Connect with us

The Conversation

What the ‘moral distress’ of doctors tells us about eroding trust in health care

Published

on

theconversation.com – Daniel T. Kim, Assistant Professor of Bioethics, Albany Medical College – 2025-02-04 07:45:00

What the ‘moral distress’ of doctors tells us about eroding trust in health care

Daniel T. Kim, Albany Medical College

I sit on an ethics review committee at the Albany Med Health System in New York state, where doctors and nurses frequently bring us fraught questions.

Consider a typical case: A 6-month-old child has suffered a severe brain injury following cardiac arrest. A tracheostomy, ventilator and feeding tube are the only treatments keeping him alive. These intensive treatments might prolong the child’s life, but he is unlikely to survive. However, the mother – citing her faith in a miracle – wants to keep the child on life support. The clinical team is distressed – they feel they’re only prolonging the child’s dying process.

Often the question the medical team struggles with is this: Are we obligated to continue life-supporting treatments?

Bioethics, a modern academic field that helps resolve such fraught dilemmas, evolved in its early decades through debates over several landmark cases in the 1970s to the 1990s. The early cases helped establish the right of patients and their families to refuse treatments.

But some of the most ethically challenging cases, in both pediatric and adult medicine, now present the opposite dilemma: Doctors want to stop aggressive treatments, but families insist on continuing them. This situation can often lead to moral distress for doctors – especially at a time when trust in providers is falling.

Consequences of lack of trust

For the family, withdrawing or withholding life-sustaining treatments from a dying loved one, even if doctors advise that the treatment is unlikely to succeed or benefit the patient, can be overwhelming and painful. Studies show that their stress can be at the same level as people who have just survived house fires or similar catastrophes.

While making such high-stakes decisions, families need to be able to trust their doctor’s information; they need to be able to believe that their recommendations come from genuine empathy to serve only the patient’s interests. This is why prominent bioethicists have long emphasized trustworthiness as a central virtue of good clinicians.

However, the public’s trust in medical leaders has been on a precipitous decline in recent decades. Historical polling data and surveys show that trust in physicians is lower in the U.S. than in most industrialized countries. A recent survey from Sanofi, a pharmaceutical company, found that mistrust of the medical system is even worse among low-income and minority Americans, who experience discrimination and persistent barriers to care. The COVID-19 pandemic further accelerated the public’s lack of trust.

In the clinic, mistrust can create an untenable situation. Families can feel isolated, lacking support or expertise they can trust. For clinicians, the situation can lead to burnout, affecting quality and access to care as well as health care costs. According to the National Academy of Medicine, “The opportunity to attend to and ease suffering is the reason why many clinicians enter the healing professions.” When doctors see their patients suffer for avoidable reasons, such as mistrust, they often suffer as well.

At a time of low trust, families can be especially reluctant to take advice to end aggressive treatment, which makes the situation worse for everyone.

Ethics of the dilemma

Physicians are not ethically obligated to provide treatments that are of no benefit to the patient, or may even be harmful, even if the family requests them. But it can often be very difficult to say definitively what treatments are beneficial or harmful, as each of those can be characterized differently based on the goals of treatment. In other words, many critical decisions depend on judgment calls.

Consider again the typical case of the 6-month-old child mentioned above who had suffered severe brain injury and was not expected to survive. The clinicians told the ethics review committee that even if the child were to miraculously survive, he would never be able to communicate or reach any “normal” milestones. The child’s mother, however, insisted on keeping him alive. So, the committee had to recommend continuing life support to respect the parent’s right to decide.

Physicians inform, recommend and engage in shared decision-making with families to help clarify their values and preferences. But if there’s mistrust, the process can quickly break down, resulting in misunderstandings and conflicts about the patient’s best interests and making a difficult situation more distressing.

Moral distress in health care.

Moral distress

When clinicians feel unable to provide what they believe to be the best care for patients, it can result in what bioethicists call “moral distress.” The term was coined in 1984 in nursing ethics to describe the experience of nurses who were forced to provide treatments that they felt were inappropriate. It is now widely invoked in health care.

Numerous studies have shown that levels of moral distress among clinicians are high, with 58% of pediatric and neonatal intensive care clinicians in a study experiencing significant moral distress. While these studies have identified various sources of moral distress, having to provide aggressive life support despite feeling that it’s not in the patient’s interest is consistently among the most frequent and intense.

