Canada revisits an old quandary, assisted suicide, in case of dying 63-year-old

To be clear, though, the story that appears in the article about the father who suffocated and killed his 12-year-old quadriplegic daughter because of her condition is not physician-assisted suicide; that’s murder (actually, I think that story’s inclusion is the piece is reckless, irresponsible reporting that does a great disservice to the public by confounding the issue in an effort to be provocative).

There’s a difference between allowing mentally competent, terminal patients (as classified by physicians and psychologists, just like Oregon’s DWD Act) to end their lives voluntarily and in a peaceful, dignified manner of their choosing versus suffocating people with disabilities using exhaust from a car.  The former affords respect and dignity to people who want to die on their own terms; the latter is, quite simply, homicide.

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In relation to a previous post of mine, which appeared on Dan Ariely’s blog, a recent article in the Washington Post:

Canada woman pursues doctor-assisted suicide with plea before court

Of particular note:

“I must make this very clear: I do not want to die,” she said. “I want to live every day that I can to the fullest, one day at a time. What I do not want is to die an agonizing, slow, difficult, unpleasant, undignified death.”

The woman suffers from Lou Gehrig’s disease, which damages the neuromuscular system and eventually causes death by suffocation.

There’s a right thing to do here.

Steve Jobs was an idol of mine whose life serves as an inspiration for all of us who seek to innovate in any field.  His words – like those in the following video – are powerful, but his iconoclasm, creativity, and dogged dedication to the perfection of a vision he invented and sought are even more so.  His death  marks the loss of one of the greatest innovators, inventors, managers, and leaders that we were fortunate enough to witness at work.

In a completely unrelated sequence of events, Tommy, Insun and I have enrolled in Duke’s “Senior Bhangra” event where 100+ seniors of all races perform bhangra in the final act of the school’s largest cultural show of the year.  Actually, the story of how we convinced Tommy to join us merits some description.  Insun was game, and I was ready to go, but Tommy storms out of his room in a huff and tells us that “he has too much work.”  Specifically, he is finishing an essay for a medical school application that is due at midnight (it is 4:30pm right now) that is limited to about a page in length.  This frustrates me, since it is common knowledge that the vast majority of Tommy’s “working” involves reading espn.com and clicking the “Random Article” button on Wikipedia to read about totally bizarre subjects (once, I kid you not, I saw him reading an article about ancient Mayan weaponry, and then I saw him read about Vladimir Putin’s childhood – within the same hour).  So I say, “Tommy, there’s no way it takes you six hours to write a page.”  He stubbornly disagrees.

Insun and I silently make a pact to do all we can to convince him to come, so for the next fifteen minutes we assault him with repeated arguments for why he should attend with us.  Tommy parries most of our aggression, but we see him falter and know that victory is near.  I elevate the tone of my voice.  I assume the good cop role, Insun assumes the bad cop.  We speak rapidly.  Tommy’s eyes slide out of focus, and he begins shaking his head and massaging his temples and paces.  Finally, he cracks.  ”Goddammiti’mgoingtokillyouboth.”  (See “Tommyyoushouldgetarat.”)

We arrive.  I don’t know if you’ve ever been in a dance studio, but for some god forsaken reason they surround you with mirrors at all four sides so you are constantly reminded how awkward you look.  The choreographer begins directing us from up front.  One of the steps involves (forgive the description) moving one’s arms out in front as if an over-sized beach ball is in one’s grasp while simultaneously kicking one’s feet in an alternating fashion.  There is a graceful way to do it, and after a few minutes I had it down pat, and then I looked at Tommy.  Tommy has this dazed look on his face and is hopping aimlessly across our side of the room while moving his hands in front of him as if he’s trying to create a tornado.  He turns to me and says, “I need to be shitfaced to do this.”

Later, we are asked to rotate our hands in a clockwise fashion while kicking and then a counterclockwise fashion while kicking again.  This step requires some coordination.  I look over at Tommy, who is sweating profusely and muttering angrily under his breath.  Insun is not faring any better.  Insun says, “the amount of mental dexterity you need for this step is absurd.”  To my right, Tommy mutters, “I can f***ing solve Schrodinger’s equation, but I can’t rotate my f***ing hands back and forth.”

To both of their credit, towards the end of the hour, we had the steps down pretty well and are set to stun audiences far and wide with our agility and grace.  But it occurred to me that I might, in my future, try to turn to dancing lessons in a misguided effort to “meet people.”  A mental note to myself – don’t.  At least, don’t go with a group of guys.  Frustrations mount quickly, and the girls don’t mingle with you – they just aggregate in the front and giggle to themselves anyway.  Loathe.

