Suggested Answers to the Short Quiz

[johnkarls]

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Introductory Remarks

We studied 4 years ago for our 1/9/2013 meeting the subject of Assisted Suicide.

Since the material covered by the Short Quiz for the 1/9/2013 meeting is so relevant to our focus for 1/12/2016 on “Being Mortal: Medicine and What Matters in the End” by Harvard Medical Prof. Atul Gawande, the 1/9/2013 Suggested Answers to the Short Quiz are reproduced below in their entirety.

However, several additional questions are also germane. They are listed first.


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New Questions

Question A

Is our author, Atul Gawande, a Professor at Harvard Medical School and Harvard School of Public Health, and a Surgeon at Boston’s Brigham and Women’s Hospital?

Answer A

Yes.

Question B

Is Dr. Gawande the author of three other books: “Complications: A Surgeon’s Notes on an Imperfect Science” (2002) which was a finalist for the National Book Award and published in over 100 countries; “Better: A Surgeon’s Notes on Performance” (2007) which was selected by Amazon.com as one of the ten best books of 2007; and “The Checklist Manifesto: How to Get Things Right” (2009) which was yet another NY Times Best Seller?

Answer B

Yes.

Question C

Has Dr. Gawande, a staff writer for The New Yorker since 1998, won two National Magazine Awards, a MacArthur Fellowship, and been named one of the world's hundred most influential thinkers by both Foreign Policy Magazine and Time Magazine?

Answer C

Yes.

Question D

Was one of the book reviews posted in the Reference Materials section for our 1/12/2016 meeting on http://www.ReadingLiberally-SaltLake.org entitled “Going Gently Into The Night: A surgeon learns the lesson formulated by Cicely Saunders, the founder of hospice care: ‘Last days need not be lost days’”?

Answer D

Yes.

That book review was written for the Wall Street Journal by Dr. Paul McHugh who is the University Distinguished Professor of Psychiatry at Johns Hopkins University School of Medicine, the author of “Try to Remember: Psychiatry’s Clash Over Meaning, Memory, and Mind” and the author, co-author or editor of six additional books within his field.

Question E

What is Hospice Care?

Answer E

According to http://www.hospice.org, hospice is “a special healthcare option for patients and families who are faced with a terminal illness. A multi-disciplinary team of physicians, nurses, hospice aides, social workers, bereavement counselors and volunteers work together to address the physical, social, emotional and spiritual needs of each patient and family. The hospice team provides care to patients in their own home or a home-like setting regardless of the patient’s age or ability to pay.”

[NB: There does NOT appear to be a national, or even a state-by-state, hospice organization. The foregoing description seemed to capture the idea well though http://www.hospice.org is the website for Hospice of Southern Illinois, but it was the top hit when Googling “hospice care.”]

Question F

Does the Roman Catholic Church oppose both euthanasia and suicide (much less assisted suicide)?

Answer F

Yes.

Question G

Do many Roman Catholics believe that Roman Catholic Hospice Care in fact comprises euthanasia?

Answer G

The short answer is yes.

When I became interested, for the reasons explained in Q&A-H which follows immediately below, how long elderly people survive in Jewish Hospice Care, I also asked quite a few of my Roman Catholic friends about how long they survive in Roman Catholic Hospice Care.

A long-time close friend who is Roman Catholic said that the common perception among Roman Catholics is that when you take a relative to Roman Catholic Hospice Care, s/he will be given pain killers that have the side effect of killing one’s appetite!!!

So that, as a practical matter, the relative starves to death within a few weeks, if not days. [The lack of nourishment will also reduce the ability of an elderly person to fight disease, and the resulting disease may kill the elderly person before s/he starves to death.]

After receiving this news, I asked more than a dozen Roman Catholic friends about whether the information about Roman Catholic Hospice Care that I had received was accurate.

Each of them got a funny look on her/his face as if I had been told something that is not politically correct either to notice or to discuss.

But each of them proceeded to confirm the accuracy of what typically happens in Roman Catholic Hospice Care and what the typical perception of Roman Catholic Hospice Care is among Roman Catholics.

Question H

In stark contrast to Roman Catholic Hospice Care, do recipients of Jewish Hospice Care often survive for many years?

Answer H

The short answer is yes.

