Sunday, March 29, 2015

Lessons from the Impulsive Suicide of Andreas Lubitz

Parthian has read much prescriptive punditry following the horrendous impulse of the  Germanwings co-pilot to act out his recurrent, if not obsessive, fantasies– of destroying himself, an expensive aircraft, his anonymity, and 149 strangers, in that order. Reactions have ranged from resignation (Gourevitch, New Yorker) to hi-tech drone remedies (Cassidy, id), to palliative but practical measures (immediate change in protocol to mandate 2 crew members in the cockpit during flight). Rational risk assessors tell us that the incident represents an infinitesimal and irreducible residue of hazard after all other economically sensible prophylactics have been applied. Commentators with a broader perspective see worthwhile prospects from investing in: 

  • ground controller overrides
  • fully automated (drone) pilotage
  • more frequent and intensive mental health exams and background checks… etc.


Parthian proposes two practical measures that are immediately available, at a more acceptable cost relative to expected benefit than adoption of the U.S. crew protocol might entail. 

First, accept that powerful incentives to deny or conceal mental issues from employers and licensing authorities cannot be eliminated, however low the rate of impulsive pilot suicide may be.  The emphasis must be upon impulsive  self-destruction, because the Lubitz event’s most powerful teaching is that many, probably most, suicides do not fit the commonly held scenario of mounting despair reaching a tipping point or crisis, whereupon the dam of self-control is breached. It is much more likely that they represent long-festering suicidal ideation, confronted by an unexpected and irresistible temptation. Motive + opportunity.

Partial Remedy (with collateral benefits)
Revise protocols, to require the Pilot and First Officer to follow the cabin crew as they perform the seatbelt, tray tables, and stowage inspection after the doors close. Their duty is to make eye contact and exchange a few words with at least one passenger, in every X (time studies to determine number) rows.  This can be managed efficiently enough to cost little time, although the pre-take off checklists and other tasks must be delayed pro tanto. Parthian’s unverifiable but confident assumption is that the next Andreas Lubitz would be deterred at some significant (but indeterminate) margin from acting out a suicidal impulse because of his or her fresh and immediate encounters with trusting passengers (rather than “the passengers” generically considered).

Second, understanding that fresh personal encounters will not entirely foreclose another Lubitz-like incident, improve cockpit safety by adopting an arguably “riskier” alternative strategy to the current U.S. protocol. The alternative eliminates a cost–  impairment of the burdensome duties of the cabin crew. 

Saturday, March 21, 2015

Clerihews (Spring Cleaning)


Georgia O'Keefe
was of the belief
that flowers resemble vaginas–
and so her paintings remin' us

Frieda Kahlo & Leon Trotsky:
She his doll, he her tchotchke.
too soon!– dead
before they bred.

Philosopher Jacques Derrida
never varied a
whit from his claim
that all texts miss their aim.

Philosopher Jacques Derrida
construed whatever he saw
as text, only text,
never asking “What's next?”

Emily Dickinson's
similes quicken one's
sense of the numinous.
brief her effusions; in sum, voluminous!

Monday, March 16, 2015

World's Oldest Worldly Man

Methuselah's Rebirth


Supine upon his gurney,  waiting to succumb,
Methuselah’s epiphanies sum up a weary life.
Caressing beads beneath a calloused thumb
He’s glad, at last, to face the surgeon’s knife.

Methuselah’s epiphanies sum up his weary life:
Erotic memories, those little deaths he savors
(He’s glad, at last, to face the surgeon’s knife)
Will help his end epitomize the joys he favors.

Erotic memories, those little deaths he savors
When the mask upon his grizzled face descends
Will help his end epitomize the joys he favors:
Orgastic ecstasy, in an unexpected instant sends

(When the mask upon his grizzled face descends)
Oblivion, relief– the true surcease of sorrow.
Orgastic ecstasy, in an unexpected instant blends
Nowhere, hell, & paradise, into clay we borrow.

Thursday, February 26, 2015

A Strange Verse

A gaggle of Parthian vets gathered a few weeks ago to bemoan the world’s decline, and to compare contemporary and ancient bards. Not surprisingly, most of us liked the poets best who are included in standard mid-20th Century anthologies. Our leader then challenged us to produce a few lines governed by a restrictive and rigid formal design (sonnet, sestina, villanelle…whatever) which nevertheless feel ‘contemporary’. We must armor them against critics who will surely say we are anachronistic. A week later, we gave leftover plastic laurels to our most taciturn member. 

