Author Archives: Dunn Firm - Morgan Claire Dunn

OHHHHHHHHH Canada …

A number of countries set aside March 17 as a celebration of St. Patrick’s Day.

The first St. Patrick’s Day parade in Ireland was held in Waterford in 1903. Strangely enough, this came hundreds of years after the first parade in North America. 

One of the longest-running and largest Saint Patrick’s Day parades in North America occurs each year in Montreal whose city flag includes a shamrock in its lower-right quadrant. This yearly celebration has been organized by the United Irish Societies of Montreal since 1929.

The parade has been held yearly without interruption since 1824. St. Patrick’s Day itself, however, has been celebrated in Montreal since as far back as 1759 by Irish soldiers in the Montreal Garrison following the British conquest of New France.

But this year’s St. Patrick Day promised a much darker, very somber day of international concern. This was the day Canada was prepared to implement medically assisted suicide for people whose primary health issue was a mental health disorder.

In 2015, Canada introduced medically assisted dying after its Supreme Court ruled that requiring people to cope with intolerable suffering infringed on fundamental rights to liberty and security. In 2021, the Canadian law was expanded after the Superior Court of Quebec struck down the government’s original assisted death law on constitutional grounds because it only applied to people whose deaths were “reasonably foreseeable.”

The 2021 law then expanded eligibility to people experiencing “grievous and irremediable” conditions. It included a separate provision for people suffering from mental illnesses. This provision was added to the law by Canada’s unelected Senate.

Perhaps understanding that the mental health aspect of the law was not just controversial but beyond the pale of the act of a compassionate, informed society, the implementation of this aspect of the law was postponed until 2023. It was then again postponed until March 17, 2024.

In the last two weeks, Canada announced it was postponing implementation of the mental health aspect of the law until 2027.

The reasons given were varied. The official, governmental explanation was, “… a special parliamentary committee studying the law concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.” A committee spokesperson stated, “The system needs to be ready, and we need to get it right … It’s clear from the conversations we’ve had that the system is not ready, and we need more time.”  

 Many other reasons for this delay have been speculated. These reasons include:

It is a consequence of the inability of Canada’s public health care system to offer adequate psychiatric care, which is chronically underfunded and facing demand that outstrips its availability.

Many psychiatrists say the plan would undermine efforts to prevent suicide, and they have expressed fear that patients with complex problems will abandon treatments that can take years to achieve results in favor of a medically assisted death.

Not wanting to be left out, political viewpoints have entered the fray. The opposition Conservative Party charged that the liberal government of Prime Minister Justin Trudeau is promoting a “culture of death.” Some on the left oppose the expansion for mental illnesses and have said they want to focus on further expanding psychiatric care. At least one conservative member in Parliament favors an indefinite extension stating, “I don’t see any indication that the fundamental issues that are at the heart — or should be at the heart — of putting a pause on this expansion will be resolved.”

There are still other speculations. Canada has a socialized health care system. One analysis conducted in 2020 estimated a potential annual health care cost savings of $66 million. Certainly, the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on the health care system is alarming.

Then, there are religious aspects being taken into consideration. In Canada, in every province but one, the government exempts taxpayer-funded religious institutions from providing services deemed contrary to their beliefs. In 2016, these exemptions were extended to specifically cover assisted suicide. Last week, a Catholic archbishop filed a challenge to Canada’s law on physician-assisted death, which includes both medically assisted suicide and euthanasia.

Lack of access to quality care has been a baseline, foundational issue for as long as there has been a health care system. If you are wealthy or have health insurance coverage, you have the keys to unlock the door of the healthcare system. If you do not have that key, you are confronted with a “No Trespassing” sign. Shouldn’t a compassionate enlightened society be known not for how it treats the elite in its society, but the downtrodden?

In addition, readily being presented with assisted dying services—instead of treatments or alternatives—can create a sense of being undervalued or marginalized. It implies that end-of-life choices should be prioritized over efforts to provide care, support, or treatments that could improve one’s quality of life or extend their lifespan.

I have the good fortune of being included in a small group of professionals studying eating disorders and end of life options. The issues are many and daunting. Any real progress is problematic, albeit not impossible, at best.

And then, I read a question which so eloquently encapsulated a fundamental concern about physician assisted suicide. That is …

“Why is their suffering acknowledged enough for euthanasia but not enough to fund clinical research?”

Why indeed.

Diamonds in the Undertow

One definition of undertow is “a strong current flowing underwater in a different direction from the way the water on the surface is moving.” This is mostly experienced on a beach where the undertow strongly flows away or sideways in a different direction from the waves breaking on that beach.

There are so many factors regarding undertows. They are a natural phenomenon caused by various factors.  They can also be much stronger than what they appear. They can rapidly change directions and even strong swimmers can be pulled out to sea. Swimming or fighting against an undertow can exhaust a person until they lose all strength to keep fighting.

They vary in strength and the signs of them are not always obvious. The undertow can be deadly. They serve as a reminder of the immense power and unpredictability of nature.

Of course, another definition for undertow is: “an implicit quality, emotion, or influence underlying the superficial aspects of something and leaving a particular or lasting impression.”

An implicit quality underlying surface impression.

Implicit quality such as the grief experienced by a parent after their beloved child dies. No matter how much time passes, that unthinkable grief remains within us, under the surface, swirling, changing, varying in strength, inexorably trying to pull us away from ever feeling a sense of “home.” It never leaves us. But it is there. And the undertow of grief can be brought to the surface in unexpected ways at unexpected times by unexpected events.

Yesterday, I was about to walk into a grocery store. [I do most of the cooking.] As I was about to turn off the car, “This American Life,” a program on NPR (Yes, yes… I listen to NPR and not infrequently!) began to talk about an event experienced by a grieving couple suffering the loss of a child. This couple attended a comedy show in Los Angeles and sat in the front row. The warm-up act, a comedian named Adam Ray, began a bit about children and how kids are a pain in the neck! He then involved the audience and eventually addressed the couple.

The comic asked the father how many kids they had.  He said two. The comic asked their ages.  The father hesitated. Not immediately answering. The comic took this as a sign that he did not know so he started in on his wife with what he believed was good natured ribbing. He even asked which of the children they loved more. The mom then stopped down the show by saying in a clear voice, “our son is dead.”

Naturally, at that point after hearing groans from all, shock and awkwardness permeated the crowd and the performers. Where do you go from that? The comic was stammering a bit at that point and did not know how to end his set with anything resembling grace or humor. But then from somewhere in that incredible mom’s heart, she said:

“But … my dead son would have loved this!”

