When Is It Time to Die? The Charlie Gard Situation

When Is It Time to Die? The Charlie Gard Situation July 24, 2017
How do we know when to let go? Charlie Gard
How do we know when to let go?

Life always hurts. Death always saddens. But we make it ever so much worse by denying that death is not inevitable. It is. For all of us.

Charlie Gard’s parents have decided to give up the fight. I ache for them in every cell in my body.

Charlie, as most know, was born unable to either see or hear, cannot move or even breathe on his own. Seizures have left him with profound brain damage. Once disconnected from the ventilator, his life will cease within a few moments.

In the not-too-distant past, he would not have lived past birth. Current, and genuinely amazing technological advances, have given him eleven months. Eleven months for his parents to love him even more profoundly than they did before and at the time of his birth.

And now, after a protracted court battle, they will say “goodbye.”

Again, in the not-too-distant past, women routinely bore children who died before they reached five years of age. These multiple childhood deaths are one reason why we think that people from the past lived shorter lives than we do now.

When we average in infant mortality to calculate the “average” age of death, lifespans look shorter. But in truth, people who made it past childhood and survived the periodic wars and famines did live quite long lives. They tended to be healthy into their 80’s and 90’s, seeing a quick decline only at the end.

Our increasingly difficult decisions

But now, we are faced with increasingly difficult life and death scenarios.

Those whose genetic makeup and general life luck who live into the 9th and 10th decades find, instead of a quick decline and quiet death, a long, drawn out dying process. The process too-often quickly depletes their resources and tragically isolates their increasingly exhausted caregivers.

And babies like Charlie Gard who are given a chance to live–which in some cases means an extended dying period–may suffer greatly. We just don’t know because there is no way to peer into their brains.

John McCain’s diagnosis with glioblastoma has sucker-punched the world. This seen-as-invincible man faces an extremely poor prognosis. Glioblastomas kill and kill quickly.

This cancer, as opposed to the many slow-growing brain tumors, literally blasts through the brain, thus its name. McCain and his family have a series of increasingly agonizing decisions in front of them.

My mother’s dying process

In the summer of 2010, my mother, 89 years old and having some physical issues (which she routinely ignored) but mentally sharp, showing not one sign of losing her astonishing acuity, suffered a massive stroke.

During the aftermath, as my brother and sister and I faced the unending number of medical decisions that come from such an event, I began to blog about what we were experiencing and the deep agony of having to make these decisions. I did so just to make it easier for friends and family to keep current without the necessity of multiple phone calls or email blasts.

At that point, few read my blog. But as I continued to write about the challenges facing us, others started reading. They wrote and told me that I was putting into words their own experiences but that they were afraid to speak aloud for fear of condemnation.

AnOrdinaryDeath frontEventually, several years later, this turned into a book. I named it An Ordinary Death. I called it that because it finally dawned on me that most of us want a simple, ordinary death.

And most of us will not experience it. Despite the fact that death is the great inevitability, few of us have gained the wisdom to know when to say, “it is time.”

We are afraid to talk about death. While a few are speaking out against the practice, almost everyone else seems to have bought into the idea of “life must be prolonged at all costs.”

By so doing, we have turned what is both a sad time, as we lose those we love, and a holy time, as we release them into the fullness of the presence of love, into a circus of IV’s, tubes, isolation, often nightmarish expenses, and fear.

A pastoral response to Charlie Gard’s parents

To return to Charlie Gard’s parents: I admit I don’t know what I would have been saying to them were I their pastor at the time he was born.

Hopefully, I would have spent far more time listening than talking. Ideally, I would have provided these grieving people a safe spot to speak of their agony, their “how could God let this happen” questions, their anger, their sense of helplessness, their love.

Somewhere in there, I would like to think that I helped them to come to terms with the necessity of letting Charlie go. All parents at some point have to let their children go–but most have the privilege of doing so as they enter adulthood.

Charlie’s release comes too soon, as it does for any parent who has gone through the agonies of seeing a child die or experienced a stillborn. Nothing can get us ready for this kind of pain.

No, God didn’t “need another angel.”

But this is life. If we want to live without pain, we must never be born.

Life always hurts. Death always saddens. But we make it ever so much worse by denying that death is not inevitable. It is. For all of us.