The way I stumbled across this fact is described in Q&A-29 for our 8/12/2015 meeting 18 months ago. Question 29 had asked --

“[D]id two of America’s largest Jewish organizations fail to file Pre-Cert Amicus Curiae Briefs with the U.S. Supreme Court pursuant to its Rule 37(2) in the litigation against 15 of the world’s largest financial institutions for the $84 billion that they owed for conversion (the civil-law counterpart to theft) and that had been long since pledged in legally-binding fashion to rescue 10 million inner-city children ‘from a fate worse than death’ -- to affirm that conversion is not restricted to heirs of Holocaust victims whose fine art was stolen by the Nazis, but even applies to the second-class American citizens living in our inner-city ghettos? [Hint: Please see the third and fourth sections of http://www.ReadingLiberally-SaltLake.org entitled ‘Inner-City Holocaust and America’s Apartheid ‘Justice’ System.’]”

Answer 29 had said --

“Gerald S. Cook was the roommate of Yours Truly throughout law school. Jerry was also the Best Man six months following graduation at the wedding of Yours Truly. And Yours Truly served in Jerry’s wedding party a year or two later (Jerry’s brother was his Best Man). However, Jerry returned to Michigan and became a senior partner in Detroit’s largest Jewish law firm -- Honigman Miller Schwartz & Cohen. When Mikhail Gorbachev first began permitting Jewish emigration in 1989, Jerry wrote a personal check to charter the first 747 into Moscow to ferry Russian Jews to Israel. Over the years, Jerry headed the boards of two of the largest Jewish organizations in the U.S. And over the years, Jerry often requested Yours Truly to write letters to America’s decision makers to champion Israeli causes because, as Jerry liked to claim, America’s decision makers paid more attention to the opinions of Goyim. Yours Truly had always been happy to comply because the causes, in each instance, were just. [Please see, for example, all of the massive information contained in the Expired Proposed Topic entitled “The Presbyterian Church Bearing False Witness Against Israel” posted in the second section of http://www.ReadingLiberally-SaltLake.org.] However, other than asking Jerry to be the Best Man at my wedding in 1967, I had never asked Jerry for a favor until 6/16/2010, the day after filing our first appeal to the U.S. Supreme Court. I asked Jerry to contact the two of the largest American Jewish organizations whose boards he had chaired about filing Pre-Cert Amicus Curiae Briefs with the U.S. Supreme Court pursuant to its Rule 37(2) in the litigation against 15 of the world’s largest financial institutions for the $84 billion that they owed for conversion (the civil-law counterpart to theft) and that had long since been pledged in legally-binding fashion to rescue 10 million inner-city children ‘from a fate worse than death’ -- to affirm that conversion is not restricted to heirs of Holocaust victims whose fine art was stolen by the Nazis, but even applies to the second-class American citizens living in our inner-city ghettos. [Jerry had been quite familiar with the litigation for more than a year.] Jerry flatly refused to lift a finger to help the 10 million children living in America’s inner-city ghettos to escape ‘from a fate worse than death.’”

The excuse that Jerry used to turn me down flat was that he had just entered his mother in Hospice Care.

So when I had lunch with Jerry and his wife more than 5 years later on 7/31/2015, I was surprised when Jerry happened to mention that his mother had just passed away a month earlier.

Which is how, without reacting at our lunch to the significance of the news about the passing of Jerry’s mother for Jerry’s turning me down flat 5 years earlier, I became interested in inquiring of quite a few of my other Jewish friends about how long elderly people survive in Jewish Hospice Care.

The consensus was that several years is the norm and 5 years is far from uncommon.

Question I

At the time of our 1/9/2013 meeting 4 years ago, was one of our regular attendees Lori Noda who, at that time, was an Assistant Utah Attorney General?

Answer I

Yes.

Question J

At our 1/9/2013 meeting, did Lori say that suicide is quite common in Japan (the country of Lori’s ancestors) and other Eastern Cultures?

Answer J

Yes.

Question K

Did Lori also say that in Japan and other Eastern Cultures, suicide is viewed as the proper thing to do when one’s honor is involved?

Answer K

Yes.

Question L

Did Lori also say that in Japan and other Eastern Cultures, when a person becomes old and believes that s/he has become a burden to others, it would be considered honorable to commit suicide?

Answer L

Yes.

Question M

Did Lori also say that when anyone commits suicide, it is presumed that honor was the motive – and there is ABSOLUTELY NO INQUIRY whether the suicide's perception of what honor demanded was appropriate? Though an inquiry regarding honor, of course, is different from an inquiry regarding whether homicide or suicide was involved, but such an inquiry takes place only if there are suspicious circumstances suggesting there has been a homicide?

Answer M

Yes.

Question N

Finally, did Lori say that Japanese and members of other Eastern cultures cannot fathom why there is such a fuss in the West about suicide?

Answer N

Yes.

