DYING, ILLNESS, AND AGING WITH GRACE - Complex and Difficult Endings

Suicide, homicide, physician-assisted suicide, violence (including domestic violence and gun violence), sudden death (from accidents and otherwise), dementia and other forms of lingering illness -- complex and difficult endings may bring complicated losses and complicated grief. You'll find some resources to deal with such losses here. Alternatives include assisted dying ("aid in dying") and VSED (voluntarily stopping eating and drinking).

Suicide, suicidal thinking, and suicide prevention

“There is no suffering greater than that which drives people to suicide, suicide defines the moment in which mental pain exceeds the human capacity to bear it. It represents the abandonment of hope.” ~ John T. Maltsberger

Medical aid in dying (MAID), assisted death, assisted suicide

The right-to-die movement, "right-to-choose-to-die," and "death with dignity"

Terminology is a problem in discussing this subject. What supporters call "aid-in-dying" or "medical aid in dying" or "physician aid in dying" or "death with dignity," opponents call "assisted suicide" or "physician-assisted suicide," emotionally freighted phrases that cannot capture the choices individuals and families face in the presence of prolonged illness.

"Various forms of medical assisted dying have been approved in various states and nations. Each law has its own limits, rules and guidelines. All but Switzerland forbid foreigners this type of help to die. Only Canada, the Netherlands, and Belgium permit chosen death via doctor lethal injection; all others are by doctor prescription which the patient drinks. A policy statement in England gives clear guidance when helping another to die would not be prosecuted, but there is no law." ~ Rosalind Kipping on assisted dying law reforms, Compassion and Choices, April 2019

• Death with Dignity Law (state by state)
---Get Your Life File Checklist
---Life File: Will and Estate Planning
---Do I need a will or an estate plan?
---What should be included in a will
---What should not be included in a will
---What happens if I don't have a will or estate plan?
---How do I get started making a will or estate plan?

"Making your own will often does not require an attorney. There are online resources like FreeWill that will help you create a will and make plans for charitable giving. The ACLU also has a guide to writing a will without an attorney and a printable PDF estate organizer.

• Don’t let polarizing politics derail how we talk about death (Ellen Goodman, WaPo editorial, 6-6-16) "...in Oregon, the first state to pass a “Death With Dignity Act,” only one out of every 500 deaths comes from doctor-ordered medication. So why are we spending so much political energy to help the one rather than the 499? ...Too many of us do not die in the way we would choose. Too many survivors are left guilty, depressed and bereft. Rather than just offering a few patients the 'comfort and dignity' of lethal medication, we need to assure everyone the comfort and dignity of a humane, caring ending."
• 'I'm Dying, You're Not': Terminally Ill Ask More States for Physician-Assisted Death (Associated Press, MedPage Today, 4-12-24) Debates on medical aid in dying bills are playing out in Kentucky, Delaware, Maryland, and Iowa.
     "At least 12 states currently have bills that would legalize physician-assisted death. Eight states and Washington, D.C., already allow it, but only for their own residents. Vermont and Oregon permit any qualifying American to travel to their state for the practice. Patients must be at least 18 years old, within 6 months of death, and be assessed to ensure they are capable of making an informed decision.
     "Two states have gone in the opposite direction. Kansas has a bill to further criminalize those who help someone with their physician-assisted death. West Virginia is asking voters to enshrine its current ban into the state constitution.
    "That patchwork of laws has left Americans in most states without recourse."

And then some real-life stories.
• To Die on Her Own Terms, a Connecticut Woman Turns to Vermont (Lola Fadulu, NY Times, 3-29-23) Connecticut does not allow medical aid in dying, so Lynda Bluestein sued Vermont to take advantage of that state’s law. Now, legislators may make the practice more broadly available.
---Compassion & Choices Succeeds in Rolling Back Residency Requirement for Vermont’s Aid-in-Dying Law Compassion & Choices filed Bluestein v. Scott, a federal lawsuit that challenged the constitutionality of the residency requirement in Vermont's medical aid-in-dying law, in August of 2022. The suit was brought by Ms. Bluestein and Diana Barnard, a hospice and palliative care physician and associate professor of family medicine at the University of Vermont who was prevented from helping out-of-state patients interested in the option of medical aid in dying.
• I Promised My Sister I Would Write About How She Chose to Die (Steven Petrow, Opinion essay, NY Times, 12-28-23) “The MAID,” the acronym for the New Jersey law referred to as Medical Aid in Dying, allows New Jersey residents with terminal illnesses to choose to end their lives by taking a cocktail of life-ending medications. My sister Julie, a lawyer, had done her research and had told me that the Garden State is one of only 11 jurisdictions (10 states and the District of Columbia) that allow medical aid in dying, also known as death with dignity and end-of-life options....

       'In late 2017, Julie learned she had advanced ovarian cancer. Since then, she’d endured one nine-hour surgery, six rounds of chemo, three recurrences and two clinical trials. “Enough,” my sister told her oncologist...One by one, women she had befriended in an online support group died, their last weeks and days often made awful by what Julie called “Hail Mary” treatments — drugs, many with harsh side effects, often used out of desperation or denial.
       Kim Callinan, the chief executive of Compassion and Choices, a nonprofit that led the effort to pass New Jersey’s MAID legislation, told me these “laws are meaningless if patients are not aware they exist, which is why we focus on public education during the first five to 10 years after a jurisdiction has authorized medical aid in dying.”
       'A study published in The Journal of the American Geriatrics Society last year found that 96 percent of people who died by medical aid in dying were white and 72 percent had at least some college education. “The reality is that communities of color, for a wide variety of reasons, also are more likely to utilize aggressive care and less likely to use other end-of-life care options, such as hospice and palliative care,” explained Ms. Callinan. People without the resources to pursue MAID may be forced to make a different choice: suffer through a painful death or take matters into their own hands. “Be sure to include these statistics when you write about this,” my sister directed me.'
      'In recent months, lawmakers in at least nine other states have introduced MAID legislation, but opponents remain adamant. As recently as last year, Pope Francis condemned assisted suicide, saying, “We must accompany death, not provoke death or help any kind of suicide.” Other objections come from advocacy groups like the National Council on Disability, an independent federal agency that advises on government policies affecting people with disabilities; the council fears the potential exploitation of vulnerable people, especially if they feel they are a burden to family members. Julie was well aware of these concerns, but she believed MAID’s built-in safeguards prevented such exploitation.'
• We Have the Right to Live Our Lives with Dignity and to Die with Dignity As Well (Phara Souffrant Forrest, Empire Network, New York, 2-9-23) A nurse who was elected to the NY State Assembly, reassures Black and Brown people: "Far from endangering the lives of Black and Brown people, the option of medical aid in dying empowers us. There is power in charting one’s own end-of-life journey. We should all have the ability to die in a way that is consistent with our faith, values and beliefs."
• Medical Aid in Dying Compassion & Choices is leading efforts to authorize, implement and defend medical aid in dying so all terminally ill people who are eligible will have access to the full range of end-of-life care options. What is medical aid in dying? Where is medical aid in dying authorized? Is medical aid in dying safe? Who is eligible for it? What safeguards are in place? How does a person in an authorized state access medical aid in dying? How does medical aid in dying benefit society? Who supports medical aid in dying? State End-of-Life Information Packets.
---Thirteen states introduce legislation to authorize medical aid in dying: Arizona | Connecticut | Florida | Indiana | Iowa | Kentucky | Maryland | Massachusetts | Minnesota | Nevada | New York | Rhode Island | Virginia.
---While legislation varies by state, all of the bills are similar to the Oregon Death with Dignity Act.
---Delaware is also expected to introduce legislation to authorize medical aid in dying this year.
---Two states seek to permanently remove the state residency requirements: Oregon and Vermont. After reaching settlements in Oregon and now Vermont, C&C is now advancing legislation to permanently remove the residency requirements in both states so that out-of-state residents can more easily access the laws.
---Four additional states consider legislation to improve or clarify existing medical aid-in-dying laws: Hawai’i | New Jersey | New Mexico | Washington. Across these states, we are seeing the following types of improvements:

Allowing advanced practice registered nurses (APRNs) and physician assistants (PAs) to practice medical aid in dying (Hawai’i and Washington).

Reducing the waiting period or allowing it to be waived under certain circumstances, such as imminent death (Hawai’i, New Jersey and Vermont).

Eliminating the residency requirement (Oregon and Vermont).

Improving transparency (Washington).
• Medical Aid in Dying and ALS: How the Option Can Ease End-of-Life Suffering (Compassion & Choices) ALS is the second leading diagnosis among individuals who request and use medical aid in dying. This webinar will explore how patients with ALS and other neurologic disorders who may have limited capacity due to muscle weakness are able to access medical aid in dying. Topics include how written and oral consent are obtained, the definition of “self administration,” and how family members may participate.
• City of Hope Presents: How Medical Aid in Dying Really Works in Authorized States (Compassion & Choices) Learn about the barriers and roadblocks eligible patients face when trying to access the option of medical aid in dying in states where it is authorized.

• City of Hope Presents: Patient Perspectives on Medical Aid in Dying (Compassion & Choices) This webinar (recorded 11-5-2020) is part of the City of Hope End-of-Life Symposium Webinar Series.
• In Love: A Memoir of Love and Loss by Amy Bloom. Diagnosed with Alzheimer's a few years before his death, Amy's husband made her promise that when the time came and he no longer knew her or was incapacitated, she would help him die. They chose Dignitas, flew to Switzerland, and she was with him when he died.

"Bloom’s unfiltered glimpse into a working marriage is both a touchingly besotted portrait of her husband and a wrenching account of his gradual retreat from her. Their resolute approach to his death yields a story pulsing with raw life.”—Alison Bechdel, author of Fun Home
“This is a beautiful, necessary book for anyone who loves their partner deeply and wonders and worries what the end might be like: poignant, kind, funny, and ultimately redemptive. One cries a lot, in the best of ways.”—Alain de Botton, author of The Course of Love
---Exit International A leading non-profit organisation devoted to providing rational adults with information & education about practical DIY end of life choices.
---Dignitas (Digitas costs money and they have a rigorous procedure for screening before you are accepted.)
• Scheduled to Die: The Rise of Canada's Assisted Suicide Program (Rupa Subramanya, Common Sense, 10-11-22) What do you do when you discover your son has made an appointment for his death? On September 7, Margaret Marsilla called Joshua Tepper, the doctor who planned to kill her son. That was when Marsilla learned that Kiano had applied and, in late July, been approved for “medical assistance in dying,” aka MAiD, aka assisted suicide. Wherever he went, whatever he did—he was unhappy. Going blind in his left eye, this past April, was the tipping point.

"In 2015, Canada’s Supreme Court ruled that assisted suicide was constitutional. In June 2016, Parliament passed Bill C-14, otherwise known as the Medical Assistance in Dying Act. Anyone who could show that their death was “reasonably foreseeable” was eligible. In this respect, Canada was hardly alone: The Netherlands, Switzerland, Belgium, Spain, Australia, and New Zealand, among others, allow assisted suicide. So do ten states in the U.S.

"In 2017, the first full year in which MAiD, which is administered by provincial governments, was in operation, 2,838 people opted for assisted suicide, according to a government report. By 2021, that figure had jumped to 10,064—accounting for more than 3 percent of all deaths in Canada that year." "Tremblay was MAiD-curious. The MAiD-curious were lonely and scared, and they had coalesced into a growing, online community, mostly on Twitter and Facebook, and through the spread of death cafés. There were more than 1,300 death cafés in Canada and 14,000 worldwide." (See also Death Cafes and Conversations About End-of-Life Concerns)
• How This NPR Host Became an Advocate for Assisted Suicide (Richard Harris, Next Avenue) NPR talk-show host Diane Rehm answers questions about her book On My Own; about her husband's decision--after years of living with Parkinson's, when he was no longer able to use his hands, arms or legs and couldn't stand, bathe or eat by himself--to end his life. After he asked for a lethal dose of medication, his doctor refused. "Still determined to die, John Rehm spent his last 10 days refusing all food, water and medications. He died of dehydration." An experience like that brings many survivors like Diane Rehm into the "right to die" movement.
• Oregon ends residency rule for medically assisted suicide (Gene Johnson, AP News, 3-29-22) Oregon will no longer require people to be residents of the state to use its law allowing terminally ill people to receive lethal medication, after a lawsuit challenged the requirement as unconstitutional. In a settlement filed in U.S. District Court in Portland on Monday, the Oregon Health Authority and the Oregon Medical Board agreed to stop enforcing the residency requirement and to ask the Legislature to remove it from the law.
• The Doctors Who Invented a New Way to Help People Die (Jennie Dear, The Atlantic, 1-22-19) The two lethal medications used by terminal patients who wish to end their own life recently became unavailable or prohibitively expensive....since 2015, they’ve been largely unavailable. U.S. pharmacies stopped carrying pentobarbital approved for human use, and the price of secobarbital, under the brand name Seconal, doubled from an already historic high after Valeant Pharmaceuticals (today known as Bausch Health) bought the manufacturing rights. A few years ago, a lethal dose cost about $200 or $300; now it can cost $3,500 or more."

See also Penalized by the Death Penalty (Nigel Jaquiss, Willamette Week, 5-20-14) "In recent years, death-penalty opponents have pressured drug companies here and in Europe to restrict drugs used to execute death-row inmates. States such as Texas and Oklahoma that regularly execute prisoners have found it increasingly difficult to obtain the drugs they require, including pentobarbital....
• Medical Aid in Dying Is Not Assisted Suicide, Suicide or Euthanasia (Compassion & Choices) "Medical aid in dying is a safe and trusted medical practice in which a terminally ill, mentally capable adult with a prognosis of six months or less to live may request from his or her doctor a prescription for medication which they can choose to self-ingest to bring about a peaceful death. Physician-assisted suicide, suicide, and euthanasia are often terms that popular media and our opposition use to describe the practice of medical aid in dying. This is misleading and factually incorrect. We should no longer use these terms to describe this compassionate option.

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• Advance directive (end of life treatment) for patients in dementia Various articles that indicate how to provide in advance how you want your life to end, if you have been diagnosed with dementia.
• Clinical Criteria for Physician Aid in Dying. These clinical aid-in-dying guidelines were published in the Journal of Palliative Medicine in 2016. “The fear of being sued or prosecuted is still there.”
• Getting a Prescription to Die Remains Tricky Even as Aid-in-Dying Bills Gain Momentum (Katheryn Houghton, KHN, 3-30-21) in 2009, the Montana Supreme Court had, in theory, cracked open the door to sanctioned medically assisted death. The court ruled physicians could use a dying patient’s consent as a defense if charged with homicide for prescribing life-ending medication. But the ruling sidestepped whether terminally ill patients have a constitutional right to that aid. Whether that case made aid in dying legal in Montana has been debated ever since. “There is just no right to medical aid in dying in Montana, at least no right a patient can rely on, like in the other states,” said former state Supreme Court Justice Jim Nelson. “Every time a physician does it, the physician rolls the dice.”
• What is physician aid in dying Michael J. Strauss and Terri L Hill, Marylanders for End-of-Life Options, Maryland State Medical Society, Jan 2019) A clear explanation and defense.
• What is Medical Assistance in Dying? (MAiD) (FAQs, Ottawa Hospital, Canada) Medical Assistance in Dying (MAiD) is a procedure in which a patient is given medications to intentionally and safely end their life. Federal law Bill C-14 governs who is eligible for MAiD, and the processes under which a patient can receive it. Click on FAQs to get answers to frequent questions.
• In the face of death: How a Seattle man celebrated his life, then ended it (Gene Johnson, AP, in Seattle Times, 8-25-19) The day he picked to die, Robert Fuller had the party of a lifetime. He was one of about 1,200 people who have used Washington’s Death with Dignity Act to end their lives in the decade since it became law. A human yet balanced story.
• Despite Sweeping Aid-In-Dying Law, Few Will Have That Option (Robin Marantz Henig, Shots, NPR, 10-7-15)

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• At 94, she was ready to die by fasting. Her daughter filmed it. (Tara Bahrampour, WaPo, 11-3-19) After Rosemary Bowen, 94, incurred a spine injury, she decided to terminate her life by fasting and asked her daughter, Mary Beth, to document her final days: 'Leaving life on my own terms.'
• Dying Is Now a Choice (Breena Kerr, Hawaii Business, 11-6-18) Hawaii’s Medical Aid in Dying law takes effect Jan. 1, but some doctors are among the local professionals who are not ready to deal with the law. A good discussion of the issues raised by legalizing physician-assisted death. See also Alyssa Thurston's Physician-Assisted Death: A Selected Annotated Bibliography.
• AMA contradicts itself by passing resolution saying medical aid in dying is unethical, but ethical doctors can practice it (News, Compassion and Choices, 6-10-19) Opposition to practice at odds with leading AMA member societies that provide care for dying patients. “Leading AMA member societies that provide care for dying patients have adopted value-neutral terminology to describe medical aid in dying,” said Dr. Grube. “Yet, sadly the AMA ignores this fact and clings to ‘physician-assisted suicide’ despite its Council on Ethical and Judicial Affairs’ admitting the term has ‘negative connotations.’”
• ‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day (JoNel Aleccia, KHN, 8-14-18) Last November, doctors told McQ he had six months or less to live. The choice, he said, became not death over a healthy life, but a “certain outcome” now over a prolonged, painful — and “unknowable” — end. “I’m not wanting to die,” he said. “I’m very much alive, yet I’m suffering. And I would rather have it not be a surprise.” More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues — including, this year, Hawaii — it has remained controversial. Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show. Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016. “It’s really tough to be alive and then not be alive because of your choice,” she said. “If he had his wish, he would have died in his sleep.”
• It’s not pain but ‘existential distress’ that leads people to assisted suicide, study suggests (Ariana Eunjung Cha, Washington Post, 5-26-17) A study released "in the New England Journal of Medicine suggests the answers may be surprising: The reasons patients gave for wanting to end their lives had more to do with psychological suffering than physical suffering....“It's what I call existential distress,” explained researcher Madeline Li, an associate professor at University of Toronto. “Their quality of life is not what they want. They are mostly educated and affluent — people who are used to being successful and in control of their lives, and it’s how they want their death to be.” "One of the main things these patients bring up has to do with 'autonomy.' It's a broad philosophical concept that has to do with being able to make your own decisions, not being dependent on others, wanting to be able to enjoy the things you enjoy and wanting dignity." “'For the terminally ill like Brittany, it's not a choice between not living and dying. The fact that she would die is a given. It was about the manner in which a person will die. She was literally been tortured to death. What she wanted was having the option to pass away gently,' he said."

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• Another Word for It (I highly recommend this essay by Alison Lester, about her father's death in 2010). Lester writes of this essay (in a comment about a RadioLab podcast, The Bitter End) "My father owned the way he wanted to die in a way that had us all in awe." Lester's essay "covers what it was about him that made it possible for him to decide how to end his life and see that decision through, and what it required from us as a family. It is my fervent hope that this account of his death can help people facing similar situations."
• Medical Assistance in Dying: Our Lessons Learned (Kieran L. Quinn and Allan S. Detsky, JAMA Internal Medicine, Sept. 2017. Abstract) 'On February 6, 2015, the Supreme Court of Canada struck down the prohibition of physician-assisted dying and ordered the federal parliament to enact legislation to allow it within 12 months.... This act made it legal for physicians to provide assistance in dying to individuals in an advanced state of irreversible decline whose natural death was “reasonably foreseeable.” Canada’s health care system rapidly developed protocols for Medical Assistance in Dying, which became known by its acronym, MAID.'
• She’s Accused of Texting Him to Suicide. Is That Enough to Convict? (Jess Bidgood, NY Times, 6-6-17) To what extent can one person be responsible — and criminally liable — for the suicide of another person?
• It’s Time to Reinvigorate the Constitutional Claim for Physician Assistance in Dying (Norman L. Cantor, Bill of Health, Harvard Law, 4-30-18) A rational approach to the subject.
• Online Talk, Suicides and a Thorny Court Case (Monica Davey, NY times, 5-13-10) 'Groups that work to prevent suicide compare suicide chat rooms to “pro-ana” sites, Internet sites that portray anorexia as a lifestyle as opposed to a disease. Anti-suicide advocates say that there has been more than one instance recently where a person killed himself on a Webcam as others watched. Papyrus, a charity in Britain that works to stop young people from killing themselves, says it has tracked 39 cases in that country alone where young people committed suicide after visits to “pro-suicide” chat rooms.'

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• Bullying, Suicide, Punishment (John Schwartz, NY times, 10-2-10) What should the punishment be for acts like cyberbullying and online humiliation? “Those students who are face-to-face bullied, and/or cyberbullied, face increased risk for depression, PTSD, and suicidal attempts and ideation,” Professor Blumenfeld said. For all the talk of cyberbullying, the state statute regarding that particular crime seems ill suited to Tyler Clementi’s suicide.
• When my time comes, I want the option of an assisted death (Archbishop Desmond Tutu, WaPo editorial, 10-6-16) "I have been fortunate to have long spent my time working for dignity for the living. Now, with my life closer to its end than its beginning, I wish to help give people dignity in dying. Dying people should have the right to choose how and when they leave Mother Earth. I believe that, alongside the wonderful palliative care that exists, their choices should include a dignified assisted death."
• Freedom to kill, permission to die (Kathleen Parker, WaPo, 6-10-16) "I’d like to have the means to end my own life on my own terms when my body has clearly called it quits. I’m just not sure I like the idea of the state and doctors lending a hand."
• Lawsuit Seeks to Legalize Doctor-Assisted Suicide for Terminally Ill Patients in New York (Anemona Hartocollis, NY Times, 2-3-15) A group of doctors and terminally ill patients are asking New York courts to declare that doctor-assisted suicide is legal and not covered by the state’s prohibition on helping people take their own lives. Assisted suicide — advocates prefer the term “aid in dying” — is legal in only a few states, including Montana, Washington, New Mexico, Oregon and Vermont. The author lays out the arguments for and against.
• Cancer Patients and Doctors Struggle to Predict Survival (Amanda Aronczyk, Shots, NPR, 2-10-15) "...prognoses are almost never that clear-cut, despite the fact that patients need to make big decisions based on those numbers. Should she quit her job? Take that dream cruise? Write a living will? Physicians play a part in the confusion, too. Doctors consistently overestimate how long a patient has to live... And if patients think a doctor is doing a good job of communicating with them, they're more likely to be erroneously optimistic about a cure. That can keep patients from fulfilling key goals before they die."...Sometimes a family's desire to "think positive" can make people reluctant to bring up death or dying. "And the end result is that the patient is left alone with his fear of dying and he can't speak to anyone about it." Levin also wants the doctors to make it clear to their patients that they will not abandon them if the worst-case scenario comes to pass.

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• Sharlotte Hydorn of GLADD exit bags dies at 94 (Faye Girsh, ERGO, Assisted Dying blog, 12-13-13) "...she did so much to give people around the world the comfort and reassurance of a peaceful death by making and distributing her GLADD exit bags. GLADD = Good Life and Dignified Death." A story in which it's not always clear who the good guys are.
• A Candid Conversation with Public Radio's Diane Rehm (Part 1). Public radio host Diane Rehm‘s new book “On My Own” details her husband’s battle with Parkinson’s Disease, and her decision to support “right to choose to die,” as she puts it, after John Rehm was denied assisted suicide and starved himself to death. In the first of a two-part interview, Here & Now’s Robin Young speaks with Rehm about her often fraught marriage and her husband’s illness. Part 2, an excerpt from Rehm's book On My OwnWhen John Rehm could not legally receive medically aid to die comfortably (his state didn't allow it), he followed his doctor’s suggestion and starved himself to death. The experience set Rehm on a path to better understanding medically assisted death, which is only legal in a handful of states.
• The terminal confusion of Dignity in Dying (Jenny McCartney, The Spectator, UK, 7-5-14) The closer you look at the campaign in the UK to legalize assisted dying, the less reassuring it all becomes. What is this clause of ‘six months or less’ to live? As most doctors know, such diagnoses can be deeply unreliable. And by what logic do we attach an ‘assisted death’ to a six-month prognosis but not, say, that of a year?... If you were around in the days when the US series M*A*S*H was a regular feature on British television, its sing-song theme is probably still lodged in your memory: ‘Suicide is painless/ It brings on many changes/ And I can take or leave it if I please’. However catchy, it is broadly untrue. The human life force is stubborn, and it takes a visceral struggle to extinguish it. Suicide, as commonly practised by amateurs, is not painless: it is frequently agonising, complicated, botched and has ample potential to leave one still alive but with a cruel legacy of permanently damaged health to add to one’s existing woes.

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• The right to regret by Kathleen Parker. "Freedom to kill, permission to die." I’d like to have the means to end my own life on my own terms when my body has clearly called it quits. I’m just not sure I like the idea of the state and doctors lending a hand....Will the right to die ultimately be considered as just another facet of “health care,” as abortion is? And when do six months become a year? A novelist would propose that it’s just a matter of time before a glut of elderly people in poor health, who are by definition 'terminal,'; so overwhelm the health-care system that 'opting out' becomes an expectation rather than a choice."
• Does Life Insurance Cover Suicide? (Christian Simmons, Retire Guide) "Life insurance typically will not cover suicide if the death occurs within the first two years of the policy. In those circumstances, the insurance company may just refund the premiums you have paid. A suicide may still be covered by life insurance if it occurs more than two years into the policy."
• Assisted suicide compromise (Arthur Caplan and Wesley J. Smith, USA Today, 11-13-14). As matters stand, the law requires patients considering hospice to make an awful choice. In exchange for insurance paying for hospice care — which focuses on pain control, symptom management and social support — the patient must forgo all other forms of treatment. As Ira Byock says, "A third of all U.S. hospice patients die within a week of being admitted. Thus, because of the 'terrible choice' Medicare rules impose, hospice is not doing end-of-life care as much as brink-of-death care."

• My right to death with dignity at 29 (Brittany Maynard, CNN Opinion, 10-7-14). Note that what makes her feel better is knowing she has a choice.
• Physician-Assisted Dying: Compassion or a Slippery Slope? (Roxanne Nelson, Medscape, 8-13-15) This piece draws on two reports, one from the Netherlands and one from Belgium, the first countries to legalize these practices.
• The End Is Near: Lawrence Egbert has replaced Jack Kevorkian as the face of assisted suicide in America. (Manuel Roig-Franzia, Wash Post Magazine, 1-19-12) He has helped about 300 people die but, he says, "I never get used to it." A thoughtful piece, which explains death by helium, among other things.
• ‘Aid in Dying’ Movement Takes Hold in Some States Erik Eckholm, NY Times, 2-7-14) "Helping the terminally ill end their lives, condemned for decades as immoral, is gaining traction. Banned everywhere but Oregon until 2008, it is now legal in five states....About 3,000 patients a year, from every state, contact the advocacy group Compassion & Choices for advice on legal ways to reduce end-of-life suffering and perhaps hasten their deaths."
• Politics: Democrats Shouldn’t Endorse Suicide (Dr. Ira Byock, Politico, 6-7-15) "For years it seemed like we were on a path to a future in which every person could be assured of comfort and having their dignity honored through the very end of life. Unfortunately, countervailing forces, chief among them the profit motive, supervened. Instead of transforming mainstream health care to become genuinely person-centered, hospice, palliative medicine and geriatrics are largely being absorbed within corporatized medicine." "Despite having the resources and technical know-how to reliably care well for people through the end of life, a persistent public health crisis surrounds the way we die." "An authentic, socially sound solution to this crisis is readily achievable if we can muster the will to demand it. A tectonic shift in the way healthcare is paid for—from financially rewarding quantity of services to measured quality of care delivered—has the potential to improve care for seriously ill people in transformative ways."

