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The killing wards

From commentator Mark in the thread below comes a link to this incredibly disturbing story of death in hospice.

The story is utterly believable: The kindly relative who signs the order to move his uncle into hospice after being confronted with the uncle's advance directive. The relative's eventual realization that "including nutrition and hydration" on the advance directive is taken to mean all nutrition and hydration, even when the patient can eat by mouth. The unnecessary medication with morphine of patients who are not in pain--automatically, just because they are in hospice. And eventually, the tyrannical nurses and doctors who stop the Filipino orderlies from "sneaking" food to patients who must die. The final scene, where the relative listens to a nurse rant about the importance of advance directives while watching over her shoulder as an orderly, seeing the nurse not watching, sneaks into another room to feed a patient, caps it off. The author says that at that moment he chose his side.

I find notable in the story the fact that everyone involved assumes that somehow these patients, including the uncle, had chosen to die in this way by signing advance directives. No distinction is even attempted between artificial nutrition and hydration and feeding by mouth. That distinction didn't last long! And here we were all told that the reason people were starved and dehydrated to death was because "tubes" are "treatment." Welcome to the brave new world. These are patients who can eat by mouth, but the assumption is that they must be starved and dehydrated to death anyway. Even when the uncle wakes for a moment and says his first and nearly only two words, "Help me!" the nurse's instant response is to give more morphine, and that's all. (The uncle says, "No, no," the last words he gets a chance to speak, as the nurse gives the morphine.)

We should not respond to such stories with automatic expressions of faith in hospice. I don't know how widespread these practices are. In this hospice, what it amounted to was that when the doctors and nurses got iron control over the orderlies, killing the patients (by dehydration and morphine) was universal. The orderlies represent the concept many people have of hospice--of natural death at its own pace. The doctors and nurses represented a more powerful technocratic reality. At how many places is this true? I don't know. At how many places is it worse, without even the orderlies sneaking applesauce to the patients? I don't now.

And if what was done here was illegal, I can only say that no one knew that it was. Indeed, the magic of the advance directives was taken to make this sort of death legally at least permitted, if not mandatory. It was the orderlies who were perceived, by everyone involved, as the rule-breakers. There was no faintest question of anyone's prosecuting anyone; indeed, I believe no prosecutor would ever take up such a legal tar-baby of a case. The doctors have the power to enforce n.p.o. orders if they please, even for patients perfectly capable of swallowing, and who is to stop them or tell them they are killing their patients? They will claim that food by mouth is inappropriate in their medical judgement, and they will wave an advance directive at you, even if it is obvious that the patient who signed the directive didn't realize that this was what he would be taken to be agreeing to.

If you have a relative who wants to die in hospice, if you might someday have such a relative, or if someone will someday suggest it to you, you need to read this story and do all that you can to make sure that this doesn't happen to you or to someone you love. Speaking for myself, this has made me reluctant ever to agree to enter hospice anywhere. The stakes are simply too high.

Comments (34)

That "Nurse Kevorkian" gives me the willies. She ought to be electrocuted. Or shot. Or hung. Or something.

The Elephant

Oh yes, and ditto for that doctor and everyone else involved in this.

Catholics, help me out here: Exactly which circle of hell do these people belong in?

The Elephant

Hospice doesn't have to be that way.

My grandmother died this past April. She died from a metastatic colon cancer that eventually spread to cause organ failure. She had been on chemotherapy for several months up until March, but when the cancer had actually spread during the final round of chemo, she decided to stop the chemo and go home on hospice. She stayed at home on hospice, with a hospice nurse coming by once a day to help with various tasks and deliver medications, while my grandfather, my mother and my two aunts took care of her immediate needs. She lasted for about two weeks until general organ failure finally took her in the night. It was difficult, but I can't think of a way I would rather die than in my own home being cared for by my family.

So how do you make sure that hospice care is really that instead of murder of the dying? Well, having a large and loving family nearby certainly seems to help.

Brett, it seems to me that it may make a huge difference whether one is "on hospice" but actually _at home_ vs. "in hospice"--that is, in a facility. It would be much more difficult for someone to come into your own home and literally prevent you from feeding applesauce to your grandmother! If the family is doing a good bit of the care and merely supported by the medical professionals, then it seems to me it should be perfectly possible for the family to feed the patient. My impression is that even people who need a feeding tube can have it at home, though sometimes families will be _told_ that this is not possible.

