Academic literature on the topic 'Alaska Bar Association'

Photo by Anna Hecker on Unsplash ABSTRACT All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. However, until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. INTRODUCTION In the last few years, states have passed increasingly restrictive laws regarding abortion and reproductive health care. Recent legislation in Alabama effectively banned the procedure altogether, while more than a dozen states have passed or are currently in the process of enacting so-called “fetal heartbeat laws,” which ban abortion at roughly six weeks post-conception after the detection of electrical activity in what could develop into fetal cardiac tissue.[1] While courts rarely uphold outright bans and broad sweeping legislation, they garner significant media and public attention.[2] In practice, however, often smaller legislative changes that garner the least attention have the most significant impact by steadily chipping away at healthcare rights. Few people realize the ethical impact of the poorly understood legal means by which a pregnant woman has already lost her right to make autonomous healthcare decisions over her body using an advance directive in nearly every state. BACKGROUND Advance directives are one of modern medicine’s most powerful yet underused tools. Most clinicians and patients think of advance directives as being only for the elderly or terminally ill. This association stems from the 1991 Congressional Patient Self-Determination Act that requires hospitals, nursing homes, and hospice agencies receiving federal funding to inform patients of their legal right to prepare an advance directive. The 2015 announcement by the Center for Medicare and Medicaid Services (CMS) to reimburse for advance directives without requiring a diagnosis code recognizes that all adult patients can benefit from advance directives regardless of illness or life expectancy.[3] Providers should be aware of a small but significant exemption found in most state advance directive laws. This exemption, commonly known as the pregnancy clause, invalidates the advance directive of a pregnant woman, negating autonomy. The pregnancy clause can lead to treatment against medical standards of care and places private interests over public health. Advance directive statutes are frequently amended, but currently, only eight states allow patients to write their pregnancy-related wishes into their advance directive and guarantee that their instructions will be followed. Eleven states automatically invalidate advance directives during pregnancy, while 18 states permit physicians to disregard a pregnant woman’s (or her proxy’s) wishes based on the likelihood of viability, pain, and suffering, or conscientious objector clauses. Thirteen states remain silent on whether an advance directive is binding during pregnancy or have contradictory statutes.[4] Viability has no standard definition for the purposes of the clauses and viability-based pregnancy clauses can lead to the same loss of rights as pregnancy clauses that invalidate advance directives due to pregnancy without any exceptions. Many may wonder about the clinical relevance of pregnancy clauses. The likelihood that a woman will need to effectuate an advance care directive while pregnant is higher than many people would realize. This situation is most commonly assumed to occur in instances of a brain-dead pregnant woman, of which there are a few cases reported each year. But brain death and persistent vegetative states are just two reasons to look to an advance directive. Advance directives more commonly apply to patients with dementia, strong religious objections to medical care, or during cancer treatments, surgery, or acute injury with temporary loss of capacity. In surgery or acute lapses of capacity, a proxy may be asked to make decisions if complications arise. The number of women potentially affected by pregnancy clauses is significant. Each year, 75,000 pregnant women will undergo non-obstetrical surgery;[5] one in 1,500 pregnant women will be diagnosed with cancer;[6] and an estimated 250,000 Americans will exhibit early-onset Alzheimer’s symptoms between the ages of 30 and 50.[7] ANALYSIS Though pregnancy clauses are a seemingly narrow focus, they can nullify an entire advance directive and restrict care not related to the fetus. By negating entire advance directives, the clauses negate proxy appointments, allowing decision-makers other than the intended proxy. Providers and proxies are left with little guidance over who can make decisions on behalf of the patient. Many states will appoint a biological family member as the surrogate decision maker if there is no designated proxy or the directive is invalid. The outdated language and assumptions about nuclear families found in these structures could significantly impact unmarried couples, same-sex partnerships, and relationships that do not meet state-defined partnership standards where the courts may appoint someone other than the woman’s significant other even when she designated them as a proxy.