Willis's Walkabouts Newsletter 90, April 2017 — The Last Taboo

The Last Taboo — A Debate We Have To Have

We're all going to do it someday but talking about death and dying seems to be the last big taboo in our society. Our inability to talk about it leads to an immense amount of unnecessary suffering. This was brought home to me by a New York Times article, First, Sex Ed. Then Death Ed. * It suggests that, "The sooner we start talking about how we die, the better." It's, "the great unmentionable and because we don't talk about it, most of us don't get the kind of death we'd prefer."

That article got me thinking and digging. What Our Cells Teach Us About a 'Natural' Death * explains how "our biology may offer a challenge to the common wisdom about the artificial extension of life."

For those who want to dig a bit deeper, by far the best and most comprehensive of everything I found was an eight part series in The Conversation. The more I read the more outrageous I found it. Hopefully some things have changed for the better since the articles were written. Sadly, I suspect that most things remain the same.

• Deadly censorship games: keeping a tight lid on the euthanasia debate
  "There's plenty of information available on how to kill yourself violently, so why does the Australian government so vigorously censor information on peaceful methods? .... No other government has taken such extreme measures to prevent access to information on peaceful death."
  If you read the full article, you might agree with me that the government's stand might be described as 'obscene'.
• End of the care conveyor belt: death in intensive care units
  "Around 70% of Australians would like to die at home but over half will eventually die undignified and painful deaths in hospitals. .... one study showed that hospice care combined with the option for active treatment resulted in greater survival and less suffering than for active management alone. The conclusion was, that given the choice, many will opt for hospice care rather than the often cruel and futile use of options such as more chemotherapy. Almost half of the cost of health care is spent in the last six months of life. This is a huge and increasing burden for our aging society." It also means that many people whose quality of life could be greatly improved continue to suffer because of all the resources wasted on those we prefer to torture rather than allow to die peacefully.
• Caring or curing: the importance of being honest
  There is no one size fits all. "Truth comes in different shades. And it is my obligation as a doctor to know my patient well enough to tailor the truth to the individual."
• Death and despair or peace and contentment: why families need to talk about end-of-life options
  "Most people in Australian society aren't comfortable discussing their death even though it's becoming a more important topic as the population ages. .... the longer it takes for the family to come to an agreement, the longer the person continues to suffer. It's not what anyone wants to go through. .... start the conversation with your loved ones and your doctor before you get sick. Be sure they know what you would want in the event that something happens in the future. Get to know what your loved ones would want too. While the conversation may be uncomfortable at first, it can save a lot of heartache later on."
• Body or soul: why we don't talk about death and dying
  "A decade into the 21^st century, a number of people still die unjustifiably delayed, painful, poorly supported and undignified deaths in Australian hospitals and other health-care institutions. .... Hence, the great difficulty in talking about death, in recognising the point at which treatment harms begin to outweigh benefits, and in participating at the end of life in ways that suggest any active and responsible role in death. Because this has been a matter of professional cultural anathema for a significant time, the calls for change have not produced immediate results. .... Despite important progress, cultural forces affecting both patients and doctors continue to prevent us from talking openly about the end of our lives. Much work remains to be done."
  This is my small contribution to what needs to be done.
• Planning your endgame: Advance Care Directives
  "Many people in the community fear the end stage of life, not because they're afraid of dying but because they fear such things as the loss of mental faculties, control and dignity, being a burden on family and not receiving adequate pain relief." The article goes on to give info about how you can pre-plan. Some things may have changed since it was written, but it's a good start.
• A challenge to our leaders — why don't we legalise euthanasia?
  "Most people would like a quick and painless death, but unfortunately that's the exception. Death is more likely to come after a long medical struggle with an incurable illness. .... Public opinion polls on voluntary euthanasia are becoming more frequent and they show that public support for physician-assisted suicide is overwhelming. Over 80% of Australians believe in the right of the terminally or incurably ill to obtain medical assistance to end their lives. .... Current laws condemn people to needless suffering, deny individuals the right to make the most personal of choices and ignore the reality that doctors are already helping people to die."
• A personal account of life with terminal cancer
  "Unwilling as he was to say so, he nevertheless told me that one of the pills I was taking would indeed end my life. I would go to sleep and then my heart would stop. .... For that bit of information I am eternally grateful. My abject fear of death ended at that point. The pills gave me choice. I was in control of my life and that would save me from palliative care and people who could keep me alive but in a terrible state. .... politicians, praise be not all, but unhappily most by far, are unwilling to develop policy for physician-assisted death in the face of terminal illness, which is causing great suffering. And most of the physicians I have dealt with are unwilling to talk about it. This is also true of my oncologist. He didn't want to discuss anything about euthanasia. Good Lord, we don't let that happen to our cats and dogs but we allow it with humans. My loving little dog died in my arms a few years back. Yes, I wept, but he was saved from suffering. Politicians, of any persuasion, fearful of the next election, don't take into account those with terrible, painful, terminal illnesses.
  Think about that for a minute. Our laws treat people worse than we treat our pets.

