Chapter 11: Bringing a Legal Perspective into Ethics Work
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Description
In this chapter, Dr. Ewer explains why he earned a legal degree (JD 2001, Advanced degree in Health Law) and the impact it has had on his thinking about ethics. He begins by how he first thought of law school when he worked for Princess Cruises because of a chance encounter with Earl Warren, former Chief Justice of the Supreme Court. He sketches the process of getting into law school at the University of Houston then gives examples to demonstrate how this perspective has shaped his thought.
Next, Dr. Ewer talks about his roles as Special Assistant to the David Callendar (1994-1997), the VP of Patient Care.
Identifier
EwerMS_02_20180725_C11
Publication Date
7-25-2018
City
Houston, Texas
Topics Covered
Overview; The Business of MD Anderson; The Institution and Finances; Growth and/or Change; Professional Path; Leadership; On Leadership; Obstacles, Challenges
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey A. Rosolowski, PhD:
Now, tell me about the evolution of your interests into law, and how you began to continue with your teaching in the area of ethics after you left the Committee and formal work within the institution.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
What I... Yeah, I had been... I mean, it goes way, way back. You know all about my stories on the cruise ship. Did I tell you about my interaction with Earl Warren?
Tacey A. Rosolowski, PhD:
No. (laughs)
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Okay. I was on the Love Boat, and one day this guy comes to me (laughs) and says, “Could you make a cabin call? A friend of mine is having some problems.” So we took care of the friend, and he said, “Well, you seem to know what you’re doing. Would you like to join me for dinner?” And I said, “No, I’m at the captain’s table, but I’d like to meet you, and we could...” So we sit at the bar, where I have a Coke, without rum, and he has whatever he has, and we spar together. And he’s under a different name. We have no idea who he is. (laughs) And here I am, a 31-year-old guy, arguing about everything from Kennedy’s assassination, and having no clue that the guy I’m talking with wrote the Kennedy Report. And finally he says, “You know, you argue really well. You should consider going to law school.” (laughter) And I said, “I would love to go to law school.” He said, “Well, you know, maybe I could help you.” And I said, “How can you help me?” He said, “Well, you know, I told you I was a lawyer.” And I said, “Where did you practice law?” And he said, “Well, I practiced law in California, and I practiced law in Washington.” He was the Governor of California. (laughter) Okay. So finally I said, there’s something about him that doesn’t make sense. I said—you know, it was Earl and Mike, okay. “Earl, there’s something about you. I mean, here you say that you might even help me get into law... Do you teach law?” He said, “Oh, I’ve taught a little bit here and there. Why don’t you visit me in Washington? I’d like to get to know you better.” And I said, “Well, I’d love to do that, but first I want to know who you are.” And he said, “Well, I’m Earl Warren, former Chief Justice of the Supreme Court.” (laughter) End of sparring. But the idea that he suggested that I might enjoy law school never died. Earl died the following year. I have a picture of me and Earl together down in the office; I’ll show it to you sometime.
Tacey A. Rosolowski, PhD:
Oh, cool, yeah!
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
And so here I am, working in ethics, and I thought, well, you know, I should apply for law school. So in 1995, I applied to the University of Houston Law Center, was rejected. Applied again the following year, and Margaret Kripke [oral history interview] wrote a letter in support, and I think Matt Masek wrote a letter in support, and I got in. I mean, at that point it was ’96, so I was, what, 55 years old, and going to law school, competing with 20-year-old brilliant people. And I managed, had a weak beginning but I managed to finish on time. And I graduated in 2000 or 2001. Immediately signed up for an advanced degree in health law. And then started to teach there, and now I’m the head of the what’s called an LLM degree. It’s an advanced degree in health law. I’m the head of that program at the University of Houston Law Center. So I’ve taught several different courses there. I’ve taught at Texas Southern, and I’ve taught at the McGeorge School of Law. And I’ve never looked back. I’ve never written serious law articles, but there’s very often a bit of law in what I write. I wrote a paper—we just sent it off—about guidelines, and the shifting of burdens, which nobody has really addressed before, but I addressed it in this paper. If you’re a physician, and you follow guidelines, and something bad happens, then the patient has the burden to say, “It was really stupid to follow guidelines because I was so different,” and that’s a very hard position to take. If the doctor takes the position of “I didn’t follow guidelines” and something bad happens, and the patient says “You didn’t even follow guidelines,” then the burden falls on the doctor to say why it was appropriate not to follow guidelines. So the guidelines are a double-edged sword legally. Nobody’s actually written about this, but I finally put it down, and it’s going to come out one of these times.
