Artículos de revistas sobre el tema "Plutonium – health aspects – colorado"

Following the tragic shootings in Newtown (Connecticut), Aurora (Colorado), Isla Vista (California) and others, increased national attention has focused on the relationship between mental illness and gun violence. While some have called for enhanced regulation of firearm possession by persons with mental illness, others have argued that such actions would be ineffective and enhance stigma associated with mental illness while discouraging treatment seeking.

Consensus is growing on the need to investigate the joint impact of neighborhood-level social factors and environmental hazards on respiratory health. This study used latent profile analysis (LPA) to empirically identify distinct neighborhood subtypes according to a clustering of social factors and environmental hazards, and to examine whether those subtypes are associated with lung function. The study included 182 low-income participants who were enrolled in the Colorado Home Energy Efficiency and Respiratory Health (CHEER) study during the years 2015–2017. Distinct neighborhood typologies were identified based on analyses of 632 census tracts in the Denver-Metro and Front Range area of Colorado; neighborhood characteristics used to identify typologies included green space, traffic-related air pollution, violent and property crime, racial/ethnic composition, and socioeconomic status (SES). Generalized estimating equations were used to examine the association between neighborhood typology and lung function. We found four distinct neighborhood typologies and provide evidence that these social and environmental aspects of neighborhoods cluster along lines of advantage/disadvantage. We provide suggestive evidence of a double jeopardy situation where low-income populations living in disadvantaged neighborhoods may have decreased lung function. Using LPA with social and environmental characteristics may help to identify meaningful neighborhood subtypes and inform research on the mechanisms by which neighborhoods influence health.

Since 1991, over half the states have enacted laws that restrict or prohibit insurers’ use of genetic information in pricing, issuing, or structuring health insurance. Wisconsin was the first state to do so, in 1991, followed by Ohio in 1993, California and Colorado in 1994, and then several more states a year in each of the next five years. Similar legislation has been pending in Congress for several years. Also, a 1996 federal law known as the Health Insurance Portability and Accountability Act (HIPAA) prohibits group health insurers from applying “preexisting condition” exclusions to genetic conditions that are indicated solely by genetic tests and not by any actual symptoms.

This article takes a birds-eye view of equity in action, showcasing efforts to embed an equity lens in legislated and non-legislated policies and practices in three states. Authors from California, Colorado, and Minnesota provide state-specific examples of how equity has been advanced and operationalized in state-level governance. The article describes progress and lessons learned and offers guidance to others.

AbstractMedical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

Abstract Background Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. Objectives To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. Methods Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003–2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from “not at all well prepared” to “extremely well prepared” for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. Results Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. Conclusions Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.

This article is the offshoot of a Pediatric Oncology Group (POG) seminar presented at the Adams Mark Hotel, Denver, Colorado, Friday, May 21, 1999, titled “The Frozen Section in Pediatric Solid Tumors—Crucial Issues.” There were eight presenters who spoke on a wide range of topics that included historical perspectives of the frozen section and discussion of the following systems: brain, renal, germ cell, bone, soft tissue, and lymph nodes. To complement these presentations, a pediatric surgeon explained his concern and philosophy regarding the use of frozen sections, and a lawyer tackled the issues and risks in rendering a frozen section diagnosis. We think that this review covers all the important aspects of the frozen section in our current practice of pediatric pathology.

After recent tragedies involving mass murders on a college campus in Virginia, an Army base in Texas, a congressional constituent event at a shopping center in Arizona, and a movie theater in Colorado, one might have assumed the public had become numb to horrendous and senseless acts of killing. If so, one would have been wrong. The public was not prepared for the brutal and cold-blooded murder of 20 first-grade school children and six teachers and staff at Sandy Hook Elementary School in Newtown, Connecticut, on December 14, 2012.Following the all-too-familiar emotional stages of shock, grief, and anger, many members of the public and elected officials turned to the issue of how to prevent such tragedies in the future. Two main questions quickly became the focus of policy makers.

We say that celebrated accidents shape public perception of safety and risk in health care. Take the so-called celebrated story of the three Colorado nurses who, by administering bezathine penicillin intravenously, caused the death of a neonate. The nurses were charged with criminal negligence, with one pleading guilty to a reduced charge and another fighting the charge and eventually being exonerated. “Celebrated” accidents (i.e., celebrated in the media and, accordingly, popular imagination, amplified momentarily by the media as it may get ferried along from courtroom to courtroom) seem to follow a predictable script and cast participants in recognizable roles. They present heroes (e.g., a care provider who tried to save the patient despite the odds and errors of others), survivors, and victims. And, of course, they put villains, or anti-heroes, center stage – the chief protagonists of a fatal plot.

In recent years, the law in the area of recovered memories in child sexual abuse cases has developed rapidly. See J.K. Murray, “Repression, Memory & Suggestibility: A Call for Limitations on the Admissibility of Repressed Memory Testimony in Abuse Trials,” University of Colorado Law Review, 66 (1995): 477-522, at 479. Three cases have defined the scope of liability to third parties. The cases, decided within six months of each other, all involved lawsuits by third parties against therapists, based on treatment in which the patients recovered memories of sexual abuse. The New Hampshire Supreme Court, in Hungerford v. Jones, 722 A.2d 478 (N.H. 1998), allowed such a claim to survive, while the supreme courts in Iowa, in J.A.H. v. Wadle & Associates, 589 N.W.2d 256 (Iowa 1999), and California, in Eear v. Sills, 82 Cal. Rptr. 281 (1991), rejected lawsuits brought by nonpatients for professional liability.

AbstractPrevious studies have reported significant associations between measures of the family environment and behavior problems in children. However, because children in these studies were genetically related to their parents, such links may not be caused solely by environmental influences. The goal of this study was to investigate genetic influence on associations between family environment and problem behavior using an adoption design. Participants in the study included 179 adopted and 176 nonadopted children, as well as their parents and teachers, in the Colorado Adoption Project (CAP; Plomin, DeFries, & Fulker, 1988). Mothers and fathers each completed the Family Environment Scale (FES) when their child was 1, 3, and 5 years of age; the child's problem behavior at age 7 was rated by both mothers and teachers using the Child Behavior Checklist (CBCL). Patterns of correlations for nonadopted versus adopted boys indicated that associations between aspects of the family's relationship (conflict, cohesion, expressiveness) and behavior problems in home and school were mediated genetically. For girls, however, these links appeared to be influenced by direct shared environmental effects.

In April 1999, Dr. Curt Freed of the University of Colorado in Denver and Dr. Stanley Fahn of Columbia Presbyterian Center in New York presented the results of a four-year, $5.7 million government-financed study using tissue from aborted fetuses to treat Parkinson’s disease at a conference of the American Academy of Neurology. The results of the first government-financed, placebo-controlled clinical study using fetal tissue showed that the symptoms of some Parkinson’s patients had been relieved. This research study involved forty subjects, nineteen women and twenty-one men; all suffered from Parkinson’s disease for an average of 13.5 years. In the study, each subject underwent neurosurgery: “four tiny burr holes, drilled through the wrinkle lines above the eyebrows into the skull, to clear a pathway to the brain. But only half received injections of fetal cells into the putamen, the region of the brain that controls movement; the other half received nothing. One year later, three members of the placebo group said their symptoms had improved.” In two-thirds of the transplant recipients, the fetal tissue took hold and seemed to establish a new network to produce the missing neurochemical dopamine.

There were more than 36,000 firearm-related deaths in the U.S. in 2015. Under federal law, a background check is required only for gun purchases from licensed dealers. Research suggests that some persons prohibited from owning a gun turn to private sellers, including those identified online, to attempt to obtain a firearm. State-level approaches to make it more difficult for high-risk persons to purchase or possess firearms include universal background check (UBC) and gun violence restraining order (GVRO) laws. UBC laws, on the books in 18 states as of the end of 2016, can reduce both homicide and suicide rates. After Colorado adopted a UBC law in 2013, the number of background checks conducted by private sellers for sales occurring at places other than gun shows steadily increased. GVRO laws give law enforcement and families the authority to petition a court to temporarily remove firearms from an individual who presents a danger to himself or others during times of crisis, regardless of whether that person has been diagnosed with a mental illness. California enacted a GVRO law in 2014. Data are emerging to suggest the effectiveness of GVRO-type laws at averting suicides and providing an entryway to services.

ABSTRACT: As Vice Chair of Clinical Services of Psychiatry at the University of Colorado, I choose to work where clinical services need most attention. As a woman, I want to show up where we can be seen and show up in the best possible way. Just as COVID began, I found myself doing clinical shifts in the newly created psychiatry emergency room. I became part of a front-line team, where “I” became “We,” facing an unknown enemy. Not only was my work life upended, but my personal life was too, as I rushed to help my daughter, a medical student, care for her son when his day-care closed. My commentary highlights the increased burden experienced by women during this time, an example of systemic bias in medicine.

Abstract Sleep quality (SQ)-cognition associations are prevalent across aging, with stronger associations observed in midlife. Whether these associations persist within micro-level timescales (e.g., day-to-day) is unclear, particularly in individuals approaching midlife. Burst data from a subsample of the Colorado Adoption/Twin Study of Lifespan behavioral development and cognitive aging (CATSLife1) who participated in the ambulatory smartphone substudy (N=440, Mage=35.78 range=28.07-51.32, %Female=57.7%) were utilized to examine associations between self-reported daily SQ and cognitive performance, measured up to three times a day for 14 days, while accounting for age, sex, and educational attainment. There was a small positive age effect on average SQ (e.g., d=.18 comparing 36 versus 46 year-olds). Separable between-person and within-person time varying covariate effects were extracted for SQ to capture individual differences in typical levels versus variations from one’s typical pattern. The between-person SQ was individually significant and positive (B=0.023, se=0.009, p=0.019) suggesting better Stroop accuracy for each unit increase in SQ. Daily differences from one’s average SQ did not additionally predict daily Stroop performance suggesting the salience of general quality. Estimates suggest higher accuracy for individuals who report higher average SQ (d=.19, average SQ versus +2SD above average SQ). However, there were no Age by SQ effects on Stroop accuracy. Additional SQ aspects (e.g., sleep latency and sleep maintenance) are explored. Examining sleep quality-cognition associations across micro-level timescales are salient to discern whether and how effects accumulate and contribute to performance differences over larger timescales in individuals approaching midlife.

