Good morning.....So VoodooV, simply not a good person...

One might imagine that you've mistaken paranoid rage for a genuine concern for the people who must suffer the damaged, soon beyond-repair law-enforcement establishment in the U.S. While I can't vouch for many municipalities, I have dealt with law enforcement in multiple states since I was old enough to drive a car.
Texas has an inordinate amount of assholes in law enforcement, which has sullied or otherwise affected my opinion of peace officers (that term an oxi-moron for millions of people who have had to deal with profiling, unprovoked aggression, and general douche-baggery from the hind-brained, alpha-or-wannabe-alpha victims of abuse and racism who choose a career in "law enforcement".

We have several versions of cops here, Sheriffs, constables, state troopers, city police, game wardens, etc., all with their privilege and jurisdictions, all with varying levels of professionalism and personalities some of which are synonymous with their particular group.
I maintain, that In ALL of these branches of law enforcement due to corruption and abuse of power as the rule for over 50 years combined with the systematic granting of more and more powers to state over individual rights that the SYSTEM is inherently corrupt and anti-human rights. I have come to this conclusion in my dealings with them personally and by paying attention to the fucking world without blinders and outside of the insular framework of my own perception of how i would LIKE the world to be.

What is your personal experience in dealing with law enforcement robots? Where do you live? What is your station in life economically, socially. Are you Caucasian or a minority? All these questions beg an answer because I suppose that your exposure to the world outside of the comfort of your CONSTRUCT, is causing this consternation and judgement vomited-forth in your last comment, and I would hate to have some skewed opinion of you based on your reaction to mine on issues that have EVERYTHING to do with human rights, justice, blah blah blah, all the shit that's important to people like us, schmoes slaving for paper-tickets to buy more play-time in the world created while you were fast-fucking asleep.

Fix it instead of whining like a spoiled brat??
Well sir, when you live in a country with the majority of peeps fast-asleep with their heads up movie-stars and basketball-player's asses whose political system is a fucking joke and her government co-opted by corporate and security interests then civil disobedience or heaven-forbid, UNCIVIL should the situation necessitate is about the only reasonable, actionable, effective solution for me.
Malcolm X was right, rich, sociopathic white people suck donkey balls and run the whole fucking show.

Would you like to have a discussion on the state of the Prison system in the United States? Hand-in-hand with the men in blue are the men in brown who would, that the current model be expanded and improved upon....It's broken and you have an opinion,??

Please enlighten us all-

yea but the forces acting on evolution currently skew to favor what some would see to be less fitness ... evolution doesnt favor the smart, or the best, just the most fit.

It seems this life and world are most fit for people who dont really care.... and survive through no effort of their own... i mean he could have really fucked up a major artery but no... and i bet he will fuck someone without protection and etc... we've all seen Idiocracy... that is pretty accurate tbh.. he will live long and so will his offspring...

You can do your own research if you really want to find the answer. From the research I've done, I've already established that the availability of guns does not guarantee a significant reduction in violent crime. If that were the case, DC's violent crime rate would be significantly lower than it is because they have very strict gun laws. I've also established that a ban on assault rifles would not have a significant impact on gun-related crime because the vast majority of gun-related crime is committed using pistols, not fully-automatic weapons. I've also established that the majority of guns used in gun-related crimes are obtained illegally, either stolen or obtained through unofficial means. The facts simply don't support the idea that banning assault rifles (or even all guns) would significantly reduce violent crime.

The current fixation on gun control is a purely reactionary response to recent shooting sprees (which comprise a negligible percentage of all gun violence). The only reason people care now is because these shooting sprees generally take place in middle and upper-class areas. Nobody cares when people get killed in poor areas, where the bulk of violent crime occurs.

I'm in no way a gun nut (I don't own nor plan to ever own any guns) but I'm not going to let my opinion of guns get in the way of facts. People who blindly believe that banning guns will solve all problems are just as bad as the NRA. Do your own research and don't ignore facts that contradict your own position. The FBI website is a great place to start, as they provide annual statistics on all crime in the U.S. and they don't have any reason to skew the numbers.

