Cuomo Bucks Tide With Bill to Lift Abortion Limits

ALBANY — Bucking a trend in which states have been seeking to restrict abortion, Gov. Andrew M. Cuomo is putting the finishing touches on legislation that would guarantee women in New York the right to late-term abortions when their health is in danger or the fetus is not viable.

Mr. Cuomo, seeking to deliver on a promise he made in his recent State of the State address, would rewrite a law that currently allows abortions after 24 weeks of pregnancy only if the pregnant woman’s life is at risk. The law is not enforced, because it is superseded by federal court rulings that allow late-term abortions to protect a woman’s health, even if her life is not in jeopardy. But abortion rights advocates say the existence of the more restrictive state law has a chilling effect on some doctors and prompts some women to leave the state for late-term abortions.

Mr. Cuomo’s proposal, which has not yet been made public, would also clarify that licensed health care practitioners, and not only physicians, can perform abortions. It would remove abortion from the state’s penal law and regulate it through the state’s public health law.

Abortion rights advocates have welcomed Mr. Cuomo’s plan, which he outlined in general terms as part of a broader package of women’s rights initiatives in his State of the State address in January. But the Roman Catholic Church and anti-abortion groups are dismayed; opponents have labeled the legislation the Abortion Expansion Act.

The prospects for Mr. Cuomo’s effort are uncertain. The State Assembly is controlled by Democrats who support abortion rights; the Senate is more difficult to predict because this year it is controlled by a coalition of Republicans who have tended to oppose new abortion rights laws and breakaway Democrats who support abortion rights.

New York legalized abortion in 1970, three years before it was legalized nationally by the Supreme Court in Roe v. Wade. Mr. Cuomo’s proposal would update the state law so that it could stand alone if the broader federal standard set by Roe were to be undone.

“Why are we doing this? The Supreme Court could change,” said a senior Cuomo administration official, who spoke on the condition of anonymity because the governor had not formally introduced his proposal.

But opponents of abortion rights, already upset at the high rate of abortions in New York State, worry that rewriting the abortion law would encourage an even greater number of abortions. For example, they suggest that the provision to allow abortions late in a woman’s pregnancy for health reasons could be used as a loophole to allow unchecked late-term abortions.

“I am hard pressed to think of a piece of legislation that is less needed or more harmful than this one,” the archbishop of New York, Cardinal Timothy M. Dolan, wrote in a letter to Mr. Cuomo last month. Referring to Albany lawmakers in a subsequent column, he added, “It’s as though, in their minds, our state motto, ‘Excelsior’ (‘Ever Upward’), applies to the abortion rate.”

National abortion rights groups have sought for years to persuade state legislatures to adopt laws guaranteeing abortion rights as a backup to Roe. But they have had limited success: Only seven states have such measures in place, including California, Connecticut and Maryland; the most recent state to adopt such a law is Hawaii, which did so in 2006.

“Pretty much all of the energy, all of the momentum, has been to restrict abortion, which makes what could potentially happen in New York so interesting,” said Elizabeth Nash, state issues manager at the Guttmacher Institute, a research group that supports abortion rights. “There’s no other state that’s even contemplating this right now.”

In most statehouses, the push by lawmakers has been in the opposite direction. The past two years has seen more provisions adopted at the state level to restrict abortion rights than in any two-year period in decades, according to the Guttmacher Institute; last year, 19 states adopted 43 new provisions restricting abortion access, while not a single significant measure was adopted to expand access to abortion or to comprehensive sex education.

“It’s an extraordinary moment in terms of the degree to which there is government interference in a woman’s ability to make these basic health care decisions,” said Andrea Miller, the president of NARAL Pro-Choice New York. “For New York to be able to send a signal, a hopeful sign, a sense of the turning of the tide, we think is really important.”

Abortion rights advocates say that even though the Roe decision supersedes state law, some doctors are hesitant to perform late-term abortions when a woman’s health is at risk because the criminal statutes remain on the books.

“Doctors and hospitals shouldn’t be reading criminal laws to determine what types of health services they can offer and provide to their patients,” said M. Tracey Brooks, the president of Family Planning Advocates of New York State.

