Atlas Shrugged: Ayn Rand: 9780451191144: Amazon.com: Books

INTRODUCTION: Ayn Rand held that art is a re-creation of reality according to an artist s metaphysical value judgments. By its nature, therefore, a novel (like a statue or a symphony) does not require or tolerate an explanatory preface; it is a self-contained universe, aloof from commentary, beckoning the reader to enter, perceive, respond. Ayn Rand would never have approved of a didactic (or laudatory) introduction to her book, and I have no intention of flouting her wishes. Instead, I am going to give her the floor. I am going to let you in on some of the thinking she did as she was preparing to write Atlas Shrugged. Before starting a novel, Ayn Rand wrote voluminously in her journals about its theme, plot, and characters. She wrote not for any audience, but strictly for herself that is, for the clarity of her own understanding. The journals dealing with Atlas Shrugged are powerful examples of her mind in action, confident even when groping, purposeful even when stymied, luminously eloquent even though wholly unedited. These journals are also a fascinating record of the step-by-step birth of an immortal work of art. In due course, all of Ayn Rand s writings will be published. For this 35th anniversary edition of Atlas Shrugged, however, I have selected, as a kind of advance bonus for her fans, four typical journal entries. Let me warn new readers that the passages reveal the plot and will spoil the book for anyone who reads them before knowing the story. As I recall, Atlas Shrugged did not become the novel s title until Miss Rand s husband made the suggestion in 1956. The working title throughout the writing was The Strike. The earliest of Miss Rand s notes for The Strike are dated January 1, 1945, about a year after the publication of The Fountainhead. Naturally enough, the subject on her mind was how to differentiate the present novel from its predecessor. Theme. What happens to the world when the Prime Movers go on strike. This means a picture of the world with its motor cut off. Show: what, how, why. The specific steps and incidents in terms of persons, their spirits, motives, psychology and actions and, secondarily, proceeding from persons, in terms of history, society and the world. The theme requires: to show who are the prime movers and why, how they function. Who are their enemies and why, what are the motives behind the hatred for and the enslavement of the prime movers; the nature of the obstacles placed in their way, and the reasons for it. This last paragraph is contained entirely in The Fountainhead. Roark and Toohey are the complete statement of it. Therefore, this is not the direct theme of The Strike but it is part of the theme and must be kept in mind, stated again (though briefly) to have the theme clear and complete. First question to decide is on whom the emphasis must be placed on the prime movers, the parasites or the world. The answer is: The world. The story must be primarily a picture of the whole. In this sense, The Strike is to be much more a social novel than The Fountainhead. The Fountainhead was about individualism and collectivism within man s soul ; it showed the nature and function of the creator and the second-hander. The primary concern there was with Roark and Toohey showing what they are. The rest of the characters were variations of the theme of the relation of the ego to others mixtures of the two extremes, the two poles: Roark and Toohey. The primary concern of the story was the characters, the people as such their natures. Their relations to each other which is society, men in relation to men were secondary, an unavoidable, direct consequence of Roark set against Toohey. But it was not the theme. Now, it is this relation that must be the theme. Therefore, the personal becomes secondary. That is, the personal is necessary only to the extent needed to make the relationships clear. In The Fountainhead I showed that Roark moves the world that the Keatings feed upon him and hate him for it, while the Tooheys are out consciously to destroy him. But the theme was Roark not Roark s relation to the world. Now it will be the relation. In other words, I must show in what concrete, specific way the world is moved by the creators. Exactly how do the second-handers live on the creators. Both in spiritual matters and (most particularly) in concrete, physical events. (Concentrate on the concrete, physical events but don t forget to keep in mind at all times how the physical proceeds from the spiritual.). However, for the purpose of this story, I do not start by showing how the second-handers live on the prime movers in actual, everyday reality nor do I start by showing a normal world. (That comes in only in necessary retrospect, or flashback, or by implication in the events themselves.) I start with the fantastic premise of the prime movers going on strike. This is the actual heart and center of the novel. A distinction carefully to be observed here: I do not set out to glorify the prime mover ( that was The Fountainhead ). I set out to show how desperately the world needs prime movers, and how viciously it treats them. And I show it on a hypothetical case what happens to the world without them. In The Fountainhead I did not show how desperately the world needed Roark except by implication. I did show how viciously the world treated him, and why. I showed mainly what he is. It was Roark s story. This must be the world s story in relation to its prime movers. (Almost the story of a body in relation to its heart a body dying of anemia.) I don t show directly what the prime movers do that s shown only by implication. I show what happens when they don t do it. (Through that, you see the picture of what they do, their place and their role.) (This is an important guide for the construction of the story.) In order to work out the story, Ayn Rand had to understand fully why the prime movers allowed the second-handers to live on them why the creators had not gone on strike throughout history what errors even the best of them made that kept them in thrall to the worst. Part of the answer is dramatized in the character of Dagny Taggart, the railroad heiress who declares war on the strikers. Here is a note on her psychology, dated April 18, 1946: Her error and the cause of her refusal to join the strike is over-optimism and over-confidence (particularly this last). Over-optimism in that she thinks men are better than they are, she doesn t really understand them and is generous about it. Over-confidence in that she thinks she can do more than an individual actually can. She thinks she can run a railroad (or the world) single-handed, she can make people do what she wants or needs, what is right, by the sheer force of her own talent; not by forcing them, of course, not by enslaving them and giving orders but by the sheer over-abundance of her own energy; she will show them how, she can teach them and persuade them, she is so able that they ll catch it from her. (This is still faith in their rationality, in the omnipotence of reason. The mistake? Reason is not automatic. Those who deny it cannot be conquered by it. Do not count on them. Leave them alone.) On these two points, Dagny is committing an important (but excusable and understandable) error in thinking, the kind of error individualists and creators often make. It is an error proceeding from the best in their nature and from a proper principle, but this principle is misapplied. The error is this: it is proper for a creator to be optimistic, in the deepest, most basic sense, since the creator believes in a benevolent universe and functions on that premise. But it is an error to extend that optimism to other specific men. First, it s not necessary, the creator s life and the nature of the universe do not require it, his life does not depend on others. Second, man is a being with free will; therefore, each man is potentially good or evil, and it s up to him and only to him (through his reasoning mind) to decide which he wants to be. The decision will affect only him; it is not (and cannot and should not be) the primary concern of any other human being. Therefore, while a creator does and must worship Man (which means his own highest potentiality; which is his natural self-reverence), he must not make the mistake of thinking that this means the necessity to worship Mankind (as a collective). These are two entirely different conceptions, with entirely (immensely and diametrically opposed) different consequences. Man, at his highest potentiality, is realized and fulfilled within each creator himself. Whether the creator is alone, or finds only a handful of others like him, or is among the majority of mankind, is of no importance or consequence whatever; numbers have nothing to do with it. He alone or he and a few others like him are mankind, in the proper sense of being the proof of what man actually is, man at his best, the essential man, man at his highest possibility. (The rational being, who acts according to his nature.) It should not matter to a creator whether anyone or a million or all the men around him fall short of the ideal of Man; let him live up to that ideal himself; this is all the optimism about Man that he needs. But this is a hard and subtle thing to realize and it would be natural for Dagny always to make the mistake of believing others are better than they really are (or will become better, or she will teach them to become better or, actually, she so desperately wants them to be better) and to be tied to the world by that hope. It is proper for a creator to have an unlimited confidence in himself and his ability, to feel certain that he can get anything he wishes out of life, that he can accomplish anything he decides to accomplish, and that it s up to him to do it. (He feels it because he is a man of reason. But here is what he must keep clearly in mind: it is true that a creator can accomplish anything he wishes if he functions according to the nature of man, the universe and his own proper morality, that is, if he does not place his wish primarily within others and does not attempt or desire anything that is of a collective nature, anything that concerns others primarily or requires primarily the exercise of the will of others. (This would be an immoral desire or attempt, contrary to his nature as a creator.) If he attempts that, he is out of a creator s province and in that of the collectivist and the second-hander. Therefore, he must never feel confident that he can do anything whatever to, by or through others. (He can t and he shouldn t even wish to try it and the mere attempt is improper.) He must not think that he can. somehow transfer his energy and his intelligence to them and make them fit for his purposes in that way. He must face other men as they are, recognizing them as essentially independent entities, by nature, and beyond his primary influence; [he must] deal with them only on his own, independent terms, deal with such as he judges can fit his purpose or live up to his standards (by themselves and of their own will, independently of him) and expect nothing from the others. Now, in Dagny s case, her desperate desire is to run Taggart Transcontinental. She sees that there are no men suited to her purpose around her, no men of ability, independence and competence. She thinks she can run it with others, with the incompetent and the parasites, either by training them or merely by treating them as robots who will take her orders and function without personal initiative or responsibility; with herself, in effect, being the spark of initiative, the bearer of responsibility for a whole collective. This can t be done. This is her crucial error. This is where she fails. Ayn Rand s basic purpose as a novelist was to present not villains or even heroes with errors, but the ideal man the consistent, the fully integrated, the perfect. In Atlas Shrugged, this is John Galt, the towering figure who moves the world and the novel, yet does not appear onstage until Part III. By his nature (and that of the story) Galt is necessarily central to the lives of all the characters. In one note, Galt s relation to the others, dated June 27, 1946, Miss Rand defines succinctly what Galt represents to each of them: For Dagny the ideal. The answer to her two quests: the man of genius and the man she loves. The first quest is expressed in her search for the inventor of the engine. The second her growing conviction that she will never be in love For Rearden the friend. The kind of understanding and appreciation he has always wanted and did not know he wanted (or he thought he had it he tried to find it in those around him, to get it from his wife, his mother, brother and sister). For Francisco d Anconia the aristocrat. The only man who represents a challenge and a stimulant almost the proper kind of audience, worthy of stunning for the sheer joy and color of life. For Danneskjld the anchor. The only man who represents land and roots to a restless, reckless wanderer, like the goal of a struggle, the port at the end of a fierce sea-voyage the only man he can respect. For the Composer the inspiration and the perfect audience. For the Philosopher the embodiment of his abstractions. For Father Amadeus the source of his conflict. The uneasy realization that Galt is the end of his endeavors, the man of virtue, the perfect man and that his means do not fit this end (and that he is destroying this, his ideal, for the sake of those who are evil). To James Taggart the eternal threat. The secret dread. The reproach. The guilt (his own guilt). He has no specific tie-in with Galt but he has that constant, causeless, unnamed, hysterical fear. And he recognizes it when he hears Galt s broadcast and when he sees Galt in person for the first time. To the Professor his conscience. The reproach and reminder. The ghost that haunts him through everything he does, without a moment s peace. The thing that says: No to his whole life. Some notes on the above: Rearden s sister, Stacy, was a minor character later cut from the novel. Francisco was spelled Francesco in these early years, while Danneskld s first name at this point was Ivar, presumably after Ivar Kreuger, the Swedish match king, who was the real-life model of Bjorn Faulkner in Night of January 16th. Father Amadeus was Taggart s priest, to whom he confessed his sins. The priest was supposed to be a positive character, honestly devoted to the good but practicing consistently the morality of mercy. Miss Rand dropped him, she told me, when she found that it was impossible to make such a character convincing. The Professor is Robert Stadler. This brings me to a final excerpt. Because of her passion for ideas, Miss Rand was often asked whether she was primarily a philosopher or a novelist. In later years, she was impatient with this question, but she gave her own answer, to and for herself, in a note dated May 4, 1946. The broader context was a discussion of the nature of creativity. I seem to be both a theoretical philosopher and a fiction writer. But it is the last that interests me most; the first is only the means to the last; the absolutely necessary means, but only the means; the fiction story is the end. Without an understanding and statement of the right philosophical principle, I cannot create the right story; but the discovery of the principle interests me only as the discovery of the proper knowledge to be used for my life purpose; and my life purpose is the creation of the kind of world (people and events) that I like that is, that represents human perfection. Philosophical knowledge is necessary in order to define human perfection. But I do not care to stop at the definition. I want to use it, to apply it in my work (in my personal life, too but the core, center and purpose of my personal life, of my whole life, is my work). This is why, I think, the idea of writing a philosophical nonfiction book bored me. In such a book, the purpose would actually be to teach others, to present my idea to them. In a book of fiction the purpose is to create, for myself, the kind of world I want and to live in it while I am creating it; then, as a secondary consequence, to let others enjoy this world, if, and to the extent that they can. It may be said that the first purpose of a philosophical book is the clarification or statement of your new knowledge to and for yourself; and then, as a secondary step, the offering of your knowledge to others. But here is the difference, as far as I am concerned: I have to acquire and state to myself the new philosophical knowledge or principle I used in order to write a fiction story as its embodiment and illustration; I do not care to write a story on a theme or thesis of old knowledge, knowledge stated or discovered by someone else, that is, someone else s philosophy (because those philosophies are wrong). To this extent, I am an abstract philosopher (I want to present the perfect man and his perfect life and I must also discover my own philosophical statement and definition of this perfection). But when and if I have discovered such new knowledge, I am not interested in stating it in its abstract, general form, that is, as knowledge. I am interested in using it, in applying it that is, in stating it in the concrete form of men and events, in the form of a fiction story. This last is my final purpose, my end; the philosophical knowledge or discovery is only the means to it. For my purpose, the non-fiction form of abstract knowledge doesn t interest me; the final, applied form of fiction, of story, does. (I state the knowledge to myself, anyway; but I choose the final form of it, the expression, in the completed cycle that leads back to man.) I wonder to what extent I represent a peculiar phenomenon in this respect. I think I represent the proper integration of a complete human being. Anyway, this should be my lead for the character of John Galt. He, too , is a combination of an abstract philosopher and a practical inventor; the thinker and the man of action together In learning, we draw an abstraction from concrete objects and events. In creating, we make our own concrete objects and events out of the abstraction; we bring the abstraction down and back to its specific meaning, to the concrete; but the abstraction has helped us to make the kind of concrete we want the concrete to be. It has helped us to create to reshape the world as we wish it to be for our purposes. I cannot resist quoting one further paragraph. It comes a few pages later in the same discussion. Incidentally, as a sideline observation: if creative fiction writing is a process of translating an abstraction into the concrete, there are three possible grades of such writing: translating an old (known) abstraction (theme or thesis) through the medium of old fiction means (that is, characters, events or situations used before for that same purpose, that same translation) this is most of the popular trash; translating an old abstraction through new, original fiction means this is most of the good literature; creating a new, original abstraction and translating it through new, original means. This, as far as I know, is only me my kind of fiction writing. May God forgive me (Metaphor!) if this is mistaken conceit! As near as I can now see it, it isn t. (A fourth possibility translating a new abstraction through old means is impossible, by definition: if the abstraction is new, there can be no means used by anybody else before to translate it.) Is her conclusion mistaken conceit ? It is now forty-five years since she wrote this note, and you are holding Ayn Rand s master-work in your hands. You decide. Leonard Peikoff September 1991. Chapter 1: THE THEME Who is John Galt? The light was ebbing, and Eddie Willers could not distinguish the bum s face. The bum had said it simply, without expression. But from the sunset far at the end of the street, yellow glints caught his eyes, and the eyes looked straight at Eddie Willers, mocking and still as if the question had been addressed to the causeless uneasiness within him. Why did you say that? asked Eddie Willers, his voice tense. The bum leaned against the side of the doorway; a wedge of broken glass behind him reflected the metal yellow of the sky. Why does it bother you? he asked. It doesn t, snapped Eddie Willers. He reached hastily into his pocket. The bum had stopped him and asked for a dime, then had gone on talking, as if to kill that moment and postpone the problem of the next. Pleas for dimes were so frequent in the streets these days that it was not necessary to listen to explanations and he had no desire to hear the details of this bum s particular despair. Go get your cup of coffee, he said, handing the dime to the shadow that had no face. Thank you, sir, said the voice, without interest, and the face leaned forward for a moment. The face was wind-browned, cut by lines of weariness and cynical resignation; the eyes were intelligent. Eddie Willers walked on, wondering why he always felt it at this time of day, this sense of dread without reason. No, he thought, not dread, there s nothing to fear: just an immense, diffused apprehension, with no source or object. He had become accustomed to the feeling, but he could find no explanation for it; yet the bum had spoken as if he knew that Eddie felt it, as if he thought that one should feel it, and more: as if he knew the reason. Eddie Willers pulled his shoulders straight, in conscientious self-discipline. He had to stop this, he thought; he was beginning to imagine things. Had he always felt it? He was thirty-two years old. He tried to think back. No, he hadn t; but he could not remember when it had started. The feeling came to him suddenly, at random intervals, and now it was coming more often than ever. It s the twilight, he thought; I hate the twilight. The clouds and the shafts of skyscrapers against them were turning brown, like an old painting in oil, the color of a fading masterpiece. Long streaks of grime ran from under the pinnacles down the slender, soot-eaten walls. High on the side of a tower there was a crack in the shape of a motionless lightning, the length of ten stories. A jagged object cut the sky above the roofs; it was half a spire, still holding the glow of the sunset; the gold leaf had long since peeled off the other half. The glow was red and still, like the reflection of a fire: not an active fire, but a dying one which it is too late to stop. No, thought Eddie Willers, there was nothing disturbing in the sight of the city. It looked as it had always looked. He walked on, reminding himself that he was late in returning to the office. He did not like the task which he had to perform on his return, but it had to be done. So he did not attempt to delay it, but made himself walk faster. He turned a corner. In the narrow space between the dark silhouettes of two buildings, as in the crack of a door, he saw the page of a gigantic calendar suspended in the sky. It was the calendar that the mayor of New York had erected last year on the top of a building, so that citizens might tell the day of the month as they told the hours of the day, by glancing up at a public tower. A white rectangle hung over the city, imparting the date to the men in the streets below. In the rusty light of this evening s sunset, the rectangle said: September 2. Eddie Willers looked away. He had never liked the sight of that calendar. It disturbed him, in a manner he could not explain or define. The feeling seemed to blend with his sense of uneasiness; it had the same quality. He thought suddenly that there was some phrase, a kind of quotation, that expressed what the calendar seemed to suggest. But he could not recall it. He walked, groping for a sentence that hung in his mind as an empty shape. He could neither fill it nor dismiss it. He glanced back. The white rectangle stood above the roofs, saying in immovable finality: September 2. Eddie Willers shifted his glance down to the street, to a vegetable pushcart at the stoop of a brownstone house. He saw a pile of bright gold carrots and the fresh green of onions. He saw a clean white curtain blowing at an open window. He saw a bus turning a corner, expertly steered. He wondered why he felt reassured and then, why he felt the sudden, inexplicable wish that these things were not left in the open, unprotected against the empty space above. When he came to Fifth Avenue, he kept his eyes on the windows of the stores he passed. There was nothing he needed or wished to buy; but he liked to see the display of goods, any goods, objects made by men, to be used by men. He enjoyed the sight of a prosperous street; not more than every fourth one of the stores was out of business, its windows dark and empty. He did not know why he suddenly thought of the oak tree. Nothing had recalled it. But he thought of it and of his childhood summers on the Taggart estate. He had spent most of his childhood with the Taggart children, and now he worked for them, as his father and grandfather had worked for their father and grandfather. The great oak tree had stood on a hill over the Hudson, in a lonely spot on the Taggart estate. Eddie Willers, aged seven, liked to come and look at that tree. It had stood there for hundreds of years, and he thought it would always stand there. Its roots clutched the hill like a fist with fingers sunk into the soil, and he thought that if a giant were to seize it by the top, he would not be able to uproot it, but would swing the hill and the whole of the earth with it, like a ball at the end of a string. He felt safe in the oak tree s presence; it was a thing that nothing could change or threaten; it was his greatest symbol of strength. One night, lightning struck the oak tree. Eddie saw it the next morning. It lay broken in half, and he looked into its trunk as into the mouth of a black tunnel. The trunk was only an empty shell; its heart had rotted away long ago; there was nothing inside just a thin gray dust that was being dispersed by the whim of the faintest wind. The living power had gone, and the shape it left had not been able to stand without it. Years later, he heard it said that children should be protected from shock, from their first knowledge of death, pain or fear. But these had never scarred him; his shock came when he stood very quietly, looking into the black hole of the trunk. It was an immense betrayal the more terrible because he could not grasp what it was that had been betrayed. It was not himself, he knew, nor his trust; it was something else. He stood there for a while, making no sound, then he walked back to the house. He never spoke about it to anyone, then or since. Eddie Willers shook his head, as the screech of a rusty mechanism changing a traffic light stopped him on the edge of a curb. He felt anger at himself. There was no reason that he had to remember the oak tree tonight. It meant nothing to him any longer, only a faint tinge of sadness and somewhere within him, a drop of pain moving briefly and vanishing, like a raindrop on the glass of a window, its course in the shape of a question mark. He wanted no sadness attached to his childhood; he loved its memories: any day of it he remembered now seemed flooded by a still, brilliant sunlight. It seemed to him as if a few rays from it reached into his present: not rays, more like pinpoint spotlights that gave an occasional moment s glitter to his job, to his lonely apartment, to the quiet, scrupulous progression of his existence. He thought of a summer day when he was ten years old. That day, in a clearing of the woods, the one precious companion of his childhood told him what they would do when they grew up. The words were harsh and glowing, like the sunlight. He listened in admiration and in wonder. When he was asked what he would want to do, he answered at once, Whatever is right, and added, You ought to do something great. I mean, the two of us together. What? she asked. He said, I don t know. That s what we ought to find out. Not just what you said. Not just business and earning a living. Things like winning battles, or saving people out of fires, or climbing mountains. What for? she asked. He said, The minister said last Sunday that we must always reach for the best within us. What do you suppose is the best within us? I don t know. We ll have to find out. She did not answer; she was looking away, up the railroad track. Eddie Willers smiled. He had said, Whatever is right, twenty-two years ago. He had kept that statement unchallenged ever since; the other questions had faded in his mind; he had been too busy to ask them. But he still thought it self-evident that one had to do what was right; he had never learned how people could want to do otherwise; he had learned only that they did. It still seemed simple and incomprehensible to him: simple that things should be right, and incomprehensible that they weren t. He knew that they weren t. He thought of that, as he turned a corner and came to the great building of Taggart Transcontinental. The building stood over the street as its tallest and proudest structure. Eddie Willers always smiled at his first sight of it. Its long bands of windows were unbroken, in contrast to those of its neighbors. Its rising lines cut the sky, with no crumbling corners or worn edges. It seemed to stand above the years, untouched. It would always stand there, thought Eddie Willers. Whenever he entered the Taggart Building, he felt relief and a sense of security. This was a place of competence and power. The floors of its hallways were mirrors made of marble. The frosted rectangles of its electric fixtures were chips of solid light. Behind sheets of glass, rows of girls sat at typewriters,