His definition of "Corrupt" is kind of skewed, but in many ways I could see this. I don't think it's a legitimate criticism of the US being corrupt because you have to see it through a very thing perspective, but when you look at the whole, the US *IS* getting away with the most bullshit en-mass compared to every other country in the world. Corruption does not equate to chaos. There are more obviously fucked countries in the world in terms of murder, extortion and fascist control, but through that very thin perspective you can't disagree that any other country controls as much of the entire planet with as large a proportion of those in power benefiting illegitimately.
Another way of looking at it is: there are the same number of corrupt assholes in the US as any other country, but the level of control and influence over the rest of the world those in the US have simply makes them more at fault than others.
Whatever. NONE OF THIS MATTERS!

@BicycleRepairMan

Also vice versa. Which might sound circular, but isnt. Uniformitarianism is of course the simplest assumtion (occams razor) but it also correlates well with the available evidence. If natural laws acted differently in the past, we would presumably find EVIDENCE that it did. And correlating data is not a "hall of mirrors, it is evidence of correlation. This is basic statistics and empiri.

Thank you for your considered reply. Well see, here's the thing. Creationists and evolutionists are not looking at two sets of evidences. We are looking at the same evidence and interpreting it differently. There isn't creationist evidence and evolutionist evidence, there is just evidence which we both interpret according to the assumptions we bring to it. We are both looking at the same geologic record and saying it happened much differently. The evidence yields different conclusions depending on what assumptions you bring to it.

Uniformitarian is only the first assumption scientists bring to the evidence. The secondary assumption is that the different layers represent vast amounts of time. They come to this conclusion because they observe the rates of these processes are very slow today, and since in uniformitarian, the present is the key to the past, they assume that present day geological features must have taken millions or billions of years to form because of present day rates. Because of this, the completely exclude the hypothesis that the features we see could form very quickly. Therefore, they are biased in their interpretation and will miss the evidence which actually points to rapid formation. I'll give you a good example:

"Previously geologists had thought that constant, rapid water flow prevented mud's constituents -- silts and clays -- from coalescing and gathering at the bottoms of rivers, lakes and oceans. This has led to a bias, Schieber explains, that wherever mudstones are encountered in the sedimentary rock record, they are generally interpreted as quiet water deposits."

http://newsinfo.iu.edu/web/page/normal/7022.html

For a long time geologists believed that mudstones could only form a certain way, which is by slow moving water. They had completely ruled out that it could be formed rapidly. Therefore, whenever they saw mudstones the "story" the rocks told them was that of a slow process taking vast amounts of time. Yet, mudstones, they have found, can be deposited very rapidly. This is actually evidence for a global flood because mudstones make up 2/3s of the record for sedimentary rock. Yet they never saw that because of their assumptions of everything taking vast amounts of time to form. This is a classic example of how the assumptions you bring changes the interpretation of the data. Same mudstones, but the different assumptions yielded a different conclusion from the same evidence.

This is further complicated by the matter of evolution. Biostratigraphy has played a decisive role in determining the relative ages of rock layers around the world, which brings with it a whole other host of assumptions. Because evolution requires vast amounts of time, and they interpret a certain evolutionary progression through the fossil record, therefore they again make the assumption different layers must represent vast amounts of time, based on their evolutionary assumptions. They then use that assumption to validate their uniformitarian assumptions and call this evidence.

The main issue is the assumption of uniformitarian to explain the fossil record. It denies that a catastrophe like a global flood could have caused the features we see today. The geologists believe things happened very slowly, whereas creation geologists believe they have formed very quickly. There is a whole lot of evidence which shows that layers could be laid down rapidly, and canyons and other features could have been cut very quickly. Geologists do acknowledge this, which is why there is another branch of geology called Catastrophism:

http://en.wikipedia.org/wiki/Catastrophism

They can not deny that many of the things they thought took millions of years "stalactites forming, fossilization, formation of oil and precious metals) can actually happen very quickly. They still deny, however, that a global catastrophe could have been responsible for all of it, despite the fact that the whole Earth is covered by sedimentary rock which is primarily laid down by water.

And this is where we are with fossils and dating. We dont just make wild guesses on the basis of 2 or 3 fossils and one shitty chemistry experiment involving half-lives; We have literally thousands of datapoints. If this is a hall of mirrors, then Satan is truly one crafty bastard making a pretty impressive one for us.

Again, it is the assumptions you bring to that data which colors the interpretation. I can also tell you that the assumption that decay rates never change is wrong:

http://www.sciencemag.org/content/286/5441/882.summary

Pressure and chemistry can alter decay rates according to that experiment. In that instance, they were able to alter the decay rate by 1.5 percent. In much more extreme conditions, however, the decay rate could change significantly. It shows that the uniformitarian assumptions of radiometric dating can and will produce unreliable data.