Our winner cited the shaped poems of George Herbert as his formal authority, and the contemporary obsession with how we die, and of what, as his thematic justification. Parthian deems the result worth posting, largely because it met two difficult constraints. Readers may decide for themselves if the verses can compare with the preferred ebullitions of literary gatekeepers:

Angina

It is a tough job
to nab an almost-thought
springing from lips untaught,
lacking both point and plot.

My list of sorry sins
longing for oblivion
finds no shrift, nor light
to suit my plight.

I am a psalmist today,
of sour disposition

who fights
in my mind’s drama
looking about for similar fools
who know how to paint old masks
with agonistic flights of fancy.

My incantations will unfold
twists and turns of animosity
(or attraction) among my cast:
myriad walk-ons
for bit parts who 
had no try-outs, no auditions
to join my post-absurdist play.

My history is a patchwork:
rags cut badly 
by my tailor
to shroud a mortal soul 
lost
in a coma, an arc 
until at last,
startlingly, 
right now, it finds
hugs from a waiting python,
lurking in bosky shadow
hungry for long pig
on a random day.




Tuesday, February 24, 2015

Born too Soon (Update)

Parthian’s proposal for recording a “Cohort Birthday” for premature infants (to be used as the legal default for subsequent birthdays) elicited both expected and unexpected objections. The Arrow was not surprised to hear arguments about the crudeness (over- and under-inclusion) of anniversaries as a device to sort disparate people into lumped categories. Sometimes bright lines are worth their cost, and Parthian concedes that this may be true of lines drawn for voting age, driver’s licenses, and most of the other gateways we are qualified of disqualified to pass because we have reached a birthday. That however begs the question of whether a more equitable but equally bright line could not be drawn for babies born with ‘premature’ birthdays.

A more interesting objection derives from Parthian’s suggestion that a mother should be allowed some leeway in determining her child’s legally constructed Cohort Birthday. Pediatrics, and medical science more generally, continues to advance our knowledge of the developmental delays likely to ensue for children born with a great variety of essential (genetic) disabilities or accidental ones, such as oxygen deprivation in the course of delivery. In theory and in practice too, it is entirely possible to fix a more generous (i.e., later) Cohort Birthday than the limited adjustment suggested by the sketchy language Parthian included in his initial post on this subject. Therefore, it is objected, the class of infants entitled to the benefit of a Cohort Birthday should not be restricted to preemies. 

Parthian accepts that it is feasible and desirable to provide a Cohort Birthday for any child with a medically predictable delay in reaching benchmarks of normal mental or physiological maturation. Qualified doctors and lawyers should work together to formulate criteria and to set outer limits, aiming to best match a child’s adjustment to an appropriate peer group, while accommodating expected delays. This approach counsels a general statute along the lines P proposed,but implemented through detailed and more elastic regulations meant to keep pace with the progress of medical science. In many cases a confident prognosis establishes at birth a child's future need for special education services. Whether this entails a wider or narrower window for setting a Cohort Birthday is a technical question that depends upon such factors as support resource availability, effects upon children of inclusion in classes with students of different levels of physical development but roughly equal levels of educational attainment, and the like.



Saturday, February 21, 2015

Born too Soon (DOD to DOB and back)

For time immemorial, individual lives have spanned two fixed points:  birth and death. Tombstone masons, jurisprudence, medicine and religion– all agree that these dates are foundational.  You are born when you start breathing and you are dead when you stop. No elaboration required.

In two previous posts, Parthian argued that death is now problematic. He showed that from a secular and libertarian standpoint death is defined at an inconvenient moment.  The law lags an emergent popular consensus. Many of us agree that the law must accommodate the downside of medically protracted dying:  the risk that we will outlive our bodies and become helpless infantilized prisoners in solitary confinement– or that our body will survive our demented and oblivious selves.  “Second childhood” now extends for too many into second fetushood. Needless suffering results from the law’s insistence upon maintaining heartbeats despite the expressed preferences of the person whose body contains the heart. If freedom means individual sovereignty over one’s own body, the law should permit death with dignity.

This post considers birth as problematic, for similar reasons. Medical advances have complicated the lines that mark our beginnings. Consider the religious right’s insistence that a fetus already holds full civil rights from the moment of conception. They deem the unborn ‘born’ for legal purposes. Contrast the majority view that full legal recognition is a birthright. For every citizen, conception marks the first in a series of initiations. Natality may be only the first among many subsequent binary legal gateways that open at fixed anniversaries. Pediatricians employ more elastic developmental benchmarks, while legal birthdays start eligibility clocks: kindergarten, voting, driving licenses, drinking, sexual consent, conscription, retirement, medicare– all these various duties and entitlements (and many more) are measured from our first breath.

