Balkinization  

Thursday, March 27, 2008

What is Living Constitutionalism?

JB

This past week I've written a couple of posts that offer an account of living constitutionalism, in which popular mobilization and partisan entrenchment in the judiciary play a major role in shaping constitutional change. This version of living constitutionalism is also a "democratic constitutionalism." (I borrow this term from my colleagues Robert Post and Reva Siegel). It is "living" constitutionalism is because judicial and non judicial interpretations change over time, and it is "democratic" because they change in response to sustained social and political mobilizations that, in turn alter constitutional culture. Last week Dahlia Litwick and Eric Posner offered their comments on this model, and today I offer a further elaboration.

Eric goes right to the heart of the matter when he asks why we should have a system of constitutional interpretation that reflects changes in popular opinion produced by long term popular mobilizations. He asks: If constitutional change responds to political mobilizations, social movement activism, presidential appointments strategies, and shifts in popular opinion, what is the purpose of having constitutional courts in the first place? Why not just get courts out of the business of holding anything unconstitutional and exercise judicial restraint in almost every case? Why not just have a purely majoritarian democracy?

To answer this question, let's take a look at Eric's account of the system I described. First, Eric says, the effect of partisan entrenchment is "conservative (in the temporal sense)" because Justices reflect the views of political coalitions that put them in office when they were appointed. (And that means, on a multimember court, that a variety of different positions, strewn across time, are represented.) Partisan entrenchment in the judiciary may prevent drastic changes in governance, or as Eric puts it, it may promote "smooth policy variance over time." Second, the system I've described "enhances the degree of supermajoritarianism that already exists in our heavily supermajoritarian system" because laws not only have to pass Congress and the President (or the state legislature and the Governor) but also the scrutiny of a court whose members were appointed by people at different times with very different political views. Third, this process "produces a heavy orientation toward maintaining the status quo, and will cause problems in particular when public opinion changes more rapidly than the average justice's term." Put somewhat differently, if the vector sum of political forces changes swiftly on a constitutional issue, the courts will tend hold back and resist the views of the day until the change in constitutional culture proves lasting, because it will take time for new judges to replace older ones. (There is an additional point that Eric did not mention: because the federal courts are appointed by the national political process, they will tend to keep regional majorities close to the views of the national political coalition. That is to say, they are not so much counter-majoritarian as nationalist.)

It's worth noting what Eric has just described (and what he largely objects to): He is describing basic features of constitutionalism generally. Constitutionalism channels and disciplines present day majorities through supermajoritarian rules that they cannot easily change overnight (but can change eventually); this prevents drastic changes in governance and keeps temporary majorities from altering or subverting the constitutional values of more temporally extended supermajorities. In essence, what Eric finds inefficient and unnecessary is constitutionalism that interferes with simple majoritarianism, which is to say, he is opposed to most forms of constitutionalism. Most forms, but not all, because in other work Eric has offered an important exception to his generally skeptical approach: he wants constitutions to restrain democratic decisionmaking that undermines what he calls "political competition," that is laws and practices that interfere with the ability of different political elites and political parties to compete for voters, but not any other rights. Indeed, as long as we effectively protect political competition by other means, we don't really need constitutional rights guarantees at all.

Understood in this way, Eric is not objecting to my account of living constitutionalism because it is politically responsive. He is objecting to it because it is constitutionalism, i.e., because it restrains majorities, because it is not politically responsive enough. His concerns are quite different from Dahlia's. Dahlia wants to make sure that courts are not simply on a frolic and detour, and that they aren't simply mouthpieces for the views of contemporary majorities. That is to say, Dahlia's problem is the opposite of Eric's. She likes constitutionalism (and judicial review) just fine. She's not an originalist by any means, but she likes the rule of law values that originalism promises (even if it can't always deliver).

The version of living constitutionalism I've sketched out in my previous posts sits squarely between the two of them, and that is why they are objecting to it, albeit from opposite directions. Dahlia thinks there's too much democratic politics in my account, and not enough legal restraint. Eric thinks its an inefficient way to do democratic politics.

In general, living constitutionalism of the sort I've described allows social and political mobilizations, working over long periods of time, to shift the interpretation and application of abstract clauses and open ended features of the Constitution. But for the most part it has not altered the "hard wired" features of the Constitutional text. (To the extent the latter has happened, it is really quite exceptional, and, I think, quite wrong). This approach is faithful to the Constitution's original meaning but not necessarily the original expected application of the text. Long term changes in constitutional culture can move us from Plessy v. Ferguson to Brown v. Board of Education, but they won't allow a 34 year old President, or three Houses of Congress, or a simple majority of one House to overturn a Presidential veto. While Article V amendment is necessary for changing these hardwired features of the Constitution, the interpretation, implementation, and application of vague and abstract clauses like "equal protection" can and does change through sustained political mobilization.

