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Medical aid-in-dying bill advances to state Senate



medical aid-in-dying

A substantially changed medical aid-in-dying bill is headed to the Maryland Senate for debate this week.

The 2019 session will mark the first time the full Senate will debate whether a person with a terminal illness should be allowed to request medical help ending their life. The House of Delegates narrowly passed a version of the bill earlier this month. With only two weeks left in the 90-day legislative session, however, the House and Senate are far apart on several key provisions and will need to find agreement in order to send the bill to the governor’s desk.

The Senate Judicial Proceedings Committee approved nearly 30 amendments to the bill last week, before voting 8-3 in favor of the legislation on Friday. Sen. Michael Hough (R-Frederick and Carroll) and two Republicans on the committee cast the three dissenting votes.

“I think the House and Senate are very far apart, and I’m not sure what’s going to happen, even in the Senate,” Hough said.

The House version of the bill passed by a margin of eight votes, which Del. Karen Lewis Young (D-Frederick) said was the closest she had seen in her five-year tenure in the chamber. In the Senate, a difference of just a few votes is also expected.

The narrow majority support for medical aid-in-dying would not be enough in either chamber to guarantee an override vote, if Gov. Larry Hogan (R) vetoes the legislation.

The bill underwent substantial changes to be passed by the committee. Chairman Bobby Zirkin (D-Baltimore) was adamant the committee remove the bill’s “good-faith” liability exemption for doctors who prescribe the medication that patients must self-administer to end their lives. Zirkin said he would not vote for a bill that gave blanket immunity, as his committee has granted no other class of physicians the same request.

Compassion and Choices, an advocacy organization that has pushed for the bill, said it would not support the Senate version as it stood on Friday due to the changes.

“Basically, what it feels like is that they’re intentionally adding barrier after barrier in order to make it so patients are unable to access the law,” said Kim Callinan, CEO of Compassion and Choices.

Callinan said she was concerned about the lack of protection for doctors, which could lead to more doctors opting out of prescribing the necessary medication. The committee’s decision to add more restriction through vague language, such as the definition of terminal illness, also concerned Callinan.

Compassion and Choice continues its support for the House’s version.

Blurred lines
Whether the House or Senate versions of the bills would violate the state’s existing Criminal Law statute prohibiting physician-assisted suicide also remained a question for Hough.

Maryland law says a licensed health care professional may not “knowingly provide the physical means by which another individual commits or attempts to commit suicide.” Doctors are exempted from this standard only to prescribe medication to relieve pain, which may ultimately hasten or lead to death; however, the explicit purpose cannot be to cause death.

“I think the bill is just fundamentally flawed. They’re trying to pretend it’s not what it is,” which is physician-assisted suicide, Hough said.

Sen. Ron Young (D-Frederick), who sponsored two previous versions of the bill, continued to defend the bill as being separate and different from physician-assisted suicide. Terminally ill patients would request a prescription from a doctor, but the patient — not the doctor — would then have the option to administer it. The doctor does not physically administer the drugs, which makes it separate from physician-assisted suicide, Young said.

“I think like a lot of things, it’s just a matter of choice,” Young said, who was at his sister’s bedside as she died of cancer. “… I think when someone is in that kind of pain, it should be their choice to ask for medication, and call their family in and die peacefully.”

People let their religious views cloud their judgment of what people of different faiths should be allowed to do, he said. Both chambers have heard moral objections to the contents of the bill, but Sen. Mary Washington (D-Baltimore City) argued that allowing medical aid in dying was not a moral question, but a legal one.

“We’re establishing at what point … a physician may legally assist in individuals ending their life,” Washington said.

Members of Judicial Proceedings added multiple restrictions to the process of asking for medical aid-in-dying in order to prevent abuse.

The attending physician and consulting physician involved in a person seeking aid in dying will also no longer be able to be part of the same practice, if the Senate version prevails. The doctors also cannot have any agreements or share financial ties.

All individuals seeking to end their lives through aid in dying will also have to undergo a mental health examination. Opponents of the bill requested this as a mandatory provision but were disappointed to see clinical social workers included among those qualified to perform the assessment.

A person who will financially benefit from the individual’s death will no longer be able to sign as a witness to the individual’s written request for aid-in-dying. This could include a spouse or adult child who is a beneficiary in a will.

Callinan said the added stipulations could be roadblocks for patients who have little time left. The bill as originally presented had many protections in it, which may have made it already difficult for terminal patients to complete the process before dying, Young said. He did not support additional limits.