Colorado State Univ. recently underwent the development of a new all university core curriculum. All faculty were encouraged to submit proposals for new courses or revised courses, which would be reviewed for inclusion under specified categories. Basic Horticulture was redesigned te emphasize the scientific method, the understanding between science and society, and the use of handson and inquiry-based instruction in the laboratory. Horticultural Science is now an applied science course that includes the use of hypothesis formulation, experimentation, observation, data collection, summation and presentation in scientific format of reports of at least three laboratory exercises, as well as extensive general observation and presentation in both written and oral format. It teaches science in the context of everyday interaction with the environment in which the student lives, the interior and exterior plants that surrounds the student at CSU, and the controversies as well as the health aspects that surround the production of foods derived from plants that require intensive cultivation. Examples of such issues include sustainability, the organic movement, genetically modified organisms, ground water pollution form overfertilization, and water usage for landscaping and golf courses in a water short region. A review of the revisions as noted above and the use of technology in teaching the course will be presented.

In 2008, an amendment was proposed to the Colorado Constitution that sought to attach the rights and protections associated with legal “personhood” to any human being from the moment of fertilization. Although the initiative was defeated, it sparked a nation-wide Personhood Movement that has spurred similar efforts at the federal level and in over a dozen states. Personhood advocates choose terms like “fertilization,” or phrases such as “human being at any stage of development,” to identify the “person”-defining moment in the reproductive process, and these designations have profound implications for reproductive choice. Proponents are outspoken in their desire to outlaw abortion, but they are less transparent about their intent with respect to other aspects of reproductive choice, such as contraception and infertility treatments. This paper describes the background of the Personhood Movement and its attempt to achieve legal protection of the preborn from the earliest moments of biological development. Following the late 2011 failure of the personhood measure in Mississippi, the language used within the Movement was dramatically changed in an attempt to address some of the concerns raised regarding implications for reproductive choice. Putting abortion to one side, this paper identifies why the personhood framework that is contemplated by the proposed changes does not eliminate the potential for restrictions on contraception and in vitro fertilization (IVF) that put the lives of these newly recognized persons at risk; nor should it if proponents intend to remain consistent with their position. The paper goes on to suggest what those restrictions might look like based on recent efforts being proposed at the state level and frameworks that have already been adopted in other countries.

Abstract Background Stakeholder engagement helps ensure that research is relevant, clinical innovations are responsive, and healthcare services are patient-centered. Objective Establish and sustain a Veteran engagement board involving older Veterans and caregivers to provide input on aging-related research and clinical demonstration projects. Design and Participants The Older Veteran Engagement Team (OVET)—a group of eight Veterans and one caregiver who range in age from 62 to 92—was formed in November 2017 and has met monthly since January 2018. The OVET provides feedback on topics that reflect the foci of the VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC) (e.g., physical functioning, hearing health, and emotional wellness/mental health). Ongoing evaluation documents the return on investment of Veteran engagement. Main Measures The OVET member and provider/investigator meeting evaluations with longitudinal follow-up at 6 and 12 months. Results Return on investment of Veteran engagement is multi-faceted. For OVET, ROI ranges from grant support to improved healthcare quality/efficiency to social-emotional benefits. To date, funding awards total over $2.3 M for NIH and VA-funded projects to which OVET provided substantive feedback. Documented impacts on healthcare services include reductions in patient wait times, more appropriate utilization of services and increased patient satisfaction. Social-emotional benefits include generativity, as OVET members contribute to improving clinical and community-based supports for other Veterans. The OVET provides an opportunity for older Veterans to share their lived experience with trainees and early career investigators who are preparing for careers serving Veterans. Conclusion The OVET is similar to other established stakeholder engagement groups; team members offer their individual viewpoints at any stage of research, clinical demonstration, or quality improvement projects. The OVET provides a mechanism for the voice of older Veterans and caregivers to shape aspects of individual projects. Importantly, these projects support patient-centered care and promote the characteristics of an age-friendly healthcare system.

The green building or green architecture has come to light as a strong architectural movement at the end of 1990's and as a main trend in architectural practice. The architectural green is a modern architectural philosophy which deals with the competent relationship between the functional constructive systems and its vital environmental, by controlling the inputs and outputs of this system with the least negative effects on the environment and occupant's health, and the least energy consumption during the various stages of the building ( construction, operation, maintenance and destruction ) to achieve the functional activities and the inventive and efficient architectural structures. The importance of this movement lies in trying to achieve the sustainable development in its environmental, social and economic aspects because of the problems that developed and developing countries ( e.g. Iraq ) face such as energy consumption and pollution. Several international standards of different classifications, depending on local context of each country, has been appeared. Some of these tools are (BREEAM, LEED, CO-CHPS Colorado, GBTool, CASBEE) which aim to assess the performance of the building from green Architecture's perspective. Although there is a similarity in the classification levels including the sustainable location, how to use (water, energy and atmosphere, materials, resources) effectively, indoor environment quality and the design's innovation, they differ in other aspects that its importance relies on the environmental and local context. The problem of our research was the absence of the practical evaluation tool of the green building ( school buildings ) for the Iraq's local context in general and Mosul in particular, compatibly with the city climate. The research aims at making theoretical construction to identify the assessment indicators of the school buildings from green architecture's perspective, in order to create suitable and general assessment tool for schools building in Mosul city which can help improving the performance of these schools, decreasing the effect on the health, sparing energy coasts, and other benefits in the stages of the project ( pre-construction, construction, post-construction ). The research supposes that the multi-dimensional designing strategy is an active tool used in establishing the tool classification of assessment. For reaching goals, the research adopts the theoretical method and questionnaire. Finally, the research provides an assessment tool for school building in Mosul from the green architecture's perspective (AGBS) Green Building Assessment Tool for school ) in conformity with the local context of the city for enabling the designer to follow it in order to achieve the investment within his school architectural products. Results indicate six categories for assessment tool. First Sustainable Sites category (SS) which have the greatest weight 25.7%, , then Indoor Environment Quality(IEQ) 24.35667%. then Materials & Resources (M&R), Energy & Atomosphere (A&E), Water Efficiency(WE),and Innovotion in design (ID), have 17.32% ، 10.5% ، 3.987181% , Respectively.

Abstract Introductory sentence indicating purpose of the study: Over the last three decades, incidence of colorectal cancer (CRC) has risen steadily among people younger than age 50 (early-onset) in many developed countries, including the United States. More information is needed about the causes of early-onset CRC and novel, pragmatic interventions are needed to ensure rapid identification of early-onset CRC cases through timely screening and symptoms detection. Brief description of pertinent experimental procedures: The Consortium for Research on Early-Onset Colorectal Cancer (CREO) is a partnership among scientists and clinicians at four data-contributing health systems: Kaiser Permanente Northwest, Kaiser Permanente Northern California, and Kaiser Permanente Colorado, and Henry Ford Health. CREO plans to assemble a novel cohort of 8 million adults (including 3,200 early-onset CRC cases diagnosed from 2010 through 2025) encompassing electronic health record, survey, and biospecimen data to conduct research that will identify and estimate the impact of approaches to rapidly detect early-onset CRC through screening and clinical practice. Using electronic health record data from our participating health systems, we identified individuals diagnosed with CRC between 2010 and 2020. Here, we describe demographic and tumor characteristics of individuals with CRC in this cohort, and compare those to national data obtained from the Surveillance, Epidemiology, and End-Results program for the years 2012 – 2016. Summary of the new, unpublished data: We identified 15,884 adults with CRC (1,932 with early-onset CRC and 13,912 with late-onset CRC) in the four participating CREO health systems. Individuals with early-onset CRC in the CREO cohort were non-Hispanic White (54%), Hispanic (18%), Asian-American (14%), and African American/Black (9%). The proportion of CREO cohort adults with early-onset CRC was 12%; this matched the proportion in the population-based SEER data. The proportion of diagnosed CRC cases located in the rectum was 29% in both the CREO cohort and in SEER data. Anatomic location for the remaining tumors varied slightly between the CREO cohort and SEER data: in CREO data, 22% were proximal colon cancers, and 31% were distal colon cancers; in SEER data, and 29% were proximal and 22% were distal. Statement of the conclusions: Our findings show that CREO’s assembled cohort of electronic health record data from multiple large health systems matches several key aspects of population-based data from SEER. Through CREO, we plan to create a comprehensive, multi-level dataset of a new, racially and ethnically diverse cohort of 8 million adults in order to elucidate factors associated with the alarming rise in early-onset CRC and identify interventions to ensure rapid identification and secondary prevention of early-onset CRC. Citation Format: Gloria D. Coronado, Andrea Burnett-Hartman, Jeffrey Lee, Carmit McMullen, Carolyn Rutter, Mary Ann McBurnie, Christine Neslund-Dudas, John Carethers. Building a data resource to advance research on early-onset colorectal cancer: The consortium for research on early-onset colorectal cancer (CREO) [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer; 2022 Oct 1-4; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_1):Abstract nr A011.

Complex underground environments such as tunnels, underground urban settings, and natural caves present significant challenges for first responders in the event of an emergency. Each of these subdomains has unique hazards while sharing some common elements. Apart from challenging terrain features and aspects such as smoke and dust, communications in these environments are often severely degraded as well. Motivated by these difficulties, the Defense Advanced Research Projects Agency (DARPA) Subterranean Challenge (SubT) was set up to drive the global robotics community to develop novel approaches to rapidly map, navigate, and search underground environments under time pressure. The DARPA SubT,1 conducted from April 2019 to September 2021, was organized as two competition tracks. In the systems track, teams developed and demonstrated physical systems and competed live in real subterranean environments representative of the three subdomains. In the virtual track, teams developed software and algorithms using virtual models of systems and environments to compete in simulation-based events representative of the three subdomains. Phase I and Phase II of the systems track of this challenge consisted of the following events: 1. SubT Integration Exercise (STIX) at the Edgar Experimental Mine in Idaho Springs, Colorado, USA, in April 2019. 2. Tunnel Circuit event at the National Institute for Occupational Safety and Health (NIOSH) mine in Pittsburgh, Pennsylvania, USA, in August 2019. 3. Urban Circuit event at the Satsop Nuclear power plant in Elma, Washington, USA, in February 2020. The Cave Circuit event scheduled for August 2020 was canceled by DARPA due to the COVID-19 pandemic. As a result, a number of the competing teams held their local Cave events to evaluate their system performance in natural cave environments. In each of these events, the task was to deploy a fleet of robots into the subterranean course to locate and identify a set of predefined artifacts within the 60-minute run time. These artifacts included cell phones, backpacks, power drills, fire extinguishers, survivors (thermal mannequins), air vents, rooms with high carbon dioxide concentration, climbing rope, and helmets. A point was scored for each correctly identified artifact located within a 5-meter accuracy. Only one human supervisor was allowed to control and communicate with the robots once the run started. A pit crew of 10 personnel was allowed to set up the robots in the staging area outside the course entrance in the 30-minute period immediately prior to the run.