But the total control of the patient by the medical professionals is obviously not there if the patient is at home and mostly being cared for by family. This could be a good thing.

M.E., the sobering thing about imagining punishment for people like the doctor and nurse is this: In a world in which such people would face any sort of official punishment by the authorities, such things wouldn't happen in the first place. The whole smell of it, the whole atmosphere and meaning of it, is that this _is_ the "official way." These doctors and nurses wouldn't do it if they thought they would ever be punished. They are utterly self-righteous. They view themselves as representing The System. Not that you were denying that. But I find, speaking for myself, that when I envisage a just social order in which people who do such things are punished it is a sort of psychological escapism from this reality.

I think sometimes that the Nuremberg trials and the now-universal condemnation of the Holocaust (to take one example) can cause us to forget that at the time there was no recourse. These things were done by people in authority. It was only later that the world came to condemn it and stop it, by which time, of course, it was too late for very many.

I think part of the difference is just that doctors and nurses get used to death. They have to, or they wouldn't be able to do their work every day. My wife is a resident doctor at the city hospital, so I hear many (suitably anonymized) stories. Did you know that nearly every new doctor breaks down in tears when their first patient dies? And then two years later, they're used to it. Death becomes part of the normal course of events. So while the doctors certainly know more about medicine, they are often not as well placed as the family to actually make decisions about dying.

It's the same kind of dynamic that Chesterton wrote about with respect to the judicial system:
"...it is a terrible business to mark a man out for the vengeance of men. But it is a thing to which a man can grow accustomed, as he can to other terrible things; he can even grow accustomed to the sun. And the horrible thing about all legal officials, even the best, about all judges, magistrates, barristers, detectives, and policemen, is not that they are wicked (some of them are good), not that they are stupid (several of them are quite intelligent), it is simply that they have got used to it. Strictly they do not see the prisoner in the dock; all they see is the usual man in the usual place. They do not see the awful court of judgment; they only see their own workshop."

I'm sure that's part of it, Brett, but in this case the doctors and nurses couldn't even let be what would be and accept it. They came into the situation that had been going on for a month with a more "lax" nurse and "discovered" that the orderlies were feeding the patients and not giving them unnecessary morphine. So they put a nurse on 24-hour duty to stop this, to "catch" them, and to make sure the patients (and in particular, the author's uncle) died.

Those are not just acts of callous people or of people who have grown used to what happens in hospitals and hospice but acts of committed ideologues, acts of people who are determined that these patients _shall die_ and that they _shall not be fed_. They want to make sure to control what happens in a particular direction. The nurse literally sat by the uncle's bedside and registered annoyance when his vital signs did not go down.

The thing I love about Gilbert Meilaender is the pastoral approach always present in even his scholarly works. He wrote that it was not wrong to hope for, or even pray for, the death of someone that is suffering. For an end to their suffering. But that is entirely different than wishing someone's death for our own purposes. That is evil.

My Mother had in home hospice care. At the time I thought their work was wonderful. It didn't bother me that they did suggest it best to withhold food and drink from her as she had obstructed bowels causing anything that went down to come up a putrid black bile.

However, I was extremely uncomfortable with the amount of moriphine they put her on, I wasn't Catholic yet, but I knew there was something wrong with doping a dying woman to a near coma when the day before their treatment she had been carrying on conversations.

Katharine, don't misunderstand me. There are situations in which a person cannot assimilate food and fluids via digestion. (In those cases IV hydration may be possible.) Of course in the story these people were indeed assimilating food and fluids, and the only reason the nurse and doctor wanted them withheld was _because_ they were working to keep the patients alive!

The morphine just seems to have become a highly unfortunate standardized thing. It's interesting to know from your experience that that's even possible in in-home hospice care. One wonders how to avoid it.

Katherine, my mother too died at home under hospice care - with me, my wife, my children, my sister, and my sister-in-law providing care 24-7 for about 6 months. My wife and my sister-in-law, neither actually related by blood to Mom, took the brunt of it. We were fortunate in that Mom was able to take food until 3 days before she died, and water until 2 days before she died. The last food she received was the Blessed Sacrament.

Yes, we did administer morphine during her last few weeks, but she could actually tell us clearly she was in pain up until the last several days or so, and after that it was obvious from her thrashing around. We were blessed in not having to guess much, nor for very long, about just how severe her physical decline was getting - she went into a coma only about 40 hours before death, and after more than a day of being fairly insensible to stimuli.