Question O

Does the Reference Materials section for our 1/9/2013 meeting on Assisted Suicide on http://www.ReadingLiberally-SaltLake.org contain 13 postings including a History of Suicide, an Overview of Religious Views of Suicide, the Most-Recent Document on the Vatican Website Addressing Suicide, the Most-Recent Papal Encyclical Re Suicide; an Overview of Assisted Suicide; a description of The Hemlock Society; and the Statutory Text of the Oregon Death With Dignity Act?

Answer O

Yes.


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Suggested Answers to the Short Quiz for our 1/9/2013 Meeting on Assisted Suicide

Question 1

What is the difference between suicide (whether or not assisted) and euthanasia?

Answer 1

Suicide is killing oneself. So suicide would include killing oneself, even with assistance, so long as the person committing suicide is making the decision without coercion and taking the decisive or final action.

Euthanasia is killing another person by act or omission, usually someone who is hopelessly ill or injured and usually for reasons of mercy.

Question 2

Is euthanasia illegal in all 50 states?

Answer 2

Yes.

[Even though, so far as is known, all 50 states permit a patient to “pull the plug” by rejecting “life support” and then die a “natural death,” this should not be considered euthanasia since the patient is killing her/himself; it should probably be considered suicide and, indeed, legal suicide.]

Question 3

Is assisted suicide illegal in all 50 states?

Answer 3

No.

It is legal by statute in Oregon and the state of Washington, and it is legal by court decision in Montana.

Question 4

Did Massachusetts voters narrowly defeat a ballot initiative last month to legalize assisted suicide in line with the statutes of Oregon and Washington?

Answer 4

Yes.

Question 5

Is the illegality of assisted suicide in 47 states the result of religion, primarily Christianity?

Answer 5

Yes.

Question 6

Is suicide a sin under Judaism’s Ten Commandments?

Answer 6

The famous Ten Commandments are 10 of the 613 laws of Judaism. Among the Ten Commandments is the injunction “Thou Shalt Not Kill” which, in the original Hebrew, means “Thou Shalt Not Murder” since The Jewish Bible (aka, the Christian Old Testament) is riddled with stories about how God commanded the Israelites to slaughter groups of human beings, many of them quite large.

Ironically, “Thou Shalt Not Murder” appears to shift the decision to civil authorities. Accordingly, it would appear that Assisted Suicide does NOT violate the Ten Commandments in Oregon, Washington, Montana, Belgium, The Netherlands, Luxembourg, or Switzerland.

Question 7

Is suicide a sin under Christianity’s Two Commandments?

Answer 7

Christ said that THERE ARE ONLY TWO COMMANDMENTS FOR "INHERITING ETERNAL LIFE" = "Thou shalt love the Lord thy God with all thy heart, and with all thy soul, and with all thy strength, and with all thy mind; and thy neighbor as thyself" (Luke 10:27), whereupon immediately follows the parable of the Good Samaritan in answer to the follow-up question of the definition of neighbor.

The Second Commandment, often referenced as The Golden Rule and featured by most of the world’s other great religions, is the only commandment that Christianity brings to bear on the question of assisted suicide. And if the situation were reversed and the Christian would want the other person to assist with the Christian's own suicide, then The Golden Rule has been satisfied.

Question 8

Does the Roman Catholic Church condemn suicide (whether or not assisted) as a sin?

Answer 8

Yes.

Question 9

Do the Roman Catholic Church and those protestant denominations that view suicide as a sin, view it as a mortal sin (i.e., one that cannot be forgiven)? According to the Bible, how many mortal sins are there?

Answer 9

Yes.

In the case of the Roman Catholic Church, suicide was NOT a sin until it was denounced by St. Augustine in the 4th Century AD on practical (rather than theological) grounds. He wanted to curtail all of the suicides, many of them mass suicides, that had been so prevalent in Christian communities to avoid persecution. St. Augustine did NOT denounce suicide as a mortal sin.

Suicide did not become a mortal sin in the Roman Catholic Church until the 13th Century AD when it was denounced by St. Thomas Aquinas as contrary to God’s will. St. Thomas Aquinas DID denounce suicide as a mortal sin.

According to the Bible, there is only one mortal sin = Blaspheming the Holy Ghost.

[In Mark 3:28-29, Christ says: “Verily I say unto you, ALL SINS SHALL BE FORGIVEN UNTO THE SONS OF MEN, and blasphemies wherewith soever they shall blaspheme: But he that shall blaspheme against the Holy Ghost hath never forgiveness, but is in danger of eternal damnation.” And in Luke 12: 10, Christ says: “And whosoever shall speak a word against the Son of man, it shall be forgiven him: but unto him that blasphemeth against the Holy Ghost it shall not be forgiven.”]

