2012年8月21日星期二

Life after work can be emotionally draining

  Life after work can be emotionally draining



A friend of mine retired recently — for about three weeks! He did not know what to do with his free time and panicked. While he had spent most of his working life planning financially for retirement, when he had finally reached his post-working life, he did not have a clue what to do with himself. He had left out one vital piece of his retirement plan — how to fill his time while retired. According to Thomas Milroy, director of in-patient psychiatry at the McGill University Health Centre, “your friend did not plan for the emotional side of retirement.”

To some, this may seem like a silly problem. In fact, “many studies have shown that less than 20 per cent of individuals are passionate about their work and, for most, it is a relief when that part of their life is over,” says Hani Kafoury, a Westmount-based psychologist who specializes in assisting clients’ major life changes at Tranzition Consulting Services.

Whichever category you fall into, there is no doubt advance preparation is required before you step into the potential abyss that is retirement.

One of the keys to a successful retirement is to “ease into it — take small steps,” Milroy says. Some people like to begin with shorter work weeks to allow them to get comfortable with having more personal time. This helps them understand and gradually adapt to the concept while keeping them tendered to the part of life that has kept them occupied all of these years. Alternatively, “some people like to start/stop retirement until such a time as when they get themselves situated into their own projects,” Milroy says.

Kafoury points out there is a psychological preparation for retirement. “This transition process can occur months, if not years, before actually being retired. The first step is to recognize retirement as a real future possibility; then to plan one’s future accordingly; and to make the formal decision to retire at a certain time and in a certain way. Overall, it involves one’s transition and therefore detachment from one’s work role as well as from the physical and relational ties in one’s workplace.”

Building new friendships outside the workplace is not always an easy undertaking and this is particularly true in retirement. However, this can be a key element to a happy retirement. Social contacts are important to maintain and develop. Milroy encourages patients to attend family reunions, various workshops or even continuing education courses where they can develop new interactions, or reconnect with old ones, and hopefully incorporate these relationships into their daily lives and routines. People who “travel too long in retirement can lose their moorings when they return home and can then find it difficult to rekindle these relationships,” which is also something to consider during one’s planning stages, Milroy says. This is partly why some couples “retire together” and choose southern locations within the same proximity so they can regroup during the winter or even travel together.

Dealing with the psychology of retirement can be an individual’s greatest challenge, particularly for those whose “identity and self-image has been associated in good part with their work,” Kafoury says. For these transitioning retirees, (or better still, for those planning for retirement), “I like to work through with the client what has really ended for them (sense of being valued, power, influence, security, relationships, etc.) and how they are willing to mourn the loss, reframe it and ultimately replace it so to reinvent themselves. But before they can achieve this, they need to regain control of their life (especially if they were forced into retirement and feel victimized), gain understanding (make sense and learn something about their current experience), further develop their support system to help them through the transition and revive a new sense of purpose and meaning going forward.”

Yikes! That sounds like work! And in the beginning, there is no doubt that it will take effort to build this new life. But it will be worth it.

Working toward this goal while still employed will also make the transition easier. “Those who have cultivated other interests outside of work have at their disposal more enjoyable activities to delve into during their retirement years and perhaps even develop them into remunerated activities.” Kafoury cites himself as an example of this. As a young adult, his passion was film editing and, at age 51, he bought some film-editing equipment that he is currently using to edit a documentary about his recent ascent of Mount Kilimanjaro. He plans to continue honing this skill right up to and through his own retirement.

Speaking of tackling summits, exercise is also a very important component of a healthy retirement. Milroy quotes medical studies that recommend “at least 150 minutes of exercise per week” and not just the same ones. “It is more beneficial to incorporate a variety of exercises” says Milroy, who bikes, walks, swims, fishes and plays golf and squash. Learning some of these sports, or practicing them in advance of retirement, can also help contribute to that social network that is so vital later on.

There is no doubt there is much to think about as you consider retirement, whether it is looming within months or years away. However, the sooner you begin planning for

Life after work can be emotionally draining

  Life after work can be emotionally draining



A friend of mine retired recently — for about three weeks! He did not know what to do with his free time and panicked. While he had spent most of his working life planning financially for retirement, when he had finally reached his post-working life, he did not have a clue what to do with himself. He had left out one vital piece of his retirement plan — how to fill his time while retired. According to Thomas Milroy, director of in-patient psychiatry at the McGill University Health Centre, “your friend did not plan for the emotional side of retirement.”