The crowd erupted in cheers and after that mom said his name, the performers and crowd repeatedly called out Max’s name.

This interaction can be found here:

And I found myself in the car with tears coming down my cheeks.

What incredible grace this mother had. What strength. What inspiration to turn an awkward situation into one filled with laughter and love.

But now, for the rest of the story.

Today, Sunday, I went to NPR’s website to listen to that episode again. Here is the link:

https://www.thisamericanlife.org/823/the-question-trap

I am publishing this article on the afternoon of Sunday, February 3, 2024. On NPR’s website it reports this episode, “The Question Trap,” is not being aired until 7:00 p.m. … on Sunday, February 3 ,2024!

What I listened to was not a teaser-trailer. It was not a portion of that segment. At the end of what I listened to there was no promo, “For the rest of the stories tune into Socialist Radio… [I mean NPR] Sunday night, February 3, 2024, at 7:00 p.m.”

How was I able to listen to something that deeply moved me, that moved me to tears, on NPR before the episode was even released?

Sometimes salvation or enlightenment come from the most unexpected places in the most unexpected ways.

The interaction with those parents and the strength shown by that mom came on the heels of a very significant event for me … and Morgan. When Morgan passed, her bodily remains were cremated. I have given small vials of her to family, to trusted friends to be spread where they believe she would have traveled or loved to see.

And so, parts of Morgan are in Venice, Tahiti, Key West, Cabo, and even the Texas end zone in the venerable old, Cotton Bowl in Dallas, Texas. And now … Barbados.

We were there last week. Deep sea fishing. (A shark ate one of the black fin tunas up to its head while it was on the line. The shark left me alone … professional courtesy and all that). Relaxing and recalibrating. And then, snorkeling.

Barbados beaches offer crystal clear water and shipwrecks just offshore. Wrecks which have begun to turn into coral reefs. Fish life galore. Sea turtles. A different aspect of our world. And one small, precious vial of Morgan made this journey.

As I was hovering over one of those shipwrecks, the top of the ship was as close as 10 feet to the surface. It was time.

So, I pulled her vial out, said a brief prayer and opened the stopper.

When salt water initially interacts with ashes in a confined space, the initial result looks like a thickish, white smoke. By now, tears were beginning to flow. [Try snorkeling and crying at the same time.] I gently tapped what was her temporary glass home … and she was liberated.

Many fish, probably believing it was feeding time, rapidly closed on us. Too many to count.  In various colors, shapes and sizes. Swimming around us. Perhaps a few tried to ingest her. But then.

One of those moments in life you will always remember happened. Perhaps it was the manner in which the bright sun shone in the water. Perhaps it was something else.

But as the fish swam around and through Morgan, her ashes were spread out by their activity (and perhaps the gentle undertow?) and then began to slowly drop directly over the shipwreck. Through tearful eyes, I saw, I experienced, each particle of Morgan began to shine brightly, like very small diamonds. Incredibly bright. Thousands of small diamonds slowly descending. Shining. Glittering. Iridescent.

The fish continuing to swim through her, around her, spreading her further. Then those glittering diamonds began to slowly drop onto the shipwreck. To become one with it. Her new home.

I could only shake my head hoping that would clear my eyes. But the imagery remained.  Or was it the reality? I was caught in an incredible moment of love, but also of heartache. Caught up in the divine mysteries of our very existence.

Those precious, little diamonds flowing away from me as surely they must. And becoming part of something far greater. I lingered for quite some time just watching, taking in the environment, taking in one of Morgan’s last resting places. And I grieved.  But I also loved.

And once again, I was reminded of what the eating disorder community should be fighting for. A reminder of what the eating disorder community should be united behind. A reminder of what the eating disorder community should be emphasizing above all else. 

A parents love of their child. The lives of our children.

The lives of our children.

Obstacles, Self-Awareness and our Humanity

When people, organizations, and yes, even nations have strong disagreements, it seems to be human nature to focus on the need to be right. We look at existing problems myopically. It has become ingrained that we must be correct. We listen to reply … not to learn. And somewhere along the way, we lose our humanity.

Our humanity.

The essence of who we are, who we complex, yet fragile people are, becomes secondary if not lost altogether.

Our humanity.

This reality was recently brought home in an unexpected way. While on vacation, I was bobbing around in the Atlantic Ocean on the eastern most island in the Caribbean. I got this feeling of being a speck really, at the mercy of a force far greater than me. The ocean, its deep mysteries, its majestic nature, its unique characteristics, was made manifest as wave after wave pressed its might against me. Unstoppable. Unrelenting. I was in the presence of an overwhelming force, filled with its own living organisms and truth be told, I was helpless and at its mercy.

One individual. One human. Overwhelmed by the reality that the forces around me could take a life, any life, my life, without hesitation or delay. There was no humanity that I could see.

And yet, it is humanity about which we must be keenly aware. Especially in times of conflict, strife and crisis.

By now, most people know or have heard about the lawsuit involving Bonnie Harken, iaedp and the three (3) directors overseeing all of the corporate chapters. People may know the lawsuit alleges and illegal tying agreement involving certification and iaedp membership and mandatory attendance at iaedp’s symposium. This by itself would be a large obstacle.

But that is not the only huge obstacle being faced.  Complaints have also been directed against iaedp regarding BIPOC membership and lack of BIPOC leadership. The petition involving those topics (and certification) and calling for Ms. Harken’s resignation, is now up to 208 signatures. This number is incredibly significant when considering the size of the eating disorder community.

Then there is the issue pertaining to the demands for dissolution from iaedp corporate chapters. Baltimore. New Haven. St. Louis. Denver. Central Coast. Baltimore. Phoenix. All wishing to disassociate from the national chapter.

Any person facing these significant obstacles alone would surely question their own motivations and conduct. Your membership and chapters demanding disassociation and your resignation. The heartache knowing that an organization for whom you toiled for 22 years no longer wants you is shattering to the ego of any person.

And now, the stakes have escalated and exposure is far greater. With this added reality, the pressure must be nearly inconceivable. These added stakes now include complaints and requests for investigation being made to:

The Internal Revenue Service

The U.S. Department of Labor

The California Franchise Tax Board

California Senator Dan Cortese

The same Senator Cortese, the Chair of California’s Senate Labor, Public Employment and Retirement Committee who stated, “An independent contractor is a specific designation for self-employed people or businesses engaged in contract work. It’s not a gimmick for organizations to avoid paying for employee healthcare and other benefits or reducing their tax liability. Any company found breaking the law will be brought to justice, and they would certainly have no business advising other companies on labor law.”

