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Choosing Death

Meet terminally ill cancer patient Brittany Maynard:

Gene Robinson defends Maynard’s decision to end her life on November 1:

Many people would call this suicide, pure and simple. But life is much more complex, and the human spirit much more creative, than such a judgment would suggest. Perhaps more than anything, what people fear most—aside from the pain of a terminal illness—is the loss of control. Call it pride and the desire for autonomy over one’s life if you will, but to those who advocate for the right to end one’s life, it is the right to “die with dignity.” That’s what Brittany wants. I think she deserves that right. And I think it is a thoroughly moral choice.

Brittany Maynard is not mentally ill. She is not suffering from depression. No amount of therapy—whether psychological or physical—will change the fact that without intervention, she will die a horrible death. She seems to have worked through the “stages of dying” made famous by Dr. Elizabeth Kubler-Ross, and reached the final stage of accepting the fact of her imminent death.

J.D. Tuccille supports the Oregon law that allows Maynard to make this choice:

Well-spoken and obviously thoughtful, Brittany Maynard has literally become the poster child—and video child (see [above])—of the movement dedicated to expanding options available to people otherwise facing an unpleasant end. Specifically, this works out as the ability to seek medical assistance free of legal penalties for those who offer help. In Oregon, the Death with Dignity Act, enacted in 1997, “allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.” Doctors participate only at their own choosing—they’re not compelled to help patients end their lives.

Which is to say, this is about the final choice that anybody can make, and freeing others to choose to offer assistance in achieving the chosen goal. That’s about as libertarian as it gets.

Ross Douthat reflects on why such laws haven’t become more widespread:

Many liberals seem considerably more uncomfortable with the idea of physician-assisted suicide than with other causes, from abortion to homosexuality, where claims about personal autonomy and liberty are at stake.

Conservatives oppose assisted suicide more fiercely, but it’s a persistent left-of-center discomfort, even among the most secular liberals, that’s really held the idea at bay. Indeed, on this issue you can find many liberal writers who sound like, well, social conservatives — who warn of the danger of a lives-not-worth-living mentality, acknowledge the ease with which ethical and legal slopes can slip, recognize the limits of “consent” alone as a standard for moral judgment.

Jazz Shaw appreciates the complexity, presenting views on both sides:

This is a subject which we’ve had to deal with in our family and one that I’ve personally debated for a long time. It’s not an easy question for many people, though the spiritual and social dilemmas surrounding it can lead to battles which come off as unseemly when dealing with a young person facing their own mortality. …

With or without government permission or medical help, many people are going to make this choice when faced with the ultimate question. They have to struggle with asking whether life is indeed so precious that a few more hours or days of it are worth the cost if that time is spent medicated beyond conscious activity while loved ones weep at their bedside. Those who determine that is is not and who can’t obtain competent medical advice will choose a gun in their mouth, a noose, a car “accident” or some cocktail of pills and alcohol which they cobble together themselves, often with disastrous results in failed attempts. So I’m not going to judge either Maynard or [fellow cancer patient Kara] Tippetts and can only hope that others will spare me such judgement should I wind up facing the same, awful decision point.

Harold Pollack finds that “the mass appeal of assisted suicide reflects an incredible failure of our health care system”:

We do not provide proper palliative care. As Atul Gawande relates in his beautiful new book Being Mortal, we do not reliably address people’s deepest needs when they face life-ending or life-altering illnesses of many kinds. We can do a better job of relieving people’s symptoms and protecting them from pain. We can protect families much more effectively against catastrophic medical expenses and hard caregiving burdens. We can work more effectively to ensure that every patient can make the most of their remaining days. We can more effectively promise that someone will die with dignity without the need to take precipitous measures while they still believe they can.

The Institute of Medicine’s recent report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, provides many practical suggestions of how these challenges might be more effectively addressed. For example, Aetna expanded its hospice and palliative care benefit by allowing people to still receive curative therapies while enrolled in hospice, and by slightly relaxing its eligibility standards for hospice services. Such “concurrent care” models allowing people to receive improved attention to quality of life issues and symptom relief, even as they might choose fairly aggressive treatment of a life-threatening or life-ending condition.

Recent Dish on end-of-life concerns here and here. Update from a reader:

My mother died from glioblastoma, the same brain cancer that is killing Maynard. It is as horrific a disease as one can imagine. My mother seemed to lose another piece of herself each day. So I can understand Maynard’s decision to end her life before the worst of the disease affects her.

But, when I brought in home hospice the last week of my mother’s life (and I so regret not doing it sooner), they told me they would treat any symptom that could possibly cause her discomfort. And they did. That week she did not suffer. Witnessing her natural death and caring for her was one of the most profound experiences oft life. It was not a burden; it was a gift and I will always have the comfort of knowing I did this for her.

