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1NCLegalization of PAS is an armation of the act by ocial statesanction within regulation

Yuill 13

Senior Lecturer in American History at the University of Sunderland; author, Assisted Suicide: The Liberal HumanistCase Against Legalization !evin htt"s:##$evinyuill%&ord"ress%com#tag#assisted'suicide#

Second, and much more im"ortantly, the only real dierence between assisted dyingand assisted suicide is that the former has been ocially sanctioned

by doctors and by legality % Someone in !regon with" according to

two doctors" #$e months left to li$e who ingests %oison is , according to

Com"assion and Choices, (ignity in (ying, other "ro"onents of a change in the la& and, since )**+, the regon (e"artment of

Human Services, is an assisted death% Someone who is dying but has se$enmonths to li$e who ingests the same %oison is" according to thesame sources" an assisted suicide& The change in terminology, then, is

not sim%ly %olitical correctness but an indication of a new role that%ro%onents en$isage for doctors% -m"ortantly, the re'ection of the term(suicide) im%lies that the moral taint of suicide in "articular circumstances that are

determined by ocials" law ma*ers and doctors is to be remo$ed % The

action of ta$ing one.s life is no di/erent in the t&o scenarios% 0ut the former is given o1cial im"rimatur and is therefore an assisted death 2good insteadof a suicide 2bad% Such a change has im"ortant im"lications% The obvious one is that, as "riests and other religious o1cials have de"arted the deathbedscene, their "lace has been 3lled by doctors% 4or it &ould be di1cult to deny that, in the scenarios outlined in the introduction, doctors "lay a s"iritual roleonly% As &e shall e5"lore in future cha"ters, suicide may be accom"lished &ithout the aid of o1cial medicine so they "lay only an o1ciating role &herebythey dis"ense deadly drugs that the "atient might have bought herself, li$e a "riest "lacing &afers on the tongues of his 6oc$% The fact that the doctorgives the "oison ritualizes the action &ithin a set of bureaucratic guidelines% The im"lication for the "atient, similarly, is validation of their su/ering% -n the"ast, religious 3gures comforted the dying by rationalizing su/ering as "art of 7od.s "lan% 8o&, should assisted suicide be institutionalized, "hysicians &ill"rovide an end to de"ression and mental su/ering 2as &e shall see, "hysical su/ering "lays very little role in re9uests for assisted suicide by o/eringdeath as a medical treatment% The change in terminology re6ects an im"ortant shift a&ay from moral res"onsibility for the act% hereas the right to die,self'determination and assisted suicide all im"ly that the individual involved ta$es full res"onsibility for the act, assignation of moral res"onsibility forassisted dying. is more di/use% -m"ortantly, such an a""arently facile change lum"s together very di/erent things in moral terms < $illing another "ersonand suicide% Su""ose - ma$e a "act &ith my friend that, should - ever su""ort a soccer team other than Arsenal, he should $ill me and, t&enty years later,

- arrive to meet him &ith a Tottenham Hots"ur shirt and he $ills me% Alternately, su""ose - agreed, u"on meeting him &ith the o/ending shirt, that - shouldbe $illed for my lac$ of loyalty and for no& su""orting such a ridiculous football team% Su""ose - then as$ed him for his gun and shot myself% These t&overy di/erent acts might be construed as assisted dying 2to satisfy (ignity in (ying criteria, let us also say that, at the time, - had less than si5 months tolive, though, in a court of la&, the former &ould be murder and the latter suicide% Though the e/ect &ould be the same for me 2and, being dead, the9uestion of my res"onsibility moot and though my friend might bear some res"onsibility even if - "ulled the trigger, the t&o acts are "rofoundly di/erentfor him% =et the conce"t of assisted dying essentially e9uates these t&o di/erent acts% -n fact, as &e shall discuss in Cha"ter +, negating moral

res"onsibility means that courts, where indi$iduals are tried to determine thedegree of their res%onsibility for a crime, are less a%%ro%riate than%rofessional regulatory tribunals" where the +uestion becomeswhether or not a set of regulations has been followed %ro%erly%

,ather than self-determining actors who choose our own fates, &e

become "oints on an increasingly com"le5 6o& chart, re9uiring a huge a""aratus of bureaucratic e5"erts% -f &e acce"t (ignity in(ying.s suggestion that assisted dying involves only those &ho are considered to be dying, an essentially "hiloso"hical 9uestion isdetermined by a "rofessional regulatory body% There is little agreement on this issue even bet&een advocates% regon.s andashington.s legislation 2and that contained in "ro"osed U! legislation de3ne the dying as those &ith a terminal illness and si5

months to live &hereas the U! Commission on Assisted (ying recommended that the sub>ect be terminally ill and have ?) monthsor less to live% -f the "hrase su/ering unbearably. is em"loyed as it &as in the "ro"osed U! legislation, ho& &ill that be determined@

Again, there is little clarity and great sco%e for regulations at e$ery

ste% of the %rocess %?B The assisted suicide legislation and "ro"osed legislation has created a ne& identity in the dying.% 0ut

the division bet&een the dying. < &hether they have si5 or ?) months to live < and the rest of us is false% ho is not dying one day at a time@ e are allterminal., and the &orth of our lives should not be crudely measured by the time &e have left% 8or is dying a medical act; long before any medicalintervention occurred, "eo"le &ere dying &ithout any intervention at all% As (aniel Callahan has noted, there is no& a tendency to vie& death assomething that is done to us rather than something that occurs, as if death &ere no& our fault, the result of human choices, not the inde"endent&or$ings of nature.% As the old >o$e has it, life itself is a se5ually transmitted disease that is al&ays fatal% The di/erence bet&een someone &ith less thansi5 months to live and someone &ith many years is 9uantitative rather than 9ualitative% The dying. as a category are, in actuality, those &ho have littletime left or, more controversially, as &e shall e5"lore in the ne5t cha"ter, the elderly%?D Such a term also obscures the historically di/erent motivations



behind the cam"aign% Autonomy, in the classical sense, im"lies the freedom to terminate one.s o&n life &ith no intrusion by the state or anyone else%Com"assion might 2mista$enly motivate "eo"le to su""ort a cam"aign for the dying to be "ut out of their misery% As e5"ressed in the e5am"le above, if&e su""ort legalization of assisted dying, either &e su""ort selective suicides or selective $illings% As &e shall see in the ne5t cha"ter, the movement forassisted dying builds u"on distrust of medical "ersonnel; none of the cam"aigns in the English's"ea$ing &orld call for more "o&er for doctors% AsFrofessor Gay Tallis, "rominent "atron of the English "ro"onent of a change in the la& (ignity in (ying, notes, -t is one of the fundamental "rinci"les ofmedicine that you should be allo&ed to determine &hat is in your o&n best interest &hen you are of sound mind% 8obody else.s vie&s should be able toover'ride this right%.)* =et the voices of doctors, should assisted suicide be institutionalized, &ill, as &e &ill see in Cha"ter +, &ill be the loudest in thesedecisions% Criticisms of this re'branding of suicide are not all from the anti'assisted suicide side% Such seasoned advocates of assisted suicide#dying as(ere$ Hum"hry have also 9uestioned it% Geacting to ne&s that the regon (e"artment of Human Services chose in )**+ to re"lace references to assistedsuicide. &ith assisted dying., Hum"hrey noted: To &ra" u" our su""ort for "hysician'assisted suicide in fancy language invites our critics to say that &e

are trying to change the la& covertly and that &e are ashamed of being fran$ about &hat &e really &ant, neither of &hich is true%. The Commission on

(ying also refused to >ettison the term assisted suicide., referring to assisted dying. as both assisted suicide and voluntary euthanasia%)? .he

real issue at the heart of the debate / one which is obscured by the

term assisted dying / is suicide " not dying& .he +uestion at the

heart of this debate is whether we wish to %re-a%%ro$e suicide in

certain circumstances %

Should means immediateSummer 0

2ustice, $lahoma Su"reme Court, I!elsey v% (ollarsaver 4ood arehouse of (urantJ,htt":##&&&%oscn%net#a""lications#oscn#(eliver(ocument%as"@Cite-(K)*)BMmar$erNfn?O

.he legal +uestion to be resol$ed by the court is whether the word2should 213 in the ay 14 order connotes futurity or may be deemeda ruling in %raesenti &1 .he answer to this +uery is not to be di$inedfrom rules of grammar 5?P it must be go$erned by the age-old%ractice culture of legal %rofessionals and its immemorial language usage% To determine if the

omission 2from the critical Qay ?B entry of the turgid "hrase, Rand the same hereby isR, 2? ma$es it an in futuro ruling ' i%e%, ane5"ression of &hat the >udge &ill or &ould do at a later stage ' or 2) constitutes an in in "raesenti resolution of a dis"uted la& issue,the trial >udges intent must be garnered from the four corners of the entire record%?+ 8isi "rius orders should be so construed as togive e/ect to every &ords and every "art of the te5t, &ith a vie& to carrying out the evident intent of the >udges direction%? The

orders language ought not to be considered abstractly% .he actual meaning intended by the

document6s signatory should be deri$ed from the conte7t in whichthe %hrase to be inter%reted is used%?B hen a""lied to the Qay ?B memorial, these told canons

im"el my conclusion that the 'udge doubtless intended his ruling as an in%raesenti resolution of (ollarsavers 9uest for >udgment n%o%v% A""roval of all counsel "lainly a""ears on the face

of the critical Qay ?B entry &hich is BBP F%)d ?NPB signed by the >udge%?D True minutes)* of a court neither call for nor bear thea""roval of the "arties counsel nor the >udges signature% To re>ect out of hand the vie& that in this conte5t RshouldR is im"liedlyfollo&ed by the customary, Rand the same hereby isR, ma$es the court once again revert to medieval notions of ritualistic formalismno& so thoroughly condemned in national >uris"rudence and long abandoned by the statutory "olicy of this State% - C8CLUS-88isi "rius >udgments and orders should be construed in a manner &hich gives e/ect and meaning to the com"lete substance of thememorial% hen a >udge'signed direction is ca"able of t&o inter"retations, one of &hich &ould ma$e it a valid "art of the record"ro"er and the other &ould render it a meaningless e5ercise in futility, the ado"tion of the former inter"retation is this courts due% Arule ' that on direct a""eal vie&s as fatal to the orders e1cacy the mere omission from the >ournal entry of a long and customarilyim"lied "hrase, i%e%, Rand the same hereby isR ' is soon li$ely to drift into the body of "rinci"les &hich govern the facial validity of

>udgments% This develo"ment &ould ma$e >udicial acts acutely vulnerable to collateral attac$ for the most trivial of reasons and tendto undermine the stability of titles or other ad>udicated rights% -t is obvious the trial >udge intended his Qay ?B memorial to be an in

"raesenti order overruling (ollarsavers motion for >udgment n%o%v% -t is hence that memorial, and not the later une ) entry, &hichtriggered a""eal time in this case% 0ecause the "etition% in error &as not 3led &ithin N* days of Qay ?B, the a""eal is untimely% -&ould hence sustain the a""ellees motion to dismiss%)? 4ootnotes: ? The "ertinent terms of the memorial of Qay ?B, ?DDN are: -8

THE (-STG-CT CUGT 4 0G=A8 CU8T=, STATE 4 !LAHQA CUGT Q-8UTE P#?B#DN 8o% C'D?'))N After having heard andconsidered arguments of counsel in su""ort of and in o""osition to the motions of the (efendant for >udgment 8%%% and a ne&trial, the Court 3nds that the motions should be overruled% A""roved as to form: #s# !en Gainbolt #s# Austin G% (eaton, r% #s# (onQichael Haggerty #s# Goc$y L% Fo&ers udge ) The turgid "hrase ' Rshould be and the same hereby isR ' is a tautological absurdity%

This is so because Rshould2 is synonymous with ought or must and is in itselfsucient to eect an in%raesenti ruling - one that is couched in 2a%resent indicati$e synonymous with ought&2 See infra note ?P% N Carter v% Carter, $l%, BN F%)d D+D, D* 2?DBD; Horizons, -nc% v% !eo Leasing Co%, $l%,

+B? F%)d P, PD 2?DBO; Amare5, -nc% v% 0a$er, $l%, +PP F%)d ?*O*, ?*ON 2?DBN; !nell v% 0urnes, $l%, +OP F%)d O?, ON 2?DB); Froc$ v% (istrict Court of Fittsburgh County, $l%, +N* F%)d ), P 2?DB?; Harry v% Hertzler, ?BP $l% ?P?, D* F%)d +P+, +PD 2?DND; 7inn v% !night, ?*+ $l% O, )N) F% DN+, DN



2?D)P% O RGecordableR means that by force of ?) %S% ?DD? )O an instrument meeting that sections criteria must be entered on or RrecordedR in the courts >ournal% The cler$ may R enterR only that &hich is Ron 3le%R The "ertinent terms of ?) %S% ?DD? )O are: RU"on the >ournal record re9uired to be $e"t bythe cler$ of the district court in civil c ases % % % shall be entered co"ies of the follo&ing instruments on 3le: ?% All items of "rocess by &hich the c ourt ac9uired >urisdiction of the "erson of each defendant in the case; and )% All instruments 3led in the case that bear the signature of the and >udge and s"ecifyclearly the relief granted or order made%R Em"hasis added% P See ?) %S% ?DD? ???+ & hich states in "ertinent "art: REvery direction of a court or >udge made or entered in &riting, and not included in a >udgment is an order%R Em"hasis added% + The "ertinent terms of ?) %S% ?DDN +D+%N , e/ectivectober ?, ?DDN, are: RA% udgments, decrees and a""ealable orders that are 3led &ith the cler$ of the court shall contain: ?% A ca"tion setting forth the name of the court, the names and designation of the "arties, the 3le number of the case and the title of the instrument; )% A statement of the dis"osition ofthe action, "roceeding, or motion, including a statement of the relief a&arded to a "arty or "arties and the liabilities and obligations im"osed on the other "arty or "arties; N% The signature and title of the court; % % %R The court holds that the Qay ?B memorials recital that Rthe Court 3nds that the motionsshould be overruledR is a R3ndingR and not a ruling% -n its "ure form, a 3nding is generally not e/ective as an order or >udgment% See, e%g%, Tillman v% Tillman, ?DD $l% ?N*, ?BO F%)d BO 2?DO, cited in the courts o"inion% B hen ruling u"on a motion for >udgment n%o%v% the court must ta$e into account all theevidence favorable to the "arty against & hom the motion is directed and disregard all con6icting evidence favorable to the movant% -f the court should conclude the motion is sustainable, it must hold, as a matter of la&, that there is an entire absence of "roof tending to sho& a right to recover% See Austin v%il$erson, -nc%, $l%, P?D F%)d BDD, D*N 2?DO% D See 0ullard v% 7risham Const% Co%, $l%, ++* F%)d ?*OP, ?*O 2?DBN, &here this court revie&ed a trial >udges R3ndings of factR, "erceived as a basis for his ruling on a motion for >udgment n%o%v% 2in the face of a defendants reliance on "lainti/s contributorynegligence% These >udicial 3ndings &ere held im"ermissible as an invasion of the "rovidence of the >ury and "roscribed by !LA% C 8ST% AGT, )N, + % -d% at ?*OB% ?* Everyday courthouse "arlance does not al&ays distinguish bet&een a >udges R3ndingR, &hich denotes nisi "rius resolution of fact issues, andRrulingR or Rconclusion of la&R% The latter resolves dis"uted issues of la&% -n "ractice usage members of the bench and bar often confuse &hat the >udge R3ndsR &ith &hat that o1cial RconcludesR, i%e%, resolves as a legal matter% ?? See 4o&ler v% Thomsen, +B 8eb% PB, DO 8%% B?*, B??'?) 2?D*N, &here thecourt determined a ruling that R? 3nd from the bill of "articulars that there is due the "lainti/ the sum of % % %R &as a >udgment and not a 3nding% -n reaching its conclusion the court reasoned that Re/ect must be given to the entire in the doc$et according to the manifest intention of the >ustice in ma$ingthem%R -d%, DO 8%% at B??% ?) hen the language of a >udgment is susce"tible of t&o inter"retations, that &hich ma$es it correct and valid is "referred to one that &ould render it erroneous% Hale v% -nde"endent Fo&der Co%, O+ $l% ?NP, ?OB F% ?P, ?+ 2?D?P; Shar" v% QcColm, D !an% ), ?*? F% +PD, ++)2?D*D; Clay v% Hildebrand, NO !an% +DO, D F% O++, O* 2?BB+; see also ? A%C% 4GEEQA8 LA 4 U(7QE8TS + 2Pth ed% ?D)P% ?N RShouldR not only is used as a R"resent indicativeR synonymous &ith ought but also is the "ast tense of RshallR &ith various shades of meaning not al&ays easy to analyze% SeeP C%% Shall D, udgments ?)? 2?DN)% % ESFEGSE8, 7GTH A8( STGUCTUGE 4 THE E87L-SH LA 87UA7E 2?DBO; St% Louis V S%4%G% Co% v% 0ro&n, OP $l% ?ON, ?OO F% ?*P, ?*B*'B? 2?D?O% 4or a more detailed e5"lanation, see the Fartridge 9uotation infra note ?P% Certain conte5ts mandate aconstruction of the term RshouldR as more than merely indicating "reference or desirability% 0ro&n, su"ra at ?*B*'B? 2>ury instructions stating that >urors RshouldR reduce the amount of damages in "ro"ortion to the amount of contributory negligence of the "lainti/ &as held to im"ly an obligation and to bemore than advisory; Carrigan v% California Horse Gacing 0oard, +* ash% A""% D, B*) F%)d B?N 2?DD* 2one of the Gules of A""ellate Frocedure re9uiring that a "arty Rshould devote a section of the brief to the re9uest for the fee or e5"ensesR &as inter"reted to mean that a "arty is under an obligation to

include the re9uested segment; State v% Gac$, N?B S%%)d )??, )?P 2Qo% ?DPB 2RshouldR &ould mean the same as RshallR or RmustR &hen used in an instruction to the >ury &hic h tells the triers they Rshould disregard false testimonyR% ?O 8n %raesenti

means literally 2at the %resent time&2 0LAC!S LA (-CT-8AG= D) 2+th Ed% ?DD*% -n legal"arlance the %hrase denotes that which in law is %resently orimmediately eecti$e" as o%%osed to something that &ill or wouldbecome eecti$e in the future in futurol% See an yc$ v% !nevals, ?*+ U%S% N+*, N+P, ? S%Ct% NN+, NN,

) L%Ed% )*? 2?BB)%

9,esol$ed: meansreWsolve verb Xri'YzZlv, 'Yz[lv also 'YzZv or 'Yz[vX : to 3nd an ans&er or solution to 2something : to settle or solve 2something

: to ma*e a de#nite and serious decision to do something

.hat)s erriam ;ebster 1 htt":##&&&%merriam'

&ebster%com#dictionary#resolved

.he a doesn)t defend a certain" immediate regulatorystructure for Physician Assisted Suicide

<ote Negati$e

A& S%ec / if they ma*e a we meet argument" then you should$ote neg on the fact that they wouldn)t s%ecify out of the 1AC /

that ma*es it im%ossible to create negati$e strategy and re-starts the debate in the =AC" ti%s the balnce in fa$or of the a

Predictable Limits - ,egulations tie the to%ic s%eci#cally to%ositi$e go$ernment action" there are in#nite negati$e stateactions that could be ta*en / %ositi$e action is chec*ed byother words in the resolution while negati$e state action isnot" ma*es it %ossible for e7tra to%ical %lans&

.o%ic >round -- all of the contro$ersy comes from the

regulations %ortion of the debateA%%el (?@

2acob Q% A""el The Hastings Center Ge"ort% )**;N2N:)?')N% IA Suicide Gight for the Qentally -ll@ A S&iss Case"ens a 8e& (ebateJ htt":##&&&%medsca"e%com#vie&article#PPB?, TS

Ad$ocates for the legalization of assisted suicide in the nited States,

including those &ho s"onsored regons (eath &ith (ignity Act in ?DDO and current bac$ers of Californias "ro"osed Com"assionate

Choices Act, ha$e sought to %ermit the %ractice only under highly limited



circumstances\namely" when the re+uesting %atient is terminally ill&? -n contrast, the 8etherlands allo&s "hysician'assisted suicide in nonterminal cases of Rlasting and unbearableR su/ering, and0elgium authorizes "hysician'assisted suicide for nonterminal "atients &hen their su/ering is RconstantR and Rcannot bealleviated%R) =et no country has la&s on the sub>ect as liberal as those of S&itzerland, &here assisted suicide has been legal since?D?B% -t remains the only >urisdiction that allo&s nonresidents to terminate their o&n lives%N -t is also the only >urisdiction that doesnot re9uire that a "hysician be involved in the "rocess% 8o&, a recent decision by the S&iss 4ederal Su"reme Court threatens toundermine yet another longstanding taboo in the debate over assisted suicide and euthanasia% -n its ruling on 8ovember N, )**+,the high tribunal in Lausanne laid out guidelines under &hich, for the 3rst time, assisted suicide &ill be available to "sychiatric

"atients and others &ith mental illness%O The case &as that of an unnamed 3fty'three'year'old manic de"ressive &ith t&o "riorsuicide attem"ts &ho sought a "rescri"tion for 3fteen grams of sodium "entobarbital in order to end his o&n life%P He claimed aright to self'determination under Article B of the Euro"ean Convention on Human Gights and alleged that no "hysician &ould"rescribe him this lethal dose for fear of legal or "rofessional re"ercussions%+ (ignitas, a ]urich'based advocacy grou", su""ortedhis suit% The S&iss high court res"onded &ith a s&ee"ing o"inion u"holding the right of those su/ering from Rincurable, "ermanent,severe "sychological disordersR to terminate their o&n lives% According to the court, a distinction should be made bet&eentem"orarily im"aired individuals &ho &ish to die as Ran e5"ression of treatable "sychological disturbancesR and those individuals&ith severe, long'term mental illness &ho have made RrationalR and R&ell'consideredR decisions to end their lives to avoid furthersu/ering%B Since serious mental disorders could ma$e life seem as unbearable to some "atients as serious somatic ailments do toothers, the court reasoned, those &ho re"eatedly e5"ressed a &ish to end their lives under such circumstances should be "ermittedto do so% 2The court also ruled that the "lainti/ in this case &ould have to obtain a thorough "sychiatric evaluation to determine&hether he met these standards before he could end his life% 0oth su""orters and o""onents of assisted suicide have been highlycritical of e5tending suicide rights to "sychiatric "atients%D ne set of ob>ections is directed against the "ractice of assisted suicideitself\for a host of reasons ranging from a belief in the inherent sanctity of human life to a fear of sliding do&n a sli""ery slo"eto&ard involuntary euthanasia; that debate has been e5tensively addressed else&here% Another set of ob>ections are from those&ho su""ort a basic right to assisted suicide in certain situations, such as those of terminal disease, but do not &ish to e5tend it tocases of severe and incurable mental illness% This resistance may be inevitable, considering the increased em"hasis thatcontem"orary "sychiatry "laces on suicide "revention, but the "rinci"les favoring legal assisted suicide lead logically to the

e5tension of these rights to some mentally ill "atients%?* At the core of the argument

su%%orting assisted suicide are the twin goals of ma7imizing

indi$idual autonomy and minimizing human suering& Patients, advocates

believe, should be able to control the decision of when to end their ownli$es" and they should be able to a$oid unwanted distress" both%hysical and %sychological% ;hile these two %rinci%les might e7%lainwhy a $ictim of amyotro%hic lateral sclerosis or cancer would chooseassisted suicide, they a%%ly e+ually well in many cases of %urely%sychological disease: a victim of re"eated bouts of severe de"ression, "articularly in cases &here treatment

has consistently "roven ine/ective, rationally might "refer digni3ed death over future su/ering% bviously, there is a di/erence in

$ind bet&een the terminally ill cancer "atient and the acutely de"ressed teenager &ho transiently desires to end his life after aromantic setbac$; it seems logical to "revent "atients from committing suicide until they have considered all of their o"tions over ane5tended "eriod of time, and to be certain that they are not acting in haste% 0ut the di/erence bet&een a "atient &ho desiressuicide after enduring the long'term agonies of rheumatoid arthritis or trigeminal neuralgia and the "atient &ho &ants to end his life

after years of debilitating an5iety or intermittent "sychotic e"isodes is not so clear% !ne crucial distinctionbetween chronic mental illness and terminal disease is that death isine$itable in the latter cases& Yet 2ine$itable2 is really not +uiteright& Brom today6s $antage %oint" a ra%id cure for ALS or certaincancers a%%ears highly unli*ely" yet the history of modern medicineis re%lete with e7am%les of illnesses ty%e 8 diabetes" acutelym%hoblastic leu*aemia" choriocarcinomaD that ha$e ra%idly gonefrom uni$ersally fatal to highly manageable& hat &e really mean &hen &e s"ea$ of

inevitability is that &e believe the "atient should be able to &eigh the unli$ely "ossibility of a cure against her other interests% hilethe &indo& of o""ortunity for discovering e/ective treatment may be longer in cases of chronic mental illness, it seems reasonableto a/ord the "atient the same choice in balancing li$elihoods against other values% And if the o/er is that an e/ective treatmentmay eventually be found, but a "erson &ill have to su/er for some decades more until that ha""ens, then it might still be rational to

"refer suicide% A second concern in cases of mental illness is that of thecom%etence of the decision-ma*er% 4or e5am"le, a severely de"ressed "atient might substantially

underestimate her long'term "rognosis% 0ut rather than arguing against assisted suicide, this might indicate even further the de"th

of the "atients "resent su/ering% Clearly" %atients who e7%erience %sychosis or areinca%able of ma*ing general medical decisions should not be able to



ta*e their own li$es until they can thin* rationally% Qorever, the 3nality of a life'

terminating decision indicates that a higher threshold of com"etence should be re9uired in suicide cases than in more run'of'the'millhealth care choices% 0ut one can be both dee"ly de"ressed and ca"able of ma$ing rational decisions% -f the values cham"ioned byassisted suicide advocates are ma5imization of autonomy and minimization of su/ering\even &hen they con6ict &ith the e5tensionof life\then it follo&s that chronically de"ressed, com"etent individuals &ould be ideal candidates for the "rocedure% At the veryleast, a "atient &ith a history of mental illness &ho is currently e5"eriencing a tem"orary remission of sym"toms &ill certainly becom"etent enough to ma$e such a choice before the return of the disease% 2An additional concern might be the increased su/ering

endured by families of assisted suicide victims\but &hy this su/ering should trum" that of the "atient is not clear% .hemost com%elling argument against e7tending assisted suicide rightsto the mentally ill relates to the role of %hysicians % The nature of "sychiatric thera"y

di/ers from that of other medical treatment in the degree of attachment bet&een caregiver and "atient% This distinction isrecognized in various regulatory codes, and most glaringly in the rules banning romantic relations bet&een "sychiatrists and former"atients, even many years after care has ceased% Qoreover, "sychiatrists are trained to "revent suicide\an outcome &idelyregarded by the "rofession as a failure% This con6ict of interest "laces the "sychiatrist in the un"leasant bind of choosing bet&een a"atients &ish and the standard of care in the 3eld% Fsychiatrists might even attem"t to avoid treating such rational but chronicallysuicidal "atients in an e/ort to avoid this choice% Any meaningful discussion of the sub>ect of assisted suicide for the mentally illshould include an e5"loration of alternative mechanisms by &hich such "atients might obtain hel" in ending their lives, "ossiblyincluding the use of full'time thanatologists s"ecially trained for the act%

.hey are e7tra to%ical -- lac* of regulations means they defendthe entirety of %hysician assisted suicide" only PAS with

regulatory regimes are . -- $oting issue because it de'usti#esthe resolution and allows un%redictable additions to the rezthat we aren)t %re%ared to debate



1NC.he nited States should substantially increase eorts toeducate medical %rofessionals and %atients who +ualify asterminally ill regarding the a$ailability of %alliati$e care

treatment" and %ro$ide substantially increased su%%ort tofacilitate necessary e7%ansions and im%ro$ements to %alliati$ecare %rograms

CP sol$es!athleen Boley and Herbert Eendin =, !athleen is a Frofessor in the(e"artment of 8eurology at the eill Qedical College of Cornell UniversityAttending 8eurologist, Fain and Falliative Care Service, also Qemorial Sloan'!ettering Cancer Center (irector; Herbert is a Frofessor in the (e"artment ofFsychiatry and 0ehavioral Sciences, 8e& =or$ Qedical College and the Qedical(irector, American 4oundation for Suicide Frevention; IThe Case against Assisted

Suicide 4or the Gight to End'of'Life CareJ, )**), ohns Ho"$ins University Fress, e'boo$,htt":##site%ebrary%com%turing%library%north&estern%edu#lib#north&estern#doc(etail%action@doc-(K?**)?P+DV""gK?

hat most "eo"le do not $no& is that such treatment is now %ossible % Ea$ing

e7%erienced the %ainful death of a family member or friend" manyassume it is not% ;hen a *nowledgeable %hysician addresses thedes%eration and suering that underlie the re+uest for assistedsuicide and assures %atients that he or she will continue to do so

until the end of their li$es" most %atients change their minds " no

longer want to hasten death" and are grateful for the timeremaining to them% 0ut at this time only a minority recei$e such care% ^ 8n the100@ ruling u%holding the constitutionality of state laws %rohibitingassisted suicide, the U%S% Su%reme Court declared that assisted suicidewas not necessary for the "lainti/s in the 8e& =or$ and ashington State cases it &as considering becausemodern medical methods of obtaining relief from suering werea$ailable to the %laintis& Fustice Sandra (ay !)Connor summarized theo%inion of the ma'ority of the 'ustices in saying that for terminally ill%atients in great %ain there were 9no legal barriers to obtainingmedication from +uali#ed %hysicians to alle$iate that suering, even to

the "oint of causing unconsciousness and hastening death%J?

Counter%lan sol$es com%assion and death control---PAS is self-%ity to rid oursel$es of the reminder of our own #nitudeEdmund Pellegrino =, Q%(%\&as the Chairman of the Fresidents Council on0ioethics and &as the founder of the Edmund (% Fellegrino Center for Clinical0ioethics 2renamed in his honor in )*?N at 7eorgeto&n University, ICom"assion -s8ot EnoughJ, found in IThe Case against Assisted Suicide 4or the Gight to End'of'

http://site.ebrary.com.turing.library.northwestern.edu/lib/northwestern/docDetail.action?docID=10021569&ppg=1






Life CareJ by !athleen 4oley and Herbert Hendin, )**), ohns Ho"$ins Fress, e'boo$,htt":##site%ebrary%com%turing%library%north&estern%edu#lib#north&estern#doc(etail%action@doc-(K?**)?P+DV""gK?

