Bills of mortality preceded modern death certificates, and they suffer from similar challenges.

Bills of mortality preceded modern death certificates, and they suffer from similar challenges.

Years ago, in a job-related field trip, I attended a tour of the medical examiner’s facility in Clark County, Nevada. As the chief office of the pathologist for Las Vegas and its environs, it was a busy place.

Like most of the living, I had never given much thought to the multiple tasks that must be performed on the dead—especially if they died under suspicious circumstances or not under the care of a doctor.

As I learned that day, the task of the M.E. is often a complex one. And nothing is more complex than the element that is often the sole source of interest for others: affixing the single cause of death.

I was reminded of that challenge during a State Bar of Arizona CLE a few weeks ago. There, a pro-con was staged on the legalization of marijuana. Though the wider acceptance of medical marijuana may suggest we’re approaching legalization, the topic is still a thorny one, as evidenced by the vehement dialogue at the CLE.

Sure as no-rain in Arizona, though, a recent death was raised, one that may suggest more questions than answers.

As background, we recall the oft-repeated position of marijuana advocates that not one death has ever been attributed to pot—and compare that with the millions killed by cigarettes and alcohol.

It’s a compelling statistic, one that continues to irk enforcement advocates. And that may be why we have heard advocates mention a Colorado death a lot the past few weeks.

The story (reported here by the Denver Post) is about a young man who jumped to his death after eating marijuana-infused cookies. Here’s the story lede:

“A college student visiting Denver jumped to his death from a hotel balcony after eating marijuana-infused cookies, according to a coroner’s report that marks the first time authorities have publicly linked a death to marijuana since legal sales of recreational cannabis began in Colorado.”

“Levy Thamba, a 19-year-old student at Northwest College in Powell, Wyo., died last month at a Holiday Inn in northeast Denver. On Wednesday, the Denver coroner released a report concluding that Thamba’s death was caused by ‘multiple injuries due to a fall from height.’”

“The coroner also listed ‘marijuana intoxication’ from cannabis-infused cookies as a significant condition contributing to the death. The report classifies the death as an accident.”

At the Bar CLE, Maricopa County Attorney Bill Montgomery alluded to the death, saying that it punches a hole in his opponent’s argument.

But does it?

An article this month in the New Yorker would suggest any coroner’s conclusion is a more nuanced one. In “Final Forms: What death certificates can tell us, and what they can’t,” Kathryn Schulz explores the history of one of civil society’s most ambiguous documents (you can read some of her great article here; sorry, but a subscription wall prevents you from reading the whole thing). And resting your argument on such a piece of paper may not tell the whole story.

Huckleberry Finn had many skills, but determining causes of death was not one of them.

Huckleberry Finn had many skills, but determining causes of death was not one of them.

Schulz opens by describing the meandering history of “bills of mortality” and the coroners who wielded them. The shift from the publicly published bills to the modern-day death certificates has been accompanied by increasing professionalism—but they still may not be the scientifically accurate document the certainty-loving may hope for.

Along the way, Schulz notes, coroners have been known to alter a cause of death to protect reputations or to soften the blow felt by grieving families of means. But if death certificates may be used to protect the dead, could they also be used politically to throw aspersions on the dead? Sure, but that’s not even the biggest challenge.

The toughest nut to crack for M.E.s may reside in the question posed by us lay-people: “Finally, what was the one thing that killed him?

As Schulz writes, “The why of death remains elusive—practically, philosophically, above all emotionally. And, the more extensively we attempt to document it through death certificates, the stranger and more troubled that project comes to seem.”

So if the accuracy of death certificates faces numerous challenges—as Schulz shows—a primary one “is how we decide what counts as a good answer.”

In that exploration, I was extremely pleased to see her turn to Mark Twain, specifically a passage from Huckleberry Finn. It involves a conversation between the stubborn Huck and the Wilks sisters, who are having none of his malarkey.