If my reading of the law and its interpretation is correct, the tax issues facing not just Bonnie Harken and iaedp, but iaedp’s national board of directors could be momentous.  And result in draconian measures against one and all.

Ms. Harken believed she could run all operations of iaedp and remain outside the purview of state and federal administrative agencies. Most tax-exempt organizations, such as iaedp, are required to withhold and pay federal income tax with respect to wages of their employees in the same manner as for-profit organizations. These organizations are also required to withhold and pay these taxes, also known as Federal Insurance Contributions Act taxes, in the same manner as for-profit organizations.

California requires employers to withhold state income tax from wages paid to employees. There are also three other state payroll taxes.

Presumably, Ms. Harken believed she could get avoid these taxes by classifying herself as an independent contractor and utilizing her dissolved corporation as a “go between” entity.  If she is wrong, the consequences for not just her but iaedp’s board of directors could be financially, mentally, and emotionally catastrophic.

With all of these issues, I cannot begin to fathom the pain, the fear, the uncertainty, the anguish experienced every day by a person facing those insurmountable objects. As the twilight of our existence on this plain overtakes us, most of us hope to be able to look back upon a life well lived and filled with happiness, purpose and love. To be thrust into numerous battles against state and federal agencies would test the resolve and strength of any person. In the twilight of our life and career though? Devastation.

We are all but specks of living tissue. Fragile bodies. Throughout our lives, we face forces so much greater than us. What we are left with as we fight our on-going and dying battles is our humanity.

Humanity.

And grace that must be extended to those in such pain. For in extending grace, we embrace our own humanity. Accountability? Yes, absolutely. But that should never color or diminish extending grace and embracing our humanity.

And the humanity of others.

When Awkward Becomes … Not Awkward

On January 8, 2024, I had the pleasure of appearing on the “Making it Awkward” podcast.  This podcast is hosted by Jessica Wilson, MS, RD, and Whitney Trotter, DNP.

Some of their past topics included: Feeling Aligned in Queer Fashion, BMI and Transcare, Things Got Awkward at the Trans Health Summit, The Research on BMI and Gender Affirming Care, Is Non-Binary Identity a 3rd Gender Category, and other important topics. At first glance, the lens utilized by the hosts on these and other topics would be very different than mine. Or is it?

When asked to appear, I did not hesitate for a second.

And so, the day arrived. Right out of the gate, the questions were hard hitting. And yet, they were fair. Potentially sensitive issues, issues which many would consider awkward, were addressed.  

There is no doubt that on many issues, our views were very different… at times maybe even polar opposite. However, at all times, as we discussed these topics, there was a feeling of respect, of professionalism, of courtesy.

If asked back, I would agree in a heartbeat.

As I reflected back upon our interaction, perhaps I gained a bit of insight. And that is, on sensitive issues, issues and topics which have the potential to be incredibly awkward, perhaps respecting the person, of treating each other with courtesy, with respect, with civility is the best weapon to diffuse these awkward topics and issues. To turn awkward issues into issues upon which we can work together even if we maintain divergent points of view. That is a special gift.

So, Whitney and Jessica, thank you for that gift.

I look forward to future interactions with you both!

Dateline iaedp … and Mixing Metaphors

I am reminded of the old saying, “If an iaedp Symposium falls in the forest and no one is there to hear it, does it make a sound?”

Bonnie Harken a/k/a iaedp is in some ways, and unlike Jules in the movie Pulp Fiction, beset on all sides by the equities of the just and the goodness of those seeking integrity. However, Ms. Harken does not see that and instead is determined to bring to reality her belief that she will, “fight to the bitter end.”

In doing so, Ms. Harken bastardizes the maritime tradition summed up by the phrase, “A captain goes down with the ship.” What that statement really represents is a captain’s sworn duty to forego their own departure from the ship and in some instances, sacrificing their own life in order to try to save as many souls as possible on board. Saving lives. Placing others before you. Selflessness. It does not mean punching holes in the hull of your own ship/organization to speed along its demise.

The iaedp ship has hit the iceberg. So, let’s examine the evidence and information supporting this inevitability.

First, some of the “independent” corporate chapters of iaedp, each of which were organized by Ms. Harken and each of which has Ms. Harken as the Chair of their Board of Directors are beginning to see the handwriting on the wall and are quickly manning the lifeboats.

The St. Louis Chapter.

The New Haven Chapter.

The Los Angeles Chapter.

Purportedly, the Phoenix Chapter is in discussions to dissolve.

And finally, the Baltimore Chapter.

However, the Baltimore Chapter opted to issue a public statement. A statement eviscerating iaedp.  That statement is here:

These are not insignificant chapters. Ms. Harken and her co-defendants have the fiduciary duty to file the Articles of Dissolution. To date, that apparently has not been done.

There are other issues of grave concern indicating the Visigoths are at the gates of iaedp.

On December 17, 2023, a petition was started calling for the ouster of Ms. Harken and the certification process being removed from iaedp. To make it clear, I did not draft the petition. I did not edit it. I did not see it. I was not asked about the petition.  IF I had been asked, I would have counseled against the petition.

Since this was one week before Christmas, to presume anyone would read, let alone sign this petition was naïve.  That time of the year we are focused on our loved ones. Our families. Our children. To believe that people would spend time in studied contemplation of a seismic change in an eating disorder organization would simply not happen. And yet.

Here we are one month after the petition started and there are now ONE HUNDRED NINETY (190) signatures. Considering the size of iaedp (and its now shrinking nature) and the small size of the eating disorder community, this number of signatures is incredibly significant.

That petition can be found here:

https://www.change.org/p/remove-bonnie-harken-as-managing-director-of-iaedp-change-certification-policy-ae99d4fe-d465-478b-85f7-9c714397fb5e

These 190 people have flooded the lifeboats. Their voices are loud.

There also seems to be an overall lack of planning, vision and collaboration in the eating disorder community.

Ms. Harken and iaedp epitomize these qualities. This is evidenced by the timing of the 2024 Symposium. The 2024 Symposium takes place one week after the International Conference of Eating Disorders (ICED) hosted by the Academy for Eating Disorders (“AED”). ICED 2024 takes place in New York City. To believe that the brightest and best clinicians, medical and mental health practitioners can take two consecutive weeks away from their patients is not possible. And this year some of the most controversial topics will be discussed and explored at ICED.