Com"assion: hat True Co'su/ering Entails

,e'ecting the argument from com%assion used by the %rotagonistsof euthanasia and assisted suicide is not the same as re'ecting the role ofcom%assion in the care of suering %ersons& .he %ro%er role of theemotion of co-suering is to com%el us to act in such a way towardthe suerer that our eort to %ut oursel$es in the suerers %lace isauthentically com%assionate& .his is not sim%ly to communicate %ityor mercy" but genuinely to ma*e some of t he suering %erson)sburden our own & .rue com%assion is an emotion accom%anied by a desireto hel%, but to hel" in a way that communicates our solidarity &ith the su/erer

without losing our ethical bearings in the "rocess% ^ To be hel"ful, we do need toshow our emotional solidarity with the one who is suering% At a""ro"riate

times\through $oice" touch" silence" or con$ersation\our feelings for the dying

"erson can be made manifest to him or her% .rue com%assion ma*es clear our

attachment to the %erson, not to our own %hiloso%hy of dying or reasons

for living% 7enuine com"assion is indis"ensable in humane and loving care of su/ering and dying "ersons% ithoutit, the su/ering individual feels abandoned, ostracized from the &orld of human interaction and communal feeling,"itied, des"ised, devalued, and &ithout dignity% Absence of com"assion\or the "erce"tion of its absence\adds

immeasurably to su/ering and reinforces any inci"ient tendency to see$ death in the face of su/ering% ^ .hereare times, ho&ever, when some degree of detachment is a%%ro%riate% Patients

need to *now that our com%assion does not undermine our

%rofessionalism , or our ca%acity to act with benign %aternalismwhen the %atient6s res%onse to illness is self-destructi$e% .he traditional

medical $irtue of e+uanimity has been seriously misunderstood%?D -t is not a call to serene,

uninterested detachment, but a call for calm a%%raisal of the clinical situationwhen emotions are threatening to engulf the doctor as well as the%atient and the %atients family & G -n my o&n clinical teaching, - often as$ dying "atients &hat

message they &ant most to communicate to medical students and residents% -nvariably, they say, RFlease tell themto "ut themselves in my "lace% These &ords sum u" our "rofessional failings to sho& true com"assion for those&ho are su/ering or dying% These "atients are s"ea$ing not only of the cruder as"ects of the many im"ersonal &aysin &hich &e relate to them, the rudeness and uninterested detachment, but also of the subtler la"ses as &ell: ouroverly hasty visits, our failure to touch the "atient "hysically, our demeaning turns of "hrase, our habit of belittlingthe "atient.s fear or of hearing &ithout listening, the subtle im"utations of loss of dignity, self'"ity, and fear\all of

&hich reinforce the "atients loss of self'&orth% ^ Seriously ill" dying " or suering%atients ha$e a heightened sensiti$ity to everything and everyone in their milieu% .heytend to associate even the most minor occurrences with their o&n

e7istential %light & They can sense indi/erence and insincerity as &ell as fear, an5iety, or the

fascination're"ulsion their "hysical a""earance may induce in others% Quch of the guilt, sense of

worthlessness" and loss of dignity that su/ering "atients feel arises from howthey %ercei$e our res%onses to their %redicament& Hy oering the



"ossibility of an assisted suicide or leaving the lethal drugs at the bedside, we con#rm the

suerer6 de$aluation of his or her own life % !ur 2com%assion2

contributes to the "atients suering and reinforces the des%erate %leafor release by any means% ^ .rue com%assion means we truly share the

other6s suering% Saint Anselm "uts it this &ay: RCom"assion is our heart made &retched by thesu/ering of the &retched%R bviously, &e cannot enter the &orld of another su/ering com"letely% 0ut by ourbeha$ior &e can communicate our concern" care" and feeling for the

suerer, our human identi#cation &ith him or her% 8n this way" the suerer

can regain some sense of the worth and dignity the "redicament of illness has

ta*en away % True com"assion is a res"onse to a "lea for hel"% -t is a sign that &e com"rehend, to some

e5tent, &hat is ha""ening to su/ering "eo"le even &hen &e cannot relieve that su/ering entirely% Fatients $no&that &e cannot enter their "redicament fully, but they can recognize &hen &e try to see ourselves in their R"lace%R ^

True com"assion re9uires that family members, friends, and "hysicians recognize their com"licity in the "atients

loss of dignity% ;e must recognize, too, that for those &ho assist in or a""rove of it, assisting in

suicide may be an act of self-%ity as much as com%assion for another% .he%atient6s death releases caregi$ers from frustration" fatigue"

hostility" and guilt& A %erson who is debilitated, dying, and emaciated reminds

us of our own #nitude , of the fact that &e, too, may someday su/er the same &ay% !ur

desire to rid oursel$es of this reminder can be the unconscious

moti$e for our 2com%assionate2 act of euthanasia or assisted suicide % ^ -t

goes &ithout saying that true com%assion means relie$ing %ain to the greateste7tent %ossible% Fain "er se is the reason for see$ing death in a minority of cases, but it is a

serious moral failure, and serious mal%ractice as &ell, not to use %ain

medication o%timally% Com"assion also means recognizing the futility of treatment &hen the burdens

dis"ro"ortionately out&eigh the bene3ts% -t means a""reciating the fact that every "erson su/ers di/erently and fordi/erent reasons% True com"assion re9uires discernment of the uni9ue constellation of causes that generatesu/ering in this "atient% -t means directing our relief to those causes as they e5"ress themselves in the "erson ofthe "atient% ^ Above all, com"assionate "artici"ation in the other "ersons su/ering means being "resent, available,and accessible, even in silence if &e do not $no& &hat to say% ur "resence assures the "erson that &e &ill not let

him or her die alone\a ma>or source of fear and su/ering in terminally ill "atients% Assurance of our

%resence is more comforting than the a$ailability of a lethal dose

of medication on the bedside table , as the advocates of suicide so con3dently aver%

.hat lethal dose only assures the %atient that we, too, thin* his or herlife is unworthy of li$ing& G Com%assionate caring "ermits the su/erer to continue

as a valued member of the human community until death occurs% -t con#rms our solidarity &ith the

su/erer and, "arado5ically, allows for healing and even emotional and s%iritual

growth % 8t is neither com%assionate nor caring to assuage our own

emotion of co-suering by hasten ing the death of the suerer&



1NC!nce legalized" PAS will e7%and uncontrollably---regulationsare a myth(aniel Callahan =, Fh%(%\Senior Gesearch Scholar and Fresident Emeritus of the

Hastings Center and co'director of the =ale'Hastings Frogram in Ethics and HealthFolicy, IGeason, Self'(etermination, and Fhysician'Assisted SuicideJ, )**), found in IThe Case against Assisted Suicide 4or the Gight to End'of'Life CareJ by !athleen4oley and Herbert Hendin, )**), ohns Ho"$ins Fress, e'boo$,htt":##site%ebrary%com%turing%library%north&estern%edu#lib#north&estern#doc(etail%action@doc-(K?**)?P+DV""gK?

Physical %ain and %sychological suering among those &ho are critically ill and dying

are great e$ils% The attem"t to relie$e them by the introduction of euthanasia and

assisted suicide is an e$en greater e$il & .hose %ractices threaten

the future security of the li$ing% They no less threaten the dying themselves% !nce a

society allows one %erson to ta*e the life of another based on theirmutual %ri$ate standards of a life worth li$ing" there can be no safeor sure way to contain the deadly $irus thus introduced& 8t will go

where it will thereafter% .he belief that % hysician- a ssisted s uicide

can be safely regulated is a myth \the con#dentiality of the doctor-

%atient relationshi% ma*es it im%ossible to %ro$ide ade+uate

o$ersight % Since we cannot *now what goes on in the %ri$acy of the

doctor-%atient encounter" we can ne$er *now whether" and to whate7tent" laws regulating %hysician-assisted suicide 2and euthanasia as &ell will

be $iolated or ignored% The lac$ of any correlation bet&een su/ering and a desire for suicide means,

of necessity, that %hysicians will ha$e enormous discretion in assisting in suicide\

but no way of *nowing how to ma*e a de#niti$e e$aluation of thee7tent of" or the legitimacy of" the suering the %atient re%orts&

.hat 'usti#es euthanasia---there)s no way to hold the line(aniel Callahan =, Fh%(%\Senior Gesearch Scholar and Fresident Emeritus of theHastings Center and co'director of the =ale'Hastings Frogram in Ethics and HealthFolicy, IGeason, Self'(etermination, and Fhysician'Assisted SuicideJ, )**), found in IThe Case against Assisted Suicide 4or the Gight to End'of'Life CareJ by !athleen4oley and Herbert Hendin, )**), ohns Ho"$ins Fress, e'boo$,

htt":##site%ebrary%com%turing%library%north&estern%edu#lib#north&estern#doc(etail%action@doc-(K?**)?P+DV""gK?

;e come here to a stri*ing %itfall of the common arguments for

% hysician- a ssisted s uicide% nce the $ey "remises of that argument are acce"ted, there

will remain no logical way in the future to 2? for long hold the line againsteuthanasia, to ta*e care of those "hysically or "sycho' logically unable to ta*e



their own li$es; 2) deny euthanasia to any com"etent %erson whore+uests it for &hatever reason, terminal illness or not; and 2N deny euthanasia and

% hysician- a ssisted s uicide to those who suer but are

incom%etent, e$en if they do not re+uest it % - am not saying that such a scenario &ill

in fact ta$e "lace, but only that the arguments gi$en in fa$or of euthanasialogically entail the %ossibility% ;e can erect legal safeguards ands%ecify re+uired %rocedures to *ee% that scenario from coming to%ass" but o$er time they will %ro$ide %oor %rotection if the logic ofthe moral %remises on which they are based is fatally Iawed& .he

safeguards will a%%ear arbitrary and Iimsy and will in$ite co$ert

e$asion or outright re'ection &



1NCJems win / ad warHla*e 1?K1@ _Aaron, The 4i5, IHo& (emocrats are &inning the ad &ars \ in )charts,J htt":##&&&%&ashington"ost%com#blogs#the'35#&"#)*?O#?*#?#ho&'

democrats'are'&inning'the'ad'&ars'in')'charts#`MSFSver the 3nal ?B days of the )*?O cam"aign, Ge"ublicans are set to outs"end (emocrats on ads in seven of the to" ?? Senate races

in the country% -n only four of those races, though, &ill the 7F actually "ut more ads on the air% !ne of the less-%ublicized realities of the =?1 Senate cam%aign is that , &hile both "arties are

s"ending hundreds of millions of dollars of money trying to secure the ma>ority, Jemocrats are gettingconsiderably more bang for their buc* & And do&n the stretch, they #gure toha$e at least a slight ad$ertising ad$antage in most of the *ey races-- des%ite being outs%ent o$erall& Thats according to data com"iled by Echelon -nsights, a

Ge"ublican research and analytics 3rm that has launched an e/ort to "redict future ad s"ending using 4ederal CommunicationsCommission data% 2This, &e &ould em"hasize, is an ine5act science, so $ee" in mind that these are estimates% Heres the

brea$do&n, both on total dollars being s"ent 2on to" and on actual ads set to run 2on bottom: =oull notice in Alas*a, for

e5am"le, that ,e%ublicans #gure to s%end more than @= %ercent of the addollars in the #nal few wee*s& (es"ite that s"ending advantage, though, they will runless than half the ads, according to these data% .here6s a similar dis%arity inAr*ansas, though the 7F still 3gures to run slightly more ads than (emocrats there% -n fact, in only two ofthe races abo$e are ,e%ublicans getting more bang for their buc*than Jemocrats" and those two states are ichigan and <irginia"which aren6t really to%-tier contests& So &hy the dis"arity bet&een dollars s"ent and ads run@ ?

.he number of ads run isn6t +uite the same thing as the number of%eo%le reached by ads & =ou can run a bunch of ads in 7rand unction, Colo%, for e5am"le, for the same "rice as

one ad in (enver% So loo$ing at ra& numbers of ads doesnt necessarily mean (emocrats &ill reach more "eo"le &ith their ads% 2Atthe same time, its li$ely both sides s"end relatively similar "ortions of their ad dollars in big mar$ets vs% small mar$ets across the

country, so its still a valuable measure% ) Candidates get lower ad rates than outsidegrou%s" and incumbents tend to raise more money than challengers&

>i$en Jemocrats ha$e so many incumbents in the races abo$enineD and ,e%ublicans ha$e 'ust two" that means Jemocrats tend tobene#t more from lower rates for candidates& N The follo&ing t&eet is from (emocratic

Senatorial Cam"aign Committee e5ecutive director 7uy Cecil on 4riday: hat Cecil is referring to is the fact that reser$ingads early secures lower rates& Huying ads at this %oint in an electioncan be $ery e7%ensi$e" because the airwa$es are Iooded in themar*ets %laying host to com%etiti$e races 2such as Qanchester% The best strategy, then, is

al&ays to reserve the ad s"ace early, &hile its still chea"% -n this area, (emocrats also bene3t, because they tend to reserve thes"ace earlier% The (SCC has raised considerably more money than its 7F counter"art this cycle and, as an incumbent'"rotection

organization, had a "retty good idea &here it needed to "ut that money early on% And it did so% Thus, >!P grou%strying to %lay catch-u% and e$en the ad$ertising battle#eld in thestates that wound u% being com%etiti$e ha$e to s%end considerablymore on ads today than Jemocrats did when they reser$ed thes%ace months ago& Rhile Ge"ublican candidates are getting better rates than their (emocratic com"etitors,

(emocrats seem to be getting much more favorable rates for issue grou"s and "arty committees,R said Fatric$ Gu1ni, a co'founderof Echelon% RGe"ublicans are obviously much more reliant on these, &hich further e5acerbates that ad'e1ciency ga"%R Ge"ublicansin the "ast com"lained that they faced sizeable advertising de3cits in $ey states li$e -o&a and 8orth Carolina, and outside grou"ssoon came to the rescue% Similarly, on Thursday, 8ational Ge"ublican Senatorial Committee e5ecutive director Gob Collins 2Cecilscounter"art mentioned that the race in 7eorgia is tightening% Thats no coincidence; if you loo$ at the chart above,

http://adage.com/article/campaign-trail/republican-analytics-startup-aims-modern-media-reports/294721/







,e%ublicans are about to get la%%ed on the airwa$es in 7eorgia, and Collins '' &ho

cant communicate directly &ith outside grou"s but can send such smo$e signals '' is doing >ust that% ell see if 7F outside grou"scome in to close the ga"% -f they can a/ord it, of course% A fe& 3nal observations about the above chart: -nde"endent 7reg rman isrunning only ?+ "ercent of the ads in his race &ith Sen% Fat Goberts 2G'!an% do&n the stretch% Hell "robably close the ga", but its"retty clear hes getting vastly outs"ent no& that the cavalry has come to Gobertss aid% Alison Lundergan 7rimes 2( faces a hugead de3cit in the !entuc$y Senate race% This is because the (SCC >ust "ulled out of !entuc$y% There &ere some &his"ers that 7rimesand other outside grou"s could "ic$ u" the slac$ and $ee" her com"etitive; this sho&s they &ould have "lenty of ground to ma$e

u"% ,e%ublicans are getting %ummeled in ichigan" !regon and<irginia& .hese are no longer e7%ected to be %otential %ic*u%o%%ortunities" and the ad-s%ending imbalance certainly won6t domuch to change that& And 3nally, the belo& chart is the same as above, e5ce"t that its for the "ast )? days

rather than the ne5t ?B% hat youll notice is that Ge"ublicans in most races have run a higher "ercentage of the ads than they arescheduled to do&n the stretch% So the 7Fs "ro>ected advertising de3cit do&n the stretch is relatively ne&% -t also suggests thatthings change, and given 7F outside grou"s have come to the rescue before, they could ti" the balance again% -f they &ant to "aythe "rice%

Physician assisted suicide is a wedge issue / strong %artisanga%&Saad, )11 Lydia, I(octor'Assisted Suicide -s Qoral -ssue (ividing AmericansQostJ, P'N?'??, 7allu", htt":##&&&%gallu"%com#"oll#?OBO)#doctor'assisted'suicide'

moral'issue'dividing'americans%as"5, GSG

FG-8CET8, 8 '' Joctor-assisted suicide emerges as the most contro$ersial

cultural issue in >allu%6s =?11 <alues and Heliefs %oll " with

Americans di$ided M $s& 4M o$er whether it is morallyacce%table or morally wrong% Having a baby out of &edloc$ and abortion also closely divide Americans%

Ho&ever, stronger "ublic consensus e5ists on ?O other issues tested% Americans are in broadest agreement about &hat behaviorsare morally &rong% At least B in ?* U%S% adults intervie&ed in the Qay P'B survey say this about e5tramarital a/airs, "olygamy,cloning humans, and suicide% At least + in ?* say "ornogra"hy and cloning animals are each morally &rong% idest agreement about&hat is morally acce"table, ranging from +* to +D, is found for divorce, the death "enalty, gambling, embryonic stem cellresearch, and "remarital se5% Also, PP or better say medical testing on animals, gay#lesbian relations, and the use of animal fur forclothing are each acce"table% The three most controversial issues '' doctor'assisted suicide, abortion, and out'of'&edloc$ births ''are the ones on &hich fe&er than ?P "oints se"arate the "ercentage considering the issue morally acce"table from the "ercentage

considering it morally &rong% Attitudes on each have been fairly stable in recent years% Partisans disagree

widely on these issues , with ma'orities of Jemocrats acce%ting of all

three issues" com%ared with" at most" barely a third of ,e%ublicans %

Abortion is the most divisive of the three, &ith a N'"oint Ge"ublican'(emocratic ga"%

>!P Senate %asses ,ussia sanctions---!bama won)t bloc* it e/rey .ayler 1, contributing editor at The Atlantic, B#?)#?O, IThe ay ut of theU$raine Crisis,J htt":##&&&%theatlantic%com#international#archive#)*?O#*B#tal$'to'the'russians#NPBDB#@single"ageKtrue

-n Qay, 0ob Cor*er, the ran$ing Ge"ublican on the Senate.s 4oreign Gelations Committee, introduced a

bill of stunning rec$lessness that seems s"eci3cally designed to destroy what

remains of relations between the nited States and ,ussia% The legislation.s very

name\the IGussian Aggression Frevention Act of )*?OJ\is a misnomer, for its %ro$isions, if enacted,

would dramatically heighten tensions between oscow and

;ashington % 0y foreclosing the o"tion of doing &hat &e really need to do\launch a serious dialogue &ith

Gussia about ho& to end the U$raine crisis\it would dee%en the conIict there, augment the

human misery s"reading as a result, and sho$e us to the brin* of war% -n fact, the bill is

http://www.theatlantic.com/international/archive/2014/08/talk-to-the-russians/375898/?single_page=true






already doing damage to the "ros"ect of "eace by serving !remlin "ro"agandists as a manifesto of U%S% intent toforce Gussia to its $nees and humiliate its leader% -t "resents an ultimatum to the !remlin that no head of state,

least of all the famously su"ercilious ladimir Futin, &ould acce"t% .he ,ussian Aggression Prevention Act

is 'ust a %ro%osed bill" for now% Hut if the ,e%ublicans ta*e the

Senate 2and retain the House of Ge"resentatives in 8ovember.s midterm elections, the legislation

shows the direction in which Congress will %ush President !bama asthe current stando intensi#es% Elections aside, the measure re%resents a

hardline a%%roach that the ;hite Eouse is warming to\at a %i$otal

moment in the months-long crisis &hen the U$rainian military is advancing on the "ro'

Gussian rebel stronghold of (onets$, and Gussian troo"s are massing on the border% Cor$er.s document reveals agrave, even ine5"licable 2in light of history misa""rehension of ho& to deal &ith an assertive Gussia% Ever since the0olshevi$ Gevolution of ?D?, &hich "ut Gussia.s socialist, e5"ansionist regime at loggerheads &ith much of the&orld for most of the )*th century, the est, and es"ecially the United States, has struggled &ith a confounding9uestion: hat to do about Gussia@ -n the ?D*s, the 8i5on administration found an ans&er: dtente, a "olicy"redicated not on threats, but on dialogue% Gussia is too big, too resource'rich, too vital 2as an energy su""lier to

Euro"e, and too technologically advanced to disregard 2or IisolateJ as bama has said he ho"es to do% 8ts

nuclear arsenal alone\the only such arsenal ca%able of destroying the

;est\im%oses an im%erati$e dialogue, as distasteful as that may be to many% -n short,if ,ussia and the nited States are +uarreling, global %eace is under

threat% Cor$er.s bill "ur"orts to o/er a Istrategic frame&or$ for United States security assistance and

coo"eration in Euro"e and Eurasia,J but in fact directs the "resident to ta$e a number of measures that &ould

im"eril both ob>ectives% According to the legislation" the nited States and NA.!would, in violation of the ?DD 4ounding Act 2concluded bet&een the alliance and Gussia, "ermanently station

troo"s in the alliance member states of Foland, Estonia, Lithuania, and Latvia, and I accelerateJ 2in an

uns"eci3ed &ay IOuro%ean and NA.! missile defense eorts %J 2There is much to

s"ecify here, since in )**D the bama administration, facing strong criticism from Gussia and "ublic o""osition inthe Czech Ge"ublic and Foland, the "ro"osed host countries, scaled bac$ "lans for missile'defense systems inEastern Euro"e% Un"recedented Ima>or non'8AT ally statusJ is to be accorded to U$raine, Qoldova, and 7eorgia%Qilitary aid is "romised to U$raine, and cry"tic verbiage about "roviding Idefense articles or defense servicesJ

leaves o"en the "ossibility of doing the same for the other t&o former Soviet re"ublics% There are many othertroubling "rovisions, but signi3cantly, the bill instructs the "resident to bloc$ Gussian assets and dramaticallybroaden sanctions against Gussia if the !remlin does not &ithdra& its military from Crimea and the U$rainianborder, and cease destabilizing the U$rainian government.s control over its eastern regions% -t also directs the U%S%secretary of state to Iincrease e/orts to strengthen democratic institutions and "olitical and civil societyorganizations in the Gussian 4ederationJ\&hich sounds an a&ful lot li$e hel"ing 87s in Qosco& "romote regimechange% 2-f Futin harbored any doubts that such 87s &ere in the "ay of the United States and &or$ing to subvert

him, the bill neatly resolves them% .he act)s chief clauses would come into force if

Putin doesn)t re$erse course on *raine within se$en to 3? days

from its enactment% Eow would the ,ussian %resident react to such

an ultimatum .he former BSH chief , &hose ?O'year tenure in the country.s highest o1ces

has bristled &ith televised dis"lays of manliness and derring'do, would ne$er submit to it %

Sanctions have so far done nothing but consolidate domestic su""ort for him and his U$raine "olicy% Truly

damaging economic restrictions would foment more anti'estern 2and, s"eci3cally, anti'

American hostility and strengthen ,ussians) con$iction\generated by the virulent

"ro"aganda streaming forth endlessly over !remlin'controlled air&aves\that the ;est is gangingu% on ,ussia and bent on destroying it% -ndeed, this "erce"tion is already &ides"read,

and has ta$en root among many Gussians &ho &ere "reviously indi/erent to "olitics or hostile to Futin, &hose"o"ularity no& stands at B "ercent% The military measures the act "ro"oses are "ositively dangerous% Frovidingestern arms, intelligence, and military advisors to U$raine, 7eorgia, and Qoldova\all of &hich are clashing or

have clashed &ith Gussia\&ould ma$e "ossible scenarios hitherto unimaginable% 8f American -made



bombs or bullets su%%lied to *raine " for e5am"le, end u% *ill ing ,ussiantroo%s, or if American intelligence hel"s U$raine score signi3cant victories against Gussian'bac$ed se"aratists,

Putin would ha$e to res%ond or ris* a%%earing wea* % Qoldova, 7eorgia, and

U$raine have never formed "art of a estern "olitical, military, or economic alliance, though they have "artici"atedin 8AT.s symbolic Fartnershi" for Feace "rogram% ith the e5ce"tion of 7eorgia, they do, ho&ever, belong to theGussia'dominated Common&ealth of -nde"endent States% ust &hat these countries &ould bring to the United States

and 8AT besides trouble is hard to see% Heyond the ,ussian Aggression Prevention Act, the

!bama administration has shown little a%titude for dealing with the crisis

in *raine, im"osing sanctions that have not "rom"ted Futin to 9uit Crimea or sto" su""orting se"aratists in

eastern U$raine, and s"outing rhetoric that has only hardened Futin.s determination to not bac$ do&n%

.riggers &S&-,ussia nuclear war and e7tinctionSteven Starr 1, Senior Scientist, Fhysicians for Social Ges"onsibility, B#))#?O,IIThe Gussian Aggression Frevention ActJ 2GAFA: A (irect Fath to 8uclear ar &ithGussia,J htt":##&&&%globalresearch%ca#the'russian'aggression'"revention'act'ra"a'a'direct'"ath'to'nuclear'&ar'&ith'russia#PND??

.he ,ussian Aggression Prevention ActJ, introduced to Congress by U%S% Senator 0ob Cor$er 2G'Tenn%, willset the S on a %ath towards direct military conIict with ,ussia in

U$raine% Any S-,ussian war is li*ely to +uic*ly escalate into a nuclear

war, since neither the S nor ,ussia would be willing to admit

defeat " both have many thousands of nuclear &ea"ons ready for instant use, and both rely u%onCounterforce military doctrine that tas$s their military, in the event of &ar, to "reem"tively

destroy the nuclear forces of the enemy% GAFA "rovides de facto 8AT membershi" for U$raine, 7eorgia, and

Qoldova via GAFA The Gussian Aggression Frevention Act, or ,APA" 9Pro$ides ma>or non'8AT ally status

for U$raine, 7eorgia, and Qoldova for "ur"oses of the transfer or "ossible transfer of defense articles or defenseservices%J Qa>or non'8AT ally status &ould for "ractical "ur"oses give 8AT membershi" to these nations, as it&ould allo& the US to move large amounts of military e9ui"ment and forces to them &ithout the need for a""roval

of other 8AT member states% Thus ,APA would e/ectively by%ass long-standing>erman o%%osition to the S re+uest to ma*e *raine and >eorgia%art of NA.!% 7ermans rightly fear "lacing US#8AT troo"s and US 0allistic Qissile (efense 20Q( in

U$raine, given the "rofound and long'standing Gussian ob>ections against the e5"ansion of 8AT 2es"ecially toU$raine and 7eorgia along &ith de"loyment of Euro"ean US#8AT 0Q(% 7ermany is acutely a&are of the distinct

"ossibility that the ci$il war raging in *raine could e$ol$e into a *rainian-,ussian war% Under such circumstances, de%loyment of S KNA.! forces in

*raine would ma*e it $irtually ine$itable they would come into

#ght with *raine against ,ussia% GAFA &ould accelerate the Iim"lementation of "hase three of the Euro"ean Fhased Ada"tive

A""roach for Euro"e'based missile defense % % % by no later than the end of calendar year )*?+%J -n )*?), Gussia.s highest ran$ing military o1cer stated that Gussia might consider a "re'em"tive stri$e against such 0Q( de"loyments I&hen the situation gets harder%J GAFA I(irects (( US (e"artment of (efense to assess the ca"abilities and needs of the U$rainianarmed forcesJ and IAuthorizes the Fresident, u"on com"letion of such assessment, to "rovide s"eci3ed military assistance to U$raine%J GAFA &ould have the US 9uic$ly su""ly U$raine&ith?** million &orth of &ea"ons and e9ui"ment, including anti'tan$ and anti'aircraft &ea"ons, cre& &ea"ons, grenade launchers, machine guns, ammunition, and Qine GesistantAmbush Frotected vehicles% GAFA re9uires the bama administration to Iuse all a""ro"riate elements of United States national "o&erto "rotect the inde"endence, sovereignty, andterritorial and economic integrity of U$raine and other sovereign nations in Euro"e and Eurasia from Gussian aggression%J This includes Isubstantially increasing United States and 8AT

su""ort for the armed forces of the Ge"ublics of Foland, Estonia, Lithuania, and Latvia,J and Isubstantially increasing the com"lement of for&ard'based 8AT forces in those states%JConse9uently, GAFA &ould "roduce signi3cant buildu"s of US#8AT forces into Foland and the 0altic States, accelerate the construction of US 0Q( systems in Eastern Euro"e, andauthorize substantial U%S% intelligence and military aid for U$rainian military forces that continue to lay siege to the largest cities in Eastern U$raine% -f GAFA did not result in thede"loyment of US forces to U$raine, it &ould certainly "osition them for ra"id de"loyment there, in the event that the U$rainian civil &ar escalates into a U$rainian'Gussian con6ict% GAFAintensi3es su""ort for ethnic cleansing in Eastern U$raine -n Gussia, Futin no& is under intense domestic "olitical "ressure to send Gussian forces into Eastern U$raine, in order to sto"the attac$s by the U$rainian military on the cities there, &hich &ere once "art of the Soviet Union%These attac$s have created an absolute humanitarian catastro"he% n August P, )*?O,the 1ce of the United 8ations High Commissioner for Gefugees re"orted that O*,*** Eastern U$rainians had 6ed to Gussia% They go there because Gussia is close, and because mostof the refugees are ethnic Gussians, a fact that e5"lains &hy the Gusso"hobes in !iev have been 9uite &illing to indiscriminately bombard their cities% hat is ta$ing "lace in EasternU$raine amounts to Iethnic cleansing,J the forced removal of ethnic Gussians from Eastern U$raine% This is a "rocess that is fully su""orted by the US; GAFA &ould greatly enhance thissu""ort% U$rainian military forces have surrounded (onets$ < a city of almost one million "eo"le < and have for &ee$s conducted daily attac$s against it using inaccurate multi"le'launchroc$ets, heavy artillery 3re, ballistic missiles carrying &arheads &ith u" to ?*** "ounds of high e5"losive, and aerial bombardments% ater su""lies, "o&er "lants, train stations,air"orts, bridges, high&ays, and schools have all been targeted, along &ith the general "o"ulation% -n Lugans$, a city of more than OO*,*** "eo"le, a humanitarian crisis has beendeclared by its mayor, because the siege of the city has left it &ith little medicine, no fuel,intermittent "o&er, and no &ater since August N 2three &ee$s at the time of this &riting% Afterthe se"aratists of Eastern U$raine demanded autonomy from !iev, and then reunion &ith Gussia, the government in !iev branded them as IterroristsJ, and sent its military forces againstthem in &hat they eu"hemistically call an Ianti'terrorist o"eration%J 4raming the con6ict this &ay ma$es it "olitically acce"table to refuse to negotiate &ith the se"aratists, and easier to

>ustify in the US and Euro"e, &hich have gro&n accustomed to Ithe ar on Terrorism%J Ho&ever, the thousands of U$rainians being $illed and hundreds of thousands of being driven fromtheir homes are >ust ordinary "eo"le, trying to l ive ordinary lives% The 8e& =or$ Times re"orts the U$rainian military strategy has been to bombard se"aratist'held cities and then send"aramilitary forces to carry out Ichaotic, violent assaultsJ against them% Qany of the U$rainian "aramilitary forces &ere recruited from ultra'nationalist, neo'8azi "olitical "arties; the



Azov battalion 6ies the Iolfs Hoo$J 6ag of Hitler.s SS divisions% Considering that more than )* million Gussians died 3ghting the 8azis during orld ar --, the "resence of o"enly 8azimilitias attac$ing ethnic Gussians in U$raine creates e5treme anger in Gussia% GAFA su""orts "lans in !iev for an attac$ on Crimea The Gussian Aggression Frevention Act demands thatGussia I&ithdra& from the eastern border of U$raine,J &hich is by de3nition, the Gussian border% -n other &ords, GAFA "rovocatively demands that Gussia remove its o&n military forces

a&ay from its o&n borders, &hile U$rainian military forces are mean&hile massed on the other side, attac$ing "redominantly Gussian cities% ,APA also

demands that 9,ussian forces must ha$e withdrawn from Crimea

within se$en days of the enactment of the Act%J Not li*ely to ha""en, given

that 2? Crimea &as "art of the Gussian em"ire from ?BN until ?DPO, 2) &ithdra&al from Crimea &ould re9uire

Gussia to abandon its only &arm &ater "ort at Sevasto"ol, &here Gussian forces have been based, byinternationally recognized treaty, since ?DD, and 2N more than three'9uarters of all Crimeans voted IyesJ to

reunify &ith Gussia, a vote &hich Gussia acce"ted by its subse9uent anne5ation of Crimea% Thus, in the eyesof ,ussia" the re+uirement to 9withdraw from Crimea: amounts to aS demand that ,ussia surrender ,ussian territory% Futin has >ust ta$en the

entire Gussian (uma 2the Gussian House of Ge"resentatives to Crimea, to address them there and strongly ma$e

the "oint that there &ill be no &ithdra&al from Crimea% ,APA, ho&ever, sti%ulates that the Sdoes not recognize the ,ussian anne7ation of Crimea" and creates sanctions

and legal "enalties for anyone &ho does% GAFA therefore "rovides both military and "olitical su""ort for U$rainianFresident Foroshen$o.s stated goat that U$raine &ill reta$e Crimea% This goal &as recently echoed by the U$rainiandefense minister, &ho &as a""lauded by the U$rainian Farliament &hen he told them that the U$rainian army &illIhave a victory "arade in Sevasto"olI% These statements are ta$en seriously in Qosco&, &here they are vie&ed as a"romise to attac$ Gussia% Thus, Futin.s advisers are telling him he must 3ght today in Eastern U$raine, or tomorro&

in Crimea% Any Gussian military intervention in Eastern U$raine &ould certainly be described in the est as Gussianaggression in "ursuit of em"ire, &hich &ould trigger deafening demands that US#8AT forces act to su""ort

U$raine% Should NA.! inter$ene, subse9uent ,ussian military action againstany NA.! member would trigger the alliance)s Cha%ter mutual

defense clause, committing it to war with ,ussia % Any ma'or *rainian

attac* u%on Crimea would ma*e war with ,ussia ine$itable% *raine

a%%ears to be %re%aring for such an assault by drafting all men of ages ?B to +*

years, in a forced mobilization of its armed forces, &hich also includes calling u" its active reserves of one millionmen, and bringing more than ?*** battle tan$sout of storage% Futin is being told by his close advisers that U$raine&ill have an army of half a million men in )*?P% GAFA &ould "rovide hundreds of millions of dollars to train and armthe ra"idly e5"anding U$rainian armed forces, and "osition US#8AT forces for ra"id intervention on the side ofU$raine in the event of a U$rainian'Gussian &ar% Thus, the many "olitical and military "rovisions of GAFA &ould

certainly act to fully encourage U$raine to carry out its stated "olicy to reta$e Crimea% The Ge"ublic of 7eorgiaattac$ed Gussian forces in )**B &ith far fe&er US "romises of aid% f course, GAFA &ould also arm 7eorgia, too%

