that palliative care responds to … in a sense … reflects the ambitions, the hopes, prayers of the people who go to medical school today.

MEIER: MmmHmm.

HEFFNER: Now you’re going to change their training so that the training corresponds to this “goodness”, essential goodness and care for people in them.

MEIER: Right.

HEFFNER: All done in a fifteen minute interview at a doctor’s office? Or are you talking always about teams?

MEIER: Well, it depends on the needs of the patient. So if, for example, I saw someone today whose wife has a new diagnosis of Alzheimer’s disease. And I could have brought the whole team in, but he and I spoke at some length about what was ahead of him for the next decade, decade and a half. How he needed to prepare himself for the long haul. And to pace himself so that he could handle the long haul and understand that when she asked every day … what day is it … and he had just said twice before in the last five minutes … “it’s Wednesday”, that it’s because she genuinely could not remember what he had said to her five minutes ago.

To help him think about how is he going to pay for the care she was going to need at home because he doesn’t have long term care insurance.

To help him think about mobilizing his two adult children to help him, so that there’s a team around him and his wife to help him get help with the financial planning that he has to do, so that he can pay the rent and buy food and take care of himself while still making sure that she has the care she needs.

There’s a lot of things he needs to start thinking about. That was just me. Was that palliative care? It absolutely was. I was asking him, you know, what were his greatest worries, what were his greatest fears, what were the things that made him feel at least able to go forward … ahmmm … you know he expressed a great deal of despair and concern about whether it was worth it to go on living. He felt he would go on living because he had to take care of his wife.

But if that wasn’t the case, confronting what he has to go through with her in the next 15 years … so he’s depressed. He’s despairing. That was just me.

However, I referred him to a social worker on my team who’s going to help him understand what the insurance options are and the financial options are … for him … when his wife needs a person with her, either at night or 24/7. How is he going to pay for that? He didn’t understand that Medicare doesn’t pay for that. And his regular …

HEFFNER: Medicare …

MEIER: … insurance doesn’t pay for that. So, you know, this is an intelligent, educated 78 year old man who didn’t know that, that Medicare doesn’t cover personal care for someone who needs it.

HEFFNER: You had told me, in our last program together that Medicare will cover the time it requires you …

MEIER: It, it will pay for my time with him … it will not pay ….

HEFFNER: But what about the social worker?

MEIER: … it depends on where he sees her. If he sees her in her office, she can bill “fee for service”. If he sees her in the hospital … I happened to see him in the office … so … not in the hospital … then her salary is supposedly covered by how Medicare pays for the hospitalization.

But … so it depends on the needs of the patient. We have, for example, patients now in the hospital who are undergoing a very difficult procedure for cancer called a bone marrow transplant. Where you’re basically like the “Boy in the Bubble”. You’re … we, we kill all your normal bone marrow in order to infuse new, healthy bone marrow. And it’s a very difficult process but it has led to a number of cures of what used to be universally fatal leukemias, lymphomas, other diseases.

What palliative care does for those patients is massage therapy, spiritual support, music therapy, art therapy, pain management, support for the families … they don’t … it’s much more about kind of helping people maintain their spirits and their sense of connection to a life worth living … for that kind of patient.

For the person I that I saw this morning it was … he needed a doctor to help him understand what the normal course of Alzheimer’s is, so that he could prepare himself and his family for what was going to come.

HEFFNER: Now going back to the matter of the willingness of the medical profession to accept what it is you know that is needed in terms of palliative care …

MEIER: MmmHmm.

HEFFNER: … you’ve said that the new generation … this is why they’re going into medicine.

MEIER: Well, I mean, that obviously there’s a bell curve in medicine like in any other biological system … so some people go into medicine because they want to cut people, they want to do procedures. And we need those people. We need good surgeons who love surgery. We need all kinds.

HEFFNER: But there is a group …

MEIER: There … we are attracting to train in palliative medicine people from the best Ivy League medical schools and residencies in the country because they … when they see it practiced during their medical school training and their residency training … they say, “Yeah, that’s why I went to medical school, I want to do that for a living”. It is so gratifying to me.

HEFFNER: Do they stay there …

MEIER: Oh, yeah.

HEFFNER: … psychologically speaking.

MEIER: It’s … you know everyone thinks it must be devastating work and must be so hard … and it is … it can be emotionally challenging and difficult work.

But I will tell you it is much harder to see people suffering unnecessarily and having it not addressed. It is … the cognitive dissonance of seeing vulnerable people not get the care they need … its much more difficult … the moral distress for doctors and nurses … seeing patients get inappropriate, harmful, burdensome care … is much greater than that the moral stress of helping people who are confronting a serious illness.

Most people in palliative care are very happy because they really get up in the morning, knowing they’re going to go to work and really help people that day. And they go home feeling good about what they did.

HEFFNER: How does the palliative care pattern and the needs it has and the demands is draws upon its practitioners, how does that relate to the movement toward hospitalists?

MEIER: MmmHmm.

HEFFNER: Here it seemed to me, you’re taking me away from my general practitioner who, to a certain extent at least … reflects the, the needs that you’ve been describing. And puts me in the hands of people in the hospital who don’t know me at all.

MEIER: Well, the hospitalist model is an example of a kind of sub-sub-sub specialization, fragmentation and silos that we talked about in the earlier show.

The recognition that the GP in his or her office, who has 50 people in the waiting room, does not have the time and attention to really focus on the sick people in the hospital, because he’s got to get back to the office and deal with the 50 people in the waiting room.

And so there is this recognition that things didn’t get done quickly, things didn’t get done well, because the people managing patients in the hospital were distracted by their office responsibilities.

So it made sense from the standpoint of the immediate need to meet patients needs are in the hospital today … to have people who are experts in hospitals. Who know Joe in radiology and can pick up the phone and say, “Joe, I got this patient, he needs a CAT scan this morning, can you get him in?” and has the relationships, knows how to work the system on behalf of patients. That the primary doc in his or her office doesn’t have time to do.

But the downside is … somebody like you or me … who has a long history with our doc, that we’ve been seeing for 10 or 20 years is suddenly being cared for by somebody whose only job is to get us through that hospital stay and out as quickly and as cheaply as possible.

Who doesn’t know, you know, about our history of depression or the fact that we have a sibling who died of the disease 10 years before, so we’re terrified.

Or doesn’t bring that kind of whole person nuanced approach. So there’s a price. There’s an advantage and there’s also a disadvantage to hospitalists.

HEFFNER: How would you … talk about how they weigh out.

MEIER: It depends on how it’s done … like everything else.

HEFFNER: What do you mean?

