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Silence is dishonesty. Or something like that.

Washington State adopted an assisted suicide law that included an opt-out clause for institutions. Now, though, it turns out that at least one pro-suicide blogger isn't happy that opt-out really means opt-out.

As Wesley J. Smith reports, an assisted suicide advocate at a blog called Slog [warning: weird ads in the sidebar of this blog which my ad-blocker did not catch] is all hot under the collar because a Catholic hospice in Whatcomb County, WA, is not giving people in the hospice "information" about assisted suicide. They even have the chutzpah (I know this will shock you) to refrain from linking visitors to their web site to the Hemlock Society so that the suicidally inclined can pursue their "options" more efficiently. The nerve!

The hospice organization has told its staff that they may not advise hospice patients and their families about how to obtain assisted suicide even if they are asked. They must remain silent. The hospice now includes a paragraph on its web site and in information given to patients acknowledging the existence of legal assisted suicide in Washington State and suggesting that those who are interested refer to the County Medical Association, the WA State Dept. of Health, or the Washington State Hospital Association, providing contact information for each of these. But they don't (as already mentioned) include "Compassion and Choice," aka Hemlock.

One woman whose husband recently died at the hospice is upset because no one suggested assisted suicide to him as an option. Shocking! Evidently it was under pressure from her that the new paragraph was inserted into the hospice's information, but they will go no farther. The widow literally says it was "criminal" of them not to talk to her and her husband about assisted suicide.

The dumb blogger literally says this about the hospice's policy:

Answering a patient's question truthfully would be equivalent to participating in the act, and thus a violation of Catholic moral theology. Huh. Perhaps there's some subtlety in the New Testament I just don't get, but I was always led to believe that honesty is supposed to be a Christian virtue.

Yep. Refusing to hand out information about assisted suicide is "dishonest." Well. So much for remaining silent. Guess that's not an option anymore.

This would all just be sounding off from one blogger, but that's not really all it is. After all, the widow's own complaints had some effect on the hospice. (In my opinion they should not even have gone as far as they did. The widow calls the new paragraph "baby steps.") Assisted suicide advocates are very unhappy about the opt-out provision and want it rolled back, perhaps to a requirement to advise and refer for assisted suicide--an option expressly suggested by Compassion and Choices regarding the Washington State situation.

Complaints about difficulty finding doctors to cooperate with assisted suicide in Washington State are not new. And Hemlock says that you are a member of the "medical right" (isn't that a neat phrase) if you oppose advise-and-refer for their services. They are hardly hiding where they are going.

Meanwhile, kudos to all hospice organizations that don't participate--at all--in assisted suicide. Keep up the silence.

Comments (79)

Answering a patient's question truthfully would be equivalent to participating in the act, and thus a violation of Catholic moral theology. Huh. Perhaps there's some subtlety in the New Testament I just don't get, but I was always led to believe that honesty is supposed to be a Christian virtue.

The sad part about this comment was that he probably thought it was intelligently snarky, rather than showing that he is dumber than dog #$%^ at basic theology.

Yes, God will be so happy with you that you said "why golly Mr. Nazi Soldier, there sure are some Jews up in my attic. Gosh, I could never tell a lie, even if the truth would cause the murder of innocent children!"

Where I come from, that's called missing the forest for the trees...

Meanwhile, kudos to all hospice organizations that don't participate--at all--in assisted suicide. Keep up the silence.

Here here!

**Apparently, he's also never heard of Rahab, whose dishonesty in the service of the Israelites was not counted against her as a sin.

***No doubt some half-assed Hitchins or Harris fan will try to link Taqqiya and the story of Rahab to prove we're related to the Taliban.

The thing is, Mike T, silence is the _classic_ "I would never lie" response to the Jews and Nazis scenario. That is to say, it's exactly not a response that indicates you would tell a lie under those circumstances. It's the purist who would never lie who just says he would remain silent, even under torture. So silence in such circumstances is as far away from dishonesty as one can get.

It's _such_ a dumb comment from that blogger.

The thing is, Mike T, silence is the _classic_ "I would never lie" response to the Jews and Nazis scenario.

Perhaps, but then I have little patience for those who get caught up in questions like "can I deceive the man who wants to unjustly kill my guests?" That's what Jesus was getting at it in the lecture on breaking the Sabbath; you get no points with God for "honoring the Sabbath" while you let your neighbor's property and family get destroyed in front of you.

Mike, whether you're right or wrong about that, the point here is that the comment is incredibly dumb precisely because merely remaining silent in such a context isn't even coming _close_ to lying, isn't even making an argument for an exception or anything. It's merely passive refusal actively to cooperate. In the Nazi scenario, it would be the equivalent of stubborn silence when the Nazis demand that you give them the location. What this guy is demanding would be (as you said in an earlier comment) the equivalent of walking up to the Nazi and saying, "Excuse me, sir, but did you know that there are some Jews hiding up in my attic? I wouldn't want to leave you without _important information_."

What is becoming so evident is that the culture of death insists that we get with the program and actively cooperate. No one is to be allowed not to be integrated into the system. They might be very, very kind and "permit" the hospices not to offer the services on their premises (though no doubt next year even that will be challenged), but you have to get integrated into the death system, provide full information, contact info. for Hemlock, and heaven knows what else. When a Catholic organization nearly got snared into an "insurance" scheme for the poor in Boston last year, the state wanted them to provide--I kid you not--_transportation_ for women to abortion facilities since they wouldn't offer abortions at their hospitals. The parallel would presumably be a taxi ride for the hospice patient to the nearest Hemlock clinic.

You people will give us what we want, when and how we want it or else. Because we are the tolerant liberal democrats and *you* people are the theocon fascists.

@Untenured: Is that a joke? I can't tell. (Looks like one...?)

Remember when the pro-death side used slogans like "Against abortion? Don't have one."? Now that they have the whip hand, they make it clear that it's not nearly enough for you simply not to have an abortion, or not to kill yourself. You have to give active support to the machinery of death.

What is becoming so evident is that the culture of death insists that we get with the program and actively cooperate. No one is to be allowed not to be integrated into the system.

If the law says you must provide assistance to people who want abortions or to be euthanized, then ignore the law.

As we're seeing with the mortgage crisis, if a significant swath of a profession breaks the law, the system cannot handle that. In this case, it'd be justified.

