Death: On God’s Terms Or On Our Own?
[guest post by Dana]
I’ve been writing and sitting on this post for the past three days, because every time I think I’ve got my thoughts solidified, I find that I don’t. I’m not inclined to vacillate on moral issues and yet, I am doing just that…
Brittany Maynard is 29 years old and dying from the deadliest form of brain cancer: Glioblastoma multiforme. Because of the size of her tumor, her recommended treatment would include full brain radiation which typically comes with some very severe and painful side effects. And because of that and her doctors informing her that her death from Glioblastoma would likely be painful and slow, she has opted to end her own life, on her own terms. This week she wrote about coming to this decision:
After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left.
I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind.
Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.
…
I quickly decided that death with dignity was the best option for me and my family.
Maynard and her family relocated to Oregon earlier this year to take advantage of Oregon’s Death with Dignity Act, which would allow her to end her life through the “voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.” The law has been in place since 1997 and as a result, more than 750 people have been allowed to die on their own terms.
Maynard is at peace with her decision. She points out that she does not believe it is suicide, and that she believes everyone should have the right to make this decision:
I’ve had the medication for weeks. I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms.
I would not tell anyone else that he or she should choose death with dignity. My question is: Who has the right to tell me that I don’t deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?
…
I hope for the sake of my fellow American citizens that I’ll never meet that this option is available to you. If you ever find yourself walking a mile in my shoes, I hope that you would at least be given the same choice and that no one tries to take it from you.
When my suffering becomes too great, I can say to all those I love, “I love you; come be by my side, and come say goodbye as I pass into whatever’s next.” I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully. I can’t imagine trying to rob anyone else of that choice.
The issue of physician-assisted suicide (PAS) is a touchy one. Proponents believe they should have the right to control their suffering to the point of ending it altogether, while simultaneously sparing their families the pain of watching their loved one suffer an agonizing death. Among other reasons, supporters also claim organs can be harvested while still viable and the skyrocketing costs of keeping a terminally ill patient alive longer can be better controlled. On the flip side, the most common argument against physician-assisted suicide involves ethics. Along with believing it to be a violation of the Hippocratic Oath, there is also the slippery-slope argument of PAS. Further, opponents ultimately argue that it is God alone who decides when a person lives and when he dies:
For You formed my inward parts; You covered me in my mother’s womb.
I will praise You, for I am fearfully and wonderfully made; Marvelous are Your works,
And that my soul knows very well.My frame was not hidden from You, When I was made in secret,
And skillfully wrought in the lowest parts of the earth.Your eyes saw my substance, being yet unformed.
And in Your book they all were written,
The days fashioned for me,
When as yet there were none of them. (from Psalm 139)
Kara Tippets is dying from cancer, too. She has battled breast cancer for two years and it has now fully metastasized in her entire body. This mother of four small children read about Brittany Maynard’s decision to end her life, and responded with her own letter to Brittany. Although both women are dying, both look at it from a different perspective:
Brittany, I love you, and I’m sorry you are dying. I am sorry that we are both being asked to walk a road that feels simply impossible to walk.
I think the telling of your story is important.
I think it is good for our culture to know what is happening in Oregon.
It’s a discussion that needs to be brought out of the quiet corners and brought brightly into the light. You sharing your story has done that. It matters, and it is unbelievably important. Thank you.
Dear heart, we simply disagree. Suffering is not the absence of goodness, it is not the absence of beauty, but perhaps it can be the place where true beauty can be known.
In your choosing your own death, you are robbing those that love you with the such tenderness, the opportunity of meeting you in your last moments and extending you love in your last breaths.
…
As I sat on the bed of my young daughter praying for you, I wondered over the impossibility of understanding that one day the story of my young daughter will be made beautiful in her living because she witnessed my dying.
That last kiss, that last warm touch, that last breath, matters — but it was never intended for us to decide when that last breath is breathed.
Knowing Jesus, knowing that He understands my hard goodbye, He walks with me in my dying. My heart longs for you to know Him in your dying. Because in His dying, He protected my living. My living beyond this place.
As a person of faith, I believe our lives, fragile and determined, always hang in the balance. Our days are numbered. The when and how is not my concern nor anything I wonder too much about. God put me on this earth, He can take me out as well. I believe it’s His decision. With that, though, I also recognize I am not at this time facing a long drawn-out painful death and all that accompanies such a system shut-down. I am not carrying inside me the very real knowledge that I am afflicted with a disease that will slowly devour me in extraordinary levels of inescapable pain while the deterioration of my entire being occurs. So, easy for me to say.
However, even as a believer, I find myself conflicted. And ironically, it is precisely because of being very close with two dear women as they went from the point of diagnosis to horrendously painful deaths of cancer that has caused me to reconsider. Because of their Christian faith, neither ever considered taking a pill to end their suffering. And suffering was putting it mildly. Because what I witnessed was so ghastly for them, that it caused my own beliefs on PAS to be turned upside down. And still remain in conflict.
I watched these loved ones, some 15 years apart in passing, transform from vigorous women to frail shadows on that last leg of their journey. One suffered from the same insidious Glioblastoma multiforme as Brittany Maynard. And it is as awful as Maynard and her doctors described. What I learned from each woman’s long goodbye was, no matter the level of pain and suffering, they had an extraordinary grace in the face of death. But they were not fearless. It was simply that their faith that God walked with them every step of the way overwhelmed their fears. Their faith was their strength. More strangely and bewilderingly, it was also their joy – no matter how bad things got. And judging by their continued grace, it was a seemingly unlimited strength. Thus both, in complete surrender to God, were able to let go of this life on His terms. In their suffering they came to know and understand the mystery and beauty that is death, and life reborn. It is something I cannot quite grasp. I have read the scriptures and have heard the teachings. But I have not “lived” it. So, from my vantage point, their crushing pain and increasing lack of function was both cruel and horrible and enough for me to believe that no one should have to endure it.
Apart from the distrust I have for those in power to not use legal PAS to their advantage and understanding the inherently weak and self-serving nature of mankind that abuses all forms of power, if solid safeguards were in place to prevent the process from ever being anything but completely voluntary by those of a sound mind, should there be a choice in the matter for those who no longer have it in them to push through to the end? Or is it a Pandora’s box and that for the betterment of our society it should remain locked? And at the heart of it, too, for the person of faith, how does one square this with God – who has called us to suffer for His namesake and appointed our days?
As I said, I remain conflicted. I’m not interested in trite footprints-in-the-sand Christian offerings, but I am interested in hearing how you’ve wrestled with the issue and come to terms with it.
–Dana
UPDATE BY PATTERICO: This is a very thoughtful post. My own thoughts, for what they are worth, is that each of us owns our own body, and we should be able to determine for ourselves how we go. But I worry about the slippery slope caused by government involvement in health care, which creates an irresistible incentive for bureaucrats to ration care by encouraging people to go before their time. If we had a true free market in health care, I would have fewer reservations.
Hello. Apologies for length, I still don’t know how to successfully note “more under the fold”…
Dana (4dbf62) — 10/11/2014 @ 3:44 pmI don’t believe anybody can say until the very last minute, Dana. Everyone has heard of suicide “hesitation cuts”. There are hesitation shots where the suicide pulls the gun away — until the third or fourth time when he finally holds it in place. I heard a story, probably not true because good stories usually are not, about a guy who changed his mind just as the hammer was falling, and he was able to tell about it because the cartridge was a dud. Call no person a suicide until he is dead. (No, that’s not the real quote.)
nk (dbc370) — 10/11/2014 @ 4:00 pmMom passed last November. Two months previous, at our usual September family get-together, we had a long discussion over this exact topic. This discussion even included the-then 15YO daughter.
When tragedy struck and it came time for “the question”, my father, my sister, and myself all looked each other square in the eye and agreed that is was time. Even though daughter didn’t have a vote she agreed as well.
It’s hard and painful to watch a loved one die in front of you. My sister didn’t bring her kids yet mine was there through the end. Given that Mom was a professional cigarette smoker that day was inevitable but I laud my daughter for handling that day as best as can be expected.
Captain Ned (d080c3) — 10/11/2014 @ 4:06 pmThank you for this post, Dana.
A certain Soprano in my church choir had tired of suffering frequent dialysis (something my sister now endures) over a very great length of time, as it was told to me by her husband. She consulted our parish priest about stopping dialysis and consequently dying after an unknown period of time.
When the Priest gave her The news that going off dialysis was not suicide, she discussed the matter with her family – consisting of four generations! She checked into a hospice and over the next week many, including, myself, visited her to express our love and support. She was barely able to move when I visited her, her husband beside her. She passed a few days later. She exemplified longsuffering. I consider hers, a happy death.
Someday I might have the strength to tell of my mother’s happy death.
felipe (40f0f0) — 10/11/2014 @ 4:12 pmI’ve watched this news story with interest for several days. As many do, I have concerns with administrative death panels and physician assisted suicide/euthanasia. But Brittany Maynard is not in that category. No one is challenging her terminal diagnosis. She has expressed herself cogently and honestly and has made certain that anyone within earshot or who has a computer knows that she believes she has come to a well thought out decision, and that she is handing her own “end of life treatment” on her own terms. She has prepared her family for her certain death and is lovingly but firmly taking the “pull the plug” or when to go to hospice decision out of their responsibility. She is sparing both herself and her family and friends from suffering through the indignity and excruciating pain during the last days and hours of her illness.
And, she can of course still change her mind since she’s the one taking the pills.
elissa (68e46b) — 10/11/2014 @ 4:13 pmAll suffering has value. It provokes the hearts of others into action. Suffering is most beautiful and fruitful when united to love. God is love.
felipe (40f0f0) — 10/11/2014 @ 4:19 pmAnd, she can of course still change her mind since she’s the one taking the pills.
elissa (68e46b) — 10/11/2014 @ 4:13 pm
Exactly, this is not the Liverpool pathway.
felipe (40f0f0) — 10/11/2014 @ 4:21 pmPerhaps this is one of those occasions where we cannot truly make an informed decision until we have arrived at that point ourselves. I am reminded though that it is always valuable to discuss these things. For the vast majority of the people facing the decision, the conclusion is already known. What’s left is the exact moment in time.
Yes this a tough one.
Allen (92c16d) — 10/11/2014 @ 4:23 pmThere is no biblical proscription against suicide. There are seven suicides in the bible: Abimelech, Samson, Saul, Saul’s armor bearer, Ahithophel, Zimri, and Judas. For four, Abimelech, Zimri, Saul, and Saul’s armor bearer, the decedents were either dying or about to be captured with the prospect of torture and death. They essentially chose “death with dignity.” Ahithophel and Judas killed themselves out despair. Samson killed himself to take vengeance on the Philistines.
In none of these are the decedents condemned *because* of their suicide. And, in contrast, the early Christians embraced martyrdom. Those who chose life over death were condemned as cowards and weak of faith. Moreover, in early Christian thought, life was something to be wished away — the proper Christian wanted to be with God and not on earth. Our time here was a tribulation to be endured.
Eusebius, the early Christian historian, records a case where Christian women drowned themselves rather than be raped. Suicide was basically not generally condemned until St. Augustine wrote that the commandment “Thou shalt not kill” included suicide, and that has been the general doctrine since then.
The problem is that most (though certainly not all) Christians view the commandment of “Thou shalt not kill” as applying to “unjust” killings, not a general ban on killing. Thus, it is not sinful to kill in self-defense. Some take it to mean “murder” only. In that perspective, the Augustinian perspective begs the question. The sixth commandment condemns unjust killing, but does not say what is unjust.
The general condemnation of suicide is thus one of dogma, not explicit biblical statement. There are lots of arguments that suggest convincingly that life is a gift of God and should not be discarded thoughtlessly. There are other arguments that because our life belongs to God, we do not have the “right” to end it. However, both of these have problems. A person with terminal cancer or otherwise looking at a near-term painful and demeaning death is not thoughtlessly discarding life. Instead, it may be considered that suicide in the face of a demeaning death represents an action to preserve the well-lived life up until that part. God may own our lives, but He has given us the right to do with that life what we will; it is not clear that He wants us to suffer without reason, or that our God-given right to make rational decisions about life does not include making a rational decision to end it.
