Dear Cyndy,

Thank you for your letter.
I find that disagreeing is preferable by far
to misunderstanding or being misunderstood.
It's more dignified and more realistic.
We are, after all, different individuals
with different experiences. I repeat myself
when I quote Schopenhauer: I can will what I do,
but I can't will what I will. In retrospect,
I can always attach a label to what I have thought,
to what I have done. But what I think and what I do
in this present moment wells spontaneously from the
"subconscious," is revelation and demonstration of
what I am. And "what I am" is plastic and changeable,
is molded by the circumstances in which I find myself.
That is why my action is modifiable by punishment and
by reward. The "criminal", the "evil" individual is a
personality insufficiently sensitive to adapt itself
to the demands of society. I blame the "evil" person 
for his lack of "moral" or "social" sensitivity no
more than I blame the the (partially) blind person
for his inability to see or the deaf person for his
inability to hear.

So far as the "reporting" of legal cases is concerned,
it's my impression that all Federal Supreme Court cases
are reported, but that reporting of cases in the appellate
and trial courts is discretionary with the judges. My
lawsuit against Mass Eye and Ear Infirmary in 1970, where
I refused to be complicit in surgical operations, nominally
under my direction, which were done as teaching exercises
for residents and which I considered harmful to the patients, -
that lawsuit was reported by Judge Garrity soon after his
initial ruling and nine years before the case was finally
closed. Judge Garrity, however, didn't tell the whole story;
as a matter of fact, he didn't tell it at all.  I assume that
the reported Massachusetts cases are similarly selected and
similarly censored by the judges, but I don't really know.
What I have seen of the opinion in the unreported Nantucket
case about plumbing, Herrick v. Butler, seems to me
embarrassingly poor. Given that only selected cases
are reported and that the Court's ruling may ignore the
most significant pleadings in the case, the doctrine that
reported cases reflect the history of the law is a myth.
Rather, reported cases strike me as a very sophisticated
species of political correctness propaganda.

Off and on, I've been thinking about my present case.
I append my thoughts to a memorandum file in my computer,
to which I will refer weeks or months hence, when it's time
to compose the definitive memorandum prior to the hearing
and the judgment. Since I don't undertake to edit it,
this file is unavoidably repetitive.  I'll send it to you
if you ask to see it. I wonder whether the circumstance
is of any signficance that an asistant attorney general,
rather than the inhouse lawyer of the plumbing board,
has been assigned to defend the case. I have no idea
what that significance might be.

Meanwhile I have been perusing Internet sites for information
about electronic medical records and about uptodate requirements
for patent applications. At the root of my project is my conviction
that the logical foundations of contemporary medical practice are
far from optimal, and my concern that the implementation of faulty
reasoning in a mandated computer program will prove pervasively
destructive to the profession. My observation is that diseases are
not nearly so sharply defined as the lecturers and the textbooks
would have it; that disease processes cannot be interpreted
independent of their specific manifestations; that understanding
and interpreting the illness of a given patient is a creative
intellectual (and spiritual) exercise, which may be made virtually
impossible for a physician who is forced to conform to specifications
of a computer program that has been composed by committee and 
published in the Federal Register before it was adopted as a
Federal regulation that has the force of law. Such an arrangement
will unavoidably meet with much resistance on the part of physicians,
and will, to the extent that it is implemented at all, prove very
inefficient and expensive.

Rather than having unrealistic governmentally approved formulas
forced upon him I propose an inductive approach which gives the
individual physician unlimited discretion in selecting, and entering
into the system, that information which seems to him appropriate on
the occasion of his encounter with the patient. A computing technique
which I conceive of as a kind of artificial intelligence will
then collate and combine the newly entered data with existing
information about the patient and about the disease, and will
provide the physician in real time with perspectives and
considerations that might otherwise have escaped him. All
"raw" data provided by the physician should be stored in files
denominated as physicians'"work product", in strict analogy to
the lawyers' work product which has always been immune to
judicial discovery. (Lawyers may be reluctant to demand access
to physicians'"work product" files, lest the precedent jeopardize
the security of their own.) The patient's official medical record 
will then be an impeccable abstract of the multifarious "raw" data.

When I contemplate applying for a software patent, I feel guilty
about betraying the "open source" and "free software" tradition
in contemporary computing to which I owe so much. However,
without a patent, I can't expect my ideas to be taken seriously
by anybody, - perhaps not even with a patent, - and if the project
proved successful, it would be easy enough to disclaim the patent
in favor of the public.  Of course I would like to learn to write
all the programs myself; but it is an unrealistic wish, and I know
that if I succumb to it, nothing will ever come of my project, -
it probably won't, anyway.  Meanwhile, occupying myself with so
challenging an undertaking, keeps my mind agile and keeps me happy.

So I hope are you. I can't say that I share your dislike of the
winter. I find it an occasion for spiritual hibernation. I am
a bit fearful that when spring comes, there will more work for
me than I can accomplish. Please give my best to Ned.

Jochen