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Oregon's Death With Dignity Law and Me

Last week, I spent the better part of an hour in a video meeting with a physician at the medical center where I have been treated for pancreatic cancer and COPD for the past three years.

The reason for our conversation was Oregon's Death With Dignity law or, as the doctor referred to it and which phrase I much prefer, Medical Aid in Dying.

Oregon was the first U.S. state, in 1994, to enact such a statute and it went into effect in 1997. Since then, seven more states and the District of Columbia have adopted similar statutes.

• California (End of Life Option Act; approved in 2015, in effect from 2016)
• Colorado (End of Life Options Act; 2016)
• District of Columbia (D.C. Death with Dignity Act; 2016/2017)
• Hawaii (Our Care, Our Choice Act; 2018/2019)
• Maine (Death with Dignity Act; 2019)
• New Jersey (Aid in Dying for the Terminally Ill Act; 2019)
• Oregon (Death with Dignity Act; 1994/1997)
• Vermont (Patient Choice and Control at the End of Life Act; 2013)
• Washington (Death with Dignity Act; 2008)

Here is a map of the United States showing the status of each state in regard to this kind of legislation:

DeathWithDignityMap

According to the Oregon Death With Dignity annual report as quoted at the Death With Dignity website,

”In 2019, 112 Oregon physicians wrote 290 prescriptions to dying Oregonians who qualified for the Act; 188 people died using the medications obtained under the law.”

The 102 people with prescriptions in 2019 who did not take the prescribed drugs may have died without using them or may yet take them. Some people, I am told, like the feeling of control in having the drugs handy.

The up-front requirements to use the law are that the patient be at least 18 years old, a resident of Oregon, capable of making and articulating healthcare decisions and diagnosed with a terminal illness that will lead to death within six months.

There are several additional hoops to maneuver but they are not too onerous. First, the person must verbally request the drugs from the attending physician on two occasions, at least 15 days apart.

The attending physician and a consulting physician must agree on the diagnosis and the prognosis.

In addition to those two verbal requests 15 days apart, the patient must complete a written request form that requires two witness signatures. One witness may not be a relative or a physician who treats the person.

The doctor I spoke with Thursday helpfully told me that for $7, a UPS store will witness the document. I thought this odd, even kind of funny at first but I can understand that a relative or friend – and certainly an acquaintance – might not want to be part of such a request.

If either of the two physician feels the patient's judgment is impaired, the patient must be referred for a psychological examination.

From what I can tell, pharmacists can refuse to fill prescriptions for these lethal drugs. The doctor told me there is one pharmacy in Portland that does fill them. The price, he said, is about $700. Private insurance may pay the cost. Medicare does not.

A doctor need not be present when the patient takes the drug although he or she may be there if the patient asks. However, only the patient can administer the medication.

The drugs, the doctor told me, come in a bottle to which apple juice is added. The drugs cause no pain. The patient feels woozy almost immediately upon drinking the mixture, he said, and will fall into coma in four to five minutes. Death comes usually in 30 minutes to two hours. Rarely, it can be longer.

The patient can rescind the request for the drugs at any point in the process. There is, of course, no requirement that the drugs be used.

* * *

I'm writing this because I thought you might be interested and, having had the conversation only a few days ago, it is fresh in my mind now. You may have noticed that throughout, I have referred to “the patient” and not to I or me.

That is because it is hard to talk about my own death this way. (Or in any way, I suppose.) I thought, having understood from the diagnosis three years ago that I would eventually die of this cancer, I had it under control, that I accepted the eventuality and had made peace with it.

Apparently this is not so. Yet.

The question has come up now because, as I reported not long ago, the cancer in my lung is growing and due to the additional diagnosis of COPD, my immune system is too damaged for more chemotherapy that otherwise – in theory - could slow the cancer's growth.

Now, with the coronavirus that attacks lungs, chemotherapy is even moreso not an option.

So I contemplate my death a bit more urgently now. I am making peace with the fact that I will never have all the bits and pieces of my life in good order for the dear, dear friend who will be stuck with sorting it all out when I am gone. She says to me, don't worry about it. I'm trying.

My question to myself right now is how to live in the time remaining. And I do mean, live. But also, that is not to deny what is happening to me. The disease, doing what it must, marches forward even into its own oblivion. As do I.