MEIER: If hospital medicine is practiced in the optimal way, there is very high quality communication between the hospitalist and the primary doc. There is direct telephone communication that occurs at the beginning of the hospital stay, in the middle of the hospital stay and after discharge, so that the hand-off is pure, is high quality.

When people get too busy, when things get crazy, when the volume pressures in the hospital or in the office are too high, those are the first things that get dropped.

HEFFNER: You, you probably would be quite familiar with this. The first time that the word “hospitalist” was heard on the Open Mind which was about a year and a half ago … I said, “What?” …

MEIER: (Laughter)

HEFFNER: … and the doctor explained to me … my viewers and listeners knew as little as I did … nobody … and when I would talk about … the same response from so many people in the public … well-educated people, too.

MEIER: MmmHmm. Well, once you’re in the hospital, you get it …

HEFFNER: (Laughter)

MEIER: … and in fact you get a different one every week. It’s not even the same one, if you’re in the hospital more than a week because they turn over very rapidly.

HEFFNER: How come we know so little about this?

MEIER: Because it just was an industry shift that spread like a virus across the entire healthcare system. And as I said, it has its pros and it has its cons … but let the buyer beware … let the patient understand that the person they’re going to see in the hospital is probably within five years of finishing his or her training, has only worked in a hospital setting, doesn’t have a clue what goes on at home or in the doctor’s office or in the community …

HEFFNER: And sure as hell doesn’t know me.

MEIER: And doesn’t know you personally. So lest, lest you thought you could just relax into the caring and responsible arms of the healthcare system and, you know, trust that everything would be fine … you have, you have to be an informed consumer and you have to be an assertive consumer and if you’re too sick to do it, you’ve got to have a family member who can do it for you.

Because, because the system is not well designed to promote communication, clarity, coordination … unfortunately families and patients have to step into that breach ever more, with every passing year. And, again, this is a place where I feel that palliative care has stepped into that breach, particularly for the most vulnerable patients … those with the most live threatening and serious illness. Those whose family members are exhausted and overwhelmed and just can’t serve as the advocate because they could barely sleep at night.

Those are the really vulnerable patients to the mistakes, miscommunications, fragmentation and chaos of the modern healthcare system.

So, again, if I can convey one message to your audience it is to demand palliative care if you or a loved one has a serious illness and get connected to the team at your hospital.

Even if you don’t need it right now, you may need it later. You need the relationship, you need to be known to the team.

So that if there’s a pain crisis at 5:17 p.m., you don’t end up getting a tape that says, “Call 911, if this is a medical emergency.” You can get help from someone who can actually help you.

HEFFNER: What happens overseas. Where are “they”, by which I mean obviously the major advanced, generally Western countries?

MEIER: It’s an interesting question because we tend to think, in the United States, that we’re way behind other countries in this regard. And, in fact, the palliative care movement had its origin in London with Dame Cicely Saunders, who established the first hospice.

But, in a way, one of the problems that Europe and the United Kingdom and other developed nations face is that that origin sat within cancer. So the hospice movement was based on the needs of cancer patients.

It may come as a surprise to you, but only 22% of us die of cancer. 78% of us die of lots of other things … kidney problems, dementia, heart failure, emphasema, renal … kidney disease, frailty … debility … old age, as they say.

And in those countries … that 78% is out in the cold. If you have cancer, you can get palliative care. If you don’t have cancer, you’re kinda on your own. And in many ways the United States, to my great surprise, I learned this traveling around a lot … is ahead of other countries in recognizing that it doesn’t matter what the disease is, it doesn’t matter what the prognosis is … what matters is the needs of the patient and the family. Whatever the diagnosis is, whatever the prognosis is. Needs need to be identified and addressed, so that people can get through this.

And we’re doing better in this country in many ways than most other nations. There are exceptions … so, for example, I think New Zealand has really strong, nationally linked well-integrated palliative care teams.

A lot of the UK does not. A lot of Canada does not. There are some locations where it’s stronger … Edmonton has very strong, community-wide palliative care. Montreal does not.

HEFFNER: Even with a single payer system?

MEIER: Right. And, you know, it’s … you know how they say “all politics is local” … all healthcare is local … regardless of how it’s paid for, things evolve in a customized way based on the leadership and the local patterns of local communities.

HEFFNER: It’s so strange to me that like politics, medicine is a local …

MEIER: Well, you may be familiar from the Dartmoth Atlas which analyzes Medicare claims data that shows that the same medical problem in New York City is managed totally differently than the same medical problem in Iowa City, even though the patient is identical.

HEFFNER: And even … and with different costs, too.

MEIER: Very different costs, but also very different approach to management. And it’s not like the doctors are any less competent in New York or Iowa City … they were trained differently. And those local forces are very tenacious.

And that’s true everywhere in the world. So we can’t say, “Well, they had it all sown up in Canada, or they have it all sewn in New Zealand” … there are places were they … it’s better than other places.

Again, important for the patient and the family to understand what’s available in your community and at the hospital that you go to. Because if you’re getting your care in a hospital that doesn’t have strong and well-integrated palliative care … that’s not a good idea if you have a serious illness. You need to go to a hospital that’s really prepared to help you through it.

HEFFNER: This emphasis upon self-knowing, self-protective patients and their families …

MEIER: Yeah.

HEFFNER: … gives me the heebie jeebies … some …

MEIER: And you’re right.

HEFFNER: … for some reason.

MEIER: You’re right to have the heebie jeebies … when you’re least able to advocate for yourself because you’re really sick and you’re scared and you’re exhausted and you’re not sleeping and you’re in pain, and you’re worried about your wife and you’re worried about your kids … we’re saying …

HEFFNER: Yeah, how am I going to …

MEIER: … here’s where you gotta step up and be the corporate captain of your own ship. I wish it wasn’t the case. I wish I could say to you … you can … just fall back into the arms of the doctor and the healthcare system and trust that everything will be fine. The data don’t support that.

And you know, there are data … somebody gave me data yesterday that you are seven times more likely to die of a hospital medical error than you are jumping out of a plane with a parachute.

HEFFNER: (laughter) Very interesting comparison.

MEIER: So parachute jumping is safer because the quality control systems are much more standardized and consistent. If you were in Iowa City jumping out of a plane or Teterboro Field in New Jersey jumping out of a plane, they follow exactly the same safety systems. That is not true in the United States … in hospitals.

And … so the fact is hospitals are pretty risky places, particularly if you’re vulnerable, if you’re cognitively impaired, if you are immuno-suppressed from chemo therapy or radiation, or just being sick … stay out of the hospital unless you really have to be there for a procedure, like a surgery or something like that. Because they are dangerous and the more vulnerable you are, the most dangerous they are.