Purportedly, sponsorships and registration for iaedp’s 2024 Symposium is dramatically down this year. If attendance remains historically low, this will have a dramatic financial impact on Ms. Harken.

Then, there is the pending litigation. Facts and information are crucially important when allegations of the type asserted in the lawsuit against iaedp and Ms. Harken are made. In order to provide facts and information to the “independent” corporate chapters, I have on a number of occasions, communicated in writing with most of the chapters. I sent to them the following:

  1. Information on my background and advocacy;
  2. Information showing that iaedp has never had a separate, independent audited financial statement prepared;
  3. Information showing that Ms. Harken’s corporation, Crossroads Programs Inc. did not exist, and was being misrepresented on iaedp’s Form 990 tax filings as being in existence [This was admitted by Ms. Harken’s prior attorneys and on the latest Form 990, the corporate status of Crossroads has been removed];
  4. Information showing that according to the California Secretary of State’s records, iaedp was not authorized to operate or solicit for charitable purposes in the State of California since February 15, 2019 [That has since been corrected];
  5. Information showing that in the past, I had reached out to Ms. Harken asking her to provide resources that I could forward to Apple for their employees to have access when I gave a presentation to Apple’s employees;
  6. Information emphasizing that the corporate chapters were not targets for litigation and I gave them resources for them to possibly obtain very low cost attorney’s assistance;
  7. Information showing that the certification process may violate antitrust laws and information regarding the recent case in New Jersey;
  8. Information about the “Remove Bonnie” petition including the link to the petition;
  9. Illinois resources were given regarding how to dissolve a non-profit organization in Illinois.

This information was in writing and where possible, supported by documents or links to sites on the internet. I repeatedly emphasized that I was open for any questions and assured everyone they would be treated with professionalism and respect. Some people did contact me. Our communications were very cordial.

Until recently, my understanding is that instead of discussing these many concerns and issues with iaedp, Ms. Harken chose instead to attack the messenger. In the legal community, we have an old saying. “When you don’t have the facts, argue the law. When you don’t have the law, argue the facts. When you don’t have either, bang your shoe on the table and yell very loudly.” Iaedp is banging and yelling. The community deserves better than that.

There is the issue of where does the lawsuit go. The attorneys appointed by the Officers and Directors Insurance Company have signed “waivers of service” which means the defendants will file their first responses in federal court in the next few weeks. The first response will undoubtedly be a Rule 12(b)(6) Motion to Dismiss.

This motion requests the Court to dismiss the case at this very early stage and asserts that sufficient facts have not been set forth to support the pleadings. We are allowed to respond. The defendants will reply. And sometime later, the Court will decide.

Ms. Harken’s attorneys will file a Motion to Transfer the case to the district in which Ms. Harken lives. For the ease of all parties and because the parties and witnesses are spread throughout the United States, we believe it more economical for the case to remain in Texas. Again, the Court will decide this matter.

The Court may decide, “Dunn, you and your clients are loons. Case dismissed.” I respectfully submit that it is much more likely the case will not be dismissed at this stage. And when the case is not dismissed, the likelihood that certification will be taken from iaedp increases dramatically. And whatever is left of iaedp at that time, undoubtedly will do its Humpty Dumpty imitation.

Opportunities for resolution were presented to Ms. Harken before litigation was filed. They were not responded to.

Now, people in the community must ask themselves … who has the greater credibility?  The person who has been providing information, and facts, and documents (none of which has been publicly refuted by the other person) and has reached out and is open to questions and communications. Or the person who has not provided information and who instead has cast aspersions and who is insisting on absolute power and control?

This all should make any reasonable person wonder, where is iaedp’s Board of Directors? So many facts and issues have already been uncovered that one can presume any informed, involved Board of Directors would take notice and would have taken strong steps to thoroughly investigate and then take action in this matter. However, in standing with Ms. Harken, those people on the board need to understand that sometimes the light at the end of the tunnel is on oncoming freight train. And they too, could become, or are already, legitimate responsible parties.

Sometimes, the questions presented to us are very simple. And Occam’s Razor applies. Do you trust the person who repeatedly reaches out a helping hand to assist those in the water to get into a lifeboat? Or do you trust the person who is supposed to be the captain but instead, is only looking out for her own lifeboat?

DOUBLE EFFECT AND PHYSICIAN ASSISTED SUICIDE

With the approaching legalization of Physician Assisted Suicide (“PAS”) for mental disorders set to take effect in Canada on March 17, 2024, both proponents and opponents are making last ditch efforts to forestall or support implementation.

The statutory law is complex, extensive and awash in legalese.  So, I am embedding a link to this law:

https://www.parl.ca/documentviewer/en/44-1/AMAD/report-2/page-ToC

A Reader’s Digest version of this law, as it pertains to “mental disorders,” and presuming the “mental disorder” does not result in a natural death that is reasonably foreseeable is as follows:

Safeguards for persons whose natural death is not reasonably foreseeable.

The following procedural safeguards apply to persons’ whose natural death is not reasonably foreseeable (*indicates safeguards specific to those requests):

  • request for MAID must be made in writing: a written request must be signed by one independent witness, and it must be made after the person is informed that they have a “grievous and irremediable medical condition” (a paid professional personal or health care worker can be an independent witness);
  • two independent doctors or nurse practitioners must provide an assessment and confirm that all of the eligibility requirements are met;
    • *if neither of the two practitioners who assesses eligibility has expertise in the medical condition that is causing the person’s suffering, they must consult with a practitioner who has such expertise;
  • the person must be informed that they can withdraw their request at any time, in any manner;
  • *the person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide those services;
  • *the person and the practitioners must have discussed reasonable and available means to relieve the person’s suffering, and agree that the person has seriously considered those means;
  • *the eligibility assessments must take at least 90 days, but this period can be shortened if the person is about to lose the capacity to make health care decisions, as long as both assessments have been completed;
  • immediately before MAID is provided, the practitioner must give the person an opportunity to withdraw their request and ensure that they give express consent.

To provide greater insight, I am embedding testimony taken in May 2022 before the Special Joint Commission on Medical Assistance in Dying:

https://www.parl.ca/DocumentViewer/en/44-1/AMAD/meeting-9/evidence

This site contains much of the evidence and testimony elicited when the Canadian law was being vetted. And of course, there are a number of matters and issues of concern contained within the Report and testimony.

For example, with regard to the crucially important, “Balancing Individual Autonomy and the Protection of the Vulnerable,” the Committee’s findings constituted only four (4), short paragraphs and ended with the following conclusion: “The committee recognizes that a delicate balance must be struck between promoting individual autonomy and protecting against socio-economic vulnerabilities.”