Thus, I believe that life is a gift to be appreciated and valued. We should not trivially waste or end our lives. But that does not preclude making rational decisions about ending it. And those decisions can involve sacrificing our lives for a greater purpose, giving our lives in the defense of others or of the faith, or even choosing death when continuing life is nothing more than a short term period of meaningless suffering. Got is not that cruel.
billo (748bb0) — 10/11/2014 @ 4:25 pmMy mother spent several years in a persistent vegetative state before she died of natural causes. I don’t understand why there should any legal or ethical reason that should have to happen to anyone. Nor do I understand why either of those two poor people should be denied their right to choose – either way. Families should decide, not meddling grandstanding supposed “right-to-lifers” like Rick Santorum and Jeb Bush. Our nonsensical 19th century laws need to catch up to the 21st.
JEA (fb1111) — 10/11/2014 @ 4:27 pm“In your choosing your own death, you are robbing those that love you with the such tenderness, the opportunity of meeting you in your last moments and extending you love in your last breaths.
…
As I sat on the bed of my young daughter praying for you, I wondered over the impossibility of understanding that one day the story of my young daughter will be made beautiful in her living because she witnessed my dying.”
– Kara Tippets
Brittany Maynard will have last moments and last breaths just like Kara Tippets (and all of us) will. The fact that she chooses when to have them will not prevent her loved ones from sharing them with her.
A distinction between the two situations seems relevant here: Brittany Maynard has a cancer of the brain that will change her behavior as it progresses. Won’t it change who she is, in some sense, if she waits for it to run its course? I’m not a doctor, obviously, but will Kara Tippets’ cancer change her behavior, or her personality, if she waits for it to run its course?
I would bear suffering, I think, if I were to remain myself, for the reasons that Kara Tippets gives. I would spare my loved ones the suffering, I think, of watching my mind leave my body while it still lived.
Either way, both women by their introspection and openness demonstrate courage of an incredible degree.
Leviticus (566eb4) — 10/11/2014 @ 4:32 pmAs a retired nurse I know there are painful deaths, though these are not the majority of deaths. I
MJBees (4e2b69) — 10/11/2014 @ 4:34 pmlearned from a skilled anesthesiologist about narcotic use during my years in the OR and I have used that knowledge to keep two dying friends comfortable in their homes with their prescribed meds until the last few days of their lives AND they were still aware and able to communicate well until the last day. Unfortunately today’s nurses, doctors and the DEA are not sympathetic to dying persons. When I have been confronted by a few doctors or nurses, I always ask them “Why not give narcotics as needed? They ARE DYING!” I have learned even small doses given frequently can provide relief from needless suffering.
Elissa that is the key distinction. It is her choice and her choice only.
Gazzer (4d1091) — 10/11/2014 @ 4:38 pm“He has given us the right to do with that life what we will”.
No, God has given us free will to do as we will.
I appreciate that you have read scripture. There is so much in your comment that is confused that I find it daunting to address it all because one misunderstanding gives rise to another. So I will leave the rest for others of good will to help untangle your misunderstanding.
However, this part, on its own is correct and laudable:
“I believe that life is a gift to be appreciated and valued”.
felipe (40f0f0) — 10/11/2014 @ 4:38 pmI am not religious, so there’s a difference here.
I think the slippery slope argument is one to take careful note of. Slippery slopes often occur even when people say they won’t.
But to forbid Brittany from checking out on her own terms is wrongful. Making it easier – no gunshot cleanup, no blood cleanup – is better. The argument that felipe makes, that suffering is a good, strikes me as seriously misguided.
I think as a general rule, we’d be well-placed to allow people whose remainder of life is destined to be awful to die. For an angrier and more profane but similar view, see: http://dilbert.com/blog/entry/i_hope_my_father_dies_soon/
–JRM
JRM (de6363) — 10/11/2014 @ 4:41 pmI also respect Kara Tippits for wanting to publicly express another side of the “I know I’m dying soon” story. I respect her desire to say that she sees and chooses another way for herself and her own family. What I do not respect is Kara’s choice to express her contrasting views through a personal “open letter to Brittany” in which she apparently feels obligated to criticize and question Brittany’s plans concerning herself and her family. I think Kara’s direct approach to Brittany was presumptuous, cruel, and is in very poor taste.
elissa (68e46b) — 10/11/2014 @ 4:44 pmLeviticus, my dear friend who passed from the same brain cancer, had several surgeries to try and control tumor growth. Each time, because of where the tumor was located, she lost more memory and cognitive abilities. Apparently, depending on where the tumor is located and size, determines how a person is impacted. I wouldn’t say her basic personality changed at its core, but certainly everything became muddled and confusing for her.
Dana (e0f9d1) — 10/11/2014 @ 4:45 pmLeviticus (566eb4) — 10/11/2014 @ 4:32 pm
I agree with much of your comment, except I do not believe it to be courageous to avoid suffering or the prospect of suffering. I do find it courageous to endure suffering or the prospect of suffering.
felipe (40f0f0) — 10/11/2014 @ 4:47 pm“The argument that felipe makes, that suffering is a good, strikes me as seriously misguided”.
I make no such argument. Reread what I have written.
If I had made that argument, it would have been as seriously misguided as your attempt to misrepresent my words.
felipe (40f0f0) — 10/11/2014 @ 4:51 pmI’m inclined to agree more with Kara. I disapprove of death on general principles, and I cannot fully approve of euthanasia until doctors can bring a person back from death and ask him which is better. The way they do when they fit you for glasses: “Is it better this way? Or is it better this way?”
nk (dbc370) — 10/11/2014 @ 4:54 pmElissa, I think that when people confront their own deaths, there are many nuances and adjustments that we do not—cannot—understand without being in their shoes. Our shadows fall across their discourse.
In the era of my youth, it was called altering one’s consciousness. To be sure, the choice of dropping acid versus confronting the Destroyer of Delights is different. Or is it?
I think both women were expressing themselves…and not really talking to each other. They were talking to their families, and the public.
I understand and honor your point, but I am willing to just listen to their witness of the ends of their lives. Soon, they will both be silent enough. So I pray for them both, and their families.
Simon Jester (c8876d) — 10/11/2014 @ 4:55 pmelissa (68e46b) — 10/11/2014 @ 4:44 pm
I hear what you are saying, elissa. I think the door was opened to discussion, as it were, the moment she publically wrote her story. If she, indeed, made it public.
felipe (40f0f0) — 10/11/2014 @ 4:56 pm“I think that when people confront their own deaths, there are many nuances and adjustments that we do not—cannot—understand without being in their shoes. Our shadows fall across their discourse”.
I agree wholeheartedly.
felipe (40f0f0) — 10/11/2014 @ 5:00 pmThere is no virtue in suffering.
When I first saw “Misericordia Homes”, I did a double take. The misericord I knew was a thin-bladed stiff knife that could slip between plates of armor and dispatch a wounded knight. Knights carried them for their fallen, but not yet dead, foes. It was considered unchivalrous to let them suffer.
nk (dbc370) — 10/11/2014 @ 5:00 pmDana, the second anniversary of my mother’s death just passed. I am pretty sure that the hospice folks were dosing her too heavily with morphine at the end, but I did not complain. I wanted a chance to talk with her before she passed. She lived long enough for me to get home to SoCal. Long enough for me to drive from the airport to my parents’ home. Long enough to talk with me, as she was in and out of mental clarity (again, from the morphine). I was able to tell her that I loved her, and that what she had done in her difficult life mattered.
She didn’t wake up after that evening. There was a day with her not waking that was very difficult. And the morning after that, she passed. I had to fly home that evening.
My mother had told us goodbye. There was nothing else she needed to do. It’s like she knew my schedule.
Again, I am pretty sure the hospice people hurried her along. But the pain and indignity were things she did not deserve.
I wish you and I were friend in real life, so I could share the story in the detail it merits.
Thank you for your post.
Simon Jester (c8876d) — 10/11/2014 @ 5:06 pmnk (dbc370) — 10/11/2014 @ 5:00 pm
I am surprised, nk. How do you define virtue? It is one thing to say “there is no virtue in suffering a fool”. But I think even you can think of some virtue in suffering for another.
felipe (40f0f0) — 10/11/2014 @ 5:08 pmThat was very moving, Simon.
felipe (40f0f0) — 10/11/2014 @ 5:11 pmIt is times like these that I must remember what Elephant stone once advised: “you don’t have to respond to every comment”.
felipe (40f0f0) — 10/11/2014 @ 5:13 pm==I think both women were expressing themselves…and not really talking to each other. They were talking to their families, and the public.==
Well, Simon, obviously YMMV, but when the letter (as linked above by Dana in its entirety) starts out “Dear Brittany” and continues with the pronouns “you” and “your” I kinda think the letter was personal and directed to Brittany. Her efforts are valuable, but there were other, better, less invasive ways for Kara to address the issue and to get a public dialogue going, IMO.
elissa (68e46b) — 10/11/2014 @ 5:14 pmIf suicide is a sin, then both GOD and Yeshua are sinners, and therefore not GOD.
Samson said to GOD,”Lord, if you give my strength back, I will push these pillars
down and kill both myself and all of the Philistines in this temple!”
GOD gave him his strength back allowing him to suicide. Since GOD gave him back his
strength, he was a willing participant in Samson’s suicide, and that would make GOD
a sinner Himself if suicide was a sin. The one thing impossible for GOD to do is sin.
GOD sent His son, Yeshua Hamashiach, into this world for one purpose, to die for our
sins. In other words, a suicide mission! Yehsua had the power to remove Himself from
the Cross and save His life, but He did not, and remained obedient to His Father’s
Will. He also had at his beck and call, 10000 angels that would have lifted Him off the
Cross and saved Him even “Lest He dash His foot against a stone.” Failure to save yourself,
from being murdered when you have the means to do so, is just as much a suicide as if
held a gun to your own head and pulled the trigger yourself.
Now if GOD is incapable of sin and gave Samson the power to take his own life, and
Yoda (d89de1) — 10/11/2014 @ 5:19 pmYeshua lived a sinless life and is also GOD himself,and willingly failed to save His
own life, and essentially commit suicide, then the conclusion has to be that suicide
cannot be a sin.
I suppose I could have said “in suffering per se” or “suffering for suffering’s sake” but that’s not what I meant. Suffering is a mere incident of life. There is no virtue in burping. There is no virtue in itching. There is no virtue in corns and bunions. It is morally irrelevant for the sufferer. There is immorality in gratuitously inflicting it; and there is virtue in allaying it.
nk (dbc370) — 10/11/2014 @ 5:21 pmSuffering is not “beautiful”. It is ugly, it is not something to be sought or countenanced when hope is gone.
I hear complaints about this young woman’s vanity and narcissism, people calling her an attention whore. I want to punch those who moan about that and let them feel “beautiful” for a few minutes. Of course she’s making this as public as she can. She is being killed by a brain to or in the flower of youth, there is no way out except for her brain to literally pop out of the skull and get shoved down her spine. What happens when that happens, and every minute on the way there, is horrible to describe and horrible to behold. She will have dyspnea and pain, paiin that is not mediated in the normal way by painkillers. Uncontrollable agony. Seizures. Retching. Loss of control of bodily functions including elimination. She will be incoherent. You wouldn’t let a dog die like that.
She’s not killing herself, she is being killed by the cancer and there is no other escape from that wretched end except to control that end. She’s killing herself like those people who kept out of windows together holding hands to get away from not certain death, but a more horrible one. And she wants it to matter. Fark her, she wants to matter. She’ll have no fine career and she’ll have no child and she’ll have no lasting legacy except that “whore” wants one…. So she spoke up. Her story might make it possible for people not to have to move themselves or uproot an entire family to accommodate her wish to control the awfulness of her certain death. She knows people will pay attention because the story is scary and strips away layers of pretty fantasy people build up around how we will all pass out of this world like kicking the top off an anthill. People come running to put the dirt back on top they do t want those ants to be seen. As Deiter said, ANTS ANTS ANTS. I’m glad she kicked that hill and I hope she manages to hel the enforcers of “beauty” in their place.
SarahW (267b14) — 10/11/2014 @ 5:23 pmI’m in a pretty bad mood, sorry for the rant and atrocious typos
SarahW (267b14) — 10/11/2014 @ 5:25 pmCalmer discussion of death by glioblastoma: http://www.brainlife.org/reprint/2008/oberndorfer_s080100.pdf
SarahW (267b14) — 10/11/2014 @ 5:29 pmSarahW–I had an employee die from glioblastoma. She had just reached 25 years of age. You did not overstate or over dramatize the horror of that disease.
elissa (68e46b) — 10/11/2014 @ 5:33 pmI agree, there is virtue in allaying suffering. But I submit that bunions and corns are not suffering, but evidence of suffering. Virtue is in the “why”, esteemed sir.
yoda, your argument makes about as much sense as “if a horse has four legs and if a table has four legs, then a table is a horse”.
felipe (40f0f0) — 10/11/2014 @ 5:34 pmDeath sucks. I have had enough of it this year.
