The Brief

Should surgeons be allowed to perform euthanasia by removing patients' hearts and other organs while they're still alive?

The idea, dubbed "Death by Organ Donation," would enable euthanasia patients to donate organs for transplantation in a way that would make their organs more likely to be usable. It would also kill them.

"It would be an ethical thing to do because this is something the patients have chosen for themselves," says Dr. Robert Truog, a physician and bioethicist at Harvard Medical School who co-authored a paper outlining Death by Organ Donation in the New England Journal of Medicine. "They have very generously thought: 'How might my death help other people?' It's a very altruistic, generous thing to do.'"

But the idea is controversial for a variety of reasons, including because it goes against fundamental principles that have guided organ donation for decades. The Dead Donor Rule requires that patients must be dead before any organs are removed. Doctors also can't kill patients in the process of removing organs.

The rule has long generated intense debate, including disputes over how to precisely determine when a person is dead, as well as the development of new ways to extend the lives of dying patients and recover usable organs for transplants.

At the same time, many countries, including Canada, the Netherlands and Spain, have made it legal for doctors to help patients die through euthanasia.

"What if they chose to be organ donors? The problem is that under current standards doctors must not cause death in the process of procuring organs for transplant," Truog says.

So hearts, lungs, livers and kidneys can only be removed from euthanasia patients after they have received a lethal dose of drugs, which makes their organs, especially their hearts, much less useful for transplantation.

"Why would it not be OK for patients to say, 'I've chosen to die by a lethal injection. Isn't there some way I can help others?' They should be able to donate organs as a lasting gift to others. And denying them that option doesn't seem to make any sense," Truog says. "I would say a more appropriate framework is that for patients who are choosing to die from euthanasia they could also choose to have euthanasia linked with organ donation."

A "creepy idea" that might have merit

Euthanasia involves doctors administering lethal drugs to cause the death of a patient. The practice is illegal in the U.S., but a growing number of states have legalized assisted-suicide, in which doctors give patients lethal drugs to take at home.

Instead of a doctor administering lethal medication to a patient, Death by Organ Donation patients would end the patient's life by anesthetizing them and then removing their organs while they are still functioning.

"So the organs would still be in ideal condition," says Truog says.

Some other bioethicists say the argument could have merit.

"The concept of death by donation is an extremely troubling notion at first glance. It's a creepy idea," says Ruth Faden, a bioethicist at Johns Hopkins University. "But in fact if you look at it critically in terms of the foundational ethical considerations, it's not as disturbing as it first appears."

That's because, she says, of the spread and acceptance of euthanasia and the desires of some of those patients to be organ donors.

"If we're committed to respecting the autonomy of individuals at the end of their life. And if they prefer to maximize the good their bodies can do at the end of their life, that's the ethical justification for death by donation," Faden says. She adds it would be important for strong safeguards to be implemented to ensure full informed consent and to protect patients from abuse.

A shift could undermine patient trust

But some other bioethicists are horrified by the mere notion.

"This is asking surgeons to take a living person into the operating room and to come out with a dead person, which I think is murder," says Lainie Friedman Ross, a bioethicist at the University of Rochester. "There are limits to consent. And one of the things we're not allowed to do is consent to saying that somebody else can just murder you."

Others worry this approach would undermine trust in both organ donation and end-of-life care at a time when some potential donors are already wary because of controversies about organ procurement efforts.

"You could be doing real damage to both the physician-assisted suicide system and the organ donation system," says Lori Andrews, a bioethicist and professor emerita at the Chicago-Kent College of Law. "It might give people the image that these are vultures that no longer wait until you die to attack. It does give up visions of body snatchers from prior centuries."

Critics also fear that allowing Death by Donation for euthanasia patients could open the door to someday saying it would be acceptable practice for physician-assisted suicide patients and even potentially hospice patients.

But others argue that for now this approach could be considered for at least some euthanasia patients.