So, that’s why I say, “Let the buyer beware” and that’s why, if I have an older person going into the hospital, I tell the family they’ve got to take shifts, somebody’s got to be there all the time.

HEFFNER: Say that again.

MEIER: If I have an older person, a patient, going into the hospital, I will say to the family in advance … you need to pull in friends, family, people from the church and take shifts and have people sign up for shifts to sit with the patient.

HEFFNER: Now, tell me … why … what are the elements …

MEIER: Because everybody means well, but there are a lot of … there’s a lot of time pressures. And a lot of patients to take care by an ever more stressed and inadequately staffed team.

So things like … if the patient needs to go to the bathroom and they push the call bell and nobody comes … and then the patient tries to climb over the railing …

HEFFNER: MmmHmm.

MEIER: … and falls and breaks their hip. If nobody’s there … if you’re there, you can make sure that doesn’t happen, you can help the person to the bathroom. You can go out and collar the nurse and say, “You have to come in now, he’s climbing out of bed”. You have to have somebody with you … the hospitals are not staff adequately to respond quickly to important needs. Mistakes happen. Medications get given to the wrong person. You, you’ve probably read about wrong limb surgery …

HEFFNER: MmmHmm.

MEIER: … wrong side surgery … there’s a much more awareness of that now and much more effort to try to make it better, but it is far from perfect.

HEFFNER: I remember one of my early GP’s, Mack Lipkin, would tell me stories about the twenties … when well to do people would always make certain that they bought the time and services of Interns and Residents on their occasional day off to sit there with them, doing what you say a family member …

MEIER: Right.

HEFFNER: … or a friend must do now.

MEIER: So, for people who can afford it, I tell them to hire a companion who sits at the bedside, who … if someone needs help opening those impossible to open applesauce containers …

HEFFNER: (Laughter)

MEIER: … will open it. Will help the person eat. Will help them get to the bathroom. Will make sure they’re clean and dry. The staff in the hospital … you’re lucky if once a day someone comes in to clean you up. They’re busy … they’re taking care of … on a given floor … 30, 40, 50 patients. And it’s just the reality.

So, if you can’t afford it … can’t afford to pay privately for it, you need to mobilize a team to be with you. And many errors are prevented that way. And many adverse events are prevented that way.

HEFFNER: I always knew that going to the hospital was bad (laugh) for your health …

MEIER: (Laughter)

HEFFNER: … but I’ve learned more and more and more how true that is.

MEIER: Yes.

HEFFNER: I learned it as a joke. But it’s no joke.

MEIER: No, it’s not a joke. But one thing … people facing, you know, significant complex or serious illness can do is ask … even demand … palliative care support and consultation to work along side their medical team. To address all those things that get lost, that fall through the cracks.

HEFFNER: Even though you still have to fight and fight and fight to find a better, stronger place for palliative care in American medicine.

MEIER: You know, all good causes are worthy of the fight and the battle.

HEFFNER: And you feel that it’s being won.

MEIER: I do. I used to be a cynic, I’ve become an optimist. Even in this healthcare system …

HEFFNER: I don’t think you were ever a cynic …

MEIER: … even in this healthcare system … to see that despite the fragmentation and the ways in which this healthcare system does not work on behalf of patients, what I’ve seen in the last ten years in terms of the growth of palliative care, says to me this healthcare system has the capacity to heal.

HEFFNER: And do you think … in the 30, 40 seconds we have left that we’re … on a government level … moving in that direction?

MEIER: We’re trying to move in that direction on a government level … we have a political process that militates against a coherent, integrated patient centered healthcare system. And, you know, I wish more people were involved in politics and paid more attention because then maybe government would be more responsive.

HEFFNER: You’re a great interviewee …

MEIER: (Laughter)

HEFFNER: … thank you so much for having joined me the last time and this time Dr. Diane Meier. You’ll come back?

MEIER: I’d love to come back. You know I love to come and talk with you any time. Thank you for having me.

HEFFNER: Thank you. And thanks, too, to you in the audience. I hope you join us again next time. Meanwhile, as an old friend used to say, “Good night and good luck.”

And do visit the Open Mind Website at thirteen.org/openmind to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.

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GUEST: Dr. Diane Meier
AIR DATE: 2/8/2014
VTR: 07/17/13

I’m Richard Heffner, your host on The Open Mind. And my guest today is Dr. Diane Meier, Director of the Center to Advance Palliative Care, a national organization devoted to increasing the number and quality of palliative care programs in the United States. Indeed, under her leadership such programs have more than tripled in US hospitals in the last decade.

Dr. Meier is also Professor of Geriatrics and Palliative Medicine and Gaisman Professor of Medical Ethics at Mount Sinai Hospital’s Ichan School of Medicine in New York.

She has received a MacArthur Foundation “genius award” as well as the American Cancer Society’s Medal of Honor in recognition of her pioneering role in bringing palliative care into mainstream American medicine.

All of which leads me to ask my guest briefly to define or explain palliative medicine for those who may not be familiar with it … and to raise a question to which I hope she won’t take exception: just why has putting palliative care front and center in American medicine been a struggle?

MEIER: Great questions, as usual. So, palliative care is a relatively new medical specialty that is focused on maximizing the quality of life of people living with one or more serious illnesses …such as cancer or heart disease … or kidney problems or dementia and their families to make sure they have the best possible quality of life.

So that means focusing on the symptoms … pain and stress of a serious illness and very much focusing on the family as much as the patient because every patient and family caregiver knows without family patients would never make it in this healthcare system.

Palliative care is typically delivered by a team of doctors, nurses, social workers and others who come together to support the most complex patients through the course of what are often many years, sometimes many decade-long illnesses, to help serve as a quarterback in some ways for them in this very fragmented, confusing patient unfriendly healthcare system that we have here now.

Palliative care is delivered at the same time as all other appropriate medical care. So, for example, if god forbid you were newly diagnosed with a cancer that could be cured, you would receive palliative care from the point of diagnosis throughout the whole treatment and then when your oncologist said “So long, Dick, you’re cured”, we’d say, “So long, call us if you need anything.”

But most of our patients have chronic disease, things that they live with for a very long time. And what we try to do is make those extra years worth having. So that patients and family stay in control and accomplish what matters most to them and that the healthcare system serves them instead of patients and family sort of feeling like they’re serving the healthcare system.

HEFFNER: But that’s the way I would have thought one would describe medicine.

MEIER: And I think in some ways palliative care is rekindling the originating ethos and professionalism of medicine and the healthcare field.

What’s happened since World War II is that the generalist has disappeared in healthcare and all we have now are ever more narrowly defined specialists.

