Newsgroup: it.politica.internazionale
Titolo: onore al merito...

...per una volta che in America si fa qualcosa di buono e di civile, va
riconosciuto!
Dovremmo imparare...
http://www.nytimes.com/2004/06/01/health/policy/01suic.html?th
The New York Times
  In Oregon, Choosing Death Over Suffering
By JOHN SCHWARTZ and JAMES ESTRIN
Published: June 1, 2004
James Estrin/The New York Times
"When the time comes," said Arthur W. Wilson, 86, "I'm
going to swallow that bottle of Lethe and say goodbye."
PORTLAND, Ore. - Arthur W. Wilson sits in his study,
breathing oxygen through a nose clip and pausing
frequently for the coughs that rack his body.
"I'm not suicidal," he said. "I'm sane."
Mr. Wilson, 86, has been living with the profound pain of
chronic obstructive pulmonary disease for years. Now he
wants to end his life - not today, not tomorrow, but when
he chooses - under the provisions of Oregon's Death With
Dignity law.
"When the time comes," he said, "I'm going to swallow
that bottle of Lethe and say goodbye."
He is no stranger to death, having fought in World War II
and in Korea. And he craves being in control. His house
is snaked through with a clear plastic tubing system that
he devised to carry his oxygen from room to room without
having to drag a tank around behind him.
He does not seem, in other words, to be the depressed,
languishing patient many might expect to see applying for
the Oregon program.
The state's law allows adults with terminal diseases who
are likely to die within six months to obtain lethal
doses of drugs from their doctors. In the six years since
it went into effect, surprises have been common,
including the small number of people who have sought
lethal drugs under the law and the even smaller number of
people who have actually used them. In surveys and
conversations with counselors, many patients say that
what they want most is a choice about how their lives
will end, a finger on the remote control, as it were.
Last week, the United States Court of Appeals for the
Ninth Circuit upheld Oregon's law, ruling that Attorney
General John Ashcroft had overstepped his authority in
trying to punish doctors who prescribed suicide drugs
under the law.
And while there is still strong opposition around the
country to laws like Oregon's, support within the state
has grown over the years. Oregon voters passed the law in
two separate referendums. Even some former opponents say
the widespread abuses predicted by some have not emerged.
And studies are helping researchers and policymakers
understand how it really works in practice.
Perhaps the most surprising thing to emerge from Oregon
is how rarely the law has actually been used.
"We estimate that one out of a hundred individuals who
begin the process of asking about assisted suicide will
carry it out," said Ann Jackson, executive director of
the Oregon Hospice Association.
Since 1997, 171 patients with terminal illnesses have
legally taken their own lives using lethal medication,
compared with 53,544 Oregonians with the same diseases
who died from other causes during that time, according to
figures released by the Oregon Department of Health
Services in March.
More than 100 people begin the process of requesting the
drugs in a typical year. Doctors wrote 67 prescriptions
for the drugs in 2003, up from 24 in 1998. Forty-two
patients died under the law in 2003 compared with 16 in
1998.
Many patients say they want to have the option to end
their lives if the pain becomes unbearable or if they are
sliding into incompetence while still thinking clearly.
"I'd say it's less than 50-50 that I'd ever do this
thing," said Don James, a retired school administrator
with advanced prostate cancer who has not yet received
his pills.
A Desire to Be in Control
A second surprise has been the kind of people who use the
law. They are not so much depressed as determined, said
Linda Ganzini, a professor of psychiatry at Oregon Health
Sciences University. She led a recent survey of 35
doctors who had received requests for suicide drugs. The
doctors described the patients as "feisty" and
"unwavering."
A third lesson is that for most of those who seek
assisted suicide, the greatest concern appears not to be
fear of pain but fear of losing autonomy, which is cited
by 87 percent of the people who have taken their lives
with the drugs. Only 22 percent of the patients listed
fear of inadequate pain control as an end-of-life
concern, perhaps a sign that pain management has improved
over the years.
(Page 2 of 3)
And though opponents of the law argued that patients
would feel pressured by families and even insurers to end
their lives early out of financial concerns, so far
concerns of being a burden to family have been cited by