None of us knows for sure what we will face after this physical life ends. But for those of us who look to Jesus as the one who shows us the fullness of God’s love, we see hope. In our sorrow, as we let our loved ones go, we can envision with them what it would be like to experience absolute love, a place with no fear, no sadness.

Let us never pretend that death doesn’t hurt, or that it does not often come too soon. May we never say, “God needed another angel in heaven” to justify a child’s death. Just writing the words infuriates me.

But let us also learn to embrace death as normal and as necessary. Until the time comes when each of us can have an ordinary death, let us hold our lives with grateful hands, savor each breath offered to us, and love with all the boldness possible.

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  • billwald

    My parents and in-laws suffered and died of painful physical and mental conditions. My Wife and I made peace with God and are not afraid of dying, only of living in pain. We want our kids to “turn us off” when we can not and most likely will not ever be able to speak for ourselves.

  • Melissa L.

    As a parent of a full-care child I wish you, or someone like you, had been by our side to hear us when he was in the hospital. Every decision we made I wanted to say, “Perhaps we shouldn’t. Perhaps we should let him go.”, but that’s not what the world wants to hear from us. They want to support us, to urge us on, to claim victory over death, even if it means being hooked up to life-supporting equipment. Our son, though full-care, is one of the luckier kids. He doesn’t need any medical devices, nor is he on any medication; rather miraculous in the world of cerebral palsy, but I know he is alive only because we live in a country that is relatively stable, economically. If one domino falls, his life is in serious, immediate jeopardy (so you can imagine how ramped-up our anxiety is, having Trump’s circus happening). Every day I commit to keeping my son thriving, but…….I have sacrificed my own life to do so, my relationship with my husband is solid, but not at all what a married relationship “should” look like. What you said about caregivers being tragically isolated is painfully true.
    I think a lot about writing a novel about this experience. The voices of parents like myself aren’t heard because we’re all so busy keeping our kids alive (and sometimes thriving). One of us has got to get the word out that death and loss can be surmounted, so we can have a national conversation about how to let go, no matter what age a person is when death threatens. The fear of death grips our nation so tightly…..and people suffer because of it.
    Thank you for writing about this. May your day be joyful.

    • I wish you would write the book on this. I often think of parents like you who have had to lay down their lives to care for children who will never life independently and around whom your lives must circle. The rest of the world needs to have some idea of what this is like.

  • Melissa L.

    I don’t believe in coincidence, and this just came onto my Facebook newsfeed. I thought you might be interested.


    • That is just fascinating. Had no idea . . .

    • Pennybird

      It boggles the mind that the family can’t accept the inevitable and move on.

  • Lalou7

    To the author:
    Re: McCain’s glioblastoma – “This cancer, as opposed to the many slow-growing brain tumors, literally blasts through the brain, thus its name.”

    Um. No. That is not how it got it’s name. That’s not how medical terms are created.
    How about a little research. Glioblastoma comes from the Greek words Glio meaning glue, Blastos meaning germ, and Oma meaning tumor.

  • A lot of the time the Church also eggs on caregivers to keep on at it. It’s as if the church says: “Only God can play God, you don’t want to take somebody’s life before their time, do you?” The church is ever the patron of newborn life, seems to not know when to let go of fully-lived lives. I know how outrageously the church has responded to those who choose to go out on their own terms – feeling it a betrayal of everything they stand for.

  • mikehorn

    This is a balance between saving lives and knowing which we cannot save. It confuses everything that so many lives are saved that just a century or two ago would not have been. The direction of healthcare is always more lives saved. Even someone like me – childhood asthma with one really bad day that was life threatening. Before adrenaline shots and albuterol and canned oxygen, I was done around 3rd or 4th grade. Setting aside that a more rural life might have prevented my asthma altogether (maybe, maybe not), I am now well into my adult and productive life, with kids of my own. I’m a success story.

    But what is death? What does it mean to die? Heart stopping? Brain death? Cerebral cortex death? One problem is sometimes we aren’t sure. Take the extremely controversial Terry Schiavo case. Her cerebral cortex was either jelly or just plain gone, yet she had at least a partially functioning brain stem. I see an animated corpse, where medicine kept her heart and lungs alive, but the brain, and the person, were gone. Creepy. But others saw it differently. Do we actually have a good definition of death? It’s changed a bunch in just 200 years, and we don’t really have a hard line yet. We have doctors authorized to declare time of death, sure, but that is different. They have training and experience, and that feeds their judgement call. But even they aren’t always right, and some judgements are more qualified and experienced than others.