So there’s a specialist for the cataract. There’s a specialist for general ophthalmology, there’s a specialist for high blood pressure, there’s a specialist for heart failure, there’s another specialist for emphysema and yet another if you have kidney problems, and someone else to manage your low back pain and arthritis and yet another person if you happen to develop cancer.

That is the typical situation in the US now. The average Medicare beneficiary in their last two years of life see something like 18 different specialists under Medicare during that time. I mean you would have to be a rocket scientist to coordinate that, to keep that coherent, to make sure that all these people are communicating with each other and not prescribing drugs that have bad interactions, for example.

So we’ve gone from a sort of generalist medical profession where everybody had a family doc … a GP … to a situation now where most people now have a doctor for every organ and every part of their body and no one is serving as a quarter back, except the beleaguered family caregiver.

And what palliative care does is come into that gap and advocate for the patient and the family in this fragmented healthcare system, working along side the patient’s other doctors, making sure that they’re communicating with each other, making sure that what they say is translated in plain English, or Spanish, as the case may be, to the patient and family. And that the doctors understand all of the contextual factors that the often don’t know about.

So, for example, an oncologist might prescribe something for nausea from chemotherapy, without knowing that the patient and the family cannot afford the drug. Or … and not even bothering to think about whether they had health insurance that would cover the drug.

And sending them off to have uncontrolled nausea because they can’t afford to fill the prescription or because they don’t have a car to go pick it up. Or because they’re in a four story walk-up and can’t get there.

So, we kind of try to bring the reality of the patient and family’s real life into connection with the doctors and nurses that are trying to help them.

HEFFNER: It sounds impossible.

MEIER: Well, it’s not impossible, it’s very rewarding because you actually can see how by addressing these issues of transportation or people who don’t speak English or people who didn’t graduate from junior high school and really don’t understand the instructions that were given to them. Or of people who have severe pain or other symptoms. Their doctors are busy focusing on the disease, not the consequences of the disease … that we can actually restore health in a lot of ways. And, indeed, possible …

HEFFNER: You mean the disease?

MEIER: Well, I …what I mean is that if you have a bad disease and you are also depressed, not sleeping, in pain, too sick to eat … you are not well enough to fight the disease and actually multiple studies … about five different studies have now shown that people who get palliative care at the same time as treatment for their disease … as compared to people who only get the treatment for the disease, those who get both, live longer.

And when you explain this to the public, they go “Well, of course, if people aren’t in pain, if their depression is treated, if their families understand what’s going on and their families are getting help and support and the patient feels like they have the information they need and they’re in control, of course they live longer”.

But when you explain that to doctors, they just don’t get it.

HEFFNER: Well, I was just going to say, “Sure when you explain it to the public … we’re the ones who are experiencing what you’re describing …

MEIER: Right.

HEFFNER: … what happens, when you describe it to doctors?

MEIER: Well, first they have to get over feeling like you’re criticizing them. They have to get over …

HEFFNER: You are.

MEIER: Well, not really. Doctors practice as they were trained. You know, if I get a cancer, I’m going to find the oncologist who sub-specializes in my particular kind of cancer if I have to travel across the country to find that person.

HEFFNER: Right.

MEIER: But … because I want somebody who’s expertize is in my particular kind of cancer. But I know that that … I cannot expect that person to pay attention to my depression, my pain, my shortness of breath, my worry about my family, my finances, my anxieties about whether I’ll be able to complete things I’m … I started at work … I don’t expect that person to have expertise in those areas. I expect him to have expertise in my particular kind of cancer.

And, and that’s what’s happened. You know, we’ve, we’ve begun to train people in a very deep way, but not a broad way.

HEFFNER: So then you … and I’ll bet when you were a little girl, you did this, too … you’re spitting against the wind.

MEIER: Yeah, I’m a sort of rebellious type. It’s, it’s not spitting against the wind because it’s actually completely in alignment, what we’re doing is completely in alignment with why people go to medical school and nursing school.

They go to medical school and nursing school to try to help people. And then we put them through a training process and a reimbursement system that is much more about its own survival in some ways, than it is about what’s best for patients and families.

So I … what we’re doing is attracting the best and the brightest among young physicians, young nurses, who are just completing their training. They want to work in palliative care because it’s why they went into the field in the first place … to help people.

And they see how powerful the impact is … of doing simple things like actually not talking so much and primarily listening to what matters the most to the patient and the family.

It’s … there’s tremendous anxiety in doctors about talking about what might happen in the future if someone has a bad disease or helping people know what to expect if its not great news. But actually it’s not mostly about doctors talking … palliative care … it’s mostly about listening. And understanding who the patient is as a person. And what the back story is in the family and what the pressures are that they’re under. What keeps them awake at night. What are the things they’re hoping for? What are the things that cause them the most regret and distress.

And then helping to figure out a way that the healthcare system can help them achieve the things that matter most to them … work with them, pay attention to what matters to them as an individual.

It’s not designed to do that now, but we’re trying to restore that.

HEFFNER: When you say, “it is not designed …

MEIER: The healthcare system.

HEFFNER: The system.

MEIER: Right. The healthcare system is designed in this very sub-specialized organ and disease specific silos … parallel silos that don’t really talk to each other.

And are designed not to look at the patient as a whole person.

HEFFNER: There must be a plus in that design.

MEIER: Yes.

HEFFNER: There must be something very positive.

MEIER: Yeah, absolutely.

HEFFNER: Can you have that and what you’re describing?

MEIER: That’s the whole point. It’s like we don’t want to give up the wonders of advanced American science and technology in medicine. Like I said, if I get cancer I’m going to find the best specialist in that kind of cancer if I have to travel across the country to get to that person. Because I know the quality of my cancer care will be the best anywhere with a sub-sub-specialist.

But I also want a team that’s going to pay attention to everything else that matters to me as a person.

HEFFNER: Dr. Meier, you say you want that.

MEIER: MmmHmm.

HEFFNER: Can you have it?

MEIER: Actually, increasingly you can. As you mentioned in the introduction, in the last ten years or so, we’re now at a point where, if you take the big hospitals, those with more than 200 beds in the United States, and those are the places that take care of most sick people in this country. 90% now have a palliative care team.

So at 9 out of 10 of the major hospitals where people with serious illness go … because that’s where all the specialists are … there are palliative care teams. So one of the reasons I love to come on your show is because the key to getting palliative is demanding it.

Remember your oncologist, your cardiologist, your neurologist probably trained, if he or she is a seasoned, you know, prime of life professional, probably trained during an era when there was no such thing as palliative care. Doesn’t understand it, doesn’t know how to integrate it into his or her practice.

