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Context of 'July 23, 2009: $76 Million Annually Can Be Saved by ‘End-of-Life’ Discussions; No Loss in Quality of Care'

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President Arthur sends a message to Congress: “The objectives of the society are philanthropic. It does not aim at permanent political control, but seeks the neutrality of the valley. The United States cannot be indifferent to this work, nor to the interests of their citizens involved in it…It may become advisable for us to cooperate with other commercial powers: protecting the rights of trade and residence in the Kongo [sic] valley free from interference or political control of any one nation.” [Pakenham, 1992, pp. 244]

Entity Tags: Chester A. Arthur

Timeline Tags: US-Congo (1959-1997)

Frame 313 of the Zapruder film.Frame 313 of the Zapruder film. [Source: Abraham Zapruder]John F. Kennedy, the thirty-fifth president of the United States, is assassinated during a political trip to Dallas, Texas. [Earl Warren, 9/24/1964, pp. 48] Kennedy is assassinated inside a motorcade, sitting alongside his wife Jacqueline “Jackie” Kennedy, Texas Governor John Connally, his wife Nellie Connally; driving the motorcade is Secret Service agent William Greer, who is sitting next to Roy Kellerman, assistant special agent-in-charge of the Secret Service White House detail. Before the first bullet hits him, Kennedy is waving to his right at a group of people standing near a sign reading “Stemmons Freeway”. His right arm and hand are slightly over the side of the car. Approaching what is known as the “Triple Underpass”, a railroad bridge converging three streets underneath, Mrs. Connally says to the president: “Mr. President, you can’t say that Dallas doesn’t love you.” Kennedy replies, “No, you certainly can’t.” [Marrs, 1/22/1993, pp. 11] According to the Warren Commission: “… as the President’s open limousine proceeded at approximately 11 miles per hour along Elm Street toward the Triple Underpass, shots fired from a rifle mortally wounded President Kennedy and seriously injured Governor Connally. One bullet passed through the President’s neck; a subsequent bullet, which was lethal, shattered the right side of his skull. Governor Connally sustained bullet wounds in his back, the right side of his chest, right wrist, and left thigh.” [Earl Warren, 9/24/1964, pp. 48]

Entity Tags: Jacqueline Kennedy Onassis, John F. Kennedy, Idanell Brill “Nellie” Connally, William Greer, Roy Kellerman, John Connally

Timeline Tags: Misc Entries

Pat and Kevin Tillman, pro athletes who joined the Army Rangers and participated in Operation Iraqi Freedom (see May 23-June 1, 2002), are presented with the annual Arthur Ashe Courage Award by ESPN. Both refuse to attend the awards ceremony, another example of their continued effort to avoid the public acclaim surrounding their joining the military. Younger brother Richard accepts on their behalf, and for the first time since their enlistment, their friends and parents speak publicly of the brothers in the ESPN televised tribute. ESPN senior vice president Ron Semiao says of the occasion: “The Tillman brothers’ story is remarkably inspiring. They turned their backs on stardom and potential fortune, dedicated themselves to a larger cause and never once sought glory or recognition. Pat and Kevin’s approach of leading by example is reminiscent of the way Arthur Ashe lived his life and like Arthur, the Tillmans’ decisions have had a profound impact.” [ESPN (.com), 7/2003]

Entity Tags: Kevin Tillman, Excellence in Sports Performance Yearly Awards, Pat Tillman, Richard Tillman, Ron Semiao, Arthur Ashe

Timeline Tags: War in Afghanistan

CNN reports that millions could be saved per year by the so-called “end of life” discussions that the Obama health care proposal would have Medicare pay for, without a loss in the quality or availability of care. According to a recent study cited by CNN, $76 million per year could be saved “if half of the people who die from cancer annually had end-of-life conversations with their doctors.… [P]atients who reported having those talks had 36 percent lower health care costs in the final week of life.” Most of the savings would come from patients who do not want extraordinary measures taken to preserve their lives, but because hospitals have no such instructions, when a dying patient “codes,” or lapses into a terminal state, hospital doctors by default will use extraordinary methods to resuscitate them. Dr. Arthur Kellerman, chairman of the emergency medicine department at Emory University, says that many aging parents and grandparents avoid such discussions because of the strain they might place on their children and grandchildren. And the younger relatives often avoid these discussions because they don’t want to appear ungrateful or grasping. As for doctors: “There are a lot of my colleagues who don’t bother having that conversation. They just intubate them, and ship them up to an ICU, and say ‘next,’” Kellerman says. “Ultimately, it drives up costs, it degrades their quality of life, and you have less money and less resources available for people who really are salvageable and have a whole lot more time left on Earth.” Kellerman says when his own mother was at the end of his life, he had to use his position as a doctor to ensure that “do not call 911, do not send her to the hospital” was written on her chart so that she would be able to die in her nursing home. “You end up with a daughter at two in the morning, and Grandma is in respiratory failure, and we’re having a conversation in a family room in the ER about what Grandma wants,” Kellerman adds. “That conversation should have been with that grandmother and her daughter and her doctor and should have happened two years earlier, and it would have been easier on everybody.” The study shows that 60 percent of elderly patients prefer that their doctors not use extraordinary measures to preserve their lives. “Everybody wants their parents to live forever, everyone wants to live forever,” says Kellerman. “But the fact is that won’t happen, and you do need to think and plan ahead.” [CNN, 7/23/2009]

Entity Tags: Obama administration, Arthur Kellerman, CNN

Timeline Tags: US Health Care

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