Friday, March 25, 2016

Radovan Karadzic convicted of Genocide

Radovan Karadzic, a Bosnian Serb, Is Convicted of Genocide

    THE HAGUE — Radovan Karadzic, the former Bosnian Serb leader, was convicted of genocide, war crimes and crimes against humanity by a United Nations tribunal on Thursday for leading a campaign of terror against civilians in the deadliest conflict in Europe since World War II.
    Mr. Karadzic, 70, was sentenced to 40 years in prison for his role in lethal ethnic cleansing operations, the siege of Sarajevo and the slaughter of 8,000 Muslim men and boys in Srebrenica in 1995, in proceedings that were likened to the Nuremberg trials of former Nazi leaders.
    The trial here was the most important in the 23-year history of the United NationsInternational Criminal Tribunal for the Former Yugoslavia, and a defining test for the entire system of international justice, human rights advocates said.
    “Twenty-one years after Karadzic was indicted, this verdict is a forceful manifestation of the international community’s implacable commitment to accountability,” the United Nations human rights chief, Zeid Ra’ad al-Hussein, said in a statement.
    The conviction offered a note of closure to the bloodiest European conflict since World War II, a civil war that tore apart the former Yugoslavia and left more than 100,000 people dead. The main Balkan combatants, Serbia, Bosnia, Kosovo and Croatia, are now themselves members or aspiring members of the European Union, an achievement for European unity at a time when the bloc faces severe strains over migration and economic stagnation.
    While the tribunal had convicted many lesser figures of war crimes, it had never prosecuted as senior a figure as Mr. Karadzic. Slobodan Milosevic, the Serbian president whose extreme nationalism instigated and enabled much of the fighting, died in March 2006 in his cell in The Hague before the end of his trial before the United Nations tribunal. Ratko Mladic, who was Mr. Karadzic’s military chief during the campaign, is being tried separately.

    Mr. Karadzic was convicted of genocide for the Srebrenica massacr e, which aimed to kill “every able-bodied male” in the town and systematically exterminate the Bosnian Muslim population there.
    He was also found guilty of persecution, extermination, deportation, forcible transfer and murder in connection with a campaign to drive Bosnian Muslims and Croats out of villages claimed by Serb forces during the country’s civil war from 1992 to 1995. He avoided conviction on a second count of genocide in seven Bosnian towns, but was found guilty in that case on a reduced charge of extermination.
    In addition, Mr. Karadzic was found to have been “instrumental” in a campaign of sniping and shelling that terrorized the civilian population of Sarajevo, the Bosnian capital. And he was convicted of leading the seizure of United Nations employees as hostages, to obstruct NATO from carrying out airstrikes on behalf of besieged Bosnian Muslim civilians.
    Mr. Hussein said the tribunal’s judgment “strips away the pretense that what he did was anything more than political manipulation, and exposes him for what he really was: the architect of destruction and murder on a massive scale.”
    Peter Robinson, an American lawyer who was Mr. Karadzic’s chief legal adviser, said his client “was disappointed and astonished by his conviction and the judges’ reasoning, and he asked us to appeal his sentence.”
    Relatives of the victims were disappointed as well, but only because they felt the sentence was too lenient. Kada Hotic of Srebrenica, who said she had lost her only son, husband, cousins and all the other men from her family, cried with anger.
    “He got the verdict of an ordinary soldier,” she said. “He should have had a life sentence. He is guilty of all the killings in Bosnia because he pushed all sides to go to war.”
    Some critics complained that Mr. Karadzic could conceivably walk out of prison one day. Typically, those convicted at the tribunal have served two-thirds of their sentences. With a credit of eight years for time served, that means he could be freed after a little more than 20 years.
    The atrocities in Bosnia were a source of lasting regret for President Bill Clinton, and spurred his administration to broker the Dayton peace accords and, subsequently, support the NATO bombing of Belgrade in 1999 to prevent similar atrocities in Kosovo.
    The decisions were read out by the presiding judge, O-Gon Kwon of South Korea, who took more than an hour as he calmly but precisely recounted the series of atrocities Mr. Karadzic was accused of.
    His brother Luka and other relatives watched from the public gallery during the long reading. The defendant looked tense, tapping his hands and feet beneath his desk.