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Atlas Shrugged: Ayn Rand: 9780451191144: Amazon.com: Books

Atlas Shrugged | AynRand.org

Reason and freedom are corollaries, Ayn Rand holds, as are faith and force. Atlas Shrugged showcases both relationships.

The heroes are unwavering thinkers. Whether it is a destructive business scheme proclaimed as moral, the potential collapse of the economy, or a personal life filled with pain, the heroes seek to face the facts and understand. To them, reason is an absolute. Politically, therefore, what they require and demand is freedom. Freedom to think, to venture into the new and unknown, to earn, to trade, to succeed and fail and pursue their own individual happiness.

The villains, by contrast, reject the absolutism of reason. They want a world ruled by their feelings, in which wishing makes it so. James Taggart, for instance, wants to be the head of a railroad without the need of effort. No amount of thinking can bring such a world about he must attempt to bring it about by force. As Rand puts it elsewhere, Anyone who resorts to the formula: Its so, because I say so, will have to reach for a gun, sooner or later.

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SparkNotes: Atlas Shrugged: Plot Overview

In an environment of worsening economicconditions, Dagny Taggart, vice president in charge of operations,works to repair Taggart Transcontinentals crumbling Rio Norte Lineto service Colorado, the last booming industrial area in the country.Her efforts are hampered by the fact that many of the countrysmost talented entrepreneurs are retiring and disappearing. The railroadscrisis worsens when the Mexican government nationalizes TaggartsSan Sebastian Line. The line had been built to service FranciscodAnconias copper mills, but the mills turn out to be worthless.Francisco had been a successful industrialist, and Dagnys lover,but has become a worthless playboy. To solve the railroads financialproblems, Dagnys brother Jim uses political influence to pass legislationthat destroys Taggarts only competition in Colorado. Dagny mustfix the Rio Norte Line immediately and plans to use Rearden Metal,a new alloy created by Hank Rearden. When confronted about the SanSebastian mines, Francisco tells Dagny he is deliberately destroyingdAnconia Copper. Later he appears at Reardens anniversary partyand, meeting him for the first time, urges Rearden to reject thefreeloaders who live off of him.

The State Science Institute issues a denunciation of Rearden metal,and Taggarts stock crashes. Dagny decides to start her own companyto rebuild the line, and it is a huge success. Dagny and Reardenbecome lovers. Together they discover a motor in an abandoned factorythat runs on static electricity, and they seek the inventor. Thegovernment passes new legislation that cripples industry in Colorado.Ellis Wyatt, an oil industrialist, suddenly disappears after settingfire to his wells. Dagny is forced to cut trains, and the situationworsens. Soon, more industrialists disappear. Dagny believes thereis a destroyer at work, taking men away when they are most needed.Francisco visits Rearden and asks him why he remains in businessunder such repressive conditions. When a fire breaks out and theywork together to put it out, Francisco understands Reardens lovefor his mills.

Rearden goes on trial for breaking one of the new laws,but refuses to participate in the proceedings, telling the judgesthey can coerce him by force but he wont help them to convict him.Unwilling to be seen as thugs, they let him go. Economic dictatorWesley Mouch needs Reardens cooperation for a new set of socialistlaws, and Jim needs economic favors that will keep his ailing railroadrunning after the collapse of Colorado. Jim appeals to Reardenswife Lillian, who wants to destroy her husband. She tells him Rearden andDagny are having an affair, and he uses this information in a trade.The new set of laws, Directive 10-289,is irrational and repressive. It includes a ruling that requiresall patents to be signed over to the government. Rearden is blackmailedinto signing over his metal to protect Dagnys reputation.

Dagny quits over the new directive and retreats to a mountain lodge.When she learns of a massive accident at the Taggart Tunnel, shereturns to her job. She receives a letter from the scientist shehad hired to help rebuild the motor, and fears he will be the nexttarget of the destroyer. In an attempt to stop him from disappearing,she follows him in an airplane and crashes in the mountains. Whenshe wakes up, she finds herself in a remote valley where all theretired industrialists are living. They are on strike, calling ita strike of the mind. There, she meets John Galt, who turns outto be both the destroyer and the man who built the motor. She fallsin love with him, but she cannot give up her railroad, and she leavesthe valley. When she returns to work, she finds that the governmenthas nationalized the railroad industry. Government leaders wanther to make a speech reassuring the public about the new laws. Sherefuses until Lillian comes to blackmail her. On the air, she proudlyannounces her affair with Rearden and reveals that he has been blackmailed. Shewarns the country about its repressive government.

With the economy on the verge of collapse, Francisco destroys therest of his holdings and disappears. The politicians no longer evenpretend to work for the public good. Their vast network of influencepeddling creates worse chaos, as crops rot waiting for freight trainsthat are diverted for personal favors. In an attempt to gain controlof Franciscos mills, the government stages a riot at Rearden Steel.But the steelworkers organize and fight back, led by Francisco,who has been working undercover at the mills. Francisco saves Reardenslife, then convinces him to join the strike.

Just as the head of state prepares to give a speech onthe economic situation, John Galt takes over the airwaves and deliversa lengthy address to the country, laying out the terms of the strikehe has organized. In desperation, the government seeks Galt to makehim their economic dictator. Dagny inadvertently leads them to him,and they take him prisoner. But Galt refuses to help them, evenafter he is tortured. Finally, Dagny and the strikers rescue himin an armed confrontation with guards. They return to the valley,where Dagny finally joins the strike. Soon, the countrys collapseis complete and the strikers prepare to return.

