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    • Balancing Simplicity and Precision in Business and End-of-Life CareEffective business operations and financial management, particularly in multiple currencies, can lead to significant benefits. Meanwhile, the right to die with dignity raises complex questions about autonomy, dignity, and stakeholder roles.

      Simplicity and precision in business operations, as well as in managing finances across different currencies, can lead to significant benefits. Meanwhile, the right to die with dignity is a complex and emotionally charged issue that raises important questions about autonomy, dignity, and the role of healthcare and government. Britney Menard's story serves as a powerful reminder of the importance of having control and peace of mind during the end of life. Katie Englehart's book, "The Inevitable," offers valuable insights into this complex issue, highlighting the experiences of patients, doctors, and activists. Ultimately, the debate around physician-assisted death and its implications for various stakeholders continues to evolve, requiring thoughtful consideration and nuanced understanding.

    • Complex Reasons Behind the Desire for Assisted DyingPeople seek assisted dying for various reasons beyond just illness or suffering, including fear, lack of access to healthcare, financial concerns, love, and even a desire for fame. Dignity is multifaceted, with some viewing it as living authentically and others as enduring pain or avoiding embarrassment.

      That the desire for a right to die, or assisted dying, is a complex issue with various reasons behind it, beyond just the illness or suffering. People's motivations include fear, lack of access to healthcare, financial concerns, love, and even a desire for fame. The concept of dying with dignity is multifaceted, with people wanting to live authentically and write their own endings. However, the meaning of dignity can vary, with some seeing it as living consistently with oneself, while others view it as enduring pain or even just avoiding embarrassment in the face of death. The author went into the topic expecting profound wisdom but found that sometimes, dignity for people simply meant not soiling themselves.

    • Maintaining Dignity through Control in Assisted DeathAssisted death allows individuals to regain control and maintain dignity by self-administering lethal medication in the US, with legal forms, waiting periods, and a predicted 6-month life expectancy.

      Dignity, as perceived by some, is linked to maintaining control over personal functions. People seeking assisted death often do so to escape undignified states of dependence or intimacy with caregivers. In the United States, the process for someone wanting to end their life involves signing legal forms, waiting periods, and self-administering lethal medication. The patient must be predicted to die within 6 months, and the medication must be self-ingested to ensure autonomy. It's important to note that in most places where assisted death is legal, euthanasia is also an option. Around a third of cases don't go through to completion, which could be due to various reasons such as death during the waiting period or loss of mental capacity.

    • The balance between the right to life and the right to dieThe right to life and autonomy in assisted dying are complex issues, with varying laws and emotions surrounding the balance between living and dying.

      The right to life and autonomy are complex issues when it comes to assisted dying. Some people, when facing serious medical conditions, may feel that they have the autonomy to decide when they no longer wish to live, even if they don't use the option of assisted death. However, laws regarding assisted dying vary greatly from country to country, with some requiring imminent death or terminal illness, while others only require a serious medical condition and unbearable suffering. Proponents argue that the right to life has become an enforceable duty to live, while opponents fear that a legal right to die could become a duty to die due to healthcare system pressures. The concept of autonomy and what it means to be a sovereign self is a deeply emotional and complex issue, with uncertainty surrounding the balance between the right to life and the right to die, as well as the consideration of different forms of suffering.

    • The Complexity of Assisted Death for Mentally Ill IndividualsThe right to die for mentally ill individuals is a complex issue, raising questions about freedom, suicide validation, and treatment options.

      The issue of assisted death for mentally ill individuals is a complex and nuanced topic with valid arguments on both sides. While some believe mental suffering can be as debilitating as physical pain and support the right to die, others argue that doctors collaborating in a suicide could validate and fulfill suicidal ideations. The reporter, who covered this issue in Belgium, found it to be the most challenging part of her book. She spent time with women in their thirties who were approved to die due to chronic depression, and their stories challenged her perspective. Ultimately, if we take the idea of freedom seriously, it's difficult to deny an adult's wish to end their life, but determining the lines or if they're even drawable is a complicated matter. The case of Adam Maier Clayton, a young man who wanted to die due to psychosomatic pain from mental illness, highlights the complexity of the issue and raises questions about the necessity of exhausting all treatment options before qualifying for an assisted death.

    • The Right to End One's Life: Balancing Autonomy and Societal ResponsibilityThe right to end one's life is a complex issue, raising concerns about individual autonomy, medical professional roles, societal implications, and the connection between suffering and poverty. A nuanced approach is needed to balance these considerations.