I respect and understand Maynard’s decision but I urge anyone else considering assisted suicide to speak with hospice first and learn what they can do for you.

The Running Of The Indies

Danny Vinik examines the ideology of Larry Pressler, a former Republican campaigning as an independent in the South Dakota Senate race:

At first blush, it may seem like Pressler is living up to his independent candidacy. And technically that is true: On some issues, he supports the GOP. On others, he’s closer to the Democrats. But this is only the case because the Republican Party has swung so far to the right. With the exception of supporting same-sex marriage and a pathway to citizenship, Pressler’s Democratic positions—slightly more revenue in return for significant spending cuts, a moderate increase in the minimum wage, and reforming Obamacare—aren’t very Democratic. In fact, Pressler’s platform is mostly a mix of centrist and Republican positions. In years past, that would make him a Republican, not an Independent.

Francis Barry entertains the prospect of a Senate with three or four independents:

King, Orman and Pressler have all said they are open to caucusing with either party. If neither party wins outright control of the Senate, King – along with Orman and Pressler, if they win – would become the Capitol equivalents of LeBron James: highly prized free agents. (Sanders, by contrast, would sooner denounce maple syrup than join forces with Republicans.)

The independents would have enormous leverage to extract financial benefits for their states and political benefits for themselves. While King and Orman might prefer aligning with the Democrats, and Pressler would lean toward the Republicans, all would be able to play the parties against each other. Constantly.

Perhaps, but the independent candidates will have to win first. Enten takes a closer look at the Kansas race, which may be moving back towards the GOP:

In Kansas, Republican Sen. Pat Roberts faces a strong challenge from [Independent Greg] Orman. Orman, though, may have peaked too soon. Roberts recorded his first lead in two polls released last week, and a newPublic Policy Polling (PPP) survey puts Orman only up 3 percentage points. That’s down from a 10 percentage-point lead in PPP’s two prior polls. FiveThirtyEight still gives Orman a 58 percent chance of winning, but the race appears to be trending back toward the fundamentals (i.e. Kansas is a red state), and the GOP has a large advertisement advantage heading into the final few weeks of the campaign.

Tom Jensen of PPP identifies a major reason Republicans might still pull off a win in Kansas:

There’s still one big data point in Kansas pointing to the possibility of Roberts ultimately coming back to win this race. By a 52/35 margin, voters in the state would rather Republicans had control of the Senate than Democrats. And among those who are undecided there’s a 48/25 preference for a GOP controlled Senate. If voters make up their minds based on the national picture in the closing stretch it could mean voting for Roberts even if they don’t really care for him personally.

Nick Miroff reports on the aftermath of a horrifying mass disappearance in Iguala, where “43 student teachers appear to have been rounded up after a day of protests, then marched into the hills and apparently massacred by local police and gang members, who prosecutors say control the city and its officials.” The discovery of at least 28 bodies, “so butchered and burned that Mexican authorities say it could take two months for DNA testing to determine if they’re the missing students”, has sparked protests throughout the country:

Iguala — in one of Mexico’s poorest and most troubled states, Guerrero — is the place where the country’s radical protest traditions have collided tragically with a new reality of gangster-run local governments. It’s not to say that local police wouldn’t have roughed up protesters, or possibly worse, in the past. But in Iguala, where prosecutors say police act under the orders of the gangsters, there was no restraint. Where crime bosses rule — the local capo goes by the nickname “El Chucky” — there was apparently no patience for pesky protesters and other such democratic nuisances. What has been so shocking to Mexicans is that the traffickers would treat them just as any other criminal rivals. One grisly image circulating social media shows a dead student whose face has been removed.

Claudia Romero stresses that this was not an isolated incident:

[T]he state of Guerrero is only one of several Mexican states where organized crime is fighting a turf war. The government of Iguala, moreover, is not Mexico’s only bureaucracy paralyzed by corruption. Police brutality is nothing unique to this case, either. Murders, disappearances, torture—these are weapons law enforcement across Mexico has turned on peaceful protesters. Ayotzinapa calls to mind other similar cases, including; Aguas Blancas, Acteal, and Tlataya, where corrupt police in league with the mafia have effectively criminalized social protests.

“It’s not always clear,” Kathy Gilsinan adds, “whether the local government is working for the drug cartels, or the other way around”:

InSight Crime’s David Gagne suggested on Thursday that Guerreros Unidos was likely “acting as ‘muscle’ for corrupt local officials,” since the cartel itself had little incentive to target the students. “Oftentimes criminal groups can take actions that authorities cannot,” InSight Crime’s co-director Steven Dudley told me. As to who exactly is working for whom in Mexico’s criminal-political nexus, Dudley said, “The short answer is, we don’t know. And the longer answer is, it changes all the time.”