JD (b12e6e) — 10/11/2014 @ 5:39 pm“31.Suffering is not “beautiful”. It is ugly, it is not something to be sought or countenanced when hope is gone”.
SarahW (267b14) — 10/11/2014 @ 5:23 pm
Would I be wrong to think you would say the same thing about a crippled person? Who’s hope? Yours? Theirs? I would say that your inability to see beauty in “suffering united to love” is a failure on your part. Why do you insist on changing my words? I’ll tell you why, because otherwise you would have no strawman to defeat.
felipe (40f0f0) — 10/11/2014 @ 5:42 pmBecause you lack the wisdom to see the sense does not make it nonsense, Padwan!
Yoda (d89de1) — 10/11/2014 @ 5:43 pmOnly a sadist sees beauty in another persons suffering! Normal people see the
Yoda (d89de1) — 10/11/2014 @ 5:45 pmpure unadulterated evil in it!
Prayers for everyone
EPWJ (abd159) — 10/11/2014 @ 5:46 pm“She’s not killing herself” “She’s killing herself”
For me, that says it all. Sarah, when you are on, you are on. But you are not on.
felipe (40f0f0) — 10/11/2014 @ 5:47 pmfelipe, She’s fully capable of speaking for herself, but from my reading I believe SarahW was specifically addressing the “suffering” of a diagnosed as terminal glioblastoma victim, or the all hope is gone jumpers from the top of the World Trade center on 9/11. I don’t think crippled persons were in the equation. Also, I thought SarahW was responding to Kara’s verbiage, not to you.
elissa (68e46b) — 10/11/2014 @ 5:49 pmNo, yoda, you are wrong. “only a sadist”? Really? “Logic” right up there with “only a racist”!
felipe (40f0f0) — 10/11/2014 @ 5:50 pmToward the end of “Canticle for Leibowitz” the author has a priest discussing euthanizing a horribly burned child with the child’s mother. It’s about the best discussion I’ve ever seen, and scoring the winner would be difficult.
RA (f6d8de) — 10/11/2014 @ 5:51 pmBack when I was in the Army, we used to promise each other, “If I’m really ****ed up, you’ll take care of me, right? I’d do it for you.” Kind of an affecting scene in the movie “Flight of The Intruder”. An Army officer in Iraq was courtmartialed for murder, “taking care of” a horribly wounded Iraqi prisoner. Lefties, of course, figured he was a conscienceless murderer–but then they think that of all soldiers–long as they’re Americans.
It should also be noted that the sufferer’s awareness of the burden placed on others is a burden, indeed. Wouldn’t you like to free your loved ones?
OTOH, abortion was originally sold as safe, legal, rare, and an exceptional response to a crisis, which nobody would like but which, regretfully, had to be done…. As infrequently as possible.
As a physician, I have seen many people die. Some died as I was trying to save them. Some died as I knew what I was doing would end their suffering. My old professor used to treat end stage breast cancer patients with high doses of steroids (like cortisone) which makes them feel better and even induces a euphoria. When that effect of the steroids waned and nothing else was available, he would admit them to the hospital and “forget” to order steroids. After a period of high dose steroids, the adrenal cortex is suppressed and the patient has a quick and fatal collapse of vital signs. That was in the days when doctors and families made those decisions, not lawyers.
Glioblastoma is awful but the most common form of brain cancer. It tends to be multifocal which is why it is incurable.
Mike K (90dfdc) — 10/11/2014 @ 5:54 pm” Also, I thought SarahW was responding to Kara’s verbiage, not to you”.
It is always wise to allow for misunderstandings of this type. Thank you, elissa.
My point was I was offended that she was offended. I know, a perfect recipe for discord.
I guess both Sarahw and I are in pretty bad moods. I apologize, Sarahw.
felipe (40f0f0) — 10/11/2014 @ 5:56 pmfelipe, you’re not one of those guys who nails himself to a cross on Good Friday, are you?
If God had meant us to suffer, He would not have planted poppies. You are just as virtuous when you rescue a person freezing to death in the north woods in your heated survival suit and Winnebago, as you would be if you had walked barefoot for five mile through the snow dragging a cask of brandy. (Don’t ask me why this example.)
nk (dbc370) — 10/11/2014 @ 6:00 pmMy father started losing his mind to dementia in his early 60s. At some point he no longer knew who I was, and had little connection to reality. I was conflicted about signing do not resuscitate forms when he moved into a nursing home but knew this was not the way he wanted to live. He continued to deteriorate and eventually he lost weight because he did not know how to swallow food and contracted pneumonia. As medical power of attorney I declined antibiotic treatment opting for hospice instead. I was not at all conflicted about it at all about that decision.
Back then I was on the fence about God – but didn’t really believe. My more religious uncle (dad’s brother) supported my decision.
I think a person should have the right to choose to end his/her life. I don’t buy into the slippery slope argument which can easily be avoided if we require someone to be of sound mind, with witnesses and a notary present to sign the forms. I have a problem with laws against this especially when fueled by religious beliefs. I grant that they are sincere beliefs. But that does not make them true. I’d prefer laws based on reality and would be more inclined to listen if the case was convincingly made about why it is necessary to outlaw suicide for society’s benefit.
Gil (27c98f) — 10/11/2014 @ 6:01 pmDr. Mike, I believe that a little girl with an inoperable tumor of that type has gained a momentary reprieve after surgeon’s treated her with Isoray’s novel treatment.
http://finance.yahoo.com/news/isoray-announces-early-success-young-121500031.html
felipe (40f0f0) — 10/11/2014 @ 6:03 pmGil had to show up to dirty another thread. Wait for half-baked atheist cant … 3 … 2 … 1. Go find another blog to troll, pig!
nk (dbc370) — 10/11/2014 @ 6:04 pmLOL! you don’t have to worry about me, but I do know the why about the brandy!
felipe (40f0f0) — 10/11/2014 @ 6:05 pmoh, nk. You are right about that comparison, because of the whys involved, dontcha know!
felipe (40f0f0) — 10/11/2014 @ 6:08 pmUPDATE BY PATTERICO: This is a very thoughtful post. My own thoughts, for what they are worth, is that each of us owns our own body, and we should be able to determine for ourselves how we go. But I worry about the slippery slope caused by government involvement in health care, which creates an irresistible incentive for bureaucrats to ration care by encouraging people to go before their time. If we had a true free market in health care, I would have fewer reservations.
Patterico (9c670f) — 10/11/2014 @ 6:14 pmDo we differentiate between active suicide and DNR?
JD (b12e6e) — 10/11/2014 @ 6:17 pmIs there not a way to induce only brain death without killing the rest of the body? It would technically not be suicide, because it would technically not be death.
Michael Ejercito (becea5) — 10/11/2014 @ 6:24 pmI made, and carried out, my mother’s DNR “decision”. She could not. When she could no longer swallow, food or liquid, and I was not going to put her on a feeding tube. My father, I kept to the last smile he had the strength left to give to his granddaughter even though he did not have the strength for anything else, until his heart finally could no longer beat. I did not find either a burden, and neither did my brother. Not any part of it. If my brothers did, they did not complain. I’ve posted about this before.
nk (dbc370) — 10/11/2014 @ 6:31 pmI have a DNR before 9:00AM, because I hate to get up in the morning. (A little levity)
Gazzer (4d1091) — 10/11/2014 @ 6:45 pmWhat is suicide? Is choosing a quick, painless death in the face of a certain and painful death that’s only minutes away actually “suicide”? The WTC jumpers would probably say no, as elissa suggested.
If that wasn’t suicide, why should the same pain, stretched out over weeks be insufficient cause? Because you can check out with drugs without “dying”? I’m not sure I see the difference. Because you can wait until the pain is greater? Is there a point where it would become acceptable?
If instead of assisted suicide, the doctors could put you into a permanent coma until death took you, would that still be any better? Why?
Kevin M (b357ee) — 10/11/2014 @ 6:56 pmi’m on Team SarahW
happyfeet (a785d5) — 10/11/2014 @ 7:19 pmI’m all for assisting Islamists in their suicide intentions.
For all other’s I might suggest Kafka’s The Hunger Artist.
gary gulrud (46ca75) — 10/11/2014 @ 7:28 pmDo we differentiate between active suicide and DNR?
I have to because otherwise I committed homicide. But I think yes, if extraordinary measures prolong a life no different than that of a potted plant, with the added difference that the person can still feel the pain of the tubes, needles, and masks and the potted plant can’t.
nk (dbc370) — 10/11/2014 @ 7:29 pmMatricide.
nk (dbc370) — 10/11/2014 @ 7:30 pmExecuting a DNR order, and not having a feeding tube re-inserted, strikes me as dramatically different than active suicide.
JD (b12e6e) — 10/11/2014 @ 7:31 pmNk – I would be guilty of the same.
JD (b12e6e) — 10/11/2014 @ 7:32 pmShe won’t know that herself until she actually swallows the pills and, after, does not try to throw them up or ask to have her stomach pumped. Life is a tenacious thing. But it’s only my general opinion; I don’t know the girl’s mind.
nk (dbc370) — 10/11/2014 @ 7:37 pmThis young woman has more bravery than any of those who are our “political elites.” That fact shames me…but it should shame them…G-d bless her and her family.
Rich Vail (015de0) — 10/11/2014 @ 7:55 pmlater on we’ll conspire as we dream by the fire
to face unafraid
the plans that we’ve made
happyfeet (a785d5) — 10/11/2014 @ 7:57 pmI don’t want to make Dante’s judgment about suicide. I tend to agree with billo at comment 9. My grandfather’s brother chose to be executed with his sons when the Germans offered to let him go. What were the 300 if not a suicide mission? Masada? And there were many other similar stories that I grew up with.
nk (dbc370) — 10/11/2014 @ 8:01 pmI think there is strong evidence in The Netherlands and in Great Britain that the “slippery slope” is not a concern, but a reality.
On one hand, what we do and what we allow on an individual basis one by one adds up and influences society. On that basis I disagree with physician assisted suicide. In my experience as a physician and as a family member, I have repeatedly seen medical professionals give suboptimal care and hasten not only death, but incapacity. For example, one can often control pain with narcotics and keep a person awake and interactive with stimulants if a person wants to interact with friends and family, but I’ve seen professionals argue against it because “it’s prolonging life”, and family members resist it because they are the ones in line for an inheritance.
That said, I am not going to make an effort to try to stop this person.
There is a recurring conflict in our society in what we allow individuals to do and what we need to set as policy and what becomes societal “peer pressure as normal”. This is a case in point. In one way it is about one person’s decision and another person’s different decision, but in another way it has become a societal “straw poll” trying to influence what we should see as reasonable.
For myself, I disagree with the statement that my life is mine to choose as I want. My life belongs to God twice over, once for creating me, and once for redeeming me, at the cost of His own suffering in the person of Jesus. “My life is not my own”. Not to be flippant, and it is a passage more poetic than doctrinal explanation, but it does say, “Though I walk through the valley of the shadow of death…” not “When I choose to take a short cut…”
When in a proper frame of mind, I remember that there is so much I do not know. But I do know a few things, and one is Jesus suffered first extreme mental anguish in Gethsemane, and then physical and further mental and emotional suffering on the cross, and His promise is that His grace is sufficient for the struggles of the day.
Losing one’s life as a secondary result of an action with another primary purpose I guess may not be suicide, and I guess some could argue that this woman is not trying to commit suicide as to limit the suffering of a terminal disease, analogous to using narcotics to limit the suffering. But I would not see it that way for myself.
MD in Philly (f9371b) — 10/11/2014 @ 8:04 pmNK.
RA (f6d8de) — 10/11/2014 @ 8:15 pmWere I to, for example, lose my sight, my wife would not consider taking care of me a burden. But I would consider it a burden I imposed on her. I’m not talking about the others in the family. I’m talking about the sufferer’s perception.
Hospice scolded us for not giving my mother “enough” morphine. We wanted her to be able to sit up and walk a little, and her caregiver never gave up on trying to spoon feed her a drop of water at a time, so we flipped hospice off. Do they get a set fee from Medicare for home hospice, and lose money if the patient lingers “too long”?
nk (dbc370) — 10/11/2014 @ 8:15 pmI know, RA. When I had my stroke, I told my brother and my daughter’s mother “DNR if anything goes wrong”.