To some, this may seem like a silly problem. In fact, “many studies have shown that less than 20 per cent of individuals are passionate about their work and, for most, it is a relief when that part of their life is over,” says Hani Kafoury, a Westmount-based psychologist who specializes in assisting clients’ major life changes at Tranzition Consulting Services.

Whichever category you fall into, there is no doubt advance preparation is required before you step into the potential abyss that is retirement.

One of the keys to a successful retirement is to “ease into it — take small steps,” Milroy says. Some people like to begin with shorter work weeks to allow them to get comfortable with having more personal time. This helps them understand and gradually adapt to the concept while keeping them tendered to the part of life that has kept them occupied all of these years. Alternatively, “some people like to start/stop retirement until such a time as when they get themselves situated into their own projects,” Milroy says.

Kafoury points out there is a psychological preparation for retirement. “This transition process can occur months, if not years, before actually being retired. The first step is to recognize retirement as a real future possibility; then to plan one’s future accordingly; and to make the formal decision to retire at a certain time and in a certain way. Overall, it involves one’s transition and therefore detachment from one’s work role as well as from the physical and relational ties in one’s workplace.”

Building new friendships outside the workplace is not always an easy undertaking and this is particularly true in retirement. However, this can be a key element to a happy retirement. Social contacts are important to maintain and develop. Milroy encourages patients to attend family reunions, various workshops or even continuing education courses where they can develop new interactions, or reconnect with old ones, and hopefully incorporate these relationships into their daily lives and routines. People who “travel too long in retirement can lose their moorings when they return home and can then find it difficult to rekindle these relationships,” which is also something to consider during one’s planning stages, Milroy says. This is partly why some couples “retire together” and choose southern locations within the same proximity so they can regroup during the winter or even travel together.

Dealing with the psychology of retirement can be an individual’s greatest challenge, particularly for those whose “identity and self-image has been associated in good part with their work,” Kafoury says. For these transitioning retirees, (or better still, for those planning for retirement), “I like to work through with the client what has really ended for them (sense of being valued, power, influence, security, relationships, etc.) and how they are willing to mourn the loss, reframe it and ultimately replace it so to reinvent themselves. But before they can achieve this, they need to regain control of their life (especially if they were forced into retirement and feel victimized), gain understanding (make sense and learn something about their current experience), further develop their support system to help them through the transition and revive a new sense of purpose and meaning going forward.”

Yikes! That sounds like work! And in the beginning, there is no doubt that it will take effort to build this new life. But it will be worth it.

Working toward this goal while still employed will also make the transition easier. “Those who have cultivated other interests outside of work have at their disposal more enjoyable activities to delve into during their retirement years and perhaps even develop them into remunerated activities.” Kafoury cites himself as an example of this. As a young adult, his passion was film editing and, at age 51, he bought some film-editing equipment that he is currently using to edit a documentary about his recent ascent of Mount Kilimanjaro. He plans to continue honing this skill right up to and through his own retirement.

Speaking of tackling summits, exercise is also a very important component of a healthy retirement. Milroy quotes medical studies that recommend “at least 150 minutes of exercise per week” and not just the same ones. “It is more beneficial to incorporate a variety of exercises” says Milroy, who bikes, walks, swims, fishes and plays golf and squash. Learning some of these sports, or practicing them in advance of retirement, can also help contribute to that social network that is so vital later on.

There is no doubt there is much to think about as you consider retirement, whether it is looming within months or years away. However, the sooner you begin planning for

2012年8月20日星期一

Family tries life on 'Mars time'

    Family tries life on 'Mars time'
For one family, an exotic summer getaway means living on Mars.

Martian time, that is. Since the landing of NASA's newest Mars rover, flight director David Oh's family has taken the unusual step of tagging along as he leaves Earth time behind and syncs his body clock with the red planet.

Every mission to Mars, a small army of scientists and engineers reports to duty on "Mars time" for the first three months. But it's almost unheard of for an entire family to flip their orderly lives upside down, shifting to what amounts to a time zone change a day.

