Conscience and consultation are good paths through the mire of emotional and controversial policies such as euthanasia. But referedums are key to ensuring voters are heard

The End of Life bill has been read a second time and is now heading for the House for further debate. Personally, I support the proposal. I don't ever epect to take advantage of the Bill's provisions myself, but as I see this is it my life – inasmuch as it is possible, how I end it should be my decision and mine alone. 

An end of life experience is something we all face sooner or later. And it can be tough and horrible. Willie Jackson made an interesting comment about his mother. My generation of politicians well remember June Jackson – she was a tireless, feisty, uncompromising and strong advocate for her people. From Willie’s account she would be horrified if she saw herself now.

I can understand what he means. Quality as well as quantity is important. My dad had an end that stopped him after a relatively short period of increasingly serious illness, fortunately before he was too racked with pain. He still ‘had his marbles’ as they say, but he could feel his quality of life ebbing away.

If he could talk to us now he would say he was glad he didn’t hang around when his quality of life had gone. He was a southern American, spoke with a drawl and had lots of pithy statements – he always said he wanted to “wear out not rust out”. That is a good guiding principle. 

One frequently raised concern during the debate was elder abuse.

A number of MPs cited the fear that subsequent generations would feel empowered by the new law to push their seniors into killing themselves off to avoid the cost or the hassle of caring for their demands. Some disability advocates feel apprehensive and uneasy about the potential impact on those with physical or intellectual disabilities. Any such pressure and abuse should be utterly unacceptable. Protections to stop that happening should be included.

A number argued that palliative care can manage pain. My own family experience demonstrates the limitation of available pain management – it cannot manage all pain. Neither can palliative care manage many of the other horrible symptoms of the final stages of terminal illnesses. It can help, but only to a certain extent.

I found myself unable to agree with Nick Smith’s argument that the Bill was out of step with a core part of Kiwi culture – respect for human life. On the contrary I think that is what it is all about. One may not agree with the proposals in the Bill, but the motivation of people like Lucretia Seales is not to show any lack of respect for humanity but, as she put it, to die (which she knew was happening) on her own terms. 

During the debate Mark Mitchell explained the consultation process he had delivered to ascertain his constituency voters opinions. He had organised well attended public meetings and a poll. Good on him for taking the initiative.

That bouquet noted, the numbers in the poll (about 1300), while significant, were still only a small proportion of the total voter numbers in that electorate. Public meetings tend to attract the activist element. There are many voters – the great bulk in fact – who don’t attend such meetings. They too have a valid opinion.

“Conscience issues” are always difficult for MPs. A number of MPs made that point. But they are difficult, maybe more difficult, for voters too.

A dedicated supporter of End-of-Life Choice in the electorate of an MP with a well known view – North Shore for example – is going to have to end up having no choice but to vote for one of the strongest opponents of this reform if they prefer National (as a large majority do in that electorate).

Our system is party-based. Voters choose their MP generally by their party preference – not their conscience choice.

The dilemma is how in a democracy we deal with the problem of reflecting the people’s opinion on the range of issues parties as a matter of principle do not take a stand on. New Zealand First has the correct answer – refer those decisions to a public referendum. They are a good solution to the question of conscience votes. Then the whole population will determine the questions parties by their nature cannot.

Comments (24)

by Gavan O'Farrell on July 05, 2019
Gavan O'Farrell

"I don't ever epect to take advantage of the Bill's provisions myself, but as I see this is it my life – inasmuch as it is possible, how I end it should be my decision and mine alone"

(I oppose euthanasia.)  Over the months of thinking about euthanasia, I've never thought of it from my own point-of-view as an eligible patient.  From that perspective, I can certainly see the attraction.  

Assuming that "inasmuch as it is possible" includes "ethically possible", I find myself pausing at two points.  The first is the decision to take my life - a decision I believe I'm not entitled to make, for reasons I won't burden you with.

The second is the point of asking someone to kill me - not because I don't want to die (because, in the scenario, I do want to), but because I'm turning that person into a killer.  I think deliberately taking a life is very profound - not just morally, but also psychologically - profound and potentially damaging.  I must say I'm reluctant to put another human being through that experience even if they've signed up to being sanguine about it.  There is more to this transaction than my consent to being killed and their consent to doing the deed:  consent, as I see it, doesn't justify.

