A report by Progressive Future and the Ballot Initiative Strategy Center listed I-1000 as one of the best voter initiatives in the United States this year (you can see their full report in PDF form here). This is good news for several reasons, one of which being that progressive groups are seeing the value of promoting liberty as the road to achieving the goals that progressives want to achieve. If you go through the report, you’ll see that a number of the initiatives were chosen because of an emphasis on limiting government interference with our decisions. That’s how the progressive movement can succeed in this country.
In addition to this endorsement, former Oregon Governor John Kitzhaber cleared up another piece of propaganda being spread around by I-1000 opponents:
You may have seen the story of a woman on the Oregon Health Plan that makes the insinuation that services covered under Oregon’s Death with Dignity Act are prioritized over chemotherapy because it costs less for patients to die than to live. Nothing could be further from the truth.
Unfortunately, a poorly worded letter to this individual contributed to that mistaken impression. Since then, the political campaign against I-1000 has made it difficult for the public to get the facts. I would like to set the record straight.
Like most insurers, the OHP covers nearly all chemotherapy prescribed for cancer patients, including the multiple rounds of chemotherapy this patient received. The request for second-line treatment was denied because of the drug’s limited benefit and very high cost.
When the Oregon Health Plan went into effect in 1994, it was backed by principles that remain relevant today, including a process for setting health care priorities that reflects a consensus of social values and considers the good of society as a whole.
As I’ve explained previously, the argument that we must limit our choices out of fear of what could happen within our broken health care system is pure folly. It’s no different than saying that we should outlaw abortion because it could allow for health care providers to cover abortions but not cover the cost of having the child. As Kitzhaber points out, the hysteria whipped by the I-1000 opposition is completely baseless. Patients in Oregon are not at risk of being told that they won’t receive proper health care because of their death with dignity law, and neither will patients in Washington.
I can’t see anybody not supporting I-1000. I am all for it.
That’s a big part of the problem, you, for example, can’t understand people who see this issue differently.
This is a divisive issue that has little to do with improving end-of-life or health care in general, and a lot to do with implementing political philosophy. This is not about helping grampa or gramma as they exit the stage. Predicably, it’s turned into a nasty, expensive, and dare I say painful campaign.
And again, this is not for improving healthcare.
I don’t like this kind of politics, money and movers. I resent my ballot being used in this way.
I will vote no.
I sure hope this passes…it’s only right. The people who are against I-1000 are for the most part the same type that oppose a women’s right to choose.
They’re all about sticking their noses where they don’t belong and imposing their restrictive morality on others.
Lee
For someone prone to accuse others of lying, this post is over the top. The spin is worthy og Karl Rove.
I am tired of Rovism. Spinning pro abortion with the word choice or anti abortion with the word life does harm to all of us. Orwell’s “1984” would have understood perfectly such Rovianisms as death tax. And of course, in 2008 we have listened to barrages about terrorism and socialism that have deprived our language of these useful words. Calling assisted suicide death with dignity is no better.
What happened in Oregon is excatly what the opponents say and this response from the pro I-1000 forces CONFIRMS the problem. This lady’s health care porvider did advise her that it would not provide the drugs and did tell her that she had the option of suicide.
The result was that the person who wrote the letter was reprimanded, but the policy remained and remains the same.
Under I-1000 is is in the provider’s interest to prescribe suicide.
Under I-1000, it is often in the patient’s fiancial interest to choose suicide.
I try to always be factual and would defend your side by saying that, to my knowledge, this is the only evidence of abuse in Oregon. However, as you well know, I-1000 is so unpopular in Oregon that very few people actually choose it. As I have said too many times, I suspect the reason is that many physicians and patients, like myself, do not want the state or some strange psychologist interfering in what ought to be a private affair.
Talk to any physician involved with terminal care about the burdens added already by HIPPA. Well maning legislation can easily go astray.
Finally, you finish with dismissive comments like “fear of what could happen within our broken health care system is pure folly” and “hysteria whipped by the I-1000 opposition is completely baseless.” While better than the bigoted attacks of the I-1000 crew on religion, these dismissive comments are stupid and your own words illustrate why:
Your are right, the providers were reprimanded for telling Mrs. H. the truth. Given their policies, it WAS in interest to commit suicide!
*********************************
I am tired of Rovism. Spinning pro abortion with the word choice or anti abortion with the word life does harm to all of us. Calling assisted suicide death with dignity is no better.
I also expect I-1000 to pass and can only hope that well meaning people like yourself will be vigilant in promoting a health care system that does not force patients to choose between money and an early death.
@3 upton
The medical society, the bnurses society, and the hospital associations all oppose I-1000 and they certainly do not take this stand because they oppose choice.
I, for one, firmly support abortion AND would want the freedom to die under these circumstances. I do NOT want the intrusion of the government into the process and I do not want anyone to have to choose between impoverishment and terminal care.
@4
Under I-1000, it is often in the patient’s fiancial interest to choose suicide.
Without I-1000, it is just as often in the patient’s financial interest to choose suicide. I-1000 DOES NOT CHANGE THIS. You have a PhD for fuck’s sake. Stop embarrassing yourself. A child can figure this out.
@5
I, for one, firmly support abortion AND would want the freedom to die under these circumstances. I do NOT want the intrusion of the government into the process and I do not want anyone to have to choose between impoverishement and terminal care.
WOW!! After all of these months, you flat-out do not understand this initiative at even a basic level. It’s stunning. No one anywhere will ever have to choose between impoverishment and terminal care because of I-1000.
None. Zero. Zip.
And all you have to do is look at Oregon to see that this is true. We already have ten years of this law being in place in the state just to the south of us to see that people aren’t being coerced into taking the prescription.
Again, how much longer are you going to embarrass yourself here Steve?
@2 Aaron
Well said. If there is a lesson in the 08 campaign, cultural issues and newspeak ought to be left behind so we can address real problems.
I know lee well enough to beleive he means well, but he is also terribly ignorant of how medical care actually works.
The image of the ponderous I-1000 process showing up at my own bedside, when that time comes, frightens me. I want the freedom to work with my family, my rabbi, and my physicians, in private, with no government oversight when I need to make this decision.
@8
I know lee well enough to beleive he means well, but he is also terribly ignorant of how medical care actually works.