Chronic wasting disease belongs to a group of infectious diseases known as transmissible spongiform encephalopathies. The disease has been found in the Cervidae family, specifically mule deer (Odocoileus hemionus), white-tailed deer (Odocoileus virginianus), red deer (Cervus elaphus), elk (Cervus canadensis), moose (Alces alces), and reindeer (Rangifer tarandus). Unlike bovine spongiform encephalopathy and other animal transmissible encephalopathies, except scrapie, chronic wasting disease is a contagious prion disease that to our present knowledge affects only members of the Cervidae family. The causative agent of transmissible spongiform encephalopathies originates from the host-encoded cellular prion protein (PrPC), which is misfolded into a pathogenic conformer and was referred to as the abnormal prion of scrapie (PrPSc). Chronic wasting disease is the only prion disease to affect wild animals. The disease was first detected in Colorado (USA) in the late 1960s. Since 2024, chronic wasting disease has been diagnosed in at least 32 states in the United States and four provinces in Canada. In addition to North America, chronic wasting disease-infected elk have also been confirmed on ranches in South Korea. In terms of zoonotic potential, bovine spongiform encephalopathy is only prion disease in animals confirmed to be zoonotic, and numerous studies have yielded no conclusive evidence of the zoonotic potential of chronic wasting disease. However, to protect public health, further research on aspects of the disease is necessary. Chronic wasting disease first appeared in Europe in 2016, and the first case was in a reindeer in southern Norway. This was also the first evidence of natural infection with chronic wasting disease in reindeer. Very soon after, the second case was described in moose. It was confirmed that the European strain differed from the US strain, and that thestrains of the two cases in Europe also differed. The European Union has since implemented Decision (EU) 2016/1918 on certain protection measures for chronic wasting disease. In addition, the European Food Safety Agency issued an opinion proposing a three-year surveillance system in eight countries to determine possible presence of the disease (EU Member States: Estonia, Finland, Latvia, Lithuania, Poland, Sweden, and non-EU Member States, Norway and Iceland), and these countries implementeda monitoring programme for chronic wasting disease from 1 January 2018 to 31 December 2020 (EU 2017/1972). By the end of 2022, 42 positive cases of chronic wasting disease were confirmed in moose, red deer, and reindeer in Norway, Sweden, and Finland.

Background The Covid-19 pandemic has profoundly disrupted healthcare operations for vulnerable transplant and cell therapy patients. The Sarah Cannon Blood Cancer Network (SCBCN) comprises six Healthcare Corporation of America hospitals that have been certified based upon defined metrics of infrastructure, staffing, processes and volume. The SCBCN actively coordinated a response by integrating information from the framework of federal, state, network, hospital and individual transplant programs. Dynamic standards were developed taking into account operational aspects (such as PPE conservation, staffing, isolation policy, etc.), external regulations, and input from professional societies in order to balance the needs for life-saving therapy while reducing the likelihood of adverse consequences. In this study, we describe the impact of the Covid-19 across our network on transplant and cell therapy activity as well as the outcomes of the patients who were treated. Methods Data was integrated from electronic health records and a center survey questionnaire. The period of observation (defined as Covid era) was from March 15, 2020 to June 15th, 2020 to allow sufficient time for analysis of early outcomes. Transplant and cell therapy data from the prior 12 months was used as a comparator. Results: Within the SCBCN there was a decrease in overall transplant and cell therapy activity in the Covid era. Autologous transplantation was mainly diminished, particularly in the first 2 months. There was no significant impact on allogeneic or CAR-T therapy volumes. For allogeneic transplantation, there was a modest reduction in marrow grafts (11% to 8%) and a significant increase in cryopreservation (16% to 79%, P<0.001). The time to neutrophil and platelet engraftment in the Covid era were similar to those in the prior year. Day +30 survival in the Covid era for allogeneic, autologous, and CAR-T therapy were 95%, 99% and 100%, respectively. Including historically transplanted patients, centers reported a total of 22 patients who contracted proven Covid19, at a median duration of 4 years (range 3-2634 days) post infusion. There were 9-auto, 12-allo, and 1-CAR-T recipients, and two died. Of the two deaths, one 70-year old recipient died from Covid19 after first testing positive at day+3 after autologous transplantation, and another 68-year old recipient tested positive at day+464 after autologous transplantation but died with refractory lymphoma. Conclusions: We describe a deliberate and coordinated reduction in transplant and cell therapy activity across our network compared to the prior year. For those patients who were selectively transplanted during the Covid19 pandemic, outcomes were not impaired. Our analysis will be updated at the time of presentation with data covering the Covid era from July-Oct '20. Figure Disclosures Bachier: Sanofi: Speakers Bureau; AlloVir: Honoraria; CRISPR: Honoraria; Juno Therapeutics, a Bristol-Myers Squibb Company: Honoraria. Kambhampati:AbbVie: Other: Investigator in AbbVie-sponsored clinical trials.. McSweeney:Kite, a Gilead Company: Consultancy, Honoraria, Research Funding, Speakers Bureau; Fred Hutchinson: Patents & Royalties; Colorado Blood Cancer Institute: Current Employment. Ramakrishnan:Amgen: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Cigna: Honoraria. Safah:Verastem: Honoraria; Astellas: Speakers Bureau; Amgen: Honoraria; Janssen: Speakers Bureau.

ATOMIC DOCTORS: Conscience and Complicity at the Dawn of the Nuclear Age by James L. Nolan Jr. Cambridge, MA: The Belknap Press of Harvard University Press, 2020. 294 pages, plus index. Hardcover; $29.95. ISBN: 9780674248632. *This book ends with a tragic photograph. The reader will see a young boy carrying a sleeping infant on his back. However, the infant is not asleep but instead is dead as his brother waits his turn to have his brother's body thrown into a giant pyre at Nagasaki in the days following the atomic bomb blast. This picture is symbolic of the tragedy of war and provides a provocative statement regarding the involvement of US physicians in the development of the atomic weapons program toward the end of World War II. The author, James L. Nolan Jr., PhD (Professor of Sociology, Williams College), provides an excellent historical vignette of this period through a written biography of his grandfather, James F. Nolan, MD. *Dr. Nolan, as well as Louis Hempelmann, MD and Stafford Warren, MD, were intricately involved with the Trinity testing in New Mexico as well as with the development of the atomic bomb as part of the Manhattan Project. Dr. Nolan met and collaborated with such famous people associated with the Manhattan Project, including J. Robert Oppenheimer, Edward Teller, and General Leslie Groves. The entire group of physicians oversaw determining radiation risks during atomic bomb development and testing. This placed them in a difficult situation which "linked the arts of healing and war in ways that had little precedent" (p. 166) especially regarding the Hippocratic Oath.1 *Dr. Nolan was involved with setting up the hospital at Los Alamos as well as providing medical care for the Los Alamos staff and families. However, the job of these clinicians also had other aspects. Radiation exposure to workers was observed and recorded at Los Alamos leading to some of the initial descriptions of radiation poisoning. Additionally, the physicians were involved in determining radiation hazards associated with Los Alamos and in the setting of Trinity with most of their findings either being ignored or hidden from the public, sometimes with the complicity of these individuals. It is fascinating to consider that Dr. Nolan was one of the military personnel chosen to accompany Little Boy (the bomb that exploded over Hiroshima) to the Pacific Front at Tinian Island on the famous and later tragic USS Indianapolis. I cannot imagine, in our present time, that a physician would be charged with transporting and reporting the safety of a technologically advanced weapons system. *The book contains many fascinating stories, including how military physicians as well as other personnel were told to assert there was no significant radiation after the bombing in Japan (despite obvious radiation injury being noted in thousands of individuals), how the military allowed reporters at the Trinity test site after the bomb test with no protection except for "protective" booties, how US military physicians were told to not treat Japanese civilians after the bombing in order to circumvent moral responsibility of the bombing (this was ignored), how the inhabitants of the Bikini Atoll and Enewetak Atoll were forced to abandon their ancestral homes so that further atomic bomb testing could occur (with subsequent deleterious effects in their sociologic and health outcomes), and how patients in the United States (many who were already terminally ill) were secretly injected with plutonium to determine the effects of radiation injury. *Besides being a biography and history of a physician and his colleagues, this book also goes in some philosophical directions, including considering what is the goal of technology. Oppenheimer himself stated that "It's amazing ... how the technology tools trap one" (p. 33). The "trap" leads to a myriad of issues. Dr. Nolan believed radiation should be considered under the paradigm of an "instrumentalist view of technology" in which new technology could be used for the advancement or decline of our species. In his case, he began experimenting with radiation to treat gynecologic cancer in his patients. The book then explores "technological determinism," both optimistic and pessimistic, which is still an issue permeating our culture today. The author states that humans appear to always choose technologic advances even before fully knowing downstream economic, political, or cultural effects. Such examples cited by the author include the internet, social media, and genetic engineering. *A Christian will find this book unsettling when one considers what one prioritizes in his (her) faith. For example, one of the physicists who worked at Los Alamos was a Quaker. The Trinity test was named after the Christian Trinity (based on a John Donne sonnet). These facts are sobering when the author provides reports of "downwinders" who suffered catastrophic disease after the Trinity test as well as going into detail about the thousands of Japanese who suffered radiation poisoning after the nuclear bombing. In addition, the bombing of Nagasaki was close to the Christian part of the city resulting in the killing of most of the Christians living there. Indeed, the pursuit of science is a fascinating human endeavor, but the point of science is to objectively determine facts. Science does not necessarily provide subjectivity by itself which allows it to be influenced by meaning, moral values, and responsibility.2 In the moral arena, people with religious beliefs, including Christians, are required to influence the idea of technologic determinism in a positive direction. I highly recommend this book not only to learn about an interesting part of world history but also to appreciate the tragedy of the human condition in the setting of war. *Notes *1Michael North, translator, "Greek Medicine," History of Medicine Division, National Library of Medicine, National Institutes of Health, last updated February 7, 2012, https://www.nlm.nih.gov/hmd/greek/greek_oath.html. *2Mehdi Golshani, "Science Needs a Comprehensive Worldview," Theology and Science 18, no. 3 (2020): 438-47. *Reviewed by John F. Pohl, MD, Professor of Pediatrics, Department of Pediatrics, University of Utah, Salt Lake City, UT 84113.