Intrigued about abiding by extraterrestrial time, Oh's wife, Bryn, could not pass up the chance to take their kids - 13-year-old Braden, 10-year-old Ashlyn and 8-year-old Devyn - on a Martian adventure from their home near the NASA Jet Propulsion Laboratory where the Curiosity rover was built.

"We all feel a little sleepy, a little jet-lagged all day long, but everyone is doing great," Bryn Oh said, two weeks into the experiment.

Days on Mars last a tad longer. Earth rotates on its axis once every 24 hours - the definition of a day. Neighbour Mars spins more lazily. Days there - known as sols - last 39 minutes and 35 seconds longer than on Earth. The difference may not seem like much each day, but it adds up.

To stay in lockstep, nearly 800 people on the $2.5-billion project have surrendered to the Martian cycle of light and dark. In the simplest sense, each day slides forward 40 minutes. That results in wacky work, sleep and eating schedules. Many say it feels like perpetual jet lag.

The Oh family broke in slowly. A sign on their front door warns: "On Mars Time: Flight Director Asleep. Come Back Later."

Days before Curiosity's Aug. 5 touchdown, the children stayed up until 11: 30 p.m. and slept in until 10 a.m. In the beginning, it wasn't much different from a typical day on summer vacation. As the days wore on, they stayed up later and later, waking up in the afternoon and evening.

One day last week, the family ate a 3 p.m. breakfast, 8 p.m. lunch, 2: 30 a.m. dinner and 5 a.m. dessert before heading off to bed.

To sleep when the sun is out, their bedroom windows are covered with aluminum foil or cloth to keep out any sliver of light. In the hallway, a hand-made calendar keeps track of the days and schedules are writ-ten on an oversized mirror. A digital clock in the master bed-room is set to Mars time.

Bryn Oh keeps a meticulous spreadsheet updated with her husband's work hours and the family's activities. They wear a wireless device that monitors their steps, calories burned and sleep patterns.

When David Oh tells co-workers on Mars time and friends on Earth time about the switch: "Some of them think it's really cool to have the kids along. Some who worked on other Mars missions have said, 'You're crazy."'

Being night owls has its perks: Braden, Ashlyn and Devyn saw their first shooting star. The family went on night hikes in the hills around the neighbour-hood. They had a late dinner in Hollywood and gawked at street performers on the Walk of Fame with other tourists. They saw a midnight screening of a zombie film and then went bowling.

One night, Bryn Oh took the children biking in an empty parking lot. The youngest shed his training wheels, and for the first time, pedalled around.

Of the three, Ashlyn has the most difficulty sticking to the Mars rhythm. She tends to wake up too early and balks at naps.

"It's awesome, but it's tiring" she said.

Braden thrives on the weird hours. What teenager doesn't like staying up as late as possible and having frozen yogurt at midnight? He started a blog detailing the family's experiences.

Earthly sacrifices were made. The family traded a real vacation for a glorified staycation. Dental appointments, harp les-sons and play dates were scheduled around when the kids were awake, which was a moving tar-get every day.

Still, they were able to host a party a week after the landing, throwing a Mars-themed back-yard barbecue complete with a cake shaped like Gale Crater, Curiosity's new home, and topped with candles shaped like stars.

Bryn Oh said it's easy to lose track of what day it is. A simple question like "What time is it?" is difficult to answer. Do you mean Earth time? Curiosity time? The time that their bodies think they're on?

For the mission workers, the schedule is also more gruelling than in the past. Their work hours tend to whiplash around depending on when orbiting spacecraft fly over the rover landing site to relay signals to Earth. One shift sends up commands spelling out what Curiosity will do for the day; another pores over the pictures beamed back.

To cope, workers talk as if they're on Mars, saluting "Good morning" to one another even though it might be dark outside. Cots are available for siestas. There's also free ice cream - "a little pick-me-up in the middle of the night," said mission man-ager Mike Watkins.

Watkins said it's tough for anyone to stray from Earth time let alone a family.

"It's something they're going to remember the rest of their lives," Watkins said.

The family recently reached a milestone: Staying up through sunrise and sleeping during the day. And just as the children get used to Mars time, they'll have to reboot later this month when they revert to their terrestrial ways in time for the start of school.