      The right to end one's life, also known as assisted death, is a complex issue with valid arguments on both sides. While some believe individuals should have the autonomy to make this decision, especially in cases of terminal illness or unbearable suffering, others argue against it, raising concerns about the potential for misuse, the role of medical professionals, and the societal implications. The discussion also touched upon the connection between suffering and poverty, and the ethical dilemmas that arise when considering the right to die in the context of limited access to healthcare. Ultimately, the conversation highlights the importance of balancing individual autonomy with societal responsibility and the need for a nuanced approach to this complex issue.

    • Expansion of Assisted Death Eligibility in Other CountriesCanada and the Netherlands broadened assisted death eligibility, raising ethical concerns about minors and future applications for those with dementia. Neil Gorsuch's argument against assisted death laws criticized for being unrealistic.

      While the United States has kept its assisted death laws tight and limited to those who are terminally ill, other countries like Canada and the Netherlands have expanded their eligibility criteria. This expansion includes allowing those with dementia to apply for future assisted deaths and considering mature minors as eligible. The speaker raises ethical concerns about these expansions, particularly regarding the eligibility of minors. The speaker also discusses the potential ethical implications of having an assisted death law on the books, as argued by Neil Gorsuch in his PhD thesis. However, the speaker criticizes Gorsuch's argument for being offensive and unserious, and instead emphasizes the importance of acknowledging the history of the Right to Die movement and addressing the financial issues in the US healthcare system.

    • The complexities of defining a good deathReligious objections to assisted dying have historical significance, but the definition of a good death is debatable and individuals have the right to decide what it means for them, with doctors playing a role in the process

      The sanctity of life and the definition of a good death are complex issues with valid arguments on both sides. While some believe that life is sacred and should be protected at all costs, others argue that individuals have the right to decide what a dignified death looks like for them. The religious objection to assisted dying has historical significance, but the idea of who can define a good death is a debatable question. A doctor quoted in the discussion suggests that no one has a monopoly on what it means to die a good death, and that people are choosing to die for existential reasons more than purely physical ones. The role of doctors in assisted dying is also a topic of debate, as some argue that they should not have complete control over the process. Ultimately, it's an intricate issue with valid arguments on both sides, and it's important to consider the perspectives of all involved.

    • Exploring the Moral and Ethical Dilemmas of Physician-Assisted DeathProponents and opponents debate the nature of assisted death and its connection to suicide, with some seeing it as an extension of end-of-life care and others viewing it as fundamentally different. The conversation also touched upon the parallels and differences with contentious moral issues like abortion.

      The debate surrounding physician-assisted death involves complex moral and ethical issues, with proponents and opponents holding varying perspectives on the nature of suicide and the concept of agency. While some view assisted death as fundamentally different from suicide, others argue that the two are connected. The conversation also touched upon the parallels and differences between assisted death and other contentious moral issues like abortion. Doctors are already involved in end-of-life care decisions, and some see assisted death as an extension of this role. Ultimately, the discussion highlighted the importance of understanding the nuances and complexities of this complex issue.

    • Exploring the complexities of end-of-life decisionsThe speaker advocates for individual autonomy in end-of-life decisions, acknowledging potential risks but emphasizing the importance of open dialogue and careful consideration to navigate complexities.

      The complexities surrounding end-of-life decisions and the concept of sanctity of life are deeply interconnected and nuanced. The speaker acknowledges the potential risks and slippery slopes in expanding the right to assisted death, but ultimately believes that individuals should have the autonomy to make these decisions for themselves. The ongoing debate around this issue, as exemplified by the expanding laws in Canada, highlights the importance of understanding and respecting the unique circumstances and desires of each person. While there are valid concerns on both sides, the speaker argues that creating legal prohibitions based on discomfort or uncertainty is not the solution. Instead, open dialogue and careful consideration are necessary to navigate the complexities of end-of-life choices.

    • Discussing cultural differences in attitudes towards euthanasia for mental illness patientsOpen dialogue about death and end-of-life wishes is essential for individuals to reflect on their values and plan for the end of their lives, despite cultural taboos. This conversation can help navigate ethical complexities and promote more humane and nuanced approaches to death and dying.

      Our cultural aversion to discussing death and dying can lead to uncomfortable situations and potentially inadequate end-of-life care. The discussion highlighted the differences in attitudes towards euthanasia for mental illness patients between cultures, specifically comparing Belgium and Canada. The lack of open dialogue about death in American culture was emphasized, with statistics showing that a majority of Americans avoid discussing end-of-life wishes with healthcare providers. The importance of addressing this taboo topic was underscored, as it can help individuals reflect on their values and plan for the end of their lives. The conversation around the right to die also serves as an opportunity to navigate ethical complexities and work towards more humane and nuanced approaches to death and dying.