That said, I can easily understand that there are some situations where there simply is a lot of doubt about whether more food or water is actually making things worse, but it is just difficult to tell. My opinion is that a judgment call, based on best evidence and best medical advice available, that happens to be off by a day or 3, of when the food stopped being biologically beneficial, is not actually a moral failing at all, it is simply an accidental mistake. What we are seeing here is cases where there is NO DOUBT that food will do the patient's body good, but it is refused. That's just plain wrong.

Tony, I think your mother's death sounds like what many people hope for from hospice--a natural death with clarity at the various stages. What I really wish is that doctors had a light that went on on their foreheads to tell you whether one could trust their medical judgment on such things as whether food and fluids were doing good or whether they were spinning an ideologically slanted line. I mean this seriously. If one could really get an objective medical judgment on those things, of course it would be of great value. But I suspect medical training is very biased on this.

Here's a case in point: Shortly after Terri Schiavo's death (within a year, I believe) there was a woman named, IIRC, Maria Korp who was ostensibly in a PVS and whose guardian ordered the removal of all food and fluids. As I remember the story, the guardian was a medical man himself or was acting under medical advice and since, for whatever reason (don't remember why) the case was in the news, he gave as an explanation that the food and fluids were "doing no good." She lived for ten days and then died--a _very_ suspicious circumstance. When I examined his statements more closely, I realized that what was said was actually that her condition was going downhill and therefore that the food and fluids were not effective for stabilitizing her condition! Now, that's a whole different matter from their literally doing more harm than good or not being assimilated (are food and fluids themselves supposed to stabilize a person's condition?), and of course ten days is very much an expected time period for death by dehydration. As I recall, too, her condition was not the kind of thing where one would expect food and fluids not to be assimilated--I don't think it was colon cancer or kidney failure or anything like that.

In your mother's case it sounds like things made sense at each stage, but there could be a lot of circumstances in which I simply wouldn't believe or at least wouldn't trust a doctor who told me food and fluids were not doing good.

Lydia, for background, Maria Korp was an Australian suffering from severe brain damage after someone attempted to murder her. As you say, she was ostensibly PVS as a result. The Australian media did a good job of blurring the distinction between "turning off the machine" and withholding food and water. In reality, there was no machine.

I still can't figure out if journalists are really that dumb (a distinct possiblity in my experience) or whether they are enablers. Maybe it's a mixture of both.

Thanks, David. I've looked the case back up, and here is a long blog post I did on the subject at the time. I hadn't remembered how carefully I had researched and written this up:


My experience at the time was that pro-lifers in the U.S. did know that she was breathing on her own and that her food and fluids were to be withdrawn. However, some pro-lifers (one prominent person I'm thinking of in particular) would not blog on her death because they did not feel that they had enough time to research and because the news media outlets were uttering the magic phrase "not able to absorb food." Actually, the guardian expressly said that the food and fluids would "prolong her dying," which of course meant that she _was_ absorbing them. And his actual claims about her not benefiting from them went as follows:

According to medical information revealed by Mr Gardner yesterday, Mrs Korp is dying. Some of the brutal injuries from the February attack have not healed, her muscle tone is fading, her weight is falling, and her lungs and other organs are struggling to function. Her limbs had become stiff, requiring nurses to force them aside when she was washed. She suffered oxygen loss to her brain and has severe brain damage.

"Her body is not able to absorb and process the food (fed through a tube) in a way that maintains her condition, let alone improves her condition," Mr Gardner said. "The doctors' view is that her condition is terminal."

This statement is pretty darned cagey but hardly difficult to interpret. There is _nothing_ here that means that she wasn't able to process the food and water she was receiving. But because Gardner had concluded that her condition was "terminal," he decided to hurry matters along.

When I first heard of the concept of 'hospice,' a couple of decades ago, I foresaw it turning into this. In fact, due to an incomplete or muddled explanation of the concept, I initially understood the term to coying referring to just this sort of thing.

I know exactly what you mean, Ilion, and yet that definitely wasn't the original idea. The original idea was, I think, what the Filipino orderlies were trying to create.

For those hesitant about inpatient hospice care, in many cases home hospice can be a positive alternative.

The morphine just seems to have become a highly unfortunate standardized thing. It's interesting to know from your experience that that's even possible in in-home hospice care. One wonders how to avoid it.

