Saturday, August 2, 2008

National Security Roulette Follow Up (Rant)

I decided to post this on both blogs, because there may be some who only reads my rants blog. It says a lot of what I think needs to be said about the Constitution.

Here is a response to my post National Security Roulette, which was an expanded comment to a post by Too Old To Work, Too Young To Retire called Airport Security Again. The TSA (Transportation Security Administration) has a lot of problems and I chose to address some of the other problems, aside from profiling, or the lack of it. Hmm, not the lack of it, but the clumsy attempts to be doing everything possible to avoid the appearance of it - profiling, that is.

TOTWTYTR said...

A friend of mine recently returned from a week long trip to Israel. The short story is that airline security, by necessity, is much more serious a matter in Israel than it is in the US.

Not only is the questioning more intense and appropriate, but they actually *gasp* profile. Quite successfully to as it happens.

Profiling is another tool that can be used. As with any tool it can be misused. If we alienate Muslims, or Arabs, or any other group of which a small number are a threat, by using just that identity as our profile, we lose resources and gain nothing significant. The resources we lose are those in the community who are opposed to what the terrorists are doing. Even if they agree with the political aims of the terrorists, they may be completely opposed to the methods. What we gain is the appearance of safety, but not the substance.

We need counter-terrorist people from the communities that threaten us. One problem with indiscriminate profiling, other than the inherent oxymoron, is that it is just a stereotype that leads us to make mistakes that are easy to manipulate. Back in the days when drug smuggling on airlines was more common, one tactic was to have a very normal looking person carry on the drugs, with a very suspicious looking person a couple of people behind in line, the security person becomes so eager to get to the person who is the profile poster boy that he performs a more cursory than usual examination of all those between the him and the suspect.

We need to be thinking about the ways that we make security worse by profiling, but there is nothing inherently wrong with using a profile that is more specific than just Arab-looking or Muslim-looking. The FBI uses profiles to track down all sorts of criminals. The idea that this should be abandoned, just because of one of the parts of the profile is not politically correct, is a bad idea.

With the attacks on abortion clinics, the profile would have included all Christians. Christians oppose abortion and would support the aim of someone trying to limit abortions. Few Christians have supported the use of terrorism to achieve that goal. Muslims have expressed displeasure with the secular excesses of our society. The terrorists claim that this tolerance, which is essential to our Constitution, is what they seek to destroy with violence. Few Muslims have supported the use of terrorism to achieve that goal.

To limit the profile, of those attacking abortion clinics, to Christians would have been a mistake and probably would have alienated those most likely to be able to help in identifying the criminals. Christians have a similar history of killing people because of religion and they also have the history of being extremely peaceful. The same arguments of "religion of peace" and "look at this passage that demonstrates the inherent violent nature of the religion" could be used for Christians as well as Muslims.

The important point in profiling is to have people with both the capability to use critical judgment and the the permission to use critical judgment. This is not really any different from my approach to paramedics. The people who work for the TSA do not seem to have either. I'm sure there are screeners, who could be taught to use critical judgment and some who understand, but just are not permitted to use critical judgment. The approach of the TSA administration seems to be to discourage all possible critical judgment. This is not the way to security, no matter how prominently the word Security is placed in the organization's name.

Paramedics have the same problem. Protocols written to prevent critical judgment, end up discouraging all judgment. A wise medical director will know what his/her medics are capable of, will educate them to use critical judgment, and will write protocols to encourage them to use critical judgment.

While I have been posting on less medical topics lately, the reason is to discuss problems with judgment. Bad science, bad oversight, and bad judgment in general. These are problems that have significant ramifications for all medical topics.

One of the things opposed by the terrorists is the open nature of our society. This is something protected by our Constitution. They have been somewhat successful in getting us to remodel our society in a way to limit freedom. The powers given to the government, in reaction to the terrorism, have made us less protected by our Constitution, in exchange for the appearance of safety. How much of that appearance is real? I don't know, but too much of the method is in ways that strip America of the things that this country was created to exemplify.

One of my favorite quotes is from A Man for All Seasons. I hate to give a recommendation for a movie over a book, but I have not read the play. The acting is so good, that it probably only adds to the quality of the material. I think these quotes stand on their own, but I can provide more information if you disagree. This is from hundreds of years before our revolution, in the country America fought against for independence, a country not protected with something like America's Bill of Rights.

William Roper: So, now you give the Devil the benefit of law!

Sir Thomas More: Yes! What would you do? Cut a great road through the law to get after the Devil?

William Roper: Yes, I'd cut down every law in England to do that!

Sir Thomas More: Oh? And when the last law was down, and the Devil turned 'round on you, where would you hide, Roper, the laws all being flat? This country is planted thick with laws, from coast to coast, Man's laws, not God's! And if you cut them down, and you're just the man to do it, do you really think you could stand upright in the winds that would blow then? Yes, I'd give the Devil benefit of law, for my own safety's sake!

And in another part, when he is having the law used against him:

Sir Thomas More: You threaten like a dockside bully.

Cromwell: How should I threaten?

Sir Thomas More: Like a minister of state. With justice.

Cromwell: Oh, justice is what you're threatened with.

Sir Thomas More: Then I am not threatened.

We have to be careful what we give up to protect ourselves. We end up mocking those who fought and died for the freedoms we give up. Mocking those who continue to fight and die to protect and defend that Constitution. In order to protect us, it sometimes needs to protect those who would harm us.

To put this in the EMS perspective, we need to be looking to do what we can to protect and defend the well being of the patient. This is our entire reason for having EMS. Rules that defeat that purpose need to be opposed. Whether they come from doctors, lawyers, politicians, or medics. We need to stop putting the patient last, or so far down the list of priorities, that the patient might as well be last. Both directions lead to harm, but continually working to improve the care of patients is one that learns from its mistakes and improves.