Andrew Young on peace, justice, and assorted other issues

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Andrew Young wants you not to worry. Despite humankind’s failure to solve the problems of poverty, racism and inequality, and the smaller issues that cause us to despair, Young tells his listeners that a benevolent creator has everything under control. He offers this assurance in the biblical words of his grandmother …. “Don’t be anxious about tomorrow… Consider the lilies of the field; they toil not…” and after a few more verses that roll easily off his tongue he adds with a beatific smile, “You don’t have to be a believer to know that sounds good.”

Young was in San Francisco recently, drumming up support for world peace, justice, compassion and his Andrew Young Foundation. In an informal – “You don’t mind if I just sit in this comfortable chair instead of standing at the podium?” – talk at the Commonwealth Club, his remarks ranged from theories on how to make the world work to why prisons don’t.

Just a few of those random thoughts include the following:

Re dealing with the bad and the angry: “Don’t get mad, get smart.”

Re getting smart – one of the first things Young did after being elected Mayor of Atlanta in 1981 was to increase the percentages of blacks and women in the police department, in order to insure that it reflected the population of the city. A story about how well that worked in one instance delighted his 2014 audience:

Anticipating two or three thousand people for a Ray Charles concert in Piedmont Park, the city sent a contingent of a dozen police officers to look after the crowd – but the crowd turned out to be over 100,000. “Ray Charles said he wasn’t going out there,” Young recalled. “He said, ‘I’m blind, but I can see there’s people pushing against the stage and I ain’t going out there.’ And we had a dozen police officers to handle 100,000 people.” Enter one of the police contingent, “a tiny little woman named Sadie.” Sadie mounted the stage, blew her whistle, got the crowd’s attention and told them they were going to play a game. “You all know about Simon Says? Well, this is Sadie Says.” When she blew her whistle, she explained, everybody on the front row was to turn around and face the opposite direction. When she blew it again, everybody on the next row was to turn around… and so on. By the time Sadie finished blowing her whistle, the entire crowd was facing away from the stage. “Now,” she said, “everybody take ten steps forward.” The crowd surge was ended, the concert went on as planned.

FullSizeRender (2)Re prisons: “You go to prison for taking money from an ATM; you come out knowing how to take the ATM.”

Re global peace and prosperity: There are “ways to make the world work,” Young believes. Because food and jobs are two of the keys, his foundation is pushing programs to make protein from duckweed in the south. Small farmers could be back in business, the hungry could be fed.

Young is almost as enthusiastically pro-duckweed as he is anti-Halliburton. “We don’t need to be fighting ISIS,” he says; “that’s Halliburton’s war. You want to go after people for not paying taxes? Go after Halliburton.” And as to those wars, “One of the things we should know by now is that there is no military solution.”

How can we find lasting solutions to issues like poverty and war? Young says, “I don’t know how to do it – but our kids will know how to do it. I was in a restaurant where a two-year-old had his iPad out and said, ‘Mom! They don’t have wi-fi here!’ — but a few minutes later he said, ‘That’s okay Mom, I fixed it.’” Young urges audiences of all ages to work for peace and justice, acknowledging both the enormity of the tasks and the potential for success. And in the end, he says, “We just have to believe we’ve done the best we could.” You don’t have to be an Andrew Young believer to know that sounds good.

Sacramento Mayor Kevin Johnson, host of the recent event, asked Young which of his titles he preferred: Mayor, Congressman, husband, father, CEO, Ambassador…? The reply came with another quick smile.

“Andy.”

Immigration Then and Now: Three families, three stories

PRELUDE: A contemporary story -

Maluki had what she thought was a minor infection in her chest. She took a couple of pain relief tablets. She is undocumented and uninsured. She had no access to a community clinic where she might have seen a doctor with no questions asked; no one in her suburban family had heard that such things exist. Within a few weeks Maluki was doubled over with pain and was rushed by a neighbor to an emergency room at a major public hospital two hours away.

Two surgeries later the 38-year-old mother of three will be out of work for a very long time. Her husband, partly disabled, works irregular hours when he can, leaving the family dependent on what money the teenaged children – all U.S. citizens – can bring in. The children still hope somehow to finish high school and attend college.

