116. Who should decide end of life?

We recently learned that Shea, one of our beloved dogs, has bladder cancer. Although she has been responding very well to medication, we have been advised that her time is now measured in months, not years. After managing the grief that we have already suffered, and that which will overcome us when she is gone, our attention turned to her well-being. We want her to be as happy and comfortable for as long as possible. Like most dog owners, we do not want her to suffer.

The medication has actually been a rebirth; she is happier and more active now than she has been in several months. She is running and jumping like a puppy. She is also enjoying the special attention. But, again, we know this is short-lived, and we will be forced to deal with the life and death associated with all living things.

It is common for pet owners to euthanize their animals when it becomes obvious that they are in pain; when their quality of life has deteriorated beyond what any living thing should have to endure. It is well-regarded, by most, as the "humane" thing to do. Of course, this is just a guess on behalf of the pet owners, because we cannot ask our pets if they would want to live or die. Indeed, some of the decision-making process is selfish; it hurts us nearly as much to watch our animals in pain. Most pet owners will argue that they know their pets and know when it is time. I have little doubt that in many cases that is true. We know our Shea is a fighter, with a big heart. I would like to think that we will be able to recognize when she has fought all that she can.

That presents an interesting quandary, because many people will argue that it is not humane to assist in the suicide of a human being. If fact, in all states other than Oregon, it is illegal. In this respect, I have difficulty recognizing the difference between the humane euthanization of a pet, one who cannot tell you when the pain is greater than quality of life, and assisting the suicide of a human, one that often can clearly communication that they have made that same exact decision.

There are a number of arguments on both sides; some which hold some merit, others which are clearly biased. A 1998 University of Washington discussion on bio-ethics identified a number of arguments, specifically to the idea of physician-assisted suicide. In this case, a physician prepares a lethal dose of medication, but the patient/individual takes the last active step in committing suicide. But, even here there are several arguments on both sides.

The arguments against physician-assisted suicide include the sanctity of life. A religious argument headed by Thomas Aquinas condemned all suicide as harmful and in contraction with the idea that only God can take a life. They also argued that there is a difference between letting someone die and actively killing them, the passive versus active distinction. Most on both sides fear the potential for abuse, where burdened family members may encourage for assisted death rather than put forth the time and expense of a terminally-ill family member. Finally there are some physician issues, such as the integrity of the Hippocratic Oath and mistakes in diagnosis.

Those that favor the idea do so because of the respect for autonomy, the right to make one's own decisions. They also argue for justice, and as I have, compassion. There is the debate concerning the state's interest in preserving life, and the individual liberty of person to do what they desire when they are terminal and suffering. Finally, there is the argument about the openness of discussion. Here, the issue would be discussed and debated, for assisted suicide often happens already in secret or across the muddled line of comfort and death.

Personally, when faced with a difficult issue or forced to consider a complex situation, I attempt to reduce it to its simplest terms. In this case, if most people would agree that humanity rests with euthanizing a suffering animal, then I believe the same humanity should be extended to a human being- if he or she expressly and with due process chooses to end his or her life. While we should guard against any potential abuse, I think it takes a significant degree of superciliousness to decide for others when it comes to their most precious possession- life. Why not offer a painless option, and the ability to die with dignity- on your own terms? How can anyone be sentenced to suffer? For me, it indeed is a difficult issue, but not a difficult decision.

My little girl Shea was named after Shea Stadium, home of the New York Mets- which have always been my second favorite team after the Indians. We wanted our dogs to have "baseball names" and Shea, when we rescued her at about eight months old, was named Shelby. After great debate, we found Shea to be close enough not to confuse her, and yet keep our baseball theme. In a gut-wrenching coincidence, this is the last year for Shea Stadium- the Mets will have a new stadium in 2009.

115. Referendum vote not always right

Referendum is becoming a popular idea in Lorain County when it comes to tax increases. We saw it in the last general election regarding the County sales tax, and now it is being considered in regards to the Lorain City government proposal to tax license plates an additional $15 for road repairs.

Referendums are indeed democratic, as each voter has a say in the passage of legislation. Ironically, according to Ohio History Central, it arose to pass tax issues when legislatures were afraid to.

"One reform instituted by Progressives in many states was the referendum. Progressives believed that politicians were often afraid to introduce some types of legislation because it could be unpopular and prevent their reelection. Referendum would allow politicians to put legislation on the ballot so that the voters, rather than the politicians, were responsible for its passage. Tax issues were one type of legislation that might go through the referendum process. If a tax issue passed, the voters themselves, rather than the politicians, were responsible for their increased taxes. Progressives argued that the referendum made the American political system more democratic."

Today, it is just the opposite. Referendums are being used to repeal tax increases.

We ought to be careful in our haste to get these issues on the ballot, for several reasons. Raising taxes is never easy to do; however, there becomes a point when the social or government services cannot be provided based on the current revenue. Most tax payers do not realize this; all they understand that they do not want to pay more taxes. Furthermore, it is unlikely that most citizens have ever really looked at a county or city budget to the degree that they can make an informed decision as to whether a tax increase is warranted. That is why we elect representatives, people whom we trust to make informed decisions when considering all the demands of providing a government to its citizens. If we do not trust them to make decisions concerning the amount of taxes we paid, then we ought to have elected someone else. That is why it is so important people learn about their candidates, the issues they support- and get out to vote.

