The right to die  has been a contentious issue around the world. The only European countries that allow assisted suicide are Belgium, the Netherlands, Luxembourg and Switzerland. Last month, the Supreme Court of Ireland rejected an appeal by a paralyzed woman seeking to allow her partner to help her commit suicide. Although Ireland decriminalized suicide in 1993, it is still a crime to assist another to commit suicide. In December a report released by the French government recommended  that the country permit doctors to “accelerate death” for terminally ill patients seeking doctor-assisted euthanasia. In August the High Court of England and Wales denied he plea of a paralyzed man challenging the legitimacy of the Suicide Act 1961 and other laws barring his ability to commit suicide. In 2011 an Indian high court ruled passive euthanasia was permitted under certain circumstances. In 2010 a German court ruled that removing a patient from life support would not be a criminal offense if the patient had previously given consent.

Doctors and medical experts specialising in the disease welcomed her announcement as a way of raising the profile of the test, but warned that for most women it would not be relevant as the gene mutation she has inherited is so rare.

In her account, published on Wednesday, Jolie appealed for greater access for gene testing and lifesaving preventive treatment and encourages women to explore their options.

The actor has a defective gene, BRCA1, which doctors told her increased her risk of developing breast cancer to 87%; it also increased her risk of ovarian cancer.

The surgery, which began in February, had reduced Jolie’s risk of breast cancer to less than 5%. “I can tell my children that they don’t need to fear they will lose me to breast cancer,” she wrote. “It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can.

“On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.”

Jolie wrote of losing her own mother to cancer, at the age of 56, after a decade-long fight: “She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.”

The 37-year-old, who has six children – three adopted and three with Brad Pitt, who was by her side for “every minute of the surgeries” – finished three months of medical procedures on 27 April. She said she first had “nipple delay” to maximise the chances of saving her nipples, before breast tissue removal and, nine weeks later, reconstruction.

Jolie wrote: “I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.”

Wendy Watson, who founded the UK’s National Hereditary Breast Cancer Helpline, welcomed Jolie’s decision to write publicly about her operation. “It is excellent, because it is the highest profile you can get for it,” she said. “It raises the profile for other women to look to if they have a family history and would benefit from being screened more frequently, or having surgery or having a genetic test.”

The UK foreign secretary, William Hague, who visited refugee camps in the Democratic Republic of the Congo with Jolie in March, said she would be “an inspiration to many”. Hague said: “She gave no sign that she was undergoing such treatment and I think she’s a very brave lady, not only to carry on with her work so well during such treatment, but also to write about it now and talk about it.”

But Dr Marisa Weiss, who runs an online advice and information service on breast cancer based in Ardmore, Pennsylvania, pointed out that only 29% of cancers in women start in the breast and within that group only 5% to 10% of women are carriers of high-risk single genes such as the one for which Jolie tested positive, BRCA1.

Weiss said that for most women, the biggest factors are not hereditary but relate to how they lead their lives: weight, alcohol consumption, smoking, physical activity.

She anticipated that the interest level in genetic testing would soar after Jolie’s intervention, but in many cases it would be inappropriate. “Whenever a celebrity steps forward that everybody knows like Angelina Jolie people are going to relate to her and think they have the same problem even though their situation is totally unconnected. For a time people are going to say ‘I want the test that Angelina had’,” Weiss said.

That could have financial implications. In the US it costs $3,000 or more to have the genetic test for BRCA1 or the related BRCA2. Where there is a strong family history of breast or ovarian cancer, health insurance firms are likely to pay for the procedure, but where none exists the individual will be expected to pay.

Dr Richard Francis, head of research at Breakthrough Breast Cancer, said that faults in the BRCA1 gene, which on average put women at a 65% risk of developing breast cancer, were rare and in most cases were linked to family history.

He cautioned that a mastectomy would not necessarily be the appropriate treatment for everyone with the gene. “For women like Angelina it’s important that they are made fully aware of all the options that are available, including risk-reducing surgery and extra breast screening,” he said.