Personal Reflections

This is not the first time I've touched on this subject. I gave it a mention in Grief, Death and a Lost Connection in Newsletter 64. I came close to dying in a car accident a month later as described in The End of Willis's Walkabouts. That included a link to The Accident and its Aftermath, which, I believe, remains one of the best things I've ever written.

The following year, my nephew disappeared, later found murdered in Mexico.

• The Nightmare in Newsletter 71.
• My Missing Nephew in Newsletter 72.
• Harry Russell Edouard Devert in Newsletter 73.
• Russell's Family in Newsletter 74.
• My nephew was a remarkable young man. I've been sitting on this for nearly two years, wondering when to include it in a newsletter. The time has come. The Washington Post ran this a bit over a year after we found out he was dead. The Incredible Life and Haunting Death of World Traveller Harry Devert. ** I've never been quite as adventurous as Harry was, but I like to think he got a bit of his inspiration from me.

A Final Tale

I recently came back from a trip to Canberra where I visited a friend who was diagnosed with terminal cancer last September. While he is well aware that he is unlikely to make it to the end of this year, his treatment so far has allowed him to continue a decent quality of life. He has read and helped write this section in the hope that it will help someone else facing a similar situation.

He told me that when he was abruptly given the news, he was profoundly shocked and looked inside himself to see what really mattered to him. Unlike many people who go through periods of anger or denial before reaching acceptance of their fate (the well-known Kübler-Ross model of grief), he found fairly quickly that he was able to accept what had happened. He did all the internet searches he could think of to see what the reality was, and for this particular cancer there is a zero survival rate after just a few years. It therefore took him just a matter of hours before he reached the acceptance stage. However, it has been harder for his wife and daughter, for they not only have to go through the denial and acceptance stage, but in the face of a poor prognosis, they have already had to start grieving for his inevitable death not long away.

Some people seem to become more religious when they know death is approaching. My Canberra friend was and remains a confirmed atheist. He feels that having a structured system of values and belief, almost irrespective of what that belief is, has helped him in a situation like this. After having a happy and relatively fulfilled life, he looks at his remaining time (however limited) as an opportunity to leave happy memories for others as well as to enjoy his remaining time as well as he can.

When I mentioned the topic to a friend in the US, he told me the story of his father's similar diagnosis and final two years. My friend's reaction was to spend as much time as he could with his father over the next two years while his brother's reaction was to deny it until the last possible minute. My American friend finished with "I sort of wonder how my own wife and kids will react when my own death is imminent — assuming I am not hit by lightning, but have some way to know what I will die of and when, which of course we often don't. I hope I will be able to follow the same no-nonsense approach when it is me and not my father who is dying, we should all be so lucky. I think what your friend's experience shows is, when you know you are dying you do focus on what is important, and let bullshit things go. (Too bad it takes a death sentence! How hard would it be to learn to do that say, at age 30?"

I went to Canberra because my friend invited me and a number of people to his birthday party. It was a great night. As was a dinner for a smaller group at his sister's house two days later. In our last chat before I returned to Darwin, he told me that some of the happiest times in his life have been since the diagnosis. I found that hard to believe at the time but I think my American friend hit the nail on the head. "When you know you are dying you do focus on what is important, and let bullshit things go."

It's hard, but the world would be a far better place if we all devoted our lives to the things that are truly important.