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SparkNotes: Atlas Shrugged: Plot Overview

Health & Food Supplements Information Service

gMicrogram a measurement of weight equal to one millionth of a gram (or one thousandth of a milligram). Microgram (g or mcg) is used for a number of nutrients found in food supplements.Amino AcidThe building blocks of protein, there are eight essential amino acids which cannot be synthesised within the body and therefore must come from the diet. These are: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. In addition arginine and histidine are amino acids required by infants and young children which supports their rapid growth.AntioxidantA substance or nutrient which helps to protect our cells from damage caused by free radicals, damaging molecules which are found in pollution and tobacco smoke. Our bodies also produce free radicals as part of the normal biochemistry of living.DeficiencyA lack of essential macronutrients or micronutrients which results in malnutrition and or disease. This may be the result of inadequate intakes or absorption issues associated with gastrointestinal disease. There are a number of recognised deficiency diseases including (but not exclusively): scurvy (vitamin C deficiency); rickets (vitamin D deficiency); anaemia (iron deficiency, but also deficiencies in B12 and folic acid) and Kwashiorkor (protein deficiency).DHThe Department of Health is a UK Government department. It has responsibility for nutrition legislation and sets health policy for nutrition.DHADocosahexaenoic acid; one of the key omega-3 fats that provides health benefitsDietitianAn individual qualified in nutrition and dietetics who can assess, diagnose and treat health issues associated with nutrition and diet. Dietitians are governed by law with a statutory code of practice; they often work within the health service although increasing numbers are also working in a freelance capacity.EFAEssential fatty acids (omega 3 and omega 6) cannot be synthesised by the body and must be derived from the diet. EFAs do not provide fuel for energy production and are required for vital biological processes which support growth, development and health.EFSAEuropean Food Safety Authority; the European Union food risk management agency which scientifically evaluates safety across all areas of food.EPAEicosapentaenoic acid; one of the key omega-3 fats that provides health benefits.Fat soluble vitaminThe fat soluble vitamins are vitamins A, D, E and K. Because they are fat soluble these substances can accumulate in the body, often being stored in fat cells, or in the liver. This can create health issues, particularly if intakes have been high for a prolonged period of time. For example, long term high intakes of vitamin D may lead to the laying down of calcium in tissues such as liver and kidneys which can cause nausea and vomiting.Food supplementA food supplement is a concentrated source of vitamins, minerals or other substances with a nutritional or physiological effect which is sold in small, measured unit doses.FSAThe Food Standards Agency is a non-ministerial UK Government department responsible for food safety and food hygiene.GLAGamma-linoleic acid is an omega-6 fatty acid (an essential fatty acid considered to be necessary for human health which must be derived from the diet). GLA is most commonly found in evening primrose oil (EPO), borage or starflower oil and blackcurrant seed oil.Health claimA health claim is any claim which states, or implies, that consumption of a specific food will have a beneficial effect on health. Claims may be written, verbal or pictorial.Herbal medicine (herbal remedy)A product is considered to be a herbal medicine if the main active ingredient/s are only herbal substances or preparations. Not all herbal products are medicines, some may be food supplements and some may be cosmetics. What determines if a product is, or is not a medicine is complex but generally rests with how the product is presented (i.e. does it make medicinal claims to treat, prevent or cure any disease) and what it does (i.e. does it have a physiological impact on, or alter, any body functions).MacronutrientDietary constituents which are needed in significant amounts, generally protein, fat, carbohydrate, fibre and water.MalnutritionMalnutrition is a state in which the deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on the body. Malnutrition may refer to insufficient intake of protein, carbohydrate and fats (macronutrients) which can result in overly low BMI. It may also be insufficient intake of vitamins, minerals and other micronutrients, which can impact on overall health and could include obese individuals with poor diets.MgMilligram is a measurement of weight equal to one thousandth of a gram. Mg is used for a number of nutrients found in food supplements.MicronutrientA substance derived from food which is needed in extremely small amounts for the normal growth and development of living beings. Micronutrients are vitamins, minerals and essential fatty acids (omega-3 fats)MineralInorganic micronutrient essential to health and wellbeing. Minerals are absorbed from soil by plants which are in turn eaten by animals or humans. Minerals may be split into minerals which are needed in relatively high amounts (calcium, phosphorus, magnesium, sodium, chloride and potassium) and trace elements (iron, zinc, cobalt, copper, chromium, fluoride, iodine, manganese, molybdenum, boron and selenium) which are needed in very small quantities.MultivitaminA product which contains more than one vitamin, often multivitamins will contain all 13 vitamins although some may contain only the eight B vitamins, or a combination of some of the vitamins and some additional minerals.NDNSThe UK National Diet and Nutrition Survey is a continuous rolling survey of the dietary habits and nutritional status of adults and children in the UK. The results are used to assess whether intakes of food and nutrients are adequate across different ages and population groups.NRVNutrient Reference Value is the amount set by the European Food Safety Authority (EFSA), primarily to support food labelling, which the majority of the population requires to maintain health. Previously known as RDANutrientA substance derived from food which provides nourishment to the body and is essential for the maintenance of life and for growth and development.NutritionistNutritionists generally work for public bodies or governments, although some do work with private clients. They tend to look at large populations to determine risk factors and make dietary recommendations that are applied at population levels. For example, evidence on the incidence of type II Diabetes led public health nutritionists to determine that some populations are more at risk of developing this disease, and to make recommendations for dietary changes to either reduce the risk or manage the disease. However, public health nutritionists do not practice with individual patients.Omega-3 fatsEssential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-3 fats are oily fish and fish oil supplements with some also coming from enriched eggs and fortified foods. There are a number of scientifically proven health benefits for omega-3 fats including supporting the health of the eyes, brain and heart, maintaining an appropriate balance of triglycerides in the blood and reducing blood pressure.Omega-6 fatsEssential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-6 are vegetable oils such as sunflower and corn oils as well as nuts and seeds. There are a number of health benefits associated with omega-6 fatty acids; they are thought to be beneficial in the management of premenstrual syndrome and in some skin conditions including eczema and psoriasis.PAGBProprietary Association of Great Britain (PAGB) is the UK trade association which represents the manufacturers of branded over-the-counter medicines, self care medical devices and food supplements.PrebioticsFoods which promote the growth of probiotics, the beneficial bacteria that inhabit our gut. Prebiotics are generally fibres such as inulin, which our bodies cannot digest and absorb but which provide a food source for probiotics.ProbioticsLive bacteria (and some yeasts) which inhabit the digestive tract which are viewed as being beneficial to human health. There are thousands of different bacterial strains; some are resident in specific areas of the digestive tract whilst others are transient, simply passing through.Public Health England (PHE)Public Health England is an agency of the Department of Health responsible for improving public health. They work with local government, the NHS and non-governmental organisations as well as communicating public health messages to the general public.PUFAPolyunsaturated fatty acids (PUFA) are found in nuts, seeds, fish (and fish oil), krill and some algae, small amounts are also found in leafy greens. The omega-3 and omega 6 fats are PUFAs, which are generally associated with health.RDARecommended Daily Amount; previously used terminology for the amount set, primarily to support food labelling, which the majority of the population require to maintain health. Now described using nutrient reference value (NRV)SULSafe Upper Levels of vitamins and minerals were established by the Expert Group on Vitamins and Minerals who published a report in 2003 (https://cot.food.gov.uk/sites/default/files/cot/vitmin2003.pdf). The UK food supplements industry works to the levels set in this report.VitaminOrganic micronutrient essential to health and wellbeing. Vitamins cannot be synthesised in sufficient amounts by the animal or human body and must therefore be obtained from the diet. Plants manufacture vitamins which move up the food chain as the plants are consumed by animals or humans. Vitamins can be divided into fat soluble (vitamins A, D, E and K) and water soluble (vitamins B1, B2, B3, B5, B6, B12, biotin, folic acid and vitamin C).Water soluble vitaminThe B vitamins and vitamin C are water soluble. They are not stored in any significant quantities within the body and are generally either utilised or excreted in the urine. As they are not stored in the body, they tend to have low toxicity and are needed on a daily basis.

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Health & Food Supplements Information Service

Regulation of food and dietary supplements by the U.S …

The regulation of food and dietary supplements by the U.S. Food and Drug Administration is a process governed by various statutes enacted by the United States Congress and interpreted by the U.S. Food and Drug Administration ("FDA"). Pursuant to the Federal Food, Drug, and Cosmetic Act ("the Act") and accompanying legislation, the FDA has authority to oversee the quality of substances sold as food in the United States, and to monitor claims made in the labeling about both the composition and the health benefits of foods.

Substances which the FDA regulates as food are subdivided into various categories, including foods, food additives, added substances (man-made substances which are not intentionally introduced into food, but nevertheless end up in it), and dietary supplements. The specific standards which the FDA exercises differ from one category to the next. Furthermore, the FDA has been granted a variety of means by which it can address violations of the standards for a given category of substances.

The Pure Food and Drug Act of 1906 was the first of a series of significant consumer protection laws enacted by the Federal Government in the twentieth century and led to the creation of the Food and Drug Administration. Its main purpose was to ban foreign and interstate traffic in adulterated or mislabeled food and drug products, and it directed the U.S. Bureau of Chemistry to inspect products and refer offenders to prosecutors. It required that active ingredients be placed on the label of a drugs packaging and that drugs could not fall below purity levels established by The United States Pharmacopeia or The National Formulary. The Jungle by Upton Sinclair was an inspirational piece that kept the public's attention on the important issue of unsanitary meat processing plants that later formed the Pure Food and Drug Act.

The United States Federal Food, Drug, and Cosmetic Act (abbreviated as FFDCA, FDCA, or FD&C), is a set of laws passed by Congress in 1938 giving authority to the U.S. Food and Drug Administration (FDA) to oversee the safety of food, drugs, and cosmetics. A principal author of this law was Royal S. Copeland, a three-term U.S. Senator from New York.[1] In 1968, the Electronic Product Radiation Control provisions were added to the FD&C. Also in that year the FDA formed the Drug Efficacy Study Implementation (DESI) to incorporate into FD&C regulations the recommendations from a National Academy of Sciences investigation of effectiveness of previously marketed drugs.[2] The act has been amended many times, most recently to add requirements about bioterrorism preparations.

The introduction of this act was influenced by the death of more than 100 patients due to a sulfanilamide medication where diethylene glycol was used to dissolve the drug and make a liquid form.[3] See Elixir Sulfanilamide disaster. It replaced the earlier Pure Food and Drug Act of 1906.

The Food Additives Amendment of 1958 is a 1958 amendment to the Food, Drugs, and Cosmetic Act of 1938. It was a response to concerns about the safety of new food additives. The amendment established the designation of "generally recognized as safe", which refers to chemicals or substances which can be used as food additives without further evaluation or testing just because they have been long used and there is broad acceptance of their use. New food additives would be subject to testing including by the "Delaney clause". The Delaney clause was a provision in the amendment which said that if a substance were found to cause cancer in man or animal, then it could not be used as a food additive.

The Dietary Supplement Health and Education Act of 1994 is a 1994 statute of United States Federal legislation which defines and regulates dietary supplements.[4] Under the act, supplements are mainly unregulated, without proof of effectiveness or safety needed to market a supplement, as well as dietary supplements being classified as foods instead of as drugs.

Food is defined in the Act[5] to be:

The first definition offered is self-referential, defining food in part as "articles used for food", leaving it to the FDA and the courts to determine what exactly constitutes food.[6] This determination is particularly important because the definition of a "drug" under the act includes a section defining drugs as "articles (other than food) intended to affect the structure or any function of the body of man or other animals".[7] Thus, the definition of food is important not only in determining what is covered by the regulatory regime for food, but in determining what is excluded from the regulatory regime for drugs. For example, in the 1983 case of Nutrilab, Inc. v. Schweiker,[8] the United States Court of Appeals for the Seventh Circuit found that starch blockers, though derived from kidney beans, were drugs rather than food under the meaning of the Act. The starch blockers were sold as tablets, and "not consumed primarily for taste, aroma, or nutritive value".[8] Products that are normally considered to be foods may also be regulated as drugs if the parties responsible for their manufacture or sale make claims as to their ability to treat diseases,[6] although the FDA now permits advertising addressing the disease-fighting qualities in foods where those qualities have been endorsed by the scientific community.

The standards for food sold in the United States are set forth in Chapter IV of the Act.[9] These standards set forth two main areas of food that violates the Act: adulterated food and misbranded food. These categories are independent of one another; food can be completely free of adulteration and otherwise healthy to consume, and still be in violation of the act if it is misbranded. Likewise, food that has completely accurate labels, including warnings about dangers that it may pose to health, may nevertheless be deemed adulterated.

The Act sets forth several circumstances under which food will be deemed adulterated. The primary definition set forth is that food is adulterated if:

Added substances are treated separately by the FDA, meaning that the sale of an article or substance as food will generally be permitted if that article or substance is not ordinarily injurious to health.

Food is also deemed adulterated "if it consists in whole or in part of any filthy, putrid, or decomposed substance, or if it is otherwise unfit for food";[11] if it was "prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health";[12] if it was produced from "a diseased animal or of an animal which has died otherwise than by slaughter";[13] if it was packaged in a poisonous material;[14] or if it was intentionally irradiated outside of irradiation guidelines set forth by the Act.[15] These definitions are also independent, meaning that food that is "filthy" or has been "held under insanitary conditions" is still in violation of the Act and subject to condemnation even if the owner can demonstrate that it poses no actual threat to health. The phrase "otherwise unfit for food", although seeming to be a catch-all, has rarely been invoked. It would apply to a circumstance such as a seller offering wood chips as food, which might be safe to consume and prepared under sanitary conditions, but would be impossible to chew.

The FDA has the authority to inspect any establishment in which food is manufactured, processed, packed, or held.[16] In searching for contamination, the FDA typically uses organoleptic inspection methods - investigators trained to distinguish contamination and decomposition by sight and smell. Upon completion of such an inspection, the FDA will generate an "Establishment Inspection Report" (EIR)[17] detailing any problems found. Where problems are found, the FDA will instruct the owner of the inspected facility how to proceed in resolving those problems. FDA inspectors may take photographs of an establishment unless they are expressly told not to do so, and the owner of the establishment must provide an employee to answer questions that arise during the inspection. If the owner of an establishment refuses to permit FDA inspectors to enter a covered establishment, or any part of one, then the FDA may obtain a search warrant to enter.

Courts have held that, so long as the owner has not objected to the inspection and prevented the inspectors from entering, the FDA does not require a warrant to seize materials that are in violations of the Act. Furthermore, such materials may be used at trial against the owner without raising unreasonable search and seizure issues under the Fourth Amendment to the United States Constitution because the industry at issue has been found to be heavily regulated, meaning that the owner of such an establishment has no expectation of privacy with respect to premises of the type covered by the Act.

The presence of some degree of contamination is inevitable in almost all food. Technically, the FDA could inspect all food under a microscope and prohibit the sale of every article containing any discernible trace of mold, insect fragments, rodent hairs, and the like - effectively barring the sale of all food. In order to avoid this outcome, the FDA sets "action levels", which specify minimum amounts of particular contaminants that must be found in a food sample before the FDA will take action with respect to that sample. The FDA maintains a listing of all current action levels on its website.[18] The FDA also establishes action levels for man-made chemicals such as aflatoxin, lead, and mercury, and maintains these on its website.[19]

The primary basis under which food may be deemed misbranded under the Act is if "its labeling is false or misleading in any particular".[20] Labeling is defined elsewhere in the Act,[21] and includes:

...all labels and other written, printed, or graphic matter

Under the second part of this definition, it has been held that a food substance sold in conjunction with a book or pamphlet which makes false claims about the benefits of that substance is misbranded.[22] If books making false claims about a food are sold in conjunction with that food, the books themselves may also be seized and destroyed - even if the author had no intention of selling the book in conjunction with the food.[22] However, if a store happens to be selling both a food and a book which makes false claims about that food, and is selling the items separately, then no misbranding occurs. This is so even if the book and the food are both produced by the same company, and even if the maker of the food encourages the seller to carry the book.[23]

In terms of determining whether food is misbranded, the FDA only monitors labeling, and not advertising, which instead falls under the authority of the Federal Trade Commission. However, the FDA will review the advertising of a product to determine whether it is to be regulated as a food or as a drug, based on the claims that the manufacturer or seller makes about its properties.

The FDA is authorized to issue a standard of identity for any food. This is a description of what, exactly, must be in that food in order for it to be identified under a certain name. For example, a court has upheld an FDA ruling that for a product to be sold as cream cheese, it must contain a specified minimum percentage of milk fat, and a maximum level of moisture.[24] Incorrectly identifying a food by a name for which a standard of identity has been established is considered a form of misbranding. The FDA has set forth nearly 300 such standards.[6] However, in recent decades, companies marketing new types of food items have diminished the importance of these standards by simply coining new names for foodstuffs that do not conform to an existing standard, with examples including Cool Whip and Cheetos.