The solution here is for the major Protestant denominations and Catholic Church to come together and declare that any member who participates in these practices will not only be excommunicated from their local church (if Protestant), but the denominations as a whole will respect each other's decisions on excommunications over this issue.

Mike T, I was pleased to see that Wesley J. Smith, who is generally _very_ careful about this kind of thing (he's a lawyer) said that _if_ they change the law in Washington so that doctors/hospices have to refer for euthanasia, the organizations should engage in civil disobedience. He stressed that their silence now is not civil disobedience, as this is actually their right under the present opt-out clause of the law, but he said that if Hemlock gets its way and the opt-out is eliminated or watered down, they should disobey.

That is absolutely true. That would be a classic case for civil disobedience, a case where the law would be ordering active participation with evil.

Yep, DmL, Untenured is being facetious. He's one of the good guys.

That is absolutely true. That would be a classic case for civil disobedience, a case where the law would be ordering active participation with evil.

I think this is one of those cases where the local Christian leaders should "run into" the chief of police in public and discretely tell him that if his boys enforce such a law, they better hope they don't need medical attention from the local Christian medical services.

**Since trolls come by this site from time to time, by that I mean the officers should always end up at the bottom of the triage queue.

Obviously Untenured's comment is a joke. If it weren't, he would be Tenured.

Obviously Untenured's comment is a joke. If it weren't, he would be Tenured.


Zing! Well played.

Well said, c matt.

I was a little disappointed that the hospice went so far as they did in response to the ranting widow. But I understand it. I think that, if I felt that I needed to make some act of recognition of her claims, my response would have been to add a paragraph that refers you to the LAW (in particular, its opt-out), and let people take it from there. The law, after all, has the opt-out provision, which means logically that the opt-out is an opt-out from some action, etc. I don't think this would be even a slight material cooperation with evil.

I'm guessing that the hospice's policy went too far. This is from the state hospital association's model opt-out contract.

"5. All providers at [HOSPITAL] are expected to respond to any patient’s query about life-ending medication with openness and compassion. [HOSPITAL] believes our providers have an obligation to openly discuss the patient’s concerns, unmet needs, feelings, and desires about the dying process. Providers should seek to learn the meaning behind the patient’s questions and help the patient understand the range of available options, including but not limited to comfort care, hospice care, and pain control. Ultimately, [HOSPITAL’S] goal is to help patients make informed decisions about end-of-life care."

This is from an analysis by general counsel for a health care group:

"However, there are strong public policy statements contained within Section 19 that imply that “even if” an individual is employed by a prohibiting health care facility, public policy mandates that if such employee is “willing” to support activities under the Act, the employer cannot prohibit or restrict such employee from engaging in I-1000 activities outside of the course and scope of such employee’s regular employment, at sites other than the prohibiting facility. This is a very rare and interesting intrusion upon the employer-employee relationship and would, by implication, raise some interesting questions for both the employer and employee."

http://www.wsha.org/files/Pisto_--_Initiative_1000_Death_With_Dignity_CLE_Jan_2009%5B1%5D.pdf

Any concept like opt-out is still going to have to operate within the context of other concepts like informed consent. Like it or not assisted suicide is a legal option in Washington and folks have a right, at a minimum, to the basic information if they ask.

This whole conscience thing is over-rated and a sign of a self-obsessed society. While there are practical reasons for allowing those whose skill-sets involve intimate interaction to abstain from that to which they deeply object, others like pharmacists whose jobs are done remotely should, like most everyone else, do their jobs to keep their jobs.

Gotta love those liberals: they're all about killing babies, the disabled and the aged; while protecting murderers, terrorists and pedophiles! I honestly think they should stick to being musicians, actors and comedians and leave the governing to the conservatives.

Any concept like opt-out is still going to have to operate within the context of other concepts like informed consent.

So, if I ask a Chevy dealer if his engine is smaller than the Ford's, he is OBLIGATED to inform me? How is that? Or, if I ask a Hari Krishna how the Wiccans view the Harri's idea of God, he has to tell me? Or, if I ask a doctor who believes that aroma-therapy is whacko to explain how his medicine therapy stacks up to the latest aroma-therapy, he HAS to give me an informed run-down. Hey, aroma-therapy is legal, so it must be part of the informed consent picture, right?

Al, the whole point of the opt-out law is to restrain the effective reach of the general "informed consent" requirements. It is as if to say: we believe that consent ought to include this option, but we recognize a respectable difference of opinion on this matter, and for those whose philosophical, moral, and religious views make it out that there can be no such thing as moral consent to suicide, they don't have to provide information on it.

If there is some obligation on the part of a Catholic hospice in Wash. because of the law, the most that obligation could be is a response that says, roughly, that "there is a law that says suicide is legal, we believe that it is categorically impossible for it to be in the best interest of any patient, and therefore we neither offer it nor offer information about it. You have the legal right to seek information on it from those who wish to provide it. That is not part of our business operation."

This whole conscience thing is over-rated ...
If I hadn't seen the name, I would still have guessed that this gem came from Al.

Like it or not assisted suicide is a legal option in Washington and folks have a right, at a minimum, to the basic information if they ask.

Bottom line is, Al, you're wrong if by this you mean, "They have a right to obtain such information at an opting out facility." That's just false. That's part of what the opt-out provision means. If you don't like it, tough. You're the guy who is always telling us, in essence, "That's just the law. Suck it up." Well, for the moment, that the hospice and its employees do _not_ have to give out this information, even when asked, is just the law in WA, so you liberals can suck it up.

"If I hadn't seen the name, I would still have guessed that this gem came from Al."

I disagree with al a lot, but I love that he comments here, and I think he brings out the best in you all. In my not-so-humble and also not-so-well-informed opinion, he's a worthy interlocutor.

I feel like I've said this before.

One of these days I should publicly disagree with him, though, to get the whole "al experience".

I'd be curious to see some data on how representative of liberal opinion Goldy's position is re: opt outs of this sort.

Since I've no evidence that Goldy's position is representative, I assume that Chucky D. is kidding when he writes:

Gotta love those liberals: they're all about killing babies, the disabled and the aged; while protecting murderers, terrorists and pedophiles! I honestly think they should stick to being musicians, actors and comedians and leave the governing to the conservatives.

But, perhaps leprechauns have been informing folks that Goldy's position is representative... and I somehow missed it.

"Or, if I ask a doctor who believes that aroma-therapy is whacko to explain how his medicine therapy stacks up to the latest aroma-therapy, he HAS to give me an informed run-down."

