$1.76 Billion is what their budget is right now and they can't/won't stop crime. Why do you think more money to that organization will help?

The missed(or intentionally ignored) part of these types of narratives is that the money isn't going into some administrators pocket, it is going to other programs that have been underfunded for years.

The original "defund the police" campaign was to have social workers, mental health workers, or medical personnel be the first responders to scenes in a few big cities because the police were delaying care and sometimes killing people instead of helping them when having medical or mental emergencies.

They’re volunteers. Volunteers don’t cost much money. They aren’t paid social workers.

In this case, I sympathize because Portland has refused to assist or back any of their police in the riots there. The DA has refused to charge anyone who resists arrest or refuses to disperse after police have been given orders to remove rioters (they are rioters. even the Mayor is now saying to stop calling them protesters and to call them anarchists instead).

Why would anyone want to go out, night after night, and face the same people you arrested the night before doing the same stuff?

The fact also exists that Portland has made massive cuts to the police budget. That has led to time off being cancelled for police, no rotations to move fresh police into the riot situations so the same ones have to deal with the face to face confrontations with no break, and the alternative policing option which was hands off was tabled. "A paramedic and a social worker would drive up offering water, a high-protein snack and, always and especially, conversation, aiming to defuse a situation that could otherwise lead to confrontation and violence. No power to arrest. No coercion."

There are a lot of problems with police, for sure. Portland's government is the driver behind these issues, though. Until they start taking a stand against these anarchist, violent protesters (who are PREDOMINANTLY white), the situation will not get better.

https://www.nytimes.com/2021/06/09/us/portland-protests.html

No, not take Weinstein for example, that is an entirely different case and it undermines your position to use such an obvious straw man.

Society promotes the concept that men are violent, women are not. Any man that uses physical violence on a women is evil and if a woman raises a hand to a man and he strikes her in defense, he would still be the one that had to explain himself. Look at the Duluth model re: domestic violence sometime to see how truly baked in the myth that men are the perps and women are the vics...

https://medium.com/iron-ladies/men-are-still-pigs-the-politicization-of-domestic-violence-2cfa7488c204 (written by a woman for noting)

Particularly salient.

[i]It’s clear to me that despite the fact the Duluth Model has proven to be worthless, programs still adhere to the same principles. Men are still the automatic perpetrators, women are always victims. What’s worse is the men under attack by violent wives have no way of protecting themselves. Their right to self-defense in domestic violence cases has been cancelled.[/i]

I'm all for acknowledging that differences between the sexes is an absolutely real thing, but the long and the short of it is that women are basically allowed to assault men almost without consequences, but in the reverse situation the man would (justifiably) have the book thrown at him. And while men do have the physical advantage (although not always), they are hamstrung by society. The mere threat of a rape accusation (or far worse, the accusation that the husband has been abusing the kids) would silence most men in a heartbeat because they understand that the police, the judge, the social workers will believe the woman first.

Violence is wrong as is giving women a free pass because they rolled vagina in the game of life.

It wasn't the focus of the video, but her mention of women being concentrated in lower paying fields is something we could also fix. The efforts to encourage girls to get interested in science and engineering are great, but it's also shameful that we pay teachers and social workers so much less than the rest of the developed world. It's not that women are attracted to low paying work, it's that we've chosen to undervalue the work that women tend to do.

While I see where you're coming from, I have a few issues with what you're saying:

1. The organization you're referring to is staffed, has offices and overheads. Assuming it isn't corrupt and skimming and holding multi-million-dollar appreciation nights and galas (and we probably shouldn't assume that it isn't), the money you're giving this organization still gets portioned off quite a bit. Your point about helping on the systemic level is quite valid (provided you are channelling your concern into actually doing so), but I'd look more into local community health centres or the nonprofit down the street, and still, that money isn't guaranteed to reach the person in front of you. Much as a social worker can help him connect to essential services, advocate for fair and affordable housing, counsel him on trauma, etc, he will still need money for a lot of basic needs.

2. You are vastly oversimplifying the needs and situation of every person on the street. That person may actually depend on money from strangers to make rent (being that welfare barely puts a dent in even the lowest affordable housing costs), feed kids, buy food that isn't McDonald's or canned food, get a haircut, or a million other things that everyone needs money for.

