The Doctors Who Are Redefining Life and Death By William Saletan
Think being the next president would be a brutal job? Imagine being a transplant surgeon. You can't tell the parents of a dying kid when to pull the plug, but you have to be there, ready, the minute he expires. You have to wait until he's dead, but not so long that his organs become useless. You can give him drugs to keep his organs healthy, but you mustn't technically revive him. And you can't remove and restart his heart until it's been declared kaput.
Pick up a recent issue of the New England Journal of Medicine, and you'll see the far edge of this tortured world. In the journal, doctors at Children's Hospital in Denver describe how they removed hearts from infants 75 seconds after they stopped. The infants were declared dead of heart failure, even as their hearts, in new bodies, resumed ticking.
Is this wrong? We like to think that moral lines are fixed and clear: My heart is mine, not yours, and you can't have it till I'm dead. But in medicine, lines move. "Dead" means irreversibly stopped, and stoppages are increasingly reversible. And when life support ends, says one bioethicist, "not using viable organs wastes precious life-saving resources" and "costs the lives of other babies." Failure to take body parts looks like lethal negligence.
How can we get more organs? By redefining death. First we coined "brain death," which let us take organs from people on ventilators. Then we proposed organ retrieval even if non-conscious brain functions persisted. Now we have "donation after cardiac death," the rule applied in Denver, which permits harvesting based on heart, rather than brain, stoppage.
But stoppage is complicated. There's no "moment" of death. Some transplant surgeons wait five minutes after the last heartbeat; others wait two. The Denver team waited 75 seconds, reasoning that no heart is known to have self-restarted after 60 seconds. Why push the envelope? Because every second counts. Mark Boucek, the doctor who led the Denver team, says that waiting even 75 seconds makes organs less useful.
So how can death be declared based on irreversible heart stoppage when the plan is to restart that heart in a new body? Boucek offers two answers. First, even if the heart resumes pumping in a new body, it couldn't have done so in the old one. (That used to be true, but today, hearts can be restarted by external stimulation well after two or even five minutes.) Second, Boucek says the heart is dead because the baby's parents have decided not to permit resuscitation. In other words, each family decides when its loved one is dead. In a commentary attached to the Denver report, another ethicist proposes extending this idea -- letting each family decide not just whether to resuscitate but also at what point organs can be harvested. Brain death? Cardiac death? Persistent vegetative state? Death is whatever you say it is.
Robert Truog, an ethicist who supports the Denver protocol, says this redefinition of death has gone too far. Let's accept that we're taking organs from living people and causing death in the process, he argues. This is ethical as long as the patient has "devastating neurologic injury" and has provided, through advance directive or a surrogate, informed consent to be terminated this way. We already let surrogates authorize removal of life support, he notes. Why not treat donations similarly? Traditional safeguards, such as the separation of the transplant team from the patient's medical team, will prevent abuse. And the public will accept the new policy since surveys suggest we're not hung up on whether the donor is dead.
But down that road lies even greater uncertainty. How devastating does the injury have to be? If death is vulnerable to redefinition, isn't "devastating" even more so? The same can be asked of "futility," the standard used by the Denver team to select donors. Is it safe to base lethal decisions on the ebb and flow of public opinion, particularly when the same surveys show confusion about death standards? And can termination decisions really be insulated from pressure to donate? Even if each family makes its own choice, aren't we loosening standards for termination precisely to get more organs?
Modern medicine has brought us tremendous power. Boundaries such as death, heart stoppage and ownership of organs have guided our moral thinking because they seemed fixed in nature. Now we've unmoored them. I'm a registered donor because I believe in the gift of life and think that the job of providing organs falls to each of us. So does the job of deciding when we can rightly take them.
Wednesday, November 26, 2008
FIKIR KRITIS #15
How does the stock market work?
Story #1
Once upon a time, a man appeared in a village and announced to the villagers that he would buy monkeys for $10 each. The villagers, seeing that there were many monkeys around, went out to the forest and started catching them. The man bought thousands at $10 a piece and, as soon as the supply started to diminish, the villagers stopped their effort. He then announced that he would buy them for $20 each.