“Though Angelina decided that a preventative mastectomy was the right choice for her, this may not be the case for another woman in a similar situation. We urge anyone who is worried about their risk of breast cancer to talk it through with their doctor.

The genetic short straw ‘We were resigned to having it’

Angelina Jolie’s decision to have a prospective double mastectomy will resonate with many other women who have discovered they have drawn a genetic short straw.

Caroline Presho, 39, inherited the BRCA2 gene through her father. His mother had died of breast cancer in her 40s and his aunt also had the disease. His sister had ovarian cancer and urged Presho and her sister to have genetic testing. “We thought it was a lot of old nonsense and forgot about it. But a few years later when she was really ill, she told us again, so in 2006 I went to my GP with a letter she sent me. But he said: ‘No, I don’t think you will have it. Go away.’ I took his word as gospel, did nothing about it.”

But in 2007, after her father died of lung cancer, Presho, who lives in Potters Bar, Hertfordshire, found he had tested positive for the faulty gene. “At that time, they were not screening until you were 35, and I was 33, but then I got myself a bit stressed and I was Googling like mad. The moment I turned 35, I wanted screening and surgery right away.”

When a shadow was found on one of her breasts, she was called in for an ultrasound. “I realised I could not live like this. I was married with three children and had breast-fed all three. I was going to have no more children and felt my family was complete. Now I had this knowledge, was it wrong to have another child when there was a chance of passing [the gene] on?”

She had a double mastectomy and immediate reconstruction in November 2009, and has since had another child. Emma, from Bristol, found she had the BRCA2 mutation in 2008, after her mother was diagnosed with advanced breast cancer at 59. “She was tested first and when we found out that she had the mutation there was no doubt in my mind that I would have the blood test to determine whether or not I had inherited it from her. I finally took the plunge in December 2012 at the age of 36. I had immediate reconstruction with implants and I was lucky to be able to keep my nipples. My amazing surgeons did a fantastic job.”

Emma said her mastectomy turned out not to be strictly preventative as They The medics found a small amount of DCIS (early stage breast cancer, or pre-cancer) in the tissue they had removed. “Fortunately no further treatment was needed” says Emma.

Although she has had necrosis and delayed healing in the nipple on one breast meaning more treatment and surgery, she said: “I have no regrets. I’m no longer living in the shadow of breast cancer and I feel so lucky and grateful to have been able to take preventative action, a luxury that my mum, who died in 2010, did not have.”

Charlotte Pittuck, 30, from Great Dunmow, Essex, who is preparing for a double mastectomy, was 26 and pregnant when her father’s sister in Australia was diagnosed with breast cancers, and there was a family history. Tests on her aunt, brother, sister and herself showed they all had the BRCA2 gene. “My sister and I had resigned ourselves to the fact we would have it. We both knew if we had the gene, we would opt for the operation. We felt 85% was such a high chance of getting breast cancer at some stage, we didn’t want to risk it.

“I decided I would like to have a second child in quick succession, have the operation and recover and be able to have another child. In fact, child number two was twins and I had three children in 18 months. I breast-fed all three I have had all my appointments … I will be glad when the operation is done.”

The case is one of the most high-profile attempts to change the law on the  right to die in Britain, where assisted suicide is illegal.

“I’m constantly thinking, ‘how on Earth can I do it without getting someone  into trouble?’” said Paul Lamb, who was left paralyzed by a car accident in  1990.

“I just want my wishes to be respected, that’s all I want,” Lamb, 57, told  reporters outside the courtroom.

He is immobile except for limited movement in his right hand, requires  24-hour care and is constantly on morphine to relieve pain.

Judge Igor Judge, speaking at the start of the hearing in the Court of  Appeal, said he was aware of the men’s “desperate situation” and he was  sympathetic.

“But they must surely know that we cannot decide this case as a matter of  personal sympathy. We have to decide it as a point of law.”

Lamb was in court in his wheelchair as the judge spoke.

The other man, named only as Martin, is a 48-year-old who was left unable to  speak or move after a stroke four years ago. He can communicate only through  movements of the head and eyes.