CURIOSITY USES ROCK FOR TARGET PRACTICE

PASADENA, Calif. - NASA's Curiosity rover has zapped its first Martian rock, aiming its laser for the sake of science. During the target practice on Sunday. Curiosity fired 30 pulses at a nearby rock over a 10-second window, burning a small hole. Since landing in Gale Crater two weeks ago, the six-wheel rover has been checking out its instruments including the laser. During its two-year mission, Curiosity was expected to point the laser at various rocks as it drives toward Mount Sharp, a 3-mile (5-kilometre)-high mountain rising from the crater floor. This week, flight controllers plan to command Curiosity to move its wheels side-to-side and take its first short drive.


2012年8月17日星期五

Nellie Gray, founder of March for Life antiabortion rally, dies at 88

Nellie Gray, founder of March for Life antiabortion rally, dies at 88


Nellie Gray, who left a government career to start the March for Life, the annual antiabortion demonstration that for nearly four decades has drawn tens of thousands of activists to Washington to speak out on one of the most polarizing of American social issues, has died. She was 88.

Her death was announced by the March for Life Education and Defense Fund, of which Miss Gray was president. Gene Ruane, a colleague, said that he found Miss Gray dead Monday in her Washington home and that the chief medical examiner will determine the cause and date of her death.

The March for Life — held each January on the anniversary of the 1973 U.S. Supreme Court decision that legalized abortion — is reported to have drawn as many as 70,000 activists in any given year since its inception in 1974. The figures do not include the counterprotesters who often converge on Washington at the same time.

March for Life protesters traditionally wear red and carry red roses — a symbol of what is known within the movement as "the pre-born child" — and sometimes refer to the event as "Nellie's March," in honor of its founder.

"This is the land of the free, the place to come for advancement. How is it that a country built on this would kill babies?" she told The Washington Post in 1993. "I don't understand slavery. I don't understand the Holocaust. I don't understand abortion."

Miss Gray, a career woman and a Democrat, was working as a Labor Department lawyer when the Supreme Court handed down the landmark abortion ruling in Roe v. Wade.

Horrified by the decision, she left work at 48 — a decision that cut her retirement benefits in half — and began a second career in the forefront of the abortion debate.

As she told the story, she and about 30 other activists gathered in her home on Capitol Hill in the fall of 1973 to plan a demonstration for the following January.

"We just thought we were going to march one time and Congress would certainly pay attention to 20,000 people coming in the middle of winter to tell them to overturn Roe v. Wade," she once told the Religion News Service.

When that did not happen, Miss Gray soldiered on. Her basement, cluttered with buttons and banners, became the headquarters for a movement, often distributing news releases printed in red ink.

2012年8月16日星期四

Rhode Island’s CJ Adams stars in ‘The Odd Life of Timothy Green‘

Rhode Island’s CJ Adams stars in ‘The Odd Life of Timothy Green‘


Peter Hedges, the director of “The Odd Life of Timothy Green,” auditioned thousands of boys to play the naive young lead in his sentimental Disney film, which opened on Wednesday. But when he finally found his perfect Timothy — 12-year-old CJ Adams from Rhode Island — he was hesitant to cast the boy. He wasn’t worried about Adams’s ability to carry the movie; he was worried about changing the course of Adams’s youth.

“I know this is going to sound melodramatic,” the director said. “When we cast him I burst into tears because I thought I could ruin this boy’s life. I thought about his parents, I thought about the brother who he adores. You only get to be a kid once, and I want CJ to have that. I didn’t want to be the person who took that away from him.”

Hedges, who has worked on the kid-focused films “About a Boy” and the big-screen adaptation of his novel, “What’s Eating Gilbert Grape,” knew enough about child stars to realize he was flipping a coin on Adams’s future. There was a chance he could help the boy down a glittering path similar to the career of Natalie Portman or Leonardo DiCaprio. He could also unwittingly send him into the Danny Bonaduce territory of child stars gone bad.

It was that pressure that led to tears, he said, and also to his decision.

“This is an exceptional kid,” said Hedges, who was ultimately convinced that the family’s level-headed perspective would keep the young actor grounded. “It was difficult, but I think I did the right thing.”