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    Please enjoy!

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    *

    [08:04] The store where Rich's story began.

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    [59:58] Parting thoughts.

    *

    For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.

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    Past guests on The Tim Ferriss Show include Jerry SeinfeldHugh JackmanDr. Jane GoodallLeBron JamesKevin HartDoris Kearns GoodwinJamie FoxxMatthew McConaugheyEsther PerelElizabeth GilbertTerry CrewsSiaYuval Noah HarariMalcolm GladwellMadeleine AlbrightCheryl StrayedJim CollinsMary Karr, Maria PopovaSam HarrisMichael PhelpsBob IgerEdward NortonArnold SchwarzeneggerNeil StraussKen BurnsMaria SharapovaMarc AndreessenNeil GaimanNeil de Grasse TysonJocko WillinkDaniel EkKelly SlaterDr. Peter AttiaSeth GodinHoward MarksDr. Brené BrownEric SchmidtMichael LewisJoe GebbiaMichael PollanDr. Jordan PetersonVince VaughnBrian KoppelmanRamit SethiDax ShepardTony RobbinsJim DethmerDan HarrisRay DalioNaval RavikantVitalik ButerinElizabeth LesserAmanda PalmerKatie HaunSir Richard BransonChuck PalahniukArianna HuffingtonReid HoffmanBill BurrWhitney CummingsRick RubinDr. Vivek MurthyDarren AronofskyMargaret AtwoodMark ZuckerbergPeter ThielDr. Gabor MatéAnne LamottSarah SilvermanDr. Andrew Huberman, and many more.

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    • Dr. Dale’s writing, “Life Has Moments That Take Your Breath Away”
      • Life has moments that take your breath away. When I was 12 years old my father died at work. I never got to say goodbye, never got to see him, never got to say “I love you” one last time. My perfect life was shattered in an instant with a knock on the door. The police officer stated that my dad had a heart attack and passed before the paramedics arrived. Everything afterward was a blur. Phone calls, family, tears, sadness, denial, anger, helplessness, hugs, guilt, a funeral. Kind people making caring comments that couldn’t take the sadness away. My mother struggled with her own loss. I was left to figure things out. Routines helped. Back to school and my life. Friends, teachers, and family didn’t know what to say, so they said nothing. All assumed that if I was doing well in school I must be okay. Time went on. Life choices were made. I wanted to become a veterinarian. Not a common goal for a woman in the 1970”s. My awkwardness with human relationships drew me to the animals. I was shy around people but always felt an inner peace snuggling with a kitty or playing with a dog. Animals made me feel alive and loved. Veterinary school was beyond challenging mentally, emotionally, and physically. The demands of the curriculum were relentless. The love of the animals was always the reward. Restoring health to a sick, helpless creature is a joy beyond words. My years in training were spent honing my diagnostic and surgical skills to prepare me for the business world. Four years of veterinary school flew by and I moved 2000 miles across the country to start the next chapter of my life closer to family. My first job as a veterinarian lasted for 10 years. My mentors were seasoned veterinarians who shared their advice, experience, and support. I grew secure in my skills and enjoyed the challenges that my career provided. Every day was different. Nothing was ever truly routine. I would never know what surprise awaited me beyond exam room door number one. Was it a cute kitty or a snarling dog, a happy or crying pet owner, a routine vaccine appointment, or an emergency hit by car? There has never been a moment where I didn't believe I was doing important work. One day I was called into the practice owner’s office and told that the business had been sold. My employers would be moving on in their lives and the practice was now owned by a corporation. Something inside me died that day. Once again my perfect family was shattered. That night I discussed the change of circumstance with my husband. I had always fantasized about operating a house call practice. As a child, I spent hours reading James Herriot’s books and dreaming about life as a house call veterinarian. Helping pets and their people in their home environments was a life dream. Five months later Creature Comforts Mobile Veterinary Clinic was born. The day-to-day craziness of operating a small animal mobile veterinary clinic is challenging, emotional, chaotic, tiring, and beyond rewarding. At the end of the day it always comes back to the love of the animal and making a difference in someone’s life. Families who can’t get their cat in a carrier, cats who get violently ill on the car ride to the animal hospital, dogs who tremble with anxiety or growl with aggression. People don’t just call to make an appointment, they call to tell their pet’s story. Many procedures overlap in traditional vs house call medicine but the one that tweaked my thinking the most was the requests for end-of-life care. A faltering voice on the other end of the phone, sometimes silence intermixed with sobs. I learned to recognize these calls for what they were. A pet owner reaching out to a stranger asking for help to provide a gentle goodbye to a beloved family member. All veterinarians are trained to perform the euthanasia procedure but few get to experience the calmness and peacefulness that comes with attending to a pet in the comfort of home. Caring for the human and 4-legged family with dignity, respect, and privacy is truly my calling. People are placed in our path for a reason. After completing Reiki Level 1 and Level 2 certification classes it seemed like the stars were aligning for me. I found myself in polite conversation with a colleague sitting next to me at a veterinary conference. She expressed to me that she had recently opened an end-of-life and hospice care mobile practice. She ignited something in me that I had been contemplating for quite a long time. My research led me to a relatively new group of veterinarians offering end-of-life services only for their furry patients. This is my vision, my passion. I love being able to provide validation, information, options, hugs, and support to families in crisis. I love being able to walk families through an overwhelmingly tough choice and come out on the other side acknowledging that the right decisions were made. No veterinarian starts out on their career path with the goal of helping pets die. Quite frankly, we spend all our energy and training trying to save lives. Exams, laboratory work, x-ray, ultrasound, surgery, chemotherapy, radiation treatment, all with the hope of saving a life. Veterinary school does not prepare us well for the psychology of dying. Emotions are raw, the sadness is palpable and the connections to one’s pet runs deep. Death does not have to be something we fear. It can take place in a respectful way with food and music and candles and stories and hugs and tears. Tears of sadness mixed with tears of relief that our friends are no longer suffering. I am deeply honored when families reach out to me and ask for my help to provide a peaceful farewell. I have spent the last 45 years missing my father and wondering if he would be proud of the person I have become. I now know that the passion I bring to my work is due to the lessons I have received from loving and honoring the man I know he was. He gives me strength to provide support to my clients and walk beside them each step of the way as they say goodbye to a beloved friend. Many of these families I will never meet again, yet the moments that we shared will never be forgotten. “ My pet is old and his body is not cooperating with his mind and he has become a shadow of who he once was. I need to consider what life he has left and if I should be letting him go to be pain-free.” client's comment

