Welcome to Marlinspike Hall, ancestral home of the Haddock Clan, the creation of Belgian cartoonist Hergé.
Some Manor-keeping notes:
Navigation is on the right, with an explanation of the blog's fictional basis. HINT: Please read the column labelled "ABOUT THIS BLOG." Enjoy the most recent posts or browse posts by posting date in the Archives. Search the blog for scintillating, obscure topics.
Enjoy your stay! There are some fuzzy slippers over there somewhere, too.
The person who made this video added it as a "video response" to two of my CRPS / RSD vids on YouTube. Someone at YouTube decided that it was spam, so it cannot be seen -- except by going to the videographer's own channel (user name Kevscar1). To be specific, Kevscar1's montage was marked as spam on one of my uploads, and completely deleted from the other.
I am quite fuzzy-headed, tired, febrile, and yadda -- but even clear-headed, energetic, cool-as-a-cucumber, and yadda? I don't think I'd understand, even then, why this video response had to be removed or marked as "junk."
I could only watch it once, and while it was upsetting, I am not convinced that it is spam or so disturbing that it required removal.. It's self-serving, self-pitying, and an exaggeration of what CRPS / RSD is like -- which is exactly what some might say about my own pitiable artistic endeavors.
"No, it's not." That's the echo in my head. Kevscar1's work is no exaggeration, it's just what no one wants to see or hear. It's the truth, but we all know that truth is the first casualty in so many human endeavors.
But it is not something that someone newly diagnosed needs to see. It is not how the majority of cases turn out. Remember: early diagnosis and correct, aggressive treatment usually leads to a cure! In other words, it does not have to be the truth; it is not a truthful inevitability.
I didn't check the audio... watched it on mute, in mute horror. How long before my wounds and ulcers will stop healing, too? When will my frequently scheduled, but always postponed, DIY Dim Sum and High Tea Party Amputation of All Limbs stop being a joke? (Whenever I figure out how to cut off that last remaining arm, that's when! Tricky business... very tricky.)
So tell me, whether you have CRPS / RSD or whether you don't -- should this vid be classified as spam, and why, or why not? Would an age restriction have sufficed? Why leave the vid available on Kevscar1's channel but claim it too... too... whatever as a video response to my own CRPS commentaries?
This is the Launch of a Worldwide Campaign to raise Awareness of the World's Most painful incurable condition which 95% of the Medical Profession have never heard of. I don't want money I want you to spend sometime helping to spread this. If you live in the UK please sign our e-petition http://epetitions.direct.gov.uk/petitions/31344
If you are willing to help please e-mail me on RSDFighter@hotmail.co.uk
ready to stop, ready to give in, up. give out. [how many prepositions work with "to give"?]
monday got me. the screaming meanies, the spaz attacks, dystonia, whatever -- and i don't give a royal poop if you are a regular reader and know what i'm talking about or if you stumbled onto this blog in your quest for "XXX Porn, Live, Totally Naked Women, XXX Porn!" -- variations of which are my number one search terms.
not that i was stunningly functional over the weekend... i got so low that i asked fred to simply sit and hold my hand. it helped because we got to talking about brooklyn and old maps, i got distracted, and so had a few minutes of wonderful.
i cannot see -- fuzz is the operative word. double vision, or vision with a charming echo is what i trot out for medical types. "i can't see shit" is what i say in more normal circumstances. sometimes i say seemingly contradictory things, like "you see that? i can't see that!"
of the three new drugs i was excited about, it looks like a possible triple play -- all called out before getting any chance to slide for home. pain has returned to normal 8-9 out of 10 on the freaking pain scale. the screaming ninny-meanies are worse than they've ever been, unrelenting and soul destroying. the memantine? how am i to judge?
last week i went to the eye doc, who snickered when i said i was ready to have that surgery she had been referencing -- a combo cataract/glaucoma operation. it turned out none of the anesthesiologists at her hospital would touch me with this active bone infection. she did give me permission to get new glasses, finally.
so... monday. pain management dood's Nurse Practitioner, then Fred would peel off to the pharmacy while i went to the lab and made deposits, following which we'd meet up with dear darling ruby the honda crv and toodle off to Tête de Hergé's single WallyMart west of the Lone Alp. the eye doc had opined that the new eyeglass script might last a month, three months, a year, five years, she had no freaking idea. so i planned to sink very little money into these spectacles.
but i was shopping with the aid of one of the world's most reknowned consumer know-it-all. my fred. when i rejoiced over finding a NINE dollar pair of frames that would do nicely, he snorted. i found myself led by the nose to the maginc "flex" frames, frames he claimed i could not destroy. i never plan, of course, to destroy my frames, but sometimes do. i toss them on the bed and a feline waits for the dulcet tones of my sleep apneic snoring before snatching them for a good chew, to be followed by a great, fun game of "where the hell are my glasses, you nasty cat?" i drop them several times a day and pick them up with the unforgiving tines of my grabbers.
so the flex frames were my pick. yes, i looked at a grand total of 2 frames, and even those 2 i couldn't really see. that's why fred was not set loose upon the WallyMart, he had to serve as fashion consultant to this prednisone moon-faced, fat pads galore, perpetually confused looking visage.
"um, you know this a pretty serious prescription," stammered the 12 year old eye specialist. "it's going to cost extra,"
of course, it is gonna cost extra, dear heart! c'est moi!
then i had a shopping list that we proceeded to ignore because i was fading fast. would someone please tell me these fat people are driving carts all over the store, stopping with a screech in front of the generic "muffin top" super-sized bags of cereal, leaping and pirouetting from the constraints of their motorized, armored golf carts to grab 'em? some of these twirling folk stopped to talk to me, figuring i was both simple-minded and bodily disabled, as i was peering at the line up of products with a drooling incomprehension. it looks like a yogurt container but it could be ricotta or cottage cheese. it costs with 5-something or 8-something which seems ridiculous for any of those possibilities, except maybe a fine ricotta. or a whole milk actual greek-from-greece yogurt.
i had a long grocery list but gave up after frozen strawberries, frozen peaches, frozen mixed berries, yogurt, and milk. and fake sugar. all of which fred had to find and i had to buy. [these are my comfort foods. frozen fruit with milk -- consumed while still frozen -- makes me feel, at least, less febrile. yogurt is also a necessity in this world of eternal antibiotics.
we got home, i got into bed before going to the bathroom and cried for half-an-hour about that, got up and walked to the bathroom, crying the whole way, made it back to bed, but barely, as i was a-rockin' this a'way and that a'way. then i just lay there and allowed my legs to jerk and spasm while i watched the wind-up to the foreign policy debate. i thought for sure that would stop 'em.
