“Decisions about how to treat an animal toward the end of her or his life are among the most difficult we have to make and it’s our responsibility to do the best we can. Our companions trust that we will have their best interests in mind. In The Last Walk, Jessica Pierce considers all of the hard questions about sick and old animals. She seamlessly weaves in personal stories with scientific research to provide readers with an incredibly valuable guide—a must read—about when and how to end an animal’s life in the most humane way possible. I learned a lot from reading this book, and I know others will as well.”—Marc Bekoff, author of The Emotional Lives of Animals
Ody shuffles down the hall and stops at the doorway of my office, peering in at me with brown eyes made milky by age. He doesn’t come all the way into the room to put a muzzle on my lap or push a nose under my hand as he used to. For Ody the greeting remains incomplete, a reminder that he now inhabits a different world.
I turn in my chair and call him. Though he doesn’t come, I know he hears me. His stump of a tail flicks back and forth in reply. I also know, because we repeat this exchange day after day, what comes next. With a snort and a raspy cough, Ody will turn stiffly and make his way back down the hall, the click-drag click-drag of his nails telling me where he is headed. But I don’t want him to go just yet.
I stand and step into the doorway. Kneeling, I take Ody’s face in my hands. His long ears are like velour under my fingers. I run my hands along his body, feeling the spongy lumps that bulge out here and there, like a super-sized Braille inscription. The lumps, the vet tells me, are fatty deposits called lipomas and are a harmless, if unsightly, manifestation of age. Despite his lumps and skin tags and white hair, Ody is still just as handsome to me as ever.
Repeating another familiar exchange, I lower my face and touch my nose to his. I’ve always loved his nose, which is improbably colored to match the russet of his coat. I close my eyes and feel the cool roughness. His breath is a reminder of worn and broken teeth and of gums decayed by time. We remain here nose-to-nose for several long moments, and I then I stand up and turn back to my work. Ody shuffles off, click-drag, down the hall.
Ody is just over fourteen, and if you saw him on one of his occasional walks (he walks when the mood is right, and otherwise refuses to leave the house) you would know that he is an old dog. His back legs are atrophied and weak and bend awkwardly, and he stands as if he were halfway toward sitting. Every few steps one of his back legs fails to do its job, and he lands on top of his toes, rather than on his paw pad. Without support of the foot, the leg collapses, and his body dips and sways. This idiosyncrasy is most likely the result of some neurological dysfunction that causes the brain to send the wrong signals to the legs. It is one among several symptoms of “cognitive dysfunction syndrome”—in other words, Ody suffers from dementia.
Ody is nearing death. And the closer he draws toward the end, the more puzzled I become about what a good death would mean for him. It is pretty clear what a bad death looks like, and far too many animals in our world suffer a bad death, dying afraid, in pain, and alone or with strangers.
But what is a good death? The message I get from everything I read and all the people I talk to is that eventually Ody will reach a point at which his life becomes burdensome, and he will tell me, somehow, that he wants to be released. I will take him to the vet and the kindly people there will poke him with a needle and it will all be very quick and painless and gentle. But something about this scenario bothers me, like a splinter just under the skin of my conscience. And the closer Ody limps and shuffles toward this elusive endpoint, the less comfortable I become.
Is a “natural” death preferable, for Ody, to euthanasia? Why is it that we have such a revulsion against euthanasia for human beings, yet when it comes to animals this good death comes to feel almost obligatory? If it is an act of such compassion, shouldn’t we be more willing to provide this assistance for our beloved human companions as well?
I worry: will I be able to read Ody’s signals? And I wonder: does life ever become so burdensome for an animal that he or she would prefer death, or is this something we have judged from the outside? Is it that their lives become burdensome for them, or for us? The more troublesome Ody becomes—the more he pees on the floor, the more often he barks for no reason at odd hours of the night, the more frequently he stands, confused and panting, in the middle of the kitchen while I’m trying to cook dinner—the more ambiguous the question of burdens becomes.
When Ody was about thirteen and a half, I decided to keep a journal about his life. Although he was still in relatively good health, I could see age wearing its tracks onto his body and mind. His health was starting to fail in small ways—he had had mast cell tumors removed from his ear and from his haunch, his hearing was fading, and he had to work a little to stand up. I began to write down the funny and annoying things that Ody spent his days doing, so that I would remember him in color and detail. And I recorded my reactions to watching him grow old. I thought it might help me work through the anguish of someday losing him, and the difficult decisions that I suspected lay in wait for us. I didn’t know it at the time, but the “Ody Journal” was the beginning of this book.