There are two kinds of health claims that can be made about foods other than dietary supplements: structure/function claims and disease claims. Structure/function claims are claims that do not suggest that the food can diagnose, treat, or prevent any particular disease, but that it can, for example, maintain, regulate, or promote normal healthy bodily functions. Where such claims are made, foods are generally required to carry a disclaimer on their label indicating that the claim has not been evaluated by the FDA.

Disease claims suggest that the food can help prevent specific diseases. Such claims are only permitted where the FDA finds that there is "significant scientific agreement", or where the claim has been approved by another federal health agency or the National Academy of Sciences.[25]

Food additives are defined in the Act[26] to be:

The definition goes on to capture several broad categories of things not traditionally thought of as "food", including "any substance intended for use in producing, manufacturing, packing, processing, preparing, treating, packaging, transporting, or holding food".[26] The definition only applies if the substance in question is not "generally recognized as safe" by qualified experts, and also exempts substances that were in common use as food prior to January 1, 1958.[26]

The Act sets forth certain exemptions for substances which are treated under different regulatory schemes, including pesticide chemicals and their residue,[27] color additives,[28] substances previously approved under other statutes,[29] new animal drugs,[30] and dietary supplements.[31] The statute directs that food additives are generally to be presumed to be unsafe (and therefore prohibited) until they have been proven to be safe.[32] However, the statute then sets out a regulatory scheme under which a person intending to use a heretofore unapproved food additive may petition for "the issuance of a regulation prescribing the conditions under which such additive may be safely used".[33]

The Delaney clause, initially enacted in 1958, prohibits the FDA from approving food additives shown to cause cancer.[34] At the time of the passage of the amendment, little was known about the carcinogenic propensities of a wide variety of additives.[6] Following the enactment of this amendment, more and more substances were shown to be potentially carcinogenic, albeit in experiments wherein test animals were subjected to doses far in excess to the proportions which humans were likely to consume. In 1982, the FDA responded to this trend by adopting a rule that a food additive would not be denied approval under the Delaney clause unless the additive itself, and not just the constituent chemicals used to make it, was shown to cause cancer.[35] This policy was later challenged in court following FDA approval of a food coloring manufactured with a compound known to be carcinogenic, after separate testing indicated that the food coloring itself did not cause cancer in test animals. The United States Court of Appeals for the Sixth Circuit upheld the FDA's approval of the food coloring.[36]

Added substances are not separately defined in the act, but are understood to be different from food itself based on the definition of adulterated food,[37] and a later section authorizing the FDA to set forth tolerance limits for "[a]ny poisonous or deleterious substance added to any food...".[38] Such substances are prohibited, "except where such substance is required in the production thereof or cannot be avoided by good manufacturing practice".[38] Because added substances often can not be avoided in food, such as the presence of man-made pollutants in fish, the FDA is required to "promulgate regulations limiting the quantity therein or thereon to such extent as [is] necessary for the protection of public health".[38] The action levels discussed above with respect to poisonous or deleterious substances address these added substances. Added substances differ from food additives, discussed above, in that the latter applies to things which are intentionally added to food, and therefore require FDA approval prior to being added to food.

The Dietary Supplement Health and Education Act of 1994 mandated that the FDA regulate dietary supplements as foods, rather than as drugs. Consequently, dietary supplements are defined as a kind of food under the statute,[39] with the caveat that this does not exempt them from being treated as drugs in the way that other foods are exempted, if circumstances permit it.[39]

Like other food substances, dietary supplements are not subject to the safety and efficacy testing requirements imposed on drugs, and unlike drugs they do not require prior approval by the FDA; however, they are subject to the FDA regulations regarding adulteration and misbranding. The FDA can take action against dietary supplements only after they are proven to be unsafe. Dietary supplements may be deemed to be misbranded if they are marketed in a way that characterizes them as a drug, without having undergone the clinical trials to which new drugs are subjected. Manufacturers of dietary supplements are permitted to make specific claims of health benefits, referred to as "structure or function claims" on the labels of these products.[6] They may not claim to treat, diagnose, cure, or prevent disease and must include a disclaimer on the label.[40] Where a manufacturer makes a structure or function claim in connection with the sale of a dietary supplement, the manufacturer must notify the FDA within 30 days after it has introduced that product to the market.

Claims that either a food or dietary supplement acts to prevent a disease are permitted, so long as there is "significant scientific agreement" for the claim, or it has been approved in an "authoritative statement" by "a scientific body with official responsibility for the public health protection or research directly relating to human nutrition" such as the National Academy of Sciences.[41]

Consumer Reports, a consumer protection advocacy and product testing group, stated:[42]

They can be ineffective, contaminated with microbes or heavy metals, dangerously mislabeled, or intentionally spiked with illegal or prescription drugs. They can also cause harmful side effects by themselves and interact with prescription medication in ways that make those drugs less effective. [...] According to a 2015 nationally representative Consumer Reports survey, almost half of American adults think that supplement makers test their products for efficacy, and more than half believe that manufacturers prove their products are safe before selling them.

In February 2019 Scott Gottlieb said that the agency needed stronger powers over health claims and the FDA warned a dozen companies to stop claiming their products can cure diseases. The present law, established in 1994, requires the agency to prove that a product is unsafe. Manufacturers have to notify the agency of new products, but not of their ingredients. In 2019 there were between 50,000 and 80,000 dietary supplements on the American market, beyond the agency's capacity to monitor. The Council for Responsible Nutrition opposed any suggestion that the sector needed stronger regulation.[43]

The Act expressly prohibits the "introduction, or delivery for introduction into interstate commerce of food... that is adulterated or misbranded",[44] as well as the actual adulteration or misbranding of food.[45] The Act further sets forth a broad range of powers that the FDA may exercise in order to prevent distribution of adulterated or misbranded food. In addition to the express powers set forth in the statute, the FDA exercises certain implied powers, such as the issuance of Warning Letters and recall orders.

The steps which the FDA may take in response to a violation include the following:

Where food is found to be adulterated, the FDA also has the option to offer the owner the opportunity to "recondition" the food - that is, to remove all traces and contamination, and submit that food for a reinspection by the FDA, at which time it may be approved for sale. Similarly, where food is found to be misbranded, the FDA has the option of offering the owner the opportunity to correct the labeling, and put the food back on the market with new labels that are not misleading.

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How to Become Financially Independent

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Most people believe the key to wealth is a high-paying job. Yes, it's easier to amass assets if you have more money coming in each month, but one key to increasing your net worth is to spend less than you make. Ultimately, spending habits are the reason a professional athlete making $20 million a year can quickly go bankrupt while a bus driver can retire a multi-millionaire. It can be a cliche but it is a fundamental reality of money.

To escape the spending trap, you need to understand that income is not long-term wealth. What is wealth? Income is obviously a component of wealth, but wealth can have varying definitions. Many people see wealth as their total net worth at any given time. This can be paralleled to the assessment of an individuals balance sheet. Wealth can be referred to as the part of your balance sheet that is considered equity. Your assets minusliabilities. The wealth you have after liquidating.

Thinking Long-Term

Thinking long-term is an important characteristic of accumulating wealth and achieving financial independence. There can be several considerations for long-term wealth, and they will differ for everyone.

If you are a doctor or lawyer, you need to put in long hours after years of specialty training and higher education to get a paycheck. However, in any occupation, as discussed, your annual salary does not necessarily translate to wealth. With long-term thinking, helping to ensure your jobs security, taking initiative to achieve a promotion, or taking steps that will result in higher sales commissions can all be factors for wealth and ways to help ease your anxieties over financial independence.

Side gigs, private investments and a host of other variables can also be utilized for long-term thinking, wealth accumulation, and achieving financial independence. A few considerations here may include a portfolio of private businesses, car washes, parking garages, stocks, bonds, mutual funds, real estate, patents, trademarks. Some of these cash generators can be relied on for long-term income in addition to your job or just as cash generators that can pull in money while you take long vacations or sit by the pool.

Assessing Your Balance Sheet

When you take a look at your personal balance sheet, you may already have organic investments you can rely on in your quest for financial independence. Oftentimes, this is wealth that generatescapital gains, income, and dividends without labor. The more of these investments you can afford, the sooner you can fully achieve financial independence.

Reaching a Goal

Overall, the real value of your income is partially determined by the amount you can invest to achieve a financial independence goal. Setting this goal can be important for keeping your perspective on income in check. At your goal, you can successfully maintain the lifestyle you want without working.

Thus, your level of wealth can also be measured by your long-term thinking and potential sustainability. Working with a financial adviser can help you to set a goal for wealth accumulation that allows you to maintain your standard of living without an additional paycheck and achieve the financial independence of your dreams. This goal can be lofty,however, as most peoples annual spending includes a long list of budget items, such as mortgage payments, car payments, clothing, college tuitions, music lessons, entertainment expenses, and more.

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How to Become Financially Independent

Aerospace – Wikipedia

Modern aerospace began with Engineer George Cayley in 1799. Cayley proposed an aircraft with a "fixed wing and a horizontal and vertical tail," defining characteristics of the modern airplane.[2]

The 19th century saw the creation of the Aeronautical Society of Great Britain (1866), the American Rocketry Society, and the Institute of Aeronautical Sciences, all of which made aeronautics a more serious scientific discipline.[2] Airmen like Otto Lilienthal, who introduced cambered airfoils in 1891, used gliders to analyze aerodynamic forces.[2] The Wright brothers were interested in Lilienthal's work and read several of his publications.[2] They also found inspiration in Octave Chanute, an airman and the author of Progress in Flying Machines (1894).[2] It was the preliminary work of Cayley, Lilienthal, Chanute, and other early aerospace engineers that brought about the first powered sustained flight at Kitty Hawk, North Carolina on December 17, 1903, by the Wright brothers.

War and science fiction inspired great minds like Konstantin Tsiolkovsky and Wernher von Braun to achieve flight beyond the atmosphere.

The launch of Sputnik 1 in October 1957 started the Space Age, and on July 20, 1969 Apollo 11 achieved the first manned moon landing.[2] In April 1981, the Space Shuttle Columbia launched, the start of regular manned access to orbital space. A sustained human presence in orbital space started with "Mir" in 1986 and is continued by the "International Space Station".[2] Space commercialization and space tourism are more recent features of aerospace.

Aerospace manufacturing is a high-technology industry that produces "aircraft, guided missiles, space vehicles, aircraft engines, propulsion units, and related parts".[3] Most of the industry is geared toward governmental work. For each original equipment manufacturer (OEM), the US government has assigned a Commercial and Government Entity (CAGE) code. These codes help to identify each manufacturer, repair facilities, and other critical aftermarket vendors in the aerospace industry.

In the United States, the Department of Defense and the National Aeronautics and Space Administration (NASA) are the two largest consumers of aerospace technology and products. Others include the very large airline industry. The aerospace industry employed 472,000 wage and salary workers in 2006.[4] Most of those jobs were in Washington state and in California, with Missouri, New York and Texas also being important. The leading aerospace manufacturers in the U.S. are Boeing, United Technologies Corporation, SpaceX, Northrop Grumman and Lockheed Martin. These manufacturers are facing an increasing labor shortage as skilled U.S. workers age and retire. Apprenticeship programs such as the Aerospace Joint Apprenticeship Council (AJAC) work in collaboration with Washington state aerospace employers and community colleges to train new manufacturing employees to keep the industry supplied.

Important locations of the civilian aerospace industry worldwide include Washington state (Boeing), California (Boeing, Lockheed Martin, etc.); Montreal, Quebec, Canada (Bombardier, Pratt & Whitney Canada); Toulouse, France (Airbus/EADS); Hamburg, Germany (Airbus/EADS); and So Jos dos Campos, Brazil (Embraer), Quertaro, Mexico (Bombardier Aerospace, General Electric Aviation) and Mexicali, Mexico (United Technologies Corporation, Gulfstream Aerospace).

In the European Union, aerospace companies such as EADS, BAE Systems, Thales, Dassault, Saab AB and Leonardo S.p.A. (formerly Finmeccnica)[5] account for a large share of the global aerospace industry and research effort, with the European Space Agency as one of the largest consumers of aerospace technology and products.

In India, Bangalore is a major center of the aerospace industry, where Hindustan Aeronautics Limited, the National Aerospace Laboratories and the Indian Space Research Organisation are headquartered. The Indian Space Research Organisation (ISRO) launched India's first Moon orbiter, Chandrayaan-1, in October 2008.

In Russia, large aerospace companies like Oboronprom and the United Aircraft Building Corporation (encompassing Mikoyan, Sukhoi, Ilyushin, Tupolev, Yakovlev, and Irkut which includes Beriev) are among the major global players in this industry. The historic Soviet Union was also the home of a major aerospace industry.

The United Kingdom formerly attempted to maintain its own large aerospace industry, making its own airliners and warplanes, but it has largely turned its lot over to cooperative efforts with continental companies, and it has turned into a large import customer, too, from countries such as the United States. However, the UK has a very active aerospace sector, including the second largest defence contractor in the world, BAE Systems, supplying fully assembled aircraft, aircraft components, sub-assemblies and sub-systems to other manufacturers, both in Europe and all over the world.

Canada has formerly manufactured some of its own designs for jet warplanes, etc. (e.g. the CF-100 fighter), but for some decades, it has relied on imports from the United States and Europe to fill these needs. However Canada still manufactures some military aircraft although they are generally not combat capable. Another notable example was the late 1950s development of the Avro Canada CF-105 Arrow, a supersonic fighter-interceptor that was cancelled in 1959 a highly controversial decision.

France has continued to make its own warplanes for its air force and navy, and Sweden continues to make its own warplanes for the Swedish Air Forceespecially in support of its position as a neutral country. (See Saab AB.) Other European countries either team up in making fighters (such as the Panavia Tornado and the Eurofighter Typhoon), or else to import them from the United States.

Pakistan has a developing aerospace engineering industry. The National Engineering and Scientific Commission, Khan Research Laboratories and Pakistan Aeronautical Complex are among the premier organizations involved in research and development in this sector. Pakistan has the capability of designing and manufacturing guided rockets, missiles and space vehicles. The city of Kamra is home to the Pakistan Aeronautical Complex which contains several factories. This facility is responsible for manufacturing the MFI-17, MFI-395, K-8 and JF-17 Thunder aircraft. Pakistan also has the capability to design and manufacture both armed and unarmed unmanned aerial vehicles.

In the People's Republic of China, Beijing, Xi'an, Chengdu, Shanghai, Shenyang and Nanchang are major research and manufacture centers of the aerospace industry. China has developed an extensive capability to design, test and produce military aircraft, missiles and space vehicles. Despite the cancellation in 1983 of the experimental Shanghai Y-10, China is still developing its civil aerospace industry.