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Democracy

Democracy means everyone gets to vote. If you want to understand where we are, where we have come from and where we may be going, these three articles are 'must reads'.

Technocracy, Liberal Democracy and the Division of Our Time
• "The idea that expertise ought to guide our political life is at odds with the principle of national self-determination."
• "By default, the republican system has moved from a relationship between the people and their representatives to one between the people, their representatives and the managers. This process has been underway for a long time, since European states created a permanent civil service to do the bidding of their political masters. And since that time, the civil servants have increasingly managed the system – and managed their political masters."
• "This question is at the heart of many of our divisions, and is being discussed daily even when people don’t realize they are discussing it. Technocrats are struggling with how to perfect the world. Citizens are struggling with how not to lose control over their lives. It is not just that they live different lives. It is that they live in different moral universes."

Nationalism and Liberal Democracy
• "Nationalism — however distorted it might become — is the root of liberal democracy, not only historically, but also morally. The two concepts are intellectually inseparable."
• "A random collection of people without a core set of shared values cannot form a coherent regime, because nothing would hold the regime together or prevent internal chaos."
• "Contemporary tension in liberal democracy is not with the nation, but rather between democracy and liberalism. If people have a right to self-determination, then they have the right to elect leaders with values they prefer or share. The problem is that some people will object to leaders being selected who violate the principles of liberalism."

Why Facts Don't Change Our Minds" New discoveries about the human mind show the limitations of reason.
• "Reason is an adaptation to the hypersocial niche humans have evolved for themselves," Mercier and Sperber write. Habits of mind that seem weird or goofy or just plain dumb from an 'intellectualist' point of view prove shrewd when seen from a social 'interactionist' perspective.
• "Humans, they point out, aren't randomly credulous. Presented with someone else's argument, we're quite adept at spotting the weaknesses. Almost invariably, the positions we're blind about are our own."
• "We've been relying on one another's expertise ever since we figured out how to hunt together, which was probably a key development in our evolutionary history. So well do we collaborate, Sloman and Fernbach argue, that we can hardly tell where our own understanding ends and others’ begins."
• "One implication of the naturalness with which we divide cognitive labor," they write, is that there's "no sharp boundary between one person's ideas and knowledge" and "those of other members" of the group.
• "This borderlessness, or, if you prefer, confusion, is also crucial to what we consider progress. As people invented new tools for new ways of living, they simultaneously created new realms of ignorance; if everyone had insisted on, say, mastering the principles of metalworking before picking up a knife, the Bronze Age wouldn't have amounted to much. When it comes to new technologies, incomplete understanding is empowering."

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Europe

Instability

This is a time of change in Europe. The European economy is so large that what happens there can't help but affect the rest of the world. It doesn't help when other powers have an interest in further destabilisation. If you click only one link in this section, make it the first one.

• Europe: The Process of Change Continues
  Read the whole article and discover why it may be Germany which brings down the EU or at least the euro zone.
  "The EU is built around a massive exporter, and that exporter is Germany. That makes the EU susceptible to drops in demand for exports, and it also creates a particular kind of political relationship between Germany and the rest of the EU, especially countries that are markets for German goods and those that are in the German supply chain."
• Notes From Europe's Periphery
  "Europe's periphery consists of the countries and regions that surround this core: Scandinavia, the British Isles, Iberia, the Balkans and what used to be called Eastern Europe. A strong argument can be made that Italy also should be considered part of the periphery. Italy had been the center of a great Mediterranean empire in the distant past, but it was never part of the Europe that Charlemagne created."
  The European Union tried to envelop the periphery and the core into one structure. In theory, it was to be a union of equals, but increasingly it has become a periphery rotating around a core. Within the center, the periphery rotated around the true core — Germany."
• Europe Combats a New Foe of Political Stability: Fake News *
  "The rise of sophisticated hacks and a torrent of fake news coincide with angry populist movements across the Continent, and officials are nervous."
• Unpayable debts and an existential EU financial crisis
  "If a political upset in France or Italy triggers an existential euro crisis over coming months, citizens from both the eurozone's debtor and creditor countries will discover to their horror what has been done to them."
• France as a Northern and Southern European Power
  The country holds a unique position on the Continent.
• Sweden Reinstates Conscription, With an Eye on Russia *
  "There was a time after the Cold War when the Swedes felt they could drop their defenses. No more." Also worth noting that the fears include cyber war.
• As France's Towns Wither, Fears of a Decline in 'Frenchness' *
  "France is losing the core of its historic provincial towns — dense hubs of urbanity deep in the countryside where judges judged and Balzac set his novels."
• Putin and Merkel: A Rivalry of History, Distrust and Power *
  "Vladimir Putin and Angela Merkel now represent the sharply divergent visions clashing in the world. The question is, which one will come out on top?"
• How a Sleepy German Suburb Explains Europe’s Rising Far-Right Movements
  "In this apparent stronghold of ordinariness, the Alternative for Germany, a far-right populist party, won more than 22 percent of the vote in the 2016 local election — more than any other party."