Last I heard, doctors actually worked for the patient, not the other way, around. No doubt, the problem here is that the family can't just ignore the doctor as one can in leaving a hospital, AMA. This situation is nearly identical to what some states do to mental patients: probate them and treat them, whether they agree or not, on the grounds that the treatment might be useful - not that the doctor actually knows what they seedling, with sound diagnoses, etc., but simply because the treatment might be useful.

Likewise, with hospice, it is a sort of hidden collusion between a misplaced respect for the idiotic end-of-life or even quality-of-life arguments some doctors make (doctors are, many times, ethical idiots, or so I have been told by an ethicist who taught medical students) and the approval of an equally morally-challenged legal system. Is it paradoxical that the two groups most charged with preserving truth and life have become so complicit in destroying the sanctity of life? Not really. It was the loss of God in the lives of both that did it and it is a society equally devoid of God that let's them get away with it. The real question is why the lost God in the first place. This is the question that must be answered if a respect for life is to be restored. The simple answer is Row v. Wade. If one can treat a fetus as a nothing, then on can treat a dying person as a nothing. I cannot comment more, because my moral outrage is at the boiling point. There is no sin in good people resisting immoral laws and until enough people tell the courts to stuff it with their Hell-borne interpretations of the good, we will never see a change. In fact, things will get worse. How can a country that kills millions of innocent babies each year ever be expected to then turn around and pass laws that respect people who are dying? How can doctors who sign off on killing babies be expected to know anything about treating the dying with dignity? They are dead men walking - the doctors, I mean - really dead inside their souls, much more than the patients they are killing in front of them. This is a case of death delighting in death.

The Chicken

not that the doctor actually knows what they seedling, with sound diagnoses

Ah, IPad spell-check has reached a new level of insanity. I hope, someday, they put a semantic parser in the spell-checker, because how it went from a misspelled "doing," to "seedling," is beyond me and hilarious, to boot.

The Chicken

Chicken, where we're at now is that people are openly saying that the doctor should _not_ work for the patient but for society--a dangerous doctrine.

I think before that, though, we already had a false and dangerous view of the good of the patient--namely that dying as swiftly and surely as possible within the legal framework was for the good of the patient. Since outright lethal injection is not (yet) legal in America, death by dehydration-cum-morphine was seen as the next best option.

The Cruzan case was central here, and the saddest part of that case is that at the time it was perceived as a legal win by the good guys. Understandably so. The pro-death forces wanted the Supreme Court to declare that a state standard of "clear and convincing evidence" of the patient's wishes for terminal dehydration was unconstitutional! (It's amazing the things that people will try to get the court to declare unconstitutional.) That didn't happen, thank goodness, which has no doubt saved many lives. But (I've read the opinion) in the midst of the opinion was something very much like a throwaway sentence in which the court majority said that they were granting for the sake of the argument (or some similar phrase) that the patient has a "liberty interest" in refusing nutrition and hydration.

Scalia wrote a concurrence that was, in a sense, more like a dissent, in which he expressly indicated his disagreement with allowing this even for the sake of the argument.

Fallen human nature being what it is, the most influential part of that opinion has been the throwaway sentence which allowed that "liberty interest" in refusing nutrition and hydration merely arguendo. That was then treated as a court declaration of a constitutional right to be dehydrated to death, and we were off to the races. Of course, in our legal system, surrogate decision-makers can make any decision that an individual can make for himself, which added another layer of insanity.

When I was growing up, we we're told that if we didn't agree with a law, we should work within the system to change it. Little did we know that the system was going be rigged in such a way that ithis very difficult to get any rational laws passed, anymore.

If only Congress, greedy people that they are, could pass a law outlawing lobbyists - all lobbyists. It might, for once, make people in congress actually stop and do their own work instead of being coerced by outsiders. It might, more than anything else, turn the system around.

The Chicken

MC, you and I are "lobbyists", you and I are those "wicked" "special interests" from whom the Good Government Goo-Goos want to insulate Congresscritters.

If only Congress, greedy people that they are, could pass a law outlawing lobbyists - all lobbyists. It might, for once, make people in congress actually stop and do their own work instead of being coerced by outsiders. It might, more than anything else, turn the system around.