    The judges took more than a year to deliberate — after being in session for nearly 500 days, spread out over four years — reflecting the ambition of the prosecution and the complexity of conducting a criminal trial covering a lengthy civil war.
    Mr. Karadzic acted as his own lawyer in the proceedings, portraying himself as a man of peace who was driven solely by his desire to protect Serbs.
    In his closing statement, he said that he took “moral responsibility” for crimes committed by Bosnian Serb “citizens and forces.” But he denied having ordered killings and said he was not aware that a massacre would take place at Srebrenica.
    During the trial, to the amazement of experts following the case, he described himself as a “true friend to Muslims” who had tried to make them feel safe, despite his fiery speeches leading up to the war.
    He mounted a zealous defense, bringing 238 witnesses to attest to his innocence. He based his defense on the premise that the Bosnian war broke out because Serbs had no choice but to defend themselves against a Bosnian Muslim separatist regime that intended to create an Islamic state.
    The prosecution contended that Mr. Karadzic was the commander of a separatist Serb government bent on removing all non-Serbs from all areas of Bosnia that had been traditionally Serb.
    Prosecutors presented electronic intercepts, written orders, video recordings and a long line of witnesses — fighters, politicians, peacekeepers, survivors of prison camps and rape victims — to demonstrate his central role in the conflict.
    In a policy that came to be known as ethnic cleansing, hundreds of thousands of Muslims and ethnic Croats, largely Roman Catholic, were driven from their villages, their homes looted and mosques and churches demolished.

    In 1992, the height of the ethnic cleansing campaign, close to 45,000 people were killed or missing, almost half of the 100,000 who died in the Bosnian war.
    Men and boys were held in concentration camps, where prosecutors said thousands were tortured, were killed or died of starvation, and women were said to have been raped and used as sex slaves.
    Mr. Karadzic was arrested on a public bus in 2008, more than 10 years after effectively vanishing. He had taken a new identity, posing as a faith healer and using the alias Dr. Dragan Dabic. He had grown a bushy beard and had long hair fastened in a topknot. His arrest led to the creation of yet another persona — zealous defense lawyer, who worked long nights in his cell to prepare his case.
    The son of a modest family in Montenegro, he began his career as a psychiatrist and a poet who showed no political leanings.

    But as Communism collapsed in Yugoslavia and the Soviet Union and the Warsaw Pact came undone, he joined the Serb nationalists and became a populist demagogue, delivering bombastic, jingoistic speeches to incite Serbs.
    On Thursday in Belgrade, the Serbian capital, a nationalist group protested the sentence, saying Mr. Karadzic was convicted only because he was a Serb.
    Natasha Kandic, a Serbian human rights lawyer, called the verdict just and said she hoped it would be an “obstacle for future revisions of history, for what really happened” in Bosnia.

    Thursday, March 17, 2016

    sleep and eating

    Why We Eat Too Much When We Don’t Sleep Enough

    Researchers study why getting too little sleep leads us to snack more the next day, not only eating more but eating more unhealthy foods


    New studies are shedding light on why people eat unhealthier food and more of it when they don’t get enough sleep.
    A small study published in the journal Sleep earlier this month found a new mechanism that helps explain why people who are sleep-deprived are at greater risk of gaining weight. University of Chicago researchers found that 14 individuals who were sleep-deprived consumed nearly 1,000 calories in snacks in the early evening compared with 600 calories when they had a full night’s sleep, and when they were sleep-deprived they ate twice as much fat. Calories consumed at a lunch time buffet remained the same.
    The conclusion was that when deprived of sleep, the individuals had a greater activation of the endocannabinoid system, which is involved in reward-driven or pleasurable eating, said Erin Hanlon, first author of the study and a research associate at the Sleep Metabolism and Health Center at the University of Chicago.
    The endocannabinoid system—composed of lipids that are produced somewhere in the body and that can be measured in the blood—is also triggered in people who smoke marijuana and is thought to be the source of the so-called munchies.
    The individuals, sleeping in a laboratory, had four nights of 8.5 hours of sleep and four nights of 4.5 hours. Their average levels of the endocannabinoid 2-AG were the same over 24 hours following both the 8.5 hours and the 4.5 hours of sleep, but peak levels were higher and occurred later in the day in the shorter sleep condition.