[8] Members of religious groups whose doctrines prohibit certain medical therapies must be informed that if they become pregnant, their autonomous ability to decide about medical care through an advance directive and their right to freely practice religion can be voided entirely. In addition to infringing on patient autonomy, pregnancy clauses also restrict how clinicians might practice medicine by mandating medically inappropriate treatments against the provider’s recommendations. For example, Illinois’s pregnancy clause stipulates that “if you are pregnant and your health care professional thinks you could have a live birth, your living will cannot go into effect.”[9] This clause places providers in a difficult position of sacrificing their therapeutic obligation to their patients. It may require them to use futile therapy against the patient’s best interest and without regard for prolonged pain and suffering. Pregnancy clauses are void of any consideration of the best clinical interest of the patient or the fetus and instead promote conservative rhetoric that all potential fetal life is paramount. Numerous medical and chromosomal conditions are incompatible with life or present significant potential disabilities that may be accompanied by pain and suffering. The same conditions also pose risks to the mother, including death. Accordingly, the medical profession recognizes that there are instances in which it may not be in the best medical interest of the mother or the fetus to continue the pregnancy. Yet providers are seemingly required by pregnancy clauses to violate codes of conduct and subject pregnant patients and their nonviable fetuses to treatments to which other patients would not be subjected. Without evidence of a patient’s clear and convincing intentions, states have an interest in protecting life, preventing suicide, and maintaining the ethical integrity of the medical profession that could interfere with the person’s ability to refuse care.[10] The legal defense of pregnancy clauses is that the state’s interest in fetal life is sufficiently important to override the mother. As established in Planned Parenthood v. Casey (1992), however, the state’s interest only exists for fetal life post-viability.[11] Therefore, to allow the state interest to override the person’s advance directive when the fetus is not yet viable violates Casey. Individuals have a legal and ethical interest in maintaining bodily privacy, integrity, and freedom from unwanted touching. They have the right to appoint a proxy or use a directive to govern care in the case of incapacity. Even when contemplating brain death, organ donation, and whether to be cremated or buried, there is an expectation that personal wishes will govern. Honoring an advance directive allows providers to uphold the integrity of the medical profession by respecting the principles of autonomy and beneficence. Pregnancy clauses are inherently unethical as their creation was not to further the integrity of the medical or legal profession, nor protect a state’s interest in the patient’s life. In 2016, the American College of Obstetricians and Gynecologists issued a committee opinion that pregnancy is not an ethical exemption to the right of capable patients to refuse treatment.[12] The right to direct treatment while pregnant is consistent with modern medical practice, while the legislative promotion of a singular abstract interest in potential fetal life to the exclusion of all other medical and ethical considerations is not in line with the profession’s values.[13] Many pregnancy clauses are politically motivated, reflecting anti-abortion legality lobbying efforts and attempts to win over conservative voters. When Alaskan Attorney General Harold M. Brown argued the state’s pregnancy clause was unconstitutional, Governor Bill Sheffield – a Democrat in a historically red state – enacted the bill anyway. Georgia’s Governor Bill Kemp narrowly won his election, with some crediting his aggressive messaging against immigration and abortion.[14] With either advance directives, proxies, or even friends and relatives who know what the person (if not incapacitated) would have wanted, courts and legislatures should not have leeway to force care that a person, if conscious, would have refused.[15] The ability to harness advance directive law to force invasive and unwanted treatment upon a pregnant patient’s body continues to occur out of the fear of legal uncertainty. The lack of uniformity between states in their pregnancy clauses further adds to the confusion. Many advance directive statutes create a conditional proposition: if a provider acts in accordance with the carefully drawn circumstances of an advance directive, the provider is granted protective immunity from accusations of malpractice or wrongful death for that conduct. It is neither illegal nor unethical to remove a ventilator, for example, from a patient who has directed such a course of action in an advance directive. A pregnancy clause may remove that immunity making the unethical act of ignoring the directive legal, but the ethical act of following it (removing a ventilator, for example) could subject the practitioner to liability.