I would hope he would. Patients ask questions for reasons that are often unstated and may be somewhat unformed. A competent doctor would want to know what's going on and the only way to do that is to engage is a little conversation.

"So, if I ask a Chevy dealer..."

I would hope that we don't want to model medical delivery on how we sell cars or proselytize.

"Al, the whole point of the opt-out law is to restrain the effective reach of the general "informed consent" requirements."

I would hope not. Informed consent involves a basic right to receive information, not to receive a service. Defining "opt-out" in a way that forbids a doctor from answering fully a question from a patient is ethically and likely legally problematic.

"(ii) “Participate in this act” means to perform the duties of an attending physician under section 4 of this act, the
consulting physician function under section 5 of this act, or the counseling function under section 6 of this act.

'Participate in this act' does not include:
(A) Making an initial determination that a patient has a terminal disease and informing the patient of the medical
prognosis;
(B) Providing information about the Washington death with dignity act to a patient upon the request of the patient;
(C) Providing a patient, upon the request of the patient, with a referral to another physician; or
(D) A patient contracting with his or her attending physician and consulting physician to act outside of the course
and scope of the provider’s capacity as an employee or independent contractor of the sanctioning health care
provider."

Washington uses the reasonable patient standard in determining issues around informed consent. The Act passed by a 58% majority. The law is new and entities need time to get it right. As the associate counsel for the hospital association I referenced above wrote,

"• Certain activities associated with informing patient’s of their statutory rights under I-1000 are defined to “not constitute” activities under the Act. See Section 2 (d) (iii). Hospitals must ensure that those activities are not inadvertently included in definitions of prohibited acts associated with I-1000."

It would seem that the Whatcomb County entity, reflected on the letter from Mrs. Shapiro, consulted with counsel, and decided they needed to modify their policy to conform with professional ethics and the spirit and letter of the new law.. Happens all the time.

Trying to make this into a slippery slope is, once again, over-reaching.

The Whatcomb County entity, as far as I know, still prohibits its employees from providing information or referrals on their property and under the aegis of their medical care. Al, are you actually claiming that advise and refer is _required_ under the present act and that refraining from advise and refer is not _permitted_ as part of opting out? Because I have to tell you: It doesn't look like Hemlock agrees with you. They appear to want the opt-out provisions _rolled back_ to the extent of requiring advise and refer.

Here, from the blog post linked above, is the quotation to support what I just said (emphasis added):

Rob Miller of Compassion and Choices agrees,... “Patients have a right to information,” Miller told me, “and all medical providers should honor the principle of informed consent by answering questions honestly, and providing referrals when necessary.” Miller isn’t advocating the elimination of the opt-out provision, but when pushed on what might be a reasonable legislative remedy, he suggested something on the lines of a “Right to Know” law that would at least require health care providers to give direct answers to direct questions.

Perhaps, Al, you should tell Rob Miller of C & C that no "legislative remedy" is necessary, because the hospice cannot really opt out so thoroughly as all that and is already required to give such answers and/or provide referrals. I'm sure he'll be very pleased to hear it.

By the way, if I were you, Al, I wouldn't rely so heavily on that particular legal analysis you are quoting there. Having googled it myself, I notice that it advises non-participating hospitals to refer, which might give you the impression that they are required to refer. But not only does the act (the relevant section of which, yes, I just read) not only not contain any such requirement, here is a legal analysis that _expressly_ says they are _not_ required to refer and that the only requirement is to transfer records if the patient leaves their care for a facility that provides suicide assistance:

http://depts.washington.edu/bioethx/topics/WDDA%20Fact%20Sheet%2003-05-09.pdf

Folks in Washington are still feeling their way which is what happens with a new law. It would seem from the law and the opinion that, as the law allows opting-out but defines information and referrals as outside participating in the Act, they might be intruding on the rights of the providers and patients. This is why we have courts.

That policy, if it refers to mere information, is also short sighted and arguably unehtical. An in -depth discussion in which all of the options were fully and frankly discussed would likely lead to many folks passing on the suicide option. It's an involved process and likely a bridge too far for most. If those entities opting-out really have something to offer those who will soon die, honest discussion would seem to be the best course. Informed consent requires providers to deal with autonomous individuals in an open and honest manner. Why do you think suicide is so attractive?

As a side note, I would point out that the cases in some of the related stories turned south so rapidly that there wasn't time to go through the hoops required by the Act. In the Shapiro case they appear to be typical low information citizens.

I would be interested to know the Whatcom County entity's policies on pain medication - do they accept double effect? Is palliative sedation an option? Factors like that are important for a patient to understand and could easily effect a decision. All of it needs to be communicated.

Just read your last post Lydia and I'm inclined to agree on the referral part. Practically speaking, any discussion would provide enough information for the patient to take it from there. My concern is the refusal to discuss which is outside the scope of opt-out. Looking at this from a doing well by doing good perspective, I believe that an honest discussion would be useful in gaining your desired ends.

Al, even if we were to grant that a refusal to "give information about" obtaining suicide is not expressly protected by the opt-out clause, it does not follow that any provider is required to do so or even to permit employees or physicians with privileges to do so on the provider's premises. It merely would mean that the opt-out provision doesn't expressly protect that form of total non-participation by the hospice or hospital. And for that matter, the same for the refusal to refer.

And let's please remember that the people who are asking that "information" be provided are very explicit that included in that information they want contact info. for Compassion and Choices. Notice how annoyed the blogger is that this contact info. is not included in the hospice's new paragraph. This is not chiefly about some sort of general discussion with the patient. This is about making sure that the patient has the best possible information to help him obtain the suicide option if he wants it. It's not like they are being subtle about this.

My point is that prohibiting an action that is outside the scope of the act and hence outside of opt-out is arguably an unwarranted intrusion into the doctor-patient relationship and a violation of the patient's informed consent rights. Again this is why we have courts.

The County Medical Society is referenced by the hospice and the C&C site is referenced on the County Medical Society's site and it's easy to find. What any given person or organization wants isn't really the issue. What matters is that the rights of individuals to legal, medically relevant information is respected. Everything else is secondary.

I would still like to know why folks like you and Westley believe, or at least seem to believe, that, once given the facts about hospice, folks would still choose suicide? I know you all don't want that option but the people have spoken and your way of dealing doesn't seem productive.