On A Lighter Note

Paris Turns to Flower-Growing Toilet to Fight Public Urination *
"Paris has a new weapon against what the French call 'les pipis sauvages' or 'wild peeing': a sleek and eco-friendly public toilet. Befitting the country of Matisse, the urinal looks more like a modernist flower box than a receptacle for human waste."

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Climate

The Australian Monsoon

What is the Australian Monsoon?
I've been battling misconceptions about the Australian monsoon and northern wet season for years. Click the link and you might come to understand it a bit better.

The monsoon often brings cyclones. Tracking the storm: the science behind Tropical Cyclone Debbie gives a good, short explanation of how cyclones form and how the Met Bureau tracks them.

The Warming Arctic

There is no where in the world where global warming is having more obvi0us effects than in the Arctic. Here are two stories highlighting some of what's happening.

• Polar Bears’ Path to Decline Runs Through Alaskan Village *
  "The bears that come here are climate refugees, on land because the sea ice they rely on for hunting seals is receding."
• Pre-Christmas melt? North Pole forecast to warm 50 degrees above normal Thursday **
  This story was from December but it's part of a continuing saga.
• Arctic’s Winter Sea Ice Drops to Its Lowest Recorded Level *
  "After a season that saw temperatures soar at the North Pole, the Arctic has less sea ice at winter's end than ever before in nearly four decades of satellite measurements."

Water

Changing rainfall patterns are going to affect us all. Here's an example of what's happening elsewhere. Mexico City, Parched and Sinking, Faces a Water Crisis *
"Climate change is threatening to push a crowded capital toward a breaking point."
Think it doesn't matter to you? Mexico's economy is now the ninth largest in the world, greater than Australia's. What happens there will have flow on effects around the world.

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Flying

Flying is far safer than driving your own car. Unfortunately, things may be changing.

• Airport privatisations have put profit before public safety and good planning
  Remember the recent flight crash at Essenden? "State and local policy has increasingly become aligned with the Commonwealth helping to further the private interests of airport operators at increasing risk to the public."
• The frightening truth about pilots — not a happy thought.

Other News

Google comes to the rescue for cheap flights
It's worth a look — seems to have some useful tools like save & get notified of price changes.

The best and worst airports in the world
Three Australian airports "were in the South Pacific's Top Five Worst Airports for overall experience." Personally, I don't mind two of them. Maybe that says how lucky we are in comparison to some other places.

Flying to the US or UK? What Travelers Should Know About New Restrictions on Devices *
Who is affected by the flight restriction, and what should you do?

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Thoughts On Our Society

Men Without Work

While the following is based on the American experience, it's not just in America. I can see hints of something similar developing in Australia. If we're not careful, we could be paying a high price for generations to come.

American society is breaking down. "Some 10 million American men of prime working age (25 to 54) who have simply dropped out of the workforce, and the great majority of them have not only dropped out of the workforce, they have also dropped out from any commitments or responsibilities to society." Here are two articles and a link to a book to help you get your head around this.