That being said, there is a time and place for the use of referendum. It does provide voters a say in important and perhaps controversial issues. It also affords voters the opportunity to overturn poor legislation. It should always be the right of citizens to consider a referendum.

However, there is also the misuse of referendum, such as using it to build a political platform, or to oppress a minority. Unfortunately, any majority issue can be placed on the ballot to take away the rights of others. Recently, referendums were used to make gay marriage illegal and to make smoking illegal in public places. As most know, the gay marriage referendum was especially misguided since it was already illegal in the state of Ohio and it was used primarily to re-elect President Bush. Referendum should be done as an action of the citizens, not to launch, enhance, or preserve political careers.

Again, nobody likes to pay taxes. However, safe neighborhoods, high-quality schools and social services come at a price- and if we are not willing to invest in ourselves, how we will ever lure businesses and others to our area. In other words, who wants to start a business or move to an area that is unsafe, has poor roads, offers underfunded schools or does not have the essential social services? We cannot have it both ways.

What voters decide is up to them, and in times of increasing economic difficulties, I can understand why tax increases are voted down. However, all perspectives and interests should be considered when you see someone parading around a referendum. And, most importantly, voters should make an effort to understand and learn about the issues at hand. There is a reason that the tax increase was considered in the first place; our job is to legitimately decide whether or not it was warranted. But keep in mind that it is unlikely that any government official would risk his or her political career if there were other, easier, solutions.

If we are going to put some issues to vote, here is a few I would like to see (just for fun). How about a referendum limiting the amount of profits an oil company can make? What about a referendum that assures affordable healthcare to all citizens? Let us vote on an extended prison terms for animal abusers. Finally, and perhaps most importantly, we should suggest a referendum that ensures that all votes are actually counted!

114. Sport of kings is animal abuse

Talk about a change of fortune. One second Eight Belles is yards away from winning the biggest event in horseracing- one that would place her name in history, make her eligible to win the Triple Crown, and earn her owner hundreds of thousands in breeding. A few seconds later, she collapses amidst two shattered legs, and is instantly killed on the track.

When thinking about this column, I considered a number of approaches.

I first thought about explaining how my interest in the sport no longer exists after the deaths of a few horses the last couple of years. Perhaps surprisingly, I actually used to enjoy horseracing. I enjoyed the atmosphere, excitement and cheap gambling. . . because, as you know, "every nineteen minutes the place goes crazy." I considered the horses to be a beautiful display of nature's power and grace. Unfortunately, it was a situation in which ignorance was bliss.

I considered blaming the ill effects of horseracing on the wealthy; those that apparently have no better venture to make in life than breeding and training horses to run in some arbitrary race amidst national sports coverage and women in silly red hats. After all, they pay stud fees that run near a hundred of thousand; an investment in hopes of a large purse, future stud fees, prestige, and bragging rights amongst their shallow friends. For example, 2007 Kentucky Derby winner Street Sense is earning up to a $100,000 stud fee, with projected earnings of $50 million dollars. This is not a poor-man's game, and each horse is a major investment, with high expectations. Disappointing the large investments of wealthy and powerful people is a risky business for a horse that does not perform. Sooner or later, the owner will choose to cut his losses.

I pondered attacking tradition, and questioning how long this abusive sport should continue simply because it is firmly entrenched in American history. The "Race for the Roses," is horseracing's version of the Super Bowl, with all the parties and rituals therein. At some point, the horserace becomes a side show- the culmination of champagne toasts and social gatherings. The sport, long given a "pass" by the media, is finally being viewed critically. Times columnist William Rhoden asked, "Why do we refuse to put the brutal game of racing in the realm of mistreatment of animals?" He asked, "At what point do we at least raise the question about the efficacy of thousand-pound horses racing at full throttle on spindly legs?"

That leads into the ethical perspective, as I could easily maintain that horseracing breeds dangerously fragile animals and drugs them for optimal performance- all while whipping them to the finish line and slaughtering the losers and injured. Wayne Pacelle from the Humane Society of the United States commented:

"Here are some of the historic problems. Drugging of injured horses to keep them running, which makes vulnerable horses more susceptible to breakdowns. Racing horses too young. Because the marquee events feature 3-year-olds, these horses must start racing at the tender age of two years, and that's well before their skeletal systems are sturdy enough to endure the pounding from the rigors of the race track. And third, racing horses on track surfaces that are not forgiving-with American tracks favoring dirt surfaces over grass or synthetics."

Finally, I considered the socio-economic argument that horseracing among the wealthy is analogous to the dog-fighting of the poor. It is a recreational "sport" fought by animal competitors which are bred and trained to perform at a high level for the amusement of bored humans. For the spectators, it is more about the atmosphere- the betting and drinking- than it is about the event. Most only care if their dog or horse wins, not about the dog or horse itself. Granted, the analogy breaks down within the pure horror of dog-fighting, but the wealthy should not assume moral superiority simply because the horses are "humanly" euthanized.