Watching a patient suffer feels like a dereliction of duty to many health care workers. But as long as they are appropriately respecting the patient’s right to decide – or a parent’s, in the case of a minor – they are not violating their professional duty, as my colleagues and I argued in a recent paper. Doctors sometimes express their distress as a feeling of guilt, of “having blood on their hands,” but, we argue, they are not guilty of any wrongdoing. In most cases, the distress shows that they’re not indifferent to what the decision may mean for the patient.

Clinicians, however, need more support. Persistent moral distresses that go unaddressed can lead to burnout, which may cause clinicians to leave their practice. In a large American Medical Association survey, 35.7% of physicians in 2022-23 expressed an intent to leave their practice within two years.

But with the right support, we also argued, feelings of moral distress can be an opportunity to reflect on what they can control in the circumstance. It can also be a time to find ways to improve the care doctors provide, including communication and building trust. Institutions can help by strengthening ethics consultation services and providing training and support for managing complex cases.

Difficult and distressing decisions, such as the case of the 6-month-old child, are ubiquitous in health care. Patients, their families and clinicians need to be able to trust each other to sustain high-quality care.The Conversation

Daniel T. Kim, Assistant Professor of Bioethics, Albany Medical College

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Read More

The post What the ‘moral distress’ of doctors tells us about eroding trust in health care appeared first on theconversation.com

The Conversation

Some viruses prefer mosquitoes to humans, but people get sick anyway − a virologist and entomologist explain why

Published

on

theconversation.com – Lee Rafuse Haines, Associate Research Professor of Molecular Parasitology and Medical Entomology, University of Notre Dame – 2025-02-04 07:44:00

Some viruses prefer mosquitoes to humans, but people get sick anyway − a virologist and entomologist explain why

The Aedes mosquito is a vector of several viral diseases, including eastern equine encephalitis, or EEE, and West Nile fever.
Lee Haines, CC BY-ND

Lee Rafuse Haines, University of Notre Dame and Pilar Pérez Romero, University of Notre Dame

Humans have an exceptional ability to deal with viruses. In most cases, your immune system is able to fight an infection. On the other hand, your body provides a spa-like environment that is temperate and stable, optimal for viruses to replicate. Human behavior, including close contact with animals and frequent travel, also increases the likelihood of becoming infected.

From the perspective of viruses spread by insects, or arboviruses, making the evolutionary leap from insects to humans is a tough battle. Viruses cannot replicate very well in humans, which means transmission from mosquitoes is often very difficult.

One might think arboviruses continually evolve in ways that enable them to infect more species. But do they?

We are a virologist and an entomologist who study insect-borne and viral diseases and how human and insect immune systems respond to invading pathogens. Our work provides insights on the complex journey of an arbovirus as it cycles between insect and vertebrate hosts.

As an example, let’s use a Togavirus, the mosquito-transmitted arbovirus that causes eastern equine encephalitis, or EEE. This rare but serious disease can cause a potentially fatal neurological condition in humans and horses. Although EEE is primarily endemic to the eastern United States, its incidence in recent years has increased in regions farther north, with several reported cases in states such as Michigan, Massachusetts and New York.

While rare, a EEE infection in people can lead to severe complications or death.

From animals to mosquitoes

A female mosquito’s inner workings – particularly its guts and salivary glands – create the perfect environment for a virus to flourish.

When a mosquito bites an infected nonhuman host, such as a sick bird, the virus is transported with freshly ingested blood into the mosquito’s midgut – the equivalent to the human stomach and intestines where food is stored and digested. The virus quickly infects midgut cells to avoid a hostile digestive environment and quietly replicates without activating the mosquito’s immune pathways.

Within days, the virus will be released by damaged midgut cells to migrate to the mosquito’s salivary glands, where it will be positioned for transmission. Now, each time the mosquito feeds, it will pump virus-saturated saliva into its new animal host and continue the disease transmission cycle.

Microscopy image of oblong blobs filled with small red circles, surrounded by blue cicular blobs
This image shows a tissue section of the salivary gland of a mosquito infected with EEE. The virus particles are colored red.
Fred Murphy and Sylvia Whitfield/CDC

It is easy for the virus to avoid detection by the mosquito’s relatively primitive immune system. Compared with humans, the immune system of mosquitoes can launch only a generalized and overall less effective attack on pathogens. This means an arbovirus can usually establish a persistent, lifelong, almost symbiotic infection without damaging the mosquito’s health, perfect for the virus to disseminate itself.

Mosquitoes have evolved over millions of years to become tolerant to arboviral infections. This relationship has allowed the mosquito to maintain viral populations without having to launch energy-expensive immune responses. However, this does not mean mosquitoes are just passive virus carriers. An arbovirus can change how infected mosquitoes behave or reproduce.