To me it is not at all surprising that fights between so called originalist and living constitutionalist approaches almost never concern the hard wired features of the Constitution; they almost always concern the Constitution's abstract guarantees and its silences. Most living constitutionalists assume that the hard wired features of the Constitution are binding even though they were created a long time ago. That is to say, they do not object to the dead hand of the past with respect to those features; their concern is primarily the construction and interpretation of those clauses and features that use the language of general principles and standards. They argue that we are not bound by how the generation of 1791 or 1868 would have applied the text. I think they are right about that. It is our job to interpret the text in our own time.

Under this model of living constitutionalism, successive generations may not reject the Constitution's text and principles, but they may decide how best to honor, implement, and apply them through constitutional constructions and doctrinal implementations. We can reject Plessy v. Ferguson, which is simply one generation's attempt at implementing the Constitution, but not the words of the equal protection clause.

This model produces a system of judicial interpretation that is responsive to democratic politics in the long run but not directly controlled by it in the short run. It preserves constitutional law's relative autonomy from politics in the short run while making it responsive to constitutional politics in the long run.

It also involves a system of judicial review but not a system of judicial supremacy. This distinction is crucial: Courts act as a stabilizing force, and hold officials (and especially executive officials) accountable to law, but they never have the last word. The purpose of judicial review in this model is to represent and protect (in as legally principled a way as possible) the constitutional values of temporally extended majorities, and to prevent quick and drastic changes in those constitutional values unless there has been extended and sustained support for change that is reflected in long term changes in constitutional culture.

Moreover, in this model judges do not have to do anything special or out of the ordinary to participate in the process of living constitutionalism. They don't have to be politicians or moral theorists or divinities like Dworkin's Hercules or philosopher kings. They don't have to be smarter, or wiser, or more moral or more farsighted than anyone else. All they have to do, once they get appointed, is to try to decide the cases according to law, in the best way they can. If they just go about doing their jobs, they will, in spite of themselves, participate in the gradual translation of changing constitutional politics into constitutional law. Meanwhile the job of people like me, and Dahlia, and Eric, and everyone else, is to criticize how they interpret the law and to try to persuade other people, and them, that our interpretations of the Constitution are the best ones and that they should agree with us.

As many of you know, I regard myself as both an originalist and a living constitutionalist. For me originalism requires fidelity to original meaning of the text and the principles that underlie the text, but not fidelity to the original expected application. So the model of living constitutionalism I've described here is largely consistent with my originalist views about constitutional interpretation. Lest I be misunderstood, this does not mean that I agree with every decision the Court has every offered on the merits– for I do not– but that the broad outlines of change in American constitutional history are consistent with this general approach to interpretation, even if I think that many cases were wrongly decided. (Indeed, I regard this as a strength of my approach: it can make sense of what our nation has actually done in practice and what our constitutional traditional actually has produced.). I argue that the implementation and application of vague and abstract clauses is not fixed by what the adopting generation expected, but rather can change over time in response to long term changes in public opinion and sustained mobilizations in democratic politics.

You can now see the answer to the question that Eric and Dahlia posed: Why do we have judicial review at all if it is subject to democratic forces in the long term? Why is a flexible constitutionalism in which the interpretation of abstract clauses (but not the hard wired features) can change slowly over time better than a system of pure majoritarianism without constitutional constraints? The answer is that this variety of living constitutionalism still provides the valuable goods of constitutionalism, but in a way at once more flexible and, I would argue, more admirable than, say, Justice Scalia's model of originalism, which ties original meaning closely to original expected application. It is more admirable because it can make sense of the great achievements of American constitutionalism during the past two centuries that Scalia's model must treat as mistakes, mistakes that we retain only because people have come to rely on them. In my account of living constitutionalism, the reason why the Court protects women from sex discrimination is because of a sustained social movement for women's rights that changed people's views about what equality and equal protection required. In Scalia's model the Court protects women's rights today because activist judges wrongfully imposed their idiosyncratic values into the Constitution and now it's too late to change this dreadful mistake.

My account of living constitutionalism maintains the benefits of constitutionalism generally while allowing adjustments in interpretation over time in the face of sustained democratic mobilization. This makes it superior to Scalia's version of originalism, which he must continually leaven with exceptions for all those "mistakes," It also makes it superior to Eric's preference for pure majoritarianism, which loses out on the benefits of having a constitutional system that guarantees basic rights and limits on government. And it makes the most sense of our system of judicial review, which is not (and never has been) a system of judicial supremacy.

Dahlia reprinted a very interesting e-mail by Richard Shragger of U. Va., who argues that my account of living constitutionalism is too externalist and descriptive. This is an important criticism, which I will discuss in my next post on this topic.