  • cvryder2000

    When my father, who was then nearly 91 and had dementia, got pneumonia, we put him in the hospital on IV antibiotics but did, at least, specify no intubation and made him a DNR. My brothers and I flew in from various points in the country and held long consultations about what to do next. One of my brothers is a doctor, the other is a lawyer, and I’m a nurse, so we kind of had the bases covered. Someone had to sit with Dad all the time to keep him from pulling out his IV and his catheter, and we took shifts because Mom wasn’t able. Dad returned home after 2 weeks, but in a couple of days it became evident that he couldn’t be managed at home and he went back to the hospital preparatory to being transferred to a nursing home, where he died 2 months later. My M.D. brother opined to me afterwards that we probably should have just opted for minimal treatment in the first place and not been even as aggressive as we were. Tree years later, when Mom, who’d had a series of small strokes that took her speech and left her unable to walk, got pneumonia, we decided to keep her at home, The doctor prescribed oral antibiotics, but we stopped them when she couldn’t swallow them and let nature take its course. She died at home, an old woman in her own bed, with the music of her youth playing softly in the room and people she loved with her.

    • Pennybird

      My mother in law had suffered with a lengthy illness for years She was constantly in the ER, the hospital, the doctors’ offices, having medical procedures done almost weekly. Having assumed she would die under the glare of lights with strangers shouting things and prodding her with cold instruments, we were actually grateful that she passed peacefully at home after she had gone to bed. It is what I would prefer for anyone – to accept that death must happen and not try to thwart it at every turn.

  • splitrock

    Christy Thomas, you completely missed the very problematic issue with the Charlie Gard matter. The state stepped in and became Charlie’s parent. All decisions for little Charlie were to be made by the State. Charlie’s parents were treated like nonentities, like they had no connection to Charlie. That is a very scary thing and the future of big government run amok. They couldn’t even take home their own baby, they couldn’t make decisions for him. The episode is an outrage and that is what we should all be outraged about! But maybe Progressives/Leftists are OK with big government making these decisions.

    • SavannahRob

      Christian outrage over misconstrued events seems to be all that animates the poor body of Christ anymore.

      I’m curious how long could his parents have afforded to keep him on life support on their own.

      We should do everything we can to spend money our money wisely and where it actually helps, correct? Both as individuals and and when we band together for common cause. From everything I have read, the child could not possibly be saved. They were deluding themselves at the expense of others.

      • splitrock

        SavannahRob, you also missed several important points. 1. Thousands of people donated more than 1.5 million dollars, so your nasty remark about “deluding themselves at the expense of others” is not correct. 2. My main objection to Christy Thomas was the big government take over of little Charlie. That was all I wrote about; so if you respond to me, please address that matter, not something peripheral.

        • SavannahRob

          1. How many people would have donated had this not become cause célèbre among people who feel that government- by definition- is imposing terrible things on citizens?

          2. That was my second sentence. How long could they have prolonged his unfortunately short life without the “government takeover”? They would have gone bankrupt AND he would have died sooner. It’s not a government takeover except in the sense that taxes pay for it. Professionals who know more than you about medicine made this decision.

          • splitrock

            You again missed the point. Are you OK with Big Government taking over from the parents? That is what happened here. Read my post again.

          • mikehorn

            Government had no choice. In America it is spelled out in the constitution: under matters of law or controversy, the courts have authority to judge. This has its roots in earlier British law, so England is similar. The doctors, nurses, hospital, and other patients waiting for care and a hospital spot all have a legal interest in this case. The Gard parents were asking for unethical care from medical professionals legally bound to only provide ethical care. For a terminally ill patient, a doctor can and should say there is no more to do, and if the guardians disagree, the courts/government is the only place to take the matter.

            Looking for unproven experimental treatment isn’t the most ethical choice. It is the most desperate. The doctor offering such treatment might be motivated to profit off the irrational grief of parents – highly unethical. In this case even the fringe experimental doctor said it would be unethical to treat a terminally ill patient – zero prospect of improvement.

      • summers-lad

        Christian outrage??

    • mikehorn

      First, if they took the baby home it would have died quickly, possibly on the ride home. Any other statement is not factual.