 

by Gavan O'Farrell on July 05, 2019
Gavan O'Farrell

Three additional motley points, if I may:

I agree that there should be a referendum - for the reasons given in the article and because I don't trust polling "campaigns".

A further condition should be included in the Bill:  eligibility should depend on the failure of palliative care.

And we should not allow this law, if that's the way it goes, to result in any reduction in the funding for improved palliative care.

by Lee Churchman on July 05, 2019
Lee Churchman

There is more to this transaction than my consent to being killed and their consent to doing the deed:  consent, as I see it, doesn't justify.

I don't think anyone thinks consent should be a legally sufficient condition for euthanasia, although it would seem to be a necessary condition. Whether liberalism ought to allow, out of moral consistency, any consenting person to be euthanised is another issue.

by Stephen Todd on July 07, 2019
Stephen Todd

 

Gavan, your putting forward of the viewpoint of the Roman Catholic church, to which you are clearly captive, is all very nice, but what about me? I’m a secular humanist who is wholly unconvinced of the existence of your, or any other, god, and who rejects religionism in all its forms, and methods of expression.

 

 

 

As with Wyatt, I don’t expect to want to take advantage of this legislation, but then, I also don’t know what the, or my, future holds.

 

 

 

If you have no intention of taking advantage of Assisted Dying, that’s fine, but why should I live on, in pain and distress, when I just want to go, merely to satisfy your morality? In short, I would greatly prefer that you, and people like you, not get in the way of me exiting this life on my own terms, with legally-sanctioned assistance, should I reach the point where I decide that doing so is best for me.

 

 

 

And, as a fierce democrat, and a huge supporter of Swiss-style referendums, I agree that the enacted legislation should be put to We, the People at the next General Election.

 

by Stephen Todd on July 07, 2019
Stephen Todd

Sorry, people, I don't know why that spacing occurred.

by Gavan O'Farrell on July 08, 2019
Gavan O'Farrell

@Stephen.  If I were an apologist for the Christian (incl Catholic) position, I'd say that suicide itself is morally wrong - because one's life belong's to God, not to oneself - and that assisting it in any way is therefore also wrong.  None of this is in my post, so I suggest that it doesn't really matter who or what I am.

Like most Christians commenting on this topic in this secular setting, I speak the common tongue and present arguments that can be appreciated and critiqued at face value.

And there are plenty of non-religious people who oppose euthanasia:  it's not a particularly religious issue.  Human civilisation has always taken life-and-death seriously and balked at killing (and required justification). 

So, I must ask, would you allow the morality of these secular people to "get in your way"?  And, how am I required by "your morality" to get out of your way?

BTW, what is "religionism" (if not religion)?  What are the "methods of expression" that concern you?   I simply don't know what these things are. 

by Stephen Todd on July 08, 2019
Stephen Todd

Gavan, while you preferred not to explicitly state your adherence to the teachings of the Roman Catholic church, or that you are at least a cultural Catholic, I took a punt and filled in that gap, to make it clear to you that you were kidding no-one. 

The law should simply provide for assisted dying - the enacted legislation being approved by referendum. Once in place, people can choose to take advantage of it, or not. At the moment, you, and those who share your view, are getting in the way of people like me, by doing all you can to make sure the Assisted Dying option is not available to me. Barring a sudden, catastrophic accident, I want the option of deciding when I go (which I may not take advantage of) - my life belongs to me, not to your, or any other, god.

You (and people like you) can get out of my way by dropping your opposition to the Assisted Dying Bill, so that it passes into law, giving people at the end of their lives the option of dying on their own terms, if they wish to.

'Religionism' is my made-up term for religion. For me, it more accurately suggests what religion is - put simply, a nonsense that is just another way for some people to exercise power over many other people. (Therefore, adherents of religionism are religionists.) 'Methods of expression' is a reference to the many religions and denominations within religions, that have evolved over time, that are used by the practitioners of religionism to control those who are under their influence.    

 

by Gavan O'Farrell on July 08, 2019
Gavan O'Farrell

@Stephen.  I usually don't mention my faith unless it's relevant.  And because some people get distracted by it:  there's a lot of anti-Christian (esp anti-Catholic) hostility around.  I mentioned it to you because you made it relevant.  I could equally take a swipe at your secular humanism, but it isn't relevant.