What’s wrong with this picture?

Almost everything, if you asked the five California experts on a recent Commonwealth Club panel in San Francisco. “Undocumented and Uninsured” brought together two heads of clinics where treatment is available to all and two others with unique insight and perspectives. Moderated by Daniel Weintraub, Editor in Chief and Project Director, California Health Report, the panel included John Gressman, President and CEO, San Francisco Community Clinic Consortium and Scott Hauge, President of CAL Insurance & Associates Inc and Co-Founder and Vice Chairman, Clinic by the Bay; Laurel Lucia, Associate Policy Specialist, UC Berkeley Center for Labor Research and Education; and Jirayut New Latthivongskorn, Co-Founder of Pre-Health Dreamers. They were looking at how the Affordable Care Act will impact immigrants unable to get health insurance, and what the healthcare future might hold for them.

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There are, by one estimate, 11.7 million undocumented immigrants in the U.S. Some have health coverage through their jobs, and a few have private coverage; but the vast majority of these are uninsured. The resulting costs, in human terms such as the case above, are inestimable; the costs in dollars are also significant. “If we get the patient into basic care for colds and flu,” said Gressman, “we save thousands in hospital care.” In California, care is widely available through publicly funded community clinics as well as nonprofits – the problem is in getting the word out and building trust. “We look at how to get the patient to care,” Hauge said, “not at anyone’s immigration status.”

While Gressman, Hauge and Lucia each brought extensive understanding of both the policy and the real-world details affecting healthcare needs of undocumented immigrants, it is the personal stories of Lucia and Latthivongskorn that illuminate the remarkable richness of our immigrant nation.

Nearly a century before she was invited to bring her expert knowledge to a Commonwealth Club panel, Laurel Lucia’s great-grandfather was a frequent speaker at the Commonwealth Club himself. Felipe N. Puente was memorialized in the Club’s Journal upon his death in January, 1951. He was, his obituary reads, “by far the most important personal tie between Northern Californians and the Republic of Mexico for nearly a quarter of a century.

“Commencing as a colorful revolutionary Mexican leader in 1917 (as Jefe de Transportacion for the late Revolutionary General Francisco Villa), he had for 25 years been a resident of San Francisco, with five children in our public schools, and the long-time Manager of the Mexican National Railways, San Francisco division, in the Monadnock Building.

“Although a railroadman by profession, his expert and sagacious advice was freely at the service of American travelers by sea, highway or air, and a letter from ‘el Puente de San Francisco’ (the San Francisco Bridge) as he was affectionately known clear down to the border of Guatemala, opened all doors in Mexico.” Great-grandfather Puente’s expertise reached beyond transportation to government affairs. In a Commonwealth Club speech broadcast over KYA Radio in 1942 he spoke of the importance of Mexican-American cooperation in the war efforts, citing cargo lanes and Mexican ores that were critical to the U.S. and quoting President Avila Camacho as saying, “Mexican soldiers are willing to shed their blood anywhere in the world where they may be needed.” His Journal obituary began and ended, “Adios, Amigo Felipe N.Puente!”

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Lucia missed out on knowing her notable ancestor, “but I was quite close to his daughter, my grandmother.” She had not, she says, ever made any connection between his immigrant status and her current work – as a Policy Analyst for the UC Berkeley Labor Center – which partly seeks to strengthen the safety net for those more recently arriving on our shores.

 

Laurel Lucia with Moderator Weintraub

As for the other young person on the “Undocumented and Uninsured” panel, Jiryat New Latthivongskorn (hereafter identified by his familiar name, New) confesses to having been a little startled to hear himself constantly referred to during the evening as “the first undocumented student to be admitted to UCSF (the University of California San Francisco) Medical School.” But that is, in fact, part of his current resume, and a not insignificant achievement.

There were 7,453 applicants to UCSF Medical School for New’s class, out of which pool 490 were interviewed and 149 were accepted. The overall grade point average was 3.77.