      Second, the parents are not the only ones involved. Doctors and nurses must treat patients ethically and with sound medicine as known today. Hypothetical experimental treatments dip into the realm of human experiments. That is an ethical minefield. We have a vetting process for medical procedures for a reason.

      Third, in cases where the medical professionals and the patients or the competent decision authority for the patient (parents in the case of a minor) are by definition a matter that must and should go before the government. We establish governments and courts in large part to help in exactly these situations. To say otherwise is to advocate for anarchy.

    • summers-lad

      That is not the point at all. The real problem appears to me to have been a total breakdown of trust between Charlie’s parents and the medical professionals, and that his parent’s desperate desire for his survival was probably as unrealistic as it was understandable. Who funded or employed the medical professionals is not relevant to this argument, although I would add that although there are threats to the NHS, no government of any colour here in the UK would dare to do anything to fundamentally undermine it, and long may it remain so.

  • Brandon Roberts

    this absoloutely breaks my heart and this is a tough issue, but if charlies just going to suffer and die young anyways it’s better for him to die now and not suffer any longer imo

  • mikehorn

    When dealing with a hopeless situation that would require far more resources than the parents have to provide care for months or years, with an early death certain, we now have a question of priorities. Don’t get all morally high-horsed and sneer. Anyone with any medical training at all knows about triage and the decisions affecting life and death that happen every single day in medicine. My training is military. We are taught several things. First step is under fire – get control of the violent situation first. People might die before you do that, but many more will die if you fall apart during combat and place one life above many lives. Some civilian emergencies are the same. A bad crash or wreck or fire or disaster will require establishing safety before providing care. After that you prioritize who gets care. Some wounds will wait – they need care soon but 15 minutes won’t really matter. Some wounds require care now. Some wounds, all the care in the world won’t help and spending time on those might cost the life of someone else.

    These are bald and ugly and raw facts, but life and death are bald and raw and ugly. Keeping your head and establishing priorities is how you get through with the most people still living. Medical professionals know this. Parents only see their child. I get it, but sometimes the end is the end, and nothing will change that.

    • Daniel G. Johnson

      Well, what would be the bald and the ugly and raw if you wouldn’t get your way on this? What are you trying to avoid?

      • mikehorn

        What is my way I’m trying to get? I’m confused about your question – it makes no sense.

        Life and death situations are not pleasant, and ugly outcomes that we cannot prevent will happen. The only rational choice is to figure out how to save as many as you can and figure out how to deal with losing the ones you can’t save. What if the time, money, and expert effort to keep a doomed infant alive for a few extra months prevented care and money and time for another baby that could have been saved? Maybe poor parents without resources or access to the press?

        The Gard parents were advocating human medical experimentation. While I understand, we don’t need widespread human experimentation because of parental grief. That doesn’t lead to good places.

        • Daniel G. Johnson

          So, you are afraid of coming up short on the stick of resources because of someone else. This fear is in play in all social disagreements. Fear of the immigrant taking “my job”…fear of the food stamp recipient taking “my” tax money. Is it really TRUE, that going the opposite way from your program on a rare medical case is going to destroy your or someone else’s prospects at health care? How is it that so many voices are so bold at proclaiming the supposed “hard” darwinian facts of life and yet for all their supposed familiarity with the “hard” are apparently quite fearful of the most vulnerable?

          • mikehorn

            Your logic is truly twisted.

            I’m in favor of saving who we can and letting go of those we can’t. This has nothing to do with fear at all. I’m military and have been under fire in both Iraq and Afghanistan. There is a certain clarity of thought that is vital when a choice can mean life or death. What is the first priority? If you can get through priority 1, what comes next and then after that? Priority 1 here was an attempt to save the child. Early on we knew that was doomed, and after the American doctor refused care under ethical considerations, we know that is done. Priority 2 is to help the parents get through this. Promising mythical experimental cures does not do this. Getting them through a funeral and on with their lives is the only option.

            In this case, not all the medicine we have could save Charlie Gard. We were able to give his parents about a year, through centuries of human genius adding up to some care, to spend time with their doomed child. The child couldn’t hear or see them, possibly couldn’t feel their touch. This care did exactly nothing for the baby except possibly cause him some physical pain though that is an open question. It did give the parents time with a child they would not have had even 50 years ago, certainly 100 years ago the child would have died in minutes or hours. Did we do the parents a favor or harm? They lost a year where grief could have processed. Maybe they would have been pregnant again by now. This is hypothetical land, but in matters of medical ethics this is where you go.