Ody’s story soon became something more than personal. As a bioethicist, my work has focused on how the biomedical sciences intersect with human values, particularly within the context of healthcare. At the same time as I began writing my daily journal about Ody, I was finishing a large college-level textbook on bioethics. The ethics of death and dying has long been at the core of this field of applied philosophy, and one of the central chapters in the textbook focused on ethics at the end of life. I would sit at my desk, immersed in the literature about human death and dying and hear Ody retching in the background, as the water he just drank got stuck in his throat. I would have to get up from my work, frustratingly often, because he needed to go out and pee, again, or was barking at the door. It became obvious to me that many of the questions under discussion in human end-of-life care were similar to ones I might soon encounter with Ody. How aggressively should I treat his encroaching disabilities? How do I judge the quality of his daily life, as he experiences it? Might there ever come a time when his day-to-day living is filled with so much pain and fear that the humane course will be to hasten his death?
Bioethics has not generally concerned itself with animals, and most certainly not with the aging, dying, and death of animals. But as I began dealing with Ody’s aging, and thinking about how to navigate decisions at the end of his life, I realized that end-of-life care for our animal companions is worthy of sustained attention and that pet owners and veterinarians face moral quandaries every bit as complicated as those we face with human loved ones. Yet as I learned the hard way, we are not always prepared for these challenges, not having been asked to think carefully through the terrain ahead of us. No one told me that having an old dog would be hard and that his approaching death would strike so much fear into my heart. I didn’t know that planning for his death—knowing how a good death might best be accomplished, what might happen with his body, how I might find constructive ways to grieve—would have helped me do it all better, without so many regrets.
Soon enough, the bioethics book was done, and before me sat, clear as day, my next project: to write about caring for our aging and dying animals. I thought that I might, through research and deliberation, know what to do for Ody, when the time came. And I thought that hearing Ody’s story might help others deal with the dying of a beloved animal companion.
I say this is Ody’s story, but it is really my story, too. It is my story of watching an animal I love grow old, suffer the infirmities of age, and begin his descent toward death. It is my story of choosing and not choosing; of action and inaction; of coming to terms with change; of accepting the inevitable; and of holding his life in my hands and trying to figure out what to do with it. I began to worry about Ody’s death long before he even began growing old. And it scared me. It was always crouching in the back of my mind, like an animal tracking its prey from the shadows: the fear that someday I would have to choose to “put him down,” or watch him suffer; that I would have to play God. And that time did come, eventually.
But before we rush ahead, let’s go back to the beginning.
Ody joined our family as a ten-week-old wriggling sack of loose red skin. It was 1996. I was thirty. I had wanted a dog since forever, and I finally felt that I was in a position have one: settled into a life that rotated around the home. And once I wanted one, I wanted one badly. Some women in their thirties become obsessed with babies; I wanted puppies. But my husband Chris would take some convincing. I dropped hints here and there, but not too pushy. Not too needy. Subtle at first and then growing more blatant as he grew accustomed to the idea.
I didn’t care what kind of dog—any would do. So when Chris mentioned that he might be interested in a Vizsla, without even asking the obvious “What’s a Vizsla, and what are they like?” I immediately started scanning newspaper ads and kennel listings. Vizslas are not common, so I was readying myself for a hard search. But within only a few days, I opened the Omaha World Herald to the want ads and saw “Vizsla Puppies, $200.” It was a Sign. By that afternoon we had met Ody and his aptly named brother, Tank, the only two puppies left. We watched as the two pups wrestled and bit. One was clearly the boss—confident and way too busy to pay us any attention. The other, the smaller one, was sweet and friendly, and when he could push his way out from under Tank he would waddle over and crawl into our laps. We fell in love with Ody, and the rest, as they say, is history.