3. Even if that person intends to spend some of your money on oxy or crack, it is not in your right to judge that. While addiction can very generally be called "bad", this person may suffer from chronic pain, trauma, mental illnesses, or some combination and short of governments finally realizing that housing and caring for the poor is cheaper than incarcerating them and treating emergency health conditions, self-medicating is the only reasonable way they can continue functioning for another day. This isn't even an unlikely scenario; think how easily someone can go from your (or my) comfy life to homeless, poor and desperate. It isn't always "bad decisions"; you could be a contractor that falls and gets a serious injury, hit by a car, stricken with a mental illness you have no control over, traumatized earlier in life, born into a high-risk environment or social strata, or anything else, and then start sliding from there. You develop an addiction, your income comes to a screeching halt, your loved ones can't or get too tired to support you, bills that were routine become suffocating, and there you are on the street, pain exploding relentlessly in your body/mind, on the other side of the decision, seeing chins turned up and eyes turned away from you and hearing people mutter "Don't give anything to him; he's just gonna use it to get high," to each other.

4. Not a single person in the video (and really, in just about every situation you see on whatever street you're on) speaks to or even looks at the guy.

While I wouldn't expect that everyone gives money to folks on the street (I myself have only done it a few times), it frustrates me to hear people insist that nobody should. "He's just going to use it for drugs/booze" is a presumptuous and ignorant statement and mindset.

One more thing: if you really care about urban poverty and those suffering from it, the biggest thing (IMO) you can do is vote for politicians/parties who openly and strongly support social services and welfare, then hold them to their promises. I don't make a ton of money, but I am happy to pay higher taxes and lose some luxuries if it means people who need help just to get by get it.

Would be exactly the same in Finland too, i guess it's the annual cold and common sense. We wont let kids freeze, no matter what is the social status, child health is big priority here. Taking care of other peoples kids when needed is still very close to the culture.

The next thing that would've happened when heard he is 65km from home is to call the cops. They call the parents and provide temporary shelter. But then would've started the social worker round and that is not pleasant.. It's the one part of our 'nanny state' that often oversteps it's boundaries and that is really unfortunate.

You hear about similar sort of shit happening in Australia too, with social workers not removing kids from abusive carers despite reports or complaints until it's too late. However, you hear them removing kids over such minor, non-issues... like smoking pot (probably to look like they're doing their job).

And who are these people they chuck the kid in with? Is there no certification process for foster carers?

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.

A note from the inside:

Things are hot here right now (and dry), even above the Tropic of Capricorn. The PRI (right-wing) candidate, E. Peña Nieto (EPN) is accused of buying his way into the presidency, from rigging opinion polls to bribing or wielding union and corporate power to setting up twitter bot squads trying to manipulate public opinion. A huge EPN advertising presence clearly over the allowed campaign budget is visible as you travel the country.

But people aren´t having any of it and are fighting back, making sure their voices are heard. A video surfaced after EPN visited a prestigious university in Mexico City where he was shouted off campus, where 131 students state they are not paid to voice their opinions from other parties.

The surge of the #Iam132 (#YoSoy132) hashtag and subsequent movement with Worldwide TT rings a-partisan and mostly just anti-EPN and anti-PRI with their corrupt antics. Weekly protests and artistic gatherings are gaining momentum.

A 4th far-right independent party with libertarian views has surged as well, also backed by powerful unions particularly from the social workers and teacher´s unions, they are double-faced and dodgy as hell. Although Mr Quadri is a scholar and has intelligent views, he is very similar to Ron Paul and his view on drugs.

The left-wing candidate AMLO, who claims the current throne and accuses Calderon of election fraud in 2006, will probably win. He has not stated publicly that he will legalize drugs, although he says that if the people can reach more consensus on the issue, that he would go ahead with it, regardless of what the US might think.

Many are optimistic, as I.

Yeah, take that Will Smith and Oprah. God forbid you guys can become superstars and multi-millionaires. You have to "stay genuine", and never change, even if it means staying dirt poor or mediocre. Conforming to some vague notion of "blackness" is more important than personal achievement.

And fuck Obama too, and Ursula Burns, and any other black person with talent, drive and determination, who happens to have charisma and appeals to other races. And god forbid someone undergoes personal transformation and change to succeed, especially in a society where the chips are stacked against them on day 1. No, it's better to know one's place.

Yeah, Barack, Ursula, Will and Oprah, even though you guys are actually transforming what it means to be african american and black by kicking down barriers, so that black kids can feel they can do anything and be anyone, FUCK YOU.

Will, you should still be rapping about Philly with the other ol' skool rappers on tour on the c-circuit. Oprah, you should still be doing "who's the father!!" shows and competing with Jerry Springer and Maury. Ursula, wasn't middle management enough? And Barack my man, you did much more good as a community organizer.

C, your premise and line of thinking is ridiculous. Can you explain to me what role is acceptable for a black man? You castigate Will Smith for being weak then complain about Samuel Jackson and Denzel Washington? These guys aren't flava flav for gods sake.