A matter of time
For Dr. David Meyers, of Takoma Park, the Senate’s version of the bill could limit options for people like his former patients or himself.

Meyers is a family physician, although he is no longer seeing patients. He was recently diagnosed with terminal brain cancer. Like Callinan, he has concerns about the added amendments and potential barriers in the bill. As a doctor, he said he believes patients are their own experts and he wants to give them autonomy.

In his opinion, doctors can usually give a good estimate of time left, based on different equations.

Both the House and Senate versions of the bill currently use the six-month mark as the qualifying point for terminally ill patients to seek medical aid-in-dying. According to the Medicare Benefit Policy Manual, a person is considered terminally ill when they have six months left to live. Only then do they qualify for hospice under Medicare.

“The idea of saying: We think as doctors this person — if they’re average and the course goes as expected — probably has six months or fewer left to live, and, therefore, it’s a good time to start hospice care,” he said. “So is it wrong? No, that is a good estimate. Does it turn out to be accurate? No, not for some people. Some people die much sooner. And some people actually, because they start getting hospice care, may live longer.”

A 2016 analysis of 42 journal articles found that a doctor’s accuracy in determining how long a person has left ranged, between 23 and 78 percent.

Critics of the bill, like Dr. Joseph Marine, associate professor of medicine at Johns Hopkins University, point to the difficulty in determining how long someone has left to live as a reason not to make it part of the law. Unlike Meyers, Marine said the equations make it so doctors cannot give individualized timelines, and instead rely on the average time left for a person with the same illness.

Sen. Robert Cassilly (R-Harford) also said in the committee’s debate he was concerned that doctors would tell a person they have six months left in order to give them access to palliative care.

“The whole six-month thing is an administrative farce that they do under Medicare, because that’s the standard they have for hospice,” he said.

Both Marine and Meyers discussed hospice as an option for those at the end of their lives. Marine called for more awareness and funding for hospice instead of looking at end-of-life options.

The Hospice and Palliative Care Network of Maryland elected to not take a stance on the bill. Hospice and palliative care are still encouraged in the bill, though, Cassilly was disappointed the bill did not go further to encourage it. Advocates of the bill say there is more hospice use in states that have enacted similar aid-in-dying laws.

The Senate will debate the bill this week and then send it to the House for its consideration.

“I sure as heck hope this isn’t rushed through,” Hough said. “… This is the weightiest thing we’ve ever voted on [that] I’ve been a part of.”


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GM quiet about Cruise driverless taxi fleet as deadline looms




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As the self-imposed deadline for the self-driving taxi service from General Motors Co.’s autonomous vehicle development unit looms this year, the San Francisco-based GM Cruise LLC has gone quiet.

Hype for Cruise’s potential built up in late 2017 and into 2018 as the former start-up laid the groundwork for a commercial launch of its autonomous technology. Increasingly, however, company leaders have said a launch of Cruise’s driverless taxi service would be “gated by safety,” a hedge that has been repeated since October when GM’s self-driving unit partnered with Honda Motor Co.

Meantime, the industry at large has started pulling back on some of its autonomous-vehicle optimism. A fatal accident involving one of Uber’s self-driving test vehicles spurred an industry-wide reassessment of how to best validate the complex technology required to make a car navigate public roads without the help of a driver. As investors and industry observers wait to see Cruise’s robo-taxi service in action, experts say the 2019 deadline is hardly a deal-breaker for the driverless-vehicle unit’s future.

“The real question is not whether Cruise is on track for 2019 or not — it’s whether GM has the stomach to gut this thing out to completion and do everything it’s really going to take to get there,” said Mike Ramsey, an automotive analyst for research firm Gartner Inc. “Does GM have the stomach to spend money — that they don’t have a ton of — and sacrifice areas that make money now to stick this out?”

GM is trying to prove as much. The company is executing a sweeping restructuring that includes stopping production at five North American plants and cutting 15 percent of its salaried workforce. The goal is to cut costs and redirect precious capital toward expensive autonomy, electrification and mobility efforts.

The rollout of the technology has always been guided by safety, a Cruise spokesman said, reiterating what GM and Cruise executives have said in recent months. Leaders also say the quiet period for Cruise is a result of the Silicon Valley workforce’s focus on getting the technology right.