For example, viruses can manipulate mosquitoes in two ways: by making them feed more frequently, and by increasing their attraction to infected hosts. However, this behavior puts the mosquito at greater risk of being killed by irritated hosts who notice the repeated biting attempts. Arboviruses can also affect mosquito reproduction by sometimes reducing the number of eggs a female mosquito produces and increasing the length of time it takes for the eggs to mature. In some cases, these viruses can even sterilize female mosquitoes.

Arboviruses have evolved to expertly use mosquitoes as both transportation vehicles and breeding grounds. By spreading and multiplying without severely harming their insect hosts, these viruses ensure their own survival and continued transmission.

From mosquitoes to humans

The virus must overcome several barriers to successfully colonize a human host.

The initial step for successful disease transmission – the virus’s ultimate goal – is perhaps the easiest: The EEE virus infects humans when a virus-infected female mosquito has an unquenchable appetite for warm blood. From the moment the virus is deposited under the skin through the mosquito’s infected saliva, a tough battle ensues.

The first battle for the virus is to adapt to a typically much hotter setting than the ambient environment – the human body temperature of around 98.6 degrees Fahrenheit (37 degrees Celcius) or higher.

Then, the virus must evade the host’s immediate defenses, which includes physical barriers, such as layers of skin and mucosa, as well as immune cells that detect and attack invading microbes. Once in the bloodstream, the virus faces the adaptive arm of the human immune system, which is capable of targeting specific viral components with exquisite precision, like a biological sniper.

Once the EEE virus reaches the central nervous system – the brain and spinal cord – the immune system can overreact to the infection and inadvertently cause inflammation and damage nerve cells. This can lead to serious long-term effects, such as cognitive impairment.

Person with several mosquito bites on their back, some flies yet clinging to their skin
The human immune response is more robust than that of a mosquito.
Sashunita/Cavan Images via Getty Images

To persist in this hostile human environment, the virus uses various survival strategies. One technique is creating new mutations on its surface and shape-shifting to avoid immune detection. Another strategy is to hijack human cells to replicate itself, such as using the cell’s machinery to synthesize new viral components and altering how the cell regulates division.

As viruses adapt to overcome immune defenses, both humans and mosquitoes evolve countermeasures to fight infection. The greater complexity of the human immune system makes it especially challenging for viruses to survive and spread between human hosts.

From human to human?

Like many other arboviruses, the EEE virus cannot be transmitted from person to person, which effectively limits its spread among human populations. Your body keeps the virus contained. Consequently, when the EEE virus infects people via the bite from an infected mosquito, it is considered a dead end, as it cannot escape its human host or infect another bloodthirsty mosquito.

So, what does the virus that causes EEE gain by infecting people? Not likely anything. A mosquito-borne virus like the Togavirus that causes EEE prefers its established transmission cycle between mosquitoes and birds. Human infections occur only when a mosquito deviates from its typical menu of birds.

EEE spreads more easily between mosquitoes and birds than it does in humans, which helps explain why human infections don’t happen very often. Thankfully, human bodies simply aren’t the virus’s currently preferred environment.The Conversation

Lee Rafuse Haines, Associate Research Professor of Molecular Parasitology and Medical Entomology, University of Notre Dame and Pilar Pérez Romero, Associate Professor of Virology, University of Notre Dame

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Read More

The post Some viruses prefer mosquitoes to humans, but people get sick anyway − a virologist and entomologist explain why appeared first on theconversation.com

Continue Reading

The Conversation

President Trump may think he is President Jackson reincarnated − but there are lessons in Old Hickory’s resistance to sycophants

Published

on

theconversation.com – Maurizio Valsania, Professor of American History, Università di Torino – 2025-02-03 09:36:00

President Trump may think he is President Jackson reincarnated − but there are lessons in Old Hickory’s resistance to sycophants

A painting of President Andrew Jackson hangs in the Oval Office on the day Donald Trump was inaugurated for the second time, Jan. 20, 2025.
AP Photo/Evan Vucci)

Maurizio Valsania, Università di Torino

The portrait of President Andrew Jackson has recently made a comeback in the Oval Office. “Old Hickory” – Jackson’s nickname – has long been a favorite of President Donald Trump.

Trump identifies with Jackson on many levels. As a man and a leader, he likes the brash, confrontational, hypermasculine, lionlike attitude that characterized the seventh president. Jackson pushed executive power to the limits, just like Trump tries to do.