[16] Without a pregnancy clause, providers retain the ability to both follow an advance directive and to act in the best medical interest of their patient. Pregnancy clauses create confusion over the permissibility of medical acts in an attempt to coerce providers into making decisions that violate the rights of their patients and their own ethical codes of conduct. Pregnancy clauses are a fallacy of consequentialist ethics in which the morality of the outcome justifies actions. Under consequentialist reasoning, any violation to the woman is justified if the fetus develops and results in a live birth. This reasoning is further faulty as it incorrectly assumes that mechanically ventilating an unconscious, sick, dying, or dead body will result in a live birth. Consequentialist theories should be limited to situations with predictable ends. Ethical medical providers refute consequentialism in certain contexts because it treats patients as a means to an end to produce benefit for others. In pregnancy, ignoring advance directives to achieve the chance that a fetus might survive is not justified by consequentialism. Pregnancy clauses also fail through the lens of deontological ethics in which an action must be ethical in and of itself and not based on outcomes. The choice to respect autonomy through an advance directive should be followed uniformly absent special circumstances. Proponents of pregnancy clauses may argue that pregnancy is an appropriate exception because a woman “has chosen to lend her body to bring [a] child into the world.”[17] Minnesota and Oklahoma echo this belief in their statutes, which contain an unjustified rebuttable presumption that all female patients would want life-sustaining treatment if they are pregnant.[18] Pregnancy should not abrogate the rights of a person to assign a proxy for access to an abortion or to control her medical treatment. Pregnancy exclusions are not grounded in the ethical “best interest” standards for the mother or the fetus. Instead, they are rooted in outdated expectations of female gender roles, which reaffirm a legislative assumption that a pregnancy is more morally valuable than a woman’s autonomy. CONCLUSION All people deserve the legal ability to outline their care decisions in advance and expect their decisions to govern during a pregnancy. Providers and the government do not have to approve of a person’s care decisions or values, but medical practitioners must respect a person’s right to dictate their own health narratives. With the push for more patients to execute advance directives, providers and patients must be aware that their advance directives may succumb to the authority of pregnancy clauses. Until advance directives govern without pregnancy exceptions, people will not uniformly retain the ability to formulate autonomous decisions about their health care planning. Advance directive law will continue to be hijacked by politically motivated legislators. When seeking to address inequities in healthcare laws and access, it is essential to take a closer look at not only the headline cases but also the clauses and exemptions to laws seemingly designed to benefit patients. [1] For proposed and current abortion legislation and maps, see https://www.guttmacher.org/state-policy# and Anne Godlasky, Nicquel Terry Ellis, and Jim Sergent, “Where is Abortion Legal? Everywhere, but…” USA Today, May 15, 2019, updated April 23, 2020 https://www.usatoday.com/in-depth/news/nation/2019/05/15/abortion-law-map-interactive-roe-v-wade-heartbeat-bills-pro-life-pro-choice-alabama-ohio-georgia/3678225002/ [2] https://www.guttmacher.org/state-policy# (Many bills fail in legislatures and are not enacted.) [3] Department of Health and Human Services Centers for Medicare & Medicaid Services; 42 CFR Part 405, 410, 411, 414, 425, and 495; “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2016; Final Rule.” [4] DeMartino, E. S., Sperry, B. P., Doyle, C. K., Chor, J., Kramer, D. B., Dudzinski, D. M., & Mueller, P. S. (2019). US State Regulation of Decisions for Pregnant Women Without Decisional Capacity. JAMA, 321(16), 1629–1631. https://doi.org/10.1001/jama.2019.2587; Villarreal, Elizabeth. “Pregnancy and Living Wills: A Behavioral Economic Analysis.” The Yale Law Journal Forum. Vol. 128 (2019); 1052-1076. [5] “Surgery During Pregnancy.” Intermountain Healthcare: Fact Sheet for Patients and Families, (2018). https://intermountainhealthcare.org/ext/Dcmnt?ncid=520782026 [6] Basta, P. Bak, A. Roszkowski, K. “Cancer Treatment in Pregnant Women”. Contemporary Oncology, 19, no. 5 (2015): 354–360 [7] “31-Year-Old Woman Fights Alzheimer's While Pregnant.” San Francisco Globe. 9 July 2015, sfglobe.com/2015/02/19/31-year-old-woman-fights-alzheimers-while-pregnant. [8] “Health Care Proxies.” Human Rights Campaign, https://www.hrc.org/resources/health-care-proxy. [9] Illinois Department of Public Health website, Statement of Illinois Law on Advance Directives and DNR Orders, http://www.idph.state.il.us/public/books/advdir4.htm. [10] In the Matter of Karen Quinlan, 355 A.2d 647 (1976); Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990); and In re Conroy 486 A.2d 1209 (1985). [11] Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992). [12] The American College of Obstetricians & Gynecologists Committee on Ethics, Committee Opinion No. 664: Refusal of Medically Recommended Treatment During Pregnancy, (2016). [13] Lederman, Anne D. “A Womb of My Own: A Moral Evaluation of Ohio’s Treatment of Pregnant Patient’s with Living Wills”. Case W. Res. L. Rev. Vol. 45:351 (1995); 351-377. [14] Tavernise, Sabrina. “The Time Is Now: States Are Rushing to Restrict Abortion, or to Protect It.” The New York Times, 15 May 2019. [15] Cruzan. [16] Mayo, T.M. “Brain-Dead and Pregnant in Texas.” The American Journal of Bioethics, Vol. 14, no. 8 (Nov. 2014); 15-18. [17] In re A.C., 573 A. 2nd 1244 (1990). [18] Johnson, Kristeena L. “Forcing Life on the Dead: Why the Pregnancy Exemption Clause of the Kentucky Living Will Directive Act is Unconstitutional.” Kentucky Law Journal. Vol. 100 (2011-12); 209-233.

