Ruth Bader Ginsburg’s death is a tragedy. Ginsburg was a pioneer, a brilliant jurist, and a moral force. Losing anyone of her stature, and her talents, is gutting. But Ginsburg’s death is also a political crisis — one she saw coming. In a final statement, dictated to her granddaughter, Ginsburg said, “My most fervent wish is that I will not be replaced until a new president is installed.” Ginsburg’s death leaves the Senate in dangerous territory. McConnell has made his position clear. His stance on Garland was about power, not principle, and he has no intention of holding a vacancy open for Joe Biden to fill. “President Trump’s nominee will receive a vote on the floor of the United States Senate,” he said in a statement following Ginsburg’s death. Democrats remain livid over the Garland affair, and adding more justices to the Court — an idea known as “court-packing” — to balance out McConnell’s machinations has gained currency among key Democratic senators, and understandably so. Mitch McConnell set the precedent. No Supreme Court vacancies filled in an election year. If he violates it, when Democrats control the Senate in the next Congress, we must abolish the filibuster and expand the Supreme Court. — Ed Markey (@EdMarkey) September 19, 2020 It’s possible that a crisis here will be averted by a critical mass of Republicans refusing to vote on a replacement until after the election. Prior to Ginsburg’s death, Sens. Lisa Murkowski (R-AK), Lindsey Graham (R-SC), and Susan Collins (R-ME) have said they’d follow the Garland rule and hold a vacancy open until after the election. Now we’ll see if they meant it. Whatever the outcome, the core problem is the stakes of Supreme Court nominations: They’re too damn high. The Supreme Court isn’t merely an undemocratic branch of government but a randomly undemocratic branch of government. And that randomness, and the stakes of seeing it play out in your side’s favor, turn vacancies into crises. Supreme Court justices serve for life — which, given modern longevity and youthful nominees, can now mean 40 years of decisions — and no one knows when the next seat will open. President Jimmy Carter served four years and saw no open seats. President George H.W. Bush served four years and filled two. Barack Obama served two terms and confirmed two justices. After Senate Majority Leader Mitch McConnell’s blockade of the nomination of Merrick Garland, Donald Trump has already filled two vacancies, and Ginsburg’s death opens a third, raising the possibility that Trump will fill more vacancies in four years than Obama filled in eight. In practice, the Supreme Court decides how elections are funded, whether abortions are legal, whether millions of people will continue to have health insurance — if legislators and activist groups see its composition as a matter of life and death, that’s because it often is. This is why, in 2016, McConnell refused to consider any of President Obama’s nominees to fill the vacancy left by Justice Antonin Scalia: Keeping a conservative majority on the Court was, for Republicans, worth any amount of damage to the institution, and to American politics more broadly. These same incentives create extraordinary pressure for justices to stay on the bench long after they might have otherwise retired, in the hopes that they can outlast an ideologically unfriendly administration. They bias presidents toward nominating the youngest confirmable jurist they can find, rather than the best candidate they can find. And they turn an institution meant to be insulated from the political system into a threat to the political system, as almost any political cost is worth bearing if it leads to control of the Court. Rick Perry was right. We need 18-year Supreme Court terms. The Supreme Court should reflect the Constitution and the country, not the quirks of longevity. Holding justices to a single, nonrenewable term would lower the stakes of any individual Supreme Court nomination as well as make the timing of fights more predictable. An idea like this could have bipartisan support: Rick Perry proposed 18-year terms in his 2012 Republican presidential bid, making an argument that I think sounds even more persuasive today: Doing this would move the court closer to the people by ensuring that every President would have the opportunity to replace two Justices per term, and that no court could stretch its ideology over multiple generations. Further, this reform would maintain judicial independence, but instill regularity to the nominations process, discourage Justices from choosing a retirement date based on politics, and will stop the ever-increasing tenure of Justices. Eighteen-year terms would also ensure the Supreme Court keeps closer touch to the country. A seat on the Court is a plum job, and it’s understandable that few want to give it up. But there are too many examples of justices serving after their faculties began to fail; Chief Justice William Rehnquist, for instance, missed 44 oral arguments in 2004 and 2005, after undergoing a tracheotomy to treat thyroid cancer. Nevertheless, he declined to step down and, shortly thereafter, died in office. Even in less extreme cases, serving as a Supreme Court justice is the kind of job that pulls you far out of normal human context. You’re one of the most powerful people in the country, surrounded by ritual and deference, traveling in only the most rarefied circles. In an institution like that, more new blood, more often, is probably a good thing. Implementing term limits for the Supreme Court would be a step toward repairing and normalizing a process that raises the stakes of vacancies beyond what our politics, or the human beings who serve on the Court, can comfortably bear. It would be one important way we could deescalate the stakes of American politics, and protect the system from total breakdown.