 ‘He’s disarming in that way that exceptional kids are.’

  “The Odd Life of Timothy Green,” is a feel-good fable of a boy who materializes in the muddy backyard garden of a couple unable to conceive. He possesses all of the qualities they are looking for in a child, but in the film’s twist, he has ivy-like leaves growing out of his shins. “Green” could transform the chestnut-haired Adams into a break-out kid celebrity. At the very least, the film, which also stars Jennifer Garner and Joel Edgerton, has already served as a stepping stone for offers.

“I’m ready for more,” Adams said last week at Roger Williams Park Zoo in Providence as he sipped frozen lemonade. “It’s really like a family thing because my mom helps me out, and my dad helps me out, and we have an agent who gives me movies to try out for.”

Despite the Hollywood premiere and a press junket of 150 interviews to promote the film — 70 of which took place in a single day — Adams seems very much a normal boy. After answering a few questions at the park, he appeared slightly more interested in an insect crawling across a picnic table, and in the movements of a nearby squirrel. He is happy to talk about the movie and is unfailingly polite, but also happy to talk about playing with his friends.

Adams, who has never had an acting lesson, is in the process of reading scripts (he consults with his mother) and auditioning for films. Because these parts are not yet confirmed, he is light on details, although he confesses he’d love to be in a superhero movie.

Like Hedges, Adams’s parents are intent on protecting the boy’s childhood. They have no plans to move out of Rhode Island, and they let their son choose his own movies. They will juggle their lives as necessary, but they stress the importance of staying in New England and say that it’s possible for Adams to act and continue to live in Rhode Island.

“The thing we really like about living here is that we get away from everything,” says Donna Adams, who works at CVS corporate headquarters in Woonsocket. “We feel like we go back to normal life when we get back from New York or LA. With movies, you can space it out, too. You do that intense movie filming, and then you take a break for a year.’’

Hedges feels particularly protective of Adams because he was the one who set the boy’s career in motion. While scouting locations for the 2007 Steve Carell movie “Dan in Real Life” in Rhode Island, he put out a call for kid actors. Out of those hundreds who auditioned, Hedges was captivated by the then 6-year-old Adams.

“I’m told that after I saw CJ I said, ‘I could watch that kid every day of my life.’ He’s a remarkable kid who has this fantastic insight,” Hedges says. “Sometimes you get the feeling he understands more about things than you do.”

As Hedges dispenses these compliments, they sound deeper than platitudes dropped to promote the film. It seems there is a genuine affection between the two. They bonded thanks to Adams’s curiosity over the movie-making process. He called Hedges “Mr. Peter” (and still does). Hedges says by the end of the shoot, Adams was yelling “cut” and “action.”

It’s a career that almost didn’t happen. When he was first told about the 2007 audition, Adams said he wasn’t interested. When his older brother explained that it meant Adams would eventually be on a DVD, he leapt at the the chance. He was cast in a small part as Carell’s nephew.

After “Dan,” Adams didn’t show any additional interest in acting, and he went back to school. “I was just a kid then,” he explains with a serious face.

“I just felt like he was too young,” his mother says. “I felt that he probably wasn’t ready to continue in the industry. We had a blast, and we made a lot of friends in the area on that movie, but he didn’t quite understand it all. He was only 6.”

The decision to continue was left up to the CJ (that’s short for Cameron James). But performing is second nature in the Adams household. His 15-year-old brother Austin acted with the Trinity Repertory Company in Providence for six years. His mother performs in local choral groups. The patriarch of the household, Matt Adams, is a New York Times best-selling author and golf expert who hosts a show on SiriusXM satellite radio.

But after that four-year break, Adams decided he was ready to go back into film. He may have developed a friendship with “Timothy” director Hedges, but that didn’t mean Adams had a lock on the part. Not only was Hedges worried about the possibility of suffocating Adams’s childhood, he was not certain that Adams was the best boy for the part.

He reasoned that there was no way a boy from Rhode Island who had showed up at the random casting call for “Dan in Real Life” could be the right person now. So he kept auditioning more boys, and Adams always ended up as a finalist. As Adams worked with his mother on the part, his interpretation of the role improved, and the boy who enters seventh grade next month landed the part.

