The Controversy Surrounding EuthanasiaDeath and dying (Magill’s Medical Guide, Sixth Edition)
In the past, the role of the doctor was clear: The physician should minimize suffering and save lives whenever possible. In the present, it is possible for these two goals to be at odds. Saving lives in some situations seems to prolong the misery of the patient. In other cases, procedures or treatments may only marginally postpone the time of death. Advances in medical technology enable many to live who would have died just a few years ago, and massive amounts of money are spent each year on medical research with the goal of prolonging life. Experts in U.S. population trends indicate that by the year 2030, those over the age of sixty-five will comprise about 20 percent of the country’s total population. These people will probably be healthy and alert well into their eighties; however, in the last years of their lives they will probably require significant medical care, putting financial stress on the health care system.
The complex issues surrounding death, suffering, and economics create demands for answers to difficult ethical questions. Does all life have value? Should one fight against death even when suffering is intense? Should suffering be lessened if the time of death is brought nearer? Should a patient be given the right to refuse medical treatment if the result is death? Should others be allowed to make this decision for the patient? Should other factors such as the financial...
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Religious and Legal Implications (Magill’s Medical Guide, Sixth Edition)
Decisions about death concern everyone because everyone will die. Eventually, each individual will be the patient who is making the decisions or for whom the decisions are being made. In the meantime, one may be called upon to make decisions for others. Even those not directly involved in the hard cases are affected, as taxpayers and subscribers to medical insurance, by the decisions made on the behalf of others. In a difficult moral issue such as this, individuals look to different institutions for guidelines. Two sources of guidance are the church and the law.
In 1971, the Roman Catholic Church issued Ethical and Religious Directives for Catholic Health Facilities. Included in this directive is the statement that [I]t is not euthanasia to give a dying person sedatives and analgesics for alleviation of pain, when such a measure is judged necessary, even though they may deprive the patient of the use of reason or shorten his life.
This thinking was reaffirmed by a 1980 statement from the Vatican that considers suffering and expense for the family legitimate reasons to withdraw medical treatment when death is imminent. Bishops from The Netherlands, in a letter to a government commission, state that [B]odily deterioration alone does not have to be unworthy of a man. History shows how many people, beaten, tortured and broken in body, sometimes even grew in personality in spite of it. Dying...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
Although large numbers of court decision, articles, and books suggest that the issues involved in euthanasia are recent products of medical technology, these questions are not new. Euthanasia was widely practiced in Western classical culture. The Greeks did not believe that all humans had the right to live, and in Athens, infants with disabilities were often killed. Although in general they did not condone suicide, Pythagoras, Plato, and Aristotle believed that a person could choose to die earlier in the face of an incurable disease and that others could help that person to die. Seneca, the Roman Stoic philosopher, was an avid proponent of euthanasia, stating that Against all the injuries of life, I have the refuge of death. If I can choose between a death of torture and one that is simple and easy, why should I not select the latter? As I choose the ship in which I sail and the house which I shall inhabit, so I will choose the death by which I leave life.
The famous Hippocratic oath for physicians acted in opposition to the prevailing cultural bias in favor of euthanasia. Contained in this oath is the statement, “I will never give a deadly drug to anybody if asked for it…or make a suggestion to this effect.” The AMA has reaffirmed this position in a policy statement: the intentional termination of the life of one human being by another—“mercy killing”—is contrary to that for which the medical...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Corr, Charles A., Clyde M. Nabe, and Donna M. Corr. Death and Dying, Life and Living. 6th ed. Belmont, Calif.: Wadsworth/Cengage Learning, 2009. This book provides perspective on common issues associated with death and dying for family members and others affected by life-threatening circumstances.
Dowbiggin, Ian Robert. A Merciful End: The Euthanasia Movement in Modern America. New York: Oxford University Press, 2003. Blends social history, medical knowledge, and political analysis to trace the evolution of euthanasia and its perception in the United States throughout the twentieth century.
Gorovitz, Samuel. Drawing the Line: Life, Death, and Ethical Choices in an American Hospital. Philadelphia: Temple University Press, 1993. This book reflects on the author’s sabbatical-in-residence at Beth Israel Hospital. Gorovitz presents numerous insights drawn from conversations with patients and medical personnel.