<doc-sep>Most readers took this as good news. Though I didn’t mean to imply that she’s cleared. It’s true that nodules are very common—and a nodule is different from a mass, the distinction being the size. A nodule is, by definition, fewer than 3 centimeters (around an inch) in diameter. These two nodules are now gone, and there are apparently no others remaining. But the word that makes the statement more complicated and concerning is two. Pulmonary nodules are indeed extremely common, and most are benign. To find two malignant nodules in a person who smokes would not be especially surprising. However, if you have two separate malignant nodules in your lung and you do not smoke, doctors worry that this means they represent metastatic disease from a cancer somewhere else. This is especially true if the patient has a history of cancer, as Ginsburg does. She had early-stage colon and pancreatic cancers removed in 1999 and 2009, respectively. Lung nodules are generally removed when they are deemed suspicious for malignancy, meaning they either showed signs of growth or were not seen on prior oncologic screening. “Growing pulmonary nodules can be primary lung cancers, and synchronous ones do appear,” says Howard Forman, a radiologist and professor at Yale. “But in a patient with two primary known malignancies, we would need to know the pathology of the nodules before believing she is cured.” The pathology report can tell us if the malignant cells are lung cancer—meaning a rare case of two simultaneous new lung cancers in a nonsmoker—or if they represent a recurrence of metastatic colon or pancreatic cancer, or if they are of some other origin. If this is the case, it would raise concern that although current scans showed no evidence of metastatic disease elsewhere, there could be yet-undetectable cancer cells already seeded in Ginsburg’s body. The fact that the statement says the nodules are indeed malignant means that at least a preliminary pathology report has been done, but this crucial detail—what type of malignancy?—was either unclear or withheld from the statement. It reads only: “According to the thoracic surgeon, Valerie W. Rusch, MD, FACS, both nodules removed during surgery were found to be malignant on initial pathology evaluation.” (I emailed Rusch, who told me, “We have no additional information on the pathology at the present time.”) “It all depends on the pathology report,” says the pathologist Anirban Maitra, the scientific director of the Ahmed Center for Pancreatic Cancer Research at MD Anderson Cancer Center. “Cancer in the lung is not the same as primary lung cancer, especially in a person with a history of colon and pancreatic cancer. Right now it’s best for the medical community to wait for more details.” “They might need to run special stains to distinguish lung versus colon versus pancreatic,” Maitra adds. “That could take a couple days and may or may not be conclusive.” In any case, expect that Ginsburg will be monitored closely in coming years for metastatic disease. In the immediate term, recovery from a lobectomy can be a significant undertaking for an 85-year-old, and that is indeed the relevant health issue for the foreseeable future.<doc-sep>Play video content 1/9/19 SplashNews.com 1/11 -- RBG has no remaining signs of cancer and she will NOT require additional treatment, according to the Washington Post. RBG's expected to miss next week's arguments but will continue to work from home. Ruth Bader Ginsburg was spotted for the first time since undergoing surgery to remove cancerous growths from her lung. A photo agency got video of RBG leaving her Washington D.C. apartment at 9 AM Wednesday, looking frail but hopefully on the mend. The surgery was serious enough for Justice Ginsburg to miss the last 3 days at the Supreme Court ... something that has never happened in her 25-year storied career on the high court. Her health has been on the minds of everyone since she fractured several ribs during a fall in November. Doctors who treated her discovered the cancerous growths. The 85-year-old Justice was in a wheelchair and helped into a waiting car. It's unclear where she was headed but she did not go to the Supreme Court. RBG is the oldest member of the Supreme Court and the cornerstone of the liberal wing. She's been working from home while recovering from her surgery. Justice Ginsburg has battled cancer twice before -- colon cancer in 1999 and pancreatic cancer in 2009. Despite her surgeries and recoveries, she did not miss a single day at work.