GAFA moves the US to&ards nuclear &ar &ith Gussia A SKNA.!-,ussian war wouldinstantly %ut S and ,ussian nuclear forces at %ea* alert, &ith both sides

antici"ating a nuclear 3rst'stri$e from the other% 0oth the S and ,ussia ha$e changed

their nuclear war-#ghting %lans to include the use of %reem%ti$e nuclear

#rst-stri*es; both nations ha$e 9tactical: nuclear wea%ons designed for

battle3eld use% The US has ?B* 0+? nuclear bombs de"loyed on si5 military bases of 3ve other 8AT states, &hich&ould be released to these 8AT members in the event of a US#8AT'Gussian &ar% Gussia also has at least ?N**tactical nuclear &ea"ons, and Gussian &ar doctrine s"eci3es their use against over&helming conventional 28ATforces% Any use of ItacticalJ or Ibattle3eldJ nuclear &ea"ons, by either side, &ould li$ely trigger an e9ual or greaterres"onse from the other% (uring the 3rst Cold ar, the US studiously avoided any direct military confrontation &ithGussia, because it &as &idely thought that such a &ar &ould inevitably escalate to become a nuclear &ar < &hich

&ould utterly destroy both nations% Ho&ever, there seems to be little thought or discussion of this in the US today,des"ite the fact that both the US and Gussia a""ear to be "re"aring for such a &ar% -n Qay, the increasing tensionsin U$raine led both nations to almost simultaneously conduct large nuclear &ar games% Long'range Gussian nuclearbombers tested US air defenses?+ times in a ten day "eriod 2uly )D < August % US and Gussian leaders are eitheruna&are or choose to ignore the fact that such IgamesJ and ItestsJ are a dress rehearsal for human e5tinction%

Peer-re$iewed scienti#c studies %redict the en$ironmental

conse+uences of a war fought with only a fraction of S andKor

,ussian strategic nuc lear wea%ons would li$ely wi%e out the human

race% Scientists "redict that e$en a 9successful: S nuclear #rst-stri*e, &hich



destroyed ?** of Gussia.s nuclear forces before they could be launched, would createcatastro%hic changes in global weather that &ould eliminate gro&ing seasons for years%

Qost humans and large animals &ould starve to death% Nuclear war is suicide for humans,

but our leaders still have their 3ngers on the nuclear triggers% There seems to be absolutely no awareness,

either in our 4ederal government or in the American "ublic, of the e7istential danger %osed

by nuclear war% Such ignorance is embodied by .he , ussian A ggressionP re$ention A ct" which if enacted will %ut us on a direct course for

nuclear war with ,ussia%



1NCedicalization is the B,AO;!,Q in which thanato%oliticsmay e7ert $iolence -- increasing the %ower of %hysicians o$erlife gi$es 'usti#cation for the creation of bare life and war

ma$es a causal claim that &ars are 8T fought for the e5istence of the sovereign,&hich ans&ers THE-G internal lin$ of death control, they are fought based on thebiological heirchies medicalized and biologized inter"s of the &orld

Stuart Olden, "olitics at University of ar&ic$, )#)D#)*?= IThe ar of Gaces andthe Constitution of the State: 4oucaults -l faut dfendre la socit and the Foliticsof Calculation,J 0oundary,htt":##boundary)%du$e>ournals%org#content#)D#?#?)P%full%"df

.he re$erse side is the %ower to allow death % State racism is a

recoding of the old mechanisms of blood through the ne& "rocedures of regulation%

,acism" as biologizing , as tied to a state, ta*es sha%e where the %rocedures

of inter$ention R at the le$el of the body , conduct, health " and e$eryday

life" recei$ed their color and their 'usti#cation from the mythicalconcern with %rotecting the %urity of the blood and ensuring thetrium%h of the raceR 2S, ?D; !, ?OD% N 4or e5am"le, the old anti'Semitism based on religion is

reused under the ne& rubric of state racism% The integrity and "urity of the race is threatened, and the statea""aratuses are introduced against the race that has in3ltrated and introduced no5ious elements into the body% The

e&s are characterized as the race "resent in the middle of all races 24(S, +% NB .he use of medical

language is im%ortant % Hecause certain grou%s in society are concei$ed

of in medical terms " society is no longer in need of being defendedfrom the outsider but from the insider the abnormal in beha$ior"s%ecies " or race% ;hat is no$el is not the mentality of %ower but thetechnology of %ower 24(S, )N*% .he recoding of old %roblems is made%ossible through ne& techni+ues% A brea$ or cut 2cou"ure is fundamental to racism: adi$ision or incision between those who must li$e and those who must die %

.he 2biological continuum of the human s%ecies2 is fragmented by the

a""arition of races, &hich are seen as distinguished, hierarchized, 9uali3ed as good or inferior, and so forth% .hes%ecies is subdi$ided into subgrou%s that are thought of as races& -n

a sense, then, >ust as the continuum of geometry becomes divisible in (escartes, ND the human

continuum is di$ided, that is, made calculable and orderable" twocenturies later% As Anderson has "ersuasively argued, to suggest that racism has itsroots in nationalism is a mista*e% He suggests that Rthe dreams of racism actually have their

origin in ideologies of class, rather than in those of nation: above all in claims to divinity among rulers and to blueor &hite blood and breeding among aristocracies%R O* As Stoler has noted, for 4oucault, it is the other &ay around:RA discourse of class derives from an earlier discourse of races%R O? 0ut it is a more subtle distinction than EndFage ?O that% hat 4oucault suggests is that discourses of class have their roots in the &ar of races, but so, too,does modern racism; &hat is di/erent is the biological s"in "ut on the conce"ts% O) 0ut as &ell as em"hasizing thebiological, modern racism "uts this another &ay: to survive, to live, one must be "re"ared to massacre onesenemies, a relation of &ar% As a relation of &ar, this is no di/erent from the earlier &ar of races that 4oucault has



s"ent so much of the course e5"laining% 0ut &hen cou"led &ith the mechanisms of mathematics and medicine in

bio'"o&er, this can be conceived of in entirely di/erent &ays% Hio-%ower is able to establish,

bet&een my life and the death of the other, a relation that is not warli*e or confrontational but

biological : RThe more inferior s%ecies tend to disa%%ear, the more abnormal individuals

can be eliminated, the less the s"ecies &ill be degenerated, the more -\not as an individual but as a s"ecies\&ill

live, &ill be strong, &ill be vigorous, &ill be able to "roliferate%R The death of the other does not >ust ma$e me safer"ersonally, but the death of the other, of the bad, inferior race or the degenerate or abnormal, ma$es life in general

healthier and "urer 24(S, ))<)B% R.he e7istence in +uestion is no longer of

so$ereignty" 'uridical ; but that of the %o%ulation" biological % 8f

genocide is truly the dream of modern %owers" this is not becauseof a return today of the ancient right to *ill5 it is because %ower issituated and e7ercised at the le$el of life, the s"ecies, the race, and the large'scale

"henomena of "o"ulationR 2S, ?B*; !, ?N+% R-f the "o&er of normalization &ishes to e5ercise the ancient

sovereign right of $illing, it must "ass through racism% And if , inversely, a so$ereign %ower, that is to

say a "o&er &ith the right of life and death, wishes to function with the instruments"mechanisms" and technology of normalization" it must also %assthrough racismR 24(S, ))B% .his holds for indirect deathRthe e7%osureto deathRas much as for direct *illing% hile not (ar&inism, this biological sense of

"o&er is based on evolutionism and enables a thin$ing of colonial relations, the necessity of &ars, criminality,"henomena of madness and mental illness, class divisions, and so forth% The lin$ to colonialism is central: This form

of modern state racism develo"s 3rst &ith colonial genocide% The theme of the %olitical enemyis e7tra%olated biologically& 0ut &hat is im"ortant in the shift at the end of the nineteenth

century is that &ar is no longer sim"ly a &ay of securing one race by eliminating the other but of regenerating that

race 24(S, ))B<N*% As 4oucault "uts it in La volont de savoir: End Fage ?OB ;ars are no longer

waged in the name of a so$ereign who must be defended5 they are

waged on behalf of the e7istence of all5 entire %o%ulations are

mobilized for the %ur%ose of wholesale slaughter in the name of

life necessity % Qassacres have become vital vitau5\understood in a dual sense, both as essential and

biological% 8t is as managers of life and sur$i$al" of bodies and the race"that so many regimes ha$e been able to wage so many wars"causing so many men to be *illed% 2S, ?B*; !, ?N+

.he alternati$e is non-medicalized suicideSalem 00

Tania, Associate at Hos"ital "erations V Com"liance at The Advisory 7rou" %L%L, Fhysician'Assisted Suicide:Fromoting Autonomy\r Qedicalizing Suicide@ Hastings Center Report , )D: N*<N+, A0

Qedicalizing suicide as "rofessional "ractice Qedicalizing suicide also "oints to the fact that if legalized"%hysician-assisted suicide as a legitimate %ractice would becomethe %rerogati$e of %hysicians% -ndeed, ac$ !evor$ian has seen the e5clusive right as the

foundation for a ne& medical subs"eciality of Iobitiatry%J? .his mono%oly leads to the more

general +uestion of why aid in dying should be %ro$ided only by a

medical %ractitioner % ;hy " that is, should assistance in suicide be



understood as re+uiring medical authority rather than, for instance, a

community of family or friends@ The most obvious ans&er is that "hysicians\and only

"hysicians\have the necessary technical s$ills to ensure a Ira"idJ and I"ainlessJ death% 0ut as some critics have

noted, I Assisted suicide does not e$en re+uire medical s*ill % 8f freeing

u% %atients truly is the goal" then assisted suicide6s ad$ocates

disser$e %atients when they do not ad$ocate ending the

%hysician6s e7clusi$e %ower to %rescribe medication% -ronically, the

ad$ocates of %atients) rights end u% em%owering doctors more

than they do %atients %J?B =et even those &ho maintain that technical $no&ledge is im"erative do

not con3ne their >usti3cation of "hysician'assisted suicide to this reason% Placing suicide under thestewardshi% of medicine is further defended as a way of 9enhancing%ublic accountability of the %racticeJ and I"rotecting against abuse%J?D 4rom the "atients

"ers"ective, the re9uest for aid in dying may mean a Idesire for com"anionshi" in "ursuing a di1cult course ofaction, a &ish for con3rmation of a decision about &hich the "atient is unsure or sim"ly a cry for hel"J 2""% BB<BD,

note O)% Qoreover, since suicide is still stigmatized, Isee$ing a "hysicians assistance may be a &ay of trying toremove that stigma%J)* Hut inasmuch as cultural %reconce%tions andloneliness 2&hatever its source are far from being e7clusi$ely medical

issues" we must as* why we e7%ect doctors to res%ond to them & T&o

"ossible ans&ers come to mind: either medicine is mo$ing beyond its %ro%er role"or the sco%e of medical com%etence has already been e7tended

beyond a%%ro%riate boundaries&-t seems reasonable to conclude that ceding

mono%oly of assistance in suicide to doctors is anchored in an

inIation of the %hysician6s role , as well as in the e7treme

idealization of %hysicians) character and the relationshi%s theyestablish with %atients& The bond "hysicians establish &ith "atients is su""osedly e/ective,

collaborative, and committed%)? 0oth this idealization and the &illingness to delegate to

%hysicians the e7clusi$e right to assist suicide bes%ea*s the social

and symbolic %ower already conferred on medicine and medical "rofessionals in

our societies% -n other &ords, it is not 2or not only the need for technical e7%ertise

that im%els us to %hysician-assisted suicide& Gather, our culture" so

im%regnated by medicalization , ta*es for granted that assisted

suicide should fall under the control and su%er$ision of medicine&

Qedicalizing the morality of suicide As a legitimate domain of "rofessional "ractice, then, %hysician-assisted suicide necessarily in$ol$es medicalizing the moral

+uestions surrounding suicide % Physician-assisted suicide "resu""oses, and

ultimately is, a medical 'udgment about death or suicide; it is a

medical e$aluation of the fairness and legitimacy of a %erson6s 2not

sim"ly a "atients desire or choice to end his or her life% ith some fe& e5ce"tions, even the most radical



advocates of "hysician'assisted suicide recognize the need to establish "rotocols and guidelines to "revent abuses,"rotect the vulnerable, guarantee "ublic accountability, and even to assure the autonomous character of the"atients choice% Surely these aims are res"ectable and the setting u" of criteria >ust and reasonable% =et

establishing medical guidelines also introduces tensions into the

$alue of autonomy in se$eral ways %



1NC CaseAll li$es are in#nitely $aluable" the only ethical o%tion is toma7imize the number sa$edCummis*y" 0 2(avid, "rofessor of "hiloso"hy at 0ates, !antian

Conse9uentialism, "% ?N?

4inally, e$en if one grants that sa$ing two %ersons with dignity cannotoutweigh and com%ensate for *illing one\because dignity cannot beadded and summed in this way\this %oint still does not 'ustifydeontologieal constraints% n the e5treme inter"retation, why would not *illing one%erson be a stronger obligation than sa$ing two %ersons@ -f - amconcerned with the %riceless dignity of each, it &ould seem that ? may still sa& t&o; it is

'ust that my reason cannot be that the two com%ensate for the lossof the one% Consider Hills e5am"le of a "riceless ob>ect: -f 8 can sa$e two of three %riceless

statutes only by destroying one& .hen 1 cannot claim that sa$ingtwo ma*es u% for the loss of the one& 0ut Similarly, the loss of the t&o is not out&eighed by the

one that &as not destroyed% -ndeed, e$en if dignity cannot be sim%ly summed u%& Eowis the e7treme inter%retation inconsistent with the idea that 8should sa$e as many %riceless ob'ects as %ossible Even if t&o do not sim"ly

out&eigh and thus com"ensate for the lass of the one, each is %riceless: thus" 8 ha$e goodreason to sa$e as many as 8 can% -n short, it is not clear ho& the e5treme inter"retation >usti3es the

ordinary $illingletting'die distinction or even ho& it con6icts &ith the conclusion that the more "ersons &ith dignity &ho are saved,the better%

Bear of deaths ine$itableOtogre (@2E%T% gre, ne&s &ebsite for the advance of the human s"ecies, IThe Evolution ofGeligion: Flaying on Qan$ind.s 7reed, Ho"e, and 4earsJ, 8Q, htt":##etogre%com#the'evolution'of'religion'"laying'on'man$inds'greed'ho"e'and'fears#?+B#

.he fear of death is a sur$i$al instinct hard-wired into thema'ority of li$ing creatures on Oarth% .his fear of death is %erha%sbest illustrated in a classic %sychological e7am%le/ the #ght-or-Iight res%onse& This is a reaction that can normally be observed by bac$ing an animal into a corner,essentially forcing them into a stressful life or death situation% Adrenaline starts "um"ing, survival mode ta$es

over, and the animal &ill either attem"t to 6ee or hold its ground in a battle to the death% .hisinstincti$e res%onse occurs because death is essentially theunmitigated antithesis of sur$i$al " the *ey %rinci%le of e$olution & .o suggest that humans in general naturally desire to e7istfore$er is not e7actly an un%recedented claim&



9No $alue to life: doesn)t outweigh---%rioritize e7istence Torb>rn .Tnns'U 11, the !ristian Clajson Frofessor of Fractical Fhiloso"hy atStoc$holm University, )*??, IShalt Thou Sometimes Qurder@ n the Ethics of!illing,J online: htt":##"eo"le%su%se#k>olso#HS'te5ter#shaltthou%"df

- su""ose it is correct to say that,

if Scho%enhauer is right"

if life is ne$er worthli$ing " then according to utilitarianism we should all commit suicide

and %ut an end to humanity% Hut this does not mean that" each of usshould commit suicide% - commented on this in cha"ter t&o &hen - "resented the idea that

utilitarianism should be a%%lied, not only to individual actions, but to collecti$eactions as &ell% -t is a &ell'$no&n fact that "eo"le rarely commit suicide% Some even claim that no one &ho is

mentally sound commits suicide% Could that be ta$en as evidence for the claim that "eo"le live lives &orth living@ That &ould be rash% Qany "eo"le are not utilitarians% They may avoid suicide because they believe that it is morally

&rong to $ill oneself% 8t is also a %ossibility that" e$en if %eo%le lead li$es not

worth li$ing, they belie$e they do% And e$en if some may belie$e that

their li$es" u% to now" ha$e not been worth li$ing, their future li$es

will be better% They may be mista$en about this% They may hold false e5"ectations about the future% 4romthe "oint of vie& of evolutionary biology, it is natural to assume that "eo"le should rarely commit suicide% -f &e setold age to one side, it has "oor survival value 2of one.s genes to $ill oneself% So it should be e5"ected that it isdi1cult for ordinary "eo"le to $ill themselves% 0ut then theories about cognitive dissonance, $no&n from

"sychology, should &arn us that &e may come to believe that &e live better lives than &e do% y strongbelief is that most of us li$e li$es worth li$ing% Ho&ever, - do believe that our lives

are close to the "oint &here they sto" being &orth living% 0ut then it is at least not very far'fetched to thin$ that

they may be &orth not living, after all% Qy assessment may be too o"timistic% Let us >ust for the sa*e ofthe argument assume that our li$es are not worth li$ing" and let us

acce%t that" if this is so" we should all *ill oursel$es% As - noted above, this

does not answer the +uestion what we should do " each one of us % Qy

con>ecture is that

we should not commit suicide% The e5"lanation is sim"le%

8f 8 *illmyself" many %eo%le will suer% Here is a rough e5"lanation of ho& this &ill ha""en: %%% suicide

IsurvivorsJ confront a com"le5 array of feelings% arious forms of guilt are 9uite common, such as that arising from2a the belief that one contributed to the suicidal "ersons anguish, or 2b the failure to recognize that anguish, or 2c

the inability to "revent the suicidal act itself% Suicide also leads to rage" loneliness " andawareness of $ulnerability in those left behind% -ndeed, the sense that suicide is an

essentially sel3sh act dominates many "o"ular "erce"tions of suicide% .he fact that all our li$es

lac* meaning, if they do" does not mean that others will follow my

e7am%le% They &ill go on &ith their lives and their false e5"ectations \ at least for a &hile devastated

because of my suicide% 0ut then - have an obligation, for their sa$e, to go on &ith my life% -t is highly li$ely that, bycommitting suicide, - create more su/ering 2in their lives than - avoid 2in my life%

Bear of death is a %re-re+uisite to death)s symbolic $alueCara Qalnow 0 A Thesis Submitted for the (egree of QFhil at the University of St%Andre&s IH= (EATH CA8 0E 0A( A8( -QQGTAL-T= -S GSEJ htt"s:##research're"ository%st'andre&s%ac%u$#bitstream#?**)N#)O#N#Cara)*!alno&)*QFhil)*thesis%F(4

2FA also "rovided us &ith good reason to re>ect the E"icurean claim that the 3nitude of life cannot be bad for us% ith 2FA, &e sa& that ourli$es could accumulate $alue through the satisfaction of our desires



beyond the boundaries of the natural termination of life& Hut Cha"ter

4our determined that the #nitude of life is a necessary condition for the $alue of lifeas such and that many of our human $alues rely on the #nite tem%oralstructure of life% - therefore argued that an inde3nite life cannot "resent a desirable alternative to our 3nite life, because life as

such &ould not be recognized as valuable% -n this cha"ter, - have argued that the #nitude of life is

instrumentally good as it %ro$ides the recognition that life itself is$aluable & Although - ultimately agree &ith the E"icureans that the #nitude of life cannot bean e$il" this conclusion was not reached from the O%icureanarguments against the badness of death, and - maintain that 2HA and 2EA are insu1cient to

>ustify changing our attitudes to&ards our future deaths and the 3nitude of life% 8onetheless, the instrumental good of the 3nitude of life that &earrived at through the consideration of immortality should ma$e us realize that the 3nitude of life cannot be an evil; it is a necessary condition for therecognition that life as such is valuable% Although my arguments "ertaining to the nature of death and its moral im"lications have yielded several of

the E"icurean conclusions, my %osition still negotiates a middle ground betweenthe O%icureans and ;illiams, as 2FA accounts for the intuition that it is rational to feardeath and regard it as an e$il to be a$oided % - have therefore reached three of the E"icurean conclusions

"ertaining to the moral &orth of the nature of death: 2? that the state of being dead is nothing to us, 2) death sim"liciter is nothing to us, and 2N

the 3nitude of life is a matter for contentment% 0ut against the E"icureans, - have argued that we can rationally fearour future deaths" as categorical desires %ro$ide a disutility by

which the %ros%ect of death is rationally held as an e$il to bea$oided% 4inally, - also claimed against the E"icureans, that the "ros"ect of death can rationally be regarded as morally good for one if one

no longer desires to continue living% P%N Conclusion - began this thesis &ith the suggestion that in "art, the O%icureans wereright deathRwhen it occursRis nothing to us % - &ent on to defend the E"icurean "osition

against the ob>ections raised by the de"rivation theorists and illiams% - argued that the state of being dead, and death sim"liciter, cannot be an evilof de"rivation or "revention for the "erson &ho dies because 2once dead, the "erson\and the grounds for any misfortune\cease to e5ist% -

accounted for the anti'E"icurean intuition ??P that it is rational to fear death and to regard death as an evil to be

avoided, not because death sim"liciter is bad" but rather because the%ros%ect of our deaths may be %resented to us as bad for us if ourdeaths would %re$ent the satisfaction of our categorical desires &.hough we ha$e good reasons to rationally regard the %ros%ect of our own death as an e$il for us" the fact that life is #nite cannot

be an e$il and is in fact instrumentally good" because it ta*es thethreat of losing life to recognize that life as such is $aluable% -n this cha"ter, - concluded

that e$en though death cannot be of any moral worth for us once itoccurs" we can attach two distinct $alues to death while we are ali$e we can attach a $alue of disutility or utilityD to the %ros%ect ofour o&n individual deaths" and we must attach an instrumentally good$alue to the fact of death as such& Eow to decide on the balanceof those $alues is a matter for %sychological 'udgment &

Suicide doesn)t sol$e thanato%olitics

ichelsen 118icholas, RSuicide Terrorism, 0io"olitics And (eathR, -nternational StudiesAssociation, QA -nternational Con6ict Studies 4rom !ings College London, Historiesf Suicidal iolence, ihadism Terrorism, Com"le5ity Theory ,Foststructuralism#Continental Fhiloso"hy, The -nternet



-n such a case the bio"olitics of suicide. is indeed a dead end.& Suicide can ne$er be an

eecti$e bio%olitical res%onse " only forming a %olitical re'ection to

so$ereign logics 2Seery ?DD+% As sovereignty fades, so does the "olitical role of death% 8t is onlyin the %erennial resurgence of so$ereign discourses through racial

e7clusionD that death again becomes again rele$ant to %ower&Suicide -bombing" therefore" lea$es the zeitgeist" bio%ower"

untouched & 8f we desire to in$estigate how suicide-bombing might

re%resent a fundamental engagement with the structures ofcontem%orary global order we can ho&ever, and against !'a*angas, follo&

Boucault 2)**O himself inasmuch as he e7%licitly argued that bio%ower andso$ereign ha$e always e7isted in some form of 9hideous: historical

combination & .his refuses to #rmly di$ide history into a

%rogression of discrete forms of %ower % -n this conte5t, 7iorgio Agamben)s

2?DDP reading of Boucault, &hich >a$angas 2)**P e5"licitly re>ects, seems far moreuseful& Agamben argues that a conce%tion of bio%ower life-orderD

as a se%arate discourse entering into so$ereignty death-orderD is

dee%ly %roblematic % He feels that 4oucault fails to su1ciently develo" the essential relationshi"

bet&een bio"olitical sub>ectivization and ob>ectivizing sovereign "o&er that circulates around understanding thereto be a ne5us or foundational intersection around the decision on &here death should be. that is immanent to life'

"olitics% Agamben brea$s do&n the already not'so' 3rm distinction bet&een so$ereignty and

bio%ower in 4oucault, by arguing that the t&o not only cross'over, but are intrinsically

lin*ed % .he ne7us bet&een bio"o&er and sovereignty, "olitical life and e7%osure to

death" is an ontological feature of all %olitical %ra7is Agamben100D& 8t is the fact that it is a %olitics of death that constitutes

this lin* between the two diagrams of %ower that is the crucial "oint for

the argument being made here% Agamben argues, follo&ing Schmitt, that "olitical sovereignty has al&aysfunctioned through ma$ing an e5ce"tion ' deciding &ho is under the la& and &ho lies outside of it, but that this

legal e5ce"tion has al&ays been tied to the 9uestion of life itself.% O$ery %olitical order draws ade#niti$e line of (%olitical life) " in which the ability to decide on

death is always the o%erati$e e7ercise& .he 9bios: of the %olitical

community " where life is %ursued and administered" are

necessarily and always %redicated on the construction ofthanato%olitical s%aces & -ndeed it is, ironically given that disco urses of (human

rights) are so often mobilised in o%%osition to the deathly logics of

so$ereign %ower " %recisely in these (bio%olitically %roduced)

thanato-s%aces that the conce%t of (life-itself) / as a life that isfundamentally e7%osed to death / is originally de$elo%ed 2Agamben ?DDP,

"BN%



=NC



.



=NC !K<Heing able to engage in the regulations of the a *ey to sol$econce%ts of JeathSomer$ille )?1

2Qargaret Somerville (eath Tal$ "g% 5ii'5i5 Qc7ill'ueen.s University Fress

;e all need to engage in 2death tal*2 if we are to accommodate,

with some degree of comfort, the ine$itable reality of death into theli$ing of our li$es& And we must do this both as indi$iduals and asmembers of society% Until the last fe& decades, most of us %artici%ated in deathtal* as %art of our religious %ractice% Today, in industrialized ;estern

societies, the euthanasia debate %ro$ides a %rominent conte7t for such

tal*& This boo$ contains a collection of "a"ers, &hich - have &ritten over the last t&enty years, on euthanasia and % hysician'

a ssisted s uicide, and the debate that has surrounded these issues % Jeath

confronts us with terror and aloneness, e$en if we are accom%aniedby lo$ing others& ;e can res%ond in two ways% -n the 3rst, we can ta*econtrol of death and $iew it - and life - in a reductionist way& Euthanasia is

often a manifestation of this a""roach% any ad$ocates of euthanasia, while they $alue humanlife and res%ect it within gi$en %arameters" do not $iew it as ha$ingany intrinsic $alue, mystery" or meaning% Gather, they value human life for &hat it "rovides, and

believe that, &hen the human machine deteriorates beyond some "oint' &hen &e, or others, >udge the 9uality of life as Rnot &orthlivingR \ euthanasia allo&s a digni3ed e5it from life% ne "olitician of this school of thought 2Qr e/ !ennett &ho &as then "remierof the state of ictoria in Australia summed it u" in this &ay: hen you are "ast your Ruse'by.#Rbest'beforeJ date, you should bechec$ed out as 9uic$ly, chea"ly, and e1ciently as "ossible% This "oliticians consumer'mar$et'values a""roach to death ' "erha"seven seeing the morality of death as being &or$ed out in the morality of the mar$et "lace ' can be com"ared &ith the a""roach andattitudes to death ca"tured in a beautifully bound large boo$ "laced on a stand in the non'denominational cha"el of an Australian

hos"ice% The messages &ritten in this volume by "eo"le ' from small children &ho have >ust learned to &rite to s"ouses &hoselifetime "artners are dying ' ca"ture an intangible reality that - am unable to describe but that can be e5"erienced in reading theentries% The im"ression about &hat human death and dying involves that - &as left &ith &as the "olar o""osite of the one generatedby the "olitician.s remar$s% This reaction o"ens u" the other &ay to deal &ith death: to search for meaning in it% Feo"le &ho do sooften vie& human life as having intrinsic value, encom"assing a mystery 2at least the mystery of the un' $no&n, eliciting ares"onse that contains &onder and a&e% They believe that legalizing euthanasia &ould "ut at high ris$ the li$elihood that &e &ill3nd meaning in death, and that this "ossibility threatens our ability to 3nd it in life% I(eath tal$R and Ilife tal$R are t&o sides of thesame coin, and the content of these t&o forms of tal$ is ine5tricably intermingled: death tal$ forms "art of life tal$ and vice versa%e run serious ris$s as individuals and societies, moreover, if &e fail to balance one &ith the other% -n this boo$, - &ant to balancethe death tal$ articulated in the euthanasia debate'&ith life tal$ and to articulate the harmful im"act that acce"ting euthanasia&ould have on the latters content% ne of the great di1culties in the euthanasia debate is that &e lac$ a secular vocabulary thatcan ade9uately ca"ture the non'"hysical ' the meta"hysical ' realities &e need to create, "rotect, and live in if &e are to e5"eriencefully human lives% Traditionally, &e have used the language of religion to create the intangible, invisible, immeasurable reality that isessential to our human &ell'being, both as individuals and as a society% ften, &e still need to em"loy the vocabulary of thatlanguage to ca"ture the dimension of Ihuman s"iritJ \ &hich &e need, &hether &e are religious or not% The use of this languagecan cause di1culties for those &ho re>ect religion and the su"ernatural because they see this vocabulary as invo$ing theseentities% 0ut in using this language in a secular conte5t, - do not intend to base my arguments on religion or to rely on thesu"ernatural% 0y the human s"irit - mean the Idee"ly intuitive sense of relatedness or connectedness to the &orld and the universe

in &hich &e live%R) To recognize this dimension of ourselves is to recognize that &e are more than Igene machinesR and more than >ust logical, rational beings% e can create this dimension through shared language in the broadest sense of both &ords% -ndeed, onechallenge of IglobalizationJ is to 3nd a language and vocabulary that &ill cross the boundaries of religion and of ethnic and nationalorigin 2the boundaries of culture and ca"ture the "rofound realities of the human s"irit that can give meaning to our 3ves ' anddeaths% The euthanasia debate is one im"ortant conte5t in &hich &e have an o""ortunity to contribute to 3nding this commonhuman s"irit and the shared language that &ill elicit and describe it% e are story'telling animals% Some of our most im"ortantshared stories are in the form of meta"hor, "arable, and "oetry% e communicate through imagination and intuition as much asreason and cognition% And &e can 3nd and communicate certain realities only in' directly, not directly% Some $inds of $no&ledge canbe sought only by setting u" meta"horical'meta"hysical s"aces &ithin &hich &e ho"e to encounter them% This is true &ith regard to$no&ledge and &isdom about death% Setting u" a s"ace of that $ind de"ends on having a sense of be' longing to a community%Qany of us have lost this sense and, conse9uently, have di1culty 3nding or entering the meta"horical' meta"hysical s"ace &e need&hen &e, or those &e love, are dying% -n facing the circumstances of death, it can be much harder for us than it &as for ourancestors to ful3l the need to cry and to laugh through the tears; to come together to share the "ain of loss and the >oy of memory;



and to "artici"ate &ith others in "oetry, ritual, and song% Euthanasia is one res"onse to this loss% -n this boo$ - e5"lore the causes,sco"e, and im"act of the contem"orary euthanasia debate% - argue in cha"ter ? in Fart ne that this dc' bate is "art of the search fora ne& cultural "aradigm on &hich to base the societal structure% This search is also being underta$en in the con' te5t of gene ticsand re"roductive technologies% hat &e do and choose not to do in relation to both the "assing on of human life 2genetics andre"roductive technologies and the ending of it 2euthanasia &ill create the meta"hysical reality, the sense of meaning, &ithin &hich&e live our lives% e have al&ays used birth and death, the t&o great Rmar$er eventsR of human life, as central to our search formeaning% As long as &e humans have been around, &e have become ill, aged, su/ered, and died, and others have al&ays been ableto $ill us% Euthanasia is not a ne& 9uestion% 0ut our $ind of society has re>ected it for over t&o thousand years% hy, then, has thelegalization of euthanasia been seriously considered in industrialized estern societies &ithin the last t&enty years@ These are the

same societies, moreover, that have made astonishing advances in the ability to relieve "ain and su/ering% 8ot all of us agree onthe reasons, though most of us admit they are multi"le and com"le5% These factors are e5"lored in cha"ter +, ILegalizing