The Vizsla (pronounced VEESH-lə), also known as the Hungarian pointer, is considered a “general utility gundog.” Ody, being Ody, is terrified of gun sounds and will start to pant and quiver if you so much as pop a plastic bag or squeeze too hard on bubble wrap. Vizslas are light and sinewy—the average male weighs about fifty pounds. Ody is a particularly stout Vizsla—not fat, but broad-chested and muscular, all seventy-five pounds of his short-haired rust-colored body. People who know Vizslas always remark on Ody’s too-short tail. A perfect Vizsla would carry two-thirds of his tail; Ody has about one-third. Whoever did the tail docking must have slipped with the scissors. Still, it amazes me how much he can say with his stump: it embodies his personality and is a clear barometer of his mood. Pointed up (happy, excited), curved down (scared, upset), or pushed out straight as a rod behind him (squirrel mode). When Ody’s stump wags—which it does all the time—his whole body shakes back and forth.
According to my Vizsla owner’s manual, the breed originated with the Magyar hordes who during the tenth century invaded what is now Hungary. The dogs became prized hunting companions of the Hungarian aristocracy, who protected the purity of the breed through the centuries. During the Soviet occupation of Hungary after World War II, Vizslas were smuggled out of the country, and eventually they began arriving in the United States. We’ve always considered Ody an exceptionally regal dog—in looks, at least. And that explains the name Odysseus: a great king—handsome, cunning, beguiling—who undertakes an epic journey. Actually, his full legal name, if you must know, is Sadie’s Rigorous Odysseus. His mother was Sadie, and his father was Rigor (with a brother named Mortis) and belonged to a mortician.
The Vizsla is said to be an expressive, loving, and gentle dog. Though intelligent and highly trainable, they are easily distracted and have a proclivity for stubbornness. The breed is highly tactile, and many Vizslas have an odd quirk: they like to hold people’s hands in their mouth. Ody has never done this, but he does love to be touching someone whenever possible. He leans against you whenever you stroke his back, always sleeps in the bed under the covers, and fancies himself a lap dog. Vizslas are often referred to as “Velcro dogs,” wanting to be close to their owners as much of the time as possible and with a tendency toward separation anxiety. Vizsla books and websites emphasize that these are extremely athletic dogs, requiring a great deal of exercise and stimulation. One source recommends that you run or walk your Vizsla at least six miles a day, preferably more. That kind of mileage is outrageous for most people, I think, though with a smug little smile and a self-righteous pat on my own back. Here, I think, is one thing I actually did right. For his whole life, Ody has been my running and mountain biking partner, and we covered a lot of miles in our day.
As I write this, Ody is asleep on the tan couch to the left of my desk. I feel a little stab of sadness every time I glance over at him, and more often than I’d like to admit, my eyes well up. The thought of losing him hurts, but even more than this, I mourn his losses. I am sad that Ody can no longer run wild through a field of tall grasses or chase the teasing squirrel in the backyard. But how do I know that he has lost anything, in his own mind? Why should I think that his diminished mobility makes him feel frustrated? How well do I really know Ody?
Despite the close bond we share, Ody is mysterious to me. The word that comes up over and over, when I think about Ody, is “inscrutable.” And in his golden years, Ody has become, if anything, more difficult to read. In Dog Years, Mark Doty writes, “No dog has ever said a word, but that doesn’t mean they live outside the world of speech.… To choose to live with a dog is to agree to a long process of interpretation—a mutual agreement, though the human being holds most of the cards.” I try to move beyond the world of human language, into Ody’s own form of speech, but rarely do I feel confident about my translation. In our relationship, I think Ody holds more cards than I do. Doty goes on to say, “Love for a wordless creature, once it takes hold, is an enchantment, and the enchanted speak, famously, in private mutterings, cryptic riddles, or gibberish.” We have our private mutterings, Ody and I, but when I ask myself questions such as “Is Ody happy?” and “Is he suffering?” I find that I really do not know.
Wondering about Ody makes me wonder about animals in general. Are animals aware of their aging, of illness, of the dusky shadow of the grim reaper following behind them? What is their aging, dying, and death like for them? Very little sustained attention has been given to these questions. The presumption has long been that animals are not complex enough creatures and that dying and death are too abstract for any but the human mind to grasp. Even among those who fight for improved animal welfare, the focus of attention is almost always on the quality of animal lives. And this, of course, is paramount. But we mustn’t neglect the quality of their death—particularly because it is we who often orchestrate their end. The ideal of a “good death” applies not only to human beings but also to our animal kin.