Harron, Frank, John Burnside, and Tom Beauchamp. Health and Human Values. New Haven, Conn.: Yale University Press, 1983. Using a case-study approach, the authors consider the different types of euthanasia and report on policy statements from interested social groups.
Leone, Daniel A. The Ethics of Euthanasia. San Diego, Calif.: Greenhaven Press, 1998. This volume includes ten essays on the ethics and morality of euthanasia, potential abuse,...
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Euthanasia (West's Encyclopedia of American Law)
[Greek, good death.] The term normally implies an intentional termination of life by another at the explicit request of the person who wishes to die. Euthanasia is generally defined as the act of killing an incurably ill person out of concern and compassion for that person's suffering. It is sometimes called mercy killing, but many advocates of euthanasia define mercy killing more precisely as the ending of another person's life without his or her request. Euthanasia, on the other hand, is usually separated into two categories: passive euthanasia and active euthanasia. In many jurisdictions, active euthanasia can be considered murder or MANSLAUGHTER, whereas passive euthanasia is accepted by professional medical societies, and by the law under certain circumstances.
Hastening the death of a person by altering some form of support and letting nature take its course is known as passive euthanasia. Examples include such things as turning off respirators, halting medications, discontinuing food and water so as to allowing a person to dehydrate or starve to death, or failure to resuscitate.
Passive euthanasia also includes giving a patient large doses of morphine to control pain, in spite of the likelihood that the painkiller will suppress...
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Euthanasia (Encyclopedia of Nursing & Allied Health)
Euthanasia is the act of putting a person (or animal) to death painlessly, or allowing a person (or animal) to die by withholding medical treatment in cases of incurable (and usually painful) disease. The word "euthanasia" comes from two Greek words that mean "good death." Euthanasia is sometimes called "mercy killing."
Terms and categories
It is important to distinguish euthanasia from "assisted suicide," which is sometimes used loosely as a synonym for euthanasia. Assisted suicide, which is often called "self-deliverance" in Britain, refers to a person's bringing about his or her own death with the help of another person. Because the other person is often a physician, the act is often called "doctor-assisted suicide." Assisted suicide is illegal everywhere in the United States except the state of Oregon, while euthanasia is illegal in all fifty states. Euthanasia strictly speaking means that the physician or other person is the one who performs the last act that causes death. For example, if a physician injects a patient with a lethal overdose of a pain-killing medication, he or she is performing euthanasia. If the physician leaves the patient with a loaded syringe and the patient injects himself or herself with it, the act is an assisted suicide.
Euthanasia is usually categorized as either active or passive, and as either voluntary or involuntary. The first set of categories refers to the means of ending life, and the second set of categories refers to the agent of the decision. Active euthanasia involves putting a patient to death for merciful reasons; passive euthanasia involves withholding medical care, or not doing something to prevent death. In voluntary euthanasia, the patient is the one who wishes to die and has usually requested either active or passive euthanasia. In involuntary euthanasia, someone else makes the decision to terminate the patient's life, usually because the patient is in a coma or otherwise unable to make an informed request to die.
Another important term to understand is the socalled doctrine of double effect. This is a legal term that has been underscored by the United States Supreme Court in one of its decisions. The doctrine of double effect states that a medical treatment intended to relieve pain but that incidentally hastens the patient's death is still appropriate and legally acceptable. In other words, a doctor who gives a dying patient high doses of morphine to prevent pain, knowing that such high doses may shorten the patient's life by a few days, is protected by the doctrine of double effect.
Although euthanasia has been practiced in various human societies for centuries, it has become a major social issue only in the twentieth century. Some ancient societies allowed infants born with serious birth defects to die, and some allowed the elderly to starve themselves to death as a form of voluntary euthanasia. In addition, it was not unusual for soldiers on the battlefield to give a death blow, or coup de grâce, to a mortally wounded comrade to prevent him from being captured by the enemy as well as to end his suffering. The French phrase literally means "stroke of mercy."