Dying is part of living and I doubt that is something that will slip my mind. So maybe I need to find a balance.

Is there a place where life and death and meaning at least intersect if not each become part of a whole? Not that anyone has ever been able to define the meaning of life.

Undoubtedly, I'll have more to say later. Meanwhile, if you want more information about Death With Dignity laws, here are a couple of links to get you started:

Oregon Death With Dignity website
Death With Dignity National Center website

For individual state laws, search “death with dignity” and the state's name.

Comments

Everything I want to say seems idiotic. Maybe because death is, for me, such an immense, unmovable absolute. I am sitting in New York thinking about when not being able to find Bruno Magli in our size was a problem. And brunches and laughing about our crazy dates and The Lion's Head and the men we loved and that night we watched the fireworks with parents. Was it the 200 July 4th celebration? I wish I could say something smart, but who can? I send love, Ronni.

Thank you Ronni, these are gifts and am sure they’re not easy to write or share.

A remarkable post, Ronni. First, because of your unflagging generosity in sharing the interview and your candour about you own options. Not so long ago, no one would post such a conversation (if you could even find a doctor who would talk.) A significant contribution of your life has been to break ground, to advocate.

We have MAID in Canada, too. Though my friends and I are all counting on it, it has turned out to be difficult for some to find those two MDs. (Turns out many object on religious grounds.) IMO three weeks between the two required consents is unnecessarily long if one has had enough.

Contemplating one's own death is indeed difficult beyond anything I can imagine. I don't think anything really prepares you for it. We all know we will die someday, but when "someday" becomes soon, it's a different matter.

You are fortunate to live in a state that permits you to take the lethal drugs if that's what you decide to do. A woman I know who had terminal cancer told me she felt better just having them and knowing she could use them if life became unbearable. My state allows them also. I only wish they would let you have them if you were diagnosed with Alzheimer's, which is my greatest fear. If that happened, I'd like to know I could check out before I lost myself completely.

Anyway, for what it's worth, I will send you lovingkindness as you continue to seek peace.

I'm glad that human society finally got around to passing these laws. My heart goes out to the individuals stuck in non-tolerant states. It really is death with dignity. Why suffer to the bitter end when that end is inevitable? The only item we really own is our personal life. There is no pride in a bunch of tubes and some unknown person hovering over you. Guns and opiates have always been available for those outside the ken. Guns are messy and brutal for relatives. Saying goodbye with quiet aplomb is much much more prideful and a quiet goodbye to any and alls' eventful lives. Death is a private affair that nobody will fail at, but it should be an easy exit not another trauma. B

I love that you live in a state where such compassion, and right of choice, is available should that be a path one chooses to tread.
I send you my warm thoughts and a trans-atlantic hug....you are forever close to my heart no matter the distance or the time passed..
With all my love,
Sx.

I want to say oh no, not now, no no no no. You have been beyond generous with us, sharing, informing, modeling, living in gracious humor. When I read the postings in the comments I always have a strong sense of community, intelligence, caring and connection with the us you created. You made this out of the whole cloth of your voice and humanness. Quite an accomplishment.
Thank you. Thank you. All voices go quiet. May what lies ahead be what you want and need. I think it’s time to say I love you. Now while we can both hear it.

If you've written about death doulas, Ronni, I've missed it. I wonder if that's something that would be helpful in your situation now. AARP did an article last year. Yes - I thought I was OK with the idea of dying, but it turns out I was OK with just that: the idea. That's one thing I learned from COVID-19. I WANT TO LIVE!!

From watching my mother's death from Alzheimer's, there was a shift from living to dying. Deep in Alzheimer's, she still was enjoying life. This is my roundabout way of speculating that maybe we can't make peace with dying until we *are* dying.

Your friend Joyce said it best: anything I write seems idiotic. Please forgive me if my attempt to be helpful is just annoying. I'm so deeply grateful to you for helping me accept the fact of aging, and to try to find a way to live it well.

Allathea said it beautifully. Your sharing both your thoughts on death and this oh-so-valuable information is treasured by all of us who have the privilege of getting to know you through your blog. Heartfelt thanks and a hug.

Death with Dignity, by whatever name, should be an option to anyone who wants it. I stood by while an old friend passed away--at the predetermined time and place--and it was a peaceful way to go. Hard, yes, but no sharp edges to it as the decision had been previously been made and the friend was ready. The good fight had been fought and it was time.