But let me leave you with this point, which I will also develop in my next post.
I think that people misunderstand what a theory of living constitutionalism has to do in order to be successful. Most people assume that living constitutionalism is a theory about how to interpret the Constitution in a particular case; it is a sort of mirror image to what they think originalism is. In their view originalism is a theory directed to judges about what judges have to do to be faithful to the Constitution. Therefore living constitutionalism must be the same kind of theory. It must also be directed to judges and it must explain to judges how to decide particular cases. That is why Justice Scalia regularly makes fun of living constitutionalism. As he likes to say, it takes a theory to beat a theory, and living constitutionalism doesn't have one.

I think this is incorrect. Living constitutionalism is primarily a theory about what makes the process that produces changing interpretations of the Constitution legitimate. It is not primarily a theory that offers advice to judges about how to decide particular cases, for the general sort of advice it offers– keep up with the times, and adapt to changing conditions– is probably unnecessary in any event. More about this point in my next post.



Comments:

"As many of you know, I regard myself as both an originalist and a living constitutionalist."

This seems to answer a question I have posed to JB in earlier comments. So JB sits atop the constitutional fence with his "mug" (originalist) on one side and his "wamp" (living constitutionalist) on the other. Perhaps a hermeneutical overlay might be appropriate for the this "Mugwamp" version of living-originalism.
 

Professor Balkin:

Living constitutionalism is primarily a theory about what makes the process that produces changing interpretations of the Constitution legitimate.

It appears to me that your views of both living constitutionalism and originalism are designed to legitimatize decisions which would otherwise be illegitimate under what most theorists consider originalism.

A theory of "originalism" that abandons the original understanding of the text, expands the current meaning of the text to principles broad enough to encompass nearly anything (such as a 14th Amendment right to kill one's children) and allows interpretations of those principles to change significantly over time cannot fairly be called originalism, which requires a fidelity to a meaning fixed at the time of the ratification of a constitutional provision.

While one can fairly argue over the best means to determine the meaning fixed at the time of the ratification, originalism requires a fixed original meaning if the term originalism is to have any meaning at all.
 

Unfortunately, Bart, your account of what originalism must mean isn't the original meaning of originalism.
 

Your use of the phrase "vector sum of political forces" reminded me of my favorite analogy for the restraining (you called them "supermajoritarian") features of our system. I think of them as slosh baffles that prevent hysterical crowds from tramping individuals.
 

How about "Original Sin Originalism" along the lines of Genesis to explain away the intent, meaning, understanding, expectations, etc, of the Constitution? That would be simply divine.
 

Professor Balkin:

Unfortunately, Bart, your account of what originalism must mean isn't the original meaning of originalism.

Which is?
 

Unfortunately, Bart, your account of what originalism must mean isn't the original meaning of originalism.

Which is?


Original intent?
 

Unfortunately, Bart, your account of what originalism must mean isn't the original meaning of originalism.

Which is?

Bart, let me give you some idea of where Professor Balkin is coming from. I first encountered him long before this blog, when I read "The Crystalline Structure of Legal Thought" in law school about a decade and a half ago. The man has been seriously researching legal theory and producing peer-reviewed scholarship in major law journals for many, many years.

You might, Bart, at some point admit that he might know a little more about what originalism does and doesn't mean, and what it's theorists do and don't claim, than you do. It isn't like you are publishing in the law reviews. (As someone who, in addition to his legal work, has published a few articles in major law reviews, I can tell you that it requires a rigor that you do not bring to this issue when you talk about originalism in the same sorts of simplistic terminology ("interpreting the Constitution as written instead of inventing new rights", "14th Amendment right to kill one's children") that Rush Limbaugh and Sean Hannity might use.

Bart, Professor Balkin has a lot to tell you about originalism. And if you don't buy his arguments, you can look at the work of conservative scholars who also treat the subject seriously rather than using "living constitutionalism" as an epithet for whatever results they don't like.

I would suggest, however, that you not opine beyond your expertise, that you not go beyond your remit. You are badly overmatched when taking on someone who has been around the scholarly block as many times as Professor Balkin has on this issue.
 

dilan:

The fact that Professor Balkin and I may disagree is neither here nor there.

I offered the common definition of originalism as the theory that the meaning of provisions of the Constitution is knowable and fixed at the origin of the document.

Professor Balkin claimed that originalism actually has a quite different definition without providing that definition.

I am simply asking for the contrary definition.

No matter how learned my correspondent, I do not accept bare assertions as undisputed fact.
 

No matter how learned my correspondent, I do not accept bare assertions as undisputed fact.