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• Hoping To Live, These Doctors Want A Choice In How They Die (Anna Gorman, Kaiser Health News, 3-30-15) The American Medical Association still says that “physician-assisted suicide is fundamentally incompatible with the physician’s role as healer.” ... But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier." One doctor's story.
• Contemplating Brittany Maynard's Final Choice (Nancy Shute, Shots, NPR, 11-3-14) "...a study published last year in the New England Journal of Medicine found that just 16 percent of 114 terminal cancer patients who had asked about assisted suicide at the Seattle Cancer Care Alliance eventually decided to kill themselves....The most common reason people gave for considering assisted suicide was fear of a loss of autonomy."
• Quebec's 'dying with dignity' law would set new standards (Janet Davison, CBS News, 2-17-14) Quebec's proposed Bill 52 follows Europe's lead, legalizing both physician-assisted suicide and voluntary euthanasia for those experiencing "unbearable suffering," but who may not be within months of dying, which is the U.S. criterion. Related story: The fight for the right to die (CBS News, 6-15-12)
• A Life-or-Death Situation (Robin Marantz Henig, NY Times magazine, 7-17-13). Behind the Cover Story: Robin Marantz Henig on Making End-of-Life Decisions (and Changing Your Mind) (Rachel Nolan's interview appeared 7-22-13)
• Assisted Suicide (American Psychological Association). Arguments for and against and what experience in Oregon and Amsterdam teaches.
• In Alzheimer’s Cases, Financial Ruin and Abuse Are Always Lurking (Paul Sullivan, NY Times, 1-30-15) A woman in good health may express clear wishes about wanting to end a prolonged dying, but once Alzheimer's takes hold, she may not have the ability to end it herself. And children don't always honor their parents' wishes. Be sure to read this article.
• Happy Endings: In Real Life, Mystery Writer Promotes Assisted Death (Elihu Blotnick, Stanford Magazine, 11-8-12). At 82, Merla Zellerbach has been reborn as a mystery writer. Her culprits always get their just deserts, but her “main concern is with the needless suffering of those who don’t know they have choices, don’t want to know for religious or other reasons, or who don’t have access to aid in dying.” She explains: “I saw my beloved father die a terrible death from pancreatic cancer, and I also saw my late husband Fred die pain-free and peacefully, with physician help. After those two experiences, I began delving into the mysteries of life and death.”
• Assisted Suicide — Murder or Mercy? by Ellen Hawley Roddick (Open Salon, 2010). "Do I believe in assisted suicide? You bet I do. And here ... is why."
• Assisted-suicide laws advance, but issue still divides Americans (gperreault, ReligionLink, 7-7-13, with extensive links to other stories and sites)

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• Who’ll be in charge when we die? (Ashton Applewhite's excellent essay on the need for an advocate who will know what we want and realize that we might change our minds, on the blog, Yo, Is This Ageist? on her website on ageism, This Chair Rocks)
• New Trial Ordered for Man Who Helped a Long Island Motivational Speaker Kill Himself (Russ Buettner, NY Times, 10-3-13). The state penal code allows an assisted suicide defense in a murder case if the defendant only caused or aided another person to commit suicide “without the use of duress or deception.” Things can go terribly wrong.
• Hemlock Society (now Compassion & Choices)providing information about options for dignified death and legalized physician aid in dying
• 'The Last Good Nights'. (John West tells Diane Rehm and radio listeners why and how he assisted his parents with their suicides. He offers a first-hand account of the decision no child wants to face and explains why he followed through on his parent's desire to choose death with dignity. He also tells the story in his book The Last Goodnights: Assisting My Parents with Their Suicides Here is an excerpt (Good Morning, America)
• Tread Carefully When You Help to Die: Assisted Suicide Laws Around the World (Derek Humphrey, author of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying (Euthanasia Research and Guidance Organization, ERGO, which publishes other books on the subject)
• Hans Kueng Considering Assisted Suicide As Parkinson's Disease Suffering Continues (Tom Heneghan, Reuters, Huff Post 10-4-13) Roman Catholicism's best known rebel theologian is considering capping a life of challenges to the Vatican with a final act of dissent--assisted suicide.
• Doctor-Assisted Suicide Is Moral Issue Dividing Americans Most (Gallup poll, 5-31-11)
• Cancer center goes public with assisted-suicide protocol (Kevin O'Reilly, American Medical News, 4-22-13)
• Getting the Freedom to Die (Roy Speckhardt, director, American Humanist Association, on HuffPost, 04/16/2013, with stories about recent cases)
• In Montana, New Controversy Over Physician-Assisted Suicide (Paula Span, NY Times, New Old Age blog, 4-15-13)
• Assisted Suicide . Wikipedia's entry distinguishes between "assisted suicide" (where one person helps another end his life) and "euthanasia" or "mercy killing" (where another person ends the life). Indicates what the laws are in various countries and U.S. states.
• Why Do Americans Balk at Euthanasia Laws? (Room for Debate, NY Times, 4-10-12) What would need to change before the U.S. would legalize physician-assisted suicide?
---Comfort and Familiarity
---Too Many Flaws in the Law (Marilyn Golden, a senior policy analyst at the Disability Rights Education and Defense Fund)
---How the Dutch Are Different (Petra M. de Jong, a pulmonologist and head of Right to Die Netherlands)
---Address Inequalities First (Patricia King, the Carmack Waterhouse professor of law, medicine, ethics and public policy at Georgetown Law)
---Skeptical of the System (Rita L. Marker, a lawyer and executive director of the Patients Rights Council)
---The Role of Religion in the U.S. (Philip Nitschke, author of The Peaceful Pill Handbook)
---A Recipe for Elder Abuse (Margaret Dore, a lawyer in Washington State and president of Choice is an Illusion, a nonprofit organization opposed to assisted suicide)
---The Power of the the Culture War (Jacob Appel, a doctor and lawyer in New York City)

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Death with Dignity

("right to die," "assisted dying," "aid-in-dying," "assisted suicide," and "medical aid in dying")
'An assisted dying law would not result in more people dying, but in fewer people suffering."

Two national U.S. organizations, Compassion & Choices and Death with Dignity, advocate and provide information about death with dignity and right to die laws. Find out what the laws are in your state, and learn more from the articles below.
• State laws regarding assisted suicide in the United States Useful Wikipedia map.
• Understanding Medical Aid in Dying (Compassion & Choices) A trusted and time-tested medical practice that allows a terminally ill, mentally capable adult with a prognosis of six months or less to live to request from their doctor a prescription for medication they can decide to self-ingest to die peacefully in their sleep. Medical aid in dying is sometimes incorrectly referred to as “assisted physician suicide,” “physician aid in dying,” “death with dignity,” and “euthanasia.” Medical aid in dying is not assisted suicide, suicide, or euthanasia. Compassion & Choices has led or supported campaigns to authorize medical aid in dying and implement this medical practice in 10 jurisdictions.
• Diane Rehm tackles ‘death with dignity’ again, this time in a documentary (Katherine Ellison, Washington Post, 4-8-21) A Q&A with Diane. The video When My Time Comes chronicles the investigation of NPR’s Diane Rehm into the right-to-die movement in America.

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• The Last Day of Her Life (Robin Marantz Henig, New York Times Magazine, 5-14-15) When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when? (Read this beautiful story with a tissue on hand.)
• Choosing your own exit. For some who are terminally ill, hastening their own death may be the answer. (Samuel P. Harrington, WaPo, 11-18-18)
• At 94, she was ready to die by fasting. Her daughter filmed it. (Tara Bahrampour, WaPo, 11-3-19)
• How Death with Dignity Laws Work This page is for patients and others interested in learning how death with dignity laws work. If you are a physician or a pharmacist seeking information about implementing these laws as a healthcare provider, including forms, see this page of Information for health care providers. Death with dignity laws allow qualified terminally-ill adults to voluntarily request and receive a prescription medication to hasten their death.
• Death with Dignity Acts (Deathwithdignity.org) "Death with Dignity laws, also known as physician-assisted dying or aid-in-dying laws, stem from the basic idea that it is the terminally ill people, not government and its interference, politicians and their ideology, or religious leaders and their dogma, who should make their end-of-life decisions and determine how much pain and suffering they should endure. Death with Dignity statutes allow mentally competent adult state residents who have a terminal illness with a confirmed prognosis of having 6 or fewer months to live to voluntarily request and receive a prescription medication to hasten their inevitable, imminent death."
• Death with Dignity Acts "Death with dignity laws, also known as physician-assisted dying or aid-in-dying laws, stem from the basic idea that it is the terminally ill people, not government and its interference, politicians and their ideology, or religious leaders and their dogma, who should make their end-of-life decisions and determine how much pain and suffering they should endure.
"Death with dignity statutes allow mentally competent adult state residents who have a terminal illness with a confirmed prognosis of having 6 or fewer months to live to voluntarily request and receive a prescription medication to hasten their inevitable, imminent death."

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• Gov. Mills’ explains Death with Dignity Act support (posted on Fosters.com, 6-14-19) The very thoughtful comments Maine Gov. Janet Mills offered June 12 when signing LD 1313, Maine's Death With Dignity Act. The law establishes the procedures to allow those with a terminal illness and a short time to live to be prescribed medication to end their life. See also Mills Signs 'Death With Dignity' Bill Into Law (Steve Mistler, Main Public, All Things Considered with Nora Flaherty, NPR, 6-12-19) Maine Gov. Janet Mills agonized over a decision to join Maine with seven other states that allow terminally ill patients to end their lives with medication. And, like many of the lawmakers who grappled with the morality of a measure dubbed "death with dignity" by supporters and "assisted suicide" by opponents, the governor says she made her decision based on a legal review of an issue that encompasses the rights of self-determination and government-sanctioned suicide.
• ‘No One Is Ever Really Ready’: Aid-In-Dying Patient Chooses His Last Day (JoNel Aleccia, KHN and NBC News, 8-14-18) More than 3,000 people in the U.S. have chosen such deaths since Oregon’s law was enacted in 1997, according to state reports. Even as similar statutes have expanded to more venues, it has remained controversial. Supporters say the practice gives patients control over their own fate in the face of a terminal illness. Detractors — including religious groups, disability rights advocates and some doctors — argue that such laws could put pressure on vulnerable people and that proper palliative care can ease end-of-life suffering. Data from Oregon show that the median time from first request to death is 48 days, or about seven weeks. But it has ranged from two weeks to more than 2.7 years, records show. Neurodegenerative diseases like ALS are particularly difficult, said Dr. Lonny Shavelson, a Berkeley, Calif., physician who has supervised nearly 90 aid-in-dying deaths in that state and advised more than 600 patients since 2016. “It’s a very complicated decision week to week,” he said. “How do you decide? When do you decide? We don’t let them make that decision alone.” Along with the pain, the risk of losing the physical ability to administer the medication himself, a legal requirement, was growing. He could lose his window of opportunity.

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• Religion and Spirituality (Death With Dignity) Summaries of viewpoints of the differing faith traditions on Death with Dignity.
• Assisted suicide is controversial, but palliative sedation is legal and offers peace (Michael Olove, WaPo, 7-30-18)
• My Right to Die: Assisted suicide, my family, and me. (Kevin Drum, Mother Jones, Jan./Feb. 2016) Framed by a particular story, this is an excellent overview of the social and legal (U.S.) history of assisted suicide, physician-assisted suicide, aid-in-dying, right to die legislation. Will assisted suicide be the next civil rights battle? Drum faces the issue himself, as little by little multiple myeloma resists his battle against it. "My choice has always been clear: I don't want to die in pain—or drugged into a stupor by pain meds—all while connected to tubes and respirators in a hospital room. When the end is near, I want to take my own life. ... I suspect that taking your own life requires a certain amount of courage, and I don't know if I have it. Probably none of us do until we're faced with it head-on." The piece concludes: 'When he signed California's right-to-die bill, Gov. Brown attached a signing statement. "I do not know what I would do if I were dying in prolonged and excruciating pain," he wrote. "I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others."
• How Death with Dignity Laws Work (Death With Dignity) "Death with dignity laws allow qualified terminally-ill adults to voluntarily request and receive a prescription medication to hasten their death." As of January 1, 2019, these states have death with dignity statutes: California, Colorado, District of Columbia, Hawaii, Oregon, Vermont, and Washington. "In Montana, physician-assisted dying has been legal by State Supreme Court ruling since 2009." On this page, the processes to hasten death are explained.
• I’m dying, and I’d like D.C.’s Death with Dignity Act to help (Mary Klein, OpEd, WashPost, 4-6-18) "I would like the option of medical aid in dying, which is authorized under D.C.’s Death with Dignity Act and that took effect in February 2017 for those terminally ill patients who meet strict requirements. The law allows mentally capable terminally ill adults with six months or less to live to get prescription medication they can decide to take if the suffering becomes unbearable, so they can die peacefully in their sleep, at home, surrounded by loved ones....March 23 also was the 20th anniversary of the first prescription for medical aid in dying in the nation, under the Oregon Death With Dignity Act, the model for medical aid-in-dying laws in the District and five other states.

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• Final Exit Network Q&A Q&A concerning your questions on death-with-dignity, Final Exit Network, and related topics. Q1: When and where did the modern voluntary euthanasia movement start? Answer: In 1935 in Britain, in 1938 in the U.S., and in 1980 in Canada. The British and North America groups were very small and insignificant for the next two decades. Derek Humphry is credited with kick-starting the modern euthanasia movement in America in 1980 when he started the Hemlock Society. Derek Humphry is author of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying.
• Good Life, Good Death (watch and listen to Humanist Society teleconference, 55 minutes) In this presentation, Dr. Martin Seidenfeld of the Final Exit Network (voice and visuals) discusses the very practical issues involved when suffering persons want to exercise their right to determine their own deaths, and how The Final Exit Network works with qualified people to achieve death with dignity.
• The Prison Where Inmates Help Each Other Die With Dignity (Maura Ewing, Jeremy Leung, Narratively, 3-23-17) More Americans are dying behind bars than ever before. At one correctional facility (Osborn Correctional Institution, a medium-security prison in northern Connecticut), volunteer death-doulas offer care and comfort to their fellow prisoners. "The mantra of hospice is “death with dignity.” It is a comfort-oriented approach to death in which quality of life is deemed as important as the number of days the patient has left. Pain management is a priority, and unlike the sterile anonymity of a hospital, hospice patients die at home or in a place that feels like home, surrounded by family. Hospice care is meant to address not just the physical needs of the dying, but their mental and emotional needs as well. Osborn’s hospice may not be as cozy as a living room, but it is a definite step up from a cell or the general medical ward down the hall. Many inmates don’t have family who are willing or able to spend their last weeks, or days, with them. So in addition to medical duties, the inmate volunteers serve as a stand-in family."
• After Colorado, ‘Right To Die’ Movement Eyes New Battlegrounds (Melissa Bailey, Kaiser Health News, 11-9-16) Fortified by a solid victory in Colorado Tuesday, a controversial campaign to let terminally ill patients access life-ending medication is moving on to other battlegrounds across the country. An overview of where such campaigns stand.'
• Support Death with Dignity (Compassion & Choices) Nearly 7 in 10 Americans support giving terminally ill, mentally competent adults the option to access life ending drugs, yet it is not authorized in 45 states.

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• Death With Dignity Should Not Be Equated With Physician Assisted Suicide (Peter Ubel, Forbes, 8-26-13)
• Death with Dignity and Palliative Care (Melissa Barber, Living with Dying blog, Death with Dignity National Center, 8-28-13).
• The Dying of the Light (Craig Bowron, Washington Post, 1-11-09) This isn't about euthanasia. It's not about spiraling health care costs. It's about the gift of life -- and death. It is about living life and death with dignity, and letting go. ...At some point in life, the only thing worse than dying is being kept alive.
• Aid-in-Dying Laws Are Just a Start (Katy Butler, Opinionator, NY Times, 7-11-15) "In the hour of our deaths, most of us will yearn not to cut short our time but for a “soft technology” of compassion, caring and interpersonal skill... To truly die with dignity, we will need good nursing, practical support, pain management and kindness. All should be better reimbursed by Medicare."
• Unplugged: Reclaiming Our Right to Die in America by William H. Colby. As the tragic life and death of Terri Schiavo so poignantly illustrated, universal definitions of life, death, nature, and many other concepts are elusive at best. Unplugged addresses the fundamental questions of the right-to-die debate and discusses how the medical advances that bring so much hope and healing have also helped to create dilemmas.
• 111 people died under California's new right-to-die law (Ben Tinker, CNN, 6-28-17) Between June 9 and December 31, 2016, 258 people initiated the process, according to the report. One hundred ninety-one people were prescribed the lethal medication, of which 111 patients "were reported by their physician to have died following ingestion of aid-in-dying drugs prescribed under EOLA....The majority of the 111 people who utilized the law were cancer patients, according to the report....In California, a mentally capable adult is eligible to partake in the End of Life Option Act if he or she is determined to have a terminal illness -- meaning they have six months or less to live. The patient must make two verbal requests of their doctor, at least 15 days apart, as well as one written request. The patient must affirm his or her request 48 hours before ingesting the medication, which they must be able to self-administer, without the help of a physician, family member or friend....Physician-assisted aid-in-dying is different from euthanasia (commonly referred to as physician-assisted suicide), which is illegal in all 50 states. Aid-in-dying advocates such as former California state Sen. Lois Wolk and state Sen. Bill Monning -- who co-authored the End of Life Option Act -- dislike the term "suicide," because it implies an impulsive and irrational act."

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• My right to death with dignity (Brittany Maynard, CNN, 10-7-14) Diagnosed with terminal cancer, turning 30, a young woman chooses to die on her own terms, "Having this choice at the end of my life has become incredibly important. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty and pain."
• My Decision to Die: A terminal cancer patient's controversial choice (Nicole Weisensee Egan, People, 10-27-14) Headline: Terminally Ill Brittany Maynard: Why I'm Ending My Life in Less Than Three Weeks. Maynard, 29, has terminal brain cancer and has made plans to end her own life with the sedative Secobarbitol on Nov. 1 if her suffering becomes too much to handle. See links to more stories about this death-with-dignity advocate on website for The Brittany Maynard Fund. "With one six-minute video, Brittany Maynard started a global conversation about death with dignity."
• Long Legal Battle Over as Schiavo Dies (Manuel Roig-Franzia, Wash Post, 4-1-05) Florida Case Expected To Factor Into Laws For End-of-Life Rights
• Death with Dignity: The Oregon Experience by Susan Hedlund (Association for Death Education and Counseling, or ADEC)
• Why Americans Can't Die With Dignity (Mother Jones, 9-7-13) Katy Butler on overtreatment, end-of-life suffering, and the need for a Slow Medicine movement.

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End-of-life decision-making

Resources for when terminal or life-threatening illness requires decisions about what individuals, families, and professional caregivers should do
• Five Wishes lets your family and doctors know:
---Who you want to make health care decisions for you when you can't make them.
---The kind of medical treatment you want or don't want.
---How comfortable you want to be.
---How you want people to treat you.
---What you want your loved ones to know.
• What an End-of-Life Adviser Could Have Told Me (Jane Gross, The New Old Age, NY Times, 12-15-08). "If only I’d had the 800 number for Compassion & Choices in the last difficult months of my mother’s life."'
• Compassion and Choices (supports, educates and advocates for choice and care at the end of life -- improving pain and palliative care, enforcing living wills and advance directives, and legalizing aid in dying). See Answers to common end-of-life questions (Compassion & Choices, scroll down)
• Where You Live May Determine How You Die. Oregon Leads the Way. (JoNel Aleccia, KHN, 3-15-17) Americans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests. Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country. Across the U.S., there’s been a push to promote ways to indicate end-of-life treatment preferences, including advance directives, which provide guidance for future care, and Physician Orders for Life-Sustaining Treatment, or POLST, portable medical orders authorizing current care. Twenty-two states now have POLST programs and others are working on or considering them...But the researchers warned that, while POLST efforts are important, simply filling out the forms is not enough. “We were highlighting that there’s no simple answer,” Tolle said. “You can’t just do one thing and think that you will change the culture of end-of-life care. It is a whole lot of work.” ...a focus on single interventions ignores the complexity of end-of-life decisions....“The level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes,”
• The enemy is not death. The enemy is needless suffering. (oncologist James C. Salwitz, Kevin MD, 5-24-16) The final part of life is about being alive, not about death. Only by seizing those precious moments, deciding our own fate, can we hope for quality, comfort, and dignity.

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• At the End of Life, More Americans Are Dying at Home (Gina Kolata, NY Times, 12-11-19) In a historic reversal, fewer patients are dying in hospitals. But experts warn that many families are unprepared to care for seriously ill relatives at home. And hospice care, usually delivered at home, is more available than ever before. But many terminally ill patients wind up in the care of family members who may be wholly unprepared for the task.
• No easy end-of-life decisions, even for a family of doctors (Luanne Rife | The Roanoke Times, 9-11-17) "They recognize that they were blessed with a large, involved family that could balance the workload of caring for a terminally ill parent, the wealth to afford trained caregivers to ease the strain, and, for many of the siblings, the medical training that allowed them to understand and manage the disease process. Still, the shroud of exhaustion settled upon them, and the siblings differed on when to cease medical interventions with their father. Son Dr. Bob Keeley: “It’s like riding the crest of a wave. You either catch it or you don’t, and everything had to be perfect for him to get better.” The decision to turn to hospice was easier with their mother, but it didn’t ease the angst of turning off her pacemaker and withholding food, water and medication or of agreeing on what was needed to ease her pain."
• When Prolonging Death Seems Worse Than Death (Fresh Air from WHYY, 10-11-12). Terry Gross interview Judith Schwarz, who helps dying patients and their families decide whether and how to hasten the end. Compassion & Choices is an organization that helps terminally ill patients and their families make informed and thoughtful end-of-life decisions. Schwartz discusses the practicalities of various choices.
• Silver Anniversary. Amy Schapiro's moving account of the three things Millicent Fenwick wanted to do before she died and how she did them.
• Choosing Wisely, an initiative of the ABIM Foundation to help providers and patients engage in conversations to reduce overuse of tests and procedures, and support patients in their efforts to make smart and effective care choices. See Choosing Wisely lists (resources for consumers and providers to engage in conversations about the overuse of medical tests and procedures that provide little benefit and in some cases harm):
---Clinician lists
---Patient-friendly resources

• In Plain Language: A Glossary Of Terms For End-Of-Life Planning (New Hampshire Public Radio, 8-28-13)
• Knocking on Heaven's Door: The Path to a Better Way of Death by Katy Butler. An expertly reported memoir and exposé of modern medicine that leads the way to more humane, less invasive end-of-life care—based on Butler’s acclaimed NY Times Magazine piece What Broke My Father’s Heart. Against a backdrop of familial love, wrenching moral choices, and redemption, Butler celebrates the inventors of the 1950s who cobbled together lifesaving machines like the pacemaker—and she exposes the tangled marriage of technology, medicine, and commerce that gave us a modern way of death: more painful, expensive, and prolonged than ever before.
• Oregon Emphasizes Choices at the End of Life (Kristian Foden-Vencil, Shots, NPR Health News, 3-8-12) It turns out Americans facing death want something they also want in life: choice. A two-page form created in Oregon is providing insight into how people want to be cared for at the end of their lives. And the so-called POLST form — short for Physician Orders for Life-Sustaining Treatment — offers far more detailed options than a simple "do not resuscitate" directive does.
• An Impossible Choice: Deciding When a Life Is No Longer Worth Living ( Joanne Faryon, inewsource, ) An award-winning article by an investigative reporter -- a rare look inside a subacute unit in Coronado, Calif., one of hundreds statewide that house more than 4000 life-support patients. Berger award description: Their groundbreaking story looks at “vent farms,” the 125 care facilities across the state of California housing 4,000 patients being kept alive by machine. This number has doubled in the past decade due to advances in medicine. Many of these people appear to have no cognitive ability. All would perish if the machines were turned off. The number of people kept alive by artificial means has nearly doubled in the past decade. The average age of people who live in subacute care is 56. Subacute made so much money it subsidized the hospital’s emergency room and surgical unit. One week on life support can cost more than an entire year of health care for the average person enrolled in Medi-Cal.
• PolitiFact's Lie of the Year: 'Death panels' (Angie Drobnic Holan, PolitiFact, 12-18-09) How two words generated intense heat in the national debate over health care.
• A Family Says 'Enough' (Paula Span, Health, NY Times, 9-12-13). Before you agree to that pacemaker, know how hard it might be to undo. Deactivating an implanted cardiac device is neither euthanasia nor assisted suicide, and a doctor who feels morally unable to do it should find a colleague willing to help. The end of Katy Butler's story.

• The Conversation Project (important discussions families need to have later in life)
• The Conversation: A Family's Private Decision (ABC News)
• The Best Possible Day (Atul Gawande, NY Times, 10-5-14) If you are dying, how do you want to spend your time? People who are seriously ill might have different needs and expectations than family members predict, "Hospice’s aim, at least in theory,... is to give people their best possible day, however they might define it under the circumstances." Asking the right questions might help us figure out how to make such the best possible day happen.

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• Being Mortal: Medicine and What Matters in the End by Atul Gawande. “A deeply affecting, urgently important book—one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.” —Katherine Boo
• Our unrealistic views of death through a doctor's eyes (Craig Bowron, Washington Post, 2-17-12) When 'we did all we could' is the worst kind of medicine." In elderly patients with a web of medical conditions, the potential complications of any therapy are often large and the benefits small....At a certain stage of life, aggressive medical treatment can become sanctioned torture.
• Too much intervention makes patients sicker (Aseem Malhotra, The Guardian, 7-19-14) A culture of over-investigation and over-treatment is now one of the greatest threats to western health...Even respected medical guideline panels appear to be influenced by corporate interests....a campaign known as Choosing Wisely is gaining momentum in the US. Part of the campaign involves communicating with patients that more expensive medicine doesn't necessarily mean better medicine. And this is reflected by the evidence that four fifths of new drugs are later found to be copies of old ones – not surprising perhaps when pharmaceutical companies spend twice as much on marketing new medications as on research.... Sometimes "doing nothing is the best approach. Questions such as: do I really need this test or procedure? What are the risks? Are there simpler safer options? What happens if I do nothing? And even how much does it cost?"
• Is Dying at Home Overrated? (Richard Leiter, M.D., NY Times, 9-3-19) A palliative care physician struggles with the complex realities of dying at home, and the unintended consequences of making it a societal priority. "Unless a family has the significant resources necessary to hire aides or nurses, informal caregivers become responsible for nearly everything — from feeding to bathing to toileting. These tasks often get harder as the dying person weakens....And the length of time a patient spends in hospice care is difficult to predict, sometimes requiring caregivers to take significant time away from work or other family members. Complicating matters, I frequently detect ambivalence in patients who tell me they want to die at home. "
• The case for slow medicine (Richard Smith, BMJ, 12-17-12) "The characteristics of health systems are complexity, uncertainty, opacity, poor measurement, variability in decision making, asymmetry of information, conflict of interest, and corruption....It is time, said Domenighetti, to open up the black box of healthcare."

• When Did We Get So Old? (Michele Willens, Sunday Review, NY Times, 8-30-14) For boomers, the “what, me, get old?” generation, denial of aging is an important and difficult issue to tackle. “I had almost always been the youngest through most of my career,” says the former media executive. “Now I was the oldest, and it caused great discomfort.”

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• The Right to Know, Then to Say ‘No’ (Jane Gross, New Old Age, NY Times 10-21-08)

• Letting Go (Atul Gawande, New Yorker, 8-2-10). What should medicine do when it can't save your life? Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.

*** How to Talk End-of-Life Care with a Dying Patient (video, Atul Gawande speaking at New Yorker festival, 10-12-10) An expert tells him what to ask patients about. Do they know their prognosis? What are their fears of what is to come? What are their goals--what would they like to do as time runs short? What tradeoffs are they willing to make? How much suffering are they willing to go through for the sake of added time? There is no checklist to mark off--instead, you need a series of conversations.

• Finding Liberation in Two Deaths (Jamie Brickhouse, The End, Opinionator, NY Times, 4-25-15, from his memoir, Dangerous When Wet) The last time I wished my mother dead, I meant it.... she was in what I now know were the final stages of Lewy body dementia." As one reviewer calls it, "a dark journey studded with gems of hilarity."

• Re-Examining End-Of-Life Care (Laura Knoy with guestsPatrick Clary – doctor at the New Hampshire Palliative Care Service in Portsmouth; John Loughnane – medical director at Commonwealth Community Care in Boston, on New Hampshire Public Radio 8-28-13)

• Planning For The End: When Courts Have To Make Medical Decisions (Todd Bookman, New Hampshire Public Radio 8-28-13)

• Planning For The End: Miraculous Recovery, Little Regret (Todd Bookman, NHPR 8-28-13)

• A Graceful Exit: Taking Charge at the End of Life (Claudia Rowe, Yes! magazine, 9-19-12) How can we break the silence about what happens when we’re dying? The best thing to come out of Compassion & Choices’ campaign (informed choices about how we die) may be a peace of mind that allows us to soldier on, knowing we can control the manner of our death, even if we never choose to exercise that power.

• Let's talk about dying (Peter Saul's TED talk, Nov 2011) We can't control if we'll die, but we can “occupy death,” says Dr. Peter Saul, an Australian intensive care doctor (intensivist) who is passionate about improving the ways we die. He calls on us to make clear our preferences for end of life care -- and suggests two questions for starting the conversation.

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• The Art of Dying: A Mind-Body Transformation by Danielle Schroeder (ADEC)

• When to Refer to Hospice by Lisa Wayman (ADEC)

• Compassion & Choices: Choice and Care at the End of Life, including the blog entry A dying patient is not a battlefield (by Theresa Brown)

• A dying patient is not a battlefield (Theresa Brown, CNN Opinion, 8-31-10) Brown is author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between

• Quiet deaths don't come easy (Melissa Healy, Los Angeles Times, 2-5-12) A study finds that Medicare patients near death are increasingly choosing hospice or palliative care over heroic measures in their last days — but that many go through futile hospitalizations and treatments first. "Doctors often fail to be clear about a patient's poor prognosis and to plainly state the likely consequences of continuing painful, aggressive care." If a patient's wish to avoid aggressive treatment is clear, "you need to prevent him from getting into that cycle of acute care," gerontologist Julie Bynum said, "because once they get into the hospital, it's really hard to get them out."

• More on end-of-life care and decision-making.

