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94 95 The Peculiar Élan 1977- 1978 This address was modified for scores of different universities and hospitals, but the principles which guided my actions and, therefore, my words remained much the same in different locations. In the long haul of life, it is the philosophy - in this instance of an administration - that may make it memorable.The details of specific bills or the relentless activities of a bureaucracy are easily forgotten. It is so easy to lose the peculiar élan of an era and let sheer size - whether it be in business or academia or government - crush the individual flair and approach. It is so safe to be faceless and to treat constituents - or patients as ciphers in a computer, divorcing the numbers from humans and living in that clean world where fear and failure, frustration and pain, bigotry and ugliness do not intrude. The job at hand may get done - it usually does some way or other - but as Eugene O’Neill said, “you can take the life out of the booze.” Today, there is plenty of life in New York and a humane approach too long missing from the governmental scene. There are ethical judgments that can no longer be avoided, and which, in fact, seem to distinguish our present dilemmas from the mundane. Preserving the protection of the court and the right to redress in a medical world obsessed with rising malpractice rates; the religious concerns about the definition of death, right to life, living wills, or DNA research; the balancing of community desires for stability with the right of the mentally disabled to be served in the least restrictive setting; the insanity defense and the death penalty - all are issues that touch upon the health of a condition in many parts of the world, those who should be most able to express this have been either unable or unwilling to articulate the harsh realities of life as they exist for the majority of mankind. For too long, we who deal with and know most intimately the one unique resource, the human being, have allowed our projects to remain dreams and our priorities to be words. Somebody, surely, will shape the future for good or for ill. If professionals in science and health continue to merely rail against the system and arrogantly absent themselves from the political process, they shall not have, and do not deserve, the power to fashion our society. As you go forth today, I pray, with your family, teachers, and friends, that your dreams and aspirations may be realized. I hope for your own sakes, as well as for the professions of medicine and nursing, that you will have the courage to follow those dreams beyond the limits of your expectations. When you arrive at those new horizons and find reality, use the approach of the Irish poet, Yeats, who told his beloved: “I have spread my dreams under your feet: Tread softly because you tread on my dreams.” I have discovered there is often more understanding and consideration to be found amid the sweat and toil of the frontiers than exists in the protected environs of the establishment. May you all find as much joy in that challenging interface of dreams and reality as has your grateful and honored commencement speaker. 96 97 runaway health related costs. With the very lives of citizens at stake, the normal checks and balances of society not in play, the health system in disorder and the cost of medical services soaring out of reach, government had to assure reasonable access to such services and to regulate their quality,quantity,andcost.Thereisnoneedtoapologize for active government involvement. It would have been utterly irresponsible to return to the passive role of the past. Although the state’s direct involvement in costs and access is relatively new, ample precedent is found in the state’s constitutionally mandated public health role. There is scarcely a single act performed by any physician, or a procedure carried out in any hospital, that is not influenced in some measure by the actions of the state. Tests performed on the infant at the moment of birth are mandated by the state, as are procedures that are carried out at the pronouncement of death. Meeting that responsibility has been a challenge, made easier by the extraordinary numbers of concerned and committed citizens who have joined us. Their help has been needed for these have been very difficult days. There is...

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