In the nineteenth century, euthanasia became a topic of ethical discussion partly because the discovery of reliable anesthetics and analgesic (pain-killing) medications meant that painless death was now easier to bring about. Prior to this period, the methods of suicide that were available to people were either violent, painful, or uncertainnd sometimes all three. For example, when the heroine of one mid-nineteenth-century French novel commits suicide by taking arsenic, the author describes her agonizing death in clinical detail. But after the discovery of chloroform, ether, nitrous oxide, and similar anesthetics, people began to consider using them to relieve the suffering of the dying as well as the pain involved in surgical operations.
In the twentieth century, a number of social and technological changes made euthanasia a morally acceptable choice to growing numbers of people. The Euthanasia Society of America (which changed its name to the Society for the Right to Die in 1975) was founded as early as 1938. One important change was the increasing size of the elderly population, a development that resulted from the lengthening of the life span brought about by advances in medical science. A second was the invention of respirators, intravenous feeding, dialysis machines, and other means of prolonging a patient's life even in cases of terminal illness. Discomfort at the thought of ending one's life at the mercy of machinery is frequently mentioned in public opinion polls as a justification for euthanasia or assisted suicide. Another important transition was a change in social attitudes in favor of individual freedom and autonomy, rather than emphasizing a person's membership in a family or community. Many people today feel strongly that they are the best judges of their own well-being, and that they should have the "right to die" if necessary.
As of 2001, most North American professional societies in the health care professions have stated their opposition to active euthanasia. The American Medical Association (AMA) sponsored the establishment of an Institute for Ethics in the late 1990s, intended to educate American doctors about pain relief, palliative care at the end of life, and alleviation of patients' fears. The AMA has expressed its concern about the expansion of doctor-assisted suicide in the Netherlandshich became legal in April 2001o include euthanasia without the patient's knowledge or consent. The American Nurses Association (ANA) signed on to the amicus curiae (friend of the court) brief submitted by the AMA to the United States Supreme Court in 1997 opposing doctor-assisted suicide. The ANA also stated that the health care professions should emphasize respectful, compassionate, and ethically responsible care at the end of life, including palliative care, so that patients do not seek assisted suicide as an alternative.
Active euthanasiautting a person to death as an act of mercy, as when a physician gives a patient a lethal dose of a medication.
Assisted suicide form of self-inflicted death in which a person voluntarily brings about his or her own death with the help of another, usually a physician, relative, or friend.
Doctrine of double effect legal principle that protects physicians treating patients to relieve pain even though the palliative treatment may shorten the patient's life.
Mercy killingnother term for euthanasia.
Palliative care form of health care intended to relieve pain without attempting to cure the disease or condition.
Passive euthanasiahe withholding of medical care, or not taking some other action to prevent death; allowing a person to die.
Self-deliverancenother term for assisted suicide.
Voluntary euthanasia form of euthanasia in which a person asks to die, either by active or by passive euthanasia.
In the United States and Canada, most mainstream Christian and Jewish groups remain opposed to active and involuntary euthanasia, though some permit carefully regulated forms of passive euthanasia. Christian and Jewish bodies emphasize not only God's ultimate power over death and life, and the value of human beings as creatures made in God's image, but also the relationships that bind humans to one another and to God. From this perspective, these religious traditions stand in contrast to the individualism of much of secular culture.
Contemporary Buddhist thought is divided on the issue of euthanasia. Some Buddhist ethicists believe that euthanasia and assisted suicide are both consistent with Buddhist principles, but others disagree. One reason for the disagreement is the fact that Buddhism encountered Western medicine and its ethical dilemmas only relative ly recently.
The goals of medicine and health care
Euthanasia and assisted suicide compel medical professionals to reexamine their understanding of the purposes and goals of medical treatment. Those who maintain that preserving life and doing no harm are central to the ethical practice of medicine will have a different view of euthanasia from those who regard the relief of suffering as central.
The brief that the AMA submitted to the Supreme Court in 1997 included physician-patient relationships among its reasons for rejecting doctor-assisted suicide. Many American and Canadian physicians believe that acceptance of doctor-assisted suicide would undermine the credibility of the health care professions, and destroy trust between doctors and patients. In addition, others have pointed to the potential abuse of a physician's power to end a patient's life.