“It is their experience that their life has become unbearable,” said Paul  Bowen, a lawyer representing Lamb.

Law “inadequate”

The details of the two men’s cases are different, but in essence both are  seeking help from the courts in ensuring that anyone who helps them to die will  not be prosecuted.

Bowen cited a report to parliament last year that concluded that British law  in the area of assisted dying was “inadequate, incoherent and should not  continue”.

The issue of whether or not to decriminalize assisted suicide for people  whose lives are unbearable to them is a matter of debate in many countries.

Right-to-die advocates say people capable of making that decision should be  allowed to die with dignity. Opponents say liberalizing the law could leave  vulnerable people at risk.

Switzerland and the U.S. states of Oregon, Washington and Montana are among  places where some forms of euthanasia or assisted suicide are legal under  certain circumstances.

By coincidence, Monday’s court hearing started two days before a bill is due  to be presented to the British parliament that would legalize assisted suicide  in certain circumstances.

But Bowen said that even if that bill were to become law at some point, it  would not be enough for Lamb.

Lamb’s case was originally brought by a man with locked-in syndrome, Tony  Nicklinson. A court dismissed both Nicklinson’s and Martin’s cases last August  on the grounds that it was for parliament and not for a court to change the law  in this area.

After being told the court’s decision on August 14, Nicklinson refused food  and medication and died on August 22.

Lamb, who was not involved at that stage, has since been allowed to take up  the legal battle where Nicklinson left off.

Judge Edward R. Korman of the United States District Court for the Eastern District of New York ordered last month that the drug be made widely available and said that raw politics — not scientific evidence — was behind efforts by Kathleen Sebelius, the secretary of health and human services, to block easier distribution to young girls.

On Friday, he denied the request by government lawyers to suspend his ruling while they appeal. In the process, he lashed out again at Ms. Sebelius in unusually harsh terms, questioning her credibility and integrity.

“If a stay is granted, it will allow the bad-faith, politically motivated decision of Secretary Sebelius, who lacks any medical or scientific expertise, to prevail — thus justifiably undermining the public’s confidence in the drug approval process,” Judge Korman wrote.

Officials at the Justice Department and the Department of Health and Human Services declined to comment on Judge Korman’s ruling, citing the continuing legal case.

The issue of how broadly to distribute the morning-after pill is a politically charged one that puts President Obama’s administration at the center of a clash involving some women’s rights groups, conservative opponents of abortion and defenders of scientific integrity.

In Friday’s ruling, Judge Korman said that the government’s appeal of his order was nothing more than an attempt to “vindicate the improper conduct of the secretary.”

Andrea Costello, a lawyer for the Partnership for Civil Justice Fund and counsel to plaintiffs in the case before Judge Korman, agreed with him, saying that “this is politics at its worst and the administration should be ashamed of its duplicitous conduct.”

Judge Korman postponed the enforcement of his order until Monday to allow lawyers for the Justice Department to take their request for a delay to the appeals court. If the government ultimately fails to secure a suspension of Judge Korman’s order, it would clear the path for over-the-counter sales of the morning-after pill to very young girls, an outcome that the Obama administration has tried to block.

In 2011, Ms. Sebelius overruled a decision by the Food and Drug Administration to allow the drug to be sold without a prescription to anyone. Instead, she required that the drug be kept behind the counter at pharmacies and sold without a prescription only to women 17 and older.

Last week, the F.D.A. approved a change in that rule that would allow women and girls 15 and older to buy the drug without a prescription. At a hearing last week, Judge Korman said that decision was politically motivated and intended to “sugarcoat” the government’s appeal. He indicated he believed the drug should be made more widely available.

Judge Korman’s rulings have been filled with harsh criticism of Ms. Sebelius and the administration’s legal efforts to defend her decision. Friday’s ruling on the request for a delay in the enforcement of his order was no exception.

The judge repeatedly accused the government of operating in bad faith and said the process of denying broad distribution of the drug had been “corrupted by political interference” for years. He said he did not believe that ordering Ms. Sebelius or the F.D.A. to re-examine their decisions would make any difference.