Occasionally one encounters the theological question whether, following an act of suicide, there is time to seek forgiveness as a practical matter and, interestingly, while Italian operas invariably treat suicide as unforgivable, German operas (since Germany is 50% Lutheran and only 50% Catholic) often treat suicide as forgivable if the wannabe suicide has time after the fatal act before s/he dies and seeks divine forgiveness during that interval.

Question 10

Why should the view of the Roman Catholic Church and some protestant denominations that suicide is a sin compel the rest of the population to refrain from assisted suicide? Isn’t this an Unconstitutional Violation of the Establishment of Religion Clause?

Answer 10

It would seem that if it is an unconstitutional Establishment of Religion to have a Nativity Scene on public property, then it ought to be an unconstitutional Establishment of Religion to enshrine the Roman Catholic view of suicide in our criminal law.

However, since 6 of the 9 Justices on the U.S. Supreme Court are Roman Catholic, it is doubtful that the Court will so rule any time soon.

[It is ironic that until 1916, all of the Justices of the U.S. Supreme Court had always been White-Anglo-Saxon-Protestant (“WASP”) Males. It now has 5 Roman Catholics appointed by Republican Presidents, apparently in the hope that Roe v. Wade would be overturned, and a 6th Roman Catholic appointed by President Obama who wanted to appoint the first Latino Justice and decided a Latino who was not Roman Catholic wouldn’t be perceived as an authentic representative of the Latino community.]

Question 11

Does the view of the Roman Catholic Church and some protestant denominations that suicide is a sin constitute heresy?

Answer 11

Since, as explained in Q&A-7, Christ said there were only TWO COMMANDMENTS FOR “INHERITING ETERNAL LIFE” = love God with all your heart, soul, strength and mind, and your neighbor as yourself and since, for a Christian who would like her/his neighbor to assist the Christian commit suicide if the shoe were on the other foot, then neither of the two commandments has been violated -- neither suicide nor assisting someone else to commit suicide is a sin.

Accordingly, the Roman Catholic Church and the protestant denominations that view suicide as a sin must be making Christ out to be a liar.

Accordingly, it would appear that their position is heresy.

Question 12

Was suicide prevalent in the early Christian church to avoid persecution?

Answer 12

Yes. Indeed, there were both innumerable mass suicides as well as innumerable individual suicides.

Question 13

Was the first Christian to publicly denounce suicide as a sin St. Augustine in the 4th century AD? Was his motivation the curtailment of all the mass suicides that had prevailed in Christian communities to avoid persecution (vs. a theological reason)?

Answer 13

Yes. Yes.

Question 14

Was the first Christian to denounce suicide as a sin on theological grounds (vs. practical grounds) St. Thomas Aquinas in the 13th century? Did he denounce it as a mortal (unforgivable) sin? Was his theological position that it was an act against God’s will? If it is an act against God’s will, then isn’t all evil in the world (not just pain during a final illness) also God’s will?

Answer 14

Yes.
Yes.
Yes.
And, yes, the logical implication is that St. Thomas Aquinas believed that all evil in the world (not just pain during a final illness) was the will of God. Though most non-Catholic Christians might find it difficult to believe that God wants evil to exist!!!

Question 15

Since suicide and assisted suicide do not necessarily violate Christ’s Two Commandments, hasn’t St. Thomas Aquinas called Christ a liar?

Answer 15

Yes – please see Q&A-11.

Question 16

How does society treat a person who has tried unsuccessfully to commit suicide?

Answer 16

S/he is treated as insane and her/his freedom of action is severely curtailed.

Question 17

Is this de facto “one chance at suicide” policy based on the premise that committing suicide is insane? Isn’t it true that the decision to commit suicide could be perfectly rational?

Answer 17

Yes. Yes.

Question 18

Did Shakespeare’s characters often commit suicide for lost love or avoiding public humiliation as well as for many other rational reasons?

Answer 18

Yes.

Question 19

Do the Oregon and Washington assisted-suicide statutes recognize any reason other than terminal illness? Is pain a requirement?

Answer 19

No, and the terminally-ill applicant must have a remaining life expectancy of less than six months (i.e., fewer than 183 days).

No, interestingly, pain is NOT a requirement.

Question 20

Do all of the other states, so far as is known, permit a terminally-ill patient to reject life-support and die a “natural” death? If pain medications are provided during the “natural” death, then what’s the difference between that and Oregon/Washington?

Answer 20

Yes.

If pain medications are 100% effective and the prognosis of fewer than 183 days proves accurate, there is no difference.