For Mr. Cuomo, the debate over passing a new abortion law presents an opportunity to appeal to women as well as to liberals, who have sought action in Albany without success since Eliot Spitzer made a similar proposal when he was governor. But it also poses a challenge to the coalition of Republicans and a few Democrats that controls the State Senate, the chamber that has in the past stood as the primary obstacle to passing abortion legislation in the capital.

The governor has said that his Reproductive Health Act would be one plank of a 10-part Women’s Equality Act that also would include equal pay and anti-discrimination provisions. Conservative groups, still stinging from the willingness of Republican lawmakers to go along with Mr. Cuomo’s push to legalize same-sex marriage in 2011, are mobilizing against the proposal. Seven thousand New Yorkers who oppose the measure have sent messages to Mr. Cuomo and legislators via the Web site of the New York State Catholic Conference.

A number of anti-abortion groups have also formed a coalition called New Yorkers for Life, which is seeking to rally opposition to the governor’s proposal using social media.

“If you ask anyone on the street, ‘Is there enough abortion in New York?’ no one in their right mind would say we need more abortion,” said the Rev. Jason J. McGuire, the executive director of New Yorkers for Constitutional Freedoms, which is part of the coalition.

Members of both parties say that the issue of reproductive rights was a significant one in November’s legislative elections. Democrats, who were bolstered by an independent expenditure campaign by NARAL, credit their victories in several key Senate races in part to their pledge to fight for legislation similar to what Mr. Cuomo is planning to propose.

Republicans, who make up most of the coalition that controls the Senate, have generally opposed new abortion rights measures. Speaking with reporters recently, the leader of the Republicans, Dean G. Skelos of Long Island, strenuously objected to rewriting the state’s abortion laws, especially in a manner similar to what the governor is seeking.

“You could have an abortion up until the day the child would be born, and I think that’s just wrong,” Mr. Skelos said. He suggested that the entire debate was unnecessary, noting that abortion is legal in New York State and saying that is “not going to be changed.”

The Senate Democratic leader, Andrea Stewart-Cousins of Yonkers, who is the sponsor of a bill that is similar to the legislation the governor is drafting, said she was optimistic that an abortion measure would reach the Senate floor this year.

“New York State’s abortion laws were passed in 1970 in a bipartisan fashion,” she said. “It would be a sad commentary that over 40 years later we could not manage to do the same thing.”

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A First Step on Continent for Google on Use of Content

PARIS — Publishers in France say they have struck an innovative agreement with Google on the use of their content online. Their counterparts elsewhere in Europe, however, say the French gave in too easily to the Internet giant.

The deal was signed this month by President François Hollande of France and Eric E. Schmidt, the executive chairman of Google, who called it a breakthrough in the tense relationship between publishers and Google, and as a possible model for other countries to follow.

Under the deal, Google agreed to set up a fund, worth €60 million, or $80 million, over three years, to help publishers develop their digital units. The two sides also pledged to deepen business ties, using Google’s online tools, in an effort to generate more online revenue for the publishers, who have struggled to counteract dwindling print revenue.

But the French group, representing newspaper and magazine publishers with an online presence, as well as a variety of other news-oriented Web sites, yielded on its most important demand: that Google and other search engines and “aggregators” of news should start paying for links to their content.

Google, which insists that its links provide a service to publishers by directing traffic to their sites, had fiercely resisted any change in the principle of free linking.

The agreement dismayed members of the European Publishers Council, a lobbying group in Brussels, which has been pushing for a fundamental change in the relationship between publishers and Google. The group criticized the French publishers for breaking ranks and striking a separate business agreement that has no statutory standing.

The deal “does not address the continuing problem of unauthorized reuse and monetization of content, and so does not provide the online press with the financial certainty or mechanisms for legal redress which it needs to build sustainable business models and ensure its continued investment in high-quality content,” Angela Mills Wade, executive director of the publishers council, said in a statement.

German publishers were also scornful, with Anja Pasquay, a spokeswoman for the German Newspaper Publishers’ Association, saying: “Obviously the French position isn’t one that we would favor. This is not the solution for Germany.”

Germany has been in the forefront of the push to get Google to share with online news publishers some of the billions of euros that the company earns from the sale of advertising. A proposed law, endorsed by the government of Chancellor Angela Merkel and working its way through the federal legislature, would grant a new form of copyright to digital publishers. If enacted, it could allow publishers to charge search engines or aggregators for displaying even snippets of news articles alongside links to other Web sites.