"If there are people who want to donate organs, this would be the way to maximize their wishes and their altruistic goal to help others," says Dr. Carter Winberg, a Canadian critical care physician working on his master's degree in bioethics at Harvard who co-authored the New England Journal of Medicine paper. "These are people who are already consenting to voluntary euthanasia and already consent to organ donation. That warrants a new conversation about whether this is possibly ethical."
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The Department of Homeland Security says they have put some colleges and universities “on notice” that they could be in violation of federal rules that dictate work opportunities for international students.

The directive has left some of those students feeling worried, as their schools pause opportunities to work in the United States.

And experts warn that it could have adverse effects on U.S. industry and global growth.

What does DHS say?

In late August, the Student and Exchange Visitor Program, part of the Department of Homeland Security, issued a statement stating that they have “observed a rise" in violations related to Curricular Practical Training.

CPT is paid or unpaid work that students do as part of their degree program, like an internship. The administration says regulatory requirements permit CPT only where the training is “an integral part of an established curriculum.”

In a written statement, an unnamed DHS spokesperson told LAist, “Nothing about these regulations has changed. However, schools and employers should consider themselves on notice: under President Trump, abuse of this generous system will no longer be tolerated.”

LAist reached out to DHS for the percentage increase in CPT violations and specifically asked for data related to Southern California schools. We have not received an answer.

How have local universities responded?

Following the memo from the department, several universities including the University of Southern California, UCLA and UC Berkeley have paused or required additional information to determine if work experience is a requirement for a particular degree program.

In a written statement to LAist, a spokesperson for the UCLA Dashew Center said, “UCLA has paused certain Curricular Practical Training authorizations while the university reviews recent federal guidance and determines next steps. UCLA is communicating directly with students who have affected CPT applications and remains committed to supporting our international students as we navigate these changes.”

Why it matters

For students, this is causing uncertainty.

“It came as a surprise to all the international students. We were not aware of it and there is a lot of tension among the international students,” said Nitesh, a student from India at USC. He asked that we only use his first name for fear of repercussions from speaking to the media.

Those who applied for CPT authorizations after Aug. 23 at USC now are in limbo waiting to see if their applications will be approved.

 ”It is a real industry exposure to us when it comes to learning,” Nithesh said about the CPT component. “We definitely get lots of learnings and value from classes and by doing projects, but CPT is a way for us to understand what happens in the industry and keep us up to date.”

Nitesh, who took out an $85,000 loan to come to the U.S. for his degree program, said he would have reconsidered coming here had he known about these regulations ahead of time.

 ”Because there is a lot happening and nobody has clarity, so there is a lot of ambiguity, and we are just waiting for the right information to come in,” he said.

International enrollment impact

The memo is the latest in a string of directives targeting international students. Earlier this year, the Trump administration announced new rules limiting how long international students can remain in the country, as opposed to remaining in the U.S. for as long as it takes to complete their degree program.

Santa Monica College has seen a drastic drop in international student enrollments: In fall 2016, the community college had more than 3,500 international students enrolled; that number has dropped to less than 1,600 this year.

Grace Smith, a spokesperson for Santa Monica College said, “In recent years, several interconnected federal restrictions continue to exert pressure on international enrollment and are likely to impact future enrollment cycles.”

Declining international student enrollment has a “significant impact on the college’s fiscal outlook,” Smith said as international student enrollment accounts for about 8% of the college’s unrestricted revenue.

Caltech’s president Ray Jayawardhana told LAist’s AirTalk program that he came to the U.S. as an international student from Sri Lanka.

“ Growing up in Sri Lanka, I thought of universities like Caltech in the United States as beacons on a hill,” he said. “They really were beckoning the best and the brightest from around the world, and I think it behooves us to preserve that attraction, preserve that draw, so that this country and the world at large benefits from students, from researchers, from scholars.”

While the uncertainties are “discouraging,” Jayawardhana said, Caltech is seeing “continued interest that's as strong as ever.”

Hits to the U.S. economy

Rachel Banks,  senior director for public policy and legislative strategy at NAFSA: Association of International Educators, said the current climate for international students is the “most difficult and most challenging” it has been since World War II.