Thank you so much for being so candid and generous in sharing so much of your path with us. We all appreciate your forthrightness and benefit from your wise words. You generate love.

Thanks so much for your service, Ronni. I so appreciate you creating this forum where difficult things can be said out loud. I've been thinking about this Act and wondering how I could apply it in the case of severe stroke (would I be terminal within 6 months and/or be able to administer the dose myself?), Alzeihmer's disease (would I be competent to ask for this solution at the time I'd need it?), and, of course, COVID-19 -- not enough time.

I hope that advance directives would be honored in case of stroke or COVID-19 (comfort care), but could I ask in advance to have food and water withheld, at the very least, if I have Alzeihmer's? At what point in the progression of this disease would that be practical?

I realize that having a death plan is a lot like having a birth plan: things might not go as I wish. Nevertheless, it's comforting to know that, in Washington State and under some circumstances, I have this option.

Yes, to it as informative, don't think Florida where we have so many elders...will actually legalize, it would be better as a National endeavor...and Yes, to Balance Ronni, in all we do each day,

Because of the virus, we are rather stuck in Arizona. Reading your post made me think that we do not want to give up our citizenship in Oregon. I think this is what everyone should have-- a choice as to how we go once we know we are going. At almost 77, and with this virus out there, I sure do think about it. Thank you for the good piece on what is at stake.

Thank you for this.
I moved to Oregon 6 years ago to have this option but turns out I was cured. Who would have figured.
It still shocks me that so few states offer the option of death when dying and that Medicare won’t pay for it.
However, I think Oregon has a program for low income people that will pay. (The state saves money in the long run.)
There’s a video the Death with Dignity people put out a few years ago that included a story about a guy with only Medicaid. Medicaid denied him chemo but offered death with dignity instead.

That took strength. Sending hugs and love. Thank you.

Ronni,
Thank-you for sharing such a deeply personal struggle. You bring to the forefront what none of us want to face. I am so very sorry you do so now.

luci

God Bless you as you contemplate the remainder of your life. You have been more than generous in sharing your health, your illness, your thoughts and feelings and your day to day life. Your candor is admirable to say the least.

Dad died of lung cancer in 1994. About 6 weeks before he died, he realized how it would feel and we talked about that (I'm a RN, his DPA and a loud advocate for quality of life, not quantity of life). At that time he said, maybe Euthanasia isn't such a bad thing. (Euthanasia originated in the Netherlands-our homeland). Like my Dad, you will know what you want the day you want. And you may decide not to use the tool but having it available will provide a level of "comfort" that you otherwise will not have.

Best wishes and hugs to you. And as your friend said, don't worry about it!

Ronni, thank you
Luci, wrote what I am thinking.
Love and hugs

Ronni,
Thank you are your amazing generosity of Spirit. This information will be so useful to those who live in the compassionate states.

It makes my heart ache to read your words— your powerful profound words. Three years ago , when I had a close brush with death, I vowed to tell the people I love that I do. So I am telling you. I love you, Ronni.

You are so dear to so many. Our hearts are sending out floods of love and light.

Ronni, I know you are going through something extremely hard now, and I very much admire you for your postings and being brave in sharing your feelings. It has helped all of us. Thank you.


As a 4-year resident of retirement homes (I have moved twice) I am very
aware of the concern many of us have about death and dying. But it isn't always about a disease; for some of us, it is the worry about running out of funds! And that, too, can be painful... very!

In my personal experience, I know of a resident who, when out of money and faced with moving to live with her daughter... (who didn't want to have her, nor did she wish to go!) and no other viable option... simply stopped eating! She continued drinking water, but.. no food! Was that painful? I don't know. They found her in her bed...

Another person (and this is horrible to contemplate) suffocated by putting a plastic bag over her head, and closing it with a belt. She was discovered by another resident who had gone to check on her.

So, shame shame shame... on the pharmaceutical company who makes the
drug so costly that "the pharmacy in Portland that will prescribe it" charges $700! And on the pharmacy which makes a profit by selling it.

Oregon passed a much-needed law. Perhaps we need to follow it with
another?

May God be with you! I shall keep you in my prayers.