GM is planning to spend roughly $1 billion on Cruise in 2019 after spending about $700 million last year. That includes hiring another 1,000 people over the next nine months. Cruise has also garnered some $5 billion in outside investments from Japan’s SoftBank Investment Advisers and Honda.

And executives say a change in leadership ushers in a new phase for the self-driving car unit. Former GM President Dan Ammann took over as CEO of Cruise effective Jan. 1. He replaced co-founder Kyle Vogt who moved into the role of chief technology officer. Ammann and Vogt say the shuffle allows both executives to focus on their strengths as Cruise moves toward deployment.

But Cruise’s original vision of a driverless taxi fleet of cars without steering wheels or pedals is still stuck in neutral more than a year after the company asked NHTSA permission to put the cars on public roads. It took NHTSA about 14 months to respond to the petition, advancing it to the public review stage last month.

GM’s long wait for a response is evidence that gaining the necessary federal approval is no small step, nor is it guaranteed. Federal safety regulation language revolves around human drivers and vehicles engineered to be piloted by a human driver — as opposed to artificial intelligence.

GM CEO Mary Barra has said the San Francisco team could proceed without federal approval of the steering wheel-free models by launching the service with the safety driver-piloted test vehicles already on public roads. But even if GM Cruise doesn’t start ferrying customers in one of its lidar-equipped Chevrolet Bolt EVs by the stroke of midnight on Dec. 31, experts seem to think the company will be forgiven.

“If GM were to potentially recast its projected time horizon for the launch and rollout of its GM Cruise unit’s service at a later time (i.e. significantly beyond 2020),” Morgan Stanley analyst Adam Jonas wrote in a recent note, “we believe the stock market would be largely understanding.”

Sam Abuelsamid of Navigant Research, which recently ranked Cruise as one of the leaders in the autonomous vehicle race, said the company’s self-imposed 2019 deadline is largely arbitrary.

“If we don’t see a driverless taxi service from Cruise by the end of this year, it will not be the end of the world,” Abuelsamid said. “In the long term it’s better to delay and do this the right way — and Uber made the case last year for what happens when you rush this technology.”

Uber suspended all testing of self-driving cars last March after one of its autonomous test vehicles struck and killed a pedestrian in Arizona. The ride-hailing giant was rushing its autonomous vehicle development to keep up with leaders like GM’s Cruise and Alphabet’s Waymo LLC.

What followed was an industry-wide reckoning with autonomous-vehicle testing practices. Many companies took their driverless test vehicles off the roads while they revamped testing practices. Uber wouldn’t resume autonomous vehicle testing for another nine months. Waymo walked back promises to take human safety drivers out of its autonomous Chrysler Pacifica minivans. And GM appeared to quietly abandon plans to begin testing autonomous vehicles on the busy streets of New York City.

“This is normal,” Ramsey said. “None of what changed in the last year constitutes failure. This is just what happens when something that is really hard, but has a lot of promise, comes around. This is how new technologies get commercialized.”


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Yemeni-Americans in New York City are boycotting the New York Post after a damning Ilhan Omar cover story




yemeni americans

Yemeni-American shop owners across New York City are denouncing the New York Post in light of a controversial cover image put forth by the publication featuring the 9/11 terrorist attacks and a stand alone quote from Democratic Rep. Ilhan Omar.

“Here’s your something. 2,977 people dead by terrorism,” read last Thursday’s headline, appearing to suggest Omar, a Somali American congresswoman from Minnesota, was dismissive of the attack on the Twin Towers.

The cover was in reference to a speech Omar delivered last month at an event for the Council on American-Islamic Relations.

“For far too long we have lived with the discomfort of being a second-class citizen, and frankly I’m tired of it, and every single Muslim in this country should be tired of it,” Omar said. “CAIR was founded after 9/11 because they recognized that some people did something and that all of us were starting to lose access to our civil liberties.” (CAIR was founded in 1994, and an Omar spokesperson later told the Washington Post that the freshman lawmaker misspoke and meant to refer to the fact that the organization had doubled in size after 9/11).

Omar has faced backlash in recent weeks from the media, commentators, and politicians alike. Last Friday, President Donald Trump shared a video on Twitter blasting Omar for the speech. In the days since Trump’s tweet, Omar said she has experienced an increase in death threats. As of Monday, the video remains on his Twitter page.