    FIVE THINGS LACK OF SLEEP DOES TO YOUR BODY

    Researchers say insufficient sleep is associated with negative behaviors and physical consequences including:
    • an increased risk of developing Type 2 diabetes
    • weakened immunity and an increased tendency to get sick
    • impaired cognitive function including memory, alertness and decision-making
    • increased impulsiveness, risk-taking and addictive behavior
    • eating more and eating more unhealthy foods
    “They reported feeling hungrier and having a stronger desire to eat, which corresponds to the same time of day where we see this increase in endocannabinoid levels,” said Dr. Hanlon.
    “We certainly don’t think the endocannabinoid system and activation of it is the only contributing factor to overeating following sleep restriction, Dr. Hanlon said. “But we do think that it could be a contributing factor.”
    Previous studies have found lack of sleep leads to decreases in the hormone leptin, which inhibits hunger, and increases in ghrelin, which induces hunger, said Frank Scheer, director of the Medical Chronobiology Program at Brigham and Women’s Hospital in Boston.

    Though studies have found that being awake longer naturally leads to increased energy expenditure and a need for more food intake, the overeating that typically takes place in people who are sleep-deprived exceeds increases in energy expenditure, resulting in weight gain, said Dr. Scheer, who wrote an editorial about the study in the same issue of Sleep.
    The question of whether people who are sleep-deprived would gain weight even if they ate the same food as when they were getting a full night’s sleep remains unknown, Dr. Scheer said. The mechanism for weight gain may be primarily via increased food intake.
    He pointed to a study that touched on that question, published in 2010 in the Annals of Internal Medicine. It found individuals who were on a diet lost less fat mass and more lean body mass when they were sleep-deprived.
    Andrea Spaeth, a post-doctoral fellow at the University of Pennsylvania Perelman School of Medicine, published a study last year in the journal Obesity, where she and colleagues found that the resting metabolic rate was lower in individuals the morning after five nights of sleep restriction compared with after a normal night’s sleep.
    “The next day you’re burning fewer calories at rest than you would if you weren’t sleep-restricted,” she said, noting it was about 42 calories less. “Over time that could accumulate.”
    Eve Van Cauter, director of the Sleep, Metabolism and Health Center at the University of Chicago and senior author of the Sleep study, noted that the study demonstrated that circulating levels of 2-AG vary enormously throughout the day, with very low levels during the night and a sharp increase from morning to afternoon—an effect that is prolonged and enhanced by sleep restriction.
    “This stimulation of the endocannabinoid system may explain why people who are sleep-restricted tend to eat more snacks rather than eat larger meals,” she said. “It’s more like they just grab anything that’s around them.”
    Her research has found that sleep-deprived individuals crave salty food the most, followed by sweet and then starchy foods.
    Another unexplored question is how sleep quality affects food intake. Studies have found that when individuals get less deep or slow-wave sleep, their glucose tolerance decreases, which increases the risk of developing Type 2 diabetes.
    Before nutritionists and clinicians can start incorporating sleep recommendations into weight-loss programs, some researchers say a randomized controlled study would need to prove that extending sleep helps lead to weight loss.
    University of Chicago researchers are currently in the second year of such a federally funded study. They are looking at whether extending sleep by 1.5 hours a day in overweight adults will lead to changes in energy balance and ultimately to weight loss, said Esra Tasali, an associate professor of medicine at the University of Chicago and principal investigator of that study.
    The researchers are measuring the sleep of people who normally sleep 6.5 hours or less a night and asking them to sleep 7.5 to 8 hours—the amount recommended by sleep professionals. They are giving the participants devices to bring home that will capture their sleep patterns and energy expenditures. The researchers are currently recruiting up to 80 overweight individuals for the five-year study.
    Marie-Pierre St-Onge, an assistant professor of medicine at Columbia University Medical Center, has done neuroimaging studies on 27 people comparing their neural responses to food images when sleep-restricted to when they get a full night’s sleep. She found that when sleep-restricted, the individuals had a greater neural response in the brain regions involved in reward centers. The findings, published in the American Journal of Clinical Nutrition in 2012, dovetail well with the recent endocannabinoid study, she said.
    More recently Dr. St-Onge did a secondary analysis of the data from her 2012 study and also found what we eat may affect sleep quality. When individuals were allowed to eat what they wanted, those who ate more fiber had more slow-wave sleep, whereas those with a higher saturated fat intake had less slow-wave sleep. Additionally, a greater sugar intake was associated with more arousals in the middle of the night. The findings were published in January in the Journal of Clinical Sleep Medicine.
    “It’s important to note that what you eat during the day can impact how you sleep,” she said. “It’s sort of a vicious cycle. Your sleep at night influences your appetite and food choices during the day” and vice versa, she said.