Leon Krauze blames President Enrique Peña Nieto for failing to address Mexico’s serious corruption problem:

In lockstep with his party’s long held tradition, Peña Nieto has mostly turned a blind eye to numerous allegations of corruption at both the municipal and the state level. In the months before the kidnapping of the Ayotzinapa students, Jose Luis Abarca, the allegedly corrupt mayor of Iguala, had numerous and serious complaints filed against him. Federal authorities merely stood by. Now, the man is on the run, along with his chief of police. I’d be surprised if they’re heard from again and amazed if they’re ever prosecuted and sent to jail.

The US, Carimah Townes argues, doesn’t have clean hands here either:

Though Mexico is well-known for government corruption and systemic violence, the U.S. cannot be absolved of its involvement. The U.S. has contributed billions in financial aid to Mexico’s military under the Merida Initiative, with very little oversight. Indeed, due to concern over the U.S.-Mexico partnership and little knowledge of how the money is actually spent, Amnesty International stated, “In August [2012], despite the failure of Mexican authorities to meet human rights conditions set by the US Congress as part of the Merida initiative, the US State Department recommended that Congress release the 15% of funds subject to the conditions.” The Washington Office on Latin America, also attributes the overall militarization of Mexico’s public security to a U.S.-backed remodel, under which law enforcement officials are military-trained.

(Photo: Abandoned clothing is seen near clandestine graves in the outskirts of Iguala on October 13, 2014 in Iguala, Mexico. Mexican authorities found four more graves containing human remains near Iguala where 43 students went missing after a confrontation with local police that left 6 dead last September 26. By Miguel Tovar/LatinContent/Getty Images)

At A Loss

Sarah Varney flags research on slimmed-down daters:

Holly Fee, a sociologist at Bowling Green State University, has conducted some of the only research on dating attitudes toward the formerly obese. In 2012, Fee published her findings in the journal Sociological Inquiry. She found that potential suitors said they would hesitate to form a romantic relationship with someone who used to be heavy. “The big dragging factor in why they had this hesitation in forming this romantic relationship was that they believed these formerly obese individuals would regain their weight,” Fee said.

The prevailing belief is that people who have never been obese can control their weight, and those who’ve been heavy have less will power, said David Sarwer, a psychology professor and the director of clinical services at the Center for Weight and Eating Disorders at the Perelman School Medicine at the University of Pennsylvania. He said the physicians and the general public tend to think that obesity is “a moral failing, and that they can’t push away from the table.”

Heather Havrilesky, an advice columnist, recently addressed a reader who had rejected her friend’s advances when he was obese, but after losing 125 pounds, the tables were turned. Here’s the reader:

I asked (via text) if he still felt the same way as he did last year, and he said, “Nah not really. Kinda gave up on you.” I was furious. What had changed his mind? Was there another girl that had caught his eye? I went to the bar with a couple of female friends, but after a few drinks could not get him off of my mind. I called him and asked if he wanted to smoke, went to his apartment, and after sitting on the couch together just hanging out, he made a move. We had hours of amazing sex.

I was certain we were going to take the relationship to the next level. The man who had embodied so many of the qualities I was looking for now pretty much had ALL of them. The next few days went the same way. I would get off work, he would text me telling (never asking, TELLING) me to come over after work, and I would end up spending the night. I expected to see him more, but after a few days the texts stopped. Several days passed and I didn’t see or text with him. Had I scared him away? We communicated practically every day for years until that point, so I was pretty shocked by his silence. I got onto Instagram and saw a dozen or so photos of him at a few different outings with a girl who is pretty much the younger, dumber version of me. Same body type, same hair, on the body of a 19-year-old cocktail waitress.

After almost a week, we finally spoke again, and I asked him if they were serious, to which he replied, “Of course not.” But after a conversation of vague, ambiguous answers, I finally blurted out everything that I was feeling. I wanted him, and I felt like he was punishing me for not being interested in him before. He started laughing, then called me shallow. Saying that he could never date me because he “would have to get on a scale every morning” to determine if he was worthy of me. That his personality had not changed, and that a small change in physical appearance shouldn’t take my interest level from 0 to 100.

He then went into lawyer mode, showing me Facebook posts from his heavy days and now; the same clever Facebook status that had gotten 30 likes when he was overweight got over 100 now that he was thin. He then became upset, near tears even, and told me that the saddest part of losing weight was that people finally complimented him on qualities he’d always had. Then he kissed my forehead and told me that my first instincts on dating him were the right ones. I’m absolutely smitten, and want to prove to him that my intentions are genuine. But are they? Should I be punished for not wanting the ugly duckling, then falling for the beautiful swan? And is he really upset, or just using my feelings for him against me?