“He fit this part because there’s nothing about him that feels precocious or annoying or cloying,” Hedges says. “He’s disarming in that way that exceptional kids are.”

Adams said he had fun rubbing elbows with the celebrities during the red carpet premiere in Los Angeles last week, but he was more excited for another event back home at a theater in Rhode Island.

“I get to have a screening for my friends,” he says. “And I won't have to dress up.”


2012年8月15日星期三

Somali ransom negotiator receives 12 life sentences

Somali ransom negotiator receives 12 life sentences


A Somali man who acted as a ransom negotiator for pirates who seized a US yacht last year and killed four American hostages was sentenced on Monday by a US federal judge to serve 12 life sentences.

Mohammad Shibin was convicted in April on 15 charges including piracy, hostage-taking, kidnapping and conspiracy. He was paid $30,000 to $50,000 in cash for his negotiating services, according to a federal indictment.

In a courtroom in Norfolk, Virginia, US District Judge Robert Doumar sentenced Shibin to serve 10 concurrent life sentences, two consecutive life sentences and two 20-year sentences and ordered him to pay $5.4 million in restitution.

"Mohammad Shibin was a key participant in two of the most heinous acts of piracy in modern memory," US Attorney Neil MacBride said in a statement.

Pirates commandeered a yacht carrying Jean and Scott Adam of California and Phyllis Macay and Bob Riggle from Seattle in February 2011 off the coast of Somalia. All four hostages were killed despite attempts by the US military to negotiate their release.

Prosecutors said Shibin was among an elite group whose skills were needed to negotiate ransoms.

According to evidence presented at trial, Shibin researched the background of the hostages over the Internet to determine how much ransom to demand and to find family members to contact for the payments, prosecutors said.

Shibin also served as a ransom negotiator for pirates who seized the M/V Marida Marguerite in 2010. The German-owned vessel had a crew of 22 men who were held hostage for seven months starting in May 2010 and reported being tortured.

In 2011 Somali piracy cost the world economy $7 billion and earned the pirates some $160 million in ransoms, according to a recent report by the International Maritime Bureau.

"(Shibin's) multiple life sentences should put all pirates on notice that the Justice Department will hold you accountable in a US courtroom for crimes on the high seas," MacBride said.

2012年8月14日星期二

End-of-Life Care for Kids Raises Ethics Issues

End-of-Life Care for Kids Raises Ethics Issues

Healthcare providers should have rapid access to legal remedies for end-of-life disputes involving children whose parents resist withdrawal of aggressive therapy on the basis of religious beliefs, authors of a review concluded.

Over a 3-year period, 17 of 203 cases could not be resolved after lengthy discussions with parents. Subsequently, most of the cases were resolved, but five remained undecided, each because of the parents' belief in a miracle for their children, according to an article published online in the Journal of Medical Ethics.

"On the rare occasions that it occurs, fervent belief in religion and the interpretation of those religious teachings are significant factors in end-of-life conflict between parents and staff on pediatric intensive care units (PICUs)," Joe Brierley, MBChB, of Great Ormond Street Hospital for Children in London, and coauthors wrote.

"Protracted dialogue was often unable to resolve these differences, while the child was subject to pain and discomfort from invasive ventilation, suctioning, and multiple injections," they added. "We suggest it is time to reconsider current ethical and legal structures and facilitate rapid default access to courts in such situations when the best interests of the child are compromised in expectation of the miraculous."

Variety of Religious Views Involved

To acknowledge the widely divergent viewpoints on the subject, the editors of BMJ took the unusual step of publishing four commentaries about the article, all written by faculty at the University of Oxford. All found fault with the authors' findings and suggested alternative routes to conflict resolution, including legal, societal, and religion-oriented remedies.

Brierley and coauthors undertook a retrospective review to examine the role of religious beliefs in discussions of end-of-life care for children. During the 3-year period reviewed, 290 deaths occurred in the Great Ormond Hospital PICU. In 203 cases, the medical team recommended withdrawing or limiting invasive care as being in the best interest of the child, and parents agreed with the decision in all but 17 cases.

Review of medical notes for the 17 cases showed "a predominant theme of expression of strong religious belief influencing the family's response to the critical illness of their child." In six cases, additional discussion about the best interest of the child led to a resolution.