and i lied. i lied to friends, family, and doctors. i kept up the story of the drugs helping 30%, or maybe 25%, except for the one drug that i had not yet titrated to the highest dose, of course. the one making the spaz attacks worse?
i won't get labs back until this afternoon but i got a preview late yesterday. super nurse called to tell me to stick to the 150 dose of the spaz med and not double up to 300 on wednesday. i took the chance to ask what my hemoglobin was, as i was convinced it had to be under 7, i was that tired. nope, 11. however, my wbc was 14.9, and, again i say, that is on the antibiotic... i don't know about liver function or kidney function, or c-reactive protein, that'll be later today.
but i don't care.
i listened, as i could not watch, to frasier and the golden girls, followed by hours of i love lucy all night long.
i have failed at everything.
oh -- i did manage to ditch all my GOOG at $700 last week just after they resumed trading. i guess that's something of a coup, as i only lost thousands of dollars versus more thousands of dollars. yay, me.
i would like to be put in a nice, old-fashioned hospital, snowed, washed, wrapped in clean sheets and blankers, my vision made perfect, the nurses offering gentle massage whenever i should arch an eyelid open, followed quickly by more no-jerking, no-pain magic meds. there would be a strange lack of doctors and tests and surgeries.
and fred, of course, would be set free with his guitars, ukulele, and the new piano. did i tell you he bought a piano? my only criteria was that my laughing buddha could still sit in that spot, front and center, belly begging a rubbing.
Published on Apr 11, 2012 by Dignity Campaign Marcia Angell, M.D., Professor of Social Medicine at Harvard Medical School and former Editor of the New England Journal, discusses the proposed Massachusetts Death with Dignity Act with Emily Rooney on WGBH's April 10, 2012 episode of "Greater Boston"
Published on Oct 5, 2012 by PrayTV Description: Andrew Beckwith, the Executive Vice President of Massachusetts Family Institute, discusses the Death with Dignity Act on the upcoming November ballot in Massachusetts. The proposed bill supports physician-assisted suicide, and would allow people who have been told they have six months or less to live, to take a lethal dose of drugs. Andrew interviews Diane Kaulbach, a cancer survivor, about the complexities of her real-life situation. Dr. Jane Driver, a Geriatric Oncologist in Boston, discusses the requests of older patients, who frequently feel they want to die. She elaborates how a person can respond to pressure in times of crisis, feel like a burden, and desire to make a decision to end their life, but later, be glad to be alive. Dr. Driver raises the issue of the impact of such a decision upon society..."Whenever a society determines there is such a thing as a life worth living, then an important line has been crossed... Where do you stop?" She emphasizes the importance of learning from history such as pre-World War II Germany, and the study of countries where this procedure has been legalized. Disturbing elements of this bill require doctors to falsify the cause of death, diagnosis is not reliable, and there is no provision for a mental health evaluation. Mary Roque, an Elder Law Attorney, sounds an alarm about the vulnerability of the elderly, which leaves them open to abuse, coercion and neglect. She expresses concern that a person who is terminally ill would be able to obtain a prescription for a lethal drug, provided there are two witnesses, one of whom can be a heir. An elderly person could be at-risk to be exploited by a "greedy heir" and even murdered, because no supervision is mandated concerning the administration of the drug. John Kelly addresses the pressure already on handicapped people from the medical system and the incongruity with which the term "dignity" is applied... "The dignity they are talking about is not living with the conditions that people with disabilities know well...It's inevitable, once you describe death as a medical benefit with a price on it....when insurers see every claim as a loss, and when doctors are under financial pressure to limits costs, especially in the last year of life, it's just hopelessly naive to think that financial pressures will not distort decisions."
Published on Oct 9, 2012 by WGBHForum Dr. Marcia Angell, senior lecturer in the Division of Medical Ethics at Harvard Medical School, discusses the Massachusetts ballot initiative on physician-assisted suicide at Cambridge Forum. How does the Hippocratic Oath square with the notion that a doctor might help a patient end his or her life? Under what circumstances would this be an ethical act for a physician? What are the risks of enacting Death with Dignity legislation? Whose interests does such a law serve? Recorded 10/3/12. More lectures at http://forum-network.org
Article Abstract -- The Hastings Center Sept/Oct 2008
Physician-Assisted Death in the United States: Are the Existing 'Last Resorts' Enough?
Timothy E. Quill
*This essay is being provided in full free of charge. To see others, or to subscribe to the Hastings Center Report, register at the bottom of this page.
Although there has been relatively little activity in the last ten years with regard to legal access to physician-assisted death, this fall a citizens’ initiative in the state of Washington is proposing an Oregon-style law that would allow legal access to potentially lethal medication for terminally ill patients, subject to defined safeguards. As the rhetoric inevitably heats up, this seems like a good time to review areas of progress in palliative and end-of-life care and to consider whether laws like the one on the table in Washington are either needed or desirable.
Several things are clear: (1) Palliative care and hospice have improved in terms of access and delivery, and they remain the standards of care for addressing the suffering of seriously ill patients. (2) Despite state-of-the-art palliative measures, there will remain a relatively small number of patients whose suffering is insufficiently relieved. (3) Several “last resort” options, including aggressive pain management, forgoing life-sustaining therapies, voluntarily stopping eating and drinking, and sedation to unconsciousness to relieve otherwise intractable suffering, could address many of these cases.1 The question remains as to whether physician-assisted death—that is, providing terminally ill patients with a potentially lethal prescription that they could ingest on their own to relieve otherwise intractable suffering by directly hastening death—should be one of these last resort options.
My own answer to this last question is a cautious “yes”: open access to physician-assisted death, subject to the safeguards of excellent palliative care and access to other last resort options, gives patients an important additional option, and the benefits of legalization outweigh the risks.
Progress in the Last Decade
Perhaps the most dramatic sign of progress has been the coming of age of the palliative care movement, which allows fully informed decision-making and the provision of treatments to maximize quality of life for all seriously ill patients alongside any and all disease-directed treatment that patients want to continue. Almost all major medical centers now have inpatient palliative care consultation services, and similar services are spreading into community hospitals. Consultation possibilities are also spreading into the outpatient and home settings, although the gaps between need and availability are much wider in these contexts. The American Board of Medical Specialties has recently given palliative care the status of being a board-certified subspecialty, and fellowship programs are sprouting up across the country.
There remain serious challenges. There are not enough skilled palliative care clinicians to meet the growing needs, and reimbursement for palliative care services—which rely heavily on counseling and coordination of care rather than expensive procedures—remains problematic. Similar gaps exist in providing basic palliative care education for all clinicians who care for seriously ill patients, and in generating an evidence base for the field. Nonetheless, palliative care seems to have passed the “tipping point” as a field; most patients and families can find the treatments that they need regardless of their stage of disease.