    Wednesday, March 16, 2016

    one person's thoughts on end of life

    The Ultimate End-of-Life Plan

    http://www.wsj.com/articles/SB10001424127887324577304579054880302791624

    How one woman fought the medical establishment and avoided what most Americans fear: prolonged, plugged-in suffering

    September 6, 2013
    by Katy Butler
    [image]Butler familyValerie Butler around 1990. After Ms. Butler developed heart problems, she refused surgery because of its risks.
    My mother died shortly before her 85th birthday, in a quiet hospital room in Connecticut. One of my brothers was down the hall, calling me in California to say, too late, that it was time to jump on a plane. We were not a perfect family. She did not die a perfect death. But she died a “good-enough” death, thanks to choices she made earlier that seemed brutal at the time.
    She slept in her own bed until the night before she died. She was lucid and conscious to the end. She avoided what most fear and many ultimately suffer: dying mute, unconscious and “plugged into machines” in intensive care; or feeling the electric jolt of a cardiac defibrillator during a futile cardiopulmonary resuscitation; or dying demented in a nursing home. She died well because she was willing to die too soon rather than too late.
    [image]Butler familyValerie de la Harpe Butler and Jeffrey Butler as university students in 1946. The couple came to the U.S. from South Africa and had three children.
    Don’t get me wrong: My mother, Valerie de la Harpe Butler, loved life. She was descended from Swiss-French and Dutch Calvinist pioneers who “trekked” with their ox wagons into the dusty interior of South Africa in the mid-1800s. She and my father, Jeffrey Butler, left their African homeland in their early 20s, bursting with immigrant vigor, raised three children (all of whom ultimately moved to California) and built a prosperous life in the U.S. My father became a college professor. My mother, an amateur artist, photographed Wesleyan University faculty for their book jackets, practiced Japanese calligraphy and served tea at four without fail.
    When she got breast cancer in her 40s, she did not hesitate to undergo medical treatment at its most brutal and effective. After two mastectomies and radiation, she put up her blonde-streaked hair in its classic French twist and returned to the world as the beautiful woman she’d always been. Even as she approached 80, she hiked 2 miles a day, sewed elegant blouses on her Swiss sewing machine, weeded her garden and even stained her own deck.
    She also spent six years as a family caregiver, after a crippling stroke destroyed my father’s independence when he was 79 and she was 77. A hastily-inserted pacemaker forced his heart to outlive his brain, and she watched him slide year by year into dementia and misery. His medically-prolonged dying made her painfully aware of health care’s default tendency to promote maximum longevity and maximum treatment. It wasn’t what she wanted for herself.
    She was not alone. In California, my home state, a 2012 survey by Lake Research Partners and the Coalition for Compassionate Care of California found that 70% of state residents want to die at home, and national polls have registered even higher proportions. But in fact, nationally, less than a quarter of us do. Two-fifths die in hospitals, and a tragic one-fifth in intensive care, where deaths are often harrowing. This is an amazing disconnect in a society that prides itself on freedom of choice.
    image
    Butler familyThe Butlers at their wedding in September 1947.
    This disconnect has ruinous economic costs. About a quarter of Medicare’s $550 billion annual budget pays for medical treatment in the last year of life. Almost a third of Medicare patients have surgery in their last year of life, and nearly one in five in their last month of life. In their last year of life, one-third to one-half of Medicare patients spend time in an intensive care unit, where 10 days of futile flailing can cost as much as $323,000. Medical overtreatment costs the U.S. health care system an estimated $158 billion to $226 billion a year.
    Why don’t we die the way we say we want to die? In part because we say we want good deaths but act as if we won’t die at all. In part because advanced lifesaving technologies have erased the once-bright line between saving a life and prolonging a dying. In part because saying “Just shoot me” is not a plan. Above all, we’ve forgotten what our ancestors knew: that preparing for a “good death” is not a quickie process to save for the panicked ambulance ride to the emergency room. The decisions we make and refuse to make long before we die help determine our pathway to the final reckoning. In the movie “Little Big Man,” the Indian chief Old Lodge Skins says, as he goes into battle, “Today is a good day to die.” My mother lived the last six months of her life that way, and it allowed her to claim a version of the good death our ancestors prized.