These are things that they don't teach you in science class. When it comes down to it, there is no actual proof for deep time in the fossil record, when we're talking about actual empirical evidence. We only have circumstantial evidence based on assumptions which I have shown to be faulty. That is where the hall of mirrors comes in, where everything you see is reflecting the assumptions you make. It is what is called a worldview, which is like a set of glasses you use to see the world. Everyone has a worldview. The apriori assumptions you make about reality constitutes your worldview. That is what is going on here..their worldview of the world forming from purely naturalistic processes, and that slowly over vast amounts of time, is a bias which skews all of their data to that direction, when as I showed previously with the mudstones that it could just as easily point in the other direction.

I love VS for these kinds of debates, but I see some straw-man arguments going on here.

First, not every Palestinian belongs to Hamas. In fact, the majority of the population does not belong to Hamas. Similarly, very few Germans were actually members of the Nazi party. German citizens backed the Nazis because they felt they were the best hope for getting Germany's economy out of the toilet, getting Germany out of what the citizens perceived as the unfair terms of the Versailles Treaty, and protecting Germany from (Nazi manufactured) external threats. Again, similarly, Palestinians back Hamas because they see Hamas as the best hope of dealing with Israeli oppression.

For 45 years the world (read: United States) has shown little interest in stopping the Israelis--who are supplied with arms and training by the United States-- from forcibly displacing people from their homes and relocating them to what Chomsky calls "the world's largest open-air prison."

How could the Palestinian people possibly expect to defend themselves against Israel in an open and conventional conflict? The Palestinian people back terrorism because it works--it forces Israel to the negotiating table. Consistently, these Israeli "flexing our big muscles" incursions and retaliations by the military have failed completely to stop rocket attacks, suicide bombs, etc. and at some point they must always go to the negotiating table. A side benefit is that the terrorist attacks and subsequent negotiations get the world's media eye focused on the region and what Israel is doing there.

So this talk about whether Hamas are terrorists or freedom fighters is besides the point. They're terrorists to Israelis and they're freedom fighters to the Palestinians. Israel and the U.S. are just as much terrorists as Hamas if not more so. You can watch Chomsky clearly explain why on this Sift: http://videosift.com/video/noam-chomsky-is-america-a-leading-terrorist-state

Second, let's look at the casualties from this latest conflict:
Israel: 3 Israeli's dead, 60 injured from shrapnel (all adults according to latest reports)
Palestine: 100s dead, including 26 children

Yet, Israel tries to spin its military campaign as one of self-defense. The balance of power is so skewed here it's comical.

If there is any hope for peace in this region, it will only come after the U.S. not only stops actively supporting Israel but openly condemns them as well. But that can't possibly happen without the U.S. looking supremely hypocritical about the actions it takes globally (for instance in Afghanistan) in the name of the "War on Terror."

From there, as others have mentioned, you have to stop the occupation and bring both sides together on equal terms. Yes, there will still be fanatics who will fight to the end. But they won't be finding the sympathy and support of the majority of the populace if that populace is no longer oppressed and instead is living in free and safe conditions. Without that popular support, those fanatics will be much easier to deal with than they are now. It's not going to be an easy road to peace because hatred has been bred into both sides so deeply. But I do think it is possible if only the U.S. government will get its head out of its ass.

My 2 cents, anyways.

EDIT: Please don't take this post to mean that I support terrorism in any form or think that it is justified by the Israeli occupation. I am only pointing out the historical fact that terrorism gives the Palestinians pretty much their ONLY bargaining chip at the negotiating table--the Palestinian leadership (whoever is in charge at the time, though it is currently Hamas) agrees to reign in the terror attacks in exchange for humanitarian aid such as food, building supplies, etc. In other words, it "works" in achieving short-term goals but clearly doesn't help achieve lasting peace in the region--which as others have pointed out Hamas doesn't really want anyway.

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.
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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.

>> ^MonkeySpank:

That video stabilizer is really warping the heck out of this video. Great fun in the mud though!


Nope - that's because of a rolling shutter, not a video stabilizer. Objects look skewed when panning sideways.

tl?