When patients become terminally ill, access to palliative care is facilitated by the proliferation of hospice programs. Hospice remains our premiere program to provide palliative care for terminally ill patients who are willing to forgo further treatment of their underlying disease, as it provides, pays for, and coordinates comprehensive quality-of-life-oriented treatments for terminally ill patients. Hospice has expanded considerably in the last ten years, primarily in two domains: the inclusion of terminally ill patients with diseases other than cancer—congestive heart failure, dementia, and chronic lung disease, for example—and the ability to supplement the palliative aspects of care for terminally ill patients who reside in skilled nursing homes.
Despite this progress, the majority of patients who die in the United States are never transitioned to hospice, mostly because of a requirement that once they are in hospice they will forgo disease-directed therapy. Some larger hospices are experimenting with loosening these restrictions through “bridge” programs that let patients continue active treatments that are important to them and have some potential for helping while at the same time receiving the full benefits of hospice. Since hospices are paid on a per diem basis (on average, about $135 per day), only the very large, affluent hospices can afford to offer expensive disease-directed therapy at the same time that they are providing and paying for comprehensive palliative care, but there is much more flexibility and willingness to experiment with these areas now than ten years ago.
Significant progress has also been made in the articulation and provision of last resort options for patients whose suffering becomes unacceptable to them despite state-of-the-art palliative care. Ten years ago, the problem of intractable suffering was often not acknowledged or was blamed on the clinician (“They don’t have adequate expertise”) or the patients (“They want too much control over their fate”). Now, it is much more widely acknowledged that even with the best possible palliative care, there will always be a small percentage of cases where suffering sometimes becomes unacceptably severe, and that clinicians are obligated to treat these circumstances as a palliative care emergency that requires consultation and committed efforts to respond in the most helpful, least harmful way.
Other Last Resort Options
When unacceptable suffering persists for terminally ill patients despite state-of-the-art palliative care, four options have emerged as last resort possibilities. The first two are widely accepted and relatively uncontroversial:
Right to intensive pain and symptom management. Pain can almost always be sufficiently relieved without any significant risk of hastening death, but there will be a few cases where pain accelerates severely toward the very end of life and pain medicines must be proportionately increased, bringing an increasing risk of hastening death. Patients and families, having given their informed consent, should be able to count on their doctors’ willingness to take these risks as part of their commitment to relieve suffering, and medical ethics and law stand firmly behind this commitment.
Consider a case like this: a patient with advanced bladder cancer is nearing death and must make daily tradeoffs between adequate pain relief and sedation. She reaches a point where she “just wants to be out of pain.” After extensive discussion with patient and family, her dose of opioids is gradually increased until her pain is sufficiently relieved, but after that point she eats and drinks very little and sleeps most of the time. She dies a week and a half later. Although death may have been unintentionally hastened by a small amount, in this process the obligation to relieve her severe suffering warranted taking that risk.
Right to forgo life-sustaining therapy. Medicine has made great strides prolonging life, and a small but significant part of this progress has been the availability of life-sustaining technologies. These technologies no longer just mean ventilators and feeding tubes; they now include radical technologies such as ventricular-assist devices. But while the array of medical choices faced by patients and families has grown more complex, ethics and law remain clear that patients have a right both to forgo such treatments and to stop them once started. Here’s a typical case that turns on this kind of decision: an elderly man fractures his spine falling off a ladder. He initially accepts intubation and surgery in hope that he will recover neurological function, but four weeks later, he has not. He cannot imagine living this way, and after extensive discussions with his medical team and his family, he is mildly sedated and removed from the ventilator. He dies within twenty-four hours.
Of course, some patients suffer unacceptably from symptoms other than pain, and their lives (and deaths) are not directly dependent on life-sustaining technologies. A portion of these patients look for options to escape suffering and even hasten death by means other than physician-assisted death. Two additional possibilities have emerged over the past decade. While clearly more morally complex and less settled than the first two options, these options seem to generate less legal and ethical controversy than physician-assisted death:
Voluntarily stopping eating and drinking. VSED is different from the natural loss of interest in food and drink that occurs when a person is actively dying. It is an informed decision to stop food and fluids while one is still physically capable in an effort to hasten death and escape suffering. The decision is entirely within the patient’s control, but it requires considerable resolve, since the patient generally continues to live for one to two weeks after stopping. Although VSED is not directly “physician-assisted,” it needs to be “physician-supported”: the patient must be assessed at the outset to ensure that he or she is competent and has adequate palliative care, and the physician must help the patient and family to address any unforeseen complications as the process unfolds.
VSED is only an option when the patient retains mental capacity. Suppose, for example, that a patient with amyotrophic lateral sclerosis has become tired of living in the circumstances imposed by his illness. He does not want a feeding tube or a mechanical ventilator, and he feels that he is dying too slowly. He asks about physician-assisted death. After careful assessment of his capacity and motivation, his physician raises the possibility of VSED. Since eating and drinking are already a daily struggle, he and his family welcome this alternative. His family can then come together for his last two weeks, during which he will be supported by home hospice. In the final phase of this process, he may be mildly delirious because of the metabolic changes of dehydration, but usually these and other symptoms can be well managed as part of his hospice support.
Sedation to unconsciousness. This type of sedation is distinct from the proportionate use of sedatives to treat severe anxiety or delirium, which is a relatively common part of terminal care. Instead, it is an explicit decision to render the patient unconscious so that he or she can escape otherwise severe and intractable suffering. Other potentially life-prolonging treatments such as food and fluids are usually discontinued at the same time. There is general agreement on its use as a last resort to relieve severe, intractable suffering in imminently dying patients, but as one gets further away from these circumstances, agreement about its permissibility falls off sharply.2
Consider an elderly holocaust survivor dying of end-stage congestive heart failure who was transferred to an acute hospice/palliative care unit to manage his terminal shortness of breath. The opioids used to treat his dyspnea made him delirious, and he began having flashbacks from his time in the concentration camps. Usual sedatives did not control his agitation, and family and staff agreed that this suffering was unacceptable, so he was sedated to unconsciousness with phenobarbitol. The dose was adjusted until he appeared to be resting comfortably, but he was completely unresponsive. Artificial hydration and nutrition were not provided, with the family’s consent. His level of sedation was maintained until he died seventy-two hours later.