Interprofessional consultation and cooperation
Euthanasia and assisted suicide are questions that involve public policy, the legal system, and religious institutions as well as the health care professions. The complexity of the social and political considerations, together with the moral concerns, requires better communication among these different groups. One promising development has been the introduction of graduate-level ethics courses that bring together students from law, medical, nursing, and theological schools. Another has been the establishment of research centers and "think tanks" devoted to end-of-life issues.
Dubler, Nancy N. "Legal and Ethical Issues." Chapter 14 in The Merck Manual of Geriatrics, 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 2000.
Leone, Daniel A. (Editor). The Ethics of Euthanasia (At Issue). San Diego, CA: Greenhaven Press, 1999.
Manning, Michael. Euthanasia and Physician-Assisted Suicide: Killing or Caring? Mahwah, NJ: Paulist Press, 1998.
Pool, Robert. Negotiating a Good Death: Euthanasia in the Netherlands. Binghamton, NY: Haworth Press, 2000.
Somerville, Margaret A. Death Talk: The Case Against Euthanasia and Physician-Assisted Suicide. Montreal: McGill-Queen's University Press, 2001.
Haddad, Amy M. "Where Do You Stand on Euthanasia?" RN (April 1991): 38-42.
Hughes, James J., and Damien Keown. "Buddhism and Medical Ethics: A Bibliographic Introduction." Journal of Buddhist Ethics 7 (2000): 1-12.
Pfettscher, Susan. "Nephrology Nurses, Euthanasia, and Assisted Suicide." ANNA Journal (Oct. 1996): 524-526.
Singer, Peter A. "Medical ethics (Clinical review)." British Medical Journal 321 (July 29, 2000): 282-285.
Sullivan, Molly. "Ethics of Assisted Suicide and Euthanasia." Nursing Management (March 1999): 31-32.
American Medical Association, Council on Ethical and Judicial Affairs. 535 North Dearborn St., Chicago, IL60610. (312) 645-5000.
American Nurses Association. 600 Maryland Ave. SW, Ste. 100 West, Washington, DC 20024. (800) 274-4262. <<a href="http://www.nursingworld.org">http://www.nursingworld.org>.
Canadian Medical Association. 1867 Alta Vista Drive, Ottawa ON K1G 3Y6. (613) 731-8610307 or (888) 855-2555. Fax (613) 236-8864. firstname.lastname@example.org.
Citizens United Resisting Euthanasia. 812 Stephen St., Berkeley Springs, WV 25411. (304) 258-5433. <<a href="http://www.cureltd.home.netcom.com">http://www.cureltd.home.netcom.com>.
The Hemlock Society USA. P.O. Box 101810, Denver, CO 80250. (800) 247-7421. Web site: <<a href="http://www.hemlock.org">http://www.hemlock.org>.
Administrative Committee, National Conference of Catholic Bishops. Statement on Euthanasia. Adopted in committee, September 1993.
Commission on Theology and Church Relations of the Lutheran Church-Missouri Synod (LC-MS). Christian Care at Life's End. Report adopted, February 1993.
Evangelical Lutheran Church in America (ELCA), Division for Church in Society. End of Life Decisions. Statement adopted by the ELCA Church Council, November 1992.
National Association of Evangelicals (NAE). Euthanasia: Termination of Medical Treatment. Resolution adopted at the NAE Annual Conference, 1994.
Union of Orthodox Jewish Congregations. Testimony before the United States Senate Judiciary Committee in a hearing on the Pain Relief Promotion Act, May 2, 2000.
Ken R. Wells
Euthanasia (Genocide and Crimes Against Humanity)
Literally meaning a "good death" (from the Greek eu and thanatos), and frequently defined as a gentle or easy death, euthanasia ordinarily refers to intentional death in a medical setting or achieved by medical means. The noun is usually modified by adjectivesctive, passive, voluntary, nonvoluntary, and involuntaryhat identify the moral and legal concerns surrounding death by euthanasia. By definition, euthanasia is distinct from, although often confused with, physician-assisted suicide. The morality and legality of euthanasia are a central subject of health law and medical ethics, where the major arguments involve the individual's right to die and the doctor's ability to hasten the death of ill or suffering patients. Distinguishing the different types of euthanasia is central to understanding the moral and legal debate about its practice and legalization.