Mr. Hollande had vowed to introduce similar legislation this winter if Google and the publishers did not come to terms. It appears that Google, which had threatened to stop indexing French Web sites’ content if it had to pay for links, has sidelined the threat of legislation, at least for now; the agreement will be reviewed after three years, Mr. Hollande has said.

Under the deal, Google says it will help the publishers use several of its digital advertising services, including AdSense, AdMob and Ad Exchange, more effectively.

Publishers are already free to use these services, and it was not immediately clear how they would be able to generate more revenue from them; this part of the accord remains confidential, both sides say, because they are still negotiating the fine print.

“This agreement can help accelerate the move toward greater advertising revenues in the digital world,” said Marc Schwartz of Mazars, a consulting firm, who is serving as an independent mediator in the talks. “I’m not saying we have done everything, but it’s a first step in the right direction.”

More has been said about the planned innovation fund. Publishers will submit proposals to the fund, which will select ideas to finance and develop, with the involvement of Google engineers.

“The idea is that it would inject innovation into the sector in France,” said Simon Morrison, copyright policy manager at Google.

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IHT Rendezvous: Should Common Plastics Be Labeled Toxic?

THE HAGUE — Hoping to reduce one of the most ubiquitous forms of waste, a global group of scientists is proposing that certain types of plastic be labeled hazardous.

The group, lead by two California scientists, wrote in this week’s issue of the scientific journal Nature:

We believe that if countries classified the most harmful plastics as hazardous, their environmental agencies would have the power to restore affected habitats and prevent more dangerous debris from accumulating.

While 280 million tons of plastic were produced globally last year, less than half of that plastic has ended up in landfills or was recycled, according to the scientists’ data. Some of the unaccounted for 150 million tons of plastic is still in use, but much of it litters roadsides, cities, forests, deserts, beaches and oceans. (Just think of the great floating garbage patches at sea).

Unlike other forms of solid waste, such as uneaten food, scrap metal or last year’s clothes, plastics take an especially long time to break down. And when they finally do, they create hazardous, even toxic particles that can harm wildlife, ecosystems and humans.

For now, the group — led by Chelsea M. Rochman of the School of Veterinary Medicine at the University of California, Davis, and Mark Anthony Browne at the National Center for Ecological Analysis and Synthesis in Santa Barbara, California — is calling for the reclassification of plastics that are particularly difficult to recycle and that are most toxic when degrading: PVC, polystyrene, polyurethane and polycarbonate.

The scientists say these types of plastics — used in construction, food containers, electronics and furniture — make up an estimated 30 percent of all plastics produced.

Join our sustainability conversation. Does it make sense to re-classify common plastics as hazardous, or are their better ways to reduce the amount of plastics we throw out?

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US teen Mikaela Shiffrin wins world slalom title

SCHLADMING, Austria (AP) — American teenager Mikaela Shiffrin became the youngest women's slalom world champion in 39 years on Saturday.

At the age of 17 years, 340 days, Shiffrin beat all of her more experienced rivals to earn the U.S. team its fourth gold and fifth medal overall at the worlds, more than any other nation.

"It's such a crazy day," Shiffrin said. "It's so emotional ... I don't know yet, I can't feel yet. It's amazing."

The 17-year-old Shiffrin was third after the opening run but finished in a combined time of 1 minute, 39.85 seconds to beat Michaela Kirchgasser of Austria by 0.22 and Frida Hansdotter of Sweden by 0.26.

After the race in front of a crowd of 30,000 had ended, Shiffrin looked around in disbelief before hugging second-place Kirchgasser several times. Shiffrin's parents Jeff and Eileen embraced each other at the stands.

"I keep saying it, I keep thinking it. It doesn't make sense. It's just me," Shiffrin said when asked how it felt to be world champion.

In the first run, Shiffrin said she didn't feel quite right.

"I just tried to find my legs. They popped up out of nowhere," she said. "I was in the starting gate and I was like, 'Oh, there they are, I can go now!'"

After finish in first, Shiffrin thought, "I hope it holds. I was thinking so many things and I just can't even remember it. It's one of those things where everything is a blur and that's how you know it was good."

Shiffrin said she was inspired by teammate Ted Ligety, who won the men's super-G, super-combined and GS titles.