We have an adequate grasp of the painfully obvious. Perhaps the Committee should have focused on the merely obvious conclusion.

Under the Canadian law, the Committee stated, “To be eligible for MAID, a person must have a ‘grievous and irremediable medical condition.’ As Jennifer Chandler explained, “irremediable” is not a medical or scientific term. Rather, as noted above, “grievous and irremediable” is defined in the law as incurability, being in an advanced state of irreversible decline, and “enduring physical or psychological suffering that is intolerable to [the person] and that cannot be relieved under conditions that [the person] consider[s] acceptable.”

Because of this wording, eligibility must meet ALL of these criteria. Further, if we are to use that definition, doesn’t that necessarily exclude all instances of anorexia nervosa? Incurability? Anorexia?

With regard to Minors, the Committee stated, “In Canada, a person must be at least 18 years old to access MAID. However, minors with the requisite capacity are generally entitled to make their own healthcare decisions. The exact parameters of minor consent to healthcare vary by province.” The Committee then held, “The term ‘mature minor’ refers to a common law doctrine according to which “an adolescent’s treatment wishes should be granted a degree of deference that is reflective of his or her evolving maturity.”

Minors. Our teenagers. Our children.  The Committee also found, “In the Netherlands, MAID is allowed for minors aged 12 and over, and may soon be expanded to include younger children. In Belgium, there is no minimum age, so long as the minor has the requisite capacity.”

So, are we to allow young people, our children, whose brain is not biologically developed let alone mature to make life or death decisions? Where is the morality in that?

Principle of Double Effect

Which brings us to the issue of a just society and the morality not only of medical professionals making this life or death call, but whether the very act in question is morally right. To this, we turn to the Principle of Double Effect. (Principle)

The Principle has its historical roots in the medieval natural law tradition, especially in the thought of St. Thomas Aquinas (1225-1274). It has been refined both in its general formulation and in its application by generations of Catholic moral theologians[1].

Although there has been significant disagreement about the precise formulation of this principle, it generally states that, in cases where a contemplated action has both good effects and bad effects, the action is permissible only if it is not wrong in itself and if it does not require that one directly intend the evil result.

Classical formulations of the Principle of Double Effect require that four conditions be met if the action in question is to be morally permissible:

  1. First, that the action contemplated be, in itself either morally good or morally indifferent;
  2. Second, that the bad result not be directly intended;
  3. Third, that the good result not be a direct causal result of the bad result, and;
  4. Fourth, that the good result be “proportionate to” the bad result.

Supporters of the Principle argue that, in situations of “double effect” where all these conditions are met, the action under consideration is morally permissible despite the bad result[2].

The Principle is regularly invoked in ethical discussions about palliative sedation, terminal extubation and other clinical acts that may be viewed as hastening death for imminently dying patients. Unfortunately, the literature tends to employ this useful principle in a fashion suggesting that it offers the final word on the moral acceptability of such medical procedures. In fact, the rule cannot be applied appropriately without invoking moral theories that are not explicit in the rule itself. Four tenets of the rule each require their own ethical justification. For example, the third condition must necessarily invoke the Pauline Principle which states, “One should never do evil so that good may come.” 

Some ethicists believe that if a suffering, terminally ill patient dies because of intentionally receiving pain-relieving medications, it makes a difference whether the death itself was intended or merely anticipated.  If the death was intended it is wrong but if the death was anticipated it might be morally acceptable[3]. 

Philosophers and medical ethicists have speculated that, “According to this Principle, euthanasia and physician-assisted suicide are always illicit acts, while the same is not said for other actions that bring about patient’s death as a foreseen effect, namely, palliative treatments that hasten death or failure or interruption of life support. The reason for this difference is that, in the first two cases, the patient’s death is intended as a means of pain relief; whereas, in the latter two, death is only a side effect of a medical act, an act justifiable if it is necessary to achieve a proportionate good.”

We also need to question whether the moral objection to an action is the same as the physical performance of that action. Dr. Paulina Taboada addressed this question accordingly, “But the physical performance of an action (actus hominis) does not necessarily coincide with a moral act. Only an action in which human freedom is exercised (actus humanus) can be morally qualified. A moral act is essentially an act in which human freedom is exercised. This means that the moral act itself is marked by an ‘intrinsic intentionality’; it tends towards an object (called moral object).”

Dr. Taboada then stated, “Hence, the moral act cannot be properly characterized by describing a mere physical performance. In order to find out which is the kind of moral act we are performing (i.e., the ‘moral species’ of the act), the key question is: What are you doing? And an answer like “injecting morphine to this patient” would not do it. The proper answer to this question – relieving pain – reveals the ‘intrinsic intentionality’ of the moral act. An analysis of the lived ethical experience shows that the moral character of our free acts is basically determined by this ‘intrinsic intentionality’ of the act, i.e., by the kind (‘species’) of act we perform.”

Dr. Taboada then concluded, “A careful analysis of our most basic human moral experience shows that the ethical character of human acts does not primarily depend on the motivation or intention of the agent, but on the moral species of the action to be performed. Hence, the common saying ‘the end does not justify the means’.[4]”

The Canadian law, at best, paid lip service to this incredibly complex issue. An issue which not only touches our existence, but the very heart of our humanity. Faith. The Soul. Life. Death.

Our society seems to be in such a rush to show all others that we are capable of performing a certain act better than it has ever been done … and thus, show our individual wisdom and humanity. However, in doing so, we have lost sight of the question we need to be exploring, that is, “Should we do this act?”

A question that our medical and mental health providers certainly cannot answer. Perhaps there is no answer. And yet, if we do not keep exploring the boundaries of our being, our imagination, our very lives, we will continue to fail. We will fail on a generational level.

We cannot, and do not have the luxury of taking action without seeking wisdom from all interested parties. We must work toward being open to options we never previously considered. We must strive to chart the unknown and unlimited possibilities of existence.

And we can only do that if we take all reasonable and necessary steps to preserve the sanctity of life.

[1] http://sites.saintmarys.edu/~incandel/doubleeffect.html

[2]https://pubmed.ncbi.nlm.nih.gov/3080130/#:~:text=The%20doctrine%20holds%20that%2C%20in,%2C%20and%20(d)%20there%20is

[3] https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/euthanasia

[4] https://hospicecare.com/policy-and-ethics/ethical-issues/essays-and-articles-on-ethics-in-palliative-care/shaws-criticism-to-the-double-effect-doctrine/

The Old Gray Lady and Assisted Suicide

The New York Times was founded in 1851. In its long and storied history, it has been at the heart of important legal decisions pertaining to journalism and the freedom of the press. Since 1896, its slogan has been, “All the News That’s Fit to Print.”