    [image]Butler FamilyValerie Butler in 1986.In the early spring of 2009, I discovered that my mother, then 84, could no longer walk around Wesleyan’s indoor athletic “cage” without catching her breath. She had developed two perilously stiff and leaky heart valves. In a pounding rainstorm, I drove her to Boston’s Brigham and Women’s Hospital, a pioneer in heart-valve replacement surgery for the very old. The surgeon told her that if she survived surgery, she could live to be 90. Without it, she had a 50-50 chance of dying within two years. My mother weighed the surgery’s real and often underplayed risks of stroke and dementia. Then she said no.Her later cardiologists were disturbed by her decision. But I would discover that people of my mother’s age are often like Humpty-Dumpty, seemingly vigorous until a mishap, a traumatic surgery or a hospital-acquired infection sets them on a rapid downward spiral. One of my friends watched her 87-year-old mother die gruesomely, over three months, after exactly the surgery my mother rejected.Still, my mother’s “heart-failure management” nurse urged me to get her to reconsider. Aside from her heart, the nurse said, my mother was healthy and full of life. Torn, I called my mother’s internist. “I know your mother well enough, and I respect her,” he said. “She doesn’t want to risk a surgery that could leave her debilitated or bound for a nursing home. I think I would advise the same decision if it was my Mom.”
    image
    Matt HerronMs. Butler with husband Jeffrey and daughter Katy, the author, in 1983. Even in her later years, she hiked 2 miles a day, sewed blouses on her sewing machine, weeded her garden and stained her own deck.
    I called my mother and said, “Are you sure? The surgeon said you could live to be 90.”
    “I don’t want to live to be 90,” she said.
    “I’m going to miss you,” I said, weeping. “You are not only my mother. You are my friend.”
    That day I stopped pressuring my mother to live forever and began urging her doctors to do less rather than more. A generation of middle-aged sons and daughters are facing this dilemma, in an era when advanced medical technologies hold out the illusion that death can be perfectly controlled and timed.
    This was not the world of our ancestors. From the plagues of the Black Death through the 19th century’s epidemics of typhoid, childbed fever and tuberculosis, they helplessly watched people die, from youth to old age. By necessity, they learned how to sit at a deathbed and how to die.
    That changed in the 1950s and 1960s, when doctors and inventors in the U.S. and Europe cobbled together astonishing new medical contraptions from washing machines, vacuum cleaners, cattle watering tubs, orange-juice cans and sausage casings. Materials invented or pressed into military service during World War II—nylon, Dacron, silicon, plastics—were put to miraculous new civilian uses.
    Vaccines, antibiotics, dialysis, open-heart surgery, CPR, the 911 system, cardiac defibrillators, safer surgical techniques, pacemakers—a whole panoply of lifesaving inventions transformed medical practice and all but abolished natural death. Dying moved from the home to the hospital, obliterating Western death rituals, transforming the meaning of the body, and changing the way families, doctors, nurses—and even the dying themselves—behaved at the deathbed. Dying was transformed from a spiritual ordeal into a technological flail.
    image
    Butler FamilyAfter her husband suffered a stroke, Ms. Butler spent six years as his caregiver. The couple in May 2006, here.
    Family members who once wiped the brows of the dying were restricted to visiting hours. Often there were no “last words” because the mouths of the dying were stopped with tubes and their minds sunk in chemical twilights to keep them from tearing out the lines that bound them to Earth. Months after an ICU death, family members experience high rates of anxiety, depression and symptoms of post-traumatic stress.
    As the up-to-the-minute machines spread to newly prosperous countries around the world, they transformed the look of the dying body as well. “When I first started out washing and coffining corpses early in 1965, the majority of cases were home deaths,” wrote the Japanese Buddhist mortician Shinmon Aoki. “[The bodies] looked like dried-up shells, the chrysalis from which the cicada had fled.
    “Along with the economic advances in our country, though, we no longer see these corpses that look like dead trees,” he wrote in his memoir, “Coffinman.” “The corpses that leave the hospital are all plumped up, both arms blackened painfully by needle marks made at transfusion, some with catheters and tubes still dangling. There’s nothing natural about the way they died, as the image of dried leaves falling in autumn would impart. This tells us that our medical facilities leave us no room to think of death.”