            Did we help or harm the child? I don’t think we helped at all, and possibly harmed.

            Did we help or harm the parents? I think the harm to them is clear.

          • Daniel G. Johnson

            You are claiming the right to be a judge over many things.

            It seems that you are applying the paradigm of war to all of life…as if war is baseline normalcy.

            Do you fear to aspire to a humanity not compelled by a ontological war analogy?

          • mikehorn

            I am an expert on warfare – it sounds like you are not aware that an effective military requires laws and ethics and priorities and training. The direct overlap is triage and dealing with wounded. Often what you do or don’t do will make the difference in whether a friend and colleague lives or dies. Care under fire is a real category of thinking nad training, and priority 1 is creating a situation where any care is possible at all. That might mean ignoring the wounded completely until it is safe to do anything else. You will not do the injured any good at all if, in trying to help, you get hurt and become another casualty in need of care. That decision would make the problem worse and delay care still further. In traumatic combat wounds, there is a magic time that you can provide care within and save a life or a limb. If you are smart, do what you need to do, then give care, you might get through it with the most people alive and intact. Acting smart rather than basing action on grief is what gets you and your friends through.

            I’ve also read and studied a great deal about medical ethics. Some is military based – human experimentation needs to be treated very carefully or it becomes a crime, in war or in peace. I’ve also had family in serious situations where tough choices had to be made. Every birth, for instance, is incredibly dangerous to both mother and child. My wife crashed twice after deliverying my daughter. Once the doctors caught it, once I did and alerted the staff. My sister cannot carry without an allergic reaction to the embryo – she almost died twice from pre-eclampsia. On one the doctors recommended terminating the pregnancy because the fetus was pre-viable and the mother was dying. Ethics decided before are important and can maximize the number of lives saved.

          • Daniel G. Johnson

            I think we have thoroughly gone past each other.

          • mikehorn

            Which is one reason you need government courts to step in. Imagine if I was the doctor giving you what could be done and what was impossible, and what I thought the ethical choice was, and you were the parent.

          • Daniel G. Johnson

            I do not find grammatical sense in that statement.

            As it is, the child’s parents ultimately decided to end their efforts. I am not surprised at that. And, I am not surprised that they wanted to take the long way to get to that point. While you have raised the issue of cost primarily and welfare of the the patient secondly, the actual facts were rather reverse as the parents were endeavoring to secure funding themselves. As I’ve just recently commented, I really don’t find such an odd case instructive toward forming ethical norms, but I think a lot of arm chair public interest adverse to the parents is reflective of moral decay of the culture where an increasingly quick trigger is pulled on decisions of life and death.

          • mikehorn

            Try diagramming the second sentence. It’s a bit wordy, but it is English.

            Ethical norms exist for cases that we see a lot of. New norms come from odd cases. The new here surrounds the medical know how that can prolong a doomed life, sometimes by causing pain to patient and family, and eating time, money, and resources for little effect, no effect, or bad effect. Right now there is no good reason to treat babies with that condition. But maybe someday there might be. Back to military wounded, for the first time we are living with far more people surviving wounds that would have killed them as recently as Vietnam, and the survivors are so much more common than WWI or the civil war, it is amazing. Maybe that experimental American doctor will do work that 50 years from now will save many lives. But some things are broken and cannot be fixed, and this sort of deformity leading to a non-viable post birth baby might only be fixable by real-time genetic manipulation.

            We are in unknown and ill defined ethical land. This is the precise case to discuss medicine that prolongs pain and suffering with questionable gain.

          • Daniel G. Johnson

            You have gently shifted concern for patient to first mention, which is appropriate. But, I would not agree that you have a right to adjudicate effects over the parents/family.

            In regard an ill defined ethical land, the question is begged as to whether that is a help or a barrier to people who wish to push the envelope on life. It may be a help if it retains wiggle room discretion. A case I know: A man with a massive heart attack was treated with normal protocols. The surgeon informed the family that if Dad couldn’t go on his own after they took him off the ventilator, that was it. They took him off…the man couldn’t go on his own….and, the doctor immediately put him back on. Late into the night, the doctor put together an impromptu team between two hospitals…loaded up a whole operating room of equipment into a laundry truck and set up shop in the other hospital at midnight…and proceeded with a never before attempted procedure while being guided by another surgeon on the phone who was in Europe. They saved the man’s life. The Cleveland Clinic tried it on another guy the next week, and it worked.