For many Americans, the Times is at the forefront of their consciousness regarding the journalism industry. It is a major news outlet in the United States’ most prominent city. The Times often sets this nation’s news agenda.  All of which makes it that much more surprising when the Times lowers itself to publishing an outdated, tag along storyline devoid of substance and not current on the latest events on a crucial topic.

In this case, the January 3, 2024 article entitled, “Should Patients Be Allowed to Die from Anorexia?” To say that this article fell down the deepest well far below the Times usual standards would be charitable. In fact, this article could have jeopardized on-going debates, discussions and interactions which are currently taking place among mental health professionals on the highly controversial topic of assisted suicide and mental health, particularly anorexia nervosa.

The Times Article attempts to frame issues designed to draw the reader away from one of the most complex issues we as sentient beings face … our very mortality … and simplify it to a plug and play game devoid of any nuance, substance and morality.

The manner in which the Times article fails is legion. So, let’s address just some of its shortcomings.

First, the Times article comes across as a less informative follow up piece to the outstanding article written by Abby Ellin and published in the Washington Post on November 1, 2023. Ms. Ellin’s article was obviously thoroughly researched, and included information from doctors, research professionals, mental health advocates, families and people who have been directly impacted by anorexia’s deadly nature. It explored both sides of this highly volatile issue. Ms. Ellin’s article endeavored to stay current with the rapidly evolving events on this topic.  All of which are missing from the Times article.

The Times article was not current regarding events which have transpired on this issue since June 2023. It did not address retraction of certain articles, medical complaints being withdrawn, or the fact that a broad-based summit occurred in Denver, Colorado on November 17, 2023, or the fact that perhaps our mental health professionals are looking at new ways to address controversial topics. Instead of engaging in seemingly endless academic articles ping-ponging back and forth, face to face respectful engagement took place. Professionalism. Mutual respect. All this important information was missing from the Times Article.

The Times Article focusing on Naomi’s story was understandable. Her story is compelling. How can we not sympathize with her? Her story touches our heart. Her story and the extreme issues and measures she has faced in her life are designed to attract readers and perhaps gain support for assisted suicide for mental health issues. And yet, her story is not representative of the millions of people suffering from anorexia nervosa. There was no counterbalance showing those people who are greatly suffering and yet who are still scratching, clawing and fighting for life.

Now make no mistake. Palliative psychiatry is a topic that has arisen as an important topic of discussion and worthy of studied research and contemplation. However, the Times Article takes this topic and renders it fodder for click bait. If people are looking for substantive information on this topic, the article fails. No mention of criteria or guidelines. No mention of studying biological or more objective signs of mental impairment.

The Times Article also failed in that it did not address the ever evolving understanding of possible biological causes of anorexia nervosa. It did not address the fact that we do not completely understand the biology and neurobiology of anorexia nervosa and accordingly no treatments have been developed, tested, and approved that specifically target the underlying biology. Genetic factors? Nothing. The Times Article also does not address recent research indicating prolonged starvation damages the gastro system and impoverishes the microbial ecology making recovery more painful and more difficult.

The Times Article did not address alternative and evolving medical measures being utilized to treat anorexia.  For example, Ketamine, Psilocybin, ECT: (electroconvulsive therapy), TMS: (transcranial magnetic stimulation), tACS: (transcranial alternating current stimulation) DBS: (deep brain stimulation). After all, don’t our medical and mental health professionals have the duty to explore all viable treatment options before beginning that journey which leads to the end of life? The article failed to explore this issue.

The Times Article unfairly portrayed Dr. Joel Yager in an unflattering light. Dr. Yager virtually attended the November 17, 2023, summit. He heard inspirational stories of heartache and resiliency from Linda and Jack Mazur and heartfelt apologies from Dr. Gaudiani to those who may have been hurt. He not only heard from but collaborated with some of the leading eating disorder experts in attendance that day. He heard the term “Terminal Anorexia” is being abandoned. He heard the commitment from all in attendance to preserve, to work together, to address this volatile topic in a compassionate, intelligent collaborative manner. As such, we are certainly justified in questioning why Dr. Yager was portrayed in such a cynical manner. Was the Times Article accurate in asserting Dr. Yager questioned the ethics and competency of other psychiatrists?  Whether they had become “zealots for the model.” Whether Dr. Yager was ambivalent and equally accepting whether Naomi lived or died. Whether Dr. Yager stated, “Yager told me that he does not regret what he wrote. ‘The main point is that some people die from the disease,’ he explained.” I believe that type of cynicism could not be generated from the Dr. Yager who participated in the November 17, 2023, summit.

The Times Article did not include information about the plenary panel session to be conducted at the International Conference of Eating Disorders in mid-March in New York City. This panel includes Dr. Gaudiani, Dr. Westmoreland, and others, with all sides of this topic to be discussed in a professional, open forum. This highly volatile, emotional, potentially divisive issue which touches our very existence deserves our highest compassion, intelligence and collaborative work. The Article failed in addressing this.

The New York Times is sometimes referred to as the “Gray Lady,” or the “Old Gray Lady.” Initially, the Gray Lady was a term of affection, meaning that the Times was deserving of respect, of measured intelligent thought. This article was the antithesis of the Times past standard.

With at least one of its photos in the article deserving of both a “trigger warning” or inclusion in the National Enquirer, this article was not worthy of being called investigative journalism. The Article took a complex, emotional issue … life or death, and relegated it to a lurid standard that makes “yellow journalism” appear erudite. Even the birds in my birdcage would be offended if I used this Article to line their dwelling.

Perhaps showing that the Old Gray Lady just ain’t what she used to be … many long years ago.

The Best of Trees… The Worst of …

It was the best of trees.

It was the worst of trees.

It was a tree of wisdom.

It was a tree of foolishness.

It was a tree of light.

It was a tree of darkness.

It was a tree of hope.

It was a tree of despair.

[Apologies to Charles Dickens for bastardizing “A Tale of Two Cities.”]

I was raised in a family where artificial Christmas trees were not a consideration. Each year, a “live tree” was brought into our house. [The irony of that term is not lost.] The scent of the tree quickly filled our tiny house. But it was much more than that. The tree elevated not just our sense of smell, but it brought joy, love and light to our other senses as well. Glorious Christmas was near. And at Christmas, anything was possible!