But if you, the patient, or you the family member of the patient say, “You know, I understand from reading The New York Times, or watching TV that palliative care is a great adjunct to what you’re doing and can help me and my loved ones quality of life, and may even help me live longer. Do we have a program here?”

HEFFNER: Do we have a program here in terms of what’s happening to the costs of medical care?

MEIER: Ahemm, so what are you asking?

HEFFNER: I’m asking whether you’re running into, at this particular moment …

MEIER: MmmmHmm.

HEFFNER: … just when you’ve seen what we need …

MEIER: MmmHmm.

HEFFNER: … and for ten years have been working so hard at this and see it growing …

MEIER: MmmHmm.

HEFFNER: … are you running into that wall of … that’s made up of dollar marks.

MEIER: Yeah. No, actually, this is one of those rare events where there’s alignment between the needs of the payers … private insurers, Medicare … the needs of hospitals and health systems and the needs of patients and families.

And I’ll tell you why and I’ll give you a case example. So we have a patient … I’ll call him Mr. B. He is younger than you … 89 years old … he has some dementia, he’s okay if he’s home with his wife, but he can’t go out alone, he tends to lose his way when he’s out alone.

He has bad low back pain from arthritis, that causes him a great deal of distress, whenever he changes position, he’s in a fair amount of pain. When he wakes up in the morning, he’s very stiff and has trouble getting going.

And it’s been really hard to control the pain of his low back without it interfering with his memory and his cognition and his mental status. This man has been in the Emergency Room four times in a six month period. Twice for uncontrolled pain and once for constipation from the pain medicine that hadn’t been recognized and hadn’t been prevented and once for confusion related to unmanaged pain … that is the pain caused agitation.

Each time a crisis happened, his wife would pick up the phone and call the doctor’s office. And each time the crisis happened, of course, it was after 5 o’clock or it was Saturday or it was Sunday.

So what happens, she calls the doctor’s office and there’s a tape and the tape says, “If this is a medical emergency …

HEFFNER: Go to the Emergency …

MEIER: … call 911 …

HEFFNER: (Laughter)

MEIER: … so she calls 911 each time and goes to the Emergency Room whereupon this 89 year old cognitively impaired person in pain is admitted to the hospital. Four times. So you want to guess how much that cost Medicare in a six month period? Hundreds of thousands, if not millions of dollars. For care that should have been delivered at home, should have been … he should have been able to call someone at 5:17 p.m. or Sunday afternoon and gotten advice about how to handle this. But no, the system is not designed to do that.

So does palliative care save money? Yeah, it saves a lot of money. It saves money because it delivers better quality care. So if Mr. B had had someone at the other end of the phone that could have said … could have checked in and said “You, Mr. B … Mrs. B we just started your husband on a pain medicine that might cause constipation, I want to make sure you’re giving him the right laxatives and I need to hear from you in two days if he hasn’t had a bowel movement.” To prevent this crisis from happening …someone who would call back after starting the medicine and saying “How’s it going? Is the pain tolerable? Is he able to move around? How’s it affecting his memory?”

A phone call, a couple of two minute phone calls could have prevented four ER visits and hospital stays. Does that save the system money? A huge amount of money.

Does it improve the quality of care for Mr. B? Dramatically. So the cost savings from palliative care are not its purpose. They are an epi-phenomena, a side effect …

HEFFNER: But …

MEIER: … of better quality.

HEFFNER: … but there are two things I’d like to correct you on … first place … I’m not even 88 yet … give me another couple of weeks.

MEIER: Okay. All right, all right. Sorry, sorry (laugh).

HEFFNER: Two, more importantly … how to put this … you’re arguing to the choir, in a sense … I’m not raising the matter of dollars …

MEIER: MmmHmm.

HEFFNER: … because I’m a tax payer and you’ve got to tell me how it works out not only better for the patient, but better for my pocketbook …

MEIER: Right.

HEFFNER: I’m talking about contemporary realities …

MEIER: Yeah.

HEFFNER: … in terms of …

MEIER: No. Palliative care is paid for … it is … you know … so if I see you in my office and you have high blood pressure, I write a progress note and I submit a bill to Medicare and the diagnosis code is “high blood pressure” and I bill based on how long I spent with you … 20 minutes, 40 minutes, 60 minutes. And Medicare reimburses me.

If you come into my office for a palliative care visit because you’re in pain, or you’re depressed or your family’s falling apart, I will bill for pain or depression or family counseling and Medicare will pay me.

It’s the same as any other doctor’s visit. We get reimbursed the same as any other visit.

How do we pay for the whole team … remember I said it’s a whole team …

HEFFNER: MmmHmmm.

MEIER: … that delivers palliative care. You can’t support the whole team on “fee for service” reimbursement, because only the doctor and the nurse practitioner can get paid for what they do. We can’t get our Chaplin paid or our social worker paid, or our message therapist or our art therapist, or our music therapist … paid for what they do.

Support for those elements of the team comes from the hospital’s operating budget because it is worth it to the hospital to invest in supporting this team, because not only do the patients do better and feel better … they end up costing less because they do better and feel better.

They have fewer complications, their length of stay in the hospital is shorter, their families feel communicated with and reassured. It’s good for everybody. So in most hospitals in the country, palliative care teams are supported by … as the stockbrokers like to say, “a diversified portfolio of support”. So, some of it is “fee for service” billing, some of it is support from the health system or the hospital. Some of it is philanthropy and some of it … we just do it for free.

HEFFNER: Now, why has it been a long hard road to get the medical community to understand that it must change. You must change its training.

MEIER: It’s, it’s a cohort … a generational cohort effect …

HEFFNER: Generational …

MEIER: Yeah. So as I said … most doctors practicing today are Baby Boomers and the generation before Baby Boomers … my age and within 10 years of my age.

None of us have any exposure to the field of palliative care because it did not exist during our training.

Most doctors, and here’s the good news … do practice the way they were trained. That is, if we train you to practice a certain way, you will continue to do that for the next forty years.

HEFFNER: And if the way isn’t what it should be …

MEIER: Right.

HEFFNER: … you still will.

MEIER: Exactly. And the good news is we can change the training and change the practice. The bad news is, is it’s really hard to change physician behavior that is entrenched from training and decades of practice.

And people who have tried to change physician behavior acknowledge that it’s probably the hardest biological system to influence (laugh) on the globe. We’re very certain that the way we’ve always done it is the way to do it.

HEFFNER: Well, your training is so rigorous in the first place.