You want to back up that statement to my face, asshole? You have absolutely no idea what you’re talking about here. Let me elaborate using your next paragraph:
The image of the ponderous I-1000 process showing up at my own bedside, when that time comes, frightens me. I want the freedom to work with my family, my rabbi, and my physicians, in private, with no government oversight when I need to make this decision.
Under the law right now, you are currently prohibited by the government from being able to work with your family, your rabbi, and your physician to make a decision to choose death with dignity. Doctors routinely use loopholes in the law to allow for people to end their lives prematurely under the auspices of palliative care. Under I-1000, DOCTORS WILL STILL BE ABLE TO DO THAT. I-1000 DOES NOT TAKE AWAY THAT ABILITY.
What I-1000 does is to allow for people to have ANOTHER OPTION if they so choose. And that is for a more formalized prescription to a cocktail that allows them to end their lives without having to rely on a wink-and-a-nod from a doctor and an overdose of some opiate.
Are you ready to stop insulting my knowledge of this process, or are you going to keep being an asshole and continue to claim you understand this initiative when you clearly don’t?
A “poorly written letter”? Excuse me?
If it weren’t for the fact that we’re in the middle of the I-1000 campaign, everyone here would be all over this.
A health insurance provider sends out a letter denying treatment, but offering to pay for assisted suicide, and this group waves it off as a “poorly written letter”?
Amazing.
If this were Republican-sponsored legislation that had a provision that required that the only records that could be used to track the effects of that legislation be falsified, we would be screaming “cover-up” from the rooftops.
Look, folks. The end of life is a very emotional time, and we’re discussing situations where loved ones are dying, sometimes in terrible pain.
Additionally, there are some folks who have deeply rooted feelings about the sanctity of life. I count myself in that group, and have to examine my position carefully to avoid the trap of wanting to legislate my own morality.
Transparency is the key here. While I do not wish to tell another adult what to do with their life, I can and do insist that the decision be made without coercion, and that accurate records be kept, so that where the law is abused, it can be discovered.
This law is written in a way that disguises the facts of the situation. That is the main problem, and it is easily resolved. The problem has been brought up repeatedly by the people opposing this legislation, and none of the proponents were even willing to consider their objections seriously.
Perhaps that is part of the problem. We’re not willing to even consider the objections of people that don’t agree with us completely. We assume that they simply want to insert their beliefs into our lives.
That a person would feel that they have no better option than ending their life saddens me greatly. But I will get over that, and agree that the choice must be with the individual.
But when that individual wants the help of a state-licenced professional, then we must insist on accurate records, so that we can be sure that the law is not being abused or violated by that professional.
@7 Lee .. one of us is embarrassing himself. I do not use spin or swear words to make my points.
If you want a civil discussion, then answer these brief questions:
1. Why wouldn’t a healthcare provider prefer suicide over the costs of terminal care, or as in the case of Mrs. H, expensive treatments?
2. How does a psychiatrist make a differential diagnosis between the depression associated with being told you are going to die and the “depression” that rules out suicide under I-1000?
3. Why do you think so few patients and phsysicians in Oregon have used their act?
4. Why do you think all the physicians, nurses, and hospital organizations are opposed? OBTW, this question has nothing to do with the opinion polls you keep citing.)
Lee,
Why is it that you feel a need to talk to your opponents like that? @6, @7, and @9 you really demean the discourse with stuff like “embarrasing yourself”, “do not understand”, and “asshole”.
I don’t like reading your shit, and I tend to skip past it. Is that your intent?
@9 Lee
Do you really thinlk I am the one embarrassing hislef when you need to call me an asshole????
As for your ignorance of how healthcare works, exactly what are your credentials? Can you even tell me the criteria for receiving Medicaid in WA state? Or tell me how, under current procedure, causes of death are monitored?
As I thnk about it, as one of the proud particants in this forum, maybe I should change my nom d’ plume in YOUR honor?
I am happy to be called a Horsesasshole and will not even speculat on what that makes you.
Errr ahhh????
I think you just made my point. under I-1000, healthcare providers are incentivized to offer patients the choice of suicide.
@10. John
Kudoes.
One reason I have been an Obamist fr tree years is my admiration for that one’s respectufl and rationl way of making his points without the spin tactics we see here.
@11
If you want a civil discussion, then answer these brief questions:
1. Why wouldn’t a healthcare provider prefer suicide over the costs of terminal care, or as in the case of Mrs. H, expensive treatments?
Of course they could. But YOU DON’T NEED I-1000 TO COMMIT SUICIDE. There’s no difference between a state where death with dignity is legal and one where it’s not legal when it comes to the health care provider’s perspective. They save money by doing so with or without I-1000. In fact, I-1000 makes it MORE expensive for the health care provider to do so.
Again, as I argued in the main post, why wouldn’t a health care provider prefer abortion to bringing a fetus to term? The latter is more expensive, no?
2. How does a psychiatrist make a differential diagnosis between the depression associated with being told you are going to die and the “depression” that rules out suicide under I-1000?
They have to look at the patient’s history.
3. Why do you think so few patients and phsysicians in Oregon have used their act?
Because not that many people have the combination of:
a) Being in a position where they have a terminal illness
– and –
b) Being the type of personality who doesn’t want to lose control
4. Why do you think all the physicians, nurses, and hospital organizations are opposed?
They’re not. This is a lie. Surveys of doctors (and I’ve posted the links) show that the medical community is split roughly 50-50 on this.
@12
Why is it that you feel a need to talk to your opponents like that?
When someone compares me to Karl Rove, they’re going to fucking hear it. And loudly.
@14
I think you just made my point. under I-1000, healthcare providers are incentivized to offer patients the choice of suicide.
And as I said, they’re just as incentivized to offer patients the choice of suicide without I-1000. People who live in states without a death with dignity law can still commit suicide (and they do). Healthcare providers can just as easily tell a patient, “we’re not covering this” and force them into alternatives. There’s no evidence that Oregon’s law has made this any more common, and there’s even less evidence that you even understand this argument in the first place.
@9 Lee
Aside from insulting me, the medical association, the Catholic Church, and do son, now you want to equate the intense efforts we physsicans make to re;leive pain and suffering with a “wink and a nod” intended to kill people? And you call me an idiot?
Have you ever been involved in an end of life process with a loved one or patient? Did some ;physisican actually come to you and see he would be willign to prwescribe an early death if that is what you want?
I am not happy about being older tha you, but maybe having assisted in the terminal stages of patients lives and been involved with these ecents for several of my family and fireinds, I have a perspective you lack?