My 4 siblings and I would impatiently wait while my dad put the tree in the stand and then hung lights on it. Now, these lights were not the small, cheap, “Made in China” lights intended to last one year and then be thrown away. Oh no. They were large, colorful bulbs. Bulbs that would get hot ensuring that they would not stay on overnight. Bulbs to singe little fingers. You know, fire hazard bulbs.

That first glorious night, we would hang ornaments, both store bought and homemade on the tree. Being the 1960s, tinsel icicles would be the last items placed on the tree as mom constantly yelled out, “One at a time! Just hang one at a time!”

Nighttime was the best. The rest of the lights in the room turned off, the glow of the star on top of the tree, the bulbs smoldering on its branches, maybe Mitch Miller’s “Sing Along with Mitch Christmas Songs” album being played on the Magnavox. And all was right with the world.

As the years passed and the dreams and fantasies of childhood were left behind, our adult years came upon us. But still, the Christmas tree was eternal. It had to be real. It remained my symbol representing the endless possibilities of greater futures.

Little strangers a/k/a children came into our life. With ever growing numbers of friends and their Little Strangers, we would pile into first our cars, then onto full sized buses, and travel to Christmas tree farms to saw down our very own trees. The look of absolute wonder on our children’s faces were a time portal allowing us small glimpses into our past childhood. And for brief moments in time, we remembered.

Then, the ravages of time took its toll … work, divorce, misplaced priorities … all life lessons teaching us that life is not easy. And it is not meant to be.

And yet, the Christmas tree remained. Decorating the tree became “a thing” for Morgan and me. Each year we strung popcorn and cranberry strands. Even as her eating disorder began to ravage her bodily organs and take her away, the tree remained our last vestige of a childhood that was gone … for both of us.

And then, she was gone.

That first year, less than 2 months after Morgan was taken was gut wrenching. As for a Christmas tree? Forget it! Why go through that pain? But sometimes decisions are removed from your control. Surrounded by pushy siblings, nieces and nephews, a tree found its way into my place … and remained in my life. I still recall the hours which elapsed, tears on my face, looking at the tree. And questioning life.

For the first time, I felt that a Christmas tree was seemingly mocking me. What did I have to be thankful for, or hopeful about? And yet, the tree remained, calling me, trying to get me to remember … to not give up all hope.

A few years went by. And each year, a tree would go up. Now, make no mistake, a “live tree” is not easy. You must work it into the stand, tighten the screws, level it, remember to pour water into it, trim it. It drops needles. It is dirty and messy… and worth every second and every adversity. It helps you … feel. It helps you remember that there are far greater things than your own existence.

A few years ago, on the day I was going to pick up a young lady who was being checked into ERC the next day, just 2 hours before her flight arrived, the Christmas tree fell. Ornaments I deemed precious, shattered. I ranted about how it was NOT a Christmas tree, but it surely must be “Satan’s Shrub.” And then, a valuable life lesson was brought manifest. The only ornaments which broke were those purchased at stores. The precious ones hand made by my children… all survived. Precious memories. A truer message of Christmas, of love, of our children was brought to me.

This year’s version of the Christmas tree was … alarming. Not because of the work that went into it, but because of the incredible ease every step of the way.

We went to the local tree lot (Lowe’s), walked in and the very first tree we saw, was “it.” No bad side which would need to face the wall. Perfect height. It was full. It was perfect. We got it on top of the car with no issues. Brought it home. The stand fit it perfectly the first time. This tree stood tall and straight. After cutting off the netting, the branches settled into perfect harmony. I put on the lights with no issues at all. Ornaments adorned the tree. And then, I found a perfect “tree topper.” A beautiful, Victorian looking angel. Naturally, it fit precisely.

All was right with the world. Or so I thought.

The next morning when I went to check how much water the tree had taken in, I was surprised to see the stand still full of water. Although a bit concerned, I looked upon this as a temporary, small issue. After all, this was the perfect Christmas tree. But, as days went by and the only water leaving the stand was through evaporation, I felt the “perfect Christmas tree” drying out. And quickly at that. It remained presentable for a family and friend’s party.  But its days were quickly over. The “perfect Christmas tree,” the easiest one I had ever had, was anything but perfect.

With still almost two weeks before Christmas, this now fire hazard had to go. And so, it did.

But Christmas is before us. And to not have a tree on that sacred day was unthinkable. So … hi ho, hi ho, it’s back to the lot I go.

Not surprisingly, the only trees left were those that would have made Charlie Brown proud. I was standing on the island of misfit trees. Some beginning to brown on the edges. It was raining of course. I was the only customer there. I grabbed the least sad tree that I could find. A tree I normally would not have even considered for one second. As a last resort it had to be relatively acceptable even though scrawny. And so, this unwanted, red headed stepchild of a Christmas tree found its way home.

It is the smallest tree I have had in years. I put the lights on. Because of its size, far fewer than normal. Then the ornaments. Again, far fewer. The tree’s diminutive size would simply not allow it. And yet, somewhere along the way, just as it happened in a Charlie Brown Christmas, the tree began to transform.

Memories of Christmas tree farms, of the sweet innocence of children, the shouts of joy, the pure laughter from these soulful, little strangers, the sharing of the almost sacred ritual of decorating the tree with my daughter rose to the surface. Its scent was pure … and sublime.

And once again, another valuable lesson manifested. The Christmas tree which I had held so dear for all of these decades, was indeed merely a symbol, important yes, but just a symbol. Most importantly, it was the love surrounding the tree. The shared dear, precious time spent with loved ones. Spending time together.

This scrawny, Charlie Brown tree, overlooked by many, reminded me of the most precious times in which love, pure love, a love a parent has for his child embraces us. It is there to be held. To be cherished.

Fate, karma, or perhaps a little hand from beyond bestowed that gift upon me. Reminders of past feelings, of love, of a bond that even death cannot break. Those thoughts, those feelings came to me as I put the last few ornaments on.

I remembered. I felt that love. Tears on my face. And a Little One no longer here reminding me, of filling my heart.

What a Christmas gift.

As for the tree …

Simplify and Explain

“Explain it to me like I’m a 6-year-old, because I just don’t get it …”

            Jury Foreman, the movie “Philadelphia”

We attorneys are frequently guilty of using overly prosaic words and legalese designed to confuse even Robert Oppenheimer or Albert Einstein. Perhaps it is a defense mechanism. Or ego. Or both.

