Death with Dignity

Seneca the Younger committing
suicide with the help of his friends,
A.D. 65 (Luca Giordano, 1684)

Next month Massachusetts voters will decide whether to allow "Death with Dignity," aka physician-assisted suicide. If a majority vote yes, Massachusetts will become the fourth state (after Oregon, Washington, and Montana) to allow a licensed physician "to prescribe medication, at the request of a terminally-ill patient meeting certain conditions, to end that person’s life."

Father Tadeusz Pacholczyk, a Catholic priest and fierce right-to-lifer who weighed in on the issue in yesterday's Wall Street Journal, plans to vote no.

In "Please Step Back from the Assisted Suicide Ledge," Pacholczyk argues that physicians who provided lethal medications would destroy public trust as surely as policemen who provided guns or lifeguards who provided millstones (millstones?) to despondent people. He then offers two anecdotes: one about a woman who felt betrayed by her grandparents' joint suicide (they did not have a terminal illness, and their deaths were not physician assisted, so her story does not apply), and the other about a friend with multiple sclerosis who is glad he's still alive to enjoy his grandchildren (nobody is suggesting that PAS be mandatory, for Pete's sake, so this story doesn't apply either).

Father Pacholczyk makes me embarrassed to admit that I too would vote No.

I'm not going to make an argument here. I'll just point out that, when it comes to dying, there are more than two or three choices. Some people believe dying people should be kept alive for as long as medically possible, no matter how they or their families feel about it, no matter how much suffering is involved. Other people believe that, in extreme cases, doctors should have the right to administer lethal drugs to dying patients (euthanasia). Physician-assisted suicide lies between these two positions. So do hospice care, palliative care, and other dignified alternatives to either prolonging suffering, on the one hand, or causing death, on the other.

I believe that a lot of people support physician-assisted suicide or euthanasia because they fear they have only one alternative--to be kept alive for days, weeks, months, or even years of misery through painful interventions. Extremism breeds extremism. There are other approaches to terminal illness, however, as Bill Keller's excellent article in Sunday's New York Times points out. Last month Keller's father-in-law, Anthony Gilbey, died in a U.K. hospital of inoperable cancer. In "How to Die," Keller describes the older man's six-day dying process and the decisions--personal, medical, and political--that made his death dignified, loving, and peaceful. "We should all die so well," Keller concludes.

The approach used with Mr Gilbey, the Liverpool Care Pathway, doesn't appeal to extremists on either side, says Keller. "'Pro-life' lobbyists ... portray it as a back-door form of euthanasia.... Euthanasia advocates ... say it isn’t euthanasia-like enough." It is, however, realistic, compassionate, family oriented, spiritually sensitive, and sensible. It allowed Mr Gilbey to die at peace with God and his family, knowing he was loved.

The Liverpool Care Pathway is the standard approach "in most British hospitals and in several other countries [where, by the way, assisted suicide is illegal] — but not ours," writes Keller. "When I asked one American end-of-life specialist what chance he saw that something of the kind could be replicated here, the answer was immediate: 'Zero.'"

Learn more about how we Americans could choose to die with dignity, if only we were willing to give up our politically exacerbated extremism. Read Bill Keller's moving (and short) article. Click here.

If you love serious chocolate but are not a chocolate snob...

Give me a recipe involving chocolate, and I'll automatically double the amount of cocoa powder, switch from milk or semisweet to dark chocolate, and throw in a broken-up extra-dark chocolate bar for good measure. When it comes to chocolate, I don't mess around.

Which is why I decided to go hunting for the best extra-dark chocolate bar that is readily available. I don't mean those wimpy 72% cacao creations--I wanted a bar that was at least 85% chocolate. Nor did I want a bar that cost more than 6 cents a gram or that had to be specially ordered online. I was looking for something I could buy whenever a chocolate craving hijacked my brain cells.

I do not claim to have found the paragon I sought. Why would I want to? The joy is in the journey, not the destination. But here are some observations about four extra-dark chocolate bars that may well be available at a grocery store in your neighborhood. And if they aren't, please check out the ones that are, and let me know what you find!