            The insurance companies were furious.

          • mikehorn

            The patient here had genetic errors – simple surgery isn’t even close to a remedy. It is estimated that up to half of pregnancies are naturally terminated due to problems with the fetus, though most are in the first few weeks – reproduction isn’t a sure thing. My wife and I had problems having children, so this is something I looked into the details of. We don’t know why it happens, and a fix would have to be at the genetic level, getting into the nucleus and mitochondria of the early blastocyst, or producing better gametes. This baby was able to go to term but could not survive outside the womb. With this problem, no simple surgery with a telephone consult would help. The experimental researcher was talking about brain stimulation to try and fix basic functionality of the nervous system. Maybe someday, and with new things like CRISPR, some human experimentation in China and other places, maybe in a few decades we will have a better answer. But this baby had weeks or months, not decades.

            This case was never about the baby. It was doomed to die. That is an ugly fact but true. Like all deaths, grief, mourning, and funerals are about the living because the dead don’t care. Modern medicine gave small hope to the parents by maintaining something resembling life for a short time, but there was no long-term solution. The parents raised problems, cried on camera to the press, basically looked grief stricken and people felt bad for them. Ethically, this raises the concern that the “life support” is cruel. The baby was slowly dying for months, the parents forced to watch it struggle and suffer and get progressively worse. Even a few decades ago, the death would have been fairly quick, the parents would have mourned and moved on nearly a year ago. This is a real question, and the most central to the case I can think of. The parents went through prolonged grief for no purpose, losing a year of their lives. What medicine can fix that?

            Yes, I’m military. When you see someone die, or you know them, the military tries to take care of the survivors too. Ceremony, a flag, Taps, maybe a name on a monument, all are part of helping the living. These parents just now started that recovery. They should have been able to start months and months ago.

          • Daniel G. Johnson

            I disagree with your assuming a right to judge the parents.

            I agree with a predisposition to exhaust all possibilities. I am not so much concerned with the math of probability of survival. As the culture shifts to an easy trigger finger on the most vulnerable, the value of push-back on that is more to the collective benefit of the vulnerable as a class above and beyond an individual case.

          • mikehorn

            Of course I judge the parents. They lost a kid in a horrifying drawn out and painful way. They are hurting and haven’t even started grieving yet. They had false hopes that put their lives on hold.

            Probability of survival is one essential factor in any medical decision. This has nothing to do with vulnerable or not. Anyone hurt or sick bad enough to make these decisions real is vulnerable. Any age, any wealth status. If a patient has something that has a near term finite time limit of survival, like a condition that even its limited nervous system will degenerate in months to where basic functions like heart and lungs will stop… that patient is going to die, and soon. The most medical care we spend money on goes to those in the last six months of life. Some might grab any time they can, like Stephen Hawking who’s brain is not the problem should and will get as much as he can. Someone like Terry Schiavo was dead for years before her body stopped functioning. Charlie Gard had a short, painful, meaningless life. Should we provide care? Maybe. Oddly, im an optimist long term. What we learn from treating hopeless patients might eventually save a life. But Charlie had zero hope, probability of living zero.

          • Daniel G. Johnson

            I disagree with your statement “Charlie Gard had a short, painful, meaningless life.”

            I encourage you to poll that one with others.

            Would it matter to you if Charlie’s parents saw your statement?

          • mikehorn

            The military experience and training is directly comparable to medical staff training in life/death situations. Talk to medical professionals about ethics and priorities. I have. Sounds like you need to.

          • Ann

            My god. You are twisting what this man has clearly said. What is your problem?

          • Daniel G. Johnson

            I do not agree with his assertion that the child’s life was meaningless.

  • Daniel G. Johnson

    I think it dubious that this unusual case is a worthy springboard for consideration of more common cases. But, the high interest it generates is an indication of the incremental increasing acceptance of moving the moral lines and making the slopes more slippery. In the final analysis: it’s about the money. The more fragile a human being is/the more fearful a monster he/she becomes…threatening to extract. The culture has become that darwinian.