Havrilesky’s advice is here. And go here for a previous Dish thread on dealing with the aftermath of serious weight loss.

Is North Korea Getting Any Better?

After more than a month out of public view, the country’s state media report that the young dictator has reappeared:

Last seen on Sept. 3, Kim [Jong Un]’s lack of public appearances marked his longest span of time away from the public, and while Tuesday’s Korean Central News Agency report may put to rest rumors that Kim had been deposed, he is now walking with a cane. Kim has been dogged by persistent rumors about his ill-health, including reports of gout, diabetes, and an ankle injury. The report contains no mention of Kim’s alleged health problems.

But Mark Stone finds “nothing to prove beyond doubt that the images were taken on Monday.” Zooming out, Andrei Lankov claims that the country, while still “a brutal place,” is a little less of a hellhole than it used to be:

To understand North Korea today, one needs to admit that its economy, while grim, is nowhere near breakdown. In fact, from a nadir in the late 1990s — when state-run industries collapsed and a famine killed an estimated 600,000 people — the economy has grown slowly but steadily. … The world barely noticed a remarkable achievement last year: For the first time in nearly three decades, North Korean farmers managed to produce enough food to meet the population’s basic survival needs. In spite of a drought this spring, preliminary reports indicate that this year’s harvest is likely to be good, too.

Lankov also marshals evidence that North Korea’s gulags are housing fewer prisoners:

This has much to do with the regime’s abandonment of the so-called family responsibility principle. Previously, all immediate family members of a convicted political criminal (so long as they shared his or, far less frequently, her household registration) were deemed to be political criminals as well, and thus were also dispatched to the gulag.

After the death of Kim Il Sung in 1994, his son and successor Kim Jong Il ordered that this approach be applied selectively. A few years later, the authorities were instructed to punish relatives only in cases of especially hideous crimes — such as writing anti-government graffiti. By North Korean standards, this represented a substantial improvement.

The Grave Risks Of A Travel Ban

The debate over whether to impose a travel ban on Ebola-afflicted countries strikes Rod Dreher as a culture-war battle in the making:

I learned over the weekend that to raise the question of whether or not we should refuse travelers from Ebola-infected countries is to identify oneself as a right-wing nut, and possibly even a racist. Apparently — according to some liberal readers of this blog — Limbaugh and the usual suspects are working Ebola fears into political talking points. It is therefore required of all decent and right-thinking people to take the opposite position. So I’ve learned.

This is crazy, and dangerous. I haven’t checked, but I have no doubt that talk-radio loudmouths are making political hay about this stuff; it’s what they do. They are, in fact, the enemy of clear thinking — but so are those whose thinking is dictated by a compulsion to take the other side of whatever Limbaugh says.

McArdle fails to see why the notion of a travel ban is so controversial:

Ivory Coast cut off all travel from the affected areas in August, and if you look at maps of the outbreak, this actually seems to be controlling it pretty well within their borders. Even if all it did was buy the government time to prepare, that might help them lower their fatality rate.

You can still argue, of course, that such bans are inhumane and costly. But at least from the evidence we have, closing the borders does seem possible, so we should probably stop insisting that it isn’t. And we should stop acting as if this has any relevance to U.S. immigration policy, which takes place in a much different context, and over a different timeframe, from African travel in the time of an epidemic.

But Julia Belluz and Steven Hoffman reiterate that there are sound, practical reasons to oppose a travel ban:

There are three reasons why it’s a crazy idea.

The first is that it just won’t work. In CDC Director Tom Freiden’s words, “Even when governments restrict travel and trade, people in affected countries still find a way to move and it is even harder to track them systematically.” In other words, determined people will find a way to cross borders anyway, but unlike at airports, we can’t track their movements.

The second is that it would actually make stopping the outbreak in West Africa more difficult. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, “To completely seal off and don’t let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can’t get supplies in, you can’t get help in, you can’t get the kinds of things in there that we need to contain the epidemic.” …

The third reason closing borders is nuts is that it will devastate the economies of West Africa and further destroy the limited health systems there.

Aaron Blake examines how the public feels about it:

A new poll from the Washington Post and ABC News shows 67 percent of people say they would support restricting entry to the United States from countries struggling with Ebola. Another 91 percent would like to see stricter screening procedures at U.S. airports in response to the disease’s spread. …

Concern about Ebola, at this point, is real but not pervasive. About two-thirds (65 percent) say they are concerned about an Ebola outbreak in the United States. But while people are broadly concerned about an outbreak, they are not necessarily worried about that potential outbreak directly affecting them. Just 43 percent of people are worried about themselves or someone in their family becoming infected – including 20 percent who are “very worried.”