"Oh yeah! For sure," she said. "I think everyone was. That was amazing."

Julia Mancuso won the United States' first medal by taking bronze in the event-opening super-G.

Shiffrin is the youngest women's world champion in any discipline since fellow American Diann Roffe-Steinrotter, who was 21 days younger when she won the giant slalom title in 1985.

The only slalom world champions younger than Shiffrin were Hanni Wenzel of Liechtenstein in 1974 and Esme Mackinnon of Britain in 1931.

Shiffrin had already had a breakthrough year, winning three World Cup slaloms this season to lead the discipline standings.

By winning in Zagreb, Croatia, in early January, she became the first American woman to win two World Cup races before the age of 18. In Flachau, Austria, she added a third victory to match a record set by legend Annemarie Moser-Proell, was in 1971 at exactly the same age of 17 years, 308 days when she won her third of 62 races.

Hansdotter led the race after the opening run but could not match Shiffrin's pace in the final. The Swede had finished runner-up to Shiffrin in each of the American's World Cup wins.

"I am super happy," Hansdotter said. I had two good runs and now I have a medal. I wasn't nervous. I have to be happy because I have got a medal."

Kirchgasser, who was part of the Austrian team that won gold in the mixed team event Tuesday, earned her first individual medal at a major championship.

"It's just great. I thought, all or nothing," said Kirchgasser, who just missed the podium in fourth during the super-combined last week. "I didn't want to end up in fourth again."

Olympic slalom champion Maria Hoefl-Riesch of Germany, who won the super-combined world title last week, had 0.20 to make up in the final run but straddled a gate and failed to finish.

The fans cheered loudly for Schild on her return less than two months after picking up what initially appeared to be a season-ending knee injury in December. The World Cup champion hadn't raced since the slalom 83 days ago in Aspen, Colo., and placed ninth, 1.58 behind Shiffrin.

The men's slalom Sunday is the final event of the world championships.

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Livestrong Tattoos as Reminder of Personal Connections, Not Tarnished Brand

As Jax Mariash went under the tattoo needle to have “Livestrong” emblazoned on her wrist in bold black letters, she did not think about Lance Armstrong or doping allegations, but rather the 10 people affected by cancer she wanted to commemorate in ink. It was Jan. 22, 2010, exactly a year since the disease had taken the life of her stepfather. After years of wearing yellow Livestrong wristbands, she wanted something permanent.

A lifelong runner, Mariash got the tattoo to mark her 10-10-10 goal to run the Chicago Marathon on Oct. 10, 2010, and fund-raising efforts for Livestrong. Less than three years later, antidoping officials laid out their case against Armstrong — a lengthy account of his practice of doping and bullying. He did not contest the charges and was barred for life from competing in Olympic sports.

“It’s heartbreaking,” Mariash, of Wilson, Wyo., said of the antidoping officials’ report, released in October, and Armstrong’s subsequent confession to Oprah Winfrey. “When I look at the tattoo now, I just think of living strong, and it’s more connected to the cancer fight and optimal health than Lance.”

Mariash is among those dealing with the fallout from Armstrong’s descent. She is not alone in having Livestrong permanently emblazoned on her skin.

Now the tattoos are a complicated, internationally recognized symbol of both an epic crusade against cancer and a cyclist who stood defiant in the face of accusations for years but ultimately admitted to lying.

The Internet abounds with epidermal reminders of the power of the Armstrong and Livestrong brands: the iconic yellow bracelet permanently wrapped around a wrist; block letters stretching along a rib cage; a heart on a foot bearing the word Livestrong; a mural on a back depicting Armstrong with the years of his now-stripped seven Tour de France victories and the phrase “ride with pride.”

While history has provided numerous examples of ill-fated tattoos to commemorate lovers, sports teams, gang membership and bands that break up, the Livestrong image is a complex one, said Michael Atkinson, a sociologist at the University of Toronto who has studied tattoos.

“People often regret the pop culture tattoos, the mass commodified tattoos,” said Atkinson, who has a Guns N’ Roses tattoo as a marker of his younger days. “A lot of people can’t divorce the movement from Lance Armstrong, and the Livestrong movement is a social movement. It’s very real and visceral and embodied in narrative survivorship. But we’re still not at a place where we look at a tattoo on the body and say that it’s a meaningful thing to someone.”