MEIER: It is, it’s an intense socialization period, it’s … you know, you don’t sleep during many of those years. You’re terrified because you’re dealing with life and death and you know, the … kind of the moral burden of responsibility that you’re carrying. So it’s a very kind of deep socialization process. And people have to believe that what they were trained to do then, is the right thing to do.

Because during your training you’re, you’re terrified, you want to make sure you’re doing right for patients. You accept what you’re taught as the gospel.

HEFFNER: And you’re changing that?

MEIER: Trying. And what we’re seeing is that the younger generations of physicians, people who have been trained in the last 10 years, the last 15 years all trained in teaching hospitals that have palliative care teams. And worked right along side them to take care of their patients. And are much more comfortable working with palliative care teams because they see the benefits it brings to their patients.

They see how much better their patients do. How much better they feel. How much happier the patient and the family are and how much better the planning is for what’s going to happen when somebody goes home from the hospital.

HEFFNER: And rewards? The material rewards?

MEIER: For who?

HEFFNER: For the practitioners.

MEIER: Well, we’re like any … what we call “cognitive” specialists, so we’re not surgeons, we don’t stick things in you. We’re not interventional cardiologists, we don’t do dialysis, we don’t infuse chemo therapy.

That the rich doctors in the United States are the ones who do things to people. They infuse very expensive drugs, they stick needles in you, they cut you open.

In, in our society we pay those people literally tenfold what we pay people who think for a living. And talk to people for a living. Talk to any pediatrician, psychiatrist, general internist, family practitioner, those people get paid literally one-tenth of what most orthopedists, ophthalmologists, plastic surgeons, urologists, oncologists get paid, because they’re procedural specialists.

HEFFNER: Now that’s a reflection, you’d have to admit of our general culture.

MEIER: Yes, it is a reflection and …

HEFFNER: But where from your optimism?

MEIER: The Affordable Care Act, so …

HEFFNER: Tell me about that.

MEIER: The reason that hospital palliative care grew so rapidly in the last ten years and I wish I could say it’s because everyone saw the light that patients needed more compassionate care that was about what mattered to the patient and family.

And certainly that’s a piece of it, if we hadn’t been able to demonstrate that we were able to do that, we would have gotten nowhere. But the real driver was the business case for palliative care, which is that hospitals began to see that with a well-integrated palliative care team, they were losing less money.

We’re still losing money. But they’re losing less money on the very complex high risk patients.

HEFFNER: For real?

MEIER: For real, oh yeah, there’s multiple studies demonstrating that. What there never was was a business case for palliative care outside of hospitals. Until the Affordable Care Act passed. The Affordable Care Act health reform now creates penalties for hospitals and doctors that do not effectively manage the sickest, most complex patients.

So, for example, if I discharge you from the hospital and you come back within 30 days because I didn’t do a good job of making sure the discharge plan was safe and you were going to see your primary doc two days after you went home and that you really understood your medications and were able to say back to me what the plan was and you cam right back ‘cause I had done a very bad job of the discharge … the hospital’s going to be significantly penalized financially for the fact that you came back. I can tell you this is dramatically motivating hospitals.

HEFFNER: Does it …

MEIER: Pay a lot more attention to what happens to their sickest, most complex patients when they go home and therein is the business case for palliative care in the community.

HEFFNER: Would it be fair for me to ask whether it also provokes, stimulates, rouses opposition in the medical profession to Obamacare?

MEIER: No, I, I …

HEFFNER: No?

MEIER: … I think like the rest of the American people, physicians are confused about Obamacare. I think, you know, the fact that the bill is complex, the fact that the bill is the classic exemplar of government sausage making and special interests … hospitals, insurers, pharmaceutical manufacturers, device manufacturers … everybody got in there with their lobbyists and demanded their pound of flesh from the Bill, which is why it is such a complex, difficult to understand Bill and why it’s been so difficult to explain it in plain English to the public.

I think it’s also very difficult for physicians to understand “what does it mean to me?”. And what physicians end up hearing are kind of headlines that are hyperbolic and not balanced and … but if you survey physicians in the United States, 80% believe we need a national health insurance plan. Believe that every patient should have access to healthcare. Eight out of ten doctors think the current system is wrong.

HEFFNER: Dr. Meier, we’re at the end of our program …

MEIER: Okay.

HEFFNER: You’re at such a crucial point now on what you’re saying … would you be willing to stay and do another program?

MEIER: Sure.

HEFFNER: Good.

MEIER: Be happy to.

HEFFNER: Dr. Diane Meier then, (laugh) thank you for joining me today and I look forward to talking to you further at this table now.

And thanks, too, to you in the audience. I hope you join us again next time. Meanwhile, as another old friend used to say, “Good night and good luck.”

And do visit the Open Mind website at thirteen.org/openmind
to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.

N.B. Every effort has been made to ensure the accuracy of this transcript. It may not, however, be a verbatim copy of the program.

The post Bringing palliative care into mainstream American medicine, Part I appeared first on Richard Heffner's Open Mind Archive.

GUEST: Rabbi J. Rolando Matalon
AIR DATE:2/1/2014
VTR: 10/10/13

I’m Richard Heffner, your host on The Open Mind .. and today — as I did a few months ago — I would like so much to reprise – at least in tone and intellectual conviction – a well-remembered conversation I had at this table a little over a quarter century ago.

Its theme, as that of several other Open Mind programs in the late 20th century: was religion and social activism…which Jesuit Father John LaFarge, Editor of Catholicism’s “America” Magazine had discussed with me here on Open Mind…and as had Protestant Ministers William Sloane Coffin and Martin Luther King, Jr., among others.

But on November 22nd, 1987, my guest here was the late Marshall Meyer, the distinguished Rabbi who then presided over New York’s ancient Ashkenazic synagogue, Congregation B’nai Jeshurun…where, I should note, my wife worshipped then, and does now…and where spiritual leadership is shared now by today’s Open Mind guest, Rabbi J. Rolando Matalon, brought there to the pulpit by his great teacher, mentor and friend, Marshall Meyer.

Now, some thought Marshall Meyer too radical, perhaps preoccupied to distraction with concern for the poor, the dispossessed, the “others” of the world around us. And I asked him quite directly, those many years ago, whether this constant commingling of social activism and religion might be a divisive factor.

His reply was quite compelling:

He said, “I can see where those individuals who consider the Church, or the Synagogue in my case, to be what they require of a Valium … They would like to come on Friday night or a Saturday morning and hear a very, very anodyne, mellifluous, saccharine service of the same nature, the same taste.

“I don’t believe that that’s what a service is about, said the Rabbi.

“I believe that there are moments of jubilee, jubilation, elation. There are moments of celebration, there are moments of meditation … But the basic thrust of the service must be to find in one’s own life the presence of God, and to translate that presence into action. And I think I stand on very solid grounds on that, Dick.