During the 1930s, Germany developed state-sponsored euthanasia programs to end lives that the government deemed "unworthy of living," and these programs became the source of the Final Solution and the medicalized killing that was later conducted in the concentration camps. Hence, the specter of genocide haunts more recent discussions about any death by medical means. Analogies to Nazi practice and concerns about unrestricted killing under the German euthanasia programs continue to influence moral and legal arguments about the need for limits to death by euthanasia.
Types of Euthanasia
Euthanasia hastens death. It may do so by active or passive means employed by a doctor or other agent. Active euthanasia occurs by an affirmative act that intentionally causes death, for instance, by a lethal injection by a doctor upon a patient that ends the patient's life. Passive euthanasia occurs when medical treatment is withheld or withdrawn, with awareness that death will result from the omission of care. For example, a doctor or other individual may decide not to place or keep a patient on a respirator or feeding tube. Active refers to "causing death," while passive means "letting die."
"Causing death," namely killing another human person, is usually prohibited by the criminal law of homicide. Hence, active euthanasia is illegal in most Western nations, except the Netherlands and Belgium. In contrast, passive euthanasia has not been subject to the same criminal sanction, although some nations punish it as the crime of not helping someone in danger. Many writers have challenged the moral distinction between active and passive upon which these legal conclusions are based, arguing that intentionally causing a patient's death and intentionally letting an individual die are morally equivalent and should face similar legal bans. Moreover, active and passive may be words too simple to deal with complex clinical situations that have aspects of both causing death as well as omitting necessary care to sustain life (e.g., by withholding nutrition and hydration in some circumstances). Nonetheless, the difference between causing death and letting die remains the basis for many legal and ethical prohibitions against active but not passive euthanasia.
The adjectives active and passive focus on the nature of the actions of the medical professional (or family member or friend) who hastens death. By contrast, the words voluntary, nonvoluntary, and involuntary refer to the level of the patient's consent to euthanasia. Voluntary euthanasia occurs at the patients' request or with their consent. The nonvoluntary patients' consent is absent because these individuals are unable to give consenthey may be unconscious or otherwise incapacitated. Involuntary euthanasia is imposed against the patient's wishes or will.
The patient's level of participation in euthanasia, whether voluntary, nonvoluntary, or involuntary, is significant because a patient's informed consent to medical care became a primary concern after the revelations arising from the Nuremberg trials. Nonvoluntary and involuntary actions are unsatisfactory forms of consent. The level of patient participation also explains the distinction between euthanasia and physician-assisted suicide. In physician-assisted suicide, the medical professional provides the means of death to the patient, who uses them to commit suicide. Euthanasia, however, is done to the patient by another person. Recent legal debates about medicalized death have argued the advantages and disadvantages of physician-assisted suicide over voluntary, active euthanasia. In both cases, the patient consents to death, but only in physician-assisted suicide is the patient the agent of death. One is suicide, whereas the other is killing, or mercy killing, or murder.
Medical ethics codes have disfavored both voluntary, active euthanasia and physician-assisted suicide, both of which are distinguished from the common medical practice of providing pain-relieving medication to patients with the knowledge that it will hasten death. In such cases, deaths are foreseen but not intended, and so, according to the principle of double effect, do not qualify as either physician-assisted suicide or euthanasia. Because death is not intended, such provision of death-hastening therapeutic drugs is not ordinarily grounds for prosecution even in nations that criminalize voluntary, active euthanasia. In practice, some doctors who are prosecuted for euthanasia insist that they were just providing pain relief. Critics have argued that the moral and medical distinction between foreseeing and intending death is too slim a reed to support the legal difference.
Death with Dignity
Debate about euthanasia intensifies when patients and doctors request death with dignity and defend the right to die. Supporters of a right to die argue that hastening the death of suffering or terminally-ill patients who request death is not unjustified killing but instead promotes human dignity and patient autonomy. Advocates of a right to die have challenged traditional legal bans on euthanasia and suicide.