Geoff Livingston, a 40-year-old marketing professional in Washington, D.C., said that since Armstrong’s confession to Winfrey, he has received taunts on Twitter and inquiries at the gym regarding the yellow Livestrong armband tattoo that curls around his right bicep.

“People see it and go, ‘Wow,’ ” he said, “But I’m not going to get rid of it, and I’m not going to stop wearing short sleeves because of it. It’s about my family, not Lance Armstrong.”

Livingston got the tattoo in 2010 to commemorate his brother-in-law, who was told he had cancer and embarked on a fund-raising campaign for the charity. If he could raise $5,000, he agreed to get a tattoo. Within four days, the goal was exceeded, and Livingston went to a tattoo parlor to get his seventh tattoo.

“It’s actually grown in emotional significance for me,” Livingston said of the tattoo. “It brought me closer to my sister. It was a big statement of support.”

For Eddie Bonds, co-owner of Rabbit Bicycle in Hill City, S.D., getting a Livestrong tattoo was also a reflection of the growth of the sport of cycling. His wife, Joey, operates a tattoo parlor in front of their store, and in 2006 she designed a yellow Livestrong band that wraps around his right calf, topped off with a series of small cyclists.

“He kept breaking the Livestrong bands,” Joey Bonds said. “So it made more sense to tattoo it on him.”

“It’s about the cancer, not Lance,” Eddie Bonds said.

That was also the case for Jeremy Nienhouse, a 37-year old in Denver, Colo., who used a Livestrong tattoo to commemorate his own triumph over testicular cancer.

Given the diagnosis in 2004, Nienhouse had three rounds of chemotherapy, which ended on March 15, 2005, the date he had tattooed on his left arm the day after his five-year anniversary of being cancer free in 2010. It reads: “3-15-05” and “LIVESTRONG” on the image of a yellow band.

Nienhouse said he had heard about Livestrong and Armstrong’s own battle with the cancer around the time he learned he had cancer, which alerted him to the fact that even though he was young and healthy, he, too, could have cancer.

“On a personal level,” Nienhouse said, “he sounds like kind of a jerk. But if he hadn’t been in the public eye, I don’t know if I would have been diagnosed when I had been.”

Nienhouse said he had no plans to have the tattoo removed.

As for Mariash, she said she read every page of the antidoping officials’ report. She soon donated her Livestrong shirts, shorts and running gear. She watched Armstrong’s confession to Winfrey and wondered if his apology was an effort to reduce his ban from the sport or a genuine appeal to those who showed their support to him and now wear a visible sign of it.

“People called me ‘Miss Livestrong,’ ” Mariash said. “It was part of my identity.”

She also said she did not plan to have her tattoo removed.

“I wanted to show it’s forever,” she said. “Cancer isn’t something that just goes away from people. I wanted to show this is permanent and keep people remembering the fight.”

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The Lede: Spectacular Video of Meteor Over Siberia

Video posted on YouTube Friday appeared to catch an explosion caused by a meteor streaking over the Russian city of Chelyabinsk.

Last Updated, 11:08 a.m. As our colleagues Ellen Barry and Andrew Kramer report, Russians recorded video of bright objects, apparently debris from a meteor, “streaking through the sky in western Siberia early on Friday, accompanied by a boom that damaged buildings across a vast area of territory.” Hundreds of injuries were reported, mainly from breaking glass.

Video recorded from the dashboard camera of a car in the Russian city of Chelyabinsk on Friday.

Video said to have been recorded on Friday in the Russian city of Chelyabinsk as a meteor passed low overhead. An explosion can be heard clearly at the 7-minute mark of the video.

The video clips, many recorded from cars on the dashboard cameras that are popular in Russia, quickly spread from social networks to Russian news sites. While it was not possible to confirm the authenticity of these clips, they track closely with witness accounts and each other.

Video uploaded to YouTube on Friday was said to have been recorded over the Russian city of Chelyabinsk (although the camera’s time stamp displays an earlier date).

Several clips showed a flaming object streaking through the sky and a burst of blinding light followed by a smoke trail. One, shot by a driver named Alexander Mezentsev, showed a bright light over a city street in Chelyabinsk, a city of 1 million about 900 miles east of Moscow.