Competent performance by health care professionals is expected throughout society. However, defining what it is and teaching students how to perform competently faces many challenges. This article provides a brief overview of the contemporary focus on competency assessment in nursing education. The redesigned nursing curriculum at the University of Colorado is presented as an exemplar of a practice-oriented model that requires competent performance among students. Methods for implementing a competency-based curriculum and lessons learned during the process are discussed.

In the era of (re)legalisation of medicinal and recreational cannabis, accidental and intentional exposure to edibles, cannabis-infused food products, has increased substantially. However, there is particular concern regarding younger age groups. Most concerning is the increase in hospitalisations. According to a study by Myran et al. (1), provinces in Canada, where the sale of edibles is permitted, saw an increase in paediatric poisonings due to unintentional consumption of edibles. Similar trends have been observed in “legalised states” in the US, such as Colorado (2). The impact of using cannabis at an early age, but particularly the impact of accidental exposure to high THC quantities, may have negative mental or physical health outcomes. Whilst regulatory restrictions vary significantly from one legalised region to another, it is difficult to identify a best practice. The aim of this study is to identify and discuss new and existing risk mitigation strategies to give guidance to policymakers. Furthermore, practical aspects, such as compliance (e.g. audits by authorities), are discussed. It is noted that edibles have been around much longer than recent political attempts to regulate them.

BackgroundThe Gun Shop Project aims to reduce firearm suicide and is widely implemented in the USA, yet little is known about the core firearm business practices and behaviours that might contribute to preventing firearm suicide.MethodsOwners or managers of all firearm businesses identified as participants in Colorado’s Gun Shop Project were invited to respond to a questionnaire. Data collection occurred from March to May 2021. Analyses included unweighted descriptive statistics with CIs and Pearson χ2tests for categorical associations.Results54 firearm businesses participated (response rate: 28%). Under half reported practices that are Gun Shop Project core aspects (range: 14%–45%). 22% of businesses frequently engaged customers on the importance of safe firearm storage in suicide prevention while 26% had denied a firearm sale and 14% had assisted with temporary secure storage in the past year with customers perceived to be in suicidal crisis. However, high proportions reported willingness to engage in these behaviours if a customer was in crisis: 74% were willing to refuse a sale of a firearm or ammunition, 70% were willing to discuss temporary secure storage options and 70% were willing to direct customers to mental health services.ConclusionsThis study suggests that efforts to continue educating and involving firearm businesses may have an impact on the adoption of organisational suicide prevention practices and behaviours. Ongoing efforts are needed to understand core components of Gun Shop Project to inform standardised recommendations for effective firearm business practices that prevent firearm suicide.

ObjectiveMarginalized communities shoulder a disproportionate burden of cardiovascular disease (CVD) driven by concentrated neighborhood social risk factors. We provide a case study of systems science application to address geographic CVD health disparities at the community level – informing the science of CVD health disparities research.MethodsWe conducted a two-phased, multi-methods needs assessment in the Denver, Colorado area. Phase I consisted of a social network analysis to map a two-mode network of existing CVD prevention interventions and their implementing organizations. In Phase II, group model building (GMB) sessions with key community, public health, and healthcare provider stakeholders, were utilized to identify and visualize community factors contributing to disparities in CVD risk, producing a consensus-based causal loop diagram.ResultsBetween May 2021 and June 2022, we conducted 24 virtual, semi-structured interviews in Phase I to describe CVD prevention interventions, and 7 virtual GMB sessions in Phase II to describe experiences of disparities in CVD risk. For the purposes of this paper, we focus on a subset of results for both phases. In Phase I we identified 89 active CVD prevention interventions, 29 of which addressed tobacco use. In Phase II, causal loop diagrams revealed root causes of disparities in CVD risk. We provide an example of a causal loop diagram that focuses on the community prevalence of tobacco use, identifying stress as a key underlying factor driving disparities. The integration of findings from both phases highlighted the alignment and misalignment between quit tobacco intervention goals and how they are being experienced in marginalized communities.ConclusionSystems science methods were useful to organize a large number of CVD prevention efforts, and evaluate the root causes of CVD health disparities in a high risk community. By integrating these two aspects, interventions may be reoriented to more effectively address the root causes of CVD health disparities.

The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.

The purpose of this study was to assess the relationship between physical intimate partner violence (IPV) victimization and four related aspects of emotional well-being: threat sensitivity, intolerance of uncertainty, impulse control, and access to resources for emotional regulation. We draw on a transactional model of IPV and emotional regulation to theorize how invalidation and partner threats in relationships can generate harmful emotional outcomes. We used representative data collected for residents living in five U.S. states: Colorado, Minnesota, Mississippi, New Jersey, and Texas. Our analytic sample included individuals who reported having been in a romantic relationship in the past year ( N = 2,501). Data were collected using a probability-based web panel, between April 29 and May 15, 2022. Following the presentation of descriptive statistics and bivariate correlations, we developed a series of four multivariate models (ordinary least squares [OLS], negative binomial) to analyze the association between IPV victimization and each emotional outcome. All models adjusted for pertinent demographic and geographic control measures. Physical IPV victimization was associated with increased intolerance of uncertainty and heightened threat sensitivity. IPV victimization also corresponded with poorer impulse control and fewer resources for emotional regulation. Overall, our results demonstrate that experiences of physical IPV victimization are linked to poorer emotional outcomes. These outcomes can be harmful to broader mental health and potentially impact long-term well-being. The findings underscore the importance of mental health screenings that extend beyond assessments of diagnostic-level functions and allocating resources toward alleviating other clinically relevant factors that might arise from or even prompt additional exposure to physical IPV.

