“…any man’s death diminishes me, because I am involved in mankind.  And therefore never send to know for whom the bell tolls; it tolls for thee”  (John Donne)

“Pneumonia is the friend of the elderly.”

“That’s what Meredith says happened to her mother. Though she received $40,000 worth of care in her last two months of life, not one of her 25 doctors sat down with Dorothy Glas and her family and discussed how she wanted to die.”

If Islamic terrorists shot down a plane with 400 people on board, we would have the country’s airspace shut down, fighter jets guarding our airspace, and the economy would suffer a huge blow.  Since June, that many women have died at the hands of a man they knew.  Not much outrage.  Since early August, that many children have died because of firearms. No outrage.

As I write, Ebola, with a death toll of 1 in the US, has caused pilots not to show up to fly, schools to close, and people to buy biohazard suits.  This is the “home of the brave”? The facts: at the time of writing, the 3-week quarantine for people who treated the index case in the emergency room has quietly ended. No other cases have occurred.  Ebola has dominated the news, with a large number of articles, posts, political cartoons, demands to “do something,” stop all travel with West Africa, which is a large area, most of which is not infected with Ebola.  It is worth looking at a map of Africa some time.  The continent is 50% larger than North America.  Two thousand languages are spoken.  Worrying about “West Africa” is like worrying in Portland, Maine for a problem in Atlanta.

I am not getting to my point soon enough.  Twenty thousand people a year commit suicide in the US using firearms.  I am not talking about murders, which are about eleven thousand.  But hey, to misquote Stalin, a single death is a tragedy and a million are a statistic. We tolerate similar carnage on our highways.  A young couple and their 7-month old died on US 20 the other day near Santiam Pass following a collision with a larger vehicle. It wasn’t Ebola, so there was no outcry.  But they are still dead.  There is no way we can prevent all these deaths, but we ought to do better.  Seventy-three thousand people go to emergency departments with gunshot wounds (GSWs) every year.  The current congressional representative from Tucson, Ron Barber, whom I know, walks with a limp, for he was shot at the “Tucson Massacre” in 2011, where his predecessor, Gabby Giffords, whom I also know, was severely injured by a GSW through the parietal lobe.  Her remarkable recovery, sadly incomplete, is inspiring.  A crazy man with a gun did that.

Ron has to campaign supporting the Second Amendment, even though he was a casualty of the fact that the Second Amendment apparently has no limits in the US, at least if one wishes to get elected.

Fact: the number of homicides per 100,000 people has fallen 50% since 1993.  This, however, has not been the case with suicides. Many of us think gun violence has increased.  It hasn’t.  It is still too high.  One is too high.  Suicide is the 10th leading cause of death, and firearm use in suicides accounts for more than sixty per cent of all firearm deaths.  Firearm deaths are a public health issue far exceeding Ebola, four times that of ALS, and fifty times that of Cystic Fibrosis.

Why would the NRA, therefore, through its influence in the Senate, try to block a Surgeon General’s nomination, who believes that firearm violence is a major public health issue?  Isn’t it? If a death from Ebola is major, what about twenty thousand a year from firearm suicides?  Is that not a public health issue?  Sure, a determined person who wants to die will find a way, but many suicides can be prevented.  We know this. The availability of firearms makes suicide a lot easier.  What about homicides, especially the women who die from being murdered by their husbands or boyfriends?  Why do we panic over Ebola but are so silent when it comes to men killing women and people killing themselves with firearms?

Come to think of it, on 60 Minutes, a doctor expressed outrage at Oregon’s Death with Dignity Act (DWDA), because he called it assisted suicide.  We call it “hastening” here.  Hey, they use their words, and I will use mine.  The DWDA was voted in twice by Oregon voters, despite political action by the Catholic Church (they should have lost tax-exempt status), upheld by the Supreme Court, and accounted for exactly 112 deaths in Oregon last year. The major reasons people choose hastening is not because of pain, which is still poorly treated, and the Dartmouth physician should be addressing that, but because all are terminal and have had enough. Here are their major reasons:

Losing autonomy  (93%)

Less able to engage in activities making life enjoyable  (89%)

Loss of dignity  (73%)

All 112 were going to die in a few months.  They wanted to choose when and how.  They were not depressed, as was alleged; 2 last year required psychiatric evaluation, and as a neurologist, who diagnosed depression long before the diagnosis was “mainstream,” I have some idea of what I am talking about.  No, these people had enough.  When one stood in front of the mirror one morning, after having lost 40% of his body weight, likened himself to an Auschwitz survivor, he had seen enough.  He knew what was coming, and he wanted to be in control.

Public health issues?  There are many.  Firearms are one, and the NRA is wrong to recommend against a Surgeon General nominee who understands that.  We can easily fix Ebola, and DWDA is what most people want to have an option. If you don’t believe me, volunteer at a nursing home some time, where demented people get their pneumonia treated, so they can go back to the same existence.

Finally, every adult, and let me repeat, every adult, needs a living will.  Young people can be brain damaged from accidents and they can get cancer, too.  Be very clear on what your end of life desires are.  You do have choices.  You can make choices I may not.  That is your right.

I don’t want my pneumonia treated, should I become demented.  It will be my friend.

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  1. steve nash Says:

    Terrific, as always. Keep your ideas in the bazaar!

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