But then I am merely a ignorant Horsesasshole.
@16 Lee
You did not answer the questions,
I did not ask about the patient’s incentives, I asked about the healthcare provider who is required to offer this prescription under I-1000.
I suggets you think before you reply.
Tell you what, I will lend you a psychiatry text. Reactive depression and clinical depression are hardly just distinguished by clinical history.
That could be true and if so it means very few people have any need for I-1000.
But, if my hypothesis is correct, I-1000 may actually ne preventing patients in Oregon form getting the care you and I both feel they need.
Sighhh. I do not lie. I also, carefully included the words “OBTW, this question has nothing to do with the opinion polls you keep citing.)” in my question.
If you have some time to THINK about your answers,m try t answer the questions.
As for karl Rove, I have no interest in demonizing you, but the tactics you use are /.. if anything .. worse than his.
I remain open to civil arguements and a proud HAhole.
Gota go. Real work to do and what time I have this weekend I want t devote to Obama’s campaign.
Lets agree that a good healthcare solution would obviate I-1000.
See you at DL on Tuesday night and would love to buy you a Jemeson’s if Brack is our President!
@10
John,
Before I start, I just want to say that I’ve had good discussions with you on this issue in the past, and I respect your opinion in ways that I openly admit that I don’t respect SeattleJews. He’s a moron, a bigot, and an asshole, and has written things during this campaign that are inexcusable.
A “poorly written letter”? Excuse me?
If it weren’t for the fact that we’re in the middle of the I-1000 campaign, everyone here would be all over this.
A health insurance provider sends out a letter denying treatment, but offering to pay for assisted suicide, and this group waves it off as a “poorly written letter”?
It was a poorly written letter. I see that nowhere in your comment you address my analogy, so I’ll ask you the question in a different form.
If a health care provider sent a woman a letter saying that they will not cover the cost of childbirth, but will cover the cost of an abortion, does that mean that we have to make abortion illegal? If not, why not? It’s the exact same argument that one makes if you’re saying that the health care provider’s decision is evidence that I-1000 is a choice we shouldn’t have.
If this were Republican-sponsored legislation that had a provision that required that the only records that could be used to track the effects of that legislation be falsified, we would be screaming “cover-up” from the rooftops.
The death certificates are not falsified. The other day, I used an analogy taken from 9/11. When that happened, there were people who were trapped on the top floors of the World Trade Center. Instead of perishing in the fire, they choose to jump to their deaths. Should their death certificates say that they chose to kill themselves?
Of course not.
People who are choosing the option in I-1000 are already going to die. Their cause of death has already been determined and certified by two separate doctors. Whether or not they choose to use the death with dignity cocktail should not change what is documented as their cause of death, because without that underlying cause, there’s no death with dignity cocktail in the first place.
Transparency is the key here. While I do not wish to tell another adult what to do with their life, I can and do insist that the decision be made without coercion, and that accurate records be kept, so that where the law is abused, it can be discovered.
If the law is being abused in Oregon, you’d hear about it all the time. The fact that the process requires two separate doctors to be involved would expose abuse. Nothing has happened. We have to be vigilant, but people who want to coerce someone into dying isn’t going to try to utilize such a heavily safeguarded process. It just doesn’t make sense to do so.
This law is written in a way that disguises the facts of the situation. That is the main problem, and it is easily resolved. The problem has been brought up repeatedly by the people opposing this legislation, and none of the proponents were even willing to consider their objections seriously.
It’s not easily resolved. It’s only resolved by watering down doctor-patient confidentiality laws. And you need a far stronger reason than this to do so. Having a certain amount of privacy within our medical decisions is vital, and what worries me about I-1000 supporters is that they’ve shown themselves to be very prone to wanting to remove privacy in order to help people, but that’s very much akin to believing that one becomes more free by giving up their security.
John, again I appreciate your thoughtful comments. Some people have misconstrued my animosity towards SeattleJew as animosity towards all I-1000 opponents. I hope you do not.
@19
Aside from insulting me, the medical association, the Catholic Church, and do son, now you want to equate the intense efforts we physsicans make to re;leive pain and suffering with a “wink and a nod” intended to kill people? And you call me an idiot?
What? You’ve already gone down this path, bonehead. You yourself are the one who described it this way and now this is THE SECOND TIME you’ve said that I’m being offensive for using words that YOU’VE USED. Again, are you completely retarded?
Have you ever been involved in an end of life process with a loved one or patient? Did some ;physisican actually come to you and see he would be willign to prwescribe an early death if that is what you want?
Again, you do not understand the initiative. I-1000 would not require or even encourage a physician to come to people and see if they’d be willing to prescribe an early death. And frankly, if I were in that situation, I would be thankful to any doctor who let me know what all my options were. YOU DO NOT UNDERSTAND THE INITIATIVE. Please take the time to read through the bill, study what’s happened in Oregon and stop making an ass of yourself.
I am not happy about being older tha you, but maybe having assisted in the terminal stages of patients lives and been involved with these ecents for several of my family and fireinds, I have a perspective you lack?
No, you don’t. What you have is A BRAIN THAT DOES NOT WORK. Most of this is very easy to understand, yet you cannot grasp it. You’re not arriving at your conclusions because you’re older than me. You’re arriving at your conclusions because you’re a moron who doesn’t understand even the basics of what this initiative is about. And I will continue to elaborate on that as I break down your next comment.
@20
I did not ask about the patient’s incentives, I asked about the healthcare provider who is required to offer this prescription under I-1000.
Of course I was talking about the healthcare provider, you idiot. In fact, here’s what I wrote IMMEDIATELY AFTER THE SENTENCE YOU’RE RESPONDING TO:
How is this not an attempt on your part to blatantly distort what I was saying? You took something out of context and responded to it saying that I was saying something different than what I was clearly saying. Are you going to start debating honorably here or are you going to stick with the douchebaggery?
Tell you what, I will lend you a psychiatry text. Reactive depression and clinical depression are hardly just distinguished by clinical history.
Are you accusing doctors in Oregon of misdiagnosing people? If so, I don’t think I’m the one insulting doctors here. There is no evidence anywhere that a person in Oregon has obtained the death with dignity prescription because of depression. None. I’m no expert in psychiatry, but I think I know enough to know that you’re truly fucked in the head. Seriously.
That could be true and if so it means very few people have any need for I-1000.