But you’d be surprised how independent you can be with 20/2400 vision, in familiar surroundings. 😉
nk (dbc370) — 10/11/2014 @ 8:19 pmI think so, nk, but I’m not sure. It may be that they get so much for every “x” amount of time.
For some it is the ethos. Instead of making sure people have their symptoms managed so they can enjoy as much of life as they can while they can, many hospice people apparently see their job as “helping people die”, so they do.
MD in Philly (f9371b) — 10/11/2014 @ 8:38 pmIm all for Democrats killing themselves instead of our kids by importing 3rd world disease.
Joeschmo (3fabbc) — 10/11/2014 @ 9:01 pmC-diff will be what gets you, Perry.
nk (dbc370) — 10/11/2014 @ 9:03 pmNK, choosing to be executed alongside loved ones is not suicide. Thermopylea was not mass suicide, nor the Alamo. These were defiant decisions made in solidarity with others. Acting with resignation is not giving up.
felipe (40f0f0) — 10/11/2014 @ 9:05 pmnk (dbc370) — 10/11/2014 @ 9:03 pm
LOL, nk cannot be fooled!
felipe (40f0f0) — 10/11/2014 @ 9:06 pm” a little girl with an inoperable tumor”
The story sounds like the tumor was localized but in an inoperable location. In surgery there are three situations. “Incurable” because it is beyond extirpation. “Inoperable” because the patient will not tolerate the surgery. And “Unresectable” because it can’t be removed and leave a living patient. The little girl’s tumor sounded unresectable.
I would surprised, if the diagnosis is right, if it does not come back.
Mike K (90dfdc) — 10/11/2014 @ 9:24 pmThank you, Dr. mike. The tumor was so close to the brain stem that maybe that was why it was “inoperable”. Or maybe the journalist just thought that “unresectable” was too obscure for the rubes to understand and substituted “inoperable”.
I agree, I would be surprised if the tumor did not begin to regrow, since it only shrank. A possible clue is that there is no mention of any follow-up treatment.
felipe (40f0f0) — 10/11/2014 @ 9:59 pmpoo poo pills knock that pesky c. diff right out
faster please?
happyfeet (a785d5) — 10/11/2014 @ 10:05 pmI’ll have the Vancomycin with a Flagyl taper, thanks.
nk (dbc370) — 10/11/2014 @ 10:13 pmR.I.P. Donatas Banionis (1924-2014), Lithuanian actor who played the lead role in Andrei Tarkovsky’s Solaris (1972)
Icy (fec6f2) — 10/11/2014 @ 10:17 pm— If you’ve never seen it, I highly recommend this film. It’s available on Hulu and Amazon.
As a matter of faith, I believe our bodies are not our own.
As a matter of law, Kevorkian was basically correct: We mustn’t take that last civil right away.
I hope I would have the courage to endure.
Ed from SFV (3400a5) — 10/11/2014 @ 10:21 pmI remember reading in 1990 about Janet Adkins who was diagnosed with very early stage Alzheimer’s disease. She had minimal symptoms and would have had many years without what we know as symptoms of Alzheimer’s disease. The week before she committed suicide she beat her son in a game of tennis. For all intents and purposes she would have lived a normal life for many years.
Janet Adkins got help from Dr. Jack Kevorkian to commit suicide. She didn’t need to commit suicide, she needed help for her depression.
End of life care has much to do with the attitude and mindset of the doctor administering pain medication and the care given by medical personnel. As MD said:
My grandmother died of breast cancer. I saw her three weeks before she died. She was in and out of consciousness because of the drugs they had given her. I believe my grandmother received poor medical care. Medical staff denied her the opportunity to die with dignity because they medicated her to unconsciousness.
I saw my grandfather just before he died of colon cancer. It was a much different situation. He was thin and very ill, but he was laughing and telling jokes. He died a much better death than my grandmother.
I’ve read that in Holland the majority of patients who receive assisted suicide have not given their permission. Same thing in Britain. That’s not suicide, that’s murder. I’m sorry for the pain Mrs. Maynard will go through, but I don’t believe that giving her the out of suicide is for the “greater good”. It has already been proven that there really is a “slippery slope” and to me, it’s not worth going down that path. Committing suicide is not “death with dignity “, it’s murder.
Tanny O'Haley (066e8f) — 10/11/2014 @ 10:30 pmIn principle, I am for allowing people to end their own lives, preferably by some means that will not make a horrid mess if botched (no, I don’t know what that might be). In practice, I am leery of getting the government involved on any level. I do not trust governments for reasons too numerous to mention. I am mindful of the Terri Schiavo case, where (so far as I can see) a judge decided based on the unsupported word of a person with a financial interest. Yes, I read that post mortem examination showed that Ms. Schiavo was a vegetable. I don’t think that changes that we had moved from “We will allow you to be taken off of life support IF you have carefully left explicit written instructions” to “We’ll ask people who may or may not have your best interests at heart, and consult Learned Men, and if you didn’t leave a living will because you didn’t WANT to leave a living will, too bad.”
Any legal method by which people may decide to kill themselves openly and before things get awful would short circuit a lot of that worry. If somebody like Terry Pratchett has the option of checking out gracefully before he loses himself to his disease, it’s far less likely that some self-important idiot, or stressed out family member, will make a bad decision under pressure.
Aside: I dimly recall that Sweden has had recurring, and deeply embarrassing, problems with euthanasia and eugenics scandals, stretching back to the end of the Second World War. Does anybody know any details?
C. S. P. Schofield (848299) — 10/11/2014 @ 11:02 pmIt is better because no one is being killed.
Michael Ejercito (becea5) — 10/11/2014 @ 11:41 pmI don’t know about the scandals, but I do know they allow people to get assisted suicide for depression (mental health issues) and that teenagers are eligible for assisted suicide. I read that last year 176 people in Sweden received assisted suicide between the ages of 15-24. Do you the think that’s a problem?
People may think that it’s compassionate to allow a person to die before their time because of terminal illness, but legalizing assisted suicide for the terminally ill has always led to assisted suicide for all. That is not compassionate. You see, there really is a slippery slope.
Tanny O'Haley (066e8f) — 10/11/2014 @ 11:42 pmC. S. P. Schofield,
I don’t trust the government either. I like this quote.
They fail at almost everything. The less power they have, the better.
Tanny O'Haley (066e8f) — 10/11/2014 @ 11:50 pmI am not a doctor, so I am not qualified to give medical advice. Neither do I have any financial interest in what I am going to discuss.
I do hope that her oncologist has looked into the use of Valganciclovir to treat glioblastoma multiforme, which appears to be as dreadful a form of cancer as one can imagine. The New England Journal of Medicine reported on clinical studies of this treatment. To summarize briefly:
Valganciclovir is an FDA-approved treatment for cytomegalovirus (CMV), but off-label for glioblastoma
A sample of 75 patients with glioblastoma found that almost all had cytomegalovirus viral infections
Those with the most severe CMV infections had the shortest lifespans, 17.2% with severe infections surviving for 24 months (median survival 13 months) while 63.2% with minor infections surviving for 24 months (median survival 33 months)
In a controlled double blind study, 90% of glioblastoma patients who received continuous Valganciclovir survived for 2 years (median survival 56.4 months) compared to a control group in which 2-year survival was 18% (median survival 13.7 months)
Patients who received the drug for shorter periods had poorer survival rates, but still far better than the controls
The drug, also known as Valpers, is fairly expensive, with a daily dose costing something like $140. (Upon further reflection, that is outrageously expensive.) in a case like this, there should be massive public support to help pay for the drug if her insurance company is unwilling to pay. Even better would be for some organization, like the Bill and Melina Gates Foundation, to purchase the patent rights and lower the price by an order of magnitude (or more) so the other 12,000 glioblastoma patients each year can also have affordable access.
GaryC (989c73) — 10/12/2014 @ 1:44 amMelinda, not Melina.
GaryC (989c73) — 10/12/2014 @ 1:46 amGaryC (989c73) — 10/12/2014 @ 1:44 am
I found a few things quickly, including these (if you look at the top of the article at #1 you will see you can also find letters in response)
http://www.nejm.org/doi/full/10.1056/NEJMc1302145#t=letters
http://www.braincancer.org/2014/03/31/valcyte-and-cytomegalovirus-cmv-in-the-treatment-of-glioblastoma/
I am not an oncologist, virologist, molecular biologist, or a clinical statistician.
But my quick read suggests there is interesting evidence that valgancyclovir (Valcyte in the US) might have activity against this tumor, even if the mechanism is poorly understood.
Theories out of the mainstream are often 1 of 2 things, a grasp at straws of no benefit, or the stuff of Nobel Prizes in medicine.
Certainly a trial of the drug in a person choosing not to receive traditional therapy would be interesting, with the main downside being cost of the drug.
Whether it would indeed help this person, one could only find out by trying it.
Again, in my personal limited experience as a doctor and family member of patients, the willingness to promote death as an answer leads to lack of more creative thinking about alternatives. I had two patients referred to me with AIDS (people sick, not HIV infection) for anticipated end of life care over 15 years ago. One wanted euthanasia, I told him I would not do that, but that I would treat his depression and current symptoms that were most distressing; and another patient thought to have end-stage cardiomyopathy/heart failure related to HIV. Both are alive and active more than 15 years later. A family member was denied treatment for a likely fatal medical condition because of her advanced age at one facility, but was successfully treated for the condition at another facility with a procedure that did not require general anesthesia and took only 45 minutes to accomplish. This was accomplished only because of my efforts as a medically informed family member, and “not even the lifting of a pinky” of help from her treating physicians.
The drug is analogous to the more common Valtrex (valacyclovir) which is much more commonly used for various types of herpes infections. Valcyte is an oral form of the otherwise IV drug ganciclovir, which has much less demand for CMV disease, usually in people with AIDS or other immune suppression.
MD in Philly (f9371b) — 10/12/2014 @ 6:49 amFirst of all, doctors should only cure, never kill. It should never be a doctor’s decision to end a patient’s life, and a doctor should never take active steps to end a person’s life. Even more importantly, the Government must *never* take a person’s life without due process of law, with the exceptions of national defense / warfare and self-defense / defense of others.
That said, I don’t think I would condemn someone who commits suicide in such a case, especially if they donate their organs or do some other type of selfless action. A soldier diving on a grenade is a hero, after all. Honestly, were I running an intelligence organization, I would offer some of these patients a chance to do one last thing for their country. Were I in charge of the FDA, I would allow for terminal patients to voluntarily participate in longshot trials or other medications not cleared for human use.
OmegaPaladin (f4a293) — 10/12/2014 @ 8:53 amDana, and others, thank you.
htom (412a17) — 10/12/2014 @ 9:02 amWhere legal, the “right to die” becomes the “duty to die” in short order.
We read articles about some 20 something deciding to end her life before some incurable ailment does it for her.
What we get, in places like the UK or the Netherlands, are doctors deciding some worthless oldster shouldn’t be taking up a valuable hospital bed. Sure, they could treat granny’s pneumonia. But what’s the point? She’s old. She’ll just get sick again or fall and break her hip. Then she’ll be right back in that hospital bed, wasting everyone’s valuable time.
It’s just best for everyone if we as a society put a stop to that cycle right now.
Remember when Ezekiel Emmanuel wrote an article in which he pretended to be talking only about himself, and not about you?
http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/
Here’s a hint; if he really was writing about himself, he wouldn’t spend his time discussing how the rest of us dumb %#@!s aren’t facing facts.
And the fact is, you’ve lived long enough. It’s beyond greedy, you selfish old ninny, it’s mean and cruel. Look at how you’re forcing people to remember you as “feeble, ineffectual, even pathetic.”
Isn’t it time you stopped bitterly clinging to your guns, your religion, your xenophobia, and your life, you bitter clinger?
Steve57 (e409e4) — 10/12/2014 @ 9:03 amLate to the thread as usual. I think Kevin M @58 has a valid point. I consider it the “how many whiskers does it take to make a beard” argument, and it’s valid. In the “beard” argument, you know when someone has a beard and when he doesn’t. But the line between “beard” and “not-beard” cannot truly be found. So, if the WTC jumpers were not committing suicide due to the imminent nature of their sure deaths, where is the line when “not-suicide” and “suicide” occurs? It could be well worth the discussion.
But I am of the mind that the WTC jumpers were indeed committing suicide. And thus the difference between “valid” and “sound”. I cannot personally fault the WTC jumpers, although I believe Providence does. (And no, suicide is not the Unpardonable Sin, but dying while denying Him is.)