Thank you for again visiting this topic, Ronni. Death and how that comes is such a personal issue, and yet we are so often denied much personal choice in the matter. This COVID-19 experience, with so many people left to deal with their loved ones having died alone, adds another dimension to the discussion.

The many thoughtful comments here provide additional things to ponder. A death doula was not something I've thought of or was really even aware of, but now I realize I have been one twice, and I'm probably being one again without really thinking of the situation in those terms. My husband and I discussed this most recently when all the details of COVID-related deaths were first being revealed. He is in multiple categories of vulnerability and has not been out of the house in two months, while I am only in one. We have tried to be careful about what comes in the house, but have no control ultimately of what may happen. So far so good.

You have been a death doula as well, at least once, as I learned early on in following your blog when I read your story about caring for your mother at the end of her life. You rose to the occasion then, and you're doing an admirable of not only rising to the occasion now, but educating and enlightening others of us who may be in similar positions now, or not far down the road. You've done a good thing Ronni, with courage and honesty. I've always had mixed feelings about Dylan Thomas's words in his iconic poem, but there comes a point, I think, when rage is no longer the proper response. I have been with three people I love at the end of their lives. Like many others here, I watched some raging along the way, but was so thankful that each person went gently at the very end, despite living in a state that has no death with dignity provision. Hospice and having someone with them around the clock seemed to make the difference. As you said the other day, the universe will determine what you get to stay around for and whether you get to know the outcomes of events in which you're interested, but I really hope that you get to make the decision of how the curtain comes down for you and that it is a gentle ending, when ever it comes. Please know that there will be many giving you a standing ovation!

Sending love and thoughts of peacefulness, Ronni, for whatever and whenever you make any decision be it for or against taking the death with dignity route. You continue to do well by all of us and yourself.

Thank you for sharing so honestly and openly, Ronni! I am very sorry that you are at a point where this is becoming something to consider more seriously. Perhaps if you went ahead and got the meds, just so you knew you had that option, that would be comforting to you?...to know that you had the option available, whether or not you chose to use it. I remember that you reported that one of your nurses told you that 'you will know' when it is time...the point where death seems more desirable than continuing to live. I am grateful to live in another state where Medical Aid in Dying is an option. I have a friend who recently used that option, to shorten her death from cancer. I certainly would consider it, in a similar situation! Much love to you as you look life and death in the face!

Ronni, I rarely post here as so many people have so many thoughtful comments anything I have to say seems redundant. Like others, I want to let you know that I have come to look forward to your postings and feel like you are a part of my life. Whenever the time comes, I hope you go knowing how much you have given to so many. Sending this with love...

Thank you, Ronni, for sharing your knowledge, wisdom, humor, practicality, resources, and personnel experiences. Thanks for - well- everything. You sparkle brightly, and your sparkle will continue long after you’ve moved on from gracing our world. Much love and peace to you!

Thank you for sharing this most personal piece of you. I want to wish you serenity as you make decisions for yourself. I value your writing and attitudes about life and death. In these things I think you are a pioneer.

There's no way I can say thank you enough for all the passion and work you have put into this blog over the years. Today, I wish I could click on a little heart for each of the previous comments. They have expressed my feelings so well, I need add nothing. <3

Other Kate here.

What they all said, with special emphasis on the generosity of your candor.

I don't often comment but want you to know I read, I think, and send up a prayer if that's OK. Your shoes would be hard to walk in.

To repeat what everyone else has already said about you seems redundant.

I look forward to your blog and all the reader comments every morning, and the topic often stays with me throughout the day as I ponder my own feelings on the subject of the day. It feels like self therapy to me.

I could never express what having you in my life has meant to me. Be at peace. Never to be forgotten.

If readers are interested, google Covid-19 Addendum to My Advance Health Care Directive (authored by the Hemlock Society), and you will see a document that you can download and fill out regarding your wishes should you contract the virus. It requires your signature and two witnesses OR you can have it notorized.

If nothing else, it allowed my husband and myself to have a discussion regarding the options available to us, and also advise our children what our wishes are should we need to be hospitalized.

We have all heard the words Death is part of Life, but I find it hard to accept that the community you have created and nurtured over these years will cease after your transition. Your TGB blog has come to feel like a favorite pair of jeans. Most comfortable to slide into, no matter how serious or light the subject might be. I sense your irrepressible spirit urging us to keep on questioning, getting educated, pursuing truth, and simply living life to the fullest; that's just what I intend to do. Thank you for your candor, your intellectual honesty and integrity. Keep on trucking!