The Empirical Data
By far the best data about physician-assisted death in the United States come from Oregon, where the practice is reported to the health department and where annual summaries have been prepared every year since legalization. The practice has been remarkably stable over the ten intervening years, accounting for approximately one out of every thousand deaths per year.3 This appears to be a very small number given the amount of controversy surrounding the practice, but one in fifty patients talk to their doctor about it, and one in six talk with family members, suggesting that the availability of such an escape may be much more important to many patients than its actual use.4 The Oregon statute requires that patients be informed of “feasible alternatives,” including hospice and palliative care and other last resort alternatives, and some choose alternatives other than physician-assisted death.
There are also data from Oregon to suggest that the legalization of physician-assisted death enhances rather than undermines other aspects of palliative and end-of-life care. Oregon has one of the highest rates of hospice referral in the nation, and the vast majority of patients who choose physician-assisted death are simultaneously enrolled in hospice. Oregon also has relatively high rates of opioid prescription per capita, and physicians as well as other medical professionals have very high rates of attending training courses in both palliative care and end-of-life medical decision-making. There is also a statewide form, “Physician Orders for Life-Sustaining Treatment” (POLST), for recording a patient’s wishes about cardiopulmonary resuscitation and other potentially life-sustaining therapies. The form has become a model for other states.5 Overall, Oregon appears to be among the leaders in comparison to other states in virtually all aspects of palliative and end-of-life care, including allowing open access to physician-assisted death, subject to safeguards.
The secret practice of physician-assisted death in the rest of the nation is very difficult to study. To admit to participation, a physician has to admit to a crime, and along with any family present, runs the risk of prosecution. On the other hand, there appears to be very little interest in prosecuting such cases providing they are not discovered or flaunted, leading to a “don’t ask, don’t tell” policy that is unpredictable and potentially dangerous. Under this policy, there is no opportunity to get second opinions from experts in palliative care, no documentation, and considerable potential for idiosyncratic responses from clinicians.
In the mid-1990s, I was part of a team that conducted an empirical study of the secret practice, using research techniques that protected anonymity. We found that physician-assisted death and euthanasia accounted for approximately 1 to 2 percent of deaths. Although this appears to be ten to twenty times higher than the rates reported in Oregon, the reporting techniques were so different that the rates are not directly comparable. On the other hand, we know from Oregon that conversations with doctors about these issues are common, and it appears to be much better and safer to have the conversations out in the open rather than in secret.6
Very little is known about the frequency of other last resort practices in the United States. Data from the Netherlands, where all end-of-life practices are regularly studied, suggest that forgoing life-sustaining therapy and prescribing “opioids in large doses” are each reported to account for approximately 20 percent of deaths, which fits with my clinical experience in the United States.7 There are no reliable data about the frequency of voluntarily stopping eating and drinking in the United States, although the practice is thought to be rare. In our two hospice programs in Rochester, New York, where VSED is permitted and supported as a last resort, it accounts for less than 1 percent of deaths. Sedation to unconsciousness to treat otherwise intractable physical symptoms appears to be used very variably in the United States, apparently depending more on the values and practice patterns of the practitioners than of the patients. Reports vary from no deaths to half of all deaths, depending in part on definitions but also on practice patterns.8 At our hospital, where sedation to unconsciousness for treatment of intractable symptoms is subject to guidelines and restrictions that include a mandatory palliative care consult, it accounts for less than 1 percent of deaths.
The Clinical Context
All last resort options, including physician-assisted death, make sense only if excellent palliative care is already being provided. Mandatory palliative care consultation should therefore be a standard safeguard for any and all of these practices. Over the next ten years, medical institutions and professional groups should ensure that all clinicians who care for seriously ill patients are competent in the basics of palliative care and that specialty-based palliative care consultation is available for the more challenging cases.
There is also a need to develop explicit, predictable strategies to respond to difficult clinical situations where patients experience severe suffering despite state-of-the-art palliative care. Many of these patients will benefit from a discussion and exploration of last resort options that may or may not include physician-assisted death. There are two main clinical situations in which this might come up:
Patients who are worried about future suffering and wonder what options would be available to them. This conversation begins with an exploration about hopes, fears, and prior experiences of family and friends. Such patients frequently want to know what options they could have in the future if their suffering becomes unacceptable to them. In response to these inquiries, the clinician should talk to the patient about how he or she approaches such situations and what last resort options could be provided if needed. Many patients are reassured by learning about options other than physician-assisted death and by the willingness of the clinician to explore this domain and to commit to working with them and addressing their suffering throughout the illness until death. They can then be free to spend their remaining time and energy on other important personal and family matters.
Patients who eventually experience suffering that is unacceptable to them. This is a much smaller population than those who are worried about the future, but these patients’ needs can be more challenging. The starting point is always to explore the patient’s suffering in its totality, including why it is now experienced as unacceptable. Part of this assessment is to ensure that standard palliative care is being skillfully applied, and that the request does not emanate from anxiety or depression that might be otherwise addressed. A second opinion by a specialist in palliative care should be obtained. If there are no good alternatives, then the last resort options that are legally available should be explored in the approximate order presented in this paper. Usually, but not always, options other than physician-assisted death will adequately address the patient’s clinical situation and be acceptable to the patient. In the event that no other possibilities are workable or acceptable, physician-assisted death would need to be considered in light of the legal environment (the approach in Oregon will be very different than the rest of the country) and the values of patient, family, and clinician.
Will Physician-Assisted Death Be Necessary?
Some patients will prefer access to physician-assisted death even if the other last resort options are predictably available. Patients who request and eventually act using physician-assisted death in Oregon have a strong interest in controlling their fate, and physician-assisted death puts more choice directly in their hands. However, all the last resort options, including physician-assisted death, are imperfect. Although each addresses some situations particularly well, there are other situations where they would not be as helpful.
For example, voluntarily stopping eating and drinking has the advantage of putting the decision in the patient’s hands, but it requires tremendous discipline not to drink if one is thirsty and capable of drinking, and the duration of the process is too long if symptoms are severe and immediate. On the other hand, medical sedation to unconsciousness may be very frightening to those who value consciousness and being in charge, and there is no way to verify that the sedated patient is not still suffering but unable to report it. Finally, physician-assisted death requires that the patient be physically capable of self-administration and able to swallow a concentrated amount of lethal medication. In addition to these practical issues, any of these options may be morally troubling for patient, family, physician, or staff.
Adding physician-assisted death to the list of last resort options has both risks and benefits. One benefit is that it adds another important possibility for terminally ill patients who experience unacceptable suffering. We should be as responsive as possible to these patients without violating fundamental values, but it is clear that the patient’s values in this context count the most, followed by the family and then the clinician (if the course of action requires the physician’s participation). Most patients will be reassured by the possibility of an escape, and the vast majority will never need to activate that possibility. But some patients will need a way out, and arbitrarily withholding one important option from patients whose options are so limited seems unfair.