New Latthivongskorn came to this country with his parents when he was 9 years old. His parents worked in Thai restaurants every night until 11:00. But whenever he tried to help, he said in an interview on KQED Radio last May, “the answer never changed. ‘Don’t worry, and do your job.’ My job was to get an education.” So far, he appears to have done his job quite well. New never considered the idea of being a doctor until one scary incident during his junior year in high school when his mother fell gravely ill and had to be taken to the emergency room. The family had, until that time, relied on a medicine cabinet full of remedies for colds and pain and a few old antibiotics from Thailand. But in the ER, when his mother couldn’t understand the doctors and they couldn’t understand her, New realized his job might be more than just a translator.

There are those, including a few who commented on the KQED program, who argue that anyone who is in this country illegally should simply be sent back to wherever he or she came from and until then should receive no benefits – and certainly no healthcare. That may, however, be an overly simplistic – not to mention cruel and unusual – answer to a very complex issue.

“Immigrants don’t come here,” New told the Commonwealth Club audience, “for free healthcare. They come here to escape danger or terrible conditions; they come here to work.” In short, to create a better life for themselves and their families, and ultimately to give back to the communities of their new world. That was definitely true for immigrant Puente a century ago, and is demonstrated by the hard-working parents of doctor-to-be New.

Other than the Native Americans who pre-date most of us, it would be hard to find many U.S. citizens whose ancestors didn’t have similar stories.

 

 

On being grateful – for rain & waterfronts

bridge in rain

(This essay also appears on Huffington Post)

“It’s not happiness that makes you grateful,” goes one of my favorite recent quotes (thanks, Joann Lee;) “it’s being grateful that makes you happy.”

Here’s to gratitude.

For one thing, it has been raining in San Francisco. That strange wet stuff that falls occasionally from the sky – but we haven’t seen in a very long time. A planned Commonwealth Club Waterfront Walk tour, which I had earlier volunteered to help host, was advertised “Rain or Shine;” and as it happened there was both. The rain dampened all streets but no spirits, and the beauty of the waterfront literally shone.

There is something mystic about a waterfront on a dark day: an ethereal quiet hanging just below the clouds, the call of a gull who could be from another world, the scent of newness.

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The waterfront in sunshine is brilliant and exciting; in rain it invites your imagination – and appreciation.

As with waterfronts everywhere, San Francisco’s is steeped in history: sailors and conquerors, longshoremen and adventurers. There is public art, and private beauty. Waterfront Walk guide extraordinaire Rick Evans covers a remarkable range of them in two hours:

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The rise and – literal – fall of Rincon Hill, once one of San Francisco’s famous seven, which overlooked the Bay until the city unwisely bulldozed a street through it in the 19th century and the sandy hill collapsed upon itself. (Earthquake and fire finished the job.) Today Rincon Hill is rising again, as gleaming steel towers. The buildings that survived earthquake and fire are other centerpieces of the walk, plus the monumental artwork on the waterfront that was a trade-off for Gap tycoon Don Fisher’s corporate headquarters building when it went up – insurance of unobstructed, breathtaking views.

Some of the beauty of many waterfronts, physical and informational, is manmade, as is true of this piece of San Francisco Bay. But every waterfront has its story, and its soul.

Rain or shine. A cause for exquisite gratitude.

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Danger Zone in End-of-Life Talk

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A suicide pill for everyone over 85? Not the wisest plan to suggest right now. But it is, in fact, a possibility put forth by Joyce Appleby, Professor Emerita of History at the University of California, Los Angeles.

In a letter published in the New York Times on November 13, Appleby notes a recent anti-longevity article by Ezekiel Emmanuel and a new book on end-of-life care by Atul Gawande (both physicians,) and says,

“Perhaps the moment is right for broaching the idea of what we might call prophylactic suicide: the decision of an elderly person to pre-empt the grim reaper and avoid the disabilities of extended life.”

Appleby goes on to note that organizations such as Compassion & Choices, with which this writer has worked closely for well over a decade, “are campaigning for dignified terminations of life for those with incurable diseases” but writes, “What I propose goes a step further, extending the right to people before they face terminal or debilitating illnesses.”