This renewed the villager's efforts and they started catching monkeys again. Soon the supply diminished again even further and people started going back to their farms. The offer was increased to $25 each, and the supply of monkeys became so small that it was a great effort to find even one monkey, let alone catch it!
The man then announced that he would buy the monkeys for $50! However, since he had to go to the city on some business trip, his assistant would now buy them on his behalf.
While the business man was away, the assistant told the villagers. 'Look at all these monkeys in the big cage that the man has collected.
'I will sell them to you at $35, and when the man returns from the city,you can sell them to him for $50 each.' The villagers rounded up all their savings and bought all the monkeys.
They never saw the man nor his assistant again, only monkeys, everywhere! Now you have a better understanding of how the stock market works.
Story #2
It was autumn, and the Red Indians asked their New Chief if the winter was going to be cold or mild. Since he was a Red Indian chief in a modern society, he couldn't tell what the weather was going to be.
Nevertheless, to be on the safe side, he replied to his Tribe that the winter was indeed going to be cold and that the members of the village should collect wood to be prepared.
But also being a practical leader, after several days he got an idea. He went to the phone booth, called the National Weather Service and asked 'Is the coming winter going to be cold?' 'It looks like this winter is going to be quite cold indeed,' the weather man responded.
So the Chief went back to his people and told them to collect even more wood. A week later, he called the National Weather Service again.
'Is it going to be a very cold winter?'
'Yes,' the man at National Weather Service again replied, 'It's definitely going to be a very cold winter.'
The Chief again went back to his people and ordered them to collect every scrap of wood they could find. Two weeks later, he called the National Weather Service again.
'Are you absolutely sure that the winter is going to be very cold?'
'Absolutely, ' The Man replied. 'It's going to be one of the coldest winters ever.
''How can you be so sure?' the Chief asked.
The weatherman replied,'The Red Indians are collecting wood like crazy.'
This is how stock markets work!!!
Story #1
Once upon a time, a man appeared in a village and announced to the villagers that he would buy monkeys for $10 each. The villagers, seeing that there were many monkeys around, went out to the forest and started catching them. The man bought thousands at $10 a piece and, as soon as the supply started to diminish, the villagers stopped their effort. He then announced that he would buy them for $20 each.
This renewed the villager's efforts and they started catching monkeys again. Soon the supply diminished again even further and people started going back to their farms. The offer was increased to $25 each, and the supply of monkeys became so small that it was a great effort to find even one monkey, let alone catch it!
The man then announced that he would buy the monkeys for $50! However, since he had to go to the city on some business trip, his assistant would now buy them on his behalf.
While the business man was away, the assistant told the villagers. 'Look at all these monkeys in the big cage that the man has collected.
'I will sell them to you at $35, and when the man returns from the city,you can sell them to him for $50 each.' The villagers rounded up all their savings and bought all the monkeys.
They never saw the man nor his assistant again, only monkeys, everywhere! Now you have a better understanding of how the stock market works.
Story #2
It was autumn, and the Red Indians asked their New Chief if the winter was going to be cold or mild. Since he was a Red Indian chief in a modern society, he couldn't tell what the weather was going to be.
Nevertheless, to be on the safe side, he replied to his Tribe that the winter was indeed going to be cold and that the members of the village should collect wood to be prepared.
But also being a practical leader, after several days he got an idea. He went to the phone booth, called the National Weather Service and asked 'Is the coming winter going to be cold?' 'It looks like this winter is going to be quite cold indeed,' the weather man responded.
So the Chief went back to his people and told them to collect even more wood. A week later, he called the National Weather Service again.
'Is it going to be a very cold winter?'
'Yes,' the man at National Weather Service again replied, 'It's definitely going to be a very cold winter.'
The Chief again went back to his people and ordered them to collect every scrap of wood they could find. Two weeks later, he called the National Weather Service again.
'Are you absolutely sure that the winter is going to be very cold?'
'Absolutely, ' The Man replied. 'It's going to be one of the coldest winters ever.
''How can you be so sure?' the Chief asked.
The weatherman replied,'The Red Indians are collecting wood like crazy.'
This is how stock markets work!!!