(Photo of the Ebola virus via Getty)

Codifying Consent, Ctd

Amanda Taub defends California’s new “Yes Means Yes” law, arguing that it “emerged as a response to a status quo that has proved to be an all-too-powerful tool for sexual predators, because it enables them to claim to see consent in everything except continuous, unequivocal rejection”:

This week, a Detroit man murdered a 27-year-old mother of three named Mary Spears after she rejected him in a bar. Right now, a woman is in critical condition in a New York City hospital because a man slashed her throat on the street after she declined to go on a date with him. In April, a Connecticut teenager was murdered by her 16-year-old classmate after she turned down his invitation to prom. Stories like these (and there are others) should remind us that women have a lot of reasons to fear the consequences of saying “no.” That’s all the more reason why silence shouldn’t be presumed to be consent.

That argument in particular changed Ezra Klein’s mind. He now supports the law, even though it’s unlikely to be enforced very often:

If the Yes Means Yes law is taken even remotely seriously it will settle like a cold winter on college campuses, throwing everyday sexual practice into doubt and creating a haze of fear and confusion over what counts as consent. This is the case against it, and also the case for it. Because for one in five women to report an attempted or completed sexual assault means that everyday sexual practices on college campuses need to be upended, and men need to feel a cold spike of fear when they begin a sexual encounter.

The Yes Means Yes law could also be called the You Better Be Pretty Damn Sure law. You Better Be Pretty Damn Sure she said yes. You Better Be Pretty Damn Sure she meant to say yes, and wasn’t consenting because she was scared, or high, or too tired of fighting. If you’re one half of a loving, committed relationship, then you probably can Be Pretty Damn Sure. If you’re not, then you better fucking ask.

Robby Soave and others fire back:

First of all: who is to say that “Yes Means Yes” will actually decrease instances of sexual assault? The law’s main function is to push colleges to investigate and adjudicate sexual assault based on a narrower set of standards and without recognition of established due process rights. Given the track record of campus rape trials, there is little reason to think colleges will excel here. I predict more lawsuits—from both accusers and the accused—and similar levels of sexual assault. The heavy hand of government does not automatically and instantly change culture in the manner that central planners envision. …

Klein’s do something at all costs approach is also an indictment of the modern left’s warped priorities and callous disregard for due process. Safeguarding the rights of the accused was once a cardinal virtue of civil liberalism. But for many so-called progressives, paranoia about sexual violence trumps all other considerations. They have much in common with the tough-on-crime conservatives of past decades, in that respect.

Freddie also goes after Ezra – and the elite media in general – for not addressing the law’s risks:

We know that the police state targets the poor. We know that false convictions are far more likely to happen to black and Hispanic men. We know those things. Doing away with the presumption of innocence will not mostly hurt privileged white frat boys. It will hurt poor people and black people the way that our judicial system always does. So if you, like Klein, want to be breezy and loose in your talk about the consequences of a law that many or most admit is badly flawed, fine. But let’s count those costs like adults.

And Judith Shulevitz stands up for the rights of accused rapists:

What’s happening at universities represents an often necessary effort to recategorize once-acceptable behaviors as unacceptable. But the government, via Title IX, is effectively acting on the notion popularized in the 1970s and ’80s by Andrea Dworkin and Catharine MacKinnon that male domination is so pervasive that women need special protection from the rigors of the law. Men, as a class, have more power than women, but American law rests on the principle that individuals have rights even when accused of doing bad things. And American liberalism has long rejected the notion that those rights may be curtailed even for a noble cause.

“We need to take into account our obligations to due process not because we are soft on rapists and other exploiters of women,” says [Harvard professor Janet] Halley, but because “the danger of holding an innocent person responsible is real.”

Meanwhile, Shikha Dalmia’s reaction to the law last week provoked this rant from Erin Gloria Ryan, under the headline “Consent Laws Are Ruining Sex, Says Writer Who Probably Has Awful Sex”:

First, the assumption that sex is a horny guy trying to convince a tired woman to lie there while he pumps away at her sex hole while she wonders to herself if this is what she really wanted is an assessment of heterosexual intercourse so grim that I feel a great deal of pity for the person whose life experiences have led to those conclusions.

That, McArdle points out, is not an argument; it’s just sex shaming:

When guys do this to them, left feminists easily recognize it for what it is: reactionary, misogynist bile spewed by angry people who couldn’t think of an actual argument. So why does Erin Gloria Ryan feel free to deploy it against a woman with whom she disagrees? Why didn’t her colleagues at Jezebel take her aside and say, “Hey, that’s not how we roll. We’re against sex shaming, remember?”