The aircraft parts industry was born out of the sale of second-hand or used aircraft parts from the aerospace manufacture sector. Within the United States there is a specific process that parts brokers or resellers must follow. This includes leveraging a certified repair station to overhaul and "tag" a part. This certification guarantees that a part was repaired or overhauled to meet OEM specifications. Once a part is overhauled its value is determined from the supply and demand of the aerospace market. When an airline has an aircraft on the ground, the part that the airline requires to get the plane back into service becomes invaluable. This can drive the market for specific parts. There are several online marketplaces that assist with the commodity selling of aircraft parts.

In the aerospaces & defense industry, a lot of consolidation has appeared over the last couple of decades. Between 1988 and 2011, worldwide more than 6,068 mergers & acquisitions with a total known value of 678 bil. USD have been announced.[6] The largest transactions have been:

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Health insurance made simple | UnitedHealthOne

No individual applying for health coverage through the individual Marketplace will be discouraged from applying for benefits, turned down for coverage, or charged more premium because of health status, medical condition, mental illness claims experience, medical history, genetic information or health disability. In addition, no individual will be denied coverage based on race, color, religion, national origin, sex, sexual orientation, marital status, personal appearance, political affiliation or source of income.

References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies.Dental and Vision products are administrated by related companies.Each company is a separate entity and is not responsible for another's financial or contractual obligations.Administrative services are provided by United HealthCare Services, Inc.

Products and services offered are underwritten by Golden Rule Insurance Company, Oxford Health Insurance, Inc., UnitedHealthcare Life Insurance Company andUnitedHealthcare Insurance Company. In New Mexico, products and services offered are only underwritten by Golden Rule Insurance Company.

All products require separate applications. Separate policies or certificates are issued. Golden Rule Short Term Medical plans are medically underwritten. Related insuranceproducts offered by either company may be medically underwritten see the product brochures and applications. HealthiestYou by Teladoc is not insurance and is not associated with any other insurance product for which you are applying. HealthiestYou by Teladoc and UnitedHealthcare are not affiliated and each entity is responsible for its own contractual and financial obligations. Travel Health Insurance, Property & Casualty, Final Expense Whole Life Insurance and Pet Insurance are underwritten by different companies that are not related to the UnitedHealthcare family of companies. Product availability varies by state.

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Fifth Amendment | Wex Legal Dictionary / Encyclopedia …

Fifth Amendment: An Overview

TheFifth Amendmentof theU.S. Constitutionprovides, "No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation."

The clauses incorporated within the Fifth Amendment outline basic constitutional limits on police procedure. The Framers derived the Grand Juries Clause and the Due Process Clause from the MagnaCarta, dating back to 1215. Scholars consider the Fifth Amendment as capable of breaking down into the following five distinct constitutional rights: 1) right to indictment by the grand jury before any criminal charges for felonious crimes, 2) a prohibition on double jeopardy, 3) a right against forced self-incrimination, 4) a guarantee that all criminal defendants have a fair trial, and 5) a guarantee that government cannot seize private property without making a due compensation at the market value of the property.

While the Fifth Amendment originally only applied to federal courts, the U.S. Supreme Court has partially incorporated the 5th amendment to the states through the Due Process Clause of theFourteenth Amendment. The right to indictment by the Grand Jury has not been incorporated, while the right against double jeopardy, the right against self-incrimination, and the protection against arbitrary taking of a private property without due compensation have all been incorporated to the states.

Grand Juries

Grand juriesare a holdover from the early British common law dating back hundreds of years. Deeply-rooted in the Anglo-American tradition, the grand jury was originally intended to protect the accused from overly-zealous prosecutions by the English monarchy. In the early phases of the development of the U.S. Constituion, the Founding Fathers have decided to retain the Grand Jury system as a protection against over-zealous prosecution by the central government. Although the Supreme Court in Hurtado v. California in 1884 has refused to incorporate the Grand Jury system to all of the states, most states have independently decided to retain a similar form of Grand Jury, and currently, all but two states (Connecticut and Pennsylvania) have the grand jury.

Congressional statutes outline the means by which a federal grand jury shall be impaneled. Ordinarily, the grand jurors are selected from the pool of prospective jurors who potentially could serve on a given day in any juror capacity. At common-law, a grand jury consists of between 12 and 23 members. Because the Grandjurywas derived from the common-law, courts use the common-law as a means of interpreting the Grand Jury Clause. While state legislatures may set the statutory number of grand jurors anywhere within the common-law requirement of 12 to 23, statutes setting the number outside of this range violate the Fifth Amendment. Federal law has set the federal grand jury number as falling between 16 and 23.

A person being charged with a crime that warrants a grand jury has the right to challenge members of the grand juror for partiality or bias, but these challenges differ from peremptory challenges, which a defendant has when choosing a trial jury. When a defendant makes a peremptory challenge, the judge must remove the juror without making any proof, but in the case of a grand juror challenge, the challenger must establish the cause of the challenge by meeting the same burden of proof as the establishment of any other fact would require. Grand juries possess broad authority to investigate suspected crimes. They may not, however, conduct "fishing expeditions" or hire individuals not already employed by the government to locate testimony or documents. Ultimately, grand juries may make a presentment, informing the court of their decision to indict or not indict the suspect. If they indict the suspect, it means they have decided that there is a probable cause to believe that the charged crime has indeed been committed and by the suspect

Double Jeopardy

The Double Jeopardy Clause aims to protect against the harassment of an individual through successive prosecutions of the same alleged act, to ensure the significance of an acquittal, and to prevent the state from putting the defendant through the emotional, psychological, physical, and financial troubles that would accompany multiple trials for the same alleged offense. Courts have interpreted the Double Jeopardy Clause as accomplishing these goals by providing the following three distinct rights: a guarantee that a defendant will not face a second prosecution after an acquittal, a guarantee that a defendant will not face a second prosecution after a conviction, and a guarantee that a defendant will not receive multiple punishments for the same offense. Courts, however, have not interpreted the Double Jeopardy Clause as either prohibiting the state from seeking review of a sentence or restricting a sentence's length on rehearing after a defendant's successful appeal.

Jeopardy refers to the danger of conviction. Thus, jeopardy does not attach unless a risk of the determination of guilt exists. If some event or circumstance prompts the trial court to declare a mistrial, jeopardy has not attached if the mistrial only results in minimal delay and the government does not receive addedopportunityto strengthen its case.

Self-Incrimination

The Fifth Amendment also protects criminal defendants from having to testify if they may incriminate themselves through the testimony. A witness may "plead the Fifth" and not answer if the witness believes answering the question may be self-incriminatory.

In the landmarkMiranda v. Arizonaruling, the United States Supreme Court extended the Fifth Amendment protections to encompass any situation outside of the courtroom that involves the curtailment of personal freedom. 384 U.S. 436 (1966). Therefore, any time that law enforcement takes a suspect into custody, law enforcement must make the suspect aware of all rights.Known asMirandarights, these rights include the right to remain silent, the right to have an attorney present during questioning, and the right to have a government-appointed attorney if the suspect cannot afford one.

However, courts have since then slightly narrowed the Miranda rights, holding that police interrogations or questioning that occur prior to taking the suspect into custody does not fall within the Miranda requirements, and the police are not required to give the Miranda warnings to the suspects prior to taking them into custody, and their silence in some instances can be deemed to be implicit admission of guilt.

If law enforcement fails to honor these safeguards, courts will often suppress any statements by the suspect as violating the Fifth Amendment protection against self-incrimination, provided that the suspect has not actually waived the rights. An actual waiver occurs when a suspect has made the waiver knowingly, intelligently, and voluntarily. To determine if a knowing, intelligent and voluntary waiver has occurred, a court will examine the totality of the circumstances, which considers all pertinent circumstances and events. If a suspect makes a spontaneous statement while in custody prior to being made aware of theMirandarights, law enforcement can use the statement against the suspect, provided that police interrogation did not prompt the statement. The Fifth Amendment right does not extend to an individual's voluntarily prepared business papers because the element of compulsion is lacking. Similarly, the right does not extend to potentially incriminating evidence derived from obligatory reports or tax returns.

To be self-incriminating, the compelled answers must pose a substantial and real, and not merely a trifling or imaginary hazard of criminal prosecution

After Congress passed the Crime Control and Safe Streets Act, some felt that the statute by implication overruled the requirements ofMiranda. Some scholars also felt that Congress constitutionally exercised its power in passing this law because they felt thatMirandarepresented a matter of judicial policy rather than an actual manifestation of Fifth Amendment protections. InDickerson v.UnitedStatesthe U.S. Supreme Court rejectedthis argumentand held that the Warren Court had directly derivedMirandafrom the Fifth Amendment.

Due Process Clause

The guarantee ofdue processfor all persons requires the government to respect all rights, guarantees, and protections afforded by the U.S. Constitution and all applicable statutes before the government can deprive any person of life, liberty, or property.Dueprocess essentially guarantees that a party will receive a fundamentally fair, orderly, and just judicial proceeding. While the Fifth Amendment only applies to the federal government, the identical text in the Fourteenth Amendment explicitly applies this due process requirement to the states as well.

Courts have come to recognize that two aspects of due process exist: procedural due process andsubstantive due process.The proceduraldue processaims to ensure fundamental fairness by guaranteeing a party the right to be heard, ensuring that the parties receive proper notification throughout the litigation, and ensures that the adjudicating court has the appropriate jurisdiction to render a judgment. Meanwhile, substantive due process has developed during the20thcentury as protecting those substantive rights so fundamental as to be "implicit in the concept of ordered liberty."

Just Compensation Clause

While the federal government has a constitutional right to "take" private property for public use, the Fifth Amendment's Just Compensation Clause requires the government to pay just compensation, interpreted as market value, to the owner of the property, valued at the time of the takings. The U.S. Supreme Court has defined fair market value as the most probable price that a willing butunpressuredbuyer, fully knowledgeable of both the property's good and bad attributes, would pay. The government does not have to pay a property owner's attorney's fees, however, unless a statute so provides.

In2005, in Kelov.Cityof New London, the U.S. Supreme Court had rendered a controversial opinion in which they held that a city could constitutionally seize private property for private commercial development, where the redevelopment would economically benefit an area that was sufficiently distressed to justify a program of economic rejuvenation. 545 U.S. 469 (2005). However, after the Kelo decision, some state legislatures passed statutory amendments to counteract Kelo and expand protection for the condemnees. See e.g., Condemnation by Redevelopment Auth. of Fayette Certain Land in Brownsville Borough v. Redevelopment Auth., 152 A.3d 375, 376 (Pa. Commw. Ct. 2016). Nevertheless, Kelo remains a valid law under the federal context, and its broad interpretation of "public use" still holds true under the federal protection for the Fifth Amendment right to just compensation.

Last Edited by Jonathan Kim, June 2017

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Euthanasia | law | Britannica.com

Euthanasia, also called mercy killing, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures. Because there is no specific provision for it in most legal systems, it is usually regarded as either suicide (if performed by the patient himself) or murder (if performed by another). A physician may, however, lawfully decide not to prolong life in cases of extreme suffering, and he may administer drugs to relieve pain even if this shortens the patients life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia.

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ethics: Abortion, euthanasia, and the value of human life

A number of ethical questions are concerned with the endpoints of the human life span. The question of whether abortion or the use of human

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to contravene the prohibition of murder in the Ten Commandments. The organized movement for legalization of euthanasia commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The societys bill was defeated in the House of Lords in 1936, as was a motion on the same subject in the House of Lords in 1950. In the United States the Euthanasia Society of America was founded in 1938.

The first countries to legalize euthanasia were the Netherlands in 2001 and Belgium in 2002. In 1997 Oregon became the first state in the United States to decriminalize physician-assisted suicide; opponents of the controversial law, however, attempted to have it overturned. In 2009 the Supreme Court of South Korea recognized a right to die with dignity in its decision to approve a request by the family of a brain-dead woman that she be removed from life-support systems.

The potential of modern medical practice to prolong life through technological means has provoked the question of what courses of action should be available to the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.

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Euthanasia | law | Britannica.com

Euthanasia in the United States – Wikipedia

Euthanasia is illegal in most of the United States. Assisted suicide/assisted death is legal in Washington, D.C.[1] and the states of California, Colorado, Oregon, Vermont, New Jersey (Starting August 1, 2019),[2] Hawaii, and Washington;[3][4] its status is disputed in Montana. The key difference between euthanasia and assisted suicide is that in cases of assisted suicide, the individual receives assistance, but ultimately voluntarily causes their own death. In euthanasia the individual does not directly end their life, but another person acts to cause the individual's death.[5]

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pain of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about euthanasia raged in the United States which resulted in an Ohio bill to legalize euthanasia in 1906, a bill that was ultimately defeated.[6]

Euthanasia advocacy in the U.S. peaked again during the 1930s and diminished significantly during and after World War II. Euthanasia efforts were revived during the 1960s and 1970s, under the right-to-die rubric, physician assisted death in liberal bioethics, and through advance directives and do not resuscitate orders.

Several major court cases advanced the legal rights of patients, or their guardians, to practice at least voluntary passive euthanasia (physician assisted death). These include the Karen Ann Quinlan case (1976), Brophy and Nancy Cruzan cases. More recent years have seen policies fine-tuned and re-stated, as with Washington v. Glucksberg (1997) and the Terri Schiavo case. The numerous legislative rulings and legal precedents that were brought about in the wake of the Quinlan case had their ethical foundation in the famous 1983 report completed by the President's Commission for the Study of Ethical Problems in Medicine, under the title "Deciding to Forgo Life-Sustaining Treatment."[7] The Commission sustained in its findings that it was morally acceptable to give up a life-supporting therapy and that withholding or withdrawing such a therapy is the same thing from an ethical stand-point, while artificial feeding and other life-supporting therapy are of the same importance for the patients and doctors. Before this report, to withdraw a medical therapy was regarded as much more serious decision than not to start a therapy at all, while artificial feeding was viewed as a special treatment. By 1990, barely a decade and a half after the New Jersey Supreme Courts historic decision, patients were well aware that they could decline any form of medical therapy if they simply choose to do that either directly or by expressing their wish via appointed representative.

In a 2004 article in the Bulletin of the History of Medicine, Brown University historian Jacob M. Appel documented extensive political debate over legislation to legalize physician-assisted suicide in both Iowa and Ohio in 1906. The driving force behind this movement was social activist Anna S. Hall. Canadian historian Ian Dowbiggen's 2003 book, A Merciful End, revealed the role that leading public figures, including Clarence Darrow and Jack London, played in advocating for the legalization of euthanasia.

In the 1983 case of Barber v. Superior Court, two physicians had honored a family's request to withdraw both respirator and intravenous feeding and hydration tubes from a comatose patient. The physicians were charged with murder, despite the fact that they were doing what the family wanted. The court held that all charges should be dropped because the treatments had all been ineffective and burdensome. Withdrawal of treatment, even if life-ending, is morally and legally permitted. Competent patients or their surrogates can decide to withdraw treatments, usually after the treatments are found ineffective, painful, or burdensome.[8]

On May 31, 2013, the Maine state legislature rejected decriminalization of physician assisted suicide and voluntary euthanasia (95-43).