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Assisted dying and VSED (voluntarily stopping eating and drinking)

• A scientist just turned 104. His birthday wish is to die. (Lindsey Bever, WashPost, 4-30-18) "Goodall is set to travel more than 8,000 miles this week to Switzerland. That country, like most others, has not passed legislation legalizing assisted suicide, but under some circumstances its laws do not forbid it...For the past two decades, Goodall has been a member of Exit International, a nonprofit organization based in Australia that advocates for the legalization of euthanasia."
• Exit International
• Dignitas
• Dignitas links to other right-to-die and end-of-life organizations
• Links to videos/podcasts about death with dignity (Dignitas)
• Inside the Dignitas house (Amelia Gentleman, The Guardian, 9-18-09) More than 1,000 people have travelled to Switzerland to end their lives. But what is it really like inside the world's first assisted suicide centre?
• Assisted dying is not the easy way out (The Conversation, 2-18-20) "An assisted death is not the path of least resistance. For many, it is the path of most resistance. Those who pursue it face a range of barriers, at a time when their health is rapidly declining. Some patients navigate these waters successfully and manage to secure the coveted bottle of life-ending medication. Others give in to the opposition or simply run out of time."
• The True Cost: How the UK outsources death to Dignitas (Campaign for Dignity in Dying, UK) In the UK it is currently illegal to assist someone to die. As a result, many people travel to Switzerland to arrange an assisted death. One British person travels to Dignitas to die every 8 days. Using the voices of those most affected, we uncover the real stories behind the statistics. The cost of an assisted death in Switzerland is, for many, prohibitively expensive. Based on our calculations it costs anywhere between £6,500 to over £15,000 to have an assisted death in Zurich, where Dignitas is based. People who accompanied someone to Switzerland said that if assisted dying were legal in the UK their loved one would have died with more family and friends around them and with greater support from end-of-life care professionals. Read the full report on true costs.
• Death as a social privilege? How aid-in-dying laws may be revealing a new health care divide (The Conversation, 7-11-17) Aid-in-dying patients are more likely to be male, white, over 65 years old and with the minimum of a bachelor’s degree. As more states consider aid-in-dying laws and discussions around end-of-life options are growing, it is important to question the statistics and what they do and don’t reveal.
• Elderly couple got ‘deepest wish’ — to die together — in rare euthanasia case (Lindsey Bever, WashPost, 8-17-17) "They were both 91 years old and in declining health. Nic Elderhorst suffered a stroke in 2012 and more recently, his wife, Trees Elderhorst, was diagnosed with dementia, according to the Dutch newspaper, De Gelderlander. Neither wanted to live without the other, or leave this world alone....The Netherlands became the first country to legalize euthanasia in 2002, allowing physicians to assist ailing patients in ending their lives without facing criminal prosecution."
• The Last Thing Mom Asked (Sarah Lyall, NY Times, 8-31-18) I am not a doctor. I am not very brave. I’m also a resident of New York State, where assisted suicide is illegal. But I want to do what she wants.
• The neurosurgeon Henry Marsh on why assisted dying should be legalised Assisted dying is not euthanasia. It is about people making their own free choice that it’s time for their life to end, argues bestselling author Henry Marsh. "...only rarely is dying easy, and most of us now will end our lives in hospitals, a few of us in hospices, in the care of strangers, with little dignity and no autonomy — unlike our ancestors, who mostly died in their own homes. Although scientific medicine has brought great and wonderful blessings, it has also brought a curse — dying, for many of us, has become an unpleasantly prolonged and institutionalised experience." In several countries "it is not illegal for doctors to prescribe a drug (usually a barbiturate) with which people can bring their life to a dignified and peaceful end." A long, excellent read.
• A terminally ill woman had one rule at her end-of-life party: No crying (Lindsy Bever, WashPost, 8-16-16) Betsy Davis had ALS. “The idea of her taking charge of her departure was something she had talked about from the early stages of the diagnosis because everyone knows where this disease goes,” Niels Alpert, a longtime friend who once dated her, told The Washington Post. “She knew she would rather take control of her final destiny before she entered total locked-in syndrome and was completely helpless.”
'California’s new law states that the patient must be at least 18 years old, terminally ill and expected to die within six months. The patient must also be mentally capable of making the decision to die and physically capable of self-administering the aid-in-dying drug, according to the law. It adds that using an aid-in-dying drug under the allowed circumstances “is not suicide” and that medical personnel and insurance companies should not treat it as such.' Related story: What I Learned Helping My Sister Use California’s New Law to End Her Life (Kelly Davis, Voice of San Diego, 8-9-16)
• I didn't like it, but this was the death she chose (Cindy Schweich Handler, Washington Post, 6-21-16) "While her pronouncement that she’s “had a good run” has left Harry and me sidelined with shock, our eldest son, Ted, understands. A graduating fourth-year medical student in Boston, he has often relayed horror stories about the hospital patients whose bodies are kept alive long after their occupants have experienced any pleasure in them."
• Life, Death & Lee (a collection of stories chronicling how Northampton resident Lee Hawkins'got the death she planned for)
---Full of life, Lee Hawkins decides to plan her death (Laurie Loisel, Daily Hampshire Gazette, 9-22-14, photos by Carol Lollis) At age 90, Lee stopped taking in food and water, a method now common enough to have its own acronym: VSED, for voluntarily stopping eating and drinking. "Neither Lee nor her doctor saw this as an act of suicide, but something far more natural." This three-part series chronicles Lee’s "decision to bring about her death and the health care workers, family members and friends who accompanied her on a journey of her choosing."
---About this series
---After decision made, time for Lee Hawkins’ slow goodbye to friends, family (9-23-14)
---Decision by Lee Hawkins to stop eating and drinking prompts new policy at VNA & Hospice of Cooley Dickinson (9-24-14) “In every state this is an option, it’s a legal option,” Kirk said. “You don’t need anybody’s permission to stop eating and drinking.”
• Aid-In-Dying Laws Only Accentuate Need For Palliative Care, Providers Say (Anna Gorman, Kaiser Health News, 12-1-15) KHN staff writer Anna Gorman reports: "More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming. If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. 'I would want an escape hatch,' she said. Earlier this month, California law became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it."
• Dying vets cannot use life-ending drugs at many state homes (Julie Watson, AP, WashPost, 3-7-18) Suffering from heart problems, Bob Sloan told his children he wants to use California’s new law allowing life-ending drugs for the terminally ill when his disease becomes too advanced to bear. But then the 73-year-old former U.S. Army sergeant learned that because he lives at the Veterans Home of California at Yountville — the nation’s largest retirement home for veterans — he must first move out
• A Conversation About Assisted Death with Author Miriam Toews (YouTube, video) "It was the first time that we had sort of articulated our major problem. She wanted to die and I wanted her to live and we were enemies who loved each other" - All My Puny Sorrows
• Voluntary stopping of eating and drinking at the end of life – a ‘systematic search and review’ giving insight into an option of hastening death in capacitated adults at the end of life (BMC Palliat Carev.13; 2014, cited on Kaiser Health News (8-21-17) This analysis of VSED research concluded that “terminally ill patients dying of dehydration or starvation do not suffer if adequate palliative care is provided.” A 2003 survey of nurses in Oregon who helped more than 100 patients with VSED deaths said they were “good” deaths, with a median score of 8 on a 9-point scale. Unlike aid-in-dying laws or rulings now in place in six states, VSED doesn’t require a government mandate or doctor’s authorization.
•
• The Traveler's Final Journey (Carrie Seidman, Herald Tribune) Dorothy Conlon's final journey took 16 days. See End-of-life resources (sidebar for Dorothy's Final Journey).
• Diane Rehm: My Husband's Slow, Deliberate Death Was Unnecessary (Maggie Fox, NBC News) Polls show that 65 percent or more of the U.S. population supports having an option available to help people choose a quicker, more painless death, Compassion & Choices says. This is different from assisted suicide or euthanasia, the group stresses. “Assisted suicide is a crime in many states, including Oregon and Washington, where aid in dying is legal,” the group says....Compassion & Choices says it doesn't support euthanasia or "mercy killing," "because someone else — not the dying person — chooses and acts to cause death." What is called euthanasia and is legal in some European countries more closely resembles what the group calls aid in dying. “We do not let our little animals suffer and people shouldn’t have to suffer.” John Rehm had to deliberately die by dehydration. It took nine days. “John said he felt betrayed,” Rehm said. He said, ‘I felt that when the time came, you would be able to help me.’”
• Diane Rehm Advocates for Aid in Dying Nationwide After Husband’s Painful Death From Parkinson’s (Compassion & Choices)
• NPR host Diane Rehm's disclosure about her husband's death puts light on end-of-life choice (Jodie Tillman, Tampa Bay Times, 7-11-14) A more complete piece than most of them on this story.
• To Achieve Radical Change End-Of-Life Providers Need To Address Some Home Truths (Lloyd Riley, HuffPost, 5-23-17) Dr BJ Miller, a consultant in palliative medicine "passionately believes in the principle of person-centeredness that underpins end-of-life care and argues that the shift away from over-medicalization must be adopted by other specialties." One needn't choose between "assisted dying" and improved end-of-life care. "Dying people need to be involved in decisions about their care; and treatment preferences need to be recorded, shared and acted upon. Doctors are central to this -- caring for dying people as they want to be cared for should be seen as fundamental, not desirable. " But "fear of expressing support for assisted dying within the palliative care community in the UK is widespread." "Dying people need to know their voice matters and legalizing assisted dying can bring about the culture change the medical profession repeatedly calls for."

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Sudden death, including sudden death of children

• Sudden An introduction to sudden deaths and the devastation they cause to people’s lives, helpful mostly as an explanation for the suddenly bereaved and listing typical causes.
• Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance (NIH, National Center for Biotechnology Information)
• What Bobby McIlvaine Left Behind (Jennifer Senior, Medium, The Atlantic, 8-9-21) Grief, conspiracy theories, and one family’s search for meaning in the two decades since 9/11. "Early on, the McIlvaines spoke to a therapist who warned them that each member of their family would grieve differently. Imagine that you’re all at the top of a mountain, she told them, but you all have broken bones, so you can’t help each other. You each have to find your own way down....Roxane Cohen Silver, a psychology professor at UC Irvine who’s spent a lifetime studying the effects of sudden, traumatic loss, immediately spotted a problem with it: “That suggests everyone will make it down,” she told me. “Some people never get down the mountain at all.”
• The sudden death of a child (Compassionate Friends)
• Sudden death in young people: Heart problems often blamed (Mayo Clinic)
• Strokes, heart attacks, sudden deaths: Does America understand the long-term risks of catching COVID? (Carolyn Barber, Fortune, 10-6-22) "We need to do a much better job preventing mass infections and reinfections, fast-tracking research, funding new treatments for victims, and developing a coordinated response, both nationally and internationally. Producing universal coronavirus and nasal vaccines and drugs to minimize long COVID risk is a top priority." A rundown on findings of various studies.
• The National Registry of Exonerations
• Their baby died during his nap. Then medical bureaucrats deepened the parents’ anguish (Eric Boodman, STAT, 3-27-19) "a group of STAT reporters and editors met Holly and Eric High during a visit to Boston Children’s Hospital last fall. It wasn’t only that the Highs experienced the unthinkable tragedy of losing their 4-month-old, James. Their grief and self-blame were compounded by the authorities in charge of the subsequent investigation, even though there was no evidence of wrongdoing. While the point of such inquiries is to protect other kids, how the protocols are carried out can have profound negative effects on parents, especially given the widespread misconception that a sudden infant death must be the result of abuse or carelessness....Eric Boodman will also host an online chat on April 5 [2019] about the myths and misconceptions that accompany the cases of the thousands of babies each year who die suddenly and unexpectedly."
• After her baby died in the night, a young mother called 911. (Brett Murphy, Words of Conviction, ProPublica, 11-20-22) Police thought they could read her mind just by listening. Now she’s haunted by the words she chose. For more than a decade, those who attend a two-day law enforcement training course called “911 homicide: Is the caller the killer?” leave thinking they'll have the power to solve murders by listening to a 911 call. Pitched exclusively to law enforcement, others in the justice system, including defense lawyers and judges, often learn police have used the technique for the first time in the courtroom.

People who have taken the course could now present themselves as experts, "able to divine truth and deception — and guilt and innocence — from the word choice, cadence and even grammar of people reporting emergencies. ProPublica is running a series revealing the origins of 911 call analysis and the local, state and federal agencies that foster it, despite a consensus among experts that its application is scientifically baseless. Police and prosecutors continue to leverage this method against unwitting defendants across the country, ProPublica found, in some cases slipping it past judges to present it to jurors."
"At least 416 people nationwide have been exonerated since 2012 after they were convicted with faulty forensics or misleading expert testimony, according to data from the National Registry of Exonerations , a project from three universities."
• Sudden Cardiac Death (Sudden Cardiac Arrest) (Cleveland Clinic) Sudden cardiac death (SCD) is a sudden, unexpected death caused by loss of heart function (sudden cardiac arrest). It is the largest cause of natural death in the United States, causing about 325,000 adult deaths in the United States each year -- responsible for half of all heart disease deaths. It occurs most frequently in adults in their mid-30s to mid-40s, and affects men twice as often as it does women. This condition is rare in children, affecting only 1 to 2 per 100,000 children each year.
• Sudden death in young people: Heart problems often blamed (Mayo Clinic) Sudden death in people younger than 35, often due to undiscovered heart defects or overlooked heart abnormalities, is rare. When these sudden deaths occur, it's often during physical activity, such as playing a sport. Most often, death is due to a heart abnormality. For a variety of reasons, something causes the heart to beat out of control. This abnormal heart rhythm is known as ventricular fibrillation. Specific causes of sudden cardiac death in young people include hypertrophic cardiomyopathy (HCM), coronary artery abnormalities, long QT syndrome. These and other causes explained briefly here.
• Why Do People Drop Dead? Causes of Sudden Death (Dr. Mary Williams, CPR Certified, 8-23-17) Describes causes, risk factors, symptoms, and how to respond in an emergency (specifically for heart attack, stroke, pulmonary embolism, aortic rupture)
• Defibrillators
• Heart attack (Medline Plus information page)

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Helpful organizations and Web resources

• Aircraft Casualty Emotional Support Services (ACCESS, connecting those who have survived or lost loved ones in private, military or commercial plane crashes and other aviation tragedies with individuals who have lived through similar losses)
• American Foundation for Suicide Prevention (AFSP). Walk to save lives: Out of the Darkness Walks
• The Columbia Lighthouse Project. Identify risk. Prevent suicide. Kelly Posner Gerstenhaber, founder and director. Her Columbia-Suicide Severity Rating Scale (C_SSRS) has been adopted in thousands of public health settings, her methods rolled out worldwide.
• Compassion & Choices (committed to improving care and expanding choice at the end of life)
• Compassionate Friends (national self-help organization for help grieving the loss of a child of any age). Resources include a Chapter Locator and online brochures on topics ranging from Understanding Grief, Sudden Death, Surviving Your Child's Suicide or Homicide, The Death of an Adult Child, Death of a Special-Needs Child, Adults Grieving the Death of a Sibling, Suggestions for Various Professionals Dealing with Someone's Loss of a Child. Compassionate Friends' credo: The Compassionate Friends credo: "We reach out to each other in love to share the pain as well as the joy, share the anger as well as the peace, share the faith as well as the doubts, and help each other to grieve as well as to grow. We need not walk alone. We are The Compassionate Friends." Here Linton Weeks describes the healing that goes on at a Compassionate Friends conference. He writes: "No matter how your child dies, there is an undeniable sense of failure among bereaved parents. Jan and I are haunted by Stone's and Holt's violent, senseless deaths, and all of the wrongs that can never be righted. Including the biggest of them all — we could not save our sons from death. We should have been the ones who died first, not our precious boys. We carry that guilt in our already shattered hearts, and we relearn every morning when we wake up that the loss of our children is something we will never get over. Or past. Or through." The Compassionate Friends conference brings together parents isolated from their friends, family, work by pain and inexperience with such loss.
• ERGO bookstore (Euthanasia Research & Guidance Organization). For the rights of the terminal or hopelessly physically ill, competent adult. Sells editions of Final Exit, and specialized items such as Derek Humphrey's How to Make Your Own Inert Gas Hood Kit
• Euthanasia Research & Guidance Organization (ERGO) (Euthanasia World Directory, website of Hemlock Society founder Derek Humphrey)
• Final Exit Network (www.finalexit.org)
• Growth House provides access to over 4,000 pages of education materials about end-of-life care, palliative medicine, and hospice care, including the full text of several books.
• HALOS, a support group for families and friends who have lost a loved one to homicide (not a therapy group and not associated with any religious group)
• The Hemlock Society, founded as a right-to-die organization in Santa Monica, California, by Derek Humphrey, merged with and changed its name to Compassion & Choices in 2003, helping with end-of-life consultation.
• Homicide Outreach Project Empowering Survivors (HOPES program), William Wendt Center for Loss and Healing, Washington DC
• International Association for Suicide Prevention (IASP) Go here to find suicide crisis centers throughout the world.
• Mothers in Charge Stop the Violence! Prevention, Education, and Intervention
• National Child Traumatic Stress Network (NCTST)
• National Organization for Victim Assistance (NOVA)
• National Suicide Prevention Lifeline. Call 1-800-273-TALK (8255)
• Now I Lay Me Down to Sleep (NILMDTS), a nonprofit organization of professional photographers who, as volunteers, take photos for grieving parents, when a baby dies.
• Papyrus (UK, prevention of young suicide)
• Parents of Murdered Children (POMC, for family and friends of those who have died by violence)
• Reporting on Suicide website. Download PDF of Recommendations for Reporting on Suicide (PDF, American Foundation for Suicide Prevention) Journalists are advised to stress the effects on the bereaved family and not go into detail about means, to prevent copycat suicides.
• Right to die organizations (world directory, Final Exit)
• SAVE (Suicide Awareness, Voices of Education), suicide prevention
• Teen Suicide Prevention Campaign (American Foundation for Suicide Prevention). Watch these brief public service announcements (PSAs)
• Speaking of Suicide, A site for suicidal individuals and their loved ones, survivors, mental health professionals, & the merely curious
• Violent Death Bereavement Society
• The World Federation of Right to Die Societies(ensuring choices for a dignified death) [Back to Top]

Help Lines, Suicide Hotlines, and Lifelines

Suicide, youth, domestic violence, child abuse, human trafficking, and other crisis hotlines

If you are having thoughts of suicide, in the United States call the National Suicide Prevention Lifeline at 800-273-8255 (TALK) or text HOME to the Crisis Text Line at 741741. Go to SpeakingOfSuicide.com/resources for a list of additional resources.
For resources outside the United States, go here: International Suicide Prevention Helplines
• Two Years In, 988 Suicide Hotline Sees Successes Amid Awareness Concerns (Morning Briefing, KFF Health News, July 2024) The increases in call volume and response times has helped many people in a mental health crisis, officials say, but too many Americans still don't know the service is available. Links to many stories,including;
---Suicide hotline awareness lags, two years in (Maya Goldman, Axios, 7-16-24) Many Americans still don't know about 988, the revamped national suicide hotline, according to new polling from Ipsos on behalf of the National Alliance of Mental Illness.
---The 988 rollout remains uneven two years later (Axios, with map showing answer rate.
---Crisis Hotline Has Answered 10 Million Calls, Texts and Chats (Noah Weiland, NY Times, 7-16-24) Mental health experts have said that the 988 hotline for mental health emergencies is still a work in progress, in need of more funding, coordination and awareness.

Many of the following sites are available 24 hours a day.

• 988 Suicide and Crisis Lifeline (no longer called National Suicide Prevention Lifeline)

• The Lifeline and 988, explained 988 has been designated as the new three-digit dialing code that will route callers to the National Suicide Prevention Lifeline (now known as the 988 Suicide & Crisis Lifeline), and is now active across the United States.

• 988lifeline.org/chat/ When you call, text, or chat 988, you will be connected to trained counselors who are part of the existing Lifeline network. These counselors will listen, understand how your problems are affecting you, provide support, and connect you to resources if necessary.
The previous Lifeline phone number (1-800-273-8255 [TALK]) will always remain available to people in emotional distress or suicidal crisis. (en español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
• Speaking of Suicide (Friends and Family) A site for suicidal individuals and their loved ones, survivors, mental health professionals, & the merely curious.

• HHS Officials Preview New Three-Digit Suicide Prevention 'Lifeline' (Joyce Frieden, MedPage Today, 12-20-21) The federal government spends $282 million to get "988" hotline ready by July.

• PoisonControl (Poison Control Centers) Need immediate assistance? In the U.S., there are two ways to get help for a poison emergency. Call 1-800-222-1222 or Use the webPoisonControl tool.
• Calling 911 and Talking with Police (NAMI tips) What the police can do.
• NAMI (National Alliance on Mental Illness) When a friend or family member develops a mental health condition, it's important to know that you're not alone.
• Crisis Text Line Text HOME to 741741 to reach a Crisis Counselor
• Veterans Crisis Line 1-800-273-8255 and press 1. Support for deaf and hard-of-hearing: 1-800-799-4889 or chat online.

• National Domestic Violence Hotline1-800-799-7233 or TTY 1-800-787-3224. Computer use can be monitored and is impossible to completely clear. If you are afraid your internet usage might be monitored, call the National Domestic Violence Hotline.
• The Childhelp National Child Abuse Hotline 1-800-422-4453
• Child Welfare Information Gateway
• Rape, Sexual Assault, Abuse, and Incest National Network (RAINN)
Call 1-800-656-HOPE
Chat online at RAINN

• National Human Trafficking Hotline If you or someone you know is a victim of human trafficking, call now. "We'll listen. We'll help." 1-888-373-7888 (TTY: 711) or Text 233733
• VictimConnect (National Center for Victims of Crime) "Reach us by phone and chat: 855-4-VICTIM (855-484-2846)

• Trans Lifeline (peer support by and for trans and gender nonconforming people, divested from police) The Hotline: 1-877-565-8860
• 7 Cups of Tea 7 Cups connects you to caring listeners for free emotional support.

YOUTH HOTLINES
• Boys Town Hotline 1-800-448-3000. Serving all at-risk teens and children. Spanish-speaking counselors and translation services representing more than 140 languages are available, along with a TDD line (1-800-448-1833), that allows counselors to communicate with speech-impaired and deaf callers.
• National Runaway Safeline 1-800-RUN-AWAY
• National Teen Dating Violence Hotline ("Love is respect." 1-866-331-9474 or text “loveis” to 22522
• The Trevor Project ("Saving young LGBTQ lives") 1-866-488-7386, text or chat, 24/7

OTHER RESOURCES LISTING HOTLINES AND HELPLINES:
• Lines for Life Racial Equity Support Line staffed by people with lived experience of racism, created to address the emotional impacts of racism including work issues, micro-aggressions, police interactions, etc.
• Common Hotline Phone Numbers (Psych Central staff) Good list
• NAMI's Top HelpLine Resources (National Alliance on Mental Illness)
• Please Live list of hotlines An exceptionally helpful, detailed list of hotline phone numbers, by category of help needed.
• A Voice at the Table, developed by Marcia Epstein

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A Life-or-Death Situation (Robin Marantz Henig, NY Times Magazine, 7-17-13). A Right to Die, a Will to Live: As a bioethicist, Peggy Battin fought for the right of people to end their own lives. Suffering, suicide, euthanasia, a dignified death — these were subjects she had thought and written about for years, and suddenly, after her husband’s cycling accident, they turned unbearably personal. Follow-up story: Choosing to Die After a Struggle With Life (Henig, The 6th Floor, NY Times, 8-21-13) On Saturday, July 27, six days after the article was published in print, , Brooke Hopkins finally decided he’d had enough. "Later, Peggy told the Tribune reporter, Peggy Fletcher Stack, that 'it was peaceful and painless, just as he wanted it' — close to the kind of ending he described to me earlier as a 'generous death.'" Here's a video slideshow of about the peaceful end of Brooke Hopkins' life (Peggy Fletcher Stack, Salt Lake Tribune, 8-29-13

• Nukes (Latif Nasser, Radiolab, 4-7-17) President Richard Nixon once boasted that at any moment he could pick up a telephone and - in 20 minutes - kill 60 million people. Such is the power of the US President over the nation’s nuclear arsenal. But what if you were the military officer on the receiving end of that phone call? Could you refuse the order? If you're worried about the dangers of nuclear war, check out the excellent links alongside this thoughtful piece.

A Life Worth Ending (Michael Wolff, NY Times Magazine, 5-20-12). The era of medical miracles has created a new phase of aging, as far from living as it is from dying. A son’s plea to let his mother go. I agree with Robin Henig: ""One of the most beautifully done, searing articles I've ever read about death in the age of medical intrusion." Quoting from the article: "The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are – through careful diet, diligent exercise and attentive medical scrutiny – the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment – though far, far, far from healthy."

At the end of a loved one's life, why is it so hard to let go? (Craig Bowron, Washington Post, 2-22-12). Craig Bowron is a hospital-based internist in Minneapolis. "When families talk about letting their loved ones die 'naturally,' they often mean 'in their sleep' — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him. While it's easy to empathize with these family members' wishes, what they don't appreciate is that very few elderly patients are lucky enough to die in their sleep. Almost everyone dies of something."

UNNATURAL CAUSES | SICK AND DYING IN SMALL-TOWN AMERICA (Washington Post series, April 8, 2016)
• ‘We don’t know why it came to this’ ( Eli Saslow, Washington Post, 4-8-16) As white women between 25 and 55 die at spiking rates, a close look at one tragedy, in rural Oklahoma.
• A new divide in American death (Joel Achenbach, Dan Keating, Washington Post, 4-8-16) An urban-rural mortality gap emerges among whites as risky behaviors work to defy modern trends. White women and men in small cities and rural areas are dying at much higher rates than in 1990, while whites in the largest cities and their suburbs have steady or declining death rates. INCREASING DEATH RATES: From 1990 through 2014, the mortality rate for white women rose in most parts of the country, particularly around small cities and in rural areas. Rates often went up by more than 40 percent and, in some places, doubled. DECLINING DEATH RATES: Mortality rates were most likely to decline in the Northeast corridor and in large cities that anchor metropolitan areas of more than a million people, including Chicago, Los Angeles, Miami, St. Louis and Houston.
• Some regions are hit especially hard, such as the belt of poverty and pain that runs across the northern tier of the South, incorporating much of West Virginia, Kentucky, Tennessee and Arkansas. But significant increases in white mortality also showed up in the small-town and rural Midwest — such as Johnson County, Iowa, home of the University of Iowa — and in parts of the American West, such as Nye County, Nev., and Siskiyou County, Calif.
• Multiple factors are converging to produce this corrosion of American health. Foremost is an epidemic of opioid and heroin overdoses that has been particularly devastating in working-class and rural communities.
• Another killer is related to heavy drinking. Deaths of rural white women in their early 50s from cirrhosis of the liver have doubled since the end of the 20th century, The Post found.
• Suicides are also on the rise. The suicide rate is climbing for white women of all ages and has more than doubled for rural white women ages 50 to 54.
• Other trends may be contributing to the die-off, including obesity.
• Where living poor means dying young (Emily Badger and Christopher Ingraham, WaPo, 4-11-16) Men in the bottom income quartile live longer along the West Coast than in Las Vegas, Louisville and industrial Midwest towns, such as Gary, Ind. Life "expectancies continuously rise with income in America: The modestly poor live longer than the very poor, and the super-rich live longer than the merely rich." "...places with high shares of college graduates, high population density, high home values and high government expenditures per capita were correlated with better life expectancies for the poor. In some ways, this finding is surprising..."

Compassionate Friends (national self-help organization for help grieving the loss of a child of any age). Resources include a Chapter Locator and online brochures on topics ranging from Understanding Grief, Sudden Death, Surviving Your Child's Suicide or Homicide, The Death of an Adult Child, Death of a Special-Needs Child, Adults Grieving the Death of a Sibling, Suggestions for Various Professionals Dealing with Someone's Loss of a Child. Compassionate Friends' credo: The Compassionate Friends credo: "We reach out to each other in love to share the pain as well as the joy, share the anger as well as the peace, share the faith as well as the doubts, and help each other to grieve as well as to grow. We need not walk alone. We are The Compassionate Friends." Here Linton Weeks describes the healing that goes on at a Compassionate Friends conference. He writes: "No matter how your child dies, there is an undeniable sense of failure among bereaved parents. Jan and I are haunted by Stone's and Holt's violent, senseless deaths, and all of the wrongs that can never be righted. Including the biggest of them all — we could not save our sons from death. We should have been the ones who died first, not our precious boys. We carry that guilt in our already shattered hearts, and we relearn every morning when we wake up that the loss of our children is something we will never get over. Or past. Or through." The Compassionate Friends conference brings together parents isolated from their friends, family, work by pain and inexperience with such loss.

Complicated Losses, Difficult Deaths: A Practical Guide for Ministering to Grievers (Roslyn A. Karaban, an eBook)

Dad's Last Visit (Pat Jordan, AARP, 2006, posted on Alex Belth's Bronx Banter). He spent his life pretending to be someone he wasn't. Now he wanted me to know the real deal.

Darcy at Her Days’ End :A beloved dog afflicted with the disease of old age brings her owner face to face with responsibility in its purest form (Verlyn Klinkenborg, NYTimes, 12-18-09)

The Death Penalty: Righteous Anger or Murderous Revenge?. A Conversation with Thomas Cahill, David R. Dow and Robert K. Elder. Moderated by Jill Patterson (posted on Creative Nonfiction)

The Depressed Child

‘Everyone Welcome’—Even Now (Chris Buice, The Daily Beast, 1-9-09). After a senseless act of violence in our church, we did not give in to anger. We sought a better way.

A Facebook story: A mother's joy and a family's sorrow. Ian Shapira, Washington Post, has edited and annotated Shana Greatman Swers Facebook page to tell her story from pre-baby date nights to a medical odyssey that turned the ecstasy of childbirth into a struggle for life.

Families of Military Suicides Seek White House Condolences (James DAO, NY Times, 11-25-09, on pressure to change a hurtful policy)

Farrah Fawcett's Long Goodbye (Jim Rutenberg, NY Times, 5-27-11). Dying of cancer, she authorized a documentary of her final days. "Ms. Fawcett had intended the film to address shortcomings she saw in American cancer treatment and to present it in art-house style....After [Ryan] O’Neal and NBC gained full control of the documentary, the film took on the feel of network celebrity fodder — at once more glossy and more morbid....Many scenes addressing the American medical system were scrapped or truncated." Her final story became the object of a lengthy battle.