Euthanasia: hy 8o&@R one of several cha"ters in Fart T&o on the evolution of the euthanasia debate% !ne reason theeuthanasia debate might ha$e emerged now in industrialized;estern countries is that recent e7traordinary medical successesha$e e7%anded our life s%an and changed the diseases from whichwe are most li*ely to die from acute ones which *illed us +uic*lyD tochronic ones which do not% -n general, "eo"le &ho die of chronic diseases cost the health'care system much

more than those &ho die suddenly% e are also aging "o"ulations, &hich means that more of us are li$ely to die of chronic diseases%-n short, our medical successes bene3t us, but they also "resent us &ith their cost and the need to recognize our inability as asociety to "rovide all the health care that might bene3t everyone &ho &ants it% -t is, and should be, very di1cult to face someone&hom &e $no& &e could hel" &ith very e5"ensive medical treatment and refuse access to it% Gecently, the connection bet&eeneuthanasia and the saving of health'care resources has been articulated in "ublic forums, although the to"ic has al&ays been

discussed "rivately% -n cha"ter ), - address the 9uestion, IShould the 7rand"arents (ie@R The reasons behind calls for thelegalization of euthanasia are com"le5, as is the debate itself% Conse9uently, &e need to be a&are of the &ays in &hich the case forone side or the other is "romoted% The case for legalization has been "romoted, for instance, through confusion &ith other acts orsituations that do not, in general, raise ethical and legal di1culties% This confusion must be identi3ed and carefully e5"lored% - aim todemonstrate in cha"ter , IEuthanasia by Confusion,J that such an investigation could ma$e us see some of the argumentsdi/erently% Another reason given for the need to legalize euthanasia is that it is necessary to relieve "ain% -n Fart Three - discuss "ainand "ain'relief treatment, and their relation to euthanasia% e have been grossly negligent, even malevolent, in our failure to treat"ain% And, loo$ing bac$, - 3nd it di1cult to imagine ho& &e could have been so inhumane% -ncreasing sensitivity to the "ain ofothers, es"ecially on the "art of health'care "rofessionals, has been a ma>or advance of the last t&enty years% This a&areness is"articularly true &ith res"ect to those &ho are unable to communicate their "ain easily, &hether because they are too young, tooold, or of a di/erent cultural or linguistic bac$ground% 0ecause euthanasia is a to"ic of debate, it matters ho& &e carry out thatdebate% ften this debate centres around &hat is re9uired to res"ect dying "eo"le% The cha"ters in Fart 4our deal &ith that issue%Some of these cha"ters consist of my res"onses to others contributions, some of &hich &ere, in turn, res"onses to mine% They alsoinclude my revie&s of t&o boo$s &ritten by advocates of legalization% 4inally, in Fart Si5, - e5amine some foundational conce"ts inhealth ethics and la& that are relevant to the euthanasia debate% Cha"ter )? e5"lores some of the conce"ts that govern decision'ma$ing concerning medical treatment at the end of life \ autonomy, self'determination, com"etence, and voluntariness% Thea""roaches ta$en to these conce"ts in la&, "sychiatry, and ethics are com"ared and contrasted% -n e5"loring euthanasia, &e needto underta$e a broader analysis than one based merely on ideas that are familiar to "eo"le living in an industrialized esterndemocracy% Human rights &as one of the most im"ortant global conce"ts of the second half of the t&entieth century, and, in recentyears, human rights in health and health care have been a focus of attention% Human rights is not, ho&ever, a universally acce"tedconce"t in all circumstances ' in "art because the language of IrightsJ can seem too estern and too legalistic to some othersocieties and cultures% e have al&ays recognized that human rights necessarily encom"ass human res"onsibilities, and yet, in theest, &e have been nervous of e5"ressly naming the latter for fear they could be used as instruments to deny human 3ghts%7overnments might argue that human rights de"end on ful3lling human res"onsibilities as de3ned by the state% -n cha"ter )), onhuman rights in health and health care, - identify a conce"t of Ihuman ethicsR% This conce"t is not meant in any &ay to detract fromthe im"ortance of human rights% -ndeed, the contrary is true% The idea is that human ethics might be a more neutral and a moreuniversally acce"table term than human rights, at least that term standing alone% -n short, human rights and human res"onsibilitiesboth e5"ress the conce"t of human ethics ' and it e5' "resses them; they are interchangeable% Ado"ting the conce"t of humanethics &ould mean that, even if a state does not recognize human rights 2legally enforceable claims of individuals or grou"s againstthe state, it &ould still be bound by fundamental "rinci"les of human ethics% ne of those "rinci"les, - believe, is that, e5ce"t inessential self'defence, &e must not $ill each other \ not even for reasons of the utmost mercy and com"assion% Conse9uently,euthanasia &ould contravene the re9uirements of human ethics% The euthanasia debate has much to teach us% Those &ho o""oseeuthanasia might &ish that the debate had never emerged, yet, "ro' vided the outcome remains that euthanasia is "rohibited, thenet result of this debate might be bene3cial% e have already learned much% e $no&, for e5am"le, that "eo"le &ho &anteuthanasia have lost all ho"e% hen &e are terminally ill, by de3nition, &e cannot, a"art from a miracle, ho"e for long'term survival%

=et there arc things &e can still ho"e for ' to see a loved "erson, to see the ne5t sunrise and hear the da&n chorus of birds, tocuddle a $itten or "at a friendly dog% Ho"e is our connection with the future" and thatfuture need not be distant to %lay its essential role in allowing us toe7%erience ho%e& Ho"e is our connection &ith life and &ith the continuation of life ' even &hen &e $no& &e &ill die

2&hich is true for most of us for most of our lives% Euthanasia con3rms the "o&er of death over ho"e, of death over life% -t fails torecognize the great mystery that allo&ing death to occur, &hen its time has come, is an act of life% Euthanasia is an act of death%

There is a vast di/erence bet&een natural death and euthanasia% -n our often unsubtle, un'nuanced, very "hysically oriented, non'meta"hysically sensitive &orld at the da&n of a ne& century, many of us are failing to recognize ho& some deaths, and some formsof death, are com"atible &ith life and ho"e, but others, es"ecially those resulting from euthanasia, are not% -t might be that in lessso"histicated times, certainly in less scienti3cally so"histicated ones, &e com"rehended this distinction through our intuition% e$ne& through true sim"licity% ften, &hen &e gain $no&ledge, &e move from true sim"licity to a chaos "hase in &hich &e 3nd it



di1cult to structure our ne& $no&ledge and to formulate a""ro"riate res"onses& 8t is only when we canstructure the chaos to understand the dee% roots and com%le7itiesin$ol$ed in what we do" and the symbols and $alues aected , that &e can

ma$e decisions on an ade9uate and com"rehensive basis% .hese decisions are often similar tothose made on the basis of true sim%licity" but the resemblance is

su%er#cial% .hese decisions are based on a%%arent sim%licity , which

comes with dee% understanding&

.he need for discussing regulations !.;O8>ES the moralissues u% for debatePrado (04

2Cynthia A% Frado %(% candidate, University of Southern California La& School, ?DDD; 0%A% Fsychology, Qinor0ioethics, University of Southern California, ?DD+% IE44ECTS 4 7E8(EG (-44EGE8CES 8 FH=S-C-A8'ASS-STE(SU-C-(E: FGACT-CE A8( GE7ULAT-8J 4all, ?DDB B S% Cal% Gev% L% V omens Stud% ?*?, Le5is, TS

-% FH=S-C-A8'ASS-STE( SU-C-(E: 0AC!7GU8( A8( -SSUE 4 7E8(EG American legal and "hiloso"hical movements regarding an

individuals right to die have al&ays been "rofound and strong% Q(EL legislation, s"eci3cally regarding

euthanasia and %hysician'assisted suicide" is constantly being %ro%osed in the nited

States% The 3rst "iece of such legislation &as introduced in ?D*+% n?? The strong devotion to the estern "hiloso"hy of self'

determination and autonomy &as clearly demonstrated by udge Cardozo in ?D?O &hen he &rote that Revery human being of adult

years and sound mind has a right to determine &hat shall be done &ith his o&n body%R n?) Although the nitedStates has a long history of common law and %ro%osals of legislationsu%%orting this %hiloso%hy" only within the last decade has %assinglegislation legalizing %hysician-assisted suicide been li*ely % .his isdue to the growing su%%ort for the %ractice o f "hysician' assisted suicide% n?N

oreo$er" %assage of legislation has actually occurred in the lasttwo years &ith the enactment of the regon (eath &ith (ignity Act% -t is the &orlds 3rst statute a1rmatively legalizing the

"ractice of "hysician'assisted suicide% n?O -n vie& of the ?*P obvious growing su%%ort for the

legalization and "ractice of %hysician' assisted suicide, discussion on how it should be

regulated may ta*e %riority o$er moral and %hiloso%hical discussions&

8n all %ractices in areas of life ' familial" cultural" educational"$ocational" legal and medical ' there will always be ris* of abuses, aswell as %eo%le who are more $ulnerable than others to such abuses% 8nthe %ractice of %hysician'assisted suicide, the least %owerful grou%s of %eo%lein the nited States are generally the most $ulnerable to the ris* of abuses%

.hese grou%s include women" minorities" the elderly and the %oor"

all of whom are mostly aware of their $ulnerability% .his is e$idencedby their lac* of su%%ort for the legalization of %hysician'assisted suicide% n?P

Gegarding gender, most surveys and "olls sho& that &omen consistently o""ose euthanasia and "hysician' assisted suicide"ractices more than men% n?+ Qembers of all these grou"s are also more li$ely to re9uest such "ractices for the many di/erentreasons discussed in "art t&o of this Article% The recent, albeit insu1cient, focus on gender in Q(EL discussions has been triggered

by a recognition of gender "atterns, s"eci3cally the dis"ro"ortionate involvement of &omen% .o begin" the%ractice of %hysician'assisted suicide is most widely *nown to Americans by themedia %ublicity of the infamous ichigan %hysician" Jr& Qe$or*ian&Brom the media %resentation" most of his assistees n1@ ha$e VW1?X



been middle-aged women& n?B Thus, many critics of !evor$ian have de"icted his "ractice of "hysician'

assisted suicide as gender'biased% n?D ne critic has even described his "ractice as R&omanslaughter%R n)* -f !evor$ians assistedsuicides are vie&ed as ty"ical of the re9uests and grants of all "hysician'assisted suicides, then it may be e5"ected that the "racticeof "hysician'assisted suicide &ill dis"ro"ortionately involve &omen% Ho&ever, this e5"ectation may not be correct in vie& of the factthat the total number of !evor$ians assistees has been grossly underestimated% !evor$ian claims to have assisted bet&een * and?** "eo"le in ending their lives, and states that he receives t&o to three re9uests a day for his assistance% n)? -t is also re"ortedthat Rnearly half of the re9uests are from menR &hich may further discredit any 3nding or e5"ectation of a gender "attern% n))

Therefore, in order to e5tra"olate from !evor$ians "hysician'assisted suicide "ractice to that of broader society, accurate gender

"ro"ortions of !evor$ians "otential and actual assistees must be obtained% A second recognized gender "attern that has triggered afocus on gender issues in Q(EL are legal develo"ments arising through case la&% 8e& "recedents regarding Q(EL in both Americanand (utch la& have "rimarily involved &omen% n)N -n the United States, "recedents &ere created by the cases of Elizabeth 0ouvia,n)O !aren Ann ?* uinlan n)P and 8ancy Cruzan% n)+ -n the 8etherlands, recent legal develo"ments have involved the highlycontroversial case of Chabot% n) This case la& "attern and !evor$ians "attern may or may not be an accurate de"iction of the

current and future "ractice of "hysician' assisted suicide% 8evertheless, the %atterns ha$e triggeredneeded and long o$erdue discussion of gender issues and genderim%lications in this area of bioethics&

H&D Political Analysis JA -- Bocused debate o$er stateregulations of PAS are *ey to cost-bene#t analysis anddeliberation -- the alternati$e is abstract moral relati$ism that

fails to translate into material changeSmith 00

7eorge, Frofessor of La& The Catholic University of America, Notre Dame Journal Of Law, Ethics & Pulic Polic! ,ol% ?N, Iudicial (ecision'Qa$ing in the Age of 0iotechnologyJ, A0

Hioethics can be seen as ha$ing no de#ned essence &hich sets it a"art as a

distinct study or disci"line% Gather, its individuation derives from a de facto set of issues interrelated by &hat might

be termed Rfamily resemblances%R hile a common thread 'oining all of the issues is

e5ceedingly dicult to 3nd, the central core com"rising the list of these issues, &ithout 9uestion, is afelt concern o$er the technology of control of man6s body" his mind"

and +uality of life% Qany of the concerns of bioethics are concerns of

%ublic %olicy \or with legislation and policy guidelines \at state "

local" and federal le$els " that need to be enacted and enforced

with res%ect to all of the issues com%rising the de facto set % -t has been

suggested that bioethical concerns are but those "rohibitions all rational "eo"le urge everyone to follo& in an e/ort

to avoid evils on &hich common agreement e5ists% !utside the indi$idual conte7t of

determining ho& one treats another, for moral acce"tability to be given at the broader societal level, a

democratic consensus must be reached ac*nowledging that a

certain good must be %romoted though its "romotion causes some degree of harm% -t is

&ithin this setting &here much of &hat is recognized as RbioethicsR is focused% hile indi$idualmorality o%erates "rimarily within a system of restraints , %olicies

aect ing society as a whole o%erate on a le$el where %romotion of

good is a moral o%tion% .he %i$otal +uestion thus becomes , R&hat goods

ought to be restrained 2e%g%, scienti3c research@R !f necessity, %riorities , $alues, and goods

must be weighed, balanced, and com%ared% henever the bene3ts and the ris$s of a



"articular course of action are &eighed, it is &ell remembered that those very elements in the balancing test arebased u"on >udgments about values, &ith the "enultimate goal being the formulation and validation of a 3nal action

&hich minimizes human su/ering and ma5imizes the social good% P 8n a more s%eci#c sense,

bioethics encom%asses a whole %olitical mo$ement % + 8t is a

mo$ement which see*s to harness political forces to deal with a

"lethora of ethical %roblems relating to health care deli$ery" both at themicro and the macro le$el of economic distribution% 8t also endea$ors to

res%ond\often through legislati$e reforms \to com%le7 issues such

as p hysician a ssisted s uicide , cryonic sus"ension, genetic discrimination in the &or$"lace,

abortion, "rivacy, sterilization, human e5"erimentation, collaborative re"roduction by use of in vitro fertilization,arti3cial insemination, cloning, and "ersonal relationshi"s necessary to create a family by homose5uals and

lesbians% All too often, contem%orary society6s concerns o$er the need for

regulating ethical regimes to guide or e$en control these acti$ities

has driven it in turn to see* medical laws about areas such as death and

dying, genetic counseling and screening, re"roductive technologies, and organ trans"lants% ften there islittle choice for legal passivity or inaction since R the law is a

%rimary $ehicle for resolving disagreements about public policy

and the treatment of real persons "RB And today, Americans seem to be resha"ing their

"olitical 9uestions ultimately into >udicial 9uestions%D =et, a healthy degree of s$e"ticism is needed to see the

inherent limitations on the legal system in its e/orts to regulate biomedical develo"ments% ?* Oach legal

tool used must be constantly ne-tuned and re-evaluated by

e$er changing public policies \all with the %ur%ose of determining

&hich of the tools is best #tted to deal with s%eci#c biomedical%roblems2 and &hich one $alidates a nal action that ideally minimizes

human suering and ma5imizes the social or common good%

Legalizing PAS means regulationsrofs*y (04

2Qelvin -% Urofs$y Frofessor of History and Fublic Folicy, irginia Common&ealth University; Ad>unct Frofessor ofLa&, University of Gichmond School of La&% A%0%, ?D+?, Fh%(%, ?D+B, Columbia University; %(%, ?DBN, University ofirginia% ILEA-87 THE (G AAG: THE SUFGEQE CUGT A8( ASS-STE( SU-C-(EJ Qarch, ?DDB N) U% Gich% L% Gev%

N?N, Le5is, TSA number of doctors bitterly fought the "ro"osal% They had been trained to save lives, not to ta$e them, and they sa&

8nitiati$e 110 as o%ening the doors to a Iood of abuse& hen the ashington

State Qedical Society debated the issue, delegates voted 3ve to one against it, but a "oll of the general membershi" ta$en earlier in

the year sho&ed doctors s"lit rather evenly% !ne can surmise that although doctors dohel% some of their %atients die" they %refer to *ee% this %art of their

%ractice +uiet% .o legalize %hysician-assisted suicide would mean



additional regulation of medical %ractice& Although early signs

indicated that 8nitiati$e 110 would %ass" o%%onents gained groundas election day a%%roached% Critics claim that American NO* voters are a"athetic, but -nitiative ??D

galvanized the "o"ulace, and voters came out in large numbers% The initiative failed by a PO'O+ margin% n?*? 0oth sides agreedthat the debate had been useful and that an im"ortant "ublic "olicy issue had been raised, one that &ould not 9uietly go a&ay% n?*)R-f &e dont deal &ith the "roblems raised by ??D, &ell be facing this issue again and again and again,R said (r% Feter Qc7ough, an

o""onent of the measure% Qc7ough stated further that Rsaying no to assisted death is not enough% 8o& &e have a res"onsibility todeal &ith the "roblems that brought out this concern%R n?*N

Precision of PAS discussion is *ey to ha$ing a meaningfuldiscussion / esoteric ethical +uestions are irrele$antOPOC (?3

2Education -n Falliative And End'f'Life Care 4or ncology ISelf'Study Qodule ?O: Fhysician'Assisted SuicideJhtt":##&&&%cancer%gov#cancerto"ics#cancerlibrary#e"eco#selfstudy#module'?O#module'?O'"df , TS

The legal and ethical debate .he debate about legalizing acti$e ste%s tointentionally end life as a means to end suering remainscontro$ersial% Hecause of the added ris* of misunderstanding or overriding

the %atient)s wishes, there is currently less su%%ort for euthanasiathan for %hysician-assisted suicide% 8onetheless, both re9uests do occur and "hysicians need to

$no& ho& to res"ond to either ty"e of re9uest% 8n any discussion of % hysician' a ssisted s uicide or

euthanasia, it is im%ortant that the terminology be clear& Euthanasia is de3ned as the act

of bringing about the death of a ho"elessly ill and su/ering "erson in a relatively 9uic$ and "ainless &ay for reasons of mercy%

Physician-assisted suicide is de#ned as the act of a %hysician in

%ro$iding the means for a %atient to hasten his or her death& Although

they may have similar goals, %hysician'assisted suicide and euthanasia dier in whether ornot the %hysician %artici%ates in the action that 3nally ends life% 8n %hysician'assisted

suicide, the %hysician %ro$ides the necessary means or information and the "atient

"erforms the act% 8n euthanasia" the %hysician %erforms the inter$ention& -n the

current debate, there are t&o "rinci"les on &hich virtually all agree% 4irst, %hysicians ha$e an obligationto relie$e %ain and suering and "romote the dignity of dying "atients in their care% Second, the "rinci"le

of "atient bodily integrity re9uires that "hysicians res"ect "atients. com"etent decisions to forgo life'sustaining treatment% Anim"ortant event in the "resent debate occurred in ?DD, &hen the United States Su"reme Court recognized that there is no federalconstitutional right to "hysician assisted suicide but did a1rm that state legislatures may choose to legalize it% As of early ?DDD,regon is the only state that has voted to legalize FAS% -n contrast to the FAS debate, the right to "alliative care is uniformlyac$no&ledged% The same U%S% Su"reme Court ustices. concurring o"inions su""orted the right of all Americans to receive 9uality"alliative care% Frofessional com"etence As most "hysicians are li$ely to receive a re9uest for hastened death, every "hysician mustbe ca"able of dealing &ith these di1cult re9uests in a &ay that res"onds to the needs and e5"ectations of the "atient and o/ers thebest "ossible care that is both ethical and legal% The ability to res"ond to re9uests for hastened death &ith realistic alternativesre9uires a &or$ing $no&ledge of all as"ects of "alliative care% The "hysician must follo& usual standards for communication, $no&ho& to "rovide aggressive sym"tom control and su""ortive care, and be s$illed at a""roaches to &ithdra& or &ithhold life'sustaining interventions 2see EFEC' Qodule : Communicating E/ectively; EFEC' Qodule B: Clarifying (iagnosis and

Frognosis; EFEC' Qodule ): Cancer Fain Qanagement; EFEC' Qodule N: Sym"toms; and EFEC' Qodule ??: ithdra&ing8utrition, Hydration% Fhysicians need to be a&are of the legal issues described in the original EFEC Curriculum Flenary ): Legal

-ssues in End'of'life Care% As eecti$e a%%roaches for res%onding to sueringmay be time consuming" %hysicians will be more eecti$e if theywor* collaborati$ely with other health care disci%lines in aninterdisci%linary team& Some re+uests for PAS or euthanasia can be intense"and e$en s*illed and e7%erienced %hysicians re+uire access toconsultati$e %alliati$e care e7%ertise as %art of the s%ectrum of

http://www.cancer.gov/cancertopics/cancerlibrary/epeco/selfstudy/module-14/module-14-pdf





contem%orary health care 2see EFEC' Flenary ): Qodels of -ntegrated Care% b>ectives The ob>ectives of

this module are to: (e3ne "hysician'assisted suicide 2FAS and euthanasia% (escribe their current legal status% -dentify rootcauses of su/ering that "rom"t re9uests% Understand a si5'ste" "rotocol for res"onding to re9uests% Si5'Ste" Frotocol forGes"onding to Ge9uests for Fhysician' Assisted Suicide or Euthanasia Any re9uest for FAS should be ta$en seriously% Ges"onseshould be immediate and com"assionate% Si5 ste"s can be identi3ed for res"onding to such re9uests: ?% Clarify the re9uest% )%Assess the underlying causes of the re9uest% N% A1rm your commitment to care for the "atient% O% Address the root causes of there9uest% P% Educate the "atient and discuss legal alternatives% +% Consult &ith colleagues% hile each ste" &ill be discussed in thismodule in se9uence, these ste"s should integrate smoothly and 6e5ibly into actual "ractice as issues arise% (e"ending on the

"articular case, some ste"s may be im"licit or accom"lished in a fe& &ords, &hile others may be com"le5 and re9uire considerabletime to res"ond% Ste" ?: Clarify the re9uest hen a "atient 3rst raises the issue it is necessary to clarify >ust &hat he or she means%

The "atient may assume that if there is a routine treatment available for a condition that threatens his or her life, there is littlechoice other than to acce"t it, as if doing less than everything to "rolong life is tantamount to suicide% 0y ma$ing it clear that it islegally and ethically "ermissible to decline treatments\even antibiotics for infection and tube nutrition and hydration\and allo& anatural death to occur, "atients may be satis3ed that their lives &ill not be "rolonged against their &ishes% 2Gef% )D

Sometimes a %atient will use a %ro$ocati$e statement such as" 98ho%e you)ll hel% me die when it)s time: or 9Please %romise not to letme suer": as if to test the %hysician)s willingness to tal* about the

%atient)s fears of dying badly% -t is im%ortant to understand whether

the %atient is actually referring to %hysician-assisted suicide or

euthanasia , or ade9uate analgesia% any %eo%le do not ma*e these

distinctions and , while e7%ressing themsel$es in the language of

assisted suicide" they are actually as*ing for assurance of a way to

esca%e suering if it becomes unbearable% Such "atients are commonly reassured to learn

that good "alliative care e5tends to &hatever treatments are necessary to alleviate "hysical distress% At the same time, "atientsmay need assurance that e/ective "ain management, including Ia mor"hine dri"J or sedation &hen necessary, is not a eu"hemismfor euthanasia, but rather good medical care for a serious medical "roblem% -n discussing sedation &ith "atients, the "ractice mustbe distinguished from euthanasia% Sedation for other&ise intractable sym"toms is consistent &ith the treatment of "ain in burn unitsand surgical suites% The same "rinci"le of careful titration of anesthetic agents as necessary for ade9uate treatment and "atient

comfort a""lies to "alliative sedation% 2Gef% N* ;hen cases of re+uests to hasten death are%resented in ethical %a%ers or in %ublic debates" they often loo* li*eethical %uzzles that in$ol$e com%le7" irresol$able %sychosocial

issues and e7istential suering& 8n the real world of %atients) li$esand clinical %ractice, these cases are not esoteric ethical or clinical%uzzles but " rather" the %leas of fearful " $ulnerable %eo%le loo*ingto their %hysicians for reassurance" armation" and %ractical hel%%

;hen a %atient as*s for hastened death" listen carefully to thenature of the re+uest& As$ o"en'ended 9uestions in a calm and non>udgmental manner to elicit s"eci3c

information about the re9uest that is being made and the underlying causes for it% hile some "hysicians fear that tal$ing aboutsuicide or hastened death &ill increase the li$elihood that the "atient &ill act, this fear has not been substantiated% An o"endiscussion is more li$ely to reduce the intensity of the re9uest% nce the underlying reasons are $no&n, more directed 9uestions canbe as$ed% Several e5am"les, and the common areas to &hich ans&ers may "oint, follo&: Q(: Ihat ma$es you as$ that@J ' (esirefor a "ain'free death ' Control over the dying "rocess Q(: Ihat do you e5"ect &ill ha""en &ithout FAS@J ' Understanding ande5"ectations of the illness ' E5"ectation of &hat dying &ill be li$e Q(: Ihat ty"e of assistance do you &ant@J ' Fills, in>ection Q(:Iho do you &ant to be involved@ hy@J ' Self, family member, "hysician Q(: Ihen do you thin$ you &ant to die@J ' 8o& ' Atsome later "oint Q(: Ihat do you ho"e to accom"lish@J ' 4reedom from "ain, disability, ban$ru"tcy, de"endency, indignity 'Gemoving burden on others The ans&er to the 9uestion, Ihen do you thin$ you &ant to die@J &ill "rovide some indication of acuity%

The ans&er to the 9uestion, Ihat do you ho"e to accom"lish@J &ill "rovide some understanding of the "atient.s reasoning and&hat he or she is ho"ing for% (uring the course of the 9uestioning, it is "articularly im"ortant to learn &hether the "atient isimagining future sym"toms or other conditions that are either unli$ely or easily "reventable% As you listen to the ans&ers, use thethera"eutic e/ect of em"athic listening% Avoid endorsing the re9uest for FAS in a &ay that con3rms the "atient.s "erce"tion that hisor her life is &orthless% Similarly, avoid re>ecting the re9uest &hen it is 3rst heard as this &ill often serve to close rather than o"endiscussion% Gemember that em"athizing is not the same as agreeing% Fremature a1rmation of any "ers"ective can "ro"el both"arties to star$ choices% nly &hen the "atient.s "oint of vie& has been characterized &ill i t be "ossible to tal$ about &hat su/eringmeans to the "atient and &hat assurances can or cannot be given% Fersonal biases vs% thera"eutic listening To res"ond e/ectively tothe needs of the "atient, the "hysician must be a&are of his or her o&n biases and the "otential for counter'transference% -f the ideaof suicide is o/ensive to the "hysician, the "atient may feel his or her disa""roval and &orry about abandonment% Conversely, if the"hysician feels it &ould be best for everyone if the "atient &ere to die soon, the "atient may sense this and become more concerned



about being an un&elcome burden% 0e o"en to the "ossibility that your "ersonal reactions to the "atient.s su/ering may give insightinto his or her e5"erience% 4or e5am"le, if you feel &eighed do&n by meeting &ith the "atient, "erha"s the "atient is de"ressed% -nma$ing the re9uest, the "atient is o"ening a door for communication% The thera"eutic res"onse to a re9uest for assisted suicide oreuthanasia begins &ith listening% Fossibly because listening involves little out&ard motion, it seems "assive to the casual observerand its value as an active thera"eutic intervention is often unrecognized% -n actuality, the "hysician.s ability to listen andcommitment to stay involved are the main com"onents of an e/ective res"onse% The thera"eutic "o&er of listening must not beunderestimated% 2Gef% )D 2Gef% N? 4or a "hysician confronted &ith a re9uest to hasten death, the critical early intervention oftenconsists of a handful of minutes s"ent listening to the "atient.s fears and ac$no&ledging his or her su/ering, cou"led &ith 3rmlycommitting to remain involved, try ne& &ays to im"rove the "atient.s 9uality of life, and "rovide su""ort the "atient and family

need during this di1cult time% The "hysician'"atient relationshi" is the most "o&erful thera"eutic resource &ith &hich to intervenein su/ering% 0y carefully assessing and e/ectively treating "ain and other sym"toms, a "hysician rea1rms the "atient.s con3dencein the "hysician.s $no&ledge and s$ills% Similarly, &illingness to e5"lore a "atient.s su/ering and fears engenders con3dence in the"hysician.s com"assion and &illingness to be there in the hard times that may lie ahead% Fatients. su/ering is often rooted in fearsof the future; "atients can often tolerate the current situation but &orry &hat &ill ha""en if things get &orse% 2Gef% )P Fhysicianscan use this as"ect of su/ering to thera"eutic bene3t% -t is often "ossible to diminish an acutely an5ious "atient.s distress andim"rove the "atient.s sense of control by dra&ing attention to the "resent moment in &hich the discomfort is tolerable, if onlybarely, and by em"hasizing that life is a series of "resent moments% The future'based nature of most su/ering allo&s "hysicians toinform and a1rm for "atients that there is al&ays something they can do to decrease the severity of "ain or other sym"toms and

su""ort "atients and families through these di1cult times% !utlining s%eci#c ste%s that can beta*en if %ain or other cancer-related sym%toms worsen can bereassuring for %atients and their lo$ed ones& Patients who fear dyingin uncontrolled %hysical agony are often reassured that %alliati$esedation is a$ailable for situations in which suering cannot beotherwise controlled% 2Gef% N) Social su/ering that comes from a felt loss of meaning, i%e% a sense of having

nothing to contribute and being merely a burden to others, i%e% is not &ithout thera"eutic res"onse% A loved one.s illness and carealmost inevitably im"ose burdens on that "erson.s family% All &ho love the "erson are a/ected by his or her illness in emotional and"ractical &ays% Serious illness disru"ts "lans and sometimes derails long'held as"irations% Here again, there are no "at ans&ers%hile it is essential for "hysicians to a1rm their commitment to su/ering "atients, they need not shoulder these res"onsibilitiesalone% The multidimensional su/ering of "rogressive cancer is best addressed by interdisci"linary a""roaches to care% 2Gef% NNHos"ice and "alliative care "rograms can res"ond in s$illful &ays, and often identify &ays of lessening the burden and enablingfamilies to care &ell and &ith love &ithout losing their o&n lives in the "rocess% Ste" ): Assess the underlying causes of the re9uestA re9uest for FAS may indicate a failure to address the full sco"e of a "atient.s needs% 4ocus on all four dimensions of "hysical,"sychological, social, and s"iritual su/ering as &ell as "ractical concerns 2see EFEC' Qodule ?: Com"rehensive Assessment%Assess for clinical de"ression Among all the "sychological and "hysical "ossibilities, give "articular consideration to the "resence ofclinical de"ression or an5iety, as research indicates correlation bet&een re9uests for FAS and their "resence% 2Gef% D 2Gef% )B henevaluating "sychological and social issues; e5"lore "atients. fears about the future% Clinical de"ression occurs fre9uently and is bothunder'diagnosed and undertreated% -t can be a source of intense mental su/ering and a barrier to com"leting life closure andachieving a Igood death%J (iagnosis of de"ression is more challenging in "atients &ith advanced illness, since the "hysicalsym"toms ty"ically associated &ith de"ression 2e%g%, changes in a""etite, &eight, energy level, libido, or slee"ing fre9uently occurin these "atients as a result of their illness% Studies have sho&n that the screening 9uestion, I(o you feel de"ressed most of thetime@J is highly sensitive and s"eci3c in the medically ill% 4eelings of "ervasive hel"lessness, ho"elessness, and &orthlessness arenot normal% (o not assume that they are situational and leave them unattended 2see EFEC' Qodule N: Sym"toms% Fsychosocialsu/ering, "ractical concerns Emotional and co"ing res"onses to life'threatening illness may include a strong sense of shame,feelings of being un&anted, and di1culties co"ing% Ad>ustment to the loss of "revious function, inde"endence, control, and#or self'image may be di1cult% Each change may lead to tension &ithin relationshi"s that further increase isolation and misery% orriesabout "ractical matters 2e%g%, &ho the caregivers &ill be, ho& domestic chores &ill be done, &ho &ill care for de"endents and "ets,etc% can create considerable distress% -f su""ort is not forthcoming or is insu1cient, su/ering may ensue or increase% A""roaches tothe assessment of "sychosocial issues and "ractical concerns are covered in EFEC' Qodule ?: Com"rehensive Assessment%Fhysical su/ering A host of "hysical sym"toms may accom"any advanced illness% These may include "ain, breathlessness,anore5ia#cache5ia, &ea$ness#fatigue, nausea#vomiting, consti"ation, dehydration, edema, incontinence, loss of function, slee"de"rivation, etc% Their "resence, "articularly if they are unmanaged for long "eriods, may mar$edly increase su/ering% A""roachesto the assessment of "hysical issues are covered in EFEC' Qodule ?: Com"rehensive Assessment% The management of "ain isdiscussed in EFEC' Qodule ): Cancer Fain Qanagement% The management of other common "hysical sym"toms is discussed inEFEC' Qodule N: Sym"toms% S"iritual su/ering The "ros"ect of dying may evo$e seemingly unresolvable e5istential concernsthat are then e5"erienced as su/ering% As illness advances and disability increases, the "atient.s sense of his or her meaning, value,and "ur"ose in life may all come into 9uestion% -f there is a sense of abandonment or "unishment by 7od, faith and religious beliefsmay be eroded and anger may ensue% A""roaches to the assessment of s"iritual issues are covered in EFEC' Qodule ?:

Com"rehensive Assessment% 4ears for the future -n addition to current concerns, many "atients are fearful about their future% Theymay &orry about "ain and other sym"toms, loss of control or inde"endence, abandonment, loneliness, indignity, loss of self'image,and being a burden to others% hile their thoughts may be unrealistic in the setting of 9uality care, many have &itnessedsubo"timal care in others that fuels their fears and fantasies% (irect 9uestions may be ade9uate to assess a "atient.s fears% -f not,discussing a series of scenarios and "references, as is done during advance care "lanning, may be hel"ful% hen "ersonal valuesand goals of care are being discussed, clarify the things the "erson most &ants to avoid% This may hel" "reem"t unrealistic fears2see EFEC' Qodule ?N: Advance Care Flanning% Ste" N: A1rm your commitment to care for the "atient Fatients facing the end'of'life often have fears of abandonment% Listen to and ac$no&ledge e5"ressed feelings and fears% Qa$e a commitment to hel" 3ndsolutions to the issues of concern, both current and antici"ated% Geinforce that you &ant to continue to be the "atient.s "hysicianuntil the last "ossible moment% E5"lore o"tions to allay immediate concerns and fears% As a re9uest for hastened death a/ectseveryone &ho is close to the "atient, a commitment to the "atient also a1rms a commitment to the family and those close to the"atient, including other caregivers% Ste" O: Address the root causes of the re9uest This section "rovides a general frame&or$ for



addressing some of the "otential root causes for a re9uest for hastened death in each dimension of su/ering% Start bydiscussing the %atient)s health care goals and %references"e7%laining %alliati$e care a%%roaches and ser$ices" and describingthe legal alternati$es to PAS% Gemember that some "atients may not trust either individual health

caregivers or the health care system to meet their needs% -f "ossible, it hel"s to discuss this lac$ of trust &ith the "atient at theoutset so the issues can be understood, if not dealt &ith, early 2see EFEC' Qodule ?N: Advance Care Flanning; EFEC' Qodule

?: Com"rehensive Assessment; EFEC' Qodule D: 8egotiating 7oals of Care; and EFEC' Qodule ?): Con6ict Gesolution%Address "sychological su/ering As "sychological su/ering can lead to re9uests for "hysician'assisted suicide or euthanasia, itsmanagement &arrants considerable attention% Start by assessing and managing de"ression, an5iety, or delirium aggressively 2seeEFEC' Qodule N: Sym"toms% 0ecause "atients. emotional res"onses to illness can be "rofound and co"ing res"onses vary, they&ill re9uire careful e5"loration in a "ositive and understanding &ay% Su""ortive counseling that involves active listening andac$no&ledgment of the "atient.s feelings may be &oven into general care, or it may be "rovided more intensively throughdedicated individual or grou" counseling% Social &or$ers and cha"lains trained in su""ortive counseling can "rovide considerableassistance% Geferral to trained counselors, "sychologists, or "sychiatrists may be re9uired if the issues are com"le5 and#or the ris$sare high% Fatients can be hel"ed to see their "hysical de"endence as an unavoidable conse9uence of their illness, rather than a"ersonal failure% Clinicians can foster a sense of dignity through the manner in &hich care is "rovided% -n coming to $no& the "atientas a "erson, the "hysician ac$no&ledges the uni9ueness and inherent &orth of that individual% (eath a&aits us all; therefore, if ho"e&ere to reside solely in avoiding death, all ho"e &ould ultimately be lost% -n "ractice, it is often "ossible for "atients &ho area""roaching the end'of'life to reframe ho"e and discover meaningful o""ortunities that still e5ist% 2Gef% )D 2Gef% NO Fhysicians canassist "atients to identify achievable goals, such as "artici"ating in meaningful events, engaging in life revie&, com"leting "ersonala/airs and relationshi"s, and feeling "re"ared to leave this life% 2Gef% NP Address social su/ering, "ractical concerns Stresses andcon6icts in the social or "ractical as"ects of a "erson.s life can have "rofound e/ects on his or her &ill to live% E5"ress interest andin9uire in detail about this as"ect of the "atient.s life: hat is the "atient.s family situation@ (oes he or she live &ith someone@Are family members su""ortive@ Are there unresolved issues@ hat is the "atient.s 3nancial situation@ -s health insuranceavailable and su1cient@ Are legal a/airs in order@ (oes the "atient have a Living ill, Fo&er of Attorney for Health Care, Fo&er ofAttorney for 0usiness A/airs, or Last ill and Testament@ here &ould the "atient li$e to receive care@ ho is there to hel"@ ho&ill the caregivers be@ -s there tension over the caregiving role for either "arty@ ho attends to domestic chores such as coo$ing,cleaning, sho""ing, ban$ing, and#or bill "ayments@ Are there any de"endents the "atient cares for, or "ets@ ho &ill care for themif the "atient is unable to@ Consider re9uesting assistance from other members of the health care team 2e%g%, social &or$ers, nurses,cha"lains, occu"ational thera"ists, etc% Additional resources for hel" and su""ort may be available in the community, through a

health care institution, or from a local hos"ice or "alliative care "rogram% Address "hysical su/ering ulti%le studiesindicate that %atients with life-threatening illnesses ha$e manyunaddressed %hysical issues& 8f left unmanaged for long %eriods"each can add considerably to a %atient)s sense of suering% Today, the 3eld of

medicine has more $no&ledge and tools to manage "hysical sym"toms than ever before% Fain and sym"tom management arediscussed in detail in EFEC' Qodule ): Cancer Fain Qanagement and EFEC' Qodule N: Sym"toms% Each sym"tom needs to be"ursued aggressively and successful management often re9uires e5tensive and careful thought and individual clinical trials until

sym"toms are brought under control% 4unction is critical to maintaining inde"endence% Physiatrists" nurses"and %hysical and occu%ational thera%ists may be hel%ful and*nowledgeable about the e7ercises and aids that can be used to o"timize and maintain

function and ensure safety% Se5uality and intimacy are integral as"ects of each individual, "articularly as e5"erienced through touchand closeness to cherished "artners and family members% -llness and dis3gurement may change the &ay "eo"le are able to interact%

To determine individual desires and uncover tensions, facilitate discussions bet&een "artners and $ey family members% Hel" themloo$ for alternatives that may be comforting%



S%ec JAO7tend A%%el )?@ contro$ersy stems

Accurate di$ision of ground matters / distorting the literaturebase mean mislearn the to%ic and ne$er get into the heart of

what the to%ic literature means turns all their education args8nformed %recise debate is *ey to correct understandingOmanuel 604

2Chief, (e"artment of Clinical 0ioethics, arren 7% Qagnuson Clinical Center, 8ational -nstitutes of Health Eze$ielB) Qinn% L% Gev% DBN

-n ashington v% 7luc$sberg n? and acco v% uill n) the Su"reme Court ustices did the right thing by re>ecting aconstitutional right to "hysician'assisted suicide 2FAS or euthanasia% nN They also reached the correct decision innot foreclosing state legalization of these interventions% The decisions &ill foster a lively debate in the states aboutthe ethics and "olitical "rudence of "ermitting these interventions% Although a fe& ustices held out ho"e for a morenarro& constitutional right to FAS or euthanasia, the ma>ority holdings "ermanently shifted the forum, thearguments, the "ers"ective, and the >usti3cations in the debate over FAS and euthanasia% The forum is no longerthe courts, but the legislatures and "ublic s9uares% The arguments are no longer about constitutional rights, but

ethics and "rudent "olicies% The "ers"ective is no longer 3rst "erson, but third "er' DBO son% And the >usti3cationsno longer a""eal to individual autonomy and bene3cence, but to "robable social goods and harms% This is as it

should be in a democracy% As the debate %roceeds" ho&ever, it must be betterinformed% .he debate needs to mo$e away from this or that heart'&renching case

calling out for euthanasia, sha*e o the distortions concerning end-of-life %ractices that have so far informed it, and carefully e7amine what li*ely

bene#ts and harms might result from legalization% This means that there

will be e$en more em%hasis on accurate em%irical assessments of

li*ely %ractices and conse+uences related to PAS or euthanasia% Current

assum%tions about PAS or euthanasia

based on abstract argumentationand logical inferences will need to be tested em%irically if %ublic

%olicy is to be %rudent % Some of these assum%tions already have been shattered by

em"irical assessment% 0ut others will re+uire a commitment to collect additional

data to ma*e %ublic debate more informed&

.he details matter anyone can arm in the abstract8gnatie 2Qichael, Lesser Evils, Carr "rofessor of human rights at Harvard, "% )*'?

As for moral perfectionism, this would be the doctrine that a liberal state should never have truck with

dubious moral means and should spare its officials the hazard of having to decide between lesser andgreater evils. A moral perfectionist position also holds that states can spare their officials this

hazard simply by adhering to the universal moral standards set out in human rights

conventions and the laws of war. There are two problems with a perfectionist stance , leaving

aside the question of whether it is realistic. The first is that articulating nonrevocable,

nonderogable moral standards is relatively easy. The problem is deciding how to apply

them in specific cases. What is the line between interrogation and torture, between targeted

killing and unlawful assassination, between preemption and aggression? Even when legal and moral



distinctions between these are clear in the abstract, abstractions are less than helpful when

political leaders have to choose between them in practice. Furthermore, the problem with

perfectionist standards is that they contradict each other. The same person who shudders,

rightly, at the prospect of torturing a suspect might be prepared to kill the same suspect in a

preemptive attack on a terrorist base. Equally, the perfectionist commitment to the right to life

might preclude such attacks altogether and restrict our response to judicial pursuit ofoffenders through process of law. udicial responses to the problem of terror have their place, but

they are no substitute for military operations when terrorists possess bases, training camps, and heavy

weapons. To stick to a perfectionist commitment to the right to life when under terrorist attack might

achieve moral consistency at the price of leaving us defenseless in the face of evildoers. !ecurity,

moreover, is a human right, and thus respect for one right might lead us to betray another.



Case



=NC Cummin*syO7tinction #rst / <.LKethics ine$itable and re$ersible andlower $alue to life doesn)t mean no $alue to lifeHernstein (= 2Gichard %, era List Frof% Fhil% < 8e& School for Social Gesearch,

IGadical Evil: A Fhiloso"hical -nterrogationJ, "% ?BB'?D)

.here is a basic $alue inherent in organic being, a basic a1rmation, RThe =es of

LifeR 2-G B?% ?P RThe self'a1rmation of being becomes em%hatic in the o%%osition of life todeath% Life is the e5"licit confrontation of being &ith not'being% % % % The yes of all striving is here shar"ened by

the active pno to not'beingR 2-G B?')% 4urthermore \ and this is the crucial "oint for onas \ this

armation of life that is in all organic being has a binding obligatory force

u"on human beings% This blindly self'enacting RyesR gains obligating force in the seeing freedom of man, &ho as thesu"reme outcome of natures "ur"osive labor is no longer its automatic e5ecutor but, &ith the "o&er obtained from$no&ledge, can become its destroyer as &ell% He must ado"t the RyesR into his &ill and im"ose the RnoR to not'being

on his "o&er% 0ut "recisely this transition from &illing to obligation is the critical "oint of moral theory at &hichattem"ts at laying a foundation for it come so easily to grief% hy does no&, in man, that become a duty &hichhitherto RbeingR itself too$ care of through all individual &illings@ 2-G B)% e discover here the transition from is toRoughtR \ from the self'a1rmation of life to the binding obligation of human beings to "reserve life not only for the"resent but also for the future% 0ut &hy do &e need a ne& ethics@ The subtitle of The -m"erative of Ges"onsibility \

-n Search of an Ethics for the Technological Age \ indicates &hy &e need a ne& ethics% oderntechnology has transformed the nature and conse+uences of human action

so radically that the underlying "remises of traditional ethics are no longer $alid % 4or

the 3rst time in history human beings %ossess the $no&ledge and the %ower to destroy

life on this %lanet, including human life% 8ot only is there the ne& "ossibility of total nuclear disaster;

there are the even more invidious and threatening "ossibilities that result from the unconstrained use oftechnologies that can destroy the environment re9uired for life% The ma>or transformation brought about by modern

technology is that the conse9uences of our actions fre9uently e5ceed by far anything &e can envision% onas &asone of the 3rst "hiloso"hers to &arn us about the un"recedented ethical and "olitical "roblems that arise &ith thera"id develo"ment of biotechnology% He claimed that this &as ha""ening at a time &hen there &as an Rethicalvacuum,R &hen there did not seem to be any e/ective ethical "rinci"les to limit ot guide our ethical decisions% -nthe name of scienti3c and technological R"rogress,R there is a relentless "ressure to ado"t a stance &here virtuallyanything is "ermissible, includ'ing transforming the genetic structure of human beings, as long as it is Rfreely

chosen%R e need, onas argued, a new categorical im%erati$e that might be formulated

as follo&s: RAct so that the e/ects of your action are com"atible &ith the "ermanence of genuine human lifeR; ore5"ressed negatively: RAct so that the e/ects of your action are not destructive of the future "ossibility of such a

lifeR; or sim"ly: R Jo not com%romise the conditions for an inde#nite

continuation of humanity on earth 25 or again turned %ositi$e R-n your

"resent choices, include the future &holeness of Qan among the ob>ects of your &ill%R

a7imizing all li$es is the only way to arm e+uality

Cummis*ey 0? < Frofessor of Fhiloso"hy, 0ates (avid, !antian Conse9uentialism, Ethics ?**%N, " +*?'), " +*+,

>stor

e must not obscure the issue by characterizing this ty"e of case as the sacri3ce of individuals for some abstract Rsocial entity%R -tis not a 9uestion of some "ersons having to bear the cost for some elusive Roverall



social good%R -nstead, the 9uestion is &hether some "ersons must bear the inesca"able cost for the sa$e of other "ersons%

8ozic$, for e5am"le, argues that Rto use a "erson in this &ay does not su1ciently res"ect and ta$e account of the fact that he is ase"arate "erson, that his is the only life he has%RN* hy, ho&ever, is this not e9ually true of all those that &e do not save through

our failure to act@ 0y em"hasizing solely the one &ho must bear the cost if &e act, onefails to su1ciently res"ect and ta$e account of the many other se"arate "ersons,each &ith only one life, &ho &ill bear the cost of our inaction % -n such a situation,

&hat &ould a conscientious !antian agent, an agent motivated by the unconditional value ofrational beings, choose@ e have a duty to "romote the conditions necessary for thee5istence of rational beings, but both choosing to act and choosing not to act &ill cost the life of a rational being% Since

the basis of !ants "rinci"le is Rrational nature e5ists as an end'in'itself 27QQ, "% O)D, the reasonable solution to such a dilemma

involves "romoting, insofar as one can, the conditions necessary for rational beings% -f - sacri3ce some for the sa$eof other rational beings, - do not use them arbitrarily and - do not deny theunconditional value of rational beings% Persons may ha$e 2dignity, an unconditional and

incom"arable valueR that transcends any mar$et value 27QQ, "% ON+, but, as rational beings, "ersons also have afundamental e+uality which dictates that some must sometimes gi$e wayfor the sa*e of others & The formula of the end'in'itself thus does not su""ort the vie& that &e may never force

another to bear some cost in order to bene3t others% -f one focuses on the e9ual value of all rational beings, then e9ualconsideration dictates that one sacri3ce some to save many % continues According to !ant, the

ob>ective end of moral action is the e5istence of rational beings% Ges"ect for rational beings re9uires that, indeciding &hat to do, one give a""ro"riate "ractical considerat ion to theunconditional value of rational beings and to the conditional value of ha""iness% Since agent'centered constraints

re9uire a non'value'based rationale, the most natural inter"retation of the demand that one give e9ualres"ect to all rational beings lead to a conse9uentialist normative theory% e have seen that there is

no sound !antian reason for abandoning this natural conse9uentialist inter"retation% -n "articular, a conse9uentialist inter"retation

does not re9uire sacri3ces &hich a !antian ought to consider unreasonable, and it does not involve doing evil sothat good may come of it% -t sim"ly re9uires an uncom"romising commitment to the e9ualvalue and e9ual claims of all rational beings and a recognition that, in the moral consideration of conduct,

ones o&n sub>ective concerns do not have overriding im"ortance%



=NC A. Securityoralist foreign %olicyma*ing only results in inter$entionand lashoutHlac*will )1 2Gobert (% 0lac$&ill &as de"uty national'security adviser for

strategic "lanning and U%S% ambassador to -ndia in the 7eorge % 0ushadministration, I-n (efense of !issingerJ, htt":##nationalinterest%org#article#defense'$issinger'D+O)@"ageKsho&, anuary ), )*?O

-8 H-S 0! (i"lomacy, Henry !issinger concludes that the United States Ifaces the challenge of reaching its goals in stages, each of &hich is an amalgam of American values andgeo"olitical necessities%J? The recent debates about U%S% military o"tions in Libya and Syria re6ect the enduring tension bet&een these intert&ined, at times com"eting com"onents ofour e5ternal relations% 8o U%S% statesman can ignore this dilemma, and none &ill 3nd it easy to stri$e e5actly the right balance bet&een the t&o, es"ecially in times of crisis% All &ouldsee$ to simultaneously "ursue the "romotion of the national interest and the "rotection of human rights% !issinger, famous for advocating an American foreign "olicy based on thenational interest, has long stressed that values and "o&er are "ro"erly understood as mutually su""orting% As he argued in a ?DN s"eech, since IAmericans have al&ays held the vie&

that America stood for something above and beyond its material achievements,J a I"urely "ragmatic "olicyJ &ould confuse allies and eventually forfeit domestic su""ort% Yet9when %olicy becomes e7cessi$ely moralistic it may turn +ui7otic ordangerous ": gi$ing way to 9ineectual %osturing or ad$enturistic

crusades &:= .he *ey to a sustainable foreign %olicy " in his $iew" isthe a$oidance of either e7treme 9 A country that demands moral

%erfection of itself as a test of its foreign %olicy will achie$e

neither %erfection nor security&: 3 This ever'"resent fusion of American values and national interests &as evident in the s"ring

of ?D?, as a crisis eru"ted in South Asia during !issinger.s tenure as Gichard 8i5on.s national'security adviser% hen the 0ritish Ga> ended in ?DO, a "artition of the subcontinent led tothe creation of -ndia and Fa$istan as se"arate, estranged sovereign states% Fa$istan, envisioned as a homeland for South Asian Quslims, emerged &ith an unusual bifurcated structurecom"rising t&o noncontiguous ma>ority'Quslim areas: Iest Fa$istanJ and IEast Fa$istan%J hile united by a shared faith, they &ere divided by language, ethnicity and one thousandmiles of -ndian territory% ver the course of a fraught se9uence of events from ?D* to ?D), a "arty advocating East Fa$istani autonomy &on a national "arliamentary ma>ority, andFa$istan.s t&o &ings s"lit% Amid natural disaster 2a cyclone of historic "ro"ortions struc$ the East on the eve of the vote, $illing u" to half a million "eo"le and devastating 3elds andlivestoc$, constitutional crisis, a s&ee"ing crac$do&n by est Fa$istani forces attem"ting to hold the East, mass refugee migrations, guerilla con6ict and an -ndian'Fa$istani &ar, EastFa$istan achieved inde"endence as the ne& state of 0angladesh% 0y most estimates, the victims of the 0angladeshi inde"endence struggle, &hich included communal massacresunleashed during the crac$do&n, numbered in the hundreds of thousands% -n his ne& boo$, The 0lood Telegram: 8i5on, !issinger, and a 4orgotten 7enocide, Frinceton "rofessor 7ary0ass, &ho has &ritten "revious boo$s on humanitarian intervention and &ar'crimes tribunals, "ortrays the American "resident and his national'security adviser as the heartless villains of these events% hile 0ass ma$es a cursory ac$no&ledgement of the t&o men.s geo"olitical accom"lishments, he derides the thin$ing that informed their actions as the "roduct of aIfamiliar Cold ar chessboard%J His o&n im"licit frame&or$ is a dee"ly heartfelt and contrary vie& to !issinger.s, one that "laces human'rights concerns at the "innacle of U%S% foreign"olicy, at least in this crisis% 0ut ho& "ersuasive is 0ass.s history@ -nstead of "roducing a de3nitive account, he o/ers an ahistorical and tendentious rendition that, more often than not,lac$s a broader conte5t% He reduces a com"le5 series of overla""ing South Asian u"heavals, Cold ar alliances and di"lomatic initiatives to Ia reminder of &hat the &orld can easily loo$li$e &ithout any concern for the "ain of distant strangers%JO He faults the United States for not ta$ing a 3rmer, more "ublic stand on Fa$istan.s domestic re"ression &hile o/ering only

vague assurances that this U%S% "ressure &ould have brought about an actual im"rovement in conditions% Qoreover, he tri$ializes the%ossibility that his human rights/dominated %olicy %referencescould ha$e had %rofoundly damaging strategic conse+uences for thenited States& -ronically, in his "revious boo$ 4reedom.s 0attle, 0ass sym"athizes &ith "recisely the sort of cautionary im"ulses that animated !issinger:

O$en if a %resident or %rime minister has credible information aboutatrocities & & & there must still be a cold real%oliti* calculation aboutthe costs of inter$ening& & & & 8f a humanitarian inter$ention wouldlead to a broader international crisis" or %lunge the countryRor theworld R into a massi$e war " then most cabinets will decide that it is

'ust not worth it& & & & Helie$ing in human rights does not ma*e one

suicidal & 8n fact" he goes e$en further" allowing that the 9%oint of abalance of %ower: R!issinger.s "rinci"al "reoccu"ation in ?D?, as throughout his career as a statesmanR9is a %rofoundmoral goal it *ee%s the %eace&:P 0ut in The 0lood Telegram, he im"lies that 8i5on and !issinger should have realized that they

could have had it both &ays &ith no ris$\achieved their strategic brea$through &ith China, &ith all of its attendant geo"olitical bene3ts, and concurrently "ut human rights in EastFa$istan at the to" of their "olicy agenda% -f only life &ere that sim"le: as !issinger observes, IThe analyst runs no ris$% -f his conclusions "rove &rong, he can &rite another treatise% Thestatesman is "ermitted only one guess; his mista$es are irretrievable%J+ Thus, at a time of acute crisis, !issinger >udged that if ashington had mounted an all'out "rivate and "ublichuman'rights cam"aign against then "resident Agha Qohammad =ahya !han and the Fa$istan government, &hich &as correctly convinced that the future of the state &as at sta$e, sucha cam"aign &ould not have fundamentally altered -slamabad.s "olicy to&ard East Fa$istan, and the hite House.s China initiative could &ell have colla"sed% Ho&ever, as &ill bedemonstrated at length later in this essay, that hardly meant that he ignored the "light of the 0engali Hindus% !issinger, both &hile in o1ce and in his subse9uent &ritings, re>ected the"ro"osition that circumstances inevitably force a crude either#or choice bet&een national interests and democratic values, and during this crisis no other nation e5ce"t -ndia did as muchas the United States to directly address the human'rights tragedy in East Fa$istan% ne &ishes that the chasm bet&een academic and "olicy'ma$er "ers"ectives might have "roduced acertain modesty in 0ass.s treatment of these events% Unfortunately, it doesn.t% -nstead The 0lood Telegram o/ers a strident, almost &illfully biased attac$ on the "ersonal motives of"olicy ma$ers &hom 0ass condemns\from the comfortable "ers"ective of forty years of hindsight and an American victory in the Cold ar\for falling short of bringing about alldesirable goals simultaneously% -n 0ass.s theory, 8i5on and !issinger, motivated by a mi5ture of Iracial animus to&ard -ndians,J indi/erence to human rights and an obsessive focus on



Cold ar geo"olitics, ignored o""ortunities to save lives, ensured that Ithe United States &as allied &ith the $illersJ and incurred Ires"onsibility for a signi3cant com"licity in theslaughter of the 0engalis%J To reach his indictment of 8i5on and !issinger, 0ass "airs a myo"ic account of the 8i5on'!issinger o"ening to China and its long'term ob>ectives &ith ahighly selective rendition of U%S% "olicy to&ard the brea$u" of Fa$istan% -T -S -QFGTA8T to stress &hat 8i5on and !issinger &ere trying to accom"lish in U%S%'Chinese relations beginningin the fall of ?D*: no less than a fundamental restructuring of the global balance of "o&er and &orld order in America.s favor% 0y establishing a strategic understanding &ith 0ei>ingbased on China.s genuine &orry that the relentless Soviet military buildu" in the 4ar East could "resage an attac$ on China, they ho"ed to strengthen America.s global "osition; meet0ei>ing.s test that Ionly an America that &as strong in Asia could be ta$en seriously by the ChineseJB; incentivize Qosco& to ado"t more reasonable "olicies to&ard the United States,including in Euro"e and on arms control; bring an honorable end to the ietnam ar 2a con6ict in &hich half a million Americans &ere at &ar at the time of 8i5on.s inauguration, but&hich "ublic and elite o"inion increasingly re>ected; and reduce tensions throughout Asia% All these crucial ob>ectives\in &hich success could fairly count as both a strategic and amoral achievement\re9uired a fundamental reorientation of U%S%'Chinese relations% As !issinger observes in hite House =ears, IThe hostility bet&een China and the Soviet Unionserved our "ur"oses best if &e maintained closer relations &ith each side than they did &ith each other% The rest could be left to the dynamic of events%JD 8i5on and !issinger.s decisionin ctober ?D* 2before the Fa$istani crisis to reach out to China through the Fa$istanis is casually dismissed by 0ass as Ione of many o"tionsJ and "otentially the &orst% He suggests4rance and, curiously, totalitarian Gomania as "lausible and more ethical alternatives%?* =et the United States e5"lored all three, and 0ei>ing unambiguously chose Fa$istan% The 3rst

e5"licit indication by China that a "ersonal envoy of 8i5on &ould be &elcome in 0ei>ing came in (ecember ?D* by &ay of the Fa$istani channel, &ith Chinese "remier ]hou Enlaistressing, IThe United States $no&s that Fa$istan is a great friend of China and therefore &e attach im"ortance to the message%J?? n A"ril ), ?D?, after American re"lies throughboth Gomania and Fa$istan, 0ei>ing follo&ed u" through -slamabad and invited Idirect discussions bet&een high'level res"onsible "ersons of the t&o countries,J suggesting that the"ro"er arrangements could Ibe made through the good o1ces of Fresident =ahya !han%J?) As !issinger stresses, ]hou did not I&ant to ris$ subordinates. th&arting of our commondesign by their haggling over modalities%. 0y $ee"ing technical arrangements in the Fa$istani channel, he ensured discretion, high'level consideration, and e5"editious decisions%J?N0ass, ignoring the evident Chinese insistence on Fa$istan, attac$s the hite House.s use of =ahya !han as an intermediary as evidence of a gratuitous 8i5onian a/ection for militarystrongmen% -n addition to the strong FGC "reference for Fa$istan and the advantages of geogra"hic "ro5imity, another e5"lanation is also "ertinent: it i s di1cult to imagine ho& it couldhave been arranged for !issinger to visit 0ei>ing secretly from either Faris 2a &orld ca"ital or 0ucharest 2a "rime target of Soviet "enetration; secrecy &as an essential re9uirementsince 8i5on could ris$ neither "remature U%S% domestic eu"horia nor a "ublic failure in 0ei>ing% 8othing regarding this highly sensitive matter lea$ed from Fa$istan, and =ahya !handiscreetly managed the com"le5 arrangements to get !issinger secretly from -slamabad to 0ei>ing, as ]hou had suggested% The late great Harvard historian Ernest Qay once observed,Ihat a historian chooses to leave out or minimize is often as im"ortant and telling as &hat he decides to include%J?O ne must &onder if 0ass discounts the clear Chinese "referencefor =ahya !han as the intermediary bet&een 0ei>ing and ashington because ac$no&ledging it &ould undermine one of his core assertions: that 8i5on and !issinger could have o"enlycondemned or even attem"ted to unseat the Fa$istani "resident &ithout endangering the o"ening to China% -n his boo$, 0ass never directly confronts a series of ma>or 9uestions: -f he$ne& that the o"ening to China &ould have faltered, as 8i5on and !issinger feared, because of U%S% "ressure on =ahya over the atrocities in East Fa$istan, &ould he nevertheless haveforced a sho&do&n &ith Fa$istan over the "light of Hindu 0engalis@ ould he have been content to face an outcome in &hich the China initiative colla"sed even as Fa$istan re>ectedAmerican demands as irrelevant@ ould the ne5t ste" have been sanctions against Fa$istan, or "erha"s American su""ort for the 0engali insurgency\and &hat other results &ouldthese "olicies have entailed@ Statesmen have to ma$e such choices; "rofessors do not% To duc$ these 9uestions, 0ass must im"licitly "osit an alternative rosy scenario in &hich 8i5onand !issinger are able to establish an e9ually e/ective channel to 0ei>ing &hile bringing about a s&ift im"rovement in Fa$istan.s domestic conditions% 0ut &hat &ould the Chinesereaction have been if the United States had informed an adversary of t&o decades at an enormously delicate moment that its &atershed invitation to im"rove relations had beenmisdirected and that the =ahya !han channel &as unacce"table to ashington@ hat if those &ithin the Chinese government &ho had &ished to sabotage the "ossibility of an o"eningto the United States had used this U%S% s&itch in channels to delay !issinger.s visit@ ho could have $no&n ho& long ]hou &ould be in a su1ciently strong bureaucratic "osition to"ursue a brea$through &ith ashington@ 2-n fact, >ust t&o years later, he &as Istruggled againstJ by ultraleftists and "urged% ho could have been sure that Qao ]edong, al&aysmercurial and then in e5ceedingly "oor health, &ould not reverse course and see$ to solve his Soviet "roblem through ra""rochement &ith Qosco&@ And &hat conclusions might 0ei>inghave dra&n regarding American credibility if 8i5on and !issinger, as 0ass advises, had dramatically changed course and abandoned a longtime ally during the de3ning crisis of itsinde"endent e5istence@ AS 8-q8 A8( !-SS-87EG had &arned, the crisis in East Fa$istan "roduced escalating -ndian'Fa$istani tensions, &hich culminated in &ar in (ecember ?D?%