Except that once off life support, the patient may linger 183 days before dying a “natural” death.

And, of course, pain medications are often not 100% effective.

And predictions of remaining life expectancy are not 100% accurate.

Of course, all three of these things can take a terrible toll on both the patient and on the patient’s loved ones.

Question 21

Should assisted-suicide be permitted for reasons other than terminal illness, such as an impairment of the quality of life, or depression, or avoiding public humiliation or chronic illness that is not terminal?

Answer 21

What do you think -- let’s discuss this at our meeting.

Question 22

Do the proponents of assisted suicide view it as the next great civil-rights issue?

Answer 22

Yes.

Question 23

Even if assisted suicide is not a civil-rights issue, isn’t it still an equal-protection-of-the-law Constitutional issue because, just like abortion prior to 1973, the wealthy can travel to permissive jurisdictions but the poor are condemned to either suffer or violate the law?

Answer 23

Yes.

Though it is interesting that Roe v. Wade was not based on the Constitutional issue of “equal protection of the law” but on a Constitutional “right to privacy” even though there is no “right to privacy” written in the Constitution.

Question 24

How much of the nation’s booming medical costs relate to care during a final illness?

Answer 24

CBS’ 60 Minutes broadcast 12/3/2010 reported that in 2009, “Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients’ lives -- that’s more than the budget of the Department of Homeland Security or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact.”

In 2009, Medicare covered 45 million Americans and cost, per the Congressional Budget Office, 5.3% of GDP. GDP in 2009 was $13.04 trillion (per the final revision of the US Bureau of Economic Analysis released 7/29/2011).

Accordingly, 2009 Medicare costs must have been $691 billion.

And the cost of solely doctors and hospitals in solely the last two months of patients’ lives must have been 7.24% of total Medicare costs.

To put all of this in perspective, the budget battles between President Obama and Congress constantly refer to $4 TRillion of tax increases and/or spending cuts OVER 10 YEARS as “going big”!!! $4 TRillion over 10 years, is $400 Billion/year. And $50 Billion/year would be 12.5% of “going big”!!!

Admittedly, not all final-illness expenditures could/should be eliminated. But it is interesting to compare how little Intermountain Healthcare, which is regularly rated No. 1 in the U.S. among integrated healthcare systems, spends on the average patient’s final illness compared to other healthcare systems around the country.

And the 60 Minutes statistic was used solely because it was handy. The normal definition of “final illness” is 6 months rather than 2 months. So there is undoubtedly much more than $50 billion/year spent on the final illnesses of patients from which cuts might be possible.

Question 25

What safeguards should be required to insure the decision is voluntary (suicide, whether or not assisted), rather than forced (whether by society or by next-of-kin)?

Answer 25

What do you think -- let’s discuss this at our meeting.

Question 26

What are the lethal drugs predominantly used for assisted suicide in Oregon and Washington? How easy has it been for wannabe suicides who do not qualify for assistance in Oregon or Washington to obtain lethal drugs?

Answer 26

Seconal and Nembutal, the most quickly lethal, painless drugs with which to end life, are available only to doctors in Oregon and Washington to use pursuant to the Assisted Suicide statutes in those two states.

Both state and federal authorities monitor these two drugs very carefully and it is virtually impossible for a wannabe suicide who does not qualify for assistance in Oregon or Washington to obtain them.

Question 27

How does suicide by breathing helium work? [Breathing helium is the method featured in the Frontline/PBS documentary.]

Answer 27

In popular culture, suicide is usually committed by shooting or stabbing oneself, or sitting in a car in an enclosed garage with the motor running.

A car’s engine emits carbon monoxide. As the human body breathes a mixture that contains too much carbon monoxide or carbon dioxide, it senses the oxygen deficiency and there is a terrifying sense of suffocating.

On the other hand, the human body cannot distinguish between helium and oxygen. Accordingly, there is no sense of oxygen deprivation or any other discomfort. Five or six breaths of helium produces unconsciousness and 8-10 minutes later the person’s heart stops.

Question 28

Now that it is so easy for any wannabe suicide to simply buy helium from a party store that sells it for balloons, how easy is committing suicide painlessly and effectively without any assistance?

Answer 28

Easier than obtaining “medical” marijuana in California!!!

Question 29

Is there still the possibility for mishaps, even with helium, that would make desirable treating assisted suicide as a civil right and providing it legal protection?

Answer 29

Yes, there is a possibility that the wannabe suicide might inadvertently rip the plastic bag s/he has placed over her/his head to hold the helium before achieving unconsciousness, condemning her/him to America’s “attempted suicide” system.