Not surprisingly, Appleby’s letter – one of The Times’ regular “Invitations to Dialog” – drew more than 300 responses. Nine were selected to appear either in print or online; this writer’s is among those online and is as follows:

“I strongly support the right of a terminally ill, mentally competent adult to choose aid-in-dying, now legal in five states, but Ms. Appleby does a disservice to the cause by suggesting “a step further” — prophylactic suicide. The latter bears no relation to the former.

“We would be far better served to fight unwanted medical treatment, so often futile and excruciatingly painful at the end of life, and to enforce individual advance directives. My own directives (I’m 81) stipulate that no medication other than pain relief be given should I become unable to speak for myself, and stress that I do not wish to be fed if unable to feed myself. More important, all of my children and close friends understand these wishes because we’ve had the conversation.

“Let’s work toward those sane measures, and leave “suicide” out of it.”

Because the Death With Dignity movement is so important, and informed dialog about it so critical, it is both tragic and dangerous to have misinformation and misperception spread. There’s been enough of both over the decade+ in which the movement has slowly gained strength. To set the record straight:

Death With Dignity – the right of a terminally ill, mentally competent adult to ask a physician for aid in dying – is now legal in five states (Appleby left out New Mexico) and the movement is fast gaining ground in half a dozen others. This is partly because people increasingly understand that Death With Dignity is not suicide – and is certainly no kin to “euthanasia,” as Emmanuel would have us believe. Under Death With Dignity laws, death comes because of a disease. Every death certificate for those who have considered or used DWD laws lists the cause of death as the disease; it is not caused by suicide. Euthanasia would never be allowed under DWD laws.

But the movement is also gaining strength because it has been carefully thought out and tested. Because it is rational and safe. DWD laws are designed to promote individual autonomy, and incorporate safeguards against abuse.

Much of the opposition (as evidenced in several of the letters in The Times) comes from misunderstandings which are advanced by Emmanuel’s and others’ misuse of the word “suicide” and by fears that the elderly will be encouraged to get out of the way as Appleby’s notion suggests. Both writers muddy the waters and undermine an important cause.

Death With Dignity is a safety zone. Irresponsible words throw it into a danger zone.

 

Sign a Contract, Lose Your Rights

scales of injusticeDeep within the contract I signed for a recent $699 purchase were these words:

Arbitration Agreement: Should any dispute arise in regards to this product, I/we agree to settlement by arbitration.

Well, great, I thought, after glancing through the multiple-page document and noticing the clause. I am not a litigious sort of person, and arbitration seems far preferable to courts and lawyers and outrageous legal expenditures. A reasonable solution.

Wrong. That agreement means I signed away all rights in any future dispute involving the product, committing to a decision that will be made by the person or firm hired by the company who wrote the contract. If I complain, and the company is paying the arbitrator, guess who’s going to win? A recent study showed that 94% of the time, in cases like these, the judgment goes in the company’s favor. Appeal? There is none. The decision is binding, and I have signed away my right to appeal – that’s also in the fine print.

Lost in the Fine Print”, an eye-opening film just released by the Alliance for Justice, explains how these forced arbitration clauses affect millions of people every day, people like you and me who assume we enjoy such constitutional rights as equal protection, the right to appeal – a voice. I could be out $699. But what if the forced arbitration clause in the small print meant you were done in by a for-profit college that took your money, gave you a worthless “diploma” and prevented you from ever getting a job because they’d already flooded the market with others far less qualified? Or suppose it meant you had no power over the credit card company that was ruining your small business with ever-increasing “swipe” fees. Or it meant that though you had been unjustly fired from your job, you were denied even a hearing? These are three of the stories told in “Lost in the Small Print.”

“It’s a rigged system that helps companies evade responsibility for violating anti-discrimination, consumer protection, and public health laws,” says film narrator Robert Reich.

Reich, a noted political economist, author and speaker who served as U.S. Secretary of Labor under President Bill Clinton, explains how forced arbitration clauses usually go unnoticed in the pages of boiler-plate accompanying today’s contracts. But even if they do catch the eye of the signer – as happened with my recent purchase – their potential impact cannot be foreseen.

And that impact can be huge: a job lost, a business struggling, a life wrecked.

“Lost in the Fine Print” runs for just under 20 minutes. You can watch it online, or order the DVD. It’s free. Those could be the most important 20 minutes you’ll spend in a very long time.