Genocides, listed in order of death toll (Wikipedia)

The Good Short Life by Dudley Clendinen (NYTimes, 7-9-11). Living with Lou Gehrig's disease (ALS) is about life, when you know there's not much left. And Writer Dudley Clendinen has chosen not to go to the great expense and limited potential of extending his life--but to enjoy what he can of it, while he can. He learned he had the disease when he was 66, and Maryland Morning, an NPR news station, has been airing conversations with him about how he and his daughter Whitney have been dealing with the disease and its implications. Listen to the podcasts

The Guardians: An Elegy by Sarah Manguso. “A bittersweet elegy to a friend who ‘eloped’ from a locked psychiatric ward . . . [Manguso] explores the extent to which we are our friends’ guardians and, in outliving them, the guardians of their memory . . . Manguso’s writing manages, in carefully honed bursts of pointed, poetic observation, to transcend the darkness and turn it into something beautiful. The results are also deeply instructive, not in the manner we’ve come to fatuously call “self-help” but in the way that good literature expands and illuminates our realm of experience.” —Heller McAlpin, Barnes and Noble Review

How the mother of a slain 9-year-old sank into despair, then sought justice (Neely Tucker, Washington Post 1-20-10, part 1. Slow-loading. Part 2: Carol Smith fought for justice after daughter Erika's murder in Silver Spring

How to Die by Joe Klein, reads the cover of Time Magazine (June 11, 2012). Inside the story is called "The Long Goodbye." Klein writes about the dramatic improvement in his parents' care when they were moved to a facility with no incentives for unnecessary interventions. "For five months, I was my parents' death panel. And where the costly chaos of Medicare failed, a team of salaried doctors and nurses offered a better way."

How to Die: Safeguards for Life-Ending Decisions (by James Leonard Park). Read this book free online. He defines terms for the right to die (e.g., distinguishes between "irrational suicide" and "voluntary death") and writes about protecting patients from greedy relatives, from family pressure to die, and from health-care administrators who must save money, and other safeguards. Very informative and in useful linked format.

If You Have Dementia, Can You Hasten Death As You Wished? (Robin Marantz Henig, All Things Considered, NPR, 2-10-15). Choosing an endgame is all but impossible if you're headed toward dementia and you wait too long. Part of what happens in a dementing illness is that the essential nature of the individual shifts. Listen or read transcript.

In death, a promise for the future. As her world diminished, Elizabeth Uyehara signed her body over to researchers to help unravel the mystery of Lou Gehrig's disease. (Thomas Curwen, Los Angeles Times, 8-28-10, on the course of Uyehara's ALS and on what happens when organs are donated for science)

In Romania, bribery is a health problem (Dan Bilefsky, NY Times, 3-8-09, from a story in International Herald Tribune) Medical Care in Romania Comes at an Extra Cost

Is Your Patient a Victim of Human Trafficking? (Amy Wasdin, The Doctors Company) Human trafficking is on the rise in every state throughout the nation. The National Human Trafficking Hotline statistics for 2017 include 8,524 cases reported and 26,557 calls received. This crime occurs when a trafficker uses force, fraud, or coercion to make an individual perform labor or sexual acts against his or her will. If you suspect that a patient is a victim of human trafficking, contact the National Human Trafficking Hotline (Call 1-888-373-7888, TTY: 711, Text: 233733) If you or someone you know is a victim of human trafficking, call now.

KOTA blog (poems of grief, Knowing Ourselves Through Art)

Let's talk about dying (Lillian B. Rubin, Salon.com, 12-27-12). "At 88 and ailing, I refuse to live at any cost. I only hope that when the time comes, I'll have the courage to act. ... At 88-going-on-89 and not in great health, what’s cowardly about my deciding to turn out the lights before putting my family through the same pain they’ve already lived through with their father and grandfather? What’s courageous about spending our children’s inheritance just so we can live one more month, one more year? Is it courage or cowardice to insist on staying alive at enormous social cost – 27.4 percent of the Medicare budget spent in the last year of life – while so many children in our nation go hungry and without medical care?"

Lives Cut Short by Depression (Daniel Ofri, Well, NY Times 6-9-11)

'Making Toast': Simple Gestures for Moving On, National Public Radio story and review of Making Toast by Roger Rosenblatt, which E.L. Doctorow describes thus: "A painfully beautiful memoir telling how grandparents are made over into parents, how people die out of order, how time goes backwards. Written with such restraint as to be both heartbreaking and instructive."

The Mercy Papers: A Memoir of Three Weeks by Robin Romm (a young woman's raw unflinching account of losing her mother to cancer--with no sugar coating, as one reviewer puts it)

Months to Live, Palliative Care Doctor Fought for Life (Anemona Hartocollis, NYTimes, 4-3-10). Desiree Pardi the palliative care doctor who believed in a peaceful death, chose at the end of her own life to endure a lot, even though she knew deep inside "this was not fixable," because she wasn't ready to let go.

Moving Away From Death Panels: Health Reform for the Way We Die (Ira Byock, The Atlantic, 3-6-12). There is surprisingly little disagreement about what constitutes good care at the end of life, but we still can't seem to fix any of our problems. It's time for conservatives and progressives to declare a truce before we lose opportunities for health reform to improve the way Americans are cared for and die.

Murder-Suicide: A Review of the Recent Literature (Scott Eliason, Journal of the American Academy of Psychiatry and the Law Online Sept. 2009)

Music for Funerals and Memorial Services. This could be a healing part of the process of burying the dead. Here are links to samples of selections that may help you remember the good times, and mourn the end of the life.

National Violent Death Reporting System (NVDRS) (CDC) The National Violent Death Reporting System (NVDRS) links information about the “who, when, where, and how” from data on violent deaths and provides insights about “why” they occurred.

One Punch Homicide (Steve Kokette's video about how often one punch can kill a person and surprisingly often does. How much would it reduce domestic violence if people were taught in schools that it could be disastrous to hit other people?

Out of This World (Pulse: Voices from the heart of medicine). Fourth-year medical student Katelyn Mohrbacher on the family's and medical staff's experience with an eighty-year-old man in a persistent coma.

Sick and Tired (Paul Rousseau, in Pulse: Voices from the heart of medicine). A mother being kept alive by transfusions is sick of them and must decide whether to continue for the sake of her daughter.

The Still Point of the Turning World by Emily Rapp. This luminous memoir about mothering a dying child, Ronan, from his diagnosis with Tay-Sachs disease, a degenerative condition with no cure is also about "the loving process of letting go while holding on for dear life." Read Sarah Manguso's review, Requiem (NY Times, 3-15-13) and listen to Terry Gross's interview with the author (Fresh Air, NPR, 3-18-13).

Terminally Ill California Mom Speaks Out Against Assisted Suicide (Stephanie O'Neill, NPR: All Things Considered, 5-20-15)

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End of life decision-making in the critical care unit

End of life decision-making in the critical care unit. "For several months, Globe reporter Lisa Priest and photographer Moe Doiron documented the journeys of four patients, each hooked to a ventilator, each grappling with a debilitating illness or condition. Their stories, while deeply personal, underline the scope of the challenges facing our strained health-care system: challenges that are medical, ethical, and even economic. How much treatment is too much treatment? How and where do we draw the line? And how do we distinguish between what we can do, and what we should do?" Stories from, and related to, the Canadian series from the Globe & Mail:
• Critical care: Spending 10 weeks with patients facing death (Lisa Priest, Globe and Mail 11-26-11)
• Why are we afraid of talking about death? (Erin Anderssen 11-27-11)
• Navigating life and death in 21st-century critical care (Globe & Mail). Watch video of four patients.
• ‘Have you ever seen someone die?’ A doctor recounts her angst at shutting off life support for a dying patient. (Amy Cowan, Washington Post, 8-4-19)
• A B.C. family's secret: How they helped their parents die
• ‘Good death’ in Swiss clinic held up as model (Mark Hume, 12-7-11)
• Tale of death that took ‘painful eternity’ opens right-to-die case (11-14-11)
• Dying elderly forced into to hospital against their will, report into end of life care finds (Sarah Knapton, The Telegraph, UK,, 5-9-16) The national review of 40 clinical commissioning groups (CCGs) across England and Wales found that doctors are still refusing to accept that some elderly patients just want to die and are carrying on treatment regardless....many doctors and nurses were still uncomfortable talking about death and dying with patients, and were confused about when end of life care should begin. Charities warned that patients were being denied a ‘peaceful and dignified’ end to their life and said health providers must ‘up their game.’ Said one advocate: "This report lays bare some of the startling variation that is experienced in end of life care across the country."
• Court hears details of woman’s suffering with ALS in right-to-die case (Mark Hume 11-14-11)
• Right-to-die laws don’t lead to rise in assisted deaths, experts say (Mark Hume 12-5-11)
• The end of life: a just and reasonable accommodation (Gary Mason, 9-9-10)
• By the numbers: The costs and counts in critical care (11-25-11)
• When it’s time to die: Home is where the heart is

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Euthanasia (physician-assisted dying)

• Documenting a Death by Euthanasia (Lynsey Addario, podcast plus transcript, The Daily, NY Times, 1-24-22) Video and transcript. Belgium has some of the world’s most liberal euthanasia laws. A photojournalist documented a paralympian’s experience of them.
• Tiredness of life: the growing phenomenon in western society (Sam Carr, The Conversation, 5-4-23) "Professor of care ethics Els van Wijngaarden and colleagues in the Netherlands listened to a group of older people who were not seriously ill, yet felt a yearning to end their lives. The key issues they identified in such people were: aching loneliness, pain associated with not mattering, struggles with self-expression, existential tiredness, and fear of being reduced to a completely dependent state."
"Surgeon and medical professor Atul Gawande argues that in western societies, medicine has created the ideal conditions for transforming ageing into a “long, slow fade”. He believes quality of life has been overlooked as we channel our resources towards biological survival. This is unprecedented in history. Tiredness of life may be evidence of the cost."
• ‘My death is not my own’: the limits of legal euthanasia (The Guardian, 8-10-18) Henk Blanken knows Parkinson’s disease might one day take him past the point at which he wants to carry on. Dutch law says it is legal for a doctor to help him die when the time comes – but there’s no guarantee that will happen, particularly for people with dementia. 'An advance directive is just one factor, among many, that a doctor will consider when deciding on a euthanasia case. And even though the law says it’s legal, almost no doctors are willing to perform euthanasia on patients with severe dementia, since such patients are no longer mentally capable of making a “well-considered request” to die.'

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• Paralympic gold medalist Marieke Vervoort ends her life in Belgium (AP, The Guardian, 10-23-19) Vervoort was a strong advocate of the right to choose euthanasia. She suffered unbroken pain from an incurable, degenerative spinal disease and also from epileptic seizures. A loyal Labrador named Zenn sensed an hour beforehand when a seizure would occur and would warn her.
• The Champion Who Picked a Date to Die (Andrew Keh and Lynsey Addario, NY Times, 12-5-19) Knowing she had the legal right to die helped Marieke Vervoort live her life. It propelled her to medals at the Paralympics. But she could never get away from the pain. In Vervoort's telling, the euthanasia papers allowwed her to wrest back some control of her life. She no longer feared death because she could hold it in her hands at any time. Andrew Keh and Lynsey Addario spent almost three years reporting on Marieke Vervoort as she and her parents wrestled with her decision to die by euthanasia. Read also The Personal Toll of Photographing a Story About Euthanasia (Lynsey Addario, NY Times, 12-5-19) I spent nearly three years photographing the Paralympic athlete Marieke Vervoort as she prepared to die by choice. It became one of the most emotional assignments — and friendships — of my life. Belgium, where Marieke lived, was one of just a handful of countries where euthanasia was legal for non-terminally ill patients. Marieke’s degenerative muscular disease was not terminal, but as it worked its way up her body over two decades, it left behind a trail of paralysis.
• The Hemlock Society, a right-to-die organization founded in Santa Monica, California, by Derek Humphrey, merged with and changed its name to Compassion & Choices in 2003, helping with end-of-life consultation.
• Frequently asked questions, Death with Dignity National Center
• Physician-assisted death vs. euthanasia (explanation for journalists, Association of Health Care Journalists). See also AHCJ's explanation of physician-assisted suicide
• Euthanasia and physician-assisted suicide (BBC). Types of euthanasia, arguments for and against, good deaths and the practicalities of dying, legislation, religious views
• Sir Terry Pratchett - Shaking Hands with Death (YouTube video) Sir Terry Pratchett gives 34th Richard Dimbleby Lecture from the Royal College of Physicians in London. 2010. Sir Terry Pratchett announced in 2007 that he had been diagnosed with a rare form of early-onset Alzheimer's disease. In this keynote lecture, he explores how modern society, confronted with an increasingly older population, many of whom will suffer from incurable illnesses, needs to redefine how it deals with death.

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• Euthanasia and physician-assisted suicide, all sides to the issue, ReligiousTolerance.org, Ontario consultants on religious tolerance)
• A method for dying with dignity (Marcia Angell, Boston Globe, 9-29-12) This is not a matter of life versus death, but about the timing and manner of an inevitable death. We respect people’s right to self-determination when they’re healthy. That shouldn’t be denied to them when they’re dying.
• Government lawyer draws line between euthanasia and war (Marc Hume, Vancouver, Globe and Mail, 12-8-11). Read the comments, too.
• Listen on Interfaith Radio to"Bioethics and the Legacy of 'Dr. Death,' which includes interesting segments on dying with dignity (individuals having some control over when they die, particularly if they're heading toward the painful end of a terminal condition: After a segment in which Michael Schermer tells how our brains are hard-wired for "beliefs," listen to Should Doctors Hasten Death? (starts at 21 min 36 seconds), in which bioethicist Art Caplan explains the pros and cons of one of the most controversial practices in both religion and medicine. (You can listen to full segment here . A third segment is Making the Choice: Merrily's Story (begins at 33 min. 46 sec.). One important point: Knowing that they have some choice allows patients who are terminally ill to relax and accept the natural course of death; only 10% of those who knew they had the option to end their life with medication did so.
• Where the prescription for autism can be death (Charles Lane, WaPo, 2-24-16) "...a man in his 30s whose only diagnosis was autism become one of 110 people to be euthanized for mental disorders in the Netherlands between 2011 and 2014. That’s the rough equivalent of 2,000 people in the United States....doctors from elsewhere are starting to apply independent scrutiny to the increasingly common euthanasia of Holland’s mentally ill, and their findings are not so reassuring. To the contrary."
• Hastening Death, information and arguments for and against physician-assisted suicide (from online edition of HANDBOOK FOR MORTALS by Joanne Lynn and Joan Harrold
• Should an incurably-ill patient be able to commit physician-assisted suicide? (BalancedPolitics.org)
• State-by-State Guide to Physician-Assisted Suicide (ProCon.org)
• U.S. Supreme Court rulings on physician-assisted suicide cases (University at Buffalo Center for Clinical Ethics and Humanities in Health Care)
• For Belgium's Tormented Souls, Euthanasia-Made-Easy Beckons (Naftali Bendavid, Wall Street Journal, 6-14-13).
• Tony Nicklinson Dead: U.K. Man With Locked-In Syndrome Who Failed To Overturn Euthanasia Law Dies (Maria Cheng, Huff Post 8-22-12)
• Unflinching End-of-Life Moments, review in NYTimes of HBO documentary about physician-assisted suicide (to air summer 2011), How to Die in Oregon, which was shown at the Sundance Festival.

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Gun reform and gun control

• An Atlas of American Gun Violence (Daniel Nass, The Trace, updated 3-12-24) Ten years. 370,000 shootings. How has gun violence marked your corner of the country? (Explore the map. Take a tour.)
• The Supreme Court Will Decide if Domestic Abuse Orders Can Bar People From Having Guns. Lives Could Be at Stake. (Paige Pfleger, WPLN/Nashville Public Radio, 11-3-23) The court’s ruling on United States v. Rahimi could clarify an earlier decision on guns. Or it could take away one of the best options to protect domestic violence victims. In states like Tennessee, the consequences could be deadly.
• Senators are killing children by failing to enact gun control laws (Marina Mai, KevinMD, 5-27-22) "The main culprit in the lack of gun control legislation lies with the Senate’s filibuster power to block national policy, as it is based on the votes of individual states rather than the majority vote. There is, in fact, a majority consensus in America in favor of gun-control measures such as universal background checks and assault-weapon bans.

"However, the disproportionate power of small Republican states was made clear in 2013, after the Sandy Hook shooting, when the Senate blocked the bill imposing background checks on gun sales despite representing a minority opinion. To prevent future stalemates in the Senate, the filibuster must be addressed....To reform the filibuster power the Senate holds will require fighting legal, political, social, and ideological barriers. And yet it must be done. With each new headline of a shooting, it feels as though America has found its emotional breaking point."
• “The only thing that stops a bad guy with a gun is a good guy with a gun.” ~ said Wayne LaPierre, CEO of the National Rifle Association in the aftermath of the mass school shooting in Newtown, Connecticut.
• Members of Congress with the total most contributions from gun rights groups (Axios, 5-26-22) At the top (all Republican):

---Sen.Ted Cruz ($442,000)

---Rep. Steve Scalise ($396,000)

---Sen. John Cornyn ($340,000)

---Sen. Lindsey Graham ($284,000)

---Sen. Mitch McConnell ($247,000)

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• Gun Laws: 50-State Survey (Justia)
• Gun Violence Archive This nonprofit research group, which tracks shootings and their characteristics in the United States, defines a mass shooting as an incident in which four or more people, excluding the perpetrator(s), are shot in one location at roughly the same time. In 2022 alone (as of May), there were 212 mass shootings. Twenty-seven of these were school shootings. In a decade, each year has tallied more shootings than days in the year with an ever-increasing rise. 2021 recorded 693 mass shootings, surpassing the 611 in 2020 and the 417 in 2019. Without stronger gun control, 2022 could prove the deadliest year yet.
• Will Gun Owners Fight for Stronger Gun Laws? (Rebecca Tuhus-Dubrow, Washington Post, 9-21-22) A new group, which includes two former NRA lobbyists, is betting on it. Abra Belke is a former lobbyist for the NRA and now serves on the advisory board of 97Percent. Adam Miller is co-founder of 97Percent, which promotes pragmatic gun-policy reforms — with the goal of engaging gun owners in the conversation.
• Key facts about Americans and guns (Katherine Schaeffer, Pew Research, 9-13-23)
---About four-in-ten U.S. adults say they live in a household with a gun, including 32% who say they personally own one.
---Republicans and Republican-leaning independents are more than twice as likely as Democrats and Democratic leaners to say they personally own a gun (45% vs. 20%).
---40% of men say they own a gun, compared with 25% of women.
---47% of adults living in rural areas report personally owning a firearm, as do smaller shares of those who live in suburbs (30%) or urban areas (20%).
---Non-gun owners are split on whether they see themselves owning a firearm in the future.
---Americans are evenly split over whether gun ownership does more to increase or decrease safety.
---Americans increasingly say that gun violence is a major problem.
---About six-in-ten U.S. adults (58%) favor stricter gun laws.
---About a third (32%) of parents with K-12 students say they are very or extremely worried about a shooting ever happening at their children’s school
---38% of White Americans own a gun, compared with smaller shares of Black (24%), Hispanic (20%) and Asian (10%) Americans.
---Personal protection tops the list of reasons gun owners give for owning a firearm.
---Gun owners tend to have much more positive feelings about having a gun in the house than non-owners who live with them
---There is broad partisan agreement on some gun policy proposals, but most are politically divisive
---Americans who own guns are less likely than non-owners to favor restrictions on gun ownership, with a notable exception. Nearly identical majorities of gun owners (87%) and non-owners (89%) favor preventing mentally ill people from buying guns.

GUN SAFETY ON MOVIE SETS
• ‘Rust’ Armorer Convicted of Manslaughter in Alec Baldwin Shooting ( Julia Jacobs, NY Times, 3-6-24) The armorer, Hannah Gutierrez-Reed, had placed a live round in a gun the actor was rehearsing with when it fired, killing the film’s cinematographer, Halyna Hutchins....Mr. Baldwin is also facing a charge of involuntary manslaughter and is scheduled to stand trial in July. He has argued that he was not responsible, since he was told that there were no live rounds in the gun and there were not supposed to be any on the set.
• ‘Rust’ armorer convicted of involuntary manslaughter in fatal shooting by Alec Baldwin on movie set (The Associated Press, WTOP, 3-6-24) "The prosecution painstakingly assembled photographic evidence it said traced the arrival and spread of live rounds on set and argued that Gutierrez-Reed repeatedly missed opportunities to ensure safety and treated basic gun protocols as optional. "The defense had cast doubt on the relevance of photographs of ammunition, noting FBI testimony that live rounds can’t be fully distinguished from dummy ones on sight."

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• The Injured KFF Health News and KCUR are investigating what happens to children and adults who survive gun violence and suffer physically or emotionally for months afterward, if not the rest of their lives. The people profiled here survived the Feb. 14 mass shooting at the Kansas City Chiefs Super Bowl celebration.

• They Were Injured at the Super Bowl Parade. A Month Later, They Feel Forgotten. (Bram Sable-Smith and Peggy Lowe, KCUR and KFF Health News, 3-14-24) "During this first month, Kansas City community leaders have weighed how to care for people caught in the bloody crossfire and how to divide more than $2 million donated to public funds for victims in the initial outpouring of grief.
"The questions are far-reaching: How does a city compensate people for medical bills, recovery treatments, counseling, and lost wages? And what about those who have PTSD-like symptoms that could last years? How does a community identify and care for victims often overlooked in the first flush of reporting on a mass shooting: the injured?"
• Three People Shot at Super Bowl Parade Grapple With Bullets Left in Their Bodies (Bram Sable-Smith and Peggy Lowe, KCUR and KFF Health News, 5-8-24) KFF Health News and KCUR are following the stories of people injured during the shooting at the Kansas City Chiefs Super Bowl celebration in February. Listen to the stories of two people shot that day, who still have bullets lodged in their bodies. They’re grappling with physical and emotional wounds.
• These Gun Reforms Could Save 15,000 Lives. We Can Achieve Them. (Nicholas Kristof, Opinion, NY Times, 5-25-22) Experts suggest that over time we plausibly could reduce gun deaths by a third, or 15,000 lives saved annually, with a series of pragmatic limits on firearms and those who can get them. Kristof suggests that we
--- Work harder to engage centrists, talk about “gun safety” rather than “gun control.”
--- Consider the minimum age to buy or possess a gun.
--- Bar purchases by someone with a recent misdemeanor conviction for drug or alcohol abuse, for violence, or for stalking. Only 10 states bar people with stalking convictions from buying guns.
---Pass red-flag laws that allow guns to be removed from someone who is undergoing a mental health crisis or subject to a domestic violence protection order. Even former President Donald Trump has backed red-flag laws.
---Require universal background checks to buy a firearm.
• Why Republicans Won’t Budge on Guns (Carl Hulse, NY Times, 5-26-22) Polls show that the overwhelming majority of Americans support some restrictions on firearms, but G.O.P. lawmakers fear they would pay a steep political price for embracing them. The G.O.P. base, which decides primary contests, is zealous in its devotion to gun rights.

"The politics of gun control have always been fraught, and Democrats dodged the issue for decades following their loss of the House in 1994, which many of them attributed to their passage of an assault weapons ban. The epidemic of mass shootings has prompted Democrats to change course, and now even Democrats from red states, such as Jon Tester of Montana, have embraced background checks."By 2000 it was one of the three most powerful lobbies in Washington. It spent more than $40 million on the 2008 election.

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• The N.R.A.'s Financial Mess (Ave Carrillo and Steven Valentino, The New Yorker Radio Hour, 4-19-19) Central to the story of the N.R.A’s financial problems is an Oklahoma-based media agency called Ackerman McQueen. Ostensibly just a contractor, Ackerman influenced N.R.A. decision-making from inside, and the for-profit company seems to have used the nonprofit company as a vast source of funds to enrich itself. See also At the N.R.A., a Cash Machine Sputtering (Danny Hakim, NY Times, 5-14-19) At issue for investigators, tax experts say, would be whether money lavishly spent on top figures in the organization was being used for charitable purposes, as required by law, and not to help finance the N.R.A.’s political activities.
• Gun Control Is as Old as the Old West (Matt Jancer, Smithsonian, 2-5-18) Contrary to the popular imagination, bearing arms on the frontier was a heavily regulated business. “Having a firearm to protect yourself in the lawless wilderness from wild animals, hostile native tribes, and outlaws was a wise idea. But when you came into town, you had to either check your guns if you were a visitor or keep your guns at home if you were a resident,” says Adam Winkler, a professor and specialist in American constitutional law, and author of Gunfight: The Battle Over the Right to Bear Arms in America.
• Letters from an American: Guns and their meaning in America 3-23-2021) Heather Cox Richardson's succinct and eye-opening timeline and history of the interpretation of guns and their meaning in America. "But in the mid-1970s, a faction in the NRA forced the organization away from sports and toward opposing “gun control.” It formed a political action committee (PAC) in 1975, and two years later elected an organization president who abandoned sporting culture and focused instead on “gun rights.” This was the second thing that led us to where we are today: leaders of the NRA embraced the politics of Movement Conservatism, the political movement that rose to combat the business regulations and social welfare programs that both Democrats and Republicans embraced after World War Two." Her pieces always link to other sources on the topic; I've included her links for this piece below and highly recommend subscribing to her column, to understand current issues. There's a free subscription and a paid subscription.

• Letters from an American (Heather Cox Richardson 5-6-23) How the Republicans got in bed with the National Rifle Association.

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• What research shows on the effectiveness of gun-control laws (Glenn Kessler, Washington Post, 5-27-22) “When we passed the assault weapons ban, mass shootings went down. When the law expired, mass shootings tripled.” Many proposed laws probably would not have much impact on curbing the mass shootings that dominate the news. But stricter gun control laws could lessen their severity, and might also bring down overall gun violence. A good summary of what research shows on the effects of various types of gun control legislation.
• Best States for Gun Owners (Guns & Ammo) Listed in reverse are states with tightest gun control regulation, California and New York at top.

• On gun violence, Republicans are a profile in cowardice (Max Boot, Opinion, WaPo, 8-21-19) "Seventy percent of voters and 54 percent of Republicans surveyed by Morning Consult-Politico support banning these weapons of war. Yet President Trump claims there is no "political appetite" for such action, meaning there is no appetite in the Republican Party to challenge the National Rifle Association....Federal background checks already exist, but most mass shooters were able to acquire their weapons legally. Red-flag laws already exist in 17 states and the District of Columbia, but they have been primarily effective in reducing suicides rather than homicides. ...Much more ambitious gun controls are needed. We should treat guns the way we treat cars, requiring gun owners to pass gun safety courses, get a new license at regular intervals and carry liability insurance that would force insurance companies to investigate their background....Republicans claim to be tough on defense, but when it comes to what is, along with global warming, arguably our top national security threat (more Americans have died from gun violence in the past 50 years than in all of our wars combined), they are a profile in cowardice. In their dealings with the gun lobby, Republicans are Neville Chamberlain, not Winston Churchill."
• Restricting Research On Gun Violence (Michael Halpern on Kojo Nnandi show, 1-16-13) The headlines and debate will likely focus on the gun control measures including criminal background checks for all gun sales and reinstating an assault weapons ban but there's also call to lift restriction on federally funded research into gun violence. What restrictions you might ask? There is, for example, a law prohibiting the National Institutes of Health from spending to advocate or promote gun control. Congress, over the past two decades, has restricted federal funds from being used to “promote or advocate gun control,” which many researchers say has had a chilling effect on studies related to gun violence. Even the new health care law includes a provision preventing doctors from asking patients about guns in the home.
"Louis Klarevas, a researcher at Columbia University, found that during the 10 years when the assault weapon ban was in effect, “the number of gun massacres … fell by 37 percent, and the number of people dying from mass shootings fell by 43 percent.” The effect would have been even greater if the 1994 law had fewer loopholes and if it had banned the possession, not merely the sale, of assault weapons and large-capacity magazines. That’s essentially what Australia did in 1996 after a gunman slaughtered 35 people. Australia has had only one shooting since then that killed more than four people — and that was the slaughter of a single family carried out by a relative."

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• A Novel Gun Control Strategy: Pressure Banks and Retailers (Nick Corasaniti, NY Times, 9-10-19) Several major banks have taken matters into their own hands, cutting off banking and credit card services to gun retailers and stopping the lending of money to manufacturers who do not abide by age limits and background checks. Now New Jersey has essentially decided to make its own rules to restrict the flow of guns, and officials said they hoped it would encourage other liberal states to follow their lead. New Jersey intends to stop doing business with gun manufacturers and retailers that fail to adopt policies, like conducting background checks, to stop guns from falling into the wrong hands, becoming the first state to take such stringent action against the firearms industry. The state will also apply pressure on major financial institutions, seeking information from banks that do business with New Jersey about their relationships and policies involving gun makers and sellers.

• Case Against Gun Control (James Fallows, First Drafts, Conversations, Stories in Progress, The Atlantic, Feb. 2018) Should the owner of a gun be subject to the same level of safety regulations as the owner/pilot of a plane? Both can do extensive damage.
• Parkland Shooting Survivors Release Ambitious Gun Control Plan (Adeel Hassan, NY Times, 8-21-19) March for Our Lives, a group led by student survivors of last year’s mass shooting at a high school in Parkland, Fla., unveiled an ambitious gun control platform on Wednesday that would ban assault-style weapons, raise the minimum age for buying firearms, create a national gun registry and require gun owners to pay for new licenses each year. The plan would go well beyond gun control measures like “red flag” laws and expanded background checks, which have been openly discussed after 31 people were killed in recent mass shootings in Dayton, Ohio, and El Paso.
• 22 mass shootings. 374 dead. Here’s where the guns came from (Michael R. Sisak, AP News, 5-25-22)

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• ‘It’s the guns’: violent week in a deadly year prompts familiar US responses “It’s the fucking guns,” Shannon Watts, gun control advocate, tweeted. “If more guns and fewer gun laws made us safer, America would be the safest nation in the world. But 400,000,000 guns in the hands of civilians coupled with weak gun laws have given us a 25 times higher gun homicide rate than any peer nation.”
According to the Gun Violence Archive, there have been seven mass shootings in the US in as many days. In addition to the bloodletting in Chesapeake and Colorado Springs, four people were killed at a marijuana farm in Oklahoma on Sunday; a mother and her three children were shot dead in Richmond, Virginia, on Friday; and mass shootings – defined as four people or more killed or injured with a firearm – occurred in Illinois, Mississippi and Texas. Thanksgiving week has seen 22 people killed and 44 injured by guns, as 2022 is shaping up to be one of the worst years in recent memory.
• How gun control advocates plan to make Texas a top political priority in 2020 (Patrick Svitek, Texas Tribune, 5-7-2020) One group, Everytown for Gun Safety, has already committed $8 million to the state this election cycle and is now naming three hires, including two seasoned Democratic operatives, to help see the plan through.
• Trained, Armed and Ready. To Teach Kindergarten. (Sarah Mervosh, NY Times, 7-31-22) More school employees are carrying guns to defend against school shootings. In Ohio, a contentious new law requires no more than 24 hours of training. A decade ago, it was extremely rare for everyday school employees to carry guns. Today, after a seemingly endless series of mass shootings, the strategy has become a leading solution promoted by Republicans and gun rights advocates. The strategy is fiercely opposed by Democrats, police groups, teachers’ unions and gun control advocates, who say that concealed carry programs in schools — far from solving the problem — will only create more risk.