So what? Very few people have abortions in the third trimester in order to save the life of the mother. Should they be outlawed to because very few people have a need for it? What kind of head-up-your-ass logic is that? Again, you’re a fucking PhD! This is embarrassing.
But, if my hypothesis is correct, I-1000 may actually ne preventing patients in Oregon form getting the care you and I both feel they need.
Your hypothesis is dead wrong. In fact, studies have shown that palliative care has improved since Oregon’s law was passed.
Sighhh. I do not lie.
You just did! You said that “all” physician, nurses, and hospital organizations are opposed to I-1000. They’re not. The American Medical Student Association, the American Medical Women’s Association both support it.
If you have some time to THINK about your answers,m try t answer the questions.
Whatever, jackass.
@12
I don’t like reading your shit, and I tend to skip past it. Is that your intent?
Frankly, Aaron, I don’t care what you do. I stand up for what’s right. I stand up for people’s freedom. You may think that this is not an important issue, but you’re missing the reality of how societies succeed.
People fight for their individual freedom first before they fight for common causes. That’s just human nature. When society is bent in a way so that people’s individual freedoms are curtailed, that does have a cascading effect on a society’s ability and willingness to achieve the level of greatness it’s capable of achieving.
As you well know, I think the drug war is the elephant in the room when it comes to this. And I will say this without reservation – our health care system will remain broken as long as the drug war is still being waged. It is absolutely impossible to fix our health care system without shifting our societal mindset to deal with addiction as a health problem and not a criminal problem.
There are roughly 25 million regular marijuana users in the United States. These are people, who, instead of being motivated to use government to fix our health care system, they’re instead wary of government because of its propensity to want to use the power of the law to make their choices for them. This is absolutely one of the biggest reasons why a functioning universal health care system eludes us.
Lee
You’ve asked me to respond to particular points, so I’ll try.
“If a health care provider sent a woman a letter saying that they will not cover the cost of childbirth, but will cover the cost of an abortion, does that mean that we have to make abortion illegal?”
No, but we would not allow the doctor to document a miscarriage when it was, in fact, an abortion.
“The death certificates are not falsified. The other day, I used an analogy taken from 9/11. When that happened, there were people who were trapped on the top floors of the World Trade Center. Instead of perishing in the fire, they choose to jump to their deaths. Should their death certificates say that they chose to kill themselves?”
A reasonable point, but I wonder what the harm would be in documenting that they leapt to their deaths avoiding a fire? That is, after all, what happened. No shame in it. Actually, I would be surprised if the records regarding their deaths did not reflect that.
“People who are choosing the option in I-1000 are already going to die. Their cause of death has already been determined and certified by two separate doctors. Whether or not they choose to use the death with dignity cocktail should not change what is documented as their cause of death, because without that underlying cause, there’s no death with dignity cocktail in the first place.”
I have no problem with the underlying cause being listed on the death certificate. Often multiple causes are listed, and without that information, anyone investigating abuses would be almost as handicapped as an investigator without the assisted suicide information. List both. Even list the underlying cause as the primary. No problem. But certainly list the medical assistance as well.
“If the law is being abused in Oregon, you’d hear about it all the time. The fact that the process requires two separate doctors to be involved would expose abuse. Nothing has happened. We have to be vigilant, but people who want to coerce someone into dying isn’t going to try to utilize such a heavily safeguarded process. It just doesn’t make sense to do so.”
First, so far as we know, the law hasn’t been used that frequently. Oregon isn’t exactly the largest state in the union, and this law has very limited applicability. Folks in Oregon just aren’t dying off of lingering diseases in great numbers, and of those that are, not that many seem to be using this option. It seems to be a very small statistical universe. (Frankly, if it were not that this is literally about life and death, my opinion would be that the law doesn’t apply to enough people to be worth this much bother.)
But… We even with the very small numbers involved, and even with the lack of accurate records, are hearing about abuses. This thread is about one of them.
“It’s not easily resolved. It’s only resolved by watering down doctor-patient confidentiality laws. And you need a far stronger reason than this to do so. “
Hold on a moment. This argument only works if it also applies to other causes of death as well. If a person dies of an AIDS related cancer, it is properly recorded on the death certificate. If a person dies of a hepatitis related ailment, that is recorded. If they die of drug abuse, that is recorded.
Those situations have social repercussions, and that is sad. (I lost a step-uncle to AIDS.) We still record the actual cause of death. Those records have been important.
“John, again I appreciate your thoughtful comments. Some people have misconstrued my animosity towards SeattleJew as animosity towards all I-1000 opponents. I hope you do not.”
This blog leans towards inflammatory rhetoric, and this is an emotional topic. I would hope that you and SeattleJew would both step back a bit and realize that you usually agree, and that you are both intelligent people of good will.
“Because not that many people have the combination of:
a) Being in a position where they have a terminal illness
– and –
b) Being the type of personality who doesn’t want to lose control”
What the hell????
Lee, how old are you?
I’m nearly threescore years old, and Steve is older. We’ve both reached the point where we know we’re more than halfway through our journey through this life….and we have one hell of a lot of company. (Otherwise, the debate over Social Security would be rather moot.)
So, except for those of us who meet our end through acts of violence or some unfortunate accident, everyone eventually faces some sort of “terminal illness”….and guess what? None of us “wants to lose control”…but we do. Of our extremities, of our bladders, and in many cases, of our minds. Along the way, many of us face a modicum of suffering. I’ve already had the dubious pleasure of having cancer (and the possiblity of being a tremendous burden to my loved ones), passing several kidney stones (which hurt like bloody hell) and rupturing a lumbar disc (which hurt even more, and left me temporarily crippled). Life’s like that, and most of us play the hand we’re dealt, at least for as long as we can stand it. Some day I might be getting close to the end, and I might get to the point where I’d be OK with the morphine drip being opened up, or just deciding that it was time to give up the struggle to keep breathing. Then again, I might decide not to for a little longer if I wanted to see how the election turned out, if the Mariners were in the World Series, or if next Tuesday was my grandchild’s birthday. In any case, I don’t think I want the legislature or the cops or the courts offering their “help” in making that sort of decision, and I really fear that I1000 will provide a doorway for them to get involved. No matter how carefully this measure is crafted, once it’s on the books we’re likely to see it tinkered with by well-intentioned (or not) folks who think they need to try to quantify what constitutes unbearable pain, or how terminal is terminal, or what constitutes incompetence and who takes over after that.