36 percent of patients, and financial concerns by just 2
percent. The surveys show that the standard version of
health care for terminally ill patients might not be what
these patients are looking for, Dr. Ganzini said. The
standard version of care says, in effect, "we're going to
take care of you," she said. But "for them, the real
problem is other people taking care of you."
Ms. Jackson said the surveys were changing the hospice
association's practices.
In 1994, the group opposed the Death With Dignity law.
Now the hospices work directly with programs like
Compassion in Dying, a group that is involved in 75
percent of Oregon's assisted suicides. Thanks to the
surveys of patients seeking assisted suicide, Ms. Jackson
said, her organization learned that half the people who
rejected hospice care did so because "they thought that
hospice was condescending or arrogant."
Now the hospices fit their treatments to patients who
seek assisted suicide and emphasize that their wishes
will be respected, she said.
Opponents of the Oregon law like Dr. Kenneth Stevens,
chairman of the department of radiation oncology at the
Oregon Health and Science University in Portland, say it
violates the fundamental tenet of medicine. Dr. Stevens
argues that doctors should not assist in suicides because
to do so is incompatible with the doctor's role as
healer.
"I went into medicine to help people," he said. "I didn't
go into medicine to give people a prescription for them
to die."
Dr. Stevens heads an organization, Physicians for
Compassionate Care, that opposes assisted suicide and the
Oregon law. Members of his group, he said, tend to be
"people of faith," who believe that assisted suicide
violates their religious principles. But they base their
opposition to the law on moral and ethical grounds,
arguing that it leads down a slippery slope toward
euthanasia and patient abuses.
He recalled the struggle of his wife, who died of cancer
in 1982. In the weeks before she died, he said, her
doctor offered her an "extra-large prescription" for
painkillers.
"As I helped her into the car, she said, 'He wants me to
kill myself,' " Dr. Stevens recalled. "It just devastated
her that her doctor, her trusted doctor, subtly suggested
that."
Others who initially opposed the law, like the hospice
group, say they have learned to live with it. Michael
Bailey, for example, took out a loan in 1994 to fight the
Death With Dignity act. His daughter has Down syndrome,
and he said that at the time he could see a straight line
between voluntary assisted suicide and forced euthanasia
for the handicapped.
Now Mr. Bailey says he has not seen any abuses. "I don't
see that there's ever been a scandal," he said, "and the
numbers are not huge." Still, he does not support the
law. "If it was up to me, I'd say no, but I don't think
there's any great human rights crisis here," he said.
Support for the law crosses ideological lines, said
Nicholas van Aelstyn, a lawyer in San Francisco who works
withCompassion in Dying. Some commentators have
characterized the movement as a liberal cause, but "to
most of the people exercising it, it's a libertarian
issue," he said. "Many of our clients are die-hard
Republicans who don't want government interfering in
their lives."
That certainly describes Mr. Wilson, who calls himself a
"staunch conservative" and says Mr. Ashcroft is "dead
wrong" about the Oregon law.
The support for the law in Oregon, Mr. James said,
reflects the pioneer spirit that flows from the wagon
trains that brought the early settlers. "They were pretty
well-educated, family-oriented people willing to hack a
new life out of this wilderness," he said. "Pretty
independent folks."
Those who drafted the Death With Dignity Act say they did
not try to come up with a political document that would
warm the heart of Jack Kevorkian, or that would permit
euthanasia, which is repugnant to a significant portion
of the population. Instead, they say, they carefully drew
up a law that they believed would gain support of
everyone except the most determined opponents, and that
was loaded with safeguards against abuse.
Doctors have long made lethal doses of drugs available to
patients inclined to end their struggle against disease,
said Eli Stutsman, president of the board of the Death
With Dignity National Center.
"We took something that was already happening, and we
wrote a law around it," he said.
Opponents had argued that Oregon would become a magnet
for people seeking suicide, so the law's provisions were
restricted to the state's residents.
(Page 3 of 3)
The law also sets a high barrier to getting the
life-ending medications, giving patients the chance to
change their mind up to the last moment. A patient must
make two oral requests for the drugs and one written