#4 Lindt-Sprüngli Excellence, 100g, 12.5% sugar, $3.85
I had high hopes for this bar. I had a profound relationship with Lindt-Sprüngli the year I was 16 years old and living in France, right across from the Swiss border. And I do love Lindor truffles, even if they aren't quite dark enough. Besides, the Excellence ingredient list is pure and simple: chocolate, cocoa powder, cocoa butter, demerara sugar, bourbon vanilla beans.

Hélas, the Excellence bar disappointed. My first impression was that I was chewing wax. After 10 or 15 seconds, the chocolate flavor finally appeared, and it wasn't bad: a bit spicy, a bit fruity. But as soon as I swallowed, it went back to wherever it hides when I'm eating my vegetables. I'm not going to give up on Lindt products just yet, however: they also make a 90% bar (same ingredients) and even a 99% bar (cocoa mass, cocoa powder, cocoa butter, brown sugar).

#3 Ghirardelli Midnight Reverie, 90g, 11.1% sugar, $4.55
Higher price, smaller size. More chocolate, less sugar. This one should be fantastic, right? Well, it wasn't bad. Unlike the Lindt-Sprüngli bar, Midnight Reverie was neither waxy nor brittle, though it also started out tasteless. The chocolate flavor, which hinted of berries, developed a few seconds later, but not as late as with the Excellence bar. Contrary to the label's claim, unfortunately, the flavor was not intense. In fact, this could be a good starter bar for people who prefer milk chocolate but are switching to dark for health reasons.

Dark-chocolate purists might find the ingredients list distressingly long, with unnecessary additions: Midnight Reverie contains chocolate, cocoa butter, sugar, milk fat, soy lecithin, vanilla, and natural flavor.

#2 Trader Joe's Dark Chocolate Lover's Chocolate Bar, 100g, 12.5% sugar, $1.49
At 1.5 cents a gram, this is without a doubt the best value for serious chocolate lovers! But then, what serious chocolate lover ranks ecstasy by cost?

The Dark Chocolate Lover's bar had a consistency similar to that of Midnight Reverie, probably because both bars contain soy lecithin (DCL's ingredients: cocoa mass, sugar, cocoa butter, soy lecithin, natural vanilla flavor). Its flavor--strong on berries--hit the mouth sooner and was a bit more intense than that of its Ghirardelli counterpart.

I'd cheerfully eat little bits of this bar every day except for one thing: like the Ghirardelli bar and the Lindt-Sprüngli bar, it is not certified fair trade. That means the farmers who produced the cocoa probably did not receive a fair price for their product. Worse, it means that children, some of them actually slaves, may have been involved in farming the cocoa.

#1 Theo Organic Fair Trade Ultimate Dark, 84g, 16.7% sugar, $4.00
Theo comes from the Greek word for god (θεός), and the genus to which the cocoa plant belongs is theobroma, "food of the gods." The gods should be happy with Theo's Ultimate Dark bar, since it is both organically grown and fair traded. All the humans I've offered it to are happy with it too.

Its flavor, which evokes ripe, dark cherries, shows up immediately, intensifies while you chew, and lingers even as you consider breaking off another bite. Its consistency is smooth but not waxy. Its ingredient list is short and perhaps a bit too sweet: cocoa beans, sugar, cocoa butter, and ground vanilla beans. No soy lecithin, no cocoa powder, no milk fat, no "natural flavor," whatever that is.

I hope I liked this chocolate bar best because of its excellent ingredients. I wonder, though, if I'm mostly attracted to the extra sugar. With 7 grams of sugar in each 42-gram serving, Theo Ultimate Dark is 16.7% sugar, which seems to belie its claim to be 85% cocoa. I may have to try these all over again, and no doubt add some other brands, just to be sure ...

If you want to conduct your own chocolate research, check out One Golden Ticket, a blog I discovered while preparing this post. I wish they'd add one of those subscribe-by-email apps--I'd sign up immediately if they did.