-ndia, bac$ed by a freshly signed -ndo'Soviet friendshi" treaty &ith military clauses and an active Soviet su""ly line, crushed Fa$istani forces in East Fa$istan and recognized 0angladeshas an inde"endent state% Fressing their advantage, to" -ndian o1cials considered ob>ectives in est Fa$istan including a total destruction of Fa$istani military "o&er and 2as 0ass himself notes Iother &ays to crac$ u" est Fa$istan itself%J?P This outcome could have inaugurated an ominous "recedent in international order\the destruction of a sovereign state by foreignmilitary action\&ith conse9uences that &ould reverberate far beyond the immediate humanitarian crisis% -f -ndia succeeded, !issinger &arned during the crisis: The result &ould be anation of ?** million "eo"le dismembered, their "olitical structure changed by military attac$, des"ite a treaty of alliance &ith and "rivate assurances by the United States% And all theother countries, on &hom &e have considered &e could rely % % % &ould $no& that this has been done by the &eight of Soviet arms and &ith Soviet di"lomatic su""ort% hat &ill be thee/ect in the Qiddle East, for e5am"le\could &e tell -srael that she should give u" something along a line from A to 0, in return for something else, &ith any "lausibility@?+ And ho&&ould China have reacted if ashington had stood by "assively and &atched 0ei>ing.s chosen channel to the United States and longtime friend crushed by a combination of -ndianmilitary action and Soviet &ea"ons@ hat then for Qao.s &illingness to "ursue the o"ening of U%S%'Chinese relations@ See$ing to deter such a destructive outcome, the United Statesde"loyed an aircraft carrier to the 0ay of 0engal 2&here it &as >oined by a Soviet naval tas$ force de"loyed from ladivosto$ and "ushed for an immediate U8'bac$ed cease'3re% ithmilitary aid to Fa$istan frozen, the hite House encouraged allies to ma$e sho&s of force, including a bac$'channel "ro"osal in &hich -ran and ordan &ould transfer some of their o&nAmerican'made 3ghter >ets to the est Fa$istan front% 0ass e5"resses indignation at this "ro"osal, suggesting that it &as underta$en to assist in the re"ression of civilians in EastFa$istan% He fails to e5"lain that the discussion involved transferring >ets to est Fa$istan during a &ar in &hich -ndia &as considering a drive for total victory and an all'out destructionof the Fa$istani armed forces% -n any case, it is not a""arent &hat military role, if any, the "lanes "layed in the con6ict%? -n 0ass.s vie&, these actions constituted a "erverse betrayal ofdemocratic "rinci"les by 8i5on and !issinger\American "artici"ation in I!issinger.s secret onslaughtJ and an Iarsenal against democracyJ that drove -ndia into the arms of the SovietUnion and Ienduringly alienated not >ust -ndira 7andhi % % % but a &hole democratic society%J?B 0ut this insults the so"histication and agency of the main -ndian "layers, in addition tomisre"resenting the actual se9uence of events% Scholars &ill long marvel at ho& the &orld.s t&o largest democracies ended u" on o""osite sides of the Cold ar% =et their rift &asgro&ing &ell before the ?D? Fa$istan crisis, and it transcended Gichard 8i5on and -ndira 7andhi.s mutual "ersonal disli$e% 8egotiations over the -ndo'Soviet friendshi" treaty had begunby Qarch ?D+D, &hen the Soviet defense minister brought a draft treaty te5t to 8e& (elhi% A draft te5t &as ready by mid'?D*, though by some -ndian accounts its signing &as"ost"oned "ending the -ndian election% According to one -ndian "artici"ant in the negotiations, all that remained to be negotiated at this "oint &as the 3nal &ording of the decisivemilitary clause%?D The ?D? crisis did strain U%S%'-ndian relations\yet this &as largely because ashington and 8e& (elhi had incom"atible strategic as"irations% ashingtonincreasingly acce"ted that East Fa$istan &ould become autonomous or inde"endent, but o""osed an outcome in &hich this &as achieved through a regional &ar or &ith Soviet arms%-ndia, "ursuing a so"histicated blend of humanitarian im"ulses and Qachiavellian calculation, o"ted almost immediately for a military solution% As 0ass himself notes, In Qarch ), overthree &ee$s before =ahya launched his slaughter, -ndira 7andhi ordered her best and brightest % % % to evaluate giving hel" to 0angla (esh. and the "ossibility of recognizing an

inde"endent 0angla (esh%.J 0engali "artisans, she assessed, &ould need aircraft for I9uic$ movement inside -ndia around the borders of 0angla (eshJ and Iarms and ammunition2including Light Qachine 7uns, Qedium Qachine 7uns and QortarsJ\in other &ords, -ndian military su""ort for a cross'border se"aratist insurgency%)* At the beginning of A"ril?D?, -ndira 7andhi re"ortedly told her cabinet that I&e don.t mind a &arJ and ordered the -ndian army to "re"are for an invasion of East Fa$istan% According to one high'ran$ing -ndiano1cer 9uoted by 0ass, she ordered them to Imove inJ immediately% hen the army bal$ed at invading a 6ood "lain on the eve of a monsoon, a com"romise solution &as reached: -ndianconventional forces &ould "re"are to enter East Fa$istan around Ithe 3fteenth of 8ovember,J and in the meantime -ndia &ould "rovide 0engali se"aratists &ith Imaterial assistanceJand Itraining in guerilla tactics, to "re"are for a long struggle%J)? 0engali guerilla units\organized, trained and armed by - ndia\o"erated from border sanctuaries throughout thesummer and fall, bac$ed u" by occasional -ndian 3re"o&er and at least one cross'border -ndian raid%)) The United States\including !issinger, in his tri" to 8e& (elhi in uly ?D?, and8i5on, during his 8ovember summit &ith -ndira 7andhi\"ressed -ndia to refrain from "rovocations on the border and argued that &ar &ould be best avoided if all "arties committed to a"eaceful "olitical trac$% -ndia, convinced that it had both a moral obligation and a historic strategic o""ortunity to act, denied its covert assistance to the 0engali insurgency and insistedthat the "roblem &as Fa$istan.s to solve% -ndira 7andhi refused American re9uests to send U%S% or U8 observers to hel" administer refugee aid 2in retros"ect, most li$ely because t&oambitious -ndian "rograms &ere "roceeding simultaneously among the refugee "o"ulation\one humanitarian and the other covert% Each democracy could claim to have achieved asigni3cant "ortion of its goals% hile &elcoming and feeding millions of refugees, -ndia succeeded in s"litting East and est Fa$istan by force and emerging as the mid&ife of aninde"endent 0angladesh% The United States, after attem"ting to head o/ a &ar through both humanitarian measures and di"lomacy, successfully deterred a ma>or -ndian cam"aignagainst est Fa$istan &hile "reserving its course of ra""rochement &ith China and dtente &ith the Soviet Union% C-8C-(-87 -TH these events &as a violent i nternal crisis inFa$istan% n Qarch )P, ?D?, after the colla"se of com"romise tal$s bet&een East and est Fa$istani "oliticians, Fa$istani forces began "eration Searchlight, a systematic "lan toeliminate all resistance in East Fa$istan through an over&helming a""lication of force% This occurred >ust as 8i5on and !issinger &ere a&aiting a de3nitive re"ly from China to messagessent that &inter through Fa$istan and Gomania concerning a "ros"ective high'level bilateral meeting in 0ei>ing 2a re"ly that arrived in A"ril through the Fa$istani channel% -n 0ass.saccount, an obsessive and un&arranted desire to "reserve Fa$istan as a conduit for the unfolding U%S%'Chinese ra""rochement translated into Ia green light for =ahya !han.s $illingcam"aign%J)N -n this version of events, the o"ening to China, &hile Ian e"ochal event,J &as done at the cost of American com"licity in genocide, as Ithe 0engalis became collateraldamage for realigning the global balance of "o&er%J)O This incendiary accusation confuses both the order of events and the ability of governments to bring about ra"id changes in otherstates. internal "ractices% To blame the hite House for failing to secure a "eaceful outcome to the &inter ?D? East'est Fa$istan "olitical im"asse, as 0ass does\much less to e9uatethis failure &ith com"licity in genocide\sets the bar illogically high% The results of the ?D* election raised fundamental 9uestions about Fa$istan.s viability as a uni3ed state% Themilitary\already am"ly armed and e9ui""ed by China, 4rance, the Soviet Union and the United States under 8i5on.s "redecessors\unsur"risingly declared its refusal to abide an East'est s"lit% ould "reem"tively Ithreatening to cut o/ aidJ have moderated the generals in charge of managing the transition to democracy, or reinforced a sense of siege@)P 0ass neverseriously considers &hether, given Fa$istan.s e5isting geogra"hic, ethnic and "olitical divisions, the United States could have "revented its t&o &ings. slide to&ard violent dissolution%)+

-n their &idely res"ected study ar and Secession: Fa$istan, -ndia, and the Creation of 0angladesh\based on intervie&s &ith -ndian, Fa$istani and 0angladeshi "artici"ants in theseevents\scholars Gichard Sisson and Leo Gose assessed that the American ca"acity to sha"e events &ithin Fa$istan at this time &as, in fact, limited: The 9uestion remains &hether =ahya&ould have res"onded to a strong "ublic condemnation of the crac$do&n by moderating his re"ressive "olicy in East Fa$istan% The general consensus, even among the critics in thegovernment, &as "robably not% Fro>ected U%S% military and economic aid to Fa$istan in ?D? &as not of a magnitude to "rovide ashington &ith much leverage to "ressure theleadershi" in Ga&al"indi to change "olicies in East Fa$istan to avoid the loss of aid% % % % 0y ?D? ashington lac$ed much clout in Ga&al"indi, "articularly on issues that, in estFa$istani eyes, struc$ at the very basis of their national e5istence%) n the "articular issue of American arms transfers to Fa$istan, the total U%S% cuto/ of the long'term &ea"ons"i"eline 2&hich in any case &as e5ceedingly modest "redictably had no a""reciable e/ect on the ethnic'cleansing actions of the Fa$istani army in East Fa$istan% As &e have seenrecently &ith res"ect to Egy"t, such U%S% "unishing actions have a "oor record of actually in6uencing foreign governments that believe that they are 3ghting for the fundamental futureof their countries% Even so, 0ass has scoured the record for coarse 9uotations to bac$ his biased and incendiary charges, sideste""ing 2and seeming "ur"osefully to avoid am"leevidence that 8i5on and !issinger "ursued a far more balanced and constructive course\one in &hich the United States emerged as the leading donor and organizer of East Fa$istan.scyclone relief; "rovided hundreds of thousands of tons of grain and e5tensive emergency su""lies and 3nancial assistance to "revent a famine in East Fa$istan and among refugees in-ndia; attem"ted through di"lomacy and "ressure to avert an -ndian'Fa$istani con6ict; and then, &hen &ar bro$e out, "ressed for an early U8's"onsored cease'3re to "revent the 3ghtingfrom encom"assing est Fa$istan% All this &as achieved &hile carrying out a historic o"ening to China and ultimately "romoting dtente &ith the Soviet Union, &hich bac$ed -ndia duringthe con6ict% -t ta$es an obsessively strained reading to 3nd in this record, as 0ass does, Ione of the &orst moments of moral blindness in U%S% foreign "olicy%J)B Quch of the force of0ass.s narrative derives from vivid, often'in6ammatory 9uotations from the 8i5on ta"es, and there is no shortage of those% 8o crass 8i5on statement or sarcastic aside seems to havegone un9uoted% =et "residential vulgarity &as hardly a 8i5on innovation% (&ight Eisenho&er s&ore li$e the troo"er he &as% At a ?DPN summit &ith inston Churchill, Eisenho&erdismissed Churchill.s advice to engage the "ost'Stalin Soviet leadershi", stating 2as Churchill.s "rivate secretary recorded that IGussia &as a &oman of the streets and &hether her



dress &as ne&, or >ust the old one "atched, it &as certainly the same &hore underneath% America intended to drive her o/ her "resent beat. into the bac$ streets%J)D Lyndon ohnsononce "ressed a "oint &ith the 7ree$ ambassador as follo&s: I4 your Farliament and your Constitution, America is an ele"hant, Cy"rus is a 6ea% 7reece is a 6ea%JN* -n short, 0assa""ears to be curiously o/ended that conversations in the val 1ce are often not the stu/ of a church social% 4UGTHEGQGE, 0ASSS treatment of some sources suggests that he has"rivileged outrage over accuracy% 4or e5am"le, he recounts a uly N*, ?D?, Senior Gevie& 7rou" meeting convened to discuss American "olicy in South Asia as follo&s: -n a SituationGoom meeting, !issinger defended the "resident.s man% Ie.re not out of gas &ith =ahya,J he said% I=ahya &ill be reasonable%J He "referred to be gentle &ith =ahya, not hectoring ors9ueezing him% hen a State (e"artment o1cial suggested getting the army out of running East Fa$istan, !issinger stood u" for Fa$istan.s sovereignty: Ihy is it our business to tellthe Fa$istanis ho& to run their government@JN? Heartless real"oliti$@ 8ot 9uite% 8o reader of 0ass.s account &ould guess that !issinger &as actually discussing ho& to resolve a refugeecrisis and deliver emergency American food aid to the 0engali "o"ulation% Ges"onding to the argument that a "ush for "olitical reconciliation should "recede further humanitarianassistance, !issinger argued that the threat of a famine &as too urgent: Ie.re not out of gas &ith =ahya% - thin$ he &ill do a lot of things that are reasonable if &e concentrate on therefugee "roblem% ne thing he &ill not do is tal$ to the A&ami League, at least not as an institution% He might tal$ to some League leaders as individuals%JN) The immediate focus,!issinger insisted, should be on "roviding food aid: n famine relief, &e must get a "rogram started under any and all circumstances% -f famine develo"s, it &ill generate another ma>orout6o& of refugees% This is one thing &e can do something about% - thin$ &e can get considerable Fa$istani coo"eration on this% % % % 0ut the famine &ill start in ctober% Under the best

"ossible scenario, "olitical accommodation &ill have barely begun in ctober%NN As for a colleague.s argument that the United States should Ita$e the Fa$istani army out of the civiladministrationJ because a civilian "resence &ould encourage refugees to return, !issinger as$ed: Ie can a""ro"riately as$ them for humanitarian behavior, but can &e tell them ho& torun things@JNO The United States, he argued, &as better o/ dealing &ith an e5isting government and insisting that it acce"t American food relief and logistical guidance: -f &e are faced&ith a huge famine and a huge ne& refugee out6o& in ctober and &e.re still debating "olitical accommodation, &e.ll have a heluva lot to ans&er for% e need an emergency relief "lanand &e need to tell =ahya that this is &hat has to be done to get the su""lies delivered% =ahya &ill be reasonable%NP 8one of this discussion emerges in the 0ass account, &hich s"licesout'of'conte5t 9uotations to recast a discussion of emergency humanitarian assistance into a scene of careless indi/erence to su/ering% Similar misre"resentations recur throughout theboo$% 0ass also glosses over the action "oints decided u"on in the meeting, &hich included agreement to "re"are Ia com"rehensive relief "rogram for East Fa$istan, including &hat hasalready been moved and &here the bottlenec$s areJ as &ell as Ia telegram, to be a""roved by the Fresident, outlining an a""roach to =ahya telling him &hat needs to be done onrefugees, food relief, etc%JN+ Even as delicate di"lomacy unfolded, 8i5on and !issinger made re"eated a""eals to the Fa$istani military to moderate its domestic "ractices and see$"olitical com"romise% -n Qay ?D?, 8i5on &rote to =ahya !han "ressing him to $ee" the "eace &ith -ndia and honor his "ledges of a transition to civilian governance% 8i5on &arned thatthis &as both a humanitarian matter and a strategic im"erative: - have also noted &ith satisfaction your "ublic declaration of amnesty for the refugees and commitment to transfer"o&er to elected re"resentatives% - am con3dent that you &ill turn these statements into reality% - feel sure you &ill agree &ith me that the 3rst essential ste" is to bring an end to thecivil strife and restore "eaceful conditions in East Fa$istan% % % % -t is absolutely vital for the maintenance of "eace in the Subcontinent to restore conditions in East Fa$istan conducive tothe return of refugees f rom -ndian territory as 9uic$ly as "ossible%N The same &ee$, the American ambassador, ose"h 4arland 2a "olitical a""ointee &ho &as "ersonally close to 8i5on,met &ith =ahya !han in !arachi and told him that Ithe 3rst necessity &as to sto" the shooting and to start the rebuilding%JNB Citing re"orts from (acca of atrocities and attac$s on EastFa$istan.s Hindu minority, 4arland &arned that I&ithout the creation of normal conditions in the East, a rene&ed sense of "hysical security among the Hindu community, and a "atentmovement &ith substance behind it to&ard a "eaceful "olitical accommodation % % % the refugee "roblem &ill continue%J A continuation of the "resent course &ould "roduce anIescalation of -ndo'Fa$ tensionsJ and increasing anti'Fa$istani sentiment in the United States% 4arland concluded his conversation by urging !han to state "ublicly his commitment Itoe/ect "olitical reconciliation%JND T&o &ee$s later 4arland met again &ith =ahya !han and reiterated these "oints in shar"er terms% As he cabled bac$ to ashington: - &ent on to notethat the 6o& of refugees continued and that this 6o& is sym"tomatic of the serious situation in East Fa$istan% - "ointed out that the Embassy continued to receive re"orts of Hinduvillages being attac$ed by the army, that fear is "ervasive, and that until this situation changes the refugees &ill continue to cross over into -ndia% And - reiterated the United States7overnment.s concern that at some "oint the Hindu e5odus, if not chec$ed, could lead to a military clash &ith -ndia% 4arland admonished !han that Ia heavy res"onsibility still rests onFa$istanJ: Ine could hardly e5"ect the 6o& to cease until the level of military activity by the army is reduced and re"ressive measures against the local "o"ulation, es"ecially theHindus, &as ended%JO* These &arnings continued even during !issinger.s landmar$ secret tri" to 0ei>ing in uly ?D?% -n Ga&al"indi, on the eve of his unannounced de"arture for acountry &here no American di"lomat had been for t&o decades, !issinger admonished Fa$istan.s foreign secretary that I million refugees are an intolerable burden% They overload an

already overburdened -ndian economy, "articularly in eastern -ndia% The -ndians see enormous danger of communal riots%J Unless Fa$istan could chart a "ath bac$ to InormaladministrationJ and a "eaceful return of refugees, the li$ely result &ould be a Imilitary confrontationJ &hich Ithe -ndians feel they &ould &in%JO? arning that a failure to im"rovedomestic conditions &ould result in a catastro"hic defeat by a historic adversary hardly counts as soft'"edaling the issue% This issue of "rivate U%S% admonitions versus "ubliccondemnations of other governments is, of course, familiar% Similar 9uestions have loomed over America.s recent attem"ts to moderate "olitical u"heavals in friendly countries such as0ahrain and Egy"t 2both &ith American'trained and 'su""lied armed forces res"onding, at times brutally, to &hat they regarded as e5istential internal crises% 0ut these are "olicydilemmas, not crimes% Under 0ass.s de3nition of Icom"licityJ &ith atrocities, fe& "ractitioners of American foreign "olicy &ould esca"e unindicted% THE 4ACT that the "artition of Fa$istanin ?D? involved such catastro"hic loss of human life must count among the second half of the t&entieth century.s greatest tragedies% 0ut 0ass.s "olicy "rescri"tions seem li$ely to havebrought about the &orst "ossible outcomes\a delay, if not a ru"ture, in the U%S% o"ening to China; no easing of the tragic "light of the Hindu 0engalis; and "otentially even the com"letedisintegration of the Fa$istani state itself, sending arms, trained 3ghters and another round of refugees into already'unstable South Asia and setting a dangerous "recedent for otherregional con6icts% 4ortunately, none of this ha""ened% -n hite House =ears, !issinger observes, IThe character of leaders is tested by their &illingness to "ersevere in the face of

uncertainty and to build for a future they can neither demonstrate nor fully discern%JO)Ni7on and Qissinger surely met thattest during the South Asia crisis of 10@1& .heir geo%oliticala%%roach " which Hass derides" %roduced an e7traordinarily%roducti$e Ni7on $isit to China in Bebruary 10@= and the signing ofthe Shanghai Communi+u " which ser$es as the basic framewor* forthe two countries) relations to this day5 a broad" bi%artisan &S&

%olicy a%%roach to China that has lasted for more than forty yearsand has %romoted %eace and stability throughout Asia5 ma'or &S&-Chinese intelligence coo%eration against the SS,5 and a ay 10@=Ni7on-Hrezhne$ summit in oscow that saw the signing of the Anti-Hallistic issile .reaty" the #rst Strategic Arms Limitation .reaty andthe &S&-So$iet incidents-at-sea agreement " all hallmar*s of adtente that reduced the ris* of su%er%ower confrontation e$enwhile creating conditions that hel%ed undermine the So$iet nion)smoral and geo%olitical claims and bring about its destruction& 0ass &ould have

readers believe that all these historic U%S% foreign'"olicy accom"lishments &ere &ritten in the stars, irres"ective of U%S% "olicy to&ard Fa$istan in ?D?\and that only grotes9uecallousness "revented 8i5on and !issinger from adding an ab>ect ca"itulation by the Fa$istani government and a conse9uent radical transformation of -slamabad.s human'rights recordto their tally of achievements% 4riedrich 8ietzsche &rote that Iman.s most enduring stu"idity is forgetting &hat he is trying to do%J e should be grateful that Gichard 8i5on and Henry

!issinger did not forget &hat they &ere trying to do during this crisis regarding China, the Soviet Union, South Asia and the global balance of "o&er%

Eigh magnitude" low %robability scenario %lanning li*enuclear warD is %roducti$e in 8,

Timothy Funio 13, cybersecurity "ostdoctoral fello& at C-SAC, Fh( in "olitical

science from the University of Fennsylvania, and Thomas Qahn$en, 8aval arCollege, IConceiving of 4uture ar: The Fromise of Scenario Analysis for



-nternational GelationsJ, Se"tember, -nternational Studies Gevie& olume ?P, -ssueN, "ages NO<NDP

.his articleintroduces %olitical scientists to scenarios\futurecounterfactuals\and demonstrates their $alue in tandem &ith other methodologies and across awide range of research +uestions% The authors describe best "ractices regarding the scenario method and argue that scenarios

contribute to theory building and de$elo%ment " identifying new

hy%otheses " analyzing data-%oor research to%ics " articulating

9world $iews ": setting new research agendas " a$oiding cogniti$e

biases " and teaching % The article also establishes the low rate at which scenarios are

used in the international relations sub#eld and situates scenarios inthe broader conte7t of %olitical science methods% The conclusion o/ers t&o detailed e5am"les of the e/ective use of

scenarios%̂ -n his classic &or$ on scenario analysis, The Art of the Long ie&, Feter Sch&artz commented that Isocial scientists often ha$e a hardtime Vbuilding scenariosX5 they ha$e been trained to stay away from(what if) +uestions and concentrate on (what was.J 2Sch&artz ?DD+:N?% hile Sch&artzs comments &ere

im"ressionistic based on his years of conducting and teaching scenario analysis, his claim & ithstands em"irical scrutiny%ScenariosRcounterfactual

narrati$es about the futureRare woefully underutilized among

%olitical scientists% The method is almost never taught on graduate student syllabi, and a survey of leading international relations 2-G >ournals indicates that scenarios &ere used in only N*)

of ?B,+O sam"led articles% .he low rate at which %olitical scientists use scenarios\less than ) of

the time\is sur%rising5 the method is %o%ular in 3elds as dis"arate as business, demogra"hics, ecology, "harmacology, "ublic health, economics,

and e"idemiology 2enable, Li, 7inter, and (uncan ?DDN; Leuf$ens, Haai>er'Gus$am", 0a$$er, and (u$es ?DDO; 0a$er, Hulse, 7regory, hite, an Sic$le, 0erger, (ole, and Schuma$er )**O; Sanderson, Scherbov, 8eill, and Lutz

)**O%Scenarios also are a common tool em%loyed by the %olicyma*ers

whom %olitical scientists study& G .his articlesee*s to ele$ate the status of

scenarios in %olitical science by demonstrating their usefulness for

theory building and %edagogy & ,ather than constitute meres%eculation regarding an un%redictable future , as critics might suggest,scenarios

assist scholars with de$elo%ing testable hy%otheses , gathering data, and identifying a theorys u""er and

lo&er bounds% Additionally, scenarios are an eecti$e way to teach students to a%%ly

theory to %olicy% -n the "ages belo&, a Ibest "racticesJ guide is o/ered to advise scholars, "ractitioners, and students, and an argument is develo"ed in favor of the use of scenarios% The a rticle

concludes &ith t&o e5am"les of ho& %olitical scientists ha$e in$o*ed the scenario method to

im%ro$e the s%eci#cations of their theories" %ro%ose falsi#ablehy%otheses" and design new em%irical research %rograms& G Scenarios in the (isci"line^

;hat do counterfactual narrati$es about the future loo* li*e Scenarios may range in

length from a fe& sentences to many "ages%

!ne of the most common use s of the scenario method, &hich &ill be referenced throughout this article,

isto study the conditions under which high-conse+uence " low-

%robability e$ents may occur& Perha%s the best e7am%le of this is

nuclear war fare " a circumstance that has ne$er resulted" but has

ca%ti$ated generations of %olitical scientists& 4or an introductory illustration, let us consider a very

sim"lescenario regarding how a #rst use of a nuclear wea%on mightoccur:^ (uring the year )*)N, the US military i s ordered to launch air and sea "atrols of the Tai&an Strait to aid in a crisis% These highly visible "atrols disru"t trade o/ Chinas coast, and result in s$yroc$eting insurance



rates for shi""ing com"anies% Several days into the contingency, &hich involves over ten thousand US military "ersonnel, an intelligence estimate concludes that a Chinese conventional stri$e against US air "atrols and naval assetsis imminent% The United States conducts a "reem"tive stri$e against anti'air and anti'sea systems on the Chinese mainland% The US stri$e is far more successful than Chinese military lea ders thought "ossible; a ne& source ofintelligence to the United States\un$no&n to Chinese leadershi"\allo&ed the US military to severely degrade Chinese targeting and situational a&areness ca"abilities% Qany of the & ea"ons that China relied on to dissuadeescalatory US military action are no& reduced to single'digit'"ercentage readiness% Estimates for re"airs and re"lenishments are stated in terms of &ee$s, and Chinas con3dence in readily available, but Idumber,J &ea"ons is lo&due to the dis"ersion and mobility of US forces% ord of the successful US stri$e s"reads among the Chinese and Tai&anese "ublics% The Chinese 7overnment concludes that for the sa$e of "reserving its domestic strength, and tosignal resolve to the US and Tai&anese 7overnments &hile minimizing further economic disru"tion, it should escalate dramatically &ith the use of an e5tremely small'yield nuclear device against a stationary US military asset in the

Faci3c region%^ .his short story reIects a future e$ent that" while unli*ely to occur and far too

vague to be used for military "lanning, contains many dimensions of %olitical science theory &

.hese include the follo&ing:what leaders %ercei$e as 9limited":9%ro%ortional": or 9escalatory: uses of force5 the im%ortance of "rivate

information about ca%abilities and commitment; audience costs in international "olitics; the relationshi%between military e7%ediency and %olitical ob'ecti$es during war5and the role of com%ressed timelines for decision ma*ing , among others% .he%ur%ose of this article is to e7%lain to scholars how such stories " and morerigorously de$elo%ed narrati$es that s%ecify $ariables of interest

and draw on e7tant data" may im%ro$e the study of 8, & An im"ortant starting "oint is to e5"lain ho&

future counterfactuals 3t into the methodological canon of the disci"line%

!ur ris* assessment critical to transforming the %ublic s%hereRleads to democratic decision ma*ingHorraz" =??@ L--EG 0GGA] Centre de Sociologie des rganisations,Sciences Fo'C8GS, Faris, IGis$ and Fublic Froblems,J ournal of Gis$ Gesearch, ?*, ,ct )**, DO?'DP

These studies seem to suggest that ris* is a way of framing a %ublic %roblem insuch a way as to %oliticize the search for solutions% This "oliticization entails, in

"articular, a &idening of the range of sta$eholders, a reference to broader "olitical issues and debates, the searchfor ne& decision' ma$ing "rocesses 2either in terms of democratization, or rene&ed scienti3c e5"ertise, and thee5"licit mobilization of non'scienti3c arguments in these "rocesses% 0ut if this is the case, then it could also be truethat ris$ is sim"ly one &ay of framing "ublic "roblems% Studies in the ?DD*s, in "articular, sho&ed that a &holerange of social "roblems 2e%g%, "overty, housing, unem"loyment had been reframed as health issues, &ith theresult that their management &as transferred from social &or$ers to health "rofessionals, and in the "rocess &as

described in neutral, de"oliticized terms 24assin, ?DDB% Studies of ris* , on the contrary, seem to

suggest that similar social %roblems could well be re-%oliticized , i%e%,

ta$en u" by ne& social movements, "roducing and using alternative scienti3c data, calling for more deliberativedecision'ma$ing "rocedures, and clearly intended to "romote change in the manner in &hich the state "rotects the"o"ulation against various ris$s 2health and environment, but also social and economic% -n other &ords,

framing %ublic %roblems as ris*s could aord an o%%ortunity for atransformation in the %olitical debate" from more traditionalclea$ages around social and economic issues" to rifts stemmingfrom antagonistic $iews of science" democracy and the world order &



=NC O7t Z3 -- BoJ >oodJeath must be %re$entedPaterson 3 ' (e"artment of Fhiloso"hy, Frovidence College, Ghode -sland Craig,IA Life 8ot orth Living@J, Studies in Christian Ethics, SA7E

Contrary to those accounts, - &ould argue that it is death "er se that is really the

ob'ecti$e e$il for us, not because it de"rives us of a "ros"ective future of overall good >udged better than

the alternative of non'being% -t cannot be about harm to a former "erson &ho has ceased to e5ist, for no "erson

actually su/ers from the sub'se9uent non'"artici"ation% Gather, death in itself is an e$il to us

because it ontologically destroys the current e7istent sub'ect R it is

the ultimate in meta%hysical lightening stri*es& B* The evil of death is

truly an ontological e$il borne by the %erson who already e7ists "

inde%endently of calculations about better or worse %ossible li$es&Such an e$il need not be consciously e7%erienced in order to be an

e$il for the *ind of being a human %erson is& Jeath is an e$ilbecause of the change in *ind it brings about " a change that isdestructi$e of the ty%e of entity that we essentially are& Anything,

&hether caused naturally or caused by human intervention 2intentional or unintentional that drasticallyinterferes in the %rocess of maintaining the %erson in e7istence is

an ob'ecti$e e$il for the %erson% hat is crucially at sta$e here, and is dialectically su""ortive

of the self'evidency of the basic good of human life, is that death is a radical interferencewith the current life %rocess of the *ind of being that we are % -n

conse9uence, death itself can be credibly thought of as a (%rimiti$e e$il)for all %ersons" regardless of the e7tent to which they are currently

or %ros%ecti$ely ca%able of %artici%ating in a full array of the goodsof life& B? -n conclusion, concerning willed human actions, it is >usti3able to state that

any intentional re'ection of human life itself cannot therefore bewarranted since it is an e7%ression of an ultimate dis$alue for thesub'ect" namely, the destruction of the %resent %erson 5 a radicalontological good that we cannot begin to weigh ob'ecti$ely againstthe tra$ails of life in a rational manner& .o deal with the sources of

dis$alue 2"ain, su/ering, etc% we should not see* to irrationally destroy the

%erson " the $ery source and condition of all human %ossibility%

Jeath doesn)t *ey to <.LEri$ ,ingmar 0, London School of Economics, In the ntological Status of theState,J htt":##&&&%ringmar%net#&ritings#Eri$)*Gingmar,)*n)*the)*ntological)*Status)*of)*the)*State%"df

Such loose a"ocaly"tic tal$ is, ho&ever, not in itself evidence of the end of sub>ectivity % -n fact thevery o""osite conclusion could be dra&n% -t should, after all, not sur"rise us that an ontology based on



narratives &ill be "rofoundly "reoccu"ied &ith endings 2!ermode, ?D++: DN'?)O% The end is , after all , &hat ma$esthe story "ossible in the 3rst "lace, and by envisioning this end &e ma$e storiesma$e sense% This $ind of envisioning is, - &ould argue, "recisely &hat the discussion regarding the end of sub>ectivity is all

about% There is, in other &ords, a fundamental, yet highly ambiguous relationshi" bet&een the end of

the stories &e tell about our sel$es R death R and the meanings &e attach to

our lives% !n the one hand" death means the destruction of our sel$es%hen our story is over &e &ill no longer be, and for this reason death constantly threatens to ma$e every moment of the storyleading u" to it lose its meaning% (eath may terrify us for the sim"le reason that &e never &ill be in a "osition to tell the story of

&hat it &as li$e to go through it% (eath cannot be emasculated through narrative since death is the end of the narrative% !nthe other hand" howe$er" death is also a "rere9uisite of all stories% The story&ould not be if it did not end some&here, and thus &e \ the sub>ects &ho a""earin, and through, it \ &ould not be either % This does not mean that death is themeaning of life, but it does mean that death ma$es a meaningful life "ossible % econstantly need to envision the end of our story since only the end can ma$e senseof, and give legitimacy to, the "resent% This is true not only for our individual but also for our collective

selves, and it e5"lains &hy "olitics needs its Uto"ias and &hy intellectuals constantly"ro"hesy the end of this, that or the other % ill sub>ectivity, then, ever come to a 3nal end@ ill individual

and collective selves one day no longer be@ Ferha"s, "erha"s not% hat is certain, ho&ever, is that &hile the content that &e give toour selves \ the "lots that &e construct about our lives \ &ill change dramatically in the future >ust as they have changeddramatically in the "ast, a self &ill e5ist as long as stories are told about it% To envision an end to these stories is a crucial "art of&hat it means to understand a story and as such a "rere9uisite of sub>ectivity &hich in fact has very little to do &ith its eventualdemise%

Bear of death doesn)t cause lashoutLangford 3 2-an, Centre for Social and Economic Gesearch on the 7lobalEnvironment School of Environmental Sciences University of East Anglia andUniversity College London, A8 Eq-STE8T-AL AFFGACH T G-S! FEGCEFT-8