What would I do if I were in the shoes of the ladies above? Or the WTC jumpers? My reasoning would be entirely selfish, I am sorry to say, thus I am not on a solid footing to discuss their selfless thought processes.
John Hitchcock (d996ff) — 10/12/2014 @ 9:21 amObamacare now pays for end of life counseling.
I’m sure that will be a joy.
You’ll walk into your doctor’s office, and your doctor will look up and say, “Are you still here? Why are you still here? You know, I could be spending this time treating a patient with a future. But instead, I have to see you. And you’re done. You were done like ten years ago. Apparently, you don’t get it. Everybody around you gets it, you smelly old creature, you. Why don’t you take the hint and do everyone a favor.”
I’m really not being flippant. I just recognize the pattern. When the types of people who are in favor of euthanasia start out, they start out with stories such as Brittany Maynard’s. But where you end up, as is the case in Holland, is with old people actually carrying around cards that say “Doctor, please don’t kill me.”
Because they will whenever they decide that your life just isn’t worth living. You may think your life is worth living, but yours isn’t the opinion that counts.
Theoretically the laws in such countries supposedly provide safeguards that protect the unwilling from being offed. I can’t use the term euthanized as that’s too sanitary a term to describe good old fashioned murder. But in reality those safeguards don’t amount to anything. Any doctor who is so inclined (and many are) can simply self-certify that they complied with the law. And there is no evidence other than the doctor’s say so.
I recall reading the results of a Dutch survey, in which a sizable percentage of doctors admitted that they had killed people without bothering to get their permission first. The law requires that. But who’s to know if the doctor asked? The only other person involved is now dead.
Doctors figured this one out really quickly. And they weren’t shy about telling the people taking the survey. Because the only way they’ll ever get prosecuted is if they rat themselves out. Apparently there’s some paperwork involved if they medically murder someone. And all they have to do is claim on the paperwork that they followed all the rules.
If they even bother to admit to what they did. It’s a lot easier to just say that whatever the worthless oldster complained of is what killed them. Nobody’s going to check. It isn’t as if the authorities want to prosecute these doctors for doing what the authorities want done.
Steve57 (e409e4) — 10/12/2014 @ 9:27 amThank you, John. That was well said. About the WTC jumpers; there must have been a “fight or flight moment”. Just how involuntary a reaction it was, we will never know.
“And no, suicide is not the Unpardonable Sin, but dying while denying Him is”.
I agree with you.
felipe (40f0f0) — 10/12/2014 @ 9:30 amSpend less time talking and more time doing is all I’m saying.
f1guyus (647d76) — 10/12/2014 @ 10:04 amYes, f1guyus. Like the bumper sticker says: Hang up and drive.
felipe (40f0f0) — 10/12/2014 @ 10:06 amSuicide – since when do you need permission?
If you need someone’s permission, then you are not doing it right.
This young lady you want to make a hero of, with her commentary she is trying to ensure she has company down the river Styx.
I can see where suicide can have an appeal for some people in some situations, but that doesn’t justify lobbying for the state to get into the murder business. The state already has plenty of sonsabitches who think they’re in that business already. There are no safeguards against that sort.
So excuse me (the insane commentator) for pointing out Brittany Maynard is acting like a suicide bomber.
papertiger (c2d6da) — 10/12/2014 @ 11:07 amThat is positively the most sick, sadistic and G*d-damned perverted notion that I’ve ever read on this forum. Bar none.
J.P. (cc46f4) — 10/12/2014 @ 12:37 pmJ.P., do you think that the pain and suffering a woman goes through to bear a child is a “sick, sadistic and G*d-damned perverted notion”? You are not even mature enough to understand what is written.
felipe (40f0f0) — 10/12/2014 @ 12:46 pmAny doctor will tell you that pain is an invaluable tool in diagnostics. Without (the ability to feel) pain (the foundation of suffering) no living thing will a neuro-system would last very long. Thus, the value. Any athlete will tell you “no pain, no gain”.
felipe (40f0f0) — 10/12/2014 @ 12:50 pmObviously your mind goes to a very dark place by habit.
felipe (40f0f0) — 10/12/2014 @ 12:50 pmTruly, some subjects are not for “the weak of mind”.
felipe (40f0f0) — 10/12/2014 @ 12:52 pm103. 104 felipe, I continue to think that the reason for part of the discord on this thread is definitional. Some people separate “pain” from “suffering”– yes, they see them as perhaps related, but really rather different things. And I guess I do too. I see the pain of a broken arm, or childbirth, or appendicitis, or a kidney stone, or a triathlete’s electrolyte crash as pretty different from suffering in the sense of the suffering that Kara and Brittany seem to be facing and discussing.
elissa (35f4ae) — 10/12/2014 @ 1:10 pmThis is another %%*$%%$ERR^$%^$&%!!!!! frickin’ topic where the obvious common sense response has been largely neglected, even as I myself described earlier (Again, in my personal limited experience as a doctor and family member of patients, the willingness to promote death as an answer leads to lack of more creative thinking about alternatives.)
See, here’s the thing, this person is not simply saying, “No thank you, I’ll bypass the terrible treatment that largely doesn’t work very well in the long run and focus on enjoying the life I have left, and my doc will help me do that and keep me comfortable when the time comes.” No, she wants to schedule it for the convenience of people like a wedding.
As mentioned earlier, not only would high dose steroids make her feel better when the headaches get bad enough, they actually would be part of the emergency treatment to control brain swelling and pressure. But since there would be no other effective treatment forthcoming, the steroids would probably give her only a few days (time for everyone to fly in for the last visit) before they had diminished effectiveness. At that point you can control the pain/snow her with morphine and whatever else she needs, and stop the steroids since they aren’t doing any good anymore anyway. Between the abrupt discontinuation of the steroids and the rebound in brain swelling from stopping them, she probably would not last very long.
But again, if the conversation is dominated by contrived dilemmas that don’t have to exist, I, yes, even I 😉 , overlook the obvious.
MD in Philly (f9371b) — 10/12/2014 @ 1:19 pmFor any others who may fell uneasy with my initial comment, let me draw your attention to another commenter’s remark about suffering being neither moral nor immoral. Like an itch. I agreed, and pointed out that it is in the “why” of the suffering that is everything.
A person trying to drive a nail, instead bashes a finger by accident. Boom! Pain and suffering which in no uncertain terms informs one of the need for several things, like medical attention, more attention to the task at hand (no pun intended). But because of the “why” (accident) there is no morality involved.
If the person was aiming to do damage in order to avoid a serious obligation, or to obtain disability, well that would be immoral, and a few other things.
If the person was rebuilding (as in habitat for humanity) another’s abode and continues to perform this noble work in spite of the pain and suffering, enduring it for the sake of another, then you might admire this person for any number of virtues that had come into play such as, perseverance, for example. Add to this, an understanding that maybe this person was the last person who anyone would think capable of this selfless act, and you might be moved to act likewise. But this suffering must be known, acknowledged, and understood.
Understanding is a gift that, when properly formed, enlightens the mind and spirit to allow one to see beyond the ordinary, the vulgar, and the profane world around us, and propels us in our discernment of what is perverse, and what is sacred.
This is not even touching upon what is considered heroic.
felipe (40f0f0) — 10/12/2014 @ 1:21 pmAs I understand the historical context of the palliative care/hospice “movement”, it came about because people too often encountered the news, “There is nothing more I can do for you”. Which more accurately meant, “There are no more treatments to increase your chance of survival”, , which would then lead to the patient being “abandoned” by their doctor.
The ^&%RT^&RG*T*!!!! problem with that, which continues into the present time, is that people were not retreating patients, they were treating diseases. Now, hospice at fiorst may have helped remedy this, but no more,
it’s just that no more is the specialist treating the disease of cancer, but the disease of the dying process, and stepping back and thinking of taking care of the patient yet again is abandoned.
Outbursts over, at least for the moment, I have other things to do.
MD in Philly (f9371b) — 10/12/2014 @ 1:25 pmI completely agree, elissa, and I have tried to explain myself in my preceding comment. I erred in not providing a concrete example of where I was coming from. Whether this can be attributed to laziness or my naïve assumption that others can read my thoughts, I do not know. I always appreciate your thoughtful replies and corrections.
felipe (40f0f0) — 10/12/2014 @ 1:25 pmI have a Stage IV blood cancer that cannot be cured except through God’s grace. I have had pain and suffering from the cancer and the treatments. My oncologist has used medicines, transfusions, and hospital admissions to help me, but there are times these haven’t been enough to ease my pain or suffering.
I never would have imagined it but there is a beauty in being sick. I don’t like having cancer but it has focused my mind on important things, and lets me ignore the trivial worries that consumed most of my pre-diagnosis moments. The worst part of having a terminal disease, by far, is what it has done and is doing to my family. If I were ever to consider suicide — and please God help me not to — it would be because I want to end their suffering, not mine.
DRJ (a83b8b) — 10/12/2014 @ 1:32 pmMD, you comments are of the beacons of sanity on this thread (as in others) that I could only imitate, so I leave them to you. It that wrong? I’m sure it is lazy of me.
felipe (40f0f0) — 10/12/2014 @ 1:33 pmGod bless you, DRJ. I am including you and your family’s intentions in my daily Rosary. One of my siblings also has cancer, has had a stroke, a sextuple heart bypass and is in acute care right now. She has voiced the same thing to us. She is only 54. My sibling and I can finish off each others sentences on any subject and she is teaching me all she knows about suffering.
felipe (40f0f0) — 10/12/2014 @ 1:38 pmDRJ–I had so hoped that your reemergence and participation on this site was an indication that you were doing better and/or feeling better. I’m sorry to see that is not the case. Best to you, and your family. always.
elissa (35f4ae) — 10/12/2014 @ 1:46 pmThank you, elissa, but God is merciful. He is taking good care of me.
DRJ (a83b8b) — 10/12/2014 @ 1:51 pmDRJ,
My love and prayers, friend. I am powerless to do anything but pray for you and your family. May God gently walk you down this path and overwhelm you with His love and grace. The two women I mention in the post were frequently surprised by His nearness. It never failed to remind them that they were not alone in this vale of tears. And that gave them the strength to let go when the time came. I hope this for you, too. We are pilgrims passing through in this life, our glory is in what lies beyond. I pray that all four of you find peace through the tribulation as you cling to the Cross.
Dana (4dbf62) — 10/12/2014 @ 1:52 pmDRJ, you have always been so kind to me here, and offline. If there is anything at all I can do for you, you only need to ask. You are among the people I owe a great deal to (like Patterico and JD).
I have always lacked the deep religious faith that carries you so well…but I do know this, and we have discussed it, you and I: God whispers. Most of us (me especially) make too much noise to hear those whispers, let alone see the miracles all around us.
Imperfect as I am, you will be in my prayers.
Simon Jester (c8876d) — 10/12/2014 @ 1:59 pmDRJ, I’m saddened to learn of your condition. Your comment #112 illustrates why I am adamantly opposed to PAS, and indeed all forms of assisted suicide.
I don’t think anyone who’s been in your situation hasn’t had the thought cross their mind. And you asked for (and I’m sure will receive) God’s help to resist the temptation.
The last thing we should do as a society is to make assisted suicide more thinkable and more tempting. Moreover we shouldn’t put pressure on the seriously ill to choose that option. Which is precisely what happens in countries where it is legal. You mentioned that if you were tempted cutg
Steve57 (e409e4) — 10/12/2014 @ 2:06 pmDRJ – May showers of blessings fall upon you and your family.
daleyrocks (bf33e9) — 10/12/2014 @ 2:30 pmMy ‘puter has gone crazy.
What I was going to say is that in countries where they legalize assisted suicide for the seriously ill, it isn’t long before the attitude that is the option you’d choose if you cared anything about your family takes hold. The patients can see loved ones suffering along them. When euthanasia is legal, it’s no longer the disease that is causing the suffering. Now it’s the patient, who “selfishly” won’t take that legal option and spare them that suffering.
You can see beginning of the pattern in this article about Brittany Maynard.
When sparing your family the pain of your death is the kind, compassionate and noble choice, what kind of person would make a different, ignoble, unkind choice? If assisted suicide is “death with dignity,” who wouldn’t want that as opposed to death without dignity?
People in these countries (those who survive to tell their stories) report that when they were having their health crises they felt under a great deal of pressure to be noble and kind and compassionate and choose “death with dignity.” And if they didn’t choose that option something must be very wrong with them. They couldn’t possibly be decent people, because no decent person would make others go through all that suffering when it’s completely within their power to put an end to it.