Introduction Presidents “define who Americans are—often by declaring who they aren’t”, and “by their very utterances […] have shaped our sense of who we are as Americans” (Stuckey, front cover). This advocacy of some groups and policies to the exclusion of others has been facilitated in the United States’ political culture by the country music industry. Indeed, President Richard Nixon said of country music that it “radiates a love of this nation—a patriotism,” adding that it “makes America a better country” (Bufwack and Oermann 328). Country music’s ardent support of American military conflict, including Vietnam, has led to its long-term support of Republican candidates. There has been a general lack of scholarly interest, however, in how country music has promoted Republican definitions of what it means to be an American. Accordingly, we have two primary objectives. First, we will demonstrate that Republicans, aided by country music, have used the theme of defence of “country,” especially post-9/11, to attempt to intimidate detractors. Secondly, Republicans have questioned the love of “country,” or “patriotism,” of their electoral opponents just as country musicians have attempted to silence their own critics. This research is timely in that little has been done to merge Presidential advocacy and country music; furthermore, with the election of a new President mere days away, it is important to highlight the tendencies toward intolerance that both conservatism and country music have historically shared. Defence of ‘Country’ After the 9/11 attacks, President George W. Bush addressed the nation before a Joint Session of Congress on 20 September 2001. During this speech, the president threatened the international community and raised the spectre of fear in Americans both while drawing distinctions between the United States and its enemies. This message was reflected and reinforced by several patriotic anthems composed by country artists, thus enhancing its effect. In his remarks before Congress, Bush challenged the international community: “Either you are with us, or you are with the terrorists;” thus “advocating some groups to the exclusion of others” on the international stage (20 September 2001). With these words, the President expanded the definition of the United States’ enemies to include not only those responsible for the 9/11 attacks, but also anyone who refused to support him. Republican Senator John McCain’s hawkishness regarding the attacks mirrored the President’s. “There is a system out there or network, and that network is going to have to be attacked,” McCain said the next morning on ABC (American Broadcasting Company) News. Within a month he made clear his priority: “Very obviously Iraq is the first country,” he declared on CNN. Later he yelled to a crowd of sailors and airmen: “Next up, Baghdad!” (http://www.iht.com/articles/2008/08/17/america/mccain.php). Bush’s address also encouraged Americans at home to “be calm and resolute, even in the face of a continuing threat” (20 September 2001). The subtle “us vs. them” tension here is between citizens and those who would threaten them. Bush added that “freedom and fear” had always “been at war” and “God is not neutral between them” (20 September 2001) suggesting a dualism between God and Satan with God clearly supporting the cause of the United States. Craig Allen Smith’s research refers to this as Bush’s “angel/devil jeremiad.” The President’s emphasis on fear, specifically the fear that the American way of life was being assailed, translated into public policy including the creation of the Department of Homeland Security and the Patriot Act. This strategic nomenclature strengthened the power of the federal government and has been used by Republicans to suggest that if a candidate or citizen is not a terrorist then what does he/she have to fear from the government? The impact of Bush’s rhetoric of fear has of late been evaluated by scholars who have termed it “melodrama” in international affairs (Anker; Sampert and Treiberg). To disseminate his message for Americans to support his defence of “country,” Bush needed look no further than country music. David Firestein, a State Department diplomat and published authority on country music, asserted that the Bush team “recognised the power of country music as a political communication device” (86). The administration’s appeal to country music is linked to what Firestein called the “honky-tonk gap” which delineates red states and blue states. In