It is worth inquiring, first of all, how animals actually do die. It is impossible to say how many companion animals die each year in the United States since no one keeps a registry, as we do for human deaths. So this is merely educated guesswork. During one year, US consumers will have purchased or otherwise acquired an estimated 15 million birds, 94 million cats, 78 million dogs, 172 million freshwater fish, 14 million reptiles, and 16 million small animals. How many of these animals die each year and by what means is difficult to figure. Narrowing our attention to dogs and cats (since there are no data on other kinds of pets), cancer, kidney disease, and liver disease are the leading causes of death, in terms of disease processes. Yet the main cause of death in dogs and cats in the United States—that is to say, the central mechanism of death for most canines and felines—is undoubtedly euthanasia. The Humane Society of the United States estimates that six to eight million cats and dogs enter shelters each year, and three to four million are euthanized. No data are available for the numbers of dogs and cats euthanized each year in veterinary offices and homes; all we know for sure is that far more die by the needle than by natural causes.
What about the birds, fish, reptiles, and small animals? No one really has any idea how these pet animals die. There is no crime in buying a pet and killing it, as long as you don’t do it on purpose or with cruel intent. My guess is that the vast majority of deaths occur through inadequate care. Animals simply wither away, perhaps because they don’t have enough heat, or too much, or not enough moisture, or too much, or not the right kind of food. But “wither away” doesn’t put quite a fine enough point on it, does it? These creatures—the corn snakes, hermit crabs, leopard geckos, and bearded dragons—die slow and unpleasant deaths after protracted, though perhaps unnoticed, suffering. I call this category of death lethal neglect.
Many animals die before they even have a chance to become somebody’s pet: they die in pet stores, on the way to stores from breeders, and onsite at the breeders. Our local big box pet store has a shelf of Siamese fighting fish for sale—only $2.99!—each one in its own little tiny plastic cup. For some reason, I am drawn to this shelf of fish, and every time I enter the store I go look at them. And every time, at least two or three will be floating at the top of the cup. At this same store, company policy is that animals who escape from their cages in the store can no longer be sold, and guess what happens to them? We happen to know one of the managers, and she has over sixty pet rats at home, all rescued from the store because she couldn’t bear to see them killed. A few years ago, she talked us into adopting an ugly hairless rat who couldn’t be put out on the floor because he had been attacked by other rats and had bloody scabs all over his body. He had to wear a teeny rat-sized Elizabethan collar until his scabs could heal. We named him Hideous Henry—Hen, for short—and he lived with us for two years, until he developed a large tumor behind his left ear and we had him euthanized.
Killing is by far the most common form of human interaction with animals. The ways by which we kill animals and the meanings attached to these killings are as varied and diverse as the species of animals inhabiting this planet. Despite all this killing, a vast majority of people seem to believe that animals can suffer in ways that are morally important. Jonathan Safran Foer, for example, asserts that 96 percent of Americans believe animals deserve legal protection. (What we are protecting them against, I presume, is wanton cruelty.) That leaves a mere 12.8 million people who couldn’t care less.
Killing may be our main form of interaction with animals, and all forms of killing are morally important, including how we kill “object animals” in slaughterhouses, research labs, and fur farms. But when it comes to our pets, the question of killing, and the broader question of how they die, takes on special importance. How should we feel about forms of intentional killing that are aimed to be in the best interests of our animal? Might it ever be morally appropriate to intentionally kill Ody? Can killing ever be an act of love? Assuming we can control at least some of the factors surrounding a pet animal’s death, what might we do to make this death as good as possible?
Perhaps death matters to animals, and for reasons that might surprise us. Scientists studying wild animals have made the first few tentative steps toward what we might call animal thanatology. And those who study, care for, and live as companions with dogs and other companion animals are increasingly aware of their rich inner lives, and many believe that this richness may include some consciousness about death. What goes on inside the mind of a dog as he witnesses the death of a companion dog or as he himself draws his last breaths? Do animals grieve? Are animals aware of their own mortality? And are these questions answerable with anything firmer than conjecture? Because little research has been conducted on whether animals understand death, it is very hard to answer any of these questions with confidence. But although animal thanatology can offer us, at present, far more questions than answers, evidence and anecdote suggest that we have surprises in store. Animals likely have unique and fascinating ways of understanding dying and death.