“The cause of the rejection of over-the-counter sale of levonorgestrel-based emergency contraceptives was the secretary of health and human services,” Judge Korman wrote. “She has not changed her position. A remand would thus be futile. More significantly, I have been there and done that.”

“Indeed, in my view, the defendants’ appeal is frivolous and is taken for the purpose of delay,” he wrote.

At one point in his ruling, Judge Korman notes that lawyers for the administration insist that allowing over-the-counter access to the drug for everyone while the government appeals the case would mean “uncertainty” for girls and women about whether they could get the drug.

The judge rejected that argument out of hand, saying that “this silly argument ignores the fact it is the government’s appeal from the order that sustained the judgment of the commissioner of the F.D.A. that is the cause of any uncertainty, and that that appeal is taken solely to vindicate the improper conduct of the secretary and possibly for the purpose of further delaying greater access to emergency contraceptives for purely political reasons.”

He also rejected the government’s argument that women might be confused about the drug’s availability if it was made available to everyone without a prescription and then later restricted because the government won its appeal.

Judge Korman called that argument “largely an insult to the intelligence of women.”

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor — the size of a peach pit — using a simple procedure that the experienced head and neck surgeons who regularly examined Brook never tried. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

“I consider myself lucky to be alive,” said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was “really shocked” by his misdiagnosis.

But patient safety experts say Brook’s experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. A 2009 report funded by the federal Agency for Healthcare Research and Quality found that 28 percent of 583 diagnostic mistakes reported anonymously by doctors were life-threatening or had resulted in death or permanent disability. A meta-analysis published last year in the journal BMJ Quality & Safety found that fatal diagnostic errors in U.S. intensive care units appear to equal the 40,500 deaths that result each year from breast cancer. And a new study of 190 errors at a VA hospital system in Texas found that many errors involved common diseases such as pneumonia and urinary tract infections; 87 percent had the potential for “considerable to severe harm” including “inevitable death.”

Misdiagnosis “happens all the time,” said David Newman-Toker, who studies diagnostic errors and helped organize the recent international conference. “This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs” other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.

The problem is not new: In 1991, the Harvard Medical Practice Study found that misdiagnosis accounted for 14 percent of adverse events and that 75 percent of these errors involved negligence, such as a failure by doctors to follow up on test results.

Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the Institute of Medicine’s landmark 1999 report on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.

“You need data to start doing anything,” said internist Mark L. Graber, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of “a single hospital in this country trying to count diagnostic errors.”

In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, “How Doctors Think,” Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.

More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.

Publicity about the death last year of 12-year-old Rory Staunton, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem. At the same time, new digital databases such as IBM’s Watson and Isabel promise to boost doctors’ accuracy, although their usefulness remains a matter of debate.

“One of the reasons it’s time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place,” said Christine Cassel. A member of the panel that wrote the 1999 IOM report, she is now president and chief executive officer of the American Board of Internal Medicine.

But what if it’s not?

In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn “performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care — even if every one of the diagnoses was wrong.”

Discovered Late — Or Never

Unlike drug errors and wrong-site surgery — mistakes that patient safety experts consider to be “low-hanging fruit” amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team — there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.

“There is probably nothing more cognitively complicated” than a diagnosis, he said, “and the fact that we get it right as often as we do is amazing.”

But doctors often don’t know when they’ve gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it — particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.

Some environments are more susceptible to error than others. Graber calls the emergency room “a petri dish” for diagnostic mistakes: The doctor doesn’t know the patient, the patient doesn’t trust the doctor, and time pressures and frequent interruptions are the rule.

Misdiagnosis is not limited to hospitals; a recent commentary on the Texas VA study by Newman-Toker and Martin Makary estimates that “with more than half a billion primary care visits annually in the United States . . . at least 500,000 missed diagnostic opportunities occur each year at U.S. primary care visits, most resulting in considerable harm.”

There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.

“This really gets to who we are as clinicians,” said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.