an analysis of census data, Radio-Locator’s comprehensive listing by state of country music radio stations, and the official 2004 election results, he concluded that If you were to overlay a map of the current country music fan base onto the iconic red-and-blue map of the United States, you would find that its contours coincide virtually identically with those of the red state region. (84) And country musicians were indeed powerful in communicating the Republican message after 9/11. Several country musicians tapped into Bush’s defence of country rhetoric with a spate of songs including Alan Jackson’s Where Were You? (When the World Stopped Turning), Toby Keith’s Courtesy of the Red, White, and Blue (the Angry American), and Darryl Worley’s Have You Forgotten? to name a few. Note how well the music parallels Bush’s attempt to define Americans. For instance, one of the lines from Keith’s Courtesy of the Red, White, and Blue (the Angry American) speaks of those who have given their lives so that other Americans may rest peacefully. This sentiment is reiterated by the theme of Worley’s Have You Forgotten? in which he talks of spending time with soldiers who have no doubts about why they are at war. Both songs implicitly indict the listener for betraying United States soldiers if his/her support for the Iraqi war wanes or, put in Bush terms, the listener would become a supporter of “terrorism.” Country music’s appeal to middle-America’s red state conservatism has made the genre a natural vehicle for supporting the defence of country. Indeed, country songs have been written about every war in United States history; most expressing support for the conflict and the troops as opposed to protesting the United States’ action: “Since the Civil War and Reconstruction, ‘Dixie’ has always been the bellwether of patriotic fervour in time of war and even as the situation in Vietnam reached its lowest point and support for the war began to fade, the South and its distinctive music remained solidly supportive” (Andresen 105). Historically, country music has a long tradition of attempting to “define who Americans were by defining who they weren’t” (Stuckey). As Bufwack and Oermann note within country music “images of a reactionary South were not hard to find.” They add “Dixie fertilized ‘three r’s’ – the right, racism, and religion” (328). Country musicians supported the United States’ failed intervention in Vietnam with such songs as It’s for God and Country and You Mom (That’s Why I’m Fighting In Vietnam), and even justified the American massacre of noncombatants at My Lai in the Battle Hymn of Lt. Calley (328). Thus, a right-wing response to the current military involvement in Iraq was not unexpected from the industry and the honky-tonk state listeners. During the current election, Republican presidential nominee McCain has also received a boost from the country music genre as John Rich, of Big and Rich, wrote Raising McCain, a musical tribute to McCain’s military service used as his campaign theme song. The song, debuted at a campaign rally on 1 August 2008, in Florida, mentions McCain’s ‘Prisoner of War’ status to keep the focus on the war and challenge those who would question it. Scholars have researched the demographics of the country music listener as they have evaluated the massification theory: the notion that the availability of a widespread media culture would break down social and cultural barriers and result in a “homogenised” society as opposed to the results of government-controlled media in non-democratic countries (Peterson and DiMaggio). They have determined that the massification theory has only been partially demonstrated in that regional and class barriers have eroded to some extent but country music listeners are still predominately white and older (Peterson and DiMaggio 504). These individuals do tend to be more conservative within the United States’ political culture, and militarism has a long history within both country music and conservatism. If the bad news of the massification theory is that a mass media market may not perpetuate a homogenous society, there is good news. The more onerous fears that the government will work in tandem with the media to control the people in a democracy seem not to have been borne out over time. Although President Bush’s fear tactics were met with obsequious silence initially, resistance to the unquestioning support of the war has steadily grown. In 2003, a worldwide rally opposed the invasion of Iraq because it was a sovereign state and because the Bush doctrine lacked United Nations’ support. Further opposition in the United States included rallies and concerts as well as the powerful display in major cities across the nation of pairs of combat boots representing fallen soldiers (Olson). Bush’s popularity has dropped precipitously, with his disapproval ratings higher than any President in history at 71% (Steinhauser). While the current economic woes have certainly been a factor, the campaigns of Barack Obama and John McCain can also be viewed as a referendum on the Bush war. The American resistance to the Bush rhetoric and the Iraq war is all the more significant in light of research indicating that citizens