Friday rolls around and Amrita is leaving for Colombia.  I’m on the phone with her saying goodbye and wishing her a good trip while walking toward my car which is parked in a lot on campus.  I plop in the car (which is of course 102 degrees F at the time) and…it won’t start.  This has been happening for a while, and usually if I let it sit for like 30 minutes it fixes itself.  I wait and I wait — and finally, 30 minutes later, it starts.  Relieved, I begin to reverse out of the slot when…it stalls.  And it won’t turn on again.  Now, ordinarily I would try to put it into neutral to at least roll it out of the way, but (don’t laugh at me) I can’t figure out how to put the car in neutral.  So I have to head back up to the office I was in while I plot my next move.  A picture to show how ridiculous this was:

That is literally exactly where I left this car for upwards of an hour.  In the MIDDLE of the parking lot, with windows rolled down, no less.  People had to squeeze by me and another car to get out, and the poor guy in green parked in front of me would have no chance of leaving until much after that.

The worst is yet to come…an hour later, the car starts and I try to drive it home where I figure I can spend some more time figuring out what’s wrong.  And it stalls.  This time, it’s in the middle of a busy, rush-hour-traffic road in front of the Duke hospital.  People are yelling and honking everywhere.  I am trying to coordinate a tow truck and a repair shop on my phone which is malfunctioning because the sweat that is pouring on the screen from my face is messing with the capacitance.  And I still can’t figure out how to get it into neutral.  Awesome.  Some random guy comes up to me after 20 minutes and asks if I need help rolling my car out of the way, to which I respond “I would, but I don’t know how to put this car into neutral.”  FML.

Twenty minutes later, a tow truck comes by and takes me to safety.  He of course figures out instantly how to put the car into neutral.  We hop into his truck and begin driving to the repair shop — he knows where it is because it’s near a Papa Johns that he apparently frequents.  A weekend and a new crankshaft position sensor later, the car is now in fine working order.  Picked it up this morning, and it brightened my day.

In the meanwhile, work was not going as well as originally planned over the past couple of days either.  I am building what I consider to be an immensely complicated device by which to artificially ventilate mice and rats with special gasses that require special handling.  I’m building this from a schematic but with a few changes, so it’s dramatically easier than it ordinarily would be, but still, for someone with literally no electronic / pneumatic / major engineering experience, I’m left wondering where the chemistry set is and why I’m stuck in BME hell.  I struggle through it, and this morning, I hook it up, only to discover that I keep blowing my circuit’s fuse.  I have a short circuit somewhere.  In the words of John, a co-worker, “that sucks.”  To give you an idea of what we’re talking about here:

This is the inside of the box that I have built.  So I’m not too excited about finding the leak in the circuit.  Armed with a multimeter and yogic chants to grant me patience, I spend the ENTIRE day fiddling around with the beast, listening for irritating beeps from the multimeter, taking things apart, putting them back together, and eyeing the nearby sledgehammer.

Anyhow, like I said earlier, it all ended well; it works now, and I’m super proud of myself.  I’ve posted a few pictures of the thing below to gloat a bit, hope you don’t mind.  I’m trying it out on an animal tomorrow, after which I’m sure I’ll have a host of new issues, but for now, I celebrate my ventilator.

We’re not applauding your entrance.  We just can’t see you through the thicket of gnats that have swarmed our apartment, and so we’re trying to kill a few in our eyesight to be able to make visual contact with you.  In the interests of “being healthy,” we have a fruit basket on our kitchen bar that we keep well-stocked with bananas, watermelon, pineapple, and apples.  The gnats help themselves and have assumed that the food laid out for them is also an invitation to take up residence in our beds, bathrooms, and studies.  It’s gotten pretty bad.

Somewhere in the middle of running around the apartment with an open plastic grocery bag to try and net a few, we decided to step up our game and employ our collective genius to genocide the beasts.  As we speak, there is a ziplock bag with a half a banana inside with holes punched in it – the idea is the gnats will fly into the bag but then will not be able to find their way out.  We have also set up a bowl of vinegar – which they for some reason like, the savages – but we have poured detergent in it.  The detergent destroys the surface tension of the liquid, so when the gnats land…they drown.

Current gnat count:  13

I was visiting home one weekend and we decided to go out to see a movie together as a family since this basically never gets to happen anymore.  I should take the time to define “we:” the collective family included me, my sister, mom, dad, and grandfather.  We go out to a great mexican dinner – somewhere in Reston, maybe? I don’t recall exactly – and we discuss what movie we want to go see.  Mom enthusiastically recommends “Black Swan” on the basis that it was critically acclaimed by the Washington Post (more on this later…you’re not off the hook, Ann Hornday).  They called it a “psychological thriller,” and mom is a big fan of these movies.  Come to think of it, so am I.  I text a friend of mine, Bethany, about the choice because I remember that she saw it and said it was a pretty weird flick.  Her response:

“With who?”