I’m not in cahoots with the radicals who think this is all sponsored by some “culture of death” or that this will put us on a slippery slope to institutionalized euthanasia. To the contrary, I fear that the result might someday be further constraints on people’s right to make their own decisions about when to call it quits.
One additional thought.
Since my objection is primarily regarding the accuracy of records and the ability to track potential abuse, I should point out that there is really no need to use the emotionally charged word “suicide”.
“Final passage assisted medically”, or some other appropriate language is just as accurate, but less emotionally charged.
We aren’t talking about a big red “SUICIDE” stamped across the front of the certificate. Just some way of tracking potential abuse. One reason we’re having this argument is that the Oregon law doesn’t contain such a provision.
The argument that “this law is flawed, but it’s better than nothing” just doesn’t cut it when we’re talking about life-and-death situations.
Sadly, we have something of a “Catch-22” situation here, and I do recognize it.
If we pass this, the legislature will be very reluctant to make any changes to deal with the problems. It’s a very hot-button issue.
But if it fails, opponents of any “death with dignity” law will use that failure to attack a well-written version. “We already voted this down” will be the rallying cry.
I wish that the folks writing this initiative had taken the time to listen to all sides of the debate before putting this forward.
But in today’s extremely polarized “you’re either entirely with us or you’re evil incarnate” atmosphere, that doesn’t happen often.
@26
No, but we would not allow the doctor to document a miscarriage when it was, in fact, an abortion.
Actually, I wouldn’t have a problem at all with that situation being labeled a miscarriage. That’s actually a better description for it.
A reasonable point, but I wonder what the harm would be in documenting that they leapt to their deaths avoiding a fire?
I don’t know if death certificates get that specific. If they did, maybe they could mention both the death with dignity option along with the underlying illness. I wouldn’t be opposed to that. My hunch is that death certificates tend not to be that wordy, but I’m not a coroner. :)
That is, after all, what happened. No shame in it. Actually, I would be surprised if the records regarding their deaths did not reflect that.
I’m pretty sure they don’t, but again, I’m not 100% sure.
I have no problem with the underlying cause being listed on the death certificate. Often multiple causes are listed, and without that information, anyone investigating abuses would be almost as handicapped as an investigator without the assisted suicide information. List both. Even list the underlying cause as the primary. No problem. But certainly list the medical assistance as well.
I could go along with this and would support a change to the law along those lines.
First, so far as we know, the law hasn’t been used that frequently. Oregon isn’t exactly the largest state in the union, and this law has very limited applicability. Folks in Oregon just aren’t dying off of lingering diseases in great numbers, and of those that are, not that many seem to be using this option. It seems to be a very small statistical universe.
It is. But isn’t that an indication that we’re not dealing with some slippery slope here? As I pointed out above with the late-term abortion to save the life of the mother comparison, just because a medical decision is rare doesn’t mean it’s not important to the small subset of people who are affected.
(Frankly, if it were not that this is literally about life and death, my opinion would be that the law doesn’t apply to enough people to be worth this much bother.)
True, and when it comes to issues like the environment, there are times where there’s a legitimate contention between giving people more choices and less choices. But as I like to point out, individual morality isn’t a system we all share in the same way that the environment is.
But… We even with the very small numbers involved, and even with the lack of accurate records, are hearing about abuses. This thread is about one of them.
But this isn’t an abuse specific to I-1000 or Oregon’s law. Health care providers all over the country deny people life-saving care for financial reasons. The only difference here is that, in this case, the provider was willing to pay for the death with dignity prescription instead. Without Oregon’s law, this person would have been denied treatment anyway. That’s why it’s described as a poorly worded letter, because it leads you to believe that the death with dignity law had a part in the decision to deny coverage.
Hold on a moment. This argument only works if it also applies to other causes of death as well. If a person dies of an AIDS related cancer, it is properly recorded on the death certificate. If a person dies of a hepatitis related ailment, that is recorded. If they die of drug abuse, that is recorded.
That’s true, but that’s different than what I’m talking about.
Those situations have social repercussions, and that is sad. (I lost a step-uncle to AIDS.) We still record the actual cause of death. Those records have been important.
We are recording the actual cause of death. If someone has AIDS and they’re going to die within a few weeks, and they take a death with dignity cocktail, their cause of death was AIDS. Without AIDS, they never would have taken the cocktail. And if you’re worried about accurate recording, you’ll be under-reporting the amount of people dying from AIDS if that’s not on the death certificate.
As I said, I’d be willing to consider finding a better way to record deaths like that. But I don’t agree that it’s done this way to whitewash the reality of what happened.
This blog leans towards inflammatory rhetoric, and this is an emotional topic. I would hope that you and SeattleJew would both step back a bit and realize that you usually agree, and that you are both intelligent people of good will.
Feel free to email me offline. What I can say in response to this should probably be private.
@27
So, except for those of us who meet our end through acts of violence or some unfortunate accident, everyone eventually faces some sort of “terminal illness”….and guess what? None of us “wants to lose control”…but we do.
That’s not true. Not everyone faces a terminal illness. Many people die suddenly. My grandfather died of a heart attack at 49. A buddy of mine was found dead in his apartment about 8 years ago from a heart condition he never knew he had. I agree I could have worded that better regarding the word “control”, but it’s simply not true that every older person ends up in that situation. It’s a smaller subset of the population that does.
In any case, I don’t think I want the legislature or the cops or the courts offering their “help” in making that sort of decision, and I really fear that I1000 will provide a doorway for them to get involved.
Art, I-1000 does not provide any kind of doorway to having government make decisions for you. It just doesn’t. It hasn’t in Oregon, and it won’t in Washington. All it does is allow for someone who wants to conclude a terminal illness on their own terms to do so within a heavily safeguarded system. It doesn’t get us any closer to euthanasia or any other nightmare scenario where old or handicapped people are being coerced into ending their lives prematurely.
Why? Because people like me who’ve been fighting tooth and nail to get I-1000 passed will be fighting tooth and nail against taking it in that direction.
No matter how carefully this measure is crafted, once it’s on the books we’re likely to see it tinkered with by well-intentioned (or not) folks who think they need to try to quantify what constitutes unbearable pain, or how terminal is terminal, or what constitutes incompetence and who takes over after that.
Then why hasn’t it happened in Oregon in the past ten years?
I’m not in cahoots with the radicals who think this is all sponsored by some “culture of death” or that this will put us on a slippery slope to institutionalized euthanasia. To the contrary, I fear that the result might someday be further constraints on people’s right to make their own decisions about when to call it quits.