Not to take anything away from Brittany Maynard, but I’m sure you could teach her a thing or two about living with dignity, DRJ.
I will pray for you and your family.
Steve57 (e409e4) — 10/12/2014 @ 2:36 pmDRJ,
I’m truly sorry to hear of your condition, and you clearly have a spiritual strength that I can but envy. But I fail to see how your decision should inform us about whether others should be forced to make the same one, as some suggest. Forced virtue seems less meaningful than virtue willingly chosen.
Kevin M (b357ee) — 10/12/2014 @ 2:38 pmKevin M.
MD in Philly (f9371b) — 10/12/2014 @ 2:41 pmShe is giving us an example.
Mrs. Maynard is giving us an example, DRJ is giving an alternative example.
Perhaps we then have a different definition of death. To me, death occurs when thinking stops, and a permanent coma would be just that. BTW, my advanced directive says that in the event of an injury that leaves me severely cognitively disabled (e.g. James Brady) all medical efforts other than palliative care are to be withdrawn.
But it is not my right to make that choice for others; my 94-year-old mother has been in hospice for more than a year even though she had her last cogent thought some time ago. I asked her in a brief moment of clarity whether she wanted to go, and she said no, so there it is. Then again she’s not in much pain.
Kevin M (b357ee) — 10/12/2014 @ 2:51 pmMD, I understand DRJ’s point. I was unclear, perhaps. Others would use her decision to argue against others having a choice. Steve for example, in #119
Kevin M (b357ee) — 10/12/2014 @ 2:54 pmA more fundamental question:
Is suicide a basic human right?
Kevin M (b357ee) — 10/12/2014 @ 2:55 pmWell, you are correct that her decision in no way leads to a logical conclusion that others should do the same.
Then again, as others have already said, the possibility of assisted suicide has lead to its misuse, and the practice of assisted suicide can lead to a perception, at least by some, of a duty for assisted suicide, ala Zeke Emmanuel. I thought Steve57 was more offering encouragement more than a logical deduction.
MD in Philly (f9371b) — 10/12/2014 @ 2:59 pmIs suicide a basic human right?
Kevin M (b357ee) — 10/12/2014 @ 2:55 pm
Well, I guess if you think human rights are given by humans, it’s up for a vote,
if you think human rights are endowed by our Creator, then you need to ask Him,
if you think human rights are deduced by some appeal to logic, then deduce away.
If you ask whether a person has the right to force another person to not commit suicide, that is a slightly different question.
MD in Philly (f9371b) — 10/12/2014 @ 3:03 pmSuicide is always a choice. But that isn’t the issue. The issue is, am I required to approve of someone’s decision to commit suicide? I don’t, so when the question of legalizing assisted suicide is put to me, I vote no. My no vote will not stop anyone who’s really committed to the idea of suicide from killing themselves.
But my no vote will help prevent people who aren’t committed to the idea of suicide from being bullied into it when they are at a low ebb and most vulnerable. Which is what happens when euthanasia is legalized.
http://www.catholiceducation.org/articles/euthanasia/eu0074.htm
Don’t let the fact the article is on a Catholic website throw you off. It wasn’t written by a Catholic for a Catholic website. It’s reprinted with permission from another ezine.
Of course, not all doctors report the fact they’ve euthanized a patient. Many doctors have reported in surveys conducted by or for the Royal Dutch Medical Society that they would never report that they’ve euthanized a patient under any circumstances. They simple falsify the death certificate and attribute the death to some other cause.
Then of course we have the minor little problem that some doctors don’t wait for the patient to make a euthanasia request. The Dutch have come up with a nice, polite acronym to cover this sort of murder. LAWER. That stands for “Life-terminating Act Without Explicit Request.”
And when I call it a minor little problem, I’m simply reflecting the Dutch attitude toward it. They really don’t see it as any big deal. They in effect treat involuntary euthanasia as just another form of voluntary euthanasia. Which is of course a logical impossibility, but subscribing to the notion allows them to go about their business without dealing with the moral or legal aspects of doctors making the decision to end someone’s life entirely on their own.
As the author, a medical ethicist who supported legalizing euthanasia, notes the public has come to regard PAS as entirely normal. Not only is it normal, it is what the terminally ill are supposed to want. So even if the patient didn’t ask to be euthanized, they assume the patient would have if physically capable of it. And if the patient was physically capable of communicating his or her wishes to the doctor, and didn’t ask to die, then the patient is some sort of inconsiderate blight on society anyway. Waiting for the explicit request is seen as something of a meaningless formality.
So when it’s on the ballot, I vote against it. And if I can keep it off the ballot, I will. Because I understand what’s really on the ballot. It isn’t a “right to die” that we’re voting on. Instead, it’s a duty to die that we’ll be imposing on people.
Steve57 (e409e4) — 10/12/2014 @ 3:44 pmDRJ — healing prayers and comforting wishes. Your voice here is always one I hope to see.
htom (412a17) — 10/12/2014 @ 4:13 pmOh, my. Thank you all for your caring comments. I wasn’t expecting them because I thought I had mentioned my cancer before. Obviously my chemo fog is worse than I realized!
Kevin M:
I’m so glad you left this comment because it gives me a chance to clarify what I meant. I wish I were strong enough or wise enough to advise Brittany and Kara what to do. I’m not. All my comment was intended to convey is that I think I know how they feel because I’m taking the same cancer journey. I also wanted to say that sometimes it’s not just your own pain and suffering that you fear.
It occurs to me that having cancer, or terminal illness, or paralysis, or a serious physical disability means a loss of control of one’s body. We lose control of so many things in life. Having control of our bodies is a hard thing to give up. But FWIW I don’t think it’s as hard for me to contemplate that now as it would have been in my twenties.
DRJ (a83b8b) — 10/12/2014 @ 4:33 pmPS — The answer for me has been to put God in control. I don’t think He wants me to commit suicide. I think He has a plan for my life and my death. God has comforted me and I’ve seen His plan work during my illness. I believe in Him.
DRJ (a83b8b) — 10/12/2014 @ 4:36 pmAmen.
felipe (40f0f0) — 10/12/2014 @ 4:41 pmIf you ask whether a person has the right to force another person to not commit suicide, that is a slightly different question.
Well, maybe, if you quibble with the term “human right”. It is, however, the question I had in mind.
I should point out that I knew several people who DID commit suicide, and in each case it was a permanent solution to a temporary problem. One was a close friend and he’s 10 years gone now and it still pisses me off what he did. And yet, to me, it was his right to go as much as I disagreed with it.
Kevin M (b357ee) — 10/12/2014 @ 6:08 pmIf there’s one thing I’ve learned because of my cancer, Kevin, it’s that each person’s journey is their own. I can pray for them and encourage them, but it is their decision.
DRJ (a83b8b) — 10/12/2014 @ 6:18 pmAnd yet, to me, it was his right to go as much as I disagreed with it.
Kevin M (b357ee) — 10/12/2014 @ 6:08 pm
I didn’t mean to minimize or quibble with your question, though I see how it can be taken as such.
You make the point yourself, painfully so, that there are more people affected by suicide than just the person committing the act. The thought is “It’s my life and I’ll do with it what I like”. Well, in one way I guess the person has the free moral agency to make that decision. But we do not live in a vacuum. Do I have a “human right” to cheat on my wife? Well, in many people’s eyes a person’s decisions about sex are their own decisions and who is someone else to tell them what to do, and I don’t know that it is a criminal offense anywhere, and with “no-fault” divorce, as I understand it, there may not even be a civil penalty.
I think Steve57’s point is that if there was a strong societal message that suicide is not an acceptable option, maybe it would go a little bit toward helping a person not go down that mental path.
MD in Philly (f9371b) — 10/12/2014 @ 6:21 pmI’m hearing all these positive, uplifting thoughts about the nobility of suffering, and how caring for their loved ones during the process of dying can deepen a family’s faith, and so on…
But, PLEASE. ==> “You’ll linger and suffer like God wants you to!!! It’s good for you! It’s noble! It’s The Right Choice. And we know that because . . . Uh, because we KNOW that”.
I would really, really like to have the option of a painless end, in the event I were stricken with one of these awful diseases. (And it seems to me that I’ve read that people who have their “goodbye pills” in a bottle by the bed quite often don’t use them – that, in fact, KNOWING they have a choice means that they do, literally, CHOOSE on a daily basis to stay alive, to have one more day on Earth, right up until the morning they don’t wake up.)
Yes, there’s a danger when the State gets involved. There’s a danger when PEOPLE get involved. From the grieving not-quite widower who doesn’t want to let go, to the pushy daughter-in-law who wants to “just get this OVER with already”, to the devoutly sincere “God works on his own time and he has a Perfect Plan, so it takes as long as it takes” … everybody is busy trying to make THEIR OWN VIEWPOINT the one that decides the course of action. I really think that the choice should rest with the individual who is actually DOING the dying.
PS- Those of you who believe God’s will is thwarted when someone decides they’ve endured enough — it’s really not your business. As I understand theology, God has an individual relationship with each human being. He and the soon-to-be deceased will sort things out on another plane, and Justice and Mercy will be done. Thank you for your concern and all, but your opinions are not part of My Particular Judgment. Just so we’re clear.
A_Nonny_Mouse (e1f7a7) — 10/12/2014 @ 6:44 pmAs discussed elsewhere by me, the problem isn’t so much that I want to tell you what to do, I don’t.
MD in Philly (f9371b) — 10/12/2014 @ 6:47 pmThe problem is what millions of other people are saying to a person in a vulnerable position that might influence them to do something to themselves out of guilt or fear instead of being affirmed and reassured in what they want to do.
MD:
This is far afield from the topic of this post but I think the legal (as opposed to moral) answer to your question is interesting. The English common law applied in the U.S. because we were an English colony, and it’s still a part of our laws unless changed by the Constitution or statute. Part of English common law is the tort of alienation of affections:
I can’t vouch for this but according to Wiki, alienation of affection is still recognized in Hawaii, Illinois, North Carolina, Mississippi, New Mexico, South Dakota, and Utah.
DRJ (a83b8b) — 10/12/2014 @ 6:49 pmWhat’s interesting is the spouse isn’t the one who is liable, but the spouse’s lover and various other people may be.
DRJ (a83b8b) — 10/12/2014 @ 6:50 pmA_Nonny_Mouse,
I believe God has plans for us all but we’re weak, so we all lose the will to go on. I’ve been there. I know how attractive death can be, especially an easy death. I’m not trying to bring more pain to suffering people, but it may help them to hear that believing in God has given me the strength to go on when I thought I couldn’t.
DRJ (a83b8b) — 10/12/2014 @ 6:59 pmAlienation of affections is now statutory in Illinois, the main difference from the common law being a limitation on damages. (No, Greg Abbott didn’t do that. ^_^)
But here’s Illinois’s criminal adultery statute:
nk (dbc370) — 10/12/2014 @ 6:59 pm(720 ILCS 5/11-35) (was 720 ILCS 5/11-7)
Sec. 11-35. Adultery.
(a) A person commits adultery when he or she has sexual intercourse with another not his or her spouse, if the behavior is open and notorious, and
(1) The person is married and knows the other person involved in such intercourse is not his spouse; or
(2) The person is not married and knows that the other person involved in such intercourse is married.
A person shall be exempt from prosecution under this Section if his liability is based solely on evidence he has given in order to comply with the requirements of Section 4-1.7 of “The Illinois Public Aid Code”, approved April 11, 1967, as amended.
(b) Sentence.
Adultery is a Class A misdemeanor.
(Source: P.A. 96-1551, eff. 7-1-11.)
112. Them that have will be given more.
gary gulrud (46ca75) — 10/12/2014 @ 7:01 pmThanks, nk and DRJ for indulging my tangent. I didn’t want to lead us away from the main topic, I was looking for some example where one’s “private” behavior was recognized as injurious to others, even if not legally so. That it is a legal issue, perhaps especially for a third party, is interesting, but maybe it is an unhelpful line of discussion to take up.
MD in Philly (f9371b) — 10/12/2014 @ 7:13 pmI wonder when the last time someone was prosecuted in Ill.
It has come up in employment, under morals clauses, but never criminally. “Open and notorious” is an impossible standard for the prosecution. The co-respondents have to flaunt it and a significant portion of the community has to be saying “Shame on them”.
nk (dbc370) — 10/12/2014 @ 7:21 pmI think we have a right to commit suicide (and that right should be very rarely used; this does not mean I would admit any government association with either the decision, or the method, or the process.)