The voluntary aspect of voluntary, active euthanasia raises the question whether the law should permit euthanasia to which patients consent. In 1984, the Dutch Supreme Court recognized a defense against murder for doctors who commit voluntary, active euthanasia. In 2001, the Netherlands promulgated substantive standards to guide the legal practice of euthanasia in cases where certain safeguards are met. The Netherlands has provided the world a laboratory for observing the practice of euthanasia for over twenty years, but its legacy and lessons remain disputed.
In other Western nations, euthanasia remains illegal, while physician-assisted suicide is widely debated. During the 1990s in the United States, the state of Oregon passed legislation allowing physician-assisted suicide, and two federal appeals courts ruled that state laws banning assisted suicide are unconstitutional. In these instances, physician-assisted suicide was viewed as promoting death with dignity. The U.S. Supreme Court, however, upheld state laws against assisted suicide. The Supreme Court recognized a strong state interest in criminalizing physician-assisted suicide because the practice of legally assisted suicide may lead to episodes of nonvoluntary and even involuntary euthanasia. The Supreme Court invoked the popular "slippery-slope" argument that once assisted suicide is legalized, all forms of euthanasia may follow without restraint. Several justices cited the experience of the Netherlands, where some data suggest that euthanasia now occurs without patient consent, that is, involuntarily. The recurrent fear is that human lives, especially the lives of the vulnerable or unwanted, will be ended against their will, that patients will be pressured into requesting a death that they do not desire, and that depressed patients will choose easy death rather than receive appropriate medical care.
Ending the Lives of the Unwanted
The slippery-slope argument resonates with many individuals because of the legacy of Nazi Germany. The roots of the Nazi euthanasia program lay in the eugenics movement that was popular in both Germany and the United States in the late nineteenth and early twentieth centuries. Eugenics, literally "good genes," identified bad genes as the source of disease, mental retardation, and illness, as well as criminality. The medical or scientific solution to the problems of health and crime was to limit the heredity of bad genes. In Germany, the eugenics movement went beyond the sterilization of "defectives" to killing. German authors defended the state's right to end unhealthy or defective lives. State-sponsored sterilization and euthanasia were justified as protecting the state against those individuals it deemed unworthy of life.
With Hitler's commitment to racial purity and anti-Semitism, the Nazi government developed a systematic euthanasia program that culminated in the concentration camps and the Final Solution. Hitler ordered his physician, Karl Brandt, to develop a euthanasia program in 1939. The first to be killed were mentally retarded children, followed by mentally ill adults and the handicapped. Then the war expanded, and, among others, the Gypsies, Jews, and other concentration camp prisoners were subjected to medicalized killing. The medical apparatus was moved from the mental institutions to the concentration camps and, as Robert J. Lifton put it in his 1986 book, The Nazi Doctors: Medical Killing and the Psychology of Genocide, the doctors' euthanasia programs provided the "medical bridge to unrestrained genocide" by the Nazis.
At war's end, Brandt and other doctors were prosecuted at Nuremberg in the Medical Trials; Brandt was hanged for his crimes. Among numerous counts involving crimes of medical experimentation on unconsenting victims, Brandt and three others were charged with a war crime and crime against humanity for the euthanasia program. In The Nazi Doctors and the Nuremberg Code, edited by George Annas and Michael A. Grodin, these crimes are specified as follows:
[The] systematic and secret execution of the aged, insane, incurably ill, of deformed children, and other persons, by gas, lethal injections, and diverse other means in nursing homes, hospitals and asylums. . . . German doctors involved in the "euthanasia" program were also sent to the eastern occupied countries to assist in the mass extermination of Jews (1992, p. 101).
As Matthew Lippman notes in a 1998 article appearing in the Arizona Journal of International and Comparative Law, the Nuremberg Medical Trials set the precedent that state-sponsored euthanasia against nonnationals is a war crime and a crime against humanity.
In discussions about the morality and legality of euthanasia, analogies are frequently drawn to the Nazi doctors. Today's comatose patient may be the equivalent of yesterday's mentally retarded person, whose life is deemed unworthy of living. On the other hand, advocates of a right to die contrast Nazi state-sponsored killing with an individual's choice to die with dignity. On all sides, the moral and legal arguments about euthanasia are nuanced and contested.
SEE ALSO Eugenics; Germany; Medical Experimentation; Nuremberg Laws; Physicians
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Leslie C. Griffin