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Gun violence, crippling injuries, and violent deaths

"Call me crazy, but I hope someday women have more rights than guns do."

~Bill Abbott

"More than 311,000 students have experienced gun violence at school since Columbine."

~ Explore The Washington Post's database of school shootings (John Woodrow Cox, Steven Rich, Allyson Chiu, Hannah Thacker, Linda Chong, John Muyskens and Monica Ulmanu, WaPo, 5-27-22) Recent mass shootings.
• Gun Violence Archive An online archive of gun violence incidents collected from over 7,500 law enforcement, media, government and commercial sources daily in an effort to provide near-real time data about the results of gun violence. GVA is an independent data collection and research group with no affiliation with any advocacy organization.
• Super Bowl Rally Shooting Victims Pick Up Pieces, but Gun Violence Haunts Their Lives ( Peggy Lowe, KCUR and Bram Sable-Smith, KFF Health News, 10-17-24) “I look at people differently,” said James Lemons, who was shot in the thigh at the rally. Now when he’s around strangers he can’t help but wonder if they have a gun and if his kids are safe. Collectively it is all taking a toll. Survivors suffer panic attacks and feel a heightened sense of danger in crowds and deep anxieties about the threat of violence anywhere in Kansas City.
• Child and Teen Firearm Mortality in the U.S. and Peer Countries (Matt McGough, Krutika Amin, Nirmita Panchal, and Cynthia Cox, Global Health Policy, KFF, 7-18-23) In 2020 and 2021, firearms contributed to the deaths of more children ages 1-17 years in the U.S. than any other type of injury or illness. The U.S. is the only country among its peers in which there are more gun deaths among children and teens than deaths from cancer or motor vehicle accidents.

      The child firearm mortality rate has doubled in the U.S. from a recent low of 1.8 deaths per 100,000 in 2013 to 3.7 in 2021. The United States has by far the highest rate of child and teen firearm mortality among peer nations. In no other similarly large, wealthy country are firearms in the top four causes of death for children and teens, let alone the number one cause. Even states with the lowest child and teen firearm deaths have rates much higher than what peer countries experience.
        On a per capita basis, the firearm death rate among children and teens (ages 1-19) in the U.S. is over 9.5 times the firearm death rate of Canadian children and teens (ages 1-19). Canada is the country with the second-highest child and teen firearm death rate among similarly large and wealthy nations.
• A New Framework for Addressing 'Bullet-Related Injury' (Jeremy Faust, of MedPage Today, and LJ Punch, trauma surgeon and director of the Bullet Related Injury Clinic (BRIC), 12-6-24) Bullets are endemic. They end up in people's bodies, and not just under the circumstances of what we would call 'violence.' Bullets are much more likely to end a life when they're self-inflicted. A much broader understanding of 'bullet-related injury' takes in the physical, emotional, social, and spiritual impact that a bullet has in someone's life, not just when they're physically injured, but if someone they love has been injured or even lost.
• U.S. Has the Highest Rate of Gun Deaths for Children and Teens Among Peer Countries (KFF news release, 7-18-23) Firearms were responsible for 20 percent of all child and teen deaths in the U.S. for both 2020 and 2021, compared to an average of less than 2 percent in similarly large and wealthy nations, according to a new KFF analysis (see table). This puts the U.S. far ahead of peer nations in child and teen firearm deaths. On a per capita basis, the firearm mortality rate among children and teens in the U.S. is over 9.5 times the rate of Canada, the country with the second-highest child and teen firearm death rate. Among the 37 states with available data, Louisiana, Mississippi, and Alabama had the highest rates of firearm mortality for children and teens ages 1-19 years. Among adolescents, gun violence may lead to anxiety, post-traumatic stress disorder, and challenges with school performance, including increased absenteeism and difficulty concentrating. See
• The Lives They Lived (New York Times, 12-14-22) The children featured here are 12 of the thousands killed this year by what has become the leading cause of death for American kids: gun violence. But these are not the stories of how they died. These are the stories of The Lives They Lived.
• ‘All We Want Is Revenge’: How Social Media Fuels Gun Violence Among Teens (Liz Szabo, KFF Health News, 8-25-23) The U.S. surgeon general last month issued a call to action about social media’s corrosive effects on child and adolescent mental health, warning of the “profound risk of harm” to young people, who can spend hours a day on their phones. The 25-page report highlighted the risks of cyberbullying and sexual exploitation. It failed to mention social media’s role in escalating gun violence.
     “What used to be communicated on the street or in graffiti or tagging or rumors from one person to another, it’s now being distributed and amplified on social media,” he said. “It’s meant to embarrass and humiliate others.”
      Many disputes stem from perceived disrespect among insecure young adults who may lack impulse control and conflict-management skills, said LJ Punch, a trauma surgeon and director of the Bullet-Related Injury Clinic in St. Louis.
      “Social media is an extremely powerful tool for metastasizing disrespect,” Punch said. And of all the causes of gun violence, social media-fueled grudges are “the most impenetrable.”
• Former Gun Company Executive Explains Roots of America’s Gun Violence Epidemic (Corey G. Johnson, ProPublica, 6-2-23) What caused the radicalization? A combination of factors. After Columbine in 1999, the National Rifle Association in well-publicized meetings, literally said, Are we going to be part of the solution here? Or maybe we can use these things to drum up hate and fear in our members? We might even be able to use them to drive membership. And they chose the latter. They perfected that system.They figured out it can drive politics. And then an explosion hit. That explosion was the future Black president leading in the polls in 2007. And then Barack Obama won in 2008. So you have this sort of uncapping of hate and conspiracy, much of it racially driven, that the NRA was tapping into. Prior to 2007, people in the United States never purchased more than 7 million guns in a single year. By the time Barack Obama left office, the United States was purchasing almost 17 million guns a year. And so I think it’s impossible to discount the degree to which Obama’s presidency lit this whole thing on fire."
• How California got tough on guns (Ben Christopher, Cal Matters, 11-14-19) The Giffords Law Center To Prevent Gun Violence, a gun control advocacy group, awarded California its only “A” grade in its 2017 state gun law scorecard. A timeline of changes in California.

• The plague of gun violence (Heather Cox Richardson, 4-19-21, after a flurry of mass killings): "We are in a bizarre moment, as Republican lawmakers defend largely unlimited gun ownership even as recent polls show that 84% of voters, including 77% of Republicans, support background checks. The link between guns, cowboys, race, and government in America during Reconstruction, and again after the Brown v. Board decision, helps to explain why."

• List of mass shootings in the United States Wikipedia's link-rich list of mass shootings in the U.S. from the 1920s on, with date, location, and number of dead and wounded.
• Covering Mass Shootings (Journalist's Toolbox, 3-28-23)
"In much of America, there is a more thorough review of people adopting a rescue dog than of those buying assault rifles. And should we really continue to allow people on the 'no-fly list' to buy firearms but not board a plane? The result of our paralysis is that just since 1975, more Americans have died from guns — including suicides, murders and accidents — than in all the wars in United States history, going back to the American Revolution."
• Take this Gun Safety Survey (Sandy Hook Promise) of what measures you think would improve gun safety.
• Better Gun Violence Reporting (The Philadelphia Center for Gun Violence Reporting). Links to many resources, in sections on Reporting Resources, Gun violence prevention reporting, Covering mass shootings, Gun violence prevention research institutions, Intervention programs, and Advocacy groups.
• The Trace A newsroom focused on gun violence.

"Hunting was accomplished with long guns, but handguns had human targets."

~A Montana cowboy, troubled by the violence that ‘won’ the West (a WaPo review of Holding Fire: A Reckoning with the American West by Bryce Andrews)
• Killed for Walking a Dog (Peter Sagal, The Atlantic, 9-21-22) The mundanity and insanity of gun death in America. In a country in which guns kill more than 40,000 people every year—well, who has the time to stop and mourn for just one of them? We all now live in a kind of permanent Sarajevo.

"And because we can’t bear to confront how suicidal it is to privilege over all else the rights of those damaged young men to use killing machines, we must bury the knowledge of this insanity along with Bella, who was interred in Block 117, Lot 108 of Denver’s Fairmount Cemetery, forever wearing the Dolce & Gabbana dress her mother had been saving for a special occasion."

• Global Firearms Holdings (Small Arms Survey)
• Army Veteran Went Into ‘Combat Mode’ to Disarm the Club Q Gunman (Dave Philipps, NY Times, 11-21-22) Richard M. Fierro, who served for 15 years in the military, was at the nightclub in Colorado Springs with his family when the gunman opened fire. The long-suppressed instincts of a platoon leader surged back to life. “I just knew I had to take him down,” he said.

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• Experts share databases and other useful resources for U.S. gun violence data (Tara Haelle, Covering Health, AHCJ, 11-16-22) Another CDC data source is the Web-based Injury Statistics Query and Reporting System (WISQRS, pronounced “whiskers”). WISQRS has Fatal Injury and Violence Data and Nonfatal Injury Data. This database system can generate data visualizations to see trends over time, including the cost of firearm injuries, the cost of firearm homicides and suicides, and tables showing leading causes of death for different demographics. (Other such databases are linked to in this article.)
• Six Reasons the Murder Clearance Rate Is at an All-Time Low (Derek Thompson, Work in Progress, a newsletter about the world’s most important mysteries, The Atlantic, 7-7-22) Thompson summarizes crime analyst Jeff Asher's explanations: "I count six possible explanations for the decline in the clearance rate. One: The 1960s numbers were bunk. Two: The effects of Miranda. Three: Guns. Four: Higher standards from juries and DAs. Five: Racism and distrust between police and Black communities. Six: Fewer and overextended police officers. With the understanding that crime data is imperfect and that these are all hypotheses, which one explains most of the decline in clearance over the last 30 years?"
Asher responds: "It’s the guns. The nature of murder in America is changing in ways that we don’t really talk about enough. You’ve got a bunch of cities where firearms make up 80 to 90 percent of murders today. That is the main driver. Guns make murders much harder to solve, and it leads to lower clearance rates everywhere."
• The City Where Investigations of Police Take So Long, Officers Kill Again Before Reviews Are Done ( Laurence Du Sault, Open Vallejo, ProPublica, 7-7-22) A California city’s flawed handling of fatal police shootings allowed six officers to use deadly force again before their first cases were decided. Experts say the department’s system "isn’t even basement standard practice” and needs oversight.

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• Jason Fagone and “What Bullets Do to Bodies” (Davis Harper, Notable Narrative, Nieman Storyboard, 6-26-17) The writer talks about his Huffington Post Highline profile of a trauma surgeon, and wanting readers to get a “visceral sense of what physically happens inside a person when he’s shot”
• What Bullets Do to Bodies (Jason Fagone, Highline, HuffPost, 4-26-17) The gun debate would change in an instant if Americans witnessed the horrors that trauma surgeons confront every day....The price of survival is often lasting disability. Some patients, often young guys, wind up carrying around colostomy bags for the rest of their lives because they can’t poop normally anymore....people get shot and then they are going to survive, because trauma surgeons are going to save them, and that’s when the real suffering begins."
• "This Is Our Lane": Doctors Speak Out Against Gun Violence After Texas School Shooting (Erika Edwards, NBC News, 5-26-22) Firearms are the No. 1 cause of death in kids in the U.S., recent research shows. Dr. Bindi Naik-Mathuria, a pediatric surgeon at Baylor College of Medicine in Houston, knows what assault rifles can do to a child’s body. The damage, she said, is often insurmountable.

“It’s not just the hole you see on the outside. It’s a huge blast effect,” Naik-Mathuria said. “You see completely shredded organs. Vessels are completely disrupted. There’s no way to salvage them. ”That’s why Naik-Mathuria is full-throatedly proclaiming that the issue of gun violence is “very much our lane.” “We have our hands inside these people, these children, trying to save them,” she said. “How can anyone tell us that it’s not our problem?”

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• Immersing into the lives of children damaged by gun violence, and laws that don’t stop it (Chip Scanlan, Nieman Storyboard, 11-5-21) John Woodrow Cox of The Washington Post talks to kids like an adult, sits on their bedroom floors, and doesn't push until they're OK with him. Cox is the author of Children Under Fire: An American Crisis
• After Newtown shooting, mourning parents enter into the lonely quiet (Eli Saslow, WaPo, 6-8-13) After the gunfire, the funerals, the NRA protests and the congressional debates, they were finally coming into the lonely quiet. They were coming to the truth of what Newtown would become. Would it be the transformative moment in American gun policy that, in those first days, so many had promised? Or another Columbine, Virginia Tech, Gabby Giffords, Aurora — one more proper noun added to an ever-growing list?
• Gun Violence Prevention and Victim Support (Charity Navigator) Highly rated nonprofits focused on ending gun violence, promoting mental health, and supporting victims
• Unlocked and Loaded: Families Confront Dementia and Guns (JoNel Aleccia and Melissa Bailey, KHN, 6-25-18) As America copes with an epidemic of gun violence that kills 96 people each day, there has been vigorous debate about how to prevent people with mental illness from acquiring weapons. But a little-known problem is what to do about the vast cache of firearms in the homes of aging Americans with impaired or declining mental faculties. Look at the numbers in this piece.
• Financing gunmakers (Robert Reich) How to make big banks like JPMorgan choose whether to be socially responsible.
• The Brady Campaign to End Gun Violence (podcasts). See also Issues, Statistics, , Reports (overviews, facts, solutions), legal cases, and more.
• In America, a child is shot every hour, and hundreds die. (John Woodrow Cox, Emily Davies, Lizzie Johnson, and Reis Thebault, Washington Post, 1-12-22) Even babies are shot to death, but the vast majority of young victims are teenagers. Black kids are more than four times as likely to die in shootings as White ones, according to CDC data, though White kids are much more likely to use guns to take their own lives. The stories of 13 young lives lost in 2021.
• Two kids, a loaded gun and the man who left a 4-year-old to die (John Woodrow Cox, WaPo, 9-27-21) The children will never recover from what happened inside a D.C. apartment. The owner of the illegal gun faces far less serious consequences.
• Insight from the other side of the notebook In the wake of unspeakable grief, parents from the 2012 Sandy Hook school shootings kept lists of journalists they would, and wouldn't, talk to

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• Guns killed more young people than cars did for the first time in 2020 And again in 2021. (Dan Keating, WaPo, 5-25-22) The country is active in trying to reduce vehicle deaths but "our government has proved itself unwilling or unable to do the same with firearm deaths and injuries.”
• 90 percent of Americans "support universal background checks" for gun purchases. (PolitiFact, The Poynter Institute)
• Why 18-Year-Olds in Texas Can Buy AR-15s but Not Handguns (Why 18-Year-Olds in Texas Can Buy AR-15s but Not Handguns. (Kiah Collier and Jeremy Schwartz, ProPublica and The Texas Tribune, 5-26-22) This week’s massacre in Uvalde, Texas, highlights disparities in how federal laws regulate rifles and handguns. The shooter bought two rifles days after his 18th birthday. This week’s massacre in Uvalde, Texas, highlights disparities in how federal laws regulate rifles and handguns. The shooter bought two rifles days after his 18th birthday. Under federal law, Americans buying handguns from licensed dealers must be at least 21. Only six states — Florida, Washington, Vermont, California, Illinois and Hawaii — have increased the minimum purchase age for long guns to 21, according to the Giffords Law Center to Prevent Gun Violence.
• Student bought ‘ghost gun’ components online before wounding classmate, prosecutor says (Dan Morse and Jasmine Hilton, Washington Post, 1-24-22) The ease with which the student allegedly obtained his gun parts highlighted an alarming problem of proliferating ‘ghost guns,’ called such because they typically are not traceable. Earlier this month, an adult outside a different Montgomery County high school was found with such a weapon assembled into an AR-15 styled pistol.
• Four lessons I learned while reporting on gun violence in Chicago (Lakeidra Chavis, Center for Health Journalism, 4-7-22) Some of the tools she used for her reporting series, Aftershocks, about gun violence in Chicago:
1. Let data guide you, but numbers aren’t people.
2. Door knocks and surveys allowed her to engage with many different types of people, across varying ages and socioeconomic status
3. Collaborate on stories for various publications, to engage with as wide an audience as possible.
4. Have a maximum and a minimum story (the big story plus one focusing on a victim of gun violence).
---Aftershocks Landing page for that series (July 2021)

---Ghost Guns A series of its own, starting with The Feds Are Increasingly Worried About Extremists Acquiring Ghost Guns, Leaked Report Shows (memo by the Joint Counterterrorism Assessment Team warns that firearms made from DIY kits and 3D printers are growing in popularity among white supremacist groups).
---Illinois Has a Program to Compensate Victims of Violent Crimes. Few Applicants Receive Funds. (Lakeidra Chavis and Daniel Nass, The Trace) Less than 40 percent of applicants are compensated, but many more never apply in the first place.
---In Chicago’s Roseland Neighborhood, a Mix of Grief and Perseverance Most stories about violence focus on neighborhoods with extremely high murder rates. Residents of Roseland experience shootings at a more typical pace.

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• The Sandy Hook Settlement with Remington and the Road Ahead on Gun Violence (Amy Davidson Sorkin, New Yorker, 2-18-22) More than nine years have passed since a young man carrying a Bushmaster XM15-E2S—an AR-15-style rifle—murdered twenty first graders and six adults at the Sandy Hook Elementary School, in Newtown, Connecticut. (Before going to the school, he also killed his mother.) Sandy Hook deniers have insisted that the families prove the children were real; some parents have been threatened by people who have been persuaded that they are “crisis actors.” Gun manufacturers had considered themselves all but immune, thanks to a 2005 law, the Protection of Lawful Commerce in Arms Act. Its existence is a reminder that America’s gun culture, though touted as an expression of rugged freedom, relies on special legislative carve-outs.
• Two kids, a loaded gun and the man who left a 4-year-old to die (John Woodrow Cox, Washington Post, 9-27-21) The children will never recover from what happened inside a D.C. apartment. The owner of the illegal gun faces far less serious consequences. An eye-opening account of what a mother and little girl have to go through for the girl to learn how to talk and move again, after a bullet pierced her neck. After her brother found the gun, thought it was a toy, and pulled the trigger.
• A murdered teen, two million tweets and an experiment to fight gun violence (Rod McCullom, Nature, 9-4-18) Researchers are using artificial intelligence (AI) to decode the language of Chicago gangs. Next they’ll look for opportunities to intervene before online aggression turns deadly.
• ‘Stand Your Ground’ Laws Linked To 11 Percent Rise In U.S. Firearm Homicides, Study Says (Hannah Knowles, Washington Post, 2-21-22) “Stand your ground” laws may have led to hundreds of additional homicides every year in the United States, according to a new study that could boost criticisms that they encourage unnecessary violence. Fiercely debated and increasingly common in the United States, stand-your-ground laws remove the duty to retreat from an attacker when possible before responding with potentially deadly force. They became a flash point in national disputes over gun violence, self-defense and racial profiling, particularly after the fatal shooting of Trayvon Martin, a Black teenager, in 2012.

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• Dying of Whiteness: How the Politics of Racial Resentment Is Killing America's Heartland by physician Jonathan M. Metzl. Interviewing a range of everyday Americans, Metzl examines how racial resentment has fueled progun laws in Missouri, resistance to the Affordable Care Act in Tennessee, and cuts to schools and social services in Kansas. He shows that the policies that result actually place white Americans at ever-greater risk of sickness and death, increasing deaths by gun suicide, falling life expectancies, and rising dropout rates. Gun culture is often associated with masculinity (being macho) and with rural culture ("Respect my rural identity").
• The NRA Placed Big Bets on the 2016 Election, and Won Almost All of Them (Mike Spies and Ashley Balcerzak, Open Secrets and The Trace, 11-9-16)
• “Coincidence Number 395”: The N.R.A. Spent $30 Million to Elect Trump. Was It Russian Money? (Chris Smith, Vanity Fair, 6-21-18) Congressional Democrats, the F.B.I., and Robert Mueller want to know why Putin-tied oligarchs took such an interest in American gun ownership.
• ‘What are we doing?’ Democrats in Congress demand action on gun control as Republicans push back. (Catie Edmondson, NY Times, 3-23-21)
• No, mass shootings are not ‘the price of freedom’ (Ronald A. Klain, Opinion, Washington Post, 10-5-17) 'Gun rights zealot Bill O'Reilly encapsulated this thinking when he said that the Las Vegas mass slaughter was "the price of freedom. . . . The Second Amendment is clear that Americans have a right to arm themselves for protection. Even the loons."'
• Do 90 percent of Americans "support universal background checks" for gun purchases? (Tom Kertscher, PolitiFact, 10-3-17) Yes, they do.
• Days after assault weapons ban was lifted in Boulder, a community grieves another mass shooting in America: ‘It hurts’ (Teo Armus, Timothy Bella and Alex Horton, Washington Post, 3-23-21) The suspect purchased an AR-556 pistol March 16, according to the arrest affidavit.
• ‘This is a wake-up call’: Georgia’s Asian communities turn tragedy into political power (Maya King, Politico, 3-23-21) The Atlanta shootings injected a new sense of urgency into Georgia's Asian American and Pacific Islander communities. Now they're using their political capital to make change — and to keep Georgia at the center of the political universe.

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• Guns Are a Threat to the Body Politic (Joseph Blocher and Reva Siegel, The Atlantic, 3-8-21) America must regulate guns not only to protect life, but to protect its citizens’ equal freedoms to speak, assemble, worship, and vote without fear.
• Why America’s Great Crime Decline Is Over (Derek Thompson, The Atlantic, 3-25-21) Even before the recent mass shootings, violent crime was surging to its highest rate in 30 years. Patrick Sharkey illuminates what’s happening. An earlier drop in violence was "unsustainable because we were reliant on a model of responding to violence and urban inequality through brute force and punishment and dependence on prisons and the police to respond to every challenge that arises when poverty is concentrated."
• Red flag gun laws: Dig deeper to find stories that matter (Randy Dotinga, Covering Health, AHCJ, 11-4-22) "At this point, we're looking at critical implementation questions: Are these [laws] being used? Who's using them? And in what kinds of circumstances are they being used?" asked Shannon Frattaroli, a professor who's studied firearm violence at the Johns Hopkins Bloomberg School of Public Health. As reporters and researchers have discovered, red flag laws are barely used despite hoopla over their potential as a useful tool to prevent gun violence. There's no firm evidence — yet — that they actually keep violent people from shooting others.
• The U.S. Once Had A Ban On Assault Weapons — Why Did It Expire? (Ron Elving, NPR, 8-13-19) Twenty five years ago, Congress passed the Public Safety and Recreational Firearms Use Protection Act — the "assault weapons ban" — as a subsection of the Violent Crime Control and Law Enforcement Act of 1994, an election-year package meant to show that Democrats were "tough on crime."

It prohibited the manufacture or sale for civilian use of certain semi-automatic weapons. The act also banned magazines that could accommodate 10 rounds or more. Eagerness to tackle crime rates made at least some Democrats in 1994 also willing to address the role of guns, but the ban cost the Democrats control of Congress. In 2004 the Republican Congress refused to renew the ban.

Critics of the ban have argued that it violated Second Amendment rights while accomplishing little, and evidence suggests it did not do much to reduce the incidence of gun violence overall. But it did reduce the number of people killed in mass shootings. A survey done this month by Morning Consult and Politico found 7 in 10 voters, including 54% of Republicans, supported "a ban on assault-style weapons."
• Supreme Court Allows Sandy Hook Relatives to Sue Gun Maker (Kristin Hussey and Elizabeth Williamson, NY Times, 11-12-19) Families of victims in the 2012 shooting at an elementary school are challenging a federal law protecting gun manufacturers from liability. The lawsuit says the Madison, North Carolina-based company should never have sold a weapon as dangerous as the Bushmaster AR-15-style rifle to the public. The Supreme Court cleared the way for relatives of Sandy Hook Elementary School shooting victims to sue the Remington Arms Company, the maker of the rifle used in the massacre. CNN: Lawyers for the victims sued Remington contending that the company marketed rifles by extolling the militaristic qualities of the rifle and reinforcing the image of a combat weapon -- in violation of a Connecticut law that prevents deceptive marketing practices

Much more ambitious gun controls are needed. We should treat guns the way we treat cars, requiring gun owners to pass gun safety courses, get a new license at regular intervals and carry liability insurance that would force insurance companies to investigate their background....Republicans claim to be tough on defense, but when it comes to what is, along with global warming, arguably our top national security threat (more Americans have died from gun violence in the past 50 years than in all of our wars combined), they are a profile in cowardice. In their dealings with the gun lobby, Republicans are Neville Chamberlain, not Winston Churchill."

• Most Americans Support These 4 Types Of Gun Legislation, Poll Says (PBS NewsHour, 9-10-19) After multiple mass shootings in recent weeks, a majority of Americans think it is more important to control gun violence than to protect gun rights, according to a new PBS NewsHour, NPR and Marist poll. Policies with the strongest support include more funding for mental health screening and treatment, mandatory background checks and licensing for gun purchases, and passage of a national “red-flag” law, which would give a judge authority to order the removal of guns from a person who poses a risk to themselves or others, the poll suggests. Sixty-one percent of out of 10 Americans said they want to ban high-capacity magazines, but 51 percent of Republicans rejected the idea.
• Even gun owners agree on measures that would reduce gun violence, survey shows (Melissa Healy, Los Angeles Times, 9-10-19) Substantial majorities of Americans — both those who own firearms and those who do not — support measures that would require first-time gun buyers and those wishing to carry a concealed weapon to demonstrate they can safely own and handle a gun, according to a new study. In a national survey conducted in January, researchers from Johns Hopkins University’s Center for Gun Policy and Research found that 84% of all respondents believe that first-time gun buyers should be required to pass a safety course on the safe handling and storage of a firearm. Close to three-quarters of gun owners surveyed shared this view.

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• ‘Being silenced is not acceptable’: Doctors express outrage after NRA tells them ‘to stay in their lane’ (Frances Stead Sellers, WaPo, 11-11-18) 'At first, Judy Melinek didn’t know how to respond when she learned about a National Rifle Association tweet last week telling doctors who dared enter the gun debate “to stay in their lane.” But two days later, when the West Coast forensic pathologist was on her way to the morgue to examine the body of one of the country’s many forgotten gunshot victims, the words came to her. “Do you have any idea how many bullets I pull out of corpses weekly? This isn’t just my lane,” she tweeted Friday. “It’s my [expletive] highway.” ...Melinek and Sakran are among countless medical professionals who have taken to Twitter in the past few days to fire back at the NRA — creating a viral response that has ricocheted around the Internet under the hashtags #thisisourlane and #thisismylane....“I fix blood vessels for a living,” tweeted Westley Ohman, a vascular surgeon in St. Louis. “When you work at a major trauma center, that means fixing blood vessels shredded by bullets. My lane is paved by the broken bodies left behind by your products.” Responsible gun owners, he said, are tired of the carnage, too.'
• Mr. President, the hatred of the El Paso shooting didn't come from our city (Timothy Archuleta, El Paso Times, 8-7-19) 'Mr. President, in your February State of the Union address, you claimed that El Paso was “one of our nation’s most dangerous cities” before a border wall was built....In El Paso, we won’t ever look at someone who is different with prejudice in our hearts. The hatred that came to us came from an outsider. It did not come from El Paso."
• Taking guns away from people in crisis: Does it work? (Liz Szabo, Policy, KevinMD, 8-12-19) Protection orders are a “vital tool” that allows the people who are most likely to notice when a loved one or community member becomes a danger to take concrete steps to disarm them, according to the Giffords Law Center to Prevent Gun Violence, a San Francisco-based advocacy group named for Gabrielle Giffords, a former congresswoman who survived a mass shooting. Yet the evidence that protection orders reduce gun violence is more “suggestive” than definitive, Rosenberg said. No one has performed a large, long-term study of the state laws, mainly because of a congressional amendment from the 1990s that discouraged federal agencies from studying gun violence, he said....“Four percent of violence in this country is attributable to mental illness,” said Ronald Honberg, a senior policy adviser for the National Alliance on Mental Illness. “That means 96% of violence is not. So if somehow we were miraculously able to cure mental illness, which we’re far from being able to do at this point, we would not be appreciably reducing violence.”
• 2019 Traveler's Guide to the Firearm Laws of the Fifty States by J. Scott Kappas. "Published by a Kentucky attorney and arms dealer for a gun-toting audience, the guide is frequently promoted by the National Rifle Association. States are scored zero (for completely restrictive) to 100 (for completely permissive) based on 13 factors, including the right to carry guns in the open, limitations on the types of guns state residents can own, and whether out-of-state gun permits are recognized....for every 10-point relaxation in a state’s gun laws, the rates of mass shootings in that state increased by 11.5 percent....Leading the pack in both permissive laws and mass shooting rate were Vermont, South Carolina, Louisiana, and Arizona. (Florida, where the Parkland shooting took place last year, was the only state not included in the analysis because it doesn’t participate in the FBI’s Uniform Crime Reporting program.)" The Looser a State's Gun Laws, the More Mass Shootings It Has ~ Megan Molteni, Wired, 8-6-19.
• How US gun culture compares with the world (Kara Fox, CNN, 8-6-19) Americans own nearly half (46%) of the estimate 857m civilian-owned guns worldwide. (India is second.) There are more public mass shootings in America than in any other country in the world. Gun homicide rates are 25.2 times higher in the US than in other high-income countries. They are lowest in Japan and South Korea. In February 2017, US President Donald Trump signed a measure that scrapped an Obama-era regulation aimed at keeping guns out of the hands of some severely mentally ill people.Gun lobbyist helped write ATF official's proposal to deregulate.