    In the 1400s, a best-selling how-to book called “Ars Moriendi,” or “The Art of Dying,” offered saints and sinners alike a road map to the deathbed—framed not as a place of meaningless suffering but as a mighty, transcendent battleground where angels and demons struggled for control of the soul. Family and friends gathered at the bedside and recited prescribed prayers, giving the dying person reassurance, faith and hope. Similar guides, adapted to Protestant and Quaker theologies, stayed in print until the late 1800s. Because we do not have such pathways now, it’s no surprise that relatives often panic and insist that “everything be done,” even things that are torturous and futile. Any plan seems better than no map at all.
    That spring my mother fixed cracked windows in her basement and threw out files for the book my father never finished writing. She told someone she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden, to tidy up the neglect of my major achievement,” she wrote in her journal. “Without it the place would be so ordinary and dull. But so it goes. ACCEPT ACCEPT ACCEPT.”
    In July, a new cardiologist suggested inserting stents to reduce her chest pain and an experimental mitral valve replacement, performed by floating the device down a vein. “When I mentioned stroke risk,” he wrote in his clinical notes, “She immediately was turned off and did not want to pursue further discussion, again desiring only palliative care.”
    [image]Butler familyThe Japanese brush painting that she made and labeled, ‘For my memorial service.’That August, she had a heart attack. One of my brothers flew to her hospital bed while I raced to meet a work deadline. The next day I got a call from yet another cardiologist who had been handed my mother’s case. The narrowing in my mother’s heart vessels was in places too difficult to stent, she said. They were preparing her for heart bypass surgery and valve replacement—the very surgery she had rejected five months before.She seemed to be heading down the greased chute toward a series of “Hail Mary” surgeries—risky, painful and harrowing, each one increasing the chance that her death, when it came, would take place in intensive care. I later discovered that the cost to Medicare would probably have been in the $80,000 to $150,000 range, with higher payments if she’d suffered complications.Burning with anger, I told the astonished cardiologist that my mother had rejected surgery when she had a far better chance of surviving it, and I saw no reason to subject her to it now. I later found that in a major study, 13% of patients over 80 who underwent combined valve and bypass surgeries died in the hospital. In a smaller study, 13% died in the hospital and an additional 40% were discharged to nursing homes.
    I called my mother in the hospital.
    I said, “I think we’re grasping…”
    “—at straws,” she finished my sentence. She was quiet. “It’s hard to give up hope.”
    Four hours later she called back. “I want you to give my sewing machine to a woman who really sews. It’s a Bernina. They don’t make them like this anymore. It’s all metal, no plastic parts.”
    “I’m ready to die,” she went on. I could barely recognize my stoic and reserved mother. “Cherish Brian,” she said, speaking of my long-term partner. “I love Brian. Ilove Brian for what he’s done for you.”
    My mother was now sick enough to qualify for hospice care, and came home tethered to a portable oxygen tank. She apologized to me for not having sufficiently appreciated a loving little book I’d handcrafted in honor of her 80th birthday. She updated her will. A hospice nurse cut off her long white hair. She took digitalis and squirted morphine under her tongue to manage her intense heart pain.
    She watched a moth emerge from a chrysalis and took her last photograph of its wet crumpled wings. She pulled out her Japanese ink stone and calligraphy brushes and brushed out a final one-stroke circle, what the Japanese call an enso. Below it she wrote, “For my memorial service.”
    I was making flight plans when she and I talked on the phone for the last time. In an outpouring, I told her how I treasured the memory of her ritual teas and regretted not having learned more of her elegance in domestic matters.
    “But Katy,” she said, her voice weak. “You’re good at other things.” Then she said, “There isn’t much time.”
    That night she could not stop vomiting. She was taken to the inpatient hospice unit with one of my brothers following the ambulance. Once settled into her bed, she took off her hammered silver earrings and said to the nurse, “I want to get rid of all the garbage.” Naked she had come into the world, and naked she would return. The next morning she told my brother to call his two siblings in California. By the time he got back, she was dead. He broke into sobs.
    She died too soon for my taste. I agonized over my failure to fly in and help her. But she died the death she chose, not the death anyone else had in mind. Her dying was painful, messy and imperfect, but that is the uncontrollable nature of dying. I tell you her story that we may begin to create a new “Art of Dying” for our biotechnical age. She died a good-enough death, and she faced it head-on.
    Adapted from Ms. Butler’s book, “Knocking on Heaven’s Door: The Path to a Better Way of Death,” to be published Sept. 10 by Scribner.

    Thursday, March 10, 2016

    Junior dr's strike today, UK

    https://twitter.com/IvyOwens7/status/707548939516559360









    http://www.standard.co.uk/comment/comment/rosamund-urwin-jeremy-hunt-s-beef-with-junior-doctors-has-gone-too-far-a3200311.html

    Rosamund Urwin: Jeremy Hunt’s beef with junior doctors has gone too far

    1K
    This week, Jeremy Hunt has been talking about blunders. The Health Secretary — a man who once stated his faith in magic water (homeopathy) to cure disease — is certainly an expert in those, what with misusing statistics about weekend death rates in the NHS, igniting a mad war on junior doctors and that time he pulled the emergency cord in a train loo en route to Conservative Party conference.
    But no, he actually meant mistakes made by the medical profession. It was just one of a number of negative stories about the NHS yesterday, just as junior doctors staged a 48-hour walkout in response to Hunt’s decision to impose a new contract on them come summer. What an amazing coincidence.
    Because who are the laziest, most selfish, money-grabbing tosspots in our society? After nurses and nuns, it’s got to be doctors, hasn’t it? Why else wouldn’t they just accept Hunt’s oh-so-kind proposal of a 13 per cent pay “rise”? It is, admittedly, a strange kind of pay rise. As a friend and neurosurgeon put it: “Just received our new, improved and generous offer from the good old Department of Health. A mere 15.3 per cent pay cut. Delighted.” 
    Junior doctors have taken undeserved flak for striking. On Sunday, a trolling clown from the Adam Smith Institute dismissed them on Twitter as “low-tech prescription writing machines”. Yup, those magicians who can conjure a new jaw from part of a shoulder blade are just glorified ATMs for drugs. 
    They’ve been scolded too for having interests outside medicine, because God forbid a doctor would have enough time off work to see their friends, have a drink or travel. They must be chained to the operating table! Imprisoned on wards! My favourite of these smears was the medic accused of taking a lavish holiday when she was actually volunteering at a clinic overseas. But if she had been having a holiday, would that have been so terrible? Someone doesn’t have to forgo all joys, accept peanuts for a salary or lump godawful working conditions just because they’re a public-sector employee. They didn’t sign up for martyrdom but to save lives. 
    Most ludicrously — and yet repeatedly — the words of NHS founder Nye Bevan have been used against doctors in a bid to show that they were always out for themselves. Bevan famously said he had “stuffed [doctors’] mouths with gold” to broker the deal to create the NHS. That was in the 1940s. He clearly wasn’t talking about the same doctors we are today. Back then, doctors resisted the NHS; now they’re the ones trying to save it. 
    I bet Bevan would be at the picket line today. Because this isn’t just a pay dispute. It’s not even about keeping doctors happy (although you’d think a contented NHS workforce would be considered an asset), it’s about keeping them — and their patients — safe. 
    If this new contract is imposed, NHS England risks haemorrhaging even more junior doctors. They’ll go overseas, or to Scotland, or quit the profession altogether. Medical students will be more inclined to look at other careers. That, in an already overstretched and understaffed NHS, will be catastrophic. Doctors rightly fear being made to work even more hours and ever-more anti-social ones, plugging holes in rotas. As the placards outside hospitals today remind us, “tired doctors make mistakes”. That isn’t in any of our interests.
    Even the best medics — as Hunt noted yesterday — do sometimes make mistakes. As Health Secretary, he should be trying to foster an environment where those are as few as possible. He’d be wise to start by dropping this cruel joke of a new contract.


    Wow