“Overconfidence in our abilities is a major part of the problem,” said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. “Physicians don’t know how error-prone they are.”

Many, he noted, wrongly believe that the problem is “the other guy” and that they don’t make mistakes. A 2011 survey of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.

In the Texas VA study, more than 80 percent of cases lacked a differential diagnosis, in which a doctor not only declares what he believes is ailing the patient but also lists other potential causes of the problem based on symptoms, test results and a physical exam.

“A differential helps people to cognitively focus,” said Hardeep Singh, director of the Houston VA Patient Safety Center of Inquiry. Failure to ask “What else could this be?” can cause premature fixation on the incorrect diagnosis, said Singh, the study’s lead author.

At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to “hound” his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.

Trowbridge said the program has changed how he practices. “I’m much more reflective, much more attuned to the errors I’m prone to make. I work with checklists more.”

It Wasn’t Fibromyalgia

While second opinions are one strategy believed to reduce misdiagnosis, the original error may be the basis of a cascade of mistakes.

For nearly three years, beginning in February 2008, financial executive Karen Holliman logged more than 50 visits with various doctors in Durham, N.C., trying to get help for the increasingly severe fatigue that had plagued her for several years as well as back pain so excruciating that she wound up in a wheelchair.

Doctors variously told her she had fibromyalgia, chronic fatigue syndrome or a psychiatric problem. The real reason for her symptoms was metastatic breast cancer, which had riddled her spine, fracturing her back. Signs of cancer had been found on an MRI scan performed in February 2008. But a bone scan performed a few weeks later did not indicate cancer; her internist told her she did not have cancer, and doctors repeatedly failed to investigate the discrepancy.

To make matters worse, Holliman was taking hormone replacement pills prescribed by her internist to combat hot flashes; the drug fed her breast cancer.

“I’m terminal,” she said. In December 2010, when she was told she had Stage IV breast cancer, an oncologist estimated her life expectancy at about three years. “I could have been diagnosed in 2008,” she said, adding that she believes timely diagnosis and treatment might have extended her life expectancy to 10 years.

Holliman has regrets: that she never got a second opinion from an internist or orthopedist, that she didn’t question the radiologists who performed her scans and that she failed to obtain her medical records earlier.

During meetings last year attended by her family, including a relative who is a prominent physician, as well as by her doctors and the hospital system for which they worked, Holliman said, a hospital lawyer called her case “a series of unfortunate events” but denied that the hospital was liable for the delayed diagnosis.

“I spent a lot of time being angry,” said Holliman, who is 52. She said she has not filed a malpractice suit because she was advised she was unlikely to win. “Now I’m just trying to live a really great life in the time I have left.”

“We think it is usually better for children to be told, by their parents, about their donor conception, and if parents do decide to tell them then earlier is better”, said Dr Rhona Knight, a GP and the chair of the Nuffield enquiry. “We don’t agree that the decision of what and when to tell should be taken completely out of parents’ hands”.

The finding of the council contrasts with the view of many interest groups around the world lobbying for stricter government regulation. The Nuffield enquiry began in early 2012, and involved health-care experts from several leading British universities.

Currently in the UK, approved sperm donors are not listed as parents on birth certificates, nor is there any indication that that the child was conceived via sperm donation. Either one parent name will be left blank, or the partner of the woman inseminated will be named. Parents are at no stage required to tell their children that they are donor conceived.

They sued the IVF specialist who oversaw his conception – Christopher James – in the NSW Supreme Court for what is known as ”wrongful birth”. The couple were not properly made aware there was a 50 per cent chance Keeden would have the defective gene and said that had they been properly informed of the risk, they would not have had the IVF treatment that resulted in his birth. They sought compensation in the order of $10 million for the lifelong care of their handicapped son.

On Monday – 15 months after the case was heard – Justice John Hislop found Dr James had failed to ensure the Wallers were properly informed about the risks of inheriting ATD, and that had they been so informed, they would not have given birth to Keeden.