It depends on which "folks" you have in mind. There could be all kinds of reasons why _some_ would choose suicide and some wouldn't. Do you, Al, believe that everyone in the world would always do what you think is right? Don't you think that some people would sometimes actually choose behaviors that you think are self-destructive and wrong? Surely you do, since obviously people do so choose. And in that case, you can understand why people would want not to participate in any way. If crystal meth were legalized, you too might not want to give people a map to the nearest place where they could obtain it in the name of "giving information." And I doubt you would agree that a failure to pass out the map was somehow unethical simply because the drug was now legal. It isn't ethically required that we give people helpful information for obtaining every possible legal thing in the world.

The people haven't spoken to the effect that the hospice has to give people the information that the hospice is being asked to give. Sorry. The people _could_ of course speak wrongly (and of course I think they "spoke" wrongly in legalizing assisted suicide at all), but in this case, the people haven't said what you might have wanted them to say. They've stopped short of that.

As for informed consent, I think you're going to find that a difficult sell, because there isn't some procedure or treatment that the patient is consenting to here without being informed about, say, a risk of the procedure. The patients are being informed that the hospice doesn't have any connection with the assisted suicide act, and that's it.

"If crystal meth were legalized, you too might not want to give people a map to the nearest place where they could obtain it in the name of 'giving information.'"

Ah, but the Whatcom hospice is already providing the map, so that point is moot. What you are avoiding is discussing what would be the downside in discussing that option in the context of alternatives like hospice care.

"The people haven't spoken to the effect that the hospice has to give people the information that the hospice is being asked to give."

I don't see an employer enforced gag rule for discussions short of a referral flying but we shall see.

Oh, if crystal meth were legalized you prohibit a doctor discussing its use with a patient? Alcohol, tobacco?

al, I think the point Lydia is making is:

1. Informed consent means that the patient understands the implications of any treatment being recommended. It does not mean that staff have to supply every possible legal alternative. That's why people often get second or third opinions.

2. If a patient asks about assisted suicide, then the staff has the right to simply say "We don't provide the service." They aren't obligated to provide information on where to obtain it.

Doesn't seem troublesome to me.

Alex H: I assume that Chucky D. is kidding
Nope, not at all. I observe and report - that's all.

My point is that prohibiting an action that is outside the scope of the act and hence outside of opt-out is arguably an unwarranted intrusion into the doctor-patient relationship and a violation of the patient's informed consent rights. Again this is why we have courts.

Al, my primary point was that it is not in an opt-out provider's legal (or moral, either) obligation to "provide" information on the assisted suicide options. The provisions of the law that make this clear: the law prevents certain sanctions for a provider that chooses to provide suicide services, it does not impose sanctions for a provider that does not enter into an "act" (as defined) of providing suicide services.

There is, admittedly, a middle level: may a provider (like a facility) impose sanctions on an intermediate level provider (like a doctor) who provides suicide services on their premises and against their explicit policy? The general answer is, yes, the facility can sanction. However, it is accurate to say that providing information about the Washington law if asked is not an act that may be sanctioned, it is not "an act" of providing suicide services that may be sanctioned. It is not explicit that providing information about suicide options, methods, and such is an act protected from sanction by the facility. Nor is it explicit that providing information about the Wash. law without being asked by the patient is an act that is protected from sanction by the facility.

You may wish to infer these as implicitly protected. I would suggest that the law reads the way it does because the legislator intended it to read that way (which is the presumed stance at first consideration in court). If the facility publishes a directive to doctors saying that telling the patient about how suicide options work is (in the eyes of the institution) is contrary to the good of the patient and must not take place in the facility, then they are fairly clearly within their rights as the law reads. Especially if they explicitly hand the patient a copy of the law, get a signature on that, and then tell the doctor that any information given must stay within these bounds: the doctor may discuss the law itself, and may refer to another physician.

Tony, I definitely think they should be (as they are) sanctioning doctors on-premise who refer to suicide-helpful doctors. Surprisingly, even Al seems to think this could be sanctioned by the institution.

Referring is a very explicit doctor-doctor relationship. It sets up a connection between the referring doctor and the doctor referred to in relation to the service for which the referral took place. It shouldn't be going on for abortion, suicide, etc.

The thing is, Al is just obscuring the issue by making it about "talking about suicide," as if I or anyone else on the pro-life side would object to a doctor's trying to _deter_ someone from suicide in these states if the person raises the issue. Hence his reference to a doctor's discussing tobacco. Of course that isn't what this is about. This is about treating suicide in some neutral fashion or even a positive fashion as a live option which might in some cases be in the patient's best interests or which the patient should think about "choosing." Nor are they obligated to tell the patient all about how the suicide would work, which information the patient could use helpfully for considering and obtaining suicide. The institution is not obligated to allow its doctors to sit around saying, "Okay, here is the process you would go through if you wanted to committed doctor-assisted suicide. Here is how you would find a doctor. Here is how you would make the request" as if this is just obtaining something like a piece of medical equipment.

Suicide is the final act of a person mired in pride. So many of our modern so-called laws are nothing more than selfishness set in ink. The only solution is humility, but people so misunderstand this virtue. Humility can be a stubborn virtue and it can be a Hound of Heaven. Humility is a shouting of the truth, first from within oneself and then from without. There is no way to solve the suicide problem with earthly means. It will take supernatural grace manifested in the lives of those committed to life to do it.

Prayer is the first-line offense and a life of virtue is the first-line defense. Humility is one of the virtues the Devil does not understand and neither does the Culture of Death. We have these death laws as a result of our own pride and other sinfulness. Change those and the laws will vanish.

The Chicken

"Informed consent means that the patient understands the implications of any treatment being recommended. It does not mean that staff have to supply every possible legal alternative. That's why people often get second or third opinions."

Informed consent is, in a way, a moving target. I believe that more information is better than less so I'm inclined to push the envelope.

Tony, note my use of the word "arguably". We know at least three things for sure. The hospice modified its policy somewhat after receipt of Mrs. Shapiro's letter, Washington uses the "reasonable patient" standard for informed consent, and 58% of Washington voters consider it important that individuals with a terminal illness have physician assisted death as an option. "You don't ask, you don't get".

Anyway, we can speculate forever. If it goes to court at some point we will find out what the law says. What interests me is the reluctance to discuss the matter.