incorrectly believe that the opposition to the Vietnam War was typified by protests against the troops rather than the war itself (Beamish). This false notion has empowered the Republicans and country musicians to challenge the patriotism of anyone who would subsequently oppose the military involvement of the United States, and it is to this topic of patriotism that we now turn. Patriotism Patriotism can be an effective way for presidential candidates to connect with voters (Sullivan et al). It has been a particularly salient issue since the 9/11 attacks and the wars in Iraq and Afghanistan. Ironically, George W. Bush, a man whose limited military service had been the subject of debate in 2000, was able to employ the persistent patriotic themes of country music to his electoral advantage. In fact, Firestein argued that country music radio had a greater effect on the 2004 election than any ads run by issue groups because it “inculcated and reinforced conservative values in the red state electorate, helped frame the issues of the day on terms favourable to the conservative position on those issues, and primed red state voters to respond positively to President Bush’s basic campaign message of family, country, and God” (Firestein 83). Bush even employed Only in America, a patriotic anthem performed by Brooks and Dunn, as a campaign theme song, because the war and patriotism played such a prominent role in the election. That the Bush re-election campaign successfully cast doubt on the patriotism of three-time Purple Heart winner, Democratic Senator John Kerry, during the campaign is evidence of Firestein’s assertion. The criticism was based on a book: Unfit for Command: Swift Boat Veterans Speak Out Against John Kerry (O’Neill and Corsi). The book was followed by advertisements funded by Swift Boat Veterans for Truth which included unsubstantiated claims that Kerry lied or exaggerated his combat role in Vietnam in order to obtain two of his Purple Hearts and his Bronze Star; the testimony of Kerry’s crewmen and Navy records notwithstanding, these ads were effective in smearing Kerry’s service record and providing the President with an electoral advantage. As far as country music was concerned, the 2004 election played out against the backdrop of the battle between the patriotic Toby Keith and the anti-American Dixie Chicks. The Dixie Chicks were berated after lead singer Natalie Maines’s anti-Bush comments during a concert in London. The trio’s song about an American soldier killed in action, Travelin’ Soldier, quickly fell from the top spot of the country music charts. Moreover, while male singers such as Keith, Darryl Worley, and Alan Jackson received accolades for their post 9/11 artistic efforts, the Dixie Chicks endured a vitriolic reaction from country music fans as their CDs were burned, country radio refused to play their music, their names were added to an internet list of traitors, their concerts were protested by Bush supporters, and their lives were even threatened (http://www.poppolitics.com/archives/2003/04/Bandwagon). Speaking from experience at the 2008 Democratic National Convention, Kerry addressed the issue of patriotism stating: This election is a chance for America to tell the merchants of fear and division: you don’t decide who loves this country; you don’t decide who is a patriot; you don’t decide whose service counts and whose doesn’t. […] After all, patriotism is not love of power or some cheap trick to win votes; patriotism is love of country. (http://www.clipsandcomment.com/2008/08/27/full-text-john-kerry-speech-democratic-national-convention/) Kerry broached the issue because of the constant attacks on the patriotism of Democratic nominee, Senator Barack Obama. At the most basic level, many of the attacks questioned whether Obama was even an American. Internet rumours persisted that Obama was a Muslim who was not even an American citizen. The attacks intensified when the Obamas’ pastor, Reverend Jeremiah Wright, came under fire for comments made during a sermon in which he stated “God damn America.” As a result, Obama was forced to distance himself from his pastor and his church. Obama was also criticised for not wearing a United States flag lapel pin. When Michelle Obama stated for the “first time [she was] proud of her country” for its willingness to embrace change in February of 2008, Cindy McCain responded that she “had always been proud of her country” with the implication being, of course, a lack of patriotism on the part of Michelle Obama. Even the 13 July 2008 cover of the liberal New Yorker portrayed the couple as flag-burning Muslim terrorists. During the 2008 election campaign, McCain has attempted to appeal to patriotism in a number of ways. First, McCain’s POW experience in Vietnam has been front and centre as he touts his experience in foreign policy. Second, the slogan of the campaign is “Country First” implying that the Obama campaign does not put the United States first. Third, McCain’s running mate, Alaska Governor Sarah Palin, insisted in a speech on 4 October 2008, that Barack Obama has been “palling around with terrorists who would target their own country.” Her reference was to Obama’s acquaintance, Bill