This is not the first time I’ve run into this idea that all’s fair as long as you restrict it to conservatives. Although the exact post seems to be lost to the mists of Internet time, I’ll never forget when a woman at a major feminist site accused me of holding the political opinions I do because — wait for it — I was trying to catch a man. Or the liberal men too numerous to count, or at least bother counting up over the years, who have hailed me with every misogynist slur you could imagine, and a few I’m sure you couldn’t.

Dalmia herself hits back at her detractors:

[I]n a Wonkette–Jezebel gynocracy, discrediting someone’s (imagined) sex life = discrediting their argument.

When Limbaugh called Sandra Fluke, the Georgetown law student who wanted taxpayer funded contraceptive coverage, a “slut,” the whole feminist establishment rose in unison to condemn him—and rightly so. Ultimately, he was forced to do the decent thing and issue an apology. “I did not mean a personal attack,” he said. “My choice of words was not the best, I sincerely apologize to Ms. Fluke for the insulting word choices.” The question now is, can Gray and Ryan manage to rise to Limbaugh’s level? I’m waiting, sisters!

Ebola Politics On The Left

Alex Rogers flags the fear-mongering ad seen above, which tries to make political hay out of the Ebola crisis by blaming the lack of preparedness on budget cuts supported by Republicans:

Erica Payne, the producer of the ad and president of the Agenda Project Action Fund, blamed the Ebola crisis wholly on the Republican Party. “I think any Republican who attempts to chalk this ad up to politics is a Republican who is too afraid to examine the results of his of her actions and the very real consequences that they have,” she said. “They have developed a governing philosophy that is so fanatically anti-investment that they literally have at their doorstop death. There is no exaggeration in this.

Dr. Francis Collins, director of the NIH, tells Sam Stein that Ebola research has been hampered by stagnant funding over the past decade:

“NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here,'” Collins told The Huffington Post on Friday. “Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.” …

Money, or rather the lack of it, is a big part of the problem. NIH’s purchasing power is down 23 percent from what it was a decade ago, and its budget has remained almost static. In fiscal year 2004, the agency’s budget was $28.03 billion. In FY 2013, it was $29.31 billion — barely a change, even before adjusting for inflation. The situation is even more pronounced at the National Institute of Allergy and Infectious Diseases, a subdivision of NIH, where the budget has fallen from $4.30 billion in FY 2004 to $4.25 billion in FY 2013.

But Nick Gillespie doesn’t buy that the NIH and other government health agencies are hurting for money:

According to its budget documents, the NIH got about $23 billion in fiscal 2002 (George W. Bush’s first budget year), a figure that rose to $30.2 billion in 2009 (his last budget year) before peaking at $31 billion in 2010. It dipped a bit from then and came to $30.1 billion in 2014, which is about the same amount the NIH requested in President Obama’s 2015 budget plan.

You can argue that the United States needs to be constantly and massively increasing its spending on everything and that every time spending doesn’t go up in a lockstep fashion (and faster than inflation, as it did throughout the Bush years) that you’re killing people. You can also argue that the topline budget figures for various agencies don’t matter, but then you’re really talking about the ways in which bureaucracies, especially in the budget sector, misallocate resources. The one thing you really can’t do is say that the federal government, which is not actually controlled by the Republicans (just saying), has been slashing its spending on anything.

Noah Rothman adds:

There are some conservatives who have convinced themselves that the federal government is to blame for the spread of Ebola to the United States. A few conspiratorial types insist that Washington is indifferent to the spread of this deadly bug to America, despite the fact that this claim defies Hanlon’s razor and there is no evidence to support it. There is, however, sufficient evidence to suggest the federal agencies responsible for preventing a public health crisis – from medical care, to transportation, to oversight – are simply too unwieldy and prone to human error to take the necessary precautions which might have prevented Ebola’s spread across the Atlantic. That is a debatable point, but it is apparently so dangerous to the left that they are mounting a counteroffensive.

The Syrian-Turkish-Kurdish Clusterfuck

https://twitter.com/DavidKenner/status/521981053368418305

Turkey launched airstrikes yesterday – not against ISIS, but against Kurdish insurgents in southeast Turkey:

Turkish news reports said the strikes had been aimed at fighters of the Kurdistan Worker’s Party, known as the P.K.K., and were in retaliation for the shelling of a Turkish military base. Such airstrikes were once common, as Turkey fought a Kurdish insurgency in a conflict that claimed almost 40,000 lives over nearly three decades. But hostilities essentially ceased two years ago when the peace process began, and both the Turkish newspaper Daily Sabah and an online statement from the P.K.K. said the airstrikes on Monday were the first since then. The Turkish military also released a statement, but it did not mention airstrikes specifically, only an exchange of fire with “terrorists.”