New York City’s Yemeni-American community says they are worried that the New York Post’s front page will encourage anti-Muslim violence and rhetoric. As of Saturday morning, ten well-known Yemeni store owners had agreed to stop selling the tabloid, while Yemeni taxi drivers passed out fliers about the boycott to other Yemeni-owned establishments across the city, according to The New York Times.

In an open letter, the Yemeni American Merchants Association said the New York Post’s front page “provoked hatred against Rep. Omar,” and lambasted its decision to publish as “cheap and sensational tabloids that undermine national unity and entice violence and hate for the sole purpose of circulation and sales.”

“This rhetoric threatens the safety and wellbeing of Rep. Omar, Muslim leaders, and the larger Muslim American community at a time when Islamophobia is at an all-time high,” the letter added.

INSIDER reached out to the News Corporation, the New York Post’s parent company, for comment. On Sunday, the Yemeni American Merchants Association announced its formal boycott at a news conference outside of the News Corporation’s building in Manhattan. People in attendance displayed signs that read “boycott hate” and “New York Post take your paper back.”

The association has issued a set of demands, including a public apology to Omar by the Post, and a request that the publication’s editor-in-chief, Stephen Lynch, step down from his position.

Yemeni-American store owners have previously turned toward political activism: after the president issued a ban on travelers in 2017 from seven Muslim-majority countries, including Yemen, thousands of Yemeni-Americans closed shop and gathered together to rally against the policy.

“It’s not the first time that the New York Post basically spreads hate and fear in their newspapers,” Ayyad Algabyali, the association’s director of advocacy, told the Guardian, adding that there is “no end date” to the boycott and “this might be for good.”


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Fire Mauls Beloved Notre-Dame Cathedral in Paris




notre-dame cathedral

Notre-Dame cathedral, the symbol of the beauty and history of Paris, was scarred by an extensive fire on Monday evening that caused its delicate spire to collapse, bruised the Parisian skies with smoke and further disheartened a city already back on its heels after weeks of violent protests.

The spectacle of flames leaping from the cathedral’s wooden roof — its spire glowing red then turning into a virtual cinder — stunned thousands of onlookers who gathered along the banks of the Seine and packed into the plaza of the nearby Hôtel de Ville, gasping and covering their mouths in horror and wiping away tears.

“It is like losing a member of one’s own family,” said Pierre Guillaume Bonnet, a 45-year-old marketing director. “For me there are so many memories tied up in it.”

Around 500 firefighters battled the blaze for nearly five hours. By 11 p.m. Paris time, the structure had been “saved and preserved as a whole,” the fire chief, Jean-Claude Gallet, said. The two magnificent towers soaring above the skyline had been spared, he said, but two-thirds of the roof was destroyed.

“The worst has been avoided even though the battle is not completely won,” President Emmanuel Macron said in a brief and solemn speech at Notre-Dame on Monday night, vowing that the cathedral would be rebuilt.
“This is the place where we have lived all of our great moments, the epicenter of our lives,” he said. “It is the cathedral of all the French.”

The cause of the fire was not immediately known, officials said. But it appeared to have begun in the interior network of wooden beams, many dating back to the Middle Ages and nicknamed “the forest,” said the cathedral’s rector, Msgr. Patrick Chauvet.

No one was killed, officials said, but a firefighter was seriously injured.

The fire broke out about 6:30 p.m., upending Mr. Macron’s plans to deliver an important policy speech about trying to heal the country from months of “Yellow Vest” demonstrations that had already defaced major landmarks in the capital and disfigured some of its wealthiest streets.
The tragedy seemed to underscore the challenges heaped before his administration, which has struggled to reconcile the formidable weight of France’s ideals and storied past with the necessity for change to meet the demands of the 21st century.

A jewel of medieval Gothic architecture built in the 12th and 13th centuries, Notre-Dame is a landmark not only for Paris, where it squats firmly yet gracefully at its very center, but for all the world. The cathedral is visited by about 30,000 people a day and around 13 million people a year.

For centuries France’s kings and queens were married there. Napoleon was crowned emperor in Notre-Dame in 1804, and the joyous thanksgiving ceremony after the Liberation of Paris in 1944 took place there, led by Charles de Gaulle.
World leaders congregated at the cathedral in a memorial service for Mr. de Gaulle in 1970, and then again for President François Mitterrand in 1996.

On Monday evening, as the last rush of tourists were trying to get in for the day, the doors of Notre-Dame were abruptly shut without explanation, witnesses said. Within moments, tiny bits of white smoke started rising from the spire — which, at 295 feet, was the highest part of the cathedral.