“Having gone through the first [Trump administration], there were certain expectations of what we might see coming,” she said. “What I think was unexpected was the severity and degree to which we saw the Trump administration make moves specifically with respect to international students.”

Banks says her organization projects that the loss of around 111,000 international student enrollments could cost the U.S. economy $3.4 billion and nearly 4,000 jobs. California’s economy could see a hit of about $500 million because of declining enrollment.

The volume of visa revocations, particularly for students involved in campus protests for Palestinian rights, was “unprecedented,” she said. The State Department’s move to pause on interviews for visa applications and renewals was also something that hadn’t happened at this scale before, Banks said. And the new visa limits for international students, she said, is “incredibly disruptive” and takes the decision making away from students and universities.

The new memo about CPT authorizations adds to the uncertainty, she said.

Following World War II, the government put a lot of emphasis into fostering and developing our higher education system, Banks said, which allowed universities “to attract the best and brightest talent and that has led to the numerous innovations and achievements that we've been able to see come out of the United States.”

That talent, she said, will now look to go to other countries more favorable to international students.

In less than two years, the Olympics and Paralympics will take over Los Angeles for the summer of 2028, temporarily transforming the city and the region around it.

Hosting the world’s largest sporting event will mean commandeering a fleet of nearly 2,000 public buses, reserving stretches of freeway lanes just for Olympics traffic flow, deploying thousands of law enforcement officers across venues, taking over UCLA and USC to make way for athletes and journalists, and flooding Southern California with millions of fans.

What will everyday Angelenos get out of all this? That depends. And it’s the question LAist is dedicated to answering every Monday as we spotlight our ongoing reporting on the 2028 Olympic and Paralympic Games.

Los Angeles residents have more at stake than just inconvenience, ticket prices and traffic. The city of L.A. is the financial backstop for the Olympics, meaning taxpayers will pick up the tab if LA28, the private organization planning the Games, runs a deficit.

That makes every plan for the execution of the 2028 Games hugely important for the city — from how L.A. pens agreements with LA28 on reimbursement for city services to whether or not the federal government will pay for the enormous cost of policing the mega-event.

L.A. has hosted the Olympics before — first in 1932 and again in 1984. Both times the Games turned a profit — a rarity for a global event that has gained a reputation over the decades for leaving cities with debt and empty stadiums.

Local officials say they’re confident L.A. can pull off a third Olympic Games (and its first-ever Paralympics), pointing out that hosting will not require building any new sports venues.

Still, there’s plenty to watch, including how temporary construction will turn existing venues into Olympic competition sites, where billions in contracts for things like cleaning and construction will go and whether that money will stay local, and how the expansion of the L.A. Convention Center could affect its role as an Olympic venue.

And there are the ways the Olympics and Paralympics could influence the lives of L.A.’s most vulnerable. Researchers estimate that close to 6,000 unhoused people live within a mile of Olympic venues in L.A. County, and could be removed due to security requirements tied to the Games. Others worry about the enhanced police presence that is guaranteed to accompany Olympic and Paralympic competitions, and what the Trump administration’s involvement in planning could mean for the city.

We’ll be following all this and more. Every Monday, you can listen to the latest on how Los Angeles is preparing for the 2028 Olympics on The L.A. Report and on our homepage.

Ballots are going out in less than a month, and California remains locked in a legal battle with the Trump administration over the president’s push to rein in universal mail-in voting.

The back-and-forth has some California voters likely wondering whether they’ll be able to vote by mail in this upcoming election. And if so, should they?

In short — yes, mail-in voting will still be an option this year. And yes, it’s still safe and generally reliable, although county election officials are urging voters to send in their ballots as early as possible ahead of the Nov. 3 election.

In case you missed it, the U.S. Supreme Court is poised to issue a ruling that will determine, at least for now, whether President Donald Trump can force the U.S. Postal Service to restrict vote-by-mail ballots in time for the midterm election. Trump wants to create a federal database of registered voters that the postal service would then cross-reference to ensure mail-in ballots are only delivered to eligible voters — in other words, U.S. citizens. His plan would have the postal service refuse to deliver ballots in states that withhold the data.