I can understand the abortion thing as there is a difference of results but with this matter nothing really changes. The patients are terminal and the end result is going to be the same. This is only theology and while one is free to believe what one wishes, it seems a bit much to impose those beliefs on others when there is really nothing much at stake.

"Surprisingly, even Al seems to think this could be sanctioned by the institution."

Let me gently suggest a lack of understanding of the non-ideological left.

"Suicide is the final act of a person mired in pride. So many of our modern so-called laws are nothing more than selfishness set in ink. The only solution is humility, but people so misunderstand this virtue."

Unless one has had to have been on a morphine drip, there is much to be said for humility.

This is only theology and while one is free to believe what one wishes, it seems a bit much to impose those beliefs on others when there is really nothing much at stake.

Whether this is "only theology" and whether much is or is not at stake are, of course, things we profoundly disagree about, Al. But of course you knew that already, right?

I can understand the abortion thing as there is a difference of results but with this matter nothing really changes. The patients are terminal and the end result is going to be the same. This is only theology and while one is free to believe what one wishes, it seems a bit much to impose those beliefs on others when there is really nothing much at stake.

Every political act, no matter how inclusive it tries to be, is an imposition of belief. There is nothing morally wrong about attempting to impose your beliefs peacefully on the rest of society. The only moral issue is the policy in question.

It is not wrong for an atheist leader to outlaw violent religious practices; it is not wrong for religious politicians to outlaw medical practices which they can reasonably demonstrate are violations of the state's duty to uphold and protect human life.

I was reflecting on Oregon's experience and the rather involved process mandated in Washington. In 2009 about 31,000 people died in Oregon and 59 of them were by using physician assistance. This is really a niche sort of thing that involves a certain sort of person. It doesn't seem to be part of any slippery slope. I just don't see what the fuss is about.

"...which they can reasonably demonstrate are violations of the state's duty to uphold and protect human life."

Precisely my point. :)

Well, the fuss is about people committing suicide with the help of physicians. Some of us think that's a big deal. There is also a fuss about any attempt to require that objectors be involved in treating this as a live option and assisting people in any way, shape, or form in obtaining it. That's because we think the thing itself is a big deal.

The fundamental issue, here, is who owns your life. It cannot be the State because the State did not create you and Whoever did create you did not transfer ownership to the State, at least I never saw the document. It cannot be you because you did not create yourself and Whoever did create you did not transfer ownership to you or at least I never saw the documentary transfer for that, nor do I know a location where anyone can find such a document. The One who created you is the One who owns you and he has all rights reserved. You do not hold your life in your hands.

People suffer. People die. Even in this, no one lives as his own master and no one dies as his own master. To take one's own life is a statement to all the world that one believes he should never have been born in the first place. Life is a risk and love is a risk. To deliberately end one's own life is a final act of cowardice and a rejection of love. We live in an age when bravery has been forgotten and love has been reduced to a good feeling.

Sad.

The Chicken

If it goes to court at some point we will find out what the law says.

I can agree with this sentiment, if we change the last words: we will find out what the judge thinks the law ought to be understood to say, and if he is upheld on appeal, we will find out what most of the state authorities will take as binding interpretation.

Al, we know what the law says. It was written in English. If it takes a JUDGE to decide what the law says, then legislators are merely advance-clerks to judges, instead of a separate co-equal arm of government.

What interests me is the reluctance to discuss the matter.

Which is exactly the sentiment that creationists propose about putting creation as an alternative theory in school texts: what's the big deal? If evolution is obviously so much more cogent and better a theory, then how can you harm people by showing them an alternative theory? Why the reluctance to have students discuss the matter?

We know the reason, of course: in some cases and conditions, people will not be fully up to the challenge of reasonable debate. One such condition is the young and pliable, who are easily swayed. Another is the old and infirm, who are easily swayed. People who are looking out for the welfare of someone who is under a strain don't automatically present ALL the information that is to be had.

Al you have gone from this:

Any concept like opt-out is still going to have to operate within the context of other concepts like informed consent. Like it or not assisted suicide is a legal option in Washington and folks have a right, at a minimum, to the basic information if they ask.

Informed consent involves a basic right to receive information, not to receive a service. Defining "opt-out" in a way that forbids a doctor from answering fully a question from a patient is ethically and likely legally problematic.

Informed consent requires providers to deal with autonomous individuals in an open and honest manner.

To this:
Informed consent is, in a way, a moving target. I believe that more information is better than less so I'm inclined to push the envelope.

Notice that it was pretty well defined (Like it or not assisted suicide is a legal option in Washington and folks have a right, at a minimum, to the basic information if they ask.). Suddenly it's a moving target. Believing that more information is better than less has nothing to do with informed consent. As I stated before, informed consent requires that you receive accurate information about the procedure(s) being recommended by the physician. If does not require that they tell you about alternate procedures that they do not offer or recommend. Hence, that is why it is up to the "autonomous" individual to get the additional information.

Hi Chris, it's possible to look at the same thing from separate viewpoints. Historically speaking, informed consent is an evolving concept that changes as medical options and the public's view of the individual's role in his care change. Your definition is far too doctor-centric and constrained. it is also out of date.

There are a number of diseases in which advances in medicine have led to a number of largely equivalent treatment options - cancers like breast and prostate, for example - that are largely and quite properly the patients choice.

In like manner folks at the end of life have options. Mrs. Shapiro felt she and her husband were denied information that they reasonably should have had. I agree, most of you all don't.

Its entirely consistent for me to refer to informed consent as a moving target (which is merely a historical acknowledgment) and at the same time to have very definite ideas as to the direction in which that movement should take.

Tony, your quarrel is with the Anglo-Saxon legal system, I guess. Anyway, it's easy to apply hard-wired provisions like one votes at 18 or can become president at 35. Once we get into concepts like due process, equal protection, privileges and immunities, incorporation, etc. and things like the Ninth and Tenth Amendments we need some interpretation.

"One such condition is the young and pliable, who are easily swayed. Another is the old and infirm, who are easily swayed."

Well, that's a dark and paternalistic view of mankind. This is the United States of America. We breath the sweet air of freedom.

Mike wrote.

"...it is not wrong for religious politicians to outlaw medical practices which they can reasonably demonstrate are violations of the state's duty to uphold and protect human life."

Which phrase is at considerable tension with his statement that,

"Every political act, no matter how inclusive it tries to be, is an imposition of belief. There is nothing morally wrong about attempting to impose your beliefs peacefully on the rest of society."