• GOP-Led Senate Committee Holds Rare Hearing on Gun Control, Focusing on Taking Weapons from Dangerous People (KHN, 3-27-19). Links to articles in Wall Street Journal (3-26-19) Senate Panel Considers ‘Red Flag’ Gun Laws in Aftermath of Mass Shootings: "A GOP-led Senate committee held a rare gun-control hearing Tuesday on measures aimed at temporarily blocking dangerous people from accessing firearms, following a wave of states’ decisions to allow such curbs. The Senate Judiciary Committee focused Tuesday on extreme-risk protection orders, also known as red-flag laws, aimed at allowing courts to temporarily take guns from people deemed dangerous. Extreme-risk protection orders are designed to generally let family members or law-enforcement officials petition a court for an order that would temporarily block that person from being able to buy a firearm, or enable officials to remove his or her weapons."

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• Americans Largely Support Gun Restrictions To 'Do Something' About Gun Violence (Domenico Montanaro, NPR, 8-10-19) We know from opinion polls that there is strong U.S. support for stricter gun laws-- "universal background checks for gun purchases, extreme risk protection orders (also called red flag laws), gun licensing, assault-weapons bans and bans on high-capacity magazines. But many of these issues are hotly polarizing. While they mostly enjoy support from Democrats and independents, Republicans are not always on board." A look at where things stand, measure by measure, based on the latest polling and on Capitol Hill. "When people were asked if they thought it was more important to control gun violence or protect gun rights, 58% said control gun violence, the highest in at least six years. Just 37% responded that it was more important to protect gun rights."
• Why New Zealand isn't a perfect model for US gun reform (Sam Bookman, CNN, 3-26-19) New Zealand PM bans assault rifles; why can't we? Bookman explains:

"Part of the reason is the American political system is designed with checks and balances, creating plenty of veto points for entrenched opponents. To pass comprehensive federal gun control, lawmakers would need to build majorities in the House and the Senate. They would then need the support of the President, or else have enough support to overcome a presidential veto. That takes a lot of cooperation: something that is in short supply in gridlocked Washington today.

"The American system also gives disproportionate power in the Senate to rural minorities, where gun culture is strongest. High gun-owning states, such as Montana and Wyoming, send as many senators to Washington as more populous (but lower gun-owning) states such as Illinois and Massachusetts. Even if the legislative and executive branches could pass gun control, there is no guarantee that it would be constitutional....

"Although some limits on gun ownership are lawful, it is not clear whether these include a ban on semi-automatics. At the very least, a legislative ban would face lengthy court challenges. By contrast, New Zealand's constitutional system is designed to be representative and nimble. Parliament is proportional: seats are generally allocated on the basis of a nationwide vote. And under New Zealand's parliamentary system, majority parties in the legislature also lead the executive, reducing the chances of disagreement between the branches of government." (Interesting AND discouraging.)
• Secrecy, Self-Dealing, and Greed at the N.R.A. (Mike Spies, The New Yorker, 4-17-19) The organization’s leadership is focussed on external threats, but the real crisis may be internal. 'Even as the association has reduced spending on its avowed core mission—gun education, safety, and training—to less than ten per cent of its total budget, it has substantially increased its spending on messaging. The N.R.A. is now mainly a media company, promoting a life style built around loving guns and hating anyone who might take them away....After the mass shooting at Marjory Stoneman Douglas High School, in Parkland, Florida, Noir appeared in a video chiding “all the kids from Parkland getting ready to use your First Amendment to attack everyone else’s Second Amendment.”'
• What Happened to Gun Culture (Benjamin Wallace-Wells, New Yorker, 11-16-21) During the past three decades, it became one of the most dangerous elements of the right. How much of that can be blamed on the N.R.A.?
• The N.R.A.'s Financial Mess (Ave Carrillo and Steven Valentino, New Yorker Radio Hour, WNYC, 4-19-19) "Central to the story of the N.R.A’s financial problems is an Oklahoma-based media agency called Ackerman McQueen....In 2017, the N.R.A. paid Ackerman and affiliates forty million dollars, which totalled about twelve per cent of the N.R.A.’s total expenses that year. Ostensibly just a contractor, Ackerman influenced N.R.A. decision-making from inside, and the for-profit company seems to have used the nonprofit company as a vast source of funds to enrich itself."
• Doctors for Responsible Gun Ownership (DRGO) "Join DRGO and help bring honesty to the gun debate."

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• Texas Disability Group Wants Victims' Voices Heard In Gun Debate (Side Effects, 4-23-18). See Side Effects
• Why Republicans feel little political pressure for stricter gun control (Harry Enten, CNN, 5-26-22) Why would Republicans feel political pressure to support more gun control, when something that polls as well as universal background checks can't surpass the Democratic presidential baseline in swing states?
• Can you change how criminals think? Chicago hopes behavioral therapy can cut gun violence (Aamer Madhani, USA Today, 8-2-18) The day's group therapy session for the young detainees at the county jail started with their behavioral health specialist testing them with a hypothetical scenario: They’ve cheated on a girlfriend and the other woman is pregnant. The participants – all facing serious charges and picked for the jail's intensive therapy program because they're deemed a high risk of getting caught in Chicago’s intractable gun violence once they leave custody – bristled at a push for honest talk....Programs like S.A.V.E. (the Sheriff's Anti-Violence Effort) that use cognitive behavioral therapy (CBT), a psychological treatment that focuses on helping young men recognize their instinctual responses and slow down their thinking in high-stake situations, have gained popularity in several cities around the U.S. in recent years....In Boston and Baltimore, the anti-violence group ROCA Inc. has used CBT in its work with ex-offenders, a program that pushes the riskiest of at-risk to "think different to act different." In the group's work in the Boston area, 84 percent of its participants have no new arrests, and two out of three stay employed after finishing the program.
• Gun Violence by the Numbers (Everytown). On an average day, 98 Americans are killed with guns (on average, 7 children and teens). That's 12,000 gun deaths a year, average). For every person killed, two more are injured. 62% of firearm deaths are suicides. America's gun homicide rate is more than 25 times the average of other developed countries. In an average month 50 women are shot to death by intimate partners in the U.S. In a domestic violence situation, women are five times more likely to be killed if there is a gun in the house. Black men are 14 times more likely than white men to be shot and killed by guns.
• They Survived Mass Shootings. Years Later, The Bullets Are Still Trying to Kill Them (Melissa Chan, Time, 5-31-19) "Colin Goddard survived the April 16, 2007 massacre at Virginia Tech, which killed 32 people and was the worst school shooting in U.S. history. Twelve years later, he has dozens of constant reminders: bullet fragments lodged in his body, leaching toxins into his blood....Goddard, a 33-year-old father of two, is suffering a lesser-known and often unrecognized side effect of gun violence: lead poisoning....Now, with his blood lead levels seven times higher than what is considered safe, Goddard faces long-term health risks, including neurological problems, kidney dysfunction and reproductive issues."
• 5(ish) Questions: The True Cost of Gun Violence in America (Mark Follman, Julia Lurie, Jaeah Lee, and James West, Mother Jones, 4-15-15) The data the NRA doesn’t want you to see. Nobody, save perhaps for the hardcore gun lobby, doubts that gun violence is a serious problem. And solving a crisis, as any expert will tell you, begins with data. But the government has mostly been mute on the economic toll of gun violence. Why the lack of solid data? A prime reason is that the National Rifle Association and other influential gun rights advocates have long pressured political leaders to shut down research related to firearms. A top public health expert describes the chill this way: “Do you want to do gun research? Because you’re going to get attacked. No one is attacking us when we do heart disease.”
• A Rise in Murder? Let’s Talk About the Weather (Jeff Asher, The Upshot, NY Times, 9-21-18) The correlation between heat and crime suggests the need for more research on shootings in American cities.
• In some countries, the odds of getting shot are 1 in a million. In the U.S., it's 100 times higher (Melissa Healy, LA Times, 8-28-18) According to a first-ever study of Global Mortality From Firearms (1990-2016), guns kill people — men overwhelmingly — who are in the prime of life, between the ages of 15 and 40. In 2016, they killed 7,220 children before they reached their 14th birthday. Boys in this age group died at two-and-a-half times the rate of girls.... [A]lthough men are most often the targets of firearm violence, they are also the most likely perpetrators, often in the context of domestic and relationship violence.” The United States "has played a key role in setting the stage for gun-related deaths across the Americas, both by supplying the weapons and sustaining the drug trade that drives the mostly illegal use of guns in these countries. In many of these countries, few guns appear to be in the hands of legal owners."

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• On Seniors Packing Heat And When They Should Pack It In (Harry Stark, PhD, Letter to the editor, KHN) An estimated 9 percent of Americans 65 and older are diagnosed with dementia, marked by mental decline and personality changes. And about 45 percent of folks 65 and older have guns at home.
• Unlocked and Loaded: Families Confront Dementia And Guns (JoNel Aleccia and Melissa Bailey, KHN, 6-25-18) As America copes with an epidemic of gun violence that kills 96 people each day, there has been vigorous debate about how to prevent people with mental illness from acquiring weapons. But a little-known problem is what to do about the vast cache of firearms in the homes of aging Americans with impaired or declining mental faculties. Look at the numbers in this piece.
• 3D-Printed Guns: Are They a Serious Threat to U.S. Communities? (Aamer Madhani and Andrew Wolfson, USA Today, 8-1-18) If gun rights activist Cody Wilson gets his way in his legal battle, soon anybody – including convicted felons and the mentally ill – with a few raw materials and access to an industrial 3D printer could build a plastic firearm, gun control advocates say. But will people, particularly a criminal or someone else intent on carrying out violence, bother to make the effort? Tech experts and stakeholders in the gun control debate are divided on whether the emergence of 3D-printed plastic guns presents an immediate safety threat to U.S communities.
• Why American Can't Effectively Control Guns (Gary Rodgers, DyingWords.net) Rodgers is a retired Royal Canadian Mounted Police homicide detective and forensic coroner, who also served as a sniper on British SAS-trained Emergency Response Teams. He provides a reasonable history and overview of the U.S. problem with its guns.
• Deep Roots (Thinking About “Koreans With Guns”) (Julija Šukys, Essay Daily, 12-8-18) The text for this essay about an essay ("Koreans with Guns") is only 619 words long, but the 61 footnotes total 2695 words. The real essay is in the footnotes. "Cha reminds us that the real story often lies buried, hidden from the surface. You have to excavate to find it. You have to dig for nuance." "In the end, what does an essay about a shopkeeper shooting a young girl in 1991 have to do with a mass college shooting in 2007? What connects these two events beyond the fact that both shooters were Korean?"
• Texas Governor Scraps Campaign Contest to Give Away Shotgun (Daniel Victor, NY Times, 5-21-18) Gov. Greg Abbott of Texas’ re-election campaign scrapped its plan to give away a shotgun in a contest after a high school student used a shotgun and a handgun to kill 10 people in the state on Friday. The campaign created its contest in early May, well before Santa Fe High School, about 35 miles southeast of Houston, became the nation’s latest scene of bloodshed inside a school. Dimitrios Pagourtzis, 17, has been charged with capital murder in the killing of 10 people
• National Hotlines and Helpful Links (National Center for Victims of Crime) Many helpful links and phone numbers.
• Expanding Civil Commitment Laws Is Bad Mental Health Policy (Morgan Shields, Ari Ne'eman, Health Affairs blog, 4-6-18) Expanding civil commitment and mental health institutionalization is a convenient tool for politicians seeking to deflect public pressure for gun control laws. But research has found that only 3 to 5.3 percent of violent crime is attributable to serious mental illness. And such measures would turn back the clock to a time when individuals could be hospitalized without their consent, even if they did not pose a danger to themselves or others.

• How to Report On Survivors of Gun Violence (Elizabeth Van Brocklin, The Trace, 8-2-18) Tips on how to interview and write about America’s growing population of gunshot victims with empathy and sensitivity.
• Why Are Shootings Deadlier In Some Cities Than Others? (Jeff Asher, FiveThirtyEight, 2-21-17) Chicago in 2016 had more shootings4 per capita than Baltimore. But a smaller share of Chicago’s shooting victims ended up dying. Why? Asher explores explanations.
• Gunshot Survivors May Be Eligible for Crime Victim Compensation. Here’s Everything You Need to Know to Apply. (Elizabeth Van Brocklin, The Trace, 4-11-18)
• States Set Aside Millions of Dollars for Crime Victims. But Some Gun Violence Survivors Don’t Get the Funds They Desperately Need. (Elizabeth Van Brocklin, The Trace, 2-12-18)

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• Shot and Forgotten: 24 Stories (Elizabeth Van Brocklin, The Trace) Ever imagine what it's like to be shot? Reporters Amber Hunt of the Cincinnati Enquirer and Elizabeth Van Brocklin of The Trace traveled the country talking to people who know too well.
• Aftermath (8-podcast series, The Trace, 5-22-18 thru 7-3-18) Listen online. "Have you ever thought about what it’s like to get shot? For eight months, reporters Amber Hunt of the Cincinnati Enquirer and Elizabeth Van Brocklin of The Trace traveled the country talking to people who know the answer too well. Their backgrounds and circumstances stories all vary, but they share one defining truth: Each had their lives changed by the path of a bullet."
• Mayors want to pass gun safety laws, but the NRA and our state legislatures won't let us (Andrew Gillum, Bill Peduto and Ted Wheeler, USA Today, 3-23-18) "Forty-three states have some form of gun preemption, a tactic increasingly used by state legislators to prevent cities and counties from making local laws and decisions. States are interfering in local efforts to raise wages, pass paid sick time and non-discrimination ordinances, and adopt fracking and environmental regulations. Lawmakers are using preemption to overturn elections, perpetuate racial and economic inequality, and silence local voices....And it’s happening because lobbyists and special interests know it’s easier to influence a few state lawmakers in 50 state capitols than thousands of local mayors and city councils.
• Companies that support the National Rifle Association (Drain the NRA, links to companies that some are boycotting for their sale of military style weapons to the public)

• Surgeon struggles to save boy's life in L.A.'s shooting season (Thomas Curwen, LA Times, 8-17-13) Why so many guns? It once was fistfights. It once was stabbings. Now it’s a whole new world."— Dr. Brant Putnam
• Precious Lives Project, in collaboration with the Milwaukee Journal Sentinel, WUWM, WNOV, and the Wisconsin Center for Investigative Journalism. A two-year, 100-part radio series about young people and gun violence in Milwaukee. The stories give voice to many people not represented in mainstream media.
• Urban–Rural Differences in Suicide in the State of Maryland: The Role of Firearms (American Public Health Association, 4-13-17) Conclusions from a retrospective analysis: Suicide rates are higher in rural Maryland than in urban areas, driven by heavier rates of firearm suicides in men. Urban homicide rates from guns are higher than rural rates. Maryland is suited for this study because it is one of the few states to use appointed medical examiners exclusively, rather than elected coroners, who may not be forensic pathologists.
• How to Stop Violence (Laura L. Hayes, Slate, 4-9-14) Anger management. Mentally ill people aren’t killers. Angry people are.
• Fighting for Gun Control 50 Years Ago (Mike Shatzkin, Medium, 2-21-18)
• Out Came the Girls: Adolescent Girlhood, the Occult, and the Slender Man Phenomenon (Alex Mar, Virginia Quarterly Review, October 2017). "Girls lured out into the dark woods—this is the stuff of folk tales from so many countries, a New World fear of the Puritans, an image at the heart of witchcraft and the occult, timeless. Some of our best-known folk tales were passed down by teenagers—specifically teenage girls....

"The common belief is that many of these tales, when told to children, serve as warnings for bad behavior, harsh lessons, morality plays. But on the flipside, they’re remarkable for their easy violence and malleable moral logic, like that of a child....Nearly a third of the original eighty-six tales of the Grimms’ collection feature young people, many of them girls, making their way into the woods—lured out by a trickster, or the need to pass a life-or-death test....

"To be an adolescent girl is, for many, to view yourself as desperately set apart, powerfully misunderstood. A special alien, terrible and extraordinary....Like a fairy-tale monster, Slender Man emerged through a series of obscure clues, never fully visible. He first appeared online, in the summer of 2009, in two vague images that were quickly passed around horror and fantasy fan forums." A true horror story.
• Gun Violence Archive. Valuable in providing accurate information about gun-related violence in the United States. See, for example, page on Mass shootings.
• My son was shot at a sleepover (Jeff Truesdell, People, 11-13-17) Ashley Melton's son Noah was killed by a teen with an unsecured gun. A gun owner herself, she's trying to help other parents avoid a similar tragedy by keeping guns in a cabinet or drawer locked from children.
• The True Cost of Gun Violence in America (Mark Follman, Julia Lurie, Jaeah Lee, and James West, Mother Jones, 4-15-15) The data the NRA doesn’t want you to see.
• Unlocked and Loaded: Families Confront Dementia and Guns (JoNel Aleccia and Melissa Bailey, KHN, 6-25-18) With a bullet in her gut, her voice choked with pain, Dee Hill pleaded with the 911 dispatcher for help. “My husband accidentally shot me,” Hill, 75, of The Dalles, Ore., groaned..." As more Americans are diagnosed with dementia, families who have firearms struggle with ways to stay safe. A KHN investigation uncovered dozens of cases of deaths and injuries. See also Worried About Grandpa’s Guns? Here’s What You Can Do. (JoNel Aleccia and Melissa Bailey, KHN, 6-25-18) When a loved one gets dementia, many families get no guidance on what to do about that person’s guns. Here are legal and practical steps to stay safe.

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• If Newtown Wasn't Enough, Why Would Las Vegas Be Enough? (Charles P Pierce, Esquire, 10-2-17) Our leaders are afraid to tolerate limits on Second Amendment "freedoms."
• How to Prevent Gun Deaths? Where Experts and the Public Agree (Quoctrung Bui and Margot Sanger-Katz, The Upshot, NY Times, 1-10-17) Must-read on the subject.
• The NRA has blocked gun violence research for 20 years. Let's end its stranglehold on science. (Michael Hiltzik, Los Angeles Times, 6-14-16)
• Gun violence research: History of the federal funding freeze (Christine Jamieson, American Psychological Association, Feb. 2013) "In 1993, the New England Journal of Medicine (NEJM) published an article by Arthur Kellerman and colleagues, “Gun ownership as a risk factor for homicide in the home,” which presented the results of research funded by the Centers for Disease Control and Prevention (CDC).

The study found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide. The article concluded that rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance...

The National Rifle Association (NRA) responded by campaigning for the elimination of the center that had funded the study, the CDC’s National Center for Injury Prevention. The center itself survived, but Congress included language in the 1996 Omnibus Consolidated Appropriations Bill (PDF, 2.4MB) for Fiscal Year 1997 that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”
• The NIH Is Finding Ways to Tip-Toe Around Congress’s Restrictions on Gun Violence Research (Miles Kohrman and Kate Masters, The Trace, 4-7-16) The divergent paths followed by the Centers for Disease Control and Prevention and the National Institutes of Health — both subject to the same congressional directive seen as trying to prevent all gun research — is attracting new attention as health researchers and other critics have put new pressure on the CDC to change its practices....In 1997, Congress took $2.6 million from the CDC’s budget, the exact amount the agency had dedicated to studying gun violence in the previous year.
• 7 things journalists should know about guns (Denise-Marie Ordway, Journalist's Resource, 10-2-18)
• 1 in 4 handgun owners carry loaded weapons monthly (Denise-Marie Ordway, Journalist's Resource, 1-26-18) The researchers estimate that 9 million of the approximately 38 million adult handgun owners in the United States carry a loaded handgun with them monthly. Of those who carry loaded weapons, 3 million do it every day. Of those who carried loaded handguns, about two-thirds reported always carrying them concealed while 1 in 10 reported always carrying them openly.

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• CDC: Half Of All Female Homicide Victims Are Killed By Intimate Partners (Camila Domonoske, The Two-Way, WAMU, NPR, 7-21-17) This is a public health problem. "We found that approximately one in 10 victims of intimate-partner-violence-related homicide experienced some form of violence in the preceding month," Petrosky says. "...So this indicates that there could have been potentially an opportunity for intervention for those women." The report also analyzed the method of homicide — more than half involved firearms and 20 percent involved some sort of blade.
• US Mass Shootings, 1982-2017: Data From Mother Jones’ Investigation (Mark Follman, Gavin Aronsen and Deanna Pan, Mother Jones, updated 10-2-17) The full data set from our in-depth investigation into mass shootings.
•Congress must act to make America safer from gun violence (Americans for Responsible Solutions). Stand with Gabby Giffords. Sign this petition to Congress to make our communities safer from gun violence by taking action to make it harder for criminals, terrorists, and the dangerously mentally ill to get their hands on guns.
• You Will Not Have My Hate by Antoine Leiris. "A year after his wife Hélene was killed in the Bataclan Theatre terrorist attacks in Paris, Antoine Leiris wrote this small, powerful book. She was the love of his life, the mother of their son, and their lives will never be the same. Leiris' decision not to hate those whose actions were ignited by hate, may appear to be saintly--it is not. This is a meditation on the consequences of hate, and how one man has chosen to deal with the aftermath on a daily, and probably eternal way."--Los Angeles Public Library
• Why Can’t We Talk About Guns? (1a radio,7-13-17) An NRA video making the rounds online has been called everything from an open call to violence to protect white supremacy to a condemnation of violence. The debate over guns in America has never been easy – but is it getting harder to keep it civil and useful?
• National Association of Crime Victim Compensation Boards (NACVCB) Crime victim compensation programs in states across the country help victims of violence every day, paying for the costs of medical care, mental health counseling, and lost time at work, as well as funerals and other expenses that families face in the aftermath of homicide.
• States with the most gun violence (Thomas C. Frohlich, USA Today, 6-15-15). Watch the video.
• From San Ysidro to Sandy Hook: Surviving, but never getting over it (Joe Mozingo and Thomas Curwen, LA Times, 6-19-16)
• Precious Lives , a two-year, 100-part radio series about young people and gun violence in Milwaukee. All episodes can be downloaded, and are intended to be used in outreach and engagement. “Because we were committed to revisiting it every week, we could revisit people,” Emily Forman, a former producer on Precious Lives, told Nieman Reports. “We could go from talking to a family to the beat cop to the faith leader. You could draw connections between people, even in completely different parts of the city, so you could see how people knew each other and that violence isn’t discrete. It radiates.”
• What Bullets Do to Bodies (Jason Fagone, Highline, HuffPost, 4-26-17) The gun debate would change in an instant if Americans witnessed the horrors that trauma surgeons confront every day.
• Two-thirds of Americans are OK with doctors talking with them about gun safety (Susan Perry, Minneapolis Post, 7-27-16)
• Mass Shootings Still Happen All The Time, So Why Does The Press Look Away? (Eric Boehlert, Media Matters for America, 3-31-17)

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• After a mass shooting: A survivor’s life (Eli Saslow, Washington Post, 12-5-15) Another mass shooting was over. The country had moved on. But inside one house in Oregon, a family was discovering the unending extent of a wound. ““his auburn hair curling at the ears, his front teeth sacrificed to a soccer collision, his arms wrapped around Ninja Cat, the stuffed animal that had traveled with him everywhere, including into the hearse and underground....The fact was it felt good to be angry, to yell and curse, because if she wasn’t angry then she was mostly afraid: of nightmares, of being alone, of the shadows in the church parking lot across the street, of cars backfiring, of the sound of knocking coming now at the door.”
• A Flower for the Graves (Eugene Patterson, Atlanta Constitution and CBS News, now on Poynter, 9-16-63) Among survivors of the bombing at the Sixteenth Street Baptist Church in Birmingham, Ala., one person is holding a child's shoe found in the debris. "Let us not lay the blame on some brutal fool who didn’t know any better. We know better. We created the day. We bear the judgment. May God have mercy on the poor South that has so been led."

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• What to Do With the Tributes After the Shooting Stops (Alan Blinder, NY Times, 7-7-17)
• An Experiment in Empathy (Lisa Miller, New York, 12-26-16) “We change the world when we walk in one another’s shoes: this idea of radical empathy,” said Colum McCann, president of Narrative 4. “We don’t do direct conflict resolution. People understand one another by walking inside the language and inside the story of somebody else’s experience.” In one such activity, covered in this New York magazine story, "He auctioned off the pistol that killed Trayvon Martin. She watched her child die in a mass shooting. Can they change each other’s minds about guns?"
• Police, Protest, and Social Justice (blog post) After a short section on clashes between police, federal agents, and protesters in Portland and other cities, you will find more general links about police, protests, and racial justice.
• Five Dallas Officers Were Killed as Payback, Police Chief Says (Manny Fernandez, Richard Pérez-Peña, and Jonah Engel, NY Times, 7-9-17) See also How the Attack on the Dallas Police Unfolded
• Officer Down Memorial Page
• Everytown (fighting back against the NRA and their dangerous agenda)
• Americans for Responsible Solutions. Take Gabby's pledge: “I promise you that if we cannot make our communities safer from gun violence while protecting gun rights with the Congress we have now, I will use every means available to make sure we have a different Congress, one that puts communities’ interests ahead of the gun lobby’s.”
• Armed with Facts (mostly debunking John Lott, the NRA's "gun academic."
• Fast Facts: Firearm Violence Prevention CDC’s National Center for Injury Prevention and Control (NCIPC)
• GunPolicy.org Armed violence and gun laws, country by country-- intelligence from a broad range of official and academic sources. This university site is for researchers, officials, journalists and advocates who need accurate citations and rapid access to credible sources. (No longer updated, for lack of funding.)
"In 2013, there were 73,505 nonfatal firearm injuries (23.2 injuries per 100,000 U.S. citizens), and 33,636 deaths due to "injury by firearms" (10.6 deaths per 100,000 U.S. citizens). ... In 2012, 64% of all gun-related deaths in the U.S. were suicides." ~Gun violence in the United States (Wikipedia entry, with links to many more, relevant articles and sites)
• Homicide Outreach Project Empowering Survivors (HOPES program), William Wendt Center for Loss and Healing, Washington DC

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• Mothers in Charge Stop the Violence! Prevention, Education, and Intervention
• Women Against Gun Violence
• Violent Death Bereavement Society
• Victim Support Services (VSS)
• National Center for Victims of Crime
• Violent Loss Resources (Survivors of Violent Loss Network)
• Center for Complicated Grief ("Grief is a form of love.")
• Key Gun Violence Statistics (Brady Campaign to Prevent Gun Violence)
• After a toddler accidentally shot and killed his older sister, a family’s wounds run deep (Terrence McCoy, Washington Post, 12-1-16) See also “A mass shooting, only in slow motion” (Glenn Jeffers, Nieman Reports). Newsrooms are moving away from a focus on mass shootings to tell more nuanced stories about the people and communities marred by gun violence. Kimi Reylander, 9, was shot and killed while visiting her great-grandfather’s home in Irondale, Alabama, a small town just east of Birmingham. The culprit? Her brother Jaxon, then 3, who found a loaded handgun in a nearby bedroom and fired it.
• Insight from the other side of the notebook (Matt Tullis, Nieman Storyboard, 4-16-19) In the wake of unspeakable grief, parents from the 2012 Sandy Hook school shootings kept lists of journalists they would, and wouldn't, talk to
• Gun Violence in America: 13 Key Questions (With 13 Concise Answers) Jonathan Stray, The Atlantic, 2-4-13)

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• Inside the Notorious Gun Shop Linked to Hundreds of Chicago Guns (Vernal Coleman, ProPublica,12-11-23) The story of one Indiana store demonstrates how the more than 60,000 gun retailers in America have little financial incentive to say no to questionable buyers and face limited penalties for failing to prevent illegal transactions. The ATF views retailers as partners empowered with the discretion to decline any potential transaction they find suspicious, according to the agency’s best practices guide for retailers. That approach, as demonstrated by the transaction history of Westforth Sports and other retailers, has not halted gun trafficking.
• A Brief History of Guns in America: Guns and Public Health Part 1 (Aaron Carroll, Healthcare Triage, The Incidental Economist, 8-7-17) See also Homicide and Firearms – Guns and Public Health Part 2 (Healthcare Triage, The Incidental Economist, 8-14-17); Guns and Public Health, Part 3 (8-21-17). And What Kind of Gun Laws Work? Guns and Public Health Part 4
• The U.S. Tested 67 Nuclear Bombs in Their Country. Now They’re Dying in Oklahoma. (Zoë Carpenter and Sarah Craig, Narratively, 7-17-17) In 1954, the Congress of the Marshall Islands requested a halt to the testing, which the U.S. rejected on the grounds that the islanders “had no medical reason to expect any permanent after-effects on the general health of the inhabitants.” After a series of military experiments devastated their homeland, Marshall Islands residents were permitted to immigrate to the U.S. But they didn’t know their American dream came with a catch.

"It may well be that the magical formula for a balanced, conscious, and responsible society is gender equality in the arts of nurturing and governing." ~ Jane Evershed

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Mass shootings, including school shootings

"If you're against gun reform, you're not pro-life."~Robert ReichSEE ALSO
-Gun violence, crippling injuries, and violent deaths
Gun control and gun reform
A reading list

A mass shooting as one that injures or kills four or more people, not including the shooter, according to CNN and the Gun Violence Archive.
• Mass Shooter Database (The Violence Project) Funded by a National Institute of Justice grant. See news on mass shootings and methodology (Q&A).