The dizzying, monthslong legal saga has baffled voters and even some election officials, which some voting rights advocates argue is probably the point.

But California election officials say the state is well-equipped to administer the election, regardless of how the Supreme Court rules. Although county registrars are monitoring the court rulings, they’re also preparing to mail ballots as usual by the state’s Oct. 5 deadline. Local and state officials are urging voters to make a plan to vote early and to use the state’s various non-mail voting options, such as drop-boxes and in-person voting sites, if they’re worried about the postal service.

“Like we do for all of our elections, we have contingency plans or disaster plans put into place,” said Tricia Webber, clerk and registrar of voters for Santa Cruz County and president of the California Association of County Election Officials.

Some counties, including Santa Cruz and Los Angeles, are exploring options for pop-up stations where voters could request and submit ballots. In Santa Cruz County, Webber said her team is strategizing how to deploy their votemobile around the county to add yet another option for voters.

“Until there’s an answer,” Webber said, speaking of the pending court ruling, “California counties are doing business as usual.”

What does Trump want USPS to do?

Trump issued an executive order in March that sought to give the federal government control over who receives mail-in ballots. Almost immediately, more than 20 Democratic attorneys general, including California’s Rob Bonta, sued the Trump administration on the grounds that the Constitution allows only Congress and state governments to administer elections.

Federal district and appellate courts sided with the Democratic states and upheld a temporary injunction preventing the postal service from implementing any part of its plan while litigation continues.

The central questions in the case remain unresolved. The Supreme Court last month allowed the Trump administration to continue planning for how it would implement the president’s order. Democratic states promptly sued again to contest the postal service’s plans.

The postal service’s proposal, the final version of which was published in August, would create a system to track each voter’s ballot with a unique barcode and cross-reference it with a database of eligible registered voters.

While some states fear they’ll need to reprint envelopes if the postal service’s rule is upheld, the vast majority of California counties already use compliant ballot envelopes, Webber said.

The federal government does not have a comprehensive list of every eligible registered voter and would need to rely on states to submit voter information to a “federal ballot mail portal” that does not yet exist.

It seems unlikely that the postal service’s portal would even be functional in time for the 2026 midterm elections. A postal service whistleblower asserted that the process to develop and deploy the portal was “rushed,” “risky and haphazard” due to the “impossible timeframe,” according to Democratic Sen. Richard Blumenthal’s office, which received the whistleblower complaint.

“In an effort to meet impossible deadlines, USPS has eliminated standard and needed testing, thereby creating substantial risk of a ‘catastrophic failure’ of the system that could ‘derail the midterm elections,’” wrote Blumenthal, of Connecticut, in a late August letter to Postmaster General David Steiner.

The postmaster in June told a congressional committee that the postal service would withhold ballots in states that refuse to share basic voter information, including name, address and the unique ballot barcode.

Secretary of State Shirley Weber, California’s chief elections administrator, has not said whether California would comply with the proposed voter information requirement.

“California’s elections officials will continue to do everything within our power to ensure that every eligible California voter has the right to cast a mail ballot and have that vote count.”

Last year, the U.S. Justice Department sued Weber and five other Democratic secretaries of state for refusing to turn over their unredacted voter files, which contain far more sensitive personal information than the postal service rule would require. A federal judge in Southern California dismissed that case in January.

Uncertainty could fuel more early voting

Ironically, concerns about the postal service’s reliability could facilitate what election officials and voting advocates have struggled to do for years — get people to vote earlier.

Unlike the lead-up to the June primary, where nervous Democrats urged fellow voters to wait until the last minute to pick a candidate for governor, social media is now awash with posts urging people to vote early and use ballot drop-boxes rather than rely on the mail.

“This whole play may backfire,” said Kim Alexander, president of the California Voter Foundation. “What you’re seeing now on social media in response to this court drama and this confusion are lots of people urging their friends to vote early — and that’s exactly what we’ve been saying.”

Voting earlier helps county election officials tabulate results more quickly on election night, which helps race callers like The Associated Press declare winners faster. And since ballots in envelopes take the longest to process, dropping them off several days before the deadline is the best way to help election officials count faster, since they can remove ballots from envelopes and prepare them for counting before Election Day.