Me:  ”The fam”

“NOOOOOOOO DO NOT DO IT.  IT HAS A GRAPHIC SEX SCENE IN IT.  DO NOT SEE IT WITH YOUR FAMILY.”

I relay this information to the rest of the group, and there’s some hesitation but unfortunately there’s no real other option on the table at this point.  Dad’s famous last words were “we can handle it; we’re all adults here.”  So against my better judgement, we buy our tickets and walk in.

For those of you who have not seen it:  it’s a whackjob movie from start to finish.  It’s all about ballet – which I know absolutely nothing about, granted – but the sort of culture they portray is rich with women with no self-esteem and who took their dad’s calling them “princess” a little bit too far.  So now they’re stuck in this sort of wonderland where it matters a great deal who the “studio maestro” chooses to be the next show’s diva, sort of in the style of Simon Cowell but way more douchy.  As far as I can tell they all live in dire poverty anyhow since the studio relies on donations from society’s most pompous.  The movie is pretty accurately described here.  Regardless, the movie centers around a lesbian sex scene between Natalie Portman and Mila Kunis and then some sort of dance at the end.  I’m actually not quite sure:  let me explain.

We get partway through the movie – right around the place where Natalie tries to masturbate or something, again I sort of missed that whole theme – and my Grandfather storms out in a huff.  Maybe he’s going to the bathroom?  Then my dad gets a text.  ”We’re leaving.  Now.”  So dad pulls mom out too, and my sister and I think they might be reacting badly to the mexican food we had earlier (old people’s stomachs, you know – easily upset).  5 minutes later, my sister get’s a text:  we are to leave the theatre immediately.  I’m still waiting for Mila Kunis to take her top off, so I try to brush it off like I’m actually interested in the art or whatnot and claim that I want to watch the movie now that we’re here, but Priya is pinching my arm pretty hard now and I figure I should leave.

There’s a little council of elders going on outside the theatre door.  My grandfather is livid, my dad is sheepish, and I’m looking over my shoulder to try and catch a little Mila Kunis.  My grandfather asks – no, demands - that my father get the money for the tickets back since we are so disappointed with this film (we’re actually successful, believe it or not).  As we are leaving, my grandfather turns to me and says, “I’m disappointed that you didn’t leave on your own.  What a bukvas (trashy) movie!”

Thank god I didn’t have to endure the actual sex scene – my grandfather would have lit the place on fire.

Physician-Assisted Suicide and Behavioral Economics

by Arjun Khanna

As the American population ages, the debate about the ethics of physician-assisted suicide for terminal patients becomes more important.

Proponents of legalizing of physician-assisted suicide argue the practice is ethically justifiable because it can alleviate prolonged physical and emotional suffering associated with debilitating terminal illness.  Opponents claim that legally sanctioned lethal prescriptions might destroy any remaining desire to continue living – a sign of society having “given up” on the patient.

Ultimately, these arguments rest on differing opinions regarding the effect of this policy on the patient’s wellbeing.  The challenge, then, is to determine how legalization of physician-assisted suicide would affect the wellbeing of terminally ill patients and their medical decision-making.

Outside of philosophical arguments, examination of an interesting finding regarding physician-assisted suicide – know as “The Oregon Paradox” – can add an interesting dimension to the debate.  The paradox is the finding that when terminal patients in Oregon receive lethal medication (under Oregon’s Death with Dignity Act), they often feel a sense of greater wellbeing and a desire to live longer.  In 2010, of 96 patients requested lethal medication, only 61 actually took it. Even more interesting are the many anecdotal accounts of terminal patients, upon receiving lethal medication, that feel a surge of wellbeing and a desire to persevere through their illness.

Why is this this the case?  Looking at this question from an expected-utility perspective suggests that given the option to terminate their own life, terminal patients will decide how long they want to live by comparing the value they expect to gain from the rest of their lives to the expected intensity of their suffering.  At the point where future utility is expected to be negative – that is, when the patient’s condition becomes so intolerable that living any longer is not worth the cost – the patient would choose to end life if the option were available.

The critical point from this perspective is that patients choose the amount of time they are willing to continue living with their illness, which will depend how quickly they deteriorate.  If the rate of deterioration is slower than expected, then patients should delay terminating their lives; if the rate of deterioration is faster than expected, patients should desire to end their lives quicker.

But now let us say that patients have been prescribed lethal medication and have the option of ending their lives at any point of their choosing.  As before, patients don’t want to choose a time too soon or too distant, but with the power to control the end of their lives they no longer have a reason to err on the side of haste!  The patients can now wake up every day with the comfort of knowing that they do not have to suffer through pain or stress they might find intolerable.

Being given the option to determine the time of our own death can transform patients from powerless victims of their illness to willing survivors of it. Together, the importance of feeling in control and the ability to reduce (but not eliminate) uncertainty about rate of deterioration adds an interesting new dimension to the underlying ethical debate and seems to provide credence to the benefits of legalized physician-assisted suicide.