—
Just to bring a little lighter flavor to the conversation, in Minnesota, adultery is still a crime — for women. The “de-genderizing” movement a decade ago either missed these or was biased.
Men, though, and single women, can be found guilty of Fornication —
Minnesota used to have a very detailed group of laws forbidding all sorts of behavior; if a couple were out of ideas, the statutes could inspire them ….
htom (412a17) — 10/12/2014 @ 7:24 pmKevorkian. He was successfully prosecuted for homicide, even though he called it assisted suicide. He had a death fetish which he took from performing autopsies (he was a pathologist) to finding vulnerable and compliant victims to kill.
nk (dbc370) — 10/12/2014 @ 7:27 pmOne patient I had alluded to earlier had been in contact with Kevorkian’s “people” ( I think his lawyer) and was told he/they could not “help” my patient.
MD in Philly (f9371b) — 10/12/2014 @ 7:45 pmAs I talked about in the post, nk, man is inherently unable to not abuse power. And there is probably no greater power than that over life and death. Kevorkian illustrates that danger.
Dana (4dbf62) — 10/12/2014 @ 8:00 pmYes, doc, that’s my point. But it’s also that where it’s legal, there is a strong social message telling certain types of people that suicide really is route they should go.
I suppose I should define terms although I’m sure I’m going to be guilty of muddling them again. What is legal in Holland is not PAS but euthanasia. PAS is when a doctor provides the life-ending drugs and instructions on how to use them. In Holland it is legal for physicians to administer those drugs themselves. In fact it is only legal for a medical doctor to administer those drugs. I suppose where I have trouble keeping them separate is when the doctors euthanize a patient at the patient’s request. It’s hard not to see that as a form of PAS.
I should add that not all Dutch doctors are enthusiastic about committing euthanasia. Until 2002 euthanasia was technically illegal although widely practiced and had been since 1973 when Dutch courts ruled that any physician accused of euthanizing a patient at the patient’s request (specifically outlawed) could offer a necessity defense. The courts actually came up with criteria that the doctors would have to meet in order to succeed. In reality such cases were rarely prosecuted, and the courts eagerly accepted the necessity defense if they were.
In 2002 the Dutch changed their laws. Instead of a doctor having to offer a defense, a prosecutor would have to prove the doctor failed to follow the Royal Dutch Medical Society’s euthanasia guidelines (which were based on those earlier court decisions) before the prosecutor could even begin a prosecution.
So earlier a doctor at least had the excuse that euthanasia was against the law when refusing to assist with a patient’s suicide. That fig leaf was taken away about ten years back, and doctors find they’re under pressure to euthanize their patients.
Not all the pressure comes from the patients, nor from the patients relatives (who frequently try to pressure the doctor and the patient to choose suicide). Dutch general practitioners have reported that whey they tried to have elderly patients admitted to hospitals, the hospitals would push back and encourage the doctors to just administer a lethal dose of pain killers instead.
As Barack Obama said, sometimes you’re just better off taking the pain pill instead of having the operation. When euthanasia and/or PAS is legal, the prevailing medical opinion is that you’re better off taking a handful of those pain pills so you don’t drag things out.
It’s not polite to talk about economics intruding on “end of life” decision making, but that’s precisely one of the factors that governments trying to control health care costs give great weight to.
Earlier I mentioned that certain types of people are encouraged to kill themselves. It’s very difficult to get a handle on what types of people that would be, because euthanasia/PAS advocates deny the possibility that they would ever expand the definition of who should be able to legally kill themselves (or have a doctor do it for them). But we see by the direction Kevin has taken the discussion that this “slippery slope” argument isn’t just the product of some bible thumper’s overactive imagination. Instead it is actually a central feature of the case for euthanasia/PAS.
If suicide is a human right, then it’s not just a right that belongs to terminally ill people. I’m just guessing, but if Kevin’s friends’ suicides were permanent solutions to temporary problems then they were not terminally ill. But it was still their right even if they weren’t in unbearable physical pain (one of the necessary features for the old necessity defense which Dutch doctors no longer need). There doesn’t even need to be any physical suffering. Which is exactly the case in Holland. What was supposed to be a rarity has become normal. And euthanasia is defended in those cases where the person is just “tired of living” or feels hopeless as an act of personal autonomy.
Exactly the language Brittany Maynard uses.
Surely if we’re talking about a human right, then we all have the right to die on our own terms. Not just people with terminal cancer.
It’s not even properly called a slippery slope argument. It’s where the logic of suicide as a human right inevitably leads.
British author Malcolm Muggeridge noted that during the German occupation Holland was the one country where doctors refused to go along with the Nazi program of euthanasia. The German officer who ordered it was executed as a war criminal.
So in less than half a century euthanasia has gone from a war crime to a human right, and the Dutch have gone from fierce opponents of euthanasia to enthusiasts.
There also is what might be called a practical slippery slope in addition to the logical one. Although, that too isn’t so much a slippery slope as an inevitable product of the rationale for euthanasia/PAS. It is the assumption that doctors would never abuse this power the state has given them and euthanize people outside of the accepted protocols. But that has been the rule rather than the exception. The whole point of legalizing euthanasia or PAS is to remove whatever residual stigma society may have placed on these acts.
That also has the effect of lessening the impact of what we’re really talking about, which is ending a human life. When you remove the stigma from something, you are by definition making that thing more acceptable. In fact, not only is PAS/euthanasia acceptable, it’s positively an act of compassion. Look at this discussion thread; I’m the heartless bastard who wants to see Brittany Maynard suffer, apparently.
So what do we find in Holland? Well, one thing we find is a none-too-strict adherence to the rules. If euthanasia is an act of compassion, only a heartless bastard like me would insist that doctors adhere to their own protocols and wait until their patient’s pain has become unbearable before administering a lethal dose of drugs. In fact, only a heartless bastard like me would even want the doctors to wait until the patient is in any sort of pain.
What, do I enjoy knowing people are in pain?!?!
So since only sadists such as myself think doctors should actually follow their own protocols if they’re going to be given the power to euthanize people, now they’re increasingly not waiting for patients to ask to be euthanized. Really, who could expect doctors to wait to comply with a law against murder when compassion is so urgently needed.
And yes, even the Royal Dutch Medical Society stated in its euthanasia guidelines that killing a patient without their consent is just simple murder. At least they clearly stated that in their initial guidelines. That was before they discovered that their members were routinely killing people without waiting to be asked. As the Dutch medical community refers to the practice, LAWER. Life-terminating Acts Without Explicit Request. 20 to 25% of euthanasia in Holland fall under this heading.
It’s difficult to say because doctors who admit to “non-voluntary euthanasia” are admitting to murder. There are no ifs, ands, or buts to it. So it’s safe to say that doctors would probably be inclined to under report the number of murders they’ve committed. And the Royal Netherlands Medical Society has gone somewhat silent on the necessity for doctors to get the patients’ permission before killing them since they found out it’s so common for doctors to just go ahead and kill people.
Then falsify the death certificate.
And so successfully have the Dutch managed to remove the stigma from euthanasia, nobody thinks non-voluntary euthanasia is any big deal! That’s how successfully they, and we, have managed to convince our respective selves that the exercise of this boringly human right is so boringly normal.
Steve57 (e409e4) — 10/12/2014 @ 8:14 pm“And we know that because . . . Uh, because we KNOW that”
Aside from the gross caricature you draw, the secular answer is because of the example of many people who have already traveled this road. If you are a Christian, then the example is that of Jesus as well.
felipe (40f0f0) — 10/12/2014 @ 8:17 pmHolland is even worse than that, Steve. The legal euthanasia law applies to persons over twelve. Doctors, yes, doctors not the legislature, have developed the Groningen protocol, for children under twelve, without legislative approval, which is designed to evade prosecutorial discretion, and prosecutors have been going along with it. http://en.wikipedia.org/wiki/Groningen_Protocol Essentially, it’s late term abortion until age twelve.
nk (dbc370) — 10/12/2014 @ 8:24 pmnk (dbc370) — 10/12/2014 @ 8:24 pm
That is macabre, nk.
felipe (40f0f0) — 10/12/2014 @ 8:28 pmVery true. In fact, who is really telling other people what they should do? I can’t tell a person who really wants to commit suicide not to commit suicide. I certainly can’t prevent such a person from killing themselves.
It was my impression that the topic is physician assisted suicide. When the question of PAS comes up, essentially the proponents of PAS are asking me to help people commit suicide by voting to legalize it. That I won’t do.
Now I’m the bad guy because I won’t give my seal of approval to PAS for a multitude of reasons.
Apparently all the compassion and good intentions are all on the opposite side of the issue.
But consider; look at all the disapproval I’m getting just because I oppose PAS and euthanasia. Why, I must not have a heart. If that’s the kind of pressure people bring to bear on someone just for being against legalizing these practices, multiply that by several thousand magnitudes to approximate the kind of pressure people bring to bear on people who society thinks should be killing themselves after they’ve gone through the trouble of legalizing it. Because, again, all the compassion and good intentions are all on the proponents’ side of the issue.
I’m opposed to the whole thing. Most especially the euphemisms the proponents of PAS/euthanasia to get their program passed into law. What did they call the PAS law in Oregon? That’s right; the Death With Dignity Act. That’s about as subtle as a two-by-four to the skull. PAS equals Death With Dignity now. Society couldn’t be clearer about what you really ought to choose when your time draws near.
I suppose that’s why so many Dutch doctors just make the decision for their patients and give them a life-ending overdose without mentioning it to the patient, the patient’s family, or by the way on the death certificate. There’s just less fuss that way, and the possibility that the patient might not wish to make the socially responsible choice is neatly avoided by not giving the patient the choice. The patient might be too stubborn or too emotionally invested in the prospect of having a future to choose the dignified exit that society has so thoughtfully provided. The ingrate.
Steve57 (e409e4) — 10/12/2014 @ 8:47 pmI like how you put it, nk. The legal euthanasia law.
That’s about it. The legal euthanasia law that’s printed on paper says one thing. The actual euthanasia law that is followed in practice says quite another.
The Groningen protocol is certainly horrible. And illegal but only per the legal euthanasia law, not the actual euthanasia law. But then, the euthanasia law that deals with those over 12 isn’t actually followed in practice. And these routine violations are also not seen as any big deal.
Only me and the Marquis de Sade think it’s a big deal when the doctors cut ethical and legal corners when euthanizing the unwilling. Who else could possibly have an issue with compassionate doctors doing what’s best for the human race by reducing the total amount of human suffering on this planet one patient at a time, even if they didn’t actually get the patient’s permission to kill them as required by law. Or, in the case of people who carry around cards that ask doctors not to kill them, kill them over their actual objections.
I doubt the Dutch will change the text of their legal euthanasia laws to reflect actual practice. The law as written gives Dutch euthanasia proponents something to point to in order to maintain the fiction that euthanasia is strictly controlled in Holland.
Steve57 (e409e4) — 10/12/2014 @ 9:14 pmYou make the point yourself, painfully so, that there are more people affected by suicide than just the person committing the act
Many things we do to ourselves have effects on others. And yet we must be free to do them or we are slaves to all those others.
Kevin M (b357ee) — 10/12/2014 @ 9:38 pmKevin M-
MD in Philly (f9371b) — 10/12/2014 @ 9:57 pmNot being snarky, but the ultimate freedom is to choose to go to hell, literally, if we want.
Though it is a freedom, I wouldn’t recommend it.
But most often, suicide ends up causing your relatives to suffer.
I’ll pray for you.
Tanny O'Haley (066e8f) — 10/12/2014 @ 11:33 pmThere should not be physician-assisted suicide because patients should be able to depend on their physicians for treatment and care. If a patient wishes death, another party, not involved with curing illnesses and prolonging life, should assist. I don’t care what this profession might be called: but all nurses and doctors should be banned from participating or practicing it.
ErisGuy (76f8a7) — 10/13/2014 @ 6:35 am“But I worry about the slippery slope caused by government involvement in health care, which creates an irresistible incentive for bureaucrats to ration care”
Did you see the recent news item about the British physician who returned from a few days vacation to learn that a patient had been placed on hospice-only care, even though his condition good and expected to recover? National Health Service rules give hospitals financial incentives to put patients on the path to death.
pst314 (ae6bd1) — 10/13/2014 @ 8:23 am@159, I couldn’t agree more. Legalized euthanasia/PAS has led to hospitals, doctors, and other health care professionals committing the ultimate betrayal of a patient’s trust. As in the example cited @160, hospital workers (in the UK and Holland) have placed people on end-of-life care well before those patients are at the end of their lives. And they do it without informing the patient or their families let alone asking for their permission.