This guy does some very impressive portraits. He did some skewed perspective ones a while back that were pretty mindblowing.

Your claims here are vastly skewed. As an example I'll point out that prostitutes do, in fact, view alcoholism awareness public service announcements, but than again, so does everyone else.
Hell, better yet, I'll go ahead and inform you that fruit flies are among the most commonly used model animal in modern science. That funding could literally be going to just about any biology related field of research in existence.

I'm very much willing to read and consider your viewpoints, but please, try and present the whole facts next time.

>> ^quantumushroom:

Here's some other ways your tax dollars are being spent:
$2.6 Million Spent To Train Chinese Prostitutes To Drink Responsibly
$1,529,220 for an Appalachian Fruit Lab.
$742,764 for olive fruit fly research. ($211,509 of this amount was to be spent in Paris, France)
$172,782 for the National Wild Turkey Federation in Edgefield, S.C.
$1,128,000 for Big Brothers/Big Sisters of Alaska Eagle River for an at-risk youth mentoring program.
$50,000,000 for REAL ID grants. Got to be sure to track and trace those unruly American citizens!
$123,050 for a Mother's Day Shrine in Grafton, West Virginia (population 5,489, with a land area of 3.8 square miles)

This summer I stayed at this motel (hotel?) in Santa Maria, which, legend has it, is haunted. I don't buy into that kind of thing at all, and had a good night's sleep with no disturbances, but I will say it was very spooky from the inside. Long hallways with *something* wrong about them. It took me a while to figure out, but in the end I concluded it was because the structure was a bit skewed here and there. Things you'd expect to be straight - walls, floors etc. were subtly off kilter, probably because it was an old building, and the effect really was quite unsettling, especially as it wasn't immediately obvious.

This is a really weird juxtaposition -- Andrew Napolitano engaging in one of his usual right-wing fearmongering rants about the evils of "government", played over protesters getting the shit beaten out of them for protesting...spending cuts to government programs.

This is the kind of video blankfist would post, and then leave me a personal comment saying something about how this video demonstrates that all of my political beliefs are wrong, when all it really demonstrates is the level of cognitive dissonance inherent in the entire conservative worldview.

If you let the concept of cutting government budgets get conflated with the idea of protecting your rights as an individual, then your perceptions have become so skewed you're no longer able to make rational sense out of the world you live in.

But then, I guess modern conservatives don't really believe in individual rights anymore. Not really.

>> ^Hive13:
I was driving home from breakfast with my wife and three kids in the car on Sunday morning last year. In front of us was a big, white Ford pick-up. Suddenly a beagle darted out into the road and that big truck clipped the dog's hindquarters with his back tire. I know he saw the dog because I say him apply his brakes, yet, in true asshole form, he just kept on driving. The dog darted off into the side of the road, but I could tell it was badly hurt. This wasn't a highway, but was a four lane major thoroughfare into a very large neighborhood with lots of traffic.
I slammed on the brakes, did a u-turn over the grass median and went back around to find that poor dog. I jumped out of the car and ran over to her. Her back legs were shattered and he pelvis was broken. She was in incredible pain. I approached her slowly as I was concerned she may be aggressive in fight or flight mode, but she began crawling over to me with her front legs whimpering and wagging her broken tail. I carefully picked her up and she began licking my face, as if she was thanking me for stopping. I gently gave her to my wife and we brought her home. My kids got her a snack and some water and I wrapped her in a blanket and she was trembling from shock and fear.
She had a collar, so I called her owner and got a voicemail. I called our vet, who happens to live about a mile from us, and explained what happened. He called a local vet emergency room and arranged for a staff to be available. About 45 minutes after we picked her up, her owners finally called us back. She was about 5 miles from home and were overjoyed that we had her. I explained that she was badly injured and that we were about to take he to the vet emergency room, but they insisted on seeing her first, so we waited for them. The owners got out of the car, I could see their kids and another beagle in the car. Those kids were visibly upset.
When the owners arrived, this poor dog tried to jump up and see them, but immediately fell to the ground due to her injuries. As this was happening, our vet had come over to the house, diagnosed that both legs and pelvis were broken and that emergency surgery was needed. He got in his car and actually led them to the emergency room. Remember, this is all on Sunday morning at about 9am.
The owner tried to give us a $200 cash reward. I scoffed and said that money needed to go to getting their poor dog taken care of and that she deserved a big treat after all she had been through. He kept insisting, but there is no way I was taking money from them. He finally realized that we didn't do this for money or notoriety, we did it because it was the right thing to do.
Three months later, the owner called us and asked if she could come by and thank us. She brought her dog over and she looked amazing. She has some scars and a little bit of a skewed walk, but otherwise had recovered well. When the dog got out of the car, I sat down in the grass. She walked right over to me, climbed in my lap, looked up and gave me one, big lick right on my chin. It brought tears to my eyes. After all she had been through, she remembered me and those 45 minutes we spent helping her.
I got an email from her owners a few months ago. She is pregnant. Her owners offered us the pick of the litter. The kids don't know it yet, but we are getting a new puppy from a sweet girl that they helped save.
That is a pretty solid moment in our family.