Why, I have that very same tendency. In fact, when that correspondent miscites actual law, I'm even a bit more sceptical and ask for substantiation (and corrections as appropriate). However, not everyone here bothers to back up their assertions, even when asked repeatedly for such. In fact, a few of the more impolite ones just go on and reassert the same stuff in the next post down the line again without substantiation....

OBTW, there's a link in Prof. Balkin's point under that "originalist" blue clicky...

(documentation and substantiation of my above assertions available on request, of course)

Cheers,
 

I offered the common definition of originalism as the theory that the meaning of provisions of the Constitution is knowable and fixed at the origin of the document.

Bart, is that the common definition as put forth by Robert Bork? The common definition as put forth by Antonin Scalia? The common definition as put forth by Akhil Reed Amar? The common definition as put forth by Hugo Black? By critics like John Hart Ely or Paul Brest? Randy Barnett? Could you summarize what the differences are between those various authors' conceptions of originalism?

If I may paraphrase a great legal thinker, originalism isn't a brooding omnipresence in the sky. It is a category that includes various interpretative metrics. Indeed, some of the interpretative metrics included in originalism definitely do not believe that the meaning of the Constitution is fixed at the origin of the document. Not even Scalia, for instance, believes that. (See his majority opinion on thermal imaging.) Nor does Bork. (See his discussion of libel law in "The Tempting of America" and his wiretapping decision on the DC Circuit.)

What you are offering, Bart, is a radio talk show definition of originalism, used by right-wing hacks to claim that liberal theories of jurisprudence are unprincipled when compared to conservative theories of jurisprudence. You show no signs of having actually engaged the deep jurisprudential debates about text and meaning. Ever heard of H.L.A. Hart? "No vehicles in the park"? Those of us who have studied some of this stuff know that it is a fascinating and complex subject matter. Real interpretation is HARD, and applying netural principles rather than choosing metrics that get the results one wants is VERY HARD.

I do not profess to be an expert in jurisprudential interpretative theory; I simply know enough about it to know that the things you are saying are the words of a person who knows the Republican talking points on the issue but has not a clue about the actual academic scholarship on originalism, let alone the serious problems in interpreting legal texts that originalism does not always help to solve.

Trust me, Bart, you are way out of your league here. I know it is fashionable among conservatives to think of academics as mindless left-wing ideologues, but in fact to be a top flight published legal academic requires a sharp and precise mind, and the people who debate originalism in the academy have forgotten more about these issues than you and I combined are ever going to know.

You really should quit while you are behind, Bart. Or better yet, stop making a fool of yourself, subject your ideas to more rigorous scrutiny and research, test your hypotheses, and see if you can get a jurisprudential paper into a major law school's law review. You will find that you need to go a little deeper than facile explanations about Scalia's alleged principles and theories of originalism as mandating a Constitution of unchanged meaning.
 

Dilan:

If I may paraphrase a great legal thinker, originalism isn't a brooding omnipresence in the sky. It is a category that includes various interpretative metrics. Indeed, some of the interpretative metrics included in originalism definitely do not believe that the meaning of the Constitution is fixed at the origin of the document. Not even Scalia, for instance, believes that. (See his majority opinion on thermal imaging.) Nor does Bork. (See his discussion of libel law in "The Tempting of America" and his wiretapping decision on the DC Circuit.)

The Harvard Journal of Law and Public Policy (the Federalist Society legal mag) published one issue on "originalism" by various people; I recommended that "Bart" read it a long time ago. As the various authors in that issue pointed out, there's "original meaning", "original intent", "intent of the original founders/authors/ratifiers/judges/experts if they were presented with the current controversy", "understanding of the 'founders'", "understanding of the ratifiers", "understanding of the people", etc.. Then there's levels of "understanding" and "interpretation"; do we want to honour the specifics at the expense of the whole, or are the principles meant (or intended) to inform the specifics?

So many combinations to pick from....

It is a disservice to legal scholarship to pretend that the answers are straight-forward; matter of fact, those that make their profession at law should be thankful; were it straight-forward, and were the laws "obvious", there would be no need for lawyers, judges, and law profs, and a JavaBean macro would do all our adjudication.

Cheers,
 

I offered the common definition of originalism as the theory that the meaning of provisions of the Constitution is knowable and fixed at the origin of the document.

On a perhaps related (or unrelated, depending on how you look at the 'science' of jurisprudence) topic, one of the more compelling and curious proofs of the 20th century in mathematics was Kurt Gödel's Incompleteness Theorem: It states (roughly) that for any sufficiently powerful formal system of logic, there are statements that can be made that are true within that system but which cannot be proven to be true within that system. Translated roughly from "Bart"'s language, assuming that a legal system is akin to some formal logic system, there may be things that are "fixed" (that is, that are true), but which just aren't knowable (they either can't be found, or they can't be shown to be true) without recourse to external entities. So much for "Bart"'s 'idealism'....