And there is a commonality of philosophical and political visions. The two tap into the same definition of freedom. They both believe the president has freedom from all restraint and from every form of legislative or judicial control.

However, differences exist between the two that might prompt Trump to consider the potential danger of how he governs and whom he listens to.

Personal loyalty and devotion

As an expert on American presidents, I can state with confidence that Trump is not the first to insist on complete obedience from his subordinates. Nor is he the first to take disagreement personally.

Trump’s attempt to create an army of sycophants, along with his effort to purge government staff he deems disloyal, is nothing new in America.

Personal loyalty and devotion were important to Andrew Jackson, who didn’t trust human nature. But he was steadfast in his trust, once he decided to place it in a person.

When Jackson had to choose his advisers and shape his first Cabinet, he relied on cronies from his beloved Tennessee – plus a handful of relatives.

The most famous and infamous of those chums was John H. Eaton. Eaton had developed a brotherly relationship with Jackson. Jackson felt indebted to him because Eaton had run his presidential campaigns of 1824 and 1828. Eaton would become secretary of war, but he also ended up embarrassing the president.

A black and white cartoon of a man slumped in a chair with rats bearing human faces running away from him.
A political cartoon depicts President Andrew Jackson sitting stunned as his Cabinet, represented as rats, runs to escape his falling house during the political scandal surrounding the Eaton Affair.
Bettman/Getty Images

First off, he had an affair with a married woman, Margaret O’Neale Timberlake, whose husband was often at sea. When in 1828 Mr. Timberlake died abroad, rumor spread that he had slashed his own throat because of Margaret’s infidelity.

In Washington, D.C., gossip soon became ugly about what was known as the Eaton Affair. It ultimately led to the resignation of some Cabinet officials.

Jackson was irate. He had always realized he didn’t belong in the elite society of Washington, D.C. He was too self-conscious about his entire persona and too aware that he was perceived as an interloper. Consequently, he usually reacted defensively and often violently, thus betraying insecurity: “Our society wants purging here,” he wrote to one of his friends in 1829.

Under the same roof

Jackson’s clan lived with him in the White House. There was Andrew Jackson Jr., a nephew and his adopted son. Andrew Jr. would inherit a huge fortune, but he would die in debt. It’s no surprise that historians have described him as “irresponsible and ambitionless, a considerable disappointment to his father.”

There was Andrew Jackson Donelson and his wife, Emily. Donelson was the nephew of the just-deceased wife of the president, Rachel Jackson, who tragically died just days after her husband won the 1828 election. Donelson had served with Jackson in the Florida War – known as the First Seminole War – and later became his private secretary. Emily Donelson would act as the president’s hostess in the White House.

Another close friend from Tennessee, Maj. William B. Lewis, also moved into the White House. Also a presidential adviser, Lewis gained the official title of second auditor of the Treasury. But the Donelsons couldn’t stand the man. Emily Donelson would eventually label him a “sycophant” who had seized an opportunity to “save himself all expense.”

As he shaped his first Cabinet, Jackson consistently ignored the suggestions coming from the two higher-profile characters of his administration, Martin Van Buren and John C. Calhoun. It wasn’t just an ideological difference; it was that neither of them had been early Jackson men.

Surrounded by a few favorites

Jackson, the president who made no secret that he was running a one-man show, had a presidential style derived from his military experience. As a general, Jackson rarely summoned councils of war. When he had to decide on a given course of action, he didn’t share responsibility.

But critics saw things in a totally different way. In the spring of 1831, Sen. George Poindexter, a hesitant Jacksonian, complained that Jackson was “surrounded by a few favorites who controlled and directed all things.”

To describe the informal group of friends, family members and advisers whom they believed maintained too great an influence over the president, the opposition coined the phrase “kitchen cabinet.”

But the opposition’s image of the “kitchen cabinet” was not the reality. No matter his personal quirks, Jackson proved to be an excellent administrator. And contrary to Emily Donelson’s fears, he resisted sycophants and self-interested counselors.

Two men together, one in a red baseball hat and the other wearing dark sunglasses.
Elon Musk, right, is a top adviser and donor to Donald Trump and directs the administration’s effort to cut government spending.
Brandon Bell/Getty Images

A builder, not a destroyer

Jackson escaped manipulation because he managed to keep his eyes on his higher goal, the expansionist idea of the American nation.

He sought to create a blueprint for a government that would outlast him. He enacted impersonal rules that were sustained by elaborate systems of checks and balances. Whether you like him or not, Jackson was a builder, not a destroyer, of administrations.