Authorities in Iraqi Kurdistan are now pressing Ankara to let their fellow Kurds cross the border to help defend the Syrian town of Kobani, which remains under siege from ISIS:

Speaking on a visit to RFE/RL in Prague on October 13, Falah Mustafa, the foreign minister of the Kurdish regional government (KRG), said Ankara should heed calls from the international community to help the city, which has been under siege for almost four weeks.

“It’s a moral responsibility for all of us to move in order to help the besieged [city of] Kobani,” Mustafa said. “We hope that there would be an understanding by Turkey to the calls from the international community and to the needs of these people who have proven to be bravely fighting the terrorists throughout this period, from the day they have been besieged.” He said Ankara should establish a corridor between its border checkpoint of Mursitpinar and Kobani, whose northern edge is less than a kilometer from the Turkish frontier.

Today and yesterday, ISIS positions in Kobani and elsewhere in Syria came under heavy attack from US planes:

Centcom said the 21 strikes in and around Kobani destroyed two of the group’s staging locations and damaged another, destroyed one an ISIS-held building and damaged two others, damaged three ISIS-held compounds, destroyed one ISIS truck, and destroyed one ISIS armed vehicle and another ISIS vehicle. The US military also struck an additional seven ISIS staging areas, two ISIS mortar positions, three ISIS occupied buildings, and an ISIS artillery storage facility. Centcom said early indications were that these strikes were “successful.” Separately, the US military conducted an additional strike on an ISIS-held oil refinery near Dayr az Zawr. Centcom said this strike was also successful.

But the jihadists are apparently making gains in Iraq:

“The militants, they now control 80% of Anbar province,” said Faleh al-Issawi, a local politician from Anbar, detailing weeks of miserable performance on behalf of the Iraqi military. Government forces, he says, are constantly on the back foot, rarely launching offensives to regain territory. Outgunned and beleaguered, he says, Iraqi army units in Anbar are beginning to collapse. “We are renewing our call for American or International troops to come to Anbar province and begin ground operations,” he said, expressing a policy desire completely at odds with that of the central government.

Meanwhile, the Obama administration is claiming that Turkey has agreed to allow US warplanes carry out strikes from its bases, but Turkish officials won’t confirm that:

[National Security Advisor Susan] Rice said Ankara had joined Saudi Arabia in agreeing to allow its bases for training moderate Syrian opposition forces and had agreed that “facilities inside Turkey can be used by the coalition forces, American and otherwise, to engage in activities inside of Iraq and Syria.” Incirlik Air Base, located about 50 kilometers inland from the Mediterranean Sea in southern Turkey, is home to the U.S. Air Force’s 39th Air Base Wing and about 1,500 American military personnel and is key to protecting NATO’s southern flank.

On Monday, Turkish Foreign Minister Mevlut Cavusoglu denied there was such an agreement on bases, according to state-run Anadolu Agency. “There is no decision at the moment concerning Incirlik or any other issue,” the agency quoted Cavusoglu as saying[.]

Meanwhile, Jamie Dettmer is dismayed at the anti-Western rhetoric Turkish President Erdogan whipped out in a speech yesterday:

About T.E. Lawrence—who is still viewed as a hero in the West and by many Arabs—the Turkish President showed nothing but disdain, then used Lawrence as a vehicle to heap opprobrium on others. Erdoğan dismissed the British officer as “an English spy disguised as an Arab.” And he told the university audience—the speech was televised—that Westerners are “making Sykes-Picot agreements hiding behind freedom of press, a war of independence or jihad.”

Erdoğan argued there are modern-day Lawrences in Turkey right now “disguised as journalists, religious men, writers and terrorists.” And the remark was especially ominous on the day five foreign journalists—three of them German—were hauled before a court for a preliminary hearing in the southeastern Turkey of Diyarbakır, following their arrests at the weekend by anti-terrorist police.

Marc Champion believes Erdogan has miscalculated:

Erdogan appears to believe he can squeeze the PKK and its affiliate in Syria, while negotiating a settlement with Turkey’s Kurdish community. If so, he would be underestimating how quickly a massacre in Kobani could push events beyond his control. Erdogan is a formidable politician and never to be underestimated, yet I suspect he is making a big mistake for Turkey.

That’s because only one of the two very risky paths for Erdogan has a chance of a positive outcome. The Turkish leader has a real prospect of building a long-term alliance with the Kurds and creating a stable buffer against the chaos of the Middle East, partly because he has already done a lot to repair relations with Kurds in Iraq and Turkey in recent years. Islamic State, however, can offer nothing but instability and fear.