You mention "You (and people like you)":  I'm still not sure whether you're just referring to me and other Christians or are now including anyone who opposes euthanasia (including perhaps some secular humanists).

I don't agree that the existence of a nominal choice is enough to clinch the argument - especially regarding the role of the doctor in "assisting".  Mind you, I may be in the minority here, there was substantial discussion a week or so ago:

https://www.pundit.co.nz/content/lets-keep-things-in-proportion-shall-we#comments

 

 

 

by Stephen Todd on July 08, 2019
Stephen Todd

Gavan, "You (and people like you)" refers to all opponents of Assisted Dying, including (but not restricted to) non-Catholic Christians and the very tiny percentage (I would imagine) of secular humanists who oppose it.

Surely, it is more than a nominal choice. The enacted legislation will not simply say that "assisted dying is now legal" for those who qualify to take advantage of it, should they wish to do so. It will be a comprehensive piece of legislation. Just as it will not be compulsory for you or I to be assisted to die (should we find ourselves in a qualifying situation), nor will doctors who wish to have nothing to do with the practice be required to participate.

Two final points: (1) I take issue with your (and your church's) characterisation that those who are assisted to die have committed suicide. That is a gross insult to the people who have been assisted to die (both overseas, and in the few cases that we know of, here), and who will be in the future; and (2) I live in a democratic society, so yes, if a majority of voters vote down the enacted legislation (should the current Bill be passed into law), I will accept that outcome; that other people's morality, taken collectively, has trumped mine - at least for the time being.

by Gavan O'Farrell on July 08, 2019
Gavan O'Farrell

Thanks, Stephen, I'm clearer now.

By "nominal", I just mean that a legal right to choose doesn't mean there's a free choice:  a legal choice is only as free as context allows.  I'm thinking here not only of people who choose to die but also of people who would prefer to live and shouldn't have to say so (I know they are under no legal obligation to opt out of euthanasia, but I think they'll feel a lot of pressure once the system is up and running).  

I think the word "suicide" is only insulting if you take a dim view of the act of suicide.  It's legal, and a lot of people regard it as morally fine. Outside the euthanasia context, there are people who can quite sanely and reasonably decide that not living is better than prolonging the life they have:  I think they embrace the word "suicide" in the interests of candour.  Really, I don't know what else to call the patient's role in euthanasia, as they are just as sane etc as those others I mention.

by Stephen Todd on July 08, 2019
Stephen Todd

"I think the word 'suicide' is only insulting if you take a dim view of the act of suicide."

Suicide is almost always carried out alone, for any number of reasons, in a moment of extreme anguish. Assisted Dying can only take place, once a qualifying situation has been determined, after careful consideration, and with legally-sanctioned assistance, i.e., in concert with others, after all legally-required procedures have been followed. To refer to that as suicide, which is often committed recklessly, on the spur of the moment, etc., is indeed insulting (to the terminally-ill person who is accessing the AD option), whether one takes a "dim view of the act of suicide", or not.

The families of those who are terminally ill almost always comprise people who love their terminally ill family member dearly. There will be very few cases, if any, where people will be pressured by family members - all of them, acting together, no-one breaking ranks? - to take up the option, and "the process" will almost certainly identify such cases in any event. (Feeling "an obligation" to die, whether pressured or not, would not be a qualifying reason to access the AD option.) It is a "straw man" argument put forward by the opponents of AD to scare legislators into voting against the option.

by Lee Churchman on July 09, 2019
Lee Churchman

@Gavan

Human civilisation has always taken life-and-death seriously and balked at killing (and required justification). 

Yes, but it has also tended to allow mercy killing in unrecoverable cases of acute and intense suffering. Battlefield euthanasia has been widely practised throughout human history, for example. Are you saying that it is unreasonable in such circumstances? 

by Alex Rahr on July 09, 2019
Alex Rahr

Having seen what my grandfather went through I'm pretty clear that if I get in the same situation euthanasia is a far, far better idea. If I have to shuffle through a few doctors before I find one willing to assist then, I will - last I heard the bill wouldn't make unwilling doctors do so.