<doc-sep>Ruth Bader Ginsburg. Photo: Nicholas Kamm/AFP/Getty Images Not even Fox News can kill the Notorious RBG. On Monday morning, Fox and Friends briefly aired a graphic of Ruth Bader Ginsburg along with the dates 1933–2019, implying the Supreme Court justice had died. The 85-year-old, however, is very much alive, and Ginsburg is said to be currently convalescing at home after undergoing surgery in December for early-stage lung cancer. (Still, she’s probably in much better shape than you are. Deal with it.) Later in the show, perhaps realizing that accidentally declaring someone dead on-air isn’t great, co-host Steve Doocy issued an apology. “A technical error in the control room triggered a graphic of Ruth Bader Ginsburg with a date on it,” he said. “We don’t want to make it seem anything other than that was a mistake. It was an accident.” In a statement to Deadline, a Fox News spokesperson confirmed it was an error by the graphics team. Fox & Friends aired a graphic that showed Ruth Bader Ginsberg had passed away. Even if it was a "technical error" as they claim, why does this graphic exist in the first place? pic.twitter.com/UaVKW3IlOr — Nick Jack Pappas (@Pappiness) January 21, 2019 In 1993, Ginsburg became the second woman appointed to the United States Supreme Court, and she’s recently morphed into a gavel-wielding, pop-culture phenomenon. Her trials in life and the courtroom have been the subject of a certifiably fresh documentary, and a biopic in which her real-life husband, Marty Ginsburg, was played by a not-angry Armie Hammer. She’ll also make a cameo, at least as a mini-figurine, in The Lego Movie 2: The Second Part. Final verdict: RBG just keeps winning.<doc-sep>
After Supreme Court Justice Ruth Bader Ginsburg’s recent hospitalization and surgery to remove “two cancerous nodules” from her lung, the media can’t get their stories straight about her health, or lack thereof. Is this new lung cancer, on top of her history of pancreas and colon cancer? Or is it metastatic cancer from elsewhere in her body? Is she healthy and cancer free or does she have stage four cancer, with an extremely poor prognosis? Can she resume her duties as a Supreme Court justice, or will she be soon retiring? Or worse? Members of the media are in lockstep, pushing the narrative that Justice Ginsburg is in great health. Why, she’s almost ready to resume her famous RBG workout that “nearly broke” a Politico reporter young enough to be Ginsburg’s grandson. CNN reported the official statement from the Supreme Court, “Post-surgery evaluation indicates no evidence of remaining disease, and no further treatment is required.” I wonder if CNN’s ace reporter Jim Acosta took a walk next to Ginsburg’s home, and — not observing any cancer near him — confirmed that Ginsburg was cancer free, as he did strolling along a border fence last week? The statement is curious, however. As a physician myself, I am acutely aware of medical wording and nuance. With medical malpractice attorneys hiding behind every corner, physicians are careful how they create medical statements, especially when there is little absolute certainty in the medical world. “No evidence of remaining disease” could simply mean that they removed the two cancerous nodules they found on a lung scan after her recent fall. If these nodules represent cancer that spread from her previous colon or pancreas cancer, the doctors removed what they found in her lungs. This doesn’t speak for cancer that might have spread to her liver, brain or bones. “No further treatment is required” might imply that she is cancer free. It could also suggest the opposite, that she has metastatic cancer that is no longer treatable, other than hospice care, and that further treatment is futile at this point, hence not required. The media were giddy with excitement that the liberal lion of the court was ready to get back to her job of thwarting President Trump. TMZ caught a glimpse of her, “emerging for the first time” from her Washington, D.C., apartment. CBS reported that her recovery is “on track” with “no sign of remaining cancer.” Fox News echoed the others by saying her recovery was “on track”, although they curiously described her recent surgery as, “early-stage lung cancer surgery.” Not so if it was metastatic cancer, meaning stage four and quite advanced. One journalistic fanboy posed a question, “Asking readers if they would give up time off their own lives to allow their favorite Supreme Court justice to live longer.” He added, “If just 10,000 people did this, it would add 27 productive years to her life.” How would he react if there was a similar push to donate lives to Clarence Thomas or Sam Alito, giving them another quarter-century on the Supreme Court? The rumors swirl over Ginsburg’s health, but the White House may not be buying the media spin. “The Trump team began early groundwork for another potential confirmation battle,” according to Politico. The latest concern is that Justice Ginsburg could develop pneumonia, a common complication of lung surgery, particularly in the elderly and infirm. Pneumonia is often called “the old man’s friend” not to be sexist but because, “left untreated, the sufferer often lapses into a state of reduced consciousness, slipping peacefully away in their sleep, giving a dignified end to a period of often considerable suffering.” Big media is happy to ignore reality staring them right in the face, whether the consequences of an open border or the health of their favorite Supreme Court justice. They will spin their stories furiously to deny the obvious. Given Justice Ginsburg’s failing health, there must be panic in D.C. that can’t be spun away with creative journalism. Brian C. Joondeph (@RetinalDoctor), MD, MPS, is a Denver-based physician. The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.