But law is not math ... alas.

Cheers,
 

dilan said...

BD: I offered the common definition of originalism as the theory that the meaning of provisions of the Constitution is knowable and fixed at the origin of the document.

Bart, is that the common definition as put forth by Robert Bork? The common definition as put forth by Antonin Scalia? The common definition as put forth by Akhil Reed Amar? The common definition as put forth by Hugo Black? By critics like John Hart Ely or Paul Brest? Randy Barnett? Could you summarize what the differences are between those various authors' conceptions of originalism?


Yes, I provided the basic principle which unites those who practice originalism. Practitioners employ differing means to get to that end - textualism, original understanding and original intent to name three. However, the sought after end of a knowable meaning fixed at the time of the origin of the Constitution is generally the same among Originalists.

This is not even a close question. Consult any legal or general dictionary or encyclopedia you choose and you will find a variation of the general end of originalism which I posted.

What you are offering, Bart, is a radio talk show definition of originalism, used by right-wing hacks to claim that liberal theories of jurisprudence are unprincipled when compared to conservative theories of jurisprudence.

Unless one assumes that the Constitution is a conservative document and fidelity to the Constitution is conservatism, I do not see how one can contend that originalism is either conservative or liberal.

Real interpretation is HARD, and applying netural principles rather than choosing metrics that get the results one wants is VERY HARD.

No one said that Originalism was easy. Living constitutionalism is far easier because it is not based on neutral principles. Indeed, I suspect that the ease of living constitutionalism just as much as ideology is why judges use it.
 

one of the more compelling and curious proofs of the 20th century in mathematics was Kurt Gödel's Incompleteness Theorem: It states (roughly) that for any sufficiently powerful formal system of logic, there are statements that can be made that are true within that system but which cannot be proven to be true within that system.

Actually, you can prove such statements true, but only at the cost of contradictions in the formal system. The system can be complete -- that is, all true statements can be proved -- or it can be consistent -- no logical contradictions -- but it can't be both.

Of course, calling conservative theories of originalism "formal systems" is far too complimentary. They're muddled thinking, useful for talk radio but not much else.
 

Consult any legal or general dictionary or encyclopedia you choose and you will find a variation of the general end of originalism which I posted.

Why would you assume that a general dictionary or encyclopedia would contain an authoritative definition of a contested jurisprudential theory?

I can tell you that much of what we call originalism-- including, notably, what Scalia and Bork advocate-- does not fit into the definition that you gave earlier in this thread. Both Scalia and Bork believe that the meaning of texts can change over time. You should consult the sources I cited for the relevant discussions.

Again, just to come back to the broader point, you are arguing judicial philosophy on the most simplistic levels, and purporting to challenge a law professor who is an expert and who can describe even subtle differences in originalist approaches. You can't come to this argument with Rush Limbaugh talking points about one side following the law as written and the other side not.

Oh, and one more thing, living constitutionalism can be very hard to do too. You might want to read Breyer's book Active Liberty or Laurence Tribe's constitutional law treatise to get some idea of this.
 

@ Mark Field:

[Arne]: one of the more compelling and curious proofs of the 20th century in mathematics was Kurt Gödel's Incompleteness Theorem: It states (roughly) that for any sufficiently powerful formal system of logic, there are statements that can be made that are true within that system but which cannot be proven to be true within that system.

Actually, you can prove such statements true, but only at the cost of contradictions in the formal system. The system can be complete -- that is, all true statements can be proved -- or it can be consistent -- no logical contradictions -- but it can't be both.


Technically, what you say is true: There is a choice between a system that has unprovable but true statements and an inconsistent system. But in practise, this is not a real choice, as any inconsistent system is essentially useless; once you have any inconsistent statements (which are both true) within the system, it's then pretty trivial to prove any statement you desire as true (although perhaps that feature might come in handy in a formal legal system....)

Of course, calling conservative theories of originalism "formal systems" is far too complimentary. They're muddled thinking, useful for talk radio but not much else.

But "Bart" is pretending that they are so (as have others as well, for their own rhetorical purposes). It's a winning argument to say: "There is a true answer that can be divined ... and I, of course, have divined it, so I can't be wrong ... or even gainsaid. End of argument."

Cheers,
 

Technically, what you say is true: There is a choice between a system that has unprovable but true statements and an inconsistent system. But in practise, this is not a real choice, as any inconsistent system is essentially useless; once you have any inconsistent statements (which are both true) within the system, it's then pretty trivial to prove any statement you desire as true (although perhaps that feature might come in handy in a formal legal system....)

And my overly elliptical point was that this pretty much describes conservative forms of originalism.
 

Mark Field:

[Arne]: ... once you have any inconsistent statements (which are both true) within the system ...