I think your second sentence contradicts your first one.
@28
John,
As I mentioned above, I sympathize with the concern (and I also think that you’ve made good points in the past regarding the issue of self-administration), but in the end, these issues just aren’t deal breakers. And as I also mentioned, not listing the underlying terminal illness leads to misleading medical statistics just as much as listing it.
Listing both may require larger changes to overall laws regarding how deaths are recorded. It may be something we could research and discuss later.
~Moved from another thread. I actually have to go get some stuff done now too (this is a holiday, after all, especially for people of a certain age in my household) but I encourage other health care providers to add their viewpoints to this discussion:
I am a nurse, working at Harborview in Seattle. I also do hospice home care.
This law is not 100% perfect, and I doubt any law ever is. But it is badly, badly needed. There’s a lot of smoke being blown about how it will be abused. This is very unlikely, and after spending 20+ years watching people dying, sometimes quite terribly with unrelievable pain, I very firmly feel this choice needs to be available. Dying in real life is not like a TV drama. It can be gentle and easily managed, or it can be extremely hard. When dying is not going well, people should have the option to create the death they want. The alternative is unmitigated horror and I have seen too much dreadful suffering, in spite of all the pain drugs available, that I will never be able to forget.
If WA cannot manage to pass this or a similar law by the time I retire or am (god forbid) diagnosed with a terminal illness, I plan to move to Oregon so I can make sure I have the tools everybody should have at the end.
The decision to end one’s own unendurable suffering should always be a personal one, and cannot and should not be decided by others who may have different beliefs, opposing political views, or who are innocent of the realities of dying.
Maybe the “yes” people should read I-1000:
The Indignity of I-1000: Backers Claims Misleading
Margaret Dore, Esq.
________________________________________________
The proposed assisted suicide measure, I-1000, is promoted as giving people “choice.” As written, I-1000, instead gives the choice to other people.
“Voluntary” decision making
The Initiative’s campaign literature states: “All decisions made by the patient must be entirely voluntary.”
I-1000, however, allows someone with a financial interest in your estate, to help you request the lethal dose. That person is even allowed to witness the request form and talk for you. (Sections 3, 22 & 1(3)). This person could be your adult child or a new “best friend.” Would it really be “your choice” with him standing there to urge you on, incidentally securing his inheritance?
When signing a will, this same situation would create a presumption of undue influence, for example, that the adult child or new “best friend” pressured you to sign. The probate statute states that when one of two witnesses is a taker under the will, there is a rebuttable presumption that the taker-witness “procured the gift by duress, menace, fraud, or undue influence.” RCW 11.12.160(2).
“Self-administration”
The initiative’s campaign literature states: “Only the patient–and no one else–may administer the [lethal dose].” The initiative, however, does not say this. I-1000 states only that the patient “may” self-administer the lethal drug. I-1000 also defines “self-administer” as merely the act of ingesting. I-1000 states:
I-1000, Section 1(12).
In other words, someone else putting the lethal dose in your mouth qualifies as “self-administration.”
No witness at death
A bigger problem is that I-1000 does not require a witness at the death. This creates the opportunity for an adult child or a new “best friend” to administer the dose without your consent. Even if you struggled violently, who would know? I-1000 would give the perfect alibi.
The Oregon experience
In Oregon, the majority of patients who have used its law have been “well educated” with private insurance.. http://www.oregon.gov/DHS/ph/pas/docs/year10.pdf
In other words, people with money. Was it really their “choice?”
Conclusion
I-1000 should be judged by what it actually says and does, not by what it is promoted to be. Read it for yourself on the Secretary of State’s Web site, http://www.secstate.wa.gov/ele...../i1000.pdf
Protect yourself and your family. Vote “No” on I-1000.
* * *
Margaret Dore is a Washington State attorney. She is Immediate Past Chair of the Elder Law Committee of the ABA Family Law Section. She was nominated for the 2005 Butch Blum/Law & Politics “Award of Excellence.” See:
This article is similar to articles published in the Seattle Times and the Walla Walla Union-Bulletin.
Lee
I have other issues with this law as well, but the only “deal breaker” is the lack of transparency. Every other issue can be dealt with in other ways.
When we talk about the World Trade Center victims, I am willing to assume that the death certificates for people that died because they jumped from the burning buildings did not list “smoke inhalation” as cause of death.
Were they “committing suicide” when they jumped? I certainly don’t see it that way. But I still want accurate records, even though that situation doesn’t lend itself to significant abuse.
Some folks will oppose any sort of law allowing doctors to help patients through their last part of life. I presume that they are doing so with the best of intentions, and I think that I understand their motives, but I still disagree with them.
I can even agree with the opinion of Super RN, who says that the decision should be a personal one.
But since we are talking about death resulting from the action of a state-licenced physician, under circumstances that may be subject to abuse, we must insist on accurate records. Without them, all of the provisions in the law designed to protect patients from abuse are meaningless. We have no way of knowing whether they have been followed.
Consider this. Would you want to trust a profit-centered corporation to administer this without any requirement for accurate record keeping? Because that is exactly what we are proposing here.
Washington death certificates contain quite a bit of information. Ethnic data, job data, etc… Here’s an excerpt from the Department of Health website:
Yes, I have other issues with this proposed law. In some ways I don’t think it goes far enough. But those isn’t the issues that have me actively opposing it.
The only way we can be sure that the law is being used as enacted is to require accurate record keeping. That requirement alone will go a long way in preventing abuse.
Abuses will happen in any case. Accurate records are somewhat akin to putting a lock on a door. That lock has a key, and the door can still be used.
Just like the lock on my front door, it will not prevent someone determined to break in, but will help to keep the honest folks honest.
@33
Margaret, I have read the entire bill, and I’ve already ridiculed you here.
@34
I have other issues with this law as well, but the only “deal breaker” is the lack of transparency. Every other issue can be dealt with in other ways.
Transparency is government is good. Transparency in our personal lives in not.
When we talk about the World Trade Center victims, I am willing to assume that the death certificates for people that died because they jumped from the burning buildings did not list “smoke inhalation” as cause of death.
No, they probably listed homicide or something related to being killed by a terrorist attack, because that was the root catalyst of their death. That’s the goal of record-keeping, to accurately track what is causing death in a society. I-1000 and Oregon’s law don’t cause death in a society.