The main risk of including physician-assisted death with other last resort options is that it seems to be very polarizing in the United States, where there is wide agreement about palliative care and hospice being the standards of care and also a surprising level of acceptance of the other last resort possibilities. Even the Supreme Court, in its 1997 decision, made it clear that “obtaining medication . . . to alleviate suffering even to the point of causing unconsciousness and hastening death” is legally acceptable.9 Opponents of physician-assisted death may work to further restrict access or even prohibit access to other last resort alternatives as they become more well known and predictably available.
On the Horizon
It seems highly likely that palliative care and hospice will continue to expand in the United States and other Western countries. There are very few places in the health care system where we can simultaneously save money and improve quality, but palliative care and hospice have the potential to do both. On the quality side, improvements in pain and symptom management, more informed medical decision-making, and enhanced patient and family support are core elements of palliative care and hospice. The cost savings will come not from restricting access to expensive treatments and technologies, but from a better informed consent process for patients and families concerning medical treatments with marginal benefit and coordinated care for patients with very complex treatment. Hospice continues to be the gold standard for end-of-life care, but its challenge is to design programs that would allow patients to simultaneously continue some disease-directed therapies in order to serve a wider range of dying patients.10 If these programs can be proven cost-effective, then perhaps the hospice benefit can be expanded, and hospice and palliative care could be better integrated into traditional medical care. Palliative care needs to be part of the standard of care for all seriously ill patients, whether or not they choose to continue disease-directed therapy in any form.
The last resort options other than physician-assisted death must become more standardized, available, and accountable. There is currently too much variation. Some patients may be denied access to them because clinicians or institutions are reluctant to use them, while at the same time, others are given last resort options when more standard palliative measures would have been more appropriate. Better policies and procedures should begin at the national level, with local programs following suit. Fortunately, medicine seems to be moving in this direction. Witness a recently published American Medical Association guideline on sedation to unconsciousness that is consistent with position statements by the American Academy of Hospice and Palliative Medicine and others.11
Similar guidelines and policies are needed for voluntarily stopping eating and drinking. Because these options are intended to be rarely used, all institutions should review their own practices against the position statements of leadership organizations. For example, my institution has a guideline on sedation to unconsciousness for treatment of refractory suffering, and we review every single case in which it is utilized. The state of California is considering a law entitled the California Right to Know End-of-Life Options Act, which requires that patients be given information about both hospice and last resort options, should they request it. The goal of all these initiatives is to improve predictable access and accountability both for hospice/palliative care and for legally permitted last resort options.
In the domain of physician-assisted death, the most pressing change on the horizon is the Oregon-style citizens’ initiative in the state of Washington. Residents of the state are already relatively well educated on the subject, having been through an unsuccessful initiative in 1991, and they are more aware of the Oregon experience, being adjacent geographically and relatively similar demographically. Citizens’ initiatives begin by gathering signatures of support from a large number of residents. If the legally determined threshold is achieved, the initiative is then placed on the ballot during the next election cycle and subject to the popular vote. Not all states sanction citizens’ initiatives, but in my opinion, they are more likely to be successful in legalizing physician-assisted death than legislative approaches, given the relatively high level of public support and the tendency for the issue to get polarized in legislative situations. Nonetheless, legislative processes to legalize physician-assisted death were recently attempted in California, and before that there were near misses in Hawaii and New Hampshire.
Although some proponents of physician-assisted death will find the incremental, state-by-state approach to legalization frustrating, it has some value. For one thing, it gives us time to study the intended and unintended effects of legalization before national implementation. We can simultaneously evaluate the impact of better and more widespread access to hospice and palliative care, and of more predictable and accountable availability of other last resort options. In addition, it keeps the movement a grass-roots one—particularly when it happens through citizens’ initiatives. That may not make the practice of physician-assisted death less controversial, but it can perhaps make the process through which physician-assisted death is legalized less controversial.
1. T.E. Quill, B. Lo, and D.W. Brock, “Palliative Options of Last Resort: A Comparison of Voluntary Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide, and Voluntary Active Euthanasia,” Journal of the American Medical Association 278 (1997): 1099-2004.
2. See F.A. Curlin et al., “Religion, Conscience and Controversial Medical Practices,” New England Journal of Medicine 356 (2007): 593-600.
3. See “Death with Dignity Act, Records and Reports Data on the Act,” http://www.oregon.gov/DHS/ph/pas/.
4. S.W. Tolle et al., “Characteristics and Proportion of Dying Oregonians Who Personally Consider Physician-Assisted Suicide,” Journal of Clinical Ethics 15 (2004): 111-18.
5. “POLST: Physician Orders for Life-Sustaining Treatment Paradigm,” at http://www.ohsu.edu/ethics/polst/.
6. Tolle et al., “Characteristics and Proportion of Dying Oregonians Who Personally Consider Physician-Assisted Suicide.”
7. P.J. van der Maas et al., “Euthanasia, Physician-Assisted Suicide, and Other Medical Practices involving the End of Life in the Netherlands, 1990–1995,” New England Journal of Medicine 335 (1996): 1699-1705; B.D. Onwuteaka-Philipsen et al., “Euthanasia and Other End-of-Life Decisions in the Netherlands in 1990, 1995, and 2001,” Lancet 263 (2003): 395-99.
8. L.A. Jansen and D.P. Sulmasy, “Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation about Care at the End of Life,” Annals of Internal Medicine 136 (2002): 845-49.
9. Washington v. Glucksberg, 117 S.Ct 2258 (1997); Vacco v. Quill, 117 S.Ct. 2293 (1997).
10. A.A. Wright and I.T. Katz, “Letting Go of the Rope—Aggressive Treatment, Hospice Care and Open Access,” New England Journal of Medicine 357 (2007): 324-27.
11. K.B. O’Reilly, “AMA Meeting: AMA OKs Palliative Sedation for Terminally Ill,” American Medical News, July 7, 2008, at http://www.ama-assn.org/amednews/2008/07/07/prsi0707.htm.