“One afternoon,” writes Schulz, “while chatting with the Wilks sisters, Huck spontaneously invents a new disease—a form of mumps so virulent that, he claims, a neighbor is in danger of dying from it.”

One sister objects, but Hucks doubles down, saying it can kill the neighbor because it’s “mixed up with other things,” from “yaller janders” to “brain fever.”

Susan Wilks—whom I hope inspires M.E.s everywhere—will have none of it, reminding Huck that it is therefore not the mumps that may cause the neighbor’s demise:

“A body might stump his toe, and take pison, and fall down the well, and break his neck, and bust his brains out, and somebody come along and ask what killed him, and some numskull up and say, ‘Why, he stumped his toe.’ Would ther’ be any sense in that? No. And ther’ ain’t no sense in this, nuther.”

I leave you with Schulz’s point: “This is precisely the problem posed by death certificates; when filling them out, how far back should we chase the causal chain?

That chain could, I suppose, end with a cookie. But I suspect Susan Wilks would arch an eyebrow at that supposition.

In good times and bad—especially in bad—nothing appears to animate elected officials more than stories regarding the sinful pleasures, whether they are drunk, smoked or otherwise ingested.

A glaring example of that is in medical marijuana, which has gripped Arizona headlines for months now. (Contributing to that coverage, Arizona Attorney Magazine’s cover feature for July/August will be the fight over that medicinal weed.)

But at least that fight is over an actual controversy, as leaders try to determine what’s legal and what’s not in a state–federal tussle.

More odd is what’s going on in Minnesota. There, state government has ground to a halt because of lawmakers’ inability to agree on a budget. As a result, many services that state residents count on daily are now unavailable.

Including the renewal of liquor licenses.

As the story says:

“Hundreds of bars, restaurants and stores across Minnesota are running out of beer and alcohol and others may soon run out of cigarettes — a subtle and largely unforeseen consequence of a state government shutdown.

“In the days leading up to the shutdown, thousands of outlets scrambled to renew their state-issued liquor purchasing cards. Many of them did not make it.

“Now, with no end in sight to the shutdown, they face a summer of fast-dwindling alcohol supplies and a bottom line that looks increasingly bleak.”

“The state has stopped issuing the tax stamps that distributors must glue to the bottom of every pack before it’s sold for retail.”

Read the complete story here.

Ari Mlnarik, left, served a beer at the Ugly Mug, a bar in downtown Minneapolis

A tale of unintended consequences, certainly. But what’s surprising is the reaction of lawmakers, whose unwillingness to coalesce is causing problems huge and small for the state.

One legislator even urged the governor—of the other political party—to use his executive powers to allow alcohol sales to continue.

It is the rare occurrence that you will find a politician recommending that his political opponent assert broad powers. Health care? Jobs? Unemployment coverage? No, no, no. But smokes and drinks? That brings the parties together.

Here in Arizona, the Corporation Commission has been plunged into its own form of reefer madness, with the discovery of some pot leaves in a bathroom shared by a group of people. The result is that Commission Chair Gary Pierce has requested that drug-sniffing dogs be brought in to try to locate the source of the illegal substance.

It was reported that the Republican members of the ACC have agreed to have their offices sniffed. The Democratic members have not yet agreed to do that.

We grow used to partisan sniping in many levels of government. But the ACC was always a reliable government powerhouse, wielding enormous power and influence without shouting headlines. Sure, politics do matter where utilities and other resources are concerned. But the ACC has always maintained a rather egg-heady and admirable focus on the details of the matters before them. Politics were whispered rather than hollered.

Here’s looking forward to getting back to some of that. And here’s hoping that public agencies and public officers look to become more like the storied ACC. If the reverse occurs and we are left with an openly partisan ACC that follows the vitriolic route of others, residents will have one more reason to doubt the results that emerge from a government chamber.

As you read this, I am somewhere over the United States, stuck in a middle seat my  travel agent managed to secure for me. I’m winging my way to Washington DC, where I will make a presentation to a roomful of association publication experts. More on that later.