But he said the Wallers had not proved Keeden’s stroke had actually been caused by the blood-clotting condition. He accepted the evidence of a medical expert called by the defendant that Keeden’s antithrombin condition “at most was a minor contributing factor and was possibly irrelevant to the outcome.” “In my opinion the plaintiffs have failed to establish that the CSVT [stroke] was caused or materially contributed to by the ATD,” Justice Hislop said.

The Wallers were ordered to pay Dr James’ legal costs. Given that the hearing ran for four weeks, these costs are likely to run to thousands of dollars.The couple’s lawyer, Bill Madden of Slater & Gordon, said his clients were “upset and disappointed” and were considering an appeal. “They want an opportunity to read through the judgment and its conclusions before making a final decision.” He said it was up to Dr James’ insurer, Avant, to decide whether it would seek to have the legal costs order enforced.

Dancing Wheels, a US-based physically-integrated professional dance company, is now in its 32nd season. It tours the US and performs original works from well-known choreographers. Video of the company performing excerpts from some of its pieces can be viewed at their website.

The company has many performances coming up this spring including the world premiere of Daring to be Dumbo on May 9 -13, 2013 in Akron, OH. (A gala follows the evening performance on May 10, 2013). Tickets range in price and can be purchased online.

Daring to be Dumbo, choreographed by David Rousseve, tells the story of a teenage girl who is bullied and excluded by her peers because of her differences. She eventually embraces those differences and triumphs — after dancing with Dumbo in a dream.

Dancing Wheels also is auditioning sit-down (wheelchair) dancers to join their dance company. Selected dancers will be offered a 52-week contract and compensation that includes paid vacation, and dance training classes. Dancers keep a rehearsal schedule from Monday to Friday 10am to 3pm, and they are expected to travel on tour when necessary (all expenses paid). More information about the requirements of the dancers and the details of the audition process can be found at the site and by contacting the company.

After viewing the videos or attending a performance, what are your impressions? Do these integrated dance performances change your perspective on disability or dance? If so how? 

This poll is a startling wake-up call. How can the public be empowered to take control of their own healthcare and health in the face of so much uncertainty? How can the bioethics community better communicate with the public?

[The Washington Post] If you want to know what a challenge the Obama administration faces in implementing its signature health-care law, this statistic might help: Fewer than six in 10 Americans know that the Obamacare law is still on the books. Seven percent think the Supreme Court struck it down; 12 percent say Congress repealed Obamacare.

This comes from the Kaiser Family Foundation, which is out with a poll Tuesday morning looking at how much Americans know about the health-care overhaul—before a deluge of public outreach, set to begin this summer, kicks off.

The short answer is: They do not know a lot. Most Americans likely to access new health care programs under the Affordable Care Act—either through subsidized private insurance or the Medicaid expansion—say they don’t have enough information to understand “how it [the health law] will impact you and your family.”

This poll does, however, show greater awareness than separate research conducted last winter by Enroll America, a new non-profit that’s leading much of the outreach effort. It found that 78 percent of Americans likely to gain access to health coverage had no idea that such programs would roll out in 2014.

The challenge that the Obama administration faces is more complex than just increasing awareness and improving public awareness. It has a lot to do with improving knowledge at the exact right time—not when benefits are way out in the distance, but also not when the public has passed them by.

Consider what would happen if the Obama administration ramped up its public education effort today. There would television ads, door-to-door campaigns, celebrity endorsements and a slew of other commitments. They would all advertise new health care options—which wouldn’t be available for another seven months.

When I’ve talked to health care advocates, this is a dilemma they talk about a lot. They certainly want more people to know about the law,  but at the same time they don’t want to sell a product that won’t be on the market until the end of the year. Open enrollment on the exchanges begins in October for health plan options that will kick in on Jan. 1, 2014.

That’s why Enroll America will wait until this summer or fall to kick off its public awareness campaign. The White House has looked at getting rolling in June. This means that public awareness will probably stay low for the next few months. And health law supporters might be okay with that: They’d rather come to customers with a product to sell, rather than turn up with nothing to offer.