In order for these two statements to be consistent there needs to be something beyond mere belief and doctrine. There needs to at least be some rational basis that a law achieves a legitimate end.

The problem for you all is that Oregon has had the law to which you object for some time now and there have been no real problems. its effect has been quite modest. Your arguments haven't survived our experience.

MC, your statements, while obviously deeply felt, are another country for those who don't share your religious beliefs. Your speculations don't justify the use of state power.

and there have been no real problems.

Except that people have committed doctor-assisted suicide. Look, Al, I could refute you. Wesley J. Smith has documented the fact that assisted suicides in Oregon have not followed the protocols laid down, which I suppose ought to bother you. But I'd rather just point out that to me, that _is_ the bottom of the slope. PAS isn't bad because it's going to "lead to" something else. It's bad in and of itself.

We breath the sweet air of freedom.

That's kind of rich, Al, considering that, if I've understood you correctly, you don't want the providers to have the freedom not to give their patients a blow-by-blow on how to obtain assistance to commit suicide!

Well, that's a dark and paternalistic view of mankind. This is the United States of America. We breath the sweet air of freedom.

Every doctor since the beginning of medicine has colored his advice to his client, both by his educated opinion of the most important truths about the condition, and by

the reasonably expected response to difficult-to-hear information. Nobody gives ALL POSSIBLE information to the requester, they edit their offering. That's why the requester is free to get information from second sources, second opinions. The freedom does not consist in an absolute RIGHT to receive every possible tidbit of information the moment we ask for it.

ony, your quarrel is with the Anglo-Saxon legal system, I guess.

My quarrel was with your statement. Even in the Anglo-Saxon legal system, people other than judges know what the law says. Under the recent theory, so-called "case-law", judges are arbiters of what the effect of the law shall be, not arbiters of what the law says: when what the law says is clear, the judge has no place but to say "it is so". It belongs to legislators to decide what the law says, and (in the US,) it also belongs to legislators to sometimes lay some laws outside of the interpretation of the court. For those laws, it does NOT require a judge to "interpret" the law.

MC, your statements, while obviously deeply felt, are another country for those who don't share your religious beliefs. Your speculations don't justify the use of state power.

My point was to show that both the State and the individual derive their power to allow assisted suicide from exactly nowhere. The State does not have the power of life and death ab initio and it is difficult to see where it could reasonably derive that right from, otherwise. People cannot give to the State what they do not have to give. The State has the power to protect its people from harm, but the so-called emotional harm in dying is over, soon enough, without the help of the State (and dying is a much greater harm than the piddly little humiliation of living until one dies a natural death).

Individuals who seek assisted suicide or try to give the power to allow assisted suicide to the State also have other agendas than seeking death, otherwise, if they loved death so much, they would have killed themselves, long ago. Both parties are simply butting in where they have no mandate to do something that they have no reasonable business doing. No one likes suffering, but no one lives, truly lives, until he understands that even suffering has a purpose. Boethius's, The Consolation of Philosophy, should be mandatory reading for every high school student.

Why, by the way, should not religion have a say in matters of life and death? It is certainly better qualified and has a great deal more experience with the matter than either individuals or the State. Not believing in religion (and here I mean whatever religion is true) is a discussion to be had long before dealing with assisted suicide. It is that discussion which is being suppressed in society. This assisted suicide nonsense is a proxy for it and a smoke screen to avoid dealing with other, more important issues, such as life and the fate of one's immortal soul.

I will not play relativistic games. Those seeking assisted suicide must deal with religion or get out of the discussion. I assume we are seeking reality, here. If there is a God, they owe it to argue with him, first.

I will say it again, that which they ignore to their danger: assisted suicide is a final act of pride for the one committing the suicide and an act of cooperation for the one assisting. It is an act of cowardice, no matter how pne chooses to rationalize it. It is neither a compassionate nor a lawful choice. The voters of Washington who voted for this faux-law (since it is binding on NO ONE) are moral idiots.

Sorry for my bluntness, but in these right-to-life matters, one should never stop to bargain. I tend to get angry very quickly. This is one reason why I do not witness outside of abortion clinics. I have too much of a temptation to run in and drive everyone out.

The Chicken

Those seeking assisted suicide must deal with religion or get out of the discussion. I assume we are seeking reality, here. If there is a God, they owe it to argue with him, first.

Sure, but He rarely shows up for debates.

Anyway, here's a funny little song about hope, which is what you should be defending instead of religion.
http://www.youtube.com/watch?v=d4UwnYyUrKA

But...the only true, only real, only believable, only worthwhile source for hope in this vale of tears is...God.

Talk about capturing the imagination. There are lots of sources for hope, and they are all real and believable and worthwhile.

There are lots of sources for hope, and they are all real and believable and worthwhile.

Name one.

Music, laughter, springtime, children. How about you tell me why every other source besides God is a disappointment, or even worse, an illusion.

Where do music, laughter, springtime, and children come from?

The Chicken

And around we go. Which came first, the masked chicken or the eggs benedict?

Step2, the ancient Greeks spoke of music coming from "the muses", because they recognized that in some real sense, the person making the music is not, by himself, a sufficient explanation for the beauty, for the way the music strikes into the person's heart and soul. Similarly, the new parents' joy and wonder in the new infant is in part a recognition that some Other had to take a hand in bringing this about because they are not sufficient by themselves, and gratefulness that they have been granted the gift of playing a role in that creation.

Of course, if you don't believe in God, you don't believe that He is necessary for these. But in my experience, not believing in God tends in the direction of leading to a souring of these hope-filled experiences: a secular couple's worry that they will be able to "make everything just right" for their little baby (as if it really is all up to them - and, when they realize they don't have that much power, a growing sense of frustration); an atheist avant-garde jazz musician's flight of fancy into "music" that soothes no breast and jangles the soul, music that nobody wonders about. Viewing springtime as merely a short-term chaos/reduced random fluctuation that will eventually be evened out by entropy, with no inherent meaning whatsoever. These people, without God, have had music, and children, and Springtime, deadened for them.

It is no accident that nihilists are atheists.

Step2, the ancient Greeks spoke of music coming from "the muses", because they recognized that in some real sense, the person making the music is not, by himself, a sufficient explanation for the beauty, for the way the music strikes into the person's heart and soul.