One clip, recorded on a street in Chelyabinsk, appeared to capture the chaotic aftermath of the event, as glass shattered following the shock wave and people shouted and tried to make sense of what was happening.

Video said to have been recorded in the Russian city of Chelyabinsk on Friday after a meteor passed overhead.

A very loud explosion could be heard about 25 seconds into another video, apparently recorded on a phone in the same city by a blogger named Sergey Hametov.

Video said to have been recorded on Friday in Chelyabinsk appeared to capture a loud explosion.

“There was panic. People had no idea what was happening,” Mr. Hametov told The Associated Press. “We saw a big burst of light, then went outside to see what it was and we heard a really loud, thundering sound.”

Another video, shot from the window of a building, seemed to capture the long trail of smoke after the object passed through the sky.

Video posted on YouTube Friday appeared to show the trail of a meteorite fragment in the sky.

Several clips also showed what bloggers said was the damage caused by the sonic boom.

Damage to a school in the Chelyabinsk region of Russia, said to have been caused by the sonic boom from a meteor.

Video of what was described as damage caused by the sonic boom after a meteor passed over Russia on Friday.

Some of the numerous videos that quickly emerged of the incident highlighted a distinctly Russian phenomenon: the dashboard cam. As the blogger Marina Galperina explained last year, they are commonplace in Russia partly because of the dangerous driving conditions that lead to so many accidents, and with an unreliable police force such cameras can provide valuable evidence following a crash.

The conditions of Russian roads are perilous, with insane gridlock in cities and gigantic ditches, endless swamps and severe wintry emptiness on the backroads and highways. Then there are large, lawless areas you don’t just ride into, the police with a penchant for extortion and deeply frustrated drivers who want to smash your face.

Psychopaths are abundant on Russian roads. You best not cut anyone off or undertake some other type of maneuver that might inconvenience the 200-pound, six-foot-five brawling children you see on YouTube hopping out of their SUVs with their dukes up. They will go ballistic in a snap, drive in front of you, brake suddenly, block you off, jump out and run towards your vehicle. Next thing you start getting punches in your face because your didn’t roll up your windows, or getting pulled out of the car and beaten because you didn’t lock the doors.

These fights happen all the time and you can’t really press charges. Point to your broken nose or smashed windows all you want. The Russian courts don’t like verbal claims. They do, however, like to send people to jail for battery and property destruction if there’s definite video proof.

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Yankees razz Youkilis for Red Sox remarks

TAMPA, Fla. (AP) — Kevin Youkilis' new teammates were waiting to razz him when the third baseman walked into the New York Yankees clubhouse.

Youkilis made the back page of two New York newspapers Friday for telling reporters at the first day of spring training that "I'll always be a Red Sox."

"I was basically defining that, as a player, I'll be a Red Sox, and a White Sox, and a Yankee for life," Youkilis said Friday. "Three storied franchises. I'm excited to be part of this, and be with the Yankees. Trust me, there's no way that was meant to say my heart is in Boston or anything like that. My heart is here with the Yankees."

Youkilis took part in his first workout with the Yankees on Thursday after flying from California to Tampa.

"I think guys are having fun with it, joking around," Youkilis said.

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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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DealBook: Confidence on Upswing, Mergers Make Comeback

The mega-merger is back.

For the corporate takeover business, the last half-decade was a fallow period. Wall Street deal makers and chief executives, brought low by the global financial crisis, lacked the confidence to strike the audacious multibillion-dollar acquisitions that had defined previous market booms.

Cycles, however, turn, and in the opening weeks of 2013, merger activity has suddenly roared back to life. On Thursday, Berkshire Hathaway, the conglomerate run by Warren E. Buffett, said it had teamed up with Brazilian investors to buy the ketchup maker H. J. Heinz for about $23 billion. And American Airlines and US Airways agreed to merge in a deal valued at $11 billion.

Those transactions come a week after a planned $24 billion buyout of the computer company Dell by its founder, Michael S. Dell, and private equity backers. And Liberty Global, the company controlled by the billionaire media magnate John C. Malone, struck a $16 billion deal to buy the British cable business Virgin Media.

“Since the crisis, one by one, the stars came into alignment, and it was only a matter of time before you had a week like we just had,” said James B. Lee Jr., the vice chairman of JPMorgan Chase.