It would seem that the number of approaches that I could take to illustrate the lack of integrity and lack of meaningfulness within horseracing indicates that there is a problem with this sport from a multitude of perspectives. It cannot be "fixed," though compromises will be accepted as horseracing is finally going to be under some inquiry. Although change will be slow and often unenforceable, the racing industry has been forming panels, committees and hosting summits on animal safety. Whether it is a sincere effort or a measure of placating the activists remains to be seen. Any decision will certainly consider the financial interest of those participating, so pardon my skepticism.

I could make it is easy for them- abolish the sport. That solves all of the problems, and hurts little more than a few wealthy people. As societies evolve, traditions sometimes fall by the wayside. Traditions much more significant than horseracing have been repealed. Horse owners could spend the money on things that actually matter; I can think of a million more things more enjoyable and meaningful than watching a horse fall to her death. Again.

113. Skirting evolution doesn't change it

Our latest healthcare statements included an insert on antibiotics, entitled, "Know When to Say No to Antibiotics." This proclamation is two-fold. First, there is an overuse problem in the prescription of antibiotics- often for inappropriate illnesses, those which our bodies can handle naturally. Secondly, they are often described for illnesses in which they are ineffective, such as viruses. However, the motive is as much financial as it is good medicine, and, inevitably the health insurance company can save itself a considerable amount of money if these prescriptions are dispensed less often (some estimates are as high as $18.5 million per year for antibiotics).

But that is not what attracted my attention, rather it was the proceeding explanation, which reads, "Bacteria continue to change and grow into ‘superbugs' that do not respond to antibiotics, leading to a growing antibiotic resistance problem." Bacteria do change, but they do not "grow into superbugs." They genetically change over time in response to the selective pressure placed on their environment. They do not change into extraordinary microorganisms capable of leaping small buildings in a single bound, they change into a genetically different, or "variant" bacteria. In short, they "evolve." And I thought it was interesting that the insurance company avoided that word like the plaque.

More specifically, as the bacteria are attacked by the antibiotics, most are killed- which is fortunate, because it leads to our recovery. However, in the course of rapid reproduction, mutant bacteria, some of which may be resistant to the bacteria, are born (or replicated), and survives to reproduce and pass on its genetic makeup (other mutants die or offer no resistance to the antibiotics). Subsequently, these resistant bacteria, those that survive, are passed on to other individuals. In scientific terms, they are selected. And, obviously, since the mutant bacteria are resistant to the original antibiotic, the prescription is ineffective and scientists must now develop another antibiotic. Again, there is nothing "super" about them, except they are more resistant to our current antibiotics. There are more complicated methods in the resistive undertaking by the bacteria, such as transformation and plasmid exchange, but the effect is the same- its genetic makeup has changed. PBS has adeptly referred this process as the "evolutionary arm race."

The process I described is, granted, a bit simplified, as the entire endeavor is complicated by the intricacies of science, such as the debate to what extent the bacteria suffers a "cost of resistance." In other words, to what extent are the resistant bacteria less fit in the absence of antibiotics in the adaptation of their genotyopes? The entire exercise is a wonderful exploration into science- including our immune system, microorganisms, population genetics, mutations, and yes, that nasty word- evolution.

The religious perspective on the subject is a bit interesting, as this is of considerable importance in addressing and refuting the theory of evolution. The explanation from such groups as Apologetics Press, Answer in Genesis and The Discovery Institute, differ in how they attend to the idea. While most do not debate that the bacteria evolve, they dispute the mechanism and the significance of the change. For example, here is the conclusion drawn in answersingenesis.com:

"The mechanisms of mutation and natural selection aid bacteria populations in becoming resistant to antibiotics. However, mutation and natural selection also result in bacteria with defective proteins that have lost their normal functions.

Evolution requires a gain of functional systems for bacteria to evolve into man-functioning arms, eyeballs, and a brain, to name a few.

Mutation and natural selection, thought to be the driving forces of evolution, only lead to a loss of functional systems. Therefore, antibiotic resistance of bacteria is not an example of evolution in action but rather variation within a bacterial kind. It is also a testimony to the wonderful design God gave bacteria, master adapters and survivors in a sin-cursed world."

This explanation clearly focuses on the debate I referred to previously on the "cost of the resistance." It is a "gap argument," in which one aspect of science is used by non-scientists to justify their religious conclusions. It is obvious that science has it right otherwise antibiotics and other treatments would not be as effective as they are. And even if there is debate on the exact mechanism of mutation (scientific studies indicate that microorganisms are able to overcome the harmful side-effects of resistance), I cannot help but to wonder the outcome if they would apply the same scrutiny to their own beliefs and principles.

In the 2006 Organization for Economic Cooperation and Development (OECD) study, American students ranked 29th in science in comparison with 57 other countries. As exemplified by my medically-based insurance company avoiding and sugar-coating the science that affects our own bodies, perhaps part of the problem is that we are even afraid to admit that science exists. Maybe it could be better understood in a comic book, or video game- "Superman versus the Superbugs!" The point is that you can only "dumb it down" for only so long before people become...well, you know.