     

    The House Call Vet Academy links:

    Music:

    In loving memory of Dr. Steve Weinberg.

    Intro and outro guitar music was written, performed, and recorded by house call veterinarian Dr. Steve Weinberg.

    Thank you to our sponsors!

    This podcast is also available in video on our House Call Vet Cafe YouTube channel

     

    Atul Gawande on surgery, writing, Obamacare, and indie music

    Atul Gawande on surgery, writing, Obamacare, and indie music
    I've wanted to do this interview for a long, long time.Atul Gawande is a surgeon at Brigham and Women’s Hospital. He's a professor in the Department of Health Policy and Management at the Harvard School of Public Health. He is executive director of Ariadne Labs, a joint center for health systems innovation, and chairman of Lifebox, a nonprofit organization making surgery safer globally. He's a New Yorker writer. He's the author of some of my favorite books, including Better: A Surgeon's Notes on Performance and The Checklist Manifesto. He's a MacArthur Genius. Atul Gawande makes me feel like a slow, boring, unproductive person. What makes it worse is that he's a helluva nice guy, too. And he knows more new music than I do. There haven't been many conversations on this podcast I've looked forward to more, or enjoyed as much. Among many other things, we talked about:- How Atul makes time to do all of the writing, large-scale research, and surgery he does- His time working in Congress and in the White House- His writing process and how it’s evolved since his early days writing for Slate- Why he hates writing and likes being edited (and why I am the exact opposite)- His thoughts on ignorance, ineptitude, why we fail at things, and what hand washing has to do with it- How effective Medicaid coverage is in improving health outcomes- The ways we need to more effectively deliver existing knowledge and technology rather than always focusing on the next big discovery- What he thinks we’ve learned so far from Obamacare- How Rivers Cuomo from Weezer has applied lessons from Atul’s writing to his music- His work with the Clintons, Jim Cooper, and Al Gore and thoughts on their private versus public personas- How all the different parts of his life — the writing, the surgery, the policy work — come together into one single engine for actually making change- What new albums he thinks everyone should listen toAnd so much more. Talking to Atul was a real pleasure. I hope you enjoy it too. Learn more about your ad choices. Visit podcastchoices.com/adchoices