Let's explore that a little in practical terms. Do you think the musician should be allowed to receive payments for "his" music since it really belongs to God? Also, when you hear bad Christian music do you say that it was God's fault for creating such a cacophony?

Similarly, the new parents' joy and wonder in the new infant is in part a recognition that some Other had to take a hand in bringing this about because they are not sufficient by themselves, and gratefulness that they have been granted the gift of playing a role in that creation.

Umm, no. Parents are sufficient by themselves in creating a new infant. They may be appropriately grateful about the circumstances of that joy, and for many other things as well, but that doesn't attribute the cause to someone else.

But in my experience, not believing in God tends in the direction of leading to a souring of these hope-filled experiences...These people, without God, have had music, and children, and Springtime, deadened for them.

You can believe in the mystery of time, the moral struggle for virtue and charity, and the inescapable power of objective truth without subscribing to belief in any religion or version of God. You can be a secular humanist and still believe all those things. All religion does is give you the excuse of tradition, but tradition is never enough by itself, the point of contention has to be decided by other criteria.

It is no accident that nihilists are atheists.

Yep, atheists are simply notorious for suicide bombings.

Music, laughter, springtime, children. How about you tell me why every other source besides God is a disappointment, or even worse, an illusion.

And these give us cause to hope for what? Without God, beautiful music and the laughter of children give us no more cause for hope than a pig's fart.

Yep, atheists are simply notorious for suicide bombings.

No, they prefer concentration camps, killing fields and cultural revolutions.

Step2, we believe that *all* that we have comes from God and that we can use it well or badly. So, yes, the musician may be paid just as the mechanic may be paid, because each uses the gifts and abilities God gave him to serve his fellow man ("the laborer is worthy of his hire"); and no, we don't attribute bad music to God but rather ought to be admonishing the bad musician to make better use of God's gifts (or to realize that music is not God's gift to him and find out what is, so he can do well with that instead). In other words, a specific song is not written or played by God, it is written and played by the musician -- but by use of the gift of music that comes from God. Therefore, we praise the good musician -- but we should *also* look past him to praise God who made him able to do his work. And the bad musician remains responsible for his work -- we blame him for it -- because it is a misuse of gifts given.

You can believe in the mystery of time, the moral struggle for virtue and charity, and the inescapable power of objective truth without subscribing to belief in any religion or version of God. You can be a secular humanist and still believe all those things.

If you are a secular humanist, and you know anything at all about history, you have no rational hope in the "power of truth" because it has escaped people over and over without end. You have no rational hope in the "moral struggle for virtue and charity" being won, without a source of strength better than mankind to overcome mankind's impediments to virtue.

Parents are sufficient by themselves in creating a new infant.

Parents who think that are parents who have been robbed of the wonder of that creating, the recognition that we (mortal and finite) are privileged to touch the infinite in that moment of creating. If not infinite, then no wonder either. If infinite, then something beyond us cares.

If you are a secular humanist, and you know anything at all about history, you have no rational hope in the "power of truth" because it has escaped people over and over without end.

First, I specifically wrote objective truth, which is a far smaller set of truths than cultural and subjective truth. Second, I wrote it was inescapable because it can be objectively demonstrated time and again. You are also ignoring my point, which is that many of the traits of the God of philosophy (pure act, goodness, truth) can easily be described in secular humanist terms.

You have no rational hope in the "moral struggle for virtue and charity" being won, without a source of strength better than mankind to overcome mankind's impediments to virtue.

Oh right. Man is corrupt because of Original Sin. If only God hadn't put that tree there, or the serpent, or had given Man the ability to know he was doing something wrong before he did it.

If not infinite, then no wonder either.

So you've never experienced a single moment of wonder that wasn't contemplating the infinite. How terrible for you.

If infinite, then something beyond us cares.

There is nothing rational that requires a personification of the infinite.

Without God, beautiful music and the laughter of children give us no more cause for hope than a pig's fart.

Lyrics for a new song:
I love listening to beautiful music and humming along, but without God every note just turns out wrong.
Your sweet laughter gives me joy like a work of art, but without God you inspire me less than a pig’s fart.

No, they prefer concentration camps, killing fields and cultural revolutions.

Somewhere between totalitarian and nihilist there may be some middle ground.

Somewhere between totalitarian and nihilist there may be some middle ground.

As between suicide bomber and saint.

In order for these two statements to be consistent there needs to be something beyond mere belief and doctrine. There needs to at least be some rational basis that a law achieves a legitimate end.

Obviously, but you're not interested in how the other side is using reason to back its arguments. The way you leftists use "reason" in arguments is as a cudgel against your ideological opponents. It implies that our arguments is a "mere belief" that is no more defensible as an objective argument than personal taste.

Oh right. Man is corrupt because of Original Sin. If only God hadn't put that tree there, or the serpent, or had given Man the ability to know he was doing something wrong before he did it.

On the other hand, if the evolution side is correct, it's simply what we've always been. Even worse, we got to where we are by being like that.

As a figurative story rich in symbolism, the Creation myth has a lot of different meanings that are true in multiple contexts. For example, a child who doesn't understand right from wrong that eats a poisonous fruit will most likely perish, so disobedience can be deadly even when that severe consequence is undeserved. Also, one of the preliminary requirements of human societies from the most advanced to the most primitive is for their members to at least partially cover their nakedness. Although I think it is somewhat subtle (like the serpent) in how the narrator gets there, there is also the fact that the tree of knowledge is what gives Man a type of self-awareness that he didn't have before. Of course in the story it is described as awareness of being naked and an after-the-fact shame in doing something wrong, but really it seems to be something else. When God says that Man must be kicked out of the Garden before he also tries to become immortal, it gives the strong impression that even in the Garden humans were still mortal, they just weren't aware of it. Which means that in the Garden humans did not have an awareness of time, they lived within the immediacy of the present circumstance, like most other animals. From that major shift in perspective forward, Man was in an existential dilemma and the Word became his escape hatch to returning home. (Plenty of "Lost" clues for Bill's benefit)

When God says that Man must be kicked out of the Garden before he also tries to become immortal, it gives the strong impression that even in the Garden humans were still mortal, they just weren't aware of it. Which means that in the Garden humans did not have an awareness of time, they lived within the immediacy of the present circumstance, like most other animals.

Before the Fall, humans did not have to worry about anything. They were immortal by God's gift. They realized its loss after the Fall.