What a wonderful person you are to go to such lengths to help that poor injured dog! I'm so glad you shared this story with us. This had the best ending too! You will be adopting one of her puppies!!!

I was driving home from breakfast with my wife and three kids in the car on a Sunday morning last year. In front of us was a big, white Ford pick-up. Suddenly a beagle darted out into the road and that big truck clipped the dog's hindquarters with his back tire. I know he saw the dog because I saw him apply his brakes, yet, in true asshole form, he just kept on driving. The dog darted off into the side of the road, but I could tell it was badly hurt. This wasn't a highway, but was a four lane major thoroughfare into a very large neighborhood with lots of traffic.

I slammed on the brakes, did a u-turn over the grass median and went back around to find that poor dog. I jumped out of the car and ran over to her. Her back legs were shattered and he pelvis was broken. She was in incredible pain. I approached her slowly as I was concerned she may be aggressive in fight or flight mode, but she began crawling over to me with her front legs whimpering and wagging her broken tail. I carefully picked her up and she began licking my face, as if she was thanking me for stopping. I gently gave her to my wife and we brought her home. My kids got her a snack and some water and I wrapped her in a blanket and she was trembling from shock and fear.

She had a collar, so I called her owner and got a voicemail. I called our vet, who happens to live about a mile from us, and explained what happened. He called a local vet emergency room and arranged for a staff to be available. About 45 minutes after we picked her up, her owners finally called us back. She was about 5 miles from home and were overjoyed that we had her. I explained that she was badly injured and that we were about to take her to the vet emergency room, but they insisted on seeing her first, so we waited for them. The owners got out of the car, I could see their kids and another beagle in the car. Those kids were visibly upset.

When the owners arrived, this poor dog tried to jump up and see them, but immediately fell to the ground due to her injuries. As this was happening, our vet had come over to the house, diagnosed that both legs and pelvis were broken and that emergency surgery was needed. He got in his car and actually led them to the emergency room. Remember, this is all on Sunday morning at about 9am.

The owner tried to give us a $200 cash reward. I scoffed and said that money needed to go to getting their poor dog taken care of and that she deserved a big treat after all she had been through. He kept insisting, but there is no way I was taking money from them. He finally realized that we didn't do this for money or notoriety, we did it because it was the right thing to do.

Three months later, the owner called us and asked if she could come by and thank us. She brought her dog over and she looked amazing. She has some scars and a little bit of a skewed walk, but otherwise had recovered well. When the dog got out of the car, I sat down in the grass. She walked right over to me, climbed in my lap, looked up and gave me one, big lick right on my chin. It brought tears to my eyes. After all she had been through, she remembered me and those 45 minutes we spent helping her.

I got an email from her owners a few months ago. She is pregnant. Her owners offered us the pick of the litter. The kids don't know it yet, but we are getting a new puppy from a sweet girl that they helped save.

That is a pretty solid moment in our family.

Comment hidden because you are ignoring dag. (show it anyway)

No offence taken - she seems pretty awful.>> ^ZappaDanMan:

>> ^dag:
To be fair - I didn't hear her say that Australians should be paid $2 per day.
And this might sting my Australian mates - but productivity is low in Australia. I'm in Canberra - which is probably low productivity HQ for the whole country. <img class="smiley" src="//cdn.videosift.com/cdm/emoticon/oops.gif">

@dag yep I'm sorry, I have a real super hate for her, and of course why I skewed the title. I have bias, and sincerely wish no offence to you or anyone pointing that out (sincerely).
I exaggerated the title.
ZDM
P.S. She can go fuck herself