In the United States legal and ethical debates about euthanasia became more prominent in the Karen Ann Quinlan case who went into a coma after allegedly mixing tranquilizers with alcohol, surviving biologically for 9 years in a "persistent vegetative state" even after the New Jersey Supreme Court approval to remove her from a respirator. This case caused a widespread public concern about "lives not worth living" and the possibility of at least voluntary euthanasia if it could be ascertained that the patient would not have wanted to live in this condition.[9] In April 2019, New Jersey became the 7th US state to allow assisted dying after the Governor of New Jersey signed the bill into law and goes into effect on August 1, 2019.[10]

In 1999, the state of Texas passed the Advance Directives Act. Under the law, in some situations, Texas hospitals and physicians have the right to withdraw life support measures, such as mechanical respiration, from terminally ill patients when such treatment is considered to be both futile and inappropriate. This is sometimes referred to as "passive euthanasia".

In 2005, a six-month-old infant, Sun Hudson, with a uniformly fatal disease thanatophoric dysplasia, was the first patient in which "a United States court has allowed life-sustaining treatment to be withdrawn from a pediatric patient over the objections of the child's parent".[11]

Attempts to legalize euthanasia and assisted suicide resulted in ballot initiatives and legislation bills within the United States in the last 20 years. For example, Washington voters saw Ballot Initiative 119 in 1991, California placed Proposition 161 on the ballot in 1992, Oregon passed the Death with Dignity Act in 1994, and Michigan included Proposal B in their ballot in 1998.

Reflecting the religious and cultural diversity of the United States, there is a wide range of public opinion about euthanasia and the right-to-die movement in the United States. During the past 30 years, public research shows that views on euthanasia tend to correlate with religious affiliation and culture, though not gender.

In one recent study dealing primarily with Christian denominations such as Southern Baptists, Pentecostals, and Evangelicals and Catholics tended to be opposed to euthanasia. Moderate Protestants, (e.g., Lutherans and Methodists) showed mixed views concerning end of life decisions in general. Both of these groups showed less support than non-affiliates, but were less opposed to it than conservative Protestants. Respondents that did not affiliate with a religion were found to support euthanasia more than those who did. The liberal Protestants (including some Presbyterians and Episcopalians) were the most supportive. In general, liberal Protestants affiliate more loosely with religious institutions and their views were not similar to those of non-affiliates. Within all groups, religiosity (i.e., self-evaluation and frequency of church attendance) also correlated to opinions on euthanasia. Individuals who attended church regularly and more frequently and considered themselves more religious were found to be more opposed to euthanasia than to those who had a lower level of religiosity.[12]

Recent studies have shown white Americans to be more accepting of euthanasia than black Americans. They are also more likely to have advance directives and to use other end-of-life measures.[13] African Americans are almost 3 times more likely to oppose euthanasia than white Americans. Some speculate that this discrepancy is due to the lower levels of trust in the medical establishment.[14] Select researchers believe that historical medical abuses towards minorities (such as the Tuskegee Syphilis Study) have made minority groups less trustful of the level of care they receive. One study also found that there are significant disparities in the medical treatment and pain management that white Americans and other Americans receive.[15]

Among African Americans, education correlates to support for euthanasia. Black Americans without a four-year degree are twice as likely to oppose euthanasia than those with at least that much education. Level of education, however, does not significantly influence other racial groups in the US. Some researchers suggest that African Americans tend to be more religious, a claim that is difficult to substantiate and define.[14] Only black and white Americans have been studied in extensive detail. Although it has been found that minority groups are less supportive of euthanasia than white Americans, there is still some ambiguity as to what degree this is true.

A 2005 Gallup Poll found that 84% of males supported euthanasia compared to 64% of females.[16] Some cite the prior studies showing that women have a higher level of religiosity and moral conservatism as an explanation for major opposition to euthanasia. Within both sexes, there are differences in attitudes towards euthanasia due to other influences. For example, one study found that black American women are 2.37 times more likely to oppose euthanasia than white American women. African American men are 3.61 times more likely to oppose euthanasia than white American men.[17]

In "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia" Susan M. Wolf warns of the gender disparities if euthanasia or physician-assisted suicide were legal. Wolf highlights four possible gender effects: higher incidence of women than men dying by physician-assisted suicide; more women seeking physician-assisted suicide or euthanasia for different reasons than men; physicians granting or refusing requests for assisted suicide or euthanasia because of the gender of the patient; gender affecting the broad public debate by envisioning a woman patient when considering the debate.[18]

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Euthanasia in the United States - Wikipedia

What Happens When You Put Your Pet to Sleep? – WebMD

In this Article In this Article In this Article

Now that youve made the hard -- but humane -- choice to put your aging or ill pet to sleep, you may have questions. Will it hurt? Can I be with my pet during the process? Can it be done in my home?

Knowing the facts can help you and your family feel more at peace with what's going to happen.

It can be done at home or at your veterinarian's office. Not all vets will do this at your home so its important to check first. You may want to search for one that offers this service.

Make a time for your entire family to say goodbye. If you have children, explain what's happening in advance to help them prepare for the loss of their friend. The American Humane Association recommends books such as Fred Rogers When a Pet Dies as a way to provide comfort and understanding for children.

If you choose a vets office, bring your pets bed with you -- or a comfy blanket or pillow -- where she can rest. Most vets will provide a blanket, bugt one from home may be more soothing to you pet,

You may want to sit with your friend so you can pet and comfort her while the vet gives her the medicine.

Many vets give the pet a shot of sedative before the euthanasia drug. The vet will explain to you what he's doing and where he's giving the shot. Some vets only use a sedative if the pet is frightened or can't relax. The shot may may stin a little bit, and the drug can have side effects.So talk to your vet about whether your pet should get it. If she's very sick and already quiet or has trouble breathing she may not need it.

The euthanasia medication most vets use is pentobarbital, a seizure medication. In large doses, it quickly renders the pet unconscious. It shuts down her heart and brain functions usually within one or two minutes. It is usually given by an IV injection in one of her legs.

When your pet passes, her eyes may not fully close. She may urinate or defecate. You may see her twitch or take a final breath. This can be startling, but it's a normal part of the process. Your pet isn't in pain. Use of a sedative makes this step less likely.

In-home euthanasia can be easier if your dog has trouble moving or gets panicky at the vet's office.

Plus, if there are other animals at your house, they can see that their friend has passed. This is important for dogs -- as pack animals, they may get confused if they see another dog leave the house and not come back. Dogs often cry and search for a deceased animal after it's gone.

On the other hand, you may not want to associate your home with a beloved pet's death. It can be upsetting to children to see it happen, too. Or you may not want to be there when your pet passes.

If you want to bury your pet at home, be sure to check local, county, or state ordinances to make sure this is legal. You may also consider a pet cemetery.

The International Association of Pet Cemeteries and Crematories has a directory of pet cemeteries on its website.

Many people choose to have their pet cremated. Your city may have a company that will pick up your friend's remains from the vet's office or from your home. They'll cremate the pet and let you have time for a memorial service before if you want. Your vet may have a service he uses. If not, contact your local or state government for guidance and regulations.

Putting your pet to sleep is the final step of a lifetime of care. You're making sure your friend is treated with compassion and dignity in his final moments.

SOURCES:

American Humane Association: "Euthanasia: Making the Decision."

The Humane Society of the United States: "Euthanasia Reference Manual."

Interview: Kristen Brauer, DVM, Tampa, Fla.

Interview: Bill DeBusk, Pet Angels, Pinellas Park, Fla.

The International Association of Pet Cemeteries and Crematories.

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Euthanasia, Assisted Suicide & Health Care Decisions Part 1 …

Euthanasia, Assisted Suicide & Health Care Decisions:Protecting Yourself & Your Family

Table of Contents |Part 1 |Part 2

byRita L. Marker

INTRODUCTION

The words euthanasia and assisted suicide are often used interchangeably. However, they are different and, in the law, they are treated differently. In this report, euthanasia is defined as intentionally, knowingly and directly acting to cause the death of another person (e.g., giving a lethal injection). Assisted suicide is defined as intentionally, knowingly and directly providing the means of death to another person so that the person can use that means to commit suicide (e.g., providing a prescription for a lethal dose of drugs).

Part I of this report discusses the reasons used by activists to promote changes in the law; the contradictions that the actual proposals have with those reasons; and the logical progression that occurs when euthanasia and assisted suicide are transformed into medical treatments. It explores the failure of so-called safeguards and outlines the impact that euthanasia and assisted suicide have on families and society in general.

Withholding and withdrawing medical treatment and care are not legally considered euthanasia or assisted suicide. Withholding or withdrawing food and fluids is considered acceptable removal of a medical treatment.

Part II of this report includes information about practical ways to protect oneself and loved ones during any time of incapacity and a discussion of some of the policies that have led to patients being denied care that they or their decision-makers have requested. It concludes with an examination of the ethical distinction between treatment and care.

PART I

EUTHANASIA & ASSISTED SUICIDE

MOVING THE BOUNDARIES

In 2002, the International Task Force report, Assisted Suicide: Not for Adults Only? (1) discussed euthanasia and assisted suicide for children and teens. At that time, such concerns were largely considered outside the realm of possibility.

Then, as now, assisted-suicide advocates claimed that they were only trying to offer compassionate options for competent, terminally ill adults who were suffering unbearably. By and large, their claims went unchallenged.

A crack in that carefully honed image appeared in 2004 when the Groningen Protocol elicited worldwide outrage. The primary purpose of that protocol formulated by doctors at the Groningen Academic Hospital in the Netherlands was to legally and professionally protect Dutch doctors who kill severely disabled newborns. (2)

While euthanasia for infants (infanticide) was not new, widespread discussion of it was. Dutch doctors were now explaining that it was a necessary part of pediatric care.

Also in 2004, Hollands most prestigious medical society (KNMG) urged the Health Ministry to set up a board to review euthanasia for people who had no free will, including children and individuals with mental retardation or severe brain damage following accidents. (3)

At first, it seemed that these revelations would be harmful to the euthanasia movement, but the opposite was true.

Why?

Awareness of infanticide and euthanasia deaths of other incompetent patients moved the boundaries.

Prior to the widespread realization that involuntary euthanasia was taking place, advocacy of assisted suicide for those who request it seemed to be on one end of the spectrum. Opposition to it was on the other end.

Now, the practice of involuntary euthanasia took its place as one extreme, opposition to it as the other extreme, and assisted suicide for terminally ill competent adults appeared to be in the moderate middle a very advantageous political position and expansion of the practice to others had entered the realm of respectable debate.

This repositioning has become a tool in the assisted-suicide arsenal. In May 2006, an assisted-suicide bill, patterned after Oregons law permitting assisted suicide, failed to gain approval in the British Parliament. The bills supporters immediately declared that they would reintroduce it during the next parliamentary session.

Within two weeks, Professor Len Doyal a former member of the British Medical Associations ethics committee who is considered one of Englands leading experts on medical ethics called for doctors to be able to end the lives of some patients swiftly, humanely and without guilt, even without the patients consent. (4) Doyals proposal was widely reported and, undoubtedly, when the next assisted-suicide bill is introduced in England, a measure that would permit assisted suicide only for consenting adults will appear less radical than it might have seemed prior to Doyals suggestion.

Currently, euthanasia is a medical treatment in the Netherlands and Belgium. Assisted suicide is a medical treatment in the Netherlands, Belgium and Oregon. Their advocates erroneously portray both practices as personal, private acts. However, legalization is not about the private and the personal. It is about public policy, and it affects ethics, medicine, law, families and children.

A FAMILY AFFAIR

In December 2005, ABC News World News Tonight reported, Anita and Frank go often to the burial place of their daughter Chanou. Chanou died when, with her parents consent, doctors gave her a lethal dose of morphine. Im convinced that if we meet again somewhere in heaven, her father said, shell tell us we reached the most perfect solution.'(5)

The report about the six-month-old Dutch childs death was introduced as a report on the debate over euthanizing infants. A Dutch legislator who agrees that doctors who intentionally end their tiny patients lives should not be prosecuted said, Im certainly pro-life. But Im also a human being. I think when there is extreme, unbearable suffering, then there can be extreme relief. (6)

Gone was the previous years outrage over the Groningen Protocols. Infanticide had entered the realm of respectable debate in the mainstream media. The message given to viewers was that loving parents, compassionate doctors and caring legislators favor infanticide. It left the impression that opposing such a death would be cold, unfeeling and, perhaps, intentionally cruel.

In Oregon, some assisted-suicide deaths have become family or social events.

Oregons law does not require family members to know that a loved one is planning to commit suicide with a doctors help. (7) Thus, the first knowledge of those plans could come when a family member finds the body. However, as two news features illustrate, some Oregonians who die from assisted suicide make it a teachable moment for children or a party event for friends and family.

According to the Mail Tribune (Medford, Oregon), on a sunny afternoon, Joan Lucas rode around looking at houses, then she sat in a park eating an ice cream cone. A few hours later, she committed suicide with a prescribed deadly drug overdose. Grandchildren were made to understand that Grandma Joan would be going away soon. Those who were old enough to understand were told what was happening. (8

Did these children learn from Grandma Joan that suicide is a good thing?

UCLAs student newspaper, the Daily Bruin, carried an article favoring assisted suicide. It described how Karen Janoch who committed suicide under the Oregon law, sent invitations for her suicide to about two dozen of her closest friends and family. The invitation read, You are invited to attend the actual ending of my life. (9) At the same time Californias legislature was considering an assisted-suicide bill that was virtually identical to Oregons law, UCLA students learned that suicide can be the occasion for a party.

In Oregon, assisted suicide has gone from the appalling to the appealing, from the tragic to the banal.

During the last half of 2005 and the first half of 2006, bills to legalize assisted suicide were under consideration in various states and countries including, but not limited to, Canada, Great Britain, California, Hawaii, Vermont, and Washington. All had met failure by the end of June 2006. But plans to reintroduce them with some cosmetic changes are currently underway. A brief examination of arguments used to promote them illustrates the small world nature of assisted-suicide advocacy.

TWO PILLARS OF ADVOCACY

Wherever an assisted-suicide measure is proposed, proponents arguments and strategies are similar. Invariably, promotion rests on two pillars: autonomy and the elimination of suffering.

Autonomy

Autonomy (independence and the right of self-determination) is certainly valued in modern society and patients do, and should, have the right to accept or reject medical treatment. However, those who favor assisted suicide claim that autonomy extends to the right of a patient to decide when, where, how and why to die as the following examples illustrate.

During debate over an assisted-suicide measure then pending before the British Parliament, proponents emphasized personal choice. The bill, titled The Assisted Dying for the Terminally Ill Bill, was introduced by Lord Joel Joffe. Dr. Margaret Branthwaite, a physician, barrister and former head of Englands Voluntary Euthanasia Society (recently renamed Dignity in Dying (10)), called for passage of the Joffe bill in an article in the British Medical Journal. As a matter of principle, she wrote, it reinforces current trends towards greater respect for personal autonomy. (11)

The focus on autonomy was also reflected in remarks about a plan to introduce an assisted-suicide initiative in Washington. Booth Gardner, former governor of Washington, said he plans to promote the initiative because it should be his decision when and how he dies. He told the Seattle Post-Intelligencer, When I go, I want to decide. (12)

The rationale is that when, where, why and how one dies should be a matter of self-determination, a matter of independent choice, and a matter of personal autonomy.