Many people have heard of the recent lawsuit filed against iaedp and Ms. Bonnie Harken. Make no mistake, it is a very complex lawsuit involving class action allegations, antitrust allegations and racketeering allegations. Even younger, relatively inexperienced attorneys may have difficulty understanding the nuances of the lawsuit. So, I will endeavor to attempt to explain the lawsuit only with regard to certification.

First, it was only after all attempts to discuss and hopefully resolve troubling issues with iaedp were rebuffed by Ms. Harken that the lawsuit was filed.

The decision was not made easily. The terms offered to iaedp were designed to improve the corporate chapters, to increase their involvement and to take iaedp into the following decades with wisdom and vision. The only absolute required Ms. Harken to resign.

Ms. Harken chose to not respond.

And so, that left no alternative.

Defendants

The named defendants in the case are Bonnie Harken, her son, Matthew Harken, iaedp Foundation, Inc., Dena Cabrera, Ralph Carson and Joel Jahraus.

Ms. Cabrera, and Drs. Carson and Jahraus are not involved in the allegations and issues regarding certification so their involvement in the lawsuit will not be addressed in this article.

And so, that leads us to the specific claims made regarding certification.

Claims regarding Certification

FIRST, UNDERSTAND THAT WE ARE NOT ATTACKING THE SUBSTANCE OF IAEDP CERTIFICATION.  Nor do we want it to go away. That is beyond what this lawsuit is about.

Claims involving certification are based on the fact that certification is tied into mandatory membership in iaedp and attendance at 1 out of every 4 symposiums is required. Because iaedp certification is the only recognized eating disorder certification, we believe tying it to on-going membership and attending a symposium violates anti-trust laws.

Since membership fees and symposium fees are not reasonably related nor an integral part of iaedp certification, the mandatory inclusion of same is merely to increase the coffers of iaedp and enrichen its managing director.

iaedp has exclusive market power, a 100% monopoly, in the eating disorder Board Certification Market, as there are no substitutes for eating disorder board certification available to eating disorder specialists.

By conditioning iaedp certification on continuous membership in iaedp and the cost of iaedp’s annual membership dues, as well as mandatory in person attendance at a symposium, we believe iaedp violated the antitrust laws.

As recently as 2022,Ms. Harken had actual knowledge that this tying arrangement may run afoul of antitrust laws.   Ms. Harken had actual knowledge of the case, Talone, et. al. v. The American Osteopathic Association, Case No. 1:16-cv-04644 (D. N.J. Jun. 12, 2017) and the issues involving unlawfully tying association membership with board certification. However, Ms. Harken dismissed any concerns by attempting to justify that since the costs for association membership and certification had allegedly not increased, she could link the two.

It is interesting that in the December 5, 2023 iaedp newsletter, iaedp spends a considerable amount of time discussing the substance of certification. However, not once does iaedp address the tying arrangement aspect nor the fact that Ms. Harken had actual knowledge of a lawsuit in which a similar tying arrangement resulted in a settlement in which that certification was stripped from the organization and members were entitled to reimbursement for fees paid.

And we can’t help but wonder why? Why was this information not given to iaedp members?

Iaedp and Ms. Harken were correct in stating “allegations do not constitute facts.” Those facts will come out in Court. But, as therapists, as medical and mental health providers, you are burdened with an awful, a difficult, a herculean task. And that is, families are relying on you to try to help them save the lives of their loved ones.  Is there a bigger burden?

You deserve all relevant and material information to help you undertake this burden. Anything else and you are being betrayed.

The other issues in the lawsuit are incredibly more complex. And may be addressed in another explanatory article.

But for now, I strongly believe that most people’s goals and aspirations are the same as ours. We want the certification process to be better, stronger, forward thinking, open, transparent and to reflect the needs of professionals.

Our families deserve nothing else.

Legacies and Days of Reckoning

In the holiday movie classic, “It’s a Wonderful Life,” we are given glimpses into the life of a seemingly simple man, George Bailey. When we look closely at the George Bailey character, we see a man who is desperately trying to dictate his future and establish his own legacy. He is going to attend college, obtain his degree, then be instrumental in building big cities. He will turn his back on his bucolic little town, Bedford Falls and will be a world traveler. He will be wealthy … and he will be admired.

And yet, George Bailey failed at all of these goals and ambitions. He failed miserably. And yet, in that failure in that seething desperation, came triumph, came the richness of life, came the true legacy that life had in store for him.

Failure. Triumph. Legacy. Those concepts can provide joy. Or an improper or incorrect focus on them can provide tragedy.

Yesterday, on behalf of eating disorder professionals, I filed a lawsuit naming iaedp, Bonnie Harken and other individuals as defendants. It is a class action lawsuit alleging violations of the antitrust laws for the manner in which the iaedp certification program is operated. It also alleges violations of racketeering statutes.

Before filing this lawsuit, an honorable resolution was offered. A resolution which could have strengthened the local corporate chapters, which could have provided seed capital to those chapters, which would have empowered those chapters, and which would have brought greater collaboration amongst iaedp members and those chapters.

This offer did not receive the courtesy of a response.  Perhaps because the offer included a requirement that Ms. Harken would have to step down.

And so, we find ourselves in litigation. With possible investigations to be conducted by state agencies in the near future.

I shake my head wondering how this community got so far away from what it should be. How did the community become a war zone for tired, self-loathing, hurting people? Or people who parade their extremist political and social views in public at the expense of families and our loved ones who suffer from eating disorders. When did suffering families become secondary?

How did we get to a place where an individual’s hubris kidnaps their very identity, their very existence, and merges it with the organization they try to lead. Until that person believes they and the organization are one and the same. They lead through fear and intimidation. They trust no one.

And they fear.

They fear that they will be discovered.

What a burden that surely must be. Wondering every day whether today will be the day that questionable conduct could be exposed. And wondering still what else they, themselves missed and if that too will be exposed. To live with that uncertainty. With that fear.

As we age and we perceive the twilight of our existence is at hand, many of us concern ourselves about legacy. What ours may be. For that matter, will we even have a legacy to speak of?

How will we be remembered? Will we be remembered at all? Have we made a positive impact in this world? Is our world a better place when we depart than what it was when we came into this existence?

Questions which confound many. Questions which many people believe must be answered before they pass. By people who believe they can shape their own legacy. By people who do not understand that our legacies are dictated by the future. By the George Baileys of the world. They do not understand that they only need to be an authentic person. History will make its own judgments.

For some, a day of reckoning has arrived. Reckoning which may very well dictate legacies. Legacies of hope and triumph. Or legacies of despair.