“Fortunately, we give voters lots of options, and that’s really going to work to California’s benefit,” Alexander said. “Other states do not have the kind of robust process that creates lots of redundancies and avenues for voters to vote.”

It can be the small, curved horn of a ram or the dramatic spiral of an African antelope. The sound it creates is unmistakable.

Creating that sound is not difficult, but it does take some practice, said Rabbi Alicia Jo Rabins, a musician based in Portland, Oregon.

You take a deep breath and purse your lips, like you are playing a brass instrument.

Rosh Hashanah, the Jewish new year, begins at sunset Friday. Across the world, Jews will spend the two-day holiday in prayer, reflection and celebration. And for many, a highlight will be hearing the shofar: an animal's horn blown like a trumpet.

How did this primal instrument become a holiday's spiritual soundtrack?

" The most basic answer is that it makes noise, right? It calls people to attention," said Daniel Picus, an associate professor at Western Washington University in Bellingham who researches religious practices and rituals. "All of the instances in which a shofar is used in the Hebrew Bible, that is what it's doing."

Abraham Ribak , an Israeli, blows a shofar, a musical instrument used in Jewish religious ceremonies made from the horn of a ram.

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Shofar blasts marked the revelation of the Torah at Mt. Sinai and the start of the Jubilee year, Picus said. Priests blew shofars when they circled the walls of Jericho to bring down the walls. The shofar marks moments of heightened experience and emotion — and Rosh Hashanah.

"In the Hebrew Bible, Rosh Hashanah is the day of trumpeting and the day of remembrance," Picus said. "The association of the shofar with Rosh Hashanah is right there in the Biblical text."

Centuries later, the Mishnah, the earliest rabbinic codification of law, drilled down into greater detail in the tractate Rosh Hashanah, laying out exactly how a shofar should be prepared (hollowed out), repaired (it depends), blown (a complex series of blasts at several times during the service, thanks to debate over linguistic interpretation), and whether or not it can be blown when Rosh Hashanah falls on Shabbat (no, although some modern synagogues have changed course).

And within the Talmud and for centuries thereafter, people have debated the meaning of the shofar.

Shofars are on display for sale at the Barsheshet-Ribak Shofarot company, in Tel Aviv, Israel.

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Rabbi Micha'el Rosenberg, who teaches at the Hadar Institute, a center for Jewish learning based in New York City, pointed to several sources that compare the sound of the shofar to the cry of a mother in pain — the mother of the slain biblical military commander Sisera, and the cries of a woman in labor.

Rosenberg said you can hear that in the sound — especially the broken staccato blasts, known as "teruah."

"You can really imagine someone so caught up that they can't get the full sound out even, that they're gasping with their cries," he said.

Another interpretation comes from Maimonides, the medieval Jewish rabbi and scholar known as the Rambam, who wrote "The Laws of Repentance." He describes the blast of the shofar as a sort of spiritual wake-up call to become your best self.

"In Jewish law, we have this expression of daled amos, my four cubits: I focus on the 6 feet around me, as it were," he said. "It's easy to do that — and there's value in doing that sometimes. But the shofar, per the Rambam, wakes us up and says, 'No, there's more beyond what I can immediately see around me.'"

Rosenberg also pointed to Hasidic theories that the blowing of the shofar reenacts the breathing of life into the world. But he said one of the most powerful things about the shofar is that it doesn't say anything at all. "It transcends my words, it transcends my rational thoughts, and it really is just a feeling that I can hope to hold onto," he said.

Rabins, the Portland rabbi and musician, said the shofar can call across time to speak to those wordless places inside us. "It really brings you into the moment, and you also feel connected to your ancestors, who have been hearing this sound and making this sound for thousands of years," she said.

It's a sound, Rabin said, that can wake you up to all the joy and sadness of life, whether it be a birthday horn or a mother's cry. And it makes you pay attention — both to this moment, and to the year to come.

This story was created through a partnership between NPR and Religion News Service.
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