“Because if we had to make this division between politics and religion, then we would have — to quote the words of the magnificent Abraham Joshua Heschel, who is probably the greatest thinker of 20th century Judaism — we’d have to take out the biggest politician of all, and that’s God … who [would then have] no place in the Bible, because he is constantly interested in the poor, in the freedom of men and women, in the widow, in the defenseless, in freeing the oppressed.

“After all,” concluded Rabbi Meyer, “we Jews were slaves under Pharaoh in the land of Egypt. We Jews come from slaves … this is the thrust of prophetic Judaism … it can be divisive, and if it is, it should be.”

Now when last time I asked today’s guest how much he agrees with our late friend, he replied, “Our late friend was also my beloved teacher…he spoke eloquently…and this is why I became a Rabbi. “So I stand firm in that conviction…which is not always easy to implement. But this is what I believe…what people of faith, religious people, are called to do.”

And when I then asked Rabbi Matalon whether these beliefs also led to disagreement with his own congregation today, he essentially replied, “Not really…just here and there”. And I, of course, would ask him now just where “here and there” mostly are. Is that fair?

MATALON: Very fair.

HEFFNER: Where are they?

MATALON: So we have a very large congregation. I think we are known, we have acquired a reputation because of Marshall’s work in the new beginning of our congregation. By the way our congregation was founded in 1825 … we’ve been around for a long time.

But Marshall restarted the congregation after a very, very difficult period in the seventies and early eighties. In 1985 he came and he brought the congregation back to vibrancy.

I was privileged to be part of that resurgence together with him. And under his leadership and my partnership with him and then with the additional of my colleagues after his passing … Rabbi Bronstein and Rabbi Saul … we have acquired a reputation of an active congregation.

We believe in spiritual activism, we believe that we are required, that we are expected … that there’s an expectation that comes from God, wherever God is to … for us to stand up and to do the best we can to fix this world.

And so we have acquired a reputation of an activist congregation. We’re a large congregation. Of course, not everybody agrees with everything, as one would expect.

However, it is remarkable that on most social issues of our time, there is a great deal of consensus in our congregation. We have a great deal of consensus about most issues in America. Of course, I said here and there because we large and it cannot be expected that everybody will be in agreement.

Where there is a little bit more of a disagreement and sometimes a little bit more tension is on the issue of Israel. You know there are two major concerns about Israel.

One is the concern for Israel’s security and safety. And … to some people there is always some sort of a threat to Israel’s existence … very existence. We should not dismiss those concerns.

Another concern is the concern that Israel might be able to raise itself to, to fulfill its aspirations and its dreams … which have been stated in its Declaration of Independence and which have the roots … a very long time ago in our sacred writings and in the Torah and in the prophets, the vision that Israel will be a place of justice and peace and equality and morality where Jewish values, where the, the great Jewish … that have inspired a great part of humanity as well. That we have shared through Christianity and through Islam these great values will be the engine that move this society … this Israeli society … this country forward to fulfill its, its, its aspiration and its dream.

So you have these two concerns … the concern for security, as well as the concern for the, the aspirational vision, might we call it.

Now, of course, we have to be concerned for both. And we have to do … to be concerned for both at the same time. Now there are some people that … when the accent is placed on the aspirational vision they say, “How come you are abandoning Israel’s security?”

When we put the accent on security, some people come and say, “How come you’re abandoning the aspirational vision?”

Now my colleagues and I have the tendency, because we know that most of the Jewish community, the organized, established Jewish community is very firmly concerned and actively defending Israel’s not only right to exist, but also right to security, which is important.

We know that the community cares for them. There are some of us that need to reminding ourselves and reminding the community about this other concern. Which is often sacrificed for the sake of security.

So sometimes we … as we emphasize the aspirational vision, there are those who come to remind us that, indeed, we can’t abandon security.

And so, to quote Leon Wieseltier, he has a wonderful quote in an article in The New Republic, maybe a few years ago.

He says the centrifuges are spinning in Iran. And settlements are being built on the West Bank. He says we should be concerned about the centrifuges in Iran as if there were no settlements in the West Bank and we should be concerned about the settlements in the West Bank as if there were no centrifuges in Iran.

And I believe that is the position that we should embrace. Now, as I said before, knowing that there are a great many people and, and a great many institutions … great institutions of organized American Jewry who are availing and defending Israel’s security … some of us need to be reminding ourselves and reminding Israel and reminding world Jewry that we need not … we must not abandon Israel’s aspiration. Which I believe Israel doesn’t, but sometimes it gets caught in the, in the issues of security.

And so, that’s where sometimes the disagreements occur, the tensions occur. I think there’s a great deal of consensus in our congregation that everybody wants Israel to be secure and for there to be peace. I think there’s no fight about that … about those principles.

HEFFNER: Those are the aspirations. And you say they’re, they are common to the congregation. What happens to you in your role as spiritual leader when you feel that a point must be made on one side or the other.

Life doesn’t go in such a way that we’re always saying on the one hand …and on the other or … in point … terms of point A and in terms of point B …

MATALON: Right.

HEFFNER: What’s your relationship with the congregation?

MATALON: Well, I have … I’ve been in this congregation for now 27 years. So there’s a very long history and trajectory and besides discussing these issues which I don’t discuss as a politician, I discuss these issues as a religious leader and informed by my understanding of the sources of our tradition …

HEFFNER: Rabbi Matalon …

MATALON: … I don’t do this as a politician.

HEFFNER: What, what does that mean, “I don’t do this as a politician”?

MATALON: I don’t engage in politics. For example if we talk about the issue that we were just discussing … about Israel, for example … I’m not an expert in, in borders and, you know, how many refugees, how many … where the borders should go … I mean I’m not … that’s not my expertise. And that’s not also my interest.

There are people who would resolve this conflict and sit down and talk about maps and talk about all sorts of issues that have to be discussed. My interest is, as I said at the, in the opening that I, I believe there’s an expectation.

The expectation from God is that we will sit with those with whom we disagree and we will solve our issues peacefully and respectfully. That we will see the other person as a human being in the image of God.

That’s why I’m saying as speaking as a religious leader, as a spiritual leader. This is what our traditions command us to see the other … not as lesser, not as a … some sort of a demonic force in the world.

But somebody created in the image of God who has the same right to, to life and to dignity and to freedom as I have.

And that our conflicts have to be resolved on that basis and on the basis of morality and on the basis of justice.

So, that’s … I believe what our traditions come to remind us and this is what religious leaders are supposed to put before our followers and our congregants is to remind us all the time.