03—230 Andress, Reinhard (St. Louis U., USA), James, Charles J., Jurasek, Barbara, Lalande II, John F., Lovik, Thomas A., Lund, Deborah, Stoyak, Daniel P., Tatlock, Lynne and Wipf, Joseph A.. Maintaining the momentum from high school to college: Report and recommendations. Die Unterrichtspraxis/Teaching German (Cherry Hill, NJ, USA), 35, 1 (2002), 1—14.03—231 Andrews, David R. (Georgetown U., USA.). Teaching the Russian heritage learner. Slavonic and East European Journal (Tucson, Arizona, USA), 45, 3 (2001), 519—30.03—232 Ashby, Wendy and Ostertag, Veronica (U. of Arizona, USA). How well can a computer program teach German culture? Die Unterrichtspraxis/Teaching German (Cherry Hill, NJ, USA), 35, 1 (2002), 79—85.03—233 Bateman, Blair E. (937 17th Avenue, SE Minneapolis, MN 55414, USA; Email: bate0048@umn.edu). Promoting openness toward culture learning: Ethnographic interviews for students of Spanish. The Modern Language Journal (Malden, MA, USA), 86, 3 (2002), 318—31.03—234 Belz, Julie A. and Müller-Hartmann, Andreas. Deutsche-amerikanische Telekollaboration im Fremdsprachenuterricht – Lernende im Kreuzfeuer der institutionellen Zwänge. [German-American tele-collaboration in foreign language teaching – learners in the crossfire of institutional constraints.] Die Unterrichtspraxis/Teaching German (Cherry Hill, NJ, USA), 36, 1 (2002), 68—78.03—235 Bosher, Susan and Smalkoski, Kari (The Coll. of St. Catherine, St. Paul, USA; Email: sdbosher@stkate.edu). From needs analysis to curriculum development: Designing a course in health-care communication for immigrant students in the USA. English for Specific Purposes (Amsterdam, The Netherlands), 21, 1 (2002), 59—79.03—236 Brandl, Klaus (U. of Washington, USA; Email: brandl@u.washington.edu). Integrating Internet-based reading materials into the foreign language curriculum: From teacher- to student-centred approaches. Language Learning and Technology (http://llt.msu.edu/), 6, 3 (2002), 87—107.03—237 Bruce, Nigel (Hong Kong U.; Email: njbruce@hku.hk). Dovetailing language and content: Teaching balanced argument in legal problem answer writing. English for Specific Purposes (Amsterdam, The Netherlands), 21, 4 (2002), 321—45.03—238 Bruton, Anthony (U. of Seville, Spain; Email: abruton@siff.us.es). From tasking purposes to purposing tasks. ELT Journal (Oxford, UK), 56, 3 (2002), 280—95.03—239 Candlin, C. N. (Email: enopera@cityu.edu.hk), Bhatia, V. K. and Jensen, C. H. (City U. of Hong Kong). Developing legal writing materials for English second language learners: Problems and perspectives. English for Specific Purposes (Amsterdam, The Netherlands), 21, 4 (2002), 299—320.03—240 Chen, Shumei. A contrastive study of complimentary responses in British English and Chinese, with pedagogic implications for ELT in China. Language Issues (Birmingham, UK), 13, 2 (2001), 8—11.03—241 Chudak, Sebastian (Adam-Mickiewicz-Universität, Poznán, Poland). Die Selbstevaluation im Prozess- und Lernerorientierten Fremdsprachenunterricht (Bedeutung, Ziele, Umsetzungsmöglichkeiten). [The self-evaluation of process- and learner-oriented foreign language teaching.] Glottodidactica (Poznań, Poland), 28 (2002), 49—63.03—242 Crosling, Glenda and Ward, Ian (Monash U., Clayton, Australia; Email: glenda.crosling@buseco.monash.edu.au). Oral communication: The workplace needs and uses of business graduate employees. English for Specific Purposes (Amsterdam, The Netherlands), 21, 1 (2002), 41—57.03—243 Davidheiser, James (U. of the South, USA). Classroom approaches to communication: Teaching German with TPRS (Total Physical Response Storytelling). Die Unterrichtspraxis/Teaching German (Cherry Hill, NJ, USA), 35, 1 (2002), 25—35.03—244 Duff, Patricia A. (U. of British Columbia, Canada; Email: patricia.duff@ubc.ca). The discursive co-construction of knowledge, identity, and difference: An ethnography of communication in the high school mainstream. Applied Linguistics (Oxford, UK), 23, 3 (2002), 289—322.03—245 Egbert, Joy (Washington State U., USA; Email: egbert@wsunix.wsu.edu), Paulus, Trena M. and Nakamichi, Yoko. The impact of CALL instruction on classroom computer use: A foundation for rethinking technology in teacher education. Language Learning and Technology (http://llt.msu.edu/), 6, 3 (2002), 108—26.03—246 Einbeck, Kandace (U. of Colorado at Boulder, USA). Using literature to promote cultural fluency in study abroad programs. Die Unterrichtspraxis/Teaching German (Cherry Hill, NJ, USA), 35, 1 (2002), 59—67.03—247 Fallon, Jean M. (Hollins U., Virginia, USA). On foreign ground: One attempt at attracting non-French majors to a French Studies course. Foreign Language Annals (New York, USA), 35, 4 (2002), 405—13.03—248 Furuhata, Hamako (Mount Union Coll., Ohio, USA; Email: furuhah@muc.edu). Learning Japanese in America: A survey of preferred teaching methods. Language, Culture and Curriculum (Clevedon, UK), 15, 2 (2002), 134—42.03—249 Goldstein, Tara (Ontario Inst. for Studies in Ed., U. of Toronto, Canada). No Pain, No Gain: Student playwriting as critical ethnographic language research. The Canadian Modern Language Review/La Revue canadienne des langues vivantes (Toronto, Ont.), 59, 1 (2002), 53—76.03—250 Hu, Guangwei (Nanyang Technological U., Singapore; Email: gwhu@nie.edu.sg). Potential cultural resistance to pedagogical imports: The case of communicative language teaching in China. Language, Culture and Curriculum (Clevedon, UK), 15, 2 (2002), 93—105.03—251 Huang, Jingzi (Monmouth U., New Jersey, USA; Email: jhuang@monmouth.edu). Activities as a vehicle for linguistic and sociocultural knowledge at the elementary level. Language Teaching Research (London, UK), 7, 1 (2003), 3—33.03—252 Hyland, Ken (City U. of Hong Kong; Email: ken.hyland@cityu.edu.hk). Specificity revisited: How far should we go now? English for Specific Purposes (Amsterdam, The Netherlands), 21, 4 (2002), 385—95.03—253 Jahr, Silke. Die Vermittlung des sprachen Ausdrucks von Emotionen in DaF-Unterricht. [The conveying of the oral expression of emotion in teaching German as a foreign language.] Deutsch als Fremdsprache (Berlin, Germany), 39, 2 (2002), 88–95.03—254 Jung, Yunhee (U. of Alberta, Canada; Email: jhee6539@hanmail.net). Historical review of grammar instruction and current implications. English Teaching (Korea), 57, 3 (2002), 193—213.03—255 Kagan, Olga and Dillon, Kathleen (UCLA, USA & UC Consortium for Language Teaching and Learning, USA). A new perspective on teaching Russian: Focus on the heritage learner. Slavonic and East European Journal (Tucson, Arizona, USA), 45, 3 (2001), 507—18.03—256 Kang, Hoo-Dong (Sungsim Coll. of Foreign Languages, Korea; Email: hdkang2k@hanmail.net). Tracking or detracking?: Teachers' views of tracking in Korean secondary schools. English Teaching (Korea), 57, 3 (2002), 41—57.03—257 Kramsch, Claire (U. of California at Berkeley, USA). Language, culture and voice in the teaching of English as a foreign language. Language Issues (Birmingham, UK), 13, 2 (2001), 2—7.03—258 Krishnan, Lakshmy A. and Lee, Hwee Hoon (Nanyang Tech. U., Singapore; Email: clbhaskar@ntu.edu.sg). Diaries: Listening to ‘voices’ from the multicultural classroom. ELT Journal (Oxford, UK), 56, 3 (2002), 227—39.03—259 Lasagabaster, David and Sierra, Juan Manuel (U. of the Basque Country, Vitoria-Gasteiz, Spain; Email: fiblahed@vc.ehu.es). University students' perceptions of native and non-native speaker teachers of English. Language Awareness (Clevedon, UK), 11, 2 (2002), 132—42.03—260 Lennon, Paul. Authentische Texte im Grammatikunterricht. [Authentic texts in grammar teaching.] Praxis des neusprachlichen Unterrichts (Berlin, Germany), 49, 3 (2002), 227–36.03—261 Lepetit, Daniel (Clemson U., USA; Email: dlepetit@mail.clemson.edu) and Cichocki, Wladyslaw. Teaching languages to future health professionals: A needs assessment study. The Modern Language Journal (Malden, MA, USA), 86, 3 (2002), 384—96.03—262 Łȩska-Drajerczak, Iwona (Adam Mickiewicz U., Poznán, Poland). Selected aspects of job motivation as seen by EFL teachers. Glottodidactica (Poznán, Poland), 28 (2002), 103—12.03—263 Liontas, John I. (U. of Notre-Dame, USA). ZOOMANIA: The See-Hear-and-Do approach to FL teaching and learning. Die Unterrichtspraxis/Teaching German (Cherry Hill, NJ, USA), 35, 1 (2002), 36—58.03—264 Littlemore, Jeannette (Birmingham U., UK). Developing metaphor interpretation strategies for students of economics: A case study. Les Cahiers de l'APLIUT (Grenoble, France), 21, 4 (2002) 40—60.03—265 Mantero, Miguel (The U. of Alabama, USA). Bridging the gap: Discourse in text-based foreign language classrooms. Foreign Language Annals (New York, USA), 35, 4 (2002), 437—56.03—266 Martin, William M. (U. of Pennsylvania, USA) and Lomperis, Anne E.. Determining the cost benefit, the return on investment, and the intangible impacts of language programmes for development. TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 399—429.03—267 Master, Peter (San Jose State U., CA, USA: Email: pmaster@sjsu.edu). Information structure and English article pedagogy. System (Oxford, UK), 30, 3 (2002), 331—48.03—268 Mertens, Jürgen. Schrift im Französischunterricht in der Grundschule: Lernehemnis oder Lernhilfe? [Writing in teaching French in primary school: Learning aid or hindrance?] Neusprachliche Mitteilungen aus Wissenschaft und Praxis (Berlin, Germany), 55, 3 (2002), 141–49.03—269 Meskill, Carla (U. at Albany, USA; Email: cmeskill@uamail.albany.edu), Mossop, Jonathan, DiAngelo, Stephen and Pasquale, Rosalie K.. Expert and novice teachers talking technology: Precepts, concepts, and misconcepts. Language Learning and Technology (http://llt.msu.edu/), 6, 3 (2002), 46—57.03—270 Mitchell, Rosamond and Lee, Jenny Hye-Won (U. of Southampton, UK; Email: rfm3@soton.ac.uk). Sameness and difference in classroom learning cultures: Interpretations of communicative pedagogy in the UK and Korea. Language Teaching Research (London, UK), 7, 1 (2003), 35—63.03—271 Mohan, Bernard (U. of British Columbia, Canada; Email: bernard.mohan@ubc.ca) and Huang, Jingzi. Assessing the integration of language and content in a Mandarin as a foreign language classroom. Linguistics and Education (New York, USA), 13, 3 (2002), 405—33.03—272 Mori, Junko (U. of Wisconsin-Madison, USA; Email: jmori@facstaff.wisc.edu). Task design, plan, and development of talk-in-interaction: An analysis of a small group activity in a Japanese language classroom. Applied Linguistics (Oxford, UK), 23, 3 (2002), 323—47.03—273 O'Sullivan, Emer (Johann Wolfgang Goethe-U. Frankfurt, Germany; Email: osullivan@em.uni-frankfurt.de) and Rösler, Dietmar. Fremdsprachenlernen und Kinder-und Jugendliteratur: Eine kritische Bestandaufsnahme. [Foreign language learning and children's literature: A critical appraisal.] Zeitschrift für Fremdsprachenforschung (Germany), 13, 1 (2002), 63—111.03—274 Pfeiffer, Waldemar (Europa Universität Viadrina – Frankfurt an der Oder, Germany). Möglichkeiten und Grenzen der interkulturellen Sprachvermittlung. [The possibilities and limits of intercultural language teaching.] Glottodidactica (Poznán, Poland), 28 (2002), 125—39.03—275 Rebel, Karlheinz (U. Tübingen, Germany) and Wilson, Sybil. Das Portfolio in Schule und Lehrerbildung (I). [The portfolio in school and the image of a teacher (I).] Fremdsprachenunterricht (Berlin, Germany), 4 (2002), 263–71.03—276 Sonaiya, Remi (Obafemi Awolowo U., Ile-ife, Nigeria). Autonomous language learning in Africa: A mismatch of cultural assumptions. Language, Culture and Curriculum (Clevedon, UK), 15, 2 (2002), 106—16.03—277 Stapleton, Paul (Hokkaido U., Japan; Email: paul@ilcs.hokudai.ac.jp). Critical thinking in Japanese L2 writing: Rethinking tired constructs. ELT Journal (Oxford, UK), 56, 3 (2002), 250—57.03—278 Sullivan, Patricia (Office of English Language Progs., Dept. of State, Washington, USA, Email: psullivan@pd.state.gov) and Girginer, Handan. The use of discourse analysis to enhance ESP teacher knowledge: An example using aviation English. English for Specific Purposes (Amsterdam, The Netherlands), 21, 4 (2002), 397—404.03—279 Tang, Eunice (City U. of Hong Kong) and Nesi, Hilary (U. of Warwick, UK; Email: H.J.Nesi@warwick.ac.uk). Teaching vocabulary in two Chinese classrooms: Schoolchildren's exposure to English words in Hong Kong and Guangzhou. 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TESOL Quarterly (Alexandria, VA, USA), 36, 3 (2002), 453—75.03—284 Weasenforth, Donald (The George Washington U., USA; Email: weasenf@gwu.edu), Biesenbach-Lucas, Sigrun and Meloni, Christine. Realising constructivist objectives through collaborative technologies: Threaded discussions. Language Learning and Technology (http://llt.msu.edu/), 6, 3 (2002), 58—86.