 

 

Bold Hope for the World’s Poor

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A Solution to Poverty?

If governments can’t solve world poverty, and nonprofits can’t make serious dents in it… can the private sector be the answer? With the help of you and me and major investors?

Mal Warwick thinks so. Warwick, co-author, with Paul Polak, of The Business Solution to Poverty, spoke recently at the Commonwealth Club in San Francisco about their conviction that the long-term solution to the ongoing tragedy of global poverty lies in coming up with answers that will pay off. Not just to suffering individuals, by helping lift them out of poverty, but to investors by turning a profit.

Warwick’s audience included a variety of interested individuals familiar with much of the work already being doing by nonprofits whose funders tend to seek reward through humanitarian success rather than financial return. But major infusions of capital, Warwick maintains, will be needed to continue building the ladders people everywhere will need to climb out of poverty’s depths, and that will require – business solutions.

As a shining example, Warwick cited the treadle pump. It is a human-powered device, inexpensive to manufacture and simple to use, which enables farmers to multiply the yield of their land and thus, in many cases, raise themselves and their families out of poverty. It works as a business solution on a number of levels. Factories needed to manufacture the pump were set up in villages, providing employment for people there, village shops distributed them, workers were employed to drill the wells and financial institutions made loans for purchases.

The problem, Warwick says, was with marketing – radio, TV, newspapers and traditional advertising methods weren’t available. The solution? Roaming troubadors and a Bollywood movie.

Among the facts Warwick brought to light were: One billion people lack access to electricity. One billion people lack access to safe water. One billion farms are without irrigation. The 20 million people lifted out of poverty between 1981 and 2006 by international aid programs, Warwick says, are only a drop in the bucket to the numbers who continue to suffer.

“It’s possible,” Warwick says, “to create brave new companies” with the lure of “reaching at least 100 million $2/day customers.” Some of those companies already at work include Australia’s SunWater which is developing a variety of safe-water solutions, several businesses working toward turning organic waste into affordable charcoal briquettes, and SpringHealth, which is addressing the problem of contaminated drinking water.

If governments and nonprofits can’t solve global poverty, can businesses? It might take all of the above – plus you and me, ordinary citizens.

Thanks, Brittany

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Brittany Maynard, 1984-2014

No one was surprised by the news of Brittany Maynard’s death on November 1, as she had planned. The news arrived in my Inbox late Sunday night, November 2, in an email from Compassion & Choices, an organization I have supported — as a volunteer, Northern California board chair and in all other ways — for well over 15 years,

What Brittany did for Compassion & Choices, and for you and me, though, far exceeds what any one person might ordinarily have done. Hers was an extraordinary demonstration of how to live, and die.

More of how she lived will continue to be in the news. But it’s how she died, with generosity and grace, that is worth noticing right now. Just to touch on a few things:

Brittany, in making her own choice, showed us how to make our own choices. Demand the right to control your destiny, she was saying. Fight for legalized aid in dying. Complete your own advance directives and make sure EVERYONE in your family and circle of friends knows what your own wishes are. Death with dignity was Brittany’s choice, and she wanted it to be yours — if you choose.

“The freedom is in the choice,” Brittany said.  “If the option of Death With Dignity is unappealing to anyone for any reason, they can simply choose not to avail themselves of it.”

Brittany was irate over insinuations that she had been “manipulated” by anyone. She was a strong, educated, independent, intelligent woman who led a joy-filled life and confronted its abbreviated end with remarkable courage. The reality was simply that she took control of her own final months, weeks, days, by moving to Oregon where aid in dying is legal. The reality is that she wanted her life — and death — to have meaning for all of us. She hoped that by sharing her story all of us might benefit.

It’s about freedom. Brittany, thankfully, is now free of the terrible pain her illness was bringing, a pain that was certain only to increase. Her family will mourn for a long time, but they are free of the pain and anguish that comes from watching someone you love suffer.

You and I are free to choose. We can continue to let those who hold differing views deprive us of our right to control our final weeks and days. Or we can fight to legalize our right to choose a compassionate death. Eventually, that right will prevail.