As much as I am looking forward to my conference, I am very sorry to miss a newsworthy event occurring in Phoenix today: the grand opening of a 21,000 square foot weGrow Marijuana Superstore.

Medical marijuana is in the news daily, along with the conflict it implicates between federal and state law. In fact, we are planning a story or two on the topic in an upcoming Arizona Attorney Magazine.

Are the state leaders who have halted developments in medical-marijuana merely seeking clarity through their lawsuit, or are they thwarting the will of the people? That is a question on the mind of many.

As an example of the controversy, read what E.J. Montini had to say in the Arizona Republic about medical marijuana earlier in the week.

And some have already established a legal defense fund “to protect Arizona Medical Marijuana rights.” (See the press release at the end of the post.)

That’s all well and good, but it’s hard for me to believe that I’ll miss the opening of a place dubbed “the Walmart of Weed.” As weGrow is careful to point out, they do not actually sell marijuana (read more about the company here). But on Wednesday, anyone interested in the next chapter of the state’s pot saga will be at 2937 W. Thomas Road, Phoenix, AZ (29th Ave. & Thomas Rd.), where there will be a panel discussion, ribbon-cutting and grand-opening festival.

Oh well, better luck next time.

Here is the press release:

Legal Defense Fund Established to Protect the Rights of Arizonans and Suffering Patients Seeking Medical Marijuana 

Legality of Arizona’s Medical Marijuana Law Questioned

(Scottsdale, Arizona) – On the heels of a lawsuit filed by the State of Arizona to determine the legality of the recently enacted Medical Marijuana Law,  a legal defense fund, Don’t Let Medical Marijuana Die, has been established to protect the will of the voters and guarantee ill patients access to medication that relieves their pain and suffering.

The lawsuit, initiated by the Governor and the AZ Attorney General, puts the future of AZ’s Medical Marijuana Act in question and leaves sick and dying patients wondering when they will be able to relieve their pain and suffering.  At issue in the suit is whether AZ’s law can legally be enacted even though Federal law continues to make possession and distribution of marijuana illegal.  The suit seeks to obtain clarity regarding this seemingly conflicted legal status of medical marijuana laws.

Attorney Ryan Hurley leads the Medical Marijuana Division at Scottsdale’s Rose Law Firm.  While disappointed about the halt on Arizona’s Medical Marijuana program, he feels the lawsuit will ultimately be decided in favor of patients and states’ rights, “Health care providers and medical marijuana dispensary operators shouldn’t have to worry about federal prosecution for simply trying to treat sick patients. Ill patients should not have to worry about access to medication as they battle  HIV, cancer, spinal cord injuries, or multiple sclerosis, just to name a few.  Hopefully this fear of prosecution can be put to rest and the legality of State MMJ laws can finally be upheld.”

Don’t Let Medical Marijuana Die was formed to protect the rights of Arizonans and protect the dispensaries and health care providers who are simply trying to relieve the pain and suffering of their patients. It’s seeking donations to cover their legal expenses in this vitally important battle.  Here is a link to the organization’s website.

The Board Members include:

  • Dr. Daniel Rubin,  Medical Director of Naturopathic Specialists, LLC in Scottsdale, AZ, where he practices full time as a naturopathic oncologist
  • State Senator Robert Meza, a 3rd generation Phoenician who sits on many civic boards
  • Ari Schafer, President of the Civic Center Pharmacy, a locally and nationally recognized source of custom compounded medications not routinely available through the larger chain stores
  • Victor Ostrow, Former General Manager of Rawhide western theme park and a 37 year resident of Arizona. His work in promoting Arizona tourism includes past participation in the Valley of the Sun Convention and Visitors Bureau, and the Scottsdale Chamber of Commerce 

These individuals have courageously stepped forward to protect the rights of countless Arizonans seeking relief from debilitating pain.

Overwhelmingly approved by voters in November 2010, the Arizona Medical Marijuana Act legalizes medical marijuana with a doctor’s recommendation. 16 other states have done the same.