Photo ID 129550055 © Katarzyna Bialasiewicz | Dreamstime.com ABSTRACT It has been 26 years since medical aid in dying (“MAiD”) was first legalized in Oregon, and today, about 20 percent of people in the US live in jurisdictions that permit MAiD. The New York State legislature is currently considering a bill that would permit Medical Aid in Dying for terminally ill patients in certain defined circumstances. Those states now benefit from decades of experience, evidence, and reporting from MAiD jurisdictions. This demonstrates that legislation can simultaneously grant terminally ill citizens the civil right to access MAiD while also aggressively protecting all patients from coercion, manipulation, and harm. Given the copious evidence gathered in the past decades, concerns about abuse can no longer be credited as grounds for opposing the passage of legislation that is demonstrably both effective and safe. INTRODUCTION It has been 26 years since medical aid in dying (“MAiD”) was first legalized in Oregon,[1] and today, about 20 percent of people in the US live in jurisdictions that permit MAiD.[2] Other jurisdictions, including New York, are actively considering adopting MAiD laws. Those states now benefit from decades of experience, evidence, and reporting from MAiD jurisdictions, demonstrating that legislation can permit MAiD while also aggressively protecting all patients from coercion, manipulation, and harm. The data should allay the concerns of those who oppose MAiD due to the risk of abuse, coercion, and a hypothetical slippery slope. We, as a society, as clinicians, and as ethicists, must remain vigilant and prevent abuse of MAiD, given the potential risks in the community and in congregate care settings and the risk of patient exploitation by family members. However, given the copious evidence, concerns about abuse do not justify opposition to legislation that is effective and safe. I. New York’s MAiD Bill The New York State legislature is currently considering a bill that would permit MAiD for terminally ill patients in defined circumstances.[3] The bill applies only to adults with a terminal illness or condition that is “incurable and irreversible” and “will, within reasonable medical judgment, produce death within six months.” The bill contains numerous protective requirements: MAiD requests can only be made by the patient themself; requests cannot be made by healthcare agents, surrogates, or anyone else; MAiD requests must be made both orally and in writing to the patient’s attending physician; No person is eligible for MAiD solely because of age or disability; The patient’s attending physician must determine the patient has a qualifying terminal illness, has decision-making capacity, and has made a voluntary, informed decision to request MAiD, in the absence of coercion; These determinations must be confirmed by a second consulting physician in writing; If the attending physician has any concern that the patient may not have decision-making capacity, the patient must be referred to a mental health professional; The attending physician has additional duties to the patient, including ensuring the decision is informed, by discussing the patient’s condition and prognosis; discussing the MAiD process, and treatment alternatives like palliative and hospice care; offering referrals to other appropriate treatment, like palliative and hospice care; and educating the patient that their request can be rescinded at any time and offering them an opportunity to do so; The written request must be witnessed by at least two adults who cannot be (i) related to the patient, (ii) entitled to any portion of the patient’s estate, (iii) employed by a healthcare facility where the patient is receiving treatment or residing, (iv) or the attending physician, consulting physician, or mental health professional determining decision-making capacity; and MAiD medication must be self-administered by the patient, and it must be voluntarily ingested.[4] ARGUMENTS FOR AND AGAINST MAiD II. No Evidence of Abuse of Existing MAiD Laws MAiD supporters and critics alike have a concern about the abuse of MAiD. For this reason, MAiD laws throughout the US incorporate strict eligibility criteria and protective procedural requirements. For instance, patients are eligible only if they are terminally ill with six months or less to live, more than one physician must be involved, and requests must be witnessed (by individuals unrelated to the patient who will not profit from the patient’s estate). MAiD requests have been closely examined in the 27 years since Oregon became the first state to legalize the practice. The results show that these compassionate and protective measures have worked. There have been no documented or substantiated incidents of MAiD abuse since Oregon became the first to implement a MAiD law in 1997.[5] In 2019, the executive director of Disability Rights Oregon (DRO), an organization mandated by federal law to investigate complaints of abuse or neglect of people with disabilities, reported that DRO has never received a complaint that a person with disabilities was coerced into obtaining a prescription for MAiD drugs.[6] A recent study of aggregated data from all nine of the US jurisdictions with publicly available MAiD records from 1998 to 2002 found that 95.6 percent of those who died by MAiD were non-Hispanic white individuals, and 53.1 percent were male.[7] 72.2 percent of these individuals had at least some college education, 74 percent had a cancer diagnosis, and the median age of MAiD death was 74 years old. Only 11 percent of patients were uninsured. MAiD users tend to be white, older, educated, diagnosed with cancer, and insured. Fears that MAiD would overwhelmingly be used by (or on) the poor, the uninsured, the uneducated, or racial and ethnic minorities have not materialized. This data has actually raised a converse concern: that MAiD may, inequitably, not be readily available to less privileged populations or those with a diagnosis other than cancer.[8] Opponents of MAiD may argue that the recent relaxation of certain legal restrictions in some jurisdictions is evidence that the slippery slope to unrestricted euthanasia has begun. This is a mischaracterization. Certain restrictions have been adjusted. For instance, Oregon and Vermont removed the residency restriction that previously excluded non-residents from eligibility.[9] Both states changed the residency requirement due to lawsuits challenging the constitutionality of requiring residence.[10] New Jersey’s law will likely change soon, as well.[11] Initial MAiD laws were drafted to be highly restrictive out of concern about unintended and unforeseeable consequences. Given the gravity of the subject, decades ago, it was better to err on the side of caution, even if that meant excluding from eligibility people who ought to, ethically or legally, be included. Now, with nearly 30 years of experience and data, we can better determine which requirements are necessary to appropriately protect patients, clinicians, and society. Restrictions proven to be unnecessary can now be modified. The core purposes of MAiD laws and the rights and protections they provide are not changing. Rather, a few aspects of the regulations are being adjusted so they are not more restrictive than necessary to achieve their purpose. The ever-growing body of evidence that MAiD laws can adequately protect against abuse and the mythic slippery slope has assured many that their fears will not materialize.[12] For example, NYU bioethicist Arthur Caplan was once a vigorous opponent of MAiD. He worried that MAiD laws would lead to the abuse of the poor, uninsured, and disabled in service of cost-saving or the convenience of others. [13] But, after closely following the empirical evidence from MAiD early-adopters, Oregon and Washington, Caplan changed his mind. In 2018, he argued in favor of the NY MAiD bill before the New York State Assembly Standing Committee on Health.[14] Discussing his review of evidence from these states, Caplan stated: I found no cause for my concerns, none with respect to the slippery slope. There isn’t solid evidence of coercion or duplicity being exercised with respect to people who choose assistance in dying in either state. The police, government officials, families of those who have chosen to use the legislation and the general citizenry find no causes or basis for changing the laws due to abuse or misapplication . . . These slippery slope arguments are just not true . . . there is no current factual support for this slippery slope argument that vulnerable individuals are at risk for being coerced into using the law.[15] Decades of evidence has shown that legislation can simultaneously grant terminally ill patients access to MAiD while also protecting against coercion and abuse. In the face of this evidence, continuing to deny access to MAiD because of hypothetical abuse is unjust and unethical. III. Views of Opponents are Neither Grounded in Fact nor Consistent with Current End-of-Life Practices a. Risk of coercion One common argument heard today from some disability advocates who oppose MAiD goes something like this: Everybody who would qualify for and use MAiD is (or will become) a disabled person, so MAiD only kills people with disabilities. The most common reasons people choose to end their lives via MAiD are disability issues, like loss of autonomy, less ability to engage in activities, and loss of dignity. They argue that, instead of making it easier for disabled people to die, we should make sure that proper services and support exist so that disabled people do not choose to die. Such disability-rights-based arguments tend to assert that to avoid abuse, we must prohibit MAiD altogether. They argue that legalizing MAiD will inexorably lead to abuse and coercion, and disabled people will be pressured into suicide. Some even argue that MAiD laws are the first step to euthanasia, noting the path in other jurisdictions.[16] As an initial matter, people with disabilities deserve adequate support and services, and these are not always available to them. People with disabilities have faced tremendous discrimination in the healthcare system and have been historically prevented from accessing proper care and asserting their autonomy. Ensuring that all can access adequate end-of-life care, like palliative or hospice care, is an ongoing battle that ought not be abandoned. But fighting for adequate end-of-life care and legalizing MAiD are not mutually exclusive. In Oregon, 90 percent of those who access MAiD are enrolled in hospice and states with MAiD laws tend to have better access to palliative care than states without.[17] MAiD proponents seek only to add another choice for the dying, not to diminish any other options. This is reflected in the text of New York’s pending bill, which explicitly requires patient education and referrals to appropriate end-of-life services, like palliative care and hospice.[18] No one has openly argued that society should hold terminally ill patients hostage in order to obtain broader support and funding for palliative care, but that is the practical effect. Beyond the need for supportive services and proper access to the full range of end-of-life care options, the disability argument fails. First, the assertion that MAiD laws will be abused and disabled people will be coerced into suicide is not grounded in fact. To the contrary, real-life evidence gathered in over two decades of legal MAiD has shown no documented or substantiated incidents of abuse, as discussed above.