I know we’ve talked in the past about the level of mistrust there is among people when it comes to expecting the government to respect their privacy and the sanctity of their medical and health decisions. Recording that death with dignity was related to the cause of death is another thing that crosses that line for people.
You want to record it for recordkeeping/oversight purposes, but many would be concerned that it would be recorded in order to regulate choices. I certainly see your side in this, but I don’t understand why it should be a deal-breaker. I don’t buy your argument that we can’t detect abuse without knowing which specific people are using it. We already know how many people get the prescription, we just don’t know who. And if there are no family members or friends coming to the people saying that so-and-so was coerced into ending their lives prematurely, it’s hard to argue that there’s any abuse going on.
This just isn’t an easily corruptible process. And at it’s heart, it relies completely on the person choosing to die expressing that choice to two separate doctors very clearly. If there was a logical basis for believing that abuse would be likely and that recording this on a death certificate would help root that out, then I’d be right there alongside you. But you haven’t shown me anything to demonstrate that this is the case.
Consider this. Would you want to trust a profit-centered corporation to administer this without any requirement for accurate record keeping?
No, that wouldn’t be ideal. But I’d much rather have that than to not have a choice at all.
Lee @25: So you agree, this is more about political philosophy than health care.
Frankly, I think your unwillingness to make your arguements, then let them stand at the top of the page, weakens your cause in most of your postings. You continue a pattern of doing your best to not only set the entire tone of what may well be a two sided argument with your initial posting, you feel a need to hammer it home with post after post after post in the comment threads.
Other essayists seem content to allow what they write to stand alone, only responding occasionally in the comment thread. You by contrast get really nasty really fast.
I think your style betrays your lack of maturity.
It is incomprehensible to me that anyone of the Jewish faith with any sense of history could support I-1000, when in fact it recapitulates the first deadly phase of the Holocaust: legalized murder by doctors of deformed and handicapped children and disabled people. Don’t forget, as Adolph Eichman was fond of pointing out, the Holocaust was legal in Germany at the time. They had safeguards, too. How can you be so unaware of history? Everything in our society is being pushed in the neo-fascist direction, as Naomi Wolf has expertly pointed out in her book, The End of America, a letter of warning to a young patriot. http://www.youtube.com/watch?v=RjALf12PAWcThis is the last brick in the wall.
You should immediately go to http://books.google.com/books?.....;ct=result, and reeducate yourself.
My father was Jewish, and my daughter is an autistic adult. I am very sensitive to these issues, and aware of their history. I am also a senior citizen age 67. With NO WITNESS, this leaves the door ajar to open season on the elderly and disabled. With young kids like you voting without any political sophistication, we are doomed to repeat the past, and it won’t be nice.
Do some homework.
the URL was incorrect above but here is the corrected URL for Naomi Klein’s terrific speech on YouTube:
http://www.youtube.com/watch?v=RjALf12PAWc
I can’t believe that Lee would try to use Governor Kitzhaber’s Op ed piece to attempt to debunk Barbara Wagner’s story. Governor Kitzhaber’s sorry piece only debunks itself.
Two days ago, in a Seattle PI Guest Column, Former Oregon Governor John Kitzhaber, in defending his Oregon DWD statute, unwittingly provided one of the most compelling smoking gun arguments I have seen so far for rejecting I-1000, in a field teeming with good opposing arguments. Read it here: http://seattlepi.nwsource.com/.....ber29.html.
In this piece, this Governor claimed that “Washington voters have all been misled” by the recent story of poor Oregon cancer patient Barbara Wagner, who died recently after receiving a letter from the Oregon Health Plan, denying her coverage for chemotherapy recommended by her doctor but offering instead assisted suicide as an acceptable option. See story: http://disabilitymatters.blogs.....kness.html. He said the letter was insensitively written, that’s all.
At this time I suggested that Barbara Wagner would be the perfect poster person for not only defeating I-1000 but, as many Oregon doctors suggest, repealing DWD itself. There were a lot of those letters sent out to patients. See YouTube video online: http://video.google.com/videos.....#038;cd=1#.
Twice in this editorial, Governor Kitzhaber contradicted his own argument in a most revealing fashion. First denying that here was any cost-benefit analysis, he then frankly admitted in plain language that the state’s commission warmly embraced the questionable principles of health care rationing and futile care theory”?
He said, “When the Oregon Health Plan went into effect in 1994, it was backed by principles that remain relevant today, including a process for setting health care priorities that reflects a consensus of social values and considers the good of society as a whole.”
Then he said, “The Oregon Health Plan is charged with prioritizing services that reflect the values of Oregonians.” When the first chemotherapy drug did not work, the second one was denied as being too expensive. Suicide apparently did “reflect the consensus of social values” so it was offered. So actually, DWD motivated by concerns of cost cutting and HMO’ing care for the terminally ill after all!
Governor, sir! We hear all your supporters up here screaming that this is only a matter of “personal choice” or “personal autonomy”, relieving pain, getting government off our backs in this critical moment and leaving this personal decision up to the individual! But now you admit in your own words that all your commission really cares about is “good of society as a whole” and “prioritizing services”?
This is exactly what we have been warning about. It isn’t about allowing personal choice. It is really about big government making our life or death choices for us by denying health care choices, offering the vanguard of 40 Million Americans a fatal substitute for real health care. It’s about MONEY!
Whatever justifications exist for I-1000 and compassionate palliative care, I-1000 is snake oil substituting for HMO cost cutting, and the wrong approach that makes the cure worse than the disease. People can still kill themselves legally in Washington without turning our doctors into unwilling murderers. Vote NO.
@40 Jeff
I second your post enthusiastically.
Lee is a good person but arrogant whenever it comes to any issue he takes on. (I likley share that claim to fame.)
Since I-1000 is likely to pass, lets hope that Lee will join with others in seeing that ti is implemented in a better way in WASTATE that assure no one has to choose between a suicide cocktail and expensive medicine.
@32 Super RN
I likes and sympathize with your post.
May I suggest that whether I-1000 paaases or not, that we agree on one thng .. death should be better treated than it si now. No one should have to make decisions of this sort based on whether they can or can nto afdford terminal care.
Moreover, if we do pass this law, the isotic requirement that some psyschologist claim to have the divine wisdom to diofferentiate clinical from reactive depression needs ot be doner away with.