Dear Ronni,

You are one of the greatest authors that I know of. Your words move us and change us, no matter what the topic. So much more with the profound issue of death, or as I call it, the transition to another life between lives.

No matter what happens I know that I will want this blog, your Book of life, love, disease, well being, affliction, and joy to keep and to cherish. Your book will last long after you and I are gone, bringing your life and words to readers anew. Please offer this gift to your readers, and thank you for opening your experience to us. It's your history!

Since I am living with the same medical issues as you, I am most grateful for your generosity in sharing what you have learned, as well as your questions & feelings about possible or expected outcomes You have helped me in sorting out my own thoughts. You are so appreciated! Wishing you peace & joy. Every day is a gift to be savored.

I am so full of feeling I want to respond but I don’t know what to say —everybody else has said it so well. I wish I could face life like you do—with courage, and humor, and intellectual honesty. You make the world a better place, Ronni.
I would like to echo aidawedo—since I am not facing these issues yet but it’s onky a matter of time before I do, I want to be able to refer to your blog when I need it. If it means so much now, how much more will it mean when I face the same thing or something similar? How many others don’t know about you but would benefit from your incredible wisdom and insight? So I’m adding my plea to aidawedo:
“No matter what happens I know that I will want this blog, your Book of life, love, disease, well being, affliction, and joy to keep and to cherish. Your book will last long after you and I are gone, bringing your life and words to readers anew. Please offer this gift to your readers, and thank you for opening your experience to us. It's your history!”
Making this blog live on in some way —your parting gift to your readers who value you and love you, and to the world.

Anything I would say has already been said so I'll just reiterate that I've been a long-time supporter of medical aid in dying laws and am SO glad I live in a state that has one. My only wish is that it included provisions for conditions like stroke and Alzheimer's. I fully intend to use the law if I don't die in my sleep (preferred!)or suddenly drop to the ground--and can qualify under the strict regulations.

I already have a Medical Directive stating that I do not want to be put on a ventilator or a feeding tube, so that should pretty much cover the situation if I were to become seriously ill with COVID-19. Still, I hope I stick around for a while longer to see what happens, especially in November!

I love you. And so so much mad respect for you. And also this is incredibly important information that you relate in such an understandable and kind way, even as you yourself sit with its enormity. That’s you.

Love you Ronni. That is all.

Thank you for sharing your thoughts and the informative links on this end of life matter. Between your words and others comments here I usually have my thoughts stimulated even further which is an attraction of TGB. I guess we plan as best we can, try to consider all the possibilities that might occur and yet for some of us there may be situations beyond our control. Key seems to be having our right mind at the time we must begin to act which gives me pause for consideration, wondering what my condition will be when my time nears.

I wish the circumstances were such that this discussion wasn't prompted by your personal situation, but as my mother used to say, "If wishes were horses, beggars would ride". Meanwhile, I'll continue this journey with you, sending positives wishes across the miles.


So many of us have been touched and helped by your honesty and courage. Sending you prayers and love.

I was wondering when you would begin to consider this option, Ronni, and congratulate you on your strength and realism. G.M. Hopkins, in his beautiful poem "To a Young Girl", about death, has the line, "It is the blight that man was born for". Yep, it is.

For those who don't live in states that allow self-deliverance, and/or have worries about dementia preventing the use of it, Final Exit now offers a new form specifically addressing dementia, specifying exactly what steps should or should not be taken if you are suffering from it. It is meant to be placed with your Advance Directive.

I just keep thinking of poetry tonight. Do any of you know this poem? I'll quote only the first 2 lines of this lament for a friend.

They told me, Heraclitus, they told me you were dead.
They brought me bitter news to hear and bitter tears to shed.

Holding you in the light, Mary

Hopefully, someday we will understand that as much as we have the right to live on our own terms we should also have the right to die the same way. I've been thinking about the end more and more these days wondering what single thing would make me want have that "one for the road."
Would it be unrelenting pain? Abject loneliness? Or, just not wanting to be part of the future.

