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Perhaps the most poignant image of the coronavirus pandemic captures desperate family members, with tears streaming down their faces, their noses pressed against hospital doors, barred from entry to visit their loved ones. But families are not just tragic icons at life’s end; they are often its choreographers. A large national survey that predated the pandemic found that 70 percent of Americans over age 60 who required medical decisions during the final days of their lives lacked the capacity to make them.
Charles Perrow described the 1979 Three Mile Island nuclear reactor meltdown as a Normal Accident. Normal accidents are a class of events produced when subsystems in risky, complex and tightly coupled systems fail. Tight linkages between subsystems propagate failure, and local breakdowns cascade into systemic collapse. Diane Vaughn applied the normal accident metaphor to the 1986 Challenger Disaster.