It is clear is that we need a greater understanding of the decision-making of patients at the end of their lives, and that with this improved understanding we can construct policy to better protect their wellbeing (for an interesting recent movie on this topic see “How to Die in Oregon”).

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References:

Lee, Li Way, 2010.  “The Oregon Paradox” Journal of Socio-Economics.  39(2):204-208.

Turman, S.A., 2007.  The Best Way to Say Goodbye:  A Legal Peaceful Choice at the End of       Life.  Life Transitions Publications.

Submitted this in ECON 197:  ”Behavioral Economics” with Professor Dan Ariely in Spring 2011.

I love our President.

Check out the pictures he did release.

They have this dog – her name is Ruthy.  It’s quite a nice-looking beast; an energetic, cute, golden retriever.  On this inside, however, this dog is a homicidal maniac.  It has not taken kindly to me.  It is a radical feminist and loathes all new men.  I’m fairly certain this dog burns bras.  I’ve hung out with this dog’s family for quite some time now, and it doesn’t just bark at me – it growls and howls madly whenever I come near it.  While it dislikes Bethany as well, it has reserved a special spot in its heart for me that is full of hatred and malice.

We were just getting to warm up to it – when I say that, I mean that it had for the time being stopped going nuts whenever I approached it – when the owners left for vacation.  Yesterday, when we walk up to the house, the dog senses our arrival and predictably starts going mad.  While it was uncomfortable with us when its owners were around, it is even more petrified of our presence when it is home alone.  To be fair, if I were a dog whose owners were a quaint family of four and I was expecting them to arrive home one night but instead was treated to people of an entirely different color, I would be a little alarmed too.  But Ruthy decided to take it to a whole new level, bark madly, and hide under tables and chairs.

At this point, I’m beyond making friends with the beast and all I want to do is feed the thing and get my ass out of there.  The problem is that Ruthy has decided to hide herself somewhere in the dark house where she is plotting her next move which undoubtably ends in my death.  We lay out her food as loudly as we can, hoping to attract the animal to her bowl of food.  No effect.  We have to go find her, but the problem is that she is in her own territory now.  She knows the lay of the land; we, sadly, do not.

But I have played my fair share of Starcraft.  I, too, know how to wage war.  The tactics of unfamiliar territory are difficult, yes, but the application of simple strategy can be effective in vanquishing the enemy.  First – you must carefully select your weapon.  There is only one that will be effective in quelling the dog’s attack – doggy biscuits.  We head over to the biscuit bowl and arm up.  Each of us laden with about 10 biscuits, Bethany and I plan our route of attack.  We carefully inch up the stairs.  I toss a biscuit up at the top step, hoping to lure the dog out into plain view.  Nothing happens.  The house is eerily quiet.  We creep into each room.  For some reason, all of the fans are on.  Clearly, this house is haunted, or Ruthy has been turning on all of the fans.

Anyway, fast forward sixty (60) minutes, and we’re back in the kitchen where we started and still dogless.  We eventually find her hiding under the dining room table and still very much our enemy.  We bring the food bowl to this room and slide it toward her with a stick.  She eats, and we discuss how to overcome this problem that the dog hates us.  If you still cannot sympathize with our plight, consider babysitting for a child who actively plots your death.  I suggest to Bethany that we make use of drugs to calm Ruthy down.  We are on our way out when Bethany picks up Ruthy’s leash to get to her shoes, which are underneath it.  Suddenly, Ruthy comes bounding toward us.  I shriek in terror, but as it turns out Ruthy’s tail is wagging madly.  She likes walks.  Crisis averted!  We take Ruthy for a walk, and we become the best of friends.

…Bethany tells me her name is actually Rosy.  Oh.

• The entire concept of the modern novel sprung out of three words:  Character Is Destiny.
• The dog barked incessantly.  What he was saying was: “Please, open up the universe a little.”
• You cannot push the boundaries from the middle of the road.  To push the boundaries,  you must go to the boundary, and you must push.

He talked about how he is disturbed by the slippery slope of “cultural relativism.”  Why is it that we create unique standards by which to make moral judgements of individual societies because of “cultural difference?”  Why is female genital mutilation morally acceptable in some societies because “it’s their culture?”  Why is wearing a hijab and other forms of female oppression acceptable because “it’s their culture?”  He says it stems from a fundamental redefinition of the idea of “respect.”  Respect used to mean that you took someone seriously.  It has now come to mean agreement.  By my extension, then, we feel that the only way to accept other cultures is to agree with them, which is why we create moral double standards and embrace cultural relativism.  It is possible to both respect a culture and disagree with it.  Which is more constructive?  And which is right?

Embarrassingly, I haven’t read any of his work.  But I think I’ve found my next fiction piece to read!