Until recently, no significant consequences turned upon the fact that the length of human gestation is variable. In most cases, conception + 37 weeks = DOB, or DOB - 37 weeks = conception date. In the last few decades, however, we have learned to better pinpoint the conception date, perhaps to the hour or minute (think of in vitro fertilization).  Modern medicine has also extended the viability of premature babies.  

Medical advances call for systematic cultural and legal reform. We should stipulate that birth means conception + 37 weeks, for most legal purposes.  A new understanding of “birth” is justified by reasons of equal opportunity.  All babies no longer start from the same bright line in life’s competitive race.  Prematurely born babies with disabilities form a subset of a group, all of whom are genuinely handicapped by the legacy definition of a deceptively simple term. 

Friday, February 20, 2015

Buyers, Sellers and Flunkers



Seeking relief from cabin fever, the snowbound Arrow crossed the Common to see a biopic/hagiography about the Bletchley Park team who cracked the Enigma Machine code, led by the saintly Asperger-afflicted gay martyr math genius Alan Turing. Parthian was entertained, but he gagged or guffawed at the melodrama, and the screenplay’s trite tropes. No wonder the Turing Test was fresh in mind the next morning as he signed an email petition forwarded by a friend, imploring Congress to regulate robo-callers. He has no illusions about Congress biting the hand that twirls the revolving door to a lucrative K Street future.

More annoying, and far more costly than robo-calling machines are robo-answerers, in Parthian’s experience. One of the least publicized major disruptions enabled by the digital revolution is the wholesale transfer of clerical workloads from competing sellers, eager to please, to uncompensated buyers, unhappy to be frustrated.  There is no cost to sellers when a consumer with nowhere else to go finds his time wasted parsing FAQ’s, downloading reams of information to be culled–or not– for a specific answer, and surrendering all pretense of privacy in order to ‘register’ for attention that sellers once upon a time were enforceably duty bound to provide. Today’s sellers satisfy their executory contractual obligations by making the performance of their side of a bargain “available”, instead of providing satisfaction with what we buy and dealing directly with dissatisfied customers. Parthian asks, do you know of any words more degrading and deceitful than the voice loop endlessly repeating, “Your business is important to us. Thank you for your patience waiting for the next available representative”? 

Wednesday, February 18, 2015

A Seventh Wish


Parthian heard a broadcast last night by Diane Rehm and her guests with mixed emotions, of condolence and congratulation for the hostess. Recently widowed, Ms Rehm boldly and fairly discussed the personal and ethical issues surrounding physician-assisted death. The discussion renewed Parthian’s interest in his own prospects as he follows the path her husband took.

The last post to this blog presented a template to be added to Five Wishes, in the hope that our ethics and laws will soon respect individual autonomy in choosing how and when to end life when the body survives the mind. That is the hardest way we can round out our mortal span, presenting the most difficult ethical choices.

This post considers the converse case, faced by the Rehm family: what respect is due to a person whose mind has survived the useful life of his still-breathing body? Shouldn’t a competent adult who has entered the end stages of Parkinsonian helplessness be accorded the choice to expire comfortably, at his own chosen time? What difference does it make if the prognosis calls for an indeterminably long period of expensive and passive existence? Why should individual choice be foreclosed when clinical honesty denies  or delays the label “terminal” to many end-stage conditions? One of the  discussants disparaged Diane Rehm’s husband’s bravery, debating with loaded labels: existential (in contrast to medical) suffering. 

Parthian thinks that medical advice about a patient’s prognosis is a useful factual input when he or she ponders a profoundly personal decision. Trustworthy clinical opinion that distinguishes between ‘existential’ anguish or distress on the one hand, and a recognized, clinically treatable psychiatric disorder–depression– on the other, is another input (or possibly a matter for personal experiment) that anyone contemplating his or her end of life should consider. 

Parthian does not believe that medicine’s trustworthiness at the psychiatric boundary can or should be determined in advance by legislation or by debated and evolving professional conventions. Questions about why and when to end one’s life resemble questions about ending potential life with an abortion. The issue is personal. In terms of Roe v. Wade, it is a private matter between doctor and patient. In the case of one’s own spent life, it is arguably easier. It is a “now or later” question, while abortion is “now or never”. 