The circumstances of the Jackson and Trump presidencies might look similar, but the key is that they are two very different men. Both wanted to fully reform the federal government, faced scandal, felt like an outsider in Washington, D.C., and had all sorts of close loyalists around pushing their agendas.

But Jackson didn’t get distracted. So he was not a useful puppet for those who sought to exploit him that way.

By contrast, it will be difficult for Trump to morph into President Jackson. Since the 1970s, the power of unelected and unconfirmed presidential aides and counselors has become more intense.

These individuals may easily end up negotiating deals or directing the course of events while escaping both congressional oversight and public scrutiny.

In their unaccountable influence, they are joined by major donors to a president’s campaign or causes.

There’s no doubt that they are a potential liability more dangerous than Jackson’s sycophants, more problematic than his cronies, more embarrassing than his wacky nephews.The Conversation

Maurizio Valsania, Professor of American History, Università di Torino

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Read More

The post President Trump may think he is President Jackson reincarnated − but there are lessons in Old Hickory’s resistance to sycophants appeared first on theconversation.com

Continue Reading

The Conversation

Trump’s Project 2025 agenda caps decades-long resistance to 20th century progressive reform

Published

on

theconversation.com – Colin Gordon, Professor of History, University of Iowa – 2025-02-03 07:33:00

Trump’s Project 2025 agenda caps decades-long resistance to 20th century progressive reform

There has long been a tug-of-war over White House plans to make government more liberal or more conservative.
Douglas Rissing/iStock / Getty Images Plus

Colin Gordon, University of Iowa

For much of the 20th century, efforts to remake government were driven by a progressive desire to make the government work for regular Americans, including the New Deal and the Great Society reforms.

But they also met a conservative backlash seeking to rein back government as a source of security for working Americans and realign it with the interests of private business. That backlash is the central thread of the Heritage Foundation’s “Project 2025” blueprint for a second Trump Administration.

Alternatively disavowed and embraced by President Donald Trump during his 2024 campaign, Project 2025 is a collection of conservative policy proposals – many written by veterans of his first administration. It echoes similar projects, both liberal and conservative, setting out a bold agenda for a new administration.

But Project 2025 does so with particular detail and urgency, hoping to galvanize dramatic change before the midterm elections in 2026. As its foreword warns: “Conservatives have just two years and one shot to get this right.”

The standard for a transformational “100 days” – a much-used reference point for evaluating an administration – belongs to the first administration of Franklin D. Roosevelt.

A smiling man in a light-colored suit signs papers at a table, surrounded by about a dozen people.
President Franklin D. Roosevelt signs the Social Security Bill in Washington on Aug. 14, 1935.
AP Photo, file

Social reforms and FDR

In 1933, in the depths of the Great Depression, Roosevelt faced a nation in which business activity had stalled, nearly a third of the workforce was unemployed, and economic misery and unrest were widespread.

But Roosevelt’s so-called “New Deal” unfolded less as a grand plan to combat the Depression than as a scramble of policy experimentation.

Roosevelt did not campaign on what would become the New Deal’s singular achievements, which included expansive relief programs, subsidies for farmers, financial reforms, the Social Security system, the minimum wage and federal protection of workers’ rights.

Those achievements came haltingly after two years of frustrated or ineffective policymaking. And those achievements rested less on Roosevelt’s political vision than on the political mobilization and demands made by American workers.

A generation later, another wave of social reforms unfolded in similar fashion. This time it was not general economic misery that spurred actions, but the persistence of inequality – especially racial inequality – in an otherwise prosperous time.

LBJ’s Great Society

President Lyndon B. Johnson’s Great Society programs declared a war on poverty and, toward that end, introduced a raft of new federal initiatives in urban, education and civil rights.

These included the provision of medical care for the poor and older people via Medicaid and Medicare, a dramatic expansion of federal aid for K-12 education, and landmark voting rights and civil rights legislation.

As with the New Deal, the substance of these policies rested less with national policy designs than with the aspirations and mobilization of the era’s social movements.

Resistance to policy change

Since the 1930s, conservative policy agendas have largely taken the form of reactions to the New Deal and the Great Society.

The central message has routinely been that “big government” has overstepped its bounds and trampled individual rights, and that the architects of those reforms are not just misguided but treasonous. Project 2025, in this respect, promises not just a political right turn but to “defeat the anti-American left.”