"Variables include: the perpetrator’s employment status, known prejudices, and experience with mental illness; the victims’ relationship to the perpetrator and estimated years of life they lost; and the firearms’ make, model, and method of acquisition." ~ Data Is Plural (a weekly newsletter of curious/useful datasets).

• Mass killing database (USA Today, 8-18-22; updated 10-26-23) A partnership with The Associated Press and Northeastern University. How many mass killings are there in the US? High profile public shootings are only a portion of the nation's mass killings since 2006 – deaths by guns, knives, fires, vehicles and other weapons in public and in private – that plague the U.S., research shows.
• A list of mass killings in the United States since January (AP News, 10-26-23)
• List of mass shootings in the United States Wikipedia's link-rich list of mass shootings in the U.S. from the 1920s on, with date, location, and number of dead and wounded.

• Gun Violence Archive An online archive of gun violence incidents collected from over 7,500 law enforcement, media, government and commercial sources daily in an effort to provide near-real time data about the results of gun violence. GVA is an independent data collection and research group with no affiliation with any advocacy organization.
• A Guide to Mass Shootings in America (Mark Follman, Gavin Aronsen, and Deanna Pan, Mother Jones, 3-22-21, regularly updated) There have been at least 121 mass shootings in the past four decades—and more than three quarters of the killers got their guns legally. In July 2012, in the aftermath of the movie theater massacre in Aurora, Colorado, Mother Jones created a first-of-its-kind open-source database documenting mass shootings in the United States. Its research focused on indiscriminate rampages in public places resulting in four or more victims killed by the attacker. It excludes shootings stemming from more conventionally motivated crimes such as armed robbery or gang violence. There have been many similar indiscriminate gun rampages in public places—but resulting in fewer fatalities—that would otherwise be included in MJ's dataset. More than half of the cases involved school or workplace shootings (12 and 20, respectively); the other 30 cases took place in locations including shopping malls, restaurants, and religious and government buildings. Forty-four of the killers were white males. Only one was a woman. The average age of the killers was 35, though the youngest among them was a mere 11 years old. See also US Mass Shootings, 1982-2019: Data From Mother Jones’ Investigation (the full data set from Mother Jones)

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• His Siblings Gathered to Sell the Family Home. Then He Started Shooting. (Corey Kilgannon, NY Times, 8-27-24) Joseph DeLucia, despondent over the sale of the Long Island house where he lived with his mother, killed three siblings, a niece and himself, the police said. “He kept saying, ‘I’m going to be homeless — my siblings are not going to help me. They’re just going to sell the house.’”

• The Injured (Super Bowl Mass Shooting)
---They Were Injured at the Super Bowl Parade. A Month Later, They Feel Forgotten. (Bram Sable-Smith and Peggy Lowe, KCUR, KFF Health News, 3-14-24) In the first of our series "The Injured," a Kansas family remembers Valentine's Day as the beginning of panic attacks, life-altering trauma, and waking to nightmares of gunfire. Thrown into the spotlight by the shootings, they wonder how they will recover.

The Barton family is not included in the official tally of 24 injured survivors of a mass shooting at the Kansas City Chiefs Super Bowl parade in February. But Jason Barton; his wife, Bridget; and her 13-year-old daughter, Gabriella, are still reeling from their roles at its epicenter. Although the Bartons aren’t included in that official victim number, they were traumatized, physically and emotionally, and pain permeates their lives: Bridget and Jason keep canceling plans to go out, opting instead to stay home together; Gabriella plans to join a boxing club instead of the dance team.---$2 Million Disbursed to Victims and Community Groups in Wake of Super Bowl Mass Shooting (Peggy Lowe, KCUR and Bram Sable-Smith, KFF Health News, 6-28-24) The United Way of Greater Kansas City gave $1.2 million to victims and $832,000 to 14 community groups Thursday, hoping to reach other victims from the violence at the Kansas City Chiefs’ Super Bowl parade, as well as those working to prevent gun violence.
---Super Bowl Parade Shooting Survivors Await Promised Donations While Bills Pile Up (Peggy Lowe, KCUR and Bram Sable-Smith, KFF Health News, 6-21-24) Families of the people hurt during the Feb. 14 mass shooting are carrying what one expert calls “victimization debt.” In the third story of our series “The Injured,” we learn about the strain of paying small and large medical bills and other out-of-pocket costs.
---Three People Shot at Super Bowl Parade Grapple With Bullets Left in Their Bodies (Bram Sable-Smith and Peggy Lowe, KCUR, KFF Health News, 5-8-24) Despite the rise of gun violence in America, few medical guidelines exist on removing bullets from survivors’ bodies. In the second installment of our series “The Injured,” we meet three people shot at the Kansas City Super Bowl parade who are dealing with the bullets inside them in different ways.

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• The Lawyer Trying to Hold Gunmakers Responsible for Mass Shootings (Michael Steinberger, NY Times Magazine, 9-29-23) Josh Koskoff’s legal victory against Remington has raised the possibility of a new form of gun control: lawsuits against the companies that make assault rifles.
• The Creator of the AR-15 Didn’t See This Coming (Zusha Elinson and Cameron McWhirter, The Atlantic, 9-27-23) Eugene Stoner wanted to design a modern rifle for the U.S. military. Today, it’s a weapon of choice for mass shooters. The AR-15 is a symbol of Second Amendment rights to millions of Americans and an emblem of a violent gun culture run amok to millions more.
• To End School Shootings, Activists Consider a New Culprit: Parents (KFF Health News podcast, 2-8-24) For the first time, a jury has convicted a parent of a school shooter of charges related to the child’s crime, finding a mother in Michigan guilty of involuntary manslaughter and possibly opening a new legal avenue for gun control advocates. Alice Miranda Ollstein of Politico, Sarah Karlin-Smith of the Pink Sheet, and Rachana Pradhan of KFF Health News join Julie Rovner to discuss these issues and more. For the first time, a jury has convicted a parent of a school shooter of charges related to the child’s crime, finding a mother in Michigan guilty of involuntary manslaughter and possibly opening a new legal avenue for gun control advocates.
• Terror on Repeat (Silvia Foster-Frau, N. Kirkpatrick and Arelis R. Hernández, American Icon, illustrated, 11-16-23) A rare look at the devastation caused by AR-15 shootings. The photos, videos and personal accounts are extremely disturbing and may be too upsetting for some people, but the full effects of the AR-15’s destructive force are rarely seen in public.
• The Grim Truth: The War on Guns Is Lost (Brynn Tannehill, The New Republic, 4-10-23) There are more unregistered guns in this country than are possessed by the Pentagon, DHS, and police departments combined. There are 400 million unregistered guns in this country, and 20 million of them are AR-15s. And Republicans want more of them.

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• Uvalde/Ross Elementary school shooting (NPR stories)
• Key Republicans pull out of NRA forum as political pressure mounts (Stephen Collinson, CNN, 5-27-22) Republicans habitually criticize Democrats for calling for gun control after America's regular mass killings but many support the NRA — itself a highly politicized body that spent decades radicalizing the GOP on guns and tearing down moderate firearm laws. There are now many high-powered weapons in private hands — like the kind an 18-year-old gunman bought legally and used for his rampage in Uvalde.
• The U.S. is uniquely terrible at protecting children from gun violence (Laurel Wamsly, NPR, 5-28-22) The dangers young people face from firearms in America go well beyond school shootings, which account for only a fraction of all gun-related deaths. Whether it's the gun violence they face in their neighborhoods, or suicide or accidents at home when guns are left unsecured, the threat to the nation's children and teenagers is not only bad, but worsening. In 2020, gun violence overtook car accidents to become the No. 1 cause of death for U.S. children and adolescents. Across the 29 countries in one study, the U.S. accounted for almost 97% of the firearm deaths among children 4 years old or younger, and 92% of firearm deaths for those between the ages of 5 and 14. Civilians in the U.S. own an estimated 393 million firearms, according to a 2018 study by the Small Arms Survey. That's nearly 46% of the estimated 857 million civilian-held firearms in the world.
• Inside the Uvalde Response (53-minute video, FRONTLINE, ProPublica, and The Texas Tribune, 12-5-23) Drawing on real-time, firsthand accounts, FRONTLINE, @ProPublica and @texastribune reconstruct law enforcement’s chaotic response to the May 2022 Uvalde school shooting and examine the missteps and lessons learned. Using official bodycam, audio and investigative interviews with responding officers, the documentary reconstructs how events unfolded at Robb Elementary School in Uvalde, Texas, giving a detailed analysis of one of the most criticized mass shooting responses in recent history, and providing real-time insight into law enforcement’s thoughts and actions.
• Why We’re Publishing Never-Reported Details of the Uvalde School Shooting Before State Investigators (ProPublica, The Texas Tribune and Frontline, 12-5-22) Over a year after the school shooting at Robb Elementary School in Uvalde, Texas, the community still doesn’t know what went wrong. It’s a key reason we’re publishing findings based on a trove of raw materials investigators have yet to release.
• Records Reveal Medical Response Further Delayed Care for Uvalde Victims (Zach Despart, The Texas Tribune, Lomi Kriel, ProPublica and The Texas Tribune, Alejandro Serrano, The Texas Tribune, Joyce Sohyun Lee, Arelis R. Hernández, Sarah Cahlan and Imogen Piper, The Washington Post, and Uriel J. García, The Texas Tribune, 12-20-22) Law enforcement’s well-documented failure to confront the shooter who terrorized the school for 77 minutes was the most serious problem in getting victims timely care, experts said. But previously unreleased records obtained by ProPublica, The Texas Tribune and The Washington Post for the first time show that communication lapses and muddled lines of authority among medical responders further hampered treatment. After police finally confronted the Robb Elementary shooter, the flawed medical response — captured in unreleased video footage, investigative documents, interviews and radio traffic — undermined the chances of survival for some victims of the May 24 massacre. Two teachers and 19 students died.
• Texas Agencies Fight Releasing Records That Could Help Clarify Response to Uvalde School Shooting ( Lexi Churchill, ProPublica and the Texas Tribune, 6-15-22) ProPublica and The Texas Tribune have submitted about 70 requests to state and local agencies for emergency response documentation surrounding the mass shooting at Robb Elementary. Most likely won’t be released publicly for months, if ever.
• Texas Judge Orders Release of Uvalde Shooting Records (Zach Despart, ProPublica and The Texas Tribune, 12-1-22) For more than a year, the state Department of Public Safety has blocked the release of records that could offer more clarity into the police response. The agency can appeal the ruling.

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• The Dead Children We Must See (Jay Caspian Kang, New Yorker, 11-28-23) It's time for Americans to rethink their squeamishness about releasing the photos of the youngest victims of mass violence.

• A Sweeping Report on a Michigan School Shooting Finds Multiple Failures and a Troubled Aftermath (Anna Clark, ProPublica, 10-31-23) Parents, already shaken by the fatal incident at Oxford High School, lost confidence in the school district when it hesitated to find and acknowledge accountability for the 2021 shooting. Nearly two years after the shooting, which killed four students and injured seven others, an outside consulting firm that conducted an independent investigation issued a sweeping report that faulted top administrators and other school officials for “failure and responsibility by omission.” A 572-page report from Guidepost Solutions, a New York-based firm that specializes in investigations, compliance and security, describes efforts by the lawyers for Oxford Community Schools and the teachers union to discourage people from cooperating in the investigation, showing why it can be so difficult for communities to find transparency and accountability following a mass shooting. Some school leaders encouraged staff to participate in interviews with the consultant, the report said, but the school board made it voluntary, rather than a condition of employment.
• Could a Michigan School Shooting Have Been Prevented? Families Still Waiting for a Full Accounting of What Happened. (Anna Clark, ProPublica, 5-14-23) Eighteen months after the deadly shooting at Oxford High School, parents want answers from the district. The mistrust sowed in the community by the delays reflects failures across the country to methodically investigate these tragedies.
• What Explains U.S. Mass Shootings? International Comparisons Suggest an Answer (Max Fisher and Josh Keller, NY Times, 11-7-17) Graphic showing this: The United States has 270 million guns [this was in 2017] and had 90 mass shooters from 1966 to 2012. No other country has more than 46 million guns or 18 mass shooters. Americans make up about 4.4 percent of the global population but Americans own 42 percent of the world's guns. A thoughtful set of comparisons.

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• What I Saw Treating the Victims From Parkland Should Change the Debate on Guns (Heather Sher, The Atlantic, 2-22-18) They weren’t the first victims of a mass shooting the Florida radiologist had seen—but their wounds were radically different. "One of the trauma surgeons opened a young victim in the operating room, and found only shreds of the organ that had been hit by a bullet from an AR-15, a semi-automatic rifle which delivers a devastatingly lethal, high-velocity bullet to the victim. There was nothing left to repair, and utterly, devastatingly, nothing that could be done to fix the problem. The injury was fatal....A typical AR-15 bullet leaves the barrel traveling almost three times faster than, and imparting more than three times the energy of, a typical 9mm bullet from a handgun....If a victim takes a direct hit to the liver from an AR-15, the damage is far graver than that of a simple handgun shot injury."

"It’s clear to me that AR-15 or other high-velocity weapons, especially when outfitted with a high-capacity magazine, have no place in a civilian’s gun cabinet."

• Are Mass Murderers Insane? Usually Not, Researchers Say (Benedict Carey, NY Times, 11-8-17) "It is true that severe mental illnesses are found more often among mass murderers. About one in five are likely psychotic or delusional, according to Dr. Michael Stone, a forensic psychiatrist at Columbia University who maintains a database of 350 mass killers going back more than a century. The figure for the general public is closer to 1 percent. But the rest of these murderers do not have any severe, diagnosable disorder....

"Most mass murderers instead belong to a rogue’s gallery of the disgruntled and aggrieved, whose anger and intentions wax and wane over time, eventually curdling into violence in the wake of some perceived humiliation....“The majority of the killers were disgruntled workers or jilted lovers who were acting on a deep sense of injustice,” and not mentally ill, Dr. Stone said of his research....About two-thirds of this group had faced “long-term stress,” like trouble at school or keeping a job, failure in business, or disabling physical injuries from, say, a car accident. Substance abuse was also common: More than 40 percent had problems with alcohol, marijuana or other drugs....But other factors must be weighed.

“In my large file of mass murders, if you look decade by decade, the numbers of victims are fairly small up until the 1960s,” said Dr. Stone. “That’s when the deaths start going way up. When the AK-47s and the Kalashnikovs and the Uzis — all these semiautomatic weapons, when they became so easily accessible.”

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• Why Mass Shooters Do the Evil They Do (David Brooks, Opinion, NY Times, 7-7-22) Mass shooters often start life with some sort of trauma or extreme bullying, and then become "ghosts." As one researcher put it, they are not necessarily loners; they are failed joiners. For people who have felt impotent all their lives, the guns seem to provide an almost narcotic sense of power.
• Mass Shootings: Maybe What We Need Is a Better Mental-Health Policy (Mark Follman, Mother Jones, 11-9-2012) "Nearly 80 percent of the perpetrators in 62 cases obtained their weapons legally. Acute paranoia, delusions, and depression were rampant among them, with at least 36 of the killers committing suicide on or near the scene. Seven others died in police shootouts they had little hope of surviving (a.k.a. “suicide by cop”). And according to additional research we completed recently, at least 38 of them displayed signs of possible mental health problems prior to the killings."

Listen to hour-long panel discussion in 2012 on "The Mind, Madness and Gun Violence" at the Commonwealth Club of California. Panelists: Dr. Renée Binder, a leading expert on psychiatry and the law from UCSF Medical School; board member Carol Kingsley of the Law Center to Prevent Gun Violence; and Robert J. McMenomy, assistant special agent in charge of the San Francisco division of the FBI.
• A Guide to Mass Shootings in America (Mark Follman, Gavin Aronsen, and Deanna Pan, Mother Jones, 3-22-21)
• US Mass Shootings, 1982-2021: Data From Mother Jones’ Investigation (Mark Follman, Gavin Aronsen, and Deanna Pan, Mother Jones, 3-22-21)
• Why Does the U.S. Have So Many Mass Shootings? Research Is Clear: Guns. (Max Fisher and Josh Keller, NY Times, 11-7-17)
• The Narcissism of the Angry Young Men (Tom Nichols, The Atlantic, 1-29-23) What to do about the deadly misfits among us? First, recognize the problem. "The commonalities among these young men, even across nations and cultures, are hardly a secret. They are man-boys who maintain a teenager’s sharp sense of self-absorbed grievance long after adolescence; they exhibit a combination of childish insecurity and lethally bold arrogance; they are sexually and socially insecure. Perhaps most dangerous, they go almost unnoticed until they explode. Some of them open fire on their schools or other institutions; others become Islamic radicals; yet others embrace right-wing-extremist conspiracies."

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• His Woman-Hating SciFi Went Viral in the ‘Manosphere.’ If She’d Known, Maybe She Would Have Seen Him Coming (Marisa Kabas, Rolling Stone, 6-19-22) Alicia Cardenas was a "bastion and figurehead" in the Denver tattoo community — until last December, when Lyndon McLeod brought his violent fantasies to life, murdering her and four others in cold blood. Unlike most of the mass murderers to which Americans have become so accustomed, McLeod had laid out his plans for Cardenas and others in a series of novels: thinly veiled works that could have tipped anyone off — especially law enforcement, who’d been informed of their existence — to the danger the future victims faced.
• Emma Gonzalez, a senior who survived a mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida on Feb. 14, 2018, gave a blistering speech at an anti-gun rally on Saturday about the politicians complicit in the murder of her classmates.
"Companies trying to make caricatures of the teenagers nowadays, saying that all we are is self-involved and trend-obsessed, and hushing us into submission when our message doesn't reach the ears of the nation? We are prepared to call BS!
Politicians who sit in their gilded House and Senate seats funded by the NRA, telling us nothing could have ever been done to prevent this: We call BS!
They say that tougher gun laws do not decrease gun violence: We call BS!
They say a good guy with a gun stops a bad guy with a gun: We call BS!
They say guns are just tools like knives and are as dangerous as cars: We call BS!
They say that no laws could have been able to prevent the hundreds of senseless tragedies that have occurred: We call BS!
That us kids don't know what we're talking about, that we're too young to understand how the government works: We call BS!"
To which the crowd responded, Vote them out! Vote them out! Vote them out!

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• His sister died in the Parkland massacre. He wants the gunman to live. (Danielle Paquette, Washington Post, 9-27-22) A jury will decide whether Nikolas Cruz lives or dies for killing 17 people at a high school in Parkland, Fla., in 2018. Not all victims’ relatives are convinced the death penalty will bring them a sense of justice.

Robert Schentrup moved across the country to Washington state with his parents after his sister Carmen was killed in the Marjory Stoneman Douglas High School massacre. His parents are for, and he is against, applying the death penalty. “It’s about smoke and mirrors and redirection,” Robert said. “It makes it look like you’re doing something without truly changing anything at all.”
• More states approving 'red flag' laws to keep guns away from people perceived as threats (Michael Livingston, LA Times, 5-14-18) Since the fatal shooting of 17 people at a South Florida high school, five states — Delaware, Florida, Maryland, Rhode Island and Vermont — have passed laws that allow authorities to temporarily take away guns from a person who has shown a pattern of violence. While most legislative proposals to address gun violence stall, the "red flag" laws, as they are known, have passed with bipartisan support and the collaboration of activists on both sides of the gun control debate. The momentum for these laws comes after investigations revealed that the shooters often showed warning signs that they would commit violence. Nine states now have such laws on the books and dozens of others are considering such proposals.
• When Masculinity Turns ‘Toxic’: A Gender Profile of Mass Shootings (Phillip Reese, KHN, 10-3-19) Men are far more likely than women to commit deadly mass shootings and “I think that goes deep to the issue of how we raise our boys to be men, goes deeply into values that we tend to hold dear: power, dominance and aggression over empathy, care and collaboration,” says California Gov. Gavin Newsom. Some research shows that men who commit mass murder tend to feel their masculinity has been diminished in a fundamental way.... Another common trait among mass killers is that they tend to blame others for their problems....The correlation between masculinity and homicide goes beyond mass shootings. Almost 90% of suspects arrested for any form of homicide in California in 2018 were male, a disparity that has not changed much over the decades."
• There is no single profile of a mass shooter. Our data show there are five types (Jillian Peterson and James Densley, Opinion, LA Times, 11-14-19) The K-12 school shooter, college and university shooter, workplace shooter, house of worship shooter, and retail/restaurant shooter all have different profiles. "Attacks in churches are perpetrated by a different type of person than attacks in malls and restaurants. And attacks at schools are carried out by very different types depending on whether they are at colleges or high schools."
• A Reformed White Nationalist Says the Worst Is Yet to Come (Yara Bayoumy and Kathy Gilsinan, The Atlantic, 8-6-19) Christian Picciolini discusses the mainstreaming of white nationalism, what it takes to de-radicalize far-right extremists, and why the problem is metastasizing.
• Right-Wing Media Uses Parkland Shooting as Conspiracy Fodder (Michael M. Grynbaum, NY Times, 2-20-18) In certain right-wing corners of the web — and, increasingly, from more mainstream voices like Rush Limbaugh and a commentator on CNN — the students are being portrayed not as grief-ridden survivors but as pawns and conspiracists intent on exploiting a tragedy to undermine the nation’s laws.
• Mass Shootings in 2019 (Gun Violence Archive) with interactive map

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• Scarred by school shootings (John Woodrow Cox and Steven Rich, Washington Post, 3-23-18) More than 187,000 students have been exposed to gun violence at school since Columbine, The Washington Post found. Many are never the same. 13 dead at Columbine (in 1999). 26 dead at Sandy Hook. 17 dead at Marjory Stoneman Douglas. "In total, The Post found an average of 10 school shootings per year since Columbine, with a low of five in 2002 and a high of 15 in 2014. Less than three months into 2018, there have been 11 shootings, already making this year among the worst on record."
• How White-Supremacist Violence Echoes Other Forms of Terrorism (Kathy Gilsinan, The Atlantic, 3-15-19) Their enemies are different, but their tactics are often the same.
• What mental health experts say to their kids about school shootings (Nicole Spector, Better, 3-23-18) How to help your kids feel safe when their world feels out of control.
• Before the Next One (Ira Glass and others, This American Life, 10-12-18) There’s no rulebook on how to handle a school shooting. And no real way to prepare for one. This week, people take what they’ve learned from these tragedies and try to use that knowledge to save others. Listen and/or read the transcript>.
• Share These Gun Violence Numbers with Anyone Who Will Listen (Jack Holmes, Esquire, 10-2-17) Las Vegas is a symptom of a much larger disease. "It will happen again, because it happens most days. We have reached the 275th day of 2017. The horror that rained down on the Las Vegas strip Sunday night was the 273rd mass shooting of the year. It was the second mass shooting of the day on October 1, and the third of the weekend. It was the 11th mass shooting that week, since the previous Sunday, when there were four. There were two more that Saturday. Since September 2, 2017, there have been 29 mass shootings in America."
• Parents and Students Plead With Trump: ‘How Many Children Have to Get Shot?’ (Julie Hirschfeld Davis, NY Times, 2-21-18) Along with moving videos showing the people who experienced the mass shooting in Florida there is one showing an NRA spokesman saying the Times and press are lying to you about the NRA. "Exposing mainstream media lies, etc." These are the messages gun control supporters must fight.) "We cannot protect our guns before we protect our children!" says one mother. "There is no better time than now to talk about gun control." Trump is shown arguing for "concealed carry" guns at schools--to scare off such shooters. He thinks more guns in the schools will make them safer, and wants some teachers armed with them. He found no support for that in Parkland.
• How Perpetrators of Mass Violence Learn From Each Other (David A. Graham, The Atlantic, 10-2-17) Attacks on concerts are the latest tactic to spread among those intent on taking lives.

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• With AR-15s, Mass Shooters Attack With the Rifle Firepower Typically Used by Infantry Troops (C. J. Chivers, Larry Buchanan, Denise Lu, and Karen Yourish, NY Times, 2-28-18) Since 2007, at least 173 people have been killed in mass shootings in the United States involving AR-15s. The Parkland gunman, in practical terms, had the same rifle firepower as an American grunt using a standard infantry rifle in the standard way. Representative Brian Mast of Florida, a Republican and an Army combat veteran, has called for a ban on the sale of AR-15-style rifles. “The exact definition of assault weapon will need to be determined,” Mr. Mast said. “But we should all be able to agree that the civilian version of the very deadly weapon that the Army issued to me should certainly qualify.”
• One Teacher’s Brilliant Strategy to Stop Future School Shootings—And It’s Not About Guns (Glennon Doyle Melton, Reader's Digest, 2-16-18) "Chase’s teacher is looking for lonely children. She’s looking for children who are struggling to connect with other children. She’s identifying the little ones who are falling through the cracks of the class’s social life. She is discovering whose gifts are going unnoticed by their peers. And she’s pinning down—right away—who’s being bullied and who is doing the bullying."
• Wounds From Military-Style Rifles? ‘A Ghastly Thing to See’ (Gina Kolata and C.J. Chivers, NY Times, 3-4-18) Perhaps no one knows the devastating wounds inflicted by assault-style rifles better than the trauma surgeons who struggle to repair them. The doctors say they are haunted by their experiences confronting injuries so dire they struggle to find words to describe them. At a high school in Parkland, Fla., 17 people were recently killed with just such a weapon — a semiautomatic AR-15. It was legal there for Nikolas Cruz, 19, the suspect in the shooting, to buy a civilian version of the military’s standard rifle, while he would have had to be 21 to buy a less powerful and accurate handgun.

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• Orlando Paramedics Didn’t Go In to Save Victims of the Pulse Shooting. Here’s Why. (Abe Aboraya, Trauma After Tragedy, ProPublica, 9-25-18, produced in partnership with WMFE, which is a member of the ProPublica Local Reporting Network) Emails and interviews show that the Orlando Fire Department had been working for three years on a plan to respond to a mass shooting. It had even purchased vests filled with tourniquets and special needles to relieve bleeding in the chest. But at the time of the Pulse nightclub shooting, the plan had already sputtered and the vests sat untouched. Ultimately 49 people died during the Pulse attack, one of the worst mass shootings in modern history. “My head’s still not right,” said one paramedic who responded to the Pulse nightclub shooting. He and some other responders say their departments haven’t given them the help they need. A study published this year in the journal Prehospital Emergency Care concluded that 16 of the victims might have lived if they had gotten basic EMS care within 10 minutes and made it to a trauma hospital within an hour, the national standard. That’s nearly one third of victims that died that night.
• In Parkland, journalism students take on role of reporter and survivor (Alexandria Neason and Meg Dalton, Columbia Journalism Review, 2-21-18) "In the aftermath of mass shootings and other disasters, journalists working on deadline are inevitably criticized for parachuting into communities they don’t know and pushing microphones and notebooks into the faces of the grieving. But Ma, Nookala, and their classmates—already known and trusted as press on campus—have a unique advantage. They don’t have to imagine the position their subjects are in, because they’re in it, too. They’re reporters and survivors." “We tried to have as many pictures as possible to display the raw emotion that was in the classroom,” Ma says. “We were working really hard so that we could show the world what was going on and why we need change.”
• US newspapers run more photos of school shooting suspects than victims (Denise-Marie Ordway reports on a recent study, Journalist's Resource, 8-28-18) When U.S. newspapers cover school shootings, they run more photos of the perpetrators than the victims....it’s important to look at how the news media reports on mass murder considering a growing body of research indicates news coverage contributes to copycat shootings. A 2016 study by criminologist Adam Lankford finds that fame-seeking as a motive for rampage shooting dates back decades. News organizations should consider whether the value of providing these images to the public outweighs the harm they may cause.
• When Reason Fails (Sam Kriss's essay in The Point, 10-18-22) On the literature of mass shootings. Mentions a few novels about the topic.
• Five First Responders to the Pulse Massacre. One Diagnosis: PTSD. (Abe Aboraya, WMFE and Pro Publica, 6-11-18) “My head’s still not right,” said one paramedic who responded to the Pulse nightclub shooting two years ago. He and some other responders say their departments haven’t given them the help they need. Men threw away their uniforms, they were covered in so much blood. And then the nightmares started.
• After Orlando Shooting, ‘False Flag’ and ‘Crisis Actor’ Conspiracy Theories Surface (Christopher Mele, NY Times, 6-28-16) After the mass shooting at a gay nightclub in Orlando, Fla., on June 12, Twitter brimmed with news reports of the carnage. But some posts on the massacre that claimed 49 lives also included a curious phrase: “false flag.” It was a code used by conspiracy theorists to signal their belief that the government had staged the massacre and the information the public was reading and hearing from the mainstream media was untrue.'
• More than 210,000 students have experienced gun violence at school since Columbine (John Woodrow Cox, Steven Rich, Allyson Chiu, John Muyskens and Monica Ulmanu, Wash Post, 4-23-18)
• The Uncounted (Azmat Khan and Anand Gopal, NY Times Magazine, 11-16-17) An on-the-ground and award-winning investigation reveals that the U.S.-led battle against ISIS — hailed as the most precise air campaign in history — is killing far more Iraqi civilians than the coalition has acknowledged.

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• The Mental Health System Can’t Stop Mass Shooters (Amy Barnhorst, OpEd, NY Times, 2-20-18) "But there are no reliable cures for insecurity, resentment, entitlement and hatred. The one concrete benefit of officially committing him would be that he could be prohibited from buying a gun from any federally licensed retailer. Of course, this would do nothing about any guns and ammunition he may already have amassed. Nor would it deter him from getting guns from private-party sales, which are exempt from background checks in many states."
• A Drumbeat of Multiple Shootings, but America Isn’t Listening (Sharon LaFraniere, Daniela Porat, and Agustin Armendariz, NY Times, 5-22-16) Seven people were shot in a matter of minutes last August at an Elks Lodge in Cincinnati. Most shootings with four deaths or injuries are invisible outside their communities. And most of the lives they scar are black.
• March for Our Lives Highlights: Students Protesting Guns Say ‘Enough Is Enough’ (NY Times, 3-24-18)

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Domestic violence and abusive relationships

"Love is a belief that you are exempt from reality."