[19] The slippery slope has simply not materialized. Advocates for people with disabilities who are opposed to MAiD have not clearly articulated exactly who is vulnerable to being coerced into obtaining a MAiD prescription or even how such coercion could logistically occur. Most people with disabilities are not vulnerable to MAiD abuse, as they do not have a qualifying terminal illness or lack decisional capacity due to a developmental disability and are therefore not eligible. MAiD opponents appear to be claiming that all those who qualify for MAiD are vulnerable and seek protection from MAiD laws. But this would include many of the people that, over the past decades, have aggressively and publicly advocated for access to MAiD – terminally ill people, like Brittany Maynard,[20] many of whom lobbied hard for the passage of MAiD laws while knowing that they themselves would die before the laws passed. Opponents of MAiD from a segment of the disability rights community are telling individuals who they claim, without permission, as members of the MAiD opposition community, that they must all endure unimaginable suffering without a MAiD option because they must be protected from theoretical coercive harm. People with disabilities should be allowed to make their own choices. No one, not even the most well-meaning advocate, should be allowed to obstruct a patient’s end-of-life choices – those choices belong to the patient alone. b. Argument That the Demand for MAID is a Result of Poor Disability Services Second, the argument that terminally ill patients would decline MAiD if only they had better disability services or support is disingenuous to the extent that it ignores the fact that people choosing MAiD are actively dying. No provision of supportive services can change this. And it is perfectly reasonable for someone who knows that they will die in less than six months to want some control over the manner of their death and to avoid the deterioration, indignity, and suffering that could come with it. The argument construes a MAiD death as a choice to die rather than live with a disability. But individuals choosing MAiD are not choosing death – death is coming and coming quickly. MAiD simply offers some control over this reality, giving patients an option that is safe, certain, and painless. Certainly, supportive hospice services should be available for these individuals. But there is no evidence demonstrating that any amount of service would eliminate the need and desire for the MAiD option. c. Inconsistent Positions on MAID and Other Ending Life Care Options: Palliative Sedation and VSED MAiD opponents who are concerned about abuse and coercion often hold inconsistent views on other currently available ending life care options.[21] For example, some argue that palliative sedation[22] renders MAiD unnecessary and does not present the same ethical problems.[23] However, whereas MAiD can only be chosen by the patient themself (and the patient must have decision-making capacity), the same is not true for palliative sedation. Palliative sedation, a valuable modality of end-of-life care, does not have to be initiated by the patient. If the patient is deemed not to have decision-making capacity to make that decision, their healthcare proxy can decide to initiate the process and continue it until the patient dies. Individuals other than patients often choose to begin palliative sedation and continue it to its inevitable conclusion. And because palliative sedation does not require enabling legislation, none of the protective safeguards incorporated in MAiD legislation are available to protect those who receive palliative sedation. Some may try to differentiate between palliative sedation and MAiD by saying that once started, palliative sedation can always be discontinued – it need not end in the patient’s death. This is true, but the very process of palliative sedation will inevitably make the patient insensible or unconscious or otherwise unable to exercise a choice to stop sedation. With MAiD, the patient must self-administer and ingest the medication on their own, with death following quickly. The patient can choose to forgo MAID up until the very moment of self-administration. Considering MAiD’s procedural safeguards, including that only the patient may choose and administer MAiD, MAiD patients are offered more protection from potential abuse than patients who receive palliative sedation. While some have vocally opposed MAiD for decades, there has not been similar opposition to the option of voluntarily stopping eating and drinking (VSED). With VSED, adults with decision-making capacity make a voluntary decision to refuse nutrition and hydration to die more quickly. People choosing VSED are, essentially, making the same choice that people choosing MAiD do. But VSED is a less predictable process that takes much longer to complete. Unfortunately, the process also carries a risk of unpleasant side-effects, though proper care can help mitigate them. Additionally, the practice of VSED is not constrained by statutorily defined protective measures, as is the case with MAiD – one does not even need to have a terminal illness to choose VSED.[24] It is logically inconsistent for those who oppose MAiD because of the perceived potential of abuse to hold different views about VSED.[25] If malevolent actors can unethically pressure or coerce patients into MAiD, they can also coerce them to stop eating and drinking. As with palliative sedation, it could be argued that an important difference is that VSED can be stopped, unlike MAiD. This argument fails clinically and ethically. As with palliative sedation, the VSED process eventually results in the patient losing consciousness and decision-making capacity. The patient generally becomes unarousable for a period that could last for days or even weeks. For this reason, it is crucial for VSED patients to express their choice in writing (or preferably in video recording)[26] to ensure that they will not be given nutrition or hydration when they are no longer able to enforce their refusal (or if they begin asking for nutrition or hydration). Therefore, there is a period in which the patient cannot decide to end the process, just as with palliative sedation. To the extent that someone is so concerned with potential abuse of MAiD that they seek to ban it but have not expressed similar concerns with VSED, these positions are inconsistent. At a NYS Bar Association-sponsored conference on MAiD in 2019, David Hoffman asked a MAiD opponent whether, “as someone who is looking out for the interests of a segment of the disability population,” she supports palliative sedation and VSED.”[27] Kathryn Carroll, who represented the Center for Disability Rights (“CDR”), confirmed that CDR did not oppose palliative sedation and did not offer a position on VSED. She noted the subtle difference in intention: I don’t believe the Center for Disability Rights has taken issue with palliative sedation. And my understanding is that there is a key difference between palliative sedation and assisted suicide, particularly in that palliative sedation, the point is not to bring about the death of the person, but to relieve the pain that they are experiencing. And so the death is more of a side effect rather than the intended outcome.[28] During the questioning, she provided no explanation as to why the potential for abuse would be different among palliative sedation, VSED, and MAiD.[29] The other MAiD opponent on the panel, Dennis Vacco, of Vacco v. Quill[30] fame, interjected but could not explain any ethically significant difference between VSED and MAiD. Instead, he focused solely on palliative sedation, stating that the relevant difference is that palliative sedation can be stopped: . . . treating the pain including what you referred to as terminal sedation, is not moral and legally and ethnically the same as physician-assisted suicide . . . The fact of the matter is – the difference is you can terminate that treatment, and it’s the permanent aspect of physician-assisted suicide that goes back to what I said 20 minutes ago. You can’t put the bright line anyplace else other than where it is.[31] But, as discussed above, that difference is of little import, given that palliative sedation results in patients without the ability or capacity to make the choice to stop treatment. Vacco then reverted to his concerns about the potential for coercion and the elusive slippery slope, referencing his primary argument that the only way to ensure there is no abuse of a MAiD law is not to have one at all: The bright line that is created by the law in the state of New York, which makes physician-assisted suicide a manslaughter in the second-degree, or assisting suicide by anybody, manslaughter in the second degree . . . is unfortunately the only place that line can be. That line should not move further toward accommodation. And we see here in the context of . . . all of the so-called protections in the statute. With every protection that is not prohibition, with every protection, you raise the possibility of abuse. You raise the possibility with every protection.[32] Neither Vacco nor Carroll addressed the fact that many common practices today can be the result of coerced decisions. These practices have none of the safeguards contained in MAiD legislation. As another panelist, David Leven, stated: consider that people who want to have life-sustaining treatment withdrawn, whether it’s a ventilator or feeding tube, they can also be coerced by family members. That can happen even more often, of course, because that process takes place more and more often, and there are none of the safeguards that we’re talking about here . . . there are risks involved in any process which might result in a hastened death. But there seems to be very little risk involved with medical aid in dying based on the experience in 40 years and the nine states which now permit medical aid in dying.[33] There is an inescapable inconsistency within the disability argument: one cannot logically be so concerned about the abuse of legalized access to MAiD to justify opposing all MAiD legislation while simultaneously supporting options like palliative sedation or VSED as abuse-free alternatives. d. Argument Against Speaking for a Community with Diverse Views Finally, while some disability advocates opposing MAiD will claim terminally ill patients as part of their community, they have no right or authorization to speak for the extremely heterogeneous group of terminally ill patients or the disability community[34] as a whole. The disability community is not homogenous; while some members oppose MAiD, others support it.[35] Recent polling indicates that MAiD may have broad support across the disability community.