They most certainly had an awareness of time because every gardener (which is what Adam was) haa to know something about the time-dependent nature of gardening. Also, speech is a form of time-binding, to use General Semantic-speak. Speech relates observations and organizes them into an historical continuity. When Adam said of Eve, "At last, this is bone-of-my bone..." he realized that there was a time when this was not the case.

The Chicken

Oh, and hope gives rise to laughter, not laughter gives rise to hope. You have to explain where the hope comes from, first, before you can explain the laughter (unless you are talking about non-cognatively-based laughter, which is more or less an stimulus-driven response). Why should the universe provide any hope, a priori? Why is it not just as likely that the universe provide despair? Why is depression not the most likely state for the rational man?

There is a movement in humor theory called the Vitalist Movement that attempts to make some humanistic arguments to explain humor, but it is too ad hoc and to New Agey to be consistent, in my opinion.

The Chicken

Step2, I fail to understand why anyone would bother trying to make the Genesis myth into a worthwhile metaphor for man if God is not part of what makes man to be man. If God is not part of the picture, then Genesis is just another stupid story made up by an ancient story-teller, and has no more capacity for displaying the truth of man to himself than our current ability to do so. I don't need an ancient myth to tell me that I am mortal, or that being ashamed of doing something wrong is common to humanity. It's just pure guess-work to suggest that man came to have more self-awareness after some passage of time/events than he did before, unsubstantiated and untestable. As a way of conveying something valid about what we are, either the myth is hopelessly dull platitudes that don't actually say anything that wasn't totally obvious before, or it says something about causes and those causes are tied in to God.

Before the Fall, humans did not have to worry about anything. They were immortal by God's gift.

The part about not worrying is true under my scenario as well. The part about immortality has nothing to back it up. The narrator was making an insightful observation about nature, time, knowledge, and tragedy. You are the one who wants to make this a story about human beings literally made from dust and bone, talking serpents, an omniscient Creator who doesn't know what is going on in his own backyard, and a magical tree. If there is anything funny about this, it is that you can convince a single individual of the literal truth of this story.

I overstated the point about time in order to make it stand out, so I'll apologize for the overstatement. Most every animal has a limited awareness of time, and of course time-dependent communication and environmental triggers for instinctive behavior are found among most living things. There is still something unique to humans in our relationship to time and existential anxiety, which is essentially what the Genesis narrator was exploring.

Why should the universe provide any hope, a priori? Why is it not just as likely that the universe provide despair? Why is depression not the most likely state for the rational man?

Why should God provide any hope, a priori? Heather MacDonald phrased this best, "Why can't God be 100% malevolent and only 10% effective?" After reading the more brutal demands of the jealous God of the Old Testament, she may have a valid point.

The narrator was making an insightful observation about nature, time, knowledge, and tragedy.

There is still something unique to humans in our relationship to time and existential anxiety, which is essentially what the Genesis narrator was exploring.


You've spoken to the narrator so that you know his intentions?

"Why can't God be 100% malevolent and only 10% effective?"

Ed Fesser takes a stab at answering this in his latest post on the obligations of God. One thing to ask is how does one define goodness and malevolence? What is the correct standard?

The Chicken

"Why can't God be 100% malevolent and only 10% effective?"

Or, why can't god be the worm on my sidewalk right now?

If there is a unique super-being that is the origin of all things, then he cannot be malevolent without defying his own being, since being and goodness are co-relative transcendentals. If there is a unique super-being that is responsible for that which is, then he cannot be only 10% effective. What you are describing is a poor stand-in for God based on demons. But demons are not the unique super-being, they are caused by Him, and cannot be the super-being we mean by "super", because "super" excludes anything caused by another. A demon can be malevolent and partly effective. The uncaused super-being as a malevolent being is an oxymoron.

You've spoken to the narrator so that you know his intentions?

No, but it plainly has fictional elements and the best explanation for that is because it is fiction. Of course fiction can be true in a figurative sense because it addresses something in the human condition. I think the narrator was trying to make sense of the world in symbolic terms and he used this story to address the sense of loss that comes with gaining wisdom. There is another way it could be read. I'll just say that it wouldn't surprise me at all if our impressions about God are formed before a filter gets imposed to categorize the world. There was an excellent radio show that explored this aspect a little.
http://www.radiolab.org/blogs/radiolab-blog/2009/aug/24/after-birth/

Ed Fesser...

Et tu, Chicken? I hate being a spelling Nazi because I'm so bad about it myself, but it drives me up the wall to see Dr. Feser's name misspelled.

If there is a unique super-being that is the origin of all things, then he cannot be malevolent without defying his own being, since being and goodness are co-relative transcendentals.

I wouldn't say they are co-relative, there are plenty of weapons I consider evil even though they exist. The whole thing gets confused when you start talking about the originator of all things who can be held to a standard. If the originator creates all things, where did the standard come from?

I think the narrator was trying to make sense of the world in symbolic terms and he used this story to address the sense of loss that comes with gaining wisdom.

And I think that trying to back-fill extraneous meanings into a 4000 year old text in order to fit modern theories is a special kind of hubris. Trying further to use that 4000 year old text to provide a reason for accepting the modern theory on top is self-defeating. If you can back-fill meaning to that extent, then whatever meaning the text had is so pliable and flexible that it is valueless as support.

If the originator creates all things, where did the standard come from?

The word, "creates" is used in a derivative sense for all creatures. To God, alone, belongs creation. The word creation is used analogically for man and univocally for God. Analogies are referential and need a standard. God's actions are non-analogical and, hence, non-referential. They do not need a higher referred to standard. God's creation is the standard.

I hate being a spelling Nazi because I'm so bad about it myself, but it drives me up the wall to see Dr. Feser's name misspelled.

Point taken. Apologies to Ed.

The Chicken

One thing to ask is how does one define goodness and malevolence? What is the correct standard?

Analogies are referential and need a standard. God's actions are non-analogical and, hence, non-referential. They do not need a higher referred to standard. God's creation is the standard.

If God is beyond standards of goodness and malevolence, it makes no sense for us to talk about His goodness or malevolence. Yet theists never stop talking about God's goodness, exactly as if there was an independent standard that others could reference. Creation may be the standard, but the natural world is no less savage or capricious than man's uniquely sinful world.

If you can back-fill meaning to that extent, then whatever meaning the text had is so pliable and flexible that it is valueless as support.

If I thought it was valueless, I wouldn't be trying to find some value in it. I just don't consider it sacred.

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