For sure, I believe that by trying to be all things, it has made compromises in other areas. But perhaps the flexibility is a more important than a few advantages here and there. All of the current US planes are also multi role as well, with the exception of dedicated bombers. So any jack of all trades worries also apply to the majority of the planes that have been in service for the last 30 years. It seems like versatility has been the driving factor for upgrades. So it makes sense a new plane would be designed with versatility in mind.

For things like Close Air Support, I would much rather be in the invisible fast plane, than the bullet proof slow plane like the A-10. You've dropped your bombs before the enemy even know you're there, and before the bombs hit the ground, you're 40KMs away, at an altitude where most ground based missile systems can't hit you(even if they can detect you).

Close air support of that nature of course only happens when you have reached full air superiority, which the F-35 is the best plane for.

It might seem overkill now to have such an advanced plane to drop bombs on people with AK-47's, but you never know how politics can change. Assad might decide to start buying some advanced Russian SAM systems, and that's when a stealth plane will come in handy.

I really thought a Klingon warship was an overkill solution to take down a drone.

There was a lot of posturing from Star Wars fans (from stardestroyer.net, I think) for a long time, with exaggerations about the power of imperial starships. However, some fans have done an extensive (and pretty ridiculous) amount of work to make a lengthy comparison, that, while only as accurate as can be interpreted from the provided material, does come out in strong favor towards Star Trek technology:
http://www.st-v-sw.net/
So yes, NdGT is correct, and really, you don't need to do the extensive research the fans did to confirm that. Logistics in a post-scarcity civilization alone gives a significant advantage.
But this is to be expected. When you have a TV show as focused on science and technology as Star Trek, it will certainly excel.
Meanwhile, Star Wars isn't supposed to be about high end technology. For them the technology is only there to highlight the story. The charm of the Millenium Falcon is not that it's a god-like ship that can mop the floor with everyone else, but that it's some guy's souped up junker that's full of surprises. The Death Star isn't the ultimate weapon, but a weapon of fear. (A weapon that destroys excessive amounts of available resources is impractical for anything else, and that especially includes Starkiller Base.)
And if there really needs to be some sort of sci-fi-peen competition, you can go the complete nonsense route with Doctor Who, where one Dalek could probably conquer both the Trek and Wars universes with minimal effort.
Or the overkill route with the Culture, where wiping the rest out would be an idle task, pursued for entertainment.
Star Wars fans just need to chill and embrace their universe of junkers and quaint technology. Star Trek fans have already embraced the fact that their universe isn't about action and explosions. (No, we don't include the Abramsverse.)

Yeah, like the SEAL said, athletes don't need to be physically prepared for life and death situations 24-hours a day. I mean, that SEAL training ramps up to "hell week" where they basically train 20-hours a day to simulate an extended combat engagement. No athlete needs that level of mental/physical endurance excluding maybe ironman race participants and even then that kind of training is likely overkill.

Three year olds are easily amused, the sculpture was overkill:

I agree the story in your link is overkill, but I called the cops in a similar situation just last year. Two little girls walking down a busy (15-20 cars per minute) rural road, obviously nowhere near home, neither one over 4 or 5 years. Freaked me right out. I wasn't in it to embarrass anyone like the bitch portrayed in your link, but sincerely worried about the kids. When making assumptions in children's welfare, you're never truly wrong dropping to the lowest denominator.

But it's just political show for the masses. Look here, we do something about our shitty police! That's the sad part.
That won't stop cops from showing up with SWAT teams at your house because you didn't pay parking tickets.
The problem isn't being run over with a tank or getting shot to pieces by .50 cal machine guns. Any sensible law enforcement officer working in the US should just know that this is ridiculous overkill. They're not fighting Terminators or Transformers, they're fighting fleshy, squishy humans.
And here's the real problem. They shoot people with handguns and kneel on their throats. They spray you with mace or beat you with sticks. They use somewhat low tech weaponry to cross the lines.
The only field where that military equipment could become a real problem is in mass-protest situations. Just look at the occupy protests. However, teargas, riotgear and batons are still the very effective go-to-solution.

I hope this was done to prevent damage to the powerlines (or similiar).

It's a bird! It'll fly into a freaking window the next day, wasting fuel on that helicopter is overkill.

our Lincoln Marathon is in a few weeks. I imagine a huge knee-jerk reaction and an overkill of security and paranoia will be the result. Almost makes me glad I took this year off.