Elimination of suffering

The second pillar of assisted-suicide advocacy is elimination of suffering. During each and every attempt to permit euthanasia and assisted suicide, its advocates stress that ending suffering justifies legalization of the practices.

California Assemblywoman Patty Berg, the co-sponsor of Californias euphemistically named Compassionate Choices Act, (13) said the assisted-suicide measure was necessary so that people would have the comfort of knowing they could escape unbearable suffering if that were to occur. (14)

In an opinion piece supporting the failed 1998 assisted-suicide initiative in Michigan, a spokesperson for those favoring the measure wrote that the patients targeted by the proposal were those who were tortured by the unbearable suffering of a slow and agonizing death. (15)

In the United Kingdom, Lord Joffe said his bill would enable those who are suffering unbearably to get medical assistance to die. (16) Testimony before the British House of Lords Select Committee studying the bill noted that, where assisted dying has been legalized, it has done so as a response to patients who were suffering. (17)

The centerpiece of the 1994 Measure 16 campaign that resulted in Oregons assisted-suicide law was a television commercial featuring Patti Rosen. Describing her daughter who had cancer, Rosen said, The pain was so great that she couldnt bear to be touched. Measure 16 would have allowed my daughter to die with dignity. (18)

When an assisted-suicide proposal that later failed was being considered by the Hawaiian legislature in 2002, a public relations consultant who was working on behalf of the bill, e-mailed a template for use in written or oral testimony. The template suggested inclusion of the phrases agonizingly painful, pain was uncontrollable, and pain beyond my understanding. (19)

During consideration of an assisted-suicide bill in Vermont, the states former governor Philip Hoff said, The last thing I would want in this world is to be around and be in pain, and have no quality of life, and be a burden to my family and others. (20) Dick Walters, chairman of Death with Dignity Vermont, said the proposal would permit a person to peacefully end suffering and hasten death. (21)

Thus, the rationale given by euthanasia and assisted-suicide proponents for legalization always includes autonomy and/or elimination of suffering. However, the laws they propose actually contradict this rationale.

CONTRADICTIONS

When proposed, laws such as those now in existence in Oregon and similar measures introduced elsewhere include conditions or requirements limiting assisted suicide to certain groups of qualified patients. A patient qualified to receive the treatment of assisted suicide must be an adult who is capable of making decisions and must be diagnosed with a terminal condition.

If one accepts the premise that assisted suicide is a good medical treatment that should be permitted on the basis of personal autonomy or elimination of suffering, other questions must be raised.

If the reason for permitting assisted suicide is autonomy, why should assisted suicide be limited to the terminally ill?

Does ones autonomy depend upon a doctors diagnosis (or misdiagnosis) of a terminal illness? If a person is not terminally ill, but is suffering whether physically, psychologically or emotionally why isnt it up to that person to decide when, why and how to die? Does a person only have autonomy if he or she has a particular condition or illness? Is autonomy a basis for the law?

If assisted suicide is a good and acceptable medical treatment for the purpose of ending suffering, why should it be limited to adults who are capable of decision-making?

Isnt it both discriminatory and cruel to deny that good and acceptable medical treatment to a child or an incompetent adult? Why is a medical treatment that has been deemed appropriate to end suffering available to an 18-year-old, but not to a 16-year-old or 17-year-old? Why is a person only eligible to have his or her suffering ended if he or she has reached an arbitrary age?

And, what of the adult who never was, or no longer is, capable of decision-making? Should that person be denied medical treatment that ends suffering? Are euthanasia and assisted-suicide laws based on the need to eliminate suffering, or not?

Establishing arbitrary requirements that must be met prior to qualifying for the medical treatment of euthanasia or assisted suicide does, without doubt, contradict the two pillars on which justification for the practices is based.

The question then must be asked: Why are those arbitrary requirements included in Oregons law and other similar proposals? The answer is simple. After a series of defeats, euthanasia and assisted-suicide proponents learned that they had to propose laws that appeared palatable.

In April 2005, Lord Joffe, the British bills sponsor, acknowledged that his bill was intended to be only the first step. During hearings regarding the measure, he said that this is the first stage and went on to explain that one should go forward in incremental stages. I believe that this bill should initially be limited. (22)

He repeated his remarks a year later when discussing hearings about his bill. I can assure you that I would prefer that the [proposed] law did apply to patients who were younger and who were not terminally ill but who were suffering unbearable, he said and added, I believe that this bill should initially be limited. (23)

STEP-BY-STEP APPROACH

Proposals for euthanasia and assisted suicide have always emanated from advocacy groups, not from any grassroots desire. Those groups learned that attempting to go too far, too fast, leads to certain defeat.

After many failed attempts, most recently those in the early 90s in Washington and California when ballot initiatives that would have permitted both euthanasia by lethal injection and assisted suicide by lethal prescription were resoundingly defeated death with dignity activists changed their strategy. They decided to take a step-by-step approach, proposing an assisted-suicide-only bill which, when passed, would serve as a model for subsequent laws. Only after several such laws were passed, would they begin to expand them. That was the strategy that led to Oregons Measure 16, the Oregon Death with Dignity Act.

Those who were most involved in the successful Oregon strategy were not new to the scene.

Cheryl K. Smith, who wrote the first draft of Oregons law, had served as a special counsel to the political action group Oregon Right to Die (ORD). Smith had been the National Hemlock Societys legal advisor after her graduation from law school in 1989 and had been a top aide to Hemlocks co-founder, Derek Humphry. While a student at the University of Iowa College of Law, Smith helped draft a Model Aid-in-Dying Act that provided for childrens lives to be terminated either at their own request or, if under 6 years of age, by parental request. (24)

Barbara Coombs Lee was Measure 16s chief petitioner. At the time, she was a vice president for a large Oregon managed care program. After the laws passage, she took over the leadership of Compassion in Dying. (25) [Note: In early 2005, Compassion in Dying merged with the Hemlock Society. The combined organization is now called Compassion and Choices.]

Coombs Lees promotion of assisted suicide and euthanasia began prior to her involvement with the Death with Dignity Act. As a legislative aide to Oregon Senator Frank Roberts in 1991, she worked on Senate Bill 114 that would have permitted euthanasia on request of a patient and, if the patient was not competent, a designated representative would have been authorized to request the patients death. (26)

Upon passage of the Oregon law in 1994, many assisted-suicide supporters were certain that other states would immediately fall in line. However, that did not occur. Between 1994 and mid-2006, assisted-suicide measures were introduced in state after state.(27) Each and every proposal failed. All of the proposals were assisted-suicide-only bills and, with one exception, (28) every one was virtually identical to the Oregon law.

Among supporters of assisted suicide and euthanasia, though, the Oregon law is seen as the model for success and is referred to in debates about assisted suicide throughout the world. For that reason, a careful examination of the Oregon experience is vital to understanding the problems with legalized assisted suicide.

OREGON

Under Oregons law permitting physician-assisted suicide, the Oregon Department of Human Services (DHS) previously called the Oregon Health Division (OHD) is required to collect information, review a sample of cases and publish a yearly statistical report. (29)

However, due to major flaws in the law and the states reporting system, there is no way to know for sure how many or under what circumstances patients have died from physician-assisted suicide. Statistics from official reports are particularly questionable and have left some observers skeptical about their validity.

For example, when a similar proposal was under consideration in the British Parliament, members of a House of Lords Committee traveled to Oregon seeking information regarding Oregons law for use in their deliberations. The public and press were not present during the closed-door hearings. However, the House of Lords published the committees proceedings in three lengthy volumes, which included the exact wording of questions and answers.

After hearing witnesses claim that there have been no complications associated with more than 200 assisted-suicide deaths, committee member Lord McColl of Dulwich, a surgeon, said, If any surgeon or physician had told me that he did 200 procedures without any complications, I knew that he possibly needed counseling and had no insight. We come here and I am told there are no complications. There is something strange going on. (30)

The following includes statistical data from official reports and other published information dealing with troubling aspects of the practice of assisted suicide in Oregon. Statements from the 744-page second volume of the House of Lords committee proceedings are also included. None of the included statements from the committee hearings were made by opponents of Oregons law.

OFFICIAL REPORTS

Assisted-suicide deaths reported during the first eight years

Official Reports: 246Actual Number: Unknown

The latest annual report indicates that reported assisted-suicide deaths have increased by more than 230% since the first year of legal assisted suicide in Oregon. (31) The numbers, however, could be far greater. From the time the law went into effect, Oregon officials in charge of formulating annual reports have conceded theres no way to know if additional deaths went unreported because Oregon DHS has no regulatory authority or resources to ensure compliance with the law. (32)

The DHS has to rely on the word of doctors who prescribe the lethal drugs. (33) Referring to physicians reports, the reporting division admitted: For that matter the entire account [received from a prescribing doctor] could have been a cock-and-bull story. We assume, however, that physicians were their usual careful and accurate selves. (34)

The Death with Dignity law contains no penalties for doctors who do not report prescribing lethal doses for the purpose of suicide.

Complications occurring during assisted suicide

Official Reports: 13 (12 instances of vomiting & one patient who did not die fromlethal dose.)

Actual number: Unknown

Prescribing doctors may not know about all complications since, over the course of eight years, physicians who prescribed the lethal drugs for assisted suicide were present at only 19.5% of reported deaths. (35) Information they provide might come from secondhand accounts of those present at the deaths (36) or may be based on guesswork.

When asked if there is any systematic way of finding out and recording complications, Dr. Katrina Hedberg who was a lead author of most of Oregons official reports said, Not other than asking physicians. (37) She acknowledged that after they write the prescription, the physician may not keep track of the patient. (38) Dr. Melvin Kohn, a lead author of the eighth annual report, noted that, in every case that they hear about, it is the self-report, if you will, of the physician involved. (39)

Complications contained in news reports are not included in official reports

Patrick Matheny received his lethal prescription from Oregon Health Science University via Federal Express. He had difficulty when he tried to take the drugs four months later. His brother-in-law, Joe Hayes, said he had to help Matheny die. According to Hayes, It doesnt go smoothly for everyone. For Pat it was a huge problem. It would have not worked without help. (40) The annual report did not make note of this situation.

Speaking at Portland Community College, pro-assisted-suicide attorney Cynthia Barrett described a botched assisted suicide. The man was at home. There was no doctor there, she said. After he took it [the lethal dose], he began to have some physical symptoms. The symptoms were hard for his wife to handle. Well, she called 911. The guy ended up being taken by 911 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. I dont know if he went back home. He died shortly someperiod of time after that. (41)

Overdoses of barbiturates are known to cause vomiting as a person begins to lose consciousness. The patient then inhales the vomit. In other cases, panic, feelings of terror and assaultive behavior can occur from the drug-induced confusion. (42) But Barrett would not say exactly which symptoms had taken place in this instance. She has refused any further discussion of the case.

Complications are not investigated

David Prueitt took the prescribed lethal dose in the presence of his family and members of Compassion & Choices. After being unconscious for 65 hours, he awoke. It was only after his family told the media about the botched assisted suicide that Compassion & Choices publicly acknowledged the case. (43) DHS issued a release saying it has no authority to investigate individual Death with Dignity cases. (44)

Referring to DHSs ability to look into complications, Dr. Hedberg explained that we are not given the resources to investigate and not only do we not have the resources to do it, but we do not have any legal authority to insert ourselves. (45)

David Hopkins, Data Analyst for the Eighth Annual Report, said, We do not report to the Board of Medical Examiners if complications occur; no, it is not required by law and it is not part of our duty. (46)

Jim Kronenberg, the Oregon Medical Associations (OMA) Chief Operating Officer, explained that the way the law is set up there is really no way to determine that [complications occurred] unless there is some kind of disaster. [P]ersonally I have never had a report where there was a true disaster, he said. Certainly that does not mean that you should infer there has not been, I just do not know. (47)

In the Netherlands, assisted-suicide complications and problems are not uncommon. One Dutch study found that, because of problems or complications, doctors in the Netherlands felt compelled to intervene (by giving a lethal injection) in 18% of cases.(48)

This led Dr. Sherwin Nuland of Yale University School of Medicine to question the credibility of Oregons lack of reported complications. Nuland, who favors physician-assisted suicide, noted that the Dutch have had years of practice to learn ways to overcome complications, yet complications are still reported. The Dutch findings seem more credible [than the Oregon reports], he wrote. (49)

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Euthanasia, Assisted Suicide & Health Care Decisions Part 1 ...

Euthanasia | PETA

Approximately 6 to 8 million animals are handled by animal shelters in the U.S. each year. Even though some are reclaimed or adopted, nearly 4 million unwanted dogs and cats are left with nowhere to go. Animal shelters cannot humanely house and support all these animals until their natural deaths. They would be forced to live in cramped cages or kennels for years, lonely and stressed, and other animals would have to be turned away because there would be no room for them.

Trying to build enough animal shelters to keep up with the endless stream of homeless animals is like putting a bandage on a gunshot wound. Turning unwanted animals loose to roam the streets is not a humane option, either. If they dont starve, freeze, get hit by a car, or die of disease, they may be tormented and possibly killed by cruel juveniles or picked up by dealers who sell animals to laboratories.

Euthanasia literally means good death, and true euthanasiadelivered by an intravenous injection of sodium pentobarbitalis painless, quick, and dignified. Because of the high number of unwanted companion animals and the lack of good homes, sometimes the most humane thing that a shelter worker can do is give an animal a peaceful release from a world in which dogs and cats are often considered surplus. The American Veterinary Medical Association and the Humane Society of the United States agree that an intravenous injection of sodium pentobarbital administered by a trained professional is the kindest, most compassionate method of euthanizing animals.

Unfortunately, some animals will be killed by municipal officials using unacceptable and cruel methods, such as gunshot. Bullets are often not placed precisely in the struggling animals head or are deflected, and some animals survive the first shot only to be shot again and again.

Many animal shelters still use outdated gas chambers to kill animals who arent adopted or reclaimed. Even the best gas boxes can expose conscious animals to the horror of watching other animals in the box suffer from convulsions and muscular spasms as they slowly die. Old, young, and sick animals are particularly susceptible to gas-related trauma and will die slow and highly stressful deaths.

And as hard as it is to believe, there are still facilities in the U.S. that kill animals using painful electrocution or cruel decompression chambers, which make the gases in animals sinuses, middle ears, and intestines expand quickly, causing considerable discomfort or severe pain. Some animals survive the first go-around in decompression chambers and are recompressed because of malfunctioning equipment or an operators mistake or because they get trapped in air pockets. They are then put through the painful procedure all over again. For more information, click here.

Until dog and cat overpopulation is brought under control through spaying and neutering, we must prevent the suffering of unwanted animals in the most responsible and humane way possible. Euthanasia, performed properly, is often the most compassionate option.