In the Netherlands patients are so afraid of hospitals they avoid going even when they should. And some of them have formed patients’ rights groups and carry cards on their persons telling physicians that they don’t want their lives terminated.
The problem is that many doctors in Holland admit to doing so anyway. Undoubtedly more doctors kill patients without their permission, and even overruling the patients’ wishes in the case of people who carry those cards in case they’re physically unable to communicate their intent.
There are a lot of reasons for this. The elderly and the chronically ill have concluded, with significant justification, that bureaucracies will decide it just doesn’t make economic sense to keep treating them. And as pst314 notes, doctors and hospitals respond very well to the UK’s NIH when it provides financial incentives to cut costs (as will doctors and hospitals here under Obamacare).
There are other reasons unrelated to economics, which I won’t go over again. But since there are reasons to be 100% positive that despite assurances about strict guidelines, the medical profession will not limit the practice to within those strict parameters. So when the medical profession starts violating those restrictions you can’t call it a “slippery slope” or an “unintended consequence” since it’s by design.
It is amusing to follow Dana’s links above. One of them links to a site that discusses the theoretical pros and cons of PAS. The professor who takes up the pro side says this:
We don’t need to speculate in a vacuum. The evidence is in. PAS/euthanasia does destroy a patient’s trust in the medical profession. But more importantly when PAS/euthanasia is legalized it is never restricted to patients who are experiencing “unbearable suffering.”
It’s amusing because “unbearable suffering” is supposedly one of the criteria a patient’s case is supposed to meet before the doctor is legally allowed to euthanize him or her upon their request. There are other paper requirements. The patient’s case must be hopeless, with no chance of recovery. And it’s all BS because those terms have no legal meaning whatsoever.
More to the point, Kevin M. and Brittany Maynard have provided us with the actual rationale for PAS/euthanasia upon request. It is “ending your life on your own terms.” It is a human right, an expression of personal autonomy, the ultimate expression of control over your own destiny.
Who is the government to dictate terms about suffering and hopelessness to people who have successfully lobbied for the right to end their lives on their own terms? They can’t. It’s a logical contradiction. So doctors do “the right thing” and report they followed the guidelines when they haven’t. Which is precisely the behavior that PAS/euthanasia laws actively encourage everywhere it’s tried.
And, as I mentioned earlier, when you abandon strict adherence to protocol it all goes out the window. Including that pesky little detail about asking first to see if ending it all is what the patient wants.
Steve57 (4d34f4) — 10/13/2014 @ 9:48 amI should add that in the Netherlands doctors frequently “do the right thing” and end their patient’s life. And then don’t report it at all.
Steve57 (4d34f4) — 10/13/2014 @ 9:51 amSteve–
BTW, you have my position correct. And I actually agree with you that state involvement in the, ah, process is unwanted. I no more want state-assisted suicide than I want state-prevented suicide. Both are a problem.
Question: Should a physician be allowed to honor a terminal patient’s request for enough pills to do the job? Not to offer, or suggest or prod or hint, but to honor the request?
Then again, there’s always the Edward G Robinson scene in Soylent Green, which was disturbing even if Soylent Green was NOT people.
Kevin M (b357ee) — 10/13/2014 @ 10:30 amIt’s not a recent news item, but I did recently blog about it. Maybe you saw it here.
Patterico (9c670f) — 10/13/2014 @ 10:36 am==More to the point, Kevin M. and Brittany Maynard have provided us with the actual rationale for PAS/euthanasia upon request. It is “ending your life on your own terms.” It is a human right, an expression of personal autonomy, the ultimate expression of control over your own destiny. Who is the government to dictate terms about suffering and hopelessness to people who have successfully lobbied for the right to end their lives on their own terms?==
Steve57-your intentions regarding PAS are no doubt well meant and we realize your personal beliefs about suicide are strongly held. Your arguments above using the experiences in foreign countries have merit, and those abuses/potential abuses do concern many of us, as has been made pretty clear here. Keeping government bureaucrats out of “healthcare” is a goal of nearly everybody who comments on this site. However, what Mrs. Maynard says she is planning to do is legal in the state in which she lives. There is no indication that “she lobbied for it”. There is no indication that her physician is not fully living up to his Hippocratic oath. And most important, really, it’s her illness, her life, her family, and her death–not yours. Your apparent need to pontificate– to criticize, and to belittle her personally as she tries to make sense of her own life just makes you look small and judgmental. I really think you are better than this, more humane than this.
elissa (b6b39a) — 10/13/2014 @ 10:39 amTo answer your question, no, it should not ever be legal for a doctor to give a patient a lethal dose of medicine. As Dutch bioethicist Theo Boer concluded after initially supporting the euthanasia law, you’re opening Pandora’s Box when you do. For a number of reasons.
I linked to his article earlier, but here’s the link again.
http://www.catholiceducation.org/articles/euthanasia/eu0074.htm
But if I understand your position correctly, and apparently I do, when it becomes a basic human right for a patient to ask a doctor to help them commit suicide, it creates a duty for the doctor to act whether or not they have moral objections to PAS. The public’s perception of PAS changes over time as it inevitably evolves from a medical procedure intended only to end the unbearable suffering of the hopelessly ill to an act of personal autonomy. And how dare the doctor deny such a basic human right to their patient.
That isn’t my only objection. But the bottom line is that I don’t take this position because I’m eager to pass judgement on people like Brittany Maynard. Or you, Kevin. In general I have no desire to pass judgement on anyone, but this issue stands out as something I’m not remotely qualified to judge.
The only question it’s appropriate for me to answer is to what am I willing to give my consent. There are a host of consequences that even PAS proponents agree are really bad and that they don’t want to see. But there’s no way to prevent them once you start going down this road. And since you can’t prevent them, I can’t agree to taking even the first step.
Steve57 (4d34f4) — 10/13/2014 @ 11:06 amelissa, I’ve never belittled Brittany Maynard. I do think by going public about having to move from California to Oregon where PAS is legal she is lobbying for broader legalization of the practice. But that’s hardly belittling her or even a criticism. She has that right, doesn’t she?
Steve57 (4d34f4) — 10/13/2014 @ 11:19 am==Exactly the language Brittany Maynard uses.
And I want to die on my own terms.
Surely if we’re talking about a human right, then we all have the right to die on our own terms. Not just people with terminal cancer. It’s not even properly called a slippery slope argument. It’s where the logic of suicide as a human right inevitably leads.==
Steve57, this @150 is just one of your comments which caught my eye–a case of your glomming onto a statement and imputing a much larger mission and a greater evil to Brittany’s simple poignant words about her terminal brain cancer than is there. Don’t make this so personal. That’s my advice. The anger toward a sick woman makes your arguments less effective and less compelling–not more so.
elissa (04e1fa) — 10/13/2014 @ 11:40 amsmall points to the aside
Self-administration of lethal medications, expressly prescribed by a physician for that purpose.
That is breaking the Hippocratic oath as far as I am concerned, but I’m old school and don’t ignore the part about not causing an abortion, either.
From the link:
MD in Philly (f9371b) — 10/13/2014 @ 11:54 amEditor’s note: Brittany Maynard is a volunteer advocate for the nation’s leading end-of-life choice organization,
and it seems that she has a website for her own foundation.
She made it an issue for the public. If the public responds, it should be expected.
It isn’t personal, elissa. It’s correctly grasping the true nature of the argument. How is it personal to say, “If I understand your position, it’s this…” and then to restate the position?
I didn’t even claim to have any insights into Brittany Maynard’s true views on the subject. I pointed out she’s using the same language that other people use to argue for suicide as a basic human right unrelated to terminal disease or any amount of suffering.
Professor Boer wasn’t be judgmental when he wrote:
He’s describing how these mobile euthanizing clinics actually operate. And he’s describing the Dutch Right to Die Society’s clearly stated position. They really do advocate that lethal drugs should be available to anyone over 70 who is merely “tired of living.” They couldn’t be more clear.
Whether Brittany Maynard subscribes to this view of assisted suicide, or to what degree, I have no way of knowing. But I do know she is using the language of people who do subscribe to it in no uncertain terms. And in countries where euthanasia/PAS is legal, this language shapes the public perception of when these procedures are acceptable. Because it is a logical contradiction to claim people have the basic human right to die on their own terms, and to simultaneously claim that the government can enforce strict guidelines about who is allowed to commit suicide. When the public grows to accept euthanasia/PAS as a basic human right, then they reject the idea of the government trying to restrict that right. If it is a basic human right to end your life on your own terms, then the government can’t legitimately dictate what those terms should be.
There is nothing judgmental about observing that the two claims are mutually exclusive. Your terms are yours, not the government’s. And the government’s terms are the government’s not yours. People get that.
What is your basic objection, elissa? Is it that if I don’t agree that PAS should be legal nationwide I must be judging Brittany Maynard? That’s a leap. On the other hand I’m not making any such leaps. I don’t claim to be able to read her mind or to be in a position to judge her. It is not a leap to observe that the language she is using conveys a certain view of what the right to die consists of. It may not be her view, but where that language is used then the public does develop its understanding of the right to die based upon that language. Not anyone’s personal, unstated beliefs.
You know, if people are clear about their beliefs and their goals its possible to understand those goals. And if they’re clear, then it’s also possible to either agree or disagree with their position. Because you know what their position consists of; this isn’t possible if they’re vague. I think Kevin has been clear about his position on the subject. Just be sure, I restated it to make sure I understand it. According to him, I do. I disagree with him, and I explained my reasons.
In what way am I being judgmental? I’m not passing judgment on him or Ms. Maynard. I disagree with them, though.
Steve57 (4d34f4) — 10/13/2014 @ 12:26 pmStev57 treads heavily at times, but I believe this is a time and a subject when treading heavily is warranted. I, too, feel he takes things personally which may or may not be becoming in another’s eyes. But I, for one, find his “taking this subject personal” quite becoming of him. IMO Steve fights for us all, including those who would be carried, bighting and scratching, to safety – devil take all the eggshells and PC sensitivities.
” I really think you are better than this, more humane than this”.
elissa (b6b39a) — 10/13/2014 @ 10:39 am
Let me confess, right now that I find this sentiment to be very offensive to my sensibilities. It may be that I have been biased by overhearing this phrase, and similar (“You are better than this”) ones in countless discussions. I find it a veiled attempt at flattery, an appeal to appeasement, a denial of who one is, and ##wait for it## makes it personal.
felipe (40f0f0) — 10/13/2014 @ 12:50 pmI stand corrected, Steve. you are not taking it personal.
felipe (40f0f0) — 10/13/2014 @ 12:53 pm170. Never mind, Steve57. I’m not going to facilitate moving this well crafted, valuable and interesting thread about Kara and Brittany and end stage cancer any more towards being all about you than it already is.
elissa (04e1fa) — 10/13/2014 @ 12:59 pm171. Thank you for your input felipe. It was not meant as a veiled attempt at flattery or an appeal to appeasement. It was meant as a clear expression of disappointment in the tone of the argument based on the assumption that he would not want it to have come across that way to readers. I know now that he did want it to come across that way so my point was obviously moot.
elissa (04e1fa) — 10/13/2014 @ 1:12 pmelissa, it isn’t all about me. But then, it’s about more than just Kara and Brittany and end stage cancer. It is also about legalizing PAS. And Brittany Maynard is advocating a position on the issue, whether you would prefer to call observing that basic fact “judgmental” or not. She is a volunteer advocate for a right to die organization. She does come right out and say in her article that she thinks all Americans should have the same legal option that she has in Oregon.
That’s not a decision that should be left up to just certain people, it effects us all. And as far as making this personal, I’ve gone to lengths to raise logical and practical objections, backed by evidence, when disagreeing with the position Brittany Maynard advocates. I’ve left how I feel out of it.
Steve57 (4d34f4) — 10/13/2014 @ 1:24 pmAgain with the mind-reading, elissa?
Steve57 (4d34f4) — 10/13/2014 @ 1:27 pmDRJ,
It makes me terribly sad to learn of your illness. As always, I see that you bear adversity with faith, grace, and courage. As I hope you know, you are dearly loved and admired in this community (and in many others, I am certain).
I will pray for your recovery.
Leviticus (f9a067) — 10/13/2014 @ 2:41 pmDRJ, I am very, very sorry to hear of your illness. I am glad that your faith is a comfort to you in this time, and I hope that your suffering is as minimal as can be.
aphrael (af3e66) — 10/13/2014 @ 2:52 pm