And my overly elliptical point was that this pretty much describes conservative forms of originalism.


I don't think it was overly elliptical; that approach seems to describe current foreign policy, at the very least: "Violence is up, we're winning; violence is down, we're winning...."

Cheers,
 

The late Justice William J. Brennan Jnr characterised "Originalism" thus:

“In its most doctrinaire incarnation, this view demands that Justices discern exactly what the Framers thought about the question under consideration and simply follow that intention in resolving the case before them. It is a view that feigns self-effacing deference to the specific judgments of those who forged our original social compact. But in truth it is little more than arrogance cloaked as humility. It is arrogant to pretend that from our vantage point we can gauge accurately the intent of the Framers on application of principle to specific, contemporary questions.
All too often, sources of potential enlightenment such as records of the ratification debates provide sparse or ambiguous evidence of the original intention. Typically, all that can be gleaned is that the Framers themselves did not agree about the application or meaning of particular constitutional provisions, and hid their differences in cloaks of generality. Indeed, it is far from clear whose intention is relevant—that of the drafters, the congressional disputants, or the ratifiers in the states?—or even whether the idea of original intention is a coherent way of thinking about a jointly drafted document drawing its authority from a general assent of the states. And apart from the problematic nature of the sources, our distance of two centuries cannot but work as a prism refracting all we perceive."

Other senior common law judges have been even less flattering to the proponents of "Originalism". In his Sir Anthony Mason Honorary Lecture, presented at the Law School, The University of Melbourne, 9th September 1999, entitled "Constitutional Interpretation and Original Intent: A Form of Ancestor Worship", (later published in the Melbourne University Law Review [2000] MULR 1, The Hon Mr Justice Michael Kirby recounted that at a conference in Auckland (New Zealand) on constitutional interpretation, there had been a debate between Scalia J and Binnie J of the Supreme Court of Canada. "It was in the context of defending the Canadian approach to that task", said Mr Justice Kirby "that Binnie J let slip the opinion (which he suggested was held by some Canadian judges) that the approach of their counterparts in the United States could only be explained by appreciating that Americans were engaged in a ritual of ancestor worship".

"Originalism" is a heretical method of interpretation contrary to the collon law tradition latched upon by the American extreme right so as to provide cover for the evisceration of the constitutionally guaranteed rights which US citizens ought to enjoy".
 