Dear Mr. Romney: Don't lie. Care.

Dear Mr. Romney:

I am a woman. Like most other women, I am not likely to vote for you. Your unpopularity among women worries you, I know. That's no doubt why you're claiming that Mr. Obama's policies have been disastrous for women's jobs. Promoting a cynical lie, however, is not a good way to attract women's votes.

These days the word lie is thrown around too often and too loosely. Since I am accusing you of using a lie--a serious charge--let me define my terms. A lie is a statement intended to deceive. It can be nonfactual or factual; the speaker's intent is what matters. President Bush was probably not lying when he said Iraq had WMD, even though they didn't. If he believed what he said, though it was untrue, it was not a lie.

By contrast, when your press secretary tweeted that "92.3% jobs lost under [Obama} r women's," she was making a true statement. She may or may not have intended to deceive: I don't know if she paid attention to all the relevant facts before tweeting. By now, though, the facts have been checked, and you have no excuse for repeating her claim on your website. To do so is to turn truth into falsehood.

Here are the facts: The recession officially began in December 2007, while Mr. Bush was president. From that date until June 2009, six months into Mr. Obama's presidency, men lost some 5.3 million jobs while women lost about 2.1 million. This is a typical pattern, says Betsey Stevenson, a business and public policy professor at Princeton University: "In every recession men’s job loss occurs first and most, with unemployment rates for men being more cyclical than those of women’s."

My mother finished secretarial school and began her first job in 1929, the year the Great Depression hit. She managed a small office for maybe half a dozen church administrators--all male, of course. Then the stock market crashed, donations plummeted, and most of the men were let go.  Before long the only people left in the office were the president and my poorly paid 20-year-old mother.

That's how it has always worked. Men lose jobs first; women lose  jobs later. Still, with women making up 47% of the labor force (2010 figures), they "account for just 39.7 percent of the total" jobs lost from the beginning of the recession to the present. It is grossly misleading to imply that the recession was caused or worsened by Mr. Obama, and that it was harder on women than on men. You need to distance yourself from that claim, not promote it.

The recession was indeed hard on many women--and on just about everybody else except people in your income bracket, Mr. Romney. I suspect you truly believe that you are better suited than Mr. Obama to restore America's prosperity. Do you want women to give you a chance to try? Then forget about badmouthing the president. Instead, show us you care.

A lot of us, as you've pointed out, need work. How would your administration help us meet our obligations and feed our families until we find it? A lot of us, or our family members, have serious health problems. How would you help us pay for medical care? A lot of us want to strengthen our public schools. How would you improve the quality of elementary and high school education? A lot of us would like to send our children to college. How would you make higher education affordable? A lot of us are concerned about the effects of pollution on our families' health. How would you keep our food and air clean? A lot of us are getting older and frailer. How would you deal with our needs for housing and medical care?

I know that some vocal Americans believe the federal government should do just about nothing except arm our young people and send them out to kill. I know there are people who cry "socialism!" whenever the government tries to make people's lives better. Fortunately, most Americans disagree with such extremists. And yet there are honest differences between conservatives and progressives as to how the common good is best served.

Mr. Romney, if you have ways of serving the common good that you think are more effective than Mr. Obama's ways, please tell us about them. Don't worry about your supposedly stiff persona; it doesn't bother us nearly as much as it bothers the press. And don't try to scare us with lies and negative ads. That just turns us off. If you convince us that you care about us when we need help, and if you offer us solutions that will help us survive and thrive, we will listen. Otherwise, we'll vote for the candidate who does.

Steve Forbes's Prostate vs Mehmet Oz's Heart

Last week two articles highlighted America's split over health-care policy. One likened the U.S. Preventive Services Task Force* to a "death panel" and argued that we need more free enterprise in our health-care system. The other lamented the tens of millions of Americans who do not have adequate health care and argued that our inability to come up with "a health care reform law that we can all live with" is "a failure of basic morality."