Still, bankers and lawyers remain circumspect, warning that it is still too early to declare a mergers-and-acquisitions boom like those during the junk bond craze of 1989, the dot-com bubble of 1999 and the leveraged buyout bonanza of 2007. They also say that it is important to pay heed to the excesses that developed during these moments of merger mania, which all ended badly.

A confluence of factors has driven the recent deals. Most visibly, the stock market has been on a tear, with the Standard & Poor’s 500-stock index this week briefly hitting its highest levels since November 2007. Higher share prices have buoyed the confidence of chief executives, who now, instead of retrenching, are looking for ways to expand their businesses.

A number of clouds that hovered over the markets last year have also been removed, eliminating the uncertainty that hampered deal making. Mergers and acquisitions activity in 2012 remained tepid as companies took a wait-and-see approach over the outcome of the presidential election and negotiations over the fiscal cliff. The problems in Europe, which began in earnest in 2011, shut down a lot of potential transactions, but the region has since stabilized.

“When we talk to our corporate clients as well as the bankers, we keep hearing them talk about increased confidence,” said John A. Bick, a partner at the law firm Davis Polk & Wardwell, who advised Heinz on its acquisition by Mr. Buffett and his partners.

Mr. Bick said that mega-mergers had a psychological component, meaning that once transactions start happening, chief executives do not want to be left behind. “In the same way that success breeds success, deals breed more deals,” he said.

A central reason for the return of big transactions is the mountain of cash on corporate balance sheets. After the financial crisis, companies hunkered down, laying off employees and cutting costs. As a result, they generated savings. Today, corporations in the S.& P. 500 are sitting on more than $1 trillion in cash. With interest rates near zero, that money is earning very little in bank accounts, so executives are looking to put it to work by acquiring businesses.

The private equity deal-making machine is also revving up again. The world’s largest buyout firms have hundreds of billions of dollars of “dry powder” — money allotted to deals in Wall Street parlance — and they are on the hunt. The proposed leveraged buyout of Dell, led by Mr. Dell and the investment firm Silver Lake Partners, was the largest private equity transaction since July 2007, when the Blackstone Group acquired the hotel chain Hilton Worldwide for $26 billion just as the credit markets were seizing up.

But perhaps the single biggest factor driving the return of corporate takeovers is the banking system’s renewed health. Corporations often rely on bank loans for financing acquisitions, and the ability of private equity firms to strike multibillion-dollar transactions depends on the willingness of banks to lend them money.

For years, banks, saddled by the toxic mortgage assets weighing on their balance sheets, turned off the lending spigot. But with the housing crisis in the rearview mirror and economic conditions slowly improving, banks are again lining up to provide corporate loans at record-low interest rates to finance acquisitions.

The banks, of course, are major beneficiaries of megadeals, earning big fees from both advising on the transactions and lending money to finance them. Mergers and acquisitions in the United States total $158.7 billion so far this year, according to Thomson Reuters data, more than double the amount in the same period last year. JPMorgan, for example, has benefited from the surge, advising on four big deals in recent weeks, including the Dell bid and Comcast’s $16.7 billion offer for the rest of NBCUniversal that it did not already own.

Mr. Buffett, in a television interview last month, declared that the banks had repaired their businesses and no longer posed a threat to the economy. “The capital ratios are huge, the excesses on the asset aside have been largely cleared out,” said Mr. Buffett, whose acquisition of Heinz will be his second-largest acquisition, behind his $35.9 billion purchase of a majority stake in the railroad company Burlington Northern Santa Fe in 2009.

While Wall Street has an air of giddiness over the year’s start, most deal makers temper their comments about the current environment with warnings about undisciplined behavior like overpaying for deals and borrowing too much to pay for them.

Though private equity firms were battered by the financial crisis, they made it through the downturn on relatively solid ground. Many of their megadeals, like Hilton, looked destined for bankruptcy after the markets collapsed, but they have since recovered. The deals have benefited from an improving economy, as well as robust lending markets that allowed companies to push back the large amounts of debt that were to have come due in the next few years.

But there are still plenty of cautionary tales about the consequences of overpriced, overleveraged takeovers. Consider Energy Future Holdings, the biggest private equity deal in history. Struck at the peak of the merger boom in October 2007, the company has suffered from low natural gas prices and too much debt, and could be forced to restructure this year. Its owners, a group led by Kohlberg Kravis Roberts and TPG, are likely to lose billions.