Oh, man, thank you. THANK YOU. Much much better!

I share the concern over the size of the thumbnail. Seems a little overkill -- hard to tell there any other vids to scroll down to. For the casual dropper-by, they might think it is just that one.

And the demote idea.... I am struggling with that. Don't like the idea of content police. Having said that, there have been times, as @BoneRemake noted, that some pretty sketchy material has been prominently displayed right up front. Maybe have it be like the ban thing? Takes two Sifters to demote back? Plus, that would mean it takes more power points to remove than it does to put it there to start with (unless it was a self promote.) I believe demoting is best done sparingly, and if it is made more "expensive", that would raise the bar.

This is sooo much better. Thank you, thank you!

@radx No problem on the short comment, I do the exact same thing

I find your question hard to address directly because it is a series of things I find kind of complexly contradictory. IE, market forces causing undesirable things, and the lack of market forces because of centralization causing undesirable things. Not to say you are believing in contradictions, but rather it is a complex set of issues that have to be addressed, In that, I was thinking all day how to address these, and decided on an a round about way, talking about neither, but rather the history and evolution as to why it is viewed the way you see it, and if those things are necessarily bad. This might be a bit long in the tooth, and I apologize up front for that.

Firstly, reactors are the second invention of nuclear. While a reactor type creation were the first demonstration of fission by humans (turns out there are natural fission reactors: Oklo in Gabon, Africa ), the first objective was, of course, weapons. Most of the early tech that was researched was aimed at "how to make a bomb, and fast". As a result, after the war was all said and done, those pieces of technology could most quickly be transitioned to reactor tech, even if more qualified pieces of technology were better suited. As a result, nearly all of Americas 104 (or so) reactors are based on light water pressure vessels, the result of mostly Admiral Rickover's decision to use them in the nuclear navy. This technological lock in made the big players bigger in the nuclear field, as they didn't have to do any heavy lifting on R&D, just sell lucrative fuel contracts.

This had some very toxic effects on the overall development of reactor technology. As a result of this lock-in, the NRC is predisposed to only approving technology the resembles 50 year old reactor technology. Most of the fleet is very old, and all might as well be called Rickover Reactors. Reactors which use solid fuel rods, control rods, water under pressure, ect, are approved; even though there are some other very good candidates for reactor R&D and deployment, it simply is beyond the NRCs desire to make those kinds of changes. These barriers to entry can't be understated, only the very rich could ever afford to attempt to approve a new reactor technology, like mutli-billionaire, and still might not get approved it it smells funny (thorium, what the hell is thorium!)! The result is current reactors use mostly the same innards but have larger requirements. Those requirements also change without notice and they are required to comply with more hast than any industry. So if you built a reactor to code, and the wire mesh standards changed mid construction, you have to comply, so tear down the wall and start over unless you can figure out some way to comply. This has had a multiplication effect on costs and construction times. So many times, complications can arise not because it was "over engineered", but that they have had to go super ad-hawk to make it all work due to changes mid construction. Frankly, it is pretty amazing what they have done with reactor technology to stretch it out this long. Even with the setbacks you mention, these rube goldbergian devices still manage to compete with coal in terms of its cost per Kwh, and blow away things like solar and wind on the carbon free front.

As to reactor size LWRs had to be big in the day because of various reasons, mostly licencing. Currently, there are no real ways to do small reactors because all licencing and regulatory framework assumes it is a 1GW power station. All the huge fees and regulatory framework established by these well engineered at the time, but now ancient marvels. So you need an evacuation plan that is X miles wide ( I think it is 10), even if your reactor is fractionally as large. In other words, there is nothing technically keeping reactors large. I actually would like to see them go more modular, self regulating, and at the point of need. This would simplify transmission greatly and build in a redundancy into the system. It would also potentially open up a huge market to a variety of different small, modular reactors. Currently, though, this is a pipe dream...but a dream well worth having and pushing for.