The first article, "The Department of Health and Human Services' Death Panel" (Forbes magazine, 21 November 2011), is by Steve Forbes, a publisher and businessman whose net worth is estimated at $430 million.

The second article, "Enough Is Enough" (Time Ideas, 31 October 2011) is by Mehmet Oz, a cardiothoracic surgeon and media personality whose net worth is estimated at $7 million.

I'm pretty sure both writers are part of the 1%. Both were graduated from Ivy League universities: Mr Forbes with a history major from Princeton, Dr Oz with an undergraduate degree from Harvard, an MD from the University of Pennsylvania Medical School, and an MBA from the Wharton School of Business. Both are Boomers: Mr Forbes was born in 1947, Dr Oz in 1960. But despite the similarities, their views on health care couldn't be further apart.

Steve Forbes is irate with what he calls a "committee of 'experts' [scare quotes in original] appointed by the Department of Health & Human Services," because "this group recently declared that men should not be routinely screened for prostate cancer." See, Mr Forbes recently had a routine exam which led to removal of his prostate, and he is convinced - medical research be damned - that routine prostate exams save lots of lives. What is more, he is sure that the HHS research is all about "rationing and saving money," and that "what we need in health care is more free enterprise, not Soviet-style controls." He does not explain why he is opposed to the government's saving money, or why he thinks free enterprise would be less interested than the government in doing so.

Let's say Mr Forbes is right, the researchers are mistaken, and all men should get regular prostate exams. I am wondering how free enterprise will encourage that, given the ever-increasing number of uninsured Americans. Mr Forbes has endorsed Rick Perry for president; both men believe that health care is best handled by the private sector. It's not working so well in Governor Perry's Texas, however, according to a September 8, 2011, article in the L.A. Times. Insurance premiums are up - "when compared with incomes, insurance in Texas is less affordable than in every state but Mississippi" - as is infant mortality. "More than a quarter of Texans lack health insurance, the highest rate in the nation." Texas has some of the best hospitals in America for the rich and the well-insured, but "nearly a third of the state's children did not receive an annual physical and a teeth cleaning in 2007, placing Texas 40th in a state ranking by [the nonprofit Commonwealth Fund]." I don't imagine Texas, despite its governor's faith in private enterprise, will be offering free prostate exams any time soon.

Looked at another way, how would a federally managed health-care system prevent men from getting regular prostate exams if they really want them? A PSA test can cost as little as $45. If insurance companies, those pillars of private enterprise, stop subsidizing such tests on the grounds that the federal government says they have no proven value, will it be such a hardship for men to pay for their own tests? The poor might not be able to afford them, of course, but they're mostly uninsured and aren't getting them anyway - unless they are enrolled in some government program like Medicare or Medicaid. Yet Mr Forbes doesn't seem worried that those very programs may be cut back by politicians who favor a free-enterprise-based health-care system. His logical contradictions make the head spin.

Mehmet Oz, by contrast, doesn't serve up any ideology in his article. If he cares whether our health-care system is based on free enterprise, a single-payer system, or some combination of government and private business, he doesn't say. His article was sparked, not by a personal health crisis, but by what he saw when he volunteered at the "CareNow Free Clinic in the Los Angeles Sports Arena, where more than 700 doctors, nurses and health professionals had turned out to serve the local community."

During this four-day event, according to the CareNow website, "1,000 patients per day [were provided] with medical, dental and vision care they would not otherwise have received. A total of 7,200 procedures were performed, from dental fillings and root canals to medical exams and podiatry; from eye exams and prescription glasses to mammograms, Pap smears, immunizations and other services. Everything was offered at no cost to the patient."