It’s … of course, it’s, it’s much easier … the other path is much easier.

HEFFNER: That of the politician?

MATALON: That, that … no, that of not resolving the conflict and that of war and that of permanent conflict. It’s the … it’s much more difficult to uphold these principles to see the other in, as I was explaining. And so we have to … because it’s more difficult … we have to keep reminding and working and making the effort to … to bring ourselves … to put ourselves on that path.

And so I speak this language, informed … what does it mean “informed” by the, the tradition? I understand the texts of our tradition … I’ve studied them. I’ve studied our history. I understand, as best I can what are the essential values of, of our tradition and I do my best to try to, to mediate them to my congregation … to explain them, to search together about what this could possible mean in more complicated situations.

And this is, this is part of my work. Now, I’ve been there for, for a long time. I, I don’t … as I said, I don’t only speak about these things, I also teach about other things, we pray together, we serve together, we study together.

I attend to people who are sick and also to, to mourners and, and so on and so forth. My work is encountering the members of my congregation in all sorts of different situations and that’s where the, the bonds between the spiritual leaders and the congregants is forged.

And so over these years, you know, I’ve had the occasion to, to be with people in happy occasions, to celebrate and I’ve been with people in difficult and sad occasions. And, and we have a bond. So when I speak about these issues, I don’t, I don’t speak in the vacuum, I speak in the context of, of a relationship.

And sometimes people disagree, but the disagreements … most of the time, hopefully are within the context of a relationship.

HEFFNER: Again, Roly, if, if I may … I’m not a troublemaker, you know that … but I can’t help because others after we did our last program referred back to what was happening in December 2012, when the New York Times, which I don’t think was making trouble or trying to make trouble had stories relating to your synagogue cheering UN Palestine vote tests its members … “Congregation B’nai Jeshurun a large synagogue on the Upper West Side of Manhattan is known for its charismatic Rabbis, its energetic and highly musical worship and its Liberal stances on social issues, but on Friday when its Rabbis and lay leaders sent out an email enthusiastically supporting the vote by the UN to upgrade Palestine to a non-member observer state … the statement was more than even some of its famously Liberal congregants could stomach.”

And then it quotes some of your congregants who took great exception to it. How was that resolved?

MATALON: So first of all, it was a statement that intended to indicate or to express the, the wish that this vote that took place in the UN on November 29th of last year … the, the wish that it would be a good step forward … that once the Palestinians received such recognition from an overwhelming majority of the UN members … received the sense of recognition and dignity … that this would move the peace process forward in, in … in a faster way, in a better way … in a, in a firmer way.

The … that expression was not properly captured in the an email that was sent to the congregation. The thoughts that we shared were drafted by someone … it did not exactly capture … exactly the nuances that we were looking …this is a very delicate issue and the email went out on a Friday afternoon … without proper editing and proper checking … and there was some miscommunication … internal miscommunication and a number of people were offended by the celebratory tone of this message.

I do believe that something positive can come out of this … my colleagues, as well, believe that something positive can come out … it’s not necessarily a bad thing that the … Palestinians received such recognition. And we were hoping that this would move the efforts of the … the diplomacy efforts in a positive direction.

But some people, as you said, took exception with the language. Some people took exception with the, the mistakes that were made in sending this email when it was known that a number of mistakes had been made.

And there was some discontent over a period of time and we had a number of conversations with congregants and dialogues and we had to move past this issue. We’ve all learned from this. And we … one of the very positive outcomes of this is that … not only that we created systems so that such mistakes would not recur …

HEFFNER: In dealing with the outside world.

MATALON: No, in dealing with the internal mistakes that were made in sending this communication. So there were a number of protocols that were put into place to, to make sure that everything works the way it should work.

But we’ve also had to clarify our positions and we had to establish a mechanism by which people who disagree with any position that the Rabbis take and we didn’t take this position on behalf of the congregation, we took it on behalf of ourselves.

But that was not clear in the email and so people say, you know, “Don’t speak for me. You know, speak for yourself.”

So we have to, number one be careful that when we speak we should speak for ourselves, we don’t represent anybody but ourselves. And that when people disagree with positions that we might take, which people are entitled to disagree … and we’re entitled to our positions … people are entitled to disagree that we might have some form of a dialogue and constructive dialogue and, and, and engage with one another, acknowledging that our community, our congregation is not monolithic and that there is a spiritual leadership that has ideas and thoughts and that there is a, a large congregation where not everybody is in agreement with this position or that position.

HEFFNER: That differentiation between spiritual leadership and the congregation at large, is that something that one would have found expressed a half century ago … a century ago, two centuries ago when the congregation was established?

MATALON: Well, I think that there is a great variety of, of congregation dynamics between the spiritual leaders and, and the members of the congregation. You have congregations where the, the membership represented by their Board of Directors or Board of Trustees … Christian and, and the Jewish congregation equally would empower the spiritual leader to, to say certain things and then certain other things could not be said.

There’s a great many examples of, of such congregational arrangement and then there are examples of spiritual leaders who spoke their mind, regardless of what their members of the congregations thought.

And in many cases Rabbis or Preachers or Pastors who have found that something in the situation having to leave their congregations because of disagreement.

There was one very famous Rabbi in the early 20th century who was a Rabbi at our congregation for just a short period … for a few years … who founded his own congregation in order to be able to speak his mind freely.

He called … his name was Rabbi Stephen Wise, he was a luminary of the Reform Movement in the early 20th century and he founded his congregation called the Stephen Wise Free Synagogue and it … the Free Synagogue is that he would have the freedom of the pulpit.

Now many places, many congregations have in their By-laws the principle of freedom of the pulpit. And in many cases it becomes just some sort of theoretical freedom of the pulpit where the Rabbi or the Pastor is not allowed to, to, to be really … to speak his … freely his or her mind.

And so most places, I think, are somewhere in between in some sort of a back and forth and some sort of creative tension and that’s not necessarily bad.

HEFFNER: And Rabbi Matalon, at this point neither of us has the freedom to go on because the program is over …

MATALON: I’m so sorry …

HEFFNER: (laugh) and our time is up. But thank you …

MATALON: Thank you for having me.

HEFFNER: Thank you for joining me …

MATALON: Thank you.

HEFFNER: … Rabbi Matalon.

MATALON: Thank you.

HEFFNER: And thanks to you in the audience. I hope you join us again next time.

Meanwhile, as another old friend used to say, “Good night and good luck”.

And do visit the Open Mind Website at thirteen.org/openmind to reprise this program online right now or to draw upon our Archive of 1,500 or so other Open Mind and related programs. That’s thirteen.org/openmind.

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