Aging is intimately tied to death. But in addition to paying little attention to animal death, we suffer from a certain ageism in our attitudes toward animals. Biologists and ethologists categorize and study animals based on their age, recognizing that each life stage is physiologically and behaviorally unique. They study neonates, infants, juveniles, and adults. But there is no category for the aged, even though many animals, even in the wild, do live to be elderly and go through distinct physical and behavioral changes as they move beyond adulthood. Within the population of pets, the elderly is the fastest growing category. Despite increasing attention to their needs, prejudice against the old runs deep. Many elderly animals are euthanized simply because they are old or because their human owners don’t have the patience or resources to adapt to their changing needs. And many senior animals languish in shelters. It seems to me that when we commit to owning an animal, we must commit all the way to the bitter end, as in a marriage. We can do many things to help them age successfully and to adapt to physical or behavioral changes. But as I know from living with Ody, doing our best is much easier said than done.
Given the popularity of pets in the United States, many people will share a portion of their life with an animal. Many will watch their animal age and eventually die, often after suffering from a painful decline. In deciding whether to hasten the death of an animal, the central consideration is usually pain. Although it may seem that pain is obvious, there are still many things that scientists don’t understand about animal pain (or, for that matter, human pain). This is partly because pain is complex in its origins and manifestations, partly because pain is highly subjective and animals cannot communicate to us about their pain using our common currency of words, and partly because until recently people generally assumed either that animals didn’t feel pain or that their pain didn’t matter. Fortunately, the landscape of animal pain is undergoing dramatic change. Recognition and treatment of pain have greatly improved, and palliative care for animals is becoming more widely available and more effective.
The animal hospice movement, like a slow-moving glacier, is gradually carving out changes in how we care for our animals at the end of life. Hospice is neither, as some people mistakenly believe, a place to go and die, nor is it even so much a mode of treatment. Rather, it is a philosophy of care. It focuses attention on palliative treatments, maximizing quality of life, and shifting therapeutic priorities so that the emphasis is on care and comfort, not cure. Yet all is not easy and peaceful within animal hospice: lurking beneath the surface are deep moral disagreements about what constitutes a good death for an animal. Some believe that animals must be allowed to die a natural death, while others believe that the humane end point of animal hospice care is almost always euthanasia and that “natural” death is often far uglier than death under the needle.
Animal euthanasia is mired in contradiction. It serves on the one hand to release beloved pets from suffering and, on the other, to destroy millions of healthy animals whose only crime is being unwanted. It is certainly true that in human medicine there are plenty of opportunities to point out inconsistencies and absurdities. We clearly don’t follow a simple maxim such as “all life has equal and unique and inestimable value” (else why would so many poor people die for lack of simple and inexpensive medical care? and why would so many pregnant women receive no prenatal care?). But with animals it is different. Not everyone values animals, and in fact many wear their contempt for animals quite visibly on their sleeve. And there are groups and individuals aplenty that either glorify (Killing for Jesus, the blog of a “Christian” hunter) or make light of (PETA—people eating tasty animals) or capitalize on the suffering of animals (such as the roadkill toys made to resemble various animals killed by automobiles each year, including Twitch the raccoon and Grind the rabbit). Yet perhaps more troubling than outright contempt for animals is the nonchalance that feeds the tremendous problem of homeless animals and the plight of the millions of animals killed each year in shelters and pounds across the nation, to say nothing of the billions of living creatures killed in slaughterhouses, research and product-testing labs, and fur farms. How do we embrace euthanasia as an act of mercy for suffering animals, while challenging its use as a tool for easy disposal of unwanted or fractious animals?
What remains after an animal has died? Well, a body, for one. Some people choose to bury their pets in the backyard, but it can be tricky, depending on the neighbors, and is, in many places, illegal. Another option is a pet cemetery or the increasingly popular choice: cremation. Of course many other more ephemeral things remain as well—our grief, our memories, perhaps some guilt over things done or not done. The time we lost our temper with our dog and smacked him over the head with a news paper, or the fact that we put off making a vet appointment because other things took priority. Aftercare for companion animals is gaining attention, expanding the range of options for people wanting to memorialize their animal and providing options for those who believe that a deceased animal’s body should be treated with care and respect.
I want to celebrate animal life, and this includes celebrating the fact that their death is meaningful, both to us and to them. Many of us love animals deeply and choose to welcome them into our homes, and as their companions we try to take full moral responsibility for our relationship with them. One of my early ethics professors, Ed Freeman, always started his lectures by saying that ethics is for good people. It isn’t for the crooks and liars; it is for those of us who are trying to do right in the world. I couldn’t agree more. This book is about the kinds of quandaries that good people find themselves in with regard to their aging or dying animals.