The above case studies sho& that other %ers%ecti$es on ris* %erce%tion can be

gained by e7amining underlying e7istential an7ieties, and e5istential analysis

can "rovide a lin$ between widely diering ris* issues and across $ery dierent

methodologies% E5istential analysis is, of course, only one of a number of theoretical and "ractical

a""roaches that can be ta$en to&ards ris$s, but it is "otentially ca%able of transcending the

dierence between cultures and histories & ;hilst the challenges

and ris*s "osed by living today in a techno-logically ad$anced society are$ery dierent from those faced a thousand years ago in the same

geogra%hical locations, the e7istential an7ieties remain the same" as

they are a common %ro%erty of being human " although co%ing

strategies may change somewhat% Qillenium an5iety. in ?DDD &as not so di/erent from that

dis"layed in DDD A(% 4urther, e7istential analysis can reIect on the societal

challenges %osed by ( modern) ris*s as well as the indi$idual

ada%tations re+uired in order to sur$i$e in the =1st century& 7iddens

2?DD? lin$s e5istential an5iety to loss of trust, and 0ec$ 2?DDD comments on ho& the orld Gis$ Society brings"eo"le together as &ell as se"arating them though the o"eration of the global "olitical economy% There are &inners

and losers, but all are beginning to %lay on the same #eld& Although cross'cultural



com"arisons are not the focus of this "a"er, it is &orth mentioning that from research conducted in the U!, and alsoin 7reece 2!ontogianni et al%, )**?, it is "ossible to see the commonalities bet&een at least these t&o cultures, as&ell as the di/erences% ith regard to ris$s, res"ondents in the U! generally too$ a more individualistic "ersonals"ecialness. a""roach, for e5am"le, in the research on "erce"tions of climate change, &hilst in 7reece res"ondentsstill held more belief in the divine order of things% 7ree$ res"ondents often e5"ressed a belief in wx 2theo'"ronia, &hich has no direct English translation, but can be inter"reted as meaning that if you do the right thing,7od &ill give you luc$.% So, for e5am"le, if you 3sh according to natural la&s., 7od &ill ma$e sure the 3sh don.t runout%%%%%in general, 7ree$s favoured the ultimate rescuer. defense% -n terms of the orld Gis$ Society, andindividual co"ing mechanisms, it a""ears that death an5iety is "articularly "revalent &hen "eo"le consider theirfears of the un$no&n and un$no&able% The un$no&n is re"resented by uncertainties over the future, given thecurrent rate of technological change, and con6icting messages received from the scientists, government and themedia about a &ide range of ris$ issues% The un$no&able is re"resented by fear of the com"le5ity of scienti3c$no&ledge, and its inaccessibility to lay "eo"le, as &ell as the com"le5 and inter&oven nature of manyenvironmental and health ris$s% ith many )*th century diseases., such as allergic and immunocom"etenceconditions, traditional e"idemiological methods of 3nding a single cause for a single disease fail because the )+causes are multi"le and synergistic, and the conditions ill'de3ned and variable bet&een individuals% E5istentialisolation an5iety is characterized by feelings of ho"elessness and hel"lessness in the face of the global "oliticaleconomy, and the striving for community. or togetherness. is often founded on ma$ing >oint "rotests or o"ting outof conventional lifestyles and discourses% This can sometimes lead to idealistic tribalism., &hich re"lacesgeogra"hical tribalism. via the sharing and reinforcement of common ideas amongst similar thin$ing "eo"le via theease of modern day travel and information#communication technologies such as email and the internet% Alienationis often a matter of scale, &ith individuals feeling "o&erless in the face of &orld mar$ets and internationalagreements% Ho&ever, modern forms of communication and lifestyles and the social structures they su""ort may

themselves be alienating in containing little face'to'face human contact or 9uality time.% 4reedom andres"onsibility are again often framed in terms of not being sub>ugated by the global "olitical economy or thediscourses it "romotes < the modern e9uivalent of Hiedegger.s im"ersonal They'Self.% -ndividuals and grou"s canchoose to o"t out, give u", try their best, or carry on regardless < but it is al&ays in o""osition to or in collusion &ith"olitical and economic forces seen as being at a scale beyond the individual.s "o&er to change, and individualaction is hence usually framed in terms of "ersonal lifestyle choice to reduce ris$s, "rotect the environment or"romote social e9uity% Qeaninglessness an5iety seems to be a common res"onse in the orld Gis$ Society% -dentityand self'esteem are either maintained by small'scale successes, or reliance on being informed and using commonsense, but "essimism, crusad'ism, nihilism and vegetativeness are all common res"onses to technological andenvironmental ris$s% Unfortunately, the great increase in information in techno'logical societies has created moreconfusion and, in the o"inion of many "eo"le, devalued all information < leading to more reliance on fol$lore., laye"idemiology and common sense. to evaluate uncertain and ill'de3ned ris$s% Gebellion against "olitical andinstitutional structures has often been reduced to stigmatization of "articular organizations 2such as the "rivatized&ater com"anies, see Langford et al%, ?DDDa; 7eorgiou et al%, ?DDB or "roducts 2such as 7Q foods% Thisatomization of "rotest increases the sense of meaningless'ness, &here one can only ho"e to achieve something

small < and hence "otentially meaningless < or else give u" ho"e of things ever being di/erent and merely 3nd acomfortable &ay to survive the inevitable% -n conclusion, this "a"er has attem"ted, via theoretical argument, case

studies and discussion, to %resent a dierent analysis of ris* %erce%tion by

indi$iduals within social and %olitical systems% O7istential issues

and an7ieties " that are common to being human across s%ace and

time, have been e5"lored &hilst at the same time e5amining the relationshi" bet&een humans and ris$ in

contem"orary "ost'industrial society% ne conclusion that can be dra&n from this analysis is that the range ofindividual and social res"onses to ris$ are sym"tomatic of far more global an5ieties about the functioning andfuture of the &orld in general% Gis$ issues and con6icts are therefore not merely a "roduct of a ris$ society, but an

integral "art of its o"eration% !nly by %ro$iding %eo%le with a genuine chance

to understand" ha$e ho%e and belie$e in the %ossibility of instigating

change " can ris$ managers "rovide ris$ communication strategies that actually

communicate about ris* % This is because of the com%le7 and %rofound

role that ris* %erce%tion %lays in structuring identities" de#ning

discourses and bringing order and sense to the world& !therwise"

fear of the un*nown" alienation" hel%lessness and reactions to these

states of mind will always win the day %



8gnoring the threat causes %anic / worse than fear" sto%ssol$ency" turns their state %ower arguments

Sandman ?3Feter Q% Fh( in Communications and Frofessor at Gutgers s"ecializing in crisis communication; ody, Fsychiatrist, )B A"ril, I4ear -sS"reading 4aster than SAGS \ And So -t Should{J

China is universally condemned for covering u" SAGS and "utting the &orld at ris$% Co$ering u% ane%idemic is about as bad a communication strategy as we canimagine% Among its outcomes: China actually does face a %anic %roblem" asits %eo%le confront not 'ust a raging e%idemic but a go$ernmentthat lies to them about it& .he ;est)s 9soft co$er-u%: is muchgentler and less dishonest \ a cover'u" of over'reassurance and minimization rather than of lies%

Hut if SA,S does *ee% getting worse in the ;est, as it has in China, the softco$er-u% will also fail &&& and may also %ro$o*e %anic & Public an7ietycan lead to genuine %anic or to astonishing resilience % The "arado5 is that

e/orts to s+uelch the an7iety 2Iallay the "ublic.s fearJ is the usual "hrase can actually

induce the %anic it aims to %re$ent & ,esilience is li*elier whenauthorities ally with the an7iety " harness it" and steer it instead of trying to "revent

it% f course even su"erb handling of the "ublic.s fears may not "revent "anic if the e"idemic gets bad enough%

There has often been some "anic during the great e"idemics of the "ast% 0ut %anic will be li*elierand more wides%read if the authorities ha$e been minimizing theris* than if they ha$e been ac*nowledging it candidly and com"assionately%

.a*es out alt sol$ency and turns their im%acts

Sandman ?3Feter Q% Fh( in Communications and Frofessor at Gutgers s"ecializing in crisis communication; ody, Fsychiatrist, )B A"ril, I4ear -s

S"reading 4aster than SAGS \ And So -t Should{J

Let.s start &ith the obvious% Any normal %erson is going to be more an7iousthan usual while awaiting a bio%sy result" a turbulent air"lane landing, or a lBayo/

notice% Euman emotions tend to match the situation& .he same is true

of a more wides%read threa t& f course the "ublic at large &ill be commensurately alarmed

&hen told that a terrorism attac$, an e"idemic, or a hurricane may be a""roaching% Qoreover, fear isn)t 'ust normal in frightening situations5 it is functional% 0oth the human body and

the body "olitic ultimately bene3t from the changes 2"hysiological and sociological %%% and inevitably emotional thataccom"any "re"aredness for crisis% Ta$e terrorism as a case in "oint% 8early everyone agrees that &e need "eo"le

to be vigilant for indications of terrorist attac$s; to "re"are themselves and their families to co"e &ith "ossibleattac$s; to be su""ortive of "re"aredness e5"enses and tolerant of "re"aredness inconveniences% And nearlyeveryone agrees that &e need all this to ram" u" in an actual attac$, so that "eo"le "ut other agendas on hold,follo& instructions &illingly, and hel" care for their neighbors% The 9uestion is &hat emotional state, &hat state of

mind, is conducive to this sort of "ublic readiness% e believe the right ans&er is fear% ;e won)t get

there if terrorism is merely one of many issues %eo%le are

9concerned: about" along with ;est Nile <irus and inIation and ra%

lyrics& Oither terrorism is dierent from most other concerns" or it



isn)t& 8f it is" we need to get used to the idea that %eo%le are going

to be a%%ro%riately frightened " and &e need to hel" them get used to it too% 8ot all fear is

functional% Bear that is %aralyzing, fear that $erges on %anic" is ob$iously not

functional & .error is the goal of terrorism" not the goal of

%re%aredness& Hut fear is not necessarily terror& .his is a conce%tualmista*e ocials routinely ma*e, a mista$e they seem terribly attracted to \ theembedded " %reconscious" erroneous assum%tion that all fear is oneshort ste% remo$ed from %anic% Some fear is% Qost fear is not% hen o1cials e5"ress their

reluctance about Iunduly frightening "eo"le,J they are literally right% The $ey &ord here is Iunduly%J nduly

frightening %eo%le is wrong& July frightening %eo%le is right " and

im"ortant% The "roblem is telling the t&o a"art% The distinction is "artly a matter of degree \ IenoughJ fear versusIe5cessiveJ fear% Ferha"s in addition there are $inds of fear li$e the $inds of cholesterol \ IgoodJ fear versus IbadJ

fear% 0ut &e sus"ect the *ey dierence is neither the amount of fear nor the*ind of fear" but rather %eo%le)s ability to bear the fear & uch is

*nown about how to enhance that ability% Among the things that hel": >i$e%eo%le things to do R action binds an7iety& >i$e %eo%le things todecide R decision-ma*ing %ro$ides more indi$idual control, &hich ma$es

fear more tolerable% Oncourage a%%ro%riate anger \ the desire to get even often trum"s the

desire to co&er% Oncourage lo$e and camaraderie \ soldiers, for e5am"le, 3ght for their

friends and for their country% Pro$ide candid leadershi% R we get morefrightened when our leaders seem to be misleading us& Show yourown fear and show you can bear it \ a""arently fearless leaders are little hel" to a fearful

"ublic% Qost im"ortantly, treat other %eo%le)s fear as legitimate& Bear isli*eliest to escalate into terror or %anic or to Ii% into denial D whenit is treated as shameful and wrong% I-t.s natural to be afraid, -.m afraid tooJ is a much

more em"athic res"onse to "ublic fear than Ithere.s nothing to be afraid of%J -f &e &ant "eo"le to bear their fear,&e must assure them that their fear is a""ro"riate% Even fear that is statistically ina""ro"riate can and should be

legitimized as normal, understandable, and &ides"read% Leaders who are contem%tuous of%eo%le)s fear ha$e a much tougher time e7%laining the reasons whythey needn)t be afraid&

Bear of e7tinction is a legitimate and %roducti$e res%onse tothe modern condition---wor*ing through it by $alidating ourre%resentations is the only way to create an authentic

relationshi% to the world and deathacy =Q

oanna Qacy, ad>unct "rofessor at the California -nstitute of -ntegral Studies, )***, Environmental (iscourse andFractice: A Geader, "% )ON

The move to a &ider ecological sense of self is in large "art a function of the dangers that are threatening to over&helm us% ;e are confronted by

social brea*down" wars" nuclear %roliferation" and the %rogressi$e



destruction of our bios%here % Folls sho& that "eo"le today are a&are that the &orld, as they $no& it, may come to an end% This loss of

certainty that there &ill be a future is the "ivotal "sychological reality of our time% ^ ver the "ast t&elve years my colleagues and 8 ha$ewor*ed with tens of thousands of %eo%le in 8orth America, Euro"e, Asia, and Australia, hel%ing themconfront and e7%lore what they *now and feel about what is ha%%ening totheir world& .he %ur%ose of this wor* , &hich &as 3rst $no&n as I(es"air and Em"o&erment or$,J is to

o$ercome the numbing and %owerlessness that result from su%%ression of %ainful res%onses to massi$ely %ainful realities& As their grief and fear for the world

is allo&ed to be e7%ressed &ithout a"ology or argument and $alidated as a wholesome" life-

%reser$ing res%onse " %eo%le brea* through their a$oidance mechanisms"

brea* through their sense of futility and isolation% 7enerally &hat they brea*

through into is a larger sense of identity % -t is as if the %ressure of theirac*nowledged awareness of the suering of our world stretches orcolla%ses the culturally de#ned boundaries of the self % ^ -t becomes clear, for e5am"le, that the

grief and fear e7%erienced for our world and our common future are

categorically dierent from similar sentiments relating to one)s %ersonal

welfare% This "ain cannot be e9uated &ith dread of one.s o&n individual demise% -ts source lies less in concerns for "ersonal survival than in a""rehensions of collective

su/ering < of &hat looms for human life and other s"ecies and unborn generations to come% -ts nature is a$in to the original meaning of com"assion < Isu/ering &ith%J 8t isthe distress we feel on behalf of the larger whole of which we are a %art&And" when it is so de#ned" it ser$es as a trigger or getaway to a more

encom%assing sense of identity" inse%arable from the web of life in whichwe are as intricately connected as cells in a larger body% ^ This shift in consciousness is an a""ro"riate, ada"tive res"onse% 4or the

crisis that threatens our %lanet " be it seen in its military " ecological" or

social as%ects" deri$es from a dysfunctional and %athogenic notion of the

self % -t is a mista$e about our "lace in the order of things% -t is the delusion that the self is so se"arate and fragile that &e must delineate and defend its boundaries, that it is so

small and needy that &e must endlessly ac9uire and endlessly consume, that it is so aloof that &e can < as individuals, cor"orations, nation'states, or as a s"ecies < be immune to &hat&e do to other beings%



=NC O7t Z1 -- Suicide [K[ Sol$e8f the so$ereign can)t control the dying" it S. control theli$ing

PAS is practiced around fear of a bad death" not an end to

sur$i$alism& Addressing the causes of these fears if anecessary %rere+ to legalizing PAS or ine+uality and abuse isine$itableOmanuel 2Q%(%, Fh%(% ice Fresident for Ethics Standards, American Qedical

Association 04

2Linda L%, A uestion of 0alance in Gegulating ho& &e die: the ethical, medical, andlegal issues surrounding "hysician'assisted suicide, Fg% )PB'+*

Si5th, and "erha"s most im"ortant of all, "hysician'assisted suicide and euthanasia are a""arently not the real issues being raised

by su/ering "atients and "olicyma$ers, nor the best ans&er to their concerns% 8t is essential to ha$e asolid gri% on the root moti$ations for calls for assisted death , &hether

made by individu' als or the larger society, and to res%ond to the root cause before theo$ert call is e$aluated on face value% Treatment of the root cause is far more reliable, safe, and e/ective than

treatment of the "resenting com"laint alone% This is a matter of sound clinical and social "olicy "ractice& Strong dataall %oint to the %redominance of %sychosocial" conte7tual sueringor fear of suering as moti- $ators" rather than current" unbearable,

unrelievable, "atho"hysi' ological suering% ost re+uesters are moti$ated not by%ain but by fear fear of future suering " fear of indignity " fear ofburden- someness " fear of abandonment " and fear of lost control & The

severity of "sychsocial su/ering need not be understated to stand by this argument% Gather, the %oint is that

%sychosocial suering should be treated by ameliorating itssources" not by eliminating the $ictim% Unfortunately, the &idely ac$no&ledged di1cultyof

assessing and lessening "sychosocial su/ering is a factorthat could ka$e "hysicians more "rone to misuse of "hysi' cian'assistedsuicide and euthanasia if it &ere legalized% Sothis is the "osition to &hich the re6ective "rocess of editing thisvolumehas led

me: -n a very real sense, the current %hysician-assisted suicide and euthanasia debate in

the United States is a false debate % -f society ta$es the call for legally endorsed "hysi' cian'assistedsuicide and

euthanasia on face value alone, and if themedical"rofession as a &hole or "hysicians in "articular ta$e "atients calls for "hysician'assisted suicide and euthanasia on facevalue alone, society, the "rofession, and "hysicians &ill have madea graveerror,

;ithout better understanding of the fears that dri$e these re+uests"%olicies will be enacted and acts ta*en that not only miss the %ointbut ris* abuse% Some of history6s great mista*es ha$e been founded onmisconce%tions no greater than this failure to e7amine root causes %

Fositions on &hether or not "hysician'assisted suicide and euthanasia are ever >usti3able neednot hinder us from reaching aconsensus on the need to "ursuethis investigation% A res"onsible society and a res"onsible "rofession&ould not &ish to "ursuecontentious "olicy, and a "rofessional&ould not &ish to act for reasons that turn out to havebeen beside the "oint and ris$y% This isnot the "lace to e5amine in de"th the root causes of re9uestsfor assisted suicide; - am neither a "sychologist nor a sociologist,andno s"iritual authority either% 8onetheless, it is relevantto note that society in general, and medical culture too, havebeen in a death'denying era, "erha"s since the sClentl3c revolution or at least since biomedical technology became so "o&erfulin this century%Society se9uesters and sanitizes our dyingin hos"itals, it "ursues youth, control, and "otency, and -t avoidstal$ of normal dying% edo not have a healthy "lace in societyfor the dying and for rituals surrounding death% Cultural health and "ersonal maturity re9uire abalanced "lace for the realities of normal dying% Ferha"s the "hysician'assisted suicide and euthanasia debate is evidence thatsociety is beginning to climb out of its death'denying "hase% r "erha"s its is evidence of imbalance and irrational denial; the call for

"hysician'assited suicide and euthanasia could be an attem"t to be rid of normal dying% r "erha"s death denial is



only %art of the %roblem% Fer' ha"s societal sel#shness and %ride of%otency ha$e caused failing members of society to be and feelunwelcome " burdensome" abandoned" undigni#ed" and ashamed tobe the frail humans that we all are%



1N,



1N, / ni+ueness ;allO7tend the Hla*e 1?K1@ card" democrats ha$e made smarterin$estments and ha$e been %laying the long game which will%ay o on No$ember th / ignore sna%shots" our e$idence is

%redicti$eEigh amounts of uncertainty and your methods of calculatingwinners is wrong;ang 1?K1 _Sam, FEC, 8o, Ge"ublicans Arent 7uaranteed to in the Senate%Heres hy%, htt":##&&&%ne&re"ublic%com#article#??DBOO#)*?O'midterm'"redictions're"ublicans'not'guaranteed'&in'senate`MSFS

n Qonday, the Libertarian candidate for Senate in -o&a, (oug 0utzier, died in a "lane crash% 0utzier, an emergency room

"hysician, &as "olling at only ) "ercent% 0ut Ge"ublican candidate oni Ornst leads the (emocratic candidate, 0ruce

Hraley, by an even narrower margin% Ho& 0utziers su""orters eventually vote is a 9uestion of national

signi3cance% Ealf a dozen other Senate races are e+ually li*ely to come

down to the wire & Thats &hy control of the chamber is still uncertain , even

though the election is less than three &ee$s a&ay% Such uncertainty is a""arently belied by the fact that the ma>or aggregators ofSenate "olls are "ointing in the same direction, &ith "robabilities ranging from +* "ercent and u" for Ge"ublican control% Thisincludes my o&n site, the Frinceton Election Consortium, &hich recently s&itched a&ay from a (emocratic advantage in early

ctober% -ndeed, Ge"ublicans hold the lead in $ey states, but this unanimous agreement amongelection forecasters conceals an Achilles heel ;e all rely on thesame %oll data& hat if that data is o/@ A Bew Bront-,unners in Close Olections;ill Lose on Olection Jay osh !atz at The 8e& =or$ Times The U"shot has analyzed the "erformance of

Senate "olls since )**O% He found that the "redictive accuracy of "olls de"ends on ho& soon the election is and the size of the front'

runners lead% 4or instance, if the election is three wee*s away and the front-runner leads by 3 %ercent or less" that candidate will still lose 34%ercent of the time\nearly t&o times out of 3ve% -n the "eriod !atz analyzed, only three or four Senate races in

each election &ere decided by N "ercentage "oints or less% 0ut as of .uesday" such narrow marginse7isted in si7 races (ata as of Tuesday, ctober ?O, via the Frinceton Election Consortium% Bour moreracesRAlas*a" Ar*ansas" Qentuc*y" and New Eam%shireRare within or %ercentage %oints& So the %otential e7ists for many closeoutcomes& 4or election nerds li$e me, this is Christmas% -f every front'runner today &ere to &in, the Senate outcome &ould

be P) Ge"ublicans and OB (emocrats and inde"endents% 0ut history tells us to e7%ect two orthree of the current leaders to lose& (emocratic &ins in the $ey states of -o&a and Colorado &ould

give a P*'P* s"lit, &ith ice Fresident oe 0iden brea$ing Senate t ies in his "artys favor% 2This assumes that !ansas inde"endent7reg rman &ould caucus &ith (emocrats and the other inde"endents, &hich is not a sure bet% f course, if the o""osite &ere toha""en 8orth Carolina\&ith Ge"ublican Thom Tillis defeating (emocratic Senator !ay Hagan, &ho leads narro&ly\the 7F &ould

end u" &ith a convincing PN'O ma>ority% Some races are less li*ely to re$erse than %olls

would indicate& -n "olls s"anning the last t&o &ee$s, 7eorgia Ge"ublican (avid Ferdues median lead over (emocratQichelle 8unn dro""ed to ? "ercent after he "roclaimed last &ee$ to be R"roudR about outsourcing >obs as an e5ecutive at no&'defunct Fillo&te5 Cor"% To avoid a runo/, 8unn must e5ceed P* "ercent of the vote% Turnout tends to decrease in 7eorgia runo/

elections, so current "olls are of little hel" in "redicting the outcome of a runo/% <oters in these si7 closely-fought states are dis%ro%ortionately %owerful, &hich accounts for the concentration of

advertising and get'out'the'vote activity in the battleground states% Qeasured in terms of their ability to in6uence Senate control, avote cast in -o&a is about ??* times as "o&erful as that of a vote cast in Qinnesota% Similarly, a Colorado voter is over N* times as"o&erful as that of an regon voter% And my vote in 8e& ersey, a "o"ulous state &here Senator Cory 0oo$er has a ?)'"ercentage'"oint lead, is &orth less than even an regon or Qinnesota vote% (emocrats Tend To Ferform 0etter Than Folls Fredict Even in the&ee$ before the election, "olls are not "erfect% 4or e5am"le, in t&o out of ten close Senate races in )*?* and )*?)% -n those t&ocases, both in )*?*, the eventual &inner &as the (emocrat 2Harry Geid in 8evada and Qichael 0ennet in Colorado% This re6ects a



broader "attern: ;hen errors occur" the outcome tends to be more fa$orableto the Jemocrat& Lets e5amine the "ercentage di/erence bet&een "olls and election results: The "residential

3ndings come from com"aring the 3nal Qeta'Qargin &ith the eventual margin of victory in the ti""ing'"oint state, i%e% the state that"ushed the &inner >ust over the electoral'vote threshold for victory% The above table, calculated for state'level "residential andSenate contests, sho&s the di/erence bet&een Election Eve "olls &ith actual election results, using the median across all racesdecided by less than a ?*'"ercent margin% verall, these numbers set a range for ho& &rong &e &ould e5"ect a "oll'based vie& to

be% Pollsters as a grou% underestimate Jemocratic %erformance by ana$erage of 1&= %ercent& This bias is asymmetric: hen Ge"ublicans out"erformed, they did so by ?%)

"ercentage "oints or less% 0ut in four out of eight cases" Jemocrats sur%assed%olls by =& to 3&@ %ercentage %oints& .his bias was e$en larger inColorado, &here (emocrats out"erformed "olls by at least O "ercentage "oints in the )*?* and )*?) elections%

8nstead of Probability" Ostimate Eow uch Swing 8s Needed hat if this

years "olls are o/ by ) "ercentage "oints in one direction or the other@ A )'"oint advantage for (emocrats &ould ma$e the mostli$ely outcome a s"lit of P* (emocrats#inde"endents to P* Ge"ublicans% And a )'"oint advantage for Ge"ublicans &ould "ro"el themto a PN'O ma>ority% These outcomes match the R&hat if t&o races 6i"R scenarios - outlined above% 8either e5treme is guaranteed%

.he introduction of new sur$ey methods may ha$e changed theaccuracy of %ollsRfor better or for &orseRand %artisan %olls are more fre+uentthis year" creating another source of uncertainty% -n fact, the %robabilities oered by %oll

aggregators might not e$en be the best way to thin* about thisyear6s Senate forecasts " in %art because we tend to mentally round%robabilities u% to 1?? %ercent& The Frinceton Election Consortium, for instance, gives Ge"ublicans a

+D "ercent chance of ta$ing the Senate; if that fails to ha""en, many &ill claim that FEC &as &rong% 0ut a loaded coin thats biasedto come u" heads +D "ercent of the time &ould still come u" tails three times out of ten% r thin$ of it li$e a &eather forecast: -ftheres a +D "ercent chance of rain, youd be &ell'advised to bring an umbrella, but you might end u" not using it % -nstead of

"robability, - "refer a statistic - develo"ed in )**O, the Qeta'Qargin% .he Senate eta-argin isde#ned as how much the #nal $ote would ha$e to dier from %olls in*ey states to create an e7act toss-u% for control of the chamber& 7iven

the "olling errors - have analyzed in this article, neither side can breathe easier until theeta-argin gets to at least 3 %ercent in their direction % nly at that "oint can

&e "redict a &inner &ith high con3dence% As of ednesday, the Senate Qeta'Qargin sho&s a Ge"ublican lead of ?%N "ercent\too

close to call% So although Ge"ublicans have the advantage in "olls, Jemocrats6 trac* record ofout%erforming %olls wor*s in the other direction% 4or the moment, theres a decent "robability that "olling

nerds &ill be sur"rised on 8ovember O%

Eere)s some of those statesPlot*in" 1?&1&1 < "olitical analyst and contributor to the 00C on American"olitics 2Qar$, The Hill, ISome "ossible midterm su"risesJhtt":##thehill%com#blogs#"undits'blog#cam"aign#))*BBN'some'"ossible'midterm'sur"rises >b

-f either Udall or 0raley loses, the game is then over% Ge"ublicans are in charge% 0ut &ait a minute: Some very

unli$ely scenarios might 'ust ta*e %lace that could sa$e the day for the

Jemocrats & No& 1 is Qansas, &hich - &rote about last &ee$ 28nde%endent >reg!rmond beating ,e%ublican Sen& Pat ,oberts% No& =, of all "laces, is SouthJa*ota& .here is a former three-term ,e%ublican senator " theirre%ressible Larry Pressler" who $ery well may be a godsend for theJemocrats& Ee is %ulling $otes away from the ,e%ublican candidate"former >o$& i*e ,ounds% 8o&'-nde"endent Fressler is de3nitely aiding (emocrat Gic$ eiland%

Gemember, South Ja*ota has sent Jemocrats to the &S& Senate \ ames

http://thehill.com/blogs/pundits-blog/campaign/220883-some-possible-midterm-surprises






Abourez$, Tom (aschle and the retiring Tim ohnson% And, of course, 7eorge Qc7overn% A candidate canwin this race with as little as 33 %ercent & .here is no runo R it6s

'ust a sim%le %lurality& And there is e$en a fourth candidate" >ordonEowie& Hes a conservative and "robably is "ulling votes a&ay from Ge"ublican Gounds% Anothernontraditional candidate is hel%ing Jemocratic candidate ichelle

Nunn in >eorgia & Libertarian Party nominee Amanda Swaord is$iewed as ta*ing $otes away from ,e%ublican Ja$id Perdue & e havent

tal$ed about North Carolina% This is the only state where an endangeredJemocrat 2!ay Hagan seems to be leading in the "olls% .here" the sa$ior forthe Jemocrats is again a libertarian & Ee is a %izza deli$ery man& Eisname is Sean Eaugh& ,e%ublican candidate .hom .illis wishes hisname was not on the ballot% -f third "arty libertarians continue to get their names on the ballot,

this is an ominous de$elo%ment for the ,e%ublican Party in the future% -

3rmly believe that they deli$er close races to the Jemocrats& .heir

%ercent to 1? %ercent is ta*ing $otes from the >!P & So on Tuesday, 8ov% O, you

very &ell might "ay attention to former no'names \ Larry Fressler, 7ordon Ho&ie, Amanda S&a/ord and SeanHaugh% .hese so-called fringe %layers might be soon getting than*-you

notes from Senater a'ority Leader Earry ,eid 2('8ev%%

oney goes JemAngle 1?K1 _im, 4o5, I(emocrats outraising Ge"ublicans as election nears,Jhtt":##&&&%fo5ne&s%com#"olitics#)*?O#?*#?+#democrats'outraising're"ublicans'as'election'nears#`MSFS

(es"ite outrage from Senate Qa>ority Leader Harry Geid and other (emocrats about billionaires li$e the !och

brothers donating to the 7F, statistics sho& Jemocrats are outraising ,e%ublicans

this election season& Sheila !rumholz of the Center for Ges"onsive Folitics estimated, 2theJemocratic senatorial cam%aign committee has raised \111 millioncom%ared to \4= million for their ,e%ublican counter%art&2 O$enwhen you ta*e all sources of money" from all donors for all races"the Jemocrats still lead& 28t6s about \0 million for the Jemocrats"and about \? million for the ,e%ublicans"2 !rumholz said% -n the run'u" to the 8ov%

O election, the Ge"ublican Senatorial Cam"aign Committee made a last minute "ush and >ust announced it raised?P%P million in Se"tember, its best month ever% Folitical analyst Qichael 0arone of the American Enter"rise-nstitute said, Rthats a change and it says that Ge"ublican contributors big and small are martialing to the cause%R

Although the Jemocrats ha$e en'oyed a money lead for some time,

they still are as$ing for more cash% A (emocratic cam"aign grou" on ctober urged, RTodays ad buy deadline isthe most critical of the election% This is our last chance to rescue (emocrats dro&ning in !och'funded attac$s% Canyou chi" in P or more@R 0en ieder of the Center for Fublic -ntegrity, another &atchdog grou", noted,

Re$eryone *ind of li*es to %lay the underdog role& And so it6s been$ery interesting to see fundraising ads" %articularly related toSenate races where Jemocrats are claiming that" you *now" they6relosing the race&2 Quch of the (emocratic "artys money comes from the "residents non'sto" e/orts to

raise cash, having done more than P* fundraisers, seven >ust last &ee$, all closed to the media, including one at thehome of real estate baron Gich Gichman '' a name (emocrats &ould li$ely ridicule if he &ere giving to Ge"ublicans%

Jemocratic Senate candidates" while ha%%y to get the money"



sometimes try to a$oid being seen with an un%o%ular %resident&

According to 0arone, thats Rbecause these candidates are running in states &here Fresident bamas >ob"erformance rating is negative, in many cases highly negative%R -n some recent "olls, his "ersonal a""roval ratingstands at only O* "ercent% (emocrats recently "ulled money from ?? marginal races, and the Ge"ublicans >ust"oured another +%P million into the Senate race in 8orth Carolina after internal "olls sho&ed Ge"ublican Thom Tillis

in a "osition to &in% ieder e5"lained,Ras you6re getting three wee*s out" you6$e got

to s%end your money in the %laces where it will do the most good&2Hut not all money goes into ads& Some is reser$ed for $oter turnouteorts, because fe&er "eo"le vote in mid'term elections% ieder noted that R.< ads accountedfor about ? %ercent and then that %ool of the remaining ?%ercent" you can *ind of s%lit between get out the $ote" mailers"%hone calls&2 Lo& turnout elections tend to favor the angriest and most energized voters, and these days,

that tends to be Ge"ublicans% ITheres a close correlation bet&een ho& voters a""rove of the "resident, &hether itsthis "resident or the "revious one, and ho& they vote in Senate elections,R 0arone e5"lained%

oney inIuences *ey senate races / history %ro$es&Odgar, )1? 0ob, Fresident of Common Cause, IHo& Qoney -n6uences ElectionsJ,

The 8e& =or$ Times, ?*')*'?*,htt":##&&&%nytimes%com#)*?*#?*#)?#o"inion#l)?broo$s%html, GSG

-n I(on.t 4ollo& the QoneyJ 2column, ct% ?D, (avid Hroo*s argues that because big-s%ending candidates often lose to lesser-funded challengers, there.s no

reason to be concerned about the 6ood of large donations, many of them secret, 6o&ing into Congressional

contests this fall% Eis analysis fails on two le$els % 4irst, it)s clear that money

counts in our elections % Since =???" the a$erage winner in contests

for o%en Eouse seats has outs%ent the a$erage loser by at least\31?"???" according to #gures com%iled by the non%artisan