mesothelioma Mesotheliomais a form of cancer that is almost always caused by exposure to Asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the heart the pericardium (a sac that surrounds the heart or tunica vaginalis.
Most people who develop
mesothelioma have worked on jobs where they inhaled asbestos particles, or they have been exposed to asbestos dust and fiber in other ways. Washing the clothes of a family member who worked with asbestos can also put a person at risk for developing Mesothelioma Unlike lung cancer, there is no association between mesothelioma and smoking but smoking greatly increases risk of other asbestos induced cancer.Compensation via
Asbestos funds or lawsuits is an important issue in
mesothelioma The symptoms of
mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis, which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.
Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural
mesotheliomaSymptoms of peritoneal
mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal
mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions.
Mesothelioma that affects the pleura can cause these signs and symptoms:
chest wall pain
pleural effusion, or fluid surrounding the lung
shortness of breath
fatigue or anemia
wheezing, hoarseness, or cough
blood in the sputum (fluid) coughed up hemoptysis
In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung The disease may metastasize, or spread, to other parts of the body.
Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:
abdominal pain
ascites, or an abnormal buildup of fluid in the abdomen
a mass in the abdomen
problems with bowel function
weight loss
In severe cases of the disease, the following signs and symptoms may be present:
blood clots in the veins, which may cause thrombophlebitis
disseminated intravascular coagulation a disorder causing severe bleeding in many body organs
jaundice, or yellowing of the eyes and skin
low blood sugar level
pleural effusion
pulmonary emboli, or blood clots in the arteries of the lungs
severe ascites
A
mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs
Diagnosing
mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for
mesothelioma A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of
mesothelioma A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude
mesothelioma it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure
If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of
mesothelioma A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples.
If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
There is no universally agreed protocol for screening people who have been exposed to
asbestosScreening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for
mesotheliomaThe level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening. Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells
Incidence
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. The incidence rate is approximately one per 1,000,000. The highest incidence is found in Britain, Australia and Belgium: 30 per 1,000,000 per year. For comparison, populations with high levels of smoking can have a lung cancer incidence of over 1,000 per 1,000,000. Incidence of malignant mesothelioma currently ranges from about 7 to 40 per 1,000,000 in industrialized Western nations, depending on the amount of asbestos exposure of the populations during the past several decades. It has been estimated that incidence may have peaked at 15 per 1,000,000 in the United States in 2004. Incidence is expected to continue increasing in other parts of the world. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age. Approximately one fifth to one third of all mesotheliomas are peritoneal.
Between 1940 and 1979, approximately 27.5 million people were occupationally exposed to asbestos in the United States.[ Between 1973 and 1984, there has been a threefold increase in the diagnosis of pleural mesothelioma in Caucasian males. From 1980 to the late 1990s, the death rate from mesothelioma in the USA increased from 2,000 per year to 3,000, with men four times more likely to acquire it than women. These rates may not be accurate, since it is possible that many cases of mesothelioma are misdiagnosed as adenocarcinoma of the lung, which is difficult to differentiate from mesothelioma.
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure exists in almost all cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite.
asbestos
is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven.
asbestos
has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
The combination of smoking and
asbestos exposure significantly increases a person's risk of developing cancer of the airways (lung cancer bronchial carcinoma). The Kent brand of cigarettes used
mesothelioma in its filters for the first few years of production in the 1950s and some cases of
mesothelioma have resulted. Smoking modern cigarettes does not appear to increase the risk of mesothelioma.
Some studies suggest that simian virus 40 may act as a cofactor in the development of mesothelioma.
Asbestos was known in antiquity, but it wasn't mined and widely used commercially until the late 1800s. Its use greatly increased during World War II Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with
asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of
asbestos exposure in the workplace, and created guidelines for engineering controls and respirators, protective clothing, exposure monitoring, hygiene facilities and practices, warning signs, labeling, recordkeeping, and medical exams. By contrast, the British Government's Health and Safety Executive (HSE) states formally that any threshold for
mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE does not assume that any such threshold exists. People who work with
asbestos wear personal protective equipment to lower their risk of exposure. Recent findings have shown that a mineral called erionite has been known to cause genetically pre-dispositioned individuals to have malignant mesothelioma rates much higher than those not pre-dispositioned genetically. A study in Cappadocia, Turkey has shown that 3 villiages in Turkey have death rates of 51% attributed to erionite related
mesotheliomaExposure to
asbestos fibres has been recognised as an occupational health hazard since the early 1900s. Several epidemiological studies have associated exposure to asbestos with the development of lesions such as asbestos bodies in the sputum, pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumours, and diffuse mesothelioma of the pleura and peritoneum.
The documented presence of
asbestos fibres in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibres. Although many authorities consider brief or transient exposure to
asbestos fibres as inconsequential and an unlikely risk factor, some epidemiologists claim that there is no risk threshold. Cases of mesothelioma have been found in people whose only exposure was breathing the air through ventilation systems. Other cases had very minimal (3 months or less) direct exposure.
Commercial
asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.
Family members and others living with
asbestos workers have an increased risk of developing
mesothelioma and possibly other asbestos related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to asbestosMany building materials used in both public and domestic premises prior to the banning of
asbestos may contain
asbestos Those performing renovation works or activities may expose themselves to asbestos dust. In the UK use of Chrysotile asbestos was banned at the end of 1999. Brown and blue
asbestos was banned in the UK around 1985. Buildings built or renovated prior to these dates may contain asbestos materials.
For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to
mesothelioma radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.
Although
mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel.
Radiation Therapy when given alone with curative intent has never been shown to improve survival from
mesothelioma The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.
Chemotherapy is the only treatment for
mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy) in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery. This trial was the first to report a survival advantage from chemotherapy in malignant pleural
mesothelioma showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the combination pemetrexed group in patients who received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.
Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.
In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.
Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer.
mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by at the Washington Cancer Institute. The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.
This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