Also, reactors in the west are pretty safe, if you look at deaths per KWH, even figuring in the worst estimates of Chernobyl, nuclear is one of the best (Chernobyl isn't a western reactor). Even so, safety ratcheting in nuclear safety happens all the time, driving costs and complexity on very old systems up and up with only nominal gains. For instance, there are no computer control systems in a reactor. Each and every gauge is a specific type that is mandated by NRC edict or similar ones abroad (usually very archaic) . This creates a potential for counterfeiter parts and other actions considered foul by many. These edicts do little for safety, most safety comes from proper reactor design, and skillful operation of the plant managers. With plants so expensive, and general costs of power still very competitive, Managers would never want to damage the money output of nuclear reactors. They would very much like to make plant operations a combination of safe, smooth, and affordable. When one of those edges out the other, it tends to find abuses in the real world. If something gets to needlessly costly, managers start looking around for alternatives. Like the DHS, much of nuclear safety is nuclear safety theater...so to a certain extent, some of the abuses don't account for any real significant increase in risk. This isn't always the case, but it has to be evaluated case by case, and for the layperson, this isn't usually something that will be done.

This combination of unwillingness to invest in new reactor technology, higher demands from reactors in general, and a single minded focus on safety, (several NRC chairmen have been decidedly anti-nuclear, that is like having the internet czar hate broadband) have stilted true growth in nuclear technology. For instance, cars are not 100% safe. It is likely you will know someone that will die in a car wreak in the course of your life. This, however, doesn't cause cars to escalate that drastically in safety features or costs to implement features to drop the death rate to 0. Even though in the US, 10s of thousands die each year in cars, you will not see well meaning people call for arresting foam injection or titanium platted unobtanium body frames, mainly because safety isn't the only point of a car. A car, or a plane, or anything really, has a complicated set of benefits and defects that we have to make hard choices on...choices that don't necessarily have a correct answer. There is a benefit curve where excessive costs don't actually improve safety that much more. If everyone in the USA had to spend 10K more on a car for form injection systems that saved 100 lives in the course of a year, is that worth it? I don't have an answer there as a matter of fact, only opinion. And as the same matter of opinion on reactors, most of their cost, complication, and centralization have to do with the special way in which we treat reactors, not the technology itself. If there was a better regulatory framework, you would see (as we kind of are slowly in the industry despite these things) cheaper, easier to fabricate reactors which are safer by default. Designs that start on a fresh sheet of paper, with the latest and greatest in computer modeling (most current reactors were designed before computer simulations on the internals or externals was even a thing) and materials science. I am routing for the molten salt, thorium reactors, but there are a bunch of other generation4 reactors that are just begging to be built.

Right now, getting the NRC to approve a new reactor design takes millions of dollars, ensuring the big boy will stay around for awhile longer yet. And the regularly framework also ensures whatever reactor gets built, it is big, and that it will use solid fuel, and water coolant, and specific dials and gauges...ect. It would be like the FCC saying the exact innards of what a cellphone should be, it would be kind of maddening to cellphone manufacturers..and you most likely wouldn't have an iPhone in the way we have it today. NRC needs to change for any of the problems you mentioned to be resolved. That is a big obstacle, I am not going to lie, it is unlikely to change anytime soon. But I think the promise of carbon free energy with reliable base-load abilities can't be ignored in this green minded future we want to create.

Any rate, thanks for your feedback, hopefully, that wasn't overkill

@deathcow

If he is only into the anchor and it blows out he goes down. An anchor is typically two or more equalized points of protection.

Given the amount of force he was planning to put on the system my guess/hope is that he was into two bolts (basically permanent) and maybe backed up on some additional pro (temporary protection). Some may consider that overkill as two solid bolts in granite are pretty strong.

Also if the rope fails or is cut he goes down.

Unlike the movies most ropes don't snap or slowly unravel - they typically get cut on a sharp edge or sharp gear (which should have been replaced).

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
Related

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

Meh, I still prefer the way i've been making my own taters.

Peel and quarter them before boiling. Once done, put em through a potato ricer, and then add in butter and garlic powder and blend them with a mixer.

May seem like overkill, but I've gotta say, mashed potatoes are probably my favourite food, and I really hate them when they're lumpy.

>> ^entr0py:

>> ^direpickle:
>> ^CrushBug:
What's the music in this? I used to remember the name.

"Lux Aeterna," from the soundtrack for Requiem for a Dream, by Clint Mansell.

Seems like overkill that someone had to add a coir and symbols. Wasn't it epic enough to begin with? Still, nice montage.


Oh, I missed that. This is actually Requiem for a Tower, then, the version re-done for the Two Towers trailer.