A good friend of mine worked as a staffer for his home state's senator for several months before he went back to college. This was a few years ago. Being that he was a well-paid mechanical engineer before that, he had more than enough money to float himself comfortably until he started his PhD. He observed that the main problem with our system is that staffers are usually paid terrible, terrible wages and thus staffers typically come in two varieties: spoiled rich kids who often don't take the work that seriously and poor true-believers.

The way most lobbyists would bribe the staffers was with outrageously expensive presentations. They'd pay $10k-$15k to put together an elaborate food table or two to discuss talking points over dinner. They'd buy incredibly expensive wine and other amenities and in quantities where those present couldn't possibly get through more than maybe half of what the lobbyists would buy. Then they'd actively encourage the staffers to take whatever they wanted home since it was "going to waste anyway." I want to say that he said at least once he saw staffers walking out with bottles of Cristal.

It doesn't take much to buy sympathy from (mostly) college kids who are paid so little they have to live in or near SE Washington DC.

Frankly, I disagree with MC that lobbying has _anything_ to do with this issue at all.

The deaths of people in hospice and hospitals by dehydration has so far had nothing to do with federal legislation passed by Congress. Zero. It has had to do with changes in the opinions of elite "ethicists" which are taught to medical people--brainwashing them, in effect--in college and medical school. That has been combined with some unfortunate federal and many unfortunate state court decisions which have given the green light to the entire regime of advance directives and death by dehydration. Some state legislatures have written legislation reflecting this pro-death mindset for the end of life, and the entire movement has grown from there, beginning especially in the early 90's.

One could even say that in a sense this has been a bottom-up movement starting with the private sector influence the judiciary and from there to state legislatures. I imagine that as the federal government takes over the healthcare industry this will now in various ways be reflected in federal regulation. Probably not in explicit federal legislation, since Obamacare is going to be run by bureaucrats and the actual legislation for it is more or less a framework within which regulatory bureaucrats will decide what actually happens. But the rot set in at other levels first. Indeed, even the state legislators were in most cases late to the game.

Lobbying is pretty much an irrelevancy here, and I tend to agree anyway with Ilion. I have plenty of "lobbyists" in Congress (with HSLDA, for example) representing my interests, and if they weren't there, we conservatives would be worse off. But to the issue of dehydrating people to death--lobbyists in D.C. really haven't yet done much that is relevant, if anything.

With respect to the off-topic topic of "lobbyists" ... they can never be outlawed out of existence, the world simply dosn't work that way; but they can be starved to death. The reason there are so many lobbyists and that lobbying govenment functionaries is such a major "industry" in the US is that government (at all levels) is far too big and intrusinve into the lives of the so-called citizens.

... for one simple example, if government functionaries hadn't been allowed to abrogate unto themselves the power to dictate to the populace the “flush efficiency” of the toilets it buys and uses and the “energy efficiency” of the light-bulbs it buys and uses – or, to put it another way, if government functionaries hadn't been allowed to abrogate unto themselves the power to dictate that the products of Company X, which doesn’t employ a lobbyist to see to the protection of its interests against the lobbied encroachments of “public interest groups”, shall be made effectively illegal, whereas the products of its competitor, Company Y, which does employ a lobbyist to lobby for its products and, in alliance with some “public interest groups”, against the products of Company X, shall be the only products effectively allowed to be offered in the marketplace – then there would be few, in any, lobbyists in either Washington or the State capitals.

Lobbying is a rational (and inescapable) response to overweaning and overbearing government.


I was thinking about lobbying by such groups as the AMA and big Pharma. While they don't, overtly, push the agenda of killing by dehydration, etc., their mindsets on things like the efficacy of medication to relieve suffering get transfered into their lobbying efforts and these things, indirectly, will soften legislators to allow thins like the Oregon euthanasia law to be passed. Indeed, when they lobby, they bring their ethical perspective with them.

The original purpose of a representative government was the idea that our representatives were to be OUR lobbyists. The existence of metalobbyists subverts that whole idea. While HSLDA is fine, those issues should be addressed as arguments to the representative of the state while they are in the state - something for them to think about when deciding how best to represent their constituents. It has no place in Washington which, ideally, should be a place to summarize and debate the information gained at the local level. Lobbying at the federal level was never foreseen, as far as I can tell, by the Founding Fathers.

My other issue is that much Federal lobbying is, often, nothing more than bribery. Some appropriate Scripture passages:

Amo 5:12 For I know your manifold transgressions and your mighty sins : they afflict the just, they take a bribe , and they turn aside the poor in the gate [from their right].