Timothy E. Quill, "Physician-Assisted Death in the United States: Are the Existing 'Last Resorts' Enough?" Hastings Center Report 38, no. 5 (2008):
By: Rabbi Yaakov Rosenblatt
Published: October 11th, 2012
Latest update: October 19th, 2012
Dear Sarah, You have grown political as of late, and your politics have traction. Your YouTube video “Let My People Vote” has been viewed more than 1.4 million times. You have 3.4 million Twitter followers apparently eager to consume your mix of sexual references and political barbs. I wouldn’t be writing these words had your most recent video not been framed in biblical language. Its title held deep significance to me, as I am sure was your intention. Your name is Silverman. My name is Rosenblatt. We both have Jewish ancestors; I am not sure what else we share. You are good at what you do – comedy – and I try to be good at what I do – being a husband, dad, rabbi, and manufacturer of kosher meat. My wife and I are blessed with six children and my day is spent earning for the brood. You stand out among comedians because your comedy is sharper than theirs. It is crude and clever, simple and punishing; your perception of the human condition is acute, which is why your punch lines bite deeper and hurt longer. You have a knack for finding faults and inconsistencies in people and blowing them wide open with carefully plotted language and cleverly nuanced pauses. If I were to be gratuitous, I would say you mock what is imperfect because you know what perfect should look like and you seek the ultimate perfection. But I won’t be so gratuitous. You are in show biz. I am in the rabbi biz. You entertain people. I serve people. I believe I have your number. You will soon turn 42 and your destiny, as you stated, will not include children. You blame it on your depression, saying you don’t want to pass it on to another generation. I find that confusing, coming from someone as perceptive as you are in dissecting flawed arguments. Surely you appreciate being alive and surely, if the wonder of your womb were afflicted with your weaknesses and blessed with your strengths, it would be happy to be alive, too. You said you wouldn’t get married until gay people can. Now they can. And you still haven’t married. I think, Sarah, that marriage and childrearing are not in the cards for you because you can’t focus on building life when you spend your days and nights tearing it down. You have made a career making public that which is private, making crude that which is intimate, making sensual that which is spiritual. You have experienced what traditional Judaism taught long ago: when you make sex a public thing it loses its potency. When the whisper is replaced with a shout there is no magic to speak about. And, in my opinion, Sarah, that is why you have had trouble forging a permanent relationship – the most basic desire of the feminine soul. Human beings have many acquaintances and fewer friends, but only one spouse. Judaism celebrates the monogamous, intimate relationship with a spouse as the prototype of the intimate relationship with God. Marriage, in Judaism, is holy. Family, in Judaism, is celebrated. But for you, nothing is holy; in your world, nothing is permanent. Your ideology is secular. Your culture may be Jewish, but your mind is not. I think you have latched on to politics because you are searching for something to build. There is only so much pulling down one can do without feeling utterly destructive. You want to fight for a value so you take your belief – secularism – and promote it. As an Orthodox rabbi, I disagree with just about everything you say, but respect your right to say it. All I ask, respectfully, is that you not use traditional Jewish terminology in your efforts. Because doing so is a lie. Nothing you say or stand for, Sarah, from your sickening sexual proposal to a Republican donor to your equally vulgar tweet to Mitt Romney, has the slightest thing to do with the most basic of tenets which Judaism has taught the world – that the monogamous relationship is the most meaningful one and that a happy marriage is the key to wholesomeness. You are driven. You are passionate. I pray that you channel your drive and direct your passion to something positive, something that will make you a better and more positive person, something that will allow you to touch eternity and truly impact the world forever. I pray that you pursue marriage and, if you are so blessed, raise children. Marriage and children will change the way you see the world. It will allow you to appreciate the stability that Judaism, the religion of your ancestors, espouses. And it will allow you to understand and appreciate the traditional lifestyle’s peace, security, and respect for human dignity – things you have spent your life, so far, undermining.
From the comment section for the Rabbi's open letter:
Donald Silverman · Subscribe · UNH · 107 subscribers Hey asshole: Daughter #1 is a rabbi. Not by your standards. She's reform. How dare she, a lowly woman think god wants her to be a rabbi, created from a mere rib. Her hubby, three times nominated for a nobel peace prize was listed by the Jerusalem Post as the 49th most influential jew in the world built the worlds largest solar field in israel. By the way, Sarah was also on the list. I missed your name. Oldest granddaughter is serving in the Israel Defense Forces. I'm sure you also served.Oh I forgot the orthodox don't do that. You don't fuck with my family.
Reply · 752 · Like · October 13 at 8:43am
When McGovern was nominated a reporter asked him what would be his first act were he to be elected president of the United States. Missing no beat the senator wryly said, “I’ll establish diplomatic relations with the Pentagon.”
File photo by Tom Dempster, (Sioux Falls, S.D. )Argus Leader
Chairman O’Brien, Chairwoman Burke, Senator Kennedy, Senator Eagleton and my fellow citizens, I’m happy to join us for this benediction of our Friday sunrise service.
I assume that everyone here is impressed with my control of this Convention in that my choice for Vice President was challenged by only 39 other nominees.
And I can tell you that Eleanor is very grateful that the Oregon delegation at least kept her in the race with Martha Mitchell. So I congratulate you on your patience and I pay my respects to those two superb presiding officers of this convention, Larry O’Brien and Yvonne Braithwaite Burke.
So tonight I accept your nomination with a full and grateful heart.
This afternoon I crossed the wide Missouri to recommend a running mate of wide vision and deep compassion, Senator Tom Eagleton.
I’m proud to have him at my side, and I’m proud to have been introduced a moment ago by one of the most eloquent and courageous voices in this land Senator Ted Kennedy.
My nomination is all the more precious and that it is a gift of the most open political process in all of our political history.
It is the sweet harvest of the work of tens of thousands of tireless volunteers, young and old alike, funded by literally hundreds of thousands of small contributors in every part of this nation.
Those who lingered on the brink of despair only a short time ago have been brought into this campaign, heart, hand, head and soul, and I have been the beneficiary of the most remarkable political organization in the history of this country.
It is an organization that gives dramatic proof to the power of love and to a faith that can literally move mountains.
As Yeats put it, “Count where man’s glory most begins and ends, and say: My glory was I had such friends.”
This is the people’s nomination and next January we will restore the government to the people of this country.
I believe that American politics will never be quite the same again.
We are entering a new period of important and hopeful change in America, a period comparable to those eras that unleashed such remarkable ferment in the period of Jefferson and Jackson and Roosevelt.
Let the opposition collect their $10 million in secret money from the privileged few and let us find one million ordinary Americans who will contribute $25 each to this campaign, a Million Member Club with members who will not expect special favors for themselves but a better land for us all.
In the literature and music of our children we are told, to everything there is a season and a time to every purpose under heaven. And for America, the time has come at last.
This is the time for truth, not falsehood. In a Democratic nation, no one likes to say that his inspiration came from secret arrangements by closed doors, but in the sense that is how my candidacy began. I am here as your candidate tonight in large part because during four administrations of both parties, a terrible war has been chartered behind closed doors.
I want those doors opened and I want that war closed. And I make these pledges above all others: the doors of government will be opened, and that war will be closed.
Truth is a habit of integrity, not a strategy of politics, and if we nurture the habit of truth in this campaign, we will continue to be truthful once we are in the White House.