"People who want to get married in the worst way … usually do."~ psychotherapist Milton Trachtenburg

• What Is Domestic Violence? (National Domestic Violence Hotline) Domestic violence (also called intimate partner violence (IPV), domestic abuse or relationship abuse) is a pattern of behaviors used by one partner to maintain power and control over another partner in an intimate relationship. Read about the warning signs.
• The National Domestic Violence Hotline Our advocates are available 24/7 at 1-800-799-SAFE (7233) in more than 200 languages. Safety Alert: Computer use can be monitored and is impossible to completely clear. If you are afraid your internet usage might be monitored, call the National Domestic Violence Hotline at 1−800−799−7233 or TTY 1−800−787−3224.
• International Domestic Violence Resource Guide: Coronavirus Update (Michelle Cardillo, Mystic Mag, 8-22-2020) With COVID-19 domestic violence has increased 30% in the U.S., and 25% in the U.K.This directory includes a broader range of international resources than most.
• Covering Domestic Violence (Journalist's Toolbox, excellent links to resources)
• Domestic Violence Counts (Annual Census)
• National Network to End Domestic Violence (NNEDV, a leading voice for survivors of domestic violence and their allies)
• Domestic Violence Forums And Chats (DomesticShelters.org)
• He Beat Her Repeatedly. Family Court Tried to Give Him Joint Custody of Their Children. (Megan O’Matz, ProPublica, 9-16-21) Wisconsin is considered a leader in the movement to treat fathers as equal caregivers when parents separate. Shared parenting is usually better for children — but the model fails for many women forced to co-parent with their abusers. Researchers in 20 Wisconsin counties reviewed every divorce case between 2010 and 2015 in which one parent had a prior conviction for felony domestic abuse or misdemeanor battery against the other parent. There were a total of 361. They found that half the cases resulted in joint legal custody, requiring victims to cooperate in decision-making with their abusers, despite the law’s protections.
• An Author Wrote About Her Sister’s Murder. It Led to a Breakthrough. (Benjamin P. Russell, NY Times, 3-12-22) Cristina Rivera Garza said the book about her sister’s death was “written from a wound that I share with so many other families in Mexico, Latin America, and around the world.” The book came as a watershed moment for women’s rights in Mexico, part of a collective call for justice in one of the world’s most dangerous countries for women. Calling them "crimes of passion" let men off the hook. As "femicide," they're a call for women's basic human rights.
• If you beat your wife, you lose your gun. That’s how it should be. (Editorial, WashPost, 2-27-18) In criminal violence cases in Montgomery County, Maryland, guns were virtually never discussed. "Convicted abusers were not told that they, by law, were disqualified from possessing or purchasing firearms. They weren’t asked if they had any weapons. And — most alarming, given that the chances of a domestic violence victim being killed rise fivefold when an abuser has access to a gun — they weren’t told to surrender any guns." Three years ago legislation was introduced in Maryland that would plug the gap in state law by setting up a mechanism to facilitate the surrender of firearms by convicted domestic abusers, but the bill died, two years running. It's back again. "Hopefully, the attention focused on gun control that resulted from the recent tragic events in Florida will help win passage of this needed fix."
"[T]hose who choose the lesser evil forget very quickly that they chose evil." -- Hannah Arendt
• Treating Domestic Violence as a Medical Problem (Anna Gorman, Kaiser Health News, 1-29-18) A growing number of health providers and anti-abuse agencies in California and around the country are collaborating to identify victims and get them help. More doctors now screen their patients for signs of abuse and more agencies place victims’ advocates inside health centers. Education and counseling for people experiencing violence is also more widely available in clinics and hospitals. The U.S. Preventive Services Task Force recommends doctors routinely question women about violence in the home and refer them to services if needed. The task force concluded in 2013 that intervention could reduce violence and abuse as well as mental and physical health problems.
• 5 resources for journalists covering domestic violence (Kristen Hare, Poynter, 9-8-14)
---Intimate Partner Violence (Resources for journalists reporting on victims and survivors of domestic crime, Dart Center for Journalism & Trauma)
----Violence Prevention, Intimate Partner Violence (Centers for Disease Control and Prevention, CDC)
---Telling the Full Story: An Online Guide for Journalists (Rhode Island Coalition Against Domestic Violence)
• The most dangerous time (Melissa Davey, A Guardian Australia special, Five women tell their stories of leaving an abusive relationship. "I hear people in the media say to 'just leave' and they cannot understand why you can't walk out that door. But what they don’t realise is that when you look outside of that front door, it is black. You can't see any light at the end of the tunnel, you don't know what's going to happen to you."~Gee Bailey
• No Visible Bruises: Domestic Violence and Traumatic Brain Injury (Rachel Louise Snyder, New Yorker, 12-30-15) The vast majority of domestic-violence victims who show signs of traumatic brain injury never receive a formal diagnosis. Fifty per cent of domestic-violence victims are strangled at some point in the course of their relationship—often repeatedly, over years.
• Domestic Violence's Overlooked Damage: Concussion And Brain Injury (Will Stone, Shots, All Things Considered, 5-30-18) "Domestic violence is estimated to affect 10 million people each year. Head and neck injuries are some of the most common issues, and Zieman is uncovering how frequently traumatic brain injury is a part of the picture....About 70 percent of people seen in the ER for such abuse are never actually identified as survivors of domestic violence. It's a health crisis cloaked in secrecy and shame, one that Zieman is uncovering through her work at the Barrow Concussion and Brain Injury Center."
• ‘Intimate terrorism’: how an abusive relationship led a young woman to kill her partner (Sophie Elmhirst, The Guardian, 10-31-19) Fri Martin’s whole life was controlled by her violent partner until she stabbed him to death. Now her lawyers are challenging her murder conviction.
• Addressing Domestic Violence Against Women: An Unfinished Agenda (Ravneet Kaur and Suneela Garg, Indian Journal of Community Medicine, April 2008) "Domestic violence is wide spread, deeply ingrained and has serious impacts on women's health and well-being. Its continued existence is morally indefensible. Its cost to individuals, to health systems and to society is enormous. Yet no other major problem of public health has been so widely ignored and so little understood."
• Violence Against Women Act (New York Times) News about Violence Against Women Act, including commentary and archival articles published in The New York Times.
• Thermostats, Locks and Lights: Digital Tools of Domestic Abuse (Nellie Bowles, NY Times, 6-23-18) "The people who called into the help hotlines and domestic violence shelters said they felt as if they were going crazy." There is "a new pattern of behavior in domestic abuse cases tied to the rise of smart home technology. Internet-connected locks, speakers, thermostats, lights and cameras that have been marketed as the newest conveniences are now also being used as a means for harassment, monitoring, revenge and control."

"Tell me what you cannot tell me so that tomorrow you might dream the dream you dared not dream."

~Milton Trachtenburg in

Stop the Merry-Go-Round: Stories of Women Who Broke the Cycle of Abusive Relationships

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Hate crimes and assassination attempts

• Development of Federal Hate Crimes Statistics--A Timeline April 23, 1990: In response to a growing concern about hate crimes, Congress passed the Hate Crimes Statistic Act which required data collection "about crimes that manifest evidence of prejudice based on race, religion, sexual orientation, or ethnicity." From 1994 to 2009, several amendments were made to the act.
• Who Is Protected by Hate-Crime Laws? After 50 years of hate-crime legislation in the U.S., hate-motivated violence is once again on the rise. So where did we go wrong? In this week's episode of The Experiment podcast correspondent,Tracie Hunte and guests (Jami Floyd, Saida Grundy, Jason Wu,Jeannine Bell, and and Sunayana Dumala) discuss the 150-year history of legislating against racist violence in the U.S. and ask: Have we been policing hate all wrong?
• The attempt on Trump’s life is yet another violent spectacle (David Wallace-Wells newsletter, NY Times, 7-17-24) "Eleven of the last 12 American presidents have endured an assassination attempt or a plot against their lives. The same is true for 20 of the country’s 45....Everyone knows this country is an unusually violent place, but few appreciate just how unusually so....And while American murder rates are in long-term decline, mass shootings, though only a tiny fraction of the total, are becoming only more common...
• Killings of Asian women renew push for tougher U.S. hate crime laws (Nathan Layne, Andy Sullivan, Reuters, 3-20-21) "The killings of six women of Asian descent in Georgia this week have prompted fresh calls to pass hate crime laws in the handful of states without them and for law enforcement elsewhere to invoke protections already in place....Georgia passed its hate crime bill in June 2020, after the killing of Ahmaud Arbery, an unarmed Black man, sparked widespread outrage. The state laws are unevenly applied and offer varying protections, however. California’s hate crime laws cover crimes motivated by a victim’s gender identity, age, sexual orientation and political affiliation. Alabama’s laws do not cover any of those categories." “We’re seeing more types of people getting attacked, and some of them are not covered by hate crime laws,” said Brian Levin, director of the Center for the Study of Hate and Extremism at California State University, San Bernardino. A report by the center found that hate crimes against Asian Americans in 16 major U.S. cities rose by 149% from 2019 to 2020, a period when overall hate crimes dropped 7%."
• Calling the Atlanta Shootings a Hate Crime Isn’t Nearly Enough (Saida Grundy, The Atlantic, 3-25-21) Overwhelmingly, intergroup violence in the U.S. is male violence against women. And yet femicide, domestic violence, sexual assault, harassment, and stalking are almost never prosecuted as hate crimes.
• Homos 101 (Chanel Lee, Village Voice, 8-12-03) The failure to convict Price on the hate-crime statute was criticized by many LGBTQ-rights advocates, and drew attention to how hate-crime laws work—in that many times they just don’t.
• Utah governor signs long-awaited hate-crimes law (Lindsay Whitehurst AP News, 4-2-19) A long-awaited measure strengthening Utah’s hate crimes law was hailed as historic. The legislation puts teeth in a Utah law that was essentially unenforceable. It creates stiffer penalties for people convicted of targeting others because of their sexual orientation, race, religion or other factors.
• The Hate-Crime Case in Which No One Was Intimidated (Conor Friedersdorf, The Atlantic, 7-25-21) A Utah arrest shows the danger of laws that let government enforcers chill speech that they don’t like.
• Contempt of cop(Wikipedia) Law enforcement jargon in the United States for behavior by people toward law enforcement officers that the officers perceive as disrespectful or insufficiently deferential to their authority. It is not an actual offense.
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Order the beautiful gift edition of Dying: A Book of Comfort

• Teen Suicide Prevention Campaign (American Foundation for Suicide Prevention). Watch these brief public service announcements (PSAs)

On talking about suicides

“The quickness and flexibility of a well mind, a belief or hope that things will eventually sort themselves out--these are the resources lost to a person when the brain is ill.” ~ Kay Redfield Jamison

"When speaking of those who take their own lives, it is always most dignified to use silence or at least restrained language, for the ones left most vulnerable and most deeply hurt by such an occurrence can feel oppressed by the louder assertions of understanding, wisdom, and depth of remorse foisted on them by others. One must ask: Who is best served by speculation? Who is really able to comprehend? Perhaps we must, as human beings, continue to try and comprehend, but we will fall short. And the falling short will deepen our sense of emptiness." ~attributed to Yasunari Kawabata by Howard Norman, in the fifth section of his excellent memoir I Hate to Leave This Beautiful Place

Books and Stories About Suicide (and Surviving a Suicide)

• Clancy Martin Is Making Peace With His Suicidal Tendencies (Tyler Santora, Fatherly, 5-21-23) Depression is something one lives with, not something we can eliminate. Martin helps us all understand this — and build a philosophy to combat it. After 10 attempts and years of suffering and addiction, Martin describes facing the darkness in his raw memoir. Most of his friends had no idea of his inner demons until he published How Not to Kill Yourself: A Portrait of the Suicidal Mind “A rock for people who’ve been troubled by suicidal ideation, or have someone in their lives who is.” ~The New York Times. Do read the comments at Amazon.

• One Friday in April: A Story of Suicide and Survival by Donald Antrim.

"A profound, courageous, compassionate masterpiece that will, I think and I hope, change the way we think about suicide forever. What Antrim brings powerfully to bear in this inspiring and essential book is the great writer’s habits of precision and unwavering honesty. This book is an act of generosity; Antrim is trying to tell us something deeply true not just about the suicidal, but about all of us; about our culture, about the way we live, about how we might lead better, more authentic, more connected lives."~George Saunders, author of Lincoln in the Bordo.

And Andrew Solomon writes: "The book chronicles his experience at the brink, but it also describes the larger face of how little we really know of suicide and its multiplicity of causes, and how little we understand of our agency over our own lives or deaths. It is a compelling, heart-breaking, and redemptive read and it shimmers in its narratives of both loss and hope."

See also Antrim's story in the New Yorker (8-9-21): Finding a Way Back from Suicide A journey of recovery through electroconvulsive therapy. "ECT is a powerful measure against suicide, and yet it has traditionally been used as a treatment of last resort."
• Darkness Visible, the classic account by William Styron. Also available free online (Internet Archive). "The great advantage about such books as 'Darkness Visible' lies in the way it makes the intensely private confession a public, shared experience. For many suffering from the unusual form of unipolar depression that overtook William Styron in the mid-1980s, that experience of 'the walking wounded' that he refers to becomes instantly accessible. He describes it as 'idiopathic', having no known, or no immediately appreciable, cause, which is itself an aggravating feature of the illness. And illness, he emphasizes, is what it is. One of the worst aspects of it is picked out in the impossibility of small talk and the social obligation to 'God help him, even smile'. Everything goes askew in this sombre world where the only way is down." ~Jeremy Allan-Smith
• Surviving Suicide in Wyoming (Anna Maria Barry-Jester, FiveThirtyEight, 7-13-16) Self-reliance helps people thrive in a landscape that's big and tough, but it can also put them at risk if they get into a personal crisis. And the story about the story: How Anna Maria Barry-Jester turned a story about Wyoming suicides into a sensitive narrative (David Wollman, Storygram, The Open Notebook, 6-12-18) Wollman, in a Storygram, annotates an award-winning story to shed light on what makes some of the best science writing so outstanding.
• Why Michael Grosvenor Myer left his wife to die alone (Andrew Alderson, New York Times, 11-29-08), the story of a novelist whose final gift to her husband was to die alone, sparing him a jail sentence for assisting in her suicide.
• Poet Diana Khoi Nguyen on Family and Writing a Radical Eulogy for Her Brother (Peter Mishler, Lit Hub,10-23-19) By the author of Ghost Of. “Ghost Of is nothing short of an extraordinary debut. These poems are uncanny renderings of an invisibility made visible by the sheer will of candor, bemused forms, agility of lexicon, and a voice, almost noiselessly extravagant. What she gives us, she takes away; nearly impossible transformations transform. “Something keeps not happening” she writes. And then she causes it to happen in a language of grief—bold and often colder than most daring, exquisite acts.” (Terrance Hayes, judge of the Omnidawn Open, a poetry book contest)
• Adorján, Joanna. An Exclusive Love: A Memoir (translated by Anthea Bell). Adorján tries to make sense of the dual suicide of her fascinating grandparents, who survived the Holocaust and the Hungarian uprising of 1956 and died in a suicide pact in Denmark in 1991.
• Bialosky, Jill. History of a Suicide: My Sister's Unfinished Life (about both her sister, Kim's, life and death and about sibling loss and survival guilt)
• Bolton, Iris. My Son...My Son: A Guide to Healing After Death, Loss, or Suicide
• Farr, Moira. After Daniel: A suicide survivor's tale. Here is an excellent review of the book (PDF), in which the reviewer, Paul S. Links, writes: "This chilling account will remind physicians that the suicide survivor’s response is often a complex combination of posttraumatic features and guilt-laden grief. Both aspects must be worked through during the process of recovery....this book is not a tell-all story of the Toronto artistic scene. It is not an academic recounting of current scientific formulations of suicide. It is not a prescription for the self-directed recovery from grief. Rather, it is an offer of hope, a beautifully written journey of reclamation, and simply a very personal account of the author’s own grief."
• Fine, Carla. No Time to Say Goodbye: Surviving the Suicide of a Loved One
• Hammer, Signe. By Her Own Hand: Memoirs of a Suicide's Daughter
• Handke, Peter. A Sorrow Beyond Dreams (transl. Ralph Manheim, intro. Jeffrey Eugenides). A slim and sorrowful memoir of the author's depressed mother's life and suicide at 51.
• Lourey, Jessica. My Fiction Therapy (The Truth in Fiction). This moving story is the opening for a memoir in progress, tentatively titled Better than Gin: Transform Your Facts into Fiction that Sells (The One Year, One Book Challenge.
• Page, Patricia. Shadows on a Nameless Beach. A brief and beautifully crafted collection of essays, a memoir of the year after her son's death by suicide, her feelings of parental guilt, finding solace in walks through California's coastal landscape.
• Rappaport, Nancy. In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide. Haunted by the 1963 death of her mother, a Boston socialite, from an overdose when Rappaport was only four (the youngest of six children), the author tries to reconstruct what happened. As her brother asked: Didn't their mother know that she would leave all these shattered children wondering if it was their fault?
• Sharples, Madeline. Leaving the Hall Light On. A mother's memoir of living with her son's bipolar disorder and surviving his suicide. Read review by Dr. Jason M. Dew and interview with the author (on Women's Memoirs).
• Stone, Geo. Suicide and Attempted Suicide: Methods and Consequences
• West, John. The Last Goodnights: Assisting My Parents With Their Suicides
• Wickersham, Joan. The Suicide Index: Putting My Father's Death in Order "Sixteen years ago, Joan Wickersham’s father shot himself in the head. The father she loved would never have killed himself, and yet he had. His death made a mystery of his entire life. Using an index—that most formal and orderly of structures—Wickersham explores this chaotic and incomprehensible reality. Every bit of family history—marriage, parents, business failures—and every encounter with friends, doctors, and other survivors exposes another facet of elusive truth. Dark, funny, sad, and gripping, at once a philosophical and deeply personal exploration, The Suicide Index is, finally, a daughter’s anguished, loving elegy to her father."

“Few understand that the death [suicide] is seldom self-determined, but rather driven by a distortion of perception by a biochemical effect…People who die by suicide do not want to die; they simply want to end the pain…” ~ Andrew Slaby

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Complex and Difficult Endings: A Reading List

SEE ALSO
Gun violence, crippling injuries, and violent deaths
Gun control and gun reform
Mass shootings, including school shootings

• Ascher, Barbara Lazear. Landscape Without Gravity (about her brother's death from AIDS).

• Boss, Pauline. Ambiguous Loss: Learning to Live with Unresolved Grief (about the sense of "frozen grief" that can occur when a loved one is perceived as physically absent but mentally present (because of desertion, divorce, or abduction, or because missing in actions) or physically present but mentally or psychologically absent (because of dementia, mental illness, or other forms of mental or emotional loss or injury).

• Brodkey, Harold. This Wild Darkness: The Story of My Death (the story of his confrontation with AIDS)

• Butler, Katy. Knocking on Heaven's Door: The Path to a Better Way of Death. Against this backdrop of familial love, wrenching moral choices, and redemption, Knocking on Heaven’s Door celebrates the inventors of the 1950s who cobbled together lifesaving machines like the pacemaker—and it exposes the tangled marriage of technology, medicine, and commerce that gave us a modern way of death: more painful, expensive, and prolonged than ever before. A riveting exploration of the forgotten art of dying, Knocking on Heaven’s Door empowers readers to create new rites of passage to the “Good Deaths” our ancestors so prized. Like Jessica Mitford’s The American Way of Death and How We Die by Sherwin Nuland, it is sure to cause controversy and open minds.

• Caplan, Arthur L., James McCartney, and Dominic Sisti, eds. The Case of Terri Schiavo: Ethics at the End of Life
(many contributors discuss the ethical issues associated with this controversial case and others like it)

• Clift, ElinorTwo Weeks of Life: A Memoir of Love, Death, and Politics. A well-known journalist combines an account of the circus surrounding Terri Schiavo's death with the personal story of the death of her husband, journalist Tom Brazaitis

• Davis, Deborah L. Empty Cradle, Broken Heart: Surviving the Death of Your Baby<

• DeVita, Elizabeth. The Empty Room: Surviving the loss of a brother or sister at any age (partly a memoir of surviving the loss of her brother Teddy to aplastic anemia)

• Didion, Joan. The Year of Magical Thinking

• Dworkin, Ronald. Life's Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom

• Edelman, Hope. Motherless Daughters: The Legacy of Loss

• Freedman, Samuel G., and Kerry Donahue Dying Words: The AIDS Reporting of Jeff Schmalz and How It Transformed The New York Times . You can also download or listen online, free, to the audio documentary, Dying Words: The AIDS Reporting of Jeffrey Schmalz with host Rachel Maddow, hosted by MSNBC’s Rachel Maddow

• Gilbert, Sandra. Wrongful Death: A Medical Tragedy (about the death of her husband after entering the hospital for routine prostate surgery)

• Gunther, John J. Death Be Not Proud (a young son's death from brain cancer)

• Harrison, Lindsay. Missing. During her sophomore year at Brown University, Lindsay's brother called to say her mother was missing. Forty days later they discovered the unthinkable: Their mother’s body had been found in the ocean. A page-turning account of those first forty days (dealings with detectives, false sightings, wild hope, and deep despair), then her search for solace as she tries to understand who her mother truly was, makes peace with her grief, and becomes closer to her father and brothers as her mother’s death forces her to learn more about her mother than she ever knew before.

• Hill, Susan. Family (about the death of a premature child)

• Kamenentz, Rodger. Terra Infirma (a searing recollection of his mother's life and her death from cancer, his mother "yo-yoing between smothering affection and a fierce anger")

• Karaban, Roslyn A. Complicated Losses, Difficult Deaths: A Practical Guide for Working Through Grief

• Kincaid, Jamaica. My Brother (Kincaid's account of her younger brother's death from AIDS)

• Kushner, Harold S. When Bad Things Happen to Good People

• Latus, Janine. If I Am Missing or Dead: A Sister's Story of Love, Murder, and Liberation

• Elizabeth McCracken. An Exact Replica Of A Figment Of My Imagination -- expect both smiles and tears in this story of the loss of McCracken's stillborn baby

• Morrison, Blake. When Did You Last See Your Father?: A Son's Memoir of Love and Loss

• Nitschke, Philip and Fiona Stewart.The Peaceful Pill Handbook

• Nuland, Sherwin B. How We Die: Reflections on Life's Final Chapter (superb explanations of the actual physical processes of dying and good on why and when to stop trying to rescue the terminally ill and to let them die peacefully and in less pain and discomfort, written after Nuland realized that his physician's impulse to "rescue" prolonged the suffering of his older brother and other patients)

• Sittser, Jerry L. A Grace Disguised: How the Soul Grows through Loss (about the transformative grace that can come even in the face of catastrophic loss)

• Vincent, Eleanor. Swimming with Maya: A Mother's Story (how the daughter's fall from a horse ended in organ donations--transforming a mother's grief)

• Want, Barbara. Why Not Me?: A Story of Love and Loss

• Waxman, Robert and Linda. Losing Jonathan (losing a beloved child to drugs)

• West, John. The Last Goodnights: Assisting My Parents with Their Suicides

• Wiesel, Elie. Night (powerful account of surviving the nightmare world of the Nazi death camps)

• Williams, Marjorie. The Woman at the Washington Zoo: Writings on Politics, Family, and Fate (the last third is about her losing battle with cancer, saying goodbye to her husband and young children)

"The arc of the moral universe is long, but it bends toward justice."~ Theodore Parker and M. L. King
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• Taking Chance Home (Marine Lieutenant Colonel Strobl's simple and moving account of escorting the remains of Lance Corporal Chance Phelps home from Dover Air Force Base). You can watch HBO's film based on the story, Taking Chance, starring Kevin Bacon.
• TAPS (Tragedy Assistance Program for Survivors)
• Three Little Words . Roy Peter Clark's memorable series in the St. Petersburg Times, "a tale of trust, betrayal and redemption," and AIDS, which "challenges us to reconsider our thoughts about marriage, privacy, public health and sexual identity"
• UNITE (grief support after miscarriage, stillbirth, and infant death)
• What Broke My Father's Heart by Katy Butler (NY Times Magazine, 6-18-10). How putting in a pacemaker wrecked a family's life. Katy Butler's father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. She writes, of her parents: "I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims." You may also want to read Knocking on Heaven's Door: The Path to a Better Way of Death
• What Comes After by Lisa Mundy (Washington Post Magazine). They lost their daughter in the deadliest campus massacre in U.S. history. One parent wants to file a lawsuit. The other doesn't.
• What It Feels Like To Be Photographed In A Moment Of Grief (Coburn Dukehart, NPR, The Picture Show, 1-28-13)
• When Treating Cancer Is Not an Option (Jane E. Brody, Well, NY Times, 11-12-12). An excellent discussion of how doctors need to communicate with patients who are terminally ill (and check to see if their communications got through). Telling patients to plan for the worst but hope for the best gives them "better outcomes — less depression and less distress, and they’re more likely to die comfortably at home.”
• Why Didn't They Stop Him? (When Domestic Violence Laws Don't Work, by Phoebe Zerwick, O, the Oprah Magazine, August 2009)
• Recommended reading

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How to tell children their parent is dying

• How do you tell children their father is dead? (Barbara Want, The Guardian, 4-29-11) And what happens next? Barbara Want (author of Why Not Me?: A Story of Love and Loss , explains how she and her twins adjusted to being 'just the three of us' after her husband died four years ago.
• Troubled Ears And Tender Hearts: Breaking The News Of A Parent's Death (Carole Fleet, Huff Post, 5-20-13)
• Helping Children When a Family Member Has Cancer: Dealing With a Parent`s Terminal Illness (American Cencer Society), including Why should I tell my children I’m dying?
• When a parent is dying (Don Seccareccia, palliative care physician, and Andrea Warnick, RN, Palliative Care Files in Canadian Family Physician)
• How to tell your child you might be dying (Elizabeth Cohen, CNN Health, 7-1-10)
• Children's grief (links to other resources)
• Children's picture books about death and loss (a shopping and library booklist)
• When a Parent Dies (Hospice.net) A guide for patients and their families

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Buy now!
(discounts for counselors, hospices, medical staff, and hospitals)PRAISE FOR DYING: A BOOK OF COMFORT
"Although I’m not ready to admit it, my father is dying. As cancer takes over his body, we sit together – talking, enjoying the garden, and watching old movies. I’m trying to get a handle on the situation and how I feel about it, but my emotions are a tangled, jumbled mess. All at once I feel isolation, profound sadness, panic, anxiety, anger, frustration, helplessness, fatigue, and, ironically, occasional joy and humor.

When I set out to review Dying: A Book of Comfort, I worried that I might be too close to the topic. But as I read passages in this anthology, my mixed feelings began to come into focus. I realized that perhaps I’m just the kind of person who should be reviewing a book like this. Read straight through, Dying: A Book of Comfort was a spiritual exercise for me. Some chapters let me look at dying from my father’s perspective. Other chapters simply gave me the perspective of people who have been through this before me and my family.

“Pat McNees’s collection contains carefully selected and ordered pieces – poems, prayers, prose, and fiction. The anthology explores a range of experiences: living when you know you are dying; caring for and about someone who is dying; saying goodbye; and dealing with how it feels to be left behind. When Pat was talking with publishers about printing a bookstore version, some told her it should be a book either about dying or about grieving, but Pat saw them as part of a continuum.

“If read straight through, the book’s structure allows the reader to move through the process of dying and grieving in an arc, starting with ‘Illness as Awakening.’ Following chapters examine how people who are dying, as well as their loved ones, experience the process of dying and saying goodbye. The apex of the arc is death itself, with chapters including views on immortality and prayer. The book then moves into the ‘Journey Through Grief.’ What follows are chapters devoted to mourning the loss of a child, parent, or spouse, and to grieving a sudden death or suicide. The closing chapters have their focus on death’s aftermath – the remembering, for example, or the other ways we deal with the ongoingness of this greatest of all losses.

“McNees has kept her selections fairly short. The brevity of the passages, and their concrete relevance to the topic at hand, make the book very reader-friendly. These characteristics reflect the advice of grief counselor, Kathleen Braza, who has found that people who are grieving generally can’t read long passages or process symbolism.

“The first time I read this book, I jumped around, the way I usually read a book of poetry. I’d read a passage here and there, periodically finding one that rang very true for me. Beyond being a personal comfort to me, I found the book to be an excellent resource. I’m often at a loss for words when talking with or writing to someone who is grieving. In its pages I have found just the right passage to share with friends of mine who have lost a mother, a husband, a son.

“While McNees didn’t set out to write a spiritual book, she has created a volume that speaks to the heart. Written after her father’s death, her goal in working on this project was to create a book that would help people through the process of death and grieving. Dame Cicely Saunders, founder of Hospice, says of Pat’s book, ‘This remarkable collection, coming from personal experience and wide reading, will help many find the potential of growth through loss.’

“ Dying: A Book of Comfort would make a thoughtful gift for a family or individual coping with terminal illness, someone who is grieving, or people who work with dying or bereaved. It is available in trade paperback at bookstores or in hardcover from the Literary Guild. My copy has already become dog-eared and annotated, as it travels with me to visit my father. Thanks, Pat, for the words of comfort."

~ Eileen Hanning’s review, years ago, for Signature, the newsletter of the Women’s National Book Association, DC chapter

Buy now!
(discounts for counselors, hospices, medical staff, and hospitals)