FIKIR KRITIS #14
7 Ways To Recession-Proof Your Life
by Amy Fontinelle
Are you worried about how a recession might affect you? You can put your fears to rest because there are many everyday habits the average person can implement to ease the sting of a recession, or even make it so its effects aren't felt at all. In this article, we'll discuss seven ways to do just that.
No. 1: Have an Emergency Fund
If you have plenty of cash lying around in a high-interest, Federal Deposit Insurance Corporation (FDIC)-insured account, not only will your money retain its full value in times of market turmoil, it will also be extremely liquid, giving you easy access to funds if you lose your job or are forced to take a pay cut. Also, if you have your own cash, it won't be an issue if other sources of backup funds dry up, such as a home equity line of credit.
No. 2: Always Live Within Your Means
If you make it a habit to live within your means each and every day, you are less likely to go into consumer debt when gas or food prices go up and more likely to adjust your spending in other areas to compensate. Debt begets more debt when you can't pay it off right away - if you think gas prices are high, wait until you're paying 29.99% annual percentage rate (APR) on them. To take this principle to the next level, if you have a spouse and are a two-income family, see how close you can get to living off of only one spouse's income. In good times, this tactic will allow you to save incredible amounts of money - how quickly could you pay off your mortgage or how much earlier could you retire if you had an extra $40,000 a year to save? In bad times, if one spouse gets laid off, you'll be OK because you'll already be used to living on one income. Your savings habits will stop temporarily, but your day-to-day spending can continue as normal.
No. 3: Have More Than One Source of Income
Even if you have a great full-time job, it's not a bad idea to have a source of extra income on the side, whether it's some consulting work or selling collectibles on eBay. With job security so nonexistent these days, more jobs mean more job security. If you lose one, at least you still have the other one. You may not be making as much money as you were before, but every little bit helps.
No. 4: Have a Long-Term Mindset With Investments
So what if a drop in the market brings your investments down 15%? If you don't sell, you won't lose anything. The market is cyclical, and in the long run, you'll have plenty of opportunities to sell high. In fact, if you buy when the market's down, you might thank yourself later. That being said, as you near retirement age, you should make sure you have enough money in liquid, low-risk investments to retire on time and give the stock portion of your portfolio time to recover. Remember, you don't need all of your retirement money at 65 - just a portion of it. The market might be tanking when you're 65, but it might be headed to Pamplona by the time you're 70.
No. 5: Be Honest About Your Risk Tolerance
Yes, investing gurus say that people in certain age brackets should have their portfolios allocated a certain way, but if you can't sleep at night when your investments are down 15% for the year and the year isn't even over, you may need to change your asset allocation. Investments are supposed to provide you with a sense of financial security, not a sense of panic.But wait - don't sell anything while the market is down, or you'll set those paper losses in stone. When market conditions improve is the time to trade in some of your stocks for bonds, or trade in some of your risky small-cap stocks for less volatile blue-chip stocks. If you have extra cash available and want to adjust your asset allocation while the market is down, however, you may be able to profit from infusing money into temporarily low-priced stocks with long-term value.The biggest risk is that overestimating your risk tolerance will cause you to make poor investment decisions. Even if you're at an age where you're "supposed to" have 80% in stocks and 20% in bonds, you'll never see the returns that investment advisors intend if you sell when the market is down. These asset allocation suggestions are meant for people who can hang on for the ride.
No. 6: Diversify Your Investments
If you don't have all of your money in one place, your paper losses should be mitigated, making it less difficult emotionally to ride out the dips in the market. If you own a home and have a savings account, you've already got a start: you have some money in real estate and some money in cash. In particular, try to build a portfolio of investment pairs that aren't strongly correlated, meaning that when one is up, the other is down, and vice versa (like stocks and bonds).
No. 7: Keep Your Credit Score High
When credit markets tighten, if anyone is going to get approved for a mortgage, credit card or other type of loan, it will be those with excellent credit. Things like paying your bills on time, keeping your oldest credit cards open, and keeping your ratio of debt to available credit low will help keep your credit score high.