Cam%aign Binance 8nstitute% 8n races for o%en Senate seats" winners

outs%ent losers " on a$erage" in e$ery year e7ce%t =??=& Bar more

im%ortant than who wins \ and not mentioned by Qr% 0roo$s \ is the dierencethat big contributions ma*e after the election& The individuals, cor"orations, trade

grou"s and unions &riting record'sized chec$s this fall &ill &ant a return on their investments; &inning candidates,outs"ent or not, &ill have a "o&erful incentive to "rovide it% These are building bloc$s for scandal%

>rimes is awesome at fundraisingSulli$an 1?K1@ _Sean, F, The &inners and losers of the third 9uarterfundraising "eriod, htt":##&&&%&ashington"ost%com#blogs#"ost'"olitics#&"#)*?O#?*#?#the'&inners'and'losers'of'the'third'9uarter'fundraising'"eriod#`MSFS

Alison Lundergan 7rimes: This has been the roughest &ee$ of the !entuc$y (emocratic Senate nominees

cam"aign% 0ut not because of fundraising% >rimes raised a who%%ing \&0 millionduring the third +uarter" out%acing Senate Qinority Leader Qitch cConnell 2G

and reminding the %olitical world once again that she is among the=?1 cycle6s most talented fundraisers& 4undraising isnt everything, since national

(emocrats have gone dar$ in this race '' a sign that 7rimess chances of &inning have dimmed% 0ut even if sheloses, there &ill be "lenty of (emocrats &ho &ill &ant 7rimes to run for higher o1ce again in the future because ofher fundraising abilities%



Eagan winning / dolla dolla bills.aylor 1?K1@ _essica, The Hill, Cam"aign cash &inners, losers,htt":##thehill%com#blogs#ballot'bo5#))?*O+'to"'?*'fundraising'&inners'and'losers`MSFS

(emocrat !ay Hagan, 8orth Carolina Senate \

oney is one of the chief reasons this Tar

Heel incumbent Eagan may be the only red state Jemocrat to sur$i$e inNo$ember& She again to""ed the charts &ith O%D million fundraising to Tillis.s N%O million% The 7F state

House S"ea$er has "ic$ed u" the "ace from his initial "altry hauls, and has slightly more in the ban$, but

Eagan)s early s%ending %ace is what)s *e%t her abo$e water&

Same old story in C! / means dall winsScott 1?K1 _(ylan, TFQ, htt":##tal$ing"ointsmemo%com#dc#mar$'udall')*?O'is'li$e'michael'bennet')*?*`MSFS

0y all the "ublic "olling, (emocrats should really be s&eating the Colorado Senate race at this "oint% (emocratic

Sen% Qar$ Udall trails his Ge"ublican challenger, Ge"% Cory 7ardner, by more than P "oints on average% Electionforecasters have "egged Colorado 2along &ith -o&a as the most li$ely election to s&ing control of the Senate% 0ut(emocrats believe theyve seen this movie before% -n the )*?* Colorado Senate cam"aign, (emocratic nomineeQichael 0ennet trailed 2or &as at best tied in the last ?? "olls of his race against Ge"ublican !en 0uc$% 0ut then onElection (ay, 0ennet e$ed out a less'than'? "oint &in, a rare bright s"ot in an other&ise tough cycle for (emocrats% The &in &as attributed by the "ress to his cam"aigns singular focus on t&o core (emocratic constituencies ''&omen and His"anics '' and an un"recedented, data'driven get'out'the'vote e/ort% 8o& 0ennet is the chairman of

the (emocratic Senatorial Cam"aign Committee, and the JSCC has attracted headlines for e7%orting the Hennet model in =?1 to other tough races li$e Ar$ansas and Louisiana

in a +* million e/ort named for 0annoc$ Street, &here 0ennets cam"aign o1ces &ere located in (enver% Hutin an ironic twist" the model may be %ut to its se$erest test rightbac* where it began" in Colorado" where Jemocrats are ho%ing torecreate the Hennet =?1? magic to %ull out a win for dall & The methods

have evolved '' better soft&are this time, an all mail'in ballot election '' but the foundation remains the same, Faul(unn, (SCCs national 3eld director, told TFQ in a "hone intervie&% R- thin$ the core "rinci"le &as that &asestablished &ith 0ennet &as: This matters,R (unn, &ho &or$ed on 0ennets )*?* cam"aign, said% R-f you are in the

red zone, this becomes e5tremely im"ortant%R 2;hat we saw there in =?1?" the+uestion was" how are you going to o$ercome this ,e%ublican wa$ein Colorado2 he said% 2;e found that what wor*s is we ha$e ways tomechanically turn the electorate" that the way which we can do it iswith targeting and %rioritization&2 The 0ennet in6uences on Udalls cam"aign 2and )*?O

(emocratic Senate cam"aigns in general are every&here% -t starts &ith the national committee and &or$s do&n tothe cam"aign sta/% (unn and (SCC e5ecutive director 7uy Cecil &ere to" o"eratives for 0ennet )*?*% Udallcam"aign manager Adam (unstone &as a de"uty for 0ennets team% The messaging in Colorado has been

relentless% About half of dall6s .< ads ha$e been focused on women6s

issues, according to the ashington Fost% 0ac$ in )*?*, 0ennet ran an ad &ith a local 0#7=8 &arning about

0uc$s e5tremism on &omens health, and no& Udalls cam"aign is going u" &ith an ad this &ee$ featuring a local0#7=8 &arning about 7ardners o""osition to abortion, "art of its 3nal "ush to 6ood the Colorado air&aves before

Election (ay% .he dall cam%aign and the outside grou%s su%%orting himha$e released numerous S%anish-language ads" too% RThat strategy &or$ed "retty

&ell and its really the same one that (emocrats are no& ho"ing to use against Cory 7ardner,R Feter Hanson, &ho

studies Colorado "olitics at the University of (enver, told TFQ% 28f dall can get liberal-leaningwomen to turn out in larger numbers by raising fears that Cory

http://polltracker.talkingpointsmemo.com/contests/co-senator-14

http://www.realclearpolitics.com/epolls/2010/senate/co/colorado_senate_buck_vs_bennet-1106.html#polls



http://www.nytimes.com/2014/02/07/us/politics/democrats-aim-to-make-2014-more-like-2012-and-2008.html

http://www.washingtonpost.com/blogs/the-fix/wp/2014/10/13/mark-udall-has-been-dubbed-mark-uterus-on-the-campaign-trail-thats-a-problem/



http://blogs.denverpost.com/thespot/2010/09/20/senate-ads-head-toward-the-social-issues/14972/


http://talkingpointsmemo.com/livewire/mark-udall-cory-gardner-womens-health-ads


http://polltracker.talkingpointsmemo.com/contests/co-senator-14


http://www.nytimes.com/2014/02/07/us/politics/democrats-aim-to-make-2014-more-like-2012-and-2008.html






>ardner 'ust doesn6t get it" he6s much more li*ely to win the race &&&8t6s a lesson that the Jemocrats learned four years ago&2 The big test for

Udalls team is &hether they can successfully e5ecute this strategy &hen the Ge"ublican cam"aign has seemede5"licitly engineered to avoid a re"eat of )*?*% 0uc$ &as a notoriously blunt candidate that year, &ith cringe'&orthy lines li$e R- do not &ear high heels%R 0ut since he announced his candidacy in early )*?O, 7ardner has beenstraining to moderate himself% His cam"aign began &ith a renunciation of his su""ort for a state R"ersonhoodRamendment, &hich &ould outla& abortion and many $inds of birth control% 7ardner has still had some roc$ymoments, "articularly because he still co's"onsors a federal "ersonhood bill% R-ts more convenient for you to sayits not a "ersonhood bill,R a local T >ournalists sna""ed last month as 7ardner insisted that there &as no federal"ersonhood bill% R0ut does saying that ma$e it true@R 0ut bet&een his "ersonhood reversal and embrace of over'the'counter birth control, 7ardner clearly came into the cam"aign ready to 3ght the 0ennet )*?* "layboo$% IThis isthe "layboo$ that they ran in )*?*, and it &or$ed% They did it again in )*?),J he told the ashington Fost earlierthis &ee$% I-t.s a tired, old "layboo$% And as a result of the failures of the "olicies of this administration, it.s notgoing to &or$ again, because "eo"le can see right through it%J R-t is a heavier lift in )*?O than in )*?*% Ge"ublicanshave seen this strategy before,R Hanson told TFQ% RThey &ere ready for it% They are running a candidate in Cory7ardner &ho comes across as much more moderate%R RThe Ge"ublican strategy from day one has been to see$ to"ortray him in a much more "rogressive light and to try to head o/ these attac$s,R he continued% R- dont thin$ its astrategy thats going to change minds about the Ge"ublican Farty, but it might ma$e it harder for (emocrats to turnout their constituencies%R Udalls cam"aign, mean&hile, has led to an unfortunate nic$name '' RQar$ UterusR < andrebu$es from the (enver Fosts editorial board and others% 0ut that isnt sto""ing his cam"aign from "ressingfor&ard &ith the message% They also note that 7ardner has continued to run ads rebu1ng the attac$s '' &hichsuggests to Udall su""orters that theyre &or$ing% RThe fact that he has to run his ads in the 3rst "lace '' - thin$

"eo"le misunderstand &hats ha""ening here,R a Colorado (emocrat told TFQ% A robust groundo%eration -- that other *ey %iece of the Hennet model -- was also abig reason why he out%erformed the %olls on Olection Jay" as dallmust now aim to do& dall6s cam%aign sent out a memo last wee*boasting about how they had to%%ed Hennet6s o%eration in *eycategories = #eld oces in =?1" $ersus 1 in =?1?5 1?? #eldorganizers $ersus ?5 and 3"=?? $olunteers in the last month $ersusless than 1"???& Hennet beat the margin %olling margin by nearly %oints, according to Geal Clear Folitics% Fresident 0arac$ !bama did the same in =?1=%

0ased on the "olling no&, that is the same sort of "erformance that Udall is going to need% So &hile critics might bemoc$ing his strategy, if Udall can re"eat the ?'"oint edge that 0ennet had &ith &omen and his )'? margin &ith

His"anics, it &ont matter% 2Hennet and dall6s cam%aigns are doing the samething because they belie$e in science and %olls ,R the Colorado (emocrat said%

RTheyre not doing this on a &him%R

http://www.politico.com/blogs/bensmith/0710/Buck_Vote_for_me_because_I_do_not_wear_high_heels.html


http://talkingpointsmemo.com/livewire/cory-gardner-federal-personhood-bill


http://www.washingtonpost.com/politics/colorados-senate-race-will-the-democratic-playbook-work-again/2014/10/13/6ce3db58-4fc8-11e4-babe-e91da079cb8a_story.html


http://talkingpointsmemo.com/livewire/denver-post-endorsement-colorado-senate-race


https://www.youtube.com/watch?v=BuETJw-tHUw&list=UUaHpoEaT_-5EB0H-TAcWH_w


http://www.realclearpolitics.com/epolls/2010/senate/co/colorado_senate_buck_vs_bennet-1106.html

http://www.realclearpolitics.com/epolls/2012/president/co/colorado_romney_vs_obama-2023.html






http://www.realclearpolitics.com/epolls/2010/senate/co/colorado_senate_buck_vs_bennet-1106.html

http://www.realclearpolitics.com/epolls/2012/president/co/colorado_romney_vs_obama-2023.html



1N, / Lin* ;all

.he %lan alienates religious grou%s" African Americans" theelderly" and womenOmanuel ?= Eze$iel % Emanuel, Q(, Fh( 4rom the (e"artment of Clinical 0ioethics, arren 7% Qagnuson

Clinical Center, 8ational -nstitutes of Health, 0ethesda, Qd% IEuthanasia and Fhysician'Assisted Suicide A Gevie& ofthe Em"irical (ata 4rom the United StatesJ htt":##archinte%>amanet&or$%com#article%as"5@articleidK)?ON+

4inally, certain sociodemogra"hic characteristics consistently %redict su%%ort ando%%osition to euthanasia or PAS%?N' ?P Catholics and %eo%le who re%ort themsel$es to bemore religious are signi#cantly more o%%osed to euthanasia or PAS% Similarly, African

Americans and older individuals are signi#cantly more o%%osed to euthanasia or

PAS% 4inally, some, but not all, sur$eys suggest that &omen are signi#cantly moreo%%osed to euthanasia or PAS% -nterestingly, "atients &ith terminal i llnesses, such as cancer and chronic obstructive

"ulmonary disease, have attitudes that are almost identical to the "ublics%?+ -n other &ords, having a serious, life'threateningillness itself does not seem to alter attitudes to&ard the "ermissibility or o""osition to euthanasia or FAS% Similarly, being acaregiver for a terminally ill "atient or a recently bereaved caregiver does not seem to a/ect attitudes to&ard euthanasia or FAS%?+

O$angelical turnout causes a >!P $ictory / es%ecially in theSouth>ibson 1 _(avid, a&ard'&inning >ournalist, author and 3lmma$er, IGe"ublicans &oo evangelical base in

bid to reca"ture the Senate,J une )th, htt":##&&&%religionne&s%com#)*?O#*+#)#re"ublicans'launch'digital'e/ort'rally'evangelicals'"olls#`MSFS

2G8S .he Ge"ublican 8ational Committee ,NC on 4riday 2une ) launched its 3rst &eb'based

eort to rally conser$ati$e belie$ers behind the %arty" a sign of how

crucial $oter turnout will be in this fall)s close-fought midterm

elections and an indication that the >!P cannot ta*e its e$angelical

Christian base for granted& IThis shouldn.t be outreach, this should be &ho &e are \ it is &ho

&e are,J said Chad Connelly, director of faith engagement for the Ge"ublican 8ational Committee and the forcebehind this ne& initiative, 7Ffaith%com% Evangelicals, Connelly said, Iare our biggest, most reliable voting bloc%J

The "roblem, ho&ever, is that e$en though e$angelicals identify more closelythan e$er with the >!P" they ha$e not been turning out at the %ollsin sucient numbers to carry ,e%ublican candidates to $ictory &Connelly, a conservative Christian and former chairman of the Ge"ublican Farty in South Carolina, said that as he

traveled the country in )*?) &or$ing for the election of itt ,omney, he found that 9thefaith $ote was an afterthought in a lot of %laces &: .hat came bac* tohaunt the %arty, he said% He cited surveys sho&ing that while 40 million Americansidentify as e$angelical Christians" 'ust a third of them $oted in the

=?1= election R and more than a #fth of those $oters %ulled thele$er for Fresident !bama & G8C chair Geince Friebus set u" the G8C.s 4aith Engagement grou" last year, its

3rst'ever strategic initiative aimed e5clusively at conservative faith'based voters% Friebus ta""ed Connelly to headit, and this ne& get'out'the'vote cam"aign \ Ian online home for all of our e/orts, all around the country,J as he

says in a video on the site% 8n %ast years, the "arty didn.t need to ma$e such e/orts% Conser$ati$ebelie$ers reliably turned out for the >!P, often mobilized by ad>unct organizations li$e

the Qoral Qa>ority and Christian Coalition% Hut those grou%s are gone or greatly

http://archinte.jamanetwork.com/article.aspx?articleid=214736

http://archinte.jamanetwork.com/article.aspx?articleid=214736



diminished " and the 7F can no& use digital tools \ much as (emocrats have done to great e/ect \ to

directly reach constituents &ho may su%%ort their agenda but &ho are notalways showing u% on Olection Jay& The aim of the &ebsite is, as it says, Ito build an army

of conservative "ro'faith activistsJ \ sym"athetic believers of all faiths, but in "articular conservative Christians% The "lan is to identify ?**,*** believers &ho &ill s"read the &ord at the grass roots, es"ecially in churches% Centralto the e/ort are "astors, &ho Connelly said have been too reticent to "reach about "olitical issues% Under federal

la&, houses of &orshi" could >eo"ardize their ta5'e5em"t status if they endorse individual candidates% ILet.sovercome that myth of the -GS saying you can.t tal$ about this from the "ul"it,J he said% ILoo$, if there.s nofreedom of s"eech in the "ul"it, there.s no freedom of s"eech%J I8o& is the time of righteous indignation,J he said,

a time to be the Iturn'the'tables'over esusJ and not the Imee$, turn'the'other'chee$ esus%J .heimmediate goal of this initiative is to 9ma7imize the faith $ote: in *eySenate races" es%ecially in red or %ur%le states li*e Qentuc*y"

>eorgia" Ar*ansas" Louisiana and North Carolina& ;inning those

seats is essential to the >!P dreams of reta*ing the ma'ority in the

Senate this year&

;omen are *eyLiasson 1 _Qara, national "olitical corres"ondent for 8FG, Iomen oters ToFlay Critical Gole -n The )*?O Elections,J Qay *P,htt":##hereandno&%&bur%org#)*?O#*P#*P#unmarried'&omen'voters`MSFS

This year, both ,e%ublicans and Jemocrats are %aying %articular attentionto women $oters& At 3 %ercent" female $oters ma*e u% more thanhalf of the electorate" and could be a signi#cant *ey to determiningwho holds the Senate in No$ember& ,e%ublicans ha$e had a long-term %roblem attracting women $oters in general" but this year itmight be Jemocrats who face that %roblem & 8FG 8ational Folitics Corres"ondent

Qara Liasson >oins Here V 8o&.s Qeghna Cha$rabarti to discuss the critical role &omen could "lay in the )*?O

midterm elections, as "art of 8FG.s series IShe otes%J QE7H8A CHA!GA0AGT-, HST: This is HEGE A8( 8% There are many &ays to measure the American electorate: &here voters live, ho& often they cast a ballot, &ho theytend to vote for, ho& old they are, ho& much money they ma$e, et cetera, et cetera, et cetera% -n our data'driven

&orld, the list goes on% 0ut this year" both ,e%ublicans and Jemocrats are%aying close attention to one of the sim%lest" but most im%ortantas%ects of the American $oter gender& Bemale $oters ma*e u% morethan half of the electorate" 3 %ercent& And their $ote could becrucial to the balance of %ower in the Senate in No$ember& 8FG national

"olitics corres"ondent Qara Liasson >oins us no& to discuss the critical role &omen could "lay in the )*?O midtermelections% -ts "art of 8FGs series She otes% Qara, hi there% QAGA L-ASS8, 0=L-8E: Hi, there% Ha""y to be here%CHA!GA0AGT-: 7reat to have you% So, 3rst of all, - mean, lets >ust chec$ one of the ty"ical "resum"tions in "oliticsthese days, and that is that the Ge"ublican Farty is seen as having had a "roblem attracting female voters% 0utchec$ that &ith us, as - say% hat do the numbers say, and do &omen actually tend to vote more along (emocratic

lines@ L-ASS8: Theres no doubt that the gender ga% fa$ors Jemocrats & 0arac$

!bama, for instance, won the o$erall women6s $ote by close to 3? %ointslast time in =?1=& He did it by &inning &hats called the marriage ga"% Qarried &omen actually voted

for Qitt Gomney by seven "oints% He &on them% 0ut unmarried &omen voted for 0arac$ bama by N+ "oints ' a

margin of N+ "oints% So, yes, Jemocrats usually win the women6s $ote becauseof the marriage ga%& CHA!GA0AGT-: ell, and yet, for the )*?O midterms, &ere beginning to hear

concern amongst members of the (emocratic Farty that they may have trouble attracting female voters% hats

di/erent this time around@ L-ASS8: ell, the %eculiar %articular %roblem the



Jemocrats ha$e in the midterm election this year is that unmarriedwomen ' e$en though they are among the Jemocrats6 most reliablesu%%orters - tend to disa%%ear in the midterm elections& .hey 'ustdon6t turn out to $ote & .his is not uncommon with the entireJemocratic coalition% =ou $no&, &hat 0arac$ bama did &as e5"and the electorate, and he created

something thats sometimes referred to as the Gising American Electorate, GAE: young "eo"le, minorities andunmarried &omen% That is a mighty coalition in "residential years% 0ut it all but e$a%orates inmidterms& And the %roblem the Jemocrats ha$e is they ha$e a lot of reliable su%%orters out there" $ery reliable su%%orters - unmarriedwomen - but they ha$e to get them to turn out" because unmarriedwomen dro% o& -n other &ords, the di/erence bet&een their "artici"ation in "residential years and

midterm elections is huge% And thats the (emocrats "roblem this year% Theyve got to get those unmarried &omen&ho voted for them in )**B and ?), but didnt vote for them generally or didnt vote at all in )*?*, to come out thisyear% CHA!GA0AGT-: ell, and >ust to "ut a number on this, in your re"orting this morning &hen youre tal$ing about >ust &hat fraction of the electorate these unmarried or single &omen re"resent, you &ere tal$ing about a 9uarter of

the entire electorate overall% L-ASS8: ell, a +uarter of the entire electorate o$erallare single women & =ou $no&, as marriage rates decline, the numbers of single &omen are gro&ing% So

this is a gro&ing "ortion of the electorate, not unli$e all the other "ortions of the (emocratic coalition% Thats &hyits called the Gising American Electorate, because these grou"s are gro&ing% The &hiter, older, more rural marriedsection of the electorate, &here Ge"ublicans do very &ell, that "ool is shrin$ing% CHA!GA0AGT-: So is the fact thatmaybe amongst the certain "ercentage of female voters, their hearts may be in it, but their feet arent ta$ing themto the "olls this 8ovember% -s that going to aid Ge"ublican candidates@ r is the Ge"ublican Fartys historical"roblem &ith female voters >ust going to "lay out once again in 8ovember@ L-ASS8: 8o, its going to aid

Ge"ublican voters, because the ,e%ublican electorate turns out in midterm elections% -t iswhiter" older" more married " but that actually is a good descri%tionof the electorate in an o-year" in a midterm election& And so,e%ublicans are ad$antaged this year" for many" many reasons "where the crucial Senate races are ha%%en to be in red states" butalso because their electorate are more habitual $oters & Thats the "roblem

the Jemocrats ha$e% They have to #nd these women& They have to engage them% As yousaid, their hearts are &ith the (emocrats, but their feet arent ta$ing them to the "olls% Theyre not as hy"ed u"%

They dont hear about the elections as much% So it is not going to be a huge %roblem for,e%ublicans this year& Ge"ublicans have a long'term, serious "roblem &ith &omen voters,

"articularly in "residential years% 0ut this year, - &ould say the female vote "roblem is the (emocrats%

Olderlty determine the outcome Taegan >oddard, sta/, ISeniors Qay 0e the 8e& S&ing ote in )*?O,J THE EE!,

?*\N*\13, htt":##the&ee$%com#article#inde5#)P)*)B#seniors'may'be'the'ne&'s&ing'vote'in')*?O, accessed D'?O'?O%

-n "revious cycles, &eve had soccer moms and 8ASCAG dads as the $oting demogra%hic that ti%%ed

elections one &ay or another% 8e5t year it may be seniors& Seniors bro$e heavily for

Ge"ublicans in )*?* and they are usually a dis%ro%ortionate $oice in midterm electionsbecause they6re more li*ely to $ote% A ne& (emocracy Cor"s 2( surveysuggests they may %layan e$en bigger role in the =?1 midterm elections% And theyre moving to vote (emocratic%

African Americans are *ey to a democratic winartin 1 _onathan, national "olitical corres"ondent for The 8e& =or$ Times, IAt Gis$ in Senate,

(emocrats See$ to Gally 0lac$sJ Aug N*, htt":##&&&%nytimes%com#)*?O#*B#N?#us#"olitics#at'ris$'in'senate'democrats'see$'to'rally'blac$s%html@refKtodays"a"er`MSFS

http://theweek.com/article/index/252028/seniors-may-be-the-new-swing-vote-in-2014






ASH-87T8 \ ;ith their Senate ma'ority im%eriled" Jemocrats aretrying to mobilize African-Americans outraged by the shooting in 4erguson, Qo%, tohel% them retain control of at least one chamber of Congress forPresident !bama)s #nal two years in oce& -n blac$ churches and on blac$ tal$ radio,

African'American civic leaders have begun invo$ing the death of Qichael 0ro&n in 4erguson, along &ithconservative calls to im"each Qr% bama, as they urge blac$ voters to channel their anger by voting (emocratic inthe midterm elections, in &hich minority turnout is ty"ically lo&er% I4erguson has made it crystal clear to theAfrican'American community and others that &e.ve got to go to the "olls,J said Ge"resentative ohn Le&is,(emocrat of 7eorgia and a civil'rights leader% I=ou "artici"ate and vote, and you can have some control over &hat

ha""ens to your child and your country%J .he %ush is an attem%t to counter,e%ublicans) many ad$antages in this year)s races" including %ollsthat show ,e%ublican $oters are much more engaged in theelections at this %oint R an im%ortant %redictor of turnout& r&Lewis is headlining eorts to mobilize blac* $oters in se$eral stateswith com%etiti$e Senate races" including Ar*ansas" Louisiana andNorth Carolina & The drive is being organized by the Congressional 0lac$ Caucus, in coordination &ith the

(emocratic Senatorial Cam"aign Committee% ther ste"s, such as recruiting 8%0%A% "layers to hel" register more

African'Americans, are also under&ay% ;hile Jemocrats always see* to increaseAfrican-American turnout" that they are ta*ing such aggressi$este%s to rally their most loyal constituency reIects the increasinglydicult landsca%e they face & -n recent &ee$s, seats in Colorado" 8owa andNew Eam%shire" once e7%ected to tilt toward the Jemocrats" ha$ebecome more com%etiti$e& Qr% !bama)s a%%ro$al rating has tumbledbelow ? %ercent in states with some of the most com%etiti$e races"and Ge"ublicans already seem assured to &in at least three of the si5 seats they need to ta$e bac$ the Senate%

And the terrain is tric*y any of the states where the blac* $otecould be most crucial are also those where r& !bama is dee%lyun%o%ular among many white $oters & So (emocratic senators in "laces li$e Ar$ansas,

Louisiana and 8orth Carolina must distance themselves from the nation.s 3rst African'American "resident &hiletrying to motivate the blac$ voters &ho are his most loyal constituents% Labor (ay is the uno1cial $ic$o/ for the

general election cam"aign, and analysts say the contest for control of the Senateremains unsettled" though most gi$e a slight edge to the ,e%ublicans&

After a turbulent summer dominated more by a succession of grim ne&s events at home and abroad than by ty"icalelection'year a""eals, o1cials in both "arties agree that the cam"aign is 6uid and that a &ave election, &ith one

"arty &inning a large number of seats, is unli$ely to ha""en% .he blac* $ote could %ro$e%articularly decisi$e in four Southern states: >eorgia and Louisiana " &here African'

Americans ma$e u" more than N* "ercent of eligible voters; North Carolina, &here they are )) "ercent;

and Ar*ansas, ?P "ercent% hile minority turnout traditionally declines in non"residential election years,

there have been midterm elections in which Southern blac*s %lay ed a

%i$otal role& An e5am"le occurred in ?DDB, &hen Fresident 0ill Clinton &as, li$e Qr% bama, under 3refrom Ge"ublicans and nearing the end of his hite House years%



1NC Com%le7ity

Linearity might not be true but com%le7ity isn)t 1??M trueeither

(r% Sebastian L% % >or*a et al 1=, (irector of the Homeland (efense 4ello&sFrogram at the College of -nternational Security A/airs, 8ational (efense University,teaches -rregular arfare and US 8ational Security at 8(U and 7eorgeto&n, et al%,S"ring )*?), IThe Com"le5ity Tra",J Farameters,htt":##&&&%carlisle%army%mil#USAC#"arameters#Articles#)*?)s"ring#7allagher7eltzer7or$a%"df

These com"eting vie&s of America.s national security concerns indicate an im"ortant and distinctive characteristic of today.s global landsca"e:

%rioritization is simultaneously very dicult and $ery im%ortant for the United States%

Oach of these threats and %otential threats\al ]aeda" China" nuclear%roliferation" climate change" global disease" and so on\can con'ure u%a worstcase scenario that is immensely intimidating & 7iven the di1culty of combining

estimates of "robabilities &ith the levels of ris$ associated &ith these threats, it is challenging to establish

%riorities & Such choices and trade-os are dicult" but not im%ossible % N* -n fact,

they are the stoc*-in-trade of the strategist and %lanner% 8f the nited States isgoing to res%ond %roacti$ely and eecti$ely to today)s international

en$ironment" %rioritization is the *ey #rst ste% \and %recisely the

o%%osite reaction to the com%lacency and undierentiated fear that the

notion of un%recedented com%le7ity encourages% Com%le7ity suggests a

ma7imization of Ie7ibility and minimization of commitment ; but

%rioritization demands wise allotment of resources and attention in a

way that commits American %ower and eort most eecti$ely andeciently% Fhrased di/erently, com%le7ity induces deciding not to decide ;

%rioritization encourages deciding which decisions matter most& .oday)s

world of di$erse threats characterized by uncertain "robabilities and unclear ris$s will o$erwhelm us if

the s%ecter of com%le7ity seduces us into either %aralysis or %aranoia% Some

%riorities need to be set if the United States is to 3nd the resources to confront &hat threatens it most% N? As Qichael

(oran recently argued in reference to the Arab S"ring, Ithe United States must train itself to see a large dune as something more formidable than >ust

endless grains of sand%JN)^ .his is not to deny the %ossibility of nonlinear %henomena "butterIy eects" self-organizing systems that e5hibit "atterns in the absence of centralized authority,

or emergent %ro%erties% NN -f anything, these hallmar*s of com%le7ity theoryremind strategists of the im%ortance of re$isiting *ey assum%tions in

light of new data and allo&ing for tactical Ie7ibility in case of unintended conse9uences% Soundstrategy re+uires hard choices and commitments" but it need not be

inIe7ible% ;e can %rioritize without being %rocrustean& Hut a model in

which e$erything is %otentially rele$ant is a model in which nothing is%



O$en if %redictions in the abstract are wrong" %olicydebates is %roducti$e" im%ro$es %redicti$e accuracy" andsol$es cession of the debate to cloistered e7%erts.etloc* 11 2Fhili" Tetloc$ is a "rofessor of organizational behavior at the Haas

0usiness School at the University of California'0er$eley, A8( (an 7ardner is acolumnist and senior &riter for the tta&a Citizen and the author of The Science of4ear, received numerous a&ards for his &riting, including the Qichener A&ard, Q%A%History from =or$, REGCQ-87 UG AEGS-8 T AC!8LE(7-87 UG-78GA8CER uly ?? &&&%cato'unbound%org#)*??#*#??#dan'gardner'and'"hili"'tetloc$#overcoming'our'aversion'to'ac$no&ledging'our'ignorance#

.he o%timists are right that there is much we can do at a cost that is 9uite modest

relative to &hat is often at sta$e% 4or e5am"le, &hy not build on the -AGFA tournament@ 8magine a system forrecording and 'udging forecasts & -magine running tallies of forecasters. accuracy rates%

8magine ad$ocates on either side of a %olicy debate s%ecifying in advance

"recisely &hat outcomes their desired a%%roach is e7%ected to %roduce " thee$idence that will settle whether it has done so" and the conditionsunder which %artici%ants would agree to say 98 was wrong &J -magine "undits

being held to account% f course arbitration only &or$s if the arbiter is universally res"ected and it &ould be an enormous challengeto create an analytical center &hose >udgments &ere not only fair, but "erceived to be fair even by "artisans dead sure they are

right and the other guys are &rong% 0ut thin* of the %otential of such a system toim%ro$e the signal-to-noise ratio" to shar%en %ublic debate , to shift attention

from blo&hards to e5"erts &orthy of an audience, and to im%ro$e %ublic %olicy% At a minimum, it &ould

highlight ho& often our forecasts and e5"ectations fail, and if that &ere to de6ate the bloated con3dence of e5"erts and leaders,

and give "ause to those "re"aring some Igreat lea" for&ard,J it &ould be money &ell s"ent% 0ut the %essimists areright " too" that fallibility " error" and tragedy are %ermanentconditions of our e5istence% Humility is in order, or, as Socrates said, the beginning of &isdom is the admission of

ignorance% The Socratic message has al&ays been a hard sell, and it still is\es"ecially among "ractical "eo"le in business and"olitics, &ho e5"ect every "resentation to end &ith a single slide consisting of 3ve bullet "oints labeled IThe Solution%J e have no

such slide, unfortunately% Hut in defense of Socrates, humility is the foundation of the fo7 style of thin*ing and

much research suggests it is an essential com%onent of good 'udgment in ouruncertain world& 8t is %ractical& !$er the long term" it yields bettercalibrated %robability 'udgments" which should hel% you a7 morerealistic odds than your com%etitors on %olicy bets %anning out%

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