It doesn't seem clear that allowing this is so out there that it requires a referendum, but if MPs are unwilling to lead then it should be doable I think.

by Gavan O'Farrell on July 10, 2019
Gavan O'Farrell

@Stephen, I didn’t say “reckless suicide”, just “suicide”.  I had no idea that people considering euthanasia for themselves eschewed the concept of suicide:  I thought (or perhaps just assumed) they were quite candid about it.  

I didn’t say the families of an eligible patient don’t love the patient.  That’s closer to a “straw man” than my point about pressure.  Anyway, people who love do all sorts of things: love is no guarantee of right behaviour. 

Nor did I say that pressure exists only when applied by every family member.  Or even that it’s always applied maliciously, or even deliberately without malice.  In fact, the pressure may be self-imposed, for the sake of others.  I don’t think it’s reasonable to describe this line of argument as an attempt to “scare” anyone. 

@Lee, I’m very sympathetic about the battlefield scenario, and I can see how the euthaniser might do it in very good conscience (and a breaking heart).  However, I think we make concessions for decisions made in the heat of battle that may not apply to institutionalised euthanasia in a hospital setting. 

by Stephen Todd on July 10, 2019
Stephen Todd

@Gavan

"I didn’t say 'reckless suicide', just 'suicide'."

Nor did I; I said, "..., which is often committed recklessly".

"I didn’t say the families of an eligible patient don’t love the patient."

Nor did I; I said, "... almost always comprise people who love their terminally ill family member dearly."

"Nor did I say that pressure exists only when applied by every family member."

Agreed. You said, "(... I think they'll feel a lot of pressure once the system is up and running)." It is only when I tried to interpret your reference to 'pressure', that you have expanded on what you meant.

It is very reasonable to describe the "pressure" argument - however it is applied (or not), or felt - as an attempt to scare people, particularly MPs, then voters. You are throwing up every argument that you, and your church, can come up, to try and defeat this Bill.

None of your arguments, whether taken singly or together, justify me not having the Assisted Dying option available to me, should I decide I need to take advantage of it. You are, in effect, arrogantly suggesting that other people are not as capable as you are of deciding these things for themselves; that you must protect other people from themselves, because they can't be trusted to make the only decision that would be acceptable to you (and to your church), i.e. to suffer on until the bitter end, because that is the only action acceptable to your imaginary controller. Well, I don't need your protection, Gavan.

At the moment, you may end up suffering to the end, and you will be happy about that, because, in that situation, you will "know" that that is what your imaginary friend wants for you. But, if I end up in a qualifying situation, I (currently) don't have the option of taking *my* (not your imaginary friend's) life in my own hands and exiting this world on my own terms, with legally-sanctioned assistance - and I am very unhappy about that.

There are no justifiable reasons for both of us not having what we each want.

by Stephen Todd on July 10, 2019
Stephen Todd

I've made a couple of errors, which I must correct--

Paragraph starting, "It is very reasonable [...]." Firstly, the word "very" should be *very*. Third line, "can come up" should, of course, be "can come up with".

In the following paragraph, "justify me" should be "justify my".

by Gavan O'Farrell on July 10, 2019
Gavan O'Farrell

@Stephen.  Of course I'm trying to defeat the Bill, that's not so remarkable.  Yes, we disagree, but you don't have to be uncivil about it by mocking my faith.  I'm not mocking your lack of faith:  why not just leave it alone?  You are clearly capable of focusing on the arguments, and it must be possible for you to draw the line at that.  Speculating about motives gets us nowhere.

I'm not trying to protect those who are perfectly sanguine about suicide and also perfectly sanguine about dragging the medical profession and hospital administration (and Parliament and the electorate) into it.  I'm trying to protect those who consent, or might consent, only under pressure (whatever its source).  And also those people who feel pressure to say "No, thank you":  I think it's perverse that a person who wants to live is expected to say so, but that's where this leads.  You and I will have to agree to disagree about whether this pressure is real (and whether it is arrogant to suggest it's real).

Generally speaking, a person can exit on their own terms any time they like: suicide is legal.  (Not that I recommend it.)  I know some eligible people are not physically capable of suiciding, and I'm sorry for that.  But, I'm not sorry enough to agree with institutionalising the pressures I've referred to.

Perhaps if I put it this way:  I see the proposed solution as worse than the problem.  As a bottom line, I would prefer not to solve a problem (no matter how terrible it is) if the only solution is worse.

by Stephen Todd on July 10, 2019
Stephen Todd

@Gavan

Yes, you are trying to continue to deny me my right (not yet recognised in law) to decide to end my life, under certain very controlled circumstances, should I decide that that is best for me - and I resent you (and those like you) for it.