Thanks, Brittany.

WHI: Strengthening Women’s Health

WHICould the health and wellbeing of a few million women be improved, and a few billion dollars saved in the process? A very big dream.

When the Women’s Health Initiative was established more than 20 years ago, no one was talking in grandiose terms and few would have anticipated the wide-ranging health benefits (and huge cost savings) that would result in the decades ahead. Many of us were simply saying, “Imagine this. At last we’re studying women to find answers about women’s health issues.”

This writer was proud and happy to enlist in the first WHI study. I joined more than 100,000 other postmenopausal women volunteering to fill out forms, have blood drawn and answer questions over the next 15 years. That initial focus was on tracking the effects of hormone therapy, dietary patterns and/or calcium/vitamin D supplements on prevention of heart disease, cancer and osteoporotic fractures. I had not yet had breast cancer – that would come about 10 years into the study; a family history of osteoporosis added to my personal interest in WHI. Over the years I volunteered to participate in some of the wide-ranging ancillary studies looking at other health-related things like physical activities, lifestyle, tobacco and dozens of peripheral issues. (My personal favorite question appeared on one of the multi-page annual update forms. It read – Yes or No – “When you enter a room full of other people, do you have the feeling they are talking about you?” There may someday be a report on women and paranoia.)

Mysterious questions aside, WHI is serious business. Here, excerpted from the latest Extension Study newsletter are a few facts about what has been learned from the historic initiative, and a little of what is still ahead.

Those hormones millions of postmenopausal women were taking, widely thought to be miracle answers? Studies showed the risks far outweighed the benefits, and millions stopped taking them. Hormones in different combinations had been commonly taken to minimize chances of cardiovascular disease, cancers, fractures, diabetes, gall bladder disease and a variety of quality-of-life measures; quitting the hormones proved a better choice. Health benefits can’t be precisely measured, but the reduction in hormone use has led to a decrease in rates of breast cancer and cardiovascular disease.

And in dollars and cents? Some $37.1 billion, (in 2012 when all costs and quality-adjusted years of life are considered, has been the total economic return of the WHI trial.

By June, 2014, over 1000 papers based on WHI data had been published in scientific journals. What’s ahead? Researchers are looking at pet ownership and risk of cardiovascular disease; physical activity during childhood and risk of Alzheimer’s disease; breast cancer distribution by rural/urban areas and geographic differences in cognitive decline/dementia.

Every year on their birthday, WHI study participants receive a card – some of us call it the “Hooray, you’re still alive” card. For women everywhere, it represents something worth more than gold.

Adventures in Distracted Driving

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Distracted drivers kill. Not just themselves, unfortunately, but innocent others: conscious drivers, bicyclists, pedestrians, passengers. In 2012, for example, 3,328 people were killed in distracted driving crashes.

So why, some of us wonder, are today’s cars designed to distract? Touch screens for multiple uses, gadgets for audible texting, voice-activated music or phone calls, GPS instructions that can be conflicted or confusing. Aids and upgrades? Or distractions?

Even with two hands on the wheel – tough, when you’re working with a touch screen – it is not possible to have any of the above in use without being distracted from the essential goal of driving: getting from Point A to Point B without endangering yourself or others. That goal once summed up the business of driving.

But cars and driving have changed in recent years. Cars are sold on the strength of how they make you feel – free, macho, superior. Driving, at least in the ads, is not a matter of getting from Point A to Point B, but “an experience.” An enhancement of self, time and energy.

My friend Mac spends a good bit of time and energy on the 1962 Volvo which is the family transportation, not always to the delight of his wife. But a functioning car is a functioning car. My own automotive experience has evolved from a 1977 Volvo stick shift to a 2000 S40, a rather spiffy little vehicle with sun roof and great radio sound – but no computer. It is increasingly difficult to find a car as uncomplicated as a 2000 Volvo S40.