Let us say to Americans, as Woodrow Wilson said in his first campaign of 1912, “Let me inside the government and I will tell you what is going on there.”
Wilson believed, and I believe, that the destiny of America is always safer in the hands of the people then in the conference rooms of any elite.
So let us give our – let us give your country the chance to elect a Government that will seek and speak the truth, for this is the time for the truth in the life of this country.
And this is also a time, not for death, but for life. In 1968 many Americans thought they were voting to bring our sons home from Vietnam in peace, and since then 20,000 of our sons have come home in coffins.
I have no secret plan for peace. I have a public plan. And as one whose heart has ached for the past ten years over the agony of Vietnam, I will halt a senseless bombing of Indochina on Inaugural Day.
There will be no more Asian children running ablaze from bombed-out schools. There will be no more talk of bombing the dikes or the cities of the North.
And within 90 days of my inauguration, every American soldier and every American prisoner will be out of the jungle and out of their cells and then home in America where they belong.
And then let us resolve that never again will we send the precious young blood of this country to die trying to prop up a corrupt military dictatorship abroad.
This is also the time to turn away from excessive preoccupation overseas to the rebuilding of our own nation. America must be restored to a proper role in the world. But we can do that only through the recovery of confidence in ourselves.
I treasure this nomination, especially because it comes after vigorous competition with the ablest men and women our party has to offer.
-- my old and treasured friend and neighbor, Hubert Humphrey;
-- a gracious and a good man from the state of Maine, Ed Muskie;
-- a tough fighter for his own convictions, Scoop Jackson of Washington;
-- and a brave and spirited woman, Shirley Chisholm;
-- a wise and effective lawmaker from Arkansas, Wilbur Mills;
-- And the man from North Carolina who over the years has opened new vistas in education and public excellence, Terry Sanford;
-- the leader who in 1968 combined both the travail and the hope of the American spirit, Senator Eugene McCarthy;
-- And I was as moved as well by the appearance in the Convention Hall of the Governor of Alabama, George Wallace. His votes in the primaries showed clearly the depth of discontent in this country, and his courage in the face of pain and adversity is the mark of a man of boundless will, despite the senseless act that disrupted his campaign. And, Governor, we pray for your full recovery so you can stand up and speak out for all of those who see you as their champion.
Now, in the months ahead I deeply covet the help of every Democrat, of every Republican, of every Independent who wants this country to be a great and good land that it can be.
This is going to be a national campaign, carried to every part of the nation -- North, South, East and West. We’re not conceding a single state to Richard Nixon.
I should like to say to my friend, Frank King, that Ohio may have passed a few times in this convention, but Tom Eagleton and I are not going to pass Ohio.
I shall say to Governor Gilligan, Ohio is sometimes a little slow in counting the votes, but when those votes are counted next November, Ohio will be in the Democratic victory column.
Now, to anyone in this hall or beyond who doubts the ability of Democrats to join together in common cause, I say never underestimate the power of Richard Nixon to bring harmony to Democratic ranks. He is the unwitting unifier and the fundamental issue of this national campaign and all of us are going to help him redeem a pledge made ten years ago -- that next year you won’t have Richard Nixon to kick around anymore.
We have had our fury and our frustrations in these past months and at this Convention, but frankly, I welcome the contrast with the smug and dull and empty event which will doubtless take place here in Miami next month.
We chose this struggle, we reformed our Party, and we let the people in. So we stand today not as a collection of backroom strategies, not as a tool of ITT or any other special interest. So let our opponents stand on the status quo while we seek to refresh the American spirit.
I believe that the greatest contribution America can now make to our fellow mortals is to heal our own great but very deeply troubled land. We must respond -- we must respond to that ancient command: “Physician, heal thyself.”
Now, it is necessary in an age of nuclear power and hostile forces that we’ll be militarily strong. America must never become a second-rate nation. As one who has tasted the bitter fruits of our weakness before Pearl Harbor in 1941, I give you my pledge that if I become the President of the United States, America will keep its defenses alert and fully sufficient to meet any danger.
We will do that not only for ourselves, but for those who deserve and need the shield of our strength -- our old allies in Europe and elsewhere, including the people of Israel who will always have our help to hold their Promised Land.
Yet I believe that every man and woman in this Convention Hall knows that for 30 years we have been so absorbed with fear and danger from abroad that we have permitted our own house to fall into disarray.
We must now show that peace and prosperity can exist side by side. Indeed, each now depends on the existence of the other. National strength includes the credibility of our system in the eyes of our own people as well as the credibility of our deterrent in the eyes of others abroad.
National security includes schools for our children as well as silos for our missiles.
It includes the health of our families as much as the size of our bombs, the safety of our streets, and the condition of our cities, and not just the engines of war.
If we some day choke on the pollution of our own air, there will be little consolation in leaving behind a dying continent ringed with steel.
So while protecting ourselves abroad, let us form a more perfect union here at home. And this is the time for that task.
We must also make this a time of justice and jobs for all our people. For more than three and half years we have tolerated stagnation and a rising level of joblessness, with more than five million of our best workers unemployed at this very moment. Surely, this is the most false and wasteful economics of all.
Our deep need is not for idleness but for new housing and hospitals, for facilities to combat pollution and take us home from work, for better products able to compete on vigorous world markets.
The highest single domestic priority of the next administration will be to ensure that every American able to work has a job to.
That job guarantee will and must depend on a reinvigorated private economy, freed at last from the uncertainties and burdens of war, but it is our firm commitment that whatever employment the private sector does not provide, the Federal government will either stimulate or provide itself.
Whatever it takes, this country is going back to work. America cannot exist with most of our people working and paying taxes to support too many others mired in a demeaning and hopeless welfare mess.
Therefore, we intend to begin by putting millions back to work and after that is done, we will assure to those unable to work an income fully adequate to a decent life.
Now beyond this, a program to put America back to work demands that work be properly rewarded. That means the end of a system of economic controls in which labor is depressed, but prices and corporate profit run sky-high.
It means a system of national health insurance so that a worker can afford decent health care for himself and his family.
It means real enforcement of the laws so that the drug racketeers are put behind bars and our streets are once again safe for our families.
And above all, above all, honest work must be rewarded by a fair and just tax system.
The tax system today does not reward hard work: it’s penalizes it. Inherited or invested wealth frequently multiplies itself while paying no taxes at all. But wages on the assembly line or in farming the land, these hard – earned dollars are taxed to the very last penny.
There is a depletion allowance for oil wells, but no depletion for the farmer who feeds us, or the worker who serves as all.
The administration tells us that we should not discuss tax reform and the election year. They would prefer to keep all discussion of the tax laws in closed rooms where the administration, its powerful friends, and their paid lobbyists, can turn every effort at reform into a new loophole for the rich and powerful.