Prov 17:23 A wicked man accepts a bribe from the bosom to pervert the ways of justice.

What I meant about lobbying in my original comment was lobbying involving transfer of monies. I guess I didn't make that clear.

Lobbying has only a minor effect on end-of-life treatment at the moment, but as more and more Baby Boomers come of that age, I wouldn't be surprised to see it mushrooming.

The Chicken

P. S.

I know, I know...I made some comments about political history in my last comment and I apologize, in advance, if I stated an uninformed opinion. I stand to be corrected, but be kind. Chickens have weak legs.

The Chicken

Lobbying has only a minor effect on end-of-life treatment at the moment, but as more and more Baby Boomers come of that age, I wouldn't be surprised to see it mushrooming.

And as the federalization of healthcare increases. That's the real biggie. The things that have become part of "the system" on a state-by-state level will be standardized when medicine is socialized throughout the country and when such practices can be used to save what liberals so blithely call "our" healthcare dollars.

Evidence of this came over the transom, as it were, just last evening, when I checked Wesley J. Smith's blog and found this interesting post on one of those sweet little combinations of ideological advocacy and sociological "findings"--a study that found that (shocker!) surrogates are taking _too darned long_ to place DNR orders on people's charts.


Evidently these oh-so-objective "researchers" fret that these delays could boost costs! They speculate and call for further "research" on the impact of "supporting" (which I assume means pressuring and brainwashing) surrogates to get them to hurry up, by golly, and get those DNR's signed!

I note, too, that in some cases DNRs have been interpreted to rule out nutrition and hydration, even if they make no reference to nutrition and hydration.

Lobbying is a rational (and inescapable) response to overweaning and overbearing government.

Lobbying is the cause of and rational reaction to overweaning and overbearing government in quite a few cases. Not just commercial lobbying, but all lobbying.

A good example of this is that while many big software companies want to suppress "patent trolls" (companies that exist only to own patents and then sue), they also want to maintain the liberal status quo where even completely banal software ideas become patentable until a lengthy trial and they can crush small companies with minimal effort. The government isn't able to really have a rational look at the efficacy of software patents (a creation of the SCOTUS, IIRC) because lobbyists buy their way out of genuine reform.

I'm with Lydia that lobbying isn't the problem. I'm not saying there is nothing to worry about, but I think it is overdone. I think this is the analogue to the "money corrupts politics" mantra. My general rule is that when enough people say "follow the money," that usually means its not the money.

And as the federalization of healthcare increases. That's the real biggie. The things that have become part of "the system" on a state-by-state level will be standardized when medicine is socialized throughout the country and when such practices can be used to save what liberals so blithely call "our" healthcare dollars.

This is the big question. I may be the only one here, but I actually have some hope that we may pull back from the socialized medicine path. We are well-advanced on that route at this point, but the Left's gains are very precarious. Obamacare was a desperate effort to impose on us what we don't want before it was too late to do it. Majorities support repeal. But the kicker is that the program could never have worked as passed, or probably anything that could have passed. People think "oh yeah they did that in Europe it can happen here." Well, about that. European nations are small. There has never been a socialized medicine scheme on a 330+ million scale. It can't work, and it won't work. Repeal might actually be the path of least resistance even for supportive politicians. If that happens I don't think we'd just merrily go back to what we had before. We have to make changes, and if we turn away from Obamacare the changes won't be to the Libs liking. We could separate health insurance from health care, have cost transparency, consumer choices and on and on.

If I'm wrong we'll all know by 2013 in all likelihood. I'm anxious for a shaking up of the whole industry. If "socialized medicine" entrenches and advances there isn't a lot left over to fight over in ethics. That's the whole game.

Mark (immediately above),
My thought is that the "Obamanation" in which we now live is the final point of decision ... either America, as a nation and people, shall decisively reject socialism, in all its forms and blandishments -- in which case the Regime of 1787 may yet survive -- or we shall dive fully into it -- in which case, there will likely be no such thing as "the United States of America" (much less an America for the "the United States of America" to rule over) a decade hence.

Ilíon: I fully agree. The choice will be decisive.

We just had a total nutcase post in this thread. His comment has been deleted, but if anyone came along and saw it or got a screen shot or anything, for any purpose, let it be known that his comment has been deleted because it is completely rejected and that similar later comments will be deleted as well as soon as they are seen. We return to our regular programming, folks.

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