Recently I was a passenger in a new car with one of the now-standard dashboard computer screens. Traveling 75 mph on a well-lit highway we were passing an accident of some sort and a police car with red and blue lights flashing when the computer screen blinked, a beep sounded and a friendly voice from somewhere said, “Hi, I just wanted to check with you about the wine.” Happily, the driver understood the blink, knew the voice, and had earlier set the interior phone to speaker since she wasn’t using ear plugs. She was immediately able to switch from the conversation we’d been having to a conversation about buying wine for the dinner party ahead that evening – while maintaining speed and staying in the same lane. The driver is also a highly skilled multi-tasker who hadn’t had any wine at all yet.

But after the phone conversation ended (and my heartbeat had gone back to normal) the driver told me she hadn’t noticed the police car.

Suppose the flashing police light had been a warning of hazard ahead? Suppose another driver on another, more troubling, phone call had done something unexpected in another lane? However skilled at both driving and multi-tasking, could my driver have had enough remaining undistracted resources to keep driving safely?

Given my choices, I would take sharing the road with Mac and his ’62 Volvo over all these roads filled with cars equipped with audible texting devices, voice-activated music systems and dashboard computer screens.

Unfortunately, we no longer have that choice.

 

 

Peaceful dying vs Doctor Knows Best

credit acpinternist.org

Barbara Coombs Lee, the sharp and articulate president of Compassion & Choices, spoke to the issue of death with dignity on PBS NewsHour tonight, with opposing views presented by Ira Byock, noted physician, author and advocate for palliative care. Neither really won; the time was too short and the issue is too complex. The Death With Dignity movement though, is not going away, and we the people will only win when the movement wins.

Lee spent 25 years as a nurse and physician’s assistant before becoming an attorney and devoting her life to personal choice and autonomy at life’s end. She believes a terminally ill, mentally competent adult should have the right to end his or her life when and how he or she chooses. Byock, chief medical officer of the Providence Institute for Human Caring, believes that if doctors were properly trained in pain management and end-of-life care – which he readily admits is far from the case – no one would ever want, or choose, to hasten one’s end. Lee appreciates the grace with which Brittany Maynard is facing her own very premature death; Byock says the active, well-educated 29-year-old is “being exploited” by Compassion and Choices.

A few caveats:

Barbara Coombs Lee is a good friend whom I admire and respect. I have worked with Compassion & Choices for well over a decade as a volunteer, Northern CA member and board chair, and now member of the Leadership Council. I strongly support physician aid-in-dying and individual autonomy.

“Hospice and palliative care,” Lee said on the NewsHour segment, “are the gold standard” for end-of-life care. But no amount of hospice care, or palliative care, can alter “the relentless, dehumanizing, unending” progression of a disease such as Maynard has and many of us will also face. For many of us, as for Maynard, there will be loss of every bodily function, one by one, quite likely accompanied by excruciating pain and possibly things like the seizures Maynard would like to minimize for her own sake as well as the sake of her loved ones who would be forced to watch.Stethoscope

Perhaps doctors will eventually all be adequately trained in pain management and palliative care. But even then – and “then” is a very long way off – must the doctor always know best? Why can’t I, the patient, the person facing my own dying, be the one in control?

Byock is dismissive of the pain involved with watching a loved one suffer agonies of prolonged dying. Maynard’s inevitably increasing seizures, for example, would be helped by palliative care, he suggested, so she wouldn’t suffer terribly. If I chose – as Maynard is choosing – to have my loved ones remember me as a woman at peace while holding their hands rather than a disintegrating person gripped with terrible spasms – why is that not an honorable choice?

Byock – who in this NewsHour fan’s humble opinion got the better time and treatment – slipped in words like “suicide” and “slippery slope” and “euthanasia,” and phrases like “euthanized in the Netherlands” too far along in the program for Lee to answer in the brief time given her. Byock ignores the fact that no one choosing to hasten death under the existing laws (four states now have the law, two others allow aid-in-dying) is committing suicide; they are being killed by their disease. No one has been, or will be, “euthanized.” The United States is not the Netherlands. He also ignores the fact that in the long years of Oregon’s successful law – it was first enacted in 1997 – there has been not one report of abuse. Not one.

There is no slippery slope. There is only compassion. Self-determination. Autonomy. Dignity. Grace. Peace. Why should they not be legal?

I respect the medical and literary achievements of Ira Byock. But I’m sorry: the doctor does not always know best.

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