Please forgive me for not seeing your sarcasm, if that's what this is. >> ^chingalera:

When it comes right down to it, who really gives a fuck why Will Smith back-slapped a reporter, or why the reporter decided to kiss him. All that really matters is that Will Smith, one of the whitest black men in America, will never get any revenue from me, as I plan to download the film from many of my friends around the world who won;t shed a tear when Hollywood dies.
He can join the other list of sell-out negroes in Hollywood who have taken the $Bait$ and become masters of a weak stereotypical representation of the African-American male.
There's the ultimate hero negro: Denzel Washington, Jim Brown, (AKA, The Victim of Society Negro
The Superhero Negro: Wesley Snipes, Samuel L. Jackson, Laurence Fishburne
The Historical Hero negro Cuba Gooding Jr., Denzel Washington, Will Smith
The Sidekick negro-Sam Jackson, Morgan Freeman, Don Cheadle
Cop/Psychologist/Social Worker Negro-Sydney Poitier, Whoopi Goldberg
and then there's the , "Only African-American female to ever win an Academy Award for best actress getting ass-raped negress, Halle Berry
Fuck Will Smith, he's another total sell-out.

When it comes right down to it, who really gives a fuck why Will Smith back-slapped a reporter, or why the reporter decided to kiss him. All that really matters is that Will Smith, one of the whitest black men in America, will never get any revenue from me, as I plan to download the film from many of my friends around the world who won;t shed a tear when Hollywood dies.

He can join the other list of sell-out negroes in Hollywood who have taken the $Bait$ and become masters of a weak stereotypical representation of the African-American male.

There's the ultimate hero negro: Denzel Washington, Jim Brown, (AKA, The Victim of Society Negro
The Superhero Negro: Wesley Snipes, Samuel L. Jackson, Laurence Fishburne
The Historical Hero negro Cuba Gooding Jr., Denzel Washington, Will Smith
The Sidekick negro-Sam Jackson, Morgan Freeman, Don Cheadle
Cop/Psychologist/Social Worker Negro-Sydney Poitier, Whoopi Goldberg

and then there's the , "Only African-American female to ever win an Academy Award for best actress getting ass-raped negress, Halle Berry

Fuck Will Smith, he's another total sell-out.

I think my biggest problem with solutions to smoking (which have a partial answer, if you slave their addiction to patches), being fat (which CAN be caused by medical problems and medications--obviously that isn't the primary cause), or any other self-abusive scenario which may indeed need psychological help to truly treat them; the problem is that we functionally still do not understand both the on and off switches to their medical woes or the self-inflicted ones. A "cure" is absent. I do however, see ways you can help. As in having a dietitian play a key role in the reversal of patients outcomes, rather than throwing them out of the clinic with no help. Much like the work of social workers; let us not be afraid to create a new job if it's needed. The question I meant to ask earlier is: Do you wish to be your brother's keeper or did you simply lose your hope?

This is for anyone that sees that our system simply need not be there to help everyone, or help someone more than once, twice, and no matter how long. Some can't even find a doctor that can diagnose them until perhaps that fifth or sixth try...

Well, at least you're honest.

>> ^Winstonfield_Pennypacker:
I'm very upset that I chose profit and performance-rewards when it came to my own employment path. I didn't choose to be a social worker, because everyone knows that's a shit job with shit pay. But now that all my free market bullshit is blowing up in my face, because I'm at the bottom of the pyramid that I bought into, I'm going to do the most pathetic cowardly thing that I can:

I'm going to advocate that anyone who chose to help their fellow man, and take the slow, plodding, mediocre route to success be publicly exposed for their shameful weakness. Then my friends and I are going to steal our future from them instead of working for it ourselves like we always said we were going to do. Here's the thing, I could have joined the public sector and sacrificed some pay for more security. But those people all smelled, and worked in dingy offices with people who had real problems. How was I supposed to know they were making the wise decision!?!?

Well not anymore. Even though social programs fix more problems than they cause, it's time for them to go. Sure, I could work against the culture that pays their elite 500 times more than the average person makes, but that would actually take innovation and intelligence. Besides, I'm willing to overlook those people, because they share my greedy, corporate, business-reptile mentality.

No, it's the people with master's degrees who make thirty-thousand dollars a year that I'm after. Anyone who's willing to accept punishment like that has already made themselves easy prey. And how! All we have to do is present enough "evidence" accumulated by bogus, business advocacy groups to convince the rest of the tired and desperate people out there that there's a really really easy solution to their problems that involves no hard work whatsoever! We just cut all the funding to anything that involves helping people besides ourselves and all of our problems will simply go away! Well... except for the hippies.