Michael Crowley returns to our other big problem in Syria – Assad, with whom Erdogan and the Syrian rebels would like us to go to war as well:

Obama may find it increasingly difficult to battle ISIS without coming into conflict with Assad’s forces. “Sooner or later the linkage is going to be forced,” said Paul Salem, vice president of the Middle East Institute. Salem wonders how Obama would react if American-trained rebels come under aerial bombardment by Assad’s air force: Would U.S. forces pounding ISIS targets elsewhere in the country refuse to intervene? (That would hardly inspire goodwill among the rebels.) How should the U.S. respond [if] Assad’s forces move to claim territory cleared by ISIS after coalition attacks? And will Obama tolerate Assad’s infamously brutal attacks on civilian populations now that U.S. fighter-bombers are mere minutes away from the scene of such crimes?

Larison sure hopes we don’t take the bait:

It is unreasonable to expect anti-regime forces to do Washington’s bidding against other enemies of the regime when their overriding concern is to fight regime forces. However, that isn’t an argument for doing what the rebels want. It draws our attention back to why the war has been misguided and unlikely to succeed from the start, especially once it expanded into Syria. If both Turkey and the “moderate” opposition refuse to cooperate unless the U.S. attacks the Syrian government, that tells us that the war against ISIS cannot be fought effectively at an acceptable cost. That should be a clear warning to the administration to stop now before it gets in any deeper. Warring against both sides in the same civil war not only appears absurd, but it greatly increases the chances of costly failure.

Max Fisher, on the other hand, asserts that an alliance with Assad is the only logical outcome of Obama’s Syria policy:

Obama doesn’t want to build up the rebels enough to defeat ISIS, he doesn’t want to invade and occupy Syria (rightly), and he doesn’t trust Turkey enough to sponsor a Turkish invasion. With those options off the table, only Assad is left as someone who is able to re-conquer ISIS-held territory and occupy it for many years, which is what it would take to end the ISIS threat. So it looks increasingly likely that Obama will come to view Assad as his only real option if he wants to defeat ISIS.

Marriage Equality Update

A reader provides it this time:

Maybe I missed it, but how have you not posted on gay marriages happening in North Carolina? I guess it’s a sign of how radically things have shifted that Jesse Helms’ state is now performing gay marriages and the Dish doesn’t even post on it : )

The Getty caption for the above photo reads:

Lynda Johnson, center, cries as she watches her daughter Kandyce Johnson, left, marry Jana Downs outside the Mecklenburg County and Courts Office building on Monday, Oct. 13, 2014 in Charlotte, N.C. Monday was the first day that gay couples could marry in Mecklenburg County after a judge’s ruling. By Jeff Siner/Charlotte Observer/MCT via Getty Images.

Another reader reflects at length:

I had never had a strong opinion one way or another on the issue of marriage equality until I moved to North Carolina.

I grew up in Michigan and had a vague sense that a constitutional marriage amendment was wrong, and when it came up for a vote in 2004 I voted against it. My primary reason was the sense than a friend of mine who happened to be gay deserved to marry anyone she wanted just as much as I did. At the time, however, I couldn’t understand how anyone could find civil unions to be an unreasonable compromise. While opposed to enshrining discrimination into a constitution I still couldn’t appreciate the significance, let alone the necessity, of marriage equality.

As time went by this vague sense of wrongness became more and more fixed. As more of my friends felt comfortable being who they were and sharing their committed relationships publicly I began to see how wrong asking them to settle for a civil union would be. They responded to their loves exactly as I responded to mine. The benefits I received from marriage at that time had nothing to do with procreation. I started to see through the flimsy arguments made in favor of the status quo.

When Thom Tillis and others came to power in North Carolina and started making noises about adding an amendment to our state’s constitution in 2012, I finally began to understand I needed to use my voice. For the first time I had something to say about marriage equality and felt like it was time to say something to people who often vehemently disagreed with me.

I don’t share any of this because I feel like I’ve done anything. I share this because of what you and so many other people did. By sharing your voice on the Dish every day, by posting so many supporting and dissenting opinions, you challenged my level of empathy. You challenged me to see the United States of America as being capable of more than it was and at the same time not quite as perfect as I wanted it to be. I didn’t like what I found at first. In the end you taught me a lot about this issue but really you taught me a lot about myself. We’ve never met. We probably never will. But I owe you and the Dish a great deal.

Today [Friday], my state’s horrific decision to enshrine discrimination into its constitution was struck down. For the first day ever I lived in a state where all people who love each other can benefit equally from joining in marriage.

It doesn’t affect me, directly. But at the same time, it does. The days where you can personally see a nation becoming a “more perfect union” are rare throughout your life. But this day is one of those times. I wish you could be here. Those of us who spoke out and tried to change minds in 2012 came up short. But every day seeing men and women be who they are, seeing them fight through centuries of prejudice and bigotry to say this time things will be different … it’s hard to describe what I feel today watching people enjoy this opportunity they never should have been denied.

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