Ayers, who was involved in a series of Vietnam era bombings; the implication, however, was that Obama has terrorist ties and is unpatriotic. Palin stood behind her comments even though several major news organisations had concluded that the relationship was not significant as Ayers’ terrorist activities occurred when Obama was eight-years-old. This recent example is illustrative of Republican attempts to question the patriotism of Democrats for their electoral advantage. Country music has again sided with the Republicans particularly with Raising McCain. However, the Democrats may have realised the potential of the genre as Obama chose Only in America as the song played after his acceptance speech at the Democratic Convention. He has also attempted to reach rural voters by starting his post-convention campaign in Bristol, Virginia, a small, conservative town. Conclusion Thus, in the wake of 9/11, Republicans seized the opportunity to control the culture through fear and patriotic fervour. They were facilitated in this endeavor by the country music industry with songs that that would questions the motives, defence of “country,” and patriotism, of anyone who would question the Bush administration. This alliance between country music and the right is an historically strong one, and we recommend more research on this vital topic. While this election may indeed be a referendum on the war, it has been influenced by an economic downturn as well. Ultimately, Democrats will have to convince rural voters that they share their values; they don’t have the same edge as Republicans without the reliance of country music. However, the dynamic of country music has changed to somewhat reflect the war fatigue since the 2004 campaign. The Angry American, Toby Keith, has admitted that he is actually a Democrat, and country music listeners have grown tired of the “barrage of pro-troop sentiment,” especially since the summer of 2005 (Willman 115). As Joe Galante, the chief of the RCA family of labels in Nashville, stated, “It’s the relatability. Kerry never really spent time listening to some of those people” (Willman 201). Bill Clinton, a Southern governor, certainly had relatability, carrying the normally red states and overcoming the honky-tonk gap, and Obama has seen the benefit of country music by playing it as the grand finale of the Democratic Convention. Nevertheless, we recommend more research on the “melodrama” theory of the Presidency as the dynamics of the relationship between the Presidency and the country music genre are currently evolving. References Andreson, Lee. Battle Notes: Music of the Vietnam War. 2nd ed. Superior, WI: Savage Press, 2003. Anker, Elisabeth. “Villains, Victims and Heroes: Melodrama, Media and September 11th.” Journal of Communication. 55.1 (2005): 22-37. Baker, Peter and David Brown. “Bush Tries to Tone Down High-Pitched Debate on Iraq.” Monday, 21November 2005, Page A04. washingtonpost.com Beamish, Thomas D., Harvey Molotch, and Richard Flacks. “Who Supports the Troops? Vietnam, the Gulf War, and the Making of Collective Memory.” Social Problems. 42.3 (1995): 344-60. Brooks and Dunn. Only in America. Arista Records, 2003. Bufwack, Mary A. and Robert K. Oermann. Finding Her Voice The Saga of Women in Country Music. New York: Crown Publishers, 1993. Dixie Chicks. “Travelin Soldier.” Home. Columbia. 27 August 2002. Firestein, David J. “The Honky-Tonk Gap.” Vital Speeches of the Day. 72.3 (2006): 83-88. Jackson, Alan. Where Were You? (When the World Stopped Turning) Very Best of Alan Jackson. Nashville: Arista, 2004. Keith, Toby. Courtesy of the Red, White and Blue (The Angry American). Nashville: Dreamworks. November 9, 2004. Olson, Scott. “Chicago remembers war dead with 500 pairs of empty boots.” 22 January 2004. http://www.usatoday.com/news/nation/2004-01-22-chicago-boots_x.htm O’Neill, John E. and Jerome L. Corsi. “Unfit for Command Swift Boat Veterans Speak Out Against John Kerry.” Washington D.C.: Regnery Publishing, 2004. Peterson, Richard A. and Peter Di Maggio. “From Region to Class, the Changing Locus of Country Music. A Test of the Massification Hypothesis.” Social Forces. 53.3 (1975): 497-506. Rich, John. Raising McCain. Production information unavailable. Sampert, Shannon, and Natasja Treiberg. “The Reification of the ?American Soldier?: Popular Culture, American Foreign Policy, and Country Music.” Paper presented at the International Studies Association 48th Annual Convention, Chicago, Illinois, United States, 28 February 2007. Smith, Craig Allen. “President Bush’s Enthymeme of Evil: The Amalgamation of 9/11, Iraq, and Moral Values.” American Behavioral Scientist. 49 (2005): 32-47. Steinhauser, Paul. “Poll: More disapprove of Bush that any other president.” Politics Cnn.politics.com. 1 May 2008. Stuckey, Mary E. Defining Americans: The Presidency and National Identity. Lawrence: UP of Kansas, 2004. Sullivan, John L., Amy Fried, Mary G. Dietz. 1992. “Patriotism, Politics, and the Presidential Election of 1988.” American Journal of Political Science. 36.1 (1992): 200-234. Willman, Chris. Rednecks and Bluenecks: The Politics of Country Music. New York: The New Press, 2005. Worley, Darryl. Have You Forgotten? Nashville: Dreamworks, 2003.