Finally, privacy. Like you, if I come to that point of life, I want the freedom to choose. What I do not want is any baroque HIPPA like government structure that moves this decision from my bedside to a conference room.
I recommend voting against I-1000 and would be a willing volunteer to write something more humane and more respectful of individual rights.
No need to comment. Lee’s style makes Sarah Palin look good.
Why nopt asnswer the man’s question. Sudden death, esp. in Seattle with our wonderful Medic One, is realtively rare. Most of use will die of a more or less prolonged course.
Art, I-1000 does not provide any kind of doorway to having government make decisions for you. It just doesn’t….
Lee,
With all due respect, I would worry about my own morality if I felt free to make such sweeping statements of self confidence.
Lee …
Clever way of making your point Lee. Sounds like one of those folks who is coaching Guv Palin. BTW, I am not retarded but I know people are. I have even had meals with them! Maybe I am retarded by association?
Have you ever been involved in an end of life process w…
Again, you do not understand the initiative. I-1000 would not require or even encourage a physician to come to people ….
What you have is A BRAIN THAT DOES NOT WORK. Most of this is very easy to understand, yet you cannot grasp it. You’re not arriving at your conclusions because you’re older than me. You’re arriving at your conclusions because you’re a moron who doesn’t understand even the basics of what this initiative is about. And I will continue to elaborate on that as I break down your next comment.
@24 Lee
Why won’t you ever even think about an answer? People in terminal care care usually depressed. I-1000 makes no sense unless the patient already carries a clinical diagnisis of depression or manic derpression and most obviously do not.
For what it is worth, I oppose third term abortions expect where needed to protect the health of the mother. Since this is also the opinion long held by Barack Obama, I guess you are also calling him retarded Fuckass?
more Lee
For those who might be fooled by Lee’s post, he is correct in the usual Rovian sense. First, it is obvious that AMSA does not represent practicing doctors. I do not know what opinion medical student organization may have nor did I say anything about that. Perhaps Mr.
RoveLee can post a link?As for the “American Medical Women’s Association” I had never hear about them until thehim came up with them .. lie one of the ubiquitous foundations the far right creates to support their points. I did look them up. They are not a professional organization representing female health care providers per se, they are an avocacy group for women’s issue sin nhealth care and health care carears. At least as far as their own search engine tells me, they have no stance of this issue.
But then I am an HAholer and Lee is only interested in improving everyone’s lives.
Lee,
Supporting rationing of health care instead of universal health care is down right neo-con of you. Are you afraid health care for all Americans is socialism?
Setting priorities is rationing pure and simple. It’s not progressive!
You have exposed yourself as an imposter when it comes to progressive causes because health care is a core principle of the progressive movement.
The Oregon Health Plan cut healthcare benefits for 55,000 Oregonians and you don’t care about them at all. You are fundamentally duplicitous.
SJ @ 8 said:
“The image of the ponderous I-1000 process showing up at my own bedside, when that time comes, frightens me. I want the freedom to work with my family, my rabbi, and my physicians, in private, with no government oversight when I need to make this decision.”
Gee, SJ, you’re sounding almost like a Libertarian on this issue! I’m with you on this one.
@50 PI
I just try to be consistent, don’t lile labels.
Lee is a graduate of the Rove College of Trollsters, cum laude. I know this because since he started blogging I stopped getting those Nigerian advance fee fraud spam e-mails. You know the ones that start, “Greetings! I humbly wish to introduce my poor self to your esteemed majesty, in hopes that you can be of urgent assistance to my in my hour of need. I am Chief BoolaBolla of The Ingobo Tribe….” Probably because he’s been flown in and employed by the Yes-on-I1000 volunteers as head of their creative fiction project.
I think most of these stories like Lee’s about the poor beloved grandpa, the disabled veteran that scaled the cliffs at Normandy who gave everything to his family, the excruciating pain that raced through his body that could not be controlled by pain meds, the bedside promise to make sure that assisted suicide gets passed, how much mom or dad could have used a law like this, how they could have taken control of their own lives, all the hypermelodramatic flair, is just plain made up. It’s bullshit propaganda. I bet somewhere at the Death With Dignity Headquarters there is a playbook on how to write these things, probably written by Derek Humphry himself. There are not and cannot be that many cases like that. We have no way to know if those stories are real, and frankly I’m getting very suspicious that we are all being had, bigtime. Imagine if they pass a law based on a propaganda campaign. I have never once seen any video documenting these situations that they claimed to exist. Where is the proof? Where are the real facts?
One of the sure signs of an internet troll is their outrageous abusiveness and overactivity, their attempts to intimidate and bluff, the way they target the leaders of the discussion, the deceitfulness, irrelevance and misrepresentation of facts, the way they twist logic to suit their needs, and their obnoxious persistence. Mr. Lee, that is YOU.
What I do believe is the evidence of the poor woman, Barbara Wagner, who recieved that letter telling her, among others, that the Oregon Health Plan would pay for her death but not for her life-saving treatment. That was documented and that is relevant.
Apparently this discussion has been infiltrated by drooling, thumb-sucking antediluivan knuckle-draggers like Lee, and it’s time to bail.
There is an old adage: If someone has to resort to a personal attack, they have no argument. Lee’s response to my analysis of I-1000 is:
Lee’s post #35.
I then looked at “here” and it’s a two page smear campaign against me about my guest column, The indignity of I-1000: Backer’s claims misleading, Seattle Times, August 20, 2008. The last part of Lee’s post includes a complete misquote of I-1000.
Lee and the “yes” campaign do not want you to know what I-1000 really says. It’s not about giving people “choice.” It’s about getting rid of people who have “no value.” The way I-1000 is written, it protects those left behind, not you.
A copy of my guest column with supporting documentation can be viewed at http://www.margaretdore.com/i1000.cfm. A copy of the column as it appeared in the Seattle Times can be viewed at http://seattletimes.nwsource.c.....ped20.html.
Protect yourself and your family. Vote “No” on I-1000.
Margaret Dore
Law Offices of Margaret K. Dore, P.S.
http://www.margaretdore.com
1001 4th Avenue, 44th Floor
Seattle, WA 98154
Please don’t even begin to associate Lee with the conservatives. Wrong party when you’re referring to an absolute void of moral values, but nice try. Amazing that even an ineffective prune face like Gregoire doesn’t even support I-1000.
I think it’s pretty clear to readers where the credible, supportable arguments are in this blog. And the childish responses from Lee lead me to question the overall value of debating anything on this site…..