Tacey A. Rosolowski, PhD:
That’s very neat. Because I was going to ask you how work in the law has influenced your thinking about medical issues, and vice versa.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Who should have rights? Should society cater to unreasonable rights? At what point should society have the obligation to say “Enough is enough; we’re spending 18%; other people spend a third less and have just as satisfactory lifespans, infant mortality, other things”? Where and when and how should our society intervene? Because if we continue, we will compromise our ability to provide other important services. We have already made priorities. If we were to spend, for instance, the one third of our gross domestic product that we’re spending more on healthcare than other countries do, and would invest it in education, we might be better off for it, but I’m not the president. I’m not even the president of Anderson. (laughs)
Tacey A. Rosolowski, PhD:
Right. So it sounds like law has enabled you to bring another kind of perspective, or an additional tool, to think about that relationship between micro and macro ethics.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Micro and macro ethics. I taught health law at the School of Public Health next door last semester. I also got a PhD there last year, so it’s...
Tacey A. Rosolowski, PhD:
In what?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Management and policy.
Tacey A. Rosolowski, PhD:
Management. Okay, very cool, very cool.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
I think I’m the oldest—I’m the person who graduated with the most advanced age from that school, but I’m not absolutely certain about that. Was not my choice; they just kept delaying (laughter) my graduation until I became so old that...
Tacey A. Rosolowski, PhD:
You got that accolade for that achievement. Well, I wanted to ask you about some of the other roles, because I noticed you had this interesting Special Assistant to the Vice President and Special Assistant to Physician-in-Chief and all these things, so tell me about that. The first one was ’94 to ’97, and that was Special Assistant to the Vice President for Patient Care. So I’ve actually not heard about that role so early. So what did that entail?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Because I finished law school, I guess somebody thought that this would be a good fit, and they moved me in there, and I did less... (phone rings) I’m going to have to take it.
Tacey A. Rosolowski, PhD:
Yeah, I will put it on pause here. [The recorder is paused.] Oh gosh, yeah.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Where are we?
Tacey A. Rosolowski, PhD:
You were talking about how someone had—
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Special Assistant, yeah.
Tacey A. Rosolowski, PhD:
The Special Assistant. Someone said you have a law degree, and...
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
And the political impetus to putting me there is something that I never understood. I mean, I was doing lots of cardiology. People were happy with me doing cardiology. Now all of a sudden they want me to do something else. Time to reinvent myself, so I reinvented myself. I do a lot of work with advocacy. I do a lot of work with overrides and things of this type. I still read a lot of the cardiograms that get done in this institution. But I see very few patients.
Tacey A. Rosolowski, PhD:
Now, who was the VP for Patient Care at that time?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
[David] Callendar.
Tacey A. Rosolowski, PhD:
Oh, okay. And what did you do for him?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Occasionally he asked me to look into certain problems and advise him, but not very often.
Tacey A. Rosolowski, PhD:
So it was basically a close ethics advisor role, or was it a medical—
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Just whatever came up. It wasn’t specifically ethics. I could interact with everything from the law to ethics, and whatever he wanted to ask me I would do, or “This patient is complaining; would you look into that complaint and advise me?” And the guidance was very clear: it was “We want to do the right thing.” And then Tom Burke [oral history interview], and later Tom Buchholz [oral history interview], and I did relatively little for Tom Buchholz, but I did quite a bit for Alma Rodriguez [oral history interview]. And so I’m still in that position, but who knows what’ll happen next week, because that’s in a flux right now.
Tacey A. Rosolowski, PhD:
Yeah. So it’s like you’re the resident wise man. (laughs)
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
I don’t know that I’m that wise, and I don’t know that anybody really understands what I have to offer the institution. I think I have a lot of insight and a lot of common sense to offer the institution, but I don’t see people knocking on my door asking for it.
Tacey A. Rosolowski, PhD:
Yeah. Well, those people certainly did, and they were and are well-positioned individuals, so that’s pretty neat.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
They’re all gone.
Tacey A. Rosolowski, PhD:
They’re all gone, I know. (laughter) Very true.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Maybe I was lucky that I didn’t move up higher because then I might be gone, too, and I’m happy being here.
Recommended Citation
Ewer, Michael S. MD and Rosolowski, Tacey A. PhD, "Chapter 11: Bringing a Legal Perspective into Ethics Work" (2018). Interview Chapters. 813.
https://openworks.mdanderson.org/mchv_interviewchapters/813
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