• Angst in America, Part 1: Aimless Men
  • "We are witnessing an ominous and growing divergence between three trends that should ordinarily move in tandem: wealth, output, and employment. Depending upon which of these three indicators you choose, America looks to be heading up, down, or more or less nowhere."
  • "Recent research by the Japanese government showed that about 30% of single women and 15% of single men aged between 20 and 29 admitted to having fallen in love with a meme or character in a game. .... There is even a slang term, 'moe', for those who fall in love with fictional computer characters, while dating sims allow users to adjust the mood and character of online partners and are aimed at women as much as men. A whole subculture, including hotel rooms where a guest can take their console partner for a romantic break, has been springing up in Japan over the past six or seven years." See For Japan's 'stranded singles', virtual love beats the real thing
  • "If our nation’s work rate today were back up to its start-of-the-century high, well over 10 million more Americans would currently have paying jobs."
  • "Our well-intentioned social programs can create a disincentive for people to work. That's not always the case; sometimes people fall on hard times and need a temporary hand up, and society benefits by making them productive again. We need to do a better job of creating the right incentives and avoiding the wrong ones."
  The quotes above give you the gist. The whole article is worth a read.
• Men Without Work
  • "In the 20 years to 1998, the mortality rate of middle-aged white Americans fell by about 2% a year. But between 1999 and 2013, deaths rose. The reversal was all the more striking because, in Europe, overall middle-age mortality continued to fall at the same 2% pace. By 2013 middle-aged white Americans were dying at twice the rate of similarly aged Swedes of all races. Suicide, drug overdoses and alcohol abuse were to blame. .... deaths of despair are much rarer among blacks and Hispanics, whose incomes have been on similar paths."
  See the full article in The Economist. Economic shocks are more likely to be lethal in America
  • "Job destruction caused by technology is not a futuristic concern. It is something we have been living with for two generations. A simple linear trend suggests that by mid century about ¼ of men in the US aged between 25 and 54 will not be working at any moment. .... I think this is likely to be a substantial underestimate unless something is done for a number of reasons. .... I would expect that more than one third of all men in the US between 25 and 54 will be out of work at mid-century. Very likely more than half of men will experience at least a year of non-work out of every five."
  • "A single variable — having a criminal record —: is a key missing piece in explaining why work rates and LFPRs have collapsed much more dramatically in America than other affluent Western societies over the past two generations.
• Finally, a link to the book. Men Without Work: America's Invisible Crisis
  "The work rate for American males aged twenty-five to fifty-four—or 'men of prime working age' — was actually slightly lower in 2015 than it had been in 1940: before the War, and at the tail end of the Great Depression."

The Ultimate Dropout

Into the woods: how one man survived alone in the wilderness for 27 years
"At the age of 20, Christopher Knight parked his car on a remote trail in Maine and walked away with only the most basic supplies. He had no plan. His chief motivation was to avoid contact with people. This is his story."

Another Example of American Overkill

Defend Border Privacy!
• "U.S. politicians want to force every single traveller at the airport to hand over their digital devices, unlock them, and provide their social media passwords.
• That's our most intimate moments, from personal messages to loved ones to sensitive financial information and private photos. If we don't speak up now, this will become the norm not just in the U.S., but all over the world.
• The page has a link that allows you to express your opinion. Personally, I suspect that this would have a major negative impact on international tourism to the US.

Fight back! Crossing the Border? Here’s How to Safeguard Your Data From Searches. *

Political Correctness Gone Mad

No one succeeds 100% of the time. In the real world, we are faced with failure and people who disagree with us. Many American universities are doing their students no favours. Some are fighting back.

• The 12 DUMBEST EVER 'Bias Incidents' On America's College Campuses
  I weep for a society that tolerates things like these. Example: "At Colby College, a picturesque little liberal arts college in small-town Maine, the 13-person 'Bias Incident Prevention and Response Team' investigated someone who uttered the phrase 'on the other hand' in 2016. An unidentified student charged that these commonly used words are 'ableist.'"
• The Dangerous Safety of College *
  Some are fighting back. "I don't want you to be safe, ideologically," he told them. "I don’t want you to be safe, emotionally. I want you to be strong. That's different. I'm not going to pave the jungle for you. Put on some boots, and learn how to deal with adversity."
  "You are creating a kind of liberalism that the minute it crosses the street into the real world is not just useless, but obnoxious and dangerous," he added. "I want you to be offended every single day on this campus. I want you to be deeply aggrieved and offended and upset, and then to learn how to speak back. Because that is what we need from you."

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