When state law begins to recognize a right to die, scholarly legal consensus predicts that pathbreaking future decisions will extend the logic of precedent and analysis in the constitutional domain of “rights of privacy”. Parthian has no problem with that, but he also noted in the Rehm broadcast a theme of religiously justified paternalism, of ‘doctor knows best’ and unquestioned acceptance of the idea that Gottes Zeit ist die Allerbeste Zeit. In short, the anti-establishmentarian values of the First Amendment are directly implicated in this debate, in Parthian's opinion. 

Parthian’s Seventh Wish:

7. When I decide that my degenerative condition has progressed to a degree that renders my quality of life personally intolerable, I shall demand assistance from my physician or other competent caregiver, such as Hospice, to end my life in a comfortable and expeditious manner on a date of my choosing. If my competence to reach such a decision is questioned, I choose to have my competence decided by application of the current prevailing standard for determining criminal intent in cases of insanity pleas (the ‘M’Naghten standard'). I demand that any government official or clinical adjudicator accept and apply my choice of governing law.

I promise to consider my physicians’ prognosis and the costs and benefits of proposed therapy (including experimental treatments) with awareness of data establishing medical bias toward substantial overestimation of remaining life prospects. I will also consider the expected expense of maintaining life in my body and the expected fiscal needs of my heirs and estate, and the resources available to sustain each of them.







Wednesday, January 28, 2015

A Sixth Wish


Realistic secularists who desire to plan for a likely mismatch between the duration of somatic and mental life urgently need a more elastic legal understanding of “death”.

Death with Dignity laws of any sort are exceptional in this country. Such as they are, they do not help [im-]patients who cannot be medically certified as both ill and terminal. The norms of the legal and medical professions classify rationally life-weary persons as depressed. The most that they can do is to spritz a bit of psychotropic fog (talking or pharmaceutical, makes no matter) to muddle a patient’s welcoming gestures (= suicidal thoughts) toward the Reaper. To such sufferers, he is not Grim, but Dilatory. The ancients died younger and thought harder about these issues, before ethical philosophy became entwined with theological dogma as deeply as it is today. 

Until the law accommodates the wishes of today’s Stoics or Epicureans, Five Wishes provide the best control we can exercise in advance of life’s end. This readily available checklist has been vetted by lawyers and doctors. If you download and fill it out as directed, the form is believed to have legal force in about 43 of the 50 United States of America. Now, let us challenge our lawmakers and parsons to make a Sixth Wish enforceable in all 50 jurisdictions. Recognition of the Sixth Wish as a civil right would expand the range of individual autonomy, and vex the seminars of ethicists for a few more decades. Because it departs radically from mainstream funerary rituals, we must expect a fight before we realize a right to round out our brief span according to our own personal values. If we could, many of us might pre-commit to the following directive to cover the worst of final contingencies:

6. If my cognition has deteriorated so far that I cannot name two of my closest family members or friends within two minutes after being asked, and medical intervention has been ineffectual to reverse my dementia (regardless of my diagnosis) after two therapeutic attempts (of no more than [90] days duration), my designee is directed to organize a Memorial Service, and announce my death. Thereafter, I wish to be regarded as brain dead. My surviving spouse has my encouragement to remarry and to take any necessary steps to ensure recognition of the marriage. I wish my estate to be distributed as provided by my Will or the laws of intestacy. I request  the State of ____ to issue Death Certificates, and direct my discharge from any institution in which I am receiving care chargeable to my estate. I demand and consent to judicial determination that this is my governing and last competent expression of my wishes on these points.

After my death as defined above, my representative may donate my tissues and organs for transplant or investigative purposes, even if the donation [causes or] accelerates my body’s [legal/physical] demise, provided that  the standard of care for surgical or other forms of harvesting is followed as prescribed for mentally competent donors to the greatest possible extent.

In conformity with his cohort, Parthian has already executed health care proxies, advance directives, and the admirable “Five Wishes” document. Until recently, he thought that his affairs were in reasonable order. However, he has seen too many relatives and friends outlive their minds and memories. Their surrogates and intimates, stymied and nonplussed, are helpless spectators as physical remains slowly arrive at an expensive and medically protracted end. The survivors have already mourned privately. The moment of legal death is valued as a license to go public, to mark liberation from a fantasy: “where there’s life, there’s hope.” Reality teaches that sometimes “life” is only “existence”, worthless to its possessor, who has given up the ghost at some indeterminate and unmarked incremental moment long before the grave opens.