There's a small non-rational part of me that thinks the world will die along with me when I die. How's that for a narcissistic ego? (Of course, there's also a small part of me that, lacking an understanding of aerodynamics, thinks it's my belief that's holding up the plane when I fly. I may just be nuts.) And of course I wouldn't want the world to end with me — I want those I love to go on and live and be happy! I wonder if it is truly possible for us to contemplate fully our own deaths? And I find it weirdly comforting to think of all the zillions of people who have died before me...one day everyone currently alive on this planet will be gone... it's only right that I should die, too.

Ronni, I love you, too. I don't want you to die. I want you always there to teach us and make us think. In some sense, the world WILL die with you, because it sure won’t be the same without you. I am humbled to be a witness to your bravery.

You are passionate and dispassionate and funny and snarky and filled with facts when our hearts are breaking. That's always been what I admire about you and your blogging - you make us eat our vegetables while adorning the plate with whipped cream.

Adding my hugs to the ever growing pile. You are a treasure.... even if you couldn't find Bruno Magli's in your own size, please know that you went on to create a blog that fits everyone.

a/b

When I saw 42 comments on today's post, I knew it would be remarkable. You have such an ability to mingle thoughts with a talent that seems to take your readers with you. Allathea put her feelings so eloquently. I share them.

Love and Light be ever with you, Ronni.

Ronni,

Thank you for such a tender, thoughtful, and interesting essay. If I may, I'd like to offer one more resource, and that is the Doc2Doc line (Compassion & Choices).
Physicians can call this number and can have their questions answered about medical aid in dying (Death With Dignity). If a person's physician is unfamiliar with DWD (MAiD), this is a place for mentoring and support for health care providers.

The number is 1-800-247-7421. There is no charge

Quote:
"Is there a place where life and death and meaning at least intersect if not each become part of a whole"? R. Bennett

Ronni
Of all the wonderful, insightful, funny, truthful and difficult sentences you have put forward and shared here over the years I think this may be one of the most introspectively beautiful and meaningful thus far. You captured more philosophy, humanity, thoughtfulness, honesty and insight in 21 words than I have ever read before (and I suspect I will be unlikely to find elsewhere again).

Thank you, thank you, thank you.....

Faye

What a beautiful and philosophically complete post, Ronni. I can only echo what others have said about your generosity and candor.
Tomorrow is the first anniversary of my dear brother's death from leukemia. I attended him, also my father and my husband and my mother. With each one, there came a point of grace and clarity, and I absolutely believe it is true that "you will know." Each of them did seem to know, and with that knowledge came peace but also a kind of determination and a dignity I was in awe of. It seems to me they each, in their own way, chose to let go at some point, and then death came. Not easily; death is work just like birth is, but with willingness, as if they saw the open door and simply chose to step through.
Thank you for everything you do. I love you and your work and all the things others have mentioned. May it go well with you.

I'm a volunteer with Compassion and Choices, and my story is on their website. My father used Medical Aid in Dying (MAiD) in California on June 8, 2019. I am happy to share my experience with you or any of your readers. Witnessing my father's death was a peaceful and solemn event, and one reason why I will never live in a state that doesn't allow MAiD.
With the coronavirus at hand, we should all express our wishes for end-of-life care to our physicians and families. Once hospitalized with COVID-19, there may not be enough time to access MAiD should you wish to use it.

What wonderful friends you have Ronnie! I see you on your videos and I doubt you are going anywhere soon. When it is time I believe we will know it. My friend said months before she died “I trust I will know when the time has come” Indeed she did and had a dignified death within a week.
Take care - all any of us have is today. That is so obvious right now isn’t it?

I'm awed at your wisdom,

Thank you so much Ronni for your generous, kind and insightful thoughts on death and dying. You woke me up from a kind of willful slumber I've been lodged in. Not a happy slumber, just railing against my own health issues and the fear of Covid stalking outside my safety zone. Very scattered and not writing much which has always been my outlet and safety net too, organizing my own thoughts.

There is MAID here too, I need to remember that, tho I have mixed feelings on dying. I had a very rigid religious upbringing and have long been an atheist and wonder sometimes what if. I hear that many do this in old age. We want more after though logically I know (for me) it is impossible.

XO
WWW

I always think of you when I hear Simon and Garfunkel’s “Bleeker Street”. I see a free and wild young Ronni, discovering all her dreams.

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