Billowing out, the smoke started turning gray, then black, making it clear that a fire was growing inside the cathedral, which is currently covered in scaffolding. Soon, orange flames began punching out of the spire, quickly increasing in intensity.
The French police rushed in and started blowing whistles, telling everyone to move back, witnesses said. By then, the flames were towering, spilling out of multiple parts of the cathedral.

Tourists and residents alike came to a standstill, pulling out their phones to call their loved ones. Older Parisians began to cry, lamenting how their national treasure was quickly being lost.

Thousands stood on the banks of the Seine river and watched in shock as the fire tore through the cathedral’s wooden roof and brought down the spire. Video filmed by onlookers and shared on social media showed smoke and flames billowing from the top of the cathedral.

Jean-Louis Martin, 56, a native of Dijon in eastern France who works at the university in Geneva, gasped as the flames leapt up. “It hurts me,” he said. “There are no words. It’s just horrible.”

The crowd gasped and cried in horror when the spire fell. “Paris is beheaded,” said Pierre-Eric Trimovillas, 32.

Vincent Dunn, a fire consultant and former New York City fire chief, said that fire hose streams could not reach the top of such a cathedral, and that reaching the top on foot was often an arduous climb over winding steps.
“These cathedrals and houses of worship are built to burn,” he said. “If they weren’t houses of worship, they’d be condemned.”

The city’s prosecutor’s office said it had opened an investigation.

Monsignor Chauvet said firefighters were able to save some of the cathedral’s artworks but did not say how much was damaged inside the building. A linen fabric associated with Saint Louis, the Holy Crown of thorns and the cathedral’s treasury were saved.

Mr. Gallet, the fire chief, said firefighters were still rescuing artworks in the building, hours after the fire had started. The main risk, he said, was the smoke within the cathedral, and the fall of materials, including melting lead.

The cathedral had been undergoing extensive renovation work. Last week, 16 copper statues representing the Twelve Apostles and four evangelists were lifted with a crane so that the spire could be renovated.

The cathedral had been in dire need of a thorough and expensive restoration, André Finot, the cathedral spokesman, told The New York Times in 2017.

Broken gargoyles and fallen balustrades had been replaced by plastic pipes and wooden planks. Flying buttresses had been darkened by pollution and eroded by rainwater. Pinnacles had been propped up by beams and held together with straps. In some places, limestone crumbled at a finger’s touch.

Glenn Corbett, an associate professor of fire science at John Jay College in New York, said construction work and renovations had long been a dangerous combination.

“There’s a history of churches and synagogues and other houses of worship falling victim to construction fires,” he said, adding that one of the reasons for the peril was the proximity of open flames on torches, sparks from welders and other hazards on scaffolding to other flammable materials.

In recent years, the Friends of Notre-Dame, a foundation based in the United States, estimated that the structure needed nearly $40 million for urgent repairs. The French state, which owns the cathedral, already devotes up to 2 million euros a year in upkeep, or about $2.4 million.
The fire came during Holy Week, six days before Easter Sunday. For Roman Catholics, the cathedral has been a spiritual pilgrimage site for generations. France has a deep Catholic history, and nearly two-thirds of its population is Catholic, even though fewer and fewer attend Mass.

“It’s apocalyptic,” said Eleanor Batreau, 45, who organizes pilgrimages to Lourdes and sometimes works at Notre-Dame. “It reminds me of Dresden burning. I’m a Catholic, and Notre-Dame is a symbol of Mary.”

The risk of the fire is not just to the cathedral itself, but also to the gargoyles that cover its walls and to the stained glass, particularly its “rose” windows.

The largest of its bells, which dates to 1681, managed to survive the French Revolution and has been rung at some of the most important events in French history, including both World Wars.

Bernard Fonquernie, the architect in charge of the cathedral’s restoration in the 1980s and 1990s, said that he believed much of the building, its furnishings and its stained glass could be saved. “The stone vaulting acted like a firewall and it kept the worst heat away,” he said.

Yet the fire is likely to be just the latest, if most dramatic, insult to a landmark that has endured decades of neglect and damage, some at the hands of French revolutionaries, through its more than 850-year history.

Victor Hugo’s 1831 novel, “Notre-Dame of Paris,” noted even then that “one cannot but regret, cannot but feel indignant at the innumerable degradations and mutilations inflicted on the venerable pile, both by the action of time and the hand of man.”


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