Even Mr. Buffett made a mistake on Energy Future Holdings, having invested $2 billion in the company’s bonds. He admitted to shareholders last year that the investment was a blunder and would most likely be wiped out.

“In tennis parlance,” Mr. Buffett wrote, “this was a major unforced error.”

Michael J. de la Merced contributed reporting.

A version of this article appeared in print on 02/15/2013, on page A1 of the NewYork edition with the headline: Confidence on Upswing, Mergers Make Comeback.

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Pope Says He Will Be ‘Hidden To The World’ In Retirement

VATICAN CITY — Saying he would soon be “hidden to the world,” Pope Benedict XVI took his leave of parish priests and clergy of the Diocese of Rome on Thursday in a moving encounter during which he gave a personal, and incisive, recollection of the Second Vatican Council, the gathering of bishops 50 years ago that set the Roman Catholic Church’s course for the future.

Benedict, who announced his resignation four days ago — the first pope to step down willingly in nearly 600 years — also indicated that he would not hold a public role once his resignation becomes official on Feb. 28.

“Though I am now retiring to a life of prayer, I will always be close to all of you and I am sure all of you will be close to me, even though I remain hidden to the world,” he told the assembly of hundreds of priests, who had greeted him with a long, standing ovation and some tears.

The pope will live in a convent inside Vatican City.

At a news briefing Thursday, the Rev. Federico Lombardi, the Vatican spokesman, said Benedict’s longtime personal secretary, Archbishop Georg Gänswein, who was also named prefect of the papal household two months ago, would continue to work for him.

Father Lombardi said he saw no conflict of interest if Archbishop Gänswein served the current pope and his successor.

The prefect is responsible for logistical duties, and “in this sense it is not a profound problem, I think,” Father Lombardi said.

The nuns who currently tend to the pope will also live with the pontiff once he is no longer pope.

Father Lombardi also confirmed news reports that the pope had had an accident during a trip to Mexico last March, hitting his head in the middle of the night, but he denied that the episode had influenced the pontiff’s decision to retire.

Since his surprise announcement on Monday, which stunned the Roman Catholic world, there has been much closer public scrutiny of the pope’s health.

The 85-year-old pope — who has appeared increasingly frail in recent public appearances — said he felt he did not have the strength to continue in his ministry.

On Tuesday, the Vatican confirmed for the first time that the pope had had a pacemaker since his time as a cardinal and had its batteries changed three months ago.

“It didn’t impact on the trip or on his decision,” Father Lombardi said, pointing out that the pope had kept his appointments as scheduled.

The priests from the Rome diocese who attended Benedict’s audience said they felt they had witnessed a powerful moment in church history, one that also humanized a pope who has often seemed remote. “It moved me to see the pope smile,” said Don Mario Filippa, a priest in Rome. “He has found peace within himself.”

“It was a part of history,” said Father Martin Astudillo, 37, an Argentine priest who is studying in Rome. “This is a man of God who at the end of his public role transmits his vision of the church and relationship with the church,” he added. “We saw in a few words a real synthesis of his vision of the church and what he expects from whomever takes over.”

In his remarks, which touched on some of the thorniest issues of his papacy, Benedict also spoke about how the Second Vatican Council had explored ideas of “continuity” between Old and New Testaments, and of the relationship between the Catholic and Jewish faiths.

“Even if it’s clear that the church isn’t responsible for the Shoah, it’s for the most part Christians who did this crime,” Benedict said of the Holocaust, adding that this called for a need to “deepen and renovate the Christian conscience,” even if it’s true that “real believers only fought against” Nazi barbarism.

During the 45-minute reflection — or “chat” in his words — on the council, he also recalled the “incredible” expectations of bishops going into the gathering.

“We were full of hope, enthusiasm and also of good will,” he said.

But while the council made landmark decisions that would propel the church into the future, much got lost in the media’s interpretation of what transpired, he said, which led to the “calamities” that have marred recent church history.

The media reduced the proceedings “into a political power struggle between different currents of the church,” and they chose sides that suited their individual vision of the world, the pope said.

These messages, not that of the council, entered into the public sphere and that led in the years to “so many calamities, so many problems, seminaries closed, convents that closed, the liturgy trivialized,” the pope said.

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