It is also about embracing a certain level of moral failure. I have learned from my experiences with Ody that doing the right thing is not so easy. I could have done more for him. There are things I did wrong, things that I failed to do simply because there were too many other demands on my attention, and things I neglected to do because I didn’t know enough. I have sometimes taken the path of least resistance and have even felt that my life would be easier if Ody would just die already and be done with it. When it comes to our animals, we need large measures of compassion and a little bit of self-forgiveness.
Read around in the animal rights and animal welfare literature and you will soon come across one mention or another of the “five freedoms.” The five freedoms originated in Britain during the 1960s, when the welfare of farm animals came under careful discussion. The Report of the Technical Committee to Enquire into the Welfare of Animals Kept under Intensive Livestock Husbandry Systems, otherwise known as the Brambell Report, established minimal welfare standards for agricultural animals that included the freedom to stand up, lie down, turn around, groom, and stretch one’s limbs. This may not sound like much, but at the time this affirmation of basic animal needs verged on the revolutionary. It was an outright admission that we have a moral responsibility to consider their needs.
Recognizing that the ability to turn around in a stall or cage was inadequate to true animal welfare, the UK Farm Welfare Council revised the five freedoms in 1993 into their current form.
- Freedom from hunger and thirst
- Freedom from pain, injury, and disease
- Freedom from discomfort
- Freedom to express normal behavior
- Freedom from fear and distress
Of course, and as the Farm Welfare Council was careful to point out, these are not meant to represent attainable goals but, rather, ideals. A pig raised for bacon will never be free of fear, distress, pain, and discomfort and will never fully be able to express normal “pigness.” Still, we can work toward the greatest possible freedom for animals, within the constraints of our own needs.
Although these standards of animal welfare were established for agricultural species such as cows and pigs, the five freedoms have become a common baseline for discussing the welfare of all animals held in human confinement, from zoo animals to dogs in shelters to mice in laboratory cages. Even those of us who believe we are true animal lovers, attuned to the needs of the animals with whom we share our homes, will do well to pay attention to these five freedoms. We might surprise ourselves by discovering that we could do much better.
I also suggest that we add a sixth freedom: freedom to die a good death. A good death is one that is free of unnecessary pain, suffering, and fear; it is peaceful; and it takes place in the presence of compassionate witnesses. It is, above all, a death that is allowed its full meaning. Is it strange to say that we might desire for the death of an animal to be meaningful? Can the ultimate act of obliteration have meaning? Yes. It can and does. Death is obviously meaningful to the one who dies. It is like the final cadence at the end of a piece of music, bringing the music to its necessary harmonic resolution. But perhaps it is especially so to those who survive. Death affirms the value of life, and if we are to value animals, we must value their deaths.
“To die like an animal” is a phrase of common understanding. Consider this story, recently recounted in a newspaper: A junkie named Michael Faulkner was sentenced to three and a half years in prison for the crime of leaving a man to die “like an animal.” Mr. Faulkner had injected a fellow junkie with heroin, but the man had an adverse reaction to the drug— probably because he already had high levels of alcohol in his bloodstream. Instead of calling the police or an ambulance, Mr. Faulkner left the man, dying and alone, behind a local bar. To die like an animal, in the idiomatic sense, is to die in a way that is beneath dignity, to be forgotten or left, deliberately, to suffer, to die in a way that none of us desire. It is to die a bad death.
It would be nice to live in a world where “dying like an animal” signified a peaceful, respectful, and meaningful death.
Copyright notice: Excerpted from pages 1-13 of Last Walk: Reflections on Our Pets at the End of Their Lives by Jessica Pierce, published by the University of Chicago Press. ©2012 by The University of Chicago. All rights reserved. This text may be used and shared in accordance with the fair-use provisions of U.S. copyright law, and it may be archived and redistributed in electronic form, provided that this entire notice, including copyright information, is carried and provided that the University of Chicago Press is notified and no fee is charged for access. Archiving, redistribution, or republication of this text on other terms, in any medium, requires the consent of the University of Chicago Press. (Footnotes and other references included in the book may have been removed from this online version of the text.)
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