request after a 15-day waiting period. Two doctors must
determine that the patient has less than six months to
live, a doctor must decide that the patient is capable of
making independent decisions about health care and the
doctor has to describe to the patient alternatives like
hospice care.
The law also requires that the drugs be self-administered
by the patient, rather than given by a doctor or family
member, to avoid involuntary euthanasia. The death
certificate, under the law, must state the cause of death
as the underlying disease, not suicide.
That provision pleases Mr. James.
"I don't like the word 'suicide,' " he said, because "if
I'm really on a path, the natural path" toward death, and
"just hastening it a little bit, I don't call that
suicide."
Mr. Wilson's family supports him in his wishes, although
his wife, Viola, says she is against the general idea.
"This is his thing, not mine," she said. "It's not the
way I'd go."
Her views flow from her religious beliefs, she said.
"I'm inclined to think that I have a purpose in life
until I go," she said. "God has a plan for me, and I'm
here until he says it's time to go."
She said she liked her husband's idea of having family
members gather in a kind of living wake, however.
"That would be fine," she said. "You should celebrate the
life instead of worry about the death."
A Last Goodbye
Although the idea of an end-of-life celebration strikes
some people as unseemly or exhibitionist for a most
private act, many patients say it is natural to want to
bring family together for a last goodbye. Most patients
call for such a gathering, although relatively few take
the poison in the presence of their families.
Barbara Coombs Lee, the president of Compassion in Dying
Federation, said she saw the suicides not as "an impulse
to self destruction," but as "an impulse to self
preservation - preservation of the self I cherish."
That point of view clearly grates on Dr. Stevens.
Although he said he did not want to "put people down or
label people," he added, "the 'P' word is not 'pain.' The
'P' word is 'pride.' " He explained, "Rather than being
death with dignity, it's death with vanity."
But Dr. Marcia Angell, a former executive editor of The
New England Journal of Medicine and a supporter of
doctor-assisted suicide, said: "He can call it vanity.
Somebody else might call it admirable independence."
If anything, Dr. Angell said, the Oregon law may be too
restrictive and may not reach everyone who could benefit
from it.
"I am concerned that so few people are requesting it,"
she said. "It seems to me that more would do it. The
purpose of a law is to be used, not to sit there on the
books."
Mr. Stutsman, one of the law's authors, said it helped
people who never end up holding a cup of barbiturate
solution in their hands.
"They get the comfort of knowing that the Oregon Death
With Dignity Act is there if they need it," he said.
Although no state has passed its own version of the act,
"Oregon is leading the national debate," he said.
Compassion in Dying claims that the Oregon law prevents
violent suicides and the pain such deaths cause families.
The patients say, however, that to some extent, the
10-year furor over the law is academic; it is not so hard
to die, and people do it around the world without the
benefit of laws like that passed by the Oregon
Legislature.
Mr. James, for example, said, "If it gets too bad, I
might just stop eating," and refers jokingly to his
"Ashcroft kit," a sturdy plastic bag and a roll of duct
tape that he could use to asphyxiate himself. But, he
added, that would be illegal, and "I just think that's
bad karma to do it that way."
Other patients say they know a good death from a bad
death, and know which kind they prefer. Lovelle Svart, a
retired newspaper librarian, said she recently witnessed
a horrifying auto accident on the highway.
"Not that way." she recalled saying to herself. "Not the
way I want to go."

 Dovremmo imparare...
A scrivere " secondo me" o "secondo la mia opinione" (o simili)
o hai la verità assoluta?
P.S. aggiungici anche questo alla tua idea di civiltà
 
http://tinyurl.com/2g9ox
Dato che sull'ultima guerra sono state raccontate un sacco di balle
(non intendo dire sull'olocausto).....siamo propio sicuri
che i nazisti abbiano perso la guerra o che fossero solo due scuole di
pensiero contraposte (di nazismo)?
Ciao!

 Ciao!
Ciao

 ???
Eugenetica (sporca), eliminazione deboli (fastidiosi), prospettare
una vita comoda per i sani senza il fastidio dei malati, dire
che a certe condizioni la vita umana non é degna dell'uomo
(magari non usando riferimenti alla umanità). In fondo
stiamo realizzando in pieno il mondo dipinto dai nazisti
nel "loro post-guerra".
Ciao!