The only way to stop the suffering of the innocent victims of companion animal overpopulation is to prevent their births through sterilization efforts. Every last one of the millions of animal deaths at animal shelters and in the streets, alleyways, fields, basements, and back yards that occur every year could be prevented through spaying and neutering. You can help. Its as easy as ABCanimal birth control.

Please do not allow your companion animal to be needlessly euthanized during times of crises. Take the appropriate steps now to ensure that he or she is well taken care of even after your divorce or death.

For more info see how PETA saves animals.

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Euthanasia | PETA

First Amendment | Contents & Supreme Court Interpretations | Britannica.com

First Amendment, amendment (1791) to the Constitution of the United States that is part of the Bill of Rights and reads,

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

The clauses of the amendment are often called the establishment clause, the free exercise clause, the free speech clause, the free press clause, the assembly clause, and the petition clause.

The First Amendment, like the rest of the Bill of Rights, originally restricted only what the federal government may do and did not bind the states. Most state constitutions had their own bills of rights, and those generally included provisions similar to those found in the First Amendment. But the state provisions could be enforced only by state courts.

In 1868, however, the Fourteenth Amendment was added to the U.S. Constitution, and it prohibited states from denying people liberty without due process. Since then the U.S. Supreme Court has gradually used the due process clause to apply most of the Bill of Rights to state governments. In particular, from the 1920s to the 40s the Supreme Court applied all the clauses of the First Amendment to the states. Thus, the First Amendment now covers actions by federal, state, and local governments. The First Amendment also applies to all branches of government, including legislatures, courts, juries, and executive officials and agencies. This includes public employers, public university systems, and public school systems.

The First Amendment, however, applies only to restrictions imposed by the government, since the First and Fourteenth amendments refer only to government action. As a result, if a private employer fires an employee because of the employees speech, there is no First Amendment violation. There is likewise no violation if a private university expels a student for what the student said, if a commercial landlord restricts what bumper stickers are sold on the property it owns, or if an Internet service provider refuses to host certain Web sites.

Legislatures sometimes enact laws that protect speakers or religious observers from retaliation by private organizations. For example, Title VII of the federal Civil Rights Act of 1964 bans religious discrimination even by private employers. Similarly, laws in some states prohibit employers from firing employees for off-duty political activity. But such prohibitions are imposed by legislative choice rather than by the First Amendment.

The freedoms of speech, of the press, of assembly, and to petitiondiscussed here together as freedom of expressionbroadly protect expression from governmental restrictions. Thus, for instance, the government may not outlaw antiwar speech, speech praising violence, racist speech, pro-communist speech, and the like. Nor may the government impose special taxes on speech on certain topics or limit demonstrations that express certain views. The government also may not authorize civil lawsuits based on peoples speech, unless the speech falls within a traditionally recognized First Amendment exception. This is why, for example, people may not sue for emotional distress inflicted by offensive magazine articles about them, unless the articles are not just offensive but include false statements that fall within the defamation exception (see below Permissible restrictions on expression).

The free expression guarantees are not limited to political speech. They also cover speech about science, religion, morality, and social issues as well as art and even personal gossip.

Freedom of the press confirms that the government may not restrict mass communication. It does not, however, give media businesses any additional constitutional rights beyond what nonprofessional speakers have.

Freedom of petition protects the right to communicate with government officials. This includes lobbying government officials and petitioning the courts by filing lawsuits, unless the court concludes that the lawsuit clearly lacks any legal basis.

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First Amendment | Contents & Supreme Court Interpretations | Britannica.com

Fourth Amendment | United States Constitution | Britannica.com

Fourth Amendment, amendment (1791) to the Constitution of the United States, part of the Bill of Rights, that forbids unreasonable searches and seizures of individuals and property. For the text of the Fourth Amendment, see below.

Introduced in 1789, what became the Fourth Amendment struck at the heart of a matter central to the early American experience: the principle that, within reason, Every mans house is his castle, and that any citizen may fall into the category of the criminally accused and ought to be provided protections accordingly. In U.S. constitutional law, the Fourth Amendment is the foundation of criminal law jurisprudence, articulating both the rights of persons and the responsibilities of law-enforcement officials. The balance between these two forces has undergone considerable public, political, and judicial debate. Are the amendments two clauses meant to be applied independently or taken as a whole? Is the expectation of privacy diminished depending on where and what is suspected, sought, and seized? What constitutes an unreasonable search and seizure?

The protections contained in the amendment have been determined less on the basis of what the Constitution says than according to what it has been interpreted to mean, and, as such, its constitutional meaning has inherently been fluid. The protections granted by the U.S. Supreme Court have expanded during periods when the court was dominated by liberals (e.g., during the tenure of Chief Justice Earl Warren [195369]), beginning particularly with Mapp v. Ohio (1961), in which the court extended the exclusionary rule to all criminal proceedings; by contrast, during the tenure of the conservative William Rehnquist (19862005) as chief justice, the court contracted the rights afforded to the criminally accused, allowing law-enforcement officials latitude to search in instances when they reasonably believed that the property in question harboured presumably dangerous persons.

The full text of the amendment is:

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

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Fourth Amendment | United States Constitution | Britannica.com

Gene therapy | medicine | Britannica.com

Gene therapy, also called gene transfer therapy, introduction of a normal gene into an individuals genome in order to repair a mutation that causes a genetic disease. When a normal gene is inserted into the nucleus of a mutant cell, the gene most likely will integrate into a chromosomal site different from the defective allele; although that may repair the mutation, a new mutation may result if the normal gene integrates into another functional gene. If the normal gene replaces the mutant allele, there is a chance that the transformed cells will proliferate and produce enough normal gene product for the entire body to be restored to the undiseased phenotype.

Read More on This Topic

cancer: Gene therapy

Knowledge about the genetic defects that lead to cancer suggests that cancer can be treated by fixing those altered genes. One strategy

Human gene therapy has been attempted on somatic (body) cells for diseases such as cystic fibrosis, adenosine deaminase deficiency, familial hypercholesterolemia, cancer, and severe combined immunodeficiency (SCID) syndrome. Somatic cells cured by gene therapy may reverse the symptoms of disease in the treated individual, but the modification is not passed on to the next generation. Germline gene therapy aims to place corrected cells inside the germ line (e.g., cells of the ovary or testis). If that is achieved, those cells will undergo meiosis and provide a normal gametic contribution to the next generation. Germline gene therapy has been achieved experimentally in animals but not in humans.

Scientists have also explored the possibility of combining gene therapy with stem cell therapy. In a preliminary test of that approach, scientists collected skin cells from a patient with alpha-1 antitrypsin deficiency (an inherited disorder associated with certain types of lung and liver disease), reprogrammed the cells into stem cells, corrected the causative gene mutation, and then stimulated the cells to mature into liver cells. The reprogrammed, genetically corrected cells functioned normally.

Prerequisites for gene therapy include finding the best delivery system (often a virus, typically referred to as a viral vector) for the gene, demonstrating that the transferred gene can express itself in the host cell, and establishing that the procedure is safe. Few clinical trials of gene therapy in humans have satisfied all those conditions, often because the delivery system fails to reach cells or the genes are not expressed by cells. Improved gene therapy systems are being developed by using nanotechnology. A promising application of that research involves packaging genes into nanoparticles that are targeted to cancer cells, thereby killing cancer cells specifically and leaving healthy cells unharmed.

Some aspects of gene therapy, including genetic manipulation and selection, research on embryonic tissue, and experimentation on human subjects, have aroused ethical controversy and safety concerns. Some objections to gene therapy are based on the view that humans should not play God and interfere in the natural order. On the other hand, others have argued that genetic engineering may be justified where it is consistent with the purposes of God as creator. Some critics are particularly concerned about the safety of germline gene therapy, because any harm caused by such treatment could be passed to successive generations. Benefits, however, would also be passed on indefinitely. There also has been concern that the use of somatic gene therapy may affect germ cells.

Although the successful use of somatic gene therapy has been reported, clinical trials have revealed risks. In 1999 American teenager Jesse Gelsinger died after having taken part in a gene therapy trial. In 2000 researchers in France announced that they had successfully used gene therapy to treat infants who suffered from X-linked SCID (XSCID; an inherited disorder that affects males). The researchers treated 11 patients, two of whom later developed a leukemia-like illness. Those outcomes highlight the difficulties foreseen in the use of viral vectors in somatic gene therapy. Although the viruses that are used as vectors are disabled so that they cannot replicate, patients may suffer an immune response.

Another concern associated with gene therapy is that it represents a form of eugenics, which aims to improve future generations through the selection of desired traits. Some have argued that gene therapy is eugenic but that it is a treatment that can be adopted to avoid disability. To others, such a view of gene therapy legitimates the so-called medical model of disability (in which disability is seen as an individual problem to be fixed with medicine) and raises peoples hopes for new treatments that may never materialize.

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Gene therapy | medicine | Britannica.com

What is Gene Therapy? – Learn.Genetics

Could the condition be corrected by adding one or a few functional genes?For you to even consider gene therapy, the answer must be "yes." For instance, genetic disorders caused by mutations in single genes tend to be good candidates for gene therapy, while diseases involving many genes and environmental factors tend to be poor candidates.

Do you know which genes are involved?If you plan to treat a genetic flaw, you need to know which gene(s) to pursue. You must also have a DNA copy of the gene available in your laboratory.

Do you understand the biology of the disorder?To design the best possible approach, you need to learn all you can about how the gene factors into the disorder. For example, which tissues the disorder affects, what role the protein encoded by the gene plays within the cells of that tissue, and exactly how mutations in the gene affect the protein's function.

Will adding a normal copy of the gene fix the problem in the affected tissue? Or could getting rid of the defective gene fix it?Sometimes when a gene is defective, no functional protein is being made from it. In cases like these, adding a functional copy of the gene could correct the problem. But sometimes a defective gene codes for a protein that starts doing something it shouldn't or prevents another protein from doing its job. In order to correct the problem, you would need to get rid of the misbehaving protein.

Can you deliver the gene to cells of the affected tissue?The answer will come from several pieces of information, including the tissue's accessibility and molecular signatures.

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What is Gene Therapy? - Learn.Genetics

Gene Therapy Research Institutes and Universities

Collaboration between Baylor College of Medicine, The Methodist Hospital and Texas Children's Hospital. Clinical research in the areas of stem cell transplantation, cellular therapy, and gene therapy.

The Center fosters a multidisciplinary approach to new research as well as collaborative research endeavors in the area of gene therapy. The Vector Core manufactures several recombinant viral vectors.

The research is focused on various aspects of gene therapy, such as understanding basic virology, efficient gene delivery into the nucleus of cells, and incorporation of these genes into the genome.

Research in the laboratory has centered on the molecular biology of adeno-associated virus (AAV) in order to exploit the unique features of this virus to develop an efficient viral vector system for use in human gene therapy.

The Harvard Gene Therapy Initiative is headed by Dr. Richard Mulligan with the objective of promoting the use of gene therapy and to conduct research developing new gene delivery vector technologies.

Diseases of the lung, cardiovascular system, muscles, brain, and skin are focus areas of research as well as the development of gene therapy vectors and the identification of disease-causing genes.

A multidisciplinary team of scientists and physicians work together to realize the full potential of virus, gene and cell therapies from basic science discovery to clinical translation.

Oncolytic virotherapy, gene therapy for diabetes and cardiovascular diseases, virus-based gene therapy vectors.

The program has brought together regulatory, quality, product development, manufacturing and facilities engineering expertise to enable the translation of novel, experimental research into medicine for use in human clinical trials.

Penn Vector offers a variety of services associated with the development and production of both non-viral vectors and viral vectors including those derived from adeno-associated virus (AAV), adenovirus, and lentivirus.

The primary mission is to merge molecular genetics research and health care delivery by developing new therapeutic strategies for the treatment of human diseases that involve gene transfer.

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Gene Therapy Research Institutes and Universities

Gene Therapy – Sickle Cell Anemia News

Gene therapy is an experimental technique that aims to treat genetic diseases by altering a disease-causing gene or introducing a healthy copy of a mutated gene to the body. The U.S. Food and Drug Administrationapprovedthe first gene therapy for an inherited disease a genetic form of blindness in December 2017.

Sickle cell anemia is caused by a mutation in the HBB gene which provides the instructions to make part of hemoglobin, the protein in red blood cells that carries oxygen.

Researchers are working on two different strategies to treat sickle cell anemia with gene therapy. Both of these strategies involve genetically altering the patients own hematopoietic stem cells. These are cells in the bone marrow that divide and specialize to produce different types of blood cells, including the red blood cells.

One strategy is to remove some of the patients hematopoietic stem cells, replace the mutated HBB gene in these cells with a healthy copy of the gene, and then transplant those cells back into the patient. The healthy copy of the gene is delivered to the cells using a modified, harmless virus. These genetically corrected cells will then hopefully repopulate the bone marrow and produce healthy, rather than sickled, red blood cells.

The other strategy is to genetically alter another gene in the patients hematopoietic stem cells so they boost production of fetal hemoglobin a form of hemoglobin produced by babies from about seven months before birth to about six months after birth. This type of hemoglobin represses sickling of cells in patients with sickle cell anemia, but most people only produce a tiny amount of it after infancy. Researchers aim to increase production of fetal hemoglobin in stem cells by using a highly specific enzyme to cut the cells DNA in the section containing one of the genes that suppress production of fetal hemoglobin. When the cell repairs its DNA, the gene no longer works and more fetal hemoglobin is produced.

Gene therapy offers an advantage over bone marrow transplant, in that complications associated with a bone marrow donation now the only cure for the disease such as finding the right match are not a concern.

Twelve clinical trials studying gene therapy to treat sickle cell anemia are now ongoing. Nine of the 12 are currently recruiting participants.

Four trials (NCT02186418, NCT03282656, NCT02247843, NCT02140554) are testing the efficacy and safety of gene therapy to replace the mutated HBB gene with a healthy HBB gene. These Phase 2 trials are recruiting both children and adults in the United States and Jamaica.

Three trials (NCT02193191, NCT02989701, NCT03226691) are investigating the use ofMozobil (plerixafor) in patients with sickle cell anemia to increase the production of stem cells to be used for gene therapy. This medication is already approved to treat certain types of cancer. All three are recruiting U.S. participants.

One trial (NCT00669305) is recruiting sickle cell anemia patients in Tennessee to donate bone marrow to be used in laboratory research to develop gene therapy techniques.

The final study(NCT00012545) is examining the best way to collect, process and store umbilical cord blood from babies with and without sickle cell anemia. Cord blood contains abundant stem cells that could be used in developing gene therapy for sickle cell anemia. This trial is open to pregnant women in Maryland both those who risk having an infant with sickle cell anemia, and those who do not.

One clinical trial (NCT02151526) conducted in France is still active but no longer recruiting participants. It is investigating the efficacy of gene therapy in seven patients. For the trial, a gene producing a therapeutic hemoglobin that functions similarly to fetal hemoglobin is introduced into the patients stem cells. A case studyfrom one of the seven was published in March 2017; it showed that the approach was safe and could be an effective treatment option for sickle cell anemia.

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