But an election year is the people’s year to speak, and this year, the people are going to ensure that the tax system is changed so that work is rewarded and so that those who derive the highest benefits will pay their fair share rather than slipping through the loopholes at the expense of the rest of us.
So let us stand for justice and jobs and against special privilege.
And this is the time to stand for those things that are close to the American spirit. We are not content with things as they are. We reject the view of those who say, “America -- love it or leave it. “ We reply, ”Let us change it so we may love it the more.”
And this is the time. It is the time for this land to become again a witness to the world for what is just and noble in human affairs. It is time to live more with faith and less with fear, with an abiding confidence that can sweep away the strongest barriers between us and teach us that we are truly brothers and sisters.
So join with me in this campaign. Lend Senator Eagleton and me your strength and your support, and together we will call America home to the ideals that nourished us from the beginning.
From secrecy and deception in high places; come home, America
From military spending so wasteful that it weakens our nation; come home, America.
From the entrenchment of special privileges in tax favoritism; from the waste of idle lands to the joy of useful labor; from the prejudice based on race and sex; from the loneliness of the aging poor and the despair of the neglected sick -- come home, America.
Come home to the affirmation that we have a dream. Come home to the conviction that we can move our country forward.
Come home to the belief that we can seek a newer world, and let us be joyful in that homecoming, for this “is your land, this land is my land -- from California to New York island, from the redwood forest to the gulf stream waters -- this land was made for you and me.”
So let us close on this note: May God grant each one of us the wisdom to cherish this good land and to meet the great challenge that beckons us home.
Hey guys. Hope everybody's having a good weekend. We've been watching some things closely over last few days, concerned but not jumping to any conclusions. Last night and this morning we noticed some things and have been trying to figure out if its from the anti-seizure meds, low sodium, too much Taurine (I know, same stuff in Monster drink is in his Peptamen!!!) or what. Early this morning he was hiccuping and doing this thing with his mouth that he also did before seizure on the hem/onc floor before we ended up in PICU. We were this close to running him to ER. He thought he was in KY (grandpa and grandma's house) and was jumbling his words horribly. We were pretty freaked out. Yesterday, the meds zonked him out so bad, Eliz and I were discussing what we could do different to help him. Being too tired to talk is not an acceptable QOL (IE, change meds). When my son is too tired to even talk about Legos there is a problem. He just woke up and is acting fine. Although we haven't given him the VimPat or Keppra yet. Last night he got way worse AFTER giving his meds. Going to give them now. If we give them he could start seizing. If we don't (we always have per doctors orders) he could start seizing. Heck, the PI says these anti-seizure meds can cause seizures and seizure like s/e's. we just want him well. Like he was several days ago. There has been a slow decline over last few days. Somnolence and cognitive deficits. Please pray. Thank you.
Though it makes me nervous to do so, and is clearly beyond the scope of what I can actually know, I want to reiterate my comprehension of Nick and Elizabeth's understanding of their son's situation. I don't know them. All I know is what I read,
They know, the three of them, that he won't survive this recurrence of an aggressive brain and spine cancer.
They are fervent Christians, but normal people, parents to a dying, precocious child. There is dissonance.
They all want more time, but are aware of Quality of Life (QOL) issues, though there is a natural shifting of sand meeting water, there is a tide at work.
They are not being cruel by trying every thing they can think of, and all of it has the Joey Seal of Approval. I've no doubt, not one bit, that were Joey to say "stop," they will stop. The saddest, and probable, scenario is that he slips into some form of comatose state, as in this last crisis. Then, I hope, the doctors they have come to trust will guide them to letting him go.
I've no right to write these things... but I am, I have, and if it offends you, well... move along.
UPDATE 10/21/2012, 8 PM:
Saw some new symptoms. 3 hrs ago we made it up to I70 (headed to Riley) and talked ourselves out of it. Saw some new symptoms w/in last hour that really concerned us, we're at ER now. Promised I'd keep praying folks up to date. We sure appreciate it. Waiting to see ER doc.
In the Senate chamber, George McGovern stood to promote a bill co-sponsored by Mark Hatfield of Oregon to stop the funding of the American war in Vietnam. He wanted to start bringing American troops home.
September 1, 1970
Mr. President, the vote we are about to cast could be one of the most significant votes Senators will ever cast. I have lived with this vote night and day since last April 30 - the day before the Cambodian invasion - the day this amendment was first submitted. I thank God this amendment was submitted when it was, because as every Senator knows, in the turbulent days following the invasion of Cambodia and the tragedy at Kent State University, this amendment gave a constructive rallying point to millions of anguished citizens across this war-weary land. I believe that, along with the Cooper-Church amendment, the pending amendment helped to keep the Nation from exploding this summer. It was the lode-star that inspired more mail, more telegrams, more eager young visitors to our offices, more political action, and more contributions from doctors, lawyers, workers, and housewives than any other initiative of Congress in this summer of discontent. Now this question is about to be resolved. What is the choice it presents us? It presents us with an opportunity to end a war we never should have entered. It presents us with an opportunity to revitalize constitutional government in America by restoring the war powers the Founding Fathers obliged the Congress to carry. It gives us an opportunity to correct the drift toward one-man rule in the crucial areas of war and peace. All my life, I have heard Republicans and conservative Democrats complaining about the growth of centralized power in the Federal executive. Vietnam and Cambodia have convinced me that the conservatives were right. Do they really believe their own rhetoric? We have permitted the war power which the authors of the Constitution wisely gave to us as the people's representatives to slip out of our hands until it now resides behind closed doors at the State Department, the CIA, the Pentagon, and the basement of the White House. We have foolishly assumed that war was too complicated to be trusted to the people's forum - the Congress of the United States. The result has been the cruelest, the most barbaric, and the most stupid war in our national history. Every Senator in this Chamber is partly responsible for sending 50,000 young Americans to an early grave. This Chamber reeks of blood. Every Senator here is partly responsible for that human wreckage at Walter Reed and Bethesda Naval and all across our land - young men without legs, or arms, or genitals, or faces, or hopes. There are not very many of those blasted and broken boys who think this war is a glorious venture. Do not talk to them about bugging out, or national honor, or courage. It does not take any courage at all for a Congressman or a Senator or a President to wrap himself in the flag and say we are staying in Vietnam, because it is not our blood that is being shed. But we are responsible for those young men and their lives and their hopes. And if we do not end this damnable war, those young men will some day curse us for our pitiful willingness to let the Executive carry the burden that the Constitution places on us. So before we vote, let us ponder the admonition of Edmund Burke, the great parliamentarian of an earlier day: A conscientious man would be cautious how he dealt in blood.