In the remaining 11 cases, protracted discussions ensued, centering primarily on the parents' religious beliefs about the sanctity of life. Five cases were resolved with help and support from additional hospital staff and local religious leaders, which discussed the child's care with the medical team.

All six of the unresolved cases underwent ethical review, received second opinions, and were discussed at length in meetings involving the medical staff, the patient advocacy service, and the parents. One case was referred to the High Court, which ordered withdrawal of care.

The original 17 cases represented all major religious faiths, including Protestant, Jewish, Muslim, and Roman Catholic. Of the five cases that were never resolved, "Christian fundamentalist churches with African evangelical origins features most frequently, though other religions also featured."

"All these families were explicit in their expectation of a 'miraculous cure' for their child, and as such, all felt that medical scientific information was of limited use," the authors wrote. "Although ongoing daily dialog continued between the family and the teams, there was no change in the family's view that aggressive support must always be continued, waiting for God to intervene."

Arguments on Both Sides

Brierley and colleagues acknowledged legitimate arguments against their position for more rapid legal resolution of difficult end-of-life cases:

    * The "clear legal presumption for the maintenance of life," which can require weeks of discussion, argument, and deliberation
    * The religious view that "the suffering we are arguing to avoid is something that brings the truly faithful closer to God"

Finally, the authors touched on the societal perspective of end-of-life decision making as it affects utilization of limited resources.

"While we feel the best interests of the child in question are paramount, the interests of society -- including the other children who might have used this valuable resource -- cannot be ignored, especially when nonmedically indicated painful and futile therapies are continued on children due to the expectation of miraculous intervention," they wrote.

Ultimately, arguments involving end-of-life care "revolve around the balance of sanctity and quality of life versus unbearable suffering."

The author of one of the commentaries suggested that finding a common ground to engage parents would be a good starting point for resolving end-of-life conflict.

"Brierley et al appear to implicitly assume that miracle cures will never take place, but they do not justify this assumption, and it would be very difficult for them to do so," wrote Steve Clarke, PhD.

"Instead of seeking to override the wishes of parents, who are waiting for a miracle, [I suggest] that a better response may be to seek to engage devout parents on their own terms and encourage them to think about whether or not continuing life-sustaining therapies will make it more likely that a miracle cure will occur."

Legal Issues Considered

Charles Foster, BVSc, LL.B, argued that existing law already trumps parents' views.

"One hears people talk about a parental veto on proposed treatment or withdrawal of treatment," he wrote. "There is a de facto (but not de jure) presumption that a parent's views on what is in their child's best interests will coincide with what those best interests are, but that presumption is rebuttable and is very commonly rebutted."

"The legal and ethical orthodoxy is that no beliefs, religious or secular, should be allowed to stonewall the best interests of the child," Foster added.

An argument based on the best interests of the child misses the point altogether, according to ethicist Julian Savulescu, PhD, who argued for distributive justice, the societal imperative for appropriate allocation of limited resources.

"A better ethical ground for withholding or withdrawing life-prolonging treatment is not that it is in the interests of the patient to die, but rather on grounds of the limitation of resources and the requirements of distributive justice," he wrote. "Put simply, not all treatment that might be in a person's interest must be ethically provided."

"It has been a convenient fiction to tell patients and parents that treatment is not in their interests because we can't face up to the elephant of distributive justice and the inevitable limitations in our medical resources," Savulescu added. "But perhaps if we openly discussed such questions of distributive justice, we could answer them better."

Medical ethicist Mark Sheehan, PhD, also suggested that Brierley and colleagues incorrectly categorized end-of-life conflict as a religion-derived issue while ignoring well established ethical and legal arguments.

"Religion here is a red herring," he wrote. "I do agree that society -- perhaps in the form of legal precedent -- does need to be clearer about the limits of parental choice in these difficult cases, but the specification of these limits will not include reference to religious belief."

"The focus should remain on the well-articulated ethical reasons that apply to all, not on whether the parent claims a specific kind of religious reason," Sheehan added. "What matters is that, like the blood transfusion case, society has judged that there are no reasons (religious or otherwise) that warrant failing to transfuse children. Polarizing claims about religion are unproductive."