After the 1946 midterm elections, congressional Republicans struck back at the New Deal. Drawing on business opposition to the New Deal, popular discontent with postwar inflation, and common cause with Southern Democrats, they stemmed efforts to expand the New Deal, gutting a full employment proposal and defeating national health insurance.

They struck back at organized labor with the 1947 Taft-Hartley Act, which undercut federal law by allowing states to pass anti-union “right to work” laws. And they launched an infamous anti-communist purge of the civil service, which forced nearly 15,000 people out of government jobs.

In 1971, the U.S. Chamber of Commerce commissioned Lewis Powell – who would be appointed by Republican President Richard Nixon to the Supreme Court the next year – to assess the political landscape. Powell’s memorandum characterized the political climate at the dawn of the 1970s – including both Great Society programs and the anti-war and Civil Rights movements of the 1960s – as nothing less than an “attack on the free enterprise system.”

In a preview of current U.S. politics, Powell’s memorandum devoted special attention to a disquieting “chorus of criticism” coming from “the perfectly respectable elements of society: from the college campus, the pulpit, the media, the intellectual and literary journals, the arts and sciences, and from politicians.”

Powell characterized the social policies of the New Deal and Great Society as “socialism or some sort of statism” and advocated the elevation of business interests and business priorities to the center of American political life.

A large book with '2025' and 'Mandate for Leadership' printed on its cover.
A copy of Project 2025 is held during the Democratic National Convention on Aug. 21, 2024, in Chicago.
AP Photo/J. Scott Applewhite

Building a conservative infrastructure

Powell captured the conservative zeitgeist at the onset of what would become a long and decisive right turn in American politics. More importantly, it helped galvanize the creation of a conservative infrastructure – in the courts, in the policy world, in universities and in the media – to push back against that “chorus of criticism.”

This political shift would yield an array of organizations and initiatives, including the political mobilization of business, best represented by the emergence of the Koch brothers and the powerful libertarian conservative political advocacy group they founded, known as Americans for Prosperity. It also yielded a new wave of conservative voices on radio and television and a raft of right-wing policy shops and think tanks – including the Heritage Foundation, creator of Project 2025.

In national politics, the conservative resurgence achieved full expression in President Ronald Reagan’s 1980 campaign. The “Reagan Revolution” united economic and social conservatives around the central goal of dismantling what was left of the New Deal and Great Society.

Powell’s triumph was evident across the policy landscape. Reagan gutted social programs, declared war on organized labor, pared back economic and social regulations – or declined to enforce them – and slashed taxes on business and the wealthy.

Publicly, the Reagan administration argued that tax cuts would pay for themselves, with the lower rates offset by economic growth. Privately, it didn’t matter: Either growth would sustain revenues, or the resulting budgetary hole could be used to “starve the beast” and justify further program cuts.

Reagan’s vision, and its shaky fiscal logic, were reasserted in the “Contract with America” proposed by congressional Republicans after their gains in the 1994 midterm elections.

This declaration of principles proposed deep cuts to social programs alongside tax breaks for business. It was perhaps most notable for encouraging the Clinton administration to pass the Personal Responsibility and Work Opportunity Act of 1996, “ending welfare as we know it,” as Clinton promised.

Aiming at the ‘deep state’

Project 2025, the latest in this series of blueprints for dramatic change, draws most deeply on two of those plans.

As in the congressional purges of 1940s, it takes aim not just at policy but at the civil servants – Trump’s “deep state” – who administer it.

In the wake of World War II, the charge was that feckless bureaucrats served Soviet masters. Today, Project 2025 aims to “bring the Administrative State to heel, and in the process defang and defund the woke culture warriors who have infiltrated every last institution in America.”

As in the 1971 Powell memorandum, Project 2025 promises to mobilize business power; to “champion the dynamic genius of free enterprise against the grim miseries of elite-directed socialism.”

Whatever their source – party platforms, congressional bomb-throwers, think tanks, private interests – the success or failure of these blueprints rested not on their vision or popular appeal but on the political power that accompanied them. The New Deal and Great Society gained momentum and meaning from the social movements that shaped their agendas and held them to account.

The lineage of conservative responses has been largely an assertion of business power. Whatever populist trappings the second Trump administration may possess, the bottom line of the conservative cultural and political agenda in 2025 is to dismantle what is left of the New Deal or the Great Society, and to defend unfettered “free enterprise” against critics and alternatives.The Conversation

Colin Gordon, Professor of History, University of Iowa

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Read More

The post Trump’s Project 2025 agenda caps decades-long resistance to 20th century progressive reform appeared first on theconversation.com

Continue Reading

Trending