I am trying to make it clear to you, and to other people who access this post, that the Roman Catholic church - the most foul, evil, institution ever inflicted on the human race - has had its day; that its power and influence, particularly in Western societies, is waning fast, and thank goodness for that.

Its view of life - which devout adherents such as yourself, promote, I say, because you are infused with catholicism, not because you have reached your position independently of your church's teachings, whereas I, who was brought up in the Presbyterian church, but, even as a young child 60 years ago, knew that what I was being taught in Sunday School, and later in Bible Class, was not credible, and who, therefore, has effectively been a non-believer for more than 55 years, hold my views as a result of my own, independent, thinking (and lots of reading) on the matter - is now a minority view.

I know you now feel insulted, but I can't help that. I cannot allow you to put forward your Roman Catholic church-influenced views, unchallenged. I am here to make sure that everyone who reads our exchange of views (especially MPs, should they happen by, but voters, too - in effect, almost everyone) know that there is a point of view out here that is at great variance with yours.

I'll finish this part of my reply, with this: https://www.patheos.com/blogs/daylightatheism/2019/07/can-we-avoid-insulting-believers/?utm_medium=email&utm_source=BRSS&utm_campaign=Nonreligious&utm_content=459. I admit that James Haught is somewhat more accommodating towards [all] believers, than I am to the Roman Catholic church, but I make no apology for that.

Okay, with that said, what you are saying is that you are trying to protect a class of people that you don't know will exist. (And, in doing so, you're also trying to deny those who are "perfectly sanguine about suicide"* from having access to AD, should they wish it.) No dying person who wants to live, no matter what's in store for them, will be expected to say so, unless specifically asked. And that would only be by someone very close to the dying person - certainly not by a medical professional - who may or may not, have a self-serving motive for putting the question. Quite frankly, I write this off as a made-up objection.

* You object to me mocking your faith [being belief without evidence], yet you continue to refer to Assisted Dying as suicide, despite me informing you that I consider the term "suicide" as insulting to those terminally-ill people who decide, after careful consideration, to take advantage of it.  

What you are saying is that it is morally wrong for a family member, or close friend, on seeing the terrible suffering of the terminally-ill person, to even mention the Assisted Dying option. That is just nonsense. People in their last days discuss all sorts of things with those close to them. Why should the Assisted Dying option not be one of them? It might simply be, as part of a long (and perhaps last) conversation, "I hate seeing you like this. Have you considered AD?" Answer, "Yes, I have, [insert name of the dear family member / friend], and I'm not interested." End of discussion.

On the other hand, it might never be raised, yet you insist that the possibility of it being raised is enough to kill the Bill, dead, as soon as possible, meaning no-one can have access to its provisions. I cannot, and will never, agree with that.

You say the proposed solution is worse than the problem, which is simply nonsense (in my view), but in truth, there is no other solution that you would consider acceptable, either, is there?  

by Lee Churchman on July 11, 2019
Lee Churchman

@Gavan

I’m very sympathetic about the battlefield scenario, and I can see how the euthaniser might do it in very good conscience (and a breaking heart).  However, I think we make concessions for decisions made in the heat of battle that may not apply to institutionalised euthanasia in a hospital setting. 

We do, mainly because there is an urgency in these situations. However, the general principles apply to medical euthanasia, such as incurable suffering, limited life expectancy and so on. If you allow one, you ought as a matter of consistency allow the other in many cases.

by Gavan O'Farrell on July 11, 2019
Gavan O'Farrell

@Lee.  I agree that the essential ingredients may be present in both situations and I do feel awkward about it.  One difference that occurs to me - apart from uncertainty about the ingredients in individual cases - is that the soldier who euthansises his comrade (on request etc) is choosing between that and leaving his mate behind, to die in a state of utter neglect and desolation.  I struggle to align that with the hospital scenario:  the pain is the same (in our hypothetical comparison), but other features of the situation are quite different (eg caring staff who wish they could do more for you and visitors who love you).