What is the mesothelium?
The mesothelium is a membrane that covers and protects most of the internal organs of the body. It is composed of two layers of cells: One layer immediately surrounds the organ; the other forms a sac around it. The mesothelium produces a lubricating fluid that is released between these layers, allowing moving organs (such as the beating heart and the expanding and contracting lungs to glide easily against adjacent structures.
The mesothelium has different names, depending on its location in the body. The peritoneum is the mesothelial tissue that covers most of the organs in the abdominal cavity. The pleura is the membrane that surrounds the lungs and lines the wall of the chest cavity. The pericardium covers and protects the heart. The
mesothelioma tissue surrounding the male internal reproductive organs is called the tunica vaginalis testis. The tunica serosa uteri covers the internal reproductive organs in women.
What is mesothelioma?
mesothelioma (cancer of the mesothelium) is a disease in which cells of the mesothelium become abnormal and divide without control or order. They can invade and damage nearby tissues and organs.
cancer cells can also metastasize (spread) from their original site to other parts of the body. Most cases of mesothelioma begin in the pleura or peritoneum.
How common is mesothelioma?
Although reported incidence rates have increased in the past 20 years, mesothelioma is still a relatively rare cancer. About 2,000 new cases of mesothelioma are diagnosed in the United States each year. Mesothelioma occurs more often in men than in women and risk increases with age, but this disease can appear in either men or women at any age.
What are the risk factors for mesothelioma?
Working with asbestos is the major risk factor for mesothelioma. A history of asbestos exposure at work is reported in about 70 percent to 80 percent of all cases. However, mesothelioma has been reported in some individuals without any known exposure to
Asbestos is the name of a group of minerals that occur naturally as masses of strong, flexible fibers that can be separated into thin threads and woven. asbestos has been widely used in many industrial products, including cement, brake linings, roof shingles, flooring products, textiles, and insulation. If tiny asbestos particles float in the air, especially during the manufacturing process, they may be inhaled or swallowed, and can cause serious health problems. In addition to mesothelioma, exposure to asbestos increases the risk of lung cancer, asbestosis (a noncancerous, chronic lung ailment), and other cancers, such as those of the larynx and kidney.
Smoking does not appear to increase the risk of mesothelioma. However, the combination of smoking and asbestos exposure significantly increases a person's risk of developing cancer of the air passageways in the lung.
Who is at increased risk for developing mesothelioma?
asbestos has been mined and used commercially since the late 1800s. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos. Today, the U.S. Occupational Safety and Health Administration (OSHA) sets limits for acceptable levels of asbestos exposure in the workplace. People who work with asbestos wear personal protective equipment to lower their risk of exposure.
The risk o f asbestosrelated disease increases with heavier exposure to asbestos and longer exposure time. However, some individuals with only brief exposures have developed mesothelioma On the other hand, not all workers who are heavily exposed develop asbestos-related diseases.
There is some evidence that family members and others living with asbestos workers have an increased risk of developing mesothelioma, and possibly other asbestos-related diseases. This risk may be the result of exposure to
asbestos dust brought home on the clothing and hair of
asbestos workers. To reduce the chance of exposing family members to
asbestos fibers, asbestos workers are usually required to shower and change their clothing before leaving the workplace.
What are the symptoms of mesothelioma?
Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to
asbestos Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritoneal mesothelioma may include bowel obstruction blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.
These symptoms may be caused by
mesothelioma or by other, less serious conditions. It is important to see a doctor about any of these symptoms. Only a doctor can make a diagnosis
How is
mesotheliomadiagnosed?
Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.
A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the
cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the
cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.
If the diagnosis is mesothelioma, the doctor will want to learn the stage (or extent) of the disease. Staging involves more tests in a careful attempt to find out whether the cancer has spread and, if so, to which parts of the body. Knowing the stage of the disease helps the doctor plan treatment.
Mesothelioma is described as localized if the cancer is found only on the membrane surface where it originated. It is classified as advanced if it has spread beyond the original membrane surface to other parts of the body, such as the lymph nodes, lungs, chest wall, or abdominal organs.
How is
mesotheliomatreated?
Treatment for mesothelioma depends on the location of the
cancerthe stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, and chemotherapy. Sometimes, these treatments are combined.
Surgery is a common treatment for
mesotheliomaThe doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural
mesotheliomaa lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.
Stereo Tactic Radiation Therapy also called radiotherapy, involves the use of high-energy rays to kill
cancercells and shrink tumors Radiation therapy affects the
cancercells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the
cancercells are found (internal radiation therapy).
Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat
mesotheliomaare given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).
To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is called thoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation Therapy and surgery may also be helpful in relieving symptoms.
 

HD kaliteli porno izle ve boşal.
Bayan porno izleme sitesi.
Bedava ve ücretsiz porno izle size gelsin.
Liseli kızların Bedava Porno ve Türbanlı ateşli hatunların sikiş filmlerini izle.
Siyah karanlık odada porno yapan evli çift.
harika Duvar Kağıtları bunlar
tamamen ithal duvar kağıdı olanlar var
2013 Beyaz Eşya modeller
Sizlere Güvenlik Sistemleri ayarliyoruz
Arayin Hırdavat bulun
Samsung Nokia İphone Cep telefonu alin.
Super Led Tv keyfi

Amatör Porno - Amcik Porno - Anal Porno - Asyali Porno - Bakire Porno - Erotik Porno - Esmer Porno - Fantazi Porno - Gay Porno - Götten Porno - Grup Porno - Hard Porno - HD Porno - Hemsire Porno - Latin Porno - Lezbiyen Porno - Liseli Porno - Olgun Porno - Oral Porno - Rokettube - Sarisin Porno - Sert Porno - Tecavüz Porno - Travesti Porno - Türbanli Porno - Türk Porno - Ünlü Porno - Yasli Porno - Zenci Porno - Kari Koca Porno - Hayvanli Porno

 

Post a Comment

Older Posts
Newer Posts
Home