Dr Oz, who has also volunteered at free clinics in Arkansas, North Carolina, and Texas, saw a "tide of disease and despair" in Los Angeles. A young mother whose children were insured by the state but who had no insurance herself. A young man with untreated, out-of-control diabetes who had no idea how to treat it. A woman who had lost her job and her insurance two years before, and was "too ashamed to seek help for a mass she felt in her right breast. Now the tumor had replaced her entire breast and blasted through the skin." Dr Oz writes:

At what point, I wondered that day and still wonder now, will we finally say enough? ...  I don’t underestimate the complexities of implementing a health care reform law that we can all live with. As with most entitlement programs since the Great Depression, we will have to perfect health care reform over time, just as Social Security, Medicare, veterans’ benefits and others were.

But we’re not perfecting the law; we’re fighting over it. Politicians dither and people die. Lawyers argue the merits of this or that technical point, and more blameless Americans grow sick and slip away.

Which is the real "death panel" - a government agency concluding that routine PSA screenings save few lives, or a health-care system that, favoring industry profits over human needs, leaves 50.7 million Americans uninsured?
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*The USPSTF, according to their website, is

an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). [It] conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."

Ethical business : 10 field marks

In a speech to the U.S. Chamber of Commerce two days ago, President Obama appealed to some 200 business leaders to act responsibly. "I want to be clear, even as we make America the best place on earth to do business," he said,  "businesses also have a responsibility to America."

Now, I understand the challenges you face [the president said]. I understand that you're under incredible pressure to cut costs and keep your margins up. I understand the significance of your obligations to your shareholders. I get it. But as we work with you to make America a better place to do business, ask yourselves what you can do for America. Ask yourselves what you can do to hire American workers, to support the American economy, and to invest in this nation. 

A blogging friend of mine - a man who automatically opposes or is cynical about anything Mr. Obama says - responded predictably: "Amazing. The president (apparently hearkening back to JFK) tells these CEOs to ask what they can do for their country, as if providing jobs, goods, and services in a very uncertain economy is not enough. What an insult!"

My friend does not really believe that providing jobs, goods, and services is all a business needs to do, of course. He does not support pimps or drug pushers, for example, even though they provide jobs and goods or services; and I suspect that he's not fond of gambling casinos or abortion clinics either, even if they are entirely legal.

His comment, though, got me thinking, and for that I thank him. What, exactly, does an ethical business do beyond providing jobs, goods, and services? Here are some preliminary thoughts - please improve on them.

An ethical business ...

1. exists to provide life-sustaining jobs and useful goods and services.
2. makes a profit so that it can continue providing jobs, goods, and services; but rather than sitting on excessive earnings or turning them into fat bonuses, creates new products or hires more workers or increases overall employee compensation.
3. manages its affairs so that not just executives and shareholders but also rank-and-file employees are adequately compensated.
4. keeps honest and transparent accounts so that its directors, contractors, shareholders, and employees can make informed decisions.
5. markets its products honestly, not making misleading claims or delivering shoddy merchandise or poor service.
6. assures healthy working conditions for all of its employees at home and abroad, refusing to outsource to anyone who uses child labor, sweatshops, toxic working environments, or slave labor.
7. makes sure that its methods and materials preserve the environment for future generations at home and abroad, and takes responsibility to clean up any environmental disasters it inadvertently causes.
8. does not attempt to profit through taking advantage of consumers' ignorance, addictions, or desperation.
9. does not lobby or bribe lawmakers so as to be excused from ethical behavior in any of the above areas, or so as to gain an advantage over other companies.
10. gives back to the community not only through creating jobs, goods, and services; but also, whenever possible, by providing funding for community projects, rewarding employees who engage in community service, and supporting legislation that fosters the common good.

When President Kennedy challenged us to ask what we could do for our country, none of us took it as an insult. Rather, his words were an affirmation that we could, with vision and hard work, make the world a better place. I take President Obama's words to the U.S. Chamber of Commerce in the same way. Ethical businesses are a tremendous force for good, and the world needs them now more than ever.

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For further reading: Bill George, professor of management practice at Harvard Business School and a director of ExxonMobil and Goldman Sachs, has written an interesting op-ed piece listing over a dozen concrete actions President Obama has recently taken in support of the business community. Check out "President Obama's Challenge to Business: 'It's Time to Invest in America.' "