I'm concerned that, if I push the envelope further, I'll end up condemning battlefied mercy-killing - all in the interests of consistency.  This may be a topic for "Don't ask, don't tell":  one of the problems with this legislation is that is shines a glaring light on something that may be more easily resolved in the shade.  With the Bill in my face, I have to step up with a conscientious objection:  I would have preferred to leave it alone, but the process forces me to speak.

by Gavan O'Farrell on July 11, 2019
Gavan O'Farrell

@Stephen.  Sorry for the lengthy post.  My concern about your insults to my faith is not “Thou shalt not insult religious belief”.  If you’ve decided that the only respectable path to knowledge is via empirical evidence (a contentious position), then it’s only logical for you to regard people like me as delusional (hence “imaginary friend” etc).  I get that and I don’t mind it when it’s relevant.  Here, though, it takes us away from the topic.

I’m not running a religious argument.  I imagine we all regard killing as morally very significant and insist on justification, but we may differ on whether or not the arguments for euthanasia provide sufficient justification.  That’s what this is, not a barney between theists and non-theists. 

A lot of believers do a lot more thinking than you seem to give them/us credit for.  In my experience anyway, the days are long gone when a priest could tell the congregation how to think and speak and vote and expect compliance.  Christians in the West have lived with the same freedom of thought as other people:  we too would resent a cleric abusing his authority.  Not to mention the Love Commandment, which you might recall is rather vague: moment by moment, we must work out what love requires. 

Conversely, I have found a lot of secular people to have views, and modes of expression, that are so similar as to make me suspect that they’re not thinking independently [either].  We are all surrounded by pressures and influences:  the Church is one of many.

On the topic of pressure, I think your hypothetical dialogue is neater than reality.  It will be true for some, I guess, but not for others.

I’m only expressing my views here because someone wants to institutionalise something that may or may not have muddled along.  This Bill is now in all our faces and we all have to step up and give a conscientious opinion on it:  I would have preferred not to discuss it, and to continue to turn a blind eye to merciful liberties and initiatives that happen in the hospitals, to leave euthanasia as a “Don’t ask, don’t tell” topic.  But, with a Bill before the Parliament, this terrible topic (I’m extremely sympathetic about the worst scenarios described by advocates), I have to react to the open institutionalising of this practice.

Other solutions?   Continue muddling, though that may be difficult now that the cat is out of the bag.  More palliative research.  More staff, more kindness, more visits from family (hard work, I know).  More love to counteract the pain – ie make it less likely that the pain will mature into despair.  As I understand it, it is the despair more than the pain that breaks people’s will to live.  Most eligible patients are old, the West has been ditching old people for decades now (esp NZ and Australia).  So, do more and more to reduce the number of people who find themselves leaning towards death.  There will still be casualties, I know, but fewer and fewer.

by Stephen Todd on July 11, 2019
Stephen Todd

@Gavan

Thank you for the immediately-preceding comment.

This is a courtesy reply (so you know that I'm not ignoring you) to let you know that I think we have reached the end of the line here. I have said considerably more than I expected to when I put up my first comment, but then, you got the chance to tease out your thoughts on this issue, too.

I think we should have a break now; readers are probably getting sick of us, and I don't want the Editor having to step in and say, "Alright, you two. Enough! Your correspondence is now closed."

Let's agree to diasagree, and see how things pan out.

by Lee Churchman on July 11, 2019
Lee Churchman

struggle to align that with the hospital scenario:  the pain is the same (in our hypothetical comparison), but other features of the situation are quite different (eg caring staff who wish they could do more for you and visitors who love you).

What if the person in the battlefield scenario is your brother or a friend, or someone else you are charged with the care of? I just don't think there is a morally relevant difference. Medical staff are charged with the care of their patients.

These are terrible situations in which people must do what they would rather not. They also show that there is a wide level of agreement about euthanasia under certain circumstances (excluding things like people with dementia or who wish to be euthanised).

I accept that people have religious objections to VAE, but I'm not sure these can be maintained in these sort of cases without allowing level of inhumanity that is beyond most people. 

by Gavan O'Farrell on July 11, 2019
Gavan O'Farrell

@Stephen:  Agreed.

@Lee:  I can't do better on the battlefield comparison than I've done.  I don't see my objection to euthanasia as religious - especially regarding the role of the doctor - but just a lack of satisfaction with the proposed justification for killing.  Feel free to reply, of course, but that will have to do it for me, I think.  

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