Conclusion
The best part about these habits is that they won't only serve you well during times of recession - they'll serve you well no matter what's going on in the market. But if you implement these financial strategies, a recession is less likely to have a significant effect on your financial situation.
by Amy Fontinelle
Are you worried about how a recession might affect you? You can put your fears to rest because there are many everyday habits the average person can implement to ease the sting of a recession, or even make it so its effects aren't felt at all. In this article, we'll discuss seven ways to do just that.
No. 1: Have an Emergency Fund
If you have plenty of cash lying around in a high-interest, Federal Deposit Insurance Corporation (FDIC)-insured account, not only will your money retain its full value in times of market turmoil, it will also be extremely liquid, giving you easy access to funds if you lose your job or are forced to take a pay cut. Also, if you have your own cash, it won't be an issue if other sources of backup funds dry up, such as a home equity line of credit.
No. 2: Always Live Within Your Means
If you make it a habit to live within your means each and every day, you are less likely to go into consumer debt when gas or food prices go up and more likely to adjust your spending in other areas to compensate. Debt begets more debt when you can't pay it off right away - if you think gas prices are high, wait until you're paying 29.99% annual percentage rate (APR) on them. To take this principle to the next level, if you have a spouse and are a two-income family, see how close you can get to living off of only one spouse's income. In good times, this tactic will allow you to save incredible amounts of money - how quickly could you pay off your mortgage or how much earlier could you retire if you had an extra $40,000 a year to save? In bad times, if one spouse gets laid off, you'll be OK because you'll already be used to living on one income. Your savings habits will stop temporarily, but your day-to-day spending can continue as normal.
No. 3: Have More Than One Source of Income
Even if you have a great full-time job, it's not a bad idea to have a source of extra income on the side, whether it's some consulting work or selling collectibles on eBay. With job security so nonexistent these days, more jobs mean more job security. If you lose one, at least you still have the other one. You may not be making as much money as you were before, but every little bit helps.
No. 4: Have a Long-Term Mindset With Investments
So what if a drop in the market brings your investments down 15%? If you don't sell, you won't lose anything. The market is cyclical, and in the long run, you'll have plenty of opportunities to sell high. In fact, if you buy when the market's down, you might thank yourself later. That being said, as you near retirement age, you should make sure you have enough money in liquid, low-risk investments to retire on time and give the stock portion of your portfolio time to recover. Remember, you don't need all of your retirement money at 65 - just a portion of it. The market might be tanking when you're 65, but it might be headed to Pamplona by the time you're 70.
No. 5: Be Honest About Your Risk Tolerance
Yes, investing gurus say that people in certain age brackets should have their portfolios allocated a certain way, but if you can't sleep at night when your investments are down 15% for the year and the year isn't even over, you may need to change your asset allocation. Investments are supposed to provide you with a sense of financial security, not a sense of panic.But wait - don't sell anything while the market is down, or you'll set those paper losses in stone. When market conditions improve is the time to trade in some of your stocks for bonds, or trade in some of your risky small-cap stocks for less volatile blue-chip stocks. If you have extra cash available and want to adjust your asset allocation while the market is down, however, you may be able to profit from infusing money into temporarily low-priced stocks with long-term value.The biggest risk is that overestimating your risk tolerance will cause you to make poor investment decisions. Even if you're at an age where you're "supposed to" have 80% in stocks and 20% in bonds, you'll never see the returns that investment advisors intend if you sell when the market is down. These asset allocation suggestions are meant for people who can hang on for the ride.
No. 6: Diversify Your Investments
If you don't have all of your money in one place, your paper losses should be mitigated, making it less difficult emotionally to ride out the dips in the market. If you own a home and have a savings account, you've already got a start: you have some money in real estate and some money in cash. In particular, try to build a portfolio of investment pairs that aren't strongly correlated, meaning that when one is up, the other is down, and vice versa (like stocks and bonds).
No. 7: Keep Your Credit Score High
When credit markets tighten, if anyone is going to get approved for a mortgage, credit card or other type of loan, it will be those with excellent credit. Things like paying your bills on time, keeping your oldest credit cards open, and keeping your ratio of debt to available credit low will help keep your credit score high.
Conclusion
The best part about these habits is that they won't only serve you well during times of recession - they'll serve you well no matter what's going on in the market. But if you implement these financial strategies, a recession is less likely to have a significant effect on your financial situation.
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