[36] e. MAiD Opponents Hold the Rights of the Terminally Ill Subordinate to Their Personal Morality and Unsubstantiated Theoretical Concerns The argument that does not get much attention, the one that is the simplest and perhaps even the most compelling, is that all killing is wrong, and the government ought not to be in the business of enabling it. That is certainly a compelling religious and moral argument against individuals engaging in any form of acts that result in ending a human life. But such an ethical or theological position does not dictate that individuals who hold different views on personal morality should be precluded by the state from accessing the most safe, certain, and painless means of addressing an invariably terminal illness. Arguments like the one described above by Vacco (that the only way to completely avoid potential MAiD abuse is to prohibit MAiD) are essentially claiming that the safest thing to do is to subordinate the suffering of the terminally ill to avoid the more subtle task of balancing the interests of two different groups of New York state citizens. But surely, that is the role of the legislature every day. And we should expect no less from the legislature on this issue. The best way to ensure no one dies in car accidents is to prohibit driving. But instead of doing so, we implement safety regulations (like speed limits) to balance the right to travel with the right of everyone else not to be killed in the process. Evidence demonstrates that MAiD legislation can also strike a balance between the rights of the terminally ill and the need to prevent harm. It is not justifiable to support a blanket prohibition of MAiD. CONCLUSION Opponents of MAiD have had decades to cite problematic case studies or formulate a compelling moral argument against it that is grounded in data rather than an assertion of their personal morality. Plainly, no one on either side of the MAiD legislative discussion wants to see anyone subjected to involuntary euthanasia or coerced into MAiD as a better alternative to palliative care when such a plan of care is a viable alternative to “ending life care.” However, enough time has passed, and the risk of coercion has been given sufficient study and debate that we can now conclude, as a society, that the rights of the terminally ill and the rights of persons committed to living their best and longest life with a disability are wholly compatible. It is time for the legislature to strike the appropriate balance and give the terminally ill a well-regulated, responsible pathway to obtaining medication that can relieve their suffering in a manner that is safe, certain, and painless. - [1] Oregon’s Death with Dignity Act, Oregon Health Authority, https://www.oregon.gov/oha/ph/providerpartnerresources/evaluationresearch/deathwithdignityact/pages/index.aspx [2] Elissa Kozlov et al., Aggregating 23 Years of Data on Medical Aid in Dying in the United States, 70 Journal of the American Geriatrics Society 3040 (2022). https://doi.org/10.1111/jgs.17925 [3] Medical Aid in Dying Act, A.995-A, N.Y. St. Assemb. (2023), available at https://legislation.nysenate.gov/pdf/bills/2023/A995A; see also, Medical Aid in Dying Act, S.2445-A, N.Y. St. Senate (2023), available at https://legislation.nysenate.gov/pdf/bills/2023/S2445A. [4] Id. [5] Ronald A. Lindsay, Oregon’s Experience: Evaluating the Record, 9 The American Journal of Bioethics 19 (2009), https://doi.org/10.1080/15265160802654137; Christopher A. Riddle, Medical Aid in Dying: The Case of Disability, in New Directions in the Ethics of Assisted Suicide and Euthanasia 234 (Michael Cholbi & Jukka Varelius eds., 2nd ed. 2023), https://doi.org/10.1007/978-3-031-25315-7; Health Law Section: Duties, Rights & the Law at the End of Life (2019), NY ST. BAR ASSOC. (Nov. 8, 2019), https://nysba.org/products/health-law-section-duties-rights-the-law-at-the-end-of-life-2019/; Medical Aid in Dying: Hearing on A.2383-A Before the New York State Assembly Standing Committee on Health (2018) (testimony of Arthur Caplan), transcript available at https://nystateassembly.granicus.com/DocumentViewer.php?file=nystateassembly_bc5bd4afc9fd8b9021781bc9e35e15ae.pdf&view=1; Fact: Medical Aid in Dying Laws Work to Protect Patients. (n.d.). Compassion & Choices. Retrieved September 5, 2023, from https://compassionandchoices.org/resource/fact-medical-aid-in-dying-laws-work-to-protect-patients; Frequently Asked Questions. (2021, December 7). Death With Dignity. https://deathwithdignity.org/resources/faqs/. [6] Bob Joondeph, Letter from Disability Rights Oregon (DRO), Compassion & Choices (Feb. 14, 2019), https://www.compassionandchoices.org/docs/default-source/default-document-library/disability-rights-oregon-dwd-letter-2-14-19.pdf. [7] Elissa Kozlov et al., Aggregating 23 Years of Data on Medical Aid in Dying in the United States, 70 Journal of the American Geriatrics Society 3040 (2022). https://doi.org/10.1111/jgs.17925 [8] Id. [9] Medical Aid in Dying: Act 39: Patient Choice and Control at the End of Life, Vermont Ethics Network, https://vtethicsnetwork.org/palliative-and-end-of-life-care/medical-aid-in-dying-act-39 (last visited Sept. 21, 2023). [10] Gideonse v. Brown, No. 3:21-cv-01568-AC (D. Or.); Bluestein v. Scott, No. 2:22-cv-00160 (D. Vt.). [11] Govatos v. Murphy, No. 2:23-cv-12601(D.N.J.). [12] Medical associations, historically opponents of MAiD, have begun adopting neutral positions, reflecting changing attitudes of the medical community. E.g., California Medical Association removes opposition to physician aid in dying bill, California Medical Association (May 20, 2015), https://www.cmadocs.org/newsroom/news/view/ArticleId/27210/California-Medical-Association-removes-opposition-to-physician-aid-in-dying-bill; Board directs CMS to develop and distribute “End-of-Life Act” education to members, Colorado Medical Society (November 22, 2016), https://www.cms.org/articles/board-directs-cms-to-develop-and-distribute-end-of-life-act-education-to-me; Vermont Medical Society Policy on End-of-life-Care, Vermont Medical Society (2017), https://vtmd.org/client_media/files/vms_resolutions/2017End-of-Life-Care.pdf (last accessed Sept. 21, 2023); but see Physician-Assisted Suicide, AMA Code of Ethics, https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-assisted-suicide. (5.7 provides opinion opposing MAiD; opinion 1.1.7 provides opinion on conscientious objection.); The American Medical Association could vote to change its stance on medical aid in dying, Death with Dignity (Nov. 10, 2023), https://deathwithdignity.org/news/2023/11/ama-could-vote-to-change-stance-on-maid/ (Update notes that the AMA did not change its stance from opposed to neutral at its November 2023 interim meeting in Baltimore, but referred the resolutions for further study). [13] Medical Aid in Dying: Hearing on A.2383-A Before the New York State Assembly Standing Committee on Health (2018) (testimony of Arthur Caplan), transcript available at https://nystateassembly.granicus.com/DocumentViewer.php?file=nystateassembly_bc5bd4afc9fd8b9021781bc9e35e15ae.pdf&view=1. [14] Id. [15] Id. [16] Id. (noting the laws in Netherlands, Belgium and Canada.); see also National Council on Disability, The danger of assisted suicide laws: Part of the Bioethics and Disability series (2019). https://ncd.gov/sites/default/files/NCD_Assisted_Suicide_Report_508.pdf. [17] Sean Riley & Ben Sarbey, The unexamined benefits of the expansive legalization of medical assistance-in-dying, 19 J. Bioethical Inquiry 4, 663 (2022) (citing Oregon Health Authority Center for Health Statistics, Oregon Death with Dignity Act: 2018 Data Summary (2019), https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Documents/year21.pdf and R. Sean Morrison, et al., America’s care of serious illness: A state-by-state report card on access to palliative care in our nation’s hospitals, 14 J. Palliat. Med. 10, 1094–1096 (2011)). [18] Medical Aid in Dying Act, A.995-A, N.Y. St. Assembly. (2023), available at https://legislation.nysenate.gov/pdf/bills/2023/A995A [19] See also, Ben Colburn, Disability‐based Arguments against Assisted Dying Laws, 36 Bioethics 680 (2022) (cataloging research in multiple countries and concluding that “there is no evidence that assisted dying laws have a disproportionate effect on people with disabilities”). https://doi.org/10.1111/bioe.13036 [20] Eyder Peralta, As Planned, Right-To-Die Advocate Brittany Maynard Ends Her Life, NPR (Apr. 3, 2014), https://www.npr.org/sections/thetwo-way/2014/11/03/361094919/as-planned-right-to-die-advocate-brittany-maynard-ends-her-life (Activist Brittany Maynard moved to Oregon after she was diagnosed with a malignant brain tumor, because her home state did not permit MAiD at the time). [21] Ending life care is defined as the final stage of the end-of-life care continuum, where the patient chooses to end their life as a means to end their suffering or unacceptable quality of life. [22] Palliative sedation is defined as “the use of medications to induce decreased or absent awareness in order to relieve otherwise intractable suffering at the end of life,” and it carries a risk of hastening death. Molly L. Olsen, Keith M. Swetz & Paul S. Mueller, Ethical Decision Making With End-of-Life Care: Palliative Sedation and Withholding or Withdrawing Life-Sustaining Treatments, 85 Mayo Clin Proc 949 (2010). https://doi.org/10.4065/mcp.2010.0201 [23] E.g. Disability Rights Toolkit for Advocacy Against Legalization of Assisted Suicide, Not Dead Yet, https://notdeadyet.org/disability-rights-toolkit-for-advocacy-against-legalization-of-assisted-suicide (last visited Dec. 8, 2023) (describing palliative sedation as “a legal solution to any remaining painful and uncomfortable deaths; one that does not raise the very serious hazards of legalizing assisted suicide”); Testimony of CDR’s Kathryn Carroll, Esq. Opposing NY Assisted Suicide Bill A2383A, Not Dead Yet (Apr. 23, 2018), https://notdeadyet.org/testimony-of-cdrs-kathryn-carroll-esq-opposing-ny-assisted-suicide-bill-a2383a. [24] Voluntarily Stopping Eating and Drinking: A Compassionate, Widely-Available Option for Hastening Death, (Timothy E. Quill et al. eds., 2021). https://doi.org/10.1093/med/9780190080730.001.0001 [25] This is not to say that MAiD and VSED are ethically identical. Different writers have articulated various reasons why MAiD and VSED are meaningfully different and meaningfully similar. Here we distinguish the potential for abuse, as this is the argument that persists among MAiD opponents, For a broader discussion on the ethics of VSED and how it compares to MAiD, see Voluntarily Stopping Eating and Drinking: A Compassionate, Widely-Available Option for Hastening Death, (Timothy E. Quill et al. eds., 2021). https://doi.org/10.1093/med/9780190080730.001.0001 [26] Id.; see also David N. Hoffman and Judy Schwarz, Can Patients Choose to Stop Eating–Even If They Have Dementia–and Can Health Care Facilities Get Paid for Taking Care of Them? Ethics and Reimbursement at the End of Life (Am. Health L. Ass’n Conf. on Long Term Care and the Law 2020). [27] Health Law Section: Duties, Rights & the Law at the End of Life (2019), NY St. Bar Assoc. (Nov. 8, 2019), https://nysba.org/products/health-law-section-duties-rights-the-law-at-the-end-of-life-2019/. [28] Id. [29] CDR still does not appear to have articulated a position on VSED. CDR is a major and vocal opponent of MAiD legislation in NY with considerable resources (they state their projected 2010 budget was approximately $29,000,000). About Us, Center for Disability Rights, https://cdrnys.org/about/. [30] Vacco v. Quill, 521 U.S. 793 (1997) (holding that there is no equal protection violation when N.Y. law criminalized assisted-suicide but permitted removal of life-support systems). [31] Health Law Section: Duties, Rights & the Law at the End of Life (2019), supra note 5. [32] Id. [33] Id. [34] Ben Colburn, Disability‐based Arguments against Assisted Dying Laws, 36 Bioethics 680 (2022) (providing evidence that “that people with disabilities, and disability rights organizations, have diverse views on the question of whether assisted dying should be legal”). https://doi.org/10.1111/bioe.13036 [35] Us for Autonomy, https://www.usforautonomy.org (last visited Sep 10, 2023); see also, Kathryn L. Tucker, Building Bridges Between the Civil Rights Movements of People with Disabilities and Those with Terminal Illness, 78 U. of Pitt. L. Rev. 329 (2017) (collecting and describing amici participation by disability advocates supporting end-of-life liberty). https://doi.org/10.5195/lawreview.2017.473 [36] E.g., USA/National Public Opinion Survey, Susquehanna Polling & Research, Inc. (Feb. 2023),https://d31hzlhk6di2h5.cloudfront.net/20230307/2e/9e/21/